Editor's note: This article is the fifth 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. 

While in the constant pursuit of operational excellence, health care facility professionals are acutely aware of the major challenges preventing us from reaching our full potential. Some are major challenges that have remained unresolved for decades. To solve these challenges, it is essential to alter our perspective and apply a different way of thinking.

Taking an original approach to age-old issues requires thinking outside the box to make the best decisions possible; and decisions that will enable health care facility professionals to realize our future must be bold.

Reliability-centered maintenance (RCM) falls within the category of bold decision-making. One of the reasons for pursuing RCM as a potential solution is because it allows motivated individuals to boldly pursue best practices, all while delivering services at the highest value possible and contributing to an unparalleled patient care experience.

Before diving into why RCM is a viable solution, it is important to acknowledge RCM has been around for a very long time. Like many terms used to label a rigorously tested and proven strategy, the "label" is pioneered much later. In the case of RCM, the label came nearly two decades after the Federal Aviation Administration (FAA) approved the airlines to begin conducting a series of intensive engineering studies on in-service aircraft.

What the airlines developed is an approach that led to an increase in cost-effectiveness and machine uptime, and a greater understanding of risk. The strategy used to determine the optimum maintenance requirements for aircraft proved to be so successful, the U.S. military began to adopt the strategy in the mid-1970s and by the 1980s, RCM was being adopted by the U.S. commercial nuclear power industry (the single industry more regulated than health care!).

Health care organizations have utilized various methods and strategies to improve safety and quality for decades, however, the calendar continues to govern our preventative maintenance (PM) strategies. This calendar-based approach often has limitations due to a narrow focus on PM frequency. It fails to take a more holistic or systemwide view toward mitigating risk and preventing failure.

Traditional PM tasks and schedules are often generalized across a large group of equipment and fail to consider unique variables as well as key performance indicators (KPIs). On the contrary, RCM requires a deeper understanding of each individual piece of equipment and determines the maintenance requirements unique to each piece of equipment.

To put this into context, one can ponder the maintenance of two vehicles. Vehicle A is a fuel-efficient commuter, driven 400 miles to and from work per week. Vehicle B offers more options and is primarily driven on the weekends and longer road trips.

If the traditional calendar-based approach is used to maintain these two vehicles, based on a forecast of vehicle A's mileage, one would expect to see a favorable outcome for vehicle A (due to its consistent use and predictable mileage). On the other hand, vehicle B may receive maintenance prematurely and/or maintenance could be delayed due to long-distance road trips. As a result, the cost per mile to maintain vehicle B is inflated and the likelihood of failure is increased, due to the gaps in maintenance (resulting from the long-distant road trips). In contrast, if vehicle A and vehicle B were individually enrolled into an RCM program, the mechanic would be equipped with a deeper understanding of when and what type of predictive maintenance is required. Meaning, the vehicles would be enrolled in a systematic and cost-effective maintenance strategy that addresses the dominated causes of equipment failure and downtime.

When it comes to determining when a maintenance activity is triggered, we must take a closer look at the KPIs.

Imbedded within RCM is an evidence-based maintenance strategy called condition-based maintenance (CBM). Simply put, CBM provides the input of data and RCM provides the predetermined rules to make informed decisions. Based on equipment eligibility, individuals with appropriate knowledge can determine the specific KPIs which identify a decrease in performance or upcoming failure. One example of a KPI being measured by nearly every health care facility is the pressure differential across an air handler’s filter bank. When it comes to collecting the input data required to operationalize an RCM program, many of us are already capturing a large portfolio of KPIs. 

As we continue forward on our journey toward operational excellence, the RCM framework provides the process necessary for teams to migrate away from a blanketed “just-in-case" calendar-based maintenance strategy and toward reducing risk, based on evidence of need.

This means, teams would be monitoring specific criteria and/or duration of time to trigger the type of maintenance needed to prevent impact to patient, staff or visitor. When health care professionals are armed with a deep understanding of mitigating risk by preventing failure, we have the potential to overcome the deeply embedded challenges within health care operations.