How and why we came to write this book
For me, it all started with an email from my friend and colleague Azzam Taktak in April 2011 asking would I like to get involved in contributing a chapter on Medical Equipment Management to a textbook he was pulling together and editing on Clinical Engineering. (Now published as Taktak A. et al., Clinical Engineering – A handbook for Clinical and Biomedical Engineers Academic Press, Oxford, UK. 2014)
By September 2011 a group of seven people had agreed to do this section, and Fran Hegarty had agreed to lead on it. That quite quickly reduced to six people because one member felt he had a conflict of interest with another book under way. Later on, another member also withdrew due to workload and personal time commitments. That left five of us, the five that you see as authors of this HTM book. But that is jumping ahead in the story.
Fran had already done some considerable outline drafting and on 31 October 2011 we all met up in the evening prior to an IPEM meeting in York for a face-to-face progress meeting. Work progressed into early 2012. In February of that year, through my links with the Association for the Advancement of Medical Instrumentation(AAMI) in the USA we came across the deliberations they had lead into the most appropriate name for the work we all do. See Final Future Forum 4.01.13. We agreed with this proposal and embraced the term Healthcare Technology Management.
Further progress was made around all our work commitments. I had taken on the chair of the IEC SC62A committee in 2011 and was also trying to influence the revision of the IEC 62353 safety testing standard. This meant going to a series of overseas meetings and doing some income earning consultancy to help pay the travel expenses, so, though formally ‘retired’ I was also busy. Fran drove us on with a vision and ideas. We agreed that another face-to-face meeting would be productive and I offered to host it in Cardiff in June of 2012. So the other four all came to Cardiff and stayed over at my place on a Thursday evening (curry and beer to sustain us), Richard in a sleeping bag on the living room floor, and we had a whole day meeting on the Friday.
We had a productive meeting and learned that some unrealistic deadlines being suggested to Azzam by the publishers had been relaxed. My recollection is that it was at that meeting that one of us (and I think it was me) said something like, “We should not rule out the possibility of expanding further the themes we have been developing and doing our own book.” That idea clearly hovered around at the back of our minds, but we had a commitment to Azzam and colleagues. At that Cardiff meeting we also took up Paul’s suggestion to start using Dropbox to share documents. It proved to be very useful.
In September 2012 Paul first flagged up to us the then draft Standard, ISO 55000. This Standard developed out of the BSI (Publically Available Specification) PAS 55. To my shame I had looked cursorily at this back in 2008 and not paid enough attention to the details, put off by glossy pictures of oil refineries, railway installations, factories, etc. I had dismissed it as not being relevant to our work. How wrong I was!
By March of 2013 we had 74 pages of what were proposed to be seven chapters / sections in Azzam’s book and deadlines kept getting extended. We were not the group holding things up. However, in early May 2013, the publishers suddenly turned on the pressure and one email from Fran clearly gives an option of saying, “We can’t make that new deadline”, withdrawing, and doing our own book. Self publishing was mentioned. Fran had pulled it all together into the seven sections totalling 172 pages and about 50,000 words. The concept of including case studies was well established but none written. The publishers clearly meant it, so rather than withdrawing completely we all agreed that the option of editing down what we had into two linked chapters, one on HTM and one on Advancing Patient Care was the way forward. Fran did a fantastic job doing this, with John and I reviewing and editing as necessary, all in nine days. Those submitted drafts are pretty well what appear as Chapters 2 and 7 in the final Taktak et al. textbook.
This development left us with 50,000 words, a clear vision of what we wanted to say in more detail and an enthusiasm for taking this forward. So, did we start our book in April 2011 or in May 2013 or (see below) in February 2014?
As 2013 progressed, two things developed. IPEM were linking their annual scientific meeting with an International Conference on Medical Physics (ICMP) to be held in Brighton in September 2013 to mark the 50th anniversary of the founding of the International Organization of Medical Physics (IOMP). We also became aware of a conference organized jointly by the Institute of Asset Management and the IET to be held in November of 2013. We all agreed that it would be worth pitching in an abstract for both conferences and both got accepted.
