RELIABILITY CENTRED MAINTENANCE (RCM)

After being created by the commercial aviation industry, RCM was adopted by the U.S. military
(beginning in the mid!"#$s% and by the U.S. commercial nuclear power industry (in the !"&$s%. 't
began to enter other commercial industries and fields in the early !""$s.

ReliabilityCentred Maintenance, often (nown as RCM, is an industrial improvement approach focused
on identifying and establishing the operational, maintenance, and capital improvement policies that will
manage the ris(s of e)uipment failure most effectively. 't is defined by the technical standard SA*
+A!$!!, *valuation Criteria for RCM ,rocesses.

Reliability centred maintenance is an engineering framewor( that enables the definition of a complete
maintenance regime. 't regards maintenance as the means to maintain the functions a user may re)uire
of machinery in a defined operating conte-t.

As a discipline it enables machinery sta(eholders to monitor, assess, predict and generally understand
the wor(ing of their physical assets. .his is embodied in the initial part of the RCM process which is to
identify the operating conte-t of the machinery, and write a /ailure Mode *ffects and Criticality
Analysis, or /M*CA. .he second part of the analysis is to apply the 0RCM logic0, which helps
determine the appropriate maintenance tas(s for the identified failure modes in the /M*CA. 1nce the
logic is complete for all elements in the /M*CA, the resulting list of maintenance is 0pac(aged0, so that
the periodicities of the tas(s are rationalised to be called up in wor( pac(ages2 it is important not to
destroy the applicability of maintenance in this phase. 3astly, RCM is (ept live throughout the 4in
service4 life of machinery, where the effectiveness of the maintenance is (ept under constant review and
ad5usted in light of the e-perience gained.

Reliability Centred Maintenance can be used to create a costeffective maintenance strategy to address
dominant causes of e)uipment failure. 't is a systematic approach to defining a routine maintenance
program composed of costeffective tas(s that preserve important functions.

.he important functions (of a piece of e)uipment% to preserve with routine maintenance are identified,
their dominant failure modes and causes determined and the conse)uences of failure ascertained. 3evels
of criticality are assigned to the conse)uences of failure. Some functions are not critical and are left to
0run to failure0 while other functions must be preserved at all cost. Maintenance tas(s are selected that
address the dominant failure causes. .his process can only address maintenance preventable failures, i.e.
it cannot defend against unli(ely events, nonpredictable acts of nature, etc.

.he result is a maintenance program that focuses scarce economic resources on those items that would
cause the most disruption if they were to fail. RCM emphasi6es the use of ,redictive maintenance
(,dM% techni)ues in addition to traditional preventive measures.

.his is a method which can be used to determine the most effective approach to use of resources for
medical devices maintenance. RCM involves identifying actions that, when ta(en, will reduce the
probability of failure and that are the most cost effective. 't see(s the optimal mi- of Condition7ased
actions, other .ime or Cycle7ased actions, or a Runto/ailure approach. RCM is an ongoing process
that gathers data on performance and uses this data to improve planning for future maintenance. .hese
maintenance strategies, rather than being applied independently, are integrated to ta(e advantage of their
respective strengths to optimise departmental 8 e)uipment operation and efficiency within the given
resource constraints.

.he RCM method employs ,lanned ,reventive Maintenance (,,M%, ,redictive .esting and 'nspection
(,.9'%, repair (also called reactive maintenance% and ,roactive Maintenance techni)ues in an integrated
manner to increase the probability that a medical device or component will function in the re)uired
manner over its design lifecycle. .he goal of the method is to provide the re)uired reliability and
availability at the lowest cost. RCM re)uires that maintenance decisions be based on maintenance
re)uirements supported by sound technical and economic 5ustification. As with any method, there are
many paths, or processes, which lead to a final goal. .his is especially true for RCM where the
conse)uences of failure can vary dramatically.
Use methods to gather data of each machinary function to predict its brea(down, how it is functioning
and apply maintenance strategy

*7M* has adopted a simplified approach to the traditional RCM processes practiced in some :;S
;ospitals. Underlying *7M*4s RCM approach is the concept that maintenance actions should result in
real benefits in terms of improved safety, re)uired operational capability, and reduced lifecycle cost. 't
recogni6es that unnecessary maintenance is counterproductive and costly and can lead to an increased
chance of failure.

