“The penny saved on capital expenditure can be pound foolish when it has to be spent on maintenance”. The medical equipment procurement decisions should never be done considering only capital cost of equipment. It should consider maintenance cost for next seven to ten years, recurring accessory & consumable cost too. Even maintenance of medical equipment should have yearly strategy to achieve low maintenance cost index with highest uptime of equipment. The goal of this blog is to effectively address medical equipment maintenance issues using appropriate quality tools.

 The maintenance strategy where there are ranges of equipment in hospital can be adopted by using various quality tools like Pareto chart, FMEA, Poka Yoke. The Pareto chart is based on Pareto’s law which states that in any large number we have “Significant Few” and “Insignificant many”. This tool is widely used in a process improvement methodology like SIX SIGMA where in it forms the important part of DMAIC tool. This strategy will help hospital clinical engineers, administrators to get to root cause for several maintenance related issues and come out with appropriate countermeasures.  

 I have tried to apply Pareto chart as head of Clinical engineering in hospital for Hospital medical equipment maintenance management in the following area.

  • The      classification of medical equipment.
  • The      maintenance expenditure analysis
  • Critical      analysis  of equipment breakdown in  user department
  • Defect      analysis pertaining to particular medical equipment

 Equipment Classification & Maintenance expenditure analysis:

We had tagged all medical equipment in three groups as given below. The major capital medical equipment like MRI, CT scan, Gamma Camera   are grouped in group “A”.

All the life saving critical equipment like ventilator, Defibrillator, Intra Aortic Balloon Pump etc. are grouped as “B” group equipment.

Rest all medical equipment like centrifuge unit, spirometer, Headlight are grouped as “C” group equipment.

The Pareto chart is shown below is based on data compiled from maintenance module software from previous calendar year.ABC1 The Pareto chart on medical equipment & annual maintenance cost clearly shows Group “A” needs clear focus. The hospital management will be very sensitive to downtime & revenue loss of group equipment. The close monitoring of performance & maintenance cost of group ‘A’ is very important & will reflect on overall performance of maintenance department. Clinical Engineering department started focusing on information related to group ‘A’ equipment like downtime, Frequency of breakdown, spare & annual maintenance cost etc. .The weekly report on group “A” was shared to management team. The clinical engineering team designated one engineer responsible for maintenance activity of this group.

Critical analysis for Hospital user department:

 The data of department wise count of breakdown on all medical equipment is were captured from maintenance module of Hospital Information system. The Pareto chart is prepared based on tabulated the data. It is noted that few of Hospital department like laboratory, Operating theaters, radiology   contribute to about 60% of total yearly breakdown .These departments were given special attention from Clinical  Engineering Department  and individual equipment in each department were critically evaluated including service history of equipment.

 Defect Analysis for particular equipment:

 Further drill down on reason for laboratory area breakdown has led to defect analysis of blood gas analyzer.

The table below shows the usage of Pareto principal analysis of defects in given equipment in one year.ABC2


The Pareto chart reveals that few repeated type of nature of error like error due to pH electrode in given equipment contributes to more breakdown frequency & downtime.

The Clinical Engineer should identify these defects & understand the root cause for same & devise suitable operator training, preventive maintenance schedule accordingly.

 It is not necessary that strong Pareto effect is found in all cases. In case of weak Pareto effect, no one category significantly stands out .In that case we need to stratify data from another perspective.

 The application of Pareto chart can be extended to many more area’s in maintenance and is true eye opener as it addresses important  grey area’s which are generally are overlooked by Clinical engineering maintenance team.  






  1. Your article is very encouraging! I know several individuals who started out as sales representatives for medical equipment companies who are now millionaires and billionaires because in the 80s and 90s they learned the trick of giving away equipment that hospitals thought was “too expensive”, only to charge outrageous prices for the “incidental” repetitive consumable supplies needed to use the equipment! Since accountants and administrators set the budget, and physicians and medical staff chose the equipment, and later department managers set their consumable supply orders, the original purchasing decision makers never realized the ongoing cost of the equipment. They thought they were getting $2million US equipment “free”, but then for the life of the equipment would pay 1850% markup on the equipment’s filters, light bulbs, sanitary covers, etc. I am no longer in the profession, but am very encouraged that software is helping to better manage this problem, and that professionals like you are seeing the light on how to use technology to make better management decisions! Congratulations, and thank you.

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