BACKLOG MAINTENANCE MODELLING


the reported high-risk backlog of £776 m and significant risk backlog of £1.5 bn are inaccurate and overestimated,16


.


A number of people have asked me if they could use the crude calibrated scales developed within this paper within their day-to-day activities, and/or to estimate overall backlog maintenance needs (either locally or nationally), or any medical/clinical topic. The simple answer is ‘no’.


The non-calibrated matrix Impact rating scores between minor (a cut finger with an Elastoplast) and major (amputation of a leg), are shown as a ratio of 1:2, while the HTM 00 (2014) matrix gives a 1:4 ratio. The crude calibrated rating score developed within this paper improves on these comparisons by presenting a 1:8 ratio, which in the real world is a clear nonsense, but it did serve the purpose to demonstrate the Fundamental Flaw within the national guidance. Therefore, no estimations or predictions must be made referencing the figures developed within this paper.


Computations shown


When I compiled the document on which this article is based, I had much discussion with others about including these crudely calibrated figures. Reluctantly, I agreed to present the evidence relating to the problems with the uncalibrated scales, by showing all of the computations, in the knowledge that some people would attempt to draw conclusions/make speculations using the 1:8 ratio, without truly understanding the consequences of their actions. Without making this information and example available it would have been very difficult to get the point across.


The numbered NHS 5x5 Risk Matrix design was introduced throughout the NHS some 15-20 years ago, from where and by whom I have never been able to discover. Since that time – to my knowledge at least – none of the over one million NHS staff, nor any university, insurance company, or consultancy firm connected with the NHS, has raised the issue of the Fundamental Flaw inherent within the matrix. So to blame any individual within the NHS for its use, particularly as it is National


Guidance/Policy, would be wrong in my opinion, as ‘How were they to know?’ On the assumption that they had no prior knowledge of the issues surrounding this matrix design, then I would be one of the first to stand up in their defence. However, I would just close by reiterating my earlier point – it is indefensible for an organisation (or person[s]) to ignore the failings within the current national policy when known, particularly when the ramifications and scale of these problems are so major.


Table 7: The numbered 5x5 risk matrix design recommended within HTM 00.


Probability Rating Certain


Likely


Possible Unlikely Rare


Effect


16 8 4 2 1


Rating


16 8 4 2 1


1


32 16 8 4 2


2


64 32 16 8 4


4


128 64 32 16 8


8


256 128 64 32 16


16 Insignificant Minor Moderate Major Catastrophic


References 1 NHS Estates. A risk based methodology for establishing and managing backlog. The Stationery Office, 2004, London.


2 Department of Health. HTM 00, Policies and principles of healthcare engineering, 2014.


3 Department of Defense. Risk Management Guide for DOD Acquisition, 5th edn. Defense Acquisition University Press, June 2003 [www.risk-services.com/ RMG20June2003.pdf].


4 Cox LAT. What’s wrong with risk matrices? Risk Analysis 2008; 28 (2): 497-512 [https://tinyurl.com/y4j3pz93].


5 IEC/ISO 31010, Edition 1.0, 2009, Risk management – Risk assessment techniques. ISO/TC 262 Risk Management, November 2009 [https://tinyurl.com/yxw962yv].


6 Tversky T, Kahneman, D. Judgement under Uncertainty: Heuristics and Biases. Science 1974; 185: 1124-31.


7 Conrow EH. Effective risk management. Reston, Virginia. American Institute of Aeronautics and Astronautics, 2000.


8 Hubbard D, Evans D. Problems with scoring methods and ordinal scales in risk management. IBM J Res & Dev, May 2010; 54 (3): Paper 2.


9 Wharrad H. To understand the four different levels of measurement in order to know how to classify data correctly


(Online). March 10, 2004 (Cited: July 14, 2010) [http://www.ucel.ac.uk/showroom/ levels_of_measurement/downloads/ levels_notes.pdf].


10 Meyer MA, Booker JM. Eliciting and Analyzing Expert Judgement. London: SIAM re-publication of Academic Press Ltd, 2001. ISBN 0-89871-474-5.


11 Keeney RL, Raiffa H. Decisions with multiple objectives – preferences and value trade-offs. Cambridge: Cambridge University Press, 1993. ISBN 0-521-43883-7.


12 Saaty TL. Decision making for leaders: The analytic hierarchy process for decisions in a complex world, New Edition 2001 (Analytic Hierarchy Process Series, Vol 2) Paperback – September 3, 2012 1st edn, RWS Publications, Pittsburgh.


13 Ayyub BM. Elicitation of Expert Opinions for Uncertainty and Risks, 1st edn, CRC Press, USA, June 2001.


14 Department of Health HTM 00, Policies and principles of healthcare engineering, 2014: p30, Figure 3 Evaluation matrix.


15 Department of Health HTM 00, Policies and principles of healthcare engineering, 2014: p30, para 5.45, Risk and/or priority maintenance.


16 NHS high-risk maintenance backlog increases by 70%. National Health Executive, 12 October 2016 (online). [https://tinyurl.com/y4aujht4].


Dr Melvyn Langford


Having progressed from his original role as assistant engineer at Middlesbrough General Hospital, ‘through the ranks’ (and numerous reorganisations) to estates and facilities manager positions within a number of Trusts, in 1997 Dr Langford moved into the NHS Estates consultancy division, undertaking research and providing managerial consultancy services relating to all aspects of day-to-day estates operational issues.


He explained: “The embryonic stage of the research employed ‘multi-criteria decision analysis’ techniques,


married with ‘utility theory’, to create a ‘robust, transparent Risk & Hazard Model methodology for use where quantitative data was either scarce or non-existent’, and where the analysis had to rely mainly on qualitative information derived from proven expert elicitation techniques.”


Having left the NHS in 2007, Dr Langford formed his own consultancy, Healthcare Operational Risk, specialising in hazard and risk management, which he ran until he retired in 2017.


hej May 2019 Health Estate Journal 45


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