Improving

and
Maintaining Facilities
Carleen Roan S. Delloro, RN
Bhell G. Mendiola, RN
DEFINITION OF TERMS
HEALTH FACILITY
-refers to the hospital physical plant, the land and its
environment, the buildings and all its accessories,
fixtures, equipment for utilities, for communications and
for special usages which are integral to the building’s
functions.
-excludes those equipment which are used for medical
purposes such as for diagnosis, therapy, physiological
monitoring, laboratory analysis, sterilizing, etc. and for
transportation such as motor vehicles and ambulances.
PREVENTIVE MAINTENANCE
consists of planned, scheduled and cyclic tasks of parts
replacement, condition monitoring, and general
gathering of data in order to prevent untimely
breakdown of building elements and equipment;
maintain desired operating performance levels; and
generate structured and coherent data needed for
planning and decision making.
CORRECTIVE MAINTENANCE

involves minor repair of building elements and minor

servicing of equipment to correct confirmed
abnormalities or deteriorating conditions.
MAJOR REPAIR/REHABILITATION

involves major repair/rehabilitation of building elements

and major servicing or overhauling of equipment and
utility systems requiring substantial replacements and
restructuring of such building elements and systems.
may be planned or emergency in nature.
REPAIR
- work which is accomplished under normal
maintenance, involving correction of
breakdowns/defects of buildings and equipment.

EMERGENCY REPAIR
-worked accomplished immediately to rectify damages
caused by nature or man-made calamities to buildings,
utilities and equipment to prevent further deterioration
and danger to life and property.
NON-RECURRING REPAIR
-pertains to jobs or works that are done on a scheduled
basis and may comprise work.

BREAKDOWN MAINTENANCE
-The oldest and most common approach
-Maintenance of a non-routine, non-repetitive basis
performed to restore an item to satisfactory condition
after a malfunction has caused a degradation of the item
below the specified performance level.
OVERHAUL
-comprehensive examination and restoration of an item,
or a major part thereof, to an acceptable condition.

HOUSEKEEPING
- refers to the cleanliness and orderliness of buildings and
grounds.
GOAL

To attain and maintain a well functioning health facility

that is responsive to the constant as well as varying
demands of different hospital activities both in normal
crisis situations.
GENERAL TYPES OF MAINTENANCE
ACTIVITIES
Preventive
– Consist of planned, scheduled and cyclic task of parts
replacement, condition monitoring and general
gathering of data in order to:
Prevent untimely breakdown of building elements and
equipment.
Maintain desired operating performance
Generate structured and coherent data needed for
planning and decision making.
Activities:

Funding Request
The request for funds for preventive maintenance should
be INITIATED by every hospital and office and should be
reflected in their annual mode plan;
For 1997, all DOH retained hospitals and offices have
been reminded by the INFRA to utilize funds in their
mode for preventive maintenance work;
Preparation of Scope of Prioritized Preventive
Maintenance Work
The Hospital or Office Maintenance Staff shall prepare a
prioritized list of preventive maintenance work on a
monthly basis;
The list shall be based on requests by end-users of areas
needing preventive maintenance and from the results of
regular physical plant check-up by the maintenance staff;
The list shall be submitted to the Administrative Officer
for validation and recommendation for approval;
The AO will submit the list to the Chief of Hospital or
Head of office, as the case may be, for final approval.
Procurement of Work Items
The procurement of supplies and other work items shall
be conducted by the Hospital or Office Procurement Staff
subject to accounting and auditing rules and regulations
Preparation of Drawings
The preparation of drawings and other documents
reflecting the preventive maintenance work shall be done
by the Hospital or Office Maintenance Staff as the case
may be.
Execution of Work items
The execution and timely completion of preventive
maintenance work shall be the responsibility of the
Hospital or Office Maintenance Staff.
Corrective

Involves minor repair of building elements and minor

servicing of equipment to correct confirmed
abnormalities and deteriorating conditions. These
activities are generally unscheduled and emergency in
nature. Materials, parts tools and equipments for these
activities should be provided early so that they can be
readily available.
Activities:

