Historically, every hospital has always had a written medical equipment management plan (MEMP), which is used to define and outline the organization’s responsibility and actions they take to properly acquire, utilize, and maintain the equipment used to provide patient care. This MEMP document defines the roles and responsibilities of the equipment users as well as those responsible for maintaining the equipment and forms the basis of all of the activities that are required as a means to demonstrate to the various inspection agencies that their equipment is safe and effective in supporting their patient care needs.
Regardless of whether the program is implemented using an in-house or an outsourced group, it is the hospital management’s responsibility to periodically review the overall goals, effectiveness and performance of their program. This is typically done via establishment of metrics (indicators of performance), leading to periodic reporting (quarterly and/or, annually) presented to a hospital safety, environment of care, or other oversight committee or executive staff member.
At McLaren Health Care, we standardized this annual report (about 15 years ago) and have always reported familiar program operational metrics: program cost, equipment inventory, repair activities, number of scheduled inspections, and more. While these metrics are important to measure, they, by themselves, do not answer the following question:
“Is your MEMP effective and of high quality?”
I have come to the conclusion that many of the historically used metrics typically measured and reported by healthcare technology management (HTM) departments actually have very little to do with quality or effectiveness, especially the preventive maintenance (PM) completion-related number. Those are just numbers based on counting completed tasks! If a surgeon completes all his scheduled cases on a given day, is he or she an effective surgeon? Perhaps, but that tells you nothing about the effectiveness of the surgery.
Likewise, if HTM completes 100% of scheduled inspections on time, but the equipment fails after we put it back into service, is our scheduled inspection program “effective?” Completing scheduled inspections on time or late is not inherently a measure of effectiveness, defined as “the degree to which something is successful in producing a desired result.”
Shouldn’t the expected outcome of your scheduled inspection program be somehow linked to equipment failure rates, or better yet, to patient care outcomes and/or safety?
During three previous presentations I have given on this topic, I asked the audience how they define and measure effectiveness and quality of their MEMP? So far, I’ve received more than 30 different responses on how each of these metrics are defined by HTM program managers. That tells me that HTM practitioners have yet to define and standardize on measures of a MEMP program’s quality and effectiveness.
Our continual focus on measuring and reporting on the number of scheduled inspections (PMs), I believe qualifies as being a “sacred cow.” While everyone in the HTM profession should understand the original intent of scheduled inspections, perhaps the main reason why we continue to put such a high programmatic focus on it is because our inspection agencies keep asking us to do so.
While we have made progress in being allowed (and able) to justify reducing our scheduled PM workloads over the years via Alternative Equipment Maintenance (AEM) program implementation, I suspect we are still wasting a great deal of time performing inspections and procedures on medical equipment for no other reason other than the OEM manual says so. Don’t get me wrong, I am all for performing scheduled inspections and PM on equipment that truly needs it, especially if it can be shown to impact patient safety, length of stay or patient care outcomes.
Other than that, what’s the value in continual emphasis on this “cow?”
In my next blog post, I’ll discuss where we in the HTM profession should be focusing our time and effort instead.
David M. Dickey is vice president of McLaren Clinical Engineering Services in Flint, MI.