Trends in
research on healthcare facility management: an overview of the last decades
Tendencias en la investigación sobre gestión de
establecimientos de salud: un panorama de las últimas décadas
Manuel Madroñal-Ortiz*
Diego Cuartas-Ramírez*
Nelson Javier Escobar-Mora*
Marisol Osorio *
Introduction
The
Facility Management (FM) discipline has been linked to the architecture,
engineering, and management professions since the early 1970s in the United
States of America, when the first professional association was created.
Currently, FM is considered 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 environment built” (UNE, 2018). In other words,
FM brings together all the activities and support services, as well as
providing solidity to organizations through added value to the management of
real estate assets (Castellanos-Moreno, 2014). According to Madroñal-Ortiz,
Cuartas-Ramirez, Benavides-Velasco, and Osorio
(2022), the scope of FM functions within organizations encompasses both hard
and soft FM areas. The hard FM areas include Facilities Services Management,
Energy and Sustainability Management, and Maintenance and Asset Management. On
the other hand, the soft FM areas comprise Property and Real Estate Management,
Corporate Project Management, and Workplace Management.
In the case of health
institutions, FM competencies have been assumed by the clinical, hospital or
physical infrastructure engineering departments (Noor, Magray
& Chawla, 2016). On the one hand, these FM competencies are focused, in
large part, on reducing the fixed costs of the secondary activities of health
institutions (associated with the maintenance and support of the main activity)
that represent the 5-17% of the main annual expenses. According to the German
Hospital Society (Banedj-Schafii, 2010), that 34.6%
of the expenses of a hospital are within the support services (non-assistance)
covered by the FM. On the other hand, FM has focused on the life cycle of the
infrastructure of health institutions to face different challenges of adapting
their physical infrastructure (buildings, green areas, roads, etc...) due to
new medical technologies and techniques, as well as organizational and
demographic changes in the population. Related to this topic, the level of
adaptability of a building varies depending on a complex range of economic,
political and technological factors, whose interaction can lead to design results
that are not necessarily rational or optimal if they are analyzed in retrospect
or if they are taken out of context (Pinder, Schmidt
& Saker, 2013). In addition, the impact of modern
construction methods and stakeholders concerning the compromise of the first
use of a building must be weighed.
For
decades, it has been possible to identify a mere operational position of
hospitals, focused on maintenance, as opposed to a strategic focus of the FM
that allows a more holistic vision and the interaction of the stakeholders of
health institutions (Bjørberg & Verweij 2009). To understand the scope of FM in the health
sector, it is important to consider that this discipline involves more areas of
the organization than the sole functions usually performed by the so-called
General Services, Maintenance Service or Clinical Engineering; since this
discipline aligns support activities with organizational goals, strategies, and
plans. This FM alignment has been gaining space in health institutions to take
a more strategic role in support activities and, therefore, it is necessary
that the same alignment be reflected in hospital infrastructure management
models (Støre-Valen, Larssen
& Bjørberg, 2014). In any case, FM offers
alternatives in health institutions to overcome the challenges of the sector,
exposed above, and for this reason it is important to review the research
trends on its application in this sector worldwide.
The
authors of this work estimate that the needs of FM during the last decades have
been changing according to the needs of the organizations and the introduction
of this discipline in the different industrial sectors. It is even estimated
that research topics have evolved over time. Therefore, the objective of this
work has been to identify the recurrence of research on FM in the health sector
in recent decades to identify patterns in the themes, the different scenarios,
and the maximum exponents of FM in this sector.
Materials
and methods
Search and filtering of studies
This work began with a literature review that
offered a vision of academic research and its contribution to the knowledge of
the field of study (FM in the health sector) carried out in last decades. This
bibliographic review on FM at the international level in the health sector took
into consideration the following aspects:
- The analysis of the documents published in various
categories since the recognition of FM as a discipline from the 70s to 2018 in
the databases (Scopus and Web of Science).
- The assessment of the importance of publications
through impact indicators: impact of papers, citations, and impact of indexed
journals.
- The analysis of evolution, status, trends and
potential areas of future research related to FM in the health sector, using
methods and bibliographic indicators.
