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

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.

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.

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.

Implementing sustainable facility management

Purpose

The development of sustainable facilities management (FM) practices requires active and integrated engagement of the FM organization. Building on a three-year research project (2015-2018) within Nordic Built that aims to strengthen FM competencies in the Scandinavian countries, this paper aims to list and document the challenges and barriers of implementing sustainability as identified by the Scandinavian FM practitioners who took part in this research.

Design/methodology/approach

The paper builds on the understanding gained from using an interpretive sociological approach and uses qualitative mixed methods to collect data from four workshops, group sessions and expert group discussions with a mix of representatives including owners, property managers, facilities managers, consultants, teachers and academics. Four case studies were completed of refurbishment projects implementing sustainable solutions; these encompassed in-depth interviews with the stakeholders, site visits, observations of meetings and gathering project documentation. The data were complemented by a systematic literature review on a selection of topics focusing on articles referring directly to FM, the sustainability of FM, ends-user and stakeholder involvement, energy performance and sustainability. The challenges and barriers identified in practice were compared to those found in the literature.

Findings

The concept of sustainability, and its different dimensions and implications, seems to be well understood now by the practitioners who participated in this study, who claimed they were able to provide the required solutions. What seems to be lacking, though, is the possibility of convincing the end-users, who are expected to operate and maintain the facilities, to act according to the standards that these solutions require. It appears to be easier to focus on the technical aspects than on the end-users’ behaviors. The practitioners reported a shortage of social competencies and tools to deal with the situation, and despite an increasing awareness of smart technology, they lacked solutions to engage the end-users in optimizing the facilities. Besides, not all FM companies were well equipped to face the challenges imposed by the sustainable agenda; the small and medium enterprises in particular seemed to be struggling to implement the different dimensions of sustainability.

Research limitations/implications

The limitation of this research rests in the chosen research approach as it focuses on the FM practitioners. The contribution of the end-users’ perspective is not strongly represented or systematically explored, but is identified as a new topic that needs to be investigated further to provide further insight. This study focuses on refurbishment and/or retrofit of existing buildings and the operation of facilities. The authors do not embrace the design phase or the construction phase of new buildings.

Practical implications

The paper underlines the need for frameworks and concrete tools to help FM practitioners to integrate the social and cultural aspects of sustainability. It identifies end-users, both in housing and in offices, as creating a bottleneck to the implementation of sustainable FM. To gain insight into this bottleneck, the authors suggest implementing a sociologically inspired method using an integrative approach. Highlighting such issues will mean that future research will be able to define further solutions for managing and maintaining existing and future built assets and fulfilling sustainability requirements by engaging end-users. This study also emphasizes the need to introduce these topics as part of the curriculum for FM education.

Originality/value

This paper provides an update on the level of the development of sustainable FM in the three Scandinavian countries. This is highly relevant for Scandinavian practitioners, but the authors consider this relevant for international practitioners, researchers, academics and teachers and developers as well. Practitioners and researchers are invited to join in these efforts to explore how to find practical frameworks, tools, policies and instruments and new services that will improve sustainable FM practices.

Performance measurement for the strategic management of health-care estates

Purpose

The purpose of this study is to explore the role of performance measurement in current practices for strategic management of health-care estates.

Design/methodology/approach

The research adopts a constructivist grounded theory approach, combining different methodologies of a pan-European qualitative questionnaire, interviews with international health-care providers and a case study of National Health Services (NHS) Scotland. Here, documentation analysis, observations and in-depth interviews involving NHS stakeholders were undertaken.

Findings

The analysis shows evidence that measuring estate performance has limited value for individual NHS boards regarding strategic decisions related to long-term planning and investment. This was due to design issues and the prioritisation of clinical delivery, which contribute to the neglect of the estate as a consideration in long-term strategic planning. This misalignment results in a tool which is valuable for accountability but which is less helpful to NHS boards in shaping future decisions around the estate.

Practical implications

Responding to a gap in understanding of the application of performance measurement in the context of health-care estates, this research provides three recommendations to promote a more effective and relevant performance measurement system. These actively recognise the importance of the estate within strategic decision-making as helping to inform the long-term planning and management of the estate within the individual NHS boards.

Originality/value

This paper shows the current role of performance measurement for the strategic management of health-care estates and identifies issues related to its applicability and value.

