Raising the Profile of Facilities Management (FM) in Healthcare – Managing Performance of Infection Control

Hospital-acquired infections (HAIs) are a major problem in the National Health Service (NHS) in the United Kingdom (UK). One reason for this is the failure of healthcare officials to tackle the root causes of HAIs. There is sufficient epidemiological evidence showing that HAIs can occur because of, inter alia, poor performance of Healthcare Maintenance (HM) services. Despite this link, HM has not received the level of attention it deserves from healthcare authorities. As a result, some HM managers do not measure the performance of HM services in infection control (IC). The aim of this research study therefore, is to improve the overall level of performance of HM services in the control of HAIs in the NHS. Hence, the adoption of six research objectives to identify the critical success factors (CSFs) and key performance measures in the control of maintenance-associated HAIs. In addition to an in-depth literature review, a content analysis approach was adopted to establish the link between HM services and HAIs. Conversely, CSFs and performance measures in HM in IC were identified through the application of ground theory analysis. An exploratory case study was then conducted with two NHS trusts. The results of the exploratory case study revealed that some HM managers did not have the required knowledge to fulfil the research need of the study, i.e. development of the performance measurement system (PMS). Therefore, the Delphi approach was considered suitable to achieve the aforementioned need. In total, eight CSFs and fifty-three key performance measures are identified for reducing the burden of maintenance-associated HAIs in hospitals. For example, establishing clear lines of communication between the IC team and HM unit is crucial in the prevention of maintenance-associated HAIs in hospitals. Dust prevention is also identified by the healthcare experts as an important measure to prevent the transmission of maintenance-associated HAIs in high-risk patient areas. Through the application of the Balanced Scorecard (BSC) approach, the CSFs and key performance measures were categorised into a performance matrix. The result was then used to develop a performance measurement system (PMS) to control maintenance-associated HAIs. Both performance tools i.e. the BSC matrix and PMS could be applied by HM managers to reduce rates of maintenance-associated HAIs in hospitals

Application of the Delphi technique in healthcare maintenance

Purpose The purpose of this paper is to examine the research design, issues and considerations in the application of the Delphi technique to identify, refine and rate the critical success factors and performance measures in maintenance-associated infections. Design/methodology/approach In-depth literature review through the application of open and axial coding were applied to formulate the interview and research questions. These were used to conduct an exploratory case study of two healthcare maintenance managers, randomly selected from two National Health Service Foundation Trusts in England. The results of exploratory case study provided the rationale for the application of the Delphi technique in this research. The different processes in the application of the Delphi technique in healthcare research are examined thoroughly. Findings This research demonstrates the need to apply and integrate different research methods to enhance the validity of the Delphi technique. The rationale for the application of the Delphi technique in this research is because some healthcare maintenance managers lack knowledge about basic infection control (IC) principles to make hospitals safe for patient care. The result of first round of the Delphi exercise is a useful contribution in its own rights. It identified a number of salient issues and differences in the opinions of the Delphi participants, noticeably between healthcare maintenance managers and members of the infection control team. It also resulted in useful suggestions and comments to improve the quality and presentation of the second- and third-round Delphi instruments. Practical implications This research provides a research methodology that can be adopted by researchers investigating new and emerging issues in the healthcare sector. As this research demonstrates, the Delphi technique is relevant in soliciting expert knowledge and opinion to identify performance measures to control maintenance-associated infections in hospitals. The methodology provided here could be applied by other researchers elsewhere to probe, investigate and generate rich information about new and emerging healthcare research topics. Originality/value The authors demonstrate how different research methods can be integrated to enhance the validity of the Delphi technique. For example, the results of an exploratory case study provided the rationale for the application of the Delphi technique investigating the key performance measures in maintenance-associated infections. The different processes involved in the application of the Delphi technique are also carefully explored and discussed in depth

A Performance Measurement Tool (PMT) to Control Maintenance-Associated Infections

Purpose Healthcare maintenance (HM) services have an important role in the control of hospital-acquired infections (HAIs). Notwithstanding, many HM managers still do not measure the performance of HM services in infection control (IC). This research, therefore, aims to establish the level of importance of critical success factors (CSFs) and performance measures in HM IC. A performance measurement tool (PMT) was also developed to improve the performance of the HM unit in IC. Design/methodology/approach The CSFs and performance measures identified in the literature were categorised into the four perspectives of balanced scorecard and analysed through Delphi. The Delphi participants were presented with 67 performance measures and asked to rate their level of importance in HM in IC. In total, they identified 53 important performance measures to control maintenance-associated HAIs. The results obtained from the Delphi study were used to categorise the performance measures into four means zones. The mean zones were assigned weights (1-4), and the level of importance of the CSFs was established through weighted average. Liaison and communication, IC practices and maintenance resource availability emerged as the most important CSFs in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC. Findings The following CSFs, liaison and communication, IC practices and maintenance resource availability, emerged as the most important in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC. Originality/value Through the application of the PMT, performance in IC can be estimated at different levels in the HM unit. The PMT allows managers to focus on the most crucial CSFs and performance measures that drive performance in HM in IC. The PMT could also be used for benchmarking purposes