In this
work, the English language was used exclusively for the searches due to its
hegemony in the dissemination of publications and, more specifically, to obtain
a greater number of citations received by these FM research works. Therefore,
the search equations in the different databases were the following:
- In Scopus: [(“Facilities Management” OR “Facility
Management”) AND (Healthcare OR “Health-care” OR “Health” OR Clinic* OR
Hospital)]
- In Web of Science: ("facility
management" OR "facilities management") AND (hospital OR
healthcare OR clinic*)
The authors of the work designed a methodology to
obtain the most suitable results on the searches in the databases (Scopus &
Web of Science), as shown in Figure 1. Firstly, the previously mentioned search
equations that reported interim results. Secondly, a screening of the
provisional results was carried out, discarding those records without a
summary, anonymous or of another subject. Thirdly, those selected who had the
entire text were ordered to be analyzed in later phases. Fourth, those suitable
records selected in the previous step were merged with specialized software (VantagePoint™). Fifth, the duplicate records were reviewed
after the merger and, therefore, discarded to finally obtain the definitive
results of publications appropriate to the research topic.
Figure 1.
Flowchart of the work methodology
Source: Authors
Matrix of results
Next, the authors estimated that if the number of
definitive results was too large to be able to carry out an adequate analysis,
the most representative group of records had to be selected. For this, an
analytical system of the most important documents of this review was developed,
with the elaboration of a square matrix made up of the number of definitive
results in rows and columns to cross the citations of each of the records. In
this way, the records could be sorted by publication date, in ascending order
according to age. On the one hand, a review of the references of each of the
"definitive results" documents was carried out to identify if they
were cited in the documents of this group later and were reflected in the
"Y" column with the sum of citations.
On the other hand, in the most recent publications,
it was reviewed if documents from this same selected group appeared previously
published in their references and they were reflected in row "X" with
the sum of citations. Therefore, in column "Y" is the sum of the most
influential records within the set of selected documents "definitive
results" and in row "X" is the sum of the records of the most
influenced publications of the same set. Once the document matrix was
developed, the most cited documents and the most influenced documents within
the group were identified, in addition, the documents with the most citations
from both databases and the reviews of the literature on FM in health services.
All these documents would be added, merged and those duplicates would be
deleted to carry out the subsequent analysis.
Document Analysis
The resulting documents were analyzed through a
detailed reading of their summary, the identification of the methodology used,
the results obtained and the conclusions of the investigation. This analysis
allowed the authors to determine not only the specific topic of the document
but also to associate it with a specialty or field of research within the FM in
health, since it was necessary to condense the number of topics carried out in
several decades.
Results
The authors were able to obtain a total of 243
documents for the analysis of the international literature review of the FM in
health in the search and filtering works in the two bibliographic search
engines. Table 1 shows the number of records obtained in each of the phases of
the screening process until obtaining the appropriate information on the
subject, with the suitability, fusion and duplicate checking subprocesses to avoid repetitions in the databases of
Scopus and Web of Science (WoS).
Table 1.
Summary of the records found in the screening process
|
Provisional Results |
Records identified in WoS database |
|
Records identified in
Scopus database (n = 396) |
||||
|
|
|
|
|||||
|
Screening |
Anonymous and non-summary
records |
|
Records by theme and without
summary (n = 193) |
||||
|
Records by theme (n = 67) |
|
Patent records (n = 23) |
|||||
|
Total records excluded (n
= 93) |
|
Total records excluded (n
= 216) |
|||||
|
|
|
|
|||||
|
Suitability |
Records available for
selection (n = 131) |
|
Records available for
selection (n = 180) |
||||
|
|||||||
|
Database Fusion |
Merged records (WoS - Scopus) n = 311 |
||||||
|
Duplicate Check |
Duplicate records in both
databases (n = 68) |
||||||
|
Definitive Results |
Records merged for
analysis (n = 243) |
||||||
Source:Authors
In this selection of 243 records, it was possible to
identify a growth pattern in the publication of scientific articles in various
journals and conference abstracts from 1976 to 2018 (Figure 2). This means that
interest in the FM discipline in the health sector has been growing gradually
in the last four decades at the international level.
