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Received April 2, 2019, accepted September 15, 2019, date of publication November 3, 2019

Assistant Multi-Parametric Method to the 
selection in the Process of Incorporation of 
Hospital Equipment
By A. M. Marciano1, L. S. Schneider2, J. Pedroni2

1Moinhos de Vento Hospital/ Clinical and Hospital Engineering, Porto Alegre, Brazil
2Moinhos de Vento Hospital/ Hospital Engineering, Porto Alegre, Brazil

ABSTRACT
This project aims to demonstrate a multi-parametric method of hospital technology comparison. The main goal was to 
develop a method to assist the clinical and hospital engineering team, in the process of acquisition and incorporation of 
medical-hospital equipment, to be used as a tool in the comparison stage of brand options and models of available equip-
ment in the market. The method is composed by groups of criteria or characteristics that can be evaluate referring to the 
technologies to be compared. This method was applied to compare autoclaves and disinfecting machines that would be 
purchased to install in a Material Central and Sterilization in a hospital in the south of Brazil. As a result, it was obtained 
the classifications with the final scoring referring to each brand and model of technology. It also contributed significantly 
to assist the choice definition of the equipment, considering the hospital and technology profile, as well as the require-
ments and expectations of the multi-professional technical group of evaluators and users. 

Keywords – Multi-parametric Method, Hospital Equipment Comparison, Selection Assistance, Incorporation Process. 
Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION
Where technologies are evolving with great speed, new 

priorities in the medical device incorporation process 
are emerging. Medical equipment must correspond to 
local clinical needs, as well as be accurate and reliable 
in the environment for which they are used, in order to 
generate safety and effectiveness for health care.1 Medical 
device incorporation as defined by Wang “Is the entire 
process of absorbing technology into a health system or 
organization through planning, selection, and acquisition, 
with emphasis on its dependence on technology policies 
and continuous feedback from technology management.”2

The acquisition process of hospital equipment requires 
a defined criteria to make the comparison possible between 

different equipment from different brands and models and 
to the ensure ease of incorporation in the hospital for a 
specific application. A few items that must compose the 
technical specifications list of the equipment to be pur-
chased, are the characteristics of use, functioning principle, 
nominal capacity, physical dimensions, indication mode 
and parameter record, outputs and inputs, accessories, 
construction characteristics, safety, etc.3

Most hospitals (75%) do not have any decision-making 
tools such as multiple criteria decision analysis. Table 1 
represent the categorization of different criteria used 
by hospitals to select a medical device by the degree of 
importance or the applied weight.4

http://www.globalce.org
http://globalce.org
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Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019  8

An alternative to comparison of hospital equipment 
is to use a matrix composed by the models of the equip-
ment and its technical characteristics with the possibility 
of defining the weights of each characteristic and grade. 
After finding the results of each characteristic and mul-
tiplying the weight by of grade given by the specialists in 
the evaluation, it is possible to obtain the final scoring for 
each brand and model of the evaluated equipment. The 
characteristics suggested in this method are reliability, 
precision, repeatability, safety, maintainability, inter-
changeability, performance, and cost.5 Another options of 
characteristics that could be included in the comparison 
are the estimated price of parts, the existence of the part 
in national market, the stock list of the provider, the ease 
of importing parts, the proximity of the provider, stocking 
costs, reliability of the provider, and stoppage cost of the 
equipment by lack of parts.6

In the process of the comparison matrix development 
it was observed that a model should grade, weight, and 
categorize the features. This comparative matrix has three 
categories. The technical evaluation is composed of: preci-
sion, repeatability, maintainability, safety, performance, 
reliability and ergonomics. The clinical evaluation category 
includes the operation features, alarms, and display. And 
the third category, the financial evaluation accounts for 

the cost of the equipment, accessories, contract, and cost 
of the test instruments.7

