5 Years plan for anaesthetics service maintenance in house

This study compares the cost of maintenance of anaesthetic machines between an ongoing contract with a company and in-house maintenance. It analyzes the financial implications of servicing the equipment in-house and concludes that in-house maintenance is more cost-effective. The study also highlights the need for appropriate training, monitoring, and control for sustaining the in-house maintenance system.

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5 YEARS PLAN FOR ANAESTHETICS SERVICE
MAINTENANCE IN HOUSE
Submitted in (partial) fulfilment of the requirements for the degree of
….. (DEGREE)…. IN INFORMATION SYSTEMS
(FACULTY OF COMMERCE)
RHODES UNIVERSITY
by
Full Name/s & Surname
MONTH AND YEAR
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THIS WILL BE THE TITLE OF THE THESIS OR
DISSERTATION
by
Full Name/s & Surname
SUPERVISOR/S: PROF/DR/MR/MS ……
DEPARTMENT: DEPARTMENT OF INFORMATION SYSTEMS
FACULTY: FACULTY OF COMMERCE, RHODES UNIVERSITY
DEGREE: …..
Abstract
St. Thomas hospital is currently having a 5-year anaesthetics maintenance contract with
Dragger which will expire in November 2019. The contract includes maintenance and repair
of anaesthetics machine once in every 12 months which does not include spare parts involved
in the repairs. The purpose of this study was to compare the cost of maintenance of the
anaesthetic machine for which the cost analysis is made between the ongoing contract with
the company and the in-house maintenance of the anaesthetic machine, in order to investigate
the financial implications in servicing the equipment in house.
In this study the mixed method has been used where both qualitative and quantitative data
collection and analysis process will be conducted. Two types of study procedure have been
used for this project namely the document assessment and cross-sectional survey. The
primary research was conducted on 30 participants.
From the results it has been found that the in-house maintenance system will be more cost
effective and financially beneficial for the organisation than outsourcing the anaesthesia
equipments maintenance service. It has been also found that to sustain the in-house
maintenance system appropriate training, monitoring and control will be required.
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KEYWORDS: Anaesthetic apparatus; In-house; maintenance; service cost;
management;
Declaration
I declare that the Dissertation/Thesis entitled, ……. , which I hereby submit for the degree,
…… at Rhodes University, is my own work. I also declare that this thesis/dissertation has not
previously been submitted by me for a degree at this or any other tertiary institution and that
all the sources that I have used or quoted have been indicated and acknowledged by means of
complete references.
________________
Name Surname (signed)
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Acknowledgements
I wish to thank my supervisor, Prof …… for the way in which she empowered me to do and
complete my research ….. I would also like to thank my friends and family members who
continuously supported me psychologically to continue this study.
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Table of Contents
Abstract___________________________________________________________________ii
Declaration________________________________________________________________iii
Acknowledgements__________________________________________________________iv
Table of Contents___________________________________________________________1
List of Figures______________________________________________________________4
List of Tables_______________________________________________________________4
CHAPTER 1..............................................................................................................................5
Introduction and project overview............................................................................................5
1.1 Introduction and background______________________________________________5
1.2 Problem statement and research questions___________________________________5
1.3 Aim of this study_________________________________________________________6
1.4 Objective of the study_____________________________________________________6
1.5 Research Questions_______________________________________________________6
1.6 Research Hypothesis______________________________________________________7
1. 7 Overview of the methodological approach___________________________________7
1.8 Research contribution_____________________________________________________7
1.9 Thesis structure__________________________________________________________8
1.10 Limitation of the Study___________________________________________________8
1.11 Conclusion_____________________________________________________________8
CHAPTER 2..............................................................................................................................9
Review of Literature..................................................................................................................9
2.1 Introduction_____________________________________________________________9
2.2 Quality Models__________________________________________________________9
2.3 Model ISO 9001 2015____________________________________________________10
2.4 European Quality Award_________________________________________________10
2.5 Conclusion_____________________________________________________________10
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CHAPTER 3............................................................................................................................11
Research Methodology............................................................................................................11
3.1 Introduction____________________________________________________________11
3.2 Research design_________________________________________________________11
3.3 Procedure of study______________________________________________________11
3.4 Population and sample of study____________________________________________11
3.5 study instrument________________________________________________________12
3.6 Pilot of study___________________________________________________________12
3.7 Validity________________________________________________________________12
3.8 Reliability______________________________________________________________12
3.9 Data collection procedure________________________________________________13
3.10 Data analysis procedure_________________________________________________14
3.11 Conclusion____________________________________________________________15
CHAPTER 4............................................................................................................................16
