A performance management framework for healthcare facilities management

A practical framework for performance measurement of facilities management services in developing countries’ public hospitals

Purpose

Facilities management (FM) plays a vital role toward creating the hospitable environment that supports the core clinical business of rendering quality health care. To ensure optimal performance of FM, public hospitals require a performance measurement (PM) framework that could guide and assist facilities managers in their operations. This paper aims to respond to this need by developing a performance measurement framework useful to improve FM performance within the context of developing countries hospital FM services delivery.

Design/methodology/approach

The paper synthesizes knowledge from a comprehensive review of FM performance measurement literature and the results of an earlier PhD research on FM performance measurement in Ghana’s public hospitals.

Findings

The paper presents a simplified performance measurement framework which demonstrates four key performance measurement tasks: establishing performance goals; measuring the FM service delivery; evaluating FM outcomes; and performance review and reporting. The study suggests the establishment of a central coordination point to enhance performance measurement activities of public hospitals’ FM practices.

Research limitations/implications

Although reference is made to research on key performance indicators (KPIs), future study is recommended to develop appropriate methodology for selecting relevant KPIs. The author also intends to pilot the framework to a health facility in Ghana to leverage its usefulness, given the fact that it has not been tested empirically.

Practical implications

The application of the framework is expected to lead to the identification of performance gaps and weakness which when acted upon could lead to operational effectiveness and efficiency of the FM process, ultimately leading to improved FM performance.

Originality/value

The paper develops a novel performance measurement framework useful within the context of the nascent FM industry in the developing world.

A performance measurement model for the housekeeping services in healthcare facilities

Purpose

The purpose of this study is to develop a customised model to measure the performance of housekeeping (HK) services in Sri Lankan health-care facilities.

Design/methodology/approach

An exploratory sequential mixed approach was adopted in the study to collect and analyse data. A case study strategy was adopted in the initial phase to explore the current HK practices, and to determine the applicable key performance indicators (KPIs) found through literature. Semi-structured interviews were used as the data collection method in the selected case studies. A questionnaire survey was conducted in the next phase to verify the validity of case study findings. Quantitative data were analysed using descriptive statistics. One sample t-test was used to identify significant KPIs and to formulate the customised performance measurement (PM) model.

Findings

The study identified and ranked 46 KPIs, which can be used to measure the performance of HK divisions of health-care facilities, in balanced scorecard perspectives. The findings also revealed that the KPIs determined using the model have a significant impact on implementing effective health-care HK services and could be used to measure both real and subjective cleanliness.

Practical implications

The developed model can be used for numerous PM requirements in health-care setups in both developing and developed countries. The KPIs determined using this model can be presented in quality audits and government inspections as proof of effective HK management. The HK managers of the health-care sector can effectively monitor the performance of their divisions using the proposed PM model and this model can be customised to match the other facilities management service divisions.

Originality/value

Many studies focus on overall health-care PM. This study expands the knowledge on HK PM in the health-care sector by presenting a collection of performance indicators centred on HK function.

Performance assessment of the built environment in healthcare facilities

Purpose

This study presents findings of post-occupancy evaluation (POE), through a performance assessment, on a polyclinic, as a health-care facility, in Saudi Arabia.

Design/methodology/approach

Review of the literature is conducted to identify the recent publications, on conducting POE, and performance indicators (PIs) assessing performance of health-care facilities. This research uses a triangulated approach by adopting several qualitative and quantitative methods, on a case study. The approach comprised conducting investigative walkthrough to assess the case study facility, interviews with group of occupants to assess its satisfaction levels. The findings were presented to a focus group, where a plan of recommendations was raised to improve the performance of the case study facility.

Findings

A total of 24 PIs were identified, and clustered, mainly under: “Thermal comfort”, “Natural lighting”, “Artificial lighting” and others. The case study has proven a satisfactory performance to the evaluated indicators. However, observations of performance snags were identified that formulated conclusions, related to: “Improvements to air temperature performance in summer season”, “Need of control on natural lighting due to glare”, “Accommodating an over demand for car parking spaces”, Need for development of systems dedicated for collection of occupants satisfaction” and “Enhancing circulation”.

Originality/value

There is a gap identified, through the literature review on availability of systematic conduct of POE, especially in health-care facilities. This paper contributes to the body of knowledge and professional practice, as a guiding systematic scheme, for the conduct of POE, which can be followed and expanded upon by future research.

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.

Expert-based approach to rank critical asset assessment factors for healthcare facilities

Purpose

This research’s main objective is to develop an expert-based approach to rank critical asset assessment factors for health-care facilities. This approach will improve the asset management of health-care buildings. This paper aims to study and prioritize the relative importance of asset criticality factors.

