Ensuring all equipment is fit for the job

The annual Clinical Engineering Team of the Year Award, which is supported by an educational grant from Welch Allyn, was won this year by the Medical Engineering team from Sandwell and West Birmingham Hospitals for its role in the “Listening into Action” (LiA) initiative which was first implemented at the Trust in 2008. The judges were asked to choose from a variety of projects which had brought innovation to the use, management or implementation of medical devices and to identify the project that they believe had the most positive impact for a hospital or Trust. Sandwell and West Birmingham Hospitals project was unanimously chosen as the winner and was commended by the judging panel for its simplicity and effectiveness and because it engaged with all hospital staff members to identify the challenges they faced in effectively carrying out their roles and then took responsibility for improvements to the repair or replacement of equipment. The project began back in 2008, when Sandwell and West Birmingham Hospitals NHS Trust became the first in the country to adopt a new method of staff engagement called Listening into Action (LiA) on a large scale. LiA represents a fundamental shift in the way the organisation is run, putting staff at the centre of change. Lawrence Barker, deputy manager of Medical Engineering, explains the issues surrounding the decision: “The initial driver for the initiative was a relatively poor staff satisfaction survey compared to other similar sized Trusts back in 2007.” LiA was identified by the Trust as being able to offer a new way to engage staff, and in some instances patients, in the overall decision making process. The first LiA event invited a large group of hospital staff to say what they felt the Trust should prioritise in changing to enable them to be able to carry out their job effectively and to improve the service provided to patients. ‘The Equipment Fit for the job’ workstream was one among many others identified as being an area which required further work as part of the LiA project. The Medical Engineering department was asked to assist in moving this workstream forward,” said Mr Barker. At the initial LiA event, hospital staff had reported that one of the greatest challenges to carrying out their role effectively was a lack of equipment. Unfortunately it was not possible to establish what equipment they were referring to. So, over a period of around three months, the Trust’s maintenance providers arranged a number of lunch time staff drop-in sessions, to gather more detailed information. The findings were surprising, as complaints were mostly found to be in relation to basic equipment not being available, rather than the expected lack of availability of high-tech equipment. The low-tech equipment included items such as couches, wheelchairs, patient transfer trolleys and beds. Much of this equipment was in a state of disrepair but was not considered a priority. Explaining in more depth the reasons for this Mr Barker said: “In many respects, it was a lack of ownership issue. Beds and couches were once really furniture items with some hydraulic functions. They had been maintained by Estates fitters and as they had gradually been replaced with more sophisticated electrical items, which although “low-tech” were now a medical device, the workforce had not been reskilled to maintain the items, often vacancies had not been filled, leaving a gap in the Trusts maintenance capability and a frustration to the staff that needed broken equipment repaired.” The Trust also recognised that, where equipment had been replaced, it was often from Trust funds, with little regard for standardisation and equipment maintenance and support requirements. A business case was established and put to the Trust Board in a bid to secure funding for the “Equipment fit for the Job” project. Mr Barker continues: “Initially, the Trust decided that the project would receive any ‘unallocated’ revenue each year. More recently it has been agreed to put a minimum of £240,000 per annum into revenue equipment replacement, which was not previously corporately funded. This is separate to our annual Capital Programme. Additional funds have been found for bariatric equipment provision and for the maintenance of electric and mechanical beds. The amount is based on current inventory value.” A dedicated tradesman has been recruited to maintain what remains of the mechanical beds and to keep track of the inventory. This work is currently managed by Estates and Facilities with the records stored on a shared inventory of medical equipment, which has been extended to record details of all medical devices in the Trust, and not just those maintained by Medical Engineering. As with all LiA workstreams at the Trust, the Medical Engineering Team now meet with the Executive Sponsor Group, chaired by the chief executive on a regular basis to brief them on progress. Regular meetings are also held with clinical staff. Mr Barker explained: “Sharan Malhi, project administrator and office manager for Medical Engineering, has created a sponsor group to help support our next LiA event which is due to take place in December where we will invite staff to offer their views on the current situation with equipment. The consists of around six clinical staff members and members of the Medical Engineering team, and will give the project a voice, for both enforcing good practice and adhering to policies such as management of medical devices – for example ensuring pre-use checks are carried out on equipment and that faulty equipment is reported immediately – as well as directing the prioritisation of investment in equipment.” The Medical Engineering team believes that the project has had a positive effect on the patient experience, although patients may not always be aware of just how much equipment their treatment involves. It has also been of great benefit to staff. Mr Barker offered some examples: “Before the project began, the equipment library would routinely run out of volumetric pumps in the winter. There was no obvious source of funding for additional equipment. The pressure was increased when certain prescribing guidelines were revised and additional pumps were required to support diabetic patients. Project funds have now been used to adequately stock the library and there is now no delay in patients being given controlled infusions as needed. Staff are no longer wasting clinical time repeating calls to the library or to other wards to see if any pumps have been put aside for collection, and as a result, the patient receives a better experience too. “Another good example comes from the Endoscopy Unit which had a fleet of patient trolleys that required two nurses to manoeuvre and were extremely heavy and cumbersome, mechanically the equipment was in very poor condition. Through the project this fleet has been replaced by trolleys of a more lightweight design. A single nurse can now move the trolley when necessary and the risk of back injury to staff has been reduced. The patient experience is also improved as the new trolleys have more comfortable mattresses.”

Conclusion

In conclusion, Mr Barker explains some of the key learning from the project. “I think that the key learning point has been that little in a hospital is an island. Processes are intertwined and so decisions relating to equipment choices need multidisciplinary agreement. On a similar note, there is no point buying additional equipment to meet a need without having the resource to maintain it. This may sound obvious, but hospitals are complex places and different interests and budgets often blinker a joined up approach. LiA helped us to highlight such problems at senior management level and overcome many barriers to improve what we do.”