Equipment Maintenance Program

Transcription

1 Equipment Maintenance Program Julio Huerta University of North Carolina Advanced Clinical Engineering Workshop Buenos Aires, Argentina April 24-28, 2006

2 Technical Services: Maintenance Corrective maintenance or repair Planned Maintenance Performance testing/quality assurance Safety testing Upgrades Installations Calibration Overhauls & refurbishing Maintenance by users 2

3 Managing Your Medical Equipment Maintenance Program Elements of Maintenance Management Managing Labor initial training on-going training Managing Spare parts and Service Information spare parts supply stream service and operator manuals Managing workspace, tools, and test equipment place to work specialized test equipment Managing Data tracking maintenance history 3

4 Equipment Maintenance Repair : required when the equipment fails PM provides : manufacturer-specified attention to the device s non-durable parts (if any); assurance that the device is performing properly; assurance that the device is operating safely. 4

5 Repair When the equipment fails or appears to fail the user needs the device restored to proper working order as soon as possible 5

6 Planned Maintenance Scheduled Maintenance is required for all devices with parts that have known deterioration/depletion rates or with performance degradations that can be practically tested/identified e.g. filters, batteries, cables,and bearings Performance Verification and Safety Testing are considered important and, for certain critical devices, are sometimes required to be monitored. 6

7 Managing Your Medical Equipment Maintenance Program Scope of Problems high maintenance costs that kill your budgets problems that cannot be duplicated (resulting from users lack of proper training) equipment users and administrators that blame your department for all their equipment problems broken equipment that exceeds your resources equipment becomes unsafe due to misuse/abuse patient s road to health improvement hindered by equipment unavailability 7

8 Breakdown of Medical Equipment Maintenance Expenses Expenditures by Percent (%) Total 49% 8% 19% 13% 11% Clinical Lab Imaging Surgery Critical Care General 8

9 Medical Equipment Maintenance Services US Market (1998) in $ Billions Imaging equipment Biomedical equipment Totals Manufacturers ISOs In-house (69%) (48%) (19%) 0.57 (20%) 1.12 (12%) 0.88 (32%) 1.23 (59%) (20%) (21%) 9

10 Fact: service has larger contribution margins than sales for Original Equipment Manufacturers (OEMs) Typically 35% to 50% 10

11 Benchmarking Technical Support Services Cost of maintenance services over the equipment life Example: Nuclear medicine system Cost: $400,000 Manufacturer Service Contract: (12%) $48,000/year Life cycle: 10 years Total life cycle cost: $480,000 Greater than the initial price of the system 11

12 Benchmarking Technical Support Services Accepted benchmark for service costs Annual Service Cost = X % Acquisition Cost Less than 5% is target for U.S. hospitals depends upon type of equipment serviced 12

13 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Maintenance Cost - Medical Equipment Ted Cohen Survey 5.9% 6.0% 5.2% 3.8% 4.0% 4.2% 3.2% Non-Medical Life Support Diagnostic Laboratory Other Medical Imaging Types of Equipment 13 MC/AC Environmental

14 UNC OEM CONTRACT COST ANALYSIS % OEM Cost Service Cost 15% 10% 5% OEM Cost 0% <$10K >$10K <$50K >$50K <$200K >$200K Acquisition Cost 14

15 UNC INVENTORY AND MAINTENANCE COST July 2002 March 2006 Cost ACQ. COST MAINTENANCE Linear (ACQ. COST) Linear (MAINTENANCE) A21 A22 B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 Time 15

16 Downtime Minimal downtime reduces: disruptions to patient care loss of any associated revenue the need for spare (back-up) equipment 16

17 Equipment Not Available for Patient Care: Downtime Example: Computed Tomography Scanner One of the most critical items in U.S. hospitals Dramatic effect on patient care Lost revenues Average Cost of a CT Scan: approx. $1,500 CT scans per day: approx. 30/system Lost revenue: $45,000/day 17

