Espirales Revista Multidisciplinaria de Investigación, Vol. 6, No. 42.

October - December - 2022. e-ISSN 2550-6862. pp 21-29.

DOI https://doi.org/10.31876/ er.v6i43.828

Pilot diagnostic study of a Facility Management System

according to the ISO 41001 standard in Spanish hospitals

Estudio piloto de diagnóstico de un Sistema de Facility Management acorde al

estándar ISO 41001 en hospitales españoles

Manuel Madroñal-Ortiz*

Diego Cuartas-Ramírez**

Ibet Patricia Bustamante-Correa***

Marisol Osorio****

Received: June 11, 2022

Approved: August 24, 2022

*Doctor, School of Engineering, Universidad

Pontificia Bolivariana, Medellin, Colombia,

manuel.madronal@upb.edu.co,

https://orcid.org/0000-0003-1599-969X

**Magister, School of Engineering,

Universidad Pontificia Bolivariana, Medellín,

Colombia, diego.cuartas@upb.edu.co ,

https://orcid.org/0000-0001-8585-1469

***Magister, School of Engineering,

Universidad Pontificia Bolivariana, Medellín,

https://orcid.org/0000-0002-2825-6599

Colombia,ibet.bustamante@upb.edu.co,

****Doctor, School of Engineering,

Universidad Pontificia Bolivariana, Medellin,

Colombia, marisol.osororio@upb.edu.co,

https://orcid.org/0000-0003-3300-8677

Abstract

Healthcare institutions lacked tools to evaluate existing

management systems linked to support activities and services

aligned to the Facility Management discipline. The publication of

the ISO 41001 standard has provided the structure and content

for the establishment of this type of management systems. The

authors of this paper developed the first version of a diagnostic

tool for a Facility Management system in the health sector and

sought to test it in hospitals familiar with ISO management

system audits. Eleven members of Spanish hospitals were

selected for two questionnaires and an interview. Subsequently,

a quantitative analysis of the questionnaires was carried out to

obtain the average of the responses on a maturity scale of Facility

Management activities and, on the other hand, a qualitative

analysis of the interview responses. The results showed that the

hospitals interviewed have an intermediate level according to the

systems maturity scale; however, the interviewees stated that this

tool does not support objective answers.

Keyword:

Diagnostics, Management Systems, Facility

Management, Hospitals, ISO 41001

Cite this:

Madroña-Ortiz, M., Cuartas-Ramírez,

D., Bustamante-Correa, I, Osorio, M.

(2022). Pilot diagnostic study of a

Facility Management System according

to the ISO 41001 standard in Spanish

hospitals, Espirales. Revista

Multidisciplinaria de investigación

científica, 6(42), 21-29

Pilot diagnostic study of a Facility Management System according to the ISO 41001 standard in Spanish hospitals

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29.

Introduction

Facility Management (FM), is a discipline that integrates different professions "...

in order to influence the efficiency and productivity of the economies of

societies, communities and organizations, as well as the way in which individuals

interact with the built environment" (UNE, 2018). Today, FM brings together all

the activities and support services, and brings strength to organizations through

added value to real estate management (Castellanos Moreno, 2013). In the case

of healthcare institutions, FM competencies have been assumed by the clinical,

hospital or physical infrastructure engineering departments (Noor et al., 2016).

On the other hand, as has happened since the 1990s with other management

systems (GS), such as quality, environmental, occupational risks and safety

among others, the International Organization for Standardization (ISO) has

published in 2018 the ISO 41001 standard (UNE, 2018) linked to the

management of buildings and support services (FM in Spanish). This standard

like others related to SGs forms a set of coordinated elements at different levels

that interact for the establishment of organizational policies and objectives; and,

therefore, provide the basis for directing and verifying the organization's actions

in order to achieve the proposed goals (Vicente et al. , 2016). However, for the

establishment of a Facility Management System (FMS) it is necessary to know the

Resumen

Las instituciones de salud carecían de herramientas para evaluar

los sistemas de gestión existentes vinculados a las actividades y

servicios de soporte alineadas a la disciplina al Facility

Management. La publicación del estándar ISO 41001 ha dotado

de la estructura y el contenido para el establecimiento de este

tipo de sistemas de gestión. Los autores de este trabajo

desarrollaron la primera versión de una herramienta de

diagnóstico para un sistema de Facility Management en el sector

salud y buscaron probarla en hospitales familiarizados con

auditorías de sistemas de gestión ISO. Se seleccionaron 11

integrantes de hospitales españoles para realizar dos

cuestionarios y una entrevista. Posteriormente, se realizó un

análisis cuantitativo de los cuestionarios realizados para obtener

el promedio de las respuestas en una escala madurez de las

actividades de Facility Management y, por otra parte, un análisis

cualitativo sobre las respuestas de las entrevistas. Los resultados

mostraron que los hospitales entrevistados poseen un nivel

intermedio según la escala de madurez de los sistemas, sin

embargo, los entrevistados expusieron que esta herramienta no

respalda respuestas objetivas.

