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INSIDE THE CURRENT ISSUE |
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CS Connection |
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More hospitals reap preventive maintenance rewards by Julie E. Williamson
How’s this for a sharp business move: more healthcare organizations are kicking their reactive approach to instrument repairs to the curb, opting, instead, for a proactive preventive maintenance program that keeps instruments in tip-top shape and tackles minor device issues head-on before they develop into far costlier fixes. A greater willingness by facilities to embrace a proactive model for instrument maintenance and repair is a particularly wise strategy when taking into consideration today’s bleak economy and limited budgets. Although a number of hospitals in the not-so-distant past were reluctant to pay for comprehensive preventive maintenance services because they considered it an additional (or even unnecessary) expense, a growing number are now seeing it as an effective cost-cutting and customer service strategy – one that extends the life of their instrumentation inventory, while increasing satisfaction of end users in the operating room and beyond, and promoting better patient outcomes. "The past was too often driven only by price. Now, in view of less capital available to maintain new purchases in line with past purchase history, hospitals accept the fact that older instrumentation may require more maintenance than new instrumentation – and that an additional cost exists with maintaining older instrumentation," explained Frank Mohacsi, vice president of sales for InstruMedics LLC, Ann Arbor, MI. Any costs associated with a well-rounded and -implemented instrument maintenance program can be significantly offset on the back-end in the way of improved instrument set utilization, and a reduction in high-dollar repairs and premature device replacement, sources told Healthcare Purchasing News. "Savings are not always in the form of dollars," reasoned Eddie Garces, vice president, Medical Systems Group/MPRG, and chief quality improvement officer, Olympus America Inc., Center Valley, PA. "Hospitals and healthcare organizations are increasingly looking to keep their equipment functioning at the highest level of performance day after day, year after year. "Most cost and time savings come in the form of keeping repairs to a minimum, which maximizes uptime and, in turn, increases productivity within a hospital [or] healthcare organization on an ongoing basis." Vendors fine-tune their offerings Hospitals’ growing acceptance of true preventive maintenance programs hasn’t come by accident – and it hasn’t been solely driven by economics, either. Instead, their push toward proactive instrument maintenance has in great part stemmed from vendors’ willingness to push the benefits of their service offerings even further to better meet the unique and evolving needs of their customers.In the past, not all vendors lived up to their lofty promises, according to Steve Dillon, instrument product manager for Birmingham, AL-based IMS. "[Proactive maintenance] began as a good idea, a concept that made sense. It then became an empty promise that every repair vendor sold as a differentiator, but few delivered on," he noted. "Today, it is being demanded by most facilities. They understand this is the way to show true stewardship of a tremendous investment – a hospital’s stainless set inventory. [Customers] now expect proactive maintenance and they hold vendors accountable to deliver value beyond fixing what is broken." Meeting such an important goal requires a true partnership between healthcare customer and vendor, and an understanding that both parties share in the responsibility of managing instrumentation effectively. It’s not just about placing the instruments in the hands of skilled repair technicians, but rather adopting a program based on education, honesty and integrity to ensure that the instruments receive the care and attention required to drive safety, quality and long-term value. More than ever, original equipment manufacturers and third party maintenance and repair vendors are working to educate their customers on ways to prevent premature replacement and preventable repairs. At the same time, vendors are working harder to reduce service downtime.