Data analysis and results........................................................................................................16
4.1 Introduction____________________________________________________________16
4.2 Analysis of quantitative findings___________________________________________16
4.3 Analysis of qualitative findings____________________________________________18
4.3 Analysis_______________________________________________________________20
4.4 Conclusion_____________________________________________________________20
CHAPTER 5............................................................................................................................21
Conclusions and contributions...............................................................................................21
5.1 Introduction____________________________________________________________21
5.2 Summary of the thesis____________________________________________________21
5.3 Answers of the research questions__________________________________________21
5.4 Key contributions_______________________________________________________22
5.5 Recommendations and Limitations_________________________________________22
References................................................................................................................................23
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Appendices...............................................................................................................................24
Appendix A – Survey Questionnaire___________________________________________24
Appendix B – Project plan___________________________________________________26
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List of Figures
Figure 1: Conceptual structure................................................................................................8
Figure 2: Cost tally..................................................................................................................20
List of Tables
Table 1: Department................................................................................................................16
Table 2: Job role......................................................................................................................16
Table 3: Experience in this organization...............................................................................17
Table 4: Findings from major variables.................................................................................18
Table 5: Cost Estimation.........................................................................................................18
Table 6: Labour cost analysis.................................................................................................19
Table 7: In House cost for PPM.............................................................................................19
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CHAPTER 1
Introduction and project overview
1.1 Introduction and background
 1.1.1 Competitive funding changes in health care systems place hospitals under
increasing cost pressures. Hospitals are encouraged to work more efficiently, reduce
costs and adjust treatment protocols to secure their economic survival, which is
essential in every healthcare system. As the cost reduction in hospitals is a major
objective, evaluation of in-house service for anaesthetic machines is conducted.
 1.1.2. St. Thomas hospital is currently having a 5-year anaesthetics maintenance
contract with Dragger which will expire in November 2019. The contract includes
maintenance and repair of anaesthetics machine once in every 12 months which does
not include spare parts involved in the repairs.
 1.1.3. Servicing in house is a risk to reduce the incidents in the trust. But the service
cos of the equipment is too expensive and the trust is trying to save money as in a
competitive economy improvement and cost reductions are necessary for staying in
business.
 1.1.4. Checking the correct functioning of anaesthetic apparatus before use is a
Mandatory procedure. In 1990 the Association of Anaesthetists of Great Britain and
Ireland published a ‘Checklist for Anaesthetic Machines’
1.2 Problem statement and research questions
 The department in EBME have the facilities to perform the maintenance for the
anaesthetics machines. However, need to employ 2 bands 7 with experience in
anaesthetics. The service manual refers to this note in the page Furthermore; we have
to prepare training in for not less than 4 people from the trust. The reason is we don’t
have anybody with experience doing the anaesthetics job in guys and st Thomas
hospital. Which means,
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 We have to prepare the staff to perform the maintenance in those equipment’s before
take the contract.
 Another critical problem is dragger has a contract and this contract expires in March
2018.
 To buy the equipment necessary to use in the calibration procedures and servicing the
anaesthetics machine.
1.3 Aim of this study
The Aim of this study was to compare the cost of maintenance of the anaesthetic machine for
which the cost analysis is made between the ongoing contract with the company and the in-
house maintenance of the anaesthetic machine, in order to investigate the financial
implications in servicing the equipment in house.
1.4 Objective of the study
• Develop inspection and repair plan for anaesthetics medical devices in the trust
• Evaluate the physic condition of the equipment in the trust
• To find out the job specific the dragger is doing Perform the investigation of the
contract. Compare with the maintenance performed by dragger display the report the facility
to do house if it is economical to do it.
• Provide technical training to the staff and plan for 5 years
• Service 102 anaesthetics machines used across site in guys and st Thomas hospital.
• Generate savings for the trust servicing the unit’s in house and fast response for the
repairs.
• 2020 service anaesthetics machines in house.
1.5 Research Questions
The purpose of this research questions are to set of exploration goals that need to be achieved
through this research project. The research questions of this study are:
• What is the current state of equipment efficiency and condition?
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• Is in-house anaesthetic equipment repair and maintenance service better than the
service provided by Dagger ?
• What will be the inspection and repair plan for anaesthetics medical devices?
• What will be the technical training plan for next five years?
• What will be the planning for in house maintenance service for 102 anaesthetics
machines used across site in guys and St Thomas hospital?
