by K. Richard Douglas
Last year, AAMI began a campaign to promote the HTM profession to the C-suite, clinicians and prospective students through posters, brochures, PowerPoint presentations and online brochures.
The idea was to tell the story of the HTM profession and highlight the profession’s important contributions to hospitals and other healthcare environments.
For years, the professionals and departments in hospitals, were often seen as the “fix-it” guys, the department next to the morgue or repair persons indistinguishable from facilities. If this misperception has dogged the HTM field with clinicians, it has not helped enlighten the department with those who have “chief” as part of their title.
The C-suite, made up of chief executive officer, chief operating officers, chief technology officers, chief information officers and others, have the business side of the hospital in the forefront of their collective minds every day. They may rarely think about who is repairing, maintaining, inventorying and making capital purchase decisions about their inventory of medical equipment. They may want it to occur smoothly in the background where they can be blissfully unaware of what is happening.
While attention for the wrong reasons is never sought out, visibility for the right reasons can only help. The insights of those we spoke with centered on several recurring themes; the perception by the C-suite and clinicians of the HTM professional as the medical technology expert; the need to know the priorities of the C-suite and maintain participation in committees and in other thought-leadership roles.
It is also useful for the HTM professional to respect the priorities of those in the C-suite and to understand their motivations while running a healthcare organization.
1. Scoring Points
It’s all about opening up lines of communication through professionalism and offering options for decision making.
“Experience has taught me that gaining visibility to any chief business decision maker or committee, such as the C-suite, can only be accomplished through professional and effective representation and communication,” says Curtis Ange, BSTM, Manager, WellStar Health System in Marietta, Ga.
“As a leader, it’s my job to bridge information both to and from my department as well as providing options, facts or opinions to the C-suite business leaders in regards to fiscal plans, available technologies, project timelines, inherent risk factors, capital expenditures, warranties, service agreements, or anything else that may impact the organization financially.”
The participation of the clinical engineering leadership on committees can be a boon to a hospital’s HTM professionals. Combined with projects that help the hospital with budgetary constraints and patient safety.
Izabella Gieras, MS, MBA, CCE, director of clinical technology at Huntington Hospital in Pasadena, Calif. is a member of the EOC committee, Capital Medical Equipment Committee, Clinical Research Committee, Clinical Leadership Committee and chairs the hospital’s Clinical Alarms Committee. Her clinical technology department has eight employees, including six technicians and an admin. The department reports to the CIO.
“The staff works very closely with IT and all clinical end users, maintaining close to 9,000 pieces of medical equipment,” Gieras says. She says that several significant undertakings have helped increase the department’s visibility.
“Participation, and often leadership, of multidisciplinary teams on medical equipment evaluations” has been one way that her department has maintained visibility, according to Gieras. “Oversight of medical device integration to EMR for anesthesia gas machines and physiological patient monitors,” has been another.
Gieras also says that finding cost-effective and efficient solutions through the management of service contracts can capture the attention of the C-suite, which is always interested in the bottom line. Also, educating clinicians on the proper operation and safe use of medical equipment shows upper management that the biomed department adds value in several ways.
The clinical technology department at Huntington is also involved in assisting in hospital-wide regulatory reviews and risk assessments and the development of strategic, multiyear medical technology replacement planning. These value-added services catch the attention of those watching the budget.
2. HTM Expertise
Establishing a sense that the HTM professional is in the driver’s seat and the resident expert on all things related to medical equipment is shared by Perry Kirwan, MSBME, senior director, Clinical Technology Assessment and Planning for Banner Health.
“Visibility is increased by performing functions that are difficult for most IDNs. We develop and lead processes to standardize clinical technology throughout the enterprise,” Kirwin says. “We were allowed to pursue this role/responsibility by demonstrating three key things – subject matter expertise, process development and the ability to use data to drive decisions, and ability to move large groups to consensus.”
“Standardization reduces variation in healthcare delivery and leverages the full purchasing power of the IDN,” Kirwin adds. “Both drive value in terms of clinical quality/outcomes and the financial bottom-line.”