"The sole purpose of this team is to work with customers to identify and eliminate the root causes of preventable repairs," Garces noted. Facilities that forge a true partnership with its services realize both hard and soft savings associated with longer-lasting, well-functioning instrumentation, greater efficiencies in the Central Service department and in the OR, and improved knowledge on behalf of the technicians and end users who manage the instrumentation, assured Instrumedics’ Mohacsi. "Our multi-year contract customers can take advantage of our educators who may also provide in-service training as part of our long-term partnership ‘package’ at no additional charge," he said. "The relationship between the OR and CS departments generally improves, as well, because instruments that have been properly maintained are less likely to fail in the operating room." The benefits aren’t just limited to the OR and CS, however. Facilities that foster partnerships with their vendors result in knowledge gained, along with cost savings that can be shared by all instrument-using departments, according to Rick Schultz, chief executive officer, Spectrum Surgical Instruments, Stow, OH. As added value to its customers, Spectrum offers CE-approved educational lecture programs, such as Instrument University, as well as educational staff training aides, such as surgical instrument flash cards, instrument inspection mat and magnifier, instrument sharpness test kits, and an instrument inspection textbook. So just how much can a facility expect to save by implementing a quality, comprehensive preventive maintenance program? While the figures will, of course, vary from facility to facility and according to the amount of instruments in their inventory being serviced, vendor experts agree that the savings can be significant. "In most cases, at large facilities, a 20 percent and, sometimes, 50 percent cost savings have been shown," said Valerie Abouaf, marketing support specialist for Mobile Instrument Service & Repair Inc., Bellefontaine, OH. One customer that adopted Mobile Instrument’s on-site maintenance program, she pointed out, has seen major savings, not only on monthly budget numbers, but also in the ability to have quality instruments back in surgery that same day. "This helps [the facility] perform more cases on a daily basis, resulting in greater monthly revenues and less cost on purchasing new and extra inventory to maintain their case load." Part of that success comes from Mobile Instrument’s willingness to promote effective teamwork with its customers. Instrument maintenance programs can reduce instrument purchases by nearly 70 percent, assured Schultz. He suggests beginning by implementing a preventive maintenance program that reviews all sets and provides detailed reporting on a regular basis. "Through proper maintenance, the cost to maintain an instrument is far less than the cost of replacing it," he said, adding that a German-made Tungsten Carbide scissor, for example, costs only $2.02 to sharpen and restore; the cost to replace the same item is $86. Indeed, the savings can add up. One 350-bed hospital had come in nearly $280,000 over on its instrument purchasing budget. After Purchasing got buy-in from Surgery and Labor & Delivery, all employees were put through extensive educational programs and a proper preventive maintenance program was put in place. "Just two years later, the hospital estimated that the PM program saved them nearly $400,000," said Schultz. Quality at the core
Olympus Vice President Eddie Garces and Senior
Manager "This results in longer procedures and a lot of instruments being used. Obviously, with instrument maintenance, patient safety is our first priority. Customer satisfaction is also very important. You have to please the surgeons and you do that by providing quality instruments that work well, and by being as efficient as possible so they’re not having to wait for instruments and keep the patient under anesthesia any longer than necessary," said Carolyn Rutherford, RN, manager of MD Anderson’s sterile processing department. The hospital, which has partnered with IMS for approximately ten years and has at least ten instrument sets serviced on-site per week, sought a repair vendor that could handle its large instrument volume and help it get a better handle on its repair costs. While MD Anderson relies on OEMs for some instrument repairs, Rutherford said she also likes the concept of a third party repair company – with some important caveats. "You must get good service. Quality and safety is the bottom line. If that [suffers], then nothing else matters." But the savings aren’t just associated with third party vendors, as Connecticut’s Danbury Hospital proved. The 371-bed community teaching hospital had trialed one third party vendor before starting another, and experienced less than optimal repair outcomes with its older scopes. In 2002, the facility returned to Olympus under a full service agreement. Over a two-year period, the hospital saved more than $194,000 in repair costs versus what had been charged by third-party repair vendors, Olympus noted. In some cases, quality comes in the way of making qualified repair technicians part of the collective team. For some of Instrumedics’ customers, that means having repair technicians working in an in-hospital repair lab. "There’s a trend toward seeking a qualified partner, with current experience installing and operating a hospital-based repair lab," Mohacsi said, adding that Instrumedics’ key offering and best product today is its facility- or hospital-based repair lab. These in-house repair labs are a particularly good fit for larger teaching institutions with a large volume of instruments and procedures, he reasoned. Mobile Instrument facilitates teamwork by, among other ways, participating in many customers’ quality improvement teams. "Who better to have on your quality control team than the professional keeping your equipment working at its highest capability?" reasoned Abouaf. Mobile has also created a new program, called R.E.A.C.T., which serves to partner the customer and Mobile Instrument through recommendations, education, analysis, and consulting in a collaborative team environment.
