HTM Director Strives to Put ‘Sacred Cow’ Maintenance Metric Out to Pasture

Posted June 10, 2017

David M. Dickey

Will preventive maintenance (PM), which has been a cornerstone of the healthcare technology management (HTM) profession for decades, ever truly be a thing of the past? According to Dave Dickey, corporate director of McLaren Clinical Engineering Services with McLaren Health Care in Flint, MI, there are other metrics that are better at proving the quality and effectiveness of an HTM program.

In a presentation at Friday’s 33rd Annual Conference on Clinical Engineering Productivity and Cost Effectiveness (more commonly known as the Manny Meeting), Dickey presented PM as a “sacred cow”―an idea or practice that people support without question or criticism. The conference was held in conjunction with the AAMI 2017 Conference & Expo in Austin, TX.

“As far back as I can remember, we have always tracked and reported on scheduled inspection (PM) activities. Why?” Dickey asked. “Inspection agencies have always asked for numbers and reports, but they have never said ‘why’ this measure is so important.”

With The Joint Commission’s new elements of performance (EPs) that went into effect in January, “this sacred cow is getting bigger and heavier, and it’s getting more difficult to handle,” Dickey said.

Under the new EPs, hospitals are expected to complete 100% of planned maintenance activities in line with manufacturer recommendations or an alternative equipment management program on time, with the frequency being determined by the hospital.

“Just because I did a PM and I did it on time doesn’t mean it was effective,” Dickey told meeting attendees. “On time or late has nothing to do with patient safety or outcomes, but is only a reflection of staff and external labor resources (and overtime money) available to perform the work.”

According to Dickey, what departments—and surveyors—should be asking is:

  • What did you find during the inspection?
  • What value did this bring?
  • Did this work prevent failure of equipment or an equipment-related patient injury?
  • Did you do any accidental damage to the equipment or cause or contribute to failure of the equipment?

Answering these questions will require “standardizing and defining how we measure quality and effectiveness,” Dickey said.

In his presentation, Dickey proposed an approach for quantifying the effectiveness and quality of a medical equipment management plan (MEMP):

  • Tie each major element or component of the MEMP to something that can be measured and quantified.
  • Measure how effective the program is in achieving the expected or desired outcome for each element (or goal) of the MEMP.
  • Score each element based upon achieving the goal.
  • Add up the scores to come up with a grade, which equals “quality.”

Dickey has been piloting this scheme for more than a year at McLaren Health, collecting data from all of the hospitals in the system on how its MEMP affects length of stay, patient incidents, and other indicators of patient safety and satisfaction. Last year, out of nine hospitals in the system, seven achieved an ‘A’ grade and two received ‘Bs’ based on the approach outline above.

More time and data are needed to refine the parameters, but Dickey is hoping his approach could serve as a model for other hospitals to start redefining “quality” and “effectiveness” in terms other than the number of PMs completed on time.

“Hopefully, over time, the regulatory agencies that inspect HTM programs will see the value in this and stop asking the silly questions related to PMs,” Dickey said. “If we want these sacred cows to go away, we need to go to CMS with data.”

Dickey will discuss these new quality and effectiveness metrics in a session on Monday at 10 a.m. in Room 18C.