How useful is preventive maintenance (PM) in reducing or eliminating equipment failures? Not nearly as much as it could be, insist a growing number of biomeds across the country.

Accordingly, many in the profession are seriously rethinking their PM processes and are searching for ways to get a better return on their investments of time and energy.

Ken Maddock, corporate director for biomedical technology support at Baylor Health Care System in Dallas, defines the problem as one of “too many people hung up on the idea that PM is merely a process of conducting inspections and replacing worn parts in accordance with a predefined schedule. But those activities are in reality only a small part of what a good PM program today ought to be about. If you continue making inspections and proactive replacements the main focus of PM without verifying that you are having an impact on failures, you may be wasting a lot of valuable time.”

Correlation Needed
Maddock argues that, for PM to make a stronger contribution to the prevention of equipment failure, biomeds must first ascertain the correlation between scheduled inspections or servicing, and the rates of malfunction.

“When you evaluate equipment-performance data, you are going to be able to begin to see whether you are achieving actual prevention with your PM program,” Maddock explains. “I’m not saying that replacing filters, rubber hoses, belts, and the like should not be done—they should be. What I’m saying is that preventive maintenance activities should be based more on    actual failure data than on theoretical possibilities. Traditional PM programs do not typically incorporate an ongoing review of all failure data and generate actions based on that review.”

“Collected data on the nature and frequency of ‘findings’ from the PMs and on the frequency of device failures that can be attributed to a lack of timely PM, if analyzed properly, should permit those PM procedures that are genuinely useful in averting equipment failures to be identified,” contends Malcolm Ridgway, PhD, CCE, senior vice president for technology management at Chatsworth, Calif-based MasterPlan Inc, one of the nation’s largest independent service organizations. “Those would be the ones to concentrate your time and energy on, and the remainder can be assigned a low priority.”

Ridgway is active with the American Society for Healthcare Engineering (ASHE). For the past several years, he has participated on an ASHE work group assigned the task of investigating “more up-to-date maintenance practices in other industries, such as reliability-centered-maintenance, to determine whether there is an opportunity to improve the way we do things,” he says. “The work group has recently been renamed the ASHE Maintenance Practices Task Force and is charged with developing an updated version of the organization’s Maintenance Management for Medical Equipment Manual, last revised in 1996. The first draft of the update has just been completed and is being routed for review, comment, and amendment prior to its publication. We hope to release it in early 2007. It will be offered online rather than in hard-copy format so that, as new information becomes available, the newest material can be conveniently added. Each time users access the manual online, it will be in real time, meaning the information accessed will always be the latest there is.”

To be found in the updated Maintenance Management for Medical Equipment Manual are new ideas Ridgway believes will be helpful in trying to “rationalize the long-standing debate about the value of the industry’s current PM practices. The document attempts to define some relatively simple metrics for PM effectiveness, create a practical tool to standardize and facilitate the collection of maintenance-effectiveness data, and create a survey tool to collect maintenance-effectiveness data by device type.”

Practical PM
Efforts to eliminate equipment failures through a more broadly defined PM process can include actions that take into account where and how a device is used, Maddock indicates.

“For example, you might have a piece of equipment mounted right by a return air vent, which means that dirty air is  likely being pulled through the device, causing dust to build up inside,” he recounts. “The solution would be to mount the device in a location away from that air vent. Or, if you have cart-carried equipment that’s prone to collision with corridor walls because the equipment is too near the edge of the cart, you could just move the equipment closer to the cart’s centerline.”

Maddock recommends giving thought to whether equipment should be replaced with a product from another manufacturer—a step that counts as PM in the grander sense. “It’s a fact that one vendor’s products may be more susceptible to failure than another’s,” he says. “If you find that devices sold by one manufacturer fail at a much higher rate than similar devices from another, you should push to make the switch to the more reliable manufacturer.”

Besides, replacing a trouble-plagued piece of equipment may make better economic sense than trying to repair it. “Yes, a repair will be maybe half the cost of replacement,” Maddock continues, “But then it could turn out that the repair results in a life cycle half that of what a new unit would have yielded. In other words, repair could be the wrong choice in some situations because, in the end, it won’t be worth the expense.”

Another way to head off failures is by conducting PM in the manner of hospital rounds—that is, at some point during the workday you take a tour of the floors, units, and departments of your facility where mission-critical equipment is in use and have a look around, the objective being to identify trouble long before it can develop into a major problem.

