Development of metrics and an external benchmarking program for healthcare facilities

Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey

OBJECTIVE

The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized.

BACKGROUND

Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction.

METHODS

A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA.

RESULTS

The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important.

CONCLUSIONS

Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

Port productivity: benchmarking analysis of strategic ports

Purpose

The productivity of a port is a measure that is important to different stakeholders: port administrators (port authority), third-party logistics providers, manufacturers and consumers, among others. This study analyses productivity in terms of vessel movement efficiencies (loading/unloading of cargo) and container release from port facilities. Both factors add to the overall productivity in any port.

Design/methodology/approach

A comparative analysis of the productivity of three ports is measured using a Quality Function Deployment (QFD) and benchmarking analysis to help establish strategies that will help improve productivity. Considering the information confidentially the authors will call the ports according to their geographic location. The ports under study are the USA Southeast Port (Port of America), Central Asian Port (Port of Asia) and Central Europe Port (Port of Europe).

Findings

This study has established an analysis strategy that allows seeing points of sale in the ports. This study will compare three different continents, only to demonstrate the applicability of QFD and benchmarking. Still, the strategy can be used in ports that compete due to their proximity and location. Identifying the variables to be analyzed made it possible to establish a strategy to increase productivity.

Originality/value

There are many studies that analyze port productivity, but none try to standardize the variables to be compared in different scenarios. This study has compared three ports from three different geographical areas, using the same variables in all three cases. The study critically analyses the performance of three ports and proposes a strategy based on QFD and benchmarking research.

Maintenance of public hospital buildings in Nigeria – an assessment of current practices and policy options

Purpose

The recent COVID-19 pandemic has exposed the declining conditions of many of the hospital buildings, especially in developing countries. Past studies have shown inadequate maintenance practices but how far regarding Nigerian public hospital buildings is yet to receive empirical research. This paper aims to investigate the underlying issues leading to inadequate maintenance practices and proffers policy options to improve Nigerian public hospital buildings via an unexplored dimension.

Design/methodology/approach

The study used a mixed research design method involving both qualitative and quantitative data. First, results from the qualitative phase were analysed and verified at the quantitative phase through a well-structured questionnaire, developed from the qualitative findings across hospital maintenance experts (work/maintenance department, health-care provider, design team and health-care building/service contractor) in Abuja, Lagos and Benin City.

Findings

Insufficient funds for maintenance works, absence of planned maintenance programmes, inadequately trained personnel, etc., emerged as the maintenance inadequacies in the public hospital buildings across the cities covered. The paper categorised the cause of inadequate maintenance practices of public hospital buildings into six groups: statutory requirements, design stage, construction stage, budget for maintenance task, managing maintenance unit activities and user’s perception regarding maintenance management.

Research limitations/implications

This paper is limited to maintenance practices of Nigerian public hospital buildings. Future research is needed to evaluate factors that will enhance outsourcing maintenance and the use of the 4th industrial revolution (building information modelling for refurbishment and building automation systems) amongst others in maintenance practices of public hospital buildings.

Practical implications

As part of the practical implication, the government and hospital administrators should make provision for adequate funding and accountability of annual maintenance budgetary allocation. Also, the government should establish a national maintenance policy for public infrastructure with an emphasis on preventive maintenance and contractor’s reputation, outstanding pedigree, technical and financial soundness during build maintenance contract award, etc., were recommended.

Originality/value

This paper reveals that the stakeholders, especially hospital administrators, policymakers and political office holders that are concern with maintenance budget, approval and disbursement concerning maintenance practices in public hospital buildings need to reawaken to her responsibility because of the inadequate implementation across the cities covered.

Maintenance practices in Nigeria’s public health-care buildings: a systematic review of issues and feasible solutions

Purpose

Health-care building maintenance has been receiving concern because of the recent global pandemic. However, there are inadequate broad studies affecting health-care facilities maintenance and feasible solutions in Nigeria. This study aims to conduct an all-inclusive review of public hospital building maintenance issues and proffer possible solutions to improve maintenance practices in health-care buildings via a framework that will support studies in the future.

Design/methodology/approach

A review of published papers from 2006 to 2020 was conducted. Based on the keywords, 3 pertinent databases were searched and descriptions of the findings from 40 studies were recognised and used in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Findings

Two main themes (issues and feasible solutions to improve practices) emerged from public health-care building maintenance practices. The study developed a framework that describes the relationship between issues and possible solutions with an emphasis on how to improve human development, management efficiency, technical competence and professional skills, cost-minimisation and others.

Practical implications

As part of the paper implications, emerged issues were group into five categories (human development, management, technical, limited financial resources and others). The proposed framework for future studies will attempt to mitigate issues and proffer feasible solutions to improve hospital building maintenance practices in Nigeria and other developing countries that are facing similar challenges.

Originality/value

To the best of the author’s knowledge, this paper is possibly the first comprehensive review of public health-care building maintenance practices in Nigeria. Moreover, this review demonstrates how the proposed feasible solutions can mitigate problems.

Renovation in hospitals: a case study on the use of control cubes for local repairs in health-care facilities

Purpose

The purpose of this study is to evaluate the effectiveness of the control cubes for dust control in health-care facilities. Research shows that more than 80% of pathogenic agents in hospitals are spread into the air, where they either remain airborne or deposit on the surface. At the same time, renovation and repair activities, including regular maintenance, are a necessity in active health-care facilities and a multitude of studies have documented their impact on indoor air quality. The dust that is generated by construction activities may potentially carry pathogenic agents, varying from coarse particles (≤10 µm, PM10) to fine particles (≤2.5 µm, PM2.5), including airborne bacteria, and fungal spores linked to high patient mortality in immune-compromised patients.

Design/methodology/approach

This study measures the impact and effectiveness of one such preventative measure, namely, the control cube (CC), on air quality during renovation and repair. CC is a temporary structure, typically made from stainless steel, around the local repair zone to minimize the spread of dust and potential microorganisms. The current paper presents a comparative analysis to identify the effectiveness of a CC equipped with the high-efficiency particulate filtration (HEPA) filter in a hospital setting by simulating construction renovation and repair work.

Findings

A baseline was established to measure the effectiveness of CCs and the impact of negative pressure on the indoor air quality in a hospital during simulated renovation work. Results showed that CCs are very effective in minimizing the spread of dust due to construction activities in the hospital. However, it is imperative to ensure that the air inside the CC is cleaned via filtration.

Originality/value

CCs are very effective, and this paper investigates the best approach for facility managers to implement this strategy.