By Matt Skoufalos
The relationship between an imaging director and a service technician can vary greatly from site to site, and institution to institution. In some environments, it’s highly personal, “much like working with the engineer who maintains a high-performance machine like a Ferrari,” said Geoff Hunt, vice-president of imaging services for Crothall Healthcare Technology Solutions.
“You want the equipment to perform at its best every time, so technical expertise is crucial,” Hunt said. “Since you spend a fair amount of time together, personal demeanor and professional appearance are important. Trust and respect are essential.”
Michelle Nocera, director of radiology academic market at University Hospitals of Cleveland, Ohio, described the relationship between imaging directors and service technicians as “interdependent” to ensure that imaging equipment is functioning optimally. Technicians rely on directors for guidance and priority-setting, which requires mutual trust and clear communication of needs and goals, Nocera said.
Under other circumstances, the relationship between the technicians and the imaging director isn’t as important as the relationship between the technicians and the managers or lead technologists of a given modality. Kelsey Mach, director of imaging and cardiology at CHI St. Luke’s Brazosport Hospital in Lake Jackson, Texas, puts more of an emphasis on her role negotiating service contracts and communicating with service management.
“Health care delivery systems exemplify complexity in organizations and rely on service techs to maintain equipment to effectively maintain workflow,” Mach said. “Coordination between imaging directors and service techs is essential when providing high-quality patient care, [and] having a familiar and respectful rapport with one another is important when relying heavily on communication between the two.”
Whether they’re part of an in-house or third-party service team, most imaging specialists typically have the closest relationships with their direct managers, as most of their work is coordinated with team leads and imaging supervisors, said Dean Skillicorn, medical imaging service manager of clinical engineering at St. Luke’s Health System in Boise, Idaho.
Skillicorn said that it’s important for those leaders to manage service events, with technicians keeping any conversations with leadership “brief and concise,” and “immediately escalat[ing] service-related issues through their company management structure.”
“Rule of thumb: If you are a technician and involved in discussions with a director, immediate escalation should occur with your manager,” Skillicorn said. “The challenge I have seen in my career, and where most technicians get compromised, is they try to over-explain situations, or they become defensive about service delivery. They should be counseled by their leaders to be brief in discussing service delivery or serious equipment reliability issues, and provide an escalation path to their manager for further discussion if the situation merits it.”
Even amid best efforts to resolve differences in personality and maintain clearly established lines of communication, some aspects of the relationship between imaging leaders and service technicians are natural sticking points – plainly, Nocera noted, including service timelines and equipment uptime. If neither party is realistic about those goals, or if communication is strained, issues can arise.
Mach elaborated further, explaining that imaging leaders may have different ideas or expectations about the methods of service, or the origins of problems with imaging equipment, or even have a greater familiarity with the equipment than their service technicians do. This can be a source of disagreements that can stifle productivity.
“These scenarios can cause friction between the leader and the tech due to the technician’s help not being appreciated, and the leader frustrated because they do not feel heard,” Mach said.
Mario Pistilli, director of imaging services at Children’s Hospital Los Angeles, agreed.
“Where I have seen friction it usually boils down to poor communication,” Pistill said. “The relationship starts to break down when the service tech doesn’t respond or doesn’t keep the customer informed on timing or parts availability.”
To avoid such circumstances, Hunt advises tackling questions about costs, scope of work, hours of availability, and related issues as early in the process as possible. Talking about these needs from the beginning of the process facilitates healthier interactions as well as avoiding other potential sources of conflict.
“Our approach offers greater flexibility and control, allowing us to prioritize patient care and clinician support while focusing on efficient equipment service,” Hunt said. “A healthy partnership involves open discussions about proactive measures, including allocating adequate time for thorough preventive maintenance. It also fosters open communication about emerging or intermittent issues, enabling timely troubleshooting and repairs before component failure occurs.”
Eric Massey, regional director of national field service for Crothall, added that it’s often helpful to revisit such conversations throughout the relationship with intermittent check-ins that reaffirm goals, expectations, and paths to achieve the desired outcomes.
