Chapter 5: Accessible Medical Diagnostic Equipment

When implementing any new accessibility initiative at your organization, earning buy-in from leadership is essential. Ordering new and paying for the replacement of existing medical diagnostic equipment can be especially costly. Leadership support at the organization and location levels are critical.

Actions and Tasks

1. Identify what types of leadership support and buy-in you will need.
   • Do you need buy-in from organization- or system-level leadership?
   • Who will view ultimately approve equipment purchases at the clinic/department/facility level?
2. Identify potential champions across your organization.
   • Often, champions are individuals who work in disability specific disciplines (e.g., rehabilitation), are people with disabilities, or are people who have family members with disabilities.
3. Identify how prioritizing accessible medical diagnostic equipment (MDE) will fit within your organization’s existing priorities and initiatives (e.g., accessibility program, health equity, quality and safety, patient experience goals, etc.).
4. Work with your legal team to determine the legal regulations that apply to your organization (ADA/Section 504 standards, state-level requirements, etc.)
5. Create necessary charters, strategic plans, and presentations to present to leadership to garner their support.
   • Identify potential concerns leadership may have (cost, disruptions to clinical operations) and possible solutions.

Materials and Resources

• Appendix 0.3: Federal Requirements↗
• Appendix 0.10 Leadership Support: Key Individuals↗
• Appendix 5.4: Accessible MDE Costs and Funding
• New Medical Diagnostic Equipment Accessibility Requirements: What Healthcare Systems Should Know↗

*Appendices 0.3 and 0.10 can be accessed in the General Resources chapter.

The implementation team will be responsible for designing, leading, and monitoring the use of accessible MDE across your organization. Your team must include people across different departments to secure necessary approvals—implementing accessible MDE has clinical, patient safety, operational, facilities, and compliance implications.

Actions and Tasks

1. Identify the implementation team for auditing, procuring new, installing, and removing outdated MDE.
   • Include people across different departments and units within your organization.
   • Include leadership and others who have the authority to make changes and approve expenditures.
   • Include staff who will be doing the work to ensure patients receive care via accessible MDE. They know their clinic workflows and can help pilot the project. This will also help with buy-in, and sustainability will be more attainable.
   • Consider starting with a team at a pilot site or single clinic to work through challenges before expanding to the entire organization or managing several projects at once.

2. Determine how you will include patient perspectives.
   • Will you include people with disabilities on your implementation team?
   • Will you convene a patient advisory board?
   • Will you conduct a patient experience survey?
   • Will you engage disability community organizations?
3. Determine the implementation team meeting structure.
   • How often will the team meet?
   • Is this a project that will be part of an existing procurement, facilities, or quality improvement team? Or embedded within another team?
4. Identify champion(s) for the project. Who is this person(s) going to be?
   • Are they able to implement changes?
   • Consider including both a clinical and non-clinical champion.
   • Is there someone at the system level with whom you can partner? For example, a Disability Coordinator or your organization’s ADA Coordinator is often already responsible for monitoring patient complaints and compliance.
5. Establish common goals for team.
   • Ensure that it fits within organizational goals and regulatory deadlines.
   • Use SMART Goals (Specific, Measurable, Attainable, Realistic, and Time-bound).

Materials and Resources

• Appendix 0.6: Project Planning↗
• Appendix 5.1: Accessible MDE Implementation Team
• Appendix 5.3: Accessible MDE Implementation Planning Worksheet
• Appendix 5.11: Accessible MDE Barriers and Strategies

*Appendix 0.6 can be accessed in the General Resources chapter.

Using Appendix 5.2: Accessible MDE Needs Assessment, identify if and where accessible MDE exists across your organization.

Actions and Tasks

1. Review your organization’s equipment procurement request policies. Identify internal funding request deadlines and create timelines to prepare for budget requests when needed.

TIP: Align requests for accessible MDE with existing organization/clinic/department/unit equipment procurement processes, timelines, or request windows. This can minimize costs by ensuing newly acquired equipment choices are accessible from the start.