In this line of categorization, there is also a spread-
sheet that proposes additional categories that can be 
evaluated, them being: Safety (by mechanical and electric 
features), human engineering (design evaluation criteria, 
ease of maintenance, maintenance instructions, etc.), 
users experience (clinical engineering, doctors, nurses, 
and reports from other hospitals that have the referred 
equipment already evaluated, as a way of benchmarking) 
and other factors (such as standardization, familiarity). 
In this method, besides grouping criteria, scoring, and 
weighing, it is also suggests the weights of categories (0 
to 1) and the grades for each criteria (0 to 10).8

Health care decisions are complex and involve confronting 
trade-offs between multiple, often conflicting, objectives. 
Using structured, explicit approaches to decisions involv-
ing multiple criteria can improve the quality of decision 
making. A set of techniques known under the collective 
heading, multiple criteria decision analysis (MCDA), are 
useful for this purpose. MCDA methods are widely used 
in other sectors, and recently there has been an increase 
in health care applications.9

The technology assessment domain corresponds to 
the choice and applying of multi-criteria methods in sup-
porting the decision, such as: Analytic Hierarchy Process 
(AHP), Multi-Attribute Failure Mode Analysis (MAFMA), 
Elimination and Choice Translating Reality (ELECTRE) 
among others.10 Multi-criteria decision analysis (MCDA) 
concepts, models, and tools have been used increasingly 
in health technology assessment (HTA), with several stud-
ies pointing out practical and theoretical issues related 
to its use.11

The goal of this project was to develop a multi-pa-
rameter method to assist the process of acquisition and 
incorporation of hospital technologies which can be used 
as a tool in the comparison stage of brands and models of 
equipment available. Also, this project would contribute 
methodically and standardized a more assertive definition 
of the choice of equipment while considering the hospital 
profile, technologies evaluated, users, and applications.

TABLE 1. Categorization of Different Criteria used by Hospitals 
to Select a Medical Device by the Degrees of Importance



9 J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019

Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

METHODS

A. Development of the multi-parametric method 
of evaluation

The method was developed from the bibliographical 
research, by reading the technical specifications provided 
in the technical commercial propositions through the notes 
from hospital and clinical engineering professionals and 
is demonstrated in flow-gram in Figure 1. 

The stages demonstrated in Figure 1 were followed 
to develop the multi-parametric evaluation method of 
hospital equipment at the moment of acquisition to help 
determine the choice of model and equipment settings.

B. Presentation of the criteria (or attributes) and 
groups (or categories)

Examples of criteria and groups used to evaluate the 
technologies are demonstrated in Table 2.

The information from Table 2 generated the following 
model, disposed in an Excel spreadsheet and presented 
in Table 3.

The proposed method, was used to compare the hos-
pital equipment used in Material Central and Sterilization 
(CME) as support in the choice of autoclaves and washing 
disinfecting machines. A multi-professional group was 
created of specialists, composed by the areas of hospi-
tal engineering (clinical engineering, production and 
electric-mechanic) of CME (nursing and administration) 
and CCIH (nursing), to validate the weights and grades 
to each criterion, in agreement, considering the types 
of technology that would be evaluated. Meetings were 
organized to validate the scores.

FIGURE 1. Project development flow-gram TABLE 2. Evaluation Groupings and Criteria

Group/Category Examples of evaluated criteria

Cost
Installation, life cycle, parts, accessories, 

inputs...

Performance Productivity related factors

Provider Structure, profile, team, after sales…

Infrastructure
Infrastructure needs, utilities, electric, 

water...

Maintenance MTBF, Tx. Failures, parts stocked…

Operation/Usability
Operation, functions, facility, audiovisual 

indicators...

Safety
Applied technology, criteria, standards, 

redundancies...

Technology
Constructive material, applied technology, 

evolution, component types...



Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019  10

The spreadsheet with the criteria was sent to the three 
providers that took part in competition. They only had 
access to the criterion list, not to the groups weights. 
Excel was used to generate the results with suggested 
calculations.

