Construction Management and Economics ( January 2004) 22, 25–34
Integrated maintenance management of hospital buildings: a case study SAREL LAVY and IGAL M. SHOHET1* Faculty of Civil and Environmental Engineering and 1the National Building Research Institute, Technion – Israel Institute of Technology, Haifa 32000, Israel Received 26 June 2002; accepted 17 January 2003
Over the course of the past three decades, facilities management has become the subject of an increasing number of research and development efforts. The main objective of the present research was to examine the efficiency of maintenance under alternative maintenance policies and different sources of human resources. The research focused on the maintenance of public hospital buildings in Israel, with the objective of providing a model for multi-system facilities operating in a dynamic environment. This paper describes the last three stages of the research: the establishment of key performance indicators, the implementation of these indicators in a case study in order to appraise them, and the validation of the indicators. Four key performance indicators were developed, as follows: the Building Performance Indicator (BPI), the Manpower Sources Diagram (MSD), the Maintenance Efficiency Indicator (MEI) and the Managerial Span of Control (MSC). This paper illustrates a case study in which the four developed indicators were implemented in practice. Characteristics of the case study hospital are presented and analysed. Finally, the conclusions and recommendations drawn from the analysis of the hospital case study are discussed, validated and deliberated upon. The approach presented in this paper integrates performance, financial, human resources and organizational aspects to facilitate an improved evaluation method of the parameters affecting the execution of maintenance activities. Keywords: Facilities management, key performance indicators, maintenance, outsourcing, performance-based building
Background With the beginning of the 21st century, property is recognized as a large capital-centre which can contribute to competency and profit and, as such, needs to be effectively managed (Douglas, 1996). Facilities management (FM) is perceived as the management of non-core company assets (Nelson and Alexander, 2002). It includes the built space, services, technology, maintenance, modification and adaptation, function and use, security, comfort, environmental health, costs and benefits of occupancy. FM provides procedures to integrate decisions across the physical, human and financial areas of concern, all for the improvement of use, performance and productivity of facilities (Nutt, 1999; Atkin and Brooks, 2000). FM *Author for correspondence. E-mail:
[email protected]
is therefore taken to be the co-ordinating management function that concentrates on the interface between the physical workplace and people and, as a consequence, successful FM highly depends on cost and efficiency. Managers of these facilities are dictated to be capable of dealing with a wide range of issues, such as round-theclock operation, high performance, composition of human resources and limited budgets (Tay and Ooi, 2001). The first part of this paper describes the development of maintenance indicators for the examination of the performance and efficiency of the work patterns of maintenance departments in healthcare facilities. These indicators are based on the findings of field surveys conducted on hospital campuses in Israel. The second part of the paper introduces a case study in which the developed indicators are examined on a specific hospital campus. In this case study a hospital characteristics are
Construction Management and Economics ISSN 0144-6193 print/ISSN 1466-433X online © 2004 Taylor & Francis Ltd http://www.tandf.co.uk/journals DOI: 10.1080/0144619042000186031
26 presented and analysed. This analysis sheds light on various parameters of the hospital facility that led to the conclusions and recommendations for the improvement of its performance. At the end of this paper, the proposed indicators are validated by six experts, in order to evaluate their contribution to the practice. Overview The British Institute of Facilities Management (BIFM) (2001) defines the term facilities management as ‘The integration of multi-disciplinary activities within the built environment and the management of their impact upon people and the workplace’. The International Facilities Management Association (IFMA) (2001) describes FM as the ‘Practice of coordinating the physical workplace with the people and work of the organisation’. Barrett (1995) defines FM as ‘An integrated approach to maintaining, improving and adapting the buildings of an organisation in order to create an environment that strongly supports the primary objectives of that organisation’. Facilities management can be subdivided into five core themes (Quah, 1992; Barrett, 1995): (1) facility planning and management; (2) building operation and maintenance; (3) real estate and finance; (4) human and environmental factors; and (5) risk evaluation. As is evident, building operation and maintenance was defined as one of the core themes of FM. This theme includes performance management and benchmarking. The performance concept is the practice of designing and working in terms of end requirements rather than in terms of means (Becker, 1999). Performance-Based Building (PeBBu) is based on (1) translating human needs to user requirements; (2) transforming requirements into technical requirements and quantitative criteria that do not dictate the solution; and (3) responding to these requirements along the life cycle of the building. Neely (1999) suggests seven main answers to the question: why should performance be assessed? These motives include increasing competition, changing of organizational roles and changing of external demands. The main argument against measuring performance is that ‘there remains a lack of agreement across the FM field in relation to the nature and terminology for performance indicators’ (Hinks, 2002). Amaratunga and Baldry (2002) argue, however, that the objective of FM should be not merely to optimize operational costs of buildings, but also to increase the efficiency of management of related assets for the benefit of people and processes. Wyatt (2000) defines the ‘performance audit’ as the systematic objective reviewing of documented evidence of outcomes (performance) and a comparison between the stated performance and the evident performance. Miyamoto et al. (2000) demonstrate an application of such an audit, while developing an expert system for the evaluation
Lavy and Shohet of the performance of bridge members, on a scale of 0 to 100. Pullen et al. (2000) propose seven key performance indicators (KPIs) that provide benchmarks for the asset management of medical facilities. The seven indicators are as follows: (1) proportion of hospital revenue allocated to facility management expenditure; (2) ratio of the number of services provided to total energy costs; (3) ratio of the number of services provided to gross floor area; (4) asset productivity 1 (with regards to the capital replacement value); (5) asset productivity 2 (with regards to the net present value); (6) ratio of income to floor area; and (7) ratio of energy to functional area hours of operation. Most of these indicators (numbers 1, 4, 5 and 6) deal with business or financial performance and therefore apply primarily to private-sector medical facilities, which were not included in this study. Furthermore, these indicators are not sufficient for our purposes since the remaining indicators do not refer to factors such as building performance, intensity of use, sources of human resources, etc. The research methodology of examining a theory by implementing it on case studies is discussed at length in the literature. Stake (1995) explains that the case study research method was developed to fulfil our interest in a case for both its uniqueness and commonality. It is expected to capture the complexity of a single case, while relating to it as one among many. Yin (1993, 1995) claimed that the case study methodology is also a distinctive evaluation tool in its ability to capture and to assess processes and outcomes in a causal logical model. In this way it may provide useful feedback and be used to develop practical lessons for the major themes in the field. This survey of prominent research in the field of FM elucidates the need to investigate the role of multiple factors, e.g. occupancy level, building’s age, human resources composition, etc., that are involved in the operation of complex facilities. Research objectives and methodology The main objective of the present study is to examine the efficiency of maintenance under alternative maintenance policies (breakdown, preventive, and condition-based maintenance) and using different sources of human resources (outsourcing vs. in-house provision). The research focuses on the maintenance of hospital buildings in Israel, with the objective of providing a model for
Maintenance management of hospital buildings multi-system facilities operating in a dynamic environment. The research methodology consisted of the following seven-stage scheme: (1) (2)
(3) (4)
(5)
(6)
(7)
critical literature survey; field survey, using a structured questionnaire and systematic evaluation of hospital building performance; statistical analysis of data obtained in the field survey; development of quantitative indicators for maintenance of hospital buildings systems, based on the results of the statistical analysis; establishment of key performance indicators for maintenance management of hospital buildings; application of the above indicators to case studies, in order to appraise the indicators developed; and validation of the KPIs in a survey of six FM experts on six different cases.
This paper describes the final three stages of the research, whereas a previous paper describes the background and the theory in detail (Shohet et al., 2003).
Key performance indicators of maintenance The principal objective of this research is to develop quantitative management indicators for the examination of hospital building performance and budgeting of their maintenance activities. With this in mind, four indicators were developed: (1) the Building Performance Indicator (BPI); (2) the Manpower Sources Diagram (MSD); (3) the Maintenance Efficiency Indicator (MEI); and (4) the Managerial Span of Control (MSC). The main rationale and composition of each of the indicators are presented below. Building Performance Indicator (BPI) The Building Performance Indicator monitors the physical state and fitness for use of building and of its various systems, based on quantitative criteria. Each of the building’s systems is evaluated on a performance rating-scale from 0 to 100, which expresses its physical and functional (performance) states. The BPI value reflects the performance level of the building in question: When BPI > 80, the state and resultant performance of the building are good or better; 70 < BPI ≤ 80 indicates that the state of the building is such that some of the systems are in marginal condition; 60 < BPI ≤ 70 reflects deterioration of the building; and BPI ≤ 60 means that the building is run-down. Shohet (2003) presents the evaluation methodology in detail.
