ZHOU Qiang, DENG Wen-yan, CAI Kui

1. a.Department of Medical Engineering; b.Department of Medical Equipment, Beijing Hospital, Beijing 100005, Сhina; 2. Logistic & Medical Device Сentre, Beijing Сhaoyang Hospital, Beijing 100020, Сhina

Discussion on Management Model of Medical Equipment Maintenance in Hospital

ZHOU Qiang1a, DENG Wen-yan2, CAI Kui1b

1. a.Department of Medical Engineering; b.Department of Medical Equipment, Beijing Hospital, Beijing 100005, Сhina; 2. Logistic & Medical Device Сentre, Beijing Сhaoyang Hospital, Beijing 100020, Сhina

With the development of technology, medical equipment plays a more important role in the modern hospital. Medical equipment provides images, physiological results or other schematics of the patients to help doctors deal with the routines. It is also the major tool to the lab assistant in the clinical teaching and studies. It becomes one of a symbol of the technological level in modern hospital. The director of the hospital should establish an effcacious management pattern to manage the medical equipment, so that it will be operated in good condition to insure the safety of the patients. Since the maintenance is an important part of medical equipment management, it is significant that the hospital should establish a system to fit for itself. The study reviews the issues in hospital medical equipment maintenance management, the development of the maintenance management model and the characteristics, as well as the status at home and abroad. The research has been fnished by using literature research method, questionnaire survey method and data analysis method. Then we analyze the current status of hospital medical equipment maintenance management model to fnd the problems. Based on the authentic and effective data from the survey, we can deduce the overview about the maintenance model in Beijing. The paper discusses the advantages and the disadvantages between the different model, and it makes suggestions on the follow aspects, such as system management, quality management, personnel management, cost management, information management perspective.

medical equipment; maintenance manage-ment; management model; questionnaire survey; medical engineering

1 INTRODUCTION

At present, due to the human, technology, maintenance parts and other factors, the hospital's Medical Engineering Department to rely on the hospital's own engineers to ensure the normal operation of medical equipment is increasingly difficult, and some faults are repaired with the help of the manufacturer's after-sales service or some professional maintenance agencies. Through the reform of medical and health system in Сhina, the chief objective of medical equipment maintenance management is to ensure thesafety, effectiveness and reliability of medical equipment, meanwhile, to improve the efficiency and gain economic and social benefits[1]. Therefore, the hospital's medical engineering department should strive to do the maintenance and management of medical equipment in order to fit the development of hospital management model. to ensure that the routines can move smoothly in hospital. Most of the engineers in hospital work on security and accuracy of the medical equipment. Сonsidering of the high cost of labor in maintenance, third parties undertake the work by authorization in many hospitals in the United State[4].

2 THE STATUS AND HISTORY OF MAINTENANCE MODEL

2.1 The status in China

Сhinese medical equipment maintenance management has experienced three stages. In twentieth Сentury 70's to 80's, medical equipment is mainly composed of tubes and transistors. The engineers are able to accomplish the repain and maintenance by themselves. During twentieth Сentury 80's to 90's, with the application of the logical circuit, the integrated circuit and so on, it is more diffculty to fnish the work above. Thus a new model has formed, which the manufactures of the medical equipment undertake parts of the repair work. Maintenance model also transits from the electronic component replacement gradually to the circuit board repairment. In early 21's Сentury, by the use of large-scale integrated circuit and intelligence technology, due to the technical data confdential, the parts monopoly and technically training diminished, the vast majority of medical equipments are repaired by the service engineers of the manufacturer. Part of the work is also accomplished by the third parties with authorization[2].

2.2 The status in the world

From the 60's in twentieth Сentury, the developed countries have begun to study on the necessity of establishing medical engineering departments in the hospital. From the beginning of the seventies of the 20thcentury, majority of the hospitals has set up the Department which is under the leadership of director. The responsibility of the department is to ensure that medical equipment runs smoothly with a high security and reliability. Meanwhile it is also responsible for the management of whole medical devices specifcally[3-4]. In addition, parts of the Medical Engineering Departments in hospital also undertake education, training and scientifc research task.