Kirwin points out that the role of the healthcare technology professional also includes developing and leading processes to evaluate and assess new clinical technologies for their facilities.
“This represents the convergence of evidence-based medicine to clinical technology acquisition and adoption strategy,” he says. “This function actively interacts with physician thought leaders who design care practice and delivery of healthcare by the clinical service line/discipline.”
Patrick (Pat) Lynch, CBET, CCE, CPHIMS, HIT Pro/PW, of Global Medical Imaging in Charlotte, N.C., has put a lot of thought into this topic. Lynch presented “Talking to the C-suite: How to get their support” at the MD Expo held in Las Vegas earlier this year.
Lynch says that a good starting point is for the HTM professional to know who the members of the C-suite are and their responsibilities. He points out that the goals of the C-suite are multi-faceted and include everything from attracting physicians and overseeing daily operations to dealing with competing hospitals and keeping up with state and federal regulations.
It helps also, according to Lynch, to be aware of what the C-suite’s priorities are. He says that their top issue is “financial,” followed by patient safety and quality of care, care for the uninsured, physician-hospital relations and personnel shortages.
To know what hot buttons are important to the C-suite, you have to understand their world view.
“First, we technical people do not think in the same terms as does hospital administration,” Lynch says. “Our vision is much more tactical and immediate. We are problem solvers. We have difficulty putting our proposals in terms of long-term, strategic goals.”
“I specifically obtained an MBA so I could understand the thought processes of upper administration. It is this process of adapting to the wants, needs and priorities of the C-suite that is essential to biomed becoming strategic partners,” Lynch says.
Lynch says that when the biomed shop makes requests of the C-suite, the request should be framed in a way that addresses the needs of the administration and not just the needs of biomed.
“Let’s face it, as BMETs, we all take human anatomy and physiology to better be able to talk with nurses and doctors,” he says. “We do not expect them to learn our language. It is up to us to translate our conversations into language and terms that they understand and relate to. We have not taken this step with administration.”
“We speak to them in techno-geek talk and expect them to be able to translate it into hospital long-term goals. It does not work,” Lynch says. “We have to spend the time and effort to be able to reframe our goals in terms of the goals of the overall organization.”
In a presentation at last year’s AAMI conference, titled “C-Suite Driven Clinical Engineering Operations,” John-Paul Guimond, director, THCE Operations for Trinity Health Clinical Engineering covered the importance of thinking outside the box. Emphasizing the point that Lynch makes about knowing the C-suite’s concerns, Guimond asks if the biomed shop understands the C-suites view of them. Does the C-suite think of CE as the “fix-it shop,” able to fix only general biomed equipment, but not the high-end stuff, or a department that doesn’t understand finances?
Conversely, he asks of CE, do you benchmark, what makes your program better than an ISO and what are you doing to help your facility with capital planning? Guimond says that if you lead change, you will change the view of the C-suite. He suggests that CE set goals to “add relevance and importance to the services and value your department brings.”
He also suggests that you “get smarter on service support expenses and look for opportunities to manage costs. Develop a good working relationship with the finance department or controller department, similar to the relationship built with key clinical department managers. Offer to help the CFO or controller with capital equipment purchases.”
Getting the respect of the chief financial officer might come down to thinking outside the box.
“COSR (Cost of Service Ratio) should be your benchmark. COO (Cost of Ownership) should be another for high-end devices. I use both,” says Douglas Dreps, MBA, director of eastern regional operations for Mercy Clinical Engineering Services”.
“(There are) lots of good articles on COSR. COO is something we have been preaching for years now. COO covers all service costs including any contract costs,” he adds. “We look at five to 10 years of projected costs. You have to look past just the capital costs.”
Dean Stephens, EET, CBET, supervisor, Biomedical Engineering Department at Penn Highlands Healthcare says that cost considerations and a willingness to be an even bigger resource to the institution are two winning ideas for visibility.
“If you want the C-Suite to notice you, find what you can do to make their jobs easier,” Stephens says. “In my department’s case, this translates to making it possible for them to report well over $100,000 in contract savings to the board within two-three years. The fact that we are also showing that we want to take on more and more responsibility for more and more of our equipment gets their attention, too.”
