Integrated healthcare facilities maintenance management model: case studies

The effects of lamp types and surface reflectance combinations on the subjective perception of a simulated lit hospital ward environment

Purpose

Good illumination creates an aesthetic environment that may positively influence patients’ well-being and provide comfort to the hospital staff. This study aims to focus on exploring the energy efficiency of lighting and subjective perception of the lit environment in a hospital ward to assess quality indicators of ambient lighting conditions.

Design/methodology/approach

The existing conventional tubular fluorescent lamp–based lighting system in the surveyed patients’ ward was retrofitted with light-emitting diode (LED) luminaires to explore illumination and energy parameters. Thereafter, a software lighting model was created, simulated and analyzed. A Web-based survey with five bipolar adjective pairs in a semantic differential scale was conducted with 48 participants to record and analyze their subjective responses pertaining to the variations in lamp types and surface reflectance combinations.

Findings

The findings imply that the LED tubular lamp–based illumination was deemed more adequate compared to other lamp types and the effects of variations in room surface reflectance combinations on the participants’ responses were statistically significant at α = 0.05 level. The simulated horizontal work plane average illuminance level varied from 131 to 171 lx, mean room surface exitance (MRSE) levels remained between 30 and 90 lm/m2 and overall uniformity of illuminance remained between 0.5 and 0.7.

Originality/value

In a hospital ward illuminated by LED tubular lamps, variations in room surface reflectance combinations for a constant luminous flux package output from the lamps may affect the subjective perception of users and the correlation between horizontal work plane average illuminance and MRSE is found to be highly linear (coefficient of determination > 0.97).

Analytic evaluation of facilities performance from the user perspective: case study on a badminton hall

Purpose

The purpose of this study is to identify key performance indicators (KPIs) for badminton halls and, through a case study, illustrate how the facilities performance of a university badminton hall can be evaluated from the user perspective.

Design/methodology/approach

After a desktop literature review, the findings were discussed by a focus group, and the discussion result formed the basis for establishing an analytic hierarchy of facilities performance for the badminton hall. Then, interviews were made with 169 badminton hall users to solicit their perceived facilities’ importance and performance levels of the hall. Using MATLAB, a computer program incorporated with an Analytic Hierarchy Process was devised to compute the importance weights of the performance attributes under assessment. The outcomes were interpreted using an importance-performance evaluation matrix.

Findings

A facilities performance hierarchy, comprising nine KPIs, was established for the badminton hall. The factors influencing the users’ perceptions, the importance and performance levels of the KPIs and the areas of the hall requiring improvements were identified.

Research limitations/implications

Future studies can take a similar approach of this study to develop KPIs and facilities performance hierarchies for other types of sports venues.

Practical implications

The method used to identify the improvements required for the badminton hall can be applied to investigations on other sports facilities.

Originality/value

The methodology of this research was first applied to study a badminton hall – as reported in this paper.

FM and clinical employees' involvement in the design of eight Norwegian hospital projects

Purpose

This paper aims to gain insight in how the involvement of facilities management (FM) and clinical employees are practiced in new Norwegian hospital projects and to study the benefits and lessons learned from the involvement.

Design/methodology/approach

This study is conducted by cross-sectional case studies of eight hospital projects by using a literature review, interviews and document studies of FM and clinical employees and project leaders (PLs) among Sykehusbygg.

Findings

The service design approach with a structured interaction between the PL’s of Sykehusbygg, and the different disciplines of clinical employees and FM specialist was rewarding and efficient. The facilitator role of Sykehusbygg is essential to manage such a broad and complex involvement process using a wide range of various techniques at the different stages of the projects (dialogue meetings, review meetings, workshops, post-it notes, 2-D drawings, mock-up and 3-D models, as well as virtual reality (VR) and Building Information Modeling technology). The clinical employees’ framework is stronger and much more structured than the involvement of FM competences through the different stages of the projects. The property management competences were involved at the early concept phase and design phase, whereas the Operation and Maintenance (O&M) competences were getting involved through the construction and commissioning phase. The value of FM involvement in all stages of the project is seen beneficial, particularly when the FM specialist become a part of the design team and located physically at the same place. The main reported benefits of early FM involvement are cost-effective technical solutions and installations, less design flaws and improved functionality, as well as a stronger ownership and mutual respect between the clinical and FM disciplines. However, not all hospital organizations see the benefits of the FM involvement of all stages, as they are driven by reducing capital cost. In one of the new projects, other ways of involving the FM competences were tested. Additionally, particularly for the O&M competences, a dialogue meeting with a clear focus of sharing experiences with different technical solution was found rewarding in terms of cost benefits.

Research limitations/implications

This study does not consider the social impact of the choices made in the design phase. The findings also indicated a certain development of the FM involvement. This is not studied in two of the newest projects where they are still in the design phase and the FM role was not interviewed.

Practical implications

The PL role is important as a facilitator role of the involvement process.

Social implications

A dialogue meeting with a group of O&M people was found rewarding and valuable for knowledge sharing. This methodology can be further developed and tested, as this group of stakeholders is not always available for giving input in the project.

