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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



February 2014

CS Connection


Economic pressures forge differing instrument maintenance paths

by Kara Nadeau Della Vecchia

As economic pressures grow and reimbursements decline, healthcare facilities face tough decisions regarding their instrument maintenance programs. As a significant line item in most sterile processing department (SPD) budgets, some facilities are cutting preventive maintenance programs in an effort to reduce that area of spend in the short term. Others, taking a more strategic approach, are adopting preventive maintenance programs or increasing their current investments in this area, recognizing that properly maintained instruments can reduce costs in the long-term by minimizing costly repairs and enabling SPDs to better serve operating rooms, which are the revenue-generating centers of most facilities.

Greg Bright

"Ironically, the trend we are seeing is that hospitals are approaching instrument maintenance in opposite directions," said Greg Bright, Vice President of Operations and Business Development for Prezio Health. "Financially constrained, one group of hospitals is restricting the amount of instrument maintenance they are performing, thus reducing that particular spend category. On the other hand, we have seen healthcare providers recognizing the need and role these instruments play, taking a much more proactive approach to maintaining them, thus reducing spend over the life of the instrument. In both cases, healthcare providers’ behaviors are being driven by the reduced reimbursement revenue expected in the future."

The preventive path

Those facilities taking a proactive approach to preventive maintenance of surgical assets reap a broad range of rewards — from fewer repairs, longer instrument life, lower replacement costs, reduced down time of instrument sets, happier surgeons, and safer patients.

Derek Lashua

"Spectrum has demonstrated that over time healthcare facilities experience reduced repair costs with instruments lasting longer when they are properly maintained," said Derek Lashua, Marketing Director for Spectrum Surgical Instruments Corp., a subsidiary of STERIS Corporation. "As hospitals gain an understanding of the financial aspects of a successful maintenance program, they are also able to more effectively address budgeting issues. Couple preventive maintenance with education and you further fortify the program resulting in increased patient safety, more satisfied surgeons and the reduced likelihood of readmissions due to hospital-acquired infections. It’s a win/win, with the additional benefit of a more knowledgeable and educated Sterile Processing and Surgery staff."

The clearest benefit of preventive maintenance is a facility’s ability to regularly monitor instrument performance and intervene to address minor issues before major repairs are needed. This not only saves money on repairs in the short-term, but can also save a facility considerably in the long-run by enabling it to keep current inventory versus having to purchase new instruments to replace those that are beyond repair.

David Anbari

"A properly designed and implemented preventive maintenance program reduces the total cost of ownership for equipment, which includes both replacement and repair spend," said David Anbari, Vice President, National Operations, Mobile Instrument Service. "Well maintained equipment will last longer thus deferring replacement spend. In the break-fix approach where only broken items are sent for repair, many broken items are past being repairable and could have been saved had proper maintenance been performed."

In an environment where reimbursements are more clearly tied to patient safety and care, the impact of preventive maintenance on clinical outcomes is an obvious driver to the adoption of these programs. Virtually everyone in a healthcare facility these days is acutely aware of the need to reduce the risk of adverse events, such as healthcare-acquired infections (HAIs). Starting in the SPD with properly functioning, intact instruments that can be thoroughly cleaned and sterilized is critical to this effort.

"Through the proper identification of problem areas, such as trapped bioburden, surgical instruments that are hard-to-clean (such as Kerrison rongeurs and laparoscopic instruments) can be identified by hospital staff and communicated to the instrument repair vendor where issues can be properly addressed," said Lashua. "Additional areas of testing and inspection such as sharpness testing and laparoscopic insulation testing can further reduce potential risks to the patient."

By taking a preventive approach to instrument maintenance, healthcare facilities can also boost both the operational and financial performance of their ORs by assisting SPD staff in their efforts to deliver properly functioning instruments when needed for cases.

"Sterile processing departments provide critical support to one of hospital’s highest revenue-generating areas, the department of surgery," said Bright. "These two departments working together to establish a long-term plan to optimize the return on investment associated with their instrument inventory will pay the greatest dividends overtime."

Roadblocks to preventive maintenance

For those SPDs that have been unable to secure support/funding for preventive maintenance programs, or whose spend in this area has been slashed, financial pressures are just one hurdle many must overcome to get on the preventive path.

Jack Hower

Industry experts point out that in many facilities, administrators and other senior-level staff do not understand the importance of preventive maintenance in extending the life of valuable surgical instruments, supporting SPDs in the servicing of the ORs and enabling clinicians and surgeons to properly care for patients.

"As most decision-makers understand, surgical devices are costly items that need to be maintained — much the same way that commercial aircraft need to be maintained," explains Jack Hower, President, Surgical Devices, IMS. "Routine maintenance on a plane is critical to ensure safety, efficient scheduling, and, ultimately, revenues. The same is true for surgical equipment."

Others indicate that a lack of financial and/or staff resources is often cited as a reason for failure to adopt preventive maintenance. Some facilities feel they do not have the means to adopt a program and keep it successfully implemented over time.

Ralph Basile

"Failure to implement a proactive maintenance program is usually a misguided allocation of resources," said Ralph Basile, Vice President for HealthMark Industries Inc. "Preventive maintenance is an upfront cost. When in a budget crunch, administration often looks at this as an area that can be cut. This is short term thinking, as failure to properly maintain equipment will cost more in the long-run — and often the long-run cost comes a lot sooner than expected."