RCM PRINCIPLES
.he primary principles upon which RCM is based are the following<
! /unction oriented. 't see(s to preserve system or e)uipment function.
= >evice group focused. 't is concerned with maintaining the overall functionality of a group of
devices rather than an individual device
? Reliability centred. 't uses failure statistics in an actuarial manner to loo( at the relationship
between operating age and the failures. RCM is not overly concerned with simple failure rate2 it see(s to
(now the probability of failure at specific ages.
@ Ac(nowledges design limitations. 'ts ob5ective is to maintain the inherent reliability of the
e)uipment design, recogni6ing that changes in reliability are the province of design rather than
maintenance. Maintenance can only achieve and maintain the level provided for by design.
A >riven by safety and economics. Safety must be ensured at any cost2 thereafter, costeffectiveness
becomes the criterion.
B >efines failure as any unsatisfactory condition. .herefore, failure may be either a loss of function
(operation ceases% or a loss of acceptable )uality (operation continues%.
# Uses a logic tree to screen maintenance tas(s. .his provides a consistent approach to the
maintenance of all (inds of e)uipment.
& .as(s must be applicable. .he tas(s must address the failure mode and consider the failure mode
characteristics.
" .as(s must be effective. .he tas(s must reduce the probability of failure and be cost effective.
!$ Ac(nowledges two types of Maintenance tas(s and Runto failure. .he tas(s are 'nterval (.ime or
Cycle%7ased and Condition7ased. 'n RCM, Runto/ailure is a conscious decision and is acceptable
for some e)uipment.
!! A living system. 't gathers data from the results achieved and feeds this data bac( to improve future
maintenance. .his feedbac( is an important part of the ,roactive Maintenance element of the RCM
program.

REQUIREMENTS ANALYSIS
Using RCM develops maintenance standards for ensuring that a system or device meets its designed
reliability or availability (even in the procurement and installation phases%.
RCM determines maintenance re)uirements by considering the following )uestions<
! Chat does the device8system doD
= Chat is its functionD
? Chat failures are li(ely to occurD
@ Chat are the li(ely conse)uences of failureD
A Chat can be done to reduce the probability of the failure, identify the onset of failure, or reduce
the conse)uences of the failureD

RCM analysis determines the type of maintenance appropriate for a given e)uipment item. 't results in a
decision of whether a particular piece of e)uipment should be reactively maintained (0Accept Ris(0 and
0'nstall Redundant Units0%, ,M4ed (0>efine ,M .as( and Schedule0% or predicatively maintained
(0>efine ,.9' .as( and Schedule0%.

FAILURE
/ailure is the cessation of proper function or performance. RCM can e-amine failure at device group
level, system level, component level, and sometimes even the parts level. .he maintenance approach
must be based on a clear understanding of the conse)uences of failure at each level. /or e-ample, a
failed lamp on a device may have little effect on overall performance2 ;owever, several combined,
minor components in degraded conditions, could collectively cause a failure of the entire device.

1. IDENTIFY THE FUNCTIONS.
.his step involves e-amining the capability or purpose of the device8system. Some items, such as a
dyalysis pump, perform an online function (constantly circulating a fluid%2 their operational state can be
determined immediately. 1ther items, such as a compressor sump pump, perform an offline function
(intermittently evacuating a fluid when its level rises%2 their condition can be ascertained only through an
operational test or chec(. /unctions may be active, such as pumping a fluid, or passive, such as
containing a fluid. Also, functions may be hidden, in which case there is no immediate indication of a
failure. .his typically applies to an emergency or protective component such as a circuit brea(er that
operates only in case of a short circuit.

2. IDENTIFY FAILURES.
.he proactive approach to maintenance analysis identifies potential system failures and ways to
prevent them. 't, along with human observations during normal operations or maintenance tas(s, also
identifies prefailure conditions that indicate when a failure is imminent. (.he latter is a basis for
selecting ,.9' applications.%. .he >atabase Maintenance Management System and wor( order form
should include fields for failure codes in order to maintain historical data.

3. IDENTIFY THE CONSEQUENCES OF FAILURE.
.he most important conse)uence of failure is a threat to safety. :e-t is a threat to the environment or
operating capability. .he RCM analysis should pay close attention to the conse)uences of the failure of
infre)uently used, offline e)uipment and hidden function failures (e.g. overpressure sensors, over
temperature sensors%. Also, it should consider the benefit (reduced conse)uences of a failure% of
redundant systems.

4. IDENTIFY THE FAILURE PROCESS.
>etermining the methods and root causes of failures provides insight into ways to detect or avoid
failures. .he e-amination, which investigates the cause of the problem and not 5ust its effect, should
consider factors such as wear, overload, fatigue, or other processes.

