Fine-tuning critical services maintenance

Ahospital is developed to serve patients and the hospital engineering services are the lifeblood, required to support the function of a hospital. Unquestionably, engineering services are highly critical to the operation of a healthcare facility, and the consequences of their failures can contribute a significant risks – there can be risk to life if systems fail.

If reliability, availability and integrity of engineering services are to be achieved and maintained, engineers must design all mission-critical M&E services with the best approaches right from the design stage.

Maintenance is part of design, so we need to integrate maintenance with design. Nevertheless, maintenance is, generally, not fully designed during the early design stage. Furthermore, maintenance has involved preventive maintenance schedules that contain generic tasks and operate on fixed frequencies, which often have no connection to the needs of the occupiers or the actual plant loading and use. In such cases, there is a lack of recognition regarding the full effects of a failure to design and maintain building services adequately, and of the resulting effects on the value and function of assets. Therefore, a rational approach to maintenance is required.

This article gives details of how to approach maintenance with reliability-based maintenance management together with the use of prediction theory.

This approach is based on the concept of a world-class maintenance management philosophy which should avoid failure and improve the availability of engineering services.

Support
The Oxford English Dictionary defines design as to destine for service; to contrive; to plan; to purpose; to intend – and it would seem obvious that if a hospital designer contrives and plans, the purpose of the planning will ultimately be to meet the absolute goals/ expectations of all hospital users. In other words, all hospital engineering facilities and mechanical and electrical services must support the intention of a healthcare facility.

But what is maintenance?

Maintenance is to keep in order, serviceable, in proper condition, or repair. Simply put, maintenance is the retention of function.

The quality of maintenance management plays a major role in the performance of a constructed facility. Design is a problem-solving process. Since maintenance is part of a building design, good design should provide better reliability and maintainability. The early design stage is the best time to determine the eventual characteristics of future systems and operation and maintenance. Therefore, it is important that the designers should work together with the client, users, other designers, M&E contractors and the facilities manager, if the best result is to be achieved.

As hospital buildings are now larger than ever before, maintenance has become a principal phase in the life cycle of built assets. The high performance of hospital buildings requires that maintenance considerations be taken into account at the early design stages, as this is the only time that a hospital engineer can integrate maintainability and reliability considerations into a project. The engineers will then be in a better position to offer a range of options that match the intended use of a building and its engineering services, and allow the best designs to achieve the overall objectives of the owner/users. This should then provide more reliable, resilient and fully maintainable hospital engineering services. Good maintenance management issues, therefore, play a major role in the performance of constructed facilities.

Not properly addressed
Based on the author’s own research into maintenance management, even with the increasing complexity of services, this subject is still not being properly addressed in the design stage. This important issue is, sometimes, the last thing on the design team’s mind.

The reasons can be:

Maintenance design is not the first priority. Overall building design must be considered first.

Lack of integrated design, operation and maintenance.

Little understanding and use of reliability theory in engineering analysis.

Inadequate interaction between reliability engineering and maintenance engineering.

Client’s brief seldom states the maintenance characteristics that are required.

Pressure of finance takes over maintenance issue.

The typical consequences of inadequate maintenance are threats to health and safety, service failures, excessive costs and social costs.

It is clear that in engineering services terms the most important role is that of the designer.

The designer has a range of systems and equipment to select, can dictate how these will be designed and installed, and how the different components will be brought together to form the various systems to produce a functional building. Undoubtedly, a hospital engineer/designer has a professional responsibility concerning maintenance and/or make suitable provisions for higher reliability and availability for all M&E services.

Influence
As discussed earlier, there are problems in current building services design and maintenance. This means that maintenance is not designed and carried out according to actual needs. But a designer can greatly influence the future maintainability of all building services together with the maintenance personnel. In particular the following issues must be considered:

Avoiding maintenance problems by design.

Better design for supporting client operations and changing client needs.

Carrying out risk evaluation and risk analysis for all proposed designs.

Improving reliability and availability for each design by using engineering knowledge and techniques.

Selection of the most appropriate maintenance systems to ensure the continued safe and profitable or efficient use of a building at acceptable levels of risk and cost.

Finding an appropriate maintenance system is the most difficult task facing many designers and facilities managers. Given the importance of maintenance, the author would like to share the findings from his recent research into maintenance. The article discusses a systematic framework for managing vital and risky healthcare infrastructures. To give a clearer picture of the proposed framework, the first part of the article examines assessing and managing risk. The second part focuses on prediction theory.

