Benchmarking operation and maintenance costs of French healthcare facilities

Facility Management Costs for Hospital Infrastructures: Insights from the Italian Healthcare System

Background: Hospital infrastructures account for a significant portion of healthcare expenditures, yet the factors driving facility management costs (FMCs) remain underexplored, particularly in the Italian context. This study aims to analyze FMCs in hospitals, focusing on utility and maintenance expenses, while providing benchmarking values to support decision making. Methods: This study employed a mixed-methods approach, integrating a literature review, financial data analysis, and a case study of 27 hospital facilities in Lombardy. Data on utility and maintenance costs were collected from financial statements and supplemented with targeted questionnaires to enhance precision. Descriptive statistics and parametric cost indicators (e.g., EUR/sqm, EUR/bed) were analyzed to identify trends and disparities. Results: FMC increased by an average of 32.90% between 2019 and 2022, with utility expenses constituting 77.45% of total costs and maintenance accounting for 22.45%. Utility costs rose significantly (37.34%), driven by energy and cleaning services, while maintenance costs grew more moderately (18.66%). Cost variability was evident across hospital typologies, with Basic Healthcare Centers averaging 122.86 EUR/sqm compared to 232.66 EUR/sqm for Level II Emergency Hospitals. Conclusions: This study highlights significant variability in FMCs across Italian hospitals and underscores the need for benchmarking to optimize resource allocation. Future research should expand the dataset, incorporating extraordinary maintenance costs, and examine management models to enhance cost efficiency. These findings provide actionable insights for policymakers and healthcare administrators to improve hospital infrastructure sustainability and efficiency.

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.

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.

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.

Exploring Space Management Goals in Institutional Care Facilities in China

Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities.

Multi-sector framework for benchmarking in facilities management

Purpose

Benchmarking in FM practice although understood and applied globally, little is known about the practice in Nigeria. The purpose of this paper is to develop a framework to guide the use of benchmarking.

Design/methodology/approach

The research adopts a cross-sectional survey design. Data were collected using self-administered questionnaires on FM organizations in Lagos metropolis, Abuja and Port Harcourt. The results of the survey were supplemented with interviews with FM unit heads in the study areas. The framework was validated using a focus group discussion with ten FM industry experts.

Findings

A framework which serves as a guide for the use of best practice benchmarking was developed. It showed that there is a relationship between best practice benchmarking and location.

Research limitations/implications

The evaluation of the framework was limited by the number of participants involved and being that it has not been put to use.

Originality/value

This study develops a multi-sector framework to guide the use of best practice benchmarking in facilities management (FM). The framework explains the relationship between organizational characteristics and best practice benchmarking. In addition, there are limited empirical benchmarking frameworks in FM literature.

Buildings' impact on effective hospital services--the means of the property management role in Norwegian hospitals

PURPOSE

The purpose of this paper is to assess the status of the physical assets of Norwegian hospital facilities in terms of technical condition, building performance, usability and adaptability, thereby comprehending the main challenges for property management as part of facilities management (FM) within hospitals of the Norwegian Specialist Health-Care Services and permitting a discussion on a more strategic property management role.

DESIGN/METHODOLOGY/APPROACH

The research is based on an action research approach using data collection from surveys, schemes and questionnaires, literature studies, documentation analysis and workshops with an active research team involvement with stakeholders. In-depth interviews were undertaken with owner representatives, property management representatives and health-care deliverers, and a GAP analysis allowed a study of the quality of property management (as part of the FM).

FINDINGS

A severe technical backlog was documented together with a strong demand for structural upgrading, which was roughly estimated to be approximately 30-35 billion NOK in 2012 (3.75-4.4 billion euros). Improvements are necessary in all areas of FM delivery within limited economic frameworks, even though several examples of good property management (as part of FM delivery) were found. A gap exists between the general strategy concerning hospital assets and the property management role, particularly with regard to the translation of change in user needs into changed facilities. A need for an increasing professionalization of the role is pressing, turning attention from operational costs and control to potential added value. This requires a shift of focus from the property manager in order to implement visions and goals for the health-care sector, which involves several actions such as an improved communication between stakeholders and technically improved skills, thus ensuring the recruitment and capability of property management staff and improved measurement processes.

PRACTICAL IMPLICATIONS

This paper give two major recommendations: first, a stronger integration of the property management role as part of the FM delivery with the executive management of the Health Authorities and Regional and Local Health Trusts; and second, a nationally coordinated strategy for the development of property management in the Specialist Health-Care Services (called Strategic FM). The authors believe that developing a pool of competencies at the national level is necessary to develop the tools, methods and standardized measurements to enable a change in the use of the terms of added value and sustainability. Ultimately, this will enhance the assets of the healthl sector, and this paper suggests a model that allows for this development.

ORIGINALITY/VALUE

This paper shows a model for property management as a strategic role in a holistic process involving all stakeholders from both the bottom up and the top down. The authors believe this process will engage the stakeholders in agreeing upon a clear vision and set of goals for the health-care service assets.