A critical review of the implication of outsourcing in the National Health Services (UK): a facilities management perspective

Since the creation of the National Health Service (NHS) in 1948, there has been growing pressure for it to operate in a more business like fashion. By 1979 only a small fraction of private firms were doing business with the NHS. Drawing from the experience of the private sector where outsourcing was a success, the NHS was urged to work with the private sector in the provision of non-clinical services. Thus, to reduce the estimated £900 million that was required to provide non-clinical services, the governments introduced competitive tendering and market testing. The aim was to encourage a public/private sector mix and market competition in the NHS. Despite initial resistance, the NHS has grown today into a major outsourcing market in the UK. The provision of domestic cleaning services alone account for an estimated £188million. The main aim of this research paper is to investigate the benefits and problems associated with outsourcing in the National Health Service (NHS) in the UK. The paper also examines the different government initiatives that opened the NHS market to the private sector. The findings presented in this paper are primarily based on an in-depth literature review. The main driving force behind outsourcing in the NHS has been to cut down public spending.Through outsourcing, the NHS aim to provide more efficient, innovative and cost effective nonclinical services. Outsourcing firms have a pool of expertise, knowledge, methodologies and technology upon which the NHS can rely on. There are a number of problems associated with the outsourcing of non-clinical services in the NHS. Many blame the falling cleaning standards and subsequently the high rate of Hospital Acquired Infections (HAIs) on the outsourcing of domestic cleaning services. The failure of most NHS trust to evaluate the cost of HAIs associated with outsourcing is either under or over estimating the actual benefit of outsourcing. Outsourcing in the NHS has created a two tier workforce whereby, employees in the outsourcing firm experience poor remuneration, and working conditions. In some circumstances, cost reduction has been achieved through redundancies; though at the cost of high quality in-house service provision. To outsource in the NHS, there must be sufficient evidence to suggest that it will bring value for money. A well drafted service level agreement (SLA) emphasizing performance measurement should be drawn with the vendor

A Methodological Approach to Identify Key Performance Indicators and Measures in Maintenance Services in Infection Control

Hospital-acquired infections (HAIs) are a major problem in the United Kingdom (UK) and worldwide. The UK has one of the worst rates of hospital-acquired infections (HAIs) in Western Europe. One reason for such poor performance is the failure of healthcare officials to tackle the root causes of HAIs in the National Health Service (NHS). The position of healthcare officials is that HAI is mainly a clinical issue; requiring the attention of clinicians. As a result, most of the infection control policies and guidelines do not sufficiently address the non-clinical causes of HAIs in the NHS. There is strong epidemiological evidence suggesting that HAIs can also occur because of the poor performance of facilities management (FM) services. An example of an FM service that has a strong link with HAI is healthcare maintenance. Despite being linked to such infections as aspergillosis, legionnaires etc, healthcare maintenance services (HMSs) in the NHS have nonetheless failed to attract the attention of healthcare authorities. In this study therefore, we examine the methodological approach in identifying the key performance indicators and measures in HMSs in infection control. This study is divided into two main sections. In the first section, we examine different research paradigms, as well as, the rational for choosing interpretivism in this study. The second section, which is on the research design, examines the research methodology and research methods applied in this study. Addressing these methodological issues is important in identifying the key performance indicators and measures in HMSs in infection control. Read More: http://ascelibrary.org/doi/abs/10.1061/9780784412909.06

Exploratory Sequential Mixed Method Research to Investigate Factors Affecting the Reputation of PFI/PF2 Projects in the UK

The UK Government introduced the private finance initiative (PFI) as a measure to work closely with the private sector in the provision of public projects. Despite its popularity in the 1990s, it presently faces strong criticisms for failing to deliver value for money. This chapter details the practicality of using an exploratory sequential mixed methods research design to investigate the factors that affect the reputation of PFI projects in the UK. In this chapter, the processes involved in document selection for grounded theory (GT) (qualitative) and the conduct of the GT in the qualitative strand were outlined. Similarly, it detailed the process for eliciting quantitative data through a questionnaire survey. The chapter highlighted the joint display of the results of the qualitative and quantitative phases. Subsequently, both sets of results were then used to develop a theoretical framework of factors that affect PFI/PF2 projects’ reputation in the UK