Optimisation of maintenance in delivery systems for cytostatic medicines

Abstract Background 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...

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Autores principales:	María Carmen Carnero, Andrés Gómez
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Maintenance strategy selection Devices for the preparation of cytotoxic drugs Multiple-criteria decision making Fuzzy TOPSIS Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/9a251c6a97c44433b13e6b33182e417a
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spelling	oai:doaj.org-article:9a251c6a97c44433b13e6b33182e417a2021-11-07T12:10:57ZOptimisation of maintenance in delivery systems for cytostatic medicines10.1186/s12913-021-07093-w1472-6963https://doaj.org/article/9a251c6a97c44433b13e6b33182e417a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07093-whttps://doaj.org/toc/1472-6963Abstract Background 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. Methods 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. Results 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. Conclusions 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.María Carmen CarneroAndrés GómezBMCarticleMaintenance strategy selectionDevices for the preparation of cytotoxic drugsMultiple-criteria decision makingFuzzy TOPSISPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-25 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Maintenance strategy selection Devices for the preparation of cytotoxic drugs Multiple-criteria decision making Fuzzy TOPSIS Public aspects of medicine RA1-1270
spellingShingle	Maintenance strategy selection Devices for the preparation of cytotoxic drugs Multiple-criteria decision making Fuzzy TOPSIS Public aspects of medicine RA1-1270 María Carmen Carnero Andrés Gómez Optimisation of maintenance in delivery systems for cytostatic medicines
description	Abstract Background 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. Methods 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. Results 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. Conclusions 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.
format	article
author	María Carmen Carnero Andrés Gómez
author_facet	María Carmen Carnero Andrés Gómez
author_sort	María Carmen Carnero
title	Optimisation of maintenance in delivery systems for cytostatic medicines
title_short	Optimisation of maintenance in delivery systems for cytostatic medicines
title_full	Optimisation of maintenance in delivery systems for cytostatic medicines
title_fullStr	Optimisation of maintenance in delivery systems for cytostatic medicines
title_full_unstemmed	Optimisation of maintenance in delivery systems for cytostatic medicines
title_sort	optimisation of maintenance in delivery systems for cytostatic medicines
publisher	BMC
publishDate	2021
url	https://doaj.org/article/9a251c6a97c44433b13e6b33182e417a
work_keys_str_mv	AT mariacarmencarnero optimisationofmaintenanceindeliverysystemsforcytostaticmedicines AT andresgomez optimisationofmaintenanceindeliverysystemsforcytostaticmedicines
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Optimisation of maintenance in delivery systems for cytostatic medicines

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