Designing a ‘Frugal Servicing’ system for African hospitals

The Challenge

Repairing medical equipment in Africa is tough – there is a lack of local skills and spare parts, and Philips – and its competitors – struggle to provide service contracts because of the expense of sending engineers across the continent. For my graduation thesis, I was approached by Philips Africa to help build a remote servicing system for its medical imaging equipment. Remote servicing (or ‘teleservicing’) involves an expert engineer at a head office remotely guiding a local technician with maintenance or repair of equipment.

The Outcome

Extensive user research resulted in the design of a remote-repair interface which would allow remote experts to help hospital technicians on the ground. The research also discovered existing grassroots networks of local technicians who share knowledge and source materials through social media, and create their own equipment management systems. An app – Cadence – was developed to join these existing grassroots networks with the remote-repair interface, connecting manufacturers with customers of donated and second-hand equipment for the first time, and opening a large new market for equipment servicing. A low-bandwidth embodiment of the app has been developed into a patent-pending technology.

Skip to: System Analysis, Researching Existing Systems, Researching Informal Networks, App & Service Design

Cadence: Medical Equipment Breakdowns & ‘Frugal Servicing’

Simplifying a messy system

Because the market segment of Philips service contracts is so small, I wanted to understand the system of medical devices in Africa as a whole, to see different ways this segment could be expanded. I interviewed a range of stakeholders – biomedical engineers, medics, charities involved in donating equipment, 2nd-hand equipment vendors and equipment manufacturers – to get an idea of how the system functioned.

System map what is going wrong.png

All medical equipment comes from a single set of sources (manufacturers), and gets to the end user in various ways, some more direct than others. A small number of African customers – high-end hospitals – buy directly from the manufacturers. Some purchase second hand, but the vast majority receive equipment in the form of donations.

Repair service provided by the manufacturers themselves is rare, even among those who buy directly from them. Slightly more common is service provided by licensed 3rd-parties, but most hospitals rely on ad-hoc (often unreliable) service from local technicians.

Key insight: Most hospitals have no capital for new equipment, but still need servicing. Can a low-cost, ‘frugal’ remote servicing option expand the service market to hospitals with 2nd hand and donated equipment?

Rather than simply expand service to more Philips customers, I saw the opportunity to use low-cost remote servicing to expand service provision to the much larger group of customers who had never bought a machine directly from Philips.

User studies: With and without

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User studies were performed within Philips, to see how existing forms of service (including remote service) could be improved. Users outside Philips’ direct contact – those who got their equipment 2nd-hand or through donations – were also researched to see how they could be reached as a new market for remote service.

What happens with service?: Shadowing maintenance engineers

To understand the interactions involved in existing repair service systems, I performed observation studies shadowing Philips service engineers in the field in the Netherlands, South Africa and Egypt. Before this, I completed a basic service engineer’s training course so I could get to grips with the technical details of the job. I observed both in-person repair and existing remote service (mostly done by phone) to gather a set of requirements for a good remote repair system.

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Users shadowed in the field

Analysis & Insights

Contextual inquiry methods were used to map the work practices of users involved in remote repair, and empathy personas were created to capture their environment, experiences, challenges and goals.

Empathy Profiles-01
example empathy persona: radiologist

A key finding was the amount of inefficiency caused by information loss between the different users involved. Descriptions and instruction were hard to describe over the phone (especially for medical, non-technical users), and when a case was passed between different engineers, incomplete briefs were given and troubleshooting steps repeated. This implied that transfer of information through images was essential for an improved remote service system.

difficulties in remote context.png
overview of information loss problems

A second insight was the amount of task-switching remote engineers had to perform: both between different cases, and also, on a single case, between communicating with the customer and colleagues, looking at reference information, reviewing information about the history of the machine and recording their own notes. The engineer’s workspaces are not currently optimised for this workflow, leading to inefficiency and frustration.

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example of remote engineer’s workspace

A design brief (below) was formulated for a system to improve remote communication in as it exists today:

vision for product service system

What happens without service: interviews & observation with indirect customers

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Interviews and user studies were performed with stakeholders who were outside the scope of commercial manufacturers, and so represented a new customer segment that remote service could be supplied to.  In-house biomedical engineers and medical users were interviewed, as well as dealers and donators of second-hand equipment.

