Communication advice for facilities managers

Facilities managers must develop a key partnership with their executive direct report to make the case on behalf of the facilities department.

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Hospitals and health care systems are complex organizations with many layers of leadership. This makes competition for resources and capital a challenge, but it is critical to establish efficient operations for the mission of patient care. To properly articulate the needs of a facilities manager, it is important that the facilities manager has a good relationship with executive leadership.

A story of communication

Articulating the needs of the hospital facilities department to executive leadership is primarily a story of communication, whether by developing relationships, aligning with the priorities of the overall organization, demonstrating expertise or selling the facilities department’s mission, among other approaches. They include the following:

Focusing on communication. A key to health care facilities managers having good relationships with their leadership is communicating regularly to describe how systems are functioning.

At the center of these relationships is the one to whom the facilities department reports directly. Depending on the size of the health care organization and the hospital leadership structure, a facilities department usually reports to a chief operating officer (COO). The COO, in turn, interacts with the other executive leaders, including the chief medical officer, chief nursing officer and chief financial officer (CFO), and ultimately reports to a president and/or chief executive officer (CEO). In larger systems, this structure is replicated at a systemwide level to ensure consistency across the overall organization. This adds a layer of coordination and an additional executive level for facilities managers to influence for resources.

The focus of this executive team is to ensure high-quality, efficient patient care. Each executive leader’s purview impacts the patient as they progress through the health care organization for care as an inpatient or outpatient, through the emergency department (ED) or doctor’s office, and for major surgeries or minor procedures. Assessing the patient’s needs and having them in the best setting for care is a core function of the leadership team.

The COO handles all aspects of the daily operations of the hospital. This includes facilities and any other support category that maintains the setting for patient care, such as food and nutrition, security and environmental services. Each of these support services may, in fact, fall under the general facilities department, for which a facilities leader may be directly responsible. Ultimately, however, they will still fall under the COO. Whether having direct span of control by the facilities director or under the COO, it is critical the engineering department interact with both.

The COO also is responsible for ancillary patient care departments, including pathology and laboratory, imaging and, depending on the organization, even pharmacy services. The aspect of direct patient interaction is a key element in patient progression, and the connection to facilities is extensive because testing equipment, radiology scanners and sensitive environments (e.g., U.S. Pharmacopeia-rated pharmacy rooms) must be optimized and functioning so these departments can support patient care.

Being a solid member of and technical expert to the COO’s team is a key function of any facilities manager. The duality of support and ancillary services under the COO makes the role critical to efficient patient progression.

Understanding priorities. Patient progression is the priority of the institution. It means caring for patients as they move through the health care facility while simultaneously considering the volume of patients coming through the doors.

In a busy hospital, available inpatient beds are a primary consideration, with patients coming from the post-anesthesia care unit or from the ED. This puts demand on care-oriented spaces needed to move patients through their care journey. For the facilities department, utility outages interrupt that patient flow by making care areas unavailable. This is where the facilities manager comes in as a leader to support the care team.

In this case, the priority is to establish the scope of the outage and the duration for which the space will be unavailable. The scope considers the scale of the work to be done. The number of unavailable beds, operating rooms, exam rooms or ED bays has direct impact on patient care. Similarly, if work is being performed in ancillary areas, such as the lab, pharmacy or kitchen, there are indirect impacts to care by interrupting service. Establishing the duration with solid information allows staff in these areas to plan their own workflows. Working directly with operational leadership, the facilities manager plays a key role in restoring care in those spaces.

When undertaking planned capital projects or utility upgrades, coordination up front with leaders directly affected by the work is key to forming the plan. This requires extensive collaboration on the effects of the work on patient progression and any interim plans to safely care for the patient during the interruption. While the facilities leader may facilitate the discussions, the needs of the care teams must be considered to build the most effective plan. Involving the COO before planning is important to build greater awareness and ensure the correct staff come to the table. In turn, once the key stakeholders have weighed in and consensus has been gained, it is incumbent upon the facilities leader to communicate this plan in partnership with the COO. Providing full awareness of the activity enables better execution of the work for the contractors and the affected departments. Alternatively, if a plan is not well considered or communicated, it will result in stopping the work, causing delays and increased costs.

Unplanned interruptions are common but can be approached in the same way. By working with patient care, ancillary and support departments on planned work, unplanned work becomes easier. Also, by being comfortable communicating planned outages with the COO, it is easier to update the COO on situations regarding the scope of the unplanned outage and anticipated duration.

Often, during unplanned failures, the duration is not clearly defined. However, a facilities manager can communicate the duration of the work they think is needed to get spaces or systems back online. In an emergency management structure, such as the Federal Emergency Management Agency’s Incident Command Structure, duration is key to making sure alternate resources are available. If the repair work does not bring the systems back as planned, revisiting the scope and time frame is critical to communicating the plan to all parties so patient care can be modified.

Viewing problems as opportunities. A common misconception among facilities managers is that they will be in trouble if there is a breakdown. Leadership may look for the cause of the disruption without grasping all the factors of the challenge if these factors are not presented to them. By moving past the notion that a breakdown is a failure, the facilities manager has an opportunity to relay their expertise and find the best solution.

