Some primitive cultures had traditional dances that they would perform in order to achieve a specific outcome. A typical desired outcome might be rain to end a drought and assure a good crop. On some occasions the dance appeared to be successful and a soil drenching rainstorm would ensue. When there was no success it was assumed that the dance might not have been performed correctly or the gods were angry and not willing to reward the dancers. Despite the strength of the culture’s belief, we all know that there was no relationship between the dance and the production of rain.
I wonder if a similar thing is happening with our planned maintenance programs. On a regular basis, we go through the ritual of performing “PM” on many of our medical devices, but the reality is that we really do nothing to affect their reliability and longevity. While there are a few devices with moving parts that may benefit from lubrication or filter changes, most do not benefit at all. What then is the value of performing PM? Is it just as effective as a tribal rain dance? Sometimes devices fail and sometimes they don’t, but the failure or reliability is seldom related to our superstitious PM ritual.
We know that performing routine maintenance on our automobiles contributes to their longevity and reliability. Regular oil changes, checking belts, checking fluid levels and rotating tires all have proven benefit. When it comes to medical devices that have no moving parts, where are the benefits? We spend countless hours performing the PM ritual dance and the only real benefit seems to be that we assure accreditation or meet CMS requirements.
As we face the expected financial constraints of the Affordable Care Act hospitals are looking for ways to reduce costs. As part of this process, we need to look at every procedure and every policy to see if it adds any value or contributes to the general efficiency or effectiveness of the organization. Performing a series of tests that do not have a beneficial effect on a device’s reliability does not add value to the organization. Furthermore, in order to test a device it must be taken out of service. This may interfere with workflow and schedules. In essence, this tends to make the organization less efficient and in that context, PMs may do more harm than good.
Is it time for us to stop behaving like a primitive culture and stop our superstitious dancing where we regularly perform PMs that do not prevent anything? Is it time to stop pretending that we are providing a valuable service that somehow keeps devices from failing and assures patient safety? Unfortunately, the concept of PMs so embedded into our tribal culture that any suggestion of doing away with them constitutes heresy. Somehow, we need to change our primitive thinking and instead of performing PM on devices according to their risk level, wouldn’t it make more sense for us to PM only those devices where we can actually make a difference?