Two Ways to Equip a Hospital

From an equipment procurement perspective, and in the most general terms possible, the output of a hospital design is the list of equipment which is needed to go in it. There are many design systems, such as Activity DataBase, CodeBook etc which can produce this kind of output.

This list of equipment list (we call it the BOQ, or Bill-of-Quantities), is central to the entire project. It is very commonly held in one or more spreadsheets.

1. The "Traditional" Approach

Not everything in the BOQ need necessarily be purchased; you may well be transferring some equipment from your current asset-base. So you do an asset survey and somebody creates another spreadsheet for the list of transferred equipment. Having identified what you need in one spreadsheet, and what you already have in another, the difference between these is what you must buy.

Now you can start the procurement. If you know target service delivery dates and product lead-times (and possibly the time necessary to train the clinical users and for the engineering staff to install it), you should be able to work out what you should be doing next. Where does all this information get held? You guessed it, in the BOQ spreadsheet.

So, you issue a tender for some equipment. You probably have the tender in the form of several Word & PDF documents (cover letter, detailed specifications, contract terms etc) in a folder on your Windows server. At this point you probably update your BOQ spreadsheet to make a note that the tender has been raised.

Then the quotations arrive from various suppliers. Some of these are e-mails, some may well be paper documents. So you scan the paper quotations and save the files somewhere on your server. Things start to get a little difficult now in your BOQ spreadsheet, as one equipment requirement results in many quotations, but the spreadsheet is only really useful for calculations and analysis if it has one row per requirement. So you estimate that you will get a maximum of three quotations for each item, and add a bunch of extra columns like "Supplier 1", "Price 1", "Supplier 2", "Price 2" etc. While you're at it, it might be useful to add a few extra columns which tell you where on the server you have put all these documents, scans etc.

Now we're getting somewhere! You look at your three quotations and decide which one to accept. Now you need to raise a purchase order...

... Except you probably don't if you work in the NHS! You will most likely complete a requisition form, which is a request from you to the Purchasing or Supplies department to raise a purchase order. You might do this on a paper form or you might have a web-based mechanism for doing this. Don't forget to update your BOQ spreadsheet with details of the successful supplier, the requisition number, the date you raised the requisition etc. Perhaps you might like to add a few extra columns to that spreadsheet.

The Supplies department now raise the order and send it to the supplier. Now it would be nice if they told you, and sometimes they might. Sometimes you might have to e-mail them just to get them to confirm that they have. Now where's a good place to put the date of your e-mail and the date of their confirmation? We've already got 200 columns in our BOQ spreadsheet, a couple more can't hurt!

Once you have ordered stuff, sooner or later it is going to arrive. Whoever will be receiving these goods needs to know what will be arriving, and when & where it will arrive. No problem, give him a copy of the spreadsheet. And what about Clinical Engineering? They will have to do acceptance tests on medical devices, add the new items to their inventories, establish planned maintenance routines etc. Give them a copy of the spreadsheet as well so that they can type everything in all over again into their asset-management system. Perhaps you'd better let them have their copy early as they're going to be busy!

Great, you've finished! All the new equipment has been delivered, installed and commissioned. Nothing was forgotten, nothing was ordered twice and everything that was ordered actually arrived. Clinical Engineering had plenty of notice, thanks to your wonderful spreadsheet, so they had enough technicians to install all of the equipment. You didn't forget that all the nurses needed to be trained on the super new infusion pumps that you have bought, and that the engineers also had to be trained in how to maintain them. Estates were on hand to do the health-and-safety checks on the 500 new office chairs that arrived, and the removals staff were there to make sure that everything ended up in the right place.

Congratulations, another successful procurement project done and dusted. Thank goodness for Excel!

2. The "E-Quip" Approach

Spreadsheets are wonderful things. They are easy to use, everyone (well, almost everyone) understands how to use them, and they're easy to move around. This makes them a really useful communication tool. You can send someone the BOQ spreadsheet with some questions, they can fill in the answers and sent the spreadsheet back to you. Brilliant, hats off to those guys at Microsoft!

But it's not quite that easy. Because only one person can edit a spreadsheet at any one time, you will probably copy the spreadsheet before you e-mail it with your questions. When you get the answers you will extract those from the copy and update the original. If you have lots of questions, you will have lots of copies of the spreadsheet, and will have to do a lot of manual merging and updating.

Of course, some people will want to ask you questions, and they will probably use the spreadsheet that you sent them. Except your copy might have changed since you sent it to them - remember all that manual merging & updating? Let's just hope that nobody else has added some columns to the spreadsheet and sent it to someone else for further information. By the time that spreadsheet gets back to you it's not going to look much like the spreadsheet that you have.

E-Quip takes this entire process out of Excel and puts it into a database that is searchable and shareable. It still looks like Excel, so it is easy to use, but it addresses all of the problems raised in the "nightmare" scenario presented above.

Imagine a spreadsheet that everyone can use at the same time, where the BOQ links directly with transferred asset lists, tenders, orders & requisitions and deliveries, and where you can create purchase orders with a single click, all from within the BOQ. We did, and the result was E-Quip.

	Briefed Equipment	Coded equipment descriptions, normally imported from a design system, such as Activity DataBase
	Departments
	Rooms
	BOQ	Room-by-room, department-by-department or project-wide list of equipment requirements. Importing a BOQ will also import all of the associated departments, rooms and equipment
	Tenders	An invitation to one or more suppliers to provide goods or services. Tenders will normally be associated one or more equipment specifications.
	Quotations	A response from a supplier to a tender. These are manufacturer-specific, and will refer to particular models of equipment
	Orders / Requisitions	An order for the goods referred to in a quotation
	Deliveries	A GRN (Goods Received Note) for items received as a result of an order
	Asset Pools	Used for bulk items where BOQ items are not linked to individual assets. E.g. beds, power outlets
	Generic Specifications	Specification of the functional or other requirements of an item of equipment. Used in conjunction with tenders
	Models	Manufacturer-specific equipment items. Contains pricing and lead-time information
	Suppliers	Companies from whom equipment can be purchased
	Equipment Categories	Generic descriptions of different types of equipment
	Assets	A tangible, individual item of procured equipment. These are the output of the procurement process, and can be used to update asset-management systems. information

"... Let's get this straight Pete, we are talking about revision 'P' of the spreadsheet, aren't we?"