Funding Request
The request for funds for corrective maintenance should
be initiated by every hospital and office and should be
reflected either in their capital outlay plans;
For 1997, all DOH retained hospitals and offices have
been advised by the INFRA to include corrective
maintenance work in their non-infra projects listing.
Preparation of scope of Prioritized Corrective Maintenance
Work:
The Hospital or Office Maintenance Staff shall prepare a
prioritized list of corrective maintenance work on an annual or
semi-annual basis;
The list shall be based on requests by end-users of areas
needing corrective repair and from the results of regular
physical plant check-up by the maintenance staff.
The list shall be submitted to the Administrative Officer for
validation and endorsement to the Chief of Hospital or Head
of Office, as the case may be; and
The Chief of Hospital or Head of Office will submit the list to
the INFRA for review and recommendation for final approval
by the undersecretary.
Project Documentation
The preparation of architecture and engineering plans,
technical specifications, detailed estimates and other
documents necessary for bidding and procurement of a
contractor for the corrective maintenance work project
shall be conducted by the Hospital or Office Maintenance
Staff.
The INFRA and the Regional Health Offices, through the
Regional Civil Engineers, shall provide the technical
assistance in project documentation for work beyond the
in-house capability of hospital and office maintenance
staff.
Project Implementation
The procedures for project implementation including
bidding, awarding of contract, variation orders and other
pre-construction and construction activities shall comply
with PD 1594 Guidelines for Implementation of
Government Infrastructure Projects, as amended;
The provisions stipulated in AO 40 s. 1996 (Delegation of
Signing Authority) shall likewise govern project
implementation procedures.
The Hospital or Office Maintenance Staff shall be
responsible for the daily supervision of corrective
maintenance work projects
Monitoring and Reporting
The hospital or Office Administrative Officers shall monitor
the progress of corrective maintenance work. They shall
see to it that the monthly reports of physical and financial
accomplishment as prepared by Hospital or Office
Maintenance Staff, are submitted to the INFRA, copy
furnished the Regional Health Directors and the
Undersecretary.
The INFRA in turn shall prepare the overall report of
physical and financial accomplishment of the DOH 1997
Corrective Maintenance Work Projects on a quarterly basis;
The monthly status reports shall use the standard format
prescribed by the INFRA.
Final Acceptance and Turnover of Projects

The final acceptance and turnover of corrective

maintenance work projects shall be endorsed for
approval by the Hospital or Office Administrative Officer
and approved by the Chief of Hospital or Head of Office,
as the case may be.
Major Repair and Rehabilitation

Involves major repair of the building elements or

overhauling of equipment and utility system requiring
substantial replacement and restructuring. Its objective is
not to alter the general configuration/ layout of the
facility but to restore it to a previous operational status,
this maybe planned or emergency in nature.
2 Types of Major Repair / Rehabilitation
Planned Repair/ rehabilitation
This includes scheduled overhaul including internal
inspection, or calibration testing in accordance with
expected life expectancy of an equipment or its major
parts, defects and deficiencies in building elements or
the utility system. Which are wide in scope or which are
perceived to pose danger to life and property.
Emergency Repair/ Rehabilitation
is done after natural disasters and calamities like
earthquakes, floods, typhoons and volcanic eruptions.
And the unforeseen major breakdowns.
VITAL ELEMENTS AND PARAMETERS OF HEALTH FACILITY
MAINTENANCE
The Hospital Management
 sets the general direction, goals and policies of the
hospital, with which the maintenance program must be
in accord.
 defines the financial and administrative limits of what
is proposed by the maintenance staff, and interacts with
both higher management and key maintenance
personnel for the implementation of a maintenance plan.
 must be aware of the problems attendant to facility
maintenance and must be supportive of its maintenance
staff in the pursuit of valid objectives.
Key Technical Personnel

 includes professional and licensed technical staff

exercising professional, technical and administrative
supervision over the rank and file of skilled and unskilled
workers.
 must be competent in their field and must be
knowledgeable in related fields.
 must be able to synthesize the specific and disparate
demands of maintenance to unified program of action
for approval and support by management.

 must possess the ability to translate the objectives of the

program of action to specific tasks and effectively
communicate those tasks to the rank and file and
motivate them for successful implementation.
• Skilled and Unskilled Personnel

 includes tradesmen and laborers of varying skills.

 Conscientiousness, discipline and industry are the
primary traits desired in such personnel.
 Resourcefulness, the ability to work as a team and the
capability of being educated or trained are secondary
desirable traits.
THE ORGANIZATIONAL PARAMETERS ARE:
The relationship between hospital management and key
technical personnel which should be based on:
Mutual respect and trust in each other’s competence in
their respective fields;
Judicious application of administrative checks and
balances beyond what is built into or existing in the
bureaucracy; while the lack of control can give rise to
anarchy in any organization, too much control is even
more detrimental as the tasks and objective of the
maintenance organization are hampered;
Openness of communication lines
b. The relationship between personnel and the rank and file should
be characterized by:

1. Application of principles of good leadership,

2. Two-way traffic technology transfer; key technical personnel,

having undergone formal education, training and having passed
the required licensure examinations, should disseminate to the
rank and file the correct theoretical foundation and guidance
and promote scientific outlook and precise technical language;
these should be communicated in a level of language the rank
and file could understand, without sacrificing correctness;
on the other hand the rank and file should freely share
their practical knowledge, so as to enrich the collective
experience and knowledge of the maintenance
organization;
 the management and key staff should motivate the rank
and file to such sharing of practical knowledge.

