The Application of the Total Cost of Ownership Approach to Medical Equipment—Case Study in the Czech Republic

Hospodková, Petra; Vochyánová, Aneta

doi:10.1007/978-981-10-9023-3_65

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…Our study also spans participation across different hospital departments, showing a broad range of experiences mirrored across different care delivery departments. Studies do exist for other countries but tend to focus on decision-making on high-tech or high-cost medical equipment (for example Iran [ 28 ], the Czech Republic [ 29 ] and the Netherlands [ 30 ]). One notable exception is the study by Ham et al which looked at logistics across a whole hospital, not just for materials management also based in The Netherlands [ 31 ], and here also the lack of integration and silo functioning was found.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Boulding

Hinrichs

2021

BMC Health Serv Res

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Background In 2016 the UK Department of Health and Social Care published the results of a comprehensive review of efficiency in hospitals, identifying “unwarranted variation” in procurement (or purchasing) practices for materials, supplies and devices. Addressing this variation in materials and supplies procurement practice has been identified as particularly important for creating efficiencies in health service delivery. However, little is known about the behaviour and experiences of front-line individuals who make these procurement decisions, which has implications for the development of strategies to improve efficiency. The objective of this study is to improve understanding of the factors influencing procurement behaviour and decisions among requisitioners who use an internal electronic procurement portal for medical supplies and equipment, and identify areas where efficiency could be improved. Methods Qualitative semi-structured individual interview study, following approximately 70 h of exploratory observations on site. The study context was a large London National Health Service (NHS) healthcare provider (the Trust), where we focussed primarily on purchases managed by a large hospital. Participants were drawn from requisitioners from multiple directorates across the Trust (n = 15; of these n = 2 clinical staff members, n = 13 non-clinical). Results Four factors stood out in our analysis as directly affecting procurement decisions: (1) a high level of variation in electronic purchasing and inventory management procedures throughout the Trust, (ii) an inaccurate and cumbersome search facility on the internal electronic procurement platform, exacerbated by poor IT skills training and support (iii) an inefficient purchase approvals system and (iv) multiple working sites and cluttered environments. We observed that these factors led requisitioners to employ a variety of strategies or so-called ‘workarounds’ to overcome the challenges they encountered, including stockpiling, relying on internal and supplier relationships, by-passing procedures to save time, purchasing outside existing agreements to save cost, and (re) delegating purchasing responsibilities among requisitioner staff - which both addressed and created difficulties. Conclusions Working with the assumption that staff ‘workarounds’ indicate where main issues lie, we offer four possible explanations to why they occur: (a) to maintain services and prepare for future care requirements, (b) to save on costs for the organisation, (c) to develop skills and development in purchasing and (d) to break silos and work collaboratively. These four explanations help provide initial starting points for improving efficiencies in health supplies’ procurement processes.

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Section: Discussionmentioning

confidence: 99%

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Boulding

Hinrichs

2021

BMC Health Serv Res

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“…Because of the long lifespan of sophisticated medical equipment, purchase price seems to be a misguided concept in the procurement process. This argument is supported by numerous studies based on the Total Cost of Ownership (TCO) method [6][7][8][9][10].…”

Section: Maintenance Cost Of Medical Equipmentmentioning

confidence: 94%

“…It was indicated that the purchase price might amount only to 20-25% of the TCO [6][7][8][9][10]. The TCO method takes into account all cost elements that should be evaluated before purchasing any health technology.…”

Section: Maintenance Cost Of Medical Equipmentmentioning

confidence: 99%

“…TCO usually includes the costs of [6][7][8][9][10]:  procurement,  energy,  installation of equipment,  preventive maintenance of equipment,  corrective maintenance of equipment,  upgrades,  personnel training for working with the equipment,  technical personnel training for equipment maintenance,  labor costs of personnel, and  costs of equipment disposal.…”

Section: Maintenance Cost Of Medical Equipmentmentioning

confidence: 99%

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Specifications of the modern information system for maintenance of medical equipment in healthcare

