DEVELOPING COMPUTER-BASED SYSTEM FOR MAINTENANCE PLANNING AND SCHEDULING OF HOSPITAL BUILDINGS IN NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL NNEWI, ANAMBRA STATE, NIGERIA
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Statement of the Problem
Hospitals buildings are confronted with unique challenges that threaten their optimal performance, structurally and otherwise. According to Onifade 4 (2003), installed health facilities in Nigeria are as old as the hospitals themselves. He lamented that most of the buildings are dilapidated and there is no institutional policy for their maintenance. These statements aptly describe the situation at Nnamdi Azikiwe University Teaching Hospital (NAUTH), where the buildings are over 32 years old without any maintenance policy, nor programme to ensure that these buildings function optimally both structurally and aesthetically. The general lack of maintenance tends to be more noticeable in ageing facilities due to the accumulation effect of weather, usage and lack of funds. In (NAUTH), there is no planned maintenance schedule. Maintenance is carried out arbitrarily and only when defects/breakdowns are critical or when emergencies are involved. Furthermore, at NAUTH, maintenance is in the form of “request and response”, as long as the cost involved can be borne by the maintenance Department; otherwise the maintenance work is delayed until when fund is made available by the management of the hospital. NAUTH has separate buildings housing the following departments or wards/units – Works, Administration, Audit, Accounts, Pediatrics, General outpatient, public Relation, Chemical pathology, Radiology, Microbiology, Histopathology department, Haematology, Psychiatric, Medical outpatient (MOP), Surgical outpatient (SOP), Central sterilization services (CSSD), and Physiotherapy department. The hospital also has other buildings housing the following clinics, units/offices and wards – Obstetric and Gynaecology ward/clinic, Female surgical ward (FSW), Male surgical ward (MSW), Female Medical ward (FMW), Male Medical Ward (MMW), Chairman Medical Advisory committee office (CMAC), Deputy CMAC‟s office, Chief Medical Director‟s (CMD) office, Accident and Emergency (A/E), National Health Insurance Scheme (NHIS) unit, Polymerase Chain Reaction (PCR) Unit, Mortuary unit, Store unit, Special care baby unit 5 (SCBU), Labour ward, Ante-natal clinic (ANC), Main theatre unit, Intensive care unit (ICU), Renal unit, School of Nursing unit (SON), and School of health information management (SHIM). For the maintenance of these buildings and facilities, each of these departments/units or sections submits her maintenance request in a prototype form to the Works Department whenever they have the need. As a result, there are lots of maintenance requests on a daily basis. The nature of these maintenance requests range from faulty windows/doors, flaking of paints, faulty door keys/handles, leaking roofs, burnt sockets/bulbs/plugs due to partial contacts, leaking plumbing pipes, faulty taps/blockage of waste pipes, faulty air conditioning units and other electrical appliances and accessories; others include: damaged tables/ chairs and various types of furniture, which have aged over time and are in need of repairs/replacement. The maintenance work in NAUTH is constrained with the following challenges: i. diversity and volume of work; ii. Inadequacy of competent staff to attend to the myriads and backlogs of maintenance requests; iii. Insufficient fund to take care of all the maintenance needs; iv. Lack of material stocks required for maintenance. v. etc. Generally, for public buildings to meet the basic requirements for optimal performance, there is need for regular maintenance based on a well planned schedule to be carried out during holiday periods when the offices are less busy (Okereke, 2014). This is however not the case for hospital buildings especially for buildings used as medical ward/units which most times are in constant use. 6 According to Akingbohungbe (2002), Rapp and George (1998), Ahmed (2000) and Odediran et al (2012), a cursory observation of most hospital building conditions reveal a pathetic picture of neglect, deterioration, decay, dilapidation and threatening collapse. This may due generally to the above listed challenges, which are regular features in most public establishments. He further posited that this sordid condition may be due to the absence of good maintenance management systems which are sine qua non for economically viable and operationally safe buildings. Onibokun (1990) is also of the view that lack of appropriate tool for predictive maintenance of the existing buildings can have a detrimental effect on future housing development. Oladejo (2014) lamented that the maintenance of hospital buildings is reactive instead of proactive perhaps because of use or nature of building. The reactive approach to maintenance is still subject to the availability of funds, which will be minimized if effective planning