Equipment Replacement Planning Raymond Forsell, CCE, PE, CHFM - - PowerPoint PPT Presentation

VHES Presentation: Equipment Replacement Planning

Raymond Forsell, CCE, PE, CHFM November 6, 2015

Clinical Engineering Outcomes

 1. T

• improve the quality of health care

available to patients.

 2. T

• foster the successful use of health

care technology.

 3. T

• reduce risk to patients, staff, visitors,

and the facility.

 4. T

• contain and reduce costs associated

with technology.

Health Care Without T echnology?

 Imagine trying to deliver quality 1st world

health care without the building systems and medical equipment which is used today.

 Loss of a system due to gross failure

greatly jeopardizes organizational mission.

 Our facilities are a machine made up of

standalone and interconnected systems and devices.

Replacement Planning Path

 TSP began offering replacement

recommendations for medical equipment in late 1980s.

 The Equip Replacement Plan (ERP)

report is one of the most requested engineering products that we offer.

 There is significant transference between

the Facilities and Medical Equipment models.

Replacement Planning Path: Observations

 Equipment does not last forever  Organizations do not adequately plan

(fund) for routine replacement

 Competition for limited capital requires

better justification of replacement

 Life cycle is surprisingly predictable based

• n the device type and use

 High technology reduces service life  Emergency replacements cost more

Presentation Objectives

 Explain the TSP Med Equip Replacement

process as applied to medical equipment

 Make connections from Medical to

Facilities equipment

 Discuss the Capital Planning approaches

which may improve effectiveness

 Discuss standardized approaches for

justifying Facilities equipment replacement

Equipment Replacement Planning

 Vermonters use things up!  Typical for hospitals to use devices past the point when

they can be repaired.

 Costs of service can become very high as devices age.  TSP has data from 42 years of service to aid in planning

for the best time to replace devices.

 Too late: high costs; poor reliability; unsafe; unavailable;

poor negotiation leverage.

 Too early: device not depreciated, poor cost

containment; staff learning curve

Equipment Replacement Planning (ERP)

 Annual report produced  Provided to primary contact +  Multi-year projections of useful life of devices  Flexible  Can be produced at any time of the year  Data used to assess the utility of mid-year

repairs.

TSP Assessment Parameters

 Device Type  Make/Model  Age  Purchase Cost  Total Service Costs  End of Production Date  End of Support Date  Risk Score  Regulatory or Technological Obsolescence

TSP Recommendations

 Clear Identification of the Device

• Make and Model
• Control and Serial number
• Facility and Department

 Status of Device

• Age & Useful Life
• Production Status
• Support Status
• Obsolescence

TSP Recommendations

• Replacement Recommendation

 Year for Action  Priority (High, Normal, Low)  Action (Replace, Replace Capital, Track, Contingency)  (future) Estimated Replacement Cost

• Reports typically cover 3 to 5 budget years
• Intended to arrive Jan-Feb of each year

Algorithm

 Age * 2  Risk * 3  Support *3  Cost * 1  Critical >=30  High >=20  Normal >=10  Low < 10

TSP Recommendations

• Key Guidelines

 125% of estimated life  40% total cumulative service/purchase cost  End of Manufacturers Support and Dwindling Alternate Parts  Technological, Medical Obsolescence  Regulatory Prohibition

Ideally

 Medical Equipment replacement would be

distributed equally over an 8 to 12+ year period depending on life cycle

 For the normalized small hospital

inventory (1500 devices, $ 10,000 avg price per device = $ 1.5M per year

Improvements Needed

 Better justification (persuasive)  Replacement cost estimation  Failure rate modeling over life of devices  Modeling of how device reliability impacts

clinical and organizational mission

 Integration with departmental budget

planning and capital budget review process in many sites

Examples

 Full Data Report  Report to Customer  Reliability Curve

The Weibull Curve (Bathtub)

Regions of Device Life: 1

 Region 1: Early Failure

• Defect in design
• Poor materials
• Poor manufacturing

 Prevention

• Burn in period
• Environmental Stress Testing
• Commissioning

Regions of Device Life: 2

 Region 2: Service Life

• Random Failures
• Maintenance Based Failures
• Limitations of Design
• Operating Beyond Design

