Question Answered step-by-step Rachel Hunter, Manager of Bio-Medical and Clinical Engineering at NorthlakeEndoscopy Healthcare, a hospital in Barrie, Ontario, was considering her options to improve qualityand costs of repairs for the hospital’s flexible endoscopes. It was Tuesday May 25 andRachel wanted to prepare a recommendation to be presented at the monthly teammeeting which was scheduled for June 24th.Northlake HealthcareNorthlake Healthcare was one of the largest hospitals in the province, with over 500beds and an annual budget of $600,000.00. The majority of the budget came from theprovincial Ministry of Health. Northlake was part of part of four large hospitals and acancer treatment centre in the Northern Health Services (NHS) organization, whichoffered a complete range of health care services ranging from acute to specialized toover 2 million residents in north central Ontario. Each member hospital of the NorthernHealth Sciences organization offered specific areas of expertise, but together theyoffered a comprehensive health care service to its patients.The Bio-Medical and Clinical Engineering department was a team focused on themanagement of the hospital’s medical technology. The service provided by this groupincluded the purchase, maintenance, repair and disposal of hospital equipment, as wellas assistance in the adoption of new technologies. Bio-medical and Clinical Engineeringhad a budget approximately 3.5 million dollars and also had the responsibility ofmanaging Northlake Healthcare’s capital budget of approximately six million dollars.Most equipment repairs were covered by individual departmental budgets, the hospitalhad 50,000.00 of the capital budget allocated and available for repairs to equipment thatcost more than 1,500.00The Bio-Medical and Clinical Engineering team was headed by Jacob Talwar and waspart of the medical operations division of Northlake Healthcare. Morgan Patel, AaronSchneider and Rachel Hunter comprised the remaining members of the team. Morgan,the Equipment Management Co-ordinator, was responsible for financial management ofboth repair and medical equipment acquisition budgets. Patel worked closely with thePurchasing department which was part of the NHS Shared services organization. Aaronmanaged the technical concerns of the department as the Technical Supervisor.Rachel, who had a degree in Mechanical Engineering, also had an MBA from theSchulich School of Business at York University.  Northlake Healthcare used flexible and rigid endoscopes in exploratory and correctivesurgery procedures. An endoscopy was a simple surgical procedure that involved theexamination of the inside of the patient’s body suing an endoscope, which is a medicaldevice that consists of a long, thin, flexible or rigid tube that contained a light and videocamera. Images of the endoscopy procedure could be seen a monitor (screen) andrecorded if necessary. Endoscopy was commonly used to view such areas of thepatient’s body such as lungs, stomach, digestive tract and major joints. Endoscopescould also be fitted with surgical instruments capable of performing a number ofprocedures, such as removing small tumors, gallstones, suction and fluid exchange.Most endoscopes were flexible and could be manipulated using angulation knobs,which controlled the vertical and horizontal movement of the device. There had been2,500 endoscopy procedures at Northlake Healthcare in the previous twelve months.An endoscopic procedure has an advantage in that the majority of them did not requireuse of a general anesthetic and did not require a major incision as most patientsreceived a local anesthetic during the procedure. The common type of endoscopyprocedures included colonoscopy, laryngoscopy and thoracoscopy.Endoscopes were maintenance and repair intensive devices that involved extremelysensitive technology. Scopes wer tested before and after each procedure, whichincluded cleaning, leak testing, measuring of angulation ranges and video testing.Despite careful maintenance, scopes occasionally broke down during surgery whichfrequently meant aborting the operation and a rescheduling of the procedure, unlessthere was another endoscope readily available.Northlake purchased two or three new flexible endoscopes each year at a cost of$20,000.00 per unit plus additional $30,000.00 per year on related equipment. Thehospital also purchase annually several rigid endoscopes each costing between$5,000.00 and $10,000.00 each. Because of the cost of each endoscope andsupporting equipment the four facilities within the Northern Health Services shared theequipment resources as necessary.Original Equipment ManufacturersNorthern Health Services bought and serviced all the endoscopes from RichardsonSurgical Products and Modern Medical. In selecting Richardson and Modern, a cross-functional team which included representatives from purchasing from the NHS sharedservice, physicians, and the Bio-Medical and Clinical Engineering department wascreated. The Bio-Medical and Clinical Engineering department had been responsible forassessing the technical and financial issues in the supplier selection process.Richardson and Modern provide endoscopes for use with specific procedures and mostof the endoscopes used at Northlake Hospital were supplied by Richardson based on the type of endoscope that was used at that facility. Northlake Healthcare haddeveloped a good relationship with Richardson and spent approximately $190,000annually on their products and services. The service provided by Richardson includeendoscopic repairs. Since the Original Equipment Manufacturers (OEM) controlled thesupply of specialized key endoscope components, they were frequently the logicaloption to provide repair services. There were third-party organizations that provided endoscopic repair services, howeverthey were not able to provide a full range of repairs due to the difficulty in obtainingparts form the OEM’s on a timely basis. There was alos a consideration that warrantiescould be voided if the endoscope was repaired by an unapproved service provider.Some manufacturers had developed disposable scopes, but this technology was notviewed as a cost effective option.There were concerns in the healthcare industry that OEM’s were charging unreasonableprices for endoscope repairs, and there was also some suspicion that occasionallyunnecessary repairs were being made. It was difficult to verify repair work sinceremoving the sealed casing on an endoscope required specialized equipment.Furthermore, it often took three to four weeks for an endoscope to be returned afterbeing sent out for repair.Mountain Medical Repair Services In November of the previous year, Rachel had been contacted by Simon Bowler, arepresentative of Mountain Medical Repair Service from Richmond, British Columbia,Simon had met with Rachel in her office to introduce Mountain as a new player in