Editor's note: This article is part of a 14-week series titled "Reliability Asset Management: Getting Started." The series explores the use of reliability-centered maintenance in health care facilities. One article will be published every other week. 

I started in the maintenance arena in 1987 while acting as a maintenance management clerk for the United States Marine Corps.

During my military career, I was responsible for the preventive and corrective maintenance of thousands of assets and grew into devising management strategies for various organizations, even teaching maintenance concepts and practices at government schools.

As we struggled with keeping our equipment combat-ready while also using some items daily, it became evident that going by the book often wasted a lot of money. The unofficial motto was “replace this because the book says to do so, not because it's needed.” It expended a huge amount of manpower (people to manage the schedule, paperwork, parts, etc.,) and a large overhead of equipment to ensure we had enough combat-ready assets to counter the losses due to failures.

In 1999 I started my journey in the health care maintenance industry, and what a different world it was.

Unlike other industries, health care organizations are required to follow rigid manufacturer recommendations regardless of actual need, effectively stifling any sort of efficiency, monetary or reliability gains possible from doing maintenance differently. As various maintenance processes were introduced, each seemed destined for failure in health care due to the strict regulatory oversight. Fortunately, as alternative maintenance strategies have become more proven and the regulatory landscape more accepting, health care has been able to implement new ways of managing their environment of care.

Enter reliability-centered maintenance (RCM), a strategy and process that is designed to promote the reliability of equipment, systems and structures. This is a “thinking man’s” strategy, as it requires the organization to think through all aspects of an asset’s existence — from what it is supposed to do, to how it is supposed to do it, how it can fail (including those hidden ways), what is affected by a failure and what could be done to prevent failures.

Although RCM may not be applicable to all assets within a health care environment, applying this to strategic items can reap huge dividends to the organization. As an example, replacing air handling unit (AHU) filters when needed and not just every three months could save hundreds of dollars per unit per year, as well as reduce waste. Knowing how the AHU is designed to work, and the standards of performance for the unit, allows the organization to alter the standard date-based approach and move to a reliability-centered approach.

So why isn’t everyone doing this? Well, frankly, it takes commitment, and it’s a process driven from within and not from without. In other words, many organizations like the safety of following what the manufacturer says instead of putting their reputation on the line to do something better.

For each type of asset being included in the RCM program, you must do some homework. Define in writing the operational context, functions and desired standards of performance for that asset. Once you know these, you can identify how the asset can fail to perform to those definitions, as well as the probable cause and consequences of each failure type. And of course, you need to identify what your team can do to prevent those failures from happening. Sounds easy, right? Nope. For more than 20 years in the health care industry, we are still trying to standardize on failure codes, failure cause codes, effect and consequence codes, and standardized tasks. If the organization is willing to make some effort to perform these steps, the benefits are more efficient teams, lowered costs, higher equipment reliability and safer environments.

And, when implemented correctly, an RCM program will meet all regulatory requirements for an alternative equipment maintenance (AEM) program such as The Joint Commission (TJC) outlines in EC.02.04.01, EC.02.04.03, EC.02.05.01:

  1. Not reducing the equipment.
  2. Must be based on accepted standards of practice.
  3. Must have a 100% completion rate for scheduled maintenance activities.
  4. Defines the risk of the asset.
  5. Adequate history to determine failure, cause, effect and consequence values.
  6. Performed by qualified individuals.
  7. Uses written procedures to follow.

It’s time health care maintenance organizations embrace the value of AEM strategies and consider how RCM, as one of those strategies, can lead to improved safety, comfort, usability, and efficiency of equipment, systems, and resources.

Rick Joslin has been in maintenance and services management since 1984, having performed as a technician, team lead, manager, director, and compliance & enforcement surveyor. Since 1999, he has helped almost 600 health care organizations implement industry best-practice and regulatory compliance functions within computerized maintenance management systems, while also championing the need for organizational and industry-wide data standards that enable analytics of and support to total asset management.