VERIFY THE DEVICE GROUP/SYSTEM.
7efore efforts are e-pended on a system, it is important to verify that the system was installed or is
being used correctly as originally intended by the design. .his review of the Maintenance Support
'nformation (MS'% may reveal the root cause of a past or anticipated problem. Although the e-isting
design may have been correct, the installation, while functional, may have been improper or there may
have been latent manufacturing defects. .hese deficiencies should be discovered and corrected during
the acceptance process, before the e)uipment is given to the user. Changes in the intended use of
e)uipment can also create problems leading to e-cessive wear and premature failure.

DEFINE THE MAINTENANCE TASK.
.he following factors should be considered when defining the maintenance tas(< 1nce it has been
determined that the failure of an e)uipment item will have a direct effect on the safety or operation, then
a ,.9', ,M, or ,EM tas( or combination of tas(s should be identified that will lessen the chances or
conse)uences of a failure. Chere applicable, predictive technologies should be used to monitor the
condition of the e)uipment. 'f the technology or local e-pertise is not available, a preventive
maintenance program is normally applicable.
Maintenance tas(s can be time directed (e.g., every != wee(s%, condition directed (e.g., when p; is
greater than #.?%, or inspection directed (e.g., if a component is found worn%. A particular cooling fan on
a patient monitor can be monitored for vibration and cleanliness (,.'%, routinely cleaned and chec(ed
(,M%, or replaced prior to its e-pected failure point.
*valuation should be underta(en to ensure that all the individual tas(s maintain the system at the same
degree of reliability. .he tas(s should also be grouped to ensure that they can be e-ecuted in the most
economical manner. .his may be by multiple tas(s on an individual e)uipment item or li(e tas(s on
numerous items of e)uipment in a given facility.

INSTALL REDUNDANT UNIT(S).
Situations e-ist where, despite all effective maintenance efforts, the ris( of a potential failure is still
unacceptable. Fery critical care areas may re)uire uninterrupted e)uipment to maintain services. .he
criticality may prelude even shutdown for maintenance purposes. 'n these situations, redundancy is
5ustified and recommended. .he problem may be corrected through additional devices being made
available (e.g. *)uipment library%. .he need for a redundant device should be determined before the
situation becomes critical. .his will preclude premature failure resulting from a lac( of maintenance on
a system8device that cannot be shut down. 1ften the loss to services would be of much greater cost than
the redundant system. .his need re)uires close coordination and communication with the user.

ACCEPT THE RISK.
't may be that further safety or environmental precautions are not possible or that the economic or
operational cost of a failure is insignificant or substantially less than the cost of any effective
maintenance procedure. 'n the former case, the accepted ris( should be identified and )uantified, and all
parties concerned should be made aware of the ris( and appropriate recovery procedures.
!= ;igh ris( devices< 3ife support, (ey resuscitation, critical monitoring and other devices whose
failure or misuse is reasonably li(ely to seriously in5ure patients or staff. (Fentilators, defibs, anaesthetic
machines%
!? Medium ris( devices< >evice, including diagnostic instruments, whose misuse, failure or absence
(e.g. out of service with no replacement available% would have a significant impact on patient care, but
would not be li(ely to cause direct serious in5ury. (Clinical lab e)uip, Ultrasound scanners, *CE%
!@ 3ow ris(< >evices whose failure or misuse in unli(ely to result in serious conse)uences.
(opthalmoscopes, *lectronic thermometers, cast cutters%.

'n the latter situation, it does not ma(e business sense to implement a ,M or ,EM tas(. .his method is
(nown as 0runtofailure.0

RCM PROGRAM BENEFITS.
*7M* ,olicy should be to avoid loss of life, personal in5ury or illness, property loss or damage, or
environmental harm from any of its activities and ensure safe conditions for patients and staff ali(e. 7y
its very features, including analysis, monitoring, ta(ing decisive action on systems or devices before
they become problematic, and thorough documentation, RCM is highly supportive of and an integral
maintenance process.

RELIABILITY.
RCM places great emphasis on improving e)uipment reliability, principally through the feedbac( of
maintenance e-perience and e)uipment condition data to maintenance managers, technicians, and
manufacturers. .his information is instrumental in continually upgrading the specifications for
e)uipment to provide increased reliability. .he increased reliability that comes from RCM leads to fewer
e)uipment failures and, therefore, greater availability for patients and lower maintenance costs.

