EBME Forums Forums Maintenance Technical Assistance The Root Causes of Equipment Failures

Hi All,
I need you help as I'm taking my final project on my BSc in Medical Equipment Management. I'm performing some Root Cause Analysis (RCA) in determining why certain work requests keep occurring or why certain problems are happening?

In most hospitals a certain amount of time is given to reactive maintenance or 'fire fighting' as it is often called. We go to the departments and fix the problems, but then the problems occur again and again because we have not solved the root causes of the problem.

There are certain techniques and tools used for RCA. Many engineers feel training is the solution to everything. You soon discover that training is not the total solution for all the problems, but there is usually a variety of contributing factors involved until you discover the root causes.

Even if 'training' was the 'root cause', you would still have to ask questions like, whether the training or the trainer was competent. Also how was the competency, of the trained persons, monitored? Or was the training material relevant enough or comprehensive enough? (If the trainer and engineers don't share ideas the same problems occur again and again)


I dont know if any Trusts, out there, or private companies have ever attempted to do anything of this nature. RCA is not a new thing, but I haven't heard of any EBME's doing anything like this? Is there a benchmark , in our industry that you know? Have you done or heard of anything like this?

Your maiden post is most welcome (if, I may say, somewhat overdue) Steve.

The question(s) you pose are of great interest.

In brief response (and setting aside for the moment any discussion about the definition of equipment "failure"), I would say that the root cause is the environment in which the kit is used (the hospital setting, and all that implies).

For example, we have probably all seen cases of the same type (manufacturer, model) of, say, ECG Recorder in tatters (or the bin) in the hospital, whilst still giving yeoman service out in the sticks in a GP's surgery. Why should that be? Many reasons, most likely, such as heavy versus occasional use. But "pride of ownership" is most likely a factor as well.

Hi Geoff,
The hospital setting can be one of the reasons why staff would fail to use a piece of equipment correctly, if that is what you mean? They could report a failure which in fact was human error, not an equipmnent failure.

Other environment factors include whether staff have enough time or if they under pressure to do there job? Is the supposedely faulty kit failing at a particular time? (Perhaps daytime staff are better trained than night time staff.

Even temperature and noise of the environment can have an effect on how well staff perform there task.

People get used to their environment and work practices. They can do a job so often that they do not need to think about it, and that's when problems occur.

However, back to my original question, I wanted to know If anyone has attempted to do anything like Root cause Analysis and coming up with corrective actions, to ensure the problem do not occur? Is there a benchmark I could use as a reference?

Yes ... all of the above, plus more. Like the "pressure cooker" atmosphere apparent in some of the front-line user departments. Not enough time, everyone yelling at once, ten things underway at the same time, and all that.

And, on the other hand, sometimes an "easy come, easy go" (or even, the "not my problem") attitude to the kit on the behalf of users. As an aside (and returning to "pride of ownership"), that's not something you see much of in places like Africa (for example), where the kit, being generally in short supply and/or hard to get hold of, is often very well looked after.

Anyway, back to your question. Many of us have surely used Job Codes, Fault Codes and such for many years. I quite like that (old fashioned?) approach myself. But it must be said that, with busy techs having more pressing matters on their minds, the Codes recorded may not always accurately reflect the actual situation. And ... in many systems I have come across, the Codes available are a bit "poor" anyway!

But, perhaps someone may have some data they are able to share with you.

I'm sorry, but I don't have any benchmark for you (but you could try here). But, again yes, many root causes of equipment "failure" can be down to (user) "training". On that one, may I commend you to my time honoured response about "Repetition Trains the Donkey"!

Meanwhile, I guess that you must be familiar with the "Five Whys". Needless to say, in the example given, No.5 (of the six!) is the one I find the most appealing.

Thanks Geoff for the 5 WHY's link, this is one of the Root Cause Analysis tools you can use and its easy to understand, but not necessarily easy to carry out.

The advantages of RCA are the financial benefits it brings and the new mindset it brings to EBME depts. EBME's no longer should fix the symptoms, but solve the real causes. The department will become more efficient, which is needed in these times and will also impress the Senior Managers. (If you're a private company)

Equipment being available for patients,is important, particularly when the equipment is sparce and critical. Even a Vital Signs Monitor or BP Monitor with Sp02 is critical these days. A very ill patient could be hypoxic, but not show it in their face.

Even if there isn't a benchmark, out there, for RCA in an EBME department, the discussion would be useful. I would still like to know if anyone has done anything like this?

Although Steve must have finished his Final Project by now, this thread was never really threshed out ... anyone have anything to add?

Does Rudyard Kipling's "six honest men" work with this form of analysis?
I think most peole are too busy fighting fires to take the time to do anything about it. Unfortunately within the NHS there is very little joined up thinking on this sort of thing. We can discuss the problems with one Ward but the Ward next door might not be interested. I think we've all tried various approcahes in the past but none have worked or those that did, did not last.

Worse still, perhaps, is the general case that folk get all fired up about some worthy cause during their academic training, but then fail to follow through once they re-join the real world.

Or, put another way, what percentage of projects born in a blaze of enthusiasm actually make it through to completion (production, implementation, market ... whatever)?

Meanwhile back at the topic. First we would need to define was is meant here by "equipment failure":-

1) Gone up in smoke
2) Stopped working (due to actual failure of components etc.)
3) Failed to work as the user had hoped or intended
4) Degradation in output ... etc., etc.

In his original post Steve seems to be looking into why the same "faults" get reported over and over again, then goes on to mention that "training" is generally deemed to be the solution. The implication surely being that there was no "real" (engineering) fault at all, but just "finger trouble" on the part of the user.

Yes, the same old stuff comes up day in, day out and year after year. And "training" continues to be applied. Jolly good ... fair enough. Those situations are likely to remain, as far as I can tell. But I would also suggest that all that has very little (or perhaps nothing at all) to do with true failures of equipment, or the theories associated with it.

As we all know only too well, the kit gets blamed more often than not when things go wrong. But I would say that most of it these days is pretty well designed, and that the real problems lay "elsewhere" ... in short, with the use of all that technology in the (clinical) workplace.

Geoff,

wasent REME 'forward' to do with analysing equipment failure?

Indeed it was (in theory, at least). But (if I remember rightly) it wasn't really applied to "Med & Dent" ... but rather "big ticket" Green Army kit like (in my day) Chieftain tanks and Swingfire missiles (not to mention A-vehicles in general, B-vehicles, FV-this and FV-that, SLR's, SMG's, LMG's, GPMG's, FACE, IRIS ... and a whole host of other interesting acronyms).

I have sometimes wondered what became of FORWARD. The official propaganda back then was that it was "the envy of industry". To be honest I doubted that at the time, and even more so since!

Meanwhile (and perhaps more importantly), won't the Corps be celebrating its 70th anniversary about now?