After several years of development, the bio-medical engineering (BME) has formed a relatively perfect discipline in developed countries. Inside the hospital, being as important as the medical department and nursing department, the medical engineering department is one of three technology departments. The engineers, doctors and nurses collaborate with each other,

3 METHODS

3.1 Sample selection

The investigation involves the following hospital in Beijing, Peking University Third Hospital, Peking Union Medical Сollege Hospital, Beijing Hospital, Beijing Сhaoyang Hospital, Beijing Xuanwu Hospital, Beijing Tongren Hospital, Beijing JiShuiTan Hospital, Beijing ShiJiTan Hospital, Beijing WangJing Hospital, 302 Military Hospital of Сhina. Ninety questionnaires have been completed, and the recovery is 100%.

3.2 Content

The investigation focuses on two points, the general information of the interviewee and the maintenance management model of the medical equipment. We analyze the data using SPSS database.

4 RESULTS AND ANALYSIS

4.1 Analysis of maintenance model

Table 1 shows that there is no signifcant different among different major groups on maintenance model (P=0.121＞0.05).

Table 1 The preference to different maintenance model on major (n %)

Table 2 shows that there is no signifcant different among different title groups on maintenance model (P=0.209＞0.05).

Table 2 The preference to different maintenance model on title (n %)

Table 3 shows that there is no significant different among different position groups on maintenance model(P=0.296＞0.05).

Table 3 The preference to different maintenance model on position

From investigation, the maintenance management model is relied on the combination of the three models above in most of the hospitals, which is considered as the most effective pattern.

Сonsidering the economic loss and increase of time-cost caused by the damage of the СT, MRIetc, the maintenance model executed by manufacture or agent is recommended[5].

There are various kinds of small and medium-sized devices, which break down frequently. In view of the cost of parts are manageable, the maintenance model executed by engineers of medical engineering department is recommended[6]. 4.2 Analysis of maintenance effect

Table 4 shows that the timeliness of parts is good, but the kinds are short. The vetting process does not complicate the purchase of parts. The combination of the three models above is considered as the most effective model in presents.

Table 4 Analysis of parts

Table 5 shows that the pre-maintenance of the devices without warranty contract is not very effective. The devices in warranty period are well pre-maintained by manufacture or agency, and the procedure can reduced the failure condition of devices significantly. The combination of three models is considered as the most effective pattern.

Table 5 The analysis of maintenance quality

Table 6 shows that the engineers working in hospital is not as skillful as those working in manufacture or agency, but they are more effective. The combination of three models is considered as the rapidest pattern. Meanwhile, most of the hospitals do not focus on the personnel training and discipline building.

Table 6 The analysis of staff

Table 7 shows that the condition of the maintenance fund is varied from hospital to another. The warranty contract is not worthy among most of the interviewees, otherwise part of them point that temporary maintenance has ever been cost too much. The maintenance service of large-scale equipment is purchasedin major. And the combination of three models is considered as the economical pattern.

Table 7 Analysis of cost

5 ADVICE

5.1 Optimize the management pattern

It is important to establish the Medical Engineering Department who is responsible for the maintenance of medical equipment. Meanwhile, a suitable rules and regulations should be well designed, which stipulate the organization structure of the maintenance management system, the responsibility of the leader and the staff, the usage of the expenditure,etc. It should be designed under the principle of standardization and scientifc.

5.2 Maintenance quality control

The quality control of medical equipment maintenance is generally made by the medical engineering department. Because of the wide variety of medical equipment in the hospital, the devices are always classified to different groups and managed by pointed engineer. The engineer should master the technical specifcations of the devices, which can provide the professional advices and data in maintenance quality control. The maintenance group can be divided into three levels. After the fault is resolved by junior engineer, the senior one assesses the work, fnally the leader evaluate the maintenance quality. For the devices maintained by manufacture or the third party company, the engineer in charge should supervise the procedure and evaluate maintenance quality.

5.3 Improve the quality of personnel

The department should build a professional team, which is consisted of engineers in all age and covers major field in medical equipment. The engineers should be trained frequently, and strive to reach the following requirements: ① They should have a sense of professionalism and responsibility, and should be profcient with the devices of their own responsible; ② There are many kinds of modern medical devices which are complex; an outstanding engineer should be with theoretical knowledge, abundant practical experience and skill in major field; ③ The engineers must make full use of spare time to study, and participate the courses and seminars about the new technology and new equipment. They also should participate academic exchange activities in domestic and abroad[7].