18 Equipment Not Available for Patient Care: Downtime Other Examples: Lost revenues Average Cost of an MR Scan: approx. $2,000 MR scans per day: approx. 20/system Lost revenue: $40,000/day Average Cost of a Nuc Med Study: Aprox. $1,000 Nuc Med studies per day: approx. 10/system Lost revenue $10,000/day 18

19 Equipment Not Available for Patient Care: Downtime Other Examples: Lost revenues Average Cost of a Vascular Study: approx. $1,500 Vacular studies per day: approx. 6/system Lost revenue: $9,000/day Average Cost of a Lab Test: Aprox. $60 Lab tests per day: approx. 4,000/system Lost revenue $240,000/day 19

20 Technical Service Planning: Must take place prior to purchase Develop plan for service based on Resources Clinical need Vendor factors Logistics Costs 20

21 Equipment Life-Cycle Model Maximum leverage with vendors is prior to purchase 21

22 Managing Your Medical Equipment Maintenance Program Scope of Medical Equipment Level 1 - stretchers, beds, wheelchairs Level 2 - physiologic monitors, IV pumps, electrosurgical units Level 3 - general radiology, lasers, anesthesia Level 4 - CT, MRI, PACS, PET 22

23 Managing Your Medical Equipment Maintenance Program Level 1 or low-tech equipment usually in-house program Level 2 or medium-level equipment usually in-house program Level 3 & 4 or high-tech equipment usually a mix of manufacturer, independent service organization and in-house 23

24 Service Contract Basics Contract agreement to provide service according to terms and conditions Manufacturer or independent service provider Many types of agreements Full service, preventative maintenance, parts, labor, biomedical screening Reagent and lease agreements Everything is negotiable 24

25 What type of equipment is typically under service contract? 50 Percent of Devices Under Service Contract Imaging Lab Sterilizers Anes/Vent Dialysis Biomedical 0 Modality 25

26 When is a service contract needed? Keys elements for service not available Parts, Expertise, Training, Documentation, or Special Service tools including software Company will not provide it or will not provide it under reasonable conditions In-house staff or alternatives not available Uptime must be guaranteed or alternative such as loaners Less costly than alternatives Cost is known up-front. Easier to budget for. 26

27 Maintenance Management: Manufacturer Full Service Contract The most basic approach; a collection of manufacturer s FSC s Advantages Simple to set up, minimal paperwork Disadvantages The most expensive approach (~10% RC) - beware the hidden cost of contract exclusions, Many contracts to negotiate and manage, Locked into manufacturer s service providers. 27

28 Maintenance Management: Maintenance Insurance Incorporate an independent maintenance insurer to guarantee the repair budget Advantages Consolidation of financial risk can reduces the cost - by up to ~10% Eliminating contracts in favor of T&M improves flexibility; the detailed T&M service reports create good maintenance histories. Disadvantages Requires more careful management. 28

29 Maintenance Management: Independent Service Organizations Incorporate (local) independent maintenance service providers Advantages Lower rates (and less travel) lowers the cost - by up to ~25% If local, shorter travel improves response time Disadvantages May encounter manufacturer reluctance to provide support for competing ISOs 29

30 Maintenance Management: In-House Program On-site manager & service providers Advantages Lower labor costs and zero travel reduces the total cost up 50% On-site/ local staff to provide user support Vendor-neutral technical staff to assist with replacement planning and equipment selection. Faster response reduces overall down-time Disadvantages On-site staff may be diverted to other duties. 30

31 SERVICE PROVIDER COMPARISON OEM ISO In-House Response Time Questionable: in some cases the service personnel has to come from other states Reasonable: usually these groups have better local presence Good: the service personnel is always in the facility Expertise Good: manufacturers have large R&D facilities and resources Reasonable: a large portion of their service personnel comes from the manufacturers Variable: larger facilities can do a better job at maintaining up-to date expertise Experience Good: manufacturers work on a large number of similar devices Reasonable: these groups can increase their experience by supporting multiple facilities Variable: there is only a limited number of similar devices to service. 31

