Frontiers in Computing and Intelligent Systems 
ISSN: 2832-6024 | Vol. 1, No. 1, 2022 

 

62 

Research on the effect of FOCUS-PDCA quality 
management on improving the maintenance and use of 
monitors in hospitals 

Qinfeng Liu1, Qianyu Zhang2, Jialan Chen3, *, Tao Wang4 

1 Medical Equipment Management Department, Shaanxi Provincial People 's Hospital, Xi’an Shaanxi, China 
2 School of Life Science and Technology, Xi 'an Jiaotong University, Xi’an Shannxi, China. 
3 Department of Gynaecology, Shaanxi Provincial People 's Hospital,Xi’an Shaanxi, China. 
4 Department of Medical Imaging, Hospital of Stomatology, Xi’an Jiaotong University, Xi’an Shaanxi, China 

* Corresponding author: Jialan Chen 

 

Abstract: Objective To explore the application value of FOCUS-PDCA in improving the maintenance and use management 

effect of monitors in hospital. Methods A large hospital in Xi'an adopted the FOCUS-PDCA quality improvement measures in 

the maintenance and management of monitors. Through F(Find), O(Organize), C(Clarify), U(Understand), S(Select), P(Plan), 

D(Do), C(Check), and A(Action), the management efficiency can be improved. The management effect before and after using 

FOCUS-PDCA management measures was compared. Results After the implementation of FOCUS-PDCA quality improvement 

measures, the availability rate of all monitors in the hospital was improved significantly, from 92.96% before implementation to 

98.46% after implementation, the ratio of uncharged monitors to be used and the ratio of monitors with stains on the surfaces 

decreased significantly (c2=76.900, 2=174.432; P<0.05), the pass rate of monitors in one inspection increased significantly 

(c2=45.133; P<0.05). Conclusions In the maintenance and use management of monitors, the use of FOCUS-PDCA quality 

improvement can promote the daily maintenance and use management of monitors by medical staff, promote the preventive 

maintenance of monitors by clinical medical engineers. It can improve the availability rate of all monitors, and improve the 

management and use effect of monitors. FOCUS-PDCA has great value in the maintenance and use management of monitors in 

hospitals. 

Keywords: FOCUS-PDCA; Management effect; Availability rate; Application value. 

 

1. Introduction 

Monitors are the most commonly used medical devices to 

measure the physiological parameters of patients in hospitals. 

When the monitoring values are found to be beyond the 

normal value ranges, monitors will issue sound and light 

alarms[1].They can continuously monitor the vital signs of 

patients, and have the function of storing and printing, so that 

doctors can analyze and compare historical data, so as to 

make diagnostic decisions on the abnormal value found, and 

carry out medical treatment in time to control the 

development of the patients’ conditions[2].At present, 

monitors are widely used in hospitals because they can help 

medical staff monitor the signs of patients, and have the 

characteristics of small size and easy operation. Almost every 

clinical department will use them. However, due to various 

problems in the use and management of monitors, the failure 

rate of monitors is high, which affects the operation efficiency 

of clinical departments. 

FOCUS-PDCA was proposed by quality management 

experts in the United States. It is an important management 

method for continuous quality improvement. It is developed 

on the basis of PDCA cycle management. While, It can 

improve the management efficiency through nine aspects of 

quality improvement measures: F(Find), O(Organize), 

C(Clarify), U(Understand), S(Select), P(Plan), D(Do), 

C(Check) and A(Action).In recent years, PDCA management 

method has been widely used in hospital management, and it 

has achieved good results[3-5]. This study discusses the effect 

of using FOCUS-PDCA quality management to improve the 

maintenance and use of monitors in hospitals. 

2. Research materials and methods 

2.1. General materials 

Since August 1, 2021, a large hospital in Xi'an has adopted 

the FOCUS-PDCA quality improvement method in the 

maintenance and use management of monitors in the whole 

hospital. There are 1236 monitors, including 23 models of 8 

brands. There are 412 Mindray PM9000 monitors, 334 

Mindray IPM12 monitors, 137 Philips G40 monitors and 116 

Philips G70 monitors, which are the top four models with the 

largest number of monitors. All the monitors used in the 

hospital were taken as the research objects. 

