Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of Joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.

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Finances have become the dominant concern of hospital administrators and department heads. Clinical Engineering (CE) can make significant contributions to the financial health of a hospital by increasing CE departmental productivity and by improving the utilization of resources in clinical departments. Several measures of productivity and cost-effectiveness have been applied to the Biomedical Engineering Department of the University Medical Center. The Department provides a wide range of technical services that are integrated into the clinical and administrative activities of the hospital. The Department has accumulated data regarding the financial benefits provided to the hospital, and the data reveal significant savings which show that CE can be viewed as a cost-effective investment. The greatest savings occur in capital equipment acquisition (selection and installation) and maintenance, and result from CE involvement in clinical activities and administrative decision making.

DRGs--these letters, spoken as frequently as they now are, may sound familiar and perhaps even sinister. They have rapidly become the driving force of the health care system. Medicare is the largest purchaser of health care and has engineered a financing program based upon DRGs. Since other insurers are joining the program, the health care industry, along with its suppliers and clients, will never again be treated as it was in the past. As participants in the system, our work and our careers will also be changed. Yet, as with any change, there will be opportunities to acquire knowledge, to grow professionally, and to contribute to society. If hospitals are to provide quality care in a cost-effective and efficient manner, it will be both because of and in spite of technology. The appropriate selection, use, and maintenance of technology is an intrinsic part of the system. The clinical engineer's role will be to contribute technical and managerial expertise in support of the institution--in other words, in the management of technology.

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