27 Manpower Sources Diagram (MSD) The Manpower Sources Diagram expresses the composition of the maintenance personnel, i.e. in-house provision vs. external contractors (outsourcing). The rationale behind the development of this diagram was the need to examine the costs of the various work sources and their ratio. In this study, it was found that when hospital occupancy levels were standard or lower, outsourcing resulted in a saving of 8%. On the other hand, where hospital occupancy levels were higher than planned, the use of in-house provision led to a 6% saving in maintenance expenditures. Thus, by applying the MSD for a particular case, the way to an improved balance of labour can be deduced (Shohet et al., 2003). Maintenance Efficiency Indicator (MEI) The Maintenance Efficiency Indicator examines the maintenance inputs, as calculated on the basis of the Annual Maintenance Expenditure (AME) with respect to the physical and performance state of the building, as expressed by the BPI. The MEI provides a quantitative indication of the efficiency with which available resources are spent. Two additional factors are taken into account when calculating the relationship between the maintenance budget and the building’s performance, namely the building’s age (age coefficient, ACy) and its occupancy level (occupancy coefficient, OC). A previous paper (Shohet et al., 2003) explains and discusses the rationale and calculation techniques of these two coefficients. Equation 1 describes the calculation of the Maintenance Efficiency Indicator: MEI =
AME 1 1 × × ×i AC y BPI OC c
(1)
where MEI is the Maintenance Efficiency Indicator ($US/(m2 × BPI unit)); AME is the actual Annual Maintenance Expenditure ($US/m2); ACy is the age coefficient for year y; BPI is the monitored Building Performance Indicator; OC is the occupancy coefficient; and ic is the prices index. The calculated MEI may take on values greater than or equal to 0. The significance of the MEI values in hospital buildings is as follows: (1)
MEI values below 0.37 represent a state in which the budgetary investment is low, or the utilization efficiency of maintenance resources is high, or both. (2) MEI values between 0.37 and 0.52 represent the desirable situation for a maintenance department, indicating reasonable utilization of maintenance resources. Nevertheless, the effectiveness of resource utilization must be assessed using
28
Lavy and Shohet Table 1
Summary of hospital characteristics: a case study Value
Variable Built-up area (m2) Number of actual patient beds Average occupancy (number of beds per 1000 m2) Equivalent average age of the buildings (years) Annual external contractors’ budget (103 $US) Annual personnel budget (103 $US) Annual materials budget (103 $US) Total annual maintenance budget (103 $US) Annual maintenance expenditure ($US per m2) Annual maintenance budget per patient bed ($US) Average annual maintenance budget (% of reinstatement value) Total number of internal employees (Maintenance Dept) Actual Managerial Span of Control – Principal Engineer’s level
the BPI, the MSD and the MSC, as described hereafter. (3) MEI values above 0.52 indicate high inputs relative to the actual performance. Such high values may express high maintenance expenditure, or low building performance, or a combination of these two extreme situations. It should be emphasized that the above-mentioned ranges of MEI values are subject to change, depending on the type of building: the more complicated the building, the wider the ranges of values, and vice versa. Managerial Span of Control (MSC) The Managerial Span of Control is defined as the ratio between the number of managers and the respective number of personnel directly subordinated to them. The span of control is a managerial parameter, which reflects the ability of a manager (or managers) to achieve coherence among the various parts of the organization (Laufer and Shohet, 1991; Mintzberg, 1981). This indicator may assist, in certain cases, in the identification of states of lack of control and communication deficiencies in the organization and administration of maintenance in hospital facilities (Shohet et al., 2003). The proposed indicators must be simultaneously used in order to obtain a complete diagnosis of the hospital facility maintenance. A case study, in which a hospital facility is analysed using the aforementioned indicators, is presented below.