2.2. Research methods 

2.2.1. F(Find)-To find the problems 

The clinical medical engineers conducted a statistical 

analysis of the monitor maintenance records in the hospital 

and the equipment management and use records of the clinical 

departments within two years, and communicated with the 

manufacturer's engineers many times. Finally, they found that 

the faults in the use of the monitors mainly included the 

following aspects. 

(1) Medical accessories such as ECG lead wires, blood 

oxygen probes, blood pressure cuffs, etc. were damaged, 

resulting in inability to measure data, or large waveform 

interference, which affected the observation of measurement 

data. 

(2) The monitor’s rechargeable battery was low in power 



 

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or the rechargeable battery was damaged, so that the monitor 

could not continue to work after a power outage. 

(3) The motherboard memory battery was damaged, 

causing the system recording time to be inconsistent with the 

actual time. 

(4) The blood pressure control module inside the device 

was damaged, resulting in the failure to measure blood 

pressure, the failure of blood oxygen control module caused 

the failure to measure blood oxygen, and the failure of ECG 

module caused the failure to measure ECG. 

(5) The cooling fan was aging, causing the fan to make too 

much noise. 

(6) The monitoring alarm limit was unreasonable, resulting 

in frequent alarms. 

(7) The display screen and display control module were 

faulty. 

(8) The blood pressure, blood oxygen and ECG 

measurement interfaces were damaged, which led to the 

failure to insert the lead wire for corresponding inspection. 

(9) The device shell was damaged due to accidental fall 

2.2.2. O(Organize)-To establish the CQI group 

Established the CQI (Continuous Quality Improvement) 

group, whose members included relevant personnel from the 

Medical Equipment Management Department and clinical 

departments. The director of Medical Equipment 

Management Department was the leader of CQI, who was 

responsible for the coordination and implementation of the 

whole quality management process. 

2.2.3. C(Clarify)-To clarify the current management 

process 

According to the found problems, the existing management 

process of equipment maintenance and use was sorted out, 

and the weak links in the equipment maintenance system 

process and management process were found, and the root 

causes of the problem were found [6]. 

2.2.4. U(Understand)-To understand the reasons 

CQI held the quality improvement meeting, during which 

the members carried out brainstorming and discussion. 

According to the existing maintenance and use management 

system process, the root causes of the above problems were 

analyzed from the five aspects of Man, Machine, Material, 

Method and Milieu. The root causes included the following 

aspects :(1) the medical staff were not careful enough in the 

finishing process of the monitor every day, so that the medical 

accessories such as blood pressure cuff, ECG lead wires and 

blood oxygen probes were damaged but not replaced in time, 

resulting in the monitoring data process reporting errors or 

inaccurate results; (2)medical staff did not check the battery 

status of monitors in time, and did not replace or charge 

batteries of medical devices in time; (3) the preventive 

maintenance of the monitor was not carried out, which led to 

the failure of the monitor function modules and the inability 

to monitor parameters, and it also caused problems such as 

excessive fan sound; (4) nursing staff were not skilled in the 

operation of monitors. When inserting the medical 

accessories into the interfaces of medical devices, they did not 

pay attention to the insertion direction or exerted too much 

force, which led to the damage of interfaces of devices or 

medical accessories;(5)nursing staff did not fully understand 

the patients’ vital sign parameters, and the alarm limit values 

of monitors were set irrationally; (6)in the process of moving 

medical devices to monitor inpatients or transferring patients, 

the nursing staff did not place monitors properly, resulting in 

the falling of monitors and damage to devices; (7) too many 

devices were placed near the beds, resulting in crowding of 

the devices and easy pulling of the device wires, which may 

lead to devices tipping and damage;(7) the ward environment 

was not cleaned in place and timely, resulting in too much 

dust in the ward environment, which entered devices through 

the monitors’ heat dissipation holes, resulting in device 

failures;(8) the hospital lacked the quantitative assessment 

system for medical staff to operate in strict accordance with 

the operation process, resulting in non-standard operation of 

medical devices[7]. 