Figure 2. Productivity trend and
number of publications per year
Source: Authors
In this selection of the 243 documents of the
literature review, it was possible to identify the authors, research centers and
countries that set the research trends in the FM discipline in the health
sector. Table 2 presents the most relevant authors of the selection of
documents that mainly come from Anglo-Germanic speaking countries (Israel, USA,
United Kingdom, Australia, and Germany). In the analysis of the set of
documents, it is contemplated that the publications are widely distributed
among many countries, however, it is identified that the UK and the USA are the
leaders in publications on FM in health.
Although the research centers and authors from the
UK and USA correspond to just over 20% of the total number of selected
documents, their importance is evident due to their Anglo-Germanic origin.
However, other emerging countries appear with a transitory production in the FM
discipline, such as Nigeria, Malaysia, Italy, and Spain; according to the
transience indicators (Vallejo-Ruiz, 2005).
On the one hand, the authors carried out a
quantitative analysis of the research that has caused the most impact in the
scientific community of this selection of the 243 documents of FM in the health
sector, considering the number of citations up to the date of the search. In
this analysis, the 25 documents with the most citations published in indexed
journals and/or congress articles were identified. A qualitative analysis was
carried out on the summaries of these documents, in which it was noted that
they have focused on the following 8 topics:
- Cost/Design, through the evaluation of the design
of the infrastructure, the life cycle, and the simulation of its use to reduce
operating costs.
- Decision-making for management,
based on computerization, information, and communication technologies (ICTs)
and systems for sustainable decision-making by facilities managers (FMer).
- Logistics, optimization, and monitoring of
biomedical equipment, as well as users during their stay in the hospital
institution.
- Integrated maintenance, with the study of the
benefits of integrated systems and the simulation of hospital operations, for
the rational allocation of resources.
- Emergencies/Catastrophes, through the preparation
and management of risks linked to events that may arise with greater or lesser
probability in hospitals.
- Healthcare-associated infections (HAI), with the
impact of contamination for the control and spread of infections to improve
medical care.
- Service Level Agreements (SLA) with stakeholders,
which generate an added-value (AV) for the FM through agreements and
contractual systems with the stakeholders of the health services.
- Management model/Key Performance Indicators (KPI),
with the modeling of an integrated FM that manages the information for the
development of strategic KPI and models to aid decision-making for efficient
hospital operations.
Table 2. Authors, research centers
and countries most important of the review
|
Authors |
No. |
Research Centers |
No. |
Country |
No. |
||
|
Shohet I.M.
(IS) |
8 |
Virginia Polytech Institute (USA) |
7 |
USA |
37 |
||
|
Lavy, S.
(IS-USA) |
7 |
University of New South Wales (AUS) |
7 |
UK |
28 |
||
|
Bulbul, T. (USA) |
7 |
Texas A&M University (USA) |
7 |
Israel |
9 |
||
|
Loosemore, M.
(AUS) |
7 |
Clemson University (USA) |
6 |
Australia |
8 |
||
|
Liyanage, C.
(UK) |
6 |
Ben-Gurion University of Negev (IS) |
6 |
Canada |
8 |
||
|
Lucas, J. (USA) |
6 |
Sheffield Hallam University (UK) |
5 |
Germany |
8 |
||
|
Lennerts, K.
(DE) |
5 |
Karlsruhe Institute of Technology (DE) |
5 |
Nigeria |
6 |
||
|
Egbu, C.
(UK) |
5 |
University of Uyo
(NG) |
4 |
Malaysia |
5 |
||
|
Abel, J. (DE) |
4 |
Pennsylvania State University (USA) |
4 |
Italia |
5 |
||
|
Thabet, W.
