How many experts does it take to repair an X-ray machine? No, this isn't the setup for a bad healthcare technology management (HTM) joke. For the experts at Banner Health, this question begged an answer more often than they'd have liked.
Consisting of more than two dozen hospitals and specialized facilities, Banner Health is the largest healthcare system in Arizona. Like many organizations of its size, the healthcare system turns to third-party contractors to help with the servicing and repairs of its countless medical devices. As a result of workforce shortages both internally and externally, diagnostic imaging devices have proven particularly troublesome. However, that's starting to change. In a remarkably short time span, Banner Health has managed to create an in-house imaging services apprenticeship, allowing for greater flexibility and self-sufficiency.
Jon Elmore, site-based director of Technology Management/ENTECH at Banner Health, said that he first heard about a workforce shortage for imaging device repairs back in early 2019 during a monthly meeting of leadership.
“It's beyond just a huddle of team leaders,” Elmore explained. “We commit more than half a day to share information. We explore lots of different subjects, but during this particular meeting, our imaging team leadership had everyone's attention.”
The team raised concerns that as the number of diagnostic imaging devices at Banner Health was increasing, the number of experts available to repair and maintain these devices remained the same. The assembled leaders were aware that Banner Health has a supply of more than 411,000 medical devices on hand, which leads to more than 320,000 work requests annually—and that number is always rising.
If the deficit was growing between specific devices demanding repairs and the number of technicians qualified to get the job done, Banner Health needed to bolster its technician numbers.
“And we needed to do it yesterday,” added Perry Kirwan, vice president of technology management at Banner Health. “Trying to fill even existing vacancies within the imaging team due to retirements was taking too long. It's not a field in our profession that you can pluck somebody off the side of the street and ask, ‘Hey, would you like to be an imaging engineer?'”
Headquartered in Phoenix, AZ, with facilities in Colorado, Wyoming, Nebraska, Nevada, and California
Healthcare system with 30 hospitals and numerous specialized facilities
Approximately 250 employees on the Banner Health Technology Management/ENTECH team
To help with that growing workload, imaging teams across Banner hospitals were relying on technicians from a device's original equipment manufacturer (OEM) to tackle complex or time-consuming repairs. However, repair times were exacerbated by limited technician availability even on the OEM's side. Remedying Banner Health's dilemma with additional OEM assistance, therefore, was not practical given the growing demands of a modern healthcare system.
This, of course, begs a key question: Where have all the diagnostics imaging technicians gone? Kirwan suspects the educational avenues and resources that were available for training the specialty have simply disappeared.
“In Arizona in particular, we have seen relevant schools basically dry up and go away,” he said. “I couldn't name you a single program or school anymore that develops imaging techs in the entire state.”
It's a common problem that extends beyond the specific skills needed for diagnostic imaging device repair. The Bureau of Labor Statistics projected that nearly 3,000 new “medical equipment repairer” positions will be created by 2029, with an above-average growth rate of 5% for the field.1 What's worrying managers is that nearly half of the current clinical engineering workforce is older than 50 years of age. As this group retires, and the number of senior professionals available to coach new hires dwindles, the demand for new hires will only increase.
To address these concerns, AAMI rolled out the Certified Associate in Biomedical Technology (CABT)—an entry level certification test for professionals considering or just starting a career in HTM.2 The goal of the new certification is to help prospective HTM professionals make themselves known to employers while simultaneously helping employers discover new talent outside of traditional training programs.”
“AAMI is working hard not only to provide a solution for this anticipated deficit of HTM professionals but also to help promising professionals start their HTM careers right,” said M.J. McLaughlin, director of education programming at AAMI.
However, although this is a powerful resource for filling entry-level positions, training new hires into more specialized positions takes time.
“We're seeing a shrinking pipeline for training people directly into the roles we need covered, so we decided to train them ourselves,” said Kirwan. “Soon after that leadership meeting, we really started to explore what it would take to launch an in-house imaging apprenticeship.”
“Trying to fill even existing vacancies within the imaging team due to retirements was taking too long. It's not a field in our profession that you can pluck somebody off the side of the street and ask, ‘Hey, would you like to be an imaging engineer?'”
—Perry Kirwan, vice president of technology management at Banner Health
“Of course, we didn't just hand the problem back to the imaging leaders and say, ‘Go build a program,'” Kirwan added. “It takes a village, right?”