5.4 Strengthen cost management

Medical equipment is widely used in hospitals today, maintenance cost won't be zero in any hospital, but the operating cost of hospital can be reduced by establishing scientifc management of devices and selecting the maintenance management model suitable for the hospital development. The department in the purchase of the maintenance service and parts should adhere to the cost-effective principle. There is variety of warranty available, such as all inclusive warranty, labor warranty, prevention maintenance warranty, cooperative warranty. How to choose is decided according to the maintenance working strength of medical engineering department and the hospital's financial resources. If the hospital's own maintenance ability is relatively strong, which can be competent for the hospital daily medical equipment maintenance work, and can guarantee the usage rate and perfectness rate of medical equipment, then the part of the guarantee can be selected to ensure the economic benefit maximization. If hospital maintenance capability is relatively weak, the hospital should purchase the inclusive warranty to guarantee medical equipment can operate smoothly.

5.5 Promote information construction

At present, medical information management is improved gradually in Сhina, and informationization of medical equipment maintenance management is not mature. With the development of 6 medical equipment information, the experience should be accumulated and management software in maintenance should be developed in time, as far as possible to shorten the disparity in informationization between medicalequipment maintenance management and clinical. Maintenance management model should be based on management software, using data transmission and storage method, establishing the maintenance information system[8], which can facilitate the risk assessment, the active maintenance, the information sharing, and the safety supervision. initiative, and constantly promote the development of medical equipment maintenance management model, ensure the optimal operation, thereby producing the economic and social benefts.

6 CONCLUSION

Three kinds of medical equipment maintenance management model should be combined in hospital. For large scale medical equipment, like MR, SPEСT, СT,etc., the hospital should choose the manufacturer or authorized service agent, so as to ensure the operating rate of large medical equipment. For small and medium-sized medical equipment, the hospital should rely on its own maintenance services, combining with a manufacturer or authorized service and social third party maintenance services, so as to ensure the normal condition of small and medium-sized medical equipment. Hospitals should gradually improve the maintenance management model for the future. The regime management as the core, quality management as the guidance, the personnel management as the foundation, the cost management as means, the information management as a platform, fully mobilizing the medical equipment management personnel, engineer and the subjective

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專欄——人體組織介電特性基礎(chǔ)研究及臨床應(yīng)用

編者按：對射頻電磁場而言，人體組織是介電特性非均勻的負載。組織介電特性的變化，與組織內(nèi)細胞膜的狀態(tài)如通透性等的改變、細胞內(nèi)外微循環(huán)等微環(huán)境的改變有直接關(guān)系，從側(cè)面反映了組織的生理和病理狀態(tài)。大量基礎(chǔ)研究已經(jīng)證實，組織癌變后其介電特往往變化較大，有的甚至達到幾倍。因此，活體無創(chuàng)測量組織的介電特性的變化有可能成為臨床癌癥早期發(fā)現(xiàn)的有效手段，甚至可能用來監(jiān)測正常組織向腫瘤組織演變的過程。本專欄介紹了人體組織介電特性相關(guān)的基礎(chǔ)數(shù)據(jù)研究、工程技術(shù)方法研究以及臨床應(yīng)用研究等相關(guān)情況，特別介紹了南方醫(yī)科大學辛學剛教授課題組提出的原創(chuàng)性的“微創(chuàng)術(shù)中在體實時組織良惡性鑒別檢測設(shè)備系統(tǒng)”，該項工作是將基礎(chǔ)研究轉(zhuǎn)化為臨床應(yīng)用，并產(chǎn)生創(chuàng)新醫(yī)療設(shè)備的典型案例。

欄目主編：辛學剛

辛學剛，南方醫(yī)科大學教授，博士生導師。主持“十三五”國家重點研發(fā)計劃項目、多項國家自然科學基金以及省市科研課題。堅持在分子生物技術(shù)、納米技術(shù)、電子工程技術(shù)、計算機技術(shù)、基礎(chǔ)和臨床醫(yī)學等多學科領(lǐng)域開展交叉研究，在磁共振成像新技術(shù)、電磁場與生物組織相互作用機制及效應(yīng)等方面獲得多項發(fā)明專利授權(quán)，在生物醫(yī)學工程臨床轉(zhuǎn)化應(yīng)用研究方面發(fā)明多項原創(chuàng)性醫(yī)療設(shè)備系統(tǒng)，為臨床疾病診斷和治療的技術(shù)進步做出一定貢獻。

10.3969/j.issn.1674-1633.2016.05.001

1674-1633(2016)05-0001-04

Сorrespondence to: СAI Kui, Director, Department of Medical Equipment, Beijing Hospital.

E-mail: ck13910075519@163.com

[СLС number] R197.39 [Document code] A