Clinical Engineering Benchmarking

This article is on Benchmarking - and Clinical Engineering and it will review two Benchmarking processes and present some conclusion. The article will be in three parts i.e. Clinical Engineering Benchmarking, National Benchmarking and Conclusions.

The following is a definition of Benchmarking:

"Benchmarking is a process where by like groups or professions who carry out similar roles and have similar responsibilities are compared and an optimum level is agreed for what ever area the Benchmarking process is covering".

The key to the success or failure of benchmarking is the level of accuracy of the information and participation of the Benchmarking participants. For e.g. a participation level when answering questions contained in the questionnaires on benchmarking the clinical engineering profession, of approximately 80 to 90% was achieved.

Benchmarking is not the final result, put the starting point i.e. when the Benchmarking process is complete the work of implementing the results begins.

With regard to Clinical Engineering Benchmarking lengthy discussions took place within the Clinical Engineering Profession in an attempt to find a consensus as to what would be the best method to adopt when setting up a Benchmarking process. The conclusion to these discussions was that a series of one-day workshops should be held.

As outlined in the definition, the objective was to allow for the maximum participation by those Professionals who deliver the Clinical Engineering Services to the Public and also ensure that those participating felt free to answer accurately any questions raised.

These objectives were achieved by having substantial promotion of the process. A series of questionnaires were distributed on the day, these questionnaires were designed so as they could not be traced back to any of the participants, thus they remained anonymous and ensured confidentiality. The first series of questionnaires were designed to establish macro benchmarking for the profession i.e. fundamental norms associated with the profession. These questionnaires are similar in content to the PSBB questionnaires.

The Biomedical Engineering Association of Ireland facilitated the Benchmarking Day in conjunction with the Institution of Engineers of Ireland.

The Benchmarking Day was hosted by St. Vincent's University Hospital, which is a member of the MATHs group or major academic teaching hospitals in Ireland.

The introduction was given by the CEO of St. Vincent's University Hospital, who put his support for the initiative on record.

There are approximately 40 hospitals in Ireland with in house Clinical Engineering services. On the day 36 Hospitals were represented from both the public and private sectors.

The benchmarking day was broken into two sessions. A morning session and an afternoon session

The morning session consisted of three speakers.

The afternoon was dedicated to a workshop breakout

For this Workshop Breakout session the participants broke into three groups, each Group had a Chair appointed. Seven questionnaires were distributed, and it was the Chairs responsibility to answer any queries, and ensure the questionnaires were completed and returned. This was a key function in achieving the aim of the day and it was successfully completed.

The areas in which questions were asked were as follows:

• Roles and Responsibilities
• Asset Database
• Recruitment, Training, Education & Research
• Safety, Test & Calibration
• Documentation
• Equipment Commissioning and Decommissioning
• Equipment Management

There were a total of 3,800 questions answered and these results have been analysed. A sample of these results are given below:

• Is CPD encouraged in your Department? 90% answered Yes
• Is your Department Responsible for incident investigating/reporting? 90% sometimes
• Type of Database? 100% Electronic
• Do you feel that management skills would be an advantage? 90% answered Yes
• What is the most important knowledge/attribute/skill that you have that benefits you in your job? 60% answered interpersonal Skills
• Do you provide training to Clinical Staff? 90% answered yes

After reviewing this small sample, it is worth noting that Clinical Engineering scores high in these important areas, such as Training ,CPD Incident reporting etc.

The background to the formation of the National Benchmarking process is as follows:

During the 1980's there was a period of industrial unrest in Ireland with a huge loss in work hours due to strikes. As the Irish Economy was in difficulties the employers both public and private and the Unions decided that this had to be addressed, otherwise the economy would collapse.

For the past decade there has been a partnership process in existence between the employers and employees, it entails agreed pay rises, conditions of employment and social development in return for a strike free environment.

