New research looks at the factors behind effective maintenance and equipment performance.
Interview by Alyx Arnett
While maintenance is essential to keeping medical devices available and safe, the factors that most influence maintenance performance aren’t always clearly defined.
A recent study explores how maintenance decisions are made and which factors have the greatest impact on equipment performance. Using survey data and statistical modeling, the researchers identified the most influential drivers of maintenance outcomes.
“Certain equipment holds paramount importance in sustaining patients’ lives, and any failure in their functioning can swiftly escalate to life-threatening situations,” says Mahmoud Awad, one of the study’s authors.
In this research Q&A, Awad discusses how maintenance strategies are developed, the role of leadership and infrastructure, and what healthcare organizations should consider when evaluating their maintenance programs.
Read the study, “Medical equipment maintenance performance and influential factors,” in the Journal of Quality in Maintenance Engineering.
Q: What prompted you to study medical equipment maintenance practices?
It was estimated that the global medical equipment maintenance market would increase from $45.2 billion in 2021 to $74.2 billion by 2026. This rise is driven by the growing patient population and heightened awareness of early diagnosis. This highlights the criticality of well-planned maintenance decisions, efficient management practices, and adherence to safety standards when dealing with medical equipment.
However, despite the criticality of medical equipment to health—and despite high operational cost—the availability of this equipment is low in some medical clinics.
Reviewing current literature indicates that there is minimal research conducted in the context of medical equipment maintenance decisions in general and within developing countries in specific. The objective of this research is to attain an in-depth understanding of medical equipment maintenance decisions, identify the key factors that influence the performance of the devices, and provide recommendations to improve the performance of medical equipment through better maintenance decisions.
Q: What were the key findings?
The findings highlighted the importance of strategic decisions at the development phase of the maintenance program on maintenance performance in terms of availability, cost, and mean time to repair. The results also show that maintenance strategy has a direct impact on the maintenance crew and the design of delinquent work orders, which, in turn, impacts the efficiency of maintenance personnel.
Furthermore, the results show that maintenance strategy impacts infrastructure, which, in turn, impacts performance. In addition, strategic decisions impact the categorization of resources, encompassing human, financial, and physical resources necessary for performing proper maintenance. The physical resources and maintenance information system are key enablers for achieving an effective maintenance program.
Q: Your analysis found that strategic decisions and infrastructure were the most influential factors affecting maintenance outcomes. Of these, what specifically makes the biggest difference?
Active management involvement in strategic maintenance decisions and daily operations can tremendously improve current practices. Such involvement will motivate the maintenance crew to outperform their tasks, participate in decision-making, and elevate management’s awareness of available resources and existing gaps and challenges.
The findings indicate that strategic decisions, such as the maintenance method, the contract planning for maintenance (in-house, OEM, or contractor), the planning of outsourced maintenance contracts, and the budget allocated for maintenance, significantly impact maintenance performance.
In terms of strategic decisions, many strategies are focused on buying the equipment and outsourcing the maintenance to the OEM or an external contractor. This is not in line with other industries like as aerospace or construction, where the focus is on leasing the service rather than buying the equipment. Moreover, condition-based and predictive maintenance are proven to be more efficient than preventive. However, to transform maintenance to condition or predictive, you need adequate infrastructure to collect data, analyze it, and make decisions, which is lacking in many organizations.
Other decisions include investing in improving the capabilities of the in-house maintenance crew. This is justified by the impact of strategic management on the maintenance crew. The decisions can be related to the expertise of the crew, the training and development programs, and how involved the facility maintenance crew should be regarding the equipment.
Moreover, a dedicated digital platform specifically for medical equipment inventory management and maintenance management to enhance performance.
Q: The study suggests that management influences equipment performance indirectly. What role should hospital leadership play in supporting effective medical equipment maintenance programs?
Although management decisions did not have a direct impact on performance, they have an indirect impact through the strategic decisions and infrastructure investment. Management has a key role in several strategic and tactical decisions, such as selecting key performance indicators and setting objectives, choosing the maintenance provider (in-house, outsourced), and determining the overall maintenance strategy.
Unfortunately, some managers perceive maintenance as a burden and a cost center. Managers should be aware of the significance of maintenance to availability and appreciate upfront investments to design for maintainability.