Prior to the ICMP, we were approached by two publishers asking if we had any ideas for textbooks. We engaged with Francesca from Taylor and Francis to explore the possibility of them taking our project further. They were keen and we had to provide a formal proposal for their consideration. Fran got us all to independently write a single page ‘vision’ statement of our book. Two of us pitched that as a mock review of it, as if it were published. If you want to see how we thought of it in advance, you can take a look at our Five Ideas and compare to the outcome. On 19th Dec 2013 we held our first telephone conference, though John and I were unable to be in on it. These T-cons became a feature of our progress and by my reckoning we did 44 of them and should have found a cheaper system. My phone bill went through the roof! In practice, they were vital to our progress and our motivation to keep going. Meeting face-to-face was also very encouraging and productive. You need to remember that we were all more than a hundred miles from each other. We met again in Cardiff in February of 2014. Fran’s young daughter referred to it as, “Another Bioengineering sleep-over”! One thing we focused in on at that meeting was our idea of including case studies in the book. We developed a draft template for case studies so that they would all be in a common format. The template was modified in the light of experience in writing the case studies but the original was not very different from the template you see on this website.
At the end of February 2014 we had confirmation from Taylor and Francis that they had approved our proposal so maybe that was the formal start. In April we had another T-con to discuss the terms of the publisher’s contract about which we had some reservations when considering both the copyright terms and the proposed date for the handover of our manuscript. They were very accommodating to work with and we were able to resolve both issues. We agreed to a 30th November 2015 deadline.
We met again in May 2015, this time making use of the meeting room in Richard’s department on a Saturday, having got together the previous evening in Nottingham, had the obligatory curry and stayed in a Holiday Inn Express, except that Fran got upgraded to the next door Crown Plaza. Unfortunately, at the last minute, John was unable to make it. I had become a grandfather the week before. She is now 2 ¾. At that meeting we came up with a firm writing plan for the early chapters and started to discuss the systems approach that engineers innately or consciously take, and its application in HTM. Out of this has developed what became Chapter 2 in the book. In the following weeks we also started to articulate the need for something substantial on Standards, which has led eventually to Chapter 3.
We made further progress drafting chapters to the agreed plan. Mostly, one of us worked on a draft then passed to another for further comment and editing. There was considerable constructively critical internal peer reviewing and this team work was a feature and strength throughout the process. We made extensive use of email and Dropbox and made reasonable progress. The 2014 IPEM Medical Physics and Engineering Conference was held in Glasgow in September 2014 and we were able to all get together there, using a room in the IET building in Glasgow.
2015 was a key year. As well as the established internal peer review process, we agreed to ask a number of colleagues to review and critique chapters or sections. We had very useful and constructively critical feedback, but what was so encouraging was the very positive overall messages we got back for the basic concepts we were articulating. You can see the people who helped in this way acknowledged in the Preface of the book. The basic concepts of linking our vision to the ISO 55000 Asset Management Standard, promoting a value (benefit in relation to cost) approach, including illustrative case studies, and providing self directed learning points were well in hand. We established a pattern of near fortnightly T-cons, 23 in all through that year, nearly 200 email exchanges and one face-to-face meeting in London that three of us were able to make.
But we missed our deadline of 30th November 2015. The publishers accepted that this was because the scope and reach of the book had grown. By the end of the year we had a pretty solid set of chapter texts and had agreed a face-to-face meeting in London in mid January 2016. Just before that meeting, which we were all able to attend, Fran hit us with what at the time seemed like a bomb-shell. He was proposing a fairly radical restructuring of text, moving large chunks around between chapters 4, 5, 6, and 7. At the meeting, and following some fairy robust discussion, we agreed this and agreed a tight plan and timetable, aiming at getting the text finished by the end of February 2016.
