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Journal of the Academy of Hospital Administration

A Study of the Engineering Maintainance Services at AIIMS Hospital With a View to Assess It's Adequacy and Effectiveness and to Develop a Module for Efficient Functioning

Author(s): S. Marwah*, S.K. Gupta**, I.B.Singh***

Vol. 17, No. 2 (2005-01 - 2005-12)

Introduction:

The hospital building is a highly complex unit and is subjected to rigorous demands as most of it is operational both day night. Patient care is directly or indirectly dependent upon the performance of the hospital building, its utilities & services. Proper maintenance of the hospital building, its utilities & services is of paramount importance to the welfare of a patient and a major concern of the hospital administration. Aim was to study the engineering maintenance services at the AIIMS Hospital, with a view to assess it's adequacy & effectiveness and to develop a module for efficient functioning & optimum utilization of it's resources. The objectives were to study:

  • The organizational structure, staffing pattern and workload in the Maintenance Division of Engineering.
  • The budgetary provisions & monetary allocations for the Engineering Maintenance Services.
  • The existing system of Engineering Maintenance Services and it's evaluation from the viewpoint of the user and provider of the service and finally
  • To identify deficiences, if any in the existing engineering maintenance system and suggest measures for further improvement.

METHODOLOGY

In order to understand the current concepts and latest techniques in engineering maintenance, updated information was obtained from various national and international journals and documentation's from the worldwide web. The study was conducted in III phases.

Phase I: Interview and discussion

A review of available documentation followed by detailed discussions & informal interviews were held with the key officials, Engineers and other staff of the Engineering Services Department in order to appraise the organizational structure, staffing pattern and the nature of various tasks and responsibilities assigned to different functionaries of the Engineering Services Department.

Phase II: Retrospective study

  • Various records and relevant documentation pertaining to budgetary demands, allocations and final expenditure on the AIIMS Hospital over the last five years, i.e., 1999- 2000 to 2003-2004, by the Engineering Services Department were extensively studied and reviewed.
  • Records at the Enquiry-cum-Complaint office, of the maintenance sub divisions of Civil, Electrical and Airconditioning divisions of the Engineering Services Department, for one year, i.e., from 1st january,2003 to 31st December.2003 were extensively reviewed in order to understand the workload and the nature of maintenance problems. The available data on complaint records were then subjected to grouping in various categories pertaining to the kind and nature of complaints received.

Phase III: Prospective study

  1. Observation study: In order to understand the maintenance methodology followed by the Engineering Services Department at AIIMS hospital, various tasks and procedures were physically observed. The routine maintenance activities along with methods of tackling various engineering breakdowns were ascertained by first hand observations at the Enquiry-cum-Complaint offices and various maintenance sites.
  2. The initial prospective study was carried out for six months, i.e., from 1st January, 2004 to 30th june.2004 during which complaint registers at the Enquiry-cum- Complaint offices of the various sub divisions of the Civil, Electrical and Air-conditioning divisions, of the Engineering Services Department, responsible for the maintenance of the Main Hospital were studied on a monthly basis. All complaints received during this period were reviewed and grouped according to the type and nature of main maintenance breakdown and the maintenance methodology adopted thereafter.

Result and Discussion:

Budgeting

  1. The Budget of the Engineering maintenance Service at the All India Institute of Medical Sciences be prepared to all types of hospitals grouped into one category.
  2. Budgetary projections and allocations should be made separate for the civil, electrical and air-conditioning maintenance work.
  3. The financial norms laid down by the CPWD for maintenance purpose are different for various type of buildings. It is suggested that the budgetary allocation for engineering services should clearly show the sub allocation of funds for various types of buildings such as hospital buildings, institutional buildings and residential building separately and the allocated amount must be accordingly dispensed.
  4. Staffing that a team of experts from the field of Engineering, Hospital Administration may be constituted to look into the multidimensional engineering maintenance needs of the AIIMS Hospital and new staffing norms and yardsticks may be laid specifically for the Engineering Services Department at AIIMS.

Complaint communication & registration

  • A standard format for complaint communication needs to be developed and introduced which should indicate details like the ward, time and to whatever extent possible give information of the exact nature of the complaint.
  • Standard complaint registers specific to each engineering wing need to be developed and introduced which should have a prescribed format of registration of complaints with a correlation to the engineering specialty.
  • All complaints received by the Engineering maintenance staff must be recorded in the prescribed monthly complaint register. Telephonic complaints should invariably be followed on a prescribed written format.
  • Wherever possible the complaint slip should be signed by the complainant with necessary remarks like satisfactory works done not done should be obtained from the complainant. The same should be returned to the inquiry clerk who in turn should write it down in the complaint book.

Maintenance Information System

  • A 'maintenance Information System', possibly similar to the followed by the Central public work Department (CPWD), must be evolved. Details of day-to-day complaints, special repair complaints and periodical repairs may be compiled on a monthly basis and circulated to respective sections of the Engineering Services and Hospital Administration.
  • The Engineering Services Department must explore the feasibility of introduction of a Computerized Maintenance Management System.

Preventive Maintenance

  • There is a strong need to bring about a change in the maintenance methodology being followed at the hospital from breakdown maintenance in the current system to a system of preventive maintenance.
  • There is an urgent need of creating a multi specialty preventive maintenance system, which could comprise of team of engineers and various categories of maintenance staff from the various specialties of the engineering services.

Training in Hospital Engineering

  • In keeping pace with the rapid technological advances in the field of hospital engineering is a need for developing a separate cadre of hospital engineers. They should be formally trained to provide solutions to the multi dimensional engineering problems peculiar to hospitals.
  • Training programs, workshops for the engineers and other technical staff must introduced for continued education in their respective field of specialization and updating their knowledge about the recent advancements in the field of hospital engineering and maintenance techniques and strategies.
  • It is strongly recommended that a full-fledged Department of Hospital Engineering and facility Management may be explored, which could impart specialized training on Hospital Engineering to the engineer and other technical staff, not only from the Institute but all over the country.

* Deputy Medical Superitendant Max Devki Devi Hospital Saket New Delhi.
** Medical Superintendent, Dr. RP Centre for Ophthalmic Sciences, AIIMS Ansari Nagar, New Delhi.
*** Associate Professor, Deptt of Hospital Adiministration, AIIMS Ansari Nagar, New Delhi.

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