2. Determine if your organization maintains an inventory of all available MDE. If so:

• • Obtain reports from the responsible department on current equipment models available across sites and departments. Research whether those models include accessibility features/accessories.
  • Consider working with the team responsible for the inventory to incorporate equipment accessibility features. See the Standards for Accessible MDE↗ to learn what features of certain MDE are considered accessible.

TIP: If your organization does not have a centralized inventory of available MDE, this work is an opportunity to create one. Maintaining an up-to-date inventory can prevent delays in patient care, duplicate buying, and help track maintenance needs.

3. Before creating a new inventory or incorporating accessibility information in an existing one, consider:

• • Will you hire an external firm or consultant to audit available MDE facility-wide?
  • If so, what is the budget? If conducting the audit internally:
    • Who/what team will be responsible?
    • How many hours will be dedicated to conducting the audit?
    • What training or information is needed to conduct the audit accurately (e.g., education on the Standards for Accessible MDE)?
  • What is your data management plan?
    • Is there an existing template you can adapt to track recorded measurements and other data?
    • How will you track changes that occur while you are completing the inventory process, i.e., if equipment is replaced?

4. With your data management system in place, survey sites and departments for current equipment status, including what equipment is available and any accessibility features they have (see Appendix 5.5: Accessible MDE Equipment Inventory Survey). Visit sites as needed to confirm current equipment and their accessibility features.

5. Engage with other healthcare organizations to understand how they manage accessible MDE, including what is and isn’t working for them. Consider joining the Disability Equity Collaborative’s Leaders workgroup to create a peer network.

Materials and Resources

• Appendix 5.2: Accessible MDE Needs Assessment
• Appendix 5.5: Accessible MDE Equipment Inventory Survey
• Disability Equity Collaborative’s Leaders workgroup↗

Part A: Compliance and Procurement Policy

Consider working with your legal/compliance team to create a written plan demonstrating your organization’s roadmap or progress towards compliance. Additionally, consider drafting an accessible MDE procurement policy to ensure compliance is maintained as equipment is replaced over time or when new clinics/locations are acquired or built.

Actions and Tasks

1. Establish the team responsible for developing your organization’s accessible MDE compliance plan. Include a member of your organization’s legal/compliance department.
   • Will this team be different from your implementation team?
   • Identify who will review drafts and ultimately approve of the plan.
2. Referencing your inventory, identify the scope of the project. Consider if the compliance plan will apply organization-wide or will vary by clinic.
   • Calculate organization-wide and clinic-specific progress towards scoping goals, with the baseline being 10% (minimum scoping requirement), or no less than one per location/clinic.
   • Identify high-priority clinics/locations for each equipment type, including those that primarily treat mobility conditions (such as, but not limited to, Rehabilitation, Orthopedics, Neurology, Geriatrics) or routinely use a specific equipment type to deliver care. See Appendix 5.6: Accessible MDE Sample Priority Replacement Plan for more guidance.
     • Set higher scoping targets for these clinical practices, with the baseline being 20% (minimum scoping requirement for facilities that specialize in treating mobility impairments).
   • Consider if all clinics/locations in your health system will need accessible MDE, if equipment will be shared between multiple clinics/departments, or if your clinic will have designated accessible clinics/locations. See Appendix 5.8: Accessible MDE Location Decision Making Tree for more guidance.
3. Consult with your legal and/or compliance team to create a procurement policy. Review legal, regulatory, and accreditation requirements to determine what must be included.
   • Will this be its own policy, or embedded in an existing MDE procurement/replacement policy?
     • If embedded in an existing policy, include vendors offering accessible on any allowed vendors list.
4. Develop processes to ensure that when any existing inaccessible equipment is replaced, they are replaced with accessible-compliant equipment until full scoping is met. These processes can be system- or clinic-level.

Materials and Resources

• Appendix 5.1: Accessible MDE Implementation Team
• Appendix 5.3: Accessible MDE Implementation Planning Worksheet
• Appendix 5.6: Accessible MDE Sample Priority Replacement Plan
• Appendix 5.7: Accessible MDE Standards for Procurement and Replacement
• Appendix 5.8: Accessible MDE Location Decision Making Tree

Part B: Equipment

Reference your completed Needs Assessment and inventory to determine what inaccessible MDE at your organization must be replaced, what can be retrofitted, what budgets will fund this work, and how the equipment will be used.

