Over the past few decades, healthcare equipment has experienced an exponential increase in diversity, variety (from 5,000 to over 10,000 different types) and complexity. The use of medical devices for the supply of health services has grown enormously, enough to appear in various activities such as prevention, screening, diagnosis, therapy and even rehabilitation. The IX National Conference on Medical Devices declares that technologies have reached so such importance that they can be considered an essential part of the performance itself. Having this great responsibility, it is essential to constantly check their safety and functionality through maintenance activities during their entire life period. This maintenance can be divided into two main categories: preventive maintenance (or scheduled maintenance) and corrective maintenance (or unscheduled maintenance). The maintenance activity of electro-medical devices is evolving from a concept of mere operation, intended as the restoration of equipment with failures, towards a real managerial function - l’ Health Technology Management - aimed at reducing the risks associated with the use of medical devices, at the date of inactivity, to prevent breakdowns and to guarantee the quality of the services provided. From an organizational point of view, it is the Clinical Engineering Service that guarantees efficient and correct management of the electromedical equipment present in the healthcare facility. From an economic point of view, private companies as well as public entities, such as hospitals, are pushed by the scarcity of resources to focus more on their core-business, the primary area of interest of a company, delegating and commissioning auxiliary and support services. Cost reduction, specialization, innovation and flexibility become essential objectives. In this scenario, collaborations with private structures are becoming increasingly important, thus increasing the outsourcing of all those activities considered non-core, as well as necessary for the functioning of the primary ones. In the hospital environment, and specifically in the management of electromedical equipment, their maintenance is outsourced to highly specialized companies, called Global Service. This is the case of the ASST of Vimercate which, since 2015, has chosen to rely on a Global Service to manage its fleet. This thesis work is placed here, and it is made possible thanks to the collaboration with the actors directly involved in the management process of electromedical equipment, in the context of a six-month curricular internship. Initially it was necessary to uniquely define the medical device, its life cycle and, in detail, the maintenance that is necessary to ensure its safe use. Then, through an analysis of the literature, all those services and activities for which it is worth collaborating with private companies were highlighted. Then, going into the specifics of hospital structures, an adaptation of Lovelock's model was presented. Subsequently, the main drivers, the activities managed by third parties, the advantages, and disadvantages of outsourcing in the healthcare system of Germany, the United Kingdom, Australia and New Zealand, the United States and Greece were presented. This has certainly shown that the principles of business outsourcing reside in reducing costs and improving the quality of services. Then, the different types of decision-making models of outsourcing were described, as well as the traditional non-integrated single service, the single service in Facility Management, the multi-service in Facility Management and, finally, the Global Service. Going into the details of the integrated services for the management of electromedical equipment of the ASST of Vimercate is the goal of the work. The workflow, from a managerial and non-technical point of view, through the facilities are maintained by the current Global Service manager was meticulously analyzed, starting with testing, passing through corrective and preventive maintenance, ending with decommissioning.
Nel corso degli ultimi decenni le apparecchiature sanitarie hanno subito un aumento esponenziale in termini di diversità, varietà (da 5.000 a oltre 10.000 tipi diversi) e complessità. L’enorme crescita dell’uso dei dispositivi medici per la fornitura di servizi sanitari ha fatto sì che questi ultimi facessero la loro comparsa in svariate attività quali la prevenzione, lo screeening, la diagnosi, la terapia e anche la riabilitazione. La IX Conferenza Nazionale sui Dispositivi Medici dichiara addirittura che le tecnologie hanno raggiunto un’importanza tale da poter essere considerate parte imprescindibile della prestazione stessa. Data la grande responsabilità implicata, risulta fondamentale verificarne costantemente la sicurezza e la funzionalità tramite attività di manutenzione durante il loro intero periodo di vita. Tale manutenzione si può suddividere in due macrocategorie, quali manutenzione preventiva (o manutenzione programmata) e manutenzione correttiva (o manutenzione non programmata). L’attività di manutenzione degli elettromedicali sta evolvendo da una concezione di pura operatività, intesa come il ripristino delle apparecchiature con avarie, verso una vera e propria funzione manageriale – l’Health Technology Management - volta alla riduzione dei rischi connessi all’uso dei dispositivi medici, alla diminuzione dei tempi di inutilizzo, alla prevenzione dei guasti ed alla garanzia della qualità delle prestazioni erogate. Dal punto di vista organizzativo, è il Servizio di Ingegneria Clinica a garantire un’efficiente e corretta gestione delle apparecchiature elettromedicali presenti nella struttura sanitaria. Sul versante economico, le imprese private tanto quanto i soggetti pubblici, quali gli ospedali, sono spinte dalla scarsità di risorse a concentrarsi maggiormente sul proprio core-business, l'area di interesse primario di un'azienda, delegando e commissionando i servizi ausiliari e di supporto. Riduzione dei costi, specializzazione, innovazione e flessibilità diventano obiettivi imprescindibili. In questo scenario acquisiscono sempre maggiore rilevanza le collaborazioni con strutture private, con l’aumento conseguente dell’outsourcing di tutte quelle attività considerate non-core, nonché necessarie al funzionamento di quelle primarie. Nell’ambito ospedaliero, e nello specifico in quello di gestione delle apparecchiature elettromedicali, viene esternalizzata la manutenzione di esse ad aziende altamente specializzate, chiamate