“With open communication, they can anticipate needs, address challenges efficiently, and deliver superior outcomes, all while maintaining the highest standards of care and service,” Massey said.
Sometimes, communication between service technicians and imaging leaders can be complicated by their status as in-house or third-party service providers.
Nocera said she’s seen in-group and out-group dynamics in circumstances where communication about processes and priorities is unclear.
Pistilli said he’s encountered “reluctance” among in-house teams to call for vendor services for help resolving issues if they fear they’ll be called on the carpet for incurring additional costs. That anxiety can sometimes delay final repairs, he said.
Sometimes, budget issues are the whole of the departmental priority, Mach noted. If service technicians diagnose a problem and recommend a fix that’s not covered within departmental resources, the equipment won’t be fixed. That can put the onus back on the technicians to justify the cost of the work.
In other cases, a repair can be further complicated by adding additional teams or decision-makers into the process. Hunt noted that the greater the complexity of those conversations, the more challenging the service process can become. That’s where the clarity and trust established as early as possible in the relationship will be tested.
“Clear protocols and processes should be established upfront: who contacts the third-party, who manages the process, and who is responsible for closing the service event with proper documentation,” he said. “Building a trusting relationship and defining clear communication and process flows can significantly reduce confusion and ensure smooth operations.”
Massey said that sometimes third-party service technicians can find themselves having to justify their capabilities to new customers, or to in-house teams, either of whom may have only had an understanding of service as provided by original equipment manufacturers (OEMs).
“Our engineers are trained to read schematics and troubleshoot down to the component level, providing a level of technical expertise that goes beyond basic support,” he said. “Since our engineers are on-site and supported by regional resources, we can respond quickly and efficiently.”
When all the pieces work together, however, system repairs can be effectuated quickly and seamlessly. Massey described a circumstance where a client in Alabama lost two CT systems at the same time, and teams had them back up and running within five hours “thanks to immediate remote access support, an on-site engineer, and parts from our forward stocking location.”
Regardless of whether technicians work in-house, third-party, or OEM roles, Skillicorn advised that they should be focused on delivering optimal customer service through clear communication with an aim at preserving and managing key relationships among all parties.
“My philosophy as an in-house leader is that all technicians, regardless of whether they work directly for my employer, or work for an ISO or OEM, are technically a part of my in-house team as we manage the relationships, service and financials,” he said.
No matter who’s in charge of servicing imaging equipment, preventive maintenance (PM) work remains the best way to eliminate service-related downtimes. Routine service appointments allow for equipment to be taken offline at scheduled downtimes rather than emergently due to an undiagnosed failure. This approach mitigates the impact of parts and equipment failures to an entire department, its staff, and patients, eliminating the work of rescheduling exams and allowing for controls to the cost of fixes. Imaging managers and service technicians agree that although this is the ideal circumstance, it takes work to manage and coordinate.
Pistilli said his priority concern with preventive maintenance is scheduling the work without disrupting the normal operations of the imaging department. To that end, Nocera added, her organization asks its imaging leaders to schedule preventive maintenance service a year in advance.
The PM scheduling process “requires coordination across multiple roles,” Hunt said, including imaging directors, department managers, and equipment engineers, all of which will help relay expectations to service technicians. The work of the service team is to certify timely completion of maintenance “with trained engineers available, high-quality parts ready, and all necessary tools and documentation prepared.”
Massey noted that some scheduled maintenance work can last more than eight hours, and must anticipate how the rest of the department functions during equipment downtimes. Some facilities may even need to divert patients for lack of access to imaging services.
Skillicorn said that equipment downtime correlates directly with how service delivery is structured, with corrective maintenance covering emergency, non-emergency, and scheduled upgrades, like cybersecurity patches, technical upgrades, and parts recalls.
He recommended establishing service-level agreements (SLAs) for each modality in an organization, with clear paths of responsibility in leadership, maintenance, and finance. Critically, coordinating those efforts among in-house and external service teams is necessary to certify that maintenance schedules and goals align.