Originality/value

The value of this study is the description of the interaction between the PLs and the hospital organization in the eight projects and lessons learned by the involvement of FM competences and clinical employees.

A Hybrid Genetic Algorithm-Based Fuzzy Markovian Model for the Deterioration Modeling of Healthcare Facilities

Healthcare facilities are constantly deteriorating due to tight budgets allocated to the upkeep of building assets. This entails the need for improved deterioration modeling of such buildings in order to enforce a predictive maintenance approach that decreases the unexpected occurrence of failures and the corresponding downtime elapsed to repair or replace the faulty asset components. Currently, hospitals utilize subjective deterioration prediction methodologies that mostly rely on age as the sole indicator of degradation to forecast the useful lives of the building components. Thus, this paper aims at formulating a more efficient stochastic deterioration prediction model that integrates the latest observed condition into the forecasting procedure to overcome the subjectivity and uncertainties associated with the currently employed methods. This is achieved by means of developing a hybrid genetic algorithm-based fuzzy Markovian model that simulates the deterioration process given the scarcity of available data demonstrating the condition assessment and evaluation for such critical facilities. A nonhomogeneous transition probability matrix (TPM) based on fuzzy membership functions representing the condition, age and relative deterioration rate of the hospital systems is utilized to address the inherited uncertainties. The TPM is further calibrated by means of a genetic algorithm to circumvent the drawbacks of the expert-based models. A sensitivity analysis was carried out to analyze the possible changes in the output resulting from predefined modifications to the input parameters in order to ensure the robustness of the model. The performance of the deterioration prediction model developed is then validated through a comparison with a state-of-art stochastic model in contrast to real hospital datasets, and the results obtained from the developed model significantly outperformed the long-established Weibull distribution-based deterioration prediction methodology with mean absolute errors of 1.405 and 9.852, respectively. Therefore, the developed model is expected to assist decision-makers in creating more efficient maintenance programs as well as more data-driven capital renewal plans.

A review of facilities management performance measurement

Purpose

The purpose of this paper is to present a comprehensive review of facilities management (FM) performance measurement (PM) research within the past two decades to understand existing gaps in FM PM literature.

Design/methodology/approach

The paper employs a systematic approach to review papers in FM PM published from 1997 to 2017. The articles published in selected peer-reviewed international journals in the last 20 years were collected by conducting literature search in the Web of Science and Scopus databases. The content of the papers were scrutinized to understand the gap in literature.

Findings

The review depicts a slow pace of FM PM research characterized by diverse and fragmented performance measures, whereas the existing PM frameworks are at the nascent stage.

Research limitations/implications

The judgments of the paper are based on the 54 papers selected for the critical review and analysis that should be treated as key issues in FM PM research agenda. The review also excludes energy management.

Originality/value

The paper identifies the gaps in the current PM literature in FM and set propositions for future research which is of utility and relevance to FM researchers more especially on the existing conceptual frameworks. To the best of the authors’ knowledge, this paper is the first attempt to conduct a review on FM PM in the extant literature.

The history of healthcare facilities management services: a UK perspective on infection control

Purpose

The history of the development of non-clinical services in infection control (IC) dates back to the pre-modern era. There is evidence of health-care facility management (HFM) services in Roman military hospitals. With the fall of the Roman Empire, Christian beliefs and teaching shaped the development of HFM in monastic hospitals. It was not until the late Victorian era that the link between HFM services and diseases caused by “miasma”, or bad air, became established. The discovery of bacteria in the modern scientific era reduced the level of importance previously attached to non-clinical causes of infections. Today, in the NHS, HFM services continue to be treated as though they had no real role to play in IC. This paper aims to collate historical and epidemiological evidence to show the link between HFM and IC.

Design/methodology/approach

The evidence gathered in this research paper is primarily based on an in-depth review of research from a wide range of sources. A “within-study literature analysis” was conducted to synthesise the research materials. This involved the application of “between-source triangulation” to verify the quality of the information contained in the studies, and “between-source complementarity” to provide an in-depth elaboration of the historical facts.

Findings

Historical and epidemiological evidence shows that HFM services such as cleaning, waste management, catering, laundry and maintenance continue to play a crucial role in IC. This is corroborated by evidence gathered from the work of renowned pioneers in the field of IC. However, reforms in the NHS have failed to consider this, as HFM services have been largely fragmented through different partnership arrangements.

Practical implications

Among many other things, this research raises the profile of HFM staff in relation to the issue of IC in hospitals. It presents convincing evidence to show that the relationship between the clinical and non-clinical domains in controlling infections in hospitals has a long history. The findings of this research give HFM staff invaluable information about the significant role of their profession in the control of infections in hospitals.

Originality/value

This is one of the few studies examining the historical development of HFM services, as well as their contribution to IC. Other work in this area has mainly been framed from a clinical health-care perspective.

