To begin with let me put facilities management (FM) in context in relation both to the development of the management discipline in Europe and to the healthcare sector. One issue taxing the FM industry from a pan-European perspective is the differing levels of the many support services and the varying cultural and operational practices. The British Institute of Facilities Management, of which I am a past chairman, defines FM as: “The integration of multidisciplinary activities within the built environment and the management of their impact upon people and the workplace.”
By slight contrast, a recently drafted definition arising from work undertaken within the European Committee for Standardization for the first European standards in FM (CEN/TC 348) reads: “An integrated process to support and improve the effectiveness of the primary activities of an organisation by the management and delivery of agreed support services for the appropriate environment that is needed to achieve its changing objectives.” Either way, both recognise the multiplicity of support services to be managed to meet an appropriate environment for efficient delivery of the primary purpose of an organisation – in this case a hospital.
Perhaps the European use of the word facility best suits the healthcare sector, as the facility is regarded as the built “envelope” of the hospital building and its technical services. Adding the word management easily completes the defining purpose of FM in managing the support services to the primary function – the provision and management of nonclinical services in support of patient care and staff needs. In the commercial sector, FM can include responsibility for support services outside the built envelope, such as mobile communications, travel and logistics, but I will ignore those for the purposes of this article.
Support services management
It will be clear to all that there is flourishing private healthcare sector and a significant public healthcare sector in most, if not all, EC countries, but to varying degrees and standards. Both sectors rely on the provision of support services, and in most cases a mix of outsourced services are integrated with directly employed inhouse support staff. In this respect, the management of the support services in the healthcare sector needs to be closely and well managed due to the nature of the primary purpose – healing patients.
The emergence of FM as a specialist management discipline throughout Europe has begun to establish a common understanding and is settling into three levels: strategic, tactical and operational. To illustrate a classical model of FM related to a hospital facility, I have included a diagram (Figure 1) showing the key stakeholder groups. As the diagram indicates, the management function takes place between the various stakeholders from governance through to point of need. FM has to address all of those requirements and work within the constraints of the hospital management and resources. At the same time, it must ensure effective and efficient support to the patients and staff, with their welfare in mind. Very often it is the facilities manager who has the task of balancing the demands of both.
The scope of support services to be delivered within the facility will obviously vary from site to site according to the maturity of the political philosophy and/or management policy, but the key requirements will be similar. Priorities and the relative importance of services will vary from facility to facility, but there is a great deal of consulting time currently being expended on the relative performance of hospitals, as the European Community is expanding with a vision of interoperable and cross-boundary care for patients. Indeed, private healthcare companies are also looking to the pan-European business opportunity.
The holy grail of value for money
The holy grail in FM at large and for the primary process of healthcare is value for money (VfM). A major review of funding in the UK National Health Service was undertaken in 2002. The report stated: “The standard of NHS accommodation and food frequently falls below expectations. Around 30% of the NHS estate pre-dates 1948 and there is a cumulative backlog in excess of €4.3 billion … 60% of the primary care estate is over 30 years old and nearly 80% is below the current recommended size. Social care has a similar investment backlog. NHS hospital food is much criticised and despite recent efforts to improve it, spending is significantly lower than the amount spent by private healthcare providers and there is often little choice for patients about when to eat.”(1)
The UK government has made the NHS a priority in its public spending plan and, despite a €108 billion annual spend, is still apparently finding it difficult to prove VfM to the taxpayer. According to some estimates it will actually run to a deficit of €857 million in 2005 and, despite financial largesse, in October 2005 there were nearly 800,000 patients on the waiting list. Clearly, reforms on this scale take time to take effect, but VfM should be capable of being measured from the bottom up – particularly in the provision of the support services.
By its very nature, FM is concerned with the management of support services at a granular level. While cost will always be a key focus, managers now appreciate that VfM also has to take account of timeliness, quantities and compliance – all of which lead to a quality output. If more attention were given to managing support services in synchronisation with the primary processes, efficiency gains would follow. When built up to regional or national portfolios, or even a pan-European healthcare system, VfM calculations must include the support services and take both capital and revenue items into account.
The technological impact
A key driver for change is new technology. Just as new technologies are enhancing the effectiveness of healthcare, so too technology is enhancing the means of managing support services, primarily from being able to manage information much more effectively over the internet. This will probably be the biggest single driver for change in the future. As individuals become empowered by the internet, with instant access to more and more information, so too will the rules for managing information change. Much more reliance will be placed on web services, and performance will be monitored in real-time with dashboard-type exception reports alerting managers to problems the moment they become apparent.
As the diagram suggests, measurement is a critical element if we are to accurately assess VfM and performance in the healthcare sector, and I have no doubt that best practice in FM will play a significant role in the development of these ideals.
- Wanless Report.Securing our future health: taking a long term view – Chapter 2, Para 2.25. Available from:www.hm-treasury.gov.uk/Consultations_and_Legislation/wanless/consult_wanless_final.cfm