Polak,

Jakovljević,

Marković

et al. 2023

Tehnika

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Effective management of the maintenance of medical equipment (ME), especially high-tech one, is one of the main issues for the quality of health care, for the provision of cost-effective health services and for saving , even in developed countries, insufficient resources. Medical equipment maintenance (EM) includes all activities related to ensuring an adequate level of service and limiting the downtime of medical equipment in a healthcare organization. Traditionally, EM is categorized as preventive maintenance (PM) and corrective maintenance (CM). The principle of PM is prediction. PM can be planned and predictive, ie. Just-In-Time (JIT) maintenance. Predictive maintenance can only be applied to new high-tech medical devices that have built-in self-testing. Planned preventive maintenance is carried out in accordance with the maintenance plan for a certain period of time. As a rule, when creating the plan, we follow the manufacturer's recommendations for preventive maintenance of ME given in the technical documentation of the ME, especially in the instructions for the maintenance of the ME. Predictive or JIT maintenance makes it possible to detect and solve the problem before problems and contingencies actually occur, and this is done on the basis of intelligent monitoring and analysis of the state of ME at the right moment, which ensures the optimal time for intervention, so that maintenance performed only when necessary. The information system for the management of the maintenance of ME in healthcare institutions would interconnect healthcare institutions and enable the fast and safe exchange of data and information related to the maintenance of ME and enable the optimal maintenance of ME in healthcare institutions, increasing the availability of this equipment, especially high-tech equipment, with significant reduction of the total cost of maintaining ME (of the order of 30%). One of the main reasons for the unsustainability of the existing approach to the maintenance of ME in the healthcare institutions of Serbia is that each healthcare institution independently takes care of the maintenance of its own ME. This approach is expensive and significantly affects high maintenance costs. This approach needs to change.

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“…Topics Singleuse vs. reuse (Esmizadeh et al, 2021) Qualitative environmental & economic considerations X (Etim et al, 2021) Medical waste reduction (Farrell & Smyth, 2021) Medical waste reduction (Feldman & Hui, 1997) Health economics (Gaberik et al, 2021) Qualitative environmental & economic considerations (Garay et al, 2017) Health economics X (Ghodrat & Samali, 2018) Economics & environment (Gobbi, 2011) Economics & waste reduction (Goel et al, 2021) Life cycle assessment (Grimmond et al, 2021) Life cycle assessment X (Hazem & Fahim, 2021) Economics & waste reduction (Hemmes, 1991) Health economics X (Ho & Copeland, 2020) Qualitative environmental & economic considerations (Hospodkova & Vochyanova, 2019) Health economics (Houngbo et al, 2008) Health economics (Hoyle, 2011) Health economics (Hsu et al, 2008) Health economics (Hughes et al, 2021) Health economics X (Hunstiger, 1988) Health economics (Hunt et al, 2011) Qualitative environmental & economic considerations (Iyer, 2018) Life cycle assessment (Jordan, 1996) Economics & waste reduction (Kane et al, 2018) Economics & environment (Keyes et al, 1993) Health economics (Khan & Ali, 2014) Medical waste reduction (Kim et al, 2018) Health economics (Koch & James, 1995) Health economics X (Korambayil et al, 2020) Economics & life cycle assessment (Kumar, 2021) Qualitative environmental & economic considerations (Kwakye et al, 2010) Economics & environment X ( Larsen et al, 2019) Health economics X (Latta et al, 2021) Life cycle assessment (Lee & Kim, 2019) Health economics X ( …”

Section: Referencementioning

confidence: 99%

A review of environmental and economic aspects of medical devices, illustrated with a comparative study of double-lumen tubes used for one-lung ventilation

Sørensen

Larsen

Andersen

2022

Environ Dev Sustain

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When health care management considers implementing a new technology such as a medical device, it is crucial to take workflow, clinical outcome, economy, and environmental impacts into consideration in the decision-making process. This study outlines the knowledge status of this complex challenge via a systematic literature review (SLR). The SLR found 133 of 1570 screened publications that covered relevant frameworks for choosing hospital equipment (i.e., related economics, life cycle assessment, waste generation and health issues). Yet, just five publications addressed choosing single-use vs. reuse of tubes or similar types of equipment by economic and environmental considerations through a systematic quantitative approach. The SLR reveals few publicly available peer-reviewed studies for the optimal sustainable choice of equipment. This study assesses environmental impacts of carbon dioxide (CO2) emissions as CO2-equivalents and resource consumption of a single-use double-lumen tube (DLT) combined with a reusable bronchoscope were compared to a single-use DLT with an integrated single-use camera. Camera DLTs exclude or minimize the need for a bronchoscope to verify correct tube placement during one-lung ventilation. The life cycle assessment shows that the materials and energy used and needed for personnel protective equipment and cleaning of the reusable bronchoscope contribute significantly to CO2-equivalent emissions. To ensure the sustainable choice of equipment this aspect must not be overlooked. Secondly, future reuse of plastic waste materials from the use can contribute significantly to better environmental performance.

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The Application of the Total Cost of Ownership Approach to Medical Equipment—Case Study in the Czech Republic

Cited by 6 publications

References 6 publications

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Specifications of the modern information system for maintenance of medical equipment in healthcare

A review of environmental and economic aspects of medical devices, illustrated with a comparative study of double-lumen tubes used for one-lung ventilation

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