Healthcare facilities maintenance management: a literature review

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.

Evaluating Therapeutic Healthcare Environmental Criteria: Architectural Designers' Perspectives

This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.

Trust and knowledge sharing among hospitals during COVID-19: the compound effect of four barriers to organisational trust for knowledge sharing

Purpose

COVID-19 highlighted the potential value of improving knowledge sharing (KS) processes among hospital estates and facilities management (HEFM) departments. Organisational trust (OT) is a recognised predictor of KS interactions, but the interplay of impersonal and interpersonal OT components is yet to be investigated fully. In response to recent calls, this study aims to explore the effect of organisational features on personal trust and OT components required for KS episodes, in the context of the English National Health Service (NHS).

Design/methodology/approach

A qualitative, exploratory grounded theory approach was selected, using primary data from 22 semi-structured interviews and secondary data from grey literature. A model of trust for KS among employees from geographically distributed units with pooled interdependence was synthesised from a review of the literature and used to connect the organisational features to different trust mechanisms.

Findings

This study identifies four organisational features with a compound barrier-effect on impersonal-based OT, interpersonal-based OT and personal trust for KS interactions: lack of professional development, inappropriate reward and incentive systems, reorganisations/organisational change and benchmarking.

Research limitations/implications

This study sought to generate theory about the interplay of organisational barriers and trust components required for KS, not to describe HEFM KS across the entire NHS. Future studies with more comprehensive data collections can build on this exploratory study by quantitatively testing the compound barrier effect of the organisational features.

Practical implications

Practitioners can benefit from the insights into the barriers inhibiting trust mechanisms required for effective KS processes. These can inform policymakers in English and potentially other health-care systems in designing enhanced collaborative arrangements, which are required as future crises, e.g. pandemics and climate change hazards, will require increasingly complex solutions.

Originality/value

This study addresses the interplay between personal trust, impersonal OT and interpersonal OT for KS by identifying the compound barrier effects of underlying organisational barriers common to personal trust and OT.

Fire safety management in public health-care buildings: issues and possible solutions

Purpose

Frequent fire incidences in various hospitals across the globe with devastating effects on humans and other resources have multiplied. Stakeholders in the health-care sector are worried because of the yearly fire outbreak increase. However, fire safety management has been proved as a successful platform to mitigate fire in health-care facilities. How far regarding public health-care facilities is yet to receive in-depth studies in Malaysia. This paper aims to investigate the issues associated with fire safety management and proffers possible solutions to improve safety in public health-care facilities from the operators’ perception.

Design/methodology/approach

The objectives were achieved through a combination of case studies of five selected Malaysia’s public hospitals and a qualitative approach. Thematic analysis with the assistance of MAXQDA (software program designed for computer-assisted qualitative and mixed methods data) 2018, a type of qualitative data analysis software was used to analyse the collated data which emerged from the knowledgeable participants.

Findings

Lax implementation of safety policy, inadequate water pressure, poor maintenance, inadequate communication system, amongst others, emerged as the issues. Findings proffer five main measures to possibly improve fire safety management in public health-care buildings. This includes a feasible institutional framework, improve the emergency response team, improve the occupational health and safety system and others.

Research limitations/implications

This paper is limited to exploring the issues associated with fire safety management and proffer possible solutions to improve safety in public health-care facilities from the operators’ perception. Future research is needed to engage useful information in advancing fire safety management in public hospital buildings and possibly developing a qualitative model using a generic fire response model. Also, to investigate the level of compliance with the requirements of a fire safety management plan and possibly develop a well-detailed fire safety plan in Malaysia’s public health-care buildings.

Practical implications

As part of the paper implications, the paper concludes that improved fire protection systems via modern technologies and training of key staff members in accident response and recovery during fire emergencies should be encouraged. This can be achieved through the enforcement and implementation of a fire safety management plan. Thus, this study is encouraging the implementation and sustainability of a fire safety management plan for health-care buildings across Malaysia.

Originality/value

To the best of this paper’s knowledge, this is possibly the first comprehensive paper on fire safety management in public health-care facilities that engaged operators in Malaysia. Moreover, this paper proffers feasible policy solutions to improve the fire safety management plan in public health-care buildings.

