Approximately 50 percent of the total work time in an HTM (Healthcare Technology Management) Department is spent performing scheduled or preventive maintenance. It is an amazingly complex task, requiring an understanding of all types of equipment, the workflow in an HTM department and the normal utilization and usage of medical devices in the hospital. The PM schedule (whether well designed and implemented or poorly executed) seriously affects overall productivity and the staffing needs of the HTM department. It is the single most important task that a manager can undertake. This is why many larger departments have a dedicated PM manager. When setting up a hospital (or tweaking an existing one), there are many steps and issues to consider.
The first is to determine what scheduled maintenance should be performed on each type of equipment.
The next is to determine when that PM is to be performed.
Finally, who is to perform the PM?
I will list the steps that I go through in order (each step can be very complex and may vary depending upon you CMMS’s [computerized maintenance management system] robustness and tools).
1. Make sure that your inventory is complete. Every item of medical equipment should be assigned a unique asset number. All nameplate information should be recorded, including a standard nomenclature of the device. (I recommend using either ECRI or the FDA’s naming conventions for consistency). Each item of equipment should be assigned to a specific department using the hospital’s cost accounting codes obtained from the accounting department. This is the owner of the equipment. The location of each item should be recorded. Moveable equipment may be given a general location, such as the department’s name. Even wall-mounted monitors should be given the general department name as their locations because specifying a specific room may cause problems when items are moved. Assume that the locations entered into your CMMS are never going to be changed, because they probably won’t. An accurate but too general location is far better than an incorrect, too specific location.
2. Determine which PM procedures that you are going to assign to each type of device. Generally, PMs can be created for each unique nomenclature in your system. A typical hospital usually has in about 700 unique nomenclatures or device names. Each device name should have its unique PM procedure. We can worry about model-specific PM procedures later. Each PM Procedure should have an approximate time assigned to it, indicating the total time to complete the procedure, as well as a recommended (or default) inspection interval. This interval can be monthly, quarterly, semiannual, annual or multi-year. Each procedure may also be assigned a skill level to indicate whether a specially trained person (imaging engineer, etc.) must perform the PM.
3. Next, we need to assign one of the 700 PM procedures to the medical devices in your inventory. Many will receive only a visual inspection and a safety test. Each device is assigned a PM procedure and an estimated time to perform the PM. Hopefully, your CMMS has the ability to make group assignments by nomenclature. For items that there is no PM procedure developed for the nomenclature, you should assign them either a general electrical safety test or develop a more complete PM.
4. Assigning frequency is next. Each PM procedure typically is a monthly, semiannual or annual PM. This should be linked to each PM so that it can become attached to each item of equipment.
5. Assigning default months to specific departments or device names. When searching for equipment, most departments are better scheduled as an entire department in a single month, such as May. That way, when a person visits that department with their PM cart, they can test everything that they find, not having to skip over equipment that isn’t scheduled for that month. But some departments and equipment types are too large for a single month PM. Anesthesia machines, surgery, ventilators and infusion pumps are but a few that must be scheduled over many months to balance the workload. These must be removed from the assignment process and handled separately. AIMS (Phoenix Data Systems) handles this very well by assigning PMs by accounting codes, but overriding this assignment for specific equipment types. Developing a comprehensive, complete and balanced PM schedule is one of the most daunting tasks that a manager can undertake. Hopefully, your CMMS has some workload balancing reports or tools to assure equal distribution by month and by technician.
6. Assigning staff resources. Are you PMs going to be performed by a PM team? Assigned to individual techs? Assigned to no one in particular, but managed by a supervisor? I have seen each of these assignment techniques work. And I have seen each of them fail miserably. Be careful and create accountability. Work assigned to no one is done by no one.
7. Now we need to analyze our inventory so that we can determine monthly scheduling. By totaling all PM times for all devices, you have a number representing the total number of PM hours for your entire inventory of equipment. Divide this number by 12 and you have the total monthly hours needed for PM. By subdividing this total number of hours by skill level, you can have the number of hours required by skill level.
8. Now we must figure out how to assign these to our technicians. Each technician should have a fairly balanced PM assignment, assuring the time necessary to complete each month’s assignments.
9. Which month to schedule which department’s PMs? I believe that the PMs for a given department should be permanently assigned to a specific month or months (May-November) and not move around. It is a good idea to query your department manager to determine when their census and acuity is lowest. Most hospitals are busy when college is not in session, such as December. Some areas such as south Florida have seasons when tourists swell their census. January is always bad for flu and respiratory issues, so PM should not be performed on ventilators in January or February. Look for local variances that would make certain departments candidates for certain months. Also look at your HTM departmental staffing. Do your guy/gals take vacations in the summer? Try to lighten the PM workload then and around the holidays. If you are a teaching institution, pay attention to when new medical students arrive each year.
10. When assigning PMs, assign the largest department and equipment types first. If there are specific departments that must be done in a particular month, get them in early. Reserve the smaller or more flexible department for the last – to fill out and balance the schedule when you have small holes to fill.
In most CMMS systems, you have the choice of having a fixed or floating PM schedule. Floating means that a PM will be automatically scheduled X months after a PM work order is closed. This may not be in the same monthly rotation as the rest of the department. This results in many trips to the same department throughout the year, searching for the few items that come due in the off months. This is not a good thing for productivity of staff or the success rate of finding the rogue equipment. Keep all PMs due in the original month they were originally assigned.
I invite you to share with me your PM assignment techniques. Do you have a policy or procedure in your hospital, department or your CMMS system? Send it to me. It may be of use to others.