EBME Forums Forums Free discussion Free discussion How Many Techs.?

As has already been said. It depends upon what equipment you put on the maintenance database. At one time I only put on equipment that was essential to maintain and omitted items such as TENS units, opthalmmoscopes and laryngoscopes knowing full well that I would never get the chance to check them. When this hospital merged with two other larger hospitals I found that at one hospital everything was put on the database and I had a situation whereby I had 600 assets to look after and the other hospital had 3000+ assets. The ratio of technicians to assets looked bad from my point of view.
Another problem was that I considered a defib to be 1 asset but the other hospital broke it down to defib, charger unit, docking bay ie 3 assets.
It also depends upon the level of work carried out on equipment and how many service contracts are in force with equipment suppliers.

A different question - When working out the number of technician hours needed, what percentage of time do you assume is needed for repairs to equipment. ie If you have 1000 hours of planned maintenance, how many hours would you assume is required for repairs to faults.

Good points Ken - obviously you have real "hands-on" experience rather than text-book answers to text book questions.

Ken,

Yes, there are indeed skills required in drawing up a "proper" asset register. I usually group "miscellanous medical equipment" together within a given department (ie, to "count" as one asset). To consider a defib as three assets is definately the wrong approach. Many years ago the army came up with the concept of the Complete Equipment Schedule (a checklist of what comprised a particular "complete equipment" - eg, the defib in your case). But I won't go into that now, for fear of upsetting our unmilitary brethren (...I could also mention the origins of the "Beyond Economic Repair" concept...).

As a "text book" rule of thumb, I have generally started off on the assumption that half of the man-hours available would be spent on PM. So we could say that the other half are spent on repairs, roughly speaking. And, of course, the basis of all maintenance planning is "how many man-hours does it take"? If you don't have enough man-hours in your year, then you cannot expect to give the sort of service so often promoted at this forum.

Lastly, need I remind our colleagues that "Failure to Plan is Planning to Fail", regardless of how much "hands-on experience" is available (...another rapidly dwindling resource, in my experience).

I find that without actually having the knowledge and skills to do something in practice then planning is somewhat redundant.

Mr. RL,

I entirely agree. But you can't do it all by yourself, can you?

Best Regards,

Geoff Hannis

Depends "what you have to do", "who you have to do it" and "how long you have to do it in" I suppose.

Ken,

Just my own personal views and ideas (not trying to be one of the "NHS Gurus" as suggested in the first post in this thread) but I think that planned maintenance is just what it says - planning the maintenance provision using "known quantities" rather than trying to predict future requirements based on "unknowns" or "rule of thumb" assumptions. Anyone can make a simple guess based on oversimplified assumptions but I am old-fashioned and think that skilled, highly paid, medical equipment Managers should work for their money like us "bodies" do - Management being the objective of course. Of course experience and “rule of thumb” are a starting point (for those with the experience and skills necessary to divine) but the idea is to apply a methodology and plan for adequate provision of maintenance, following guidelines, giving evidence if the provision is insufficient so that additional resources can be requested or priorities established at least – maybe to minimise the most significant risks associated with failure to perform regular servicing, on higher-risk devices if inadequate resources are all that’s available. Something like Rojo is getting at in his posts elsewhere I think – allocation of limited resources.

Surely adequate planning can only be applied with information about the quantity of equipment, type of equipment, servicing requirements, servicing methods and service intervals for each type of equipment and any mandatory requirements or regulations. Isn't this what maintenance databases and asset registers are for? Surely it's not just about producing a pretty list of equipment that's never used for anything else but ticking off when an item is located for safety testing? The numbers of beds have little to do with planning servicing arrangements for medical devices (unless you're servicing beds of course). The number of devices is not necessarily a good indicator of the work required in servicing them. We need to have an idea of the necessary parts, costs, time taken to perform routine servicing and the intervals between routine servicing that are required for each type. All this prioritised by assessing the risk that equipment may present when there is a failure to maintain it to the standards required.

The necessary skills are also important - what's the point of planning if the skills necessary to perform a service on a type or range of equipment do not exist or will always be beyond the capabilities and resources of a in-house department? Only with this information can the decision to perform servicing on a particular type or range of devices, in-house, be weighed-up. Planning includes allocation of the available resources, money, time and available skills – not just division of the “body-hours” between N-serviceable items.

