International Institute of Church Management Inc., Florida, USA Extension Center in Ethiopia (Graduate Studies) By: wendimagegn Meshesha November , 2015 An Assessment of Medical Equipment Maintenance Management system in public Hospitals: The Case of Adama referral Hospital
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An Assessment of Medical Equipment Maintenance Management system in public
Hospitals: The Case of Adama referral
International Institute of Church Management Inc., Florida, USA
Extension Center in Ethiopia (Graduate Studies)
By: wendimagegn Meshesha
November , 2015
International Institute of Church Management Inc., Florida, USA
Extension Center in Ethiopia (Graduate Studies)
An Assessment of Medical Equipment Maintenance Management system in public Hospitals: The Case of
Adama referral Hospital
A thesis submitted to
In partial fulfillment of the requirements for the
Degree of Master of business administration specialized
on Non - profit corporate management
Investigator: - wendimagegn Meshesha
(B. Sc in Electrical Engineering )
Advisors: Lemma Bayssa (M.A)
November , 2015
Acknowledgments
I am very grateful to my advisors Ato Lemmessa bayssa for their unreserved guidance and
constructive suggestions and comments from the stage of proposal development to the end.
My honest gratitude also goes to medical director and physicians of adama referral hospital,
maintenance staff, user of medical equipment and top management of the hospitals.
I take this opportunity to extend my thanks to all of my teachers, and other staffs of the
Extension center , for their encouragement and other necessary support during the whole
research process.
Lastly, my thanks goes to all data collectors and study participants who took part in the study
without whom this research wouldn’t have been possible.
Figure 1: Technological assessment and selection ………………………………………………………………… 17
Figure 2: Procurement and logistics … ………………………………………………………………………………….. 18
Figure 3: Installation and Commissioning ………………………………………………………………………….…… 20
Figure 4: Training and Skill development ……… ……………………………………………………………………..22
Figure 5: Operation and Safety ……………………………………………………………………………………..……… 23
Figure 6: Maintenance and Repair………………… …………………………………………………………………..… 25
Figure 7: Decommissioning and disposal……………………………………………………………………………..…26
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Abstract
Background
In Ethiopia, the lack of proper management of medical equipment has limited the capacity of
health institutions to deliver adequate health care. It is estimated that only about 61% of medical
equipment found in Ethiopian public hospitals and other health facilities is functional at any one
time (Medical equipment inventory in 2012 GC at AA referral hospitals). Poor equipment
handling and utilization, frequent power surges, the age of the equipment, lack of operator
training, lack of preventive maintenance, lack of spare parts, lack of maintenance capacity, and
minimal knowledge regarding sophisticated equipment are factors that contribute to equipment
breakdowns.
Objectives
To assess the knowledge, attitude and practices of medical equipment life cycle at
Adama referral hospital.
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Methods
The facility managers were interviewed on medical equipment management life cycle. The data
collected from the hospital maintenance staff, users, line managers and top management how
they are determined their effectiveness as they managed the life cycle of the medical equipment.
The questionnaire comprised of seven parameters of equipment life cycle which was adequately
answered by the maintenance staff, users in their respective category. The questionnaire had two
main parts; Section A and Section B. In section A, the questionnaire defines the goal of the
research and outlines the seven main parameters to be interviewed on. In section B, each main
parameter had several questions in which the facility maintenance managers were required to
answer appropriately. The weighting of each question was answered based on the following
tabulation;
0 - Very poor: 0%
1 - Poor: 20%
2 - Fair: 40%
3 - Good: 60%
4 - Very good: 80%
5 - Excellent: 100%
Results
The results were introduced into the SPSS program which is a powerful statistical analysis and
data management system. The histograms were developed for each of the seven parameters;
Technological Assessment and Selection
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The combined percentages mean ratings for maintenance staff, users, top management
and line managers were 70, 80, 80 and 90 percent respectively.
Procurement and Logistics
The combined percentages mean ratings for maintenance staff, users, top management
and line managers in organizations were 60, 80, 70 and 70 per cent respectively.