“Technicians should not be involved in this focus of service delivery scheduling except to ensure availability with management,” Skillicorn said. “This is a management issue. Scheduled management meetings with service providers should occur on a regular frequency to review uptime, service level agreements and service delivery strategies; doing so will provide insight that is immeasurable to the success of the organization.”
As communication among imaging leadership and service technicians remains a foundational aspect of delivering high-quality service and maintenance, fostering a sense of common purpose among everyone involved helps to strengthen those relationships. Asked whether there’s anything either party in the conversation wishes the other one knew about their respective roles, Hunt said it’s about developing a deeper mutual understanding of the issues at work for each.
“For directors, the priority is ensuring seamless equipment performance to support patient care and clinical outcomes, while engineers are focused on maintaining complex systems and ensuring prompt repairs,” he said.
Nocera said imaging leaders always want to communicate the breadth of organizational pressures around downtime, while service technicians likely wish those leaders grasped the constraints and challenges related to restoring equipment functionality to full service.
“As a director, I wish that the service techs would know how much stress a down machine causes the techs (technologists),” Mach said. “When a machine goes down, it is up to the tech (technologist) to call all the patients that are on the schedule, call all the doctor’s offices, call the floors and call the emergency department with regular updates on what’s wrong with the machine and when they think it will be up again. When something is down, the techs (technologists) then have to find a workaround for that issue, and still stay productive.”
Pistilli echoed those remarks, adding that institutional financial pressures and patient backlogs can be compounded by equipment downtimes.
“As a service engineer, I often wished imaging directors understood the complexities of repairs, which can be lengthy and involve multiple issues,” Massey said. “The engineer is required to complete all repairs according to OEM specifications with no shortcuts to reduce repair time.”
“If a calibration does not pass on the first attempt, the engineer is required to make an adjustment and run the test again,” he said. “This could add another four hours to a repair and should not reflect on the engineer’s ability but rather their commitment to following proper process.”
Among all the critical needs service technicians are asked to fulfill, “the most critical is building a strong, collaborative relationship,” Hunt said. “Taking the time to establish clear expectations around outcomes, processes, and communication is key. When this foundation is in place, it becomes much easier to navigate challenges and address any specific needs that arise.”
Nocera pointed out that imaging leaders should understand that service technicians need time and opportunity to train on the equipment they’re repairing, especially as that technology becomes ever more complex and challenging to maintain. Pistilli emphasized the need for qualified staffing and high-quality parts as critical to maintaining technology that runs “way past end-of-life.”
Skillicorn spoke about integrating imaging services teams with those from healthcare technology management, facilities, information technology, and supply chain, the better to coalesce institutional philosophies, chains of command, and clarity of expectations.
“It is our responsibility as service leaders to support our service technicians, regardless of who employs them, with appropriate management practices to allow them to do their job and service equipment,” he said.
Above all else, all parties involved in technology management benefit from strong, effective communication, including clearly defined roles and expectations of them. Hunt described the interconnection of “taking responsibility for shared outcomes and mutual success” among leaders and service teams.
“Leadership needs service engineers to demonstrate their commitment to the health care mission, as service delivery functions like a supply chain: competitive costs, timely delivery, and uncompromised quality are the core pillars,” he said. “Equally important, though harder to measure, are the relationships, trust, and common goals we build together. Ideally, the focus shifts from the contract itself to the outcomes we collaborate to achieve.”
Pistilli said imaging leaders need timely responses to service issues and first-time-through fixes. For their part, he said, leadership can support those outcomes by making themselves available to participate in solutions and showing respect to service technicians. A major component of the latter involves discretion in outlining the scale and scope of the problem, deciding which equipment downtimes are emergent, and not treating every service interruption as though it were “a five-alarm fire,” he said.
The best way to facilitate these outcomes, Skillicorn said, is for imaging leadership “to provide an environment of success for technicians,” developing institutional philosophies for technical training, equipment testing and documentation, and resource allocation tools.
“Supporting technical staff, regardless of whom the employer is, will result in service-level attainment and success for the healthcare delivery organization,” he added.