Unknowns such as the average number of assets associated with a bed or the average number of technicians required in servicing N-items of equipment are pointless in my view. The only thing that is valid is that the more equipment you have is that more resources will be needed to look after it - but "how much extra?" is the important question. The amount and level of complexity of equipment around beds varies considerably, so does the time taken to perform servicing on different devices and associated costs in parts and skills. The range of tasks carried out by many of us just cannot be quantified by such a simple variable such as a Technician to Beds ratio can it? This line of thinking obviously comes from individuals who do not have to get out there and do the work but sit at a database all day thinking about how to make the books balance i.e. "does everything look, on paper, like it's covered?"

Getting onto your question Ken; My own personal view is that repairs have to be assessed as and when random breakdowns or faults occur since they are "unknowns". It's really impossible to predict random breakdowns, failures or callouts associated with the use of equipment, predicting the amount of time in man-hours and the cost of such repairs. The likelihood of the quantity of repairs that occur on average over a period, based on previous occurrences, can be applied but we will never know exactly how many, when, where or how they will occur in practice. There is just so much diversity in equipment we're responsible for servicing it's impossible. When failures occur, if there is no slack in the system for carrying out repairs then it is the planned maintenance that is likely to suffer, irrespective of all the planning in the world.

So it’s likely that any planning for routine servicing will be affected by breakdowns and subsequent repairs; i.e. if you have 1000 man-hours allocated to servicing, at full capacity to the required standards, then if 500 man-hours of repairs occur and you have no additional resources then you can only fulfil 500 man-hours of routine maintenance – simple sums. Otherwise if you allocate 500 man-hours, out of 1000 avaiable, to repairs and have N-technicians on standby performing 500+N hours routine servicing until a repair comes into the workshop. Either way planning and performance of routine servicing is influenced by repairs that are unpredicatble. Perhaps the best way is to have dedicated teams of technicians allocated to routine servicing and repairs so that one group does not directly influence the activity of the other and the routine servicing commitment is fulfilled (if the commitment is realistic and applied correctly).

I say one group does not directly affect the other because if routine servicing or repairs are neglected or not carried out properly then this may contribute to future breakdowns - or is it not as simple as this? How many FOB problems do we deal with? How many requests for part numbers for accessories and consumables? How much equipment training is provided? The job cannot be broken down into servicing and repairs as some try to do. Back in the real world all you can do, I suppose, given the man-hours required to service the commitments that you already have, is to decide whether there is enough excess man-hours to apply to tasks, including repairs, so that the high-priority planned maintenance tasks are not compromised.

Hello Richard,
As your post indicates, manpower planning is a very complex issue with a number of different variables. It may be easier to calculate the number of manhours required for PM, remedial, training, management, clerical, etc. add up all the hours, and then calculate the WTE 'whole time equivalent' requirement for staffing. If we want to formulate 'how many techs do i need in my dept?' then my view is that we should not try to restrict the ways that we justify our manpower levels.

To add some numbers to the answers...

I have 1059 assets on the asset register which I'm responsible for, this includes 4 theatres' equipent (cardiac incl), 3 ITU's (mainly monitoring and ventilators) and over 250 infusion devices. With the current set-up which we've optimised over and over again it seems we are still 30%-40% short on human resources.

Rule of thumb in our case is at least one engineer per site and probably no more than 800 assets(depending on quantities of type) per engineer.

Another disappointing dip into the well guys!

I think, then, that I’ll stick with my basis of 1 technician for 300 assets.

For those who may be interested, this figure came about during glory days of medical equipment maintenance contracting in the desert. We had to protect ourselves vis-à-vis foreseeable risks and obligations against a backdrop of financial penalties. We also had to be able to offer full service, often in remote locations, and even without telephones at one or two sites. Very little effective back-up except from our own resources. Using multi-national manpower, naturally.

A bit different from the NHS situation, I know, but the basic task is surely more or less the same (ie, repair and maintenance of the kit and keeping the customers satisfied).

Keep the faith.