1.6 Research Hypothesis
This study has only one hypothesis and the hypothesis of this study is
• The anaesthetics in house equipment operation and maintenance service is better than
the anaesthetics doing by Dragger Company
1. 7 Overview of the methodological approach
In this study the mixed method has been used where both qualitative and quantitative data
collection and analysis process will be conducted. Two types of study procedure have been
used for this project namely the document assessment and cross-sectional survey.
1.8 Research contribution
There are several significances of this study for the healthcare organisation as well as the
study of process improvement based project management. The significances of this study are:
1.8.1 Developing a autonomous and more cost effective healthcare service providing facility
will improve the operational efficiency of the healthcare service procedures
1.8.2 Determine the specific contribution to the department due to the staff going to be
qualified for anaesthetics repair and even in a future we can save more money in repairs for
the trust.
1.8.3 The research study is a way to improve or develop new ways of saving capital from
over expanses for the trust (EBME), which will provide major financial benefit in long run.
1.8.4 Development of worthy workforce will empower the department with knowledge and
efficient learning/Repair of new skills in anaesthetics maintenance.
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Setting –up
Objectives
Conducting
Primary
Research
Conducting
Secondary
Research
Situation
analysis
Scope
assessment
Implementation
plan
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1.9 Thesis structure
Figure 1: Conceptual structure
1.10 Limitation of the Study
I conducted a survey to obtain my research results, my samples were asked to respond to the
Likert survey research questions. However, I have had limited ability to gain access to the
appropriate to theatres. Also the survey was done during working hours and people just
answer the questions and was difficult to find out if the answer was provide was 100%. The
reliability of the survey results increase with the sample size. In this case the sample size was
small. Therefore, reliability of the results can get affected.
1.11 Conclusion
As per the above discussion of the aims and objectives it can be clearly concluded that this
study requires several section of data presentation, decision making and discussion. In the
following section the literature review has been presented followed by the methodology.
After methodology, the data analysis and finding have been presented on which the
conclusion and recommendation have been developed. Based on the study the 5 years plan
has been develop considering the training, development of in-house maintenance service.
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CHAPTER 2
Review of Literature
2.1 Introduction
Literature review is a process of secondary research in which data and information are
collected and presented in a systematic order. In this study the secondary study has been
conducted by collecting data from various articles, government regulatory guidelines, case
studies, published reports and other researches. In this literature review the quality models
appropriate for healthcare equipments and service providing will be discussed. The literature
review can be done in many ways namely the systematic review, meta-analysis, thematic
review, narrative review, article appraisal and others. In this study the thematic literature
review method has been used.
2.2 Quality Models
Quality is the key to competitive advantage in today's business environment; quality
improvement must be at hospital. In this paper, the main goal is building a systematic
approach through software package for quality control and assurance of medical equipment
performance within the health care quality system and making continuous improvement to
the system. The biomedical engineer has the full support from technical manager and division
director to provide and arrange high quality calibration and testing for medical devices at the
hospital. Measurement is an important requirement of continuous improvement process. It is
necessary to establish appropriate metrics for measurement purpose then monitoring will
indicate the occurrence of improvement in the system. The objective of quantifying is to be
able to measure the quality of a system. Quality improvement projects and studies aimed at
making positive changes in health care processes to effecting favorable outcomes can use the
Plan-Do-Study-Act (PDSA) model. This is a method that has been widely used by the
Institute for Healthcare Improvement for rapid cycle improvement. One of the unique
features of this model is the cyclical nature of impacting and assessing change, most
effectively accomplished through small and frequent PDSAs rather than big and slow ones,
before changes are made systemwide.
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2.3 Model ISO 9001 2015
ISO 9001:2015 specifies requirements for a quality management system when an
organization:
a) needs to demonstrate its ability to consistently provide products and services that
meet customer and applicable statutory and regulatory requirements, and
b) aims to enhance customer satisfaction through the effective application of the
system, including processes for improvement of the system and the assurance of conformity
to customer and applicable statutory and regulatory requirements.
All the requirements of ISO 9001:2015 are generic and are intended to be applicable
to any organization, regardless of its type or size, or the products and services it provides.
2.4 European Quality Award
The EFQM Excellence Award is a transnational quality award that recognises
European businesses with "excellent and sustainable results" across all areas of the EFQM
Excellence Model. It was established in October 1991 as the European Quality Award by the
European Foundation for Quality Management.
2.5 Conclusion
From this literature review it has been found that quality management is very essential
part for a healthcare organisation. It has been also found that there are some measures to
assess the qualitative improvement of a healthcare facility.
