Responding to a down MR scanner prior to 2015 could take as long as four hours at Care New England health system, placing stroke patients and those with other conditions at greater risk of death or serious injury.

Addressing this issue today though is just “an elevator ride away,” according to Jillyan Morano, regional director for operations at ABM, who elaborated on the efforts of her and her team to reform and standardize the running of the Rhode Island provider at the AAMI 2018 conference and Expo in Long Beach, California.

“Downtime, repeat calls and call backs were high,” she said. “For downtime, you’d have to wait for someone to come in. It could be a four-hour response time. Now, technicians are trained or on-site service engineers take care of imaging equipment. You just need to run up the stairs or go up the elevator to address the problem. We find that’s turning around the device quicker.”

The system initially consisted of four separate hospitals, all of which were running their CE programs under different forms of management. While Butler Hospital and Women & Infants Hospital of Rhode Island relied on an HTM provided by ABM, the in-house CE program at Kent Hospital was made up of two technicians, one manager and one administrative assistant. Another third-party serviced Memorial Hospital.

These variations led a difference in the level of performances and types of services at each with no standardized process of communication among all stakeholders, burdening the hospital with unnecessary expenses for service contracts; disorganization in filling out order requests; lack of management for equipment inventories; and no common approach for training for staff at all four facilities.

In evaluating all service contracts, ABM created a system of policies for keeping tabs on vendors, service reports and the quality of work performed. This included establishing communication among different departments, particularly between CE and IT, and establishing greater transparency in budgeting by bringing the costs for equipment maintenance under clinical engineering.

It also worked with stakeholders to establish guidelines for predicting and communicating the costs of maintenance, and introduced training for self-performance to reduce the expense of services provided by vendors.

“Something may break. They may have to borrow and replace something. But for the most part, I can tell you what’s going to come out of warranty in the next year and we already know what we’re going to do with it," said Morano. "We know if we’re going to pick another service contract or we know if we’re going to self-perform on that. We can be transparent with the CFO to let them know how we think their going to finish at the end of the year on cost for medical equipment.”

Communication and organization were especially emphasized in the creation of better management of inventories and order requests.

To address these matters, ABM brought in a full-time clinical engineer to help in assessing storage and on-site managers for each facility were appointed to oversee order requests for maintenance. A CMMS was set up for work order requests to be placed into with the site manager of each facility appointing the correct technician to address the issue at hand and provide updates to the stakeholder behind the request.

In addition, plans were put in place for flexing staff during busy periods and for training new members upon hire or the acquisition of new hospitals. ABM also took on the responsibility of physical damage of equipment, cutting it down by 50 percent through training and the implementation of processes in each department for reducing issues.

In summing up her experience, Morano says the key takeaway is to make sure that every player, especially clinical engineers, feels as those they are part of the conversation.

“It’s important to make sure the clinical department knows that it doesn’t remove him from the discussion around service and how we’re managing their service," she said. "For some, that budget means control and power. They’re still part of the conversation. We just manage it better.”

Since implementing changes, ABM has helped Care New England save more than $650,000. It expects to save more than $400,000 each year for 2018 and 2019 and a range of $1.5-$1.6 billion over the next five years.