برون سپاری تعمیر و نگهداری دستگاه های پزشکی: آیا مدیریت عملیات تحقیق و تئوری های مدیریت از جامعه مهندسی پزشکی غفلت کرده است؟

In this paper, we examine the large body of existing research on outsourcing, and assess the status of research on outsourcing the maintenance of medical devices. Because so little research in this area currently exists, the study was broadened to include other fields that outsource maintenance services, and considers possible applications to the field of medical device maintenance. In all, this paper examines 55 articles spanning various dimensions, including: mathematical models, empirical studies, and conceptual papers. We conclude that research into the outsourcing of medical device maintenance services in hospitals is still in its infancy stages, and that further progress in this field would benefit from additional empirical study grounded in management theory.

Medical technology management is a systematic process that begins with strategic planning, technology assessment, and facilities planning. Once the institution has determined its technological needs, the process proceeds with technology procurement, and concludes with maintenance management (Judd, 2004: p. 159). When a health care institution lacks the technical skills or specialized assets needed for the maintenance of its medical technology, maintenance should be outsourced. Yet while outsourcing has grown in popularity, research on maintenance outsourcing in academic literature remains scarce. Our review of the literature confirms the findings of Jackson and Pascual (2008) that there is no study on maintenance service outsourcing that deals with the problems of service provider selection, evaluation, and performance measurement in an integrated manner. In the healthcare environment these problems are worthy of study, as healthcare institutions lacking the capacity to deal with these issues may face significantly higher costs. For example, it has been reported that some maintenance service providers-in most cases the original equipment manufacturer (OEM)-have created barriers to service competition by denying training or documentation to potential competitors, and withholding replacement parts (Blumberg, 2004: p. 138). For healthcare institutions in developing countries, where contracting maintenance services is often inevitable because hospitals have fewer properly trained employees on staff and less material resources are available to handle in-house maintenance, opportunistic behavior and anticompetitive practices can be even worse. These findings suggest a gap between client needs and contractor performance, prompting many studies to tackle the problem of critical elements related to maintenance outsourcing processes in general, although little research exists examining the particular case of medical device maintenance outsourcing. Thus, this paper is the first stage of research to answer the three questions formulated below. The overall goal of this study is to identify representative research measuring the performance of outsourced medical device maintenance in the hospital environment, using management theories and/or strategic management theories,2 or mathematical models. Since little research currently exists in the field of medical device maintenance outsourcing, we also identify literature on maintenance outsourcing in general that could be applied to the medical devices field. The specific research questions of this review are therefore: 1. Which are the most common dependent and independent variables for evaluating maintenance performance and outsourcing decision problems, both in the hospital environment and other technical fields? 2. What are the existing research gaps, and what future studies can be done in the field to evaluate the performance of medical device maintenance services? 3. How does a paper’s methodology, outsourcing problems tackled, area subject,3 percentage of self citations, management theories used to ground its hypothesis, the percentage of review papers appearing in the journal, and the industry research was conducted in affect the article’s impact, as measured by the Source Normalized Impact per Paper (SNIP)4 the article receives?

This paper has attempted to provide a mapping review and assessment of the status of research dealing with the maintenance outsourcing of medical devices. Because so little research currently exists, the study was broadened to include other fields that outsource maintenance services, using research on outsourcing in other industries that could be applied to the field of medical device maintenance. We looked at scholarly papers tackling the problem of outsourcing performance and outsourcing decision problems, scrutinizing four major branches of papers, including: mathematical models, conceptual papers, empirical research on the maintenance outsourcing of medical devices, and empirical research on maintenance outsourcing in other fields. To the best of our knowledge, this is the first paper that has tackled this issue in a mapping review. On one hand, we have found the main determinants that affect a paper’s impact, as measured by the SNIP impact indicator, including: the industry the research was conducted in, the type of data collection instrument used to collect data, the management theory upon which the research hypotheses were based, and the subject area of the journal in which the paper was published. Despite claims that the SNIP indicator fails to take into account the percentage of articles appearing in a journal classified as literature reviews, and the percentage of self-citations, in the results for our sample showed that neither percentages of reviews nor self-citations affected the SNIP impact values. Our analysis finds that papers reporting research applied to the manufacturing industry earn higher SNIP values, as did papers are those papers that used archival data collection instruments, used RBV or a combination of RBV and TCE management theories to ground their hypotheses, and were published in business, management, and accounting journals. On the other hand, from a management and management operations perspective, this paper confirms the findings of Jackson and Pascual (2008), who found ‘there is no study which deals with all the issues relevant to maintenance service outsourcing in an integrated manner,’ and we add that this is particularly characteristic for the maintenance outsourcing of medical devices. This paper also confirms the findings of ECRI (1989), that as of yet there is no mathematical model or empirical study that helps hospitals select the best option for decisions related to the outsourcing problem of medical device maintenance tasks. This presents significant opportunities for contributions in the field of medical device maintenance outsourcing. The issues related to this subject remain largely unstudied, with three basic aspects presenting obvious gaps in the existing research: First, after applying our inclusion criteria we found six empirical-longitudinal papers related to medical device maintenance outsourcing. While some empirical-longitudinal studies have attempted to measure the performance of maintenance outsourcing of medical devices, there are some shortcomings: (1) there is no mention of management theory to justify their findings, and (2) discussion about the managerial implications of the findings is non-existent, making it difficult to apply results in a meaningful way. Second, to make their models mathematically tractable the authors of papers proposing mathematical models made a set of assumptions that fail to hold in real world applications. While some of these models were proposed for specific industries, none of the mathematical models was specific to the maintenance outsourcing of medical devices. Third, no empirical proposal whose research was grounded in management or strategic management theory dealt in detail with the issues related to maintenance outsourcing, nor did any specifically deal with the outsourcing of medical device maintenance. The following gaps are especially evident: (1) proposals are weighed in favor of cross-sectional surveys (80.77%, 21/26) rather than longitudinal studies (7.69%, 2/26). Thus, few studies measure how the changes in both external and internal conditions over time affect governance form performance. Additionally, the distribution of the industry application of research is weighed heavily in favor of the information technology systems field, while papers most commonly used either TCE as a management theory to ground their hypotheses, or used no such management theory. (2) There is significant variation in support for management and/or strategic management theories. For example, of the total 95 hypotheses from the 26 papers in Group 3, the total number hypotheses supported was 59 (62.11%), while the number of hypotheses not supported was 27 (28.42%), 5 (5.26%) hypotheses were partially supported, and 4 (4.21%) hypotheses found statistically significant evidence to the contrary of the predicted relationships (see Table A.4(c) in Appendix A). This pattern may suggest inconsistent operationalization of these theories’ core constructs. Finally, (3) important methodological pitfalls still persist, such as a lack of bias control (David and Shin-Ka, 2004).