Global Service. Questo è il caso dell’ASST di Vimercate che, dal 2015, ha scelto di appoggiarsi ad un Global Service per gestire il suo parco macchine. Qui si colloca il presente elaborato di tesi, reso possibile grazie alla collaborazione con gli attori direttamente coinvolti nel processo di gestione delle apparecchiature elettromedicali, nel contesto di un tirocinio curricolare semestrale. Inizialmente è stato necessario definire univocamente il dispositivo medico, il relativo ciclo di vita e, nel dettaglio, le manutenzioni che si rivelano necessarie per assicurarne un uso sicuro. Dopodiché, tramite un’analisi della letteratura, sono stati messi in evidenza tutti quei servizi ed attività per cui vale la pena collaborare con aziende private. Quindi, entrando nello specifico delle strutture ospedaliere, è stato presentato un adattamento del modello di Lovelock. Successivamente, sono stati presentati i principali drivers, le attività gestite da terzi, i vantaggi e gli svantaggi dell’outsourcing nel sistema sanitario di Germania, Regno Unito, Australia e Nuova Zelanda, Stati Uniti e Grecia. Questo ha sicuramente dimostrato che i principi dell’outsourcing di attività risiedono nella riduzione dei costi e nel miglioramento della qualità dei servizi. Quindi, sono stati descritti i diversi tipi di modelli decisionali dell’outsourcing, nonché il mono servizio tradizionale non integrato, il mono servizio in Facility Management, il multiservizio in Facility Management e, infine, il Global Service. Entrare nel dettaglio dei servizi integrati per la gestione delle apparecchiature elettromedicali dell’ASST di Vimercate è l’obiettivo del lavoro, con la speranza di trasmettere l’immensa complessità che governa il corretto funzionamento di un ospedale. È stato analizzato minuziosamente il workflow dal punto di vista manageriale - e non tecnico - con cui il parco macchine è manutenuto dall’attuale gestore Global Service, a partire dal collaudo, passando per le manutenzioni correttive e preventive, concludendo con la dismissione.
Servizi integrati per la gestione delle apparecchiature elettromedicali : il modello dell'ASST di Vimercate
Morotti, Anna
2019/2020
Abstract
Over the past few decades, healthcare equipment has experienced an exponential increase in diversity, variety (from 5,000 to over 10,000 different types) and complexity. The use of medical devices for the supply of health services has grown enormously, enough to appear in various activities such as prevention, screening, diagnosis, therapy and even rehabilitation. The IX National Conference on Medical Devices declares that technologies have reached so such importance that they can be considered an essential part of the performance itself. Having this great responsibility, it is essential to constantly check their safety and functionality through maintenance activities during their entire life period. This maintenance can be divided into two main categories: preventive maintenance (or scheduled maintenance) and corrective maintenance (or unscheduled maintenance). The maintenance activity of electro-medical devices is evolving from a concept of mere operation, intended as the restoration of equipment with failures, towards a real managerial function - l’ Health Technology Management - aimed at reducing the risks associated with the use of medical devices, at the date of inactivity, to prevent breakdowns and to guarantee the quality of the services provided. From an organizational point of view, it is the Clinical Engineering Service that guarantees efficient and correct management of the electromedical equipment present in the healthcare facility. From an economic point of view, private companies as well as public entities, such as hospitals, are pushed by the scarcity of resources to focus more on their core-business, the primary area of interest of a company, delegating and commissioning auxiliary and support services. Cost reduction, specialization, innovation and flexibility become essential objectives. In this scenario, collaborations with private structures are becoming increasingly important, thus increasing the outsourcing of all those activities considered non-core, as well as necessary for the functioning of the primary ones. In the hospital environment, and specifically in the management of electromedical equipment, their maintenance is outsourced to highly specialized companies, called Global Service. This is the case of the ASST of Vimercate which, since 2015, has chosen to rely on a Global Service to manage its fleet. This thesis work is placed here, and it is made possible thanks to the collaboration with the actors directly involved in the management process of electromedical equipment, in the context of a six-month curricular internship. Initially it was necessary to uniquely define the medical device, its life cycle and, in detail, the maintenance that is necessary to ensure its safe use. Then, through an analysis of the literature, all those services and activities for which it is worth collaborating with private companies were highlighted. Then, going into the specifics of hospital structures, an adaptation of Lovelock's model was presented. Subsequently, the main drivers, the activities managed by third parties, the advantages, and disadvantages of outsourcing in the healthcare system of Germany, the United Kingdom, Australia and New Zealand, the United States and Greece were presented. This has certainly shown that the principles of business outsourcing reside in reducing costs and improving the quality of services. Then, the different types of decision-making models of outsourcing were described, as well as the traditional non-integrated single service, the single service in Facility Management, the multi-service in Facility Management and, finally, the Global Service. Going into the details of the integrated services for the management of electromedical equipment of the ASST of Vimercate is the goal of the work. The workflow, from a managerial and non-technical point of view, through the facilities are maintained by the current Global Service manager was meticulously analyzed, starting with testing, passing through corrective and preventive maintenance, ending with decommissioning.| File | Dimensione | Formato | |
|---|---|---|---|
|
TESI_ANNA MOROTTI.pdf
Open Access dal 19/11/2021
Dimensione
2.55 MB
Formato
Adobe PDF
|
2.55 MB | Adobe PDF | Visualizza/Apri |
I documenti in POLITesi sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/10589/175117