A strategic Integrated Healthcare Facility Management Model.

ABSTRACT. The requirement to reduce expenditure on "non-core" activities, along with building's owners' expectations for improved performance, are the main dilemmas with which a facility manager deals on a regular basis. The primary objective of this research was to identify the effect of defined parameters, such as the actual age of a building and its level of occupancy, on the performance of facilities and their systems. This study contributed to the development of a model capable of integrating these parameters into a Facility Management (FM) tactical and strategic decision-making process, referred to as the Integrated Healthcare Facility Management Model (IHFMM). The model's guidelines may be outlined for the methodological design and operation of facilities from a life cycle perspective. The paper presents the architecture of the developed model, and four of the 15 procedures that comprise the heart of this model.

KEYWORDS: Healthcare; Facility management; Occupancy; Performance; Service life planning

SANTRAUKA

STRATEGINIS INTEGRUOTAS SVEIKATOS PRIEZIUROS PASTATU UKIO VALDYMO MODELIS

Reikalavimas mazinti "neesmines" veiklos islaidas bei pastato savininku lukesciai del geresniu rezultatu--su tokiomis pagrindinemis dilemomis reguliariai susiduria pastatu ukio valdymo vadybininkas. Sio tiriamojo darbo pagrindinis uzdavinys yra nustatyti, koks yra apibreztu parametru, tokiu kaip realus pastato amzius ir jo uzimtumo lygis, poveikis pastatu ir ju sistemu rezultatyvumui. Sis tyrimas prisidejo kuriant modeli, kuris leidzia siuos parametrus integruoti i taktiniu ir strateginiu pastatu ukio valdymo sprendimu priemimo procesa ir yra vadinamas integruotu sveikatos prieziuros pastatu ukio valdymo modeliu. Modelio rekomendacijas galima taikyti vykdant metodologini pastatu projektavima ir eksploatavima is gyvavimo ciklo perspektyvos. Siame darbe pristatoma sukurto modelio architektura ir keturios is penkiolikos proceduru, sudaranciu sio modelio serdi.

1. INTRODUCTION

Increased competition in the business sector drives companies to reduce expenditures on "non-core" activities. At the same time, buildings' owners and users have increased their expectations and requirements of facilities. These competing demands are the main dilemmas with which a facility manager deals on a regular basis.

Five processes have led the area of facility management (FM) to become one of the most important for business success: (1) increased construction costs, particularly in the public sector; (2) greater recognition of the effects of space upon productivity; (3) increased performance requirements; (4) contemporary bureaucratic and statutory restrictions that decelerate start up of new construction projects; and (5) performance of high-rise buildings that are highly dependent on maintenance (Shohet, 2005). Consequently, the traditional "maintenance manager" has become a "facility manager," and is a key individual in an organization's continuity and success. The facility manager is responsible for making critical strategic and operational facilities-planning decisions that affect the organization's business performance. This is particularly true in healthcare facilities, considered one of the most complicated and difficult types of facilities to manage, maintain, and operate. The facility manager must make daily decisions in numerous areas, such as maintenance policy, level of performance, sources of labor, acceptable level of risk, etc.

This paper presents the principles and the architecture of the Integrated Healthcare Facility Management Model (IHFMM). The IHFMM model is composed of 15 procedures that have been developed within the framework of this research. The paper, however, describes the outlines according to which four key procedures (out of the 15 composing the model) were developed.

2. LITERATURE BACKGROUND

Facility management has traditionally been regarded in the old-fashioned sense of cleaning, repairs and maintenance (Atkin and Brooks, 2000; Regterschot, 1990) while FM responsibilities were defined as "buying, selling, developing and adapting stock to meet wants of owners regarding finance, space, location, quality and so on" (O'Sullivan and Powell, 1990). Nowadays, facility management is known as "an integrated approach to maintaining, improving and adapting the buildings of an organization in order to create an environment that strongly supports the primary objectives of that organization," as well as to achieve a balanced, high performing organization (Barrett, 2000). Then (1999) recognizes that "the FM role is to meet the business challenges that confront the organization it is supporting, for reaching the optimum balance between people, physical assets and technology."

Healthcare facility management topics are discussed widely in the literature. Natural population growth, aging of the population, and the consumer revolution have all increased the demand for health services in public hospitals (Hosking and Jarvis, 2003). Consequently, the total number of in- and out-patient admissions has increased. In order to deal effectively with the increased number of in-patient admissions, and as a result of their limited resources, hospitals have reduced the average length of stay (AHA, 2004; Federal Statistical Office Germany, 2003). These trends have led to an increasing investigation of the structure of healthcare systems and facility management decision-making in this industry. Melin and Granath (2004) conducted a study in Sweden on the effect of "Horizontal Integrated Care" (HIC deals with ways that care is delivered to patients) on facility management; Payne and Rees (1999) discuss the importance of an integrated facility management system in hospitals; Procter and Brown (1997) present a case study in which an information support system was implemented in a hospital in the UK; and Waring and Wainwright (2002) discuss the significance of implementation of Information and Communication Technologies (ICT) in the National Health Service (NHS) facility management system.

Examination of FM in the healthcare sector exposes an underinvestment in the allocation of resources (AHA, 2004; British Ministry of Finance, 2003). This lack of attention might adversely affect the non-core activities of healthcare providers, and particularly facility management aspects, such as maintenance activities and operations.

Drivers of healthcare facility management are discussed extensively in the literature. Gallagher (1998), for instance, defines the following six issues as encouraging successful implementation of healthcare FM: strategic planning, customer care, market testing, benchmarking, environmental management, and staff development. Amaratunga et al., (2002) define the following attributes as key processes for successful implementation of FM: service requirements management, service planning, service performance monitoring, supplier and contractor management, health and safety processes, risk management, and service coordination. Shohet and Lavy (2004b) identify the following five core domains (the "pentagon") within the area of healthcare facility management: maintenance management, performance management, risk management, supply services management, and development. Information and Communications Technologies (ICT) is treated as an integrator among all five domains. These healthcare facility management core domains are closely interconnected, and a modification of any one affects the others. The model this paper presents is composed of the five core domains of healthcare FM defined above as the pentagon of healthcare FM.

The problem of healthcare facility management is characterized by the existence of different types of data, including both quantitative data (e.g. maintenance resources, physical performance, and energy consumption), and data that require a means of quantification for implementation in FM (e.g. type of facility, and maintenance policy). Moreover, data for most healthcare facilities studied in extant research was partially missing or incomplete. Furthermore, the type of solution and the reasoning mechanism for FM policy setting and decision-making involves integrating statistical knowledge of the phenomenon with previous experience and heuristics of other cases. As a result, the Structural Case-Based Reasoning approach was found to be the most appropriate technique for solving healthcare FM decision-making problems.

3. OBJECTIVES