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CHAPTER 3
Research Methodology
3.1 Introduction
The methodology section presents the procedure of any research. In this case the procedures
of research include the data collection, sampling, data analysis, decision making, financial
estimation and other procedure. The structure of this methodology is based on the design of
the study, the procedure of the study, the population and sample of the study, study
instrument and validity and reliability testing.
3.2 Research design
The design of the study is based on the purpose and the instrument used in a study. There are
many designs available of a study namely the cross sectional study, the longitudinal study,
experimental study, secondary study, mixed study, observational study, case study and others.
In this study the mixed method has been used where both qualitative and quantitative data
collection and analysis process will be conducted. Ethical clearance procedures
3.3 Procedure of study
Two types of study procedure has been used for this project namely the document assessment
and cross-sectional survey. For this cost assessment has been done through reviewing
documents and budgets of the company. The situation analysis has been done by conducting
a survey among the employees.
3.4 Population and sample of study
For this survey the population with the healthcare staffs considering both technical and non-
technical employees. The sampling method used in this study is a probability sampling. The
cluster sampling has been used with the help of inclusion and exclusion criteria. The study
was conducted on 30 participants
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3.5 study instrument
The study was conducted through using 2 instruments namely the questionnaire for the
survey and the organisational documents. The questionnaire of the survey includes both
qualitative and quantitative section. The quantitative data regarding the job experience and
their opinion have been collected. The 5 option likert scale has been used in this study.
Several questions are asked regarding their perspective on current maintenance system and
the potential implementation of in-house maintenance system.
3.6 Pilot of study
The pilot study has been collected by conducting survey on 10 random samples. These
participants have been included in the final results as well. The purpose of this pilot study
was to assess the reliability of the sample selection as well as the instrument of the survey
method. The chronbach’s alpha test has been used to measure the reliability of the method.
As per the result of chronbach’s alpha test the alpha value is 0.76. This value implies that the
survey and chosen sample are 76 percent reliable to conduct the study. Hence, the survey
module was accepted for final survey.
3.7 Validity
3.7.1 Qualitative study
All the qualitative data are used from online resource and organisational documents are
completely valid and certified by higher authority.
3.7.2 Quantitative study
The chosen quantitative method is descriptive study with the help of mean value distribution
and percentage distribution. Both of these methods are calculated repeatedly to find the most
valid output.
3.8 Reliability
3.8.1 Qualitative study
The sources of the documents and the external resource are highly authentic as well as
reliable for this study.
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3.8.2 Quantitative study
As per the result of chronbach’s alpha test the alpha value is 0.76. This value implies that the
survey and chosen sample are 76 percent reliable to conduct the study. Hence, the survey
module was reliable.
3.9 Data collection procedure
Two types of data collection procedures were used namely the qualitative data collection
procedure through assessing the external secondary data and organisational previous annual
reports and the quantitative data collection procedure by conducting survey
3.9.1 Qualitative Data collection
The following criteria are used to collect data from the previous organisational documents.
5-year maintenance plan-
Tender Duration – October 2014-2019
Basic agreement of services by the company comprises of-
INCLUSIONS-
• Function check and visual inspection (flow rates, gas outlets)
• Function check of electrical outlets
• Function check of electrical switches. Lights.
• Mechanical checks, light output.
• Cleaning the system
EXCLUSIONS-
• Repair cost not includes the labour including travel and mileage.
• Spares parts are not included.
3.9.1 Quantitative Data collection
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In this process the ordinal data was collected trough using survey. The survey was conducted
in office hours. The official e-mail addresses of the employees were collected from the
human resource management department complying with the data protection act. After that
the survey form was distributed among the target participants through e-mail. The likert-scale
based ordinal options used in the questionnaire were implied with different numerical value
in ascending order. This quantitative process helped this survey to develop the quantitative
data from the survey responses.
3.10 Data analysis procedure
After collecting both qualitative and quantitative data the analysis procedures were used
accordingly. The qualitative analysis tool was used to analyse the theory and information
from external resources as well as the previous organisational documents. On the other hand,
the quantitative analysis has been used to analyse the collected data from survey and the
budget report. The Medical Devices Act, and maintenance regulations specify at what
interval and how anaesthesia equipment must be checked. Dragger is performing the
maintenance and safety checks once a year. This contract covers the maintenance costs of the
devices, which were set at fixed prices for the 5-year period. The repair cost not includes the
labour including travel and mileage and the spare parts are not included in the quotation. On
the contrary the replacement of specific parts is included in an annual in-house service. These
parts will be replaced regardless of whether or not they show signs of wear. (King, Ansell &
Hill,2013) But in-house service in this regard will also include medical technician
maintenance costs as in-house maintenance cannot predict which parts need to be replaced.