2.2.5. S(Select)-To select an improved process plan 

According to the above reasons for the high failure rate of 

monitors, the members of the IQC group finally determined 

the following improvement process plan by reviewing 

relevant materials and holding meetings and discussions: (1) 

established a three-level preventive maintenance system for 

equipment, and the first-level maintenance was carried out by 

medical staff. Completion, secondary and tertiary 

maintenance were performed by clinical medical engineers 

and the maintenance process was recorded; (2)medical staff 

carried out daily maintenance of monitors, including startup 

check, accessory check, charging power check, etc., and clean 

and maintain medical devices every day; (3)medical staff 

cleaned and dedusted the ward environment every day to 

ensure that the ward environment was free of dust;(4) Trained 

medical staff on the principle and operation of medical 

devices; (5) Trained medical staff on the process of patient 

transfer; (6) Arranged the bedside devices reasonably and 

clean up the idle devices in time; (7) established the 

quantitative assessment system for the management and use 

of medical devices and associated it with individual year-end 

assessment of medical staff;(8) strengthened the awareness of 

safety and saving of medical staff and paid attention to the 

safety of electricity[8]. 

2.2.6. P(Plan)-To make the plan 

For the above improvement process plan, the 

implementation plan should be made, mainly including the 

following aspects :(1) CQI group members should develop 

training plans for equipment management and use, patient 

vital signs explanation and patient transfer process; (2) the 

CQI group formulated the daily management list of medical 

staff; (3) the CQI group should establish the annual 

implementtation plan of the three-level maintenance of 

medical devices; (4) the CQI group studied and established 

the implementation plan of quantitative assessment of 

medical devices management for medical staff. 

2.2.7. D(Do)-To carry out the plan  

Strictly implemented the planned measures, including :(1) 

according to the developed equipment management and use 

training plan, the clinical medical engineers of the CQI group 

contacted the engineers of the monitor manufacturers to train 

the medical staff; (2) the CQI group invited the chief 

physicians of emergency medicine in the hospital to explain 

the patient's vital sign parameters; (3) the CQI team invited 

experts in transport and emergency treatment outside the 

hospital to train medical staff on the transfer process; (4) 

medical staff should strictly carry out the management of 

monitors and other medical devices according to the contents 

of the daily management list, including cleaning, disinfection, 

sorting, start-up test, etc.; (5) Carried out the three-level 



 

64 

preventive maintenance of monitors and other medical 

devices according to the implementation time and 

implementation items of the three-level maintenance annual 

implementation plan; (6) Quantitative assessment of medical 

staff was carried out according to the implementation plan of 

quantitative assessment of equipment management for 

medical staff. 

2.2.8. C(Check)-To check the implementation 

The CQI team conducted regular inspection on the 

implementation of improvement measures in the clinical 

departments, and random inspection was carried out, and the 

inspection results were recorded and summarized. 

2.2.9. A(Action) 

CQI team held a quality improvement and 

rectification meeting to discuss the problems found 

in the inspection, study and formulate rectification 

measures, and the rectification measures would be 

implemented in the next round of quality cycle. 

2.3. Observation indicators 

2.3.1. Availability rate statistics of all monitors in the 

hospital 

After the implementation of FOCUS-PDCA quality 

improvement for 3 months and before the implementation of 

quality improvement, the availability rate of all monitors in 

the hospital was statistically compared. 

2.3.2. Comparison of management effects of the monitors 

to be used 

Before and after the implementation of FOCUS-PDCA 

quality improvement, 300 monitors to be used were randomly 

selected from clinical departments, and the status of the 

monitors was compared, including the number of uncharged 

monitors to be used, the number of monitors with stains on 

the surfaces, and the pass number of monitors in one 

inspection. 

2.3.3. Statistical analysis 

The availability rate of all monitors in 2.3.1 was expressed 

as a percentage; the monitor management effect data in 2.3.2 

is count data, which was analyzed by Chi-square test, p<0.05 

indicates that the difference is statistically significant. 

3. Results 

3.1. Statistical results of the availability rate of 

the monitors in the hospital 

The availability rate of all monitors in the hospital before 

and after the implementation of FOCUS-PDCA quality 

improvement is shown in Table 1 below. It can be concluded 

that after the implementation of FOCUS-PDCA quality 

improvement measures, the availability rate of all monitors in 

the hospital was improved significantly, from 92.96% before 

implementation to 98.46% after implementation.  