"More and more, instruments are being done on-site, such as delicate ophthalmology instruments, precision heart instruments and expensive laparoscopic instruments," confirmed Abouaf. Convenience also counts. These days, customers are demanding seven days per week service, plus second- and third-shift work, said Schultz. "In the past, it was based on the convenience of when the repair vendor would be at the hospital. Those days are gone. Repair vendors should be available with multiple technicians when the customer needs them." Spectrum offers 24-hour repair service, 365 days per year for all three shifts. Data driving better results As vendors aim to enhance their value and customer service offerings, many are turning to technology to arm themselves and their customers with as much instrumentation- and service-related data as possible. "Customers are demanding more transparency from their instrument maintenance vendors. They are demanding immediate access to information such as invoices, repair prices, repair history, date of next scheduled maintenance, tracking of shipments, etc.," confirmed Michael Chow, senior product manager, services marketing, Aesculap Inc., Center Valley, PA. Indeed, advanced reporting capabilities are on more customers’ radar. In the past, a spreadsheet or log book showing which set was due for maintenance or which set had been maintained was enough to satisfy most customers. Not true today, stressed Dillon. "Facility managers are being asked to justify what they spend, and this is forcing repair vendors to provide more meaningful reports." Common requests today include the number of trays serviced, average cost to the facility for repairs, and tray history reports. "This enhanced reporting allows facilities to better manage their repair budgets." More comprehensive data also helps ensure that instrument sets are properly rotated and repaired according to use and need, as opposed to just a static schedule.
With the advent of instrument management systems, however, the full depth and breadth of instrument management could be discovered. The pivotal data point was utilization, according to Nye. "The instrument management system can validate that purchases made were indeed utilized, as predicted at the time of purchase," she said. "Trays and individual instruments can now be scheduled for inspection and repair by utilization not by an arbitrary date in time, which was the only way to manage tray repairs in the past." Vendors are also recognizing that round-the-clock accessibility of data is invaluable to customers. To meet that demand, Olympus introduced its service portal, which is available to customers on a 24/7 basis. Benefits of the portal include allowing customers to open a Return Material Authorization, authorize a repair, request a loaner, and acquire repair reports. "Pictorial repair estimates are another offering we make available to our customers that enables them to see the damage on their instruments," said Garces. Tips on how to prevent that type of damage in the future are also included. With Spectrum Surgical, each of its On-Location Repair Vehicles features Spectra-Scan technology to provide before and after photos of the repair process for educational purposes. At IMS, its Oracle database captures a facility’s repair history, which is then used to target specific process improvement needs. In gathering the data, IMS can determine which instruments are being damaged, as well as where and how these repair issues are occurring. "Then, we can focus the inservice on the processes that need to be improved at that facility," explained Dillon. Vendors generally agree that today’s savvy customers are finding more creative ways to use the available data to manage their departments. In some cases, according to Nye, a CS manager may authorize a repair technician to enter completed repairs into their instrument management system, which captures yet another step in the instrument utilization cycle. CareFusion’s instrument repair system captures the detail for each instrument repaired and allows the specialist to print and send reports to the CS manager. These repair reports are not only helpful for allowing the CS manager to analyze utilization, but also as an educational tool for the OR director. "Oftentimes, processes can be viewed in the OR to determine if surgeons, staff and instrument handling processes are contributing to frequently-repaired items," noted Nye. Communication key to lasting success Because facilities’ instrumentation inventories, volumes and needs will continue to evolve, the same can be expected of the repair vendor relationship. To ensure that instrument maintenance and repair needs continue to be adequately met, healthcare customers and vendors must continually communicate their needs and expectations. It’s this open dialog that will ultimately help sidestep disappointment and pinpoint new areas of opportunity. "Communication is critical for a healthy partnership. It is important that the maintenance/repair vendor understands the repair goals for the facility," Chow stressed. "Business reviews are recommended to ensure that the customized repair vendor is successful." At the same time, it’s important that vendors communicate their own needs and expectations to their healthcare customers. As Garces explained, customers can greatly help the instrument maintenance and repair process by following OEM instructions and recommendations for proper product usage, service, maintenance, and reprocessing. Widespread commitment to keeping instruments in top shape is also required, added Mohacsi. Hospitals must commit to preventive maintenance schedules and then mandate the compliance of these schedules to their employees, he said. In the future, vendor partnerships and benefits may become even more ironclad. Continuous improvement initiatives will continue as a top priority, as will vendors’ commitment to creating programs that are uniquely tailored to their customers’ needs and future expectations. CareFusion’s Nye noted that the next horizon for instrument maintenance will involve systems that measure "flash" events to demonstrate competency and compliance with Joint Commission standards pertaining to immediate use ("flash") sterilization. "It will be an essential function for all data created in disparate systems to be aggregated into one system for the best opportunity to analyze activities and drive process improvements." Beyond that, Mohacsi predicts that repair technicians will undergo a certification process that will promote consistency, while also making quality of repairs more of a guarantee. "Repair companies that don’t improve their quality will go away."  
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