Case study The developed indicators were implemented on the basis of five case studies examined in the course of this research. One of the more interesting cases is presented in detail in this paper. The following paragraphs review
114 880 1065 9.27 23 2205 (49.9%) 1740 (39.4%) 475 (10.7%) 4420 (100%) 38.5 4150 2.29 58 7
the background and the analysis of a hospitalization facility. Hospital characteristics Table 1 presents a summary of the hospital characteristics in the case studied. The total built-up area of the hospital in question and the number of patient beds revealed that the average occupancy in this hospital was 9.27 beds per 1000 m2 built-up. The designed standard occupancy level in hospital buildings is defined as 10.0 patient beds per 1000 m2, which means that this hospital is occupied at a level lower than standard. The Annual Maintenance Expenditure (AME) was found to be $US38.5 m-2 (in 1999 values), or $US4150 per patient bed. The distribution of this budget shows that almost half (49.9%) was spent on maintenance performed by outsourcing contractors, while 39.4% was allocated to internal maintenance personnel. The rest of the budget (10.7%) was used to acquire materials and spare parts. The total number of internal employees engaged in maintenance works was 58. This means a ratio of one internal maintenance worker per 1980 m2 of built-up area, or, alternatively, a single internal worker per 18.4 patient beds. This ratio is more than 20% lower than the average ratio of the sample population, which was found to be one internal worker per 1560 m2 of built-up area, or a single internal worker per 12.9 patient beds. The formal MSC on the Principal Engineer’s level was three subordinates (cost accountant, quality assurance officer and maintenance manager). However, the maintenance manager’s position was unoccupied, so that the actual MSC was seven subordinates (cost accountant, quality assurance officer, electrical engineer, air-conditioning engineer, water and plumbing engineer, and civil engineer). Table 2 presents the distribution of the maintenance workers by profession. The professional profile of the maintenance workers reveals two main trends: on the one hand, a surplus of
Maintenance management of hospital buildings Table 2
29
Maintenance employees (by profession)
Profession Electricity Water and plumbing Air-conditioning Metal workshop Carpentry workshop Medical gases Other (Principal Engineer, engineers, and staff) Total number of employees
Number of employees 16 11 7 6 5 3 10 58
electricity (16) and water and plumbing (11) workers, while on the other hand, a shortage of building workers in the different building professions (six metal workshop and five carpenters). The general, financial and organizational data were gathered simultaneously with the survey of the building systems’ conditions, performance, failures and maintenance policies. A summary of the Building Performance survey and the resultant BPI (Building Performance Indicator) are presented in Table 3. The Building Performance survey made it clear that the entire facility was in a run-down condition. The main systems that exhibited poor performance and maintenance levels were Low-voltage and communication, Interior finishes, HVAC, Electricity, and Exterior envelope. Only three building systems were found to be in satisfactory or good condition (Fire protection, Medical gases and Elevators). Analysis of a hospital using the indicators developed The BPI in the above-described case study indicates a deteriorating state of the building (BPI = 66.1). The AME of $US38.5 m-2, coupled with the buildings’ age Table 3
coefficient (ACy = 1.2884) and the buildings’ occupancy coefficient (OC = 0.9810) led to a MEI value of 0.46. This value expresses reasonable use of maintenance resources. It can be seen from the MEI that the BPI of the campus correctly reflects the annual level of resources allocated to maintenance. Despite the sufficient MEI value, the AME seems to be low, i.e. an increase in resources allocated to maintenance is required in order to improve the run-down condition of the building, as reflected by the BPI. Maintenance human resources costs were composed of 44% in-house provision vs. 56% outsourcing. The average occupancy in this hospital (lower than standard), together with its location in a metropolitan area where the availability of outsourcing is high, appears to justify the observed composition of labour. Moreover, the worker-m-2 ratio in this facility, in comparison with the average ratio, may indicate a shortage of internal maintenance workers. Expansion of the internal maintenance department, however, should be executed together with an increase in the budget for external contracting. The actual MSC at the Principal Engineer’s level is seven subordinates, while the maintenance manager job is unoccupied. This means that the Principal Engineer’s MSC is too wide. This situation apparently seems to save overhead expenses, although in this case it actually leads to difficulties in the Principal Engineer’s control. Instead of ‘managing’ the maintenance department, he has to confront problems, on a daily basis, which can and should be dealt with on the maintenance manager’s level. Figure 1a presents the actual maintenance and performance condition in a two-dimensional presentation, in which the horizontal axis represents the Building Performance Level (BPI), and the vertical axis represents the supplementary budget. The graphs represent the respective MEI levels.
