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How choosing the right partner Participating in a construction project to equip a new, expanded or renovated facility can make or break even the most seasoned materials manager. Soliciting help from a consultant or a group purchasing organization – or even outsourcing the project totally – may seem like an obvious solution. That is, unless you’re one of those hands-on type of executives or your administrator is evaluating how you handle the project. Oftentimes, however, hiring a professional equipment planner makes the most sense for the busy materials manager juggling day-to-day operations and trying to shoehorn in this new project. But it’s never as simple as that because the materials manager then has to choose the right equipment planner, distinguishing between the legitimate and the charlatans. Healthcare Purchasing News Senior Editor Rick Dana
Barlow posed a series of questions on the art and science of equipment
planning to several executives at Dallas-based HPN: Is there an association that represents equipment planners? If so, what is it? If not, what association represents them? CAMERON: Many equipment planners belong to the American Society of Healthcare Engineers, an American Hospital Association organization. Other organizations include the American Institute of Architects and the Association for the Advancement of Medical Instrumentation.How large an industry segment is this? HARVILLE: Assuming that medical equipment is 25 percent of the $15-billion healthcare construction market, the construction-related medical equipment market would be between $3.5 to $4 billion. The market for medical equipment planning and procurement services on the acute care side is estimated at $80 million. Non-acute care projects can account for another $2.5 million in annual billings.Typically, who brings equipment planning consultants into the process? The architects? The clients/owners of the facility under construction or development? FARRIS: This varies with each project. Many smaller equipment planning firms tend to work almost exclusively for architects and others tend to work almost exclusively for the facilities. The major equipment planning firms have broad client portfolios representing architects, developers, program managers, healthcare systems, individual facilities and government agencies.At what stage are these planners brought in? And why does it matter? CAMERON: Medical equipment planning tends to begin during design development, the ‘second pass’ by the architects to sharpen the focus of the design. Ideally, however, equipment planning should begin before the first phase of design, that is, schematic design. This allows the planner to work with the architect and clinicians to define technical requirements for equipment before the architect starts drawing.HARVILLE: Preparing a realistic budget estimate at this phase allows the client to have a clearer picture of the total cost impact of their project. The equipment planner should be involved at the very beginning of addition and renovation projects to take into account issues like the reuse of existing equipment and projected service line growth at the new facility.The later an equipment planner is brought into the project, the more redesign is required around equipment related issues, which results in delays and extra costs. Early involvement with an equipment planner also gives the project an accurate reality-check on the equipment budget. Gone are the days when you could say ‘x percent of construction will cover equipment.’ What criteria should hospitals and other healthcare facilities use to select the appropriate equipment planning consultant for them, particularly if the medical architecture/design consulting firm doesn’t provide this service? Is it the same criteria that medical architects and design consultants use to select them? FARRIS: The criteria should be the same. The equipment planning firm should have a portfolio of past projects that are similar in size and scope to the project at hand. The firm should have the staff with a knowledge base adequate to understand and contribute to the project.Careful analysis of the equipment planning firm’s staff should be done. Many equipment planning firms’ staffs are nothing more than specification-pullers and shopping list writers, while other firms have great breadth and depth in their staffs’ backgrounds. Larger firms will have a mix of clinicians, logistics and procurement experts, biomedical engineers and support personnel. What are some of the potential benefits for hiring an equipment planner? FARRIS: Market knowledge. A busy equipment planner over two or three years will be involved in more projects reflecting more capital equipment dollars than almost any healthcare administrator would experience in an entire career.Understanding of design and construction. A good equipment planner is versed in the terms and processes related to design and construction and can integrate the medical equipment into those processes. Understanding of clinical issues. A good equipment planner will also be versed in current healthcare trends and standard care delivery methods. Liaison. A good equipment planner will bring together and resolve equipment-related issues across the lines of design and construction, clinical practice, and vendor-specific technical requirements. Data management tools. Equipment planners use database tools to keep track of project budget and specification data. What are some of the drawbacks of bringing in an equipment planner? CAMERON: Generally there is no downside to using an equipment planner for any size project. The drawbacks would lie in the planner, due to:Limited market knowledge. An under-experienced equipment planner will not know what he does not know and will have a small number of facilities as an experience base. Unbalanced experience. An under-experienced equipment planner will be more clinical, to the detriment of design and construction, or vice versa. A similar kind of unbalanced experience can happen if a planner is too technology-focused and not able to keep the equipment planning in context to the rest of the project processes. What are some of the misconceptions healthcare facilities have about equipment planners? CAMERON: A common misconception is that equipment planners receive some kind of remuneration from manufacturers for specifying a company’s equipment.Is it really necessary for healthcare facilities to rely on assistance or direction from an equipment planner? Why? FARRIS: It depends on the facility. If the facility is an outpatient care clinic with nothing more complicated than X-ray viewboxes and ceiling-mounted exam lights, then an equipment planner is probably not required. But if the facility includes engineered systems such as nurse call, medical gas, PACS and other data systems, then an equipment planner could be helpful.In medicine we love the term ‘outcomes.’ Using an equipment planner is really an outcome-driven issue. Someone in the process of designing and building any medical facility will ultimately do the equipment planning, or parts of it, be it the architect, engineer or owner. The outcome of that planning is dependant on the experience of the one to whom it falls. Using an equipment planner brings a comprehensive view to the process and addresses areas such as equipment budget and procurement that are areas the design professionals are not involved in nor have expertise in. HARVILLE: The key risks associated with the delivery of medical equipment planning and procurement services if a reputable equipment planning firm is not used are:1. Insufficient quantity or quality of staff to provide the services in the timeframe required to keep the project on schedule. 2. Utilizing an equipment planning database that is not kept up-to-date with current equipment ASE or procurement specifications resulting in incorrect room designs based on outdated mechanical, electrical, plumbing and structural specifications and inaccurate project equipment budgets. 3. Lack of coordination of the procurement schedule with the construction schedule resulting in equipment being delivered too early or too late leading to extra storage cost or installation crews with no equipment to install – both resulting in extra cost to the project. 4. Costly change orders due to post CD changes in equipment ASE specifications not being communicated to the architect and engineer in a timely manner. 5. Not utilizing the same firm for both planning and procurement, delivery and installation management or trying to provide those services with already overburdened internal resources resulting in lost time, work redo and project delays. Whose decision does the equipment planner influence in terms of equipment type, brand, etc., and how much influence do they really have, particularly in the face of GPOs? FARRIS: An experienced equipment planner will apply the right equipment to its indicated use and will provide the facility with information on options concerning type, brand, etc. GPO contracts are always a consideration, and if the contracted equipment is not a correct fit, the planner will point that out. GPO contracts for capital equipment always have an exceptions clause to cover clinical reasons for buying something else.I’ve heard that many equipment planners base their equipment lists and recommendations on a number of key factors. They include material they’ve amassed from earlier projects, client budgets, clinician/physician preferences and compromises with the customer’s master plan. Is that enough? Why? FARRIS: Critical analysis of a facility’s technology needs should always be done in light of an equipment planner’s past experience and in consideration of the specific practice requirements and standards of care for the facility and its patient population. This is where broad experience and a multi-disciplinary equipment planning firm are important.Should it concern healthcare facilities if the equipment planner they’ve chosen relies heavily on suppliers for technical information and assistance? Why? FARRIS: No. This is a key function of the equipment planner; that is, gathering current and accurate information from the vendors and presenting it in a useable format to the various constituencies involved in a project. These constituencies include clinical, design, construction, finance and regulatory agencies.Should customers be concerned if equipment planners own stock in medical device and equipment firms and pharmaceutical companies? FARRIS: Probably not. No one equipment planner or equipment planning firm could carry enough market influence to sway of the price of a publicly traded company. People tend to invest in companies they are familiar with and in industries they know.Customers should be concerned with equipment planners that use third-party dealers as one of their main sources for equipment. Major professional equipment planning firms are ‘vendor neutral’ and deal direct with the original equipment manufacturers. Is it better to work with an equipment planning firm that’s fully staffed or one that assembles ad hoc teams when a project emerges? Why? FARRIS: It depends on the ad hoc team, their experience and their capacity to do work. For smaller projects, a solo consulting practice or ad hoc team could be completely adequate.CAMERON: For larger projects a client should look for a planning firm that has a critical mass of technical consultants, coupled with a support staff adequate to document and support the work of the planners. A fully staffed equipment planning firm is better able to deal with the ebb and flow of project demands and is better positioned to put additional resources on a project when required. A larger planning firm also brings with it more organizational stability and project consistency.Should healthcare facilities be concerned if equipment planners derive their fees from a percentage of equipment costs? Why? What’s a preferred method for charging fees and why is that better? FARRIS: Professional equipment planners work on a fee-for-service basis based on the scope and duration of the work.HARVILLE: Receiving a percent fee (based on equipment costs) misaligns incentives, i.e. the planner is rewarded financially for not driving the best pricing from the manufacturers. This can work as a detriment to project cost controls and to the client. A planner with a percentage interest in the equipment costs is a de facto sales representative for the equipment he specifies, and thus has an inherent conflict of interest. HPNEditor’s Note: For more information about EQ International, visit the organization’s Web site at www.eqintl.com.
● Choosing what to do
with excess significant consequences
● To loan or to lease? technology acquisition
● How three numbers
may reading
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Web Spinning for Capital Planning for capital equipment requires considerable research for the right sources.
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