Metaheuristics in the decentralization of SAMU bases using simulation in northeastern Brazil

BACKGROUND AND OBJECTIVE

The growth of the urban population exerts considerable pressure on municipalities' public managers to focus their attention on providing emergency medical care that meets the growing demand for emergency pre-hospital medical care. Currently, there are a significant number of traffic accidents and other serious occurrences, such as heart attacks, drownings, epidemics, fires and disasters (floods, landslides, earthquakes) that demand a prompt and seamless response from pre-hospital medical care. As a result of such scenario, the present article endeavours to apply a dual-coverage mathematical model (DSM-Double Standard Model) to define the optimal location of the Emergency Medical Service (SAMU) decentralized dispatch bases in Natal/RN and conduct a simulation study to evaluate the displacement of ambulances between such bases.

METHODS

The methodological course that was followed by this research constitutes of 12 steps. The location of decentralized bases for sending emergency ambulances was established using the DSM model and the simulation model was performed using the FlexSim© software version 2018 evaluating base coverage in relation to the total number of calls by demand points for different scenarios.

RESULTS

The results obtained throughout the research demonstrated the feasibility of redefining the decentralized bases of SAMU/Natal ambulances as a strategy to reduce response time and guarantee compliance with performance parameters established by international organizations (the World Health Organization, for instance, establishes the time of 8 minutes for emergency medical service calls response). The simulation study showed a significant reduction in response time, by up to 60% in some cases.

CONCLUSION

The proposition of new locations for the decentralized dispatch bases of the SAMU/Natal can provide an overall significant reduction on the ambulance response time, so as to contribute to expedite the initiation of treatment of patients, if necessary, sent to hospitals.

Renovating Healthcare Facility Maintenance Planning: A Case Study From Walter Reed National Military Medical Center (WRNMMC)

PURPOSE

This article documents the development and implementation of a new approach for health facilities construction and maintenance planning, the use of a Facilities and Clinical Coordination (FCC) Council, at Walter Reed National Military Medical Center (WRNMMC).

BACKGROUND

WRNMMC is preparing for the largest and most complex renovation project in recent Department of Defense history. There is sparse documentation demonstrating stepwise frameworks for the implementation of effective and efficient health facilities maintenance management tools and techniques.

METHOD

This study discusses the development and evaluation of the FCC Council. Clarity to the literature sources guiding the development of the FCC Council is provided, followed by the survey approach undertaken to assess Council efficacy based on participants' perceptions. Data are analyzed using descriptive and inferential statistics.

RESULTS

Our study suggests routine cross-functional synchronous FCC Council meetings improve perceptions of safety and communication, encourage teamwork, and are more productive when conducted using synchronous rather than asynchronous communication. Clinician participants strongly supported the face-to-face meeting approach and considered such meetings more effective as they are perceived to maintain staff and patient safety as a constant organizational focus.

CONCLUSION

The FCC's perceived effectiveness toward improving healthcare facilities maintenance planning centers on engaged leadership, the inclusion of diverse subject matter experts, and structured group facilitation. Our results inform health facilities planners of the value the FCC Council brings to an organization by helping to develop organizational buy-in for major facilities renovation projects.

Analyzing the operational barriers of government-supported healthcare supply chain

Purpose

The purpose of this study is to develop a methodology for the identification, categorization and prioritization of operational government-supported healthcare supply chain barriers (GHSCBs).

Design/methodology/approach

This study develops a theoretical background for identifying and segregating relevant GHSCBs and proposes a 5W2H (a Toyota production system) with fuzzy DEcision MAking Trial and Evaluation Laboratory (DEMATEL) embedded approach to quantify the causal–effect relationships among the identified operational GHSCBs.

Findings

Seven GHSCBs (i.e. uncertainty of demand management, lack of continuous improvement and learning, lack of deadline management, lack of social audit, warehousing equipment unavailability, human resource shortage and inadequate top level monitoring) were identified as significant cause group where the government, top management and decision-makers of government-supported healthcare supply chain (GHSC) have to put efforts.

Research limitations/implications

The results obtained are specific to the GHSC of Indian perspective, which could be extended to global context. However, the proposed approach can be a base and provide a platform to understand and analyze the interactions among GHSCBs.

Practical implications

The proposed methodology will show the appropriate areas for allocating efforts and resources to mitigate the impact of GHSCBs for successful implementation of healthcare supply chain.

Originality/value

According to best of the authors' knowledge, this is the first study of operational barrier for GHSC in India in specific. The use of 5W2H embedded fuzzy DEMATEL approach for the development and analysis of the theoretical framework of Indian GHSCBs is unique in barrier literature.

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.

