Drive to Succeed

Four car trips during a typical work day is not unusual for biomeds at Mercy Health Partners of Southwest Ohio (MHP SWO), a Cincinnati-based group that encompasses six hospitals under the Catholic Health Initiatives (CHI) umbrella. Most health systems with multiple facilities train technicians or specialists at each facility, but MHP officials took a different route.

Traditional setups work well, but entrenched silos readily form—not so at MHP. "What makes us special is that we train one person, and that person is the expert across the region," explains Jim Meyer, regional director, MHP SWO, CHI clinical engineering, Cincinnati. "That is a rarity in our field."

Meyer calls the strategy "regionality," and he freely acknowledges that the workflow is far from the traditional methods that have served biomeds well for decades. The confidence to buck tradition stems from rigorous analysis. In short, the numbers back him up.

Taking care of just over 24,000 devices with one regional director, three lead technicians, 10 BMETs, and seven specialists has yielded a cost-to-value ratio of 3.65%. Since training is justified based on all like devices spread out over six hospitals, biomeds are rarely, if ever, denied the chance to expand their skills. "If you look at our number of technicians and specialists and compare it with our number of devices, we are pretty low," Meyer says. "The average is about 1,200 devices per technician. We all tend to the small things, help each other out, and shift the workload around."

Meyer believes strongly in the regional strategy, while acknowledging that geography, administrative will, and timing all contribute to eventual success. The three elements came together in 2008 when MHP SWO became the fourth Catholic Health Partners (CHP) region to transition to CHI clinical engineering. At the time, 16 employees brought a whopping 276 years of MHP service to the table.

Meyer's arrival brought new managerial energy to the six Cincinnati-based acute care facilities where biomeds tended to a wide variety of devices, including 15 MRIs, 16 CTs, and eight cath labs. "Our service contract percent of budget is 47%," Meyer says. "This is a major factor contributing to our cost/value ratio of 3.65%."

These days, lead BMETs divide supervisory responsibilities, while remaining employees all tackle regional responsibilities based on skill and experience. "Our technicians and specialists are not confined to a specific facility, which avoids duplication of training and costs," Meyer says. "We logged more than 7,000 miles traveling between facilities in 2010. This approach created efficiencies and the ability for our region to continually manage costs as the region grows."

The first 16 months of the initiative yielded a 97.1 program quality evaluation rating and a 4.33 customer satisfaction score out of a possible perfect five. From there, the numbers only got better as employees settled into their roles.

In all, 12 members out of a staff of 20 are considered part of the regional team that goes from hospital to hospital as needed. While these well-trained individuals are ready to travel the familiar road to sister facilities, sharing advice through the telephone is also a common practice when a relatively easy fix is called for.

Scott Goodman, BMET II, is the "anesthesia/ventilator guy," but he often describes basic repairs to technicians at other sites. "We share information, and they can do a little first look and see if it can be easily handled within," Goodman says, who has spent his entire 15-year career at MHP. "Small leaks within the patient circuit are an example of relatively easy fixes."

Typically, anesthesia physicians will catch these small flaws, or they may have concerns as the case goes on. When this happens, clinicians usually ask Goodman to look at the anesthesia machine when the case is done. If Goodman's presence is ultimately required to finish the job, he can respond quickly.

Most hospitals are on the so-called highway "loop" that spans downtown Cincinnati and its suburbs. Joe Palmieri, field service specialist II, occasionally goes to outpatient centers even farther from the main or "home" hospital—going from the eastern side of the MHP service area to the edge of Indiana, a distance of 40 to 50 miles.

Palmieri takes care of all the gamma cameras (22 across the region), and that requires multiple trips per week—occasionally completing the loop in an 8-hour span and ending up back where he started. "With nuclear medicine, all the departments do a periodic quality assurance in the morning," Palmieri says, who has also spent his entire 18-year biomed career with MHP. "I prioritize which ones are going to go first, which depends on patient load."

According to Meyer, MHP's lab specialist ends up doing the most traveling, with 20 to 25 trips per month not uncommon. Fortunately, all driving is reimbursed at the current federal rate of 51 cents per mile. In case a biomed forgets to keep track, established mileage charts among facilities—and even modern GPS units—keep an accurate count.

Far from a nuisance, time on the road is often viewed as a respite to get some air, listen to the radio, and take a quick time-out. "I do not mind the driving at all," Goodman enthuses. "It does give you a break from the monotony of being in one facility. I go to multiple sites, and it gives you a bit of time to catch your breath and get out and see some of your other customers."

Despite all that time on the road, workers' compensation costs are no higher for MHP biomeds, and car insurance rates are not affected. After 3 years and not so much as a fender bender, all biomeds are encouraged to use caution and never rush from job to job. "You always have traffic," says David Dunn, lead BMET. "On the opposite side of town there is no real highway, so you are going through bumper-to-bumper traffic. It really comes down to these guys are willing to work together and make the commitment."

Hitting the road so often requires a "traffic cop" of sorts, and at MHP the man for the job is Dunn. Meyer established the role to take the scheduling burden off of his biomeds. "These guys have so many responsibilities they have to manage that I wanted to remove that responsibility and place it on somebody else," Meyer says. "If they have concerns with scheduling or difficulties with backup, I don't want them scrambling to find backup. I just want them to do what they do best, and that is take care of customers."

Fortunately for Dunn, the culture of cooperation is so entrenched that directing traffic usually takes care of itself.

"It's more of a role than a position," Dunn says, who has 23 years' experience as a biomed, 17 of those at MHP. "I see it more as facilitating these guys. Things can come up when somebody is going to school, a vacation, or sudden illness. That is when we usually need to backfill people. When we do send somebody to training school, that person knows his general duties and PMs are being taken care of while he is gone."

Effectively planning PMs across the region is now part of a well-oiled set of procedures, with every specialist adhering to a strict schedule. Ian Barrett, field service specialist II, is responsible for the region's CTs and MRs. In a break with the one-person-per-device workflow, Barrett shares duties with one other specialist due to sheer numbers—16 CTs and 15 MRs.

To ensure optimum patient care, Barrett coordinates with his counterpart, as well as the appropriate clinicians. "We want to keep those patients being scanned as much as possible," Barrett says, yet another employee who has spent his 27-year career on the job at MHP. "That is good for patients and beneficial for revenue. We work around patient/clinician schedules quite a bit. We do PMs on Sundays if necessary, or in the evenings. We usually have a set PM every other month on CTs and MRs, and we get them done in a timely fashion because we are flexible. We are not called out when we are doing a PM, because calibrations can take hours, and we need time to do it properly.

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