Table 1. The availability rate of all monitors in the hospital before 
and after the implementation of FOCUS-PDCA quality 

improvement [n (%)] 

Group 
Total 

number 

Availability number 

of monitors 

Availability rate 

of monitors  

Before 1236 1149 92.96% 

After 1236 1217 98.46% 

3.2. Comparison results of management effects 

of the monitors to be used 

The comparison of the management effects of the monitors 

to be used before and after the implementation of the FOCUS-

PDCA quality improvement is shown in Table 2 below. It can 

be concluded that after the implementation of the FOCUS-

PDCA quality improvement measures, the ratio of uncharged 

monitors to be used, the ratio of monitors with stains on the 

surfaces decreased significantly (2=76.900, 2=174.432; 

P<0.05), and the pass rate of monitors in one inspection 

increased significantly (2=45.133; P<0.05). 

Table 2. The comparison of the management effects of the 
monitors to be used before and after the implementation of the 

FOCUS-PDCA quality improvement [n (%)] 

Group n 

Number of 

uncharged 

monitors to 

be used 

Number of 

monitors 

with  

stains on the 

surfaces 

Pass number 

of monitors in 

one inspection  

Before 300 92(30.67) 132(44.00) 246(82.00) 

After 300 11(3.67) 29(9.67) 295(98.33) 

2 - 76.900 174.432 45.133 

P - 0.000 0.000 0.000 

4. Discussion 

Monitors are the most commonly used medical devices in 

hospitals. The availability rate of all monitors in hospital can 

represent the overall operating status of the hospital. In recent 

years, with the development of medical technology, the 

hospital has more and more high-end and large medical 

devices. The hospital attaches great importance to the 

management and use of such devices, but ignores the use and 

management of small and medium-sized medical devices. As 

a result, small and medium-sized medical devices represented 

by monitors are heavily used, but lack of standardized 

management, resulting in high device failure rate and high 

medical accessories loss rate, affecting the operation 

efficiency of clinical departments, affecting the 

hospitalization experience of patients, and even causing 

adverse events related to medical devices. The effective 

maintenance and use management of monitors is an important 

part of medical equipment management [9]. 

FOCUS-PDCA is an effective management tool for quality 

improvement. In this study, FOCUS-PDCA was used to 

manage the monitors in the whole hospital. In this process, 

firstly, the problems in the use of monitors were summarized 

by finding problems, then the CQI group was established to 

organize and coordinate the implementation of the whole 

quality management process, and the existing equipment 

maintenance management process was sorted out to find out 

the weak management links where the problems occurred. 

Then, through brainstorming discussion, the root causes of 

monitor management and use problems were analyzed. 

According to the root causes found, the improved process 

plan was selected, and the schedule of each process was made. 

Furthermore, the improved process plan was promoted 

through PDCA cycle, and the rectification plan was proposed 

for the problems found in the current cycle inspection and it 

would be executed in the next cycle. By adopting the FOCUS-

PDCA quality improvement measures, the manufacturer's 

engineers trained the medical staff on the operation of 

monitors, the medical experts in the hospital explained the 

patient's vital signs parameters, and the emergency transport 



 

65 

experts outside the hospital trained the patient's transport 

process. On the other hand, medical staff managed and 

maintained the monitor according to the contents of the daily 

management list every day, and clinical medical engineers 

carried out preventive maintenance of monitors. The above 

improvement measures significantly improved the 

availability rate of all monitors in the hospital, from 92.96% 

before implementation to 98.46% after implementation. As 

the medical staff cleaned and disinfected the monitor every 

day, checked the charging status of the devices, and monitors 

obtained effective preventive maintenance, the ratio of 

uncharged monitors to be used, the ratio of monitors with 

stains on the surfaces decreased significantly (2=76.900, 

2=174.432; P<0.05), and the pass rate of monitors in one 

inspection increased significantly (2=45.133; 

P<0.05).FOCUS-PDCA effectively improved the availability 

rate and management effect of monitors. 

5. Conclusions 

In the maintenance and use management of monitors, the 

use of FOCUS-PDCA quality improvement can promote the 

daily maintenance and use management of monitors by 

medical staff, promote the preventive maintenance of 

monitors by clinical medical engineers. It can improve the 

availability rate of all monitors, and improve the management 

and use effect of monitors. FOCUS-PDCA has great value in 

the maintenance and use management of monitors in hospitals. 

Acknowledgements 

This work was supported by grants from Innovation 

Capability Support Plan of Shaanxi Province(2017KCT-36), 

Natural Science Special Project of Shaanxi Province(2020SF-

035), Social Development Project of Shaanxi Provincial Key 

Research and Development Program(2021SF-173). 

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