Every year the healthcare industry spends billions of dollars on structures and equipment1. Grants are awarded and wings are constructed to support such equipment i.e. the capability that the equipment will provide to the medical center. So each piece of medical equipment represents a significant investment in safe healthcare delivery. New angiography suites, PET scanners, or nuclear medicine cameras are great until the novelty wears off. Then what?
There are two significant phases in the procurement cycle — acquisition planning and then contract management. While the acquisition cycle flows from a beginning to an end, it is important we learn the lessons which occur at the end as we plan our beginning. Consider the following questions as you ponder your next acquisition of equipment.
What happens if (or perhaps when):
- The manufacturer decides not to provide maintenance support for their equipment?
- The parts for equipment are unavailable due to the age of their equipment?
- The parts for equipment are unavailable due to the parts being on backorder or manufactured in China?
- The updates and upgrades to software and firmware no longer available?
- The updates and upgrades to software and firmware no longer compatible with your facilities IT infrastructure?
- The lack of information or disclosure on equipment repairs/problems (fleet wide)?
- Training of internal staff is not available on the care and maintenance of the equipment?
As this article is about patient safety, what is the impact on patient safety should the above occur? The potential adverse effect can range from a minor inconvenience to wrong diagnosis and death.
With this in mind, how would you structure your pre-acquisition question as you conduct market research on the equipment? John Strong expressed his thoughts by stating:
In healthcare, providers have tended to allow the sellers of the goods and services to set the specifications for products and services. While that has worked for a long time, and led to a great deal of important innovation, it may also have led healthcare providers to purchase too much, or the wrong things.2
Failing to consider the past or conduct a thorough life cycle analysis, we then look to the equipment manufacturer to draft the requirements. With a thorough understanding of our past and a good set of requirements, we can address our needs in a comprehensive way. If we knew the answers to the above questions, we might make a different selection.
Other questions to consider include:
- What is the project life cycle of this equipment?
- When is its projected end-of-life for purpose of ensuring follow on maintenance, parts, and software/firmware support?
- What is the history of performance to include FDA and ECRI reports on the equipment?
In making decisions about equipment, we must not rely on the industry to draft the terms and conditions. As Strong suggests, we should drive in the industry by having them address our needs and not settle with what equipment manufacturer’s terms and conditions. Patient Safety flows from this economy. When we can address the vulnerabilities of this system, we make our patients safer.
1 Abstract of the United States: 2012 – U.S. Census Bureau; Section 3 Health and Nutrition, Table 135 National Health Expenditures by Source of Funds 1990 to 2009 http://www.census.gov/prod/2011pubs/12statab/health.pdf,
2 Strong, J (2013 June), Developing Specifications Can Pay Off, The Journal of Healthcare Contracting, http://www.jhconline.com/developing-specifications-can-pay-off.html
JAMES N. PHILLIPS JR., MPA, CFCM, NCMA Fellow, is an Acquisition Professional working at the Department of Veterans Affairs National Center for Patient Safety. Disclaimer: his comments are that of his own and do not reflect that of the Department of Veterans Affairs or the National Center for Patient Safety.