Installation and Commissioning
The combined percentages mean ratings for maintenance staff, users, top management and line managers in organizations were 80, 90, 70 and 90 per cent respectively.
Training and Skill Development
The combined percentages mean ratings for maintenance staff, users, top management
and line managers of organizations were 40, 60, 60 and 70 per cent respectively.
Operation and Safety
The combined percentages mean ratings for the respective maintenance staffs, users ,top management and line managers are 60, 90, 80 and 80 percent respectively.
Maintenance and Repair
The combined percentage mean rating for the maintenance staff, users, top managment
and line managers are 50, 60, 70 and 80 per cent respectively.
Decommissioning and Disposal
The combined percentage mean rating for the maintenance staff, user, top
management and line managers are 40, 60, 70, and 80 per cent respectively.
Conclusion and recommendation
The maintenance computer program was proposed to develop to improve the existing facilities
maintenance management for adama hospitals . The program may guides the user on the causes
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of the fault, possible personnel to handle the fault and establishment of inventory system of
medical equipment
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1. Introduction
In Ethiopia, the lack of proper management of medical equipment has limited the capacity of
health institutions to deliver adequate health care. It is estimated that only about 61% of medical
equipment found in Ethiopian public hospitals and other health facilities is functional at any one
time. Poor equipment handling and utilization, frequent power surges, the age of the equipment,
lack of operator training, lack of preventive maintenance, lack of spare parts, lack of maintenance
capacity, and minimal knowledge regarding sophisticated equipment are factors that contribute to
equipment breakdowns.
2. Problem statement
As healthcare delivery continues to expand and improve in Ethiopia, and an increasing number of
sophisticated medical equipment is introduced, a system capable of supporting and managing the
medical technology must be in place. Medical Equipment Management system defines the
organization and coordination of activities that ensure the successful management of equipment
related to patient care in a healthcare facility. The medical equipment management cycle
includes planning and assessment of needs, procurement, training, operation, maintenance,
decommissioning and disposal of the item.
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3. Rational of the study
In health service sector medical equipment maintenance management system is neglected and
health services not satisfy the customers to alleviate the problem of dissatisfaction placing proper
medical equipment maintenance system is vital and this paper give highlights for policy makers
and donors in the area of health facility.
4. Objectives
General objective
To asses the knowledge ,attitude and practices of medical equipment management life
cycle at health care institution at adama referral hospital
Specific objectives
To asses the knowledge of medical equipment maintenance technology among technical
staff at adama referral hospital
To examine attitudes of medical equipment users regarding maintenance management at
adama referral hospitals.
To identify factors affecting proper medical equipment maintenance at adama referral
hospitals.
5. Scope of the study
The study will conduct at adama referral hospital.
6. Literature Review
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In 1997, an audit assessment of the facilities maintenance management in a public hospital in
Malaysia was carried out. The purpose of the research was to assess the existing facilities
maintenance management practices and processes in public hospital, in accordance with the
concession agreement, in order to identify the performance status. The government of Malaysia
took the initiative to implement this major privatization project for the provision, maintenance
and management of hospital support services (HSS) of public hospital throughout the country
(Maisarah et al, 2009). Three concession companies were selected to initially take responsibility
on a total of 123 hospitals and four health institutions throughout the entire country making a total
of 127 hospitals, on a fixed price and period basis. The questionnaire constructed
was based on the following:
Standards and guidelines in managing the environment of care as stipulated in Juran
Institute (1998) Management of environment of care standards;
Concession Agreement, hospital support services (HSS) privatization project;
Requisites, determined as necessary from the experience of the assessors, in order to
provide effective management of facility engineering maintenance.
The data was collected through questionnaires, guided interviews, documentation review and
archival records. Reviews were conducted to assess five key elements: Leadership policies,
service performance, supervision, training and orientation. The findings of the research described
the status of facilities maintenance management in the hospitals under study to be having a good
planning and management with all essential requirements and compliance with regulation.
