Daryl May

Patient choice in the NHS: How critical are facilities services in influencing patient choice?

Purpose – From December 2005, patients in the UK needing an operation will be offered a choice of four or five. These could be NHS trusts, foundation trusts, treatment centres, private hospitals or practitioners with a special interest operating within primary care. This is called “Choose and Book”. The purpose of this research is to discover how critical facilities management service factors are in influencing a choice of hospital. The aim is to find out what the most important influencing factors are to people when making a choice of which hospital to have their operation. If facilities services and the patient environment are influencing factors in the patient experience, which are considered critical.Design/methodology/approach – Focus groups were used as the primary method of data collection.Findings – The study finds that all three focus groups placed more importance on clinical factors than facilities factors. High standards of cleanliness and good hospital food were the two facilities factors that...

The impact of facilities management on patient outcomes

Purpose – The purpose of this paper is to investigate the extent to which practicing National Health Service (NHS) facilities managers thought that the contribution of facilities management (FM) could be measured in terms of health outcomes.Design/methodology/approach – A questionnaire was distributed to NHS facilities or estate managers from the majority of NHS trusts in England and Wales.Findings – In general, there is little or no evidence from pre‐existing research to prove the contribution of FM in terms of health outcomes. However, in spite of this, 59 per cent of facilities managers in the NHS believe that the contribution of FM could be measured yet only a relatively small number of Trusts (16 per cent) have attempted to measure the contribution of FM. The analysis of the secondary data does not show any conclusive evidence of a correlation between FM and health outcomes.Research limitations/implications – The scope of the study did not extend to collecting empirical evidence to prove the contribu...

Environmental cleaning in UK healthcare since the NHS Plan: A policy and evidence based context

Purpose – This paper aims to examine the policy and guidance that was issued, either as a direct result of the NHS Plan, or part of a subsequent initiative, surrounding cleaning in the NHS.Design/methodology/approach – A literature review of the Department of Health and related agency web sites was completed. In addition there was a literature review of the relevant academic journals.Findings – There is a growing evidence base on environmental cleaning in the NHS and more specifically the relationship between environmental cleaning and infection control. This paper has examined the contradiction in the evidence in the suspected correlation between infection control and environmental cleaning. However, one thing that does appear to be consistent is that a performance measure based on an observation (visual) assessment is not a sufficient tool to evaluate the environmental cleanliness of a hospital ward.Practical implications – While the clinical community recognise the contribution of environmental cleanin...

Evaluation of the new ward housekeeper role in UK NHS Trusts

In the year 2000, the UK government promoted the concept that hospital services be shaped around the needs of the patient to make their stay in hospital as comfortable as possible and advocated the introduction of a ward housekeeper role in at least 50 per cent of hospitals by 2004. This is a ward‐based non‐clinical role centred on cleaning, food service and maintenance to ensure that the basics of care are right for the patient. In 2002 the Facilities Management Graduate Centre at Sheffield Hallam University completed a series of six case studies looking at the role within different NHS Trusts. These were developed through interviews and observations with the facilities manager, ward housekeepers and nursing staff and also by collecting documentary evidence such as job descriptions, financial details and training information. Common themes were identified, relating to experiences of developing and implementing the ward housekeeper role. This paper suggests models of best practice relating to role, recruitment, induction, training, integration and management.

Facilities management help desks

Purpose – The purpose of this paper is to provide an exploratory look at facilities and estates management help desks in four different case study organisations.Design/methodology/approach – A case study methodology was adopted, with semi‐structured interviews and observations as the principal methods to collect data.Findings – The findings suggest that the key factors for the success of a facilities management (FM) help desk include mapping out all customer requirements, recruiting the correct operating staff, ensuring an appropriate working environment and client communication once the help desk is operational.Originality/value – At the time of the study there had been relatively little research completed focusing specifically on FM help desks. The paper will be of value to facilities and property managers who are considering implementing a help desk service.

Achieving patient‐focused maintenance services/systems

Purpose – The purpose of this paper is to identify and investigate the contribution made from the estates services to the quality of the patient experience from the perspective of all estates staff ranging from front‐line staff to directors of estates and facilities. The work is exploratory in nature owing to no known earlier studies in this area.Design/methodology/approach – A postal questionnaire is distributed to a non‐random self‐selecting group of National Health Service (NHS) estates staff – therefore those staff working in the areas of maintenance, engineering, building, gardening and general office estates management. A total of 920 questionnaires are distributed to the 46 NHS trusts. There are 202 responses, which is a return rate of 22 per cent.Findings – It is clear that overall estates staff consider their job/service to be important to the patient experience, 94 per cent of respondents indicate they did. This is further confirmed by 82 per cent of estates line managers considering their job t...