COST.
>ue to the initial investment re)uired in obtaining the technological tools, training and e)uipment
condition baselines, a new RCM program typically results in a shortterm increase in maintenance costs.
.his increase is relatively short lived. .he cost of repair decreases as failures are prevented and
preventive maintenance tas(s are replaced by condition monitoring. .he net effect is a reduction of both
repair and a reduction in total maintenance cost.

SCHEDULING.
.he ability of a conditionmonitoring program to forecast maintenance provides management time for
planning, obtaining replacement parts and arranging environmental and operating conditions before the
maintenance is done. ,.' eliminates unnecessary maintenance performed by a timescheduled
maintenance program which tends to be driven by the minimum 0safe0 intervals between maintenance
tas(s. Additionally, a principal advantage of RCM is that it obtains the ma-imum use from e)uipment.
Cith RCM, e)uipment replacement is based on e)uipment condition not on the calendar. .his
conditionbased approach to maintenance thereby e-tends the operating life of the properly maintained
facility and its e)uipment.

EFFICIENCY/PRODUCTIVITY.
Safety is the primary concern of RCM. .he second most important concern is costeffectiveness. Cost
effectiveness ta(es into consideration the priority or care service necessity and then matches a level of
cost appropriate to that priority. .he fle-ibility of the RCM approach to maintenance ensures that the
proper type of maintenance is performed on e)uipment when it is needed. Maintenance that is not cost
effective or not re)uired is identified and not performed.

IMPACT OF RCM ON THE LIFE CYCLE.
.he life cycle is often divided into two broad stages, ac)uisition and operation. RCM affects all phases
of the ac)uisition and operations stages to some degree. >ecisions made early in the ac)uisition cycle
profoundly affect the lifecycle cost. (e.g. consumable costs over the life of a device can sometimes
ma(e the purchase price of the device seem insignificant%. *ven though e-penditure for e)uipment may
occur later during the ac)uisition process, their cost is committed at an early stage. ,lanning affects the
overall lifecycle costs.

.he decision to include a device group in the RCM program, including ,.', is best made during the
planning phase. As RCM decisions are made later in the lifecycle, it becomes more difficult to achieve
the ma-imum possible benefit from the RCM program.

*ven though maintenance is a relatively small portion of the overall lifecycle cost, ? to A percent of
operating cost, RCM is still capable of introducing significant savings during the 1perations and
Maintenance (1M% phase. Savings of ?$ to A$ percent in the annual maintenance budget are often
obtained overtime through the implementation of a balanced RCM program.


RCM PROGRAM COMPONENTS.

An RCM program includes reactive, preventive, predictive and proactive maintenance.

REACTIVE MAINTENANCE.
Reactive Maintenance also is referred to as brea(down, repair, fi-whenfail, or Runto/ailure (R./%
maintenance. Chen applying this techni)ue, maintenance, e)uipment repair or replacement occur only
when the deterioration in an e)uipment4s condition causes a functional failure. .his type of maintenance
assumes that failure is e)ually li(ely to occur in any part, component or system. .hus, this assumption
precludes identifying a specific group of repair parts as being more necessary or desirable than others. 'f
an item fails and repair parts are not available, delays ensue while parts are obtained. 'f certain parts are
urgently needed to restore a critical medical device or system to operation, a premium for e-pedited
delivery must be paid.

STAGES OF LIFECYCLE COST COMMITMENT.
Also, there is no ability to influence when the failures occur because no (or minimal% action is ta(en to
control or prevent them. Chen this is the sole type of maintenance practiced, a high percentage of
unplanned maintenance activities, high replacement part inventories, and inefficient use of the
maintenance effort typify this strategy. A purely reactive maintenance program ignores the many
opportunities to influence e)uipment survivability. 1n the other hand, reactive maintenance can be used
effectively when it is performed as a conscious decision based on the results of an RCM analysis that
compares the ris( and cost of failure with the cost of the maintenance re)uired to mitigate that ris( and
the cost of failure. /or e-ample, periodic maintenance on a standard, ine-pensive bathroom fan could
not be costeffective. .ypically this type of fan would be runtofailure and simply replaced at that time,
since the cost of maintenance or repair would probably e-ceed the cost of a replacement fan.

PREVENTIVE MAINTENANCE (PM).
,M consists of regularly scheduled inspection, ad5ustments, cleaning, lubrication, parts replacement,
calibration, and repair of components and e)uipment. 't is performed without regard to e)uipment
condition. ,M schedules periodic inspection and maintenance at predefined intervals in an attempt to
reduce e)uipment failures for susceptible e)uipment. As e)uipment ages the fre)uency and number of
chec(points may need to be reevaluated. .his is a process that uses ,.' and other methods to e-tend the
period between ,M tas(s while maintaining e)uipment condition.