The most common problems identified were diversity of equipment and lack of information. Since equipment was acquired in a piecemeal fashion, most hospitals had many different brands, models and ages of equipment, making it difficult for hospital technicians to build up knowledge on a particular machine. Since none of the equipment had service contracts – and some not even user manuals – technicians had developed grassroots networks to share and distribute knowledge online.

example from online network of biomedical technicians, Uganda

Whatsapp groups used by hospital technicians and biomedical engineers in Uganda were ‘observed’ online, and were shown to be an important source of technical advice and places to source spare parts.

Unofficial online repositories of instruction manuals – such as the one shown below – were an essential resource for hospital technicians, though were often legally blocked by manufacturers.

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example of information repository

Another common problem in less well-resourced hospitals was the need for an adequate inventory management system to keep track of repairs and equipment condition, something particularly important with such a variable stock of equipment. Technicians improvised their own spreadsheet-based systems (see below) but these were desktop-bound, insecure and not standardised.

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hospital technician’s inventory system

These insights led to the generation of a design vision (below) for how a servicing tool would need to help these indirect customers:

Biomedical engineer research visioning.png

Design: Combining the Systems

The research showed two sets of requirements for a repair servicing system. On the company side, a better interface and better transmission of information could improve remote repair to be a sufficient replacement for in-person repair. On the customer side, a service which provided added value to donation/2nd-hand customers (inventory management, basic repair information) could bring them away from informal networks and on to an official remote servicing platform.

These led to the creation of Cadence, a tiered servicing platform which consists of an app for local technicians, a workspace for remote engineers, and communication channels between the two.

Tier 1: The Biomedical Technician’s App

Biomedical engineer/hospital technician’s portal to Cadence includes an inventory management system, allowing them to quickly record information about their stock and update it with repairs and upgrades, and a connection to a network of other technicians, sorted by machine type and location.


biomedical app 1
entering a machine into inventory and updating repair history
biomedical app 2
accessing a chat network associated with a machine model

In order to compete with existing grassroots networks, the Technician App operates as a freemium service: technicians can access the basic inventory and network services for free, and pay for additional ‘plug-ins’ such as official remote servicing from manufacturers and in-depth information.

Manufacturers have access to information shared on the Cadence network about their machines (valuable for improving their repairability), and can use it as a platform to identify indirect customers and and offer them parts and services. In exchange for these benefits, manufacturers provide a minimum amount of repair information on the ‘freemium’ Cadence portal.

biomedical app structure 2

biomedical app 3
accessing basic repair information on a machine model

Tier 2: The Engineer’s Workspace

If additional remote service is required for a persistent problem or a particularly important machine, technicians using the free Cadence app can request remote service at a fixed or contract cost from manufacturers. This opens a communication channel between their app and a manufacturer-side Engineer’s Workspace optimised for visual, effective remote troubleshooting.

biomedical app structure 3

user fills out troubleshooting checklist

Cadence engineer workspace 1.jpg
troubleshooting information is directly sent to an available remote engineer and appears on his workspace
Cadence engineer workspace 2.jpg
remote engineer can use tabs on the left to flick between different information sources, including instruction manuals and case histories, without navigating away from the customer conversation
Cadence engineer workspace 5.jpg
remote engineer can browse library of instructional images and send directly to customer
Cadence engineer workspace 6.jpg
remote engineer can leave private notes to himself and other engineers directly in the chat (ensuring all information is chronological and in the same place), and ”star” messages which are particularly important
Cadence engineer workspace 7.jpg
if the remote engineer needs additional expertise, he can pass the case on to a fellow engineer, who is directly added into the chat

Tier 3: A Multi-Vendor System

In order for Cadence to effectively compete with grassroots methods and networks, it needs to be a one-stop portal for repair of all the machines in a technician’s inventory. This means that multi-vendor support (beyond Philips) is essential. The Remote Engineer’s Workspace and access to technicians through the Technician App can be licensed out to 3rd parties – not only other vendors, but also NGOs or 2nd-hand dealers who wish to provide low-cost service support. Tiered levels of service contracts with different levels of proprietary information could be sold.

biomedical app structure multivendor2

System Overview

Cadence Design spread-01

Cashflow and User Profiles

Final Outcome

Aspects of the Cadence system are being incorporated into Philips remote servicing for imaging equipment in Africa, including a patent-pending embodiment of the system for low bandwidths.

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