3.30.1 Qualitative data analysis
Qualitative analysis is a process of non-numerical data analysis, using logical cause and
effect relationship model. For qualitative data analysis thematic data analysis process has
been used. In the thematic data analysis the themes have been chosen through considering the
emerging themes from the external secondary data and the previous reports of the
organisation.
3.10.2 Quantitative data analysis
Quantitative analysis is a process of analysis numerical data through statistical and
mathematical procedures. For quantitative study the results have been analysed through
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descriptive statistics using Microsoft excel software. The mean distribution and percentage
distribution is used for quantitative analysis. Both demographic data and major variables will
be analysed through statistical method.
3.11 Conclusion
From the above discussion about the methodology of this study it has been found that this
study uses both qualitative and quantitative study based on a survey on employees and the
organisational document analysis. The survey sample size was 30. Both qualitative and
quantitative data analysis was used. The statistical descriptive analysis was used for this
quantitative analysis.
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CHAPTER 4
Data analysis and results
4.1 Introduction
4.2 Analysis of quantitative findings
Department
Frequency Percentage
Pre/Post-Surgical Care 6 20.0
Primary Care 7 23.3
Emergency Care 3 10.0
Acute care 4 13.3
Administration 10 33.3
Table 1: Department
Job role
Frequency Percentage
Nurse 10 33.3
Midwives 5 16.7
Doctor 3 10.0
Technical Staff 7 23.3
others 5 16.7
Table 2: Job role
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Experience in this organization
Frequency Percentage
Less than 1 year 5 16.7
1 to 3 years 10 33.3
3 to 6 years 5 16.7
6 to 10 years 10 33.3
More than 10 years 0 0.0
Table 3: Experience in this organization
4.2.2 Findings from major variables
Mean Median Mode S.D
Q1 How much are you aware of the
Anaesthesia Service quality
provided by our organization to
our consumers 3.83 4.0 4 1.09
Q2 Rate our anaesthesia equipments
performance 2.83 3.0 3 0.70
Q3 Rate our anaesthesia equipments
quality 3.50 3.0 3 0.78
Q4 How often do you find
dysfunctional anaesthesia
equipments 3.00 3.0 2 0.83
Q5 Do you think the Anastasia
equipments needs better
maintenance 4.00 4.0 4 0.59
Q6 Had you have any training on
anaesthesia equipment operation
or maintenance 1.50 1.5 2 0.51
Q7 Are you agree about making an in- 3.83 4.0 4 0.91
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house anaesthesia maintenance
facility
Q8 Do you like to have training on
anaesthesia equipment operation
and maintenance 3.67 4.0 4 0.96
Table 4: Findings from major variables
4.3 Analysis of qualitative findings
All the cost comparison results related to maintenance and service of the machine in house
and by the company contract is summarised in the tables below. European list prices were
used to reference the acquisition costs of the studied anaesthetic machines.
Equipment primus Year 1 Year 2 Year 3 Year 4 Year 5
Drager service
Total care per device
annum (102)
£1385 £1385 £1385 £1385 £1385
Draeger Service
Total care per device
Annum (102)
Devices
£141.270 £141.270 £141.270 £141.270 £141.270
Total cost x 5 years £706.350
+ Vat
Table 5: Cost Estimation
Labour cost which is not included
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Labour rate Mileage rate Travel rate
£115 x hour £1.30 per mile £87 x hour
Table 6: Labour cost analysis
In House cost for PPM
Unit
quantity
No. of PPM Hrs of PPM
work
Hrs of
Admin
work
Total hrs No. of staff Mems
engineer
102 102 360 140 500 20 £25 x hour
Training cost for 8 Testing equipment Total cost
£40.000 £2.500 £22.500 + labour
Table 7: In House cost for PPM
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Figure 2: Cost tally
Estimation for Second year
 Cost x engineer (year) £35.000 x 2 £70.000
 Various £25.000
 Dragger contract (year) £140.000
 Saving £45.000
Total savings for 5 years
 Total £45.000 x 4 = £175.000 + £30.000
Total saving £205.000
4.3 Analysis
From the above data analysis and results it can be concluded that the anaesthetics in house
equipment operation and maintenance service is better than the anaesthetics doing by Dragger
Company.
