Can we EquiShare?: Equipment sharing rules in a Government hospital.

‘EquiShare”: Equipment sharing rules.

First things first: there are no rules and that’s why I am writing this. Second, not for a moment am I even pretending to suggest rules, rather, these are just thoughts on how best we can evolve a protocol of interdepartmental sharing of equipments based on a combination sound logic and pragmatism.

Logic base:

1.       Equipments in Government hospitals are bought with public money, and are not excusive property of a small number of individuals. It belongs to the patients who need it. ‘We’ just manage the life cycle of the equipment.

2.       More the number of users and larger the total duration of use, greater are the chances of malfunction and damage.

3.       Sub optimal utilization of costly equipment is often a hidden waste of money.

Obviously, there is apparent conflict between statements 2 and 3. (Damned if you share and damned if you don’t kind of paradox).  Since all equipments are bought with guarantees and pricy annual maintenance contracts, it is best to maximally use equipments as soon as it is installed. Optimal use is best assessed based on hours of active service rather than just the duration of potential availability of the device.

Time eats away everything:

Not being totally philosophical, but also taking natural entropy of chemical corrosion, out dating of technology and expiry of warranty contracts into consideration, the biggest error we tend to make is to securely keep equipment from its expected use. This probably stems from our desire to protect, preserve and perhaps hoard the valuable. Unfortunately, ultimately everything falls into disuse or decrepitude at the hands of time. (Same thing applies to virginity, cobalt-60 and cash under the pillow!)

So let’s just shift tactics and share stuff.

Divide and share!

I suggest that costly equipments be classified into three categories by the department which is managing its life cycle. (I am deliberately avoiding using phrases like “department which purchased it” to free ourselves from misplaced and over enthusiastic sense of possession that comes with the pain of chasing a purchase in a government set up)

Type A:

Equipment that is vital to every day functioning of the department’s clinical or research activity and for which there is neither standby nor spare. The clinical activity or procedure cannot be done without the use of this equipment

Type B:

Equipment that is vital to everyday functioning of the department‘s clinical or research activity and for which there is a standby or spare available. The procedure cannot be done without this equipment.

Type C:

Equipment that is only occasionally used OR something which is desirable for a clinical procedure but the procedure can also be done without it.

Sharing ‘rules’ may be as follows:

Equipment type	Cost	Share it?
Type A	Less than ten lakhs	No! Do not share.(except in an emergency)
Type A	More than ten lakhs to thirty lakhs	Yes, share it, but, at the discretion of the department managing it. Lean on sharing rather than denying.
Type A	More than thirty lakhs	Yes.
Type B	Any cost	Yes.
Type C	Any cost	Yes.

Note:

·         Departments may share stuff in a non-reciprocal manner too: Even if Department ‘X’ does not share equipment with Department ‘Y’, Department ‘Y’ can take a decision to keep sharing its resources with other departments including ‘X’, keeping in mind that it is patient’s need that is a priority rather than tit for tat games. (Although this is a violation of game theory, is it not!?).

·         ‘Discretion of the department’ means that the decision was arrived at a departmental meeting factoring in majority view of all individual consultants/users  involved rather than a single individual’s idiosyncrasy or apparent wisdom)

·         Costs mentioned are of course just my sense of value and considering speediness of various tender processes. You could think of a better way. I thought anything above thirty lakhs is just too costly to be lying underutilized. It has to be time shared by all valid users as a rule. Anything below ten lakhs can be acquired by any department fairly easily and is not worth taking a risk sharing if it shuts your own shop down

·         There may be other factors like high risk of damage on physical shifting of some heavy stuff to another building/level. But again, lean on the concept of sharing than denying, if reasonable efforts can be taken to avoid damage.

I would even take the liberty to suggest that departments be encouraged to give a monthly report of   costly equipments it successfully shared with others (and for what duration and purpose, and what it chose not to share, and why) to instill a sense of positive cooperation. Responsible and maximal use of resources is in every one’s interest. What do you say? Can we Equishare?

Regards,

MS Gopalakrishnan

Neurosurgery.