Design/methodology/approach

The research methodology begins with a comprehensive literature review of state-of-the-art health-care facilities management, asset management tools, critical asset assessment and approaches to model techniques. Then, using the expert-based opinion and the collected data through the analytical hierarchy process approach to developing the asset assessment model contains physical, environmental, general safety and revenue loss assessment models.

Findings

Results showed that the general safety factors and the sub-factors of life safety and physical safety contributed to asset condition assessment.

Practical implications

The proposed critical asset assessment ranking will benefit health-care facility organizations by assessing their asset performance according to capital renewal needs.

Originality/value

This study offers a novel conceptual framework to understand and determine rank critical asset assessment factors for health-care facilities.

Identification, classification and shortlisting of performance indicators for hospital facilities management

Purpose

This paper aims to report on a study that aims to establish a list of systematically classified key performance indicators (KPIs) that are useful for hospital facilities management (FM).

Design/methodology/approach

A review of literature was conducted to identify indicators that are applicable to hospital FM. Each indicator was classified using a phase–hierarchy (P-H) model, which is a two-dimensional matrix comprising three phases (input, process and output) of facilities services delivery and three hierarchical FM levels (operational, tactical and strategic). The classified indicators were further shortlisted via a focus group study.

Findings

From the literature review, 61 indicators were identified as applicable to hospital FM. Most of the indicators, according to the P-H model, are for evaluating the FM input or output phase, at the strategic or tactical level. Further refinement and shortlisting of the indicators by the focus group experts resulted in 18 KPIs, which fall into 4 aspects: “physical”, “safety”, “environmental” and “financial”.

Research limitations/implications

The study illustrates that the P-H model is useful for classifying the performance indicators systematically along the two fundamental FM dimensions – phase and hierarchy. Further research may use this model to classify performance indicators in other contexts.

Practical implications

The method of this study can be adapted for use in identifying, classifying and shortlisting FM performance indicators for other types of buildings. The shortlisted KPIs can be used for assessing the FM performance of hospitals.

Originality/value

To the best of the authors’ knowledge, this study is the first of its kind that used the P-H model to classify hospital FM performance indicators.

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.

Healthcare facilities maintenance management: a literature review

Purpose

The complexity and criticality of healthcare services highlight the importance of maintenance management function in healthcare facilities. The purpose of this paper is to review the literature on maintenance management of healthcare facilities and hospital buildings to provide an organized literature review and identify gaps from the perspective of research and practice.

Design/methodology/approach

The paper categorizes the literature and adopts a review hierarchy according to maintenance management functions in hospital buildings. It explores the impact of those functions on the performance of maintenance activities in hospitals. Furthermore, it examines the role of information technology and automated decision support systems in facilitating hospital maintenance management functions and performance.

Findings

Literature on maintenance management in healthcare facilities and hospital buildings has so far been very limited. Recently published literature focusing on healthcare facilities management and its maintenance management functions is classified into various areas and sub-areas. The paper highlights gaps in the literature and suggests avenues for future research and improvements.

Originality/value

The paper contains a comprehensive listing of publications and their classifications according to various attributes. It will be useful for researchers, maintenance managers, practitioners and stakeholders concerned with facility management of hospital buildings.

Public-private partnership in university female students’ hostel delivery

Purpose

Although studies on student residential satisfaction abound, yet there are limited studies conducted on students’ satisfaction in respect of hostel accommodation facilities undertaken through public-private partnerships (PPPs) in Nigeria. The purpose of this study is to assess the level of students’ satisfaction with the provision of university hostel accommodation facility using build-operate-transfer (BOT) model at University of Lagos (Unilag), Nigeria.

Design/methodology/approach

The study adopted literature review and questionnaire survey within the case study of a BOT hostel accommodation facility at Unilag in Nigeria. The students who reside at the case study were the respondents. Hence, 153 self-administered questionnaires were purposively distributed face-to-face to the entire student population that live in the BOT hostel. Thus, a total of 96 completed questionnaires representing 63 per cent were collected and found suitable for the analysis. The data collected were analysed using the mean score and chi-square (χ2) test.

Findings

The study revealed a total mean satisfaction level of 3.46 (on a 5-point Likert scale), which indicates that students are “somehow satisfied” with the university hostel accommodation facility undertaken through BOT. The study further established that age and level of students have no significant influence on the overall students’ satisfaction with their hostel accommodation facility undertaken through BOT.

Practical implications

The study would provide valuable feedback to private investors, university authorities and facility managers of higher education institutions to improve their services in the near future.

