Title
:
CLINICAL ENGINEERING TEAM – BEDFORD
HOSPITAL NHS TRUST
Date
:
27th May 2008
Entry Prepared By
:
EBME department
Entry Presented By
:
Stuart Norris, EBME Manager
Contents:
1.
Summary
Page 2
2.
Analysis of third party contracts
Page 3
2.1
Implementation / Action
Page 3
2.2
Financial Result
Page 3
3.
Standards for Better Health – S4BH
Page 4
4.
National Health Service Litigation Authority – NHSLA
Page 4
5.
Conclusion
Page 5
5.1
The future
Page 5
Appendices:
Appendix A – Action plan for contracts analysis
Page 6
1
CLINICAL ENGINEERING TEAM –
BEDFORD HOSPITAL NHS TRUST
1.
SUMMARY
Our EBME team worked together to take part in a ‘Turnaround Process’ in
2006, led by the Trust’s turnaround director. The team’s primary focus was to
come forward with ideas for cost improvements, identifying and facilitating a
short list of projects which would yield good short term savings. A
communications strategy was put in place to make Trust staff aware of the
Turnaround Team’s objectives, and staff were encouraged to come forward
with ideas for cost improvement projects.
The time frame for the work was 1 year.
This short list of 5 EBME projects were submitted for assessment to the
Turnaround director, and approved for ‘go-ahead’:
o Analysis and the subsequent management of external maintenance
contracts
o Change of temperature reading devices
o Blood cell salvaging
o Design and implementation of an Equipment Library
o Centralisation of the ordering and storage of consumables
Four of the projects were completed successfully. The Equipment Library is
still in its implementation stage.
This paper embraces the Team’s success regarding the maintenance of
medical equipment, including:



Savings from third party maintenance arrangements;
Declaration of compliance with S4BH, concerning the acquisition and
use of medical devices; and
Savings NHSLA premiums due to evidence of improving maintenance
standards
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2.
ANALYSIS OF THIRD PARTY CONTRACTS
A commercial analysis of third party maintenance contracts covered 64
contracts, and resulted in 12 being cancelled and 13 being revised yielding
net savings of c.80k pa.
An action plan (See Appendix A) was produced with the following analysis
report given to the turnaround team for review:
Contracts appraisal
It was proposed that:


12 contracts could be cancelled
13 contracts could have their maintenance cover adjusted
Potential savings
Year one (2006/2007) – partial year
Year two (2007/2008) – full year
+ £ 41K (Revenue saving)
Less:
- £ 30K – (Training) (Revenue)
- £ 13K – (Resource – staff)
(Revenue)
- £ 10K – (Test equipment) (Capital
bid)
+ £ 159K (Revenue saving)
Less:
- £ 46K – (Resource – staff)
(Revenue)
- £ 20K – (Contingency fund for major
breakdowns and service kits)
(Revenue)
Cost £ 2K (Revenue) + £ 10K Recurring Saving
(Capital)
£ 93K saving
£ 12K cost
All stakeholders were fully engaged during this process.
2.1
Implementation / Action
Although this was a ‘spend to save’ project, which can sometimes be alien to
the NHS, the process was given the full support of the Trust.
Refer to the action plan at Appendix A.
2.2
Financial Result
At the end of the financial year 2007/2008 the Trust had realised (recurring)
savings of £ 93K per year.
3
STANDARDS FOR BETTER HEALTH – S4BH
3.
During 2007/8, EBME have worked towards compliance with the S4BH
standard C4b. At the end of the financial year we declared ourselves
compliant with all five elements which come under this standard.
Compliant elements include:

We have systems and processes in place for the acquisition and use of
medical devices which are revised accordingly to comply with the
MHRA safety notices, alerts and bulletins.

We have a clear policy to ensure that ‘single use’ medical devices are
not reused.

There is a clear system of verbal and written notification for any
damage or malfunction to medical devices. All equipment is now
labelled with an ‘equipment tag’ which has relevant details about the
device, and also states that the user has cleaned it appropriately prior
to inspection or repair.

