Igal M. Shohet

Healthcare facilities management: state of the art review

Following increases in national demands on healthcare facilities and services, healthcare facilities management (FM) has gradually matured to become an established research and development topic. This paper reviews the state of the art in the main domains related to healthcare FM and defines the central themes in the development of a healthcare FM model. FM, maintenance management and performance management are reviewed in a wider context, and the main domains of healthcare FM are discussed. The five salient topics included in healthcare FM are maintenance management, performance management, risk management, supply services management, and development. These five core domains are interrelated, and can be integrated using information and communications technology, which provides the desired environment required for the challenging decision making and development prevalent in healthcare FM.

Service life prediction of exterior cladding components under standard conditions

The reliability of service life prediction of building components strongly affects the effectiveness of maintenance policy setting. Despite continuous research and development efforts, existing methods still suffer lack of robustness. Typical failure mechanisms in exterior cladding systems, deterioration patterns, and service life limiting coefficients (modifying factors) are identified for a range of failure mechanisms. The method is based on monitoring the physical and visual performance of building components under similar service conditions, at different periods in the building service life. Three types of exterior cladding are studied: cementitious mortar, synthetic rendering, and ceramic mosaic. Failure mechanisms identified include: lack of design details (such as drip‐edge and expansion joints), faulty design under marine environment, exposure to air pollution, and poor workmanship. Three typical deterioration patterns under failure conditions were determined statistically, namely, linear, exponential and logarithmic. The proposed method addresses two issues raised in ISO‐15686 in order to improve the precision and reliability of service life forecasting: (a) modifying factors for quantifying the effect of failure mechanisms are estimated within 80% confidence limits and (b) the prediction models yield high degrees of fit to the data (coefficient of determination values ranging between R 2 = 0.88 and R 2 = 0.96 at a 0.0001 level of significance).

Building evaluation methodology for setting maintenance priorities in hospital buildings

Condition‐Based Maintenance (CBM) is a common solution for the maintenance of large complex facilities under tight economic conditions. Effective implementation of CBM requires the development of performance indicators for building components and systems. The objectives of the proposed methodology are: (1) to monitor the condition of building components, based on systematic performance scales; (2) to develop a parameter that ensures clear detection of building elements that are in failing condition; and (3) to provide a Key Performance Indicator, based on a unified scale, for the comparison of the performance of different buildings. Two rating scales are used: one for the individual components (Pn ) and a second for the entire building – the Building Performance Indicator (BPI). The first scale combines criteria regarding the physical state, performance, fitness for use, and preventive maintenance of various building components. The second scale, the BPI, is a 100‐point scale that covers 10 of the buildings main systems. The proposed methodology was implemented in 17 public health care facilities in Israel. The survey results show that the overall state of the facilities is that of deterioration (BPI = 68.9). One building system, the communication and low voltage system, was consistently found to be in poor condition (Pn = 39.4), four systems (exterior envelope, interior finishing, water and waste‐water, and HVAC) were in deteriorating condition (60d ≤ Pn < 70), and five were in satisfactory or higher condition. Validity of the methodology was tested by means of a survey executed by 14 trained surveyors on the same facility. The variance of the results was relatively slight.

Decision support model for semi-automated selection of renovation alternatives

The initiation of a renovation project usually involves a long process of contemplation under conditions of high uncertainty. Large organizations, that own many buildings and other facilities, can greatly benefit from a decision-support model, which can be transformed to a computerized semi-automatic tool. It will aid them develop and execute a reasonable and economical policy of rehabilitating, renovating, remodeling, or rebuilding their facilities. This paper presents a systematic four-module decision support model: (a) Preliminary survey of background conditions; (b) Evaluation and ranking of the facilitys physical condition; (c) Generation of viable alternatives for rehabilitation, renovation, or reconstruction; and (d) Quantitative techno-economic comparison among the alternatives, and systematic presentation of recommendations. The paper concludes with a demonstrative example, concerning the renovation of a 25-year-old dining facility, that highlights both the practicality of the model and the benefits from utilizing it.

Deterioration patterns of building cladding components for maintenance management

Increasing demands are made on maintenance programmes to provide tools that will support maintenance planning. Among of the most important parameters affecting the efficiency of maintenance management are the precision and the reliability of the predicted service life (PSL) of building components. The main objective of this study was to develop a methodology for the establishment of databases listing deterioration patterns of building components based upon their actual condition. The methodology consists of four steps: (1) identification of failure patterns, (2) determination of the component performance (CP), (3) determination of the life expectancy of deterioration path (LEDP) and (4) evaluation of the predicted service life (PSL). The proposed methodology can be used for planning of maintenance activities, for evaluation of economic implications caused by intensive decay and for maintenance management.