Building systems: failures and performance rating – a case study
Building system Fire protection Medical gases Elevators Sanitary systems Skeleton Exterior envelope Electricity HVAC (heating, ventilation and air-conditioning) Interior finishes
Pn
Special remarks
100.0 100.0 82.9 79.2 72.0 67.7 66.7 65.0
– – Few failures caused by high loads on elevators Few pipe leakages and clogging of sewerage pipelines Non-periodical inspections, breakdown maintenance Leakage from the roof and exterior walls Power failures (6–12 times per year) Failures in tubing, equipment and end-devices caused by high loads on the system Floors and acoustic ceilings in poor condition, non-periodical inspections, breakdown maintenance Many failures in the patient–nurse calling system, non-periodical inspections, breakdown maintenance
56.1
Low-voltage and communications
25.0
Total BPI
66.1
30
Lavy and Shohet
Figure 1 (a) Supplementary maintenance budget vs. Building Performance Indicator for different levels of MEI; (b) Three proposed alternatives for improving hospital performance
In order to enhance the building performance, three alternatives were developed and proposed, as presented in Figure 1b. Alternative 1 Improving the BPI by improving the efficiency level (MEI). This alternative will not require any additional investment, although it supports the implementation of some organizational changes. The first step would be to employ a maintenance manager. This will reduce the Principal Engineer’s span of control, and may increase the department’s effectiveness. Additional required organizational changes can be achieved by restructuring the composition of the various maintenance teams. Table 2 shows that the Electricity team includes 16 workers, and Table 3 reveals that the Electrical system is in a deteriorated condition (66.7). This leads to the conclusion that better performance may be achieved in this system by using a greater proportion of outsourcing and reducing the size of the internal team. Moreover, Table 2 shows two additional small teams that deal with metal works and carpentry, which may cause the performance ratings of the Interior finishes and the Exterior envelope systems to be run-down and deteriorated, respectively (Table 3). In these systems, the findings also lead to the conclusion that outsourcing of maintenance in these areas may improve their performance, as well as that of the entire building, to a resultant BPI level of 68 to 69, with no additional allocation of resources. Alternative 2 Improving the BPI to 70 by preserving the current level of efficiency (MEI = 0.46). This alternative will lead to enhanced building serviceability, despite the fact that its
execution will not improve the deteriorated systems to a sufficient level of performance (Pn = 70). As evident from Figure 1b, this alternative requires an additional capital expenditure of $US2.2 m-2 built-up, i.e. an additional $US1.95 m-2 for labour costs and $US0.25 m-2 for materials and spare parts, resulting in a total supplement of $US250 000, which constitutes a 5.7% increase of the current maintenance budget. This alternative also includes the organizational changes suggested for the implementation of Alternative 1. According to this alternative, the Manpower Sources Diagram options are as follows (Figure 2): Alternative 2A proposes retaining the in-house labour as is, coupled with an increase in the outsourcing budget. On the other hand, Alternative 2D proposes equalization of internal and external resources, which means an expansion of the in-house labour, coupled
Figure 2 Manpower Sources Diagram (MSD) options for Alternative 2
Maintenance management of hospital buildings with a decrease in the outsourcing budget. Alternatives 2B and 2C are two mid-way alternatives between 2A and 2D, which propose either to maintain the current resource composition (Alternative 2B), or to increase the in-house labour component only (Alternative 2C). It is clear from Figure 2 that three of the four proposed alternatives involve an increase in internal sources (Alternatives 2B, 2C and 2D), whilst Alternative 2A is based on retaining their current level. Due to the hospital’s general characteristics (lower than standard occupancy, existing composition of human resources sources, etc.) it is recommended that external sources continue to be relied on, although the internal component may be increased due to the low ratio of maintenance workers per built-up area. The analysis leads the hospital decision-makers to prefer either Alternatives 2A or 2B, or a combination of the two. Alternative 3 Improving all the deteriorated systems to a Pn of 70 (i.e. BPI greater than 70) while preserving the existing level of efficiency (MEI). This alternative will also enhance the building’s performance; however, it requires additional financial and human resources, since many building components must be ameliorated. The implementation of this alternative requires a capital expenditure of $US4.0 m-2 (as can be seen in Figure 1b), i.e. an additional $US3.55 m-2 for labour, and $US0.45 m-2 for materials and spare parts, for a total $US450 000, representing a 10.2% increase over the current maintenance budget. This alternative also includes the organizational changes suggested for the implementation of Alternative 1. The analysis of the different MSD options for Alternative 2 can be adapted to the examination of the human resources under Alternative 3. Conclusions and recommendations There are a number of conclusions that can be drawn from the analysis of the hospital case study. (1)
The Maintenance Efficiency Indicator (0.46) shows that the BPI (66.1) is compatible with the existing annual level of available resources ($US38.5 m-2, or 2.29% of reinstatement value), considering the occupancy level in the hospital and the buildings’ age. (2) Improvement of the BPI may be achieved by one of the following three proposed alternatives. (i) Alternative 1 concentrates on organizational and labour improvements and does not require any additional investment. Implementation of this alternative may improve the BPI by approximately 2–3 points, to a BPI level of 68–9.
