By Rick Joslin, Senior Advisor, Healthcare Strategy, Accruent

As far back as 2008, The Joint Commission (TJC) has alluded to allowing alternative maintenance strategies to ensure a safe and operational environment. More recently, in 2016 TJC provided clear guidance on what it takes to put in place an alternative equipment maintenance (AEM) program – but most healthcare organizations have not yet taken the opportunity to establish an AEM.

Sadly, this also means they cannot reap the benefits an AEM strategy can provide.

It’s time healthcare maintenance teams embrace the value of AEM strategies and consider how these strategies positively affect their organization. By doing so, you can greatly improve your organizational efficiency and reduce overall costs.

Types of Maintenance Strategies

In an alternative equipment maintenance (AEM) plan, maintenance teams adjust their activities for maintaining, inspecting and testing equipment based on risk-based assessments instead of solely basing them on manufacturer recommendations. There are many ways to implement an AEM program, and it will likely take several different strategies to fully meet your goals. Different assets will benefit more from specific strategies targeting their unique combination of roles, effects of failure, risk and regulatory requirements.

Some common strategies are:

  • Preventive Maintenance. Also called scheduled or proactive maintenance, this involves performing specific tasks or procedures at pre-determined intervals. This is the most common and easiest to implement since it is driven from the manufacturer’s documentation.
  • Predictive Maintenance. This uses some form of metering (hour, flow, pressure, etc.) to trigger when a maintenance function is to occur and is usually targeted to happen just before failure. IT also uses IoT devices to monitor vibrations, harmonics and other runtime values to predict when the asset is nearing failure, and then triggers a maintenance event to prevent it.
  • Reliability Centered Maintenance (RCM). This asset-focused failure-based analytical strategy considers all possible failure modes and develops solutions for each one.
  • Run-to-Fail. This is what it sounds like: allowing non-critical assets with minimal effect on safety or the environment of care to run until they fail, and then they are repaired.

You could likely list a few more but these are the main strategies within healthcare, and each has its own positives and negatives. For example, preventive maintenance is easy to develop, maintain, analyze and prove, but it involves the greatest number of resources and may introduce failures due to the repetitive disassemble-reassemble nature of the strategy. Predictive maintenance reduces the overhead in staffing but increases costs through IoT devices and monitoring integrations. RCM is excellent at preventing failures but has a highly complex implementation cycle and does not apply to all assets.

An AEM strategy combines pieces of the above strategies to best suit the healthcare organization’s maintenance goals. For instance, your organization’s past predictive maintenance experience may show that a particular device typically nears failure before scheduled preventive maintenance would likely be called for, and therefore it would be safer to maintain that device on an alternative equipment maintenance timeline.

Roadblocks to Implementing an AEM Plan

So what’s stopping healthcare organizations from implementing strategies that improve efficiencies and reduce costs?

Oftentimes the organization lacks the commitment starting with the top and supported all the way down to the technicians. For example, developing the necessary codes to track failures, causes, effects and other key events is important – but if technicians are not applying these during the maintenance cycle, their value is lost. Likewise, if technicians are applying these values but leadership is not consuming them, their significance is lost. Also, applying the wrong strategy to an asset could lead to more failures and costs.

In the end, often many organizations prefer the safety of following what the manufacturer says instead of putting their reputation on the line to do something better.

When we also factor in the lack of industry-level standardization, implementing an AEM program becomes even more daunting. As of this writing, there are not any published standards for failure codes, failure cause codes, effect and consequence codes, or standardized tasks. Since most AEM programs require values that can be compared to similar assets across the industry and trended, this makes it difficult to gather the necessary data for AEM implementations.

Speaking of requirements, here is a listing of the requirements set out by one regulatory body (The Joint Commission) contained within EC.02.04.01, EC.02.04.03, EC.02.05.01. The AEM must:

  • Not reduce the safety of equipment
  • Be based on accepted standards of practice
  • Have a 100% completion rate for scheduled maintenance activities
  • Define the risk of the asset
  • Use adequate history to determine failure, cause, effect and consequence values
  • Involve analysis performed by qualified individuals
  • Use written procedures to follow

The Benefits of AEM Strategies

Are AEM strategies a benefit to healthcare organizations? I firmly believe the answer is a resounding “yes.” The benefits of safer equipment, more efficient teams, longer lifecycles for equipment, lowered costs and higher employee satisfaction outweigh the effort needed to implement and maintain an AEM.



regulatory compliance and preventive maintenance