Integrated maintenance monitoring of hospital buildings

The performance of hospital buildings depends to a large degree on the efficiency of maintenance execution. The research objectives were to examine the efficiency of maintenance under alternative maintenance policies and alternative sources of labour (outsourcing vs. in-house). The research focused on maintenance of hospital buildings as a model for multi-system buildings operating in dynamic environments. The research used a systematic field survey followed by an in-depth statistical analysis. Four key performance indicators (KPIs) were developed. The first, the building performance indicator (BPI), indicates the physical-functional condition of buildings. The second, the manpower sources diagram (MSD), reflects the efficiency of using in-house labour vs. the outsourcing of labour. The third, the maintenance efficiency indicator (MEI), is based on the annual costs of maintenance, the building age coefficient and the building occupancy coefficient. This indicator reflects the efficiency of usage of the resources (labour, outsourcing, materials and spare parts) in maintenance. The fourth indicator deals with the organizational structure of the maintenance division. The proposed KPIs integrate four aspects of hospital facilities management: performance management, composition of labour, efficiency of main-tenance operations and organizational effectiveness. Efficient execution of maintenance management of hospital buildings may be obtained by the simultaneous implementation of the aforementioned KPIs. The proposed indicators may be adapted to other types of facilities, such as office buildings, industrial plants and infrastructure.

Development of an integrated healthcare facilities management model

The increasing competitiveness in the business sector forces facilities managers in reducing expenditure on “non‐core” activities. Consequently, the integration of different domains related to facilities management (FM) motivates the development of a quantitative model, which may contribute both to the planning of FM activities and to the improved effectiveness of FM units. Three methodologies were used in the research presented in this paper: a structured FM survey conducted among acute care facilities in Israel; a statistical analysis of the data; and the conceptual development of an FM model. The proposed model is divided into three main phases that deal with the following five main FM domains. The outcomes of the model produce a set of variables, which can be analysed according to a given facility. In addition, the model provides guidelines for the methodological design and management of healthcare facilities from a life‐cycle perspective.

Key performance indicators for maintenance of health‐care facilities

Maintenance management of health care facilities is one of the more complex subjects in the field of maintenance. The performance of hospital buildings is affected by numerous factors, including quality of hospital maintenance, actual occupancy vs standard occupancy, age of buildings, surrounding infrastructures, etc. The purpose of this research was to quantify the effects of users, building parameters and systems on the performance and maintenance of hospital buildings. The following factors were investigated: overall performance of the building; age of the building; level of building occupancy; and extent of labor outsourcing. The effects of the above parameters and variables were examined and quantified, employing coefficients and diagrams, using analytical and statistical analysis. The coefficients and diagrams developed were integrated into four key performance indicators for hospital buildings. The model was tested on six case studies, one of which is presented here.

Integrated healthcare facilities maintenance management model: case studies

Purpose – Increasing demand for healthcare services world‐wide creates continuous requirements to reduce expenditures on “non‐core” activities, such as maintenance and operations. At the same time, owners, users, and clients of healthcare expect a high level of built‐facilities performance and minimized risks. The objective of this research is to develop an integrated facilities management (FM) model for healthcare facilities.Design/methodology/approach – The paper presents a case study analysis of an Israeli acute care hospital, in which the integrated healthcare facilities management model (IHFMM) was implemented, and the findings were examined and evaluated three years later. The case studies investigated the effectiveness of the developed model in terms of maintenance and performance management. The robustness of the model was also examined by applying sensitivity analyses to its parameters.Findings – Both of the case studies show significant results in predicting FM‐related aspects, such as the level...

On the effect of service life conditions on the maintenance costs of healthcare facilities

Global competitiveness and increasing performance requirements have placed facilities management (FM) under constraints of limited resources, particularly in non‐core aspects of facilities, such as maintenance and operations. The hypothesis applied in this research is that the actual service life of buildings, their occupancy and their ambient environmental conditions affect the required maintenance resources of these facilities. The objective was to develop a facility coefficient aiming to adjust the allocation of maintenance resources to prevailing service conditions in healthcare facilities. The research uses deterioration patterns and predicted service lives of building components and systems under moderate, standard and intensive occupancy and under two categories of environment: marine and inland. In total, five configurations combining occupancy and environmental conditions were investigated through simulations and compared to a reference configuration defined as standard occupancy and inland environment along with a building designed service life of 75 years. The findings of the simulations show that maintenance resources in healthcare facilities vary between −9% and +18% of the standard configuration. The simulation results can be used for reliable allocation of resources for maintenance of healthcare facilities. Findings can be adapted for residential, office, public and educational facilities.