Originality/value

The identified variables that have tested to be significant in assessing students’ level of satisfaction in BOT hostel accommodation facilities could be used to assess users’ satisfaction in similar facilities delivered through PPPs in other countries.

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.

Significant factors influencing outsourcing decision for facilities management (FM) services

Purpose

– The purpose of this paper is to investigate and conceptualise significant factors influencing decision to outsource facilities management (FM) services in Nigeria’s public hospitals.

Design/methodology/approach

– Data for this study were collected using a cross-sectional questionnaire survey. A total of 85 responses were received from the six states comprising the study area while 11 of them were discarded due to missing data resulting in 74 usable responses. This gave an overall response rate of 61 per cent. Data collected were analysed using descriptive and inferential statistics as well as principal component analysis.

Findings

– Findings revealed that 25 of the 31 factors were significant in explaining the decision to outsource FM service in Nigeria’s public hospitals; while 15 of them grouped into six broad categories were selected based on their factor loadings during further analysis. Besides, it was also established from the study that “to improve performance standard”, “to improve quality of services” and “to improve timely delivery of services” are the top three rated factors.

Research limitations/implications

– The study complements the body of knowledge on “make or buy” decision theory by provided empirical insight into key attributes of outsourcing decision motives for FM services from the point of view of Nigeria’s public sector spectrum that can serve as benchmark for deciding on whether to outsource or not.

Practical implications

– The study also has practical implications. More is now known as a result of this research about what factors constitute drivers for outsourcing FM services within the context of Nigeria’s public hospitals. With an aggregate opinion from 74 public hospitals, the study provides hospital administrators and public managers with a list of prioritised factors for making rational informed decision about outsourcing of services in the hospitals.

Originality/value

– The study complements the body of knowledge on “make or buy” decision theory by providing empirical insight into key attributes of outsourcing decision motives for FM services from the point of view of Nigeria’s public healthcare.

Outsourcing of facilities management (FM) services in public hospitals

Purpose

– The purpose of this paper is to extend the body of knowledge on health care facilities management (FM) by investigating the extent to which public hospitals in Nigeria have fared in terms of outsourced FM services.

Design/methodology/approach

– The paper relied on two strands of methodology common with pragmatic research. Questionnaire survey (QS) used data from 74 respondents representing 74 hospitals, while 3 of the 74 hospitals involved in the QS were selected based on their willingness to enter the case study interview. Data collected were analysed using descriptive statistics (QS) and using narrative techniques by discussing themes, sub-themes and interconnecting themes through a chronology of events, as in grounded theory.

Findings

– Findings revealed that most public hospitals do not have a policy framework for outsourcing in general and FM services in particular, giving room for duplication of functions and non-establishment of functional FM units to handle FM activities, while six FM services are outsourced in all the hospitals. Cleaning, security and catering services received the highest satisfaction ratings, while plant maintenance services, however, received the least satisfaction rating.

Originality/value

– The paper provides the first ever survey based on empirical evidence about the state of FM services outsourced in Nigeria’s public hospitals. The survey suggests a relatively low level of usage of outsourcing for its services, as only a handful of FM services are outsourced in most of the hospitals.

Using end‐user surveys to enhance facilities design and management

Purpose

This study aims to focus on the use of a survey questionnaire to inform a sustainable lighting design modification of an existing university library on the campus of a large land‐grant university in the Mid‐Western USA and also aims to suggest that a similar methodology may be useful in other facilities' design applications.

Design/methodology/approach

A 40‐item questionnaire was developed, which sought to evaluate the effect of the existing lighting design on end‐users' perceptions and opinions at the university library and to gather general opinions regarding sustainability from library end‐users. The self‐administered survey asked respondents how much they agreed or disagreed (on a five‐point, Likert‐type scale) with a set of statements about sustainability, their use of the library, and their understanding of and reaction to its existing illumination.

Findings

A total of 183 respondents completed and returned questionnaires, the majority of whom indicated that they were undergraduate students enrolled at the university. The survey results indicate that the respondents were aware of sustainability and sustainable lighting; that they were dissatisfied with the library's existing lighting; and that they suggested that these issues be addressed by the university to reduce the library's environmental footprint.

Research limitations/implications

The study fills a gap in the literature since it documents the application of citizen participation theory to solicit input from stakeholders in an institutional setting to influence facility design. However, the research is limited by the fact that the sample comprised mostly of female undergraduate students.

Originality/value

End‐users influenced the design development of a university library's lighting renovation. This renovation is ultimately anticipated to lower the energy consumed to illuminate the facility, to increase the end‐users' perceptions of the facility's sustainability, to meet new university guidelines, and to reduce the facility's environmental impact. There are potential applications for the procedures described herein for other facilities in the integration of stakeholders in renovation projects.