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Weekly UpdatesThe research method included the following phases:
1. Field survey (data gathering): carried out with a structured questionnaire, designed to identify core parameters for management of healthcare facilities;
2. Statistical analyses of the data collected in the field survey: revealed the main parameters affecting the field of healthcare facility management;
3. Conceptual development of the decision-making model (IHFMM): the five core themes of healthcare FM were identified;
4. Computing of the decision-making model: described in detail in the following paragraphs; and
5. Feasibility evaluation of the model: implementing the model in two case studies in Israeli public acute-care hospitals. Sensitivity analyses were carried out to examine the sensitivity of the results to variations in the model's parameters.
4. THE INTEGRATED HEALTHCARE FACILITY MANAGEMENT MODEL (IHFMM)
Architecture of the Model
This section delineates the architecture and rationale behind the Integrated Healthcare Facility Management Model (IHFMM). A comprehensive model should deal with all aspects of healthcare FM, as mentioned in the background literature (Shohet and Lavy, 2004b) and shown in Figure 1. Some components have already been developed in other studies, such as the development of the facility. Shen and Lo (1999), and Shen and Spedding (1998), for instance, offer a model that prioritizes maintenance tasks by weighing six criteria, three of which are physical condition, importance of usage, and cost implications. This can be used as a decision-support tool while planning maintenance projects. Likewise, in the framework of this research, only the first two modules of the IHFMM (maintenance management and performance and risk management) were thoroughly investigated as a decision-support tool. In addition, the relationships between the two modules' parameters were studied.
[FIGURE 1 OMITTED]
The model proposed in this research provides insight into the assessment of parameters that affect maintenance management, and performance and risk management in healthcare facilities. The proposed model is divided into three main interfaces: Input Interface, Reasoning Evaluator and Predictor, and Output Interface, which are subdivided into five phases (A to E), as described in the following paragraphs.
The Input Interface
The Input Interface is subdivided into two phases: (A) Facility phase; and (B) Buildings, systems and components phase. In these two phases, a variety of input parameters relevant to the facility in question are required of the user. This interface requires general data about the facility (e.g., type of facility [principal/peripheral], availability of labor, designation of areas with the facility [medical wards, utilities, outpatient clinics, laboratories, offices]), as well as specific data for each particular building and system in the facility (e.g., actual age and required service life of buildings, actual and required performance for components and systems, and actual maintenance policies). This interface uses a database of building components for each sampled building, for which the reinstatement value (cost of reconstruction) per sq-m of floor area, Designed Life Cycle, replacement cost per sq-m, and annual maintenance costs are given. The Input Interface also employs several databases, such as the pattern of deterioration for each of the building's main components.
The first phase of the Input Interface (Phase A) deals with general data from the facility; while the second (Phase B), deals with particular data from each building surveyed. These two phases are further subdivided into the following four layers: Phase A includes Layer 1--Facility: general data about the facility (type of facility, geographical location, number of patient beds, and availability of labor). Phase B is subdivided into three layers. These layers represent the input of particular data for each building, where each layer refers to a different aspect of the facility. The first layer in this phase, Layer 2--Building, deals with aspects related to the design parameters of the surveyed buildings (such as floor area per building, actual age of buildings, and required service life of buildings). Layer 3--System--deals with maintenance and required performance of each particular building system. Each building was broken into 10 building systems, for which the following information is needed: maintenance policy per building system, required level of performance score, and the level of risk attributed to the system's physical performance score. The last layer in this phase, Layer 4--Component, addresses the particular components in the different building systems. This layer requires information such as reinstatement value of each component, its annual maintenance and replacement costs, and its actual physical performance score. Some of the data is collected simultaneously at two layers; for example, annual maintenance expenditure is analyzed at both the facility level (for measurement of overall effectiveness of maintenance activities at this level) and at the component level (identifying effectiveness of maintenance for a particular component). The Input Interface is designed according to a deductive reasoning approach, i.e. from the general facility level to the specific components level. It begins by acquiring general facility data, then buildings and systems, and finally it acquires particular and detailed data about the specific components.