31 (ii) Alternative 2 concentrates on organizational improvement, together with an increase in labour resources, and it requires an additional investment of $US250 000. This alternative may improve the BPI by approximately four points, to a BPI level of 70. (iii) Alternative 3 concentrates on organizational improvement, together with a significant increase in labour resources, and it requires an additional investment of $US450 000. Its implementation may improve the BPI by approximately 6–7 points, to a BPI level of 72–3. (3) The scarcity of internal workers (1 worker per 1980 m2 of built-up area) can explain the low BPI level. Thus, a supplement of internal workers is recommended in this case, especially for the following systems: Exterior envelope, Internal finishes, and Communications. (4) A higher level of maintenance efficiency may be achieved by employing a maintenance manager. This will reduce the Principal Engineer’s span of control and, as a result, will decrease the maintenance teams’ dependence on the Principal Engineer. Results expected from the implementation of these alternatives include an improvement in the BPI, which can be achieved by carrying out activities in various building systems, such as Communications, Interior finishes, HVAC and Exterior envelope. Such activities should result in a decrease in the number of failures and should include the administration of routine periodical inspections. Issues of top priority, however, should be determined by both hospital and maintenance policies.
Validation of key performance indicators In order to examine the KPIs, several facilities managers with high acquaintance with the maintenance parameters of the facilities in question took place in a survey of evaluation of the validity of the KPIs for each facility. Each of the managers was given a detailed analysis of the facility in question, with its KPIs and resultant conclusions. The experts were asked to evaluate the precision and the reliability of these KPIs, with regard to their views toward the actual condition of the facility and to its maintenance efficiency. The evaluation was carried out on a five-point scale, in which 1 indicates completely imprecise, and 5 represents highly precise indication of the actual condition in the respondent’s views. The questionnaire was divided into four sections, regarding the precision and reliability of each KPI (BPI, MSD, MEI and MSC), and a couple of concluding
32 Table 4 Category BPI MSD MEI MSC Overall
Lavy and Shohet Validation of KPIs: survey results Mean
Standard deviation
4.17 3.67 4.25 3.71 4.18
0.65 1.14 0.93 0.91 0.75
questions regarding the validity of the results concerning the condition of the entire facility. In total, six facilities managers participated in this survey. The results are summarized in Table 4. The findings depict that among the indicators MEI is evaluated at the highest score (4.25), while the MSD (3.67) and the MSC (3.71) were appraised at the lowest, yet above average, score. The BPI was given a high evaluation of 4.17. In overall, the four developed indicators and the proposed model were given a high evaluation of 4.18 on a five-point scale, with a standard deviation of 0.75. The comments made by the experts suggested that future research effort should be focused on parameters for effective employment of human resources, and on establishing additional quantitative parameters to indicate organizational effectiveness.
Applicability of findings This section discusses the applicability of the proposed KPIs for maintenance management of healthcare facilities through three demonstrative cases.
demonstrates the effectiveness of the MEI and MSD for analysis of low building performance and low efficiency of resources usage. Organization and management (MSC) The MSC provides an indication of the organizational effectiveness and may support organizational changes in the maintenance department structures in order to improve its organizational efficiency. The following case from the study demonstrates potential application of this indicator. The BPI of this hospital was found to be 64.7 and its MEI was 0.39. This means that the facility provides a good level of efficiency; however, its performance level is quite poor. The Managerial Span of Control of the maintenance manager was observed to be seven direct subordinates (maintenance manager and assistant, with 14 maintenance crew leaders). A significant managerial change was proposed, in which the span of control of the maintenance manager be reduced. Although the maintenance manager, himself, argued these conclusions, a year later, the organizational structure was substantially modified: the maintenance manager supervises only four direct subordinates (electricity and energy, civil engineering, plumbing and other finishes, and electro-mechanics), while each one of them supervises between two and six subordinates. This case demonstrates how the MSC may reveal organizational deficiencies and how improvements may consequently be implemented.
