Internal/External Fine Line

By Jeffery Niederhausen

If I was to come to your facility, what would your balance be between external labor and internal labor? Do you strive to do everything possible under the sun internally before reaching out to vendors for help and assistance? Or, do you simply look at something and say, “Yup, it’s broke. I will call so and so?” Over the years, I have seen both sides of the coin and where it has caused issues, not only financially, but personally with departments and staff within those departments.

I have seen and met with biomed department teams whose only goal was to make sure PMs are completed, and if anything breaks, it’s boxed up and shipped to a vendor service center. Or, they have vendor X on speed dial. While getting our PMs completed on time and accurately is very important, it is also important for techs to have the drive and initiative to want to fix things or learn from past mistakes.

The more that can be done internally, the more we can control expenses and reap savings and financial benefits. For every dollar you save for your facility or company, it’s a dollar that we get to keep on our financials and not someone else’s.

Training is a big part of this. For some things, it doesn’t take a rocket scientist to work on and diagnose/fix. For other equipment, it takes training. Good examples of these are, of course, radiology equipment like CTs or MRIs. The average tech is not going to tackle those, but with training and making your tech an expert, the savings start building. With this, departments start to get comfortable with “their tech” working on the equipment. Then, downtime hopefully becomes minimal with a tech only steps or minutes away. Of course, there are always ways to look at this and take one bite at a time. The dreaded contracts can be ramped down as techs are trained and different levels are achieved, which equates to savings to the financials.

When our techs are trained, it should be the expectation of the directors of the biomed department and the department heads in the facility that the tech is going to be our in-house expert on whatever modality they were trained on. Of course, there will be something over their head and they will need some help from vendor X at first. But, over time, vendor X will become a last resort as our tech becomes the true expert. Starting with first look contracts and reducing down to parts only would be a great game plan to control expenses, and to master that fine line between internal and external labor.

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“Training is a big investment for many companies and facilities, but the return on the investment can be greater than the initial cost of the training.”


Through the years, I have had colleagues who have discussed their expectations for properly trained techs. The majority agree that techs should be doing 80 to 85 percent of the work on the equipment they are trained on. The remaining balance is what is filled in by other sources, like vendors. Sometimes, it happens, where you have a device ripped apart and you are banging your head against the wall and just can’t figure it out.

Before it gets worse, or before a department head screams in your ear saying, “This equipment makes this hospital money and the more it’s down, the more cash we are bleeding,” we should have an established relationship with the vendor as our backup. However, before making that call, you should run the situation by your director/manager for their input. Not only does it put them in the know, but they may have experience to help the situation. I have heard stories of a tech trying to fix a piece of equipment, getting stumped, calling the vendor to remedy the problem, and the vendor responding on the phone to solve the problem before they even show up.

It is important to instill pride in our techs and give them a belief in themselves that they can do what they have been called to do, fix equipment. Training is a big investment for many companies and facilities, but the return on the investment can be greater than the initial cost of the training. Having fleets of certain modalities or three or four big imaging instruments backed up with properly trained people can bring thousands of dollars in savings.

I have also seen companies invest in staff only to continue the practice of looking at a piece of equipment and sending it to a vendor or calling them in. As leaders, we should be disgusted with wasting our facility/company’s money if that is the case. Nothing was accomplished except the tech had a little vacation on the company’s dime. That is not what we want! We want empowered techs being the best they can be, doing the best work they can provide on our equipment, which in return equals happier employees and better pricing and savings for our companies and/or facilities.

With a little training and belief in our techs, we can conquer the world and have a world-class biomed program. With the attitude of “we do it all” or “go get them,” nothing is off limits. Techs who have a company or facility that invests in them and has faith in them to work on their multimillion dollar equipment is scary and exciting at the same time.

I believe techs, when given the opportunities, will rise to the challenge and show the initiative needed to walk the fine line between do it myself, or call in help.

Jeffery Niederhausen is the Chief Financial Officer of Tech Knowledge Associates, a clinical technology management provider that was formed to bring unique value to its clients by guaranteeing savings, capping their expenses and protecting them from catastrophic failures. For more information, contact TKA at or visit