and scheduling is carried out. As the operating life of any building progresses, especially, due to high rate of activities as witnessed in NAUTH, degradation is bound to occur. It is immaterial what the reasons are for this degradation; the fact is that the building element can no longer meet its original function and it‟s level of performance reduces. If this reduction in performance level is predicted or detected in advance, it will provide means to forecast a forthcoming failure and then plan by budgeting for it in advance. This is where there is a compelling need for computer-based systems to assist in ameliorating the problem in the maintenance of hospital buildings and facilities. Hospital buildings are expected to be on red-alert in performing their functions regularly and during emergency services. 7 The major challenges with such a system are: i. Its ability to store, retrieve, calculate, organize and present vast amounts of data efficiently and accurately (Teicholz, 1992); ii. The ability of the computer to identify a change in building condition in many ways, that is, by commonly used procedures including detecting change in colour, change in power usage, leaking roof, cracks on walls/floors, leaking pipes, dampness of wall, and so on; iii. The most important aspect of any such system will be its ability to detect or predict in advance failure signs early enough so that the maintenance crew will have sufficient time to plan, budget, prepare and organize correction at the least cost, bearing in mind that once the building breaks down, the establishment is bound to spend whatever time, money and resources it takes to get it back in proper use, or else jeopardize the operation of such establishment, especially a hospital. Extensive review of extant literature reveals that there is no such computerbased system for now in the Nigeria building industry, specifically prepared for the Nigeria socio-cultural and economic milieu. The nearest to such a programme in existence is the generic application of Building Information Model (BIM). “Building Information Model is a digital representation of physical and functional characteristics of a facility. A BIM is a shared knowledge resource for information about a facility forming a reliable basis for decisions during its life-cycle; defined as existing from earliest conception to demolition” ( https://en.m.wikipedia.org). Its application in maintenance is limited by the following (https//www.infocomm.org/cps/rde): i. High cost of Soft-ware and Hardware – Every organization currently utilizing 2D or 3D CAD drafting software can attribute a 8 cost element against purchasing, maintaining and upgrading software licenses to keep a competitive market advantage. Current trend show that the cost of BIM software packages tend to be more expencive than CAD software package available in the market. ii. Cost of Training- With new software, there is a great demand to train staff quickly so that the investment can be justified. With the staff disposition in NAUTH , it is unrealistic since there is no professional in the Maintenance unit with CAD proficiency who will be able to learn new BIM software quickly or without specialized training . Given the fundamental differences between BIM and CAD, such training should be considered a basic requirement for the maintenance staff. The variables of the statement of the problem include: i. The lack of deliberate planned programmes for preventive and corrective maintenance planning of hospital buildings in NAUTH. ii. The lack of computerized system in use for maintenance planning and scheduling that will make for efficient and effective maintenance which will help in timely preventive maintenance of hospital buildings and avoid interruption of medical services. The specific problem statement in the maintenance of hospital buildings generally and in NAUTH in particular could be summed up as follows: i. Rapidity in the degradation and deterioration of buildings and their components due to the nature of their uses; ii. Lack of prior knowledge of when to carry out preventive or corrective maintenance of any component of a building, thereby resulting in the general lack of maintenance culture among the maintenance department of the institution; 9 iii. Shortage of qualified and competent staff in the appropriate trades; iv. Lack of computer-based system that will predict the likely deterioration/degradation period of buildings based on their type, age, uses design, site locations and the materials/components used in their construction for maintenance planning; v. How to use such a system to inculcate maintenance culture among the management and staff of NAUTH, thus obviating the habit of arbitrariness and subjectivity in decision making in matters of maintenance works; vi. How to create maintenance records and inventory of all the buildings to serve as standard for cost and time estimation and referencing to past building maintenance.
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