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Could engineers help improve the NHS?

Engineers and doctors haven’t always had an easy relationship. In our recent article on the art of medical innovation, Imperial’s Chris Toumazou – who is both regius professor of engineering and chief scientist of the Institute of Biomedical engineering – said this: ‘When I started at Imperial I was in awe of the medical community; I felt there was a culture and mindset [that] they were the prima donnas and we [the engineers] were technicians who provided them with instruments they needed.’

Nowadays more and more engineers are used to working in partnership with clinicians to develop devices and adapt existing technologies for use in medicine. Indeed being a medical practitioner now involves using a huge array of complex equipment – from 3D printed implants to advanced scanners to diagnosis software – and this reliance on technology is only likely to grow.

The growth in biomedical engineering has prompted the Institution of Mechanical Engineers (IMechE) to produce a report looking at how the sector can be developed for the benefit of the UK economy and the NHS. One of the report’s key recommendations is that every NHS acute trust (the bodies that manage hospitals) should have a chief biomedical engineer.

The idea is that a chief engineer in hospitals would help make sure equipment was functioning and used properly, was the right bit of kit for the job and had optimum availability.

The report found that, in 2013, 13,642 incidents related to faulty medical equipment (from pacemakers to MRI scanners) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA), leading to 309 deaths and 4,955 people sustaining serious injury.

Miscalibration is also a significant problem, even at the basic level of things like weighing scales that have led to incorrect doses of medicine being distributed. And half of the high-value equipment in the NHS is due to be replaced in the next three years, creating a huge challenge to select and purchase the right technologies to meet the demands of the health service while ensuring value for money.

But why does this mean hospitals need their own engineers? Wouldn’t we be better off investing in more and better trained technicians and make sure procurement managers have a sufficient knowledge of technology as well as medicine?

Dr Patrick Finlay, lead author of the report and chairman of the IMechE’s Biomedical Engineering Association, thinks a biomedical engineer would be the best person to act as a ‘strategic leader in a hospital’s technology procurement and deployment programme’.

Speaking to The Engineer via email, he said the chief engineer would be responsible for the following:

  • Ensuring all the hospital’s imaging and procedure planning systems were compatible with each other;
  • Ensuring that systems were in place to handle routine maintenance and repair of devices, as well as critical failures;
  • Ensuring that appropriate stocks of equipment were held so that operations were never cancelled due to equipment non-availability;
  • Liasing with suppliers and researchers to evaluate new equipment;
  • Cost effective life-cycle management: should equipment be bought, leased or rented? Should maintenance be in house or subcontracted? When does equipment become obsolete and need replacing?

Having more trained engineers in managerial roles would be no bad thing. But would it be making the most of their skills to limit them to procurement and planning? One of the other roles of a chief biomedical engineer proposed by the IMechE would be to contribute to research, development and translation. Perhaps in this context what we’d really benefit from is more “engineers-in-residence”.

By immersing themselves in a hospital setting and examining the daily routine of diagnosis and treatment, such engineers may be able identify more ways to improve medical devices, which could then be fed back to industry. They may also spot problems that no one has thought to address before and develop their own solutions.

They may even be able to apply their problem-solving skills to the administration of the hospital. A fresh pair of eyes and a different way of thinking can sometimes elicit simple solutions that no one immersed in the existing culture of an organisation would have considered.

Readers' comments (18)

  • yes I would agree as a person in such a role at present would use common sence and problem solving as trained by toyota managment system .
    it works very well in major industry so will be good for the NHS.

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  • Excellent idea! Engineers can generally understand cause & effect. For example, if GPs become overpaid & hard to contact, then patients (now called 'customers'!), will go to A & E departments instead. This may not be rocket science but it appears beyond the understanding of current NHS chiefs.

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  • From what I've heard, the NHS has a problem adapting and modernising. The reason that I've heard quoted is that it's impossible to find anyone that can make a final decision and one often gets passed around in a circle when trying to find a decision maker.

    In other words it's big and indecisive.

    It's also difficult to introduce any new thing because of the number of other things that depend on what's happening right now that would also need to be changed.

    It also collects a lot of data on forms and paper and uses up a lot of manpower to computerise it afterwards when it's out of date. Errors creep in such as billing records relating to pregnant men and so on.

    The other criticism I heard is that every consultation is expensive and lots of people come in with trivial complaints that eat up money. There is not really any self-interest in being economical for users of the system.

    I think it could therefore do with quite radical *social* engineering. I don't know about Engineers but in software all these kinds of issues arise and there are some precedents - mostly with some new company slurping up the market share of the big old inflexible one. Except that can't happen here - here the problems can last as long as the country can keep paying.

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  • Of course they need more technicians to fix the issues cited, but they also need a leader, to whom they can refer to where standard procedures don't fit.

    The right engineer would have stopped them getting into this mess. We all complain about "Bean Counters" driving false economies, but engineers can build an objective case, showing the whole picture, including the costs that the "Bean Counters" haven't seen to provide better value for money.

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  • Triage at A&E improved when they looked at/learnt from/ copied the most efficient multi-system/personnel operation in man's estate: Formula I pit stops: I believe aircraft turn-rounds were improved by a similar comparison. Getting a few of Nevil Shute's "Engineers doing for 10p what any fool can do for £1" would help the NHS like every other group of sham professionals.

    But the greatest barrier to any internally developed change is as always, those whose livelihoods -the bean counters themselves- will be degraded by change -even if the very numbers they have generated and assessed scream out for it!

    "Of all baggage, mankind is the most difficult to transport (A Smith?) and clerks in particular have never voted, like turkeys do not, for an early Xmas?

    More Admirals that ships, more generals than tanks, more Air Vice Marshals than planes, and certainly more bean-counters telling medical staff how to 'manage' than are there to actually try to cure. Oh I forgot, some 10% of the NHS budget is now spent on litigation.

    The economics of the mad-house -reserve my space in the funny farm please. That is unless the bean-counters have closed it?
    Mike B

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  • Some years ago I turned down the position of Chief Engineer at one of our most prestigeous hospitals. Fully qualified and experenced in management and medically related equipment I was made to beleive that I would be totally subsurvient to the Hospital Secretary and Medical Board, a simple admin question prior to appointment was dismissed as "we can sort all of that out afterwards"
    Needless to say I declined the offer.

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  • I would have imagined that the NHS must have qualified business managers that have studied system design. Everything that functions has a system, where its a computer chip, hospital or restaurant, and they have to be organised on a logical basis. Of course commercial and political interests can twist the process, and maybe like politics, a country without a good civil service suffers. Engineers could develop a well-oiled NHS system, but would those in charge allow it?

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  • Soon after I completed my architectural studies in 1967 I started work as a junior architect at the NHS' Elephant and Castle HQ in London. I was made responsible for a small part of a programme to standardise health building components - in my case sanitary ware and doors. Full of zeal in my first job I did my best to apply principles now known in industry as value engineering. That work led me to conclude - with QS input - that there was a strong case for the NHS in its new hospitals to use the then unique Electrolux vacuum toilet/waste water system. Although its use could have radically simplified hospital floor layouts and cut typical build cost by millions the findings were ignored. I then focused on improving the grossly over specified standard door specification and had made and then demonstrated a set of 6 prototype doors which (including ironmongery) in production would have cost an average 32% cheaper less than the ones then being use throughout the UK. My door study findings and the prototypes were ignored. I was then moved to work on the final development stages of the Kings Fund standard hospital bed. The first thing that struck me about its design was its complexity and production cost, which was expected to be about the same as a new Austin Mini! I was then given permission by the department's Chief Architect to produce an alternative design, provided the work was carried out in my own time! I persuaded a couple of NHS M&E engineers who worked in the same building to help me with the design of the bed's technical details. After seven months of design and component testing a crude prototype was built which was inspected and approved for further development by NHS HQ medical staff. Production versions where expected to cost roughly half the Kings Fund version. To receive final approval the prototype needed to be shown to the three senior nursing officers (three retired matrons known in the Ministry as "the three dragons"). Part of the prototype concept involved designing a way to make bed making much quicker than usual by making the operation semi-automatic and only requiring one nurse's input. After their inspection the ”three dragons’ blocked further development of the bed on the grounds that "Its widespread use would be bad for nurse discipline." Shortly after receiving that blow I decided the NHS’ attitude to cost-effective design was very different to mine and resigned. After all this time things in the NHS should have improved, but after a recent spell in my newish local hospital to have a tumour removed I was forced to conclude that they haven’t.

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  • After several decades of working with the medical community I wish to warn aspiring engineers to be careful - medical people are terrible scientists and usually have virtually no science in their background. They also do not like to be told that they do not understand something that you know is important. You will have to learn how to tell good stories that intrigue them so that they can change their point of view and understanding without their wounded egos preventing them from taking good advice. Also, the management structure of most hospitals, worldwide, is set up to protect the organization, not the clients. Getting around that reality will also require a good technique. Engineers helping make better decisions is a great idea, but you may have to learn new skills if you are not to be demonized and/or ignored. Good luck and hopefully you will be able to tell great stories that makes the choice of the correct actions a fait-accompli. Also, they do not understand that humans have one or more control systems for every function and do not understand most measurement systems and any associated control functions. Be prepared for blank looks and hurt feelings!

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  • Get in touch with Hethel Engineering Centre (adjacent to Lotus Cars in Norfolk). They applied some engineering best practices at Norwich and Norfolk Hospital in Norwich.

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