The following conclusions have been drawn based on each component of the process map:

The realisation time can be reduced by introducing equipment operator’s shift checklist based on the recommended checks and procedures to be performed and documented at the start of each shift. Delay in inspection time by hospital biomedical engineer is reduced by the technician lodging in complaint in the hospital equipment maintenance tracker software and the concerned engineer will be paged automatically. The escalation of call should be made to the biomedical department head in case the complaints are not resolved by the concerned engineer.

As it is noted from Table-A that the minor (first hand level) complaints form 67 per cent of total complaints but the hospital biomedical engineer was able to rectify only 32 per cent of those. The delay in diagnosis time can be further improved by providing regular training to hospital biomedical engineer and providing good workshop facility for the hospital biomedical engineering department (i.e. well-equipped with toolkits, calibration devices and equipment service manuals). Also, the concerned department should function round the clock.

The delay in inspection by equipment vendor service engineer can be reduced by lodging in call at vendor uptime centre by biomedical engineer in case the problem is not resolved within one hour from compliant lodging.

The biggest challenge is in reducing the spare procurement time. This delay in activity includes:

• Delay in getting proforma invoice from vendor.
• Delay in getting approval from hospital administration on required spare parts. To facilitate the hospital administration in taking decision, the biomedical engineer should provide information on equipment capital cost, age, capital cost, frequency of equipment breakdown, spare part price (when previously ordered).
• Delay in order processing and distribution can be reduced by generating purchase order in hospital information system to enable user departments and stores to have prior information before arrival of spare parts.
• Delay in clearance of spare parts can be reduced by hiring efficient clearing agent and furnishing all the necessary documents before arrival of spare parts.

The downtime can be checked and controlled at the time of negotiation of medical equipment procurement with the vendor by incorporating uptime guarantee (usually from 95-99 per cent) and having downtime penalty clearly specified in the purchase order.

To conclude the above analysis with effective measures taken in each component of downtime process map, hospitals can achieve an average much lesser downtime and thereby improve their patient care facilities and productivity.