Palabras clave:

Diagnóstico, Sistemas de Gestión, Facility

Management, Hospitales, ISO 41001

Manuel Madroñal-Ortiz; Diego Cuartas-Ramírez, Ibet Patricia Bustamante-Correa, Marisol Osorio

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29

status of the existing FS in a healthcare institution in order to establish action

plans that help to implement the desired FMS according to the guidelines of the

ISO 41001 standard.

The problem identified from a review of FM in the health sector (Madroñal-Ortiz,

2022) was the lack of diagnostic tools for SFM according to international

standards and, therefore, the authors of this work developed a tool suitable for

the hospital context, aligned to ISO SG standards and the FM discipline.

However, the objective of this work was to test the tool in institutions familiar

with ISO SG audits and to evaluate its suitability for use in institutions with SGs

not aligned to ISO standards.

Materials and methods

The authors of this study considered that the tool called "DiagSFMHosp v1.0"

was based on a version of the "ISO 9001:2015 Self-Assessment Guide" tool

(ICONTEC, 2015), lighter than the standardized Self-Assessment Methodology

(SAM) tool of the Institute of Asset Management (IAM, 2014), but without losing

the effectiveness and efficiency of the use of this type of tool. In addition, the

authors considered that it should conform to the criteria of the SFM of the ISO

41001 standard (UNE, 2018) and the main areas of the FM (Madroñal et al.,

2021). Finally, this version of the tool was developed from an analysis of each of

the sections of the ICONTEC guide, which were merged and those analogous

questions that encompassed the requirements of the ISO 41001 standard were

adapted to comprise an appropriate number of questions.

The first questionnaire was composed of 41 questions arranged to obtain

answers by means of a structured consultation arranged in an electronic form.

The type of response for each of the questions was adjusted to a Likert scale

(Complete, Partial, None), coming from the ICONTEC guide, intended to show

the status of the different criteria of the high-level structure (EAN) of the SFM in

the respective institutions, according to the ISO 41001 standard. However, it was

observed that this tool lacked an input factor and the balance in a matrix

composed of the 7 SFM criteria and the 6 main areas of the FM (Madroñal et al.,

2021): Asset & Maintenance Management, Real Estate & Property Management,

Energy & Sustainability Management, Corporate Project Management,

Workplace Management and Facilities Services Management. Thus, the authors

developed a second questionnaire to show results on the impact of these 6 FM

areas on each of the 7 SFM EAN criteria in the organization and to complement

the previous questionnaire. The response type for the questions on the FM areas

was again adapted to the same Likert scale (Full, Partial, None) showing the

maturity status of the FM areas in the respective institutions.

Pilot diagnostic study of a Facility Management System according to the ISO 41001 standard in Spanish hospitals

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29.

Subsequently, the authors of the research proposed to carry out these two

questionnaires to 11 professionals from general services (SSGG) hospitals in

Andalusia (Spain). The reason for conducting this pilot test in Andalusian public

hospitals was because 100% of these institutions have an ISO environmental

management system certificate in the entire organization. This means that these

institutions and their employees are familiar with these SGs and, therefore, are

aligned to this type of questionnaire similar to ISO environmental audits.

The quantitative analysis of both questionnaires was performed by averaging the

results, considering a numerical assignment of the Likert scale responses to

reach each level of the Brooks et al. (2018) maturity scale for FM activities (Figure

1). That is, three response options (None, Partial, Complete) were answered with

a corresponding assignment (0; 0.5 and 1), the average of the questions for each

SFM criterion or FM area was performed. Subsequently, the mode was identified

among the results in each criterion and the final result was an average among

the different criteria in each respondent that was arranged in five ranges from 0

to 1 to adapt it to the maturity scale of the FM (Figure 1). In contrast, the

qualitative analysis of the interviews obtained the commonalities among all the

interviewees about the SG linked to the FM activities in the Andalusian hospitals

and the comments were linked to each SFM criterion or FM area.

Figure 1.

FM maturity scale in organizations.

(Figure adapted from Brooks et al., 2018).

