Administrative Oversight

This may sound unfair, but as a department head, do you feel lonely because the VP you report to knows more about floor polish than….”what’s that?…a refibillator? Defibulator?”
Copyright, May 2003.

When it comes to managing technology, I’ll bet my VOM many hospital administrators wish they were in a different business. Back to the mid 1970’s, medical technology was less prevalent and less complex. If a power plug failed, the maintenance person who fixed the lights and kept the boiler going, was often the one to repaired it. Other failures were referred to the manufacturer.

This now ancient starting point of the medical technology service industry has a remnant carried forward to today’s high-tech environment – hospital administrators, sometimes overseeing food service, security, laundry, maintenance, or perhaps the IT department, sometimes also oversee the maintenance of medical instrumentation.

The quantity and complexity of medical technology has mushroomed, yet in some facilities, the administrative structure in place to oversee the safe use and maintenance of these tools is growing mold. The problem is that many of these administrators have neither the expertise, nor the time to acquire the knowledge necessary to look beyond the sparse summary reports they receive on a quarterly basis. The result of this inattention to detail can be increased risk to patients and increased costs to hospitals.

The excuse often used to explain oversights, that is, mistakes, in this bureaucratic system is: “It’s not the individual’s fault, it’s the system.” As concerns the maintenance of medical technology in hospitals, this rationale couldn’t be more true: the failure of an institution is not incompetence, as much as incompetence, the result of a failed system.

The BME Director should report to someone who understands the nuance, or at least the terminology of the clinical environment. Want to increase your ability to interact on a meaningful level? Change the administrator from “ancillary support” to “clinical.” In other words, place oversight for medical technology into the hands of someone who understands and appreciates it – whether engineer, physician, or nursing director.

The AHA, NIH, ECRI, and manufacturers recommend periodic calibration checks for aneroid manometers because they are mechanical and vulnerable to physical abuse. Accurate and stable mercury manometers are being replaced nationwide by less stable aneroids. Periodic inspections of these devices will cost an institution resources it can ill afford to squander. (Note, mercury manometers required maintenance, but not periodic.)

Department Directors are often either business or engineering oriented (sometimes both), and always caught between cost and service issues. Who in upper management can the BME director brain-storm with concerning equipment replacement analysis, in-house vs. outsourcing maintenance, or risk assessment methodology? Who in upper management will appreciate penny-wise/pound-foolish directives?

Financial and technical expertise are both necessary in overseeing the use of technology, and in this tech-heavy work environment, there must be a balance between cost savings, and effective and safe applications of technology. There should be checks and balances, helping to assure that neither cost savings nor caution dominate the end result (financially hurting an institution can hurt patients too).

Budgetary cost analysis, survey preparations, and new equipment purchases are all significant issues, but risk assessment, maintenance compliance monitoring, and administrative oversight are functions that can have an immediate and direct impact on patients’ health and the welfare of an institution.

The win/win situation is collaboration.

Win/lose is a directive.

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