Actions and Tasks

1. Identify equipment models that will replace existing inaccessible equipment.
   • Can any equipment models satisfy multiple requirements simultaneously? For example, if a clinic is in need of a height-adjustable exam table and wheelchair-accessible scale, purchasing a height-adjustable exam table with a built-in scale would satisfy both compliance needs.
2. Identify the accessories (i.e., patient/transfer support rails, handrails, after-market compliance kits, etc.) you will purchase for otherwise compliant equipment.
3. Identify what accommodations your organization will purchase and provide to ensure equal access to equipment that cannot be made accessible.
4. Plan how new MDE will be purchased, including which budget(s) will fund them.

TIP: Consider bulk ordering selected equipment to a central location and internally distributing MDE where needed. This can reduce shipping/freight costs or allow for purchasing agreements with vendors to lower per item costs.

5. Consider:
   • Who will purchase the necessary equipment?
   • How many of each type of equipment will each clinic/unit/department need?
   • Where will the equipment be located? Work with clinic staff to determine ideal locations or exam rooms for accessible equipment, considering the layout of the areas and staff workflows.
   • Do exam rooms meet ADA accessibility requirements so that accessible MDE can fit and be used safely in the space? Who will be responsible for making this determination? See Chapter 6: Accessible Physical Structures and Features for more information.

TIP: Wheelchair-accessible scales have large platforms and maneuvering clearances. If an exam room is too small to house it, consider moving the scale to a larger, centralized space, selecting a model that folds against the wall, or procure alternate equipment that can measure weight, such as exam tables or lifts with built-in scales.

• • How or when will new equipment be ordered? This should be built into existing MDE procurement processes.
  • How will equipment be maintained? Who will be responsible for maintenance?
  • What infection control issues need to be considered?

6. Identify who will be responsible for distributing and installing new equipment and accessories.

7. If new equipment is replacing existing non-accessible equipment, determine how existing equipment will be removed, including where it’s going, associated costs, and who is responsible.

8. Develop a timeline for equipment replacement, installation, and retrofitting, beginning with highest priority locations (see Appendix 5.6: Accessible MDE Sample Priority Replacement Plan).

Materials and Resources

• Appendix 5.1: Accessible MDE Implementation Team
• Appendix 5.3: Accessible MDE Implementation Planning Worksheet
• Appendix 5.4: Accessible MDE Costs and Funding
• Appendix 5.6: Accessible MDE Sample Priority Replacement Plan
• Appendix 5.7: Accessible MDE Standards for Procurement and Replacement
• Appendix 5.8: Accessible MDE Location Decision Making Tree

Part C: Clinic Workflow Design

Decide how accessible MDE will be used within a clinic. Aim to integrate the process into existing clinic and system-level workflows when possible.

1. Identify how patients will be asked about their need for accessible MDE.
2. Identify local barriers and facilitators to utilizing accessible MDE, such as staff readiness.
3. Identify how staff will ensure accessible MDE is available to patients who need it during their scheduled appointment time.
   • For example, identify who will be responsible for scheduling a patient in an exam room with a height-adjustable exam table.
4. Determine how staff will coordinate when one or more people are required to assist a patient.
   • For example, two staff members may be needed to safely transfer and/or position a patient properly on an MRI bed.
5. Determine what can and cannot be adapted in the standard process for providing care via accessible MDE.
   • For example, if the height-adjustable exam table(s) is in use with another patient during the appointment time, is there another accommodation, such as a ceiling-mounted lift, that can be used to ensure the patient with a disability receives the same quality of care as someone without a disability?
6. Determine the resources needed to utilize accessible MDE.
   • For example, you will need to dedicate time for staff to complete trainings, such as use of equipment or transfer training.

Materials and Resources

• Appendix 5.9: Accessible MDE Process Map
• Appendix 5.11: Accessible MDE Barriers and Strategies
  
  

Having accessible equipment alone is not enough to ensure that (1) staff will use it and (2) patients in need will actually have access to and receive care with the equipment. Ahead of implementation, consider the following actions to ensure staff, patients, and your organization’s systems are prepared to provide care using accessible MDE.