Results

The information provided by the 11 professionals of the SSGGs in this pilot test

showed that more than 80% of the interviewees had more than 5 years of

experience in areas related to FM. The degree of expertise in FM-related

activities at different management levels (strategic, tactical and operational) was

medium-high in more than 90% of the respondents; and finally, the degree of

expertise in ISO SGs (quality, environmental, energy) was medium-high in more

than 80% of the respondents, considering the levels of expertise from 0 to 10

(Table 1).

Manuel Madroñal-Ortiz; Diego Cuartas-Ramírez, Ibet Patricia Bustamante-Correa, Marisol Osorio

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29

Table 1.

Data on respondents for the diagnosis of MFS in Spanish hospitals.

Interviewee

Experience in Facility

Management, Hospital

Engineering, Maintenance

or Management Systems.

Level of expertise in

Facility Management at

different levels

Level of expertise in

Management Systems

at different levels

5 - 10 years

0 - 5 years

More than 15 years

0 - 5 years

10 - 15 years

5 - 10 years

More than 15 years

5 - 10 years

In the results of the first questionnaire of the SFM diagnostic tool in the

interviewed hospitals (Table 2) it could be observed that the overall result of the

SFM EAN criteria has been identified as MEASURED with respect to the FM

maturity scale (Brooks et al., 2018). This result in the SFM criteria of the

interviewed hospitals are at the top of the maturity scale, among them the

Operation criterion had the best positioning as "OPTIMIZED" (Table 2) and, on

the other hand, the Performance Evaluation criterion is in the worst situation as

it received the rating as "DEFINED" (Table 2) according to the same FM maturity

scale (Figure 1).

Table 2.

Results of questionnaires 1 and 2 in Spanish hospitals.

Questionnaire 1

Questionnaire 2

EAN Criteria

Rating (Average)

FM areas

Rating (Average)

Organizational Context

Measured

MAM

Managed

Leadership

Measured

REM

Initial

Planning

Measured

CPM

Managed

Support

Measured

Initial

Operation

Optimized

ESM

Measured

Performance Evaluation

Defined

FSM

Managed

Improvement

Measured

Global (Modal)

Measured

Global (Modal)

Managed

ABSOLUTE RESULT

DEFINED

On the other hand, in the second questionnaire of the SFM diagnostic tool in

Pilot diagnostic study of a Facility Management System according to the ISO 41001 standard in Spanish hospitals

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29.

interviewed hospitals (Table 2) it could be observed that the overall result of the

main areas of FM has been identified as "MANAGED" with respect to the FM

maturity scale. This was due to the fact that most of the responses obtained in

the second questionnaire were answered on the Likert scale as "Partial", with

the exception of the ESM area which has the best overall result as "MEASURED".

The authors of this work deduce that this total result of the ESM area (energy

and sustainability) is due to the fact that most of the hospitals interviewed have

ISO 14001 certification for environmental management in the entire organization

and, consequently, this environmental certification has led by inertia to most of

the criteria of the SFM EAN being partially realized and the overall result of

"MANAGED" on the FM maturity scale being obtained (Figure 1). In summary,

as can be seen in Table 2, the absolute result of the hospital SFM diagnosis of

the group of SAS surveyed hospitals has been evaluated as "DEFINED", based

on the average between the overall results of questionnaires 1 and 2, in

accordance with the maturity scale of FM activities (Figure 1).

Despite having obtained good results positioned in the medium-high part of the

FM maturity scale (Figure 1), the interviewees expressed that the implementation

of this SFM could generate, in the near future, rather than possible benefits,

many more bureaucratic formalities. They even expressed that in many cases the

management tools, in order to have an MFS in a good state, have to be used by

qualified people and currently they are not available and, therefore, they distrust

their benefit in the short term if the conditions of human resources are not

improved. Likewise, the interviewees stated that all support activities were at a

very operational level, with the exception of environmental actions as they have

an ISO 14001 certified SG, and that tactical and strategic activities depended

heavily on political decisions. In other words, the interviewees argued that the

long-term terms (tactical and strategic levels of business management) in public

hospitals correspond to the period of political government in the public

administration, i.e., they concern elections every 4 years and therefore no real

long-term policies can be developed.

