Administrative Oversight  

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5/10/03

When it comes to technology, I’ll bet many hospital administrators wish they were in a different business.

30 years ago, medical technology was less prevalent, and less complex. If a power plug failed, the maintenance person who fixed the lights and kept the boiler going, repaired it. Other failures were referred to the manufacturer. This now ancient starting point of the medical technology service industry has a remnant carried forward to today's high-tech environment--hospital administrators managing food service, security, laundry, patient transport, and the maintenance department, also oversee the maintenance of complex high-tech instrumentation.

The quantity and complexity of medical technology has mushroomed, yet in some facilities, the administrative structure in place to oversee the safe use and maintenance of these new tools is growing mold. The problem is that many of these administrators have neither the expertise, nor the time to acquire the knowledge necessary to look beyond the sparse summary reports they receive on a quarterly basis. The result of this inattention to detail can be increased risk to patients and increased costs to hospitals.

The excuse often used to explain away this kind of failure within a bureaucratic system is: "It's not the individual's fault, it's the system." As concerns the maintenance of medical technology in hospitals, this rationale couldn’t be more true: the failure of an institution is not incompetence, as much as incompetence is the result of a failed institution.

The BME Director should report to someone who understands the nuance, or at least the terminology of the clinical environment. Want to increase your ability to interact on a meaningful level? Change the administrator from "ancillary support" to "clinical." In other words, place oversight for medical technology into the hands of someone who understands and appreciates it—whether physician, Ph.D., or Nursing Director.

The more things change, the more they are not the same. The AHA, NIH, ECRI, and manufacturers recommend periodic calibration checks for aneroid manometers because they are mechanical and vulnerable to physical abuse. Accurate and stable mercury manometers are being replaced nationwide by less stable aneroids. Periodic inspections of these devices will cost an institution resources it can ill afford to squander.

Department Directors are often either business or engineering oriented (rarely both), and always caught between cost and service issues. Who in upper management can the BME Director brain-storm with concerning equipment replacement analysis, in-house vs. outsourcing maintenance, or risk assessment methodology? Who in upper management will appreciate penny-wise/pound-foolish objectives?

Financial and technical expertise are both necessary in overseeing the use of technology, and in this tech-heavy work environment, there must be a balance between cost savings, and effective and safe applications of technology. There should be “checks and balances,” helping to assure that neither cost savings nor caution dominate the end result (financially hurting an institution can hurt patients too).

Budgetary cost analysis, survey preparations, and new equipment purchases are all significant issues, but risk assessment, maintenance compliance monitoring, and administrative oversight are functions that can have an immediate and direct impact on patients' health and the welfare of an institution.