(USA) |
3 |
New Caledonian University (UK) |
4 |
Spain |
4 |
On the other hand, in the group of 243 initial
documents, research on literature reviews on FM in health was identified, of
which 20 documents published in journals, congresses and books. In the analysis
of the 20 documents of the literature reviews, it was possible to identify that
70% were published in high-impact journals (Q1 and Q2) and the rest were
published in abstracts of international congresses and in a book. This exposes
that most of the reviews on FM are investigations that are of interest to
high-impact journals, these documents have undergone an analysis of the
conclusions to identify the research topics. In this analysis, various research
focuses on FM in the health sector were found, instead of research topics,
since each of the documents has a different focus on:
- The roles and responsibilities of the FM
- The scope of financial management within the FM
- HAI control
- Legionella control and risk management in IPS
- Performance measurement in FM and maintenance
- Sustainability in FM and maintenance
- Subcontracting in FM and supply services
- Patient safety between FM and medical care
- Other minorities
In this section, it was also identified that the
authors, the research centers, and the Anglo-Germanic speaking countries that
continue that set the research trends in FM in the health sector in recent
decades. Considering the lines of research identified in the documents with the
most citations, it is understood that aspects such as the design of buildings
are important for the life cycle cost of hospital physical assets. In the
operation of support activities, important aspects are related to the logistics
of physical assets and the personnel in charge of said activities, as well as
the preparation of the infrastructure for emergencies or catastrophes and the
control of HAIs through FM.
From the coincidences in the conclusions of these
documents, the authors of this work deduce that the development of management
models and the development of KPIs for performance management are essential
elements that help to obtain an integrated maintenance of the assets and to
improve the agreements with stakeholders of the system. Above all, since the
development of management models and performance indicators help senior
management make decisions based on data and justify them to shareholders.
Once the main references for investigative impact
were identified with the previous reviews of the discipline, the information of
the group of the 243 documents obtained in the initial search was crossed and
the 22 most influential records (most cited) within the group and the 19 most
influenced records (with most citations) of the group of initial documents. In
this analysis, the 25 records with the most citations in both databases were
considered, in addition to 20 reviews of the literature on FM linked to health
services.
All these records add up to 86 documents, some of
which were merged, and others were deleted because they were duplicate, making
a total of 57 publications. The study of research trends on FM in health has
some limitations, it should be noted that a low percentage of the selected
documents could not be found, but that percentage should not significantly
affect the identification of existing thematic trends in this review of the
literature.
This selected group of 57 documents identified as
the most important (Table 3) was qualitatively analyzed to obtain the trends of
the research topics related to the FM discipline in the health sector from 1981
to 2019. Table 3 shows the documents listed with the corresponding title, the
year of publication and the main research topic, which is linked to the FM
discipline in the health sector. A qualitative analysis of the information was
applied to this set of 57 selected publications by reading the summary and/or
document to identify the theme, objective, methodology and conclusions.
Table 3. Set of 57 documents analyzed
by research topics
|
No. |
Authors |
Theme |
No. |
References |
Theme |
||
|
1 |
Kuzdrall, Kwak
& Schmitz (1981) |
Optimization of processes |
30 |
Lo, Guo & Chen (2011) |
Maintenance costs |
||
|
2 |
Smith (1995) |
Functions and competences of FMers
in health |
31 |
May & Pitt (2012) |
FM cleaning plans in the health sector |
||
|
3 |
Simon, McLario, Daily, Lanese, Castillo & Wright (1996) |
Optimization of processes |
32 |
Mohammadpour, Anumba,
Bulbul & Messner (2012) |
Improvement of health processes through FM |