Table 4 shows some examples of the criteria and catego-
ries used to compare the washing disinfecting machines.

TABLE 3. Comparative Spreadsheet Configuration
Criteria/ 
attributes

Group/ 
category Weight Option 1 grade Total grade of Option 1 Total grade of Option 2,3, ...

1

2

3 ...

TABLE 4. Examples of Criteria and Evaluation Categories

What is the annual cost of non-contract preventive maintenance 
and no MP kit in Porto Alegre?

Cost

What is the annual cost of non-contract preventivemaintenance 
and MP kit in Porto Alegre?

Cost

What is the cost of infrastructure adequacy? Cost

What is the cost of replacing the gate trim? Cost

What is the replacement cost of the resistors? Cost

What is the cost of the controller for the disinfecting machine? Cost

What is the cost of the water reuse system for the disinfecting 
machine?

Performance/Efficiency

What is the water consumption per tray (in L)? Performance/Efficiency

What is the water consumption per complete cycle (in L)? Performance/Efficiency

What is the average time of the flash cycle including drying? Performance/Efficiency

What is the average time of the instrumental cycle including drying? Performance/Efficiency

What is the average cycle time for ventilator material including drying? Performance/Efficiency

What is the time for daily water heating when the machine is cold? Performance/Efficiency

What is the size of the inner chamber (height x width x depth)? Performance/Efficiency

What is the capacity of loading in number of DIN baskets? Performance/Efficiency

What is the load capacity in number of ISO baskets? Provider

Does the company have any quality certification? (e.g. ISO 9001, 
BPF, BPAD)

Provider

Does the company have its own or outsourced technical assistance 
(representative) in POA?

Provider

Does the warranty cover the door resistances and fittings? Provider

Do you provide operation manuals in Portuguese? Provider

Do you provide technical reference manuals? Provider

Is there another differential related to the technical assistance 
structure not addressed? If so, please comment

Provider

Will the engineers and technicians attending the HMV have an 
NR-32 or NR-10 training certificate?

Infrastructure

What is the weight of the equipment? (net weight + charge) Infrastructure

What is the electric peak power? Infrastructure

What is the nominal electric power? Infrastructure

Is there a need for exhaustion? Infrastructure

Is there a need for a water treatment system? Infrastructure

Is there a need for an energy stabilization system? Infrastructure

Is there a need for a compressed air point? Infrastructure

Does the passageway have the necessary floor dimensions/resis-
tance required for this equipment?

Maintenance

What is the maximum period for delivery of the pieces in Porto 
Alegre? Inform in numbers of days

Maintenance

What is the maximum time in hours for call after call on HMV 
POA? (State whether there is difference with and without contract)

Does the manufacturer recommend preventive maintenance at what 
intervals?

Maintenance

What will be the technical assistance telephone service? Maintenance

Does the company have stock for immediate supply of parts for the 
maintenance of the products offered? Is there any part that you do 
not keep in stock? (Please attach list)

Maintenance

Allows remote access to services? What infrastructure is needed? Maintenance

In short, what preventive care will be required for this equipment? Maintenance

What are the types of maintenance contracts available? Maintenance

Can the equipment be connected to a material traceability system? Operational/Usability

Is the control display colourful? Operational/Usability

Does it have a printer / registration system? Operational/Usability

Does it send data for external printing? Operational/Usability

How is the door locking system? Operational/Usability

How are notifications and alerts displayed /viewed? Operational/Usability



11 J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019

Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

The criteria were listed according to the number 
of specifications and technical descriptions that these 
types of equipment present. This was done through the 
initial proposals received from both the suppliers and 
the technical knowledge of the multiprofessional team 
from the hospital (which listed which criteria would be 
important to evaluate for the technical comparison of 
these types of equipment). The information or data in 
Tables 4 and 5 were initially obtained by sending the 
complete spreadsheets (some criteria were exemplified 
in Table 4) to the representatives / suppliers of the three 
equipment brands that participated in the comparison. 
The spreadsheets were received, filled in, and returned 
us with the information or data of the equipment.

