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Guide 1 How to Organize a System of Healthcare Technology Management

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Guide 1 How to Organize a System of Healthcare Technology Management ‘How to Manage’ Series for Healthcare Technology Guide 1 How to Organize a System of Healthcare Technology Management by: Andreas Lenel Health Economist Consultant, FAKT, Stuttgart, Germany Caroline Temple-Bird Healthcare Technology Management Consultant, Ziken International Consultants Ltd, Lewes, UK Willi Kawohl Financial Management Consultant, FAKT, Stuttgart, Germany Manjit Kaur Development Officer, ECHO International Health Services, Coulsdon, UK Series Editor Caroline Temple-Bird Healthcare Technology Management Consultant, Ziken International Consultants Ltd, Lewes, UK Contents CONTENTS Section Page Foreword i Preface i Acknowledgements iii Abbreviations v List of Boxes and Figures vi 1. Introduction 1 1.1 Introduction to the Series of Guides 1 1.2 Introduction to this Specific Guide 9 2. Framework Requirements for Quality Health Services 15 2.1 Regulatory Role of Government 16 2.2 Establishing Standards for your Health System 19 2.3 Developing Policies for Health Services 23 2.3.1 A Vision for Health Services 24 2.3.2 Standardization of Healthcare Technology 25 2.3.3 Provision of Maintenance 26 2.3.4 Finances 28 2.4 The Importance of Introducing a Healthcare Technology Management Service 30 2.5 How to Manage these Changes 35 3. How to Determine Your Technical Requirements 39 3.1 A Summary of Technical Requirements for HTM 40 3.2 Skill Requirements at Different Levels of the Health System 41 3.2.1 Understanding the Skill Requirements 41 3.2.2 Determining Your Skill Requirements 46 3.3 Workload Requirements 47 3.3.1 Understanding the Workload Requirements 47 3.3.2 Determining Your Workload Requirements 48 Contents 4. How to Choose the Model for Your HTM Service 57 4.1 Providers of HTM Activities 57 4.1.1 Possible Sources 57 4.1.2 Strategies to Consider 64 4.2 Incorporating HTM into Health Management 66 5. How to Develop an Organizational Structure for the HTM Service 71 5.1 Relationship between the Health Delivery System and the HTM Service 72 5.2 Placing Staff at the Different Levels of the HTM Service 75 5.3 Responsibilities at Each Level of the HTM Service 83 6. How to Determine the Human Resources Required 91 6.1 Types of Staff Required 91 6.2 Numbers of Staff Required 97 6.3 Establishment Posts and Career Progression 100 6.4 Terms and Conditions of Employment 103 7. How to Set Yourself Goals and Monitor Progress 107 7.1 Setting Goals for Organizing a System of HTM 109 7.2 Monitoring Progress 113 7.3 Gathering Data 118 Annexes 121 1. Glossary 121 2. Reference Materials and Contacts 126 3. Sample Job Descriptions 149 4. Source Material/Bibliography 155 Foreword Foreword This Series of Guides is the output from a project funded by the UK government’s Department for International Development (DFID) for the benefit of developing countries. The output is the result of an international collaboration that brought together: ◆ researchers from Ziken International and ECHO International Health Services in the UK, and FAKT in Germany ◆ an advisory group from WHO, PAHO, GTZ, the Swiss Tropical Institute, and the Medical Research Council of South Africa ◆ reviewers from many countries in the developing world in order to identify best practice in the field of healthcare technology management. The views expressed are not necessarily those of DFID or the other organizations involved. Garth Singleton Manager, Ziken International Consultants Ltd, Lewes, UK Preface The provision of equitable, quality and efficient healthcare requires an extraordinary array of properly balanced and managed resource inputs. Physical resources such as fixed assets and consumables, often described as healthcare technology, are among the principal types of those inputs. Technology is the platform on which the delivery of healthcare rests, and the basis for provision of all health interventions. Technology generation, acquisition and utilization require massive investment, and related decisions must be made carefully to ensure the best match between the supply of technology and health system needs, the appropriate balance between capital and recurrent costs, and the capacity to manage technology throughout its life. Healthcare technology has become an increasingly visible policy issue, and healthcare technology management (HTM) strategies have repeatedly come under the spotlight in recent years. While the need for improved HTM practice has long been recognized and addressed at numerous international forums, health facilities in many countries are still burdened with many problems, including non-functioning medical equipment as a result of factors such as inadequate planning, inappropriate procurement, poorly organized and managed healthcare technical