CONSEQUENCES OF EQUIPMENT/SYSTEM FAILURE
!A *mergency Safety of life or property threatened. 'mmediate serious impact on mission.
!B Urgent Continuous facility operation threatened. 'mpending serious impact on mission.
!# ,riority >egrades )uality of mission support. Significant and adverse effect on pro5ect.
!& Routine Redundancy available. 'mpact on services insignificant.

REACTIVE MAINTENANCE PRIORITIES.
.his process can result in substantial maintenance savings. .hese savings are dependent on the ,M
intervals set, which can result in a significant decrease in inspection and routine maintenance2 however,
it should also reduce the fre)uency and seriousness of unplanned medical device failures for
components with defined, agerelated wear patterns.
.raditional ,M is (eyed to failure rates and times between failures. 't assumes that these variables can
be determined statistically, and therefore one can replace a part due for failure before it fails. ,M
assumes that the overhaul of medical devices by disassembly and replacement of worn parts restores the
medical device to li(enew condition with no harmful side effects and that the new components are less
li(ely to fail than the old components of the same design.
/ailure rate, or its reciprocal, meantimebetweenfailures, is often used as a guide to establishing the
interval at which maintenance tas(s should be performed. .he ma5or wea(ness in the application is that
failure rate data determines only the average failure rate. 'n reality, failures are e)ually li(ely to occur at
random times and with a fre)uency unrelated to the average failure rate. /or some items, failure is not
related to age, and conse)uently, timed maintenance can often result in unnecessary maintenance. ,M
can be costly and ineffective when it is the sole type of maintenance practiced.

PREDICTIVE TESTING AND INSPECTION (PTI)
,.', also (nown as predictive maintenance or condition monitoring, uses primarily nonintrusive testing
techni)ues, visual inspection, and performance data to assess medical device condition. 't replaces
arbitrarily timed maintenance tas(s with maintenance that is scheduled only when warranted by
e)uipment condition. Continuing analysis of e)uipment conditionmonitoring data allows for the
planning and scheduling of maintenance or repairs in advance of catastrophic and functional failure.
Collected ,.' data is used for trend analysis, pattern recognition, data comparison, tests against limits
and ranges, correlation of multiple technologies and statistical process analysis to determine the
condition of the e)uipment and to identify the precursors of failure. ,.' does not lend itself to all types
of e)uipment or possible failure modes and therefore should not be the sole type of maintenance
practiced.

PROACTIVE MAINTENANCE.
,roactive maintenance improves maintenance through better installation, maintenance procedures,
wor(manship and scheduling.

THE CHARACTERISTICS OF PROACTIVE MAINTENANCE ARE THE FOLLO!ING"
!" 't uses feedbac( and communications to ensure that changes in procedures are promptly made
available to managers. list item
=$ 't employs a lifecycle view of maintenance and supporting functions.
=! 't ensures that nothing affecting maintenance occurs in isolation.
== 't employs a continuous process of improvement.
=? 't optimises and tailors maintenance techni)ues and technologies to each application.
=@ 't integrates functions that support maintenance into maintenance program planning.
=A 't uses rootcause failure analysis and predictive analysis to ma-imi6e maintenance effectiveness.
=B 't periodically evaluates the technical content and performance interval of maintenance tas(s (,M
and ,.'%

A SUCCESSFUL MAINTAINABILITY PROGRAM !ILL HAVE THE FOLLO!ING
ATTRIBUTES"
=# Corporate commitment
=& ,rogram support
=" Maintainability planning
?$ Maintainability implementation
?! ,rogram updating

THE MAINTAINABILITY PROCESS HAS SI# MA$OR MILESTONES"
?= Management commitment to maintainability. >emonstrated through commitment of resources,
development policies, and designating a maintainability champion.
?? *stablishing a maintainability program. >emonstrated through development of a maintainability
staff, procedures and a database.
?@ 1btaining maintainability capabilities. >emonstrated by establishing pro5ect level maintainability
responsibility and developing resources for pro5ect maintainability reviews.
?A ,lanning Maintainability implementation. >emonstrated by forming a crossfunctional medical
devices group, defining maintenance strategies and maintainability goals and integrating appropriate
RCM technology
?B 'mplementing maintainability. >emonstrated by conducting maintainability meetings, providing
documentation and conducting maintenance training.
?# Updating the maintainability program. >emonstrated by evaluating program effectiveness and
updating the process in the database.

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