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4.4 Conclusion
Hence, it is the time to proceed with the quality improvement plan for next 5 years that
includes the on-house maintenance facility building and training for workforce development.
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CHAPTER 5
Conclusions and contributions
5.1 Introduction
In this section the implication of this study has been presented with summary of the paper and
the conclusive discussion. The contribution and recommendation have been also discussed in
this section. In a nutshell the implications of the findings from this research have been
presented in this conclusion section.
5.2 Summary of the thesis
Given the pressure on hospitals to decrease their costs, this work aimed to develop a
methodology for comparing two methods of maintenance services which a self inhouse
service by the hospital and other under the contract with Dragger for servicing and
maintenance of 102 anaesthetic machines. The running costs of different elements were
evaluated using a cost analysis and it is evident in the cost analysis with the help of tables and
graphs that cost reduction is possible with in house service of machines to survive in this
competitive economy and thus staying in business.
5.3 Answers of the research questions
It is highly essential that only appropriately trained and experienced people are required to
perform the service for this machine every 12 months and a register consisting of minute
details and issues regarding the maintenance should be maintained and updated periodically.
It should also keep the training records and risk management protocols. A register should be
keeping the training records. Regarding risk and management for anaesthetics machine.
carried out risk analysis on all potential’s combinations will be very important. The cost of
implementing and sustaining an anaesthetic service in house is lesser in comparison to the
maintenance cost under the contract with Dragger. Therefore, it is possible to standardise the
cost analysis method which compare compare acquisition, maintenance and running costs
between the two service management systems.
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5.4 Key contributions
This study provides details how we can implement this project for other equipment in the
hospital. We can follow the same guidelines and make the project for other population of the
equipment and save money for the trust such as ultrasound machines.
5.5 Recommendations and Limitations
For further studies I recommend to follow this procedure to replace the service in house. The
way we precede in anaesthetics machines going to be useful for other items in the hospital
such as ultrasounds machine.
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References
Allen, M. and Smith, L., 2018. Equipment Checkout and Maintenance. Veterinary Anesthetic
and Monitoring Equipment, pp.365-375.
Goodman, D., Ogrinc, G., Davies, L., Baker, G.R., Barnsteiner, J., Foster, T.C., Gali, K.,
Hilden, J., Horwitz, L., Kaplan, H.C. and Leis, J., 2016. Explanation and elaboration of the
SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V. 2.0:
examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual Saf,
25(12), pp.e7-e7.
Keeley, K.A., 2017. Equipment Safety, Maintenance and Inspection: What the Oral Surgeon
Needs to Know. Oral and Maxillofacial Surgery Clinics, 29(2), pp.209-221.
Kolbay, P., Orr, J.A. and Kück, K., 2016. A New Era of Anesthetic Equipment.
Lechner, M., Chandrasekharan, D., Vithlani, R., Sutton, L., Grandidge, C. and Elmiyeh, B.,
2017. Evaluation of a newly introduced tonsillectomy operation record for the analysis of
regional post-tonsillectomy bleed data: a quality improvement project at the London North
West Healthcare NHS Trust. BMJ Open Qual, 6(2), p.e000055.
Leung, L., 2015. Validity, reliability, and generalizability in qualitative research. Journal of
family medicine and primary care, 4(3), p.324.
McCusker, K. and Gunaydin, S., 2015. Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), pp.537-542.
Renedo, A., Marston, C.A., Spyridonidis, D. and Barlow, J., 2015. Patient and Public
Involvement in Healthcare Quality Improvement: How organizations can help patients and
professionals to collaborate. Public Management Review, 17(1), pp.17-34.
Waring, J., Allen, D., Braithwaite, J. and Sandall, J., 2016. Healthcare quality and safety: a
review of policy, practice and research. Sociology of Health & Illness, 38(2), pp.198-215.