After receiving the answers from the suppliers, they 
were evaluated by the multiprofessional group from the 
hospital according to the information received. These scores 
were equivalent to the levels of information provided by 
the manufacturers for each criterion (according to the 
consensus of this multiprofessional group).

C. Weighing Coefficients
The goal of the replacement of sterilization and ther-

modynamic equipment was to optimize flow, increase 
productivity, and thus qualify the service of Material and 
Sterilization Center, due to the demand in elevation and 
restricted physical area. For this, the multiprofessional 
group defined that the criteria / category of performance, 
and consequently technological characteristics / category 
(which allows increased productivity with decreasing 
process times, for example), as well as usability criteria 
/ category (to facilitate the use, avoiding unavailability 
of the equipment due to doubts of use, difficulty of use 
and even misuse, were avoided). It was also defined that 
the post-sale / technical assistance category would have 
relevance (so that preventive maintenance and correc-
tive maintenance routines were the most assertive and 
performed by a technical team capable of reducing down-
time). We use AHP method to validate the consistency of 
the weights uses for each criterion.

D. How to transform qualitative criteria to 
quantitative criteria.

      The multidisciplinary group defined analogy to 
transform criteria with qualitative to quantitative an-
swers. For example, score from 0 to 5, where 0 (equals 
not shown, non-existent). Score 1 (equals little, or bad, 
weak, ... up to 5 (equals a lot, good, strong, ...)

RESULTS 
With the scores inserted a spreadsheet summarizing 

the final results was generated (Table 5).
The weight for the cost-related criteria group was 

15%. And as explained earlier, the initial goal was to in-
crease productivity, and from this, given relevance to the 
criteria and groups, that would impact on productivity. 
The groups with the highest weights (with 15%) were 
the cost criteria; Performance / Efficiency; Maintenance; 
Operation / Usability and Technical / Technology. It was 
also observed that the acquisition and lifecycle prices 
were similar, varying in a small range, between the three 
options of models and brands. Thus, incorporation and 
lifecycle costs would not have a major impact on the 

What notifications appear on the display and are easyto see? Operational/Usability

What is the layout of the command? Operational/Usability

What is the layout of the display? Operational/Usability

What is the construction material of the inner chamber? Safety

Is the control display touchscreen? Safety

Are the measuring instruments calibrated? Safety

Does it have the option of two independent control systems (one for 
control and one for recording) as well as temperature sensors?

Safety

How is the door security system? Safety

What is the guarantee of the chamber? Safety

What is the construction material of the generator safety valve? Safety

What is the door type? Safety

What is the spray cover of the spray arms? Technology

What is the thermal dissipation? (Wall thickness and insulation 
type)

Technology

What is the construction material of the control panel? Technology

What is the construction material of the water pump? Technology

What is the electrical resistance construction material? Technology

What is the printer type? Technology



Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019  12

organization, if one or the other brand (among those 
compared) was chosen.

After generating the results an opinion was issued to the 
Purchases/Supplies sector of the hospital who performed 
the final scores for each brand/model of participating 
equipment. The acquisitions were made considering the 
best scores resulting from this method.

The deal was closed in the third trimester of 2016. The 
equipment arrived in the first trimester of 2017 and the 
installing was finalized in May of 2017. The machines are 
in initial process of use after going through installation, 
validation, performance, calibration, and operational 
training of the users and technical team. The technical 
trainings are scheduled for June/July of 2017.

DISCUSSION
Not only was the method model creation and definition 

laborious, so too was assigning the criteria (which were 
very extensive) and receiving the information from the 
providers/representatives. The companies, in general, 
don’t know all their products’ information. All companies 
needed to request information from their respective in-
dustries. These factors took a long time and delayed the 
comparison process.