Simulation of home-hospital impacts on crowding – FM implications

Purpose

This study aims to evaluate home-hospital implications for facility management (FM) and, in particular, ED crowding. Home-hospital programs, in which select patients receive hospital-level care at home, can extend hospital facility capacity. Emergency department (ED) crowding, a sensitive hospital capacity indicator, is associated with unsafe operations and reduced quality of care.

Design/methodology/approach

The impact of a home-hospital program on crowding was analyzed with a discrete-event simulation model using one month of historical data from a case hospital. Time ED patients waited for inpatient beds was the primary endpoint. Five scenarios with different levels of patient suitability for home-hospital were each run 30 times. Differences were evaluated using paired t-tests.

Findings

Implementing home-hospital reduced ED crowding by up to 3 per cent. Additionally, the simulation yielded insights regarding advantages and limitations of various home-hospital arrangements, suggested which hospital types may be the best candidates for home-hospital and highlighted the role of bed-cleaning turnaround times and environmental services staffing schedules in operations.

Research limitations/implications

This research examined home-hospital and crowding at one hospital. Developing a model that accounts for all hospital types requires significant data and many hospital partnerships but could allow for more informed decisions regarding implementation of such programs.

Social implications

This research has implications for ensuring access to ED care, an important source of acute care generally and particularly for the underserved.

Originality/value

This research systematically evaluates home-hospital’s impact on ED crowding. Simulation modeling resulted in analytical results and allowed for evaluation of what-if scenarios providing recommendations for hospital FMs on their role in decreasing ED boarding.

Connectivity, cost-efficiency, community and collaboration

Purpose

This paper aims to increase understanding on how co-locating in a multi-firm campus setting could be of value to healthcare organizations.

Design/methodology/approach

The paper presents a qualitative case study of two health campuses in Finland. The data comprises interviews with different organizations operating on the campuses, complemented by onsite observations, and analysis of archival data.

Findings

Based on the empirical analysis, the value of co-locating as perceived by the organizations operating on campus is grouped into four categories: connectivity, cost-efficiency, community and collaboration (or the “four Cs”).

Research limitations/implications

The study does not aim at statistical genaralizability but rather seeks to draw analytical generalizations based on identified empirical regularities. The developed value framework, the four Cs, contributes to current scholarly knowledge on location strategies.

Practical implications

Furthermore, the managerial implications of the four Cs entail a new twofold role for property management: the traditional facilitator role, which is suitable for delivering the two tangible values of connectivity and cost-efficiency, and the modern era integrator, a community builder that is able to deliver community and collaboration.

Originality/value

Previous literature on healthcare facilities has focused on the technical performance of the buildings, while previous literature on the collaborative value of co-location has studied mainly single-firm corporate campuses. This study uniquely explores the potential value of health campuses, where different private, public and third sector organizations co-locate.

Optimal maintenance scheduling for local public purpose buildings

Purpose

– The purpose of this paper is to set up and analyze a formal model for maintenance scheduling for local government purpose buildings.

Design/methodology/approach

– The authors formulate the maintenance scheduling decision as a dynamic optimization problem, subject to an accelerating decay. This approach offers a formal, yet intuitive, weighting of an important trade-off when deciding a maintenance schedule.

Findings

– The optimal maintenance schedule reflects a trade-off between the interest rate and the rate at which the decay accelerates. The prior reflects the alternative cost, since the money spent on maintenance could be saved and earn interests, while the latter reflects the cost of postponing maintenance. Importantly, it turns out that it is sub-optimal to have a cyclical maintenance schedule where the building is allowed to decay and then be intensively maintained before decaying again. Rather, local governments should focus the maintenance either early in the building’s life-span and eventually let it decay toward replacement/abandonment or first let it decay to a target level and then keep it there until replacement/abandonment. Which of the two is optimal depends on the trade-off between the alternative cost and the cost of postponing maintenance.

Originality/value

– The paper provides a first formal inquiry into important trade-offs that are important for maintenance scheduling of local public purpose buildings.

Can game theory explain poor maintenance of regional government facilities?

Purpose

– The purpose of the paper is to analyze the decision to postpone maintenance expenditures in regional governments using a game-theoretical approach and investigate whether there may be rational reasons for regional governments to carry a maintenance backlog.

Design/methodology/approach

– A theoretical political economy model, originally used to explain fiscal deficits in regional governments, is revisited and used to explain maintenance backlogs.

Findings

– It can be fully rational for regional governments to carry maintenance backlogs, given that they expect the central government to “bail out” this backlog, e.g. through an extra grant earmarked for upgrading of facilities. Hence, a balanced budget regulation (BBR) demanding fiscal balance in regional governments is not sufficient to avoid bailouts. The results suggest that the central government should consider including maintenance of facilities in formal BBRs.

Originality/value

– The paper is relevant for policy makers, as it can give guidance with respect to the design of BBRs. The paper illustrates that regulations that only take fiscal balance into account are too narrow to secure that bailouts are avoided. The reason is that regional governments can strategically use maintenance backlogs to generate bailouts even when regional government borrowing is abolished. To avoid this, the central government could make the regulations more extensive, and also include demands regarding maintenance in the regulations.