Case Study 1
Managed Equipment Services: Equipment Review
Organisation
An English NHS Acute Trust.
Purpose
Determine the actual scope and feasibility of a perceived opportunity to improve the quality
and efficiency of acute hospital services through improved equipment management.
Objectives
1. Identify, and assess the scale and impact of, equipment related service quality issues.
2. Determine the extent of surplus medical equipment capacity – if any.
3. Measure the potential value to the Trust of redesigning equipment management
structures and systems.
Method
The current situation was assessed by means of:
1. Primary research by personal observation
2. Interviews with key staff
3. Analysis of existing Trust data
Summary Findings
1. Ineffective equipment management processes exposed patients to increased risk
through sub-optimal equipment decontamination and staff training.
2. The Trust owned and operated previously unrecognised substantial surplus equipment
capacity.
3. This surplus capacity incurred significant procurement and maintenance cost for no
added value.
4. The existence of spare capacity was attributable to ineffective equipment
management processes.
5. Service quality was adversely affected by the procurement and maintenance of
surplus equipment capacity since it prevented sufficient investment in leading edge
technology.
6. The Trust’s equipment base was relatively old and the average age of equipment was
increasing.
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© Pentagon Healthcare 2008
Key Learning Points
1. Operation of an Equipment Library does not, of itself, deliver optimal equipment
management.
2. Separation of control of equipment management services from equipment users
resulted in users failing to comply with equipment management systems.
3. Fragmentation of responsibility and accountability for equipment management
prevented the development of effective and efficient business processes.
4. Inability of staff to locate a required item of equipment is every bit as likely, if not
more so, to be attributable to the absence of effective equipment access arrangements
than insufficient equipment capacity.
5. When front line staff are subjected to intense time pressure they tend to bypass
decontamination (and other) policies and procedures which are intended to reduce
risk to patients and increase service efficiency – especially if compliance is not
adequately monitored.
6. Absence of the application of objective, evidence-based purchasing criteria can lead
to surplus equipment capacity and poor returns upon investment.
Detailed Findings
1. Patients received inappropriate treatments because the correct equipment was not
immediately available. In many instances the required item was standing idle in large
numbers elsewhere on the hospital site. However, front line staff had no means of
locating the required item.
2. During 2007 approximately 90 patient related incidents were reported involving
equipment failure in use of some kind.
3. Annual equipment purchases over recent years averaged £600,000 on an equipment
base of £15 million (4%) – meaning that it would take 25 years to renew every item.
Average age of equipment was 9.5 years and surgeons reported frequent failures of
equipment in use.
4. There was no formal system by which staff training in the use of equipment was
recorded and monitored. Most training was cascaded from one staff member to
another with no formal accreditation. Some reported patient related incidents were
attributable to poor staff training in the use of specific equipment.
5. Staff training issues were aggravated by a failure to achieve standardisation of
equipment types. The wide variety of makes and models made it even more difficult
to ensure that every member of staff was competent to use every different type of
equipment.
6. The Trust had attempted to address some of the equipment related issues by operating
an equipment library. However, most staff saw this as a ‘failed experiment’ since the
system adopted did not meet user requirements.
7. There was no single person or department responsible for equipment management.
Maintenance, decontamination, procurement, storage and distribution were handled
by different departments with little effort being made to achieve effective integration.
8. There was no objective means by which equipment purchase requests could be
prioritised. This resulted in scarce resources being expended upon items demanded by
individuals with the greatest power and influence.
9. Some front line staff circumvented formal procurement rules to obtain new
equipment by approaching charities with specific requests.
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10. There was no single source of information containing essential equipment data. Three
separate databases were in use concurrently and equipment information was spread
across all three. In all three instances data integrity had been multiply breached
making it difficult to arrive at a clear picture of what equipment the Trust owned and
operated.
11. Some front line staff were so confused by contradictory equipment decontamination
policies that they decided to ‘do their own thing’. There were numerous instances
where the decontamination procedure recommended by the equipment manufacturer
were not followed (indeed staff were not aware of their existence).
12. Analysis of the validated Trust equipment database indicated that it owned and
operated around 800 items surplus to requirement with a value in the order of £2.5
million.
