By Alan Gresch / Special to Healthcare Facilities Today

The typical U.S. hospital system uses, manages and maintains hundreds or thousands of different pieces of medical technology provided by dozens of different suppliers. Each item has passed rigorous FDA approvals, which include manufacturers’ conservative maintenance procedures.

The problem is that by following manufacturers’ precise instructions for each and every device, hospital systems suffer inefficiencies in use of trained resources, parts sourcing, inventorying and staff deployment. With all the challenges of managing a complex device portfolio, including the latest cybersecurity threats to patient safety, what is a manager in health technology (HTM) or health facilities management (HFM) to do in order to stay compliant and within budget? The answer can come in the form of alternative equipment maintenance (AEM) strategies, programs and tactics.

The Centers for Medicare & Medicaid Services (CMS) allows for deviations from manufacturers’ specified maintenance protocols. However, the provider must be able to make the case, grounded in data, that their approach will not negatively affect equipment safety or effectiveness. AEM programs typically achieve superior results by adjusting service intervals, fine-tuning parts inventories or rebalancing between preventive and corrective maintenance resource plans. When implemented, these AEM programs can save significant maintenance resources while maintaining, or even enhancing, patient safety and care efficiency.

Deviations must be carefully justified 

For organizations considering optimization through an AEM program, there are several key challenges. The first is that the case needs depth. A rationale simply based on time savings and increased technician productivity is not acceptable to the Boards. Patient safety must be explicitly considered, and no approach will pass scrutiny if it might have a negative impact in that area. Another challenge is that, in every case, AEM programs require vast quantities of data to support their case. Then, the rationale for making deviations, such as to procedures or intervals, must be accompanied by a documented process for continuously monitoring failure rates to ensure that, over time, the AEM deviations don’t negatively impact safety.

It's worth the effort

This approach does come with overhead. Each AEM program must include committed processes and procedures to document the purchase, installation, regular inspection, testing, repairs and failure incidents to all included equipment. But they are worth the effort, as they help healthcare executives do more with less, increasing efficiency, while continuing to deliver positive patient outcomes.

Consider this real-life example from an Accruent client. A large multi-hospital system had a set of medical devices that were consistently exceeding their target failure rate. Through an AEM approach, they determined that modified PM procedures could lower failure rates significantly. They invested 135 additional planned maintenance hours to the set of devices, and realized over 1,500 hours annually in reduced corrective maintenance for that same portfolio. When they applied the new approach across their facilities, the organization reduced the maintenance effort they needed by over 3,000 hours per year, the equivalent of two full time employees

Watch out for exclusions

While AEM is an attractive approach for optimizing HTM and HFM, some equipment areas and types cannot be included in an AEM implementation. Organizations cannot use alternative maintenance for the following equipment categories:

• Imaging devices, such as X-Rays

• Lasers

• Devices specifically regulated by state or federal authorities

• New devices without a substantial database of performance and failure rates

It's hard to do alone

While it is possible for a single provider to make an AEM case based on their own usage data, it’s generally impractical given the limited data available within that single institution. A solo provider might need years to accumulate enough data to satisfy CMS requirements, and prove their case. However, the Joint Commission and other CMS agencies accept data collected across healthcare facilities by asset and maintenance management providers. If your data is pooled into such a large installed base, it’s possible to justify and deploy an AEM approach quickly and easily.

Embrace evidence-based maintenance

The AEM approach to improved HTM and HFM performance is grounded in empirical data. Broadly speaking, this is part of the larger trend. Evidence-Based Maintenance (EBM) as noted by healthcare consultants and researchers is one of the best umbrella methodologies for selecting equipment for AEM, as well as confirming AEM’s safety and effectiveness. EBM embodies a continual improvement process for analyzing the effectiveness of maintenance resources and processes deployed. By making comparisons to outcomes achieved previously or elsewhere, the EBM methodology informs what adjustments are needed in maintenance planning and implementation. Evidence-Based Maintenance is comparable to Evidence-Based Medicine, which is known and respected across healthcare for its role in raising accuracy and dependability. By using an EBM methodology as the umbrella for an AEM program, organizations can be confident they are on the path to doing more with less.

While healthcare organizations are acquiring more equipment all the time, they’re generally not hiring more staff, even as experienced professionals are retiring. Therefore, it is imperative to work smarter. Alternative Equipment Maintenance programs instituted as part of an Evidence-Based Maintenance umbrellas can ensure that the right maintenance is done, correctly, and at the lowest possible cost.

Alan Gresch is Vice President, Customer Success, Healthcare at Accruent, a provider of physical resource management solutions.