Modifications to medical devices are controlled as part of our Quality
Management System – ISO 9001:2000. Authorisation for modifications
comes from the EBME Manager.

The Trust has ‘adequate arrangements’ for the training of staff in the
use of medical devices. This process is also audited once a year.
EBME have a trainer who trains staff predominantly on infusion
devices, which also forms part of the staff induction process.
4
4.
NATIONAL HEALTH SERVICE LITIGATION AUTHORITY - NHSLA
A key function of the NHSLA is to ‘contribute to incentives for reducing the
number of negligent or preventable incidents’. The Trust currently holds a
CNST rating of level one, with the aim of progressing to level two over the
next year. EBME have worked towards evidencing that requirements are met,
to help the Trust move to the next level. An improvement in the CNST rating
results in better patient care and also offers the Trust financial savings
through lower premium payments.
Evidence has now been produced in the following areas:

There is an accurate inventory of devices held on a management
database in the EBME department. A rolling replacement programme
has been produced.

There is a process for identifying which staff are authorised to use
which equipment. This process also identifies which staff require
training.

The above mentioned process is monitored through yearly auditing.

All medical devices are properly maintained and a history is held on an
appropriate medical device management database. Management
reports are produced and reviewed, enabling the EBME department to
set clear objectives.
This information is reported through to the Medical Devices Group and
upward reported to the Trust’s Patient Safety Committee. This ensures that
the effectiveness is monitored.
5.
CONCLUSION
An evaluation of the equipment maintenance, especially Anaesthetics and
Ventilation, made a clear case for the work to be done ‘in-house’ and opened
the door to People Development’ opportunities. Key appointments, all within
budget, included Specialist and Chief Technicians and a part-time Clerical
Assistant. Most staff have attended several training courses over a one-year
period.
The transition of the department restructure and the expansion of our
maintenance responsibilities were assisted by our ‘Quality’ Management
System (ISO 9001:2000). Our system has been in place for almost four years
and has matured and continually improved over that time. Our last
assessment from the British Standards Institute (BSI) was a successful
‘strategic audit’.
The training and competence levels of our staff has benefited the Trust, and
offered them what we believe is a service of ‘Excellence and Technical
5
Integrity’. We have decreased equipment downtime and improved the
standard and reliability of devices.
Without doubt, all of these projects have been a team effort from all EBME
staff, Management, Technical and Clerical, ultimately offering the Trust an
expanded quality driven service provision and an improvement in its ‘Medical
Device Management’ processes.
5.1
The Future
The EBME department is pro-active and committed to our aim of continual
improvements. Over the next year we will be looking into areas of cost
improvements, and expansion of our service provision into the area of
Radiology.
6
Action Plan for Contracts Analysis
Appendix A
Project - EBME Maintenance contracts.
Objective - To make non-pay savings through adjustment of medical equipment maintenance contracts.
Deliverables - Recurrent annual savings in excess of £ 90K.
Action-
Commence
s
18/09/06
 Additional resources and training agreed for the EBME department.
As contracts are adjusted or cancelled, medical equipment technical training and test
equipment needs to be purchased.
 Contract adjustments 2006/2007
30/09/06
 Commence contract appraisals and adjustment reducing the cost by £ 41k
Complete
30/09/06
Responsibilit
y
EBME
MANAGER
31/03/07
EBME
MANAGER
EBME
MANAGER
EBME
MANAGER


Recruitment
Additional Clerical support recruited.
30/09/06
20/11/06

Additional Technical support recruited.
30/09/06
08/01/07

 Training
Technical training
01/10/06
20/06/07
EBME
MANAGER,
SPECIALIST
TECHNICIAN


Test equipment purchase
Purchase test equipment from a £ 10K capital bid
01/04/07
July 2007
EBME
MANAGER

Contract adjustments 2007/2008
7

Continue contract appraisals and adjustments reducing the cost by £ 159K
01/04/07
16/08/07
EBME
MANAGER


End of year Financial report 2007/2008
Management Accounts to produce the final savings report
April 2008
April 2008
MANAGEMEN
T
ACCOUNTAN
T
8