Re: your last paragraph ... it sounds like you've had some bad experience(s) there, Mate.
Modern approaches (such as AEM, Evidence-Based et al) do not allow a free-for-all attitude at all ... but simply permit (and expect) those responsible for tech support to keep abreast of all options.
Rather than a "one size fits all" (scatter-gun) approach, any and all methods may be on the cards (no PM at all, "run to fail", MRM, RCM and all the others). All in the interest of patient safety (what risk assessment is all about) and efficiency (the best use of limited resources). Cost savings hardly get a mention at all (as they should automatically accrue).
Have you taken a look at AEM? Each group of equipment - and (or) individual items in some cases - has to jump through many hoops (tick many boxes) in order to qualify for consideration. It is (should be) a continuous process of review. Otherwise, the PM default remains MRM.
AEM (etc.) requires a lot of documentation (for instance, the "evidence" in Evidence-Based Maintenance). My own problem is how best to incorporate such requirements within a traditional ("crude but effective") database system.