theendoscope repair industry. Simon claimed that they could provide repair service fortwenty-five to seventy five percent cheaper then the OEM’s as well as providing atwenty-four hour free estimate and a three to five day turnaround. Simon stated”Mountain Medical Repair only repairs what is broken and bills you accordingly”In February, Rachel decided to test Mountain’s services and sent them an endoscopefor repair. True to their word, a repair estimate was received in 24 hours and the scopewas returned within five days. The repaired endoscope was used for three weeks afterits return, at which point one of the angulation wires snapped. Rachel intended to sendthe endoscope back to Mountain for repair, but it was inadvertently sent to Richardsoninstead. A few days later, Neil Knott, the technical representative from Richardson,brought the endoscope to Rachel’s office. The sealed casing had been removed andRachel was shocked at what see saw. She found it difficult that anyone wouldintentionally damage the scope, nor could she believe that anyone could be soincompetent as to do such an unprofessional job (see Exhibit 1) Neil explained that thiswhat Rachel could expect when Richardson scopes were repaired by a third-partyrepair company. Exhibit 1:List of Items Damaged on the Repair of the Endoscope1 Threaded attachment nut, not used to seal the end of the body cover grip, wasgalled by an attempted removal using improper tool2 Opening in forward body frame was damaged with the improper removal of aninsert3 After the seal between the main housing and body cover grip was damaged,glue was used in an unsuccessful attempt to repair the seal4 Forward body trim nut to seal the forward body frame cover was also galled byattempting removal using improper tool5 The male threads on both the proximal and distal ends of the forward bodyframe were stripped6 An attempted remedy to correct the improper fit of the body cover grip due tostripped threads was to attempt to add large quantities of silicone on the “O” ring7 An edge on the UD guide plate was filed down approximately 2 mm for noapparent reason8 A brass angulation wire guide was removed, possibly because the threadedmounting holes were stripped9 In palce of the two missing screws, two ne holes were drilled and tapped tosecure the UD guide plate10 Metal filings from the filed down section were still found in the housing11 A spare screw was found floating in the housing when the housing was opened12 Angulation wires appear to have neither replaced or repaired13 The field service report and accompanying documentation from Mountain did notindicate any difficulties in achieving a suitable repairJacob Talwar was travelling to the Richmond area the following week on business andtook the endoscope with him as he planned to visit Mountain Medical Repair Services.Simon Bowler was defensive and claimed to have no knowledge of the damage to thescope. After some persistence by Jacob, Simon allowed him to speak to the technicianthat performed the repair on the endoscope. The technician was insulted that Simonsuggested that the technician might be responsible for the damage and threatened toresign.The damaged endoscope was left with Mountain and it took more then four week to berepaired – apparently due to difficulty in getting the necessary parts. When it was finallyreturned, it was put back into use and an angulation wire snapped during the firstprocedure.Shortly thereafter, Rachel received a strange invoice from Richardson Surgical foranother endoscope that had been sent out for repairs. The invoice received included acharge for repairs that had resulted, according to Richardson, from a third partyattempting to open the endoscope using improper tools.In-House RepairsIn December of the previous year, Jacob Talwar attended a conference organized bythe consortium of seven hospitals in the Greater Toronto Area. One of the sessions wasexplaining how the consortium had been successful in combining their endoscope repairand moving it in-house, resulting in a savings of 35 percent. Jacob felt that the Bio-Medical and Clinical Engineering department should consider asimilar initiative, asking Rachel to consider it and make a recommendation. Thehospitals in the Northern Health Service spent approximately three-hundred and fiftythousand dollars annually on endoscope repairs. Rachel determined that there werefour levels of service for an in-house repair operation;?Preventative Maintenance?Screening and providing Repair Estimates?Minor Repairs?Large RepairsRachel estimated that 80 percent of repair costs were in the first three levels, andcurrently the department performed in the first level, preventative maintenance. Shewas concerned that it would extremely difficult to move level four repairs in-house dueto lack of technical abilities. Recently, however, Richardson had been more responsiveto assisting its customers with implementing levels two and three.Neil Knott had indicated that Richardson would supply parts for minor repair work andwould provide a list of the necessary tools required, which would cost approximatelyfifteen thousand dollars. As well, Richardson would provide training for two techniciansat a cost of 3,000.00 per technician. Rachel felt the technicians after training would becapable of performing all the minor repairs for the entire Northern Health Service, whichwould provide the advantage of reducing the turnaround time on endoscope repairsfrom two to three weeks to one to three days.Rachel knew that the endoscope repair situation at Northlake Healthcare needed to beresolved soon. Jacob wanted to focus on endoscopes at the upcoming team meeting,and Rachel wanted to sort through the issues and make recommendations regardingthe Richardson/Mountain matter, as well as the possibility of setting up an in-houserepair operation. Question :1. There are two potential main issues in this casea. What to do about endoscope repair in the short term.b. What to do about endoscope repair in the longer termWhich one in your opinion is more important to resolve. Explain your reasoning for the selection. 2.Based on the identified four level of repair, which once did Rachel estimate could be completed in-house, and how much of a saving do you think she would be able to obtain. 3.Do you think the in-house repair option for endoscopes is viable ? (justify your answers) 4.What is your impression of mountain medical and their representative Simon Bowler? What action by Bowler justifies your position – explain. 5- What are the impact of an endoscope failure ? 6- What is the cost of implementing the in-house repair option ?a.$93000b.$75000c.$21000d.$15000 7-What is your opinion of Richardson Surgical and their representative Neil Knott? What actions by Knott justifies your position – explain.  Health Science Science Nursing QUALITY MA MGMT6087 Share QuestionEmailCopy link Comments (0)