Performance measurement for the strategic management of health-care estates

Coping with uncertainties: challenges for decision makers in healthcare

Purpose

Health care organizations’ decision-making for the future relies on anticipating changes. Reliable predictions are becoming increasingly difficult, creating anxiety and requires long-term adaptive planning to cope with unforeseen circumstances. The purpose of this study is to gain insights into the awareness of uncertainties that decision makers in healthcare have, particularly when making long-term investments.

Design/methodology/approach

This is a qualitative study with an explorative purpose. The data were collected through semi-structured and open interviews with board members of long-term care organizations.

Findings

The study revealed that respondents are most uncertain about the future financing of their real estate system. Another concern revealed is about the shortage of care professionals combined with an increasing demand for future care. Despite most decision makers do recognize uncertainties during the decision-making process, decision makers hardly address the level of these uncertainties. Although this study did find that some decision makers are aware of deep uncertainties, in terms of “unknown unknowns,” they have no actual approaches for dealing with such situations.

Originality/value

Decision makers at healthcare organizations are uncertain as to their ability to anticipate technological, economic, social and political developments, as well as predict future healthcare system transformations. Some decision makers are aware of deep uncertainties, in terms of “unknown unknowns” and “unidentified unknowns,” but they lack an actual approach to deal with such situations. This study examines how strategies adapt to unforeseen developments or how to deal with deep uncertainties in healthcare as complex adaptive system.

The role of facilities management in fighting COVID-19 outbreak: Evidence from Malaysian public hospitals

The aim of this study is to provide a holistic review of the fight against COVID-19 in developing countries, particularly Malaysia. Specifically, the study aims to determine how facilities management delivery in public hospitals can be improved to ensure readiness in handling COVID-19 cases. We conducted a review of the literature and reliable media updates on COVID-19 and services management. A critical synthesis of COVID-19 information was conducted to scrutinise the technical aspects and highlight how facilities management can be improved to ensure hospital readiness in managing COVID-19 cases. The data and information used in the present study were collected up to the time of writing this paper, which leaves a room for further studies. Nonetheless, this study's recommendations are useful for understanding the present and future pandemics. This study is a first attempt to summarise the data on facilities management in relation to the COVID-19 pandemic in the Malaysian context. The study's findings are suitable for the developing countries in managing healthcare management practices in the fight against COVID-19. This study aims to highlight current issues in order to provide a more objective assessment of facilities management to ensure hospital readiness in handling COVID-19 cases.

The mediation effects of finance on the relationship between service quality and performance of hospital facilities management services

Purpose

With rising health-care costs and the financial constraints in most developing countries, prioritization of needs have become an issue of strategic importance in public hospitals. As a result, there is the intense competition of scare resources between core health care and non-core facilities management (FM) services. Given that financial resources are needed to facilitate the smooth operation of the FM department, this paper aims to investigate the direct and indirect effects of finance on the relationship between service quality and performance of hospital FM services.

Design/methodology/approach

The paper adopts a quantitative approach following a general questionnaire survey which was conducted on the research population. Partial least squares structural equation modelling was used to investigate the relationships between service quality and performance of hospital FM services.

Findings

The study highlights the relevance of service quality to improving FM performance and demonstrate the direct and indirect influence of finance to ensure quality FM services delivery to improve core health care outcomes in hospitals.

Practical implications

The result of this study should motivate hospital management to prioritize attention on FM in scare resources management in public hospitals to create and maintain a decent health-care environment for better health outcomes. Further, managerial commitment to facilitate employee training, empowerment, incentives, awards and compensation should be strengthened in the quest of ensuring quality services delivery.

Originality/value

The paper extends knowledge by mediating the influence of finance on the relationship between service quality and FM performance. Proposes a parsimonious financial mediation framework which can easily be adaptable to several developing countries health-care FM management.

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.

Enhancing the role of facilities management in the fight against the COVID-19 (SARS-CoV-2) pandemic in developing countries’ public hospitals

Purpose

This paper aims to present a review of the current COVID-19 pandemic with particular emphasis on developing countries in Africa. It aims to demonstrate how facilities management (FM) services delivery in public hospitals can be improved for the fight against the COVID-19 pandemic.

Design/methodology/approach

This paper embraces a review of current literature on COVID-19 and FM together with credible media updates. The paper critically synthesizes knowledge on the pandemic to position a technical view on how FM can be improved in the fight against the COVID-19 pandemic.

Findings

The COVID-19 pandemic presents unprecedented challenges and realities to the health-care system of most African countries. Despite the significant efforts being made by various governments, there appears to be a lack of a coherent and strategic FM plan to fight the pandemic. To create the necessary antivirus built environment, actionable and timely FM interventions are needed.

Research limitations/implications

The report herein is case guarded, based on the prevailing data and information as at the time of writing the paper. Nevertheless, the recommendations from the paper are useful for a worse future trajectory of the pandemic.

Practical implications

Knowledge of the proposed interventions will inform and assist health-care facilities managers in the fight against the COVID-19 pandemic.

Originality/value

The paper presents the first step towards encapsulating knowledge on FM and the COVID-19 pandemic. It sets forth recommendations that are useful for most developing countries’ public hospitals’ FM practices in the fight against this global pandemic. The authors intend to follow-up with future empirical studies for more objective assessments of FM and the COVID-19 pandemic.

Identifying the criteria for corporate real estate decisions through the laddering technique: an analysis of care organisations in The Netherlands

Purpose

Board members and real estate managers (decision makers) play an important role in the decision-making process in nursing home organisations. This study aims to provide an understanding of underlying attributes and benefits sought by decision makers when making nursing home real estate decisions.

Design/methodology/approach

Decision makers from seven different nursing home organisations in The Netherlands were interviewed using the laddering technique to determine the individual requirements, the considerations of the decision alternatives, the relevant attributes and benefits and their mutual relationships.

Findings

This study details the motivations behind real estate management decisions in nursing home organisations. The findings show that apart from financial considerations, decision makers strive to enhance the quality of life and satisfaction of users with their real estate decisions and seek to include residents and employees in the process. These benefits are connected to the goals of well-being and innovation in health care. Furthermore, functionality, physical and functional flexibility and technology are key considerations when undertaking corporate real estate (CRE) decisions, to ensure that real estate management aligns with the strategic goals of the nursing home organisation.

Practical implications

The insights of this study can support decision makers in healthcare facilities to create strategic value with their real estate. Understanding how to obtain certain benefits from nursing home real estate may result in a better realisation of organisational objectives and user needs.

Originality/value

This study reveals the decision-making process in a nursing home context. Moreover, the laddering technique is used as a new method to explore and gain a deep understanding of CRE decision-making processes.

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.