32 SERVICE PROVIDER COMPARISON OEM ISO In-House Spare Parts Good: manufacturers support a large number of similar devices Reasonable: these organizations share the cost of specialized purchasing groups among multiple facilities Variable: larger facilities can dedicate staff to purchasing functions Training Good: manufacturers have adequate training facilities and resources Reasonable: expensive training can be justified by supporting multiple facilities Variable: expensive training is hard to justify when the number of similar devices is small Price High: large overhead and cost shifting (sales to service). Usually over 8% of equip. acquisition cost Moderate: duplication of some hospital functions. Usually around 5% to 7% of equip. acquisition cost Low: cost oriented and low overhead. Usually 4% to 6% of equip. acquisition cost. 32

33 Technical Services: Vendor Partnerships Work with manufacturers and service vendors Win-win situation Example: First look by in-house staff Hospital fast response, trained technical service staff, improved morale Vendor does not have to travel to hospital, better relations and communication Promotes standardization 33

34 Technical Service Personnel: Requirements Technical education and training Formal Service training Basic troubleshooting skill Understanding of hospitals and patient care implications of technical services 34

35 Technical Service Personnel: Requirements Resourceful Focus for the future Information technology Imaging Clinical Laboratory 35

36 Converting a Manufacturer s Contract to IH Staff (Imaging) $100,000 contract includes $40,000 of labor charges $40,000 of labor charges = 267 m-hrs of labor (at $150/hr) 267 m-hrs of labor = 0.24 FTE (1,113 m-hrs/year) Potential saving: $16,020 ( = 267 x $60) in labor charges + $60,000 parts only contract = $76,020 ( 24% savings ) and you still have 0.76 FTE available for other repairs 36

37 Converting a Manufacturer s Contract to IH Staff (Biomed) $100,000 contract includes $40,000 of labor charges $40,000 of labor charges = 345 m-hrs of labor ( at $116/hr) 345 m-hrs of labor = 0.31 FTE (1,113 m-hrs/year) Potential saving: $19,320 ( = 345 x $56) in labor charges + $60,000 parts only contract = $79,320 ( 21% savings ) and you still have 0.69 FTE available for other repairs 37

38 What is best? A mix In general, the best option is a mix of In-house service Vendor time and materials Service contracts and/or Managed maintenance insurance 38

39 Technical Service Operations: Computerized Management Knowing your medical equipment assets Determining the level of management of assets Using a computerized database to manage assets Inventory, work orders, parts, PM, reports Controlling for cost-effective operations Use data and knowledge to make safe, effective equipment available for patient care 39

40 Technical Service Operations: Computerized Management Information About Each Device Equipment information Purchase information Warranty Maintenance Intervals & Procedures Service history information 40

41 Technical Service Operations: Computerized Management Information entered MUST use Standardized Nomenclature AAMI EQ Recommended Practices for a Medical Equipment Management Program 41

42 Equipment ID Dept. No Equipment Description Manufacturer Model Serial No Purchase Cost Purchase Date (1) (owner) (2) (3) (4) (1) A unique ID num ber such as a Fixed Asset No. or Property No. if available. (2) A two or three word description of the equipment's function. Examples: Portable X-Ray, Portable C-arm, Imaging Ultrasound, Therapy Ultrasound, Vital Signs Monitor, Infusion Pump, Respirator, Anesthesia Mach (3) Price paid if purchased new, or approximately market value if known. (4) Month/Year. If exact date not available, the best guess based on information from people who have worked in the department the longest. 42

43 Equipment ID: Dept. No (owner): Section ID:? Biomedical? Imaging? Other Equipment Description: Manufacturer: Model: Serial No: Location: Acquisition Cost: Acquisition Date: Warranty Expiration Date: Fixed Asset No: Comments: Equipment ID: Dept. No (owner): Section ID:? Biomedical? Imaging? Other Equipment Description: Manufacturer: Model: Serial No: Location: Purchase Cost: Purchase Date: Warranty Expiration Date: Fixed Asset No: Comments: Equipment ID: Dept. No (owner): Section ID:? Biomedical? Imaging? Other Equipment Description: Manufacturer: Model: Serial No: Location: Purchase Cost: Purchase Date: Warranty Expiration Date: Fixed Asset No: Comments: 43