Actions and Tasks

1. Purchase new equipment, accessories, and items needed for accommodations.
   • Establish relationships with vendors.
2. Determine how clinicians and staff will be made aware of where accessible MDE is located.
3. Ensure that relevant staff are prepared to ask about and document patient accessible MDE needs in the electronic health record (EHR). (See Chapter 2: Documenting Disability Status and Accommodation Needs↗ for additional information).
4. Determine who will provide consultation to assist with training for providers and staff on how to use accessible MDE.
   • This person (or people) will offer expert guidance, feedback, and problem-solving to a site longitudinally.
5. Identify or create resources and trainings on how to use accessible MDE for staff and providers.
   • Determine how trainings may differ depending on staff roles.
   • Determine frequency of training/re-training (e.g., one time, annual, etc.)
6. Identify or develop tools and reminders to encourage use of accessible MDE.
   • Pictures and diagrams can be helpful. For example, post photos or diagrams in an exam room of its intended layout so that staff can maintain access to the equipment.
7. Decide how accessible MDE will be maintained in the clinic or unit. Aim to integrate the process into existing clinic and system-level workflows when possible. Consider:
   • Who in the facility will be responsible for observing and tracking repair/replacement needs?
   • What is the process for clinic staff to request a repair/replacement equipment?
   • What budgets will fund repairs/replacements?
8. Identify or develop patient-facing education materials to disseminate information on accessible MDE available.
9. Determine how success will be defined for using accessible MDE, including appropriate metrics (e.g., was accessible MDE used when needed; fewer missed appointments; reduced number of complaints, etc.).
   • Specify how you will monitor or assess whether patients are receiving care via accessible MDE.
   • Develop an evaluation plan to reflect your definition of success.

Materials and Resources

• Appendix 5.3: Accessible MDE Implementation Planning Worksheet
• Appendix 5.9: Accessible MDE Process Map
• Appendix 5.10: Accessible MDE Frequently Asked Questions
• Appendix 5.12: Accessible MDE Monitoring Progress and Adaptations
• Appendix 5.13: Accessible MDE Training Resources
• Chapter 2: Documenting Disability Status and Accommodation Needs↗

Follow the timeline developed in Step 4 to replace or retrofit equipment in order of highest to lowest priority locations. Roll out the implementation plan to use accessible MDE.

Actions and Tasks

1. Track and communicate rates of accessible MDE use to responsible individuals (i.e., clinic leadership, those scheduling patients where accessible MDE is located) and the implementation team.
2. Track any changes to patient outcomes (i.e., rates of missed or cancelled appointments, cancer screening rates, quality of imaging) or patient complaints. Communicate those to responsible individuals (e.g., clinic leadership, system leadership, staff working in these spaces, compliance) and the implementation team.
3. Review site-level data to determine if and where additional equipment is needed.
4. Make and document all needed adaptations.
5. Conduct Audit and Feedback, an implementation strategy that includes providing site-level staff, provider, or team-level data on use of accessible MDE to those assigned to perform tasks.
   • For example, create a progress chart to display in a staff breakroom.
   • This Audit and Feedback article↗ details how to employ the strategy.
6. Recognize high performing staff, clinicians, or specific clinics or sites to celebrate improved patient experience, care quality, or high utilization rates.
7. Gather feedback from clinicians on how the use of accessible MDE informs care. Clinicians may become strong advocates for accessible MDE once they experience how the equipment can improve care and their experience providing it.
   • For example, when patients are more easily transferred with the assistance of equipment, staff may experience less difficulty and injury.
8. Continue to solicit patient feedback and make adjustments to your implementation plan and protocols for equipment replacement as necessary.

Materials and Resources

• Appendix 5.10: Accessible MDE Frequently Asked Questions
• Appendix 5.11: Accessible MDE Barriers and Strategies
• Appendix 5.12: Accessible MDE Monitoring Progress and Adaptations
• Appendix 5.13: Accessible MDE Training Resources