The Reasoning Evaluator and Predictor Interface
The Reasoning Evaluator and Predictor Interface is both the mind and the heart of the developed model, since it includes the calculating, analyzing, and deducing stages of the facility's Key Performance Indicators. This interface includes a single phase--Key Performance Indicators (Phase C)--in which the different procedures of the IHFMM are implemented. This phase is composed of 15 procedures, based on previous studies and on the statistical analyses of the field survey carried out in the preliminary stages of the current research (presented and discussed in Shohet and Lavy, 2004a). The Reasoning Evaluator and Predictor Interface measures and predicts KPI's of maintenance, performance, and risk for the facility, the buildings, the systems, and their components. Thus, a set of outcomes and recommendations is deduced, as described in the following paragraphs.
The scheme of the Reasoning Evaluator and Predictor Interface is presented in Figure 2. As seen in Figure 2, this interface is sub-divided into three hierarchical layers, i.e. the procedures are implemented and computed from Facility Parameters (Layer 5), through Actual Indicators of the facility FM (Layer 6), to Prediction Indicators of facility performance (Layer 7).
[FIGURE 2 OMITTED]
The Facility Parameters layer (Layer 5) implements seven procedures that calculate and determine the following parameters in the surveyed facility: (1) facility coefficient calculates an economic coefficient that assesses the amount of resources allocated on an annual basis for implementing annual maintenance activities (as detailed in the following paragraphs); (2) facility area calculates the total surveyed floor area; (3) Total Annual Maintenance Expenditure (TAME) indicates the sum of actual annual maintenance expenditure spent for the whole facility; (4) required performance indicator shows the required level of performance (as set by the facility manager) for the different buildings and systems on-campus, as measured on a 100-point scale (Shohet et al., 2003); (5) building systems' weights in the performance indicator calculates the economic weights (based on Life Cycle Costs analysis) with which the systems in each surveyed building are weighted in the different performance indicators; (6) Building Importance Indicator (BII) indicates the priority setting according to which the surveyed buildings are prioritized for maintenance, as defined by the facility manager; and (7) building systems' weights in the risk indicator shows the potential risk involved in the maintenance of different building systems, defined by a combination of parameters, such as the area of the building and the vitality of the system (for example, medical gases and fire protection systems ought to be in a much higher risk category than the interior finishes and the exterior envelope systems).
As seen in Figure 2, some of Layer 5's outputs are used by Layer 6 (Actual Indicators layer), including the following four procedures.
(1) Maintenance Efficiency Indicator (MEI) indicates the efficiency with which maintenance activities are implemented (as detailed in the following paragraphs).
(2) Annual Maintenance Expenditure is the annual resources allocated for maintenance activities per building.
(3) Building Performance Indicator (BPI) indicates the actual performance of the surveyed buildings on a 100-point scale, weighted according to their systems' and components' shares in the building's Life Cycle Costs (as weighted in procedure no. 5 in Layer 5). The BPI score is measured by using previously defined performance scales (Shohet, 2003). An example of the scales used for measuring performance is given in Appendix A, where a given scale for exterior cladding system performance rating is presented. A similar scaling system was used to evaluate the level of performance of 51 components in a building.
(4) Actual risk indicates the actual levels of risk with regard to each of the systems in the surveyed buildings, defined by a default set of rules that can be modified by the user and measured on a 5-point scale (Very Low, Low, Moderate, High, and Very High).
The main outcomes of this interface are shown in Layer 7--The Prediction Indicators layer, which constitutes four procedures for computing the following projections for FM planning of a facility: (1) Projected Annual Maintenance Expenditure (PAME) per built sqm of floor area in a facility--this procedure computes the annual maintenance expenditure required to perform a given maintenance policy under a given condition of the facility; (2) projected performance indicator for different components, systems, buildings, and for the entire facility--projects the future physical condition of the facility, buildings, and systems for a given actual condition and a given maintenance policy; (3) projected level of risk involved in maintaining the buildings--projects the level of risk of systems and buildings for a given actual physical condition and risk, and a given maintenance policy; and (4) policy setting, to compare the surveyed facility with other similar facilities, based on "best practice cases."
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