||
|
4 |
Akhlaghi (1997) |
Benchmarking in FM processes in the health sector |
33 |
Chakkalakal, Cherlin,
Thompson, Lindfield, Lawson & Bradley (2013) |
The FM in the Ministry of Health for the design of
clinical guidelines |
||
|
5 |
Rees (1997) |
Functions and competences of FMers
in the health sector |
34 |
Lucas, Bulbul & Thabet
(2013) |
Information management model for FM |
||
|
6 |
Rees (1998) |
Introduction of the FM within the executive boards
of hospitals |
35 |
Talib, Yang & Rajagopalan (2013) |
FM strategic healthcare building performance |
||
|
7 |
Payne & Rees (1999) |
Functions and competences of FMers
in the health sector |
36 |
Irizarry, Gheisari,
Williams & Roper (2014) |
BIM and mobile augmented reality (MAR) for decision
making |
||
|
8 |
Featherstone & Baldry (2000) |
Strategic role of the healthcare FM |
37 |
Ruiz-Ruiz, Blunck, Prentow, Stisen & Kjærgaard (2014) |
Hospital logistics optimization |
||
|
9 |
Okoroh, Gombera,
John & Wagstaff (2001) |
Healthcare FM in service level agreements with added
value |
38 |
Windlinger, Hofer, Coenen, Honegger, von Felten, Kofler & Wehrmüller (2014) |
Review of the FM for health in Switzerland |
||
|
10 |
Amaratunga, Haigh, Sarshar & Baldry (2002) |
Processes optimization of the strategic objectives
of the FM |
39 |
Ganisen, Nesan,
Mohammad, Mohammed & Kanniyapan (2015) |
The FM in the design of sustainable buildings |
||
|
11 |
Kirkham, Boussabaine &
Awwad (2002) |
Life cycle cost analysis |
40 |
Beggs, Knibbs,
Johnson & Morawska (2015) |
Spread of Healthcare-associated Infections (HAI) |
||
|
12 |
Schultz, Mothershead &
Field (2002) |
Preparing hospitals for bioterrorism |
41 |
Hicks, McGovern, Prior & Smith (2015) |
Participatory of healthcare facilities design |
||
|
13 |
Lennerts, Abel, Pfründer & Sharma (2003) |
Improvement of FM processes to save operating costs |
42 |
Lucas & Bulbul (2015) |
Processes operation model |
||
|
14 |
Shohet, Lavy-Leibovich,
& Bar-On (2003) |
KPI for FM to control the maintenance of hospital
buildings |
43 |
Baaki, Baharum,
& Ali (2016) |
Financial management for sustainable FM |
||
|
15 |
Shohet & Lavy (2004a) |
FM integrated model |
44 |
Hashim, Sapri
& Low (2016) |
Challenges of the public private partnership (PPP)
framework |
||
|
16 |
Shohet & Lavy (2004b) |
Review of core issues for FM models |
45 |
Leiblein, Tucker, Ashall, Lee, Gollnisch, &
Hofer (2016) |
Roles and responsibilities of the FM |
||
|
17 |
Chaudhury, Mahmood & Valente
(2005) |
Private rooms with FM, operating costs and
healthcare associated infections (HAI) |
46 |
Madroñal, Galeano
& Escobar (2016) |
Identification of KPI for healthcare FM |
||
|
18 |
Heng, McGeorge
& Loosemore (2005) |
Strategic functions of the FM |
47 |
Mohammadpour, Anumba,
Bulbul, Messner, Singh & Singh (2016) |
Failure impact analysis |
||
|
19 |
Lennerts, Abel, Pfründer & Sharma (2005) |
FM processes analysis |
48 |
Pheng & Rui (2016) |
FM evaluation and patient satisfaction |
||
|
20 |
Liyanage & Egbu (2005) |
FM in control of healthcare associated infections
(HAI) |
49 |
Shohet & Nobili (2016) |
FM model based on KPI and life cycle cost (LCC) |
||
|
21 |
Beatty, Phelps, Rohner
& Weisfuse (2006) |
Improvements in business continuity plan (BCP) or
emergencies for health services |
50 |
Boge & Aliaj (2017) |
Benchmarking studies of facilities services (FS) in
hospitals |
||
|
22 |
Shohet (2006) |
KPIs in FM for financial management |
51 |
García-Sanz-Calcedo & Gómez-Chaparro (2017) |
Review of the FM and the standardization of its
professional practices |
||
|
23 |
Lavy & Shohet (2007a) |
FM integrated quantitative model |
52 |
Roper (2017) |
Review of the FM and the standardization of its
professional practices |
||
|
24 |
Lavy & Shohet (2007b) |
FM integrated quantitative model |
53 |
Shohet & Lavy (2017) |
FM performance in clinics and hospitals |
||
|
25 |
Lavy & Shohet (2007c) |
Annual maiwntenance
expense indicator (AME) |
54 |
Yousefli, Nasiri
& Moselhi (2017) |
Health maintenance management gaps |
||
|
26 |
Ciarapica. Giacchetta
& Paciarotti (2008) |
FM service contracts and service level agreements |
55 |
Chew, Conejos & Asmone
(2017) |
Sustainable FM linked to life cycle cost |
||
|
27 |
Liyanage & Egbu (2008) |
FM service performance management |
56 |
Njuangang, Liyanage
& Akintoye (2018) |
FM services for healthcare associated infections
(HAI) |
||
|
28 |
Lavy & Shohet (2009) |
Financial strategic decisions in the FM |
57 |
Voordt & Jensen (2018) |