DEVELOPING A STRATEGIC SUSTAINABLE FACILITY PLAN FOR A HOSPITAL LAYOUT USING ELECTRE AND APPLES PROCEDURE

Today healthcare globally is growing at a rapid pace and despite the huge technological advancement, healthcare still faces primitive challenges and hence results in the poor service and facility to the needy. Layout planning acts as one major reason which requires improvements for the effective and efficient working of the healthcare facilities. This research aims at optimizing several quantitative criteria related to economic, technology and society which are taken into consideration for the decision-making during the evaluation, analysing and selection of the best layout for an existing healthcare facility. Critical areas for the improvement were found out using statistical analysis based on a survey questionnaire and Apple’s layout procedure is utilised to design the different possible layouts for an efficient facility. The seven criteria namely inter-departmental satisfactory level, the average distance travelled and the average time required for staff flow, the average distance travelled and the average time required for patient flow, the average distance travelled and the average time required for material flow were taken into consideration. The ELECTRE methodology was used as multi-criteria decision making based on decided seven criteria for comparing the different layout by methodical and orderly thinking.

Validation of a multiple criteria tool for healthcare facilities quality evaluation

Purpose

Several healthcare quality assessment tools measure the processes and outcomes of the care system. The actual physical infrastructure (buildings and organizational) aspects are, however, rarely considered. The purpose of this paper is to describe the process of validation and weighting of an evidence-informed framework for the quality assessment of hospital facilities from social, environmental and organizational perspectives to complement other assessments.

Design/methodology/approach

Sustainable High-quality Healthcare version 2 (SustHealth v2) is the updated version of an existing framework composed of three domains (social, environmental and organizational quality). To validate and establish a relevant weighting, interviews were conducted with 15 professionals within the field of healthcare planning, design, research and management. The study has been conducted through semi-structured interviews and the application of the Simon Roy Figueras (SRF) procedure for the elicitation of weights criteria. The data collected have been processed through the DecSpace web platform.

Findings

Among the three domains, the organizational qualities appear to be the most important (W = 49%), followed by the environmental (W = 29%) and social aspects (W = 22%). Relevant indicators such as future-proofing, wayfinding and users’ space control emerged as the most important within each macro-area. Those results are confirmed by the outcome of the interviews that highlight user/patient-centeredness, wayfinding strategies and space functionality as the most important concepts to foster in existing healthcare facilities improvement.

Practical implications

The study highlights important structural and organizational aspects that hospital managers and planners can consider when dealing with healthcare facilities’ quality improvement.

Originality/value

The use of the SRF multicriteria method is novel in this context when used to weight an assessment tool with a focus on hospital built environment.

Natural Language Processing Model for Managing Maintenance Requests in Buildings

In recent years, facility management (FM) has adopted many computer technology solutions for building maintenance, such as building information modelling (BIM) and computerized maintenance management systems (CMMS). However, maintenance requests management in buildings remains a manual and a time-consuming process that depends on human management. In this paper, a machine-learning algorithm based on natural language processing (NLP) is proposed to classify maintenance requests. This algorithm aims to assist the FM teams in managing day-to-day maintenance activities. A healthcare facility is addressed as a case study in this work. Ten-year maintenance records from the facility contributed to the design and development of the algorithm. Multiple NLP methods were used in this study, and the results reveal that the NLP model can classify work requests with an average accuracy of 78%. Furthermore, NLP methods have proven to be effective for managing unstructured text data.

Lean Management Framework for Healthcare Facilities Integrating BIM, BEPS and Big Data Analytics

An increase in the usage of information and communication technologies (ICT) and the Internet of Things (IoT) in Facility Management (FM) induces a huge data stack. Even though these data bring opportunities such as cost savings, time savings, increase in user comfort, space optimization, energy savings, inventory management, etc., these data sources cannot be managed and manipulated effectively to increase efficiency at the FM stage. In addition to data management issues, FM practices, or developed solutions, need to be supported with the implementation of lean management philosophy to reveal organizational and managerial wastes. In the literature, some researchers performed studies about awareness about building information modeling (BIM)-FM, and FM-related data management problems in terms of lean philosophy. However, the comprehensive solution for effective FM has not been investigated with the application of lean management philosophy yet. Therefore, this study aims to develop an FM framework for healthcare facilities by considering lean management philosophy since more stable workflow, continuous improvement, and creating more value to customers will help to deliver a more acceptable solution for the FM industry. Within this context, the integration of BIM, Building Energy Performance Simulations, and Big Data Analytics are proposed as a solution. In the study, the Design Science Research (DSR) methodology was followed to develop the FM framework. Depending on the DSR methodology, two scenarios were used to investigate the issue in a real healthcare facility and develop the FM framework. The developed framework was evaluated by four experts, and the revisions of the proposed framework were realized.