44 Department No Department Name Deptartment Manager Phone No PM Month Location 44

45 Equipment Tags Control Numbers Informational Tags Color coded Tracking Tags (RF, IR) 45

46 Recordkeeping Incoming Inspections-gatekeeper Standards for work orders Technicians versus Clerical Staff Dual Use:Productivity/Documentation 46

47 INITIAL INCOMING INSPECTION & EQUIPMENT EDIT FORM SECTION I ACTS # System ID Old ID: Hosp. Asset #: = Addition To Inventory = Edit/Change To Inventory = Delete From Inventory SCO DESCRIPTION : ALTERNATE DESCRIPTION : STATUS : ACTIVE STORAGE DELETE MANUFACTURER : MODEL NAME : MODEL NO. : ACQ COST : $ SERVICE CONTRACT DOWNTIME YES NO OWNERSHIP HOSPITAL CONTRACTED LEASE/LOAN/RENTAL OTHER ACQ DATE : / / WRTY EXP: LABOR / / LIFE (YRS) SEV INDEX CONDITION CODE CAPITAL PURCHASE ORDER # INSURANCE CONTRACT WRTY EXP: PARTS / / UTIL CODE ORIG INV DATE: / / SERIAL NO. : DEPT NO. : LOCATION : EQ TYPE : SECTION: ADDITIONAL NOTES OR COMMENTS: IF NO MDR DESCRIPTION IS AVAILABLE, ASSIGN A SEVERITY INDEX, PM PROCEDURE, MONTH & FREQUENCY: SEVERITY INDEX VALUE : PM PROC NO. : MONTH : SR# : ANNUAL MONTHLY SEMI-ANNUAL QUARTERLY OTHER: ACTS CONTRACT STATUS SERVICE FREQ HRS DAYS PARTS GLASS DEFAULT WR PM 85 MF RECOMMENDED DEFINITIONS *For Additional Definitions Refer to Your CTS Policy Manual WR=Warranty PC=ARAMARK PM=PM Only FS=Full Service SECTION II WR# WORK REQUEST CLASS : DATE RECEIVED : PROBLEM CODE : 85=8:00am-5:00pm MF=Monday-Friday AL=All Parts 00=No Parts 00=No Glassware AL=All Glassware PROBLEM REPORTED: REQUESTOR NAME: REQUESTOR PHONE: SR# COMPONENT: WORK TYPE: WP STATUS: WP DATE: WP CODE: 47