Looking for better methods
Maintenance is ensuring that physical assets continue to do what their users want. Therefore good maintenance should receive a higher level of attention by all engineers.

Traditionally, maintenance has involved preventive maintenance schedules that contain generic tasks and operate on fixed frequencies, which often have no connection to the business needs of the occupiers or the actual plant loading and use. This approach is not effective and appropriate in many circumstances.

The desire to improve the traditional approach has meant that engineers are now looking for better methods.

Furthermore, as building services are becoming more and more sophisticated, it is now emerging as an area that requires a high level of competence in a variety of disciplines including management of resources and risk, numerical and analytical capability, system redundancy assessment and probability theory.

Unquestionably, maintenance of engineering services is becoming more analytical and numerically biased. To add value, it is necessary to achieve a level of maintenance that matches the strategic service level requirements. This can be done by evaluating risk and consequences of failure in conjunction with the adoption of the latest concept of business-centred maintenance expressed in terms of availability, quality and engineering economy.

This approach should enable engineers to find the right balance between optimum design, right cost, highest reliability and performance required for a particular building.

Risk management
The risk inherent in building services design and maintenance is coming under even greater scrutiny.

Risk is the product of probability and consequences. So, there are two apparently different situations – one with a high probability and low consequences, and one with a low probability and high consequence. It is only human to focus more on high-consequence events, even when they are unlikely, than on those with little impact.

A major equipment failure represents an extreme need to manage maintenance risk. The downtime could affect service delivery to the customers and cost the business a great deal of money. There could be further losses if the equipment failure threatened the safety of employers/users or adversely affected the environment.

The term risk refers to a situation in which the outcome is uncertain and the consequences generally undesirable. As far as building services are concerned, there are four risks: business, design and installation, operation and maintenance, and disposal.

Business risks are related to the type of operation carried out by the organisation and will influence the final design of the building services (an inappropriate choice will therefore affect the operation of the business). Design, installation and O&M risks are all related to correctness of the selected design and installation as well as conditions of upkeep and running of all M&E services plant and systems. Removing plant and equipment from buildings may also present special risks, especially if this issue is missed out in the design stage.

In any system and operation, there is always some degree of risk. In maintenance, the impact is typically on equipment failure, people’s health and safety, or the environment. Generally, risk involves three issues:

The frequency of the loss.

The consequences and extent of the loss.

The perception of the loss to the ultimate interested party.

Risk can occur when the wrong design/maintenance decision is made about an asset. The consequences can be many: reduced plant reliability and availability, less output, and increased operating cost.

So a detailed study of risk must be carried out to ensure that significant risks are identified and appropriate designs and maintenance methods adopted to minimise them as much as possible.

To be able to manage risk, it is necessary to make good use of the process for managing risk (i.e. risk identification, risk analysis, risk response and ensuring that the risk is managed properly). A model should be of great help for this purpose.

Maintenance management Model
Given the complexity of building services, managing the design of operation and maintenance requires a methodical approach. A model can be used – a model is a representation of reality. The objective of the model proposed is the conceptualisation of one comprehensive picture of the author’s proposed management system of maintenance.

It should enable all important issues to be visualised and comprehended, and assist in explanation. Furthermore, it can aid better understanding of the interrelationships among all sub-systems within this business-centred maintenance model. The model can be shown as in Figure 1.

Main points in model
What the model shows is very simple. There are several points:

1 Before designing all M&E systems, an engineer should understand the purposes/functions and the characteristics of the building.

2 An engineer should determine the performance requirements of this asset and the users or organisations occupying the building.

3 Design of M&E systems and O&M should be based on a thoughtful evaluation of business-centred maintenance. The proposed design and O&M should incorporate the following points:

Putting the important things first.

– Identifying the M&E system required for the building.
– Knowing the customers’ requirements with respect to supportability and reliability.
– Defining functions and desired performance standards of M&E systems in the context of the business needs of an organisation.

Defining the problem and gathering information.

– Knowing the relationship between the most important M&E services and the business function.
– Exploring possible ways in which services can fail to deliver users’ desired requirements.
– Establishing the causes of failure.
– Knowing what happens when failures occur.
– Assessing the probability of failure.
– Checking how the failure could be limited, reduced or pre-empted.

Assessing failure consequences.

– Failures which affect the customers.