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Appendices
Appendix A – Survey Questionnaire
Questions Options
B1 Department Pre/Post-
Surgical
Care
Primary
Care
Emergency
Care
Acute care Administration
B2 Job role Nurse Midwives Doctor Technical
Staff
Others
B3 Experience in this
organization
Less than
1 year
1 to 3
years
3 to 6
years
6 to 10
years
More than 10
years
Q1 How much are you aware
of the Anaesthesia Service
quality provided by our
organization to our
consumers
Very Low Low Moderate High Very High
Q2 Rate our anaesthesia
equipments performance
Very
inefficient
Somewhat
Inefficient
Moderate/I
don’t
Know
Somewhat
Efficient
Very Efficient
Q3 Rate our anaesthesia
equipments quality
Very Low Low Moderate/I
don’t
Know
High Very High
Q4 How often do you find
dysfunctional anaesthesia
equipments
Never Rarely Sometimes Frequently Always
Q5 Do you think the Anastasia
equipments needs better
maintenance
Highly
Disagree
Disagree Moderatel
y Agree
Agree Highly Agree
Q6 Had you have any training
on anaesthesia equipment
operation or maintenance
Never Rarely Sometimes Frequently Always
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Compiled by KEM Krauss © Rhodes University 2014
Q7 Are you agree about
making an in-house
anaesthesia maintenance
facility
Highly
Disagree
Disagree Moderatel
y Agree
Agree Highly Agree
Q8 Do you like to have
training on anaesthesia
equipment operation and
maintenance
Highly
Disagree
Disagree Moderatel
y Agree
Agree Highly Agree
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Compiled by KEM Krauss © Rhodes University 2014
Appendix B – Project plan
Who is going to pay the service cost for the vaporisers?
Currently the hospital is paying for those charges. This agreement can’t be changed. We
don’t have the adequate equipment to test the vaporizers and other equipment. This does not
affect the cost of the service due to the hospital is paying the service for those devices when
dragger are servicing the machine.
Anaesthesia vaporiser manufacturers recommend calibrating your equipment on a regular
basis. A common range is from one to three years, depending on your model. This work is
more complex, so the vaporiser should be serviced by a qualified professional. In addition to
regular servicing, get your vaporiser checked out if knobs are sticking, or if patients aren’t
responding as expected to
any units we going to service. How many units we have for replace faulty one.
Plan
This is the gun chart how we going to deliver the project
Findings
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Clinical
 Easy to use for the Clinical staff
 Integral Monitor/Ventilation
 Anaesthetics
 Used in other trusts
 Staff ready to perform the job
Financial
This is a scheme of the money the contract with dragger cost
To do we can see the year cost of the service is £141.276
The total unit in service are 102 machines.
Dragger Total cost per unit £1385
Cost per unit Ebme department engineer
Hour £16 x 4 hours = £64 hour
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Compiled by KEM Krauss © Rhodes University 2014
Admin = £40
Insurance
Lower Maintenance
Difference in whole life cycle
Salary & Cost
2 engineers cost £35.000 each £70.000
Equipment tools £20.000
Management office £10.000
Total £100.000 first year
After second year we are planning to save £50.000 per year
Not include:
 Service Kits
 Routinely changeable service parts
 Consumable items including items with a defined life span eg batteries
 Repair Parts
 Repair labour, including travel & mileage**
 All software upgrades
Additional Information
All maintenance and repair work will be carried out during normal working hours, any
requests for out of hours working will be subject to additional charges.
Where applicable the following will apply:
Unless stated this agreement does not cover any third party mounting / trolley systems
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Were fitted, scale functionality will be checked and tested during routine maintenance
If required were additional expenses are incurred such as flights, ferries and overnight
accommodation Dragger will pass on this cost
Only the devices shown on the equipment list are covered by this agreement. *normal
working hours (08.30 – 17.00 Monday – Friday) ** Labour Rate £115.00 per hour, Travel
Rate £87.00 per hour, Mileage Rate £1.30 per mile (these prices are current year list price and
may be subject to annual increase after the 31st December of the current yea
Methodology
In order to investigate the degree of the service we going to provide
The methods used to get evidence of the project were:
 Create Inventory
Create a database of the equipment we going to service. These units and the jobs
created by the department going to be registered in the history of the equipment.
 Results to be achieved (report 5 years plan).
The results and the data gathered going to be displayed in the report of the 5 years
plan of the unit every year the results have to be stored in the database.
 Face to face talking with the users.
To make clear impact of the service we provide. We have a talk with the costumers
and we received updates about the problems,
 Cleaning & maintenance
 Equipment inspection
 Preventive maintenance
 Research from other hospital performing the maintenance in house.
 Econometric methods, further scrutinized by secondary sources and by the experts in
house.
 Technology market identification in London region.
 Common problems
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Compiled by KEM Krauss © Rhodes University 2014
Operational cost includes:
A. Resource planning
B. Expertise (training)
C. Facility (workshop)
 Technical cost.
Tasks
A. Service manual
B. Methods
Tasks
I. Monitoring
II. Gas
III. Scavenging
C. Test equipment /Modules
D. Time
Analysis
The service report currently dragger is doing is just reactive maintenance when there
Equipment fail. And secondly the annual check compulsory for the regulations in
Anaesthetics protocols. The service the dragger provide is the basic service to keep
The equipment running following the regulations or anaesthetics protocols.
