Maintenance department improves timely fixes

Preventative maintenance cuts complaints

Patients at Virginia Baptist Hospital in Lynchburg often complained on patient satisfaction surveys that things such as televisions, lights, or call buttons were not always in working order. Scores for the plant engineering department (maintenance) at the 320-bed Centra Health facility hovered around 79 points out of 100. The hospital uses the patient satisfaction firm Press, Ganey Associates in South Bend, IN, to measure and benchmark patient satisfaction levels.

"With today’s shorter lengths of stay, when patients noticed something was wrong, we often couldn’t get to it before they left, adding to their frustration," says Deanna Storey, maintenance management planner.

In addition, the process of getting things fixed was not a customer-focused one. In most cases, hospital staff waited until a patient pointed out something was wrong before they took corrective action. A nurse or clerk was interrupted from other work and required to call the plant engineering department to initiate a work order, then a mechanic came to the area to do the repair work. Another frustration: Maintenance work was often required again — within the next day or so — in the same area. The process would repeat with the same nurse or clerk calling again and the mechanic returning, disrupting the normal flow of patient care — setting up a ladder in the hallway, for example, to change a light bulb right next to the one changed the day before.

The solution to the problem is an Area Sweep preventive maintenance program. Plant engineering department mechanics conduct numerous maintenance activities in one area of the hospital at the same time, moving methodically from area to area, completing a sweep of the entire facility in a year’s time. This process helps prevent things from breaking down in the first place and circumvents wasted steps in returning to the same area time and again as maintenance problems arise.

"It’s better for us to find and correct things like leaky faucets and rattling telephones before the patient does," Storey says.

The results of the program include a slow but steady gain in the department’s patient satisfaction scores, which have risen to 83.2 since the program began in 1995. In addition, the number of maintenance work orders per year has decreased even as the hospital’s census has increased. (See bar chart, p. 106.)

The 13-member plant engineering department CQI team developed the Area Sweep and an accompanying preventive maintenance (PM) guide. They took the following steps to create the program:

• The CQI team started by researching patient satisfaction survey responses to determine where patients found problems.

• Because patients often weren’t specific on the survey forms, team members also used data from the hospital’s computerized maintenance management system to determine which kinds of problems arose with what frequency.

• Team members researched census data to determine the best time periods to "sweep" different areas of the hospital — during the time of year when the area’s census was normally at its lowest, Storey explains.

• The team sought out nursing staff’s and department managers’ input to get a better handle on the past situation and ideas for improving it.

• It researched code books and instruction manuals for various pieces of equipment to determine exactly how and how often the equipment needed to be checked.

• The team researched issues such as the life expectancies of light bulbs and drinking water filters.

The result of the research is a detailed PM guide or checklist that mechanics use as they conduct a PM sweep through an area. The team also made sure the entire hospital was swept on an annual basis in an order that made sense, Storey says. (See list of maintenance activities, below.)

Support ensures program’s success

After the details of the program were ironed out, Storey introduced it to hospital staff, directors, unit managers, and her own department’s staff, outlining the programs goals. "Communication was a key factor in making the project successful," she says. "To generate support within the plant engineering department, mechanics and other staff were involved in the development of the program and PM guide."

In addition, Storey emphasized the we’re-all-in-this-together aspect of patient satisfaction. An employee financial incentive program is partially based on patient satisfaction ratings, she explains. "They could easily see that as the program increases patient satisfaction, the potential for a large bonus exists."

Another factor Storey had going for her was that nurses and other staff could see the Area Sweep program was taking part of the burden for maintenance off them.

Here’s how the PM program works:

• Prior to the month in which a particular area of the hospital is scheduled for a sweep, plant engineering staff notify the area’s staff that they will be coming and ask for any input into the process.

• Again, working with the area’s staff and examining daily census data, plant engineering staff determine when they can conduct the PM sweep in each room. For example, if a room is empty, it will be done immediately. If it is occupied, the mechanic will ask the nurse or the admissions department to notify plant engineering when the room is vacant. (For the most part, the room should not be occupied during the sweep.)

• Using the PM guide, a mechanic visits the area — replacing light bulbs, conducting electrical safety checks, and calibrating thermostats, for example — and when possible, corrects problems on the spot. A PM cart ensures the mechanic has the necessary equipment. If a problem is beyond his or her level of expertise, the mechanic can write a work order, and the job will be assigned to a trade mechanic.

• Storey measures the program’s success by tracking several indicators, including:

— quarterly Press, Ganey reports;

— patient satisfaction survey forms with complaints or comments;

— the completion rate of area PM sweeps;

— an ongoing summary of the types of problems in patient rooms as reported by the maintenance management system.