48 SECTION III 1. Does the device appear to be undamaged? Yes: Proceed to step 2. No: Do not accept for use and contact seller for corrective action. 2. Is the device electrically operated by 120 VAC? Yes: Proceed to step 3. No: Proceed to step Has the device been evaluated by a qualified testing laboratory? Refer to hospital policy and state administrative code or policy, if applicable. Yes: Proceed to step 4. No: Do not accept for use and contact seller for corrective action. 4. Visually inspect power cord, plug, and strain relief s. Refer to NFPA 99 chapter 9. Pass: Proceed to step 5. Fail: Do not accept for use and contact seller for corrective action. 5. Does the device pass electrical safety inspections? Refer to NFPA 99 Chapter 9. Yes: Document results in Section II and proceed to step 6. No: Do not accept for use and contact seller for corrective action. 6. Does the unit seem to be operating properly? Refer to manufacturer specifications. Yes: Proceed to step 7. No: Do not accept for use and contact seller for corrective action. 7. Have all accessories been included in shipment? Yes: Proceed to step 8. No: Do not accept for use and contact seller for corrective action. 8. If ownership is loan, demo, rental, or other, how long will the device be in the hospital? If hospital owned or leased, proceed to step 9. Less than 6 months: Write the serial number in the equipment ID field in Section I and proceed to step months or greater: Proceed to step Have (2) two operator, (2) two service manuals, OPERATING & DIAGNOSTIC SOFTWARE been included in shipment? Yes: Proceed to step SOFTWARE COPIES SHOULD BE RETAINED IN CLINICAL TECHNOLOGY SERVICES. No: This is basis for non-acceptance. Evaluate literature needs. If adequate proceed to step 10. Otherwise do not accept for use and contact seller for corrective action. 10. Has technical service training and operator training been provided for the device? Yes: Proceed to step 11. No: This is basis for non-acceptance. Evaluate educational needs. If training is adequate proceed to step 11. Otherwise do not accept for use and contact seller for corrective action. 11. Who will be responsible for the management of the device? ACTS: Affix a ACTS identification label to the device, indicate in Section I and proceed to step 12. Other department: Proceed to step 15 and contact appropriate department for inclusion in their program. 12. If applicable, evaluate the Clinical Application, Physical Risks, Maintenance Requirements and Incident History of the device. Assign a severity index value to the device. If the device is not listed in SAMM, calculate the severity index value according to the scoring criteria in Table I. High Incident history or failure rate may indicate the need for a more frequent inspection interval than required by Severity Index. Severity Index Value From SAMM = Indicate severity index value in Section I and proceed to Step 13. Equipment Function: Physical Risks: Maintenance Requirements: Calculated Severity Index Value: Incident History Reviewed = = = = 13. Will the device be included in the ACTS Planned Maintenance Program? Refer to Table I for inclusion criteria. (Note: All equipment items that are the responsibility of ACTS will be inventoried. The risk assessment determines inclusion in the PM program only.) Yes: Proceed to step 14. No: Proceed to step

49 Estimating Workload Inventory Group into four risk categories Estimate average inspection times for each category Estimate average repair time for each category Include time for installation, user training and incoming inspections 49

50 Unscheduled Service Most important area for Customer satisfaction Receiving, logging and tracking requests Response Time Turnaround Time Work Assignment 50

51 Analysis and Reporting Repair Frequency Analysis Optimize Planned Maintenance and inspection frequency and tasks Timeliness of service Productivity Analysis User Error and No Problem Found reporting Service Quality Annual Review 51

52 Repair Frequency Analysis Purpose-Improving Reliability of Equipment Performance Select Categories based on annual # Repairs/# Items Collect Data Analyze Quarterly 52

53 Response Time Determining Standard Collecting Data Incentives 53

54 Turnaround Time Determining Standard Collecting Data Improving Performance 54

55 Documentation Rate Productivity DR= # Documented Hours/Paid Hours DR<90% Unsatisfactory 90%<DR<95% Satisfactory 95%<DR<100% Excellent DR>100% Suspect Productive Hours PH= # Productive Hours/Paid Hours PH<75% Unsatisfactory 75%<PH<80% Satisfactory 80%<PH<85% Excellent PH>85% Suspect 55

56 Productivity on Specific Tasks PM Completion Time P:Mean time to complete monitor PM R:Collect data I:Interpret why one type takes longer D:Design improvement plan E:Execute 56

57 User Error Reporting Establish standards Facilitate reporting Determine corrective action Education Device or environmental problems Follow-up Also reporting on no problem found and abuse 57

58 Improving Service Quality Process Relevant Data Interpret Design Execute 58

59 Annual Review Audit of additions Review service histories and Risk numbers Review average inspections times Compare workload Vs manpower Review local codes Document all reviews 59

60 Technical Service Operations: National, Regional and Local Support Tiered approach to support Most complex and specialized support in national metropolitan centers Staff, parts, tools, etc. Regional support for next level of technology Local support of basic technology First look on all equipment Communicate failures with specialists Infrastructure is critical 60

61 Summary: Technical Service Operations Technical Service Operations are a critical part of technology management Maintenance services can be expensive Self-managed or hospital shared management programs more cost-effective Work with manufacturers and vendors A mix of service sources works best 61

62 Summary: Technical Service Operations A computerized database is excellent management tool Investment in resources will pay off Expert staff, tools, parts, facilities, documentation 62

63 Questions Comments Discussion 63