Banner Health has more than 50,000 employees across six states. Instead of limiting who could help design their apprenticeship to the imaging team, Kirwan, Elmore, and Jon Morgan (senior manager of Diagnostics Imaging Services) started an in-house talent hunt.
“We joined the imaging leaders with some nonimaging leaders who had experience in medical imaging management. We leveraged our military background–based personnel because they've had formal training or have been trainers themselves, and we found people familiar with educating others,” Kirwan said. "We brought this unique mix of people together and joined them with people who had a propensity to write and build course curriculum.”
It took nearly half a year of routine meetings to pool expertise and outline a program. It also took time to gather the right tools. Portable X-ray devices were chosen as the starting modality for hands-on curriculum, which led to a need for service manuals, radiation badges, and radiation shielding.
By mid-2019, Banner Health's apprenticeship program was ready to do a test launch. All that remained was picking the right candidates.
“An apprenticeship like this creates a pathway for nonimaging engineers or technicians to move into an exciting new specialty role,” said Elmore. “It creates an opportunity for growth that's not always available for people in this field, so we wanted to select students who would benefit the most from this.”
Nonimaging leaders were asked to recommend a member from their team, resulting in one or two candidates from each Banner Health hospital.
“None of them were newbies,” Kirwan added. “We asked for people who had been with us a while and had shown the initiative or desire to build their skillsets.”
However, it wasn't just the right attitude that was required. The apprenticeship was also screening for the right interpersonal skills. Morgan emphasized that based on the necessity of working with OEMs, clinicians, and other HTM departments, a diagnostics imaging repair job can demand more communication than what the average tech might expect.
“There's a behavioral aspect to this that will make people in that service a little more successful,” Morgan said.
Leadership ended up with 20 candidates: volunteers from the pool of recommended nonimaging technicians. Those candidates were then interviewed by Elmore, Morgan, and other imaging leaders until four apprentices were chosen. They also thought to create a “wait list” of two alternates.
“That turned out to be a great idea. One of our first four candidates decided to drop out of the program early,” Kirwan admitted. “You can do all the screening that you want, but sometimes when you get into the meat of a subject, an apprentice may realize the work just isn't for them.”
Results and Next Steps
For Jimmy Peralta, joining the apprenticeship was a momentous decision. He spoke with BI&T from a vendor training program in New York to tell us about his experience.
“It was a great success for Banner Health, as well as for my career,” he said. “I signed with Banner Technology Management/ENTECH as a diagnostic imaging equipment technician in June, and now I'm learning about new imaging modalities. Before the apprenticeship started, I wouldn't have imagined I'd be doing this.”
Peralta was the first employee to make it through the imaging apprenticeship, but ultimately all four trial candidates graduated. They either took their newfound servicing knowledge about portable X-ray devices and computed radiography back with them to their respective HTM departments or, in Peralta's case, joined a diagnostic imaging team full time.
Peralta's success story also exemplifies a next step for the program. After the apprenticeship establishes a foundation for understanding diagnostic imaging devices, graduates will find additional learning opportunities, such as product training sessions offered by OEMs.
Of course, these first four candidates were the test pilots for a program that will ultimately grow. Kirwan explained that next steps for leadership will be to assess what needs to be improved or changed before interviewing a second wave of applicants. As COVID-19 has put many training opportunities on hold, they've had time to think about the challenges they've encountered.
“Working with your human resources department, for instance, can be a ‘got ya,'” Kirwan said. “If you take somebody that's not in an imaging job description, you apprentice them in, they're successful, and they graduate your program, now what happens? How do you pay them as an apprentice, an imaging engineer, or a general biomedical technician from whence they came? What happens if there's not a position for them where they live? Do they relocate? Fortunately, we were careful to think through these kinds of problems, and when the program starts up again, we'll be ready.”
Kirwan added that an additional, unexpected benefit of introducing the program has been a boost in aspirations across his HTM departments.
“Now, we have a bunch of people eager to learn. They're saying, ‘Okay, maybe it wasn't my turn at this particular juncture, but I see an opportunity now.' There are more rungs on the ladder than there used to be,” he explained. “Our third chapter of this is to figure out how to ultimately set graduates up for advanced modalities, such as magnetic resonance imaging, and keep the growth trajectory going.”
Brian Stallard is the media relations manager at AAMI. Email: email@example.com