In any health care organization, large or small, independent or network-affiliated, collaboration is the engine that drives success. Whether it’s in-house, among different divisions within a large hospital, or involves taking on external partners with the capacity to enhance the offerings on the ground, the relationships that produce the greatest results are those that fulfill institutional aims while also supporting the success of individual departments.
Nick Gaffey, head of OMI MedTech, an independent service organization based in Orlando, Florida, has seen the world of healthcare technology management (HTM) as both the operator of an independent service organization (ISO) and an OEM equipment support manager. Before establishing his own business, Gaffey worked as a service director at Omega Medical Imaging of Sanford, Florida, which manufactures artificial intelligence fluoroscopy/cine (AIF/C) imaging systems. His role there was to support the Omega Medical Imaging install base of AIF/C products across its customer sites, most of which had contracted with the company for a service plan.
In structuring those agreements, Gaffey said the company would create a “team assurance contract,” a tiered agreement that leverages in-house biomed teams as a first line of defense for systems maintenance and repairs. He described such an agreement as “really beneficial to both parties because we’re able to save the department money and also have boots on the ground.”
“I think it’s more efficient if HTM and imaging can work together, hand in hand, and form a strong partnership,” Gaffey said. “Whenever possible, we always encouraged a team approach, and that gave us an in-house partner. It takes people who have a collective goal to keep these things up and running.”
“What we got out of it was help when we needed it diagnosing issues, and keeping the system up and running and safe, and what they got out of it was a financial incentive and a knowledge of the room and the equipment,” he said. “What it did for the hospital, the [imaging] department, and the HTM group is put more money in their budget because the costs of any service agreement would be reduced. We also provided training along with that team assurance plan.”
When Gaffey founded OMI MedTech, he carried forward that same tiered approach to HTM with his own clients, seeking opportunities to partner with OEM vendors who need local service subcontractors with knowledge of their technology and access to his geographic region. At the same time, he works with standalone medical imaging facilities and institutional imaging departments who need the skills and services of a seasoned biomed. Keeping a foot in both worlds requires the ability to manage relationships with professionals who use the technology he services as well as those who develop it.
“You have to have the relationship and the trust, and then also have an in-depth, expert knowledge of the equipment you’re taking care of,” Gaffey said. “You build that trust by having the expertise and knowledge of the equipment. I’m using the knowledge I gained from my time at Omega, and trying to be flexible. That’s the name of the game in this business.”
In addition to his years of experience, Gaffey continues to establish that trust with his clients by delivering what they want and need, and not trying to sell them on things they don’t. Most of them want support training their in-house teams to repair and maintain their medical devices, or some financial incentive to add the extra layer of service his support crews provide. Given the variability of those needs, he tailors every service contract to the distinct needs of each client.
“Most of the time, imaging departments want to learn more about the system in the room, and we really value that onsite partner relationship,” Gaffey said. “In a lot of cases, it’s a win-win for everyone involved. We’re doing preventive maintenance and calibrations for these systems to keep them working to manufacturer’s specs, and a lot of biomed work. And if there’s an issue, we’ll come in and repair the issue.”
OMI MedTech also grew its business during the novel coronavirus (COVID-19) pandemic by being the local, on-the-ground partner that its clients needed when the pandemic shut down or severely limited widespread travel, which in many cases cut off departments in need of service from the OEM providers that would have dispatched technicians to support them. For those cases they couldn’t reach in person, OMI MedTech leveraged tele-coaching to help diagnose concerns and offer fixes.
“For a lot of local surgery centers that don’t have an in-house biomed or imaging team, we’re their in-house support,” Gaffey said. “We concentrate on the central and southwest Florida area, and dispatch same-day in most cases. That’s what our value is: if something happens, and the airport’s shut down, and you can’t get that OEM guy out, we’re going to be there.”
“With the pandemic making it harder to get onsite and to travel, we utilized a lot of video chats,” he said. “My guys never stopped traveling but having the ability to have someone onsite with a camera diagnosing issues and walking them through repairs was invaluable.”
