October 2017 will mark 40 years since the first time I deinstalled and moved a piece of medical equipment. It happened to be a rectilinear scanner that was destined for the People’s Republic of China. Since that time, I have been involved in what seems like countless equipment moves from one part of the world to another. I have to say that the biggest problems I have had in my career have dealt with either deinstallation or transportation.

When you walk in to buy an iPhone, you know what you are getting. You expect to open the box and have everything work. And, in fact, you do. Most people expect that when a businessperson tells them they are going to do something, it is going to get done. But anyone who has been in the medical field for any length of time knows that the deinstallation of a piece of capital equipment has a lot of moving parts, each of which can derail the project and result in not being able to treat patients, and unnecessary expenses.

So, what is a fellow to do? Who can you trust? How involved do you have to be? What can you do to increase the chances that everything goes smoothly?

Whether you are the vendor, charging to deinstall the equipment, or the customer with the equipment that needs to be deinstalled, in my opinion the rules are the same. Both of you have a vested interest. The vendor wants things to go smoothly because he or she wants a repeat customer, and a smart vendor doesn’t want any problems. As the customer, you want to minimize the impact that the removal has on your department, and you do not want a black eye with your CEO, either because you made a mistake in planning, or the person you hired made a mistake in planning.

So whether you are the vendor or the customer, your challenge is the same: How to make the perfect plan for the removal of your equipment?

Again, whether you are the vendor or the customer, you have to make sure that you are picking the right person for the job. If you are the customer, you want to go with a known entity. Maybe it is a person you know or a company you trust. Hopefully, you are able to select a company that you have a little history with. However, even if you know the company or the individual, things can still go wrong because somebody forgot something.

Make a checklist
I sit down at my desk with a sheet of paper and make a checklist of all of the things that have to happen, and try to decide who is going to be responsible for what and what can go wrong in the process. Here are a few things that a good checklist should include:

What is the best day for the removal? What is the best time for the equipment to be moved to the loading dock or truck? How many days will the deinstallation take?

How many people will be needed for the job? Will any other departments be impacted? Will patient areas be impacted? Does patient data have to be removed from the machine and who is responsible for that?

Will any construction be required? Since the time the equipment was installed, have any plumbing fixtures or electrical conduit been installed? Is there an outdoor chiller or even an indoor chiller? Who is going to recapture the glycol and how do we avoid having it spill on the floor?

Are there cables running through the floor, and is access required from the floor below? Will the floor be damaged when the equipment is moved down the hallway? Are the doors wide enough? Is the ceiling high enough? Is the freight elevator wide or big enough? Can the freight elevator hold the weight?

Will riggers be involved? Will a crane be needed? Is the loading dock the right height? Is there a dock plate? Who is bringing the pallet jack? Who is supplying cardboard boxes? Who is supplying the packing material?

Will spaces be needed in the parking lot? Is the loading dock team aware of the removal? Will a hospital electrician be needed? Is there equipment in the room that is not included and has to be removed? Who is going to remove it? Do gases have to be disconnected? Will a plumber be needed? Do windows have to be removed? Is there a glazier standing by? Does a door have to be removed? Must concrete blocks be removed?

Are any permits required? Can work take place after hours? Is vendor credentialing required?

And, of course, that all-important question, do the vendors have the proper insurance, and do you have a copy of their insurance certificate correctly filled out?

All of this is a lot to keep track of and it does not apply to each deinstall, but it is not uncommon in the case of X-ray, MRI or CT for all of these disciplines to be involved. Once the customer or the vendor answers these questions, the extent of the challenge begins to take shape.

If you are the customer, chances are you are going to hold someone else responsible, but if you are the person in charge, and if they screw up, you are the one with the black eye, so you probably want to satisfy yourself that your vendor has taken all of this into account.

I have learned the hard way
I have learned the hard way over the years to document everything. It is so easy to have a conversation and not really be listening. As I am walking out the door to the grocery store and my wife reminds me to pick up some cucumbers, I nod my agreement while I am really thinking about the olive oil and batteries and toilet paper I have to buy. I do not mean to forget to pick up the cucumbers, but I do. That is why I always put everything in writing. Yes, it is a pain in the neck and yes, it is time consuming, but by documenting the process and outlining who is responsible to do what, you create an added layer of mental responsibility in everyone’s mind. The vendor knows that the hospital is responsible for the disposal of the glycol, and the client knows that the vendor has to bring their own pallet jack and their own cardboard boxes, and not borrow a pallet jack from the loading dock.

As the client, you may want to trade the system in, and task the OEM selling the new machine with the responsibility of removing the old machine. But more and more, the OEMs are farming out the responsibility of handling the deinstall to either third parties or the customer that purchased the machine from the OEM trade-in desk. More often than not, the successful bidder at the OEM trade-in desk will subcontract the deinstall to a third party, so as the client, you are back in the hot seat. You have the security of being able to lean on the OEM and maybe even receive compensation from the OEM, but that is a small consolation if, at the time, things are not going well.

Failure to plan is planning to fail
Smart money makes a plan for the deinstall in advance. Smart money considers all of the items I have listed above and maybe a few more and assigns someone to be in charge of each and every task. Doing this saves you embarrassment, frustration, delays and possibly even treating patients.

Once again, whether you are dealing with the OEM or a third party, or the man in the moon, get it written down and get everyone to sign off. Remember, an ounce of prevention is worth a pound of cure. Sometimes, you are going to have no choice but to make the arrangements on your own. You are selling a machine and you have to hire someone to remove it. Maybe no one wants to purchase the system, or maybe you just do not have the time to sell it, and you have to go to an outside vendor.

If you are lucky, you are going to deal with someone you know. If you want to stay friends with that person, my advice is to follow the plan I have outlined above and make sure that everyone puts everything in writing. However, sometimes, you are going to have to deal with a stranger, and if you are going to deal with a stranger, I advise investigating the person before you do business with them. This is what we do when we have to remove something from a hospital.

Nowadays, it is so easy to go on the Internet and investigate a company. I hate to put in a shameless plug for DOTmed.com, but we have over 2,000 vendors that have been rated on our site. Many are DOTmed Certified and some are in our DOTmed 100. You can look up a company on our site and see what people in the industry have said about them. Do they keep their word? Do they show up on time? Do they communicate and answer their email?

I cannot tell you how many people have written to us to complain about someone who has treated them unfairly and we have to refer them to our Honest/Dishonest Dealings Forum or our DOTmed Ratings, where they will see that this particular company has a bad reputation, and if they had only checked, they would have saved themselves time and money. So when a person comes to you and makes a little drawing on a piece of paper and tells you, “don’t worry,” just remember, it is always easier on paper, and if you do not want to have any problems, you need to plan for everything.

ABOUT THE AUTHOR: Phil Jacobus is the president of DOTmed.com and the publisher of HealthCare Business News. He has been involved in health care since 1977, when he visited China to sell equipment. He has done business in 35 countries and still travels extensively. In 1998 he founded DOTmed.com.