Improving medical devices management

High on the agenda will be the issue of patient safety and delivering improvements in practice.

The EBME seminar is a free, independent, annual educational event bringing together healthcare professionals that are responsible for the management of medical equipment. The aim of the conference is to explore the risks associated with equipment and some of the highly innovative practices that are being brought to bear by the professional EBME community. The formation and implementation of medical devices management policy will be discussed, including a best practice model that can be used by any healthcare organisation. Delegates will be discussing improvement initiatives with an expert panel of their professional colleagues. This will enable analysis of policy issues to a much deeper level, creating an improved understanding of the intricacies involved in device management. Some of the core issues to be discussed will be procurement and the impact it has on user training and cost. By revisiting and questioning current good practice, the problems discussed by the delegates can be used to promote innovation and thereby deliver improvement. Standards, regulations, politics, and stakeholder involvement all impact on improving practice. By critically reflecting on the current status quo, EBME professionals can offer up improvements that can be shared nationally. One example of innovation to improve practice could be changing the buying culture of clinical users of the equipment. Historically, users have had the ability to be involved in choosing equipment. These choices are made on clinical grounds, but do not always best serve the needs of the organisation. John Sandham, managing director of EBME, pointed out that although clinical users will choose equipment that is suitable to do the job, different clinical users choose different equipment that performs the same job. However, procurement savings can be achieved by reducing such variation and by harnessing the power of ‘bulk buying’ when negotiating with suppliers, in much the same way ‘fleet purchasing’ offers cost benefits for customers in the automotive market. Using this analogy, John Sandham outlined how healthcare providers could improve their procurement strategy: “Two families living next door to each other want to buy a car. Each family is exactly the same, but one buys a Ford, and the other family buys a Vauxhall. Both cars have exactly the same function. Taking this analogy one step further, could involve a street. Imagine a street with 100 houses. They all have the same size families in the same size houses. What is the likelihood that they would all purchase the same car? The likelihood is that there would be a huge variety of cars that all do the same job. “However, if they were all to purchase the same car, they would potentially be able to negotiate fleet discount, upgrades and discounted prices for parts and servicing. Now, if I take this analogy and apply it to 100 wards and departments within an NHS hospital, the fragmented approach is exactly what happens within many hospitals. Nurses, doctors, and consultants are all choosing to buy medical equipment that they prefer.” This is not a cost-efficient approach to procurement, as John Sandham pointed out, but it is also important to understand exactly how this occurs. Many problems originate from when devices arrive into the Trust, so the question that needs to be asked is: ‘how does the equipment get into the organisation?’ Figure 1 shows the many routes into the NHS Trust. The equipment gets into the organisation in many ways, including being bought from hospitals funds, donated by charity, rented, patient owned, or brought in on an ambulance stretcher when a patient is transferred from another hospital. “We especially need to look at the way the equipment is bought from hospitals’ funds and question why the users (buyers) involved are allowed to have such a variety of choice.” commented John Sandham. “This seems to be historic and part of the culture within many NHS organisations. They have been able to operate like this for decades – the difference is that in the past there was very little medical electronic equipment available. The purchasing of equipment was less important and there were very few people buying equipment within the organisation, so it made sense for finance managers to allow those people using medical devices to have the authority to choose and buy it. “This is now the normal way equipment is bought, and part of the structure within the finance and procurement mechanisms. These mechanisms have not changed very much over the years, other than IT systems have been specifically designed around these procurement mechanisms.” John Sandham pointed out that finance and procurement in the NHS is based around choice and variety. Figure 2 and 3 are indicative of how the volume of devices and technology groups have increased over the decades. This growth is slowing down, but has not levelled out yet. “We need to question whether the foundations that the policy is built upon also need to be changed,” commented John Sandham. “There has been a significant growth in the numbers of technology groups available for nurses, doctors and other healthcare practitioners to use in the patient environment. Depending on the type of organisation, the number of different types of technology being used varies. Within an average NHS hospital Trust, there are approximately 400 technology groups used to deliver the patient services. Within these technology groups, there are a variety of makes and models. “It is not necessary to have the level and variety of choice to deliver the patient services required. We can improve on the current procurement models, if the prime objective becomes standardisation within technology groups, as well as increased utilisation. This can have an impact on the amount of money being spent on medical devices, and the ease of delivery for user training and maintenance.” The fact that hospital staff have so much choice, when it comes to buying equipment, leads to higher costs and higher risks, John Sandham argued. Instead of looking at the current organisational politics and processes and trying to apply current best practice models, he proposes that stakeholders consider the question: ‘What if the current procurement and finance systems were redesigned?’ Is it possible to start with a ‘clean sheet’ and what could be achieved? “The current model being used in many NHS Trusts was developed to meet the needs of the regulators, and also to meet the needs of the organisation. Sometimes, these models do deliver improvements in terms of regulatory compliance and also cost savings. Although on the face of it these models are working well, if we drill more deeply into the underlying reasons that create risk and cost within a Trust, can we create a new operational paradigm?” Figure 4 can, at first, seem very simple: identify what you need, buy it, accept it into the organisation – ensuring it meets specifications that were stated at the time that it was bought, and then use it. This raises a number of questions, however. When buying for a large organisation, with thousands of pieces of equipment, it is important to understand how the business need is identified. “As an individual, a consultant surgeon knows what he or she wants and will speak to their business manager instructing them what to buy, but is this right? Should the consultant be making these decisions as an individual or should the organisation be speaking to all of the consultants in that field and make a decision that involves stakeholders, but allows standardisation within that technology group, so that economic efficiency can be achieved and training can be more easily achieved because there is less variety?” John Sandham questioned. “Unfortunately, many consultants will put pressure on the management to have the devices they want. Their arguments can seem to make sense and the managers may be concerned that they may lose the services of that consultant. Rather than upset the consultant, the business manager may simply provide the equipment that they prefer.” He suggested that it is important to challenge the current status quo: “A far better way would be to invite consultants to be on a procurement committee that decides what is best for the organisation, the patient, and the equipment user,” he continued, adding: “To enable this to happen requires changes to policy that ensures all purchasing of medical equipment is done in such a way as to include the users, but remove variety. The removal of the variety of devices within technology groups will lead to reduced costs, reduced risks, and ease of training and maintenance. “When it comes to writing a medical devices management policy, we must work within the boundaries of the regulations and the organisational management structures. In our current good practice models, some organisations have already managed to reduce some of the variety of devices within technology groups. This has been achieved by setting up medical devices committees, and having all of the purchases approved through these committees.” Although this has been partially successful in reducing the variety and cost, it still does not address the underlying ability of users to place orders for non-standard equipment, and therefore only acts in a reactive way, John Sandham pointed out. “In order to make a significant contribution to the understanding of the problem, we need to look more deeply at the regulatory constraints, the organisational constraints, and the individual constraints. What comes out of this debate is an understanding from those involved that, even though we are doing better than in the past, we still have to address the problem which lies at the heart of this matter – i.e. there is no planned procurement methodology for bringing devices into the organisation for the benefit of all stakeholders, including patients, the organisation and users.” The main expert panel debate of the 2013 EBME seminar will focus on how to overcome regulatory, organisational, and individual constraints that increase risks to patients, while putting pressure on already tight budgets (Fig. 5). An exhibition featuring 49 stands will also take place alongside the seminar. A guide to the solutions and innovations is featured in this issue of CSJ.