 Prevention

• Predictive Maintenance
• Use within Design

Regions of Device Life: 3

 Region 3: Wear Out Period

• Increasing Failures
• Fatigue Evidenced
• Obsolescence (components or design)
• Systemic Failures

 Prevention (not really)

• Increased Preventive Maintenance
• Workarounds

The Weibull Curve (Bathtub)

Facilities Equipment

 Similar to that of medical equipment  More mechanical in nature  Similar Levels of T

echnology (computers, electronics)

 Very transferable theories for

replacement planning of both

 Building based systems may be more

expensive and difficult to maintain/replace

We Must…

 Compile data for systems and

components relative to life cycle (Use your CMMS)

 Document status of systems and publish

life cycle projections on systems and major components

 Link systems to key values of the

• rganization

Key Justifications

 Clinical Impact

• Necessity to specific patient care and safety

 Financial Impact

• Support of income stream functions

 Community Impact

• Market Share, Community Support

 Regulatory Impact

• Specific links to FDA, CMS, TJC, USP….OSHA,

EPA

Establish Champions

 Clinical (MDs…)  Organizational Leadership  Long term knowledge of the needs  Involve them with ongoing information as

time ticks on

 Use photos and videos for justification  Show change or degradation

Facilities Systems

 Illumination  Electrical Power (Normal)  Electrical Power (Emergency)  Security / Observation  Access Control  Fire Alarm  Fire Suppression  Security Alarm

Facilities Systems

 Elevators  Domestic Water  Waste Water  Waste Disposal  Steam  Chilled Water  Heating

Ventilation and AC

 Medical Gas

Facilities Systems

 Communications  Building Operating Components (Doors,

etc)

 Building Control System  The Buildings (Structure, Envelope, Roof,

Finish…)

Organize

 Facilities equipment within one of the

systems just described

 Define its useful life and place in Weibull

curve

 Use Key Justifications for each system to

help to build your case for planned replacement

Exercise #1

 T

eams of T wo (Name your team)

 Take 1 or 2 cards with system names at

• top. For each:
• List major component devices in system
• What is your estimated service life of each?
• What are the ways they fail?
• What data can you collect on failures?
• When is end of life obvious?

 Round table presentations

Prep for Capital Cycle

 Enter data into CMMS  Model life cycles for all systems and key

components (reliability, finance)

 Extract data multiple times per year  Present as part of facilities management

reporting

 Justify using your facility’s capital

budgeting process

Story Building Ideas

 System and Function  Year installed  Estimated Life  Key Justifications that affect organization  What happens if the device fails (minor

and major)

 Cost of replacement  Payback Period

Story Building Ideas

 T

• tal Service Costs

 Rate of Failure (esp if increasing)  Cost per failure  Lost Revenue per failure  Delayed patient care per failure  Alternatives  Effect if not funded in request year  Budgetary quote for replacement

Story Building Ideas

 Savings from replacement (energy…)  Service cost savings  Operating cost savings  Regulatory factors  Request or complaints by physicians or

departments

 Renovations and project costs  How the technology has changed

Discussion: Your Capital System

 Timing  Format  Submissions  Review  Competition  Approval  Pitfalls

During Capital Budgeting Process

 Use Key Factors in justifying requests  Use story building skills  Prepare to compromise (indicate

consequences)

 Utilize Champions  Plan for multi-year progress  Care in prioritizing requests  Be persistent

Exercise # 2

 2 to 3 T

eams

 T

eam picks one system and piece of equipment to evaluate

 Ray will provide some initial conditions  Discuss and present your case for capital

replacement

T

• ols

 Your FM staff  The CMMS system and its data  Life Cycle modeling assistance  Benchmarks and manufacturer data  Clinical and leadership champions  Persuasive, objective justification

Train Managers for Successful Equipment Acquisition

 Don’t shop hungry  Don’t walk home alone  Get comparative data  Don’t Rush  Justify. Justify. Justify  Plan for Installation, Training, Service, Life

Cycle

 Don’t be a hoarder

Access

 Contact Ray Forsell at 802 881 5646

(cell) raymond.forsell@its.uvm.edu