Preventive maintenance options available

For those facilities that have chosen to implement a preventive maintenance program, there is a broad range of options available to meet their specific needs, from in-house repair facilities staffed by dedicated technicians, to mobile labs where instrument maintenance can be performed on-site, which increases efficiency and reduces set down time compared with shipping instruments out to a remote location.

Mobile services

Jim Tobin

Industry experts agree that the majority of preventive instrument maintenance and repair today is performed on-site via mobile labs. This can be an ideal option for those facilities that either do not have the need for an in-house facility or the resources to establish one.

"On-site mobile repair services have been growing," said Jim Tobin, Group Product Director, Aesculap Technical Services. "For those facilities with more modest needs and/or without the space for an in-house repair center, the on-site mobile repair services provide them with same-day turnaround of sets and the ability to have an instrument expert available to the clinical staff for questions and consultation."

In-house facilities

While mobile labs can meet the needs of the majority of healthcare facilities today, larger facilities with high procedure volume and/or those looking for more extensive technical support can bring preventive maintenance in-house by dedicating existing space or building a new in-facility maintenance and repair center.

"The majority of preventive maintenance and on demand repair services continues to take place via mobile labs. However, where synergy and scale are present, certain integrated delivery networks have elected to bring these core competencies in-house," said Bright. "This is generally done in concert with a proven industry leader and a committed, defined vendor-client relationship."

Tobin notes that Aesculap has seen a particularly strong growth in the implementation of in-facility repair centers. He points out that a key benefit of this approach is it offers clinical staff direct access to technicians with extensive knowledge of and experience with instruments and other devices.

"It a great opportunity to educate clinical staff on the proper use and care of various surgical assets," said Tobin. "The clinical staff loves the ability to speak to an in-house expert on the manufacturing and maintenance of surgical instruments, and we can provide unique insights on the care and handling of surgical assets as they make their way through the hospital."

Anbari concurs that mobile labs are the most widely used option for on-site instrument maintenance today but indicates a growing trend toward building repair centers into facilities. He notes that this can be a "good option if you have space and the demand for service on a regular basis," but cautions facilities:

"Of late, too much time gets invested on where the facility is located and not enough on ensuring the service provider is delivering the right overall program in terms of cost, quality and service."

Remote servicing

While sending out instruments to remote facilities for maintenance and repair is not an ideal solution, it is sometimes necessary for specialty instruments or complex devices that cannot be serviced via mobile lab or in-house due to the need for advanced repairs and/or hard to find parts. Tobin adds that some facilities simply have very modest needs when it comes to instrument maintenance that can be fulfilled via remote servicing.

"There is a sizable minority of facilities that choose to have their surgical assets serviced remotely like at our National Repair Center," said Tobin. "For these facilities, their needs may be very modest where on-site services may not make sense for them and/or they require more advanced services beyond the capabilities offered on-site. For most specialty devices, servicing of these products are handled in this way."

Considerations when choosing a program

With a variety of preventive maintenance options available, an SPD leader must first conduct a self-evaluation to determine what its facility needs in terms of maintenance and repair services, and then evaluate vendors based on this criteria to choose the program that best meets their requirements.

According to Lashua, a successful preventive maintenance program starts with education. He states:

"This cannot be emphasized enough. Begin by sitting down with a representative from your instrument repair vendor and find out what they offer in the way of CE-approved educational programs. These programs should be offered at no charge to your hospital and will serve to educate your staff on how to proactively identify potential problem areas before the instruments reach the operating room. Tour your vendor’s on-location repair vehicle, and if possible, schedule a tour of your repair vendor’s facility. Education coupled with preventive maintenance is key to reducing overall spend and improving patient safety."

Anbari recommends SPDs ask the following questions when evaluating preventive maintenance solutions providers:

  • Will service be provided when optimal for the facility or service provider?

  • Will the service provider provide service level guarantees for turn-time, percent of repairs completed on location, and percent of instruments requiring replacement?

  • What is the experience level of the technician?

  • What is the proposed preventive maintenance schedule and what method was used to create the schedule?

  • Does the provider offer a comprehensive approach to equipment management and repair reduction or are they content to fix broken instruments?

Tips to SPDs for securing buy-in

For those SPDs that see the value in adopting a preventive maintenance approach, but face challenges in securing the necessary resources to implement a program, the industry experts offer up this advice:

Anbari: "We find the most impactful message is that preventive maintenance reduces total cost of ownership and improves patient outcomes. You must show a business case for preventive maintenance and what long-term spend for repairs, replacement, and maintenance look like with and without a preventive maintenance program."

Basile: "Often times the instrument repair budgets are the largest item in a department’s operating budget. By demonstrating the ability to reduce expenditures in this area by taking relatively inexpensive and modest preventive maintenance steps is key to getting administration buy-in."

Hower: "One important point is Surgeon Satisfaction. No clinician wants a piece of equipment to fail during a procedure. Imagine driving on a vacation with your family and having the car break down on the side of the road because you failed to have routine maintenance such as oil changes, performed on your vehicle. As a reminder, according to regulatory standards, endoscopes should be included on the medical equipment inventory to ensure that proper management of them is occurring." 

Tobin: "Aesculap has been working through this ‘learning curve’ with facilities to demonstrate that not only can they make the move to a robust preventive maintenance program but the return on investment is significant enough to make the decision right away."