Whenever W. Thomas Schipper, CCE, FASHE, manager of environmental risk for Children’s Hospital of Orange County, Calif., is asked if reliability-centered maintenance (RCM) is appropriate for health care facilities, his answer is simple: “If it’s good enough to keep airplanes in the sky, we need to pay attention.”

RCM as a concept started snowballing in 1960, when the Federal Aviation Administration and the airline industry studied why conventional maintenance approaches were inadequate for contemporary aircraft. They determined that many equipment failures could not be prevented or reduced by simply abiding by the “right age” principle, which espoused that every piece of complex equipment has an ideal time at which complete overhaul is needed to ensure reliability and safety.

Before long, RCM principles and best practices — which called for balancing resources used with the inherent reliability expected of a given piece of equipment — were put into practice on airplanes, ships and military systems.

“In the late 1960s, United Airlines created a new maintenance approach that managed the reliability of functions as opposed to the reliability of equipment components. Consequently, they were able to increase their Boeing 747 aircraft’s amount of profitable time in the air and reduce maintenance costs,” says Schipper, who also is a former American Society for Health Care Engineering president. “RCM was further validated when the U.S. Navy adopted similar procedures for its nuclear fleet in the 1970s and by the Electric Power Research Institute as the methodology for nuclear power plants in the 1980s.” 

Since then, RCM has been implemented by manufacturing, refineries and other large industries — but not by most health care organizations. 

“Other fields have focused on recovering costs generated per hour of downtime and the consequences of functional failure,” Schipper says. “These two reasons have not greatly affected health care in the same way, but interest in RCM is growing thanks to a stronger push toward evidence-based medicine and The Joint Commission’s initiative on high-reliability medicine.”