Hospitals offer unique services as compared to other healthcare organizations. According to the American Hospital Association, there are three types of characteristics that are especially distinctive to hospitals:

• Hospitals provide care 24 hours a day, 7 days a week;

• All patients seeking emergency care are cared for regardless of ability to pay;

• Hospitals must ensure that staff and facilities are prepared to care for victims of large-scale accidents, natural disasters, epidemics and terrorist actions.

(Source: Prepared to Care Report, 2006, American Hospital Association)

Modern technologies and techniques combined with CMMS software are increasingly essential tools to ensure that facility maintenance keeps pace with the demands of today’s hospital requirements.

While this plethora of add-on services provides a challenge for hospital managers and medical staff they also mean an increase in responsibility for those who must ensure the hospital’s physical infrastructure and equipment are available and reliable.

The facility manager can no longer rely on yesterday’s technology to meet today’s demands. This has lead to the widespread adoption of computerized maintenance management systems or CMMS. This software is a critical strategic tool in improving maintenance performance as part of the solution to address those problems particularly facing hospital facility managers today.

Computerized Maintenance Management System (CMMS)
CMMS is basically what QuickBooks is to accounting. Instead of manually writing out work orders and scheduling maintenance technicians, a CMMS automates these functions and takes the ‘pencil and paper’ function out of maintaining facilities. The CMMS also ensures that all relevant data is collected so that there is a complete picture of equipment performance and cost. A CMMS is also used proactively; instead of reacting to maintenance problems on an ‘as needed’ basis, the CMMS schedules planned work via work orders for the maintenance staff. Equipment Asset details are inputted into the CMMS for all kinds of equipment and then maintenance tasks are scheduled on a calendar or usage such as operating hours, number of cycles, etc. basis. For more complex equipment such as MRI or x-ray machines, even more detailed information can be gathered and linked via the CMMS, and individual parts can be monitored. In addition, maintenance history is contained for each piece of equipment and trouble spots can be identified through analysis of work order history.

Affordability of CMMS
In 2005, over 25% of hospitals operated at negative total margins due to escalating costs. In comparison, due to economies of scale and technological advances, the cost of CMMS has dramatically decreased over the past few years and the cost savings it generates allows the software to pay for itself. This fact came as a pleasant surprise to Chris Hall, a seasoned facilities manager, when he came to Hamilton Memorial Hospital, in McLeansboro, Illinois in 2004. As the support services director, Hall knew that to efficiently run the maintenance of any facility - a daunting and crucial function in hospitals - he needed an efficient CMMS in place. Yet, he also knew that he was constrained by a limited budget.

After researching CMMS options on the Internet, Hall found that there were not many options available with efficient maintenance management systems for less than $1000 for a credible and complete CMMS, including customer support. Hall immediately chose an option that fit his hospital’s budget and provided excellent maintenance monitoring and reporting. Now instead of spending his time answering the phone fielding questions about work order  status, he or his staff can look up the information online via the CMMS. “I used to get contacted every five minutes. So this really saves me the time of having to explain the issues or the status of orders,” he says. And it was all done within his hospital’s budget.

Other Bells and Whistles of CMMS:
A Handheld or PDA
Besides affordability, other advances associated with CMMS that are being implemented in today’s hospitals include the use of personal digital assistants (PDAs). These personal computers help facility workers maintain their hospital’s 24/7 schedule. PDAs were originally designed as personal organizers. It is expected in the near future that the use of these devices will increase as they gain acceptance in the marketplace and their cost decreases. Besides being handheld computers which is optimal in hospitals where large square footage is the norm, PDAs can be online or synchronized. Online means the handhelds have constant contact with the database via a wireless connection. Thus, where there is zero tolerance for downtime and constant wireless connections are present, real time offers current information no matter where the technician is located; uploads and downloads are in real time. In comparison, synchronized PDAs are uploaded with maintenance data at the beginning of the work shift and then downloaded during regular intervals or at the end of the shift. Usually, the synchronized handheld will contain all of the work orders that need to be accomplished by the facility technician during his shift. They can be used anywhere and real time wireless contact is not required. Handhelds are especially important due to the round the clock maintenance required by hospitals.

Radio Frequency Identification (RFID) tags
RFIDs are already in use in many areas such as large shipping crates and security applications but these tags have not yet reached the hospital arena. RFID is a method of identification through the use of radio waves. Typically, a RFID tag would be attached to a particular asset and would be identified by a unique ID number. As these devices or ‘tags’ “listen for a radio query and respond by transmitting their unique ID code”, very large amounts of information about that asset can be recorded and accessed. Similar to a barcode application where the RFID tag is “read”, the antenna is excited and transmits the unique number associated with that to the reader device. Thus all sorts of information about the asset can be accessed including its repair history and condition reports of that asset. For instance, due to strict state regulations, hospitals must continuously monitor generators as part of their life/safety aspect of facility management. A RFID tag for a generator could contain the history of that generator so that an inspector equipped with an RFID reader could instantly access that information to evaluate the asset’s functionality and its repair history since the last inspection. This information could then be updated to ensure it is current.

Predictive Maintenance
Traditionally preventive maintenance has consisted of a technician lubricating and physically inspecting a machine. This physical inspection can include partial or complete disassembly of the machine for inspection or to change parts. There are several problems with this:

• There may be nothing wrong with the machine, operating time has been lost and failure is more probable when it is put back into service after re-assembly;

• Some problems may not be discernible by physical inspection;

• Some problems may only be discernible when the machine is in operation.

Predictive maintenance consists of a series of technologies that can be used to detect future problems thus ensuring the machine remains in operation until the optimum moment to stop the machine for service. Typical of these would be:

• Vibration Analysis - These identify vibration parameters that vary from the baseline norm that has been established for that machine;

• Infrared - This identifies, for example, hot spots on electrical connections that are a precursor to failure and/or fire;

• Noise Detection - Leaks and other related problems can be detected through ultrasound techniques.

Modern technologies and techniques combined with CMMS software are increasingly essential tools to ensure that facility maintenance keeps pace with the demands of today’s hospital requirements. Implementation of CMMS software and its technological advances are essential to the proper maintenance of a hospital and allow medical practitioners to achieve their primary goal of providing patient care without distraction.

David Griffiths is the senior management consultant for Williamsville, NY–based CWorks Systems, Inc. CWorks can be reached at:
716- 631-4750 or at: www.cworkssytems.com.

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