Added value model of FM performance |
||
|
29 |
Njuangang & Liyanage (2010) |
Cleaning contracts and infections linked to the FM |
|
|
|||
Source: Authors
In the set of 57 selected documents, 74% of the
publications belong to journals with an impact index Q1-Q2, and the rest of the
publications belong to sources of lesser impact such as conference summaries
and/or peer-reviewed books. In the group of 57 documents are the same
Anglo-Germanic speaking countries that set trends in research on FM in the
health sector (Table 2). In this group of documents, it has been possible to
identify the contribution of each country with the following percentages in
Figure 3, in which almost 70% of the documents have been prepared by authors
and/or institutions from the Anglo-Germanic sphere: USA, UK, Australia, Canada,
Germany, the Netherlands, Switzerland, Denmark and Norway. The other 30% of the
documents belong to countries such as Israel, Malaysia, Spain, Italy,
Singapore, India, China, and Colombia.
Figure 3. Countries and their
contribution to this review of hospital FM
Source: Authors
Discussion
In the analysis of all the summaries of the 57
documents, it was possible to detect that these investigations could be
classified into different themes. The 11 research trends identified in this
review are as follows:
- Process management of the organization linked with
FM
- Functions, competencies, roles, and responsibilities
of FM
- The strategic positioning of FM in the
organization
- The collaboration agreements with the facilities
services (FS) companies and added-value (AV) of the FM
- Financial management, maintenance costs and life
cycle costs through the FM
- FM models based on key performance indicators
(KPIs)
- The performance of FM services through KPIs and
customer satisfaction
- Management and control of HAI
- Emergency management and business continuity plan
(BCP)
- Management of sustainability in the FM
- Other minorities
Likewise, it was verified that several of these
research trends were developed for different research groups, being of
interest, in several decades. Also, it was possible to relate other points of
interest, such as the periods or countries involved in the following issues:
- The optimization of processes based on
benchmarking to obtain improvements in FM models by reducing the impact of
failures and, therefore, the reduction of forced stoppages of those critical
activities in health institutions. This theme was practically developed by
research centers in the USA from the 1980s to 2016, in which other countries
such as Spain, Denmark and Germany have also ventured to a lesser extent.
- From the 1990s to 2017, the identification of the FMer was carried out, particularly in the UK; and the need
to include this figure in top management to coordinate the functions,
competencies, roles and responsibilities in health institutions. This has led
to research on the standardization of professional practices to improve
discipline through the learning of good practices guides.
- Research on FM in the strategic level is
represented by research from the UK and to a lesser extent Australia, USA, and
Israel in the last three decades (1990-2018). These were focused on positioning
the strategic role of this discipline in decision-making and improving the
performance of FM services for creating AV health services.
- An important aspect has been the generation of
added-value (AV) in FM through collaboration agreements between organizations
and stakeholders, through service contracts with FS companies and Public
Private Participation (PPP). This has been dealt with by different countries
such as the UK, Italy, Malaysia, and Norway that have promoted the development
of an AV model of FM performance. Specially, the Netherlands and Denmark
studied about the objectives, functions, and responsibilities of the AV of FM
in health research institutions.
- In recent decades, the management and control of
HAI has been linked to FM, because it is considered an important factor in
controlling the spread of nosocomial infections within health institutions.
These studies have considered from the architectural design of the type of
room, both for individual use and those shared. Further, the impact of HAI on
the operating cost, to the management and control of FM service contracts,
especially from cleaning companies.
- The KPI for infrastructure management are
essential for evaluating the performance of support activities in health institutions.
