Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Solution oriented partnerships - A new business model for integrating global-production efficiencies with sustainability

A business model for integrating global-production efficiencies with sustainability is discussed. Two trends that emulate some of the aspects of the wealthy are the increasing willingness of many to pay extra for customization such as clothes, of kitchens and the increasing acceptance of purchasing a service as a product substitute. Two final trends that are also based in the attitudes of people is an increased awareness of the value of local culture and an increased concern with issues of sustainability. The results show that the goal congruence between for-profit and not-for-profit organizations puts emphasis on value and belief of the organization.

Testing in harsh conditions: Tracking resources on construction sites with machine vision

When tracking resources in large-scale, congested, outdoor construction sites, the cost and time for purchasing, installing and maintaining the position sensors needed to track thousands of materials, and hundreds of equipment and personnel can be significant. To alleviate this problem a novel vision based tracking method that allows each sensor (camera) to monitor the position of multiple entities simultaneously has been proposed. This paper presents the full-scale validation experiments for this method. The validation included testing the method under harsh conditions at a variety of mega-project construction sites. The procedure for collecting data from the sites, the testing procedure, metrics, and results are reported. Full-scale validation demonstrates that the novel vision tracking provides a good solution to track different entities on a large, congested construction site.

Material efficiency: providing material services with less material production.

Material efficiency, as discussed in this Meeting Issue, entails the pursuit of the technical strategies, business models, consumer preferences and policy instruments that would lead to a substantial reduction in the production of high-volume energy-intensive materials required to deliver human well-being. This paper, which introduces a Discussion Meeting Issue on the topic of material efficiency, aims to give an overview of current thinking on the topic, spanning environmental, engineering, economics, sociology and policy issues. The motivations for material efficiency include reducing energy demand, reducing the emissions and other environmental impacts of industry, and increasing national resource security. There are many technical strategies that might bring it about, and these could mainly be implemented today if preferred by customers or producers. However, current economic structures favour the substitution of material for labour, and consumer preferences for material consumption appear to continue even beyond the point at which increased consumption provides any increase in well-being. Therefore, policy will be required to stimulate material efficiency. A theoretically ideal policy measure, such as a carbon price, would internalize the externality of emissions associated with material production, and thus motivate change directly. However, implementation of such a measure has proved elusive, and instead the adjustment of existing government purchasing policies or existing regulations-- for instance to do with building design, planning or vehicle standards--is likely to have a more immediate effect.