Philippa Graves

Funding is a constant challenge for imaging departments, and equipment needs can sometimes get lost or forgotten on the road to achieving targets in health systems. We may find ourselves left with an aging equipment portfolio in an ever-changing technological marketplace, amid growing public demand for timely diagnostic studies.

Equipment is expensive to buy, run, and maintain-yet when it comes to bidding time, hospital funds may be limited. In the face of these challenges, some basic principles can help radiology departments succeed in getting sign-off for replacement equipment:

- Think finance. It is important to gain an understanding of who holds the purse strings at your hospital. Typically, it is not the chief executive who makes the decision alone, but also the finance director who manages all the money and can support or veto equipment purchases. Therefore, you should aim to speak regularly to your finance director and to invite him or her to spend a day in your department to gain a clear understanding of your needs. Prior to the meeting, try having the finance director sit in the waiting room with all of the patients to underscore issues with waiting times and to provide a user's perspective of department facilities.

- Tabulate the risk. If you present the status of your equipment in a clear, complete table format, no one can claim that they did not know that

your machines were out of date. Seek guidelines on advised equipment age limits from professional sources, such as the U.K. Royal College of Radiologists, and show how some of your equipment is too old, based on these standards. Present a detailed and complete picture of your equipment portfolio, including date of installation and number of years beyond recommended guidelines, at every opportunity, including high-profile hospital administrative meetings. Some equipment is perfectly functional even though it is old, but if it is not, make sure you carry out proper radiation risk assessments.

- Be prepared. Ensure that you are made aware of hospital developments that will affect radiology services and equipment demands. If a hospital adds a dermatologist, for example, the impact will be slight. But the recruitment of a new orthopedic doctor will result in considerable additional study workload. Make the link between new staff and your budget, using the Addenbrookes formula, a method of calculation developed by the Royal College of Radiologists, or with your own formula. One such analysis showed that the recruitment of an orthopedic physician equated to 2889 new studies per year and British Sterling 176,599 (about Euro 256,000) in new revenue.

- Be precise. Be honest and accurate when assessing costs associated with new acquisitions-underestimating them could present major problems for the department down the line. Consider pre-paying for expected upgrades.

- Have a clear vision. Your vision for radiology department development must be crystal-clear and backed up by a strong business case. Make sure you have considered alternatives to purchases and demonstrate that you have already made the department as efficient as possible, using existing resources.

- Spread the word. Once you have a vision, share it with everyone at your hospital. Organize an "open day" for staff, local visitors, and politicians to capitalize on your past successes and stress your vision for development in the future. Maintain good communication with clinical departments and cooperate on equipment bids where possible. Joint bids will be given higher priority. Touch base with patient groups and encourage patients to fill out comment cards when they are dissatisfied, as well as satisfied.

- Organize official visits. Visits from government health bodies may also present opportunities for you to make your needs known. At one hospital, government representatives made a general hospital visit under the banner headline of "patient dignity." Visitors were called into the radiology department, where patients could be seen walking around with gowns flapping open, a move that emphasized the need for changing rooms.

- Ingenuity counts. Your means of communicating needs may be as important as the substance of your argument. In one case, a piece of equipment was continually shutting down and required a manual reset that could have presented health and safety problems for staff. In addition to the risk assessment, we emphasized the risk to staff from repeatedly having to manually reset the equipment. We ensured that we had the support of the hospital physicist, who denounced the equipment.

- Always be planning. You never know when occasional windfalls will become available. Be prepared with a business case to take advantage of last-minute bids.

MS. GRAVES is general manager for radiology and pathology at East and North Hertfordshire NHS Trust, U.K. This column was adapted from her presentation at the British Institute of Radiology meeting, "Current Issues in Radiology Practice," held in London on 9 September 2004.

Philippa Graves

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How to make the case for new equipment