services, and a shortage of skilled personnel. The situation is similar for other health system physical assets such as buildings, plant and machinery, furniture and fixtures, communication and information systems, catering and laundry equipment, waste disposal, and vehicles. i Preface Preface (continued) The (mis-)management of physical assets impacts on the quality, efficiency and sustainability of health services at all levels, be it in a tertiary hospital setting with sophisticated life-support equipment, or at the primary healthcare level where simple equipment is needed for effective diagnosis and safe treatment of patients. What is vital – at all levels and at all times – is a critical mass of affordable, appropriate, and properly functioning equipment used and applied correctly by competent personnel, with minimal risk to their patients and to themselves. Clear policy, technical guidance, and practical tools are needed for effective and efficient management of healthcare technology for it to impact on priority health problems and the health system's capacity to adequately respond to health needs and expectations. This Series of Guides aims to promote better management of healthcare technology and to provide practical advice on all aspects of its acquisition and utilization, as well as on the organization and financing of healthcare technical services that can deliver effective HTM. The Guides – individually and collectively – have been written in a way that makes them generally applicable, at all levels of health service delivery, for all types of healthcare provider organizations and encompassing the roles of health workers and all relevant support personnel. It is hoped that these Guides will be widely used in collaboration with all appropriate stakeholders and as part of broader HTM capacity-building initiatives being developed, promoted and implemented by WHO and its partners, and will therefore contribute to the growing body of evidence-based HTM best practice. The sponsors, authors and reviewers of this Series of Guides are to be congratulated for what is a comprehensive and timely addition to the global HTM toolkit. Andrei Issakov, Coordinator, Health Technology and Facilities Planning and Management, World Health Organization, Geneva, Switzerland Mladen Poluta, Director, UCT/WHO HTM Programme, University of Cape Town, South Africa ii Acknowledgements Acknowledgements This Guide was written: ◆ with specialist support from: Juergen Clauss, formerly Consultant in Healthcare Technology, FAKT, Stuttgart, Germany Andreas Mallouppas, Director, Service for External Affairs and Projects, University of Cyprus, Nicosia, Cyprus ◆ with assistance from an Advisory Group of: Hans Halbwachs, Healthcare Technology Management, Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ-GmbH), Eschborn, Germany Peter Heimann, Director, WHO Collaborating Centre for Essential Health Technologies, Medical Research Council of South Africa, Tygerberg, South Africa Antonio Hernandez, Regional Advisor, Health Services Engineering and Maintenance, PAHO/WHO, Washington DC, USA Andrei Issakov, Coordinator, Health Technology and Facilities Planning and Management, Department of Health System Policies and Operations, WHO, Geneva, Switzerland Yunkap Kwankam, Scientist, Department of Health Service Provision, WHO, Geneva, Switzerland Martin Raab, Biomedical Engineer, Swiss Centre for International Health of the Swiss Tropical Institute, Basle, Switzerland Gerald Verollet, Technical Officer, Medical Devices, Blood Safety and Clinical Technology (BCT) Department, WHO, Geneva, Switzerland Reinhold Werlein, Biomedical Engineer, Swiss Centre for International Health of the Swiss Tropical Institute, Basle, Switzerland ◆ and reviewed by: Dr. P. Asman, Head of the Bio-engineering Unit, Ministry of Health, Accra, Ghana Tsibu J. Bbuku, Medical Equipment Specialist, Central Board of Health, Lusaka, Zambia Sue Carr-Hartley, Director of Nursing, Aga Khan Foundation Private Hospital, Nairobi, Kenya Ms. Sok Chann, PAM Coordinator at Biomedical Engineering Unit, Ministry of Health, Phnom Penh, Cambodia Juliette Cook, Biomedical Engineer, Advisor to Ministries of Health of Mozambique, and Vanuatu iii Acknowledgements Peter Cook, Biomedical Engineer, ECHO International Health Services, Coulsdon, UK Freedom Dellosa, Chief of Hospital Equipment Maintenance Service Division, Region 9 – Mindanao Peninsula, Department of Health, Zambonga City, Philippines Pieter de Ruijter, Consultant, HEART Consultancy, Renkum, The Netherlands Roland Fritz, HCTS Coordinator, Christian Social Services Commission, Dar es Salaam, Tanzania Andrew Gammie, Project Director, International Nepal Fellowship, Pokhara, Nepal Dr. Nichodemus Gebe, Medical Devices Training Coordinator, Biomedical Engineering Unit, Accra, Ghana Richard Hudson, Team Leader, Technical Assistance
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