{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:46:26Z","timestamp":1793832386134,"version":"4.6.1"},"reference-count":14,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"unspecified","delay-in-days":33,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2026,7,7]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Medical equipment downtime is a major challenge in healthcare facilities, often driven by mechanical and electrical failures, delayed fault reporting and the absence of structured preventive maintenance. At Suhul Hospital, Shire, these issues were compounded by human error, outdated maintenance practices, limited standards and shortages of spare parts, leading to prolonged equipment unavailability and disrupted patient care.<\/jats:p>\n                  <jats:p>This project applied a Lean Six Sigma (LSS) approach to address these inefficiencies. Key tools included 5S practices, detailed process mapping, corrective maintenance standardisation and a structured preventive maintenance plan. A mixed-methods design was used, combining document review with semi-structured interviews involving 18 purposively selected professionals with at least a diploma and 4 years of relevant experience. Quantitative measures focused on downtime, defects and process capability, while qualitative data explored root causes and waste within the maintenance workflow.<\/jats:p>\n                  <jats:p>Implementation of Lean Six Sigma produced substantial improvements in medical equipment maintenance performance. Total equipment downtime decreased from 89,735 minutes to 292 minutes, while recorded defects decreased from 842 to 43. Overall, downtime decreased by 99.67%, defects by 94.89% and the Sigma level improved from 2.74 to 3.62, indicating a shift from low to moderate process reliability.<\/jats:p>\n                  <jats:p>These findings demonstrate that structured quality improvement methods can significantly enhance the efficiency and reliability of medical equipment maintenance in resource-constrained settings. While the intervention was successful, the project was limited to a single hospital, and further multi-site studies are recommended to strengthen generalisability.<\/jats:p>","DOI":"10.1136\/bmjoq-2026-004253","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:05:25Z","timestamp":1785758725000},"page":"e004253","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Reducing medical equipment downtime using Lean Six Sigma: a quality improvement project at Suhul Hospital, Shire"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2856-4042","authenticated-orcid":false,"given":"Hawelti Messele","family":"Gebremariyam","sequence":"first","affiliation":[{"name":"Industrial Engineering, Mekelle University, Ethiopian Institute of Technology - Mekelle, Mek\u2019ele, Tigray, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"2026080305051265000_15.3.e004253.1","unstructured":"World Health Organisation . Medical equipment maintenance programme overview WHO medical device technical series WHO medical device technical series: to ensure improved access, quality and use of medical devices development of medical device policies WHO medical device technicals. 2011. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241501538"},{"key":"2026080305051265000_15.3.e004253.2","first-page":"37","article-title":"Efficiency of Medical Equipment Utilization and Its Associated Factors at Public Referral Hospitals in East Wollega Zone, Oromia Regional State, Ethiopia","volume":"16","author":"Tesfaye Geta","year":"2023","journal-title":"Med Devices (Auckl)"},{"key":"2026080305051265000_15.3.e004253.3","unstructured":"Scottish Government . Donating medical equipment: report. 2023. Available: https:\/\/www.gov.scot\/publications\/chief-medical-officers-donating-medical-equipment-report\/"},{"key":"2026080305051265000_15.3.e004253.4","first-page":"1753","article-title":"Impact of biomedical engineering on the functionality of medical devices in Government Hospitals in Uganda","volume":"1","author":"Lopuka","year":"2022","journal-title":"IQ Res J"},{"key":"2026080305051265000_15.3.e004253.5","unstructured":"Elhaddad H , Saleh M , El-Sherif L , et al . Applying Lean Six Sigma to enhance the medical devices repair process in public healthcare sector in Egypt. 7th North American International Conference on Industrial Engineering and Operations Management; Florida, USA, 2022"},{"key":"2026080305051265000_15.3.e004253.6","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.14260\/jemds\/2018\/847","article-title":"Application of lean six-sigma approach to reduce biomedical equipments breakdown time and associated defects","volume":"7","author":"Thapa","year":"2018","journal-title":"JEMDS"},{"key":"2026080305051265000_15.3.e004253.7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3991\/ijoe.v13i02.6422","article-title":"Downtime reduction on medical equipment maintenance at the directorate of biomedical engineering in the Jordanian MOH","volume":"13","author":"Al-Bashir","year":"2017","journal-title":"Int J Onl Eng"},{"key":"2026080305051265000_15.3.e004253.8","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s12553-023-00755-1","article-title":"Implementation of a decentralised maintenance model with a measurable impact on the functionality and availability of medical equipment in healthcare facilities in Burundi","volume":"13","author":"Beniacoub","year":"2023","journal-title":"Health Technol"},{"key":"2026080305051265000_15.3.e004253.9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.4172\/2475-7586.1000123","article-title":"Maintenance practice, causes of failure and risk assessment of diagnostic medical equipment","volume":"02","author":"Kwaku Kutor","year":"2017","journal-title":"J Biomed Eng Med Devic"},{"key":"2026080305051265000_15.3.e004253.10","doi-asserted-by":"crossref","first-page":"464","DOI":"10.18203\/2320-6012.ijrms20200034","article-title":"A comprehensive study on the maintenance of medical equipment at tertiary care hospital in India","volume":"8","author":"Tadia","year":"2020","journal-title":"Int J Res Med Sci"},{"key":"2026080305051265000_15.3.e004253.11","doi-asserted-by":"publisher","DOI":"10.2147\/MDER.S398933"},{"key":"2026080305051265000_15.3.e004253.12","first-page":"15","article-title":"Assessment of availability and utilization of medical equipment\u2019s in Nekemte Specialized Hospital, August, 2021","volume":"11","author":"Desalign","year":"2023","journal-title":"AJBLS"},{"key":"2026080305051265000_15.3.e004253.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-016-1523-2","article-title":"Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study","volume":"16","author":"Ademe","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2026080305051265000_15.3.e004253.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2026-004253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:05:27Z","timestamp":1785758727000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2026-004253"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":14,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,3]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjoq-2026-004253"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2026-004253","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}