Modelling the performance of waste management services in Ghana’s public hospitals

Purpose

The purpose of this paper is to explore and establish key performance indicators that could be considered towards improving the delivery of waste management (WM) services in public hospitals.

Design/methodology/approach

An exploratory sequential mixed-methods approach was adopted for this study. This involved two phases of data collection and analysis. Specifically, interviews in selected case studies hospitals and a general questionnaire survey. Partial least squares structural equation modelling was used to model the relationships among the performance variables. An expanded balanced scorecard typology was used to categorize performance variables.

Findings

The results demonstrate that quality and internal business strategic indicators have a significant influence on WM performance. By implication, public hospital managers would be well advised to invest resources in improving internal business operations, learning and growths, as well as prioritizing finance in the process of managing healthcare waste.

Practical implications

The developed WM structural model can be used to identify performance indicators that can be incorporated into public hospitals’ WM strategy to improve performance leading to a decent healthcare environment.

Originality/value

The majority of studies have centered on the knowledge and practices of healthcare WM. This study extends the knowledge of healthcare WM literature from the perspective of FM performance measurement. The developed model of the study is invaluable to many developing countries that are faced with the challenge of improving WM practices.

Data center maintenance: applications and future research directions

Purpose

One of the most critical infrastructures is a data center (DC) because of it having many servers, computers and other equipment. DCs provide online services for various companies in the information technology (IT) industry. DC facilities should provide reliable online services while addressing the required quality and performance level considering maximum reliability and availability. The purpose of this study is to represent and classify the main findings in this area and to identify the main research gaps and shortcomings from the perspective of research.

Design/methodology/approach

This paper provides an organized and systematic literature review focusing on topics regarding the operation and maintenance (O&M) management of DCs.

Findings

Although there are several studies on O&M management systems for industrial systems and facilities, a limited number of studies with few methods and models have focused on DCs so far and these facilities require more attention. This paper identifies the issues and challenges for DC buildings and facilities and provides a conclusion of the findings to highlight the main research limitations for discovering new potential methods as future research opportunities.

Research limitations/implications

The paper has highlighted the main practical issues of DCs in terms of maintenance management. Several research works have been discussed specifically for DC’s maintenance, which makes this paper a credible source for researchers, maintenance managers and companies involved in the area of DC. Because several of the reviewed literature were based on real case studies, decision-makers in the DC maintenance sector can take advantage of new research on maintenance scheduling to reduce the costs of maintenance.

Originality/value

The paper has presented a comprehensive list of frequent keywords in recent publications related to O&M management for DCs. It has provided a categorized list of publications based on by their topic, methodology and case study. Because this paper has discussed research works specifically for DC’s maintenance, it is a credible source for researchers, maintenance managers and companies involved in the area of DCs.

A systematic literature review of healthcare supply chain and implications of future research

Purpose

This paper aims to review the healthcare supply chain (HSC) literature along various areas and to find out the gap in it.

Design/methodology/approach

In total, 143 research papers were reviewed during 1996-2017. A critical review was carried out in various dimensions such as research methodologies/data collection method (empirical, case study and literature review) and inquiry mode of research methodology (qualitative, quantitative and mixed), country-specific, targeted area, research aim and year of publication.

Findings

Supply chain (SC) operations, performance measurement, inventory management, lean and agile operation, and use of information technology were well studied and analyzed, however, employee and customer training, tracking and visibility of medicines, cold chain management, human resource practices, risk management and waste management are felt to be important areas but not much attention were made in this direction.

Research limitations/implications

Mainly drug and vaccine SC were considered in current study of HSC while SC along healthcare equipment and machine, hospitality and drug manufacturing related papers were excluded in this study.

Practical implications

This literature review has recognized and analyzed various issues relevant to HSC and shows the direction for future research to develop an efficient and effective HSC.

Originality/value

The insight of various aspects of HSC was explored in general for better and deeper understanding of it for designing of an efficient and competent HSC. The outcomes of the study may form a basis to decide direction of future research.

Using Virtual Reality to Compare Design Alternatives Using Subjective and Objective Evaluation Methods

OBJECTIVE

This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies.

BACKGROUND

VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback. While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives.

METHOD

A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform.

RESULTS

The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction.

CONCLUSION

Simulation-based evaluations in VR that use a combination of users' subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options. The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users' physical response to a simulated healthcare environment.