The results of both analyses led to a consultation on the responses obtained with

other researchers of the similar project on diagnosis of asset management

systems in hospitals (Madroñal et al. , 2018) in which the first two authors of this

paper participated. In the discussion with those researchers, it was noted that

the developed tool did not obtain all the information about the SFM of

healthcare institutions and that the responses of the respondents could be

subjective. Furthermore, in this discussion it was noted that the analyzed results

of these questionnaires showed that the Likert scale applied to the responses

(Complete - Partial - None) was limited, as respondents expressed the need for

Manuel Madroñal-Ortiz; Diego Cuartas-Ramírez, Ibet Patricia Bustamante-Correa, Marisol Osorio

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29

intermediate steps or perhaps a range of associated percentages. Therefore, it

was necessary to expand this scale and change the nomenclature so that it would

be better understood by the staff to be interviewed.

Conclusions

The authors of this study deduced from the results and from the comments of

the interviewees of the diagnosis of MFS in Spanish hospitals described above

that this diagnostic tool has limitations in obtaining reliable information on the

state of maturity of MFS. Therefore, the authors of this work proposed that the

new Likert scale to be used in the tool should have at least 5 levels comprising

different states of the status of the FFS criteria; however, the Likert scale

proposed for the FM areas is understood to be sufficient. In addition, this work

has shown that the interviewed hospitals, which have ISO environmental SG

certificates, have a tendency to partially fulfill the requirements of the SFM

because the conditions of both SGs have a similar EAN in both standards. Finally,

the authors consider that the work presented in this study is a fundamental part

for the development of a new version of an EMS diagnostic tool that is made up

of questionnaires focused on the demand for evidence that will reflect the

establishment of the EMS, even if it does not really request a justification of the

existence of this evidence.

..........................................................................................................

References

Brooks, A., Mitchell, S., & Rowland, D.

(2018). ISO 41000 Family of

Standards: Raising the bar for FM

Globally. British Standard Institute.

[Internet, Accessed January 2022]

Available from:

https://www.bsigroup.com/globalass

ets/localfiles/en-gb/raising-the-bar-

for-fm-globally190618v2-

presentation-slides.pdf

Castellanos-Moreno, M. (2013). Social

responsibility as an added value of

the facilities manager in real estate

management. [Doctoral thesis,

Universidad Politécnica de Madrid].

IAM (2014). The Self-Assessment

Methodology Guidance Version 1

June 2014. General Guidance Notes

Pilot diagnostic study of a Facility Management System according to the ISO 41001 standard in Spanish hospitals

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29.

for using the SAM: a Self-Assessment

Methodology for use with BSI PAS

55:2008 and ISO 55000/1/2:2014.

The Institute of Asset Management,

2014.

ICONTEC (2015). ISO:2015 Self-diagnosis

Guide. Colombian Institute of

Technical Standards and Certification

(ICONTEC). Bogotá. 2015. [Internet,

Accessed January 2022] Available at:

http://www.ucm.edu.co/sig/wp-

content/uploads/docs/documentos_i

nteres/matriz_autodiagnostico.xls

Madroñal-Ortiz, M. (2022). Proposal for a

hospital infrastructure management

model through Facility Management

for Colombia. [Doctoral Thesis,

Universidad Pontificia Bolivariana].

Madroñal, M., Galeano, B. J., Escobar, N.

J., & Cuartas, D. (2018).

Establishment of requirements for a

survey to diagnosis physical asset

management for health institutions in

Colombia. In 2018 Global Medical

Engineering Physics Exchanges/Pan

American Health Care Exchanges

(GMEPE/PAHCE) (pp. 1-1). IEEE.

Madroñal-Ortiz, M., Cuartas-Ramirez, D.,

Benavides-Velasco, C. A., & Osorio,

M. (2021). Identification and

classification of facilities managers

functions: a proposal validated by

Latin American experts. Journal of

Engineering Research.

Noor, M. M., Ram, D. C., Magray, I. A., &

Chawla, E. S. (2016). Maintenance

and modelling strategies of

biomedical equipment's in hospitals:

a review. Adv Life Sci Technol, 40, 31-

35.

Manuel Madroñal-Ortiz; Diego Cuartas-Ramírez, Ibet Patricia Bustamante-Correa, Marisol Osorio

Espirales. Revista multidisciplinaria de investigación científica, Vol. 6, No. 42

October - December - 2022. e-ISSN 2550-6862. pp 21-29

UNE (2018). UNE-ISO 41001:2018.

Property management and support

services - Management systems -

Requirements with guidance for use.

Spanish Association for

Standardization (UNE). Madrid. 2018.

Vicente, S. G., González, A. L., & Suárez-

Varela, M. M. (2016). Implementation

of voluntary environmental

management systems in the Spanish

hospital network: current status

(2015). Journal of Environmental

Health, 16(2), 92-102.