3. The Boss’s Perspective
Thomas Malasto, chief patient experience officer for Community Health Network, provides some insights from the C-suite.
“The items that catch my attention in my role as CXO, and this applies to any idea not only those coming from clinical engineering, include the following: Improve patient or team member safety, improve clinical outcomes, remove ‘waste,’ decrease cost or improve patient/family/guest perception of care.”
“An idea with a material impact in any of these areas, or an idea that touches more than one of these areas in a meaningful way, are the ideas that get my attention,” Malasto says. “I also believe having a regular dialogue with key C-suite leaders is a must for clinical engineering. Look for a leader where you can establish a mentoring relationship and take advantage of their insight and sponsorship to get your voice heard.”
There is a perspective that shouldn’t be missed when trying to understand the whims of the C-suite. Senior management is as plugged in as anyone and understands the chief officer’s perspective.
“Increasing visibility in the eyes of the C-suite comes down to understanding the challenges they face and creating value that matches their needs,” says Tim Riehm, MBA, CBET, CRES, vice president, Technology Management for Banner Health.
Riehm suggests that the best approach is the same as in marketing or financial services — know your customer.
“Presenting traditional clinical engineering metrics that do not match the current landscape of healthcare provides little value to our stakeholders. The first step to creating visibility should always be to find out what is important to the audience and creating processes that help support those functions,” he says.
“Increasing and keeping visibility is also equally important once you establish the connection,” Riehm adds. “Always be transparent in meetings regardless of whether the information is perceived as good or bad. C-suite members will respect the fact that you always present the facts and elicit support when facing tough obstacles.”
4. A Value Proposition
Whether on the Internet or in a corporate setting, the concept of bringing value to any engagement is paramount. Websites that bring value to their visitors are particularly popular. Departments that bring value to a corporation or its customers are prized. The concept holds true in the relationship between the biomed or clinical engineering department and the C-suite as well.
“Providing value to the facilities is one of the easiest things to accomplish, but one of the most difficult for traditional clinical engineering departments to present,” Riehm says. “Controlling expenses, decreasing capital expenses, increased clinical productivity, reducing variability in care, and providing expertise to many systemwide committees regarding technology are all examples of how to provide value.”
“At Banner Health, we meet with several of the system-wide C-suite teams on a monthly or quarterly basis,” Riehm says. “During these meetings, we provide many of the updates above that impact the organization and tie them back to the overall system-wide goals of Banner Health.”
Riehm expands on the concept of value with the suggestion that a transparent financial model can help the C-suite appreciate the cost versus service paradigm.
“Creating a transparent financial model is also extremely helpful in regards to bringing value to our facilities. Clinical engineering expenses should never be a mystery to the hospital. Clearly outlining the expenses and the drivers to either increased or decreased costs is imperative to bringing value,” he says.
“If the C-suite doesn’t understand the drivers of our business then we have little chance to place any value on the services we perform,” Riehm adds. “The C-suite should clearly understand the expenses in Clinical Engineering and understand the plans you have in place to address any gaps. A simple question I often ask our C-suite is ‘Do you clearly understand the cost of our Clinical Engineering services and the value you are receiving in return?’ ”
The reporting that funnels its way up to senior management, and eventually to the C-suite, should give those chief officers a clear picture of the state of medical devices and financial considerations.
“Standardization efforts get reported on each time a project is completed and then year-end results are also summarized and presented to senior leadership in the form of a publication,” Kirwin says. “Technology Assessment reports are presented and published for senior leadership as well. In addition to those published materials, senior leadership also sees the financial value of this process each time we perform capital planning.”
Knowing how the C-suite sees the world will go a long way to make certain that the biomed shop, and its mission, are in clear focus. From the great starting point of AAMI’s promotional materials (available at IamHTM.com), to knowing what the C-suite values, the HTM professional has an opportunity to elevate their shop and profession before administration. Putting ideas into action is the first step to reminding the C-suite of the critical role that HTM professionals play in their organization.