Carnero María Carmen, Gómez Andrés
Technical School of Industrial Engineers, University of Castilla-la Mancha, Ciudad Real, Spain.
CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
BMC Health Serv Res. 2021 Nov 2;21(1):1188. doi: 10.1186/s12913-021-07093-w.
The real-world application of maintenance in organisations brings together a number of maintenance policies in order to achieve the desired availability, efficiency and profitability. However, the literature mostly chooses a single maintenance policy, and so the decision process is not suited to the real conditions in the company to which it is applied. Our study takes a combination of maintenance policies as alternatives, and so conforms to the actual practice of maintenance in organisations. Furthermore, it introduces the possibility of including extra spare parts, or outsourcing maintenance policies. Although the selection of maintenance policies has been applied to many kinds of business and of machine, there is almost no instance of its application to hospitals, and it has never been applied to delivery systems for cytostatic drugs.
The model uses the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), which is recognised as being highly suitable for solving group decision-making problems in a fuzzy environment. Fuzzy set theory is also considered to be more proficient than crisp numbers for handling the ambiguity, imprecisions, data scarcity, and uncertainty inherent in decisions made by human beings. The judgements required were obtained from a decision group comprising the heads of facilities maintenance, maintenance of medical equipment, health and safety at work, environment, and programming-admission. The group also included care staff; specifically, the heads of the main clinical services, and the medical supervisors. The model includes original criteria, such as Quality of health care, which measures impact on care as a function of mean availability of each alternative. It also considers Impact on hospital management via the criteria: Working environment in the organisation and Impact on health care; the former criterion measures equality among care services in the hospital, while the latter assesses the effect on regional health cover. The model was built using real data obtained from a state hospital in Spain. The model can also be easily applied to other national and international healthcare organisations, providing weights specific to the criteria. These are produced by a decision group from each healthcare organisation and the alternatives are updated in accordance with what is considered important in each hospital.
The results obtained from the model recommend changing the alternative that is currently in use, Corrective and Preventive Maintenance, to Corrective and Preventive Maintenance plus two spare hoods. This alternative would lead to an availability of 1 (the highest possible) in the systems for preparing personalised cytotoxic drugs, and so the quality of service is therefore very high. Additionally, it could offer services to all the users of the hospital, and also offer cover in the preparation of cytotoxic medicines to other hospitals in the catchment area.
The results suggest the possibility that improvements to the support and logistical systems, which include maintenance, traditionally held to have no effect on quality of care, may be key to improving care quality, but also in reducing risk to patients, care and non-care staff, and the environment.
组织中维护工作的实际应用整合了多种维护策略，以实现预期的可用性、效率和盈利能力。然而，文献大多只选择单一的维护策略，因此决策过程并不适用于其应用所在公司的实际情况。我们的研究将维护策略的组合作为备选方案，因此符合组织中维护工作的实际做法。此外，它还引入了增加额外备件或外包维护策略的可能性。尽管维护策略的选择已应用于多种业务和机器，但几乎没有应用于医院的实例，更从未应用于细胞毒性药物输送系统。
该模型使用模糊理想解贴近度排序法（TOPSIS），该方法被认为非常适合解决模糊环境下的群体决策问题。模糊集理论也被认为在处理人类决策中固有的模糊性、不精确性、数据稀缺性和不确定性方面比清晰数字更具优势。所需判断来自一个决策小组，成员包括设施维护主管、医疗设备维护主管、工作场所健康与安全主管、环境主管以及规划入院主管。该小组还包括护理人员，具体而言，主要临床服务部门的主管和医疗监督人员。该模型包括原始标准，如医疗保健质量，它根据每个备选方案的平均可用性来衡量对护理的影响。它还通过以下标准考虑对医院管理的影响：组织内的工作环境和对医疗保健的影响；前一个标准衡量医院护理服务之间的平等性，而后一个标准评估对区域医疗覆盖的影响。该模型是使用从西班牙一家国立医院获得的实际数据构建的。该模型也可以很容易地应用于其他国家和国际医疗组织，并提供特定于标准的权重。这些权重由每个医疗组织的决策小组制定，备选方案根据每家医院认为重要的内容进行更新。
该模型得出的结果建议将目前使用的备选方案，即纠正性和预防性维护，改为纠正性和预防性维护加两个备用罩。这种备选方案将使个性化细胞毒性药物制备系统的可用性达到1（可能的最高值），因此服务质量非常高。此外，它可以为医院的所有用户提供服务，还可以为集水区内的其他医院提供细胞毒性药物制备方面的保障。
结果表明，传统上认为对护理质量没有影响的包括维护在内的支持和后勤系统的改进，可能是提高护理质量的关键，同时也是降低对患者、护理和非护理人员以及环境风险的关键。