What we going to offer is a plan how to maintain the equipment.
Is like detect the failure before this happened.
We are planning:
Predictive maintenance every 6 months
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Annual Service Every year
Reactive maintenance
During the development of the job the routine of inspection of the equipment in case of
damage will be very difficult. For this reason we are planning constantly check on the
equipment before any procedure. The main target of the ebme department is Zero incidents
and in this way we are planning complete the job.
Inspection
 Chassis
 Brakes
 Cables
 Switches
 Tubes and hoses
 Water inlet
 Gas inlet
 Controls
 Sensor and actuators
 Filters
 Battery
 Chargers
 Monitors
 Ventilator
 Vaporizer is update
 Respiration inlets
Which evaluation we going to do
In the evaluation the majority of times we are looking for problems this going to be
performed before the case. In addition we going to perform adjustments to the equipment due
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to keep the good control in the unit and avoid failure during the procedure. The main
objective of the evaluation is physical inspection.
We have to inspect fails like.
Cables broken in monitor
Leaks from the inlet system
Screen crack
Brakes problems in the unit
Gas leak from the pipe in the wall
Leak in the vaporiser.
Sensors replacement.
In retrospective
Analysis of the data obtain
The survey obtain provided the qualitative data, which al use how tool the Likert scale obtain
create an scale and convert the data in quantitative, this help me to obtain the measure for the
desirable variable.
Determination of variables
In first instance, I evaluate the answers obtain rom the area of theatres, the number of servers
apply was seven in total, five a nurse and two anaesthesiology where the variables to measure
was
Research hypothesis
My hypothesis is find out the way to prove the anaesthetics service in house is better than the
anaesthetics doing by Dragger Company. I want to try
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The
Checklist
 Resources
Are not available,
 Time
 I THINK FOR MY THE MAJOR CONSTRAIN IS RELATING TO TIME.
THE REASON :
 I HAVE TO FIND INFORMATION OUTSIDE THE HOSPITAL DUE TO THE
hospital does not does anaesthetics in house currently.
 There is limited the information you can get regarding to technical information
involve. I have to work in the trust and follow the curriculum of the degree and
produce reports and so on. Like family life etc etc.
 To deliver will increase. This may also increase project
Difficult to find the right information.
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I went to clinical engineer and was difficult especially when you does not work in the
department.
 If QA team finds that the
 Quality of a deliverable is going bad, more resources may be required. This
increases the cost—for additional resources—and effort to fix the faulty deliverable.
This will also increase the time to deliver.
 If scope creep happens on the project, it will result in increased time, cost,
resources, and potentially reduced quality. And thus increased risk on delivery.
Upgraded software to 4.53.00, reconfigured to
Trust defaults.
Maintenance completed with reference to and in
Accordance with manufacturer protocols
Work performed:
Upgraded software to 4.53.00,
Reconfigured to trust defaults.
Maintenance completed with reference
To and in accordance with manufacturer
Maintenance completed with reference
To and in accordance with manufacturer
Protocols
070 1.00 items MX08241 Primus Serv Set 1 Year
MX08468 Primus Serv Set 3 Year 01/02/2019
020 2.00 items M35122 S-spring 01/02/2019
030 1.00 items AF00352 O-ring seal
Analysis
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Describe the analysis that you performed on the data to arrive at a conclusion that
again relates to the objective.
The service report currently dragger is doing is just reactive maintenance when there
equipment fail. And secondly the annual check compulsory for the regulations in anaesthetics
protocols. The service the dragger provide is the basic service to keep the equipment running
following the regulations or anaesthetics protocols.
What we going to offer is a plan how to maintain the equipment.
Is like detect the failure before this happened.
We are planning:
Predictive maintenance every 6 months
Annual service. Every year
Reactive maintenance
They are currently doing upgrades for the software every year. This upgrade we have to do
this
General Objectives
 Develop inspection and repair plan for anaesthetics medical devices in the trust
 Evaluate the physic condition of the equipment in the trust
 To find out the job specific the dragger is doing
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Compiled by KEM Krauss © Rhodes University 2014
Methodology
Create inventory
Inspection of the equipment
General revision
Significance
In retrospect
Daily
Inspection routine programme daily x 100
Number of routines done x day
Week
Weekly inspection program x 100
# of routines complete per week
Monthly
Weekly inspection program x 100
# of routines complete per week
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