Environmental cleaning in UK healthcare since the NHS Plan

Pitfall benchmarking of cleaning costs in hospitals

Purpose

It is typical of public real estate benchmarking reports to show only highly aggregated benchmarks based on buildings’ floor areas. They hardly provide disaggregated benchmarks for usage clusters. The aim of this study is to show the caveats from highly aggregated benchmarking without consideration of cluster-specific characteristics.

Design/methodology/approach

Based on the parameters of the German facility management association 812 standards, cleaning costs and costs for the surfaces of seven hospitals have been collected and allocated to specific room clusters. Using these basic data, a calculation and simulation conducted with the aim of simulating facilities that are comparable in the sum of costs yet feature varying sub-clusters as cost drivers. In particular, during this simulation, area ratios were varied randomly and the average cleaning costs per cluster were held constant for all hospitals. Therefore, the costs per square meter in the clusters of all simulated hospitals are identical and the full costs only depend on the area ratios.

Findings

The simulation shows that highly aggregated cleaning costs lead to large spans, and thus, to misinterpretations in the field of action. In the case, the aggregate benchmark ranges from 40.6 to 66.5 EUR/m², although, for all hospitals the same costs per square meter had been used. Thus, the bias results only from varying the share of area across the clusters. This finding is caused by a well-known statistical problem: the Simpson’s paradoxon, which currently receives little attention in real estate benchmarking.

Practical implications

The results show, that the regular benchmarking with high aggregated data, often used in practice, cannot be recommended. The author consider using a detailed benchmarking as meaningful and purposeful. To be able to make a detailed benchmarking, it is essential to identify and collect the influencing factors. Only if all important factors, in this case, the clusters will be regarded in the benchmarking, a reasonable benchmarking and useful interpretation can be given. Using a simple benchmarking to get a rough overview is refused steadfastly.

Originality/value

The study highlights that a comparison with public benchmarking reports (operation costs) must be taken with great caution. The author has quantified the bias from the aggregated benchmarking and have shown, that the Simpson’s paradox fully explains the consequences.

Being a cleaner in The Netherlands: coping with the dirty work stigma

Purpose

This study aims to explore what it is like to be a cleaner in the Netherlands. Drawing on the dirty work theory, it answers the question of how cleaners in the Netherlands cope with the dirty work stigma.

Design/methodology/approach

This study used a qualitative approach: 24 cleaners were interviewed and the researcher participated in a three-month cleaning course. By doing so, an insiders’ perspective was taken. Drawing upon the dirty work theory, a thematic analysis was made.

Findings

Cleaners take great pride in their work, but because of their social invisibility, they are not recognized by the people they work for, and they fail in being proud of themselves. This has moral consequences since cleaners start doubting whether they are seen as equal. Eventually, cleaners have an ambivalent relationship with their job.

Practical implications

Given the moral consequences, FM practitioners and researchers should take these findings into account. As FM value is dependent on the quality of the relations between FM and its stakeholders (e.g. cleaners), FM is challenged to think about its responsibilities toward cleaners and other dirty workers in its context.

Originality/value

There is not much research done in cleaning. The research that is done focuses on efficiency and organization of cleaning. Only little research focuses on the cleaner, an insiders’ perspective is scarce.

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.

Influence of Chinese geomancy on facilities operations and maintenance (FOM)

Purpose

There have recently been an increasing number of scientific studies exploring the effectiveness of practising Chinese geomancy or feng shui in the built environment. However, these are rather generic studies focusing mainly on urban planning, architecture and interior design. The impetus for this present research stems from the lack of understanding relating to the practice of feng shui in Facilities Management (FM). Bridging these two disciplines, this study examines the relevance of and relationship between feng shui and FM principles.

Design/methodology/approach

A questionnaire survey was conducted, the results of which affirm the validity of the assimilated relationships between the two disciplines. Interviews with three groups of experts – the feng shui practitioners, facilities managers and feng shui practitioners who are also building professionals – were also conducted to verify the assimilation of the two disciplines with a view to draw new perspectives for better understanding.

Findings

The principles of feng shui and FM were studied, and the validity of the relationships between 15 feng shui principles and three FM activities were examined. The latter relates specifically to building fabric cleaning, routine external site/lot cleaning and road and pavement cleaning. It was found that specific feng shui principles and scenarios appear to influence the three FM activities. The statistical analysis shows that the means of specific feng shui scenarios in relation to FM activities were consistently higher than those of the feng shui principles. The one-sample t-test indicates that all the feng shui principles were significant in affecting the three FM activities.

Research limitations/implications

This study provides a better understanding of the relevance of feng shui principles influencing FM principles. It also revealed the challenges and limitations in bridging the relationships between these two disciplines.

Originality/value

This study is the first investigation to examine the relevance and relationship between feng shui and FM practice. This serves to encourage further research to determine how feng shui design implementation will affect the ease of conducting FM activities. If the relationship is established, as is the case from this study, then the implementation of feng shui principles in building design can be encouraged to positively influence the ease of conducting FM activities downstream in the occupancy stage. This can serve to contribute to the improvement of sustainable building design. It can also contribute to the scientific investigation of feng shui, which has so far been largely overlooked in built environment studies. Such studies can help to demystify and provide logical and scientific interpretations of how feng shui principles actually work.