3. Flexibility
C. The relationship between management and the rank
and file which should be that:

1. The cohesiveness of the maintenance organization is

sustained and enhanced;
2. Morale of the rank and file as well as the technical
personnel is promoted;
3. Technical, as well as administrative authority of the key
technical personnel over the rank and file is supported by
management.
THE LOGISTICS COMPONENTS
TOOLS AND EQUIPMENT
COMMON CONSUMABLES AND SPARE PARTS
 should be available according to the requirements of the
facility.
 Judicious planning, procurement scheduling, and
management of such supplies, should be based on
experience derived from past as well as informed
foresight.
DOCUMENTS AND RECORD

These should be complete, up-to-date, well-kept and

properly filed, from project development plans, site
surveys and investigations, approved plans.

Equipment warranties, and manuals, records of post

commissioning deletions and accretions, and all data
accruing from regular and emergency maintenance
procedures instituted including regular monitoring and
post repair evaluation.
WORKPLACE ENVIRONMENT

A maintenance workshop should be sufficient

in space, ventilation, water, power and
lighting so as to promote an atmosphere
conducive to efficient work. There should be
adequate facilities for storage and easy
retrieval of documents, records, tools and
supplies as well as living quarters with toilet
and bath for night duty personnel.
THE LOGISTICS INTERRELATIONSHIPS ARE ALSO CRITICAL
PARAMETERS WHICH SHOULD BE PROPERLY APPRECIATED BY ALL
CONCERNED:
Tools and equipment, as well as stock of common
consumables and materials should be adequate for the
requirements of the maintenance program. Arguments
of these are:
There is a limit of resourcefulness and innovation to
make up for the lack of these basic materials. Aside from
engendering inefficiency and wastefulness, sometimes
more troubles are created when the improper tools,
equipment and materials are used.
Institutional tasks and functions can be held up by lack of
such simple tools, equipment and materials.

 Lack of foresight can paralyze essential hospital

operations is an acknowledge vulnerability of
government-run institutions. Levels of maintained
inventory of stock should be determined primarily by key
technical personnel, and controlled by management.
Factors to be taken into account when planning for such
resources are:

FACILITY SIZE AND COMPLEXITY

-The requirement of a 25-bed differ from that of a 50-

bed, 100-bed, and so on. Even among hospitals of the
same bed capacity, requirements vary widely;
THE ORGANIZATIONAL SIZE AND WORKLOAD

Ideally, each workman should be provided with his basic

tools so that individual responsibility for their upkeep and
care can be instituted.
Key technical personnel should advocate for the
procurement of more sophisticated equipment and their
use by the rank and file so that efficiency is increased and
dependence outside contractors or jobbers is minimized.
ADMINISTRATIVE PROCESSES and difficulties in procurement
including the sourcing of funds, and the required proximity to urban
centers where the required logistics components are mostly available.
The critical importance of complete and comprehensive
documentation should already be well appreciated by key technical
personnel. Because of lack of such documentation to begin with, this
aspect of maintenance has been the one most neglected, if not totally
ignored.
This attitude should change starting from the key personnel, and
down to the technical rank and file. Management should be aware of
their importance and shall support efforts to obtain complete
documentation, even up to the point of commissioning the
preparation of as-built plans by private consultants, if such plans are
not available.
Some of the reasons for this are as follows:
Because of the uncertainty factor arising from lack of
data, rehabilitation works usually encompasses more
than what is necessary. This cautionary practice though
commendable, is uneconomical;

T he alteration of utilities, particularly of the electrical

system, without regard for the existing systems designed
limits. This error is dangerous and such practice should
be discontinued;
Completeness and availability of plans, documents and
data remove the mystery from the health facility not only
‘’user-friendly’’ but also ‘’maintenance-friendly’’. This
gives the management and the maintenance staff a
sense of being in control of their environment. In effect,
the existing facility becomes a part of their material
resource whose fate becomes subject to their decision
and action, and not the other way around. As a
psychological benefit.
Unnecessary anxiety is eliminated, practical
planning and programming is made possible and
workman’s confidence, removed of unknown
dangers is uplifted.

The importance of an ideal workplace is basic to any

laboring organization. Provision of such indicates
that management cares for the welfare of its
personnel. This promotes high morale, gives a sense
of belonging and develops a unity of purpose.
It is basic principle that a system is only as
good as its weakest link. This is particularly true
of hospital physical plant maintenance.
Deficiency in any of the above components and
parameters will cripple, to varying degrees, its
effectiveness. This awareness and proper
appreciation of the same is a necessary first
step in the development and execution of a
successful maintenance program.