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Preventive Maintenance: A Look at the Big Picture

2006; Association for the Advancement of Medical Instrumentation; Volume: 40; Issue: 2 Linguagem: Inglês

10.2345/i0899-8205-40-2-167.1

1943-5967

Kenneth Maddock,

Quality and Safety in Healthcare

I read with a great deal of interest two articles in the July/August 2005 issue of BI&T. One was by Jeff Maxwell, titled “Prioritizing Verification Checks and Preventive Maintenance,” and the other by Larry Fennigkoh, titled “Human Factors and the Control of Medical Error.” Preventive maintenance (PM) is a topic that has been discussed endlessly in articles, online discussion forums, national conferences, etc. I have my own ideas on PM programs and seeing these two articles in the same issue really helped to solidify my thoughts on this matter.You see, I have had a sneaking suspicion that something has been missing from the articles that have been published on the subject. I keep thinking that there has to be more to a PM program than just equipment inspections. I thought I would start by looking up the definition of preventive maintenance. I did a web search and found quite a number of different entries. Some definitions, focused on inspection and testing:Preventive Maintenance (PM): To bring down a machine for inspection or test purposes. (http://dictionary.reference.com)Others focused on replacing parts in an attempt to prevent failure:An equipment maintenance strategy based on replacing, overhauling or remanufacturing an item at a fixed interval, regardless of its condition at the time. Scheduled Restoration tasks and Scheduled Discard tasks are both examples of Preventive Maintenance tasks. (www.maintenanceresources.com/ReferenceLibrary/MaintenanceManagement/KeyTerms.htm)These definitions—considered separately or together—are examples of what I feel most people in our field think of when they think of a preventive maintenance program. There is no question that the inspection of equipment and the replacement of worn parts are important components of a preventive maintenance program. But I don't think they are the program. So I kept looking and I found a definition that I think makes a lot of sense:Preventive Maintenance: Changes made to a system to avoid possible future problems (http://www.cbu.edu/~lschmitt/I351/glossary.htm)It mentions making changes to a system. What system are they talking about? Do you think they are referring to a specific device or group of devices working together? That's a pretty safe guess. But that's not what I'm thinking. I'm thinking of the device, the environment, and the people. I believe that is the system that we need to think about. And we need to think of that entire system when we think about trying to avoid possible future problems.To put it very simply, the goal of a PM program is to prevent failures. In our situation, we are talking about any type of failure that directly or indirectly impacts the ability of a caregiver to perform their duties. A PM program may include a great deal of things that are not typically considered in the context of a PM program. It may mean periodic training of the staff members in an area with high turnover. It may mean buying better quality lead wires and cables. Or it may mean buying equipment from different manufacturers. I am not implying that clinical engineering departments never take these actions now. I am just suggesting that it is not typical for those kinds of actions to be considered as part of a PM program.Most of us work for organizations that cannot afford to expend resources inappropriately. I happen to feel that many of us do expend resources inappropriately, especially through our PM programs. Just about everyone doing this is doing it with the best of intentions. Unfortunately, wasting resources with the best of intentions does not make that waste any less painful. And before I go any further, let me reassure you that I am not suggesting eliminating scheduled inspections just to decrease the workload.A PM program in our field needs to be built upon a foundation of safety and regulatory compliance. What I'm suggesting is that you can't stop after building the foundation. Among other things, you need to make sure your organization is making the right decisions on equipment, and that the processes and workflow associated with the use of medical equipment are effective and appropriate. The analysis you do may result in less inspections being performed or it may result in more being performed. But either are just possible outputs of the process, not the ultimate goal. The goal should be to tweak your processes to ensure that your efforts are contributing to the reduction of failures.Well, I think I have figured out what I believe is typically missing from most PM programs. But is it an earthshaking revelation? Not really. I'm just talking about a traditional PDCA (Plan-Do-Check-Act) quality improvement process. But I don't think that most people think of a preventive maintenance program as a quality improvement process. I think that many of us are focusing very heavily on the Plan-Do and overlooking the Check-Act. I think that a preventive maintenance program is not simply a sequential series of scheduled events. It is a cycle involving analysis and the development of actions based on that analysis. Those actions may change every cycle and they may not involve as many routine, periodic inspections. This may be uncomfortable to many, but if the result is a reduction in equipment failures, isn't that what we are after?I wish I could point you to a program that is taking the approach I am suggesting and using it successfully. I can tell you that my program is not. We use a fairly traditional approach to our preventive maintenance program. But we are going to try something different. I intend to assign a team to this project on an ongoing basis, and I firmly believe that the result will be fewer real and perceived failures. I think that my team will be able to take the time previously spent doing useless inspections or performing repairs that could have been prevented, and spend it more productively with our customers. We can gain a better understanding of what they do, of the challenges they face, of what we can do on a routine basis to make their job easier. We can better understand the devices, the people, and the environment in which they exist. As we gain that increased understanding, I have no doubt that we will find that we are able to apply our skills and talent in ways that will have even more of a positive impact on the operations of our organization than they do today. We'll just have to see how it goes. Maybe this is not realistic. Maybe I'm dreaming. But if I am, don't wake me up! I think I like where this dream is heading.