​Congratulations!​

Clinica Imbanaco (Cali, Colombia) has been selected as the winner of ECRI's 18th Health Technology Excellence Award for its demonstrated commitment to facilitating better strategic management of health technology to help improve patient safety, enhance processes, and reduce costs. The organization implemented multiple initiatives over the past several years to expand the capabilities and upgrade the quality of its health technology management function, positioning itself as a pioneer in the region.

ECRI congratulates Karent Muñoz Salazar and the rest of the Clinica Imbanaco team.

Clinica Imbanaco in Cali, Valle Del Cauca, Colombia. (Image courtesy of Clinica Imbanaco.)​

Strengthening the Health Technology Management Function​

Following are a few of the projects that Clinica Imbanaco has implemented to improve how health technology is managed at the institution.

Reducing Medical-Device-Related Risks—Focusing on Proactive, Rather Than Corrective, Maintenance​​

Corrective maintenance is a reactive measure: A problem occurs, then staff need to identify the cause and restore the equipment to normal operation. This approach can be costly in terms of time and financial resources, and it can subject patients to harm from malfunctioning medical devices.

To help prevent such incidents, Clinica Imbanaco focused on identifying and addressing potential problems proactively, rather than responding to failures after they occur. This effort involved:

• Identifying and classifying risks associated with medical equipment, the probability of failure, and the potential impact of failure, and then using that information to define maintenance strategies for the equipment. For the risk assessment process, the organization developed a "heat map" to classify the probability and impact of device failures for various clinical processes, ranging from acceptable risks (low probability, low impact) to unacceptable risks (high probability, high impact).
  
• Training users on the safe use of medical technologies and evaluating the training's effectiveness (using the Kirkpatrick methodology).
• Adhering to a robust preventive maintenance program. Regular device inspections and maintenance (e.g., lubricating and adjusting components, replacing worn parts) can prevent failures and breakdowns. The organization's emphasis on preventive maintenance from 2021 to 2023 yielded compliance rates of 98% or higher each year.

Supporting the Timely Calibration of Medical Devices—Establishing an ISO/IEC-Accredited Metrology Laboratory​​

An inaccurate measurement from a medical device can lead to inappropriate care decisions. Thus, medical devices need to be periodically tested and calibrated (against a known standard) to verify that the readings they provide are accurate. Access to a timely and reliable source for medical equipment calibration is a key technology management consideration for any healthcare organization.

In many regions, healthcare organizations can contract with a reliable outside organization to perform this function. In Colombia, however, the options are limited. Clinica Imbanaco reports that there are only four health entities in Colombia with accredited metrology laboratories. Further, calibration services are expensive, are not readily available in all locations, and can be of inconsistent quality (or not conducted in accordance with the country's regulations). The organization adds that it repeatedly experienced delays in the process, resulting in medical devices not being available. To provide assurance that medical devices would be calibrated according to the organization's standards and available when needed, Clinica Imbanaco established an in-house International Organization for Standardization/International Electrotechnical Commission (ISO/IEC)-accredited metrology laboratory.

Establishing an in-house program required a significant investment. The process included infrastructure adjustments, equipment maintenance, proficiency testing, internal audits, consulting, and training for the team of professionals formed. Achieving accreditation from ONAC (Organismo Nacional de Acreditación de Colombia) under the guidelines of ISO/IEC 17025:2017 was key to the program's success. Clinica Imbanaco's metrology laboratory is accredited for measuring mass, pressure, temperature, and relative humidity. This program allows the organization's care providers to have confidence in the measurements provided by the sphygmomanometers, scales, thermometers, and other devices used in patient care.

Using an Evidence-Based Technology Selection Process—Selecting a Cranial Surgery System​

The selection of an intracranial and extracranial surgery system for treating cancer patients at Clinica Imbanaco illustrates the organization's embrace of an evidence-based technology assessment process. A multidisciplinary technology assessment team was formed to establish selection criteria, evaluate the prospective models against those criteria, and make an evidence-based selection decision.

Clinica Imbanaco's assessment followed the GRADE methodology to evaluate the certainty of the evidence; this approach helped the organization make clinical practice recommendations and decisions about new or emerging technologies systematically. Questions were framed in the PICO format, defining the population, intervention, comparator, and outcomes to be studied. (The comparator, in this case, involved comparing the technologies under consideration with the alternatives currently available for managing the health condition.)​

The team's analysis considered factors such as the system's ability to fulfill a clinical need, the features and capabilities of the systems under consideration, preinstallation conditions and testing, and economic and operational factors (e.g., cost, warranty information, expected life, service schedules). This process helps the organization identify new or emerging technologies that will meet clinical practice recommendations in a cost-effective manner.

Establishing a Clinical Alarm Management Program​

Healthcare organizations around the world struggle with the challenges of managing large numbers of medical device alarms, and thus the potential for alarm fatigue and missed alarms, which may lead to unrecognized clinically significant events. Clinica Imbanaco was no exception.

Aiming to become pioneers in clinical alarm management in Latin America, Clinica Imbanaco established a clinical alarm management program led by the clinical engineering team. Efforts included assessing clinical workflows, surveying patients and their families to learn their perceptions of noise levels, adopting a patient assessment process to facilitate early detection of patient decompensation, and upgrading medical technologies (e.g., multiparameter physiologic monitors, infusion pumps) and alarm communication systems.

Implementing Smart Infusion Technology to Reduce Medication Errors​​

During our 2022 Award competition, we described Clinica Imbanaco's program for implementing smart infusion pumps with dose error reduction system (DERS) technology. At the time, we noted that adoption of this safety technology had been slow in many parts of the world. Clinica Imbanaco identified the opportunity to reduce preventable medication errors as a key patient safety priority and instituted a program to overcome implementation barriers. For details, see Technology Management around the World: Highlights from Health Technology Excellence Award Applicants.

The Key: Striving for Excellence​​​

These initiatives, many of which represent the forefront of health technology management in Latin America, demonstrate that for Clinica Imbanaco, the desire to improve how health technology is managed is not a one-time effort, but a reflection of its culture.​