Organising in-house cleaning services in public FM

Purpose

This paper aims to describe and discuss in-house cleaning services in local authorities to gain a better understanding of current practices. These descriptions are intended to increase researchers’, practitioners’ and educators’ understanding of the studied issue, as there at present does not exist a solid understanding of in-house cleaning services in local authorities. Previous studies provide little detailed information regarding the internal environment of facility management (FM) organisations, in particular with regard to FM organisations’ individual services.

Design/methodology/approach

This research is based on two descriptive case studies, one from Norway and one from the UK. The case studies are based on semi-structured, face-to-face in-depth interviews and document reviews.

Findings

The cases demonstrate that in-house cleaning services can be structured and managed in different ways, particularly with respect to the split in services, the management of staff and customer contracts, the span of control, the chain of command, self-managed leadership, cleaners’ hours of duty and the use of outsourcing.

Research limitations/implications

Although the previous research on particular FM services is limited, this paper’s detailed descriptions may stimulate further development and research within the field. The knowledge brought forward is part of bridging a knowledge gap on cleaning in FM research. This knowledge can contribute to advancements in the way this service is discussed and measured across contexts by encouraging more rigour and specific studies on cleaning.

Originality/value

This paper constitutes one of the first detailed descriptions of in-house cleaning organisation in local authorities. This is a type of service supply that is common in certain contexts and identified as beneficial to cost-saving in other contexts.

The therapeutic impacts of environmental design interventions on wellness in clinical settings: A narrative review

PURPOSE

The aim of this review is to document the role of physical environmental factors in clinical environments and their impact on patients and staff wellness with a particular focus on physical and mental healthcare.

METHODS

Data sources comprised relevant English language articles and the results of literature search of ISI Web of Knowledge, PubMed, Scopus, ProQuest Central, MEDLINE, and Google.

RESULTS

Incorporating physical environmental factors into hospital design can facilitate better user satisfaction, efficiency and organisational outcomes. Many of the design interventions convey positive distractions for patients and staff, in terms of views of pleasant outside vistas, soothing sound, artwork and music.

CONCLUSIONS

Well-designed physical settings play an important role in the healing process of patients in health care facilities. The challenge then is to fully understand that role in the ecological context of health care. Other contributors are possible and should be explored in further research.

Facilities management: tracing its development trajectory

Purpose

– The purpose of this paper is to provide facilities management (FM) practitioners and researchers with a better understanding of the FM industry sector by analyzing the trend of its development.

Design/methodology/approach

– Semi-structured interview is adopted in this research as the main methodology. In total, 30 FM professionals in the UK were interviewed to explore the past, present and future of FM. The analysis of interview results helps to identify the key areas in which FM has changed, is changing and will change. It also helps to explain the implications of FM development in each key area.

Findings

– FM evolves and matures continuously. It is important for FM organizations and practitioners to recognize the dynamic nature of this industry sector, based on which they can develop appropriate strategies to adapt to changing circumstances. This is probably the only way for them to keep pace with the times.

Originality/value

– Both backward looking and forward looking are crucial to the development of an industry sector. However, existing studies on FM development are conducted through either review or outlook. On the other hand, most of these studies focus on one particular management area or one particular industry sector. Based on 30 expert interviews, this research attempts to bridge the knowledge gap and analyze the trend of FM development in a systematic way. A better understanding of the trend provides a possibility and a guide for FM organizations and practitioners to pursue best practice.

The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward

OBJECTIVE. To investigate the distribution of hospital pathogens within general and critical care ward environments and to determine the most significant bacterial reservoirs within each ward type. DESIGN. Prospective 4-month microbiological survey. SETTING. The intensive care unit (ICU) and gastrointestinal (GI) surgical ward of a London teaching hospital. PATIENTS. Sampling was conducted in and around the bed space of 166 different patients (99 in the ICU and 67 in the GI ward). METHODS. Conventional agar contact methodology was used to sample 123 predetermined sites twice a week for 17 weeks. Sixty-one surfaces were located within the ICU, and 62 were located within the GI ward. Each surface was located within a theoretical zone of increasing distance from the patient. Aerobic colony counts were determined, and confirmatory testing was conducted on all presumptive pathogens. RESULTS. Regardless of ward type, surfaces located closest to the patient, specifically those associated with the bed (side rails, bed control, and call button), were the most heavily contaminated. Elsewhere, the type of surfaces contaminated differed with ward type. In the ICU, bacteria were most likely to be on surfaces that were regularly touched by healthcare workers (e.g., telephones and computer keyboards). In the GI ward, where the patients were mobile, the highest numbers of bacteria (including potential nosocomial pathogens) were on surfaces that were mainly touched by patients, particularly their toilet and shower facilities. CONCLUSIONS. In terms of cleaning, a hospital should not be considered a single entity. Different ward types should be treated as separate environments, and cleaning protocols should be adjusted accordingly.