The Problem

Of the 21,000 Joint Commission surveyed institutions, no one knows the inspection rate for medical equipment – not despite Joint standards, but because of them. This fact represents possible patient safety issues, but because there is no data, no one knows how this plays out in terms of reported incidents: incidents must be reported; maintenance compliance is not required.

How is this possible?

The Joint Commission accreditation standard for medical equipment maintenance is 100%. However, inspecting 100% of the medical equipment on time is not just difficult for many institutions, it is virtually impossible to achieve because some equipment invariably is “missing” during inspections: “floaters” like IV pumps travel from one department to another, equipment may be stolen or transferred to another department, rentals are returned, staff may hide equipment because of perceived shortages, a department may send something out for repair, equipment can be in use on a patient, or perhaps maintenance technicians are just not as thorough as they might be.

The policy:
The Joint does not require 100% of the equipment to be inspected on time; their policy requires that maintenance technicians follow an inspection schedule 100% of the time. However a technician can adhere to a schedule regardless of the number of equipment pieces that are inspected: miss some equipment in a scheduled location, you can just move on to the next scheduled location. It is understandable how technicians can be motivated to stay on schedule to avoid being cited on a survey.

The problem:
Equipment not inspected can be “missing” or just not looked for during the prescribed inspection period. These numbers do not become part of the compliance calculation and reporting, even though some of the uninspected equipment may be in use on patients.

Why would The Joint set a standard of 100%, when it is virtually impossible to inspect all equipment 100% on time?
1. 100% means The Joint does not need to justify setting anything lower (95%?; why not 96%? Or 94%?). What science could they use in their rationale?
2. The Joint can have just one standard for everyone: smaller facilities (with lower numbers of “missing” equipment), and larger facilities (with higher numbers of “missing” equipment).

The reason this standard is bad.
No one can tell from compliance reporting what the actual level of equipment inspections is, nor can anyone see how long some equipment remains uninspected. Also, less meaningful data means less diligence: what incentive to improve is there if you can always achieve 100% even when you are not?

Consider this: what do you think the reaction would be if the airline industry announced that maintenance inspections on aircraft would be tracked by how often technicians report to work on time – instead of tracking the numbers of aircraft actually inspected? The obvious answer is there would be some sort of intense reaction to this news. This is exactly how the Joint Commission rates compliance for the periodic maintenance of medical equipment.

A PROPOSED FIX