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Who will be the Doctor to your Hospital Assets?

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Who will be the Doctor to your Hospital Assets?

Grand Old Buildings 


On 5th July 1948, Aneurin Bevan, then Minister of Health, launched the National Health Service (NHS) at Park Hospital in Manchester. Alike the NHS, some of its grand buildings were built many decades ago. Take Whipps Cross Hospital for example, its distinctive Victorian buildings possess a rich history. In 1917 its name was changed to Whipps Cross to coincide with a visit from King George V and Queen Mary. The hospital once accommodated sick and elderly inhabitants of a local workhouse, thousands of wounded WW1 servicemen, and today, almost 1,800 patients pass through its doors daily. With several buildings over one-hundred years old, the estate and its facilities are not fit for purpose, and St Bartholomew’s NHS Trust is developing plans for a new hospital on the site.



The deteriorating state of the NHS Estate


Many NHS England trusts reported large backlog figures during the 19-20 Estates Returns Information Collection (ERIC) report, at £9 billion, the total backlog has risen each year since 2013/14, more than doubling with an overall increase of 105%. Within an NHS report, it is stated ‘We risk patients paying the price for the mounting backlog, and the scale of the problem is gathering pace.’ Between 2017/18 and 2018/19, a 25% increase in clinical service incidents was experienced, these are incidents that are caused by estates and infrastructure failures, that led to clinical services being delayed, cancelled or otherwise interfered with (reference), (reference).



Treating your hospital like a patient


Hospitals are extremely complex environments, encompassing multiple buildings, hundreds of assets, thousands of people and numerous systems. Now if we (loosely) compare a hospital building to a human body, the doctors, nurses and operational staff representing the brain, the hospital’s building management system acting as the respiratory system, allowing the building to breath and ensuring clean air, whilst the electrical distribution network acts as the cardiovascular system, giving the hospital life.


You may wonder where I’m going with this, but it raises the question: should we care for our hospitals and their components like we would a patient? After all, they are the places where we bring life into the world, provide care and recovery for the sick and vulnerable, and at times, say goodbye to loved ones.


If our body is telling us something is wrong, for instance a high temperature or an abnormal pain, it is leaving its normal operating conditions. Would a doctor advise that we ignore these symptoms, even if they persist, and wait for the body to deteriorate and fail? Certainly not, so why would we do this with our hospitals?





What are the different forms of maintenance?


What is Corrective Maintenance (CM)?


Corrective, breakdown or reactive maintenance all refer to a run-to-failure approach that simply lets equipment run until something breaks. Although this method may save upfront costs, such as systems that perform more sophisticated maintenance procedures, or the time spent to plan repairs, there are various disadvantages that are likely to outweigh these upfront savings. These include: shorter asset lifecycle, equipment downtime, inefficient performance and higher energy costs. 




"If you don't plan your maintenance schedule your equipment will do it for you."




What is PPM (Planned Preventative Maintenance)


PPM is scheduled maintenance where equipment is maintained at regular intervals. Compared with reactive maintenance, this method helps to minimise partial or complete failure of equipment as issues can be identified before something breaks. However, PPM can lead to ‘over maintenance’, as assets that may be operating perfectly may still be checked as part of the plan. For organisations that rely on large amounts of critical equipment, determining the frequency of PPM can be a daunting task: too often and this may lead to large and unnecessary maintenance costs and downtime, not often enough may leave critical equipment vulnerable to failure.


What is Condition Based Maintenance?


Condition-based maintenance (CBM) uses conditions or thresholds to suggest when it is time to perform maintenance, for example “when this sound starts, we need to start maintenance”. Its goal is to enhance equipment reliability, keeping it as close to its optimum condition as possible. Although investment is required, the returns can outweigh costs within months. Some advantages of condition-based maintenance include:


  • Improved availability of assets, avoiding asset failure and shortening scheduled downtime
  • Reduced maintenance costs as unnecessary checks (like those performed with PPM) are avoided
  • Improved efficiency, reduced energy costs, increased asset lifecycle.


What is Predictive maintenance?


Predictive Maintenance relies on advanced statistical methods, such as machine learning, to dynamically define when a machine is okay or needs to be maintained. It looks at patterns across all sensors and makes one multivariate prediction model. The more data sources and data available the better are the predictions. For this reason, predictive maintenance models do only get better at predicting future breakdowns over time. Diagnosis of equipment issues can be achieved days, weeks or months before failure.  (reference)




Why condition-based & predictive maintenance for healthcare?


The advantages of condition-based monitoring easily transpose to a hospital setting, for example:


  1. Improving the safety of patients and staff. This can be achieved by a variety of means.
    • Reducing the risk of interruptions to operations due to a proactive maintenance approach
    • Improving the condition and safety of critical equipment that may cause harm to those operating or maintaining it
    • Ensuring that the building management system is performing effectively, 24/7, to reduce the spread of healthcare acquired infections.
  1. Reduce energy consumption by improving asset efficiency and performance. This would aid organisations in progressing towards their net zero by 2040 goals.
  1. Improve operational performance due to increased uptime of equipment and less time spent performing unnecessary maintenance.
  1. Increase patient comfort by continuously monitoring the health of the building management system so that room conditions can be accurately controlled to suit the patient’s needs.


All the above help to reduce the healthcare system costs, directly or indirectly. These savings can be invested where they are needed most, like staff wages, investment in new equipment, modernisation projects and so on.


Thank you for reading!