13. Highly qualified healthcare staff complained that a significant proportion of their time
was consumed by equipment ownership issues. They believed that they should be
equipment users not equipment owners.
14. In spite of the oversupply of routine items of equipment in wards and departments the
Trust continued to approve requests for additional items in these categories without
any serious attempt to establish genuine need. Such expenditure reduced the Trust’s
ability to invest in advanced technology to support their position within the healthcare
marketplace.
Consequences for the Trust
1. The Trust had received a reduced rating by the Healthcare Commission because of its
equipment training issues.
2. Patients were exposed to avoidable risks because of staff training issues, equipment
non-availability and sub-optimal equipment decontamination processes.
3. Competitive strength had been diminished by the Trust’s inability to keep pace with
technological advancements exploited by neighbouring Trusts.
4. Cost per case was inflated for no added value by the requirement to maintain and
finance approximately 800 items of surplus equipment.
5. Cost per case was also inflated by the requirement to consume front line staff time
compensating for poor equipment management processes.
6. The aging equipment base has led to equipment failing in use, higher risks to patients
and less efficient use of staff time.
Options Considered
The following seven options were considered:
1. Do nothing – hope that identified problems would eventually right themselves.
2. Allocate responsibility for Trust-wide equipment management to an existing Trust
manager alongside his/her existing responsibilities.
3. Recruit a new Trust-wide equipment manager to take full responsibility for
equipment management systems.
4. As option 2 but retain the services of a small team of external experts to advise and
guide Trust managers.
5. Obtain external consultancy advice only
6. Appoint an external specialist company to manage equipment across the Trust
according to the terms of a legally binding contract.
7. Transfer the ownership of assets to an external company and negotiate a service level
agreement guaranteeing a defined level of service in return for a unitary payment.
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Option Evaluation
The following table contains the results of an option appraisal:
Option:
Avoid
controversy
Cultural fit with
Trust
Best use of
Trust resources
Transfer of skills
to Trust
Trust control of
pace
Trust control
over outcomes
Low cost
Value for money
Low risk
Likelihood of
successful
outcome
1: Do
Nothing
2:
Reallocati
on
3:
Recruitme
nt
4:
External
Support
5:
Consultan
cy
6:
Managem
ent
Contract
7:
Outsourc
e
√
x
x
x
x
x
x
x
x
x
√
√
x
x
x
√
√
x
x
x
√
√
x
x
√
√
√
x
√
x
√
√
√
√
√
√
√
√
√
√
√
√
x
x
√
x
√
x
x
x
x
x
√
x
x
√
x
√
√
√
x
x
√
x
x
√
x
√
√
√
1
Although Trust managers recognised that Options 5 and 6 may possibly deliver superior
outcomes in some respects, the Trust selected Option 4 on the grounds that it was the only
option which met all of its evaluation criteria – especially those relating to organisational
culture and political sensitivity to outsourcing. Whilst the use of internal staff resources may
not maximise equipment productivity in the short to medium run, it would enable the Trust to
deliver immediate improvements in its equipment management capability and lay the
foundations for longer term progression to an even more effective solution.
Staff Response
Predictably, front line staff were initially intrigued by the extent of data collection and
suspicious of any possible change to their established routine. However, as they were exposed
to the underlying ethos of intelligent equipment management they quickly recognised the
potential benefits to them and their patients. Anxiety surrounding the possible relocation of
ward and department based equipment was gradually replaced by enthusiasm for a system
which would place control of equipment management systems where it belonged – with the
users – and which would reduce the workload of frontline staff.
By the time the final report was produced every member of the management team was
committed to implementing intelligent equipment management.
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Benefits to the Trust
By adopting intelligent equipment management the Trust has identified opportunities to:
 Reduce the risk of hospital acquired infection by improving the effectiveness of
equipment decontamination;
 Reduce the risk of harm to patients by improving the competence of equipment users;
 Reduce the procurement and maintenance cost of medical equipment;
 Release frontline staff time for improved patient care; and
 Make better informed medical equipment procurement decisions
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© Pentagon Healthcare 2008