Maddock says there are two types of PM rounds. The first involves equipment only. “If you conduct equipment rounds, you may be able to detect cables that are popping out of their strain-relief, membrane switches that are cracking, and displays that are going bad, along with quite a few other observable problems that you can then remedy,” he proffers.

The other form of rounds pertains to people. Here, the biomed pays a call on the various clinical managers and other users to inquire about any problems they might be encountering with the equipment.

Says Maddock, “In addition to collecting useful insights about equipment performance, this is also an opportunity to build or expand relationships, and to find out what new services the various units are planning to offer or what existing services they are planning to enlarge. This is where you might find out about training needs, about random failures that are corrected by nothing more than a reset and don’t require biomed intervention, about equipment that the staff does not like to use because it is not user-friendly, and so on.”

Involve Clinicians
Laura Barclift, CPCU, chief programs officer at The Remi Group in Charlotte, NC, makes the point that biomeds can do a better job with PM if they also take into account equipment utilization. “The more a piece of equipment is used, the more frequently it should be PM’ed, possibly even more frequently than the schedule recommended by the manufacturer,” she suggests.

Which leads to another problem: Sometimes, a PM must be performed on a specific piece of equipment for which there is no original equipment manufacturer (OEM) procedure available. The solution, suggests Ridgway, is to consult the generic procedures available from ECRI (formerly known as the Emergency Care Research Institute) or those from the 1996 ASHE maintenance manual.

“These generic procedures don’t get into the specifics of tasks,” he cautions. “For instance, they might only say something like ‘check battery’ but not give the specifics of how to open the battery box, as might the OEM’s procedure manual. But they at least tell you what needs to be done.”

Then, too, it occasionally happens that a piece of equipment due for a PM as mandated by the Joint Commission on the Accreditation of Healthcare Organizations’ current “environment of care” standards either cannot be located or cannot be taken offline for an inspection. Here is how Ridgway’s enterprise handles this situation: “If we find a device is in use and can’t be taken offline at that time, we put a tag on it that says, ‘This item is due for a PM; as soon as it becomes available, please call us.’ Then, when we receive the call, we come back and do the PM. As to devices that can’t be found, at the end of each month we send the user department an all-points bulletin containing descriptions of the missing items and a request for clinical personnel to be on the lookout for them. The clinicians are quite cooperative in helping us round up the strays so that we can then do our PMs.”

A common thread in Ridgway’s answers to the problem of missing or temporarily non-PM-able equipment is that some responsibility for rectifying the   matter rests with the clinicians, not exclusively with the biomeds. This shared   ownership of responsibility for making sure PMs occur carries over into a PM-scheduling technique Ridgway’s team has developed.

“We affix to each piece of equipment a Department of Motor Vehicles-style, color-coded tag that gives the month and year when its next PM is due,” he says. “We’ve educated the clinical staff to call us if they pull a piece of equipment out of the closet and see its tag is expired. We’ve educated them about the risks of continuing to use equipment that has gone beyond the PM date shown on the tag.”

Having An Impact
Barclift, whose company offers financial and management oversight of the maintenance services provided by a hospital’s choice of OEM or third-party vendor, congratulates biomeds nationwide for doing a good job on PM, whether relying on old or new formulations.

“Biomeds are not just getting PMs done, they’re doing them correctly and thoroughly,” she says. “And that’s important because, ultimately, it’s all about the uptime of the equipment, which, in turn, results in optimum patient care.”

Certainly, that is what Maddock and his biomed colleagues are trying to accomplish at Baylor.

“Our goal is to reduce failures; that’s what we can impact,” he says. “Our failure-reduction program using the broader definition of PM is still being developed. But, as we get our program in place, I would expect to see some statistically significant decrease in failures. Currently, we average about 3,000 unscheduled work orders a month. If it turns out that our program has a 10% impact, that would be a reduction of 300 unscheduled work orders a month. I’m not saying we could have a 10% impact, but if we did, and it takes us 30 minutes on average per work order, that could amount to a time savings of 150 hours of labor each month. That’s time we could be spending on any number of other things that would add even more value to our hospital.

“Bottom line, the old way of looking at PM is too narrow,” he says. “The goal should be to make the process more comprehensive, and formalize what has historically been a hit-or-miss method of incorporating data review into the process. I think we’re making good progress on that front.”

Rich Smith is a contributing writer for 24x7.