Once again, equipment risk and maintenance proved a charged topic for 24×7 readers. Binseng Wang’s article “High-Risk Doesn’t Mean High Maintenance,” in which he argues that “the fact that a particular piece of equipment could cause severe harm to a patient does not mean it also poses high risk if its failure probability is low,” sparked a flurry of comments last week.
Matt Baretich appreciated what he called “a concise overview of this issue. Sadly, the design of medical technology maintenance programs lags far behind programs in other domains, many of which have similar potentials for harm. Believing that healthcare is unique, we have not learned from our colleagues in other fields. It’s long past time to apply these principles in our work,” he declared.
William Hyman challenged the article’s premise. “As was noted, risk=severity x probability is well known but lacks scientific rigor. There is no basis for multiplying these variables, and the scales used for each has a great effect on the outcome. With equal scales there is false symmetry—a 2×3 is the same as 3×2, but this has no actual justification. Similarly, is 4×2 really twice as bad as a 2×2?…A ‘formula’ does have some value, if you remember its limited and arbitrary basis,” he concluded.
Rick Schrenker also noted that a competing school of thought has introduced a newer model for assessing risk, which is explained in this paper by Nancy Leveson, PhD, of MIT.
J. Scot Mackeil, CBET, was more concerned with biomeds’ responsibility to perform their “due diligence.” “Regardless of how we may use statistics and calculations to analyze the question of frequency…where are the ‘real’ legal, moral and ethical boundaries?” He argued that any equipment affecting the care of patients should be examined by a biomed at least once per year. While individual components of a system may not require preventive maintenance, he said, “the system the devices create in concert may well have a completely different and much more acute risk ranking.”
Wang responded to these and other comments, noting to Hyman that the formula was intended to help readers “visualize more easily Professor Reason’s Swiss-cheese model [of minimizing risk by erecting multiple barriers to failure]. In essence, CE professionals must not focus on their own slice of Swiss cheese (i.e., equipment maintenance) but also help strengthen other slices (e.g., better equipment selection, improve operator proficiency, reduce false alarms and alarm fatigue, etc.) in order to reduce risks and improve care.”
The full range of comments can be viewed on the article page.