It also required a lot of attention, time, and dedication 
to include the definition of weight average and scores to 
the criteria. Depending on the weight averages and scores, 
scales the differences in final scores became very tenu-
ous. It was also necessary to define qualitative scales to 
support the quantitative scales. However, criteria don’t 
always have data (quantitative) and there are criteria 
that are qualitative. Therefore, it is necessary to trans-
form them into quantitative data. In some cases it was 
noticed that some characteristics interface/relate each 
other with others or that can be associated with more 
than one group/category.

Table 6 demonstrates the quantity of criteria defined, 
by group/category to be evaluated in the process of 
comparison.

TABLE 5. Final Results of Option Comparison By Category
Option 

1
Option 

2
Option 

3

Cost Characteristics 
(installation, life cycle, etc.) 5,8 4,7 5,0

Performance/Efficiency 
Characteristics (productivity 

related factors...)
16,2 11,9 12,2

Provider Characteristics 
(structure, profile, team, after 

sales...)
8,9 8,4 9,6

Infrastructure Characteristics 
(structure needs, utilities, 

electric, water…)
6,0 6,5 4,1

Maintenance Characteristics 
(access, MTBF, Tx., failures, 

stock parts...)
4,7 4,4 5,1

Operational Characteristics 
(operation, functions, access, 

facility, audiovisual indicators...)
7,5 6,4 6,6

Safety Characteristics (applied 
technology, redundancies, 

criteria, standards...)
8,4 7,1 6,5

Technical Characteristics 
(constructive material, 

applied technology, evolution, 
component types...)

16,1 14,6 18,9

Total 73,5 63,8 67,9
TABLE 6. Criteria Quantity Defined by Category

Group/Category Criteria Quantity 
to Autoclave

Criteria Quantity 
to disinfecting 

washing machine

Cost 22 22

Performance 21 27

Provider 24 25

Structure 18 19

Maintenance 11 9

Operation/ 
usability

19 18

Safety 14 14

Technology 29 32

Total 158 164



13 J Global Clinical Engineering Vol.2 Issue 1: 7-14; 2019

Marciano, Schneider, Pedroni: Assistant Multi-Parametric Method to the selection in the Process of Incorporation of 
Hospital Equipment

The impacts of the technology sterilization substitutions, 
washing, and disinfection, will be measured concerning 
performance, productivity, maintainability, costs and 
other pre-evaluated criteria and can be certified in prac-
tice. Other comparative-method developments, including 
criteria inspection, groupings, weights, calculations, can 
be done. Additionally, the influence analysis on the types 
of technologies to be compared, in criteria and weights 
that work as a base to the comparison.

To make validations and adjustments possible you 
must have adhesion according to the technology to be 
compared. For example, this method was applied in other 
acquisition processes, as an assistant to the comparison 
of medical-hospital equipment. It was applied by both the 
hospital engineering team, to evaluate other technologies 
like air central and medicinal vacuum, and by the clinical 
engineering team, evaluating the multi-parametric moni-
tor options and in other cases in which the results can be 
demonstrated in further projects.

CONCLUSION
The acquisition process of hospital equipment requires 

defined criteria to make comparison possible between 
different brands and models, and to point to the selection 
and consequent definition of which item will be more fit to 
incorporate in a certain hospital in a certain application.

This project proposed the development of a multi-
criterion method to support the acquisition process and 
incorporation of hospital technologies, to be used as a tool 
in the comparison stage of brand options and equipment 
models available in the market.

The project contributed significantly in the assistance 
of more assertive definitions of the steam autoclave and 
disinfecting washing machine, while considering the 
hospital profile, requirements, and expectations from 
the multi-professional technical group of evaluators and 
users. It is believed that methods like this must be devel-
oped and replicated according to the technology profiles 
of hospitals as well as their needs and acquisition goals.

CONFLICT OF INTEREST
The author declares not having conflict of interest.

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