However the audit assessment was not able to develop and implement comprehensive and
systematic policies, plan and procedures of facilities management through a maintenance
management program. This is because the main objective of the research was only to identify the
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maturity level of the maintenance organization in specific hospitals with regard to the
effectiveness of their management of facility engineering maintenance services. The result
from the research suggested that the maintenance organization in the case study hospitals had still
not realized the importance and effective maintenance management. It was apparent from the
research findings that the maintenance organization had not made much effort to accomplish their
roles and responsibilities towards successful implementation of facility engineering maintenance
services.
In contrast the research paper on maintenance management of medical equipment in hospitals
increases awareness of the maintenance contribution and highlights the practices to be introduced
or requiring changes in the maintenance management in hospitals. The commitment and synergy
of the maintenance organization team will prove towards realising the successful implementation
of this research objective.
The research project creates a computer programme to assist in solving faults of medical
equipment in the hospitals.
Research on strategic management of technology in public health sector was conducted in Kenya
and South Africa. The main objective was to investigate factors contributing to health care
equipment problems and associated technological investments in public hospitals (Kachieng'a and
Ogara, 2004). The research reviewed the processes of equipment planning, procurement and
management in ten public equipment maintenance institutions. Fifty six questionnaires were
mailed to target technology managers, clinical/medical engineers and technicians in public
hospitals in Kenya and South Africa. Thirty eight equipment maintenance experts participated in
the survey where majority of them were drawn from teaching hospitals. After the research it was
evident that the way health technology is managed in health care institutions directly affects the
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quality of treatment patients receive (Kachieng’a, 2004). Despite the strategic importance of
technology in health care being documented widely in scientific literature; equipment planning,
procurement and management have not received the attention they deserve in the transformation
of health care service in the two countries under the survey (Kachieng'a and Ogara, 2004).
On the basis of the results of the research, several recommendations were proposed:
Hospitals need equipment assets management systems for monitoring equipment life-
cycle costs, maintenance costs and management of equipment replacement.
There is need to strengthen and streamline management of technical infrastructure for
health care equipment selection, procurement and maintenance management.
To achieve optimum utilization of expensive equipment, specialized departments in
public hospitals, such as radiation therapy, radiology, nuclear medicine and Renal units,
should be permitted to provide specialized services to private patients to generate funds
for equipment maintenance.
The research concentrated on equipment maintenance experts from public hospitals in Kenya and
South Africa. The questionnaires were emailed to the responders in their respective institutions
(Kachieng'a and Ogara, 2004).
The research paper on maintenance management of medical equipment in hospitals ensured that
the maintenance organizations from both public and private hospitals were interviewed. The main
objective was to evaluate the existing hospitals facilities maintenance management practices and
processes. A computer maintenance program was developed to assist the maintenance
organization.
7. Source Population
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All maintenance staff and medical equipment users in the hospitals, top management, line
managers health care service providers in adama referral Hospital .
8. Sample Size
Population Size — How many total people fit your sample?. It is common for the population to
be unknown or approximated.
Margin of Error (Confidence Interval) — No sample will be perfect, so you need to decide
how much error to allow. The confidence interval determines Proposition Z, with a margin of
error of +/- 5%.”
Confidence Level — How confident do you want to be that the actual mean falls within your
confidence interval? The most common confidence intervals are, 95% confident.
Standard of Deviation — How much variance do you expect in your responses? Since we
haven’t actually administered our survey yet, the safe decision is to use .5 – this is the most
forgiving number and ensures that your sample will be large enough.
Okay, now that we have these values defined, we can calculate our needed sample size.
Your confidence level corresponds to a Z-score. This is a constant value needed for this equation.
Here are the z-scores for the most common confidence levels:
90% – Z Score = 1.645
95% – Z Score = 1.96
99% – Z Score = 2.576
If you choose a different confidence level, use this Z-score table* to find your score.
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Next, plug in your Z-score, Standard of Deviation, and confidence interval into this equation:**
PART II. Knowledge on life cycle of medical equipment management
Instruction: For the questions below please encircle 0 if you have very poor understanding ,encircle 1 if you understand poor ,encircle 2 if you understand fair , encircle 3 if you understand good ,encircle 4 if you understand very good and encircle 5 if you understand excellent.