Failing to plan – planning to fail

Purpose

The purpose of this paper is to know how do early-phase planning of real estate (RE) and facilities management (FM) create value for owners and users of commercial and public sector buildings.

Design/methodology/approach

The data were collected in Norway in 2015 through a national online survey (N = 837). The sample gives a good picture of Norwegian owners’ and even users on tactical-level (customer) perspectives on RE and FM. The data have been analysed through descriptive statistics and exploratory factor analysis. The hypotheses have been tested through analyses of correlations and ordinary least square (OLS) linear regressions.

Findings

Exploratory factor analysis made it possible to establish seven composite variables (constructs). Based on these seven constructs, six hypotheses were derived and tested. Obstacles and financials have no significant effect on buildings’ perceived usability. The most important factors during early-phase planning that influence buildings’ perceived usability and lifetime value creation are measures promoting environment and life-cycle costs (LCC), FM, adaptability and image.

Research limitations/implications

Further empirical and preferably, comparative studies are needed to establish whether the findings can be generalized. The study has shown that a building’s usability and lifetime value creation is largely determined by decisions made during early phase planning.

Practical implications

Well-founded early-phase planning of RE and FM may actually provide very high return on the investments and significantly improve the buildings’ lifetime value creation for owners and users. Early-phase planning is also of great importance both for buildings’ physical design, as well as for successful FM during the buildings’ use phase, and may prevent irreversible blunders.

Originality/value

This is a large N empirical study in Norway. The findings indicate what owner and users of buildings should emphasize during early phase planning.

Practice vs theory: short-term financials trumps long-term value creation

Purpose

The aim of this paper is to present findings from the research project “Oscar – Value for Owners and Users of Buildings” and investigate two research questions: What in early-phase planning of real estate projects and facilities management creates value for owners and users of buildings? Do respondents in private enterprises, public administrations and hybrid organizations have different priorities during early-phase planning of buildings and facilities management concerning which factors creates value for owners and users of buildings?

Design/methodology/approach

This study is based on a national survey (N = 837) among Norwegian owners and users of buildings where the respondents report their emphasis on economic, social, environmental and physical aspects during early-phase planning of buildings. The data have been analysed through descriptive statistics, ranking of means and one-way ANOVA supplemented with bootstrapping.

Findings

Many Norwegian owners and users of buildings emphasize short-term financials and seem to overlook recent research concerning what creates long-term value such as life-cycle planning and the buildings’ elasticity, flexibility, generality. Respondents employed by private enterprises seem to have shorter time horizon than respondents employed by hybrid organizations and public administrations.

Research limitations/implications

Further empirical research in Norway and preferably also in other countries, based on surveys with large random samples of respondents is needed to establish whether it is possible to generalize this study’s findings.

Practical implications

Increased emphasis during early-phase planning of buildings on aspects creating long-term value can significantly increase the buildings’ value creation for owners and users. This article indicates some attention areas and possible strategies during early-phase planning to improve the long-term value creation for owners and users.

Originality/value

This is an empirical study (national survey) with particular emphasis on how early-phase planning of buildings can contribute to value creation for users and owners during the buildings’ use phase.

Analysis of assessment methodologies suitable for building performance

Purpose

The paper aims to examine assessment tools for strategic performance evaluation of building and Norwegian practice in light of international practise.

Design/methodology/approach

This paper includes a literature review of literature describing the use of assessment tools suitable for building performance evaluation. In this paper, the authors examine, first, what properties they find most essential when assessing building portfolios. This analysis is outlined in the theoretical framework section. Second, the authors examine what are the propensities of the analytic assessment tools that they perceive as to be found in the forefront of contemporary methodological development for examining building performance. These propensities are presented in the findings chapter. The authors discuss how they measure their applicability and impact of use.

Findings

The authors found several interesting methods for assessing building performance in general. In particular, the feed forward loop from Steinke, developed from BSC, Soft Landings Framework and the Norwegian multiMap method are recommended.

Practical implications

This conceptual paper addresses methodological challenges in a comparative way. This comparative approach permits for an identification of respective strengths and weaknesses. It suggests concrete points of reference enabling an increase in the performance of such methodologies.

Originality/value

The paper is original in its approach of several methodological tools in light of concepts such as viability and adaptability. By doing this, it underlines the necessity to include social and adaptive dimensions of strategic building portfolio assessment tools.