There then followed a manic few weeks of rearrangement, review, revision and checking, with 13 T-cons, nearly 900 emails and a get-together between Fran and me at my house with three computers set up on the kitchen table and a whole day of checking of internal cross-references and checking external references. We got our manuscripts (one for each chapter) submitted on 23 May 2016: a mile-stone day.
We naively thought that there would not be much to do till the proofs came in, then it would be just a question of a quick check. How wrong we were. We still had the Preface and Acknowledgements to finalize and a 22 point to-do list. We were advised that the ‘first pages’ proofs would be back to us for checking by the end of August and had a 30 email set of exchanges to answer some queries ahead of that. None were serious but despite our best efforts the publisher's contractors who were responsible for the copyediting and typesetting had reasonable questions about consistency and such like issues.
We received the copyedited proofs back on 9th August with a request to return with corrections by 29th . We devised a plan to distribute the work so that at least one of us led on a particular chapter then passed it to a second person for a detailed check. The others, where possible, then quickly reviewed the suggested edit and agreed or added to them. In this way at least two of us did a thorough check and the rest basically trusted their detailed judgement. By 16th August it became clear that there were major issues of punctuation, spelling, rewording of text and redrafting of the submitted Figures that had been introduced by the publisher's contractor at the typesetting/proofing stage. Correcting all this took till 11th September.
There was then a further set of queries followed by a discussion regarding the use of double-quotes. We had to be firm about the way we wanted things presented. All this took from 19th September to 11th October and 52 email exchanges.
Also, the positioning of the ‘value’ diagrams was a major issue. We had not realized that publishing convention is that figures and tables are always placed at the top or bottom of a page. In many cases, this put the value figures and their captions outside of the Adding Value section of the case studies and made for poor readability. The compromise we agreed with the publisher was to drop the figure numbers and captions from the Value diagrams and, using just small diagrams and adding explanatory text, those diagrams could be put into the correct place in the Adding Value sections. This was all resolved by 24th October.
On 28th October we got back the second set of typeset proofs for checking. These incorporated all the suggested changes made from the original proofs sent to us on 9th August. They asked us to get any corrections or comments back by 12th November. We did so by 8th November using 132 email exchanges. By 29th November we had sorted out a short set of further queries that came in, all of which could have been raised earlier, and a confusion as to how we wanted our names put; with or without second initials? Such things are important for consistency!
Finally, on 2nd Dec 2016 we had a formal message to say the book had been sent to the printers. What a relief.
So, what about why we wrote the book. On this I can only speak for myself. The simple answer is, ‘Because I was asked!’. I recognize that I am not a brilliant original, innovative thinker, but I am good at working with other people, pulling ideas together and sometimes contributing insights and clarity. For me, this whole exercise has been a legacy project. I have worked doing what we now call HTM for over 40 years in the NHS and continue to do so, but during this project there were times I said to myself, ‘I wish I had though like this 15 or so years ago, then we could have implemented it in our Cardiff Clinical Engineering Department.’ But, there were other times I thought, ‘We were doing that 20 years ago in Cardiff.’
So, I have learned a lot and hopefully my colleagues think I have contributed something. It has been a privilege and great fun working with them. I strongly believe that the vision we have presented is sound. I fully expect some to say, ‘That is all very well but is unachievable.’ I fully accept that establishing a Medical Devices Committee where none exists will not be achievable overnight, nor will moulding an existing one to have the purpose and authority we propose, but without a vision nothing will change.
The two closely linked key themes in the book are that healthcare technology management must be patient focused and that it must embrace both equipment management and supporting and advancing patient care – the twin pillar, keystone model shown in Figure 1.8 in Chapter 1.
It is of great regret to me that, in the UK at least, this second ‘supporting and advancing care’ pillar has been very significantly weakened in Clinical Engineering departments in recent years. We need to be politely assertive in showing that this function provides real patient and organizational benefit and therefore increases value. Have a look at the cases studies, especially those in Chapter 7.
Justin
- By Justin McCarthy
- 1st Feb 2017
- 0
- Book, History