Sometimes solutions can be hampered by the phrase, “There is nothing we can do.” These words should be eliminated from a facilities manager’s vocabulary. There’s always something to be done, including further analysis and collaboration. This could include escalating to a higher-level manager, conferring with operational staff on solutions or taking a broader view of troubleshooting to see what can be done. Another aspect of poor communication is when failures are not communicated under the misguided idea that facilities managers will be perceived as not having things under control. On the contrary, openly communicating issues to leadership and those directly affected helps establish the facilities manager’s professionalism.

Similarly, facilities managers often give inflated time estimates for a solution to make sure schedules are met. While there is value to giving worst-case scenarios for duration, it damages credibility to be too far off the mark. Instead, facilities managers should give leadership concise updates and insights into troubleshooting efforts, available solutions and the expertise being deployed to solve the issue. This gives a fuller picture of the time range. It also leads to enhanced appreciation by senior leadership that the facilities department has sufficient expertise.

Demonstrating expertise. A COO has likely experienced matters related to facilities. It is important for a facilities manager to quantify that experience to inform the COO and find common ground. For instance, the COO has likely experienced a major capital project or utility failures. Stories are common from both COOs and facilities managers regarding working on a particular project, dealing with a certain construction company or repairing a late-night water line rupture. Finding common ground is important to provide an understanding of the scope of work the facilities department covers.

Sharing the background of these experiences is important. Discussing how a particular project was approached, how an emergency was brought under control and solved, and describing any lessons learned from negative experiences is key to providing background to the COO. Practicing open communication with the COO helps show how unique, technical experience can be put to work for the greater purpose of caring for patients.

Maintaining visibility. Another way of showing expertise is to simply be present and available. An important aspect of being in communication with executive leadership is being available to peer leaders in the patient care, ancillary and support areas. A good venue for visibility is senior leader huddles, which are more common in organizations that strive for high reliability. Being present not only represents the COO team, but it also provides the opportunity to become familiar with the other senior leaders.

This level of visibility, even as things are going well in facilities operations and all systems are operational, gives leadership comfort in contacting the facilities manager as a leader of the institution. Similarly, if an issue arises or an extended outage influences patient care, the facilities manager becomes the recognized leader who managers turn to for updates and timing of the situation.

Making the case for resources. Perhaps the most difficult time for a facilities leader is when asking for resources. In addition to funding for maintenance contracts, capital improvements or deferred maintenance, staffing is a large operational resource that is frequently requested and very often denied. However, considering all the work a facilities leader is tasked with, making the case for these resources is an important responsibility.

A first step to understanding the impact of resources is to understand the financial reporting systems of the institution. This is the primary way resources are tracked by executive leadership and should be actively used by the facilities manager. Grounding the case in the normal reporting structures of the institution is an effective approach. Demonstrating a positive impact in that context is important, either in cost savings, efficiencies or fewer overall disruptions to patient care areas. Support materials or data then can be brought in based on more standard tracking mechanisms unique to the facilities department.

In the best scenario, the facilities leader will be asked to come in and directly make the case for resources in front of a CFO. But in many cases, the first person they must influence is the COO.

A key partner

Influencing hospital executive leadership is less about making an argument and more about being recognized as a key partner on a day-to-day basis.

Working with the facilities department’s executive direct report is a key factor, but being a visible, effective facilities leader during normal operations helps lend credibility when resources need to be filled, a problem needs to be solved or a case needs to be made. 

Related article // Hospital executive leadership roles

Hospital executive leadership is not a random collection of leaders behind closed doors. They each have their role to fill in the mission of patient care and lead departments in which a facilities manager has important peer groups to regularly interact with. A typical health care organization includes the following executive leaders:

• Chief executive officer (CEO). The other members of executive leadership directly report to the CEO. This position has primary reporting duties to the board of directors and is responsible for the overall performance of the hospital or health care institution.
• Chief nursing officer (CNO). The CNO is responsible for the professional practice, training and performance of the nursing staff, including registered nurses, nursing care technicians and nursing unit leadership. This is normally the largest workforce within the hospital or health care institution.
• Chief medical officer (CMO). The CMO is responsible for the medical staff, including physicians. The CMO also is responsible for quality of care in the hospital, including measures reported to the Centers for Medicare & Medicaid Services and insurance companies.
• Chief financial officer (CFO). The CFO is responsible for expense control, revenue cycle, payroll and capital planning.
• Chief operating officer (COO). The COO is responsible for the day-to-day operations of the health care institution. They are typically responsible for facilities management as well as other support areas such as environmental services, food and nutrition and security. The COO also is responsible for ancillary care areas such as imaging and radiology, pathology and laboratory, pharmacy and outpatient services. 

Jeff O’Neill, AIA, ACHA, SASHE, is vice president of plant operations at RWJBarnabas Health Robert Wood Johnson University Hospital in New Brunswick, N.J. His email is jeffrey.oneill@rwjbh.org.