Managing multiple interests in facilities management

Establishing a systemwide culture of values and expectations where every voice is heard is crucial to a successful relationship between health care system, individual facility and partner organization.

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There are a variety of reasons a health care system might choose to collaborate with a partner organization to provide and support critical facilities management duties. Some choose this avenue to expand reach, enhance services and/or optimize resources at individual facilities or across the system’s entire built environment.

These alliances might involve shared management, joint ventures or contracted services, allowing health care systems to leverage expertise and access new markets without full integration. By delegating tasks like facilities management, health care leadership can concentrate on patient care and associated ever-evolving complexities.

However, these relationships can face challenges if not managed properly since trepidation often accompanies fear of the unknown. Organizational leaders may worry about losing control over a particular department, and staff may fear working for an external partner. This fear combined with resistance to change can create obstacles in implementing new processes or systems. Another potential concern is the current relationship between the larger health care organization and its individual health care facilities. Sometimes a partner is brought into a team where there may be preexisting tensions that could affect the working relationship.

Despite these potential pitfalls, when managed effectively, the partner relationship can yield significant benefits for all three parties involved and ultimately improve patient care. The key lies in addressing concerns proactively, maintaining open communication and aligning goals across all stakeholders.

The roles and responsibilities of each entity

In the complex ecosystem of health care partnerships, generally three main entities play crucial roles: the health care system, individual health care facilities and the partner organization. Each brings unique strengths and responsibilities to the table, contributing to the overall success of the partnership.

Health care system. The health care system serves as the overarching structure in this partnership. It provides strategic direction, setting overall quality standards, implementing systemwide policies and standardizing best practices. The health care system's role is to ensure consistency across its network while leveraging economies of scale to improve efficiency and reduce costs, all in support of providing both excellent patient care and provider working environments.

Individual health care facility. The individual facility's role is crucial in delivering high-quality care, maintaining patient satisfaction and addressing the specific health needs of the local population. These entities focus on direct patient care and day-to-day operations and are responsible for maintaining local community relationships, adapting systemwide policies to local needs and ensuring compliance with both system