For this article, Paul Robbins IEng MIHEEM IIPEM MCMI, electro-medical services manager, technical support services, Papworth Hospital NHS Trust, has been awarded IHEEM’s Northcroft Silver Medal. The article, previously published in the June 2005 edition of Health Estate Journal, outlines the rationale for using a risk management based medical device support program that incorporates the best elements of industrial practice.
The NHS is moving to a climate of payment by results, and this requires resources to be targeted where they are most effective. To the private engineering sector this is nothing new, as modern production lines can be halted quickly when plant fails, therefore our industrial colleagues have to ensure that their maintenance regimes are targeted to support mission critical elements of the business. To this end industry has developed many systems such as Reliability Engineering (RA) or Total Productive Maintenance (TPM), all of which have as their basis the application of Risk Management (RM) to support this aim (Fig. 1).
Traditionally medical equipment maintenance services have concentrated on planned (PPM) and Corrective Action (CA) services. Setting aside consideration of any inspection or service requirements imposed on us as part of any statute such as Provision and Use of Work Equipment Regulations3 (PUWER), the question is why?
All Electro-Biomedical Engineering (EBME) departments will have vast historical data in equipment management systems which when statistically analysed will show no clear positive contribution by PPM to improving overall device reliability or effectiveness or indeed for that matter reducing overall equipment failure rates. In fact analysis of such data may suggest that for some items planned maintenance is actually counterproductive in “sweating” equipment life and may actually contribute to increasing the overall failure rate in terms of additional stresses imposed on equipment by continual dismantling and reassembly.
Industrial process
Further returning to the opening argument, accepting the concept of healthcare being an industrial process leads by reverse engineering to the idea that if hospitals are industrial factories then EBME departments are specialist hospitals whose patients are inanimate objects. Therefore if the “do nothing” option can be used by our medical colleagues for humans then the same can be used by EBME for inanimate objects. Therefore, and with apologies to Hamlet, “To maintain or not to maintain – that is the question”.
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