Outsourcing (MSD)
Performance-based maintenance management (BPI, MEI)
The effectiveness of outsourcing depends highly upon its availability and reliability. For example, let us consider the actual condition of a hospital in the sample population. The BPI of this hospital was found to be 66.1 and its MEI was 0.66 – a value that indicates low efficiency and high maintenance expenditure. The hospital is located in a large metropolitan area, where high quality contractors in various disciplines are available. The average occupancy in this facility is 5.0 patient beds per 1000 m2. These factors indicate that a human resources composition based on outsourcing may reduce the expenditure level and improve efficiency; however, the actual composition of labour shows that 85% of the maintenance human resources is composed of in-house workers. Hence, the MSD depicts the problematic human resources composition in this case. Substantial managerial effort should be undertaken in order to balance the composition and reduce the AME. No doubt that this kind of managerial change cannot be achieved in a short period, therefore it may take a number of years until the composition can be changed to lean on a more balanced one. This case
The BPI provides a life cycle costs-based performance monitoring procedure. This indicator enables one to find out the overall performance of a facility as well as insight into its systems and components. Facilities managers may use the MEI for overall performance-based evaluation of cost-effectiveness of maintenance. High MEI values indicate a surplus of resources and a need to reduce budgets, while low values of MEI indicate efficient use of resources, but may, in extreme cases, support provision of additional resources. The following example may demonstrate this. The BPI of the study hospital was found to be 71.4 and its MEI was 0.37. This means that the performance of the hospital is marginal, yet it is compatible with the level of resources. Based on the BPI and Pn (systems performance), the Principal Engineer in the facility developed a performance-based corrective maintenance programme. Three building systems in deteriorating condition were identified, namely: Elevators, Sanitary systems, and Low-voltage and communications. The senior management of the hospital allocated a special budget of $US100 000 for this project. The
Maintenance management of hospital buildings implementation of the proposed recommendations is expected to improve the BPI in this hospital to 75, while preserving the MEI at its high level, indicating a high efficiency usage of maintenance resources. This case demonstrates the benefits that both the senior managers and the facility manager may have from implementing the BPI and the MEI indicators in the development of a corrective maintenance programme.
Conclusions Rapid technological advances, which stimulate higher performance requirements, coupled with the complexity of modern facilities, force facilities managers to consider new patterns of enhancing the comfort, security, safety, energy efficiency and cost-effectiveness of the buildings they manage. Facilities managers must contend with various concerns, such as the composition of human resources sources, maintenance policies, budget constraints, etc. The approach presented in this paper integrates performance, financial, human resources and organizational aspects in order to obtain a quantitative tool for the evaluation of the parameters affecting the execution of maintenance activities. This paper presents four maintenance indicators: the Building Performance Indicator (BPI), the Manpower Sources Diagram (MSD), the Maintenance Efficiency Indicator (MEI) and the Managerial Span of Control (MSC). In addition, this approach uses the key parameters, Annual Maintenance Expenditure (AME), age coefficient (ACy) and occupancy coefficient (OC), that were identified in the study. The indicators must be simultaneously analysed and interpreted. The case study presented in this paper demonstrates the integrated process, beginning with data gathering, through the calculation of the maintenance key performance indicators and concluding with the analysis and diagnosis. The effectiveness of the KPIs was examined in a survey of FM experts. The survey shows a good level of precision of the BPI and MEI, while the experts recommended additional parameters for labour composition and organizational effectiveness. This research focuses on public hospital buildings, but can be implemented in other multi-system buildings, such as offices, schools, universities, industrial plants, etc. This can be achieved after modification of the four developed indicators according to the type of the building in question. The model may be developed in a computerized system for healthcare facilities management.
Acknowledgements This research was supported by the Israel Ministry of Health.
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