By Dave Francoeur
We’ve all heard that you can’t compare apples to oranges. I was curious about the origins of that common phrase, and I discovered its first use actually said you can’t compare apples to oysters – way back in a 1670 collection of proverbs.
Now, you’re probably wondering what fruit and shellfish (or mollusks, if you prefer) have to do with our HTM profession.
In a word: Everything.
Historically, it’s been difficult for healthcare systems to assess the quality of their HTM program because different service providers are using different terms, metrics and benchmarks in regular reporting. Yes, HTM has some standards for meeting regulatory requirements and OEM requirements for how to repair certain equipment, but one provider might use apples in talking about uptime while another speaks in oranges (or oysters) for downtime, which is the inverse of the same metric.
A responsible HTM provider – from a one-person biomed practice to an independent service provider (like TKA) to an OEM – establishes performance benchmarks for repairing and servicing medical devices. Absent any shared industry oversight, those benchmarks vary from provider to provider with very little context. Without those metrics to compare, a hospital truly can’t determine if a provider is delivering safe, quality and effective service. A provider can define those three words however it deems appropriate, but that doesn’t mean it is having the impact the healthcare organization expects and even demands for the best patient care – at the right cost.
In the debate over what non-OEM’s HTM providers should have the right to repair, I’ve been working with the cross-industry Medical Device Servicing Community, convened by the FDA. More specifically, I’m chairing the Standardize Benchmarking, Data Collection and Analytics (BDCA) subgroup. And more importantly, I’m focusing on raising awareness of this gap in our profession.
Starting at the ground floor
Since our profession emerged in the late 1960s and early 1970s to directly influence patient safety, we’ve struggled to work collaboratively and find ways to elevate our industry and our critical role in healthcare today. We come in all shapes and sizes as HTM businesses, but we all do the same thing: We take care of the machines that providers use to care for their patients. Some equipment is more sophisticated, which requires more highly trained biomeds, but fundamentally the model is the same from regardless of the physical size of the healthcare organization.
Standards and benchmarks represent what should be a coordinated vision, and that requires input from across our industry.
It’s not just setting benchmarks. This exercise should extend to specifying how we calculate those metrics, as our recent white paper delved into three key equations for how to leverage metrics to assess both performance and cost. Uptime is a great place to start. One HTM provider might base this metric on the total hours that a device is expected to be used. And some devices are only used during weekday business hours, so that differentiation is important. But medicine doesn’t operate on a corporate clock. Imaging devices, which are your most sophisticated and high-ticket, may or may not need 24/7 uptime. Because of that, another provider might determine uptime using every hour of the week.
That’s important, because that example rather sums up the big differentiator when comparing HTM providers, whether internal or external partners. The differentiator is the way each goes about our work. How we deal with quality management issues. How we follow through when an opportunity arises outside the norm. Hospital leaders focused on operational excellence and their bottom line need to be aware of those differences.
Because we have so few, unquantifiable differentiators, our industry, as a whole, has been hiding behind that mystique.
The reality of HTM performance today centers around CMS and The Joint Commission requirements, which advise hospitals to manage 100% of scheduled Preventative Maintenance (PM) on equipment. That’s a reasonable request as effective HTM partners proactively schedule those activities.
While that sounds like a straightforward requirement, I find a lot of misunderstanding in our industry about what “manage” means and looks like. Just hitting that target – which frankly should be a given in our business – shouldn’t become a differentiator in our business, in my perspective. But it is, only because we don’t have any other way to compare our performance across providers.
Aligning on a series of Key Performance Indicators could be how we work toward a desired set of standards, with some guardrails both above and below that demonstrate a level of effectiveness, which includes safety and quality. I can’t say if we’re talking 10 KPIs or 100, but that would bring value to our industry.
If we break down our walls, and that’s what I’m trying to do through my subgroup, no one is going to be hurt by sharing information. This isn’t an effort to take punitive action, but to ensure every provider participates with a set of best practices, standards or whatever we choose to name them.
Pushing for a unified industry
Coming to a consensus on how to appropriately demonstrate that each of us provides safe, quality and effective service will take away the barriers that are preventing us from going out and doing just that. And all of the energies that we’re putting toward trying to fight “right-to-repair” battles could go toward focusing on continually improving the service we provide and helping hospitals meet their patient-focused mission while having a positive impact on outcomes.
Healthcare systems need some guidance on how to fairly compare providers according to criteria that are important to them. Having a set of shared benchmarks levels that playing field, starting with setting standards for performance quality. A sole practitioner specializing in one type of equipment, a medium-sized firm that serves an entire hospital and a manufacturer that produces the next-generation of imaging devices each must exceed that bar to maintain the right to repair medical equipment without excluding others from this fair market practice, as reinforced in a recent presidential executive order.
Again, some might say we already have standards, if you consider the prescribed protocols detailed by OEMs in maintaining or repairing their specialty equipment. In that case, those started are created, driven and supported solely by the OEMs. Bringing in an industry organization, such as AAMI, could help us establish objective benchmarks, not to mention bring resources and data to help achieve those goals.
Best practices, standards or however we choose to define these holistic performance markers would ensure that everyone who meets them has the opportunity to service medical equipment. What then becomes most important to every HTM provider, is achieving those metrics that demonstrate safe, consistent practices that put the patient first.
Dave Francoeur is TKA’s senior vice president for marketing and sales and is the chair of the Medical Device Servicing Community’s subgroup Standardize Benchmarking, Data Collection and Analytics (BDCA).
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