Q: You observed variations in maintenance practices depending on device functionality levels. How should HTM teams approach maintenance planning differently for critical versus lower-criticality devices?
Yes, variations in maintenance practices and overall performance between devices were profound. For example, life support devices and imaging had high availability (>85%). Conversely, equipment used for treatment, prevention, and diagnostic purposes had lower availability.
In terms of the overall cost of maintenance, most respondents (more than 90%) believe that their organization’s maintenance cost for life support and imaging is either high or very high. Alternatively, the current maintenance costs were considered fair-high for treatment, prevention, and diagnostic equipment.
Several recommended actions can be made to enhance the current practices:
- Utilize predictive maintenance for the more critical devices and use preventive maintenance for the less critical devices. Predictive maintenance will greatly benefit performance, as it allows for tracking the predicted health status of the devices and scheduling maintenance based on real-time data analysis. Real-time notifications open the door for a global approach where the data can be communicated amongst different manufacturers, sharing break events and factors that deteriorate the device health conditions, thereby further enhancing predictive maintenance schedules.
- It is highly recommended to assign high-critical devices to OEM and less-critical ones to third-party service providers. OEM assignment for high-critical equipment ensures specialized and manufacturer-centric care, aligning with best practices to guarantee uninterrupted functionality and compliance with stringent regulatory standards.
- Since a major portion of maintenance is outsourced to OEMs or third-party providers, maintenance performance can be improved by carefully crafting maintenance contracts that prioritize the service levels delivered by including service level targets. The emphasis should be on assessing the quality of service provided through maintaining the medical equipment, rather than the quantity of maintenance performed. These contracts should cover the precise delineation of work scope, establishment of performance standards, definition of service level agreements, incorporation of quality assurance protocols and reporting mechanisms, assurance of regulatory adherence, and formulation of conflict resolution procedures.
- In-house maintenance can be an effective alternative if the maintenance team is well-equipped, well-trained, and motivated. This can result in reduced maintenance durations and increased device availability, ultimately contributing to improved patient outcomes.
Q: The paper highlights the importance of IT tools for monitoring and analyzing equipment performance data. What types of data or systems should HTM teams prioritize if they want to make more informed maintenance decisions?
Proper investment in infrastructure, including IT tools, has a strong positive impact on performance. Achieving optimal maintenance and economic benefit can be attained by implementing a management information system that assists in quality management and control. Such a system will help in the monitoring and management of medical devices and ensure that the quality of medical devices has reliable support.
Utilizing IT tools can help in identifying patterns that support improving current maintenance practices, standardizing documentation to ensure consistent performance among maintenance personnel, and promoting effective communication and collaboration among all relevant parties.
Although IT tools will help in all maintenance approaches, they have a critical role in the success of utilizing condition-based and predictive maintenance.
Q: What steps could healthcare organizations take to improve maintenance outcomes and equipment reliability?
The findings obtained from the analysis indicate several recommendations worth examining. Firstly, maintenance should be part of the strategic planning of the medical organizations. Setting the right maintenance objectives, selecting the right approach, and selecting the right maintenance crew (in-house, OEM, external) should be part of the strategic plan. It is recommended to uphold the existing maintenance decisions for highly critical devices and improve decisions related to less critical devices.
This entails meticulously planning maintenance contracts that consider service levels related to availability and mean time to repair. It also involves developing procurement procedures that encompass the entire life cycle of the equipment.
Secondly, the study highlights the association between a device’s criticality and acquisition cost, particularly in the context of life support and diagnostic imaging equipment, and their impact on the allocation of maintenance resources and oversight responsibility. A high level of criticality and high initial investment affect the budget allocated for maintenance and the responsible party for maintenance. Less expensive and less critical devices are often maintained either by in-house personnel or through third-party contracts with varying terms and cost structures.
The differences in maintenance method and provider have a noticeable impact on both device availability and repair times, as evident from the results.
Qualitative research results show that strategic decisions and infrastructure supporting maintenance within the medical facility have a direct effect on the performance of medical equipment. The utilization of IT tools for monitoring and logging data is crucial, as it aids in the analysis and assessment of performance, guiding decisions for corrective actions.
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Alyx Arnett is chief editor of 24×7 Magazine. Want your research featured? Email [email protected].