These studies in the last two decades have focused on factors such as
financial, environmental, technical, functional, managerial management, job
security, and user satisfaction with health services. The studies started in
Israel, by Shohet & Lavy
in the 2000s, have been continued mainly in Colombia, UK, Singapore, and USA in
the next decade (2010-2018).
- In turn, a set of investigations in the last two
decades related to the LCC in the management of physical assets linked to
hospital FM, distributed in the countries of the UK, Germany, China, and
Malaysia, were identified. In this topic, research has been carried out
encompassed in financial management for a sustainable FM that relates: the
analysis of LCC, the optimization of FM processes to reduce operating expenses,
and the control of hospital physical asset maintenance costs.
- The BCP is a topic linked to the preparation of
hospitals for bioterrorism, improvements in emergencies for health services and
factors in the design strategy of clinical guidelines for low-income countries.
These publications come from Germany, UK, and USA centers in the last two
decades. This theme may be recurring for years to come, even more so in view of
the global COVID-19 pandemic.
- Sustainability in FM has been an
underdeveloped topic in the health sector, even though it is current, were
carried out in Spain, Malaysia, Indonesia, the Netherlands, and Singapore. The
first important publications, in the last decade, are related to energy
consumption in FM activities and hospital maintenance. The impact of FM on
sustainable building design, as well as FM sustainable practices linked to LCC
are focused on reducing environmental impact.
- As in KPI, most of the research on FM models has
been developed in Israel, and later in the USA, by Shohet
& Lavy since 2003. These publications, developed
in the last two decades, have focused on the development of models through
information management and by establishing quantitative KPI. As well as on
improving the performance of the health institutions through the optimization
of the LCC and, therefore, linked to financial management.
- Other minority studies have focused on the BIM
methodology (Building Information Modelling) and Mobile Augmented Reality (MAR)
for decision making, so that through FM development studies they can be used as
a useful guide for FM practitioners and academics. in
hospital buildings. Likewise, in the last decade a study has been carried out
to identify gaps in research on maintenance management in health institutions.
Conclusions
This review of FM trends in the health sector, in
this study between 1981 and 2018, allowed the authors to confirm the increase
in publications on hospital FM. In one hand, the authors have deduced from this
work that the transmission of knowledge of FM among Anglo-Germanic speaking
countries has led to the generation of a greater number of publications than
Latin, Arab, or Asian countries. On the other hand, the transience indices of
the authors and research institutions of this selection of publications show
that they are widely distributed worldwide. In any case, the leaders of
publications about authors and institutions on hospital FM continue to be
Anglo-Germanic speaking countries, mainly USA, UK, and Israel.
In the analysis of the select group of the 57 most
important publications, it was possible to identify predominantly 11 research
themes. In the results, it has been exposed these themes have usually been
developed by several countries, except for the roles and responsibilities of
the FMer published by UK institutions. Also, in many
cases, the authors have identified the development of these themes in various
periods, both in the most cited documents and in the literature reviews of the
healthcare FM. Then, it can be verified that the topics identified in the
analysis of the documents (most cited and the literature review) are among the
11 topics resulting in this study. This makes it possible to establish a
starting point for some of the most significant topics on FM in the health
sector such as: process management of the organization linked with the FM; the
functions, competencies, roles, and responsibilities of the FM; the strategic
positioning of FM in the organization. Even so, the authors consider that the
themes published in recent decades still do not cover the current demands of
hospital institutions such as: e-health and ICT; use of data for machine
learning; energy and sustainability; among others. Therefore, all that content
that is not found in the 11 themes found in this work can be the subject of new
lines of research unpublished in healthcare FM.
Moreover, this work can be a starting point to
deepen other aspects dealt with in the documents analyzed, as the case of the
management of organizational processes through FM. This theme is suitable for
health institutions to learn which processes can be improved from case studies,
even if it will be useful to other researchers to determine new approaches in
future projects. Beyond, it would be advisable in future studies to analyze
whether research on sustainability in healthcare FM linked to the increase in
energy from international military conflicts or the optimization of congestion
in hospital institutions caused by COVID-19 has proliferated.
The authors wish to thank the CIDI research program
of the Pontificia Bolivariana
University (Medellín) for the support of research.
..........................................................................................................
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