Evaluation of a refurbishment scheme incorporating the King's Fund “Enhancing the Healing Environment” design principles

Purpose – In 2000, a national initiative “Enhancing the Healing Environment” (EHE) was launched by the Kings Fund to celebrate the millennium. This aimed to support nurse‐led teams to undertake an environment improvement programme in their National Health Service (NHS) hospital. Sheffield Care Trust (SCT) decided to carry out this project in its intensive treatment suite, a psychiatric intensive care unit (PICU) providing care for up to six patients. There were no known examples of an EHE project being undertaken in a PICU elsewhere in the NHS. The purpose of this paper is to examine the impact of EHE design principles in improving the patient experience, from the perspectives of staff and patients.Design/methodology/approach – A focus group and individual interviews were used as the primary method of data collection. Secondary data comprised sets of statistics related to pre‐ and post‐refurbishment periods.Findings – It was found that staff and patients liked many aspects of the changed environment. Sta...

A revised approach to performance measurement for health-care estates

The purpose of the research was to show how lean asset thinking can be applied to UK health-care facilities using different measures to compare the estates contribution to the business of health-care providers. The challenge to conventional wisdom matches that posed by ‘Lean Production’ to ‘Mass Manufacturing’. Data envelope analysis examined the income generated and patient-occupied area as outputs from the gross area of a NHS Trusts estate. The approach yielded strategic comparisons that conventional facilities management measures of cost per square metre hide. The annual cost of an excess estate is conservatively estimated at £600,000,000 (in England alone). Further research to understand the causes of the excess is needed. Meanwhile the research illustrates the power of an alternative way of assessing facilities performance. The authors are not aware of the lean asset perspective previously being applied to health-care facilities. The research shows the underlying fallacy of relying on cost per square metre as the primary measure of asset performance. The results and discussion will be particularly useful to senior estates and facilities managers wishing to use new measures to define strategic estates targets.

Agenda for Change: views and experiences from estates and facilities staff

Purpose – Agenda for Change is the biggest reform of staff pay in the UK National Health Service (NHS) since it began in 1948. As well as introducing a standardised pay structure; it also aims to improve recruitment, retention and staff morale. The aim of this study is to look in‐depth at the experiences and opinions of a range of estates and facilities staff surrounding Agenda for Change during the implementation period.Design/methodology/approach – Focus groups were used as the primary method of data collection in an attempt to tap into the views and opinions of staff working at operational positions in a wide range of trusts.Findings – One of the most important and common themes, which reoccurred throughout the focus groups, was the view that the Agenda for Change framework was designed around the needs of nursing staff. Therefore, the framework did not adequately cater for the needs of estates and facilities staff. Specific concerns related to this included; the role or contribution of estates and fac...

Recruitment and retention of estates and facilities staff in the NHS

Purpose – Agenda for Change is set to be the biggest reform of pay since the National Health Service (NHS) began in 1948. As well as introducing a standardised pay structure; it also aims to improve recruitment, retention and staff morale. Staff groups identified as having recruitment and retention problems include estates/works officers, qualified maintenance crafts persons and qualified maintenance technicians. The object of this research was to investigate recruitment and retention problems for estates and facilities staff currently experienced by Trusts. Design/methodology/approach – Focus groups were used as the primary method of data collection in an attempt to tap into the existing expertise of staff working at strategic and operational supervisory positions in a wide range of Trusts. Findings – Although our findings suggest that the main recruitment and retention issues fall into four main themes: social, financial, environmental and political; recruitment and retention of estates and facilities management staff is a complex problem involving a wide range of issues and these can vary from location to location. Furthermore this should also be seen as a series of issues that varies across employment groups including: domestic/housekeeping, trades, managers/officers and facilities directors, which need to be distinguished. Practical implications – There is a continuing need to raise the profile of estates and facilities management staff in the NHS to those levels enjoyed by Human Resource (HR) and Financial Management. Furthermore perceptions surrounding both recruitment and retention issues and the nature of work within estates and facilities management staff in the NHS can lead to a negative and self-perpetuating “cycle of failure” where there is an assumption of loss of control. However, there are some initiatives being undertaken that suggest it is possible to concentrate on internal matters such as more appropriate and flexible recruitment processes, improved support services for staff and greater flexibility within the job and that these can generate “cycles of success”.