Sometimes, however, forming those internal and external HTM partnerships that strengthen an organization may require overcoming a mismatch between institutional strategic initiatives — like cost-cutting – and taking the steps required to pursue these partnerships
“As I’ve gone through different organizations, imaging department goals and priorities versus biomed and IT initiatives can be quite different,” said Nicole Dhanraj, systems director at Northern Arizona Healthcare in Flagstaff, Arizona.
“I’ve experienced being in a silo versus coming together with multiple stakeholders aligning the vision for my department with the visions of other departments,” Dhanraj said. “I think sometimes department heads unintentionally forget that they need to involve these other departments to pursue their desired initiatives, and to ensure everyone shares similar priorities that ultimately support the organizational vision.”
To Dhanraj, supporting the needs of her internal HTM partners need not conflict with the financial goals of her institution. Yet despite her interest in seeking out some ISOs to help drive savings, Dhanraj said she’s been met with reluctance amid concerns that anyone other than the OEM could manage those needs effectively.
“I feel like we have been brainwashed to think about OEMs as the only people available to manage our equipment,” she said. “When those [vendor] folks are onsite, and staff is forming relationships [with them] through equipment purchases, there is a sense of obligation and loyalty in combination with this indirect marketing. In some other cases, this is an unknown, and that in itself can paralyze us to move beyond OEM contracts.”
“In my years of experience, it’s been challenging from a front-line perspective to break that apprehension; to get staff to be open and understanding about having these other partnerships,” Dhanraj said. “From an organizational perspective, generally senior leaders are afraid to go head-on with these OEMs and bring in third-party vendors because they’re fearful that they won’t get a service manual, or a firmware/software upgrade, or just move outside of traditional practices.”
Although Dhanraj has offered this suggestion as some equipment service contracts are set to expire, she has encountered a comparable degree of institutional hesitation despite the potential for “significant savings” on the table. Fear of the unknown – or of losing revenue to equipment downtime, trying a service other than OEM – is a real obstacle to trying out a new partner. Questions about whether an ISO could capably manage issues related to common, proprietary OEM concerns, such as access to technical manuals or equipment service codes, has frequently dogged her proposal. Eventually, Dhanraj brokered a compromise: trial the third-party provider on a handful of redundant pieces of equipment that could tolerate a longer downtime in the event of a catastrophe. Even then, fears of what could go wrong seem to consistently dominate the conversation instead of the possibility of achieving a comparable quality of service at a cheaper price. She said she’d rather the team focus on organizational goals rather than cave to these fears.
“There seems to be more of a deflecting to assumptions versus a collaboration,” Dhanraj said. “There are so many unknowns here regarding OEM versus HTM partnerships that nobody wants to really speak about openly; health care leaders often remain with our assumptions about what would happen if we form these partnerships.”
“At the end of the day, we still need onsite folks,” she said. “Instead of being in competition or living in fear of the unknown, how about we have these internal conversations and find common ground that can work with both sides? [In-house] biomeds can be first responders for other pieces of equipment, and then have that partnership with other vendors so they can be collaborative overall.”
What can be done to overcome this reluctance to change tack? Dhanraj believes it will involve more and deeper director-level conversations to help decision-makers grasp how to balance quality of service with the price required to obtain it. She continues to push her colleagues to regard the work of HTM from a perspective of collaboration instead of fear.
“The next aspect is to have senior leadership really start driving this,” she said. “If we’re looking to be more cost-effective, what partnerships are out there? Start with the OEM, [saying], ‘We’re unable to meet your million-dollar contract if we’re looking at saving 30 percent as an organizational goal.’ Give the OEM the opportunity to course-correct with their pricing, lest we start looking at these other partnerships, from used equipment, to leased equipment, to independent service providers.”
“ISOs are getting smarter, training people on multiple pieces of equipment, or they have enough knowledge that they can be onsite and communicate with someone else, too,” Dhanraj said. “I think the third parties are really trying to be creative to bring this level of service, not only to compete with the OEMs, but to bring that competitive edge to fair market versus OEMs holding onto their market share.”
Eventually, the same pandemic financial crunch – namely, cost-cutting amid months of lost or reduced revenue opportunities across a variety of lines of service – that drives leaders like Dhanraj to broker lower-cost and creative relationships in HTM service delivery may drive the additional changes that she believes the industry needs. Although institutional needs vary from location to location, private-practice imaging centers “don’t seem to be as afraid to take that [ISO] risk,” she said, whereas larger corporate entities fear a loss of control over managing and maintaining even a handful of devices.
“I feel like right now there is a huge stop sign for any HTM group outside of the organization, so it’s difficult for them to penetrate and start having these conversations,” Dhanraj said. “From the institutional side of it, we need to let our guard down, listen to it, be open, and have OEMs and HTMs collaborate and have the conversations about how can they meet our needs. Also, the C-suite can engage with HTMs to understand their hesitations on pursuing these partnerships, and how working together with OEMs and HTMs especially can ensure their financial viability and continuity of services.”
William McGinnis, national sales director for medical technology software vendor ContextVision, of Stockholm, Sweden, has the benefit of experience in the medical device industry and the perspective of working with an OEM that partners with medical imaging customers and other OEMs.
“We work with the largest of the large, to the strategic companies that we think we might have a good partnership with,” McGinnis said. “We have access to the experience of deploying so many different places inside your X-ray or ultrasound architecture, working with so much different technology, that [our clients] have an advantage that [they] can give to [their] partners. It gives us the opportunity for our partners to go and put their resources on working on what are true differentiators in the imaging market.”
What McGinnis has found to be true of generating the kind of organizational change that leads to cost savings, improved quality of service, or simply finding a partner that’s the best match for the needs of an organization, is that doing any of these things requires buy-in from institutional leaders. However, it also requires support from people in positions throughout the organization; those who may not have the same input on high-level decisions nonetheless can contribute to the overall success of a good partnership.
“Maximizing the cost on every system is harder and harder,” McGinnis said. “It’s important that we spread our message to folks not just in the imaging department but other decision-makers throughout the organization.”
“You need to get wide and deep,” he said. “You need to be able to have the discussion with a CEO as easily as you do someone in IT or an algorithm developer. We start the engagement with representation from our entire team. We’ll put together a group for each of our partners, from IT, from the algorithm team, from the business side, so what we can do from the very start is start to approach those pain points, and attack them very quickly.”
Being a good partner also means finding ways to calculate the return on investment (ROI) of any project on the table, which will be different in every circumstance depending upon customers, their needs and the environment in which they’re operating. Managing relationships with in-house teams makes ROI easier to calculate because the customers have some understanding of their current costs, McGinnis said. But projects that are “more abstract,” i.e., those in which the customers don’t have easy access to their internal metrics, are dealing in commoditized technologies, or don’t necessarily have needs that match with what’s on offer, it’s also important to know when to table the conversation until both sides can get what they require out of the arrangement.
“It’s very important to establish what those cost barriers are early on and find out if this is something we want to do,” he said. “I don’t want to waste a red cent on a product that doesn’t have the potential to grow for us.”
Although McGinnis believes that the flexibility he can bring to the table in terms of fee structures and process improvements will benefit his clients in any circumstance, he also knows that none of those gains may be realized without clarity among partners on all sides of a deal.
“Most of our discussions begin in a consultative way,” he said. “Either we reach out to a customer, or they engage us, or we have an annual meeting like RSNA, and that’s where we’ll discover, ‘Can we help you out?’ The benefit to us from working with other partners expands our reach.”
Beyond those opportunities to yoke several disparate entities within a single proposition is an institutional culture that values collaboration, listens well to what its clients want and strives to improve on what’s already happening. Those are all hallmarks of effective partnerships, McGinnis said, and ones that any organization can learn to embrace.
“If you can establish that culture where people feel secure, and feel that they are a contributor, you’ll see that they may have a suggestion on how something can work that hasn’t necessarily been tried before, or how to use a different product to try something new,” he said. “You have to have that curious company culture that has to exist everywhere, even in a remote office; there has to be ways to connect to drive thoughts.”