This decade of partnership processes has involved four agreements, three of which have been completed and we are now half way through the fourth. The life span of each agreement is approximately four years.

The current agreement is the Programme for Prosperity and Fairness (PPF) which is a unique initiative between the employers and employees. National Benchmarking is Government and Union driven, they represent the Public sector employer and Public sector employees respectively. There is also participation from the private sector.

The public sector benchmarking has been requested by the public service employees who felt that their pay and conditions had a falling below that of their private sector colleagues.

Benchmarking Body

• Chair - High Court Judge
• Member - Public sector Trade Union X 2
• Member - Employer Nominee X 2
• Member - Independent Nominee X 2
• Fulltime Secretariat

Benchmarking Time Scale

• March 2001. - Initial written submissions to be made
• April 2001. - Mutual Comments on employers and trade unions

Submissions to be made

• May 2001. - Benchmarking body start research
• Sept 2001. - Research Completed and circulated to unions and

Employers

• Oct 2001. - Second written submissions and oral hearing complete
• Dec 2001. - Second written submissions and oral hearing complete
• June 2002. - Benchmarking body to report

The benchmarking process will compare private sector pay with that of the public sector. It will compare individual grades with comparable private sector grades on areas, conditions, skills, roles and responsibilities. No supply compare similar jobs.

The "Benchmarking Body" is an integral part of the PPF and is a full time independent group made up of senior officials from Government and the Trade Union movement.

They operate under the independent chairmanship of a High Court Judge and will oversee all research and submissions made by relevant parties in relation to benchmarking activities. This body will benchmark the public sector grades with that of comparable grades in the private sector and will make its report in June 2002.

In order to allow the process takes place within the specified time scale, an agreed sample of grades will be Benchmarked and these grades will form an "A" first. The rest of the grades will go on to a "B" list and these grades will be aligned to one agreed grade on the "A" list.

Clinical Engineers are included in the B list and are aligned with Medical Laboratory Technicians soon to be Medical Scientists. Whatever increase the Medical Scientists may get then Clinical Engineering Technicians will get an increase.

The Public Service Benchmarking Body are using one questionnaire for all grades been Benchmarked.

The questionnaire includes question on general information such as:

• Name
• Job Title
• Job Purpose
• Key Tasks

The main headings under which all Groups of grades will be benchmarked are:

• Knowledge and Skills
• Judgement
• Leadership/Teamwork
• Accountability and Responsibility
• Interpersonal/Communication skills
• Physical Demands & Co-ordination
• Conditions & Emotional Demands

Bach up information can also be supplied in the following areas:

• Examples
• Job Description
• Other relevant information

The questionnaire is of a tick box design and those completing the questionnaire can only tick one box per heading.

A sample of the questionnaire for Education qualifications is shown below:

• No formal qualifications
• Junior Certificate
• Leaving Certificate
• National Certificate, Diploma, Apprenticeship
• Bachelors degree or equivalent Professional qualification
• Bachelors degree plus Practising Certificate
• Masters degree
• Doctorate or Higher

When we compare the sample of answers given in the Clinical Engineering professional benchmarking questionnaire, with the questions been asked in the PSSB questionnaire, Clinical Engineering scores high in most areas with the exception of Education and formal training.

With regard to the PSB questionnaire

If we look at the education heading and compare the levels of qualifications, going from low to high, to the levels used under the other heading and where clinical engineering would score, it would appear that Clinical Engineering in its current position is performing work which is normally carried out by a degree based grade.

There are no guarantees as to the outcome. It is expected that its will have a positive effect on many of the grades.

It is hoped that this will go some way towards alleviating the problem of recruiting and retention with regard to the public service.

There have been rapid changes in many areas of industry and these have lead to significantly greater increases in pay and conditions of some grades in the private sector over that of comparable grades in the public sector. This can to some degree is attributed to National agreements over the past decade where public sector pay awards were fixed while the private sector were not.

It had been hoped that there would be substantial pay rises for most of the public service grades, as many are not on parity with their private sector colleagues.

It is now quite likely that the pay increase will be much less given the current economic situation. However we have been linked to the Medical Scientist grade and it the advice received from IMPACT that this linkage can be of significant benefit to Clinical Engineering in its move to modernisation and that this is the area we have most to gain.

One option for Clinical Engineering is to stay as a Technical Grade. However for the purpose of PSB we have been aligned with the Medical Scientist who are Degree based not with Certificate Diploma and Apprenticeship based grades who are considered to be technical based grades. This has been done by IMPACT on the understanding that Clinical Engineering is in the process of moving to a degree-based structure and profesionalisation

Should we decide to stay as technical grade then for the future Clinical Engineering will not be aligned with the Medical Scientists grades.

Indeed there is now no technician based grade left in the paramedical grouping of which we were a part as they have all moved to degree based grades. If we stay a technician based grade then we will also not be grouped with the paramedical grades.

We are a relatively small group within the health service and have always been grouped with a larger group. In the past this group was the Medical Laboratory Technicians now the Medical Scientists or on some occasions with the Paramedical Group as a whole.

As we are a small group we will always be included with a larger group when it comes to negotiating pay and conditions.

The PSBB, which is a high powered Group of experts from both the employers and the employees, have grouped the Technical and Apprenticeship grades together and this is an indication of our future alignment if we stay a Technician based grade.

When it comes to pay and conditions this alignment will have a negative effect and will have a serious negative outcome for Clinical Engineering in the long-term.

During the Clinical Engineering Benchmarking day, 100% of the participants stated they were involved in clinical training. This is an area, which is growing and will become a significant part of the Clinical Engineers function. Clinical training may not be appropriate if we stay as a technical grade and this will lead to a lowering of our position within the Health Service and a slowing of the development of Clinical Engineering within our Group.

The benefit of remaining a Technical based structure is that we, as a Group, will have to do nothing but ignore the advice been given by all concerned.

The other option is to put a Professional structure in place, which is Degree based.

IMPACT who deal with our pay and conditions of employment have advised us that if we wish to hold our place within the paramedical grades then we must go to a degree based grade

The HSEA who have reviewed a document submitted by the CEPVG outlining our roles and responsibilities now agree our role and responsibilities as outlined in the document are probably not technical based but are more in line with those of a degree based grade

The CEPVG executive has been strongly advised by IMPACT, HSEA and the IEI that this is our best and perhaps only option. This advice is in keeping with what all our Colleagues have done in practice i.e. they have all gone to Degree based structures.

The benefits are that we will hold our position with the Health Service and develop into areas such as clinical training. This will be a significant area for Clinical Engineering in the future.

If we choose to go to a degree based structure the long-term outcome will be that Clinical Engineering will be able to develop and thereby enhance the jobs and careers of those involved.

The Executive of the Clinical Engineering Professional Vocational has indicated to the HSEA and IMPACT that they agree with their advice and the advice of others to move to a Degree based structure.

The members of the Clinical Engineering Professional Vocational group voted unanimously to have the IEI in conjunction with the BEAI represent them on professional issues. The IEI have agreed to take on this role and a work group within the IEI is currently working towards this goal. It is now time for the remainder of our members to join the IEI in keeping with both.

The unanimous vote to have the IEI represent us and to acknowledge the commitment shown by the IEI to Clinical Engineering. I urge those Clinical Engineers who are here to join the IEI and also to encourage your colleagues to do likewise.

Clinical Engineering as a degree based profession has a bright future in Ireland and will develop at an even greater pace in the decade to come than it has in the past decade.

The overall aim of this initiative is to enable Clinical Engineering to take its place in the Irish Health Service and develop in keeping with its related professionals in the paramedical group.

This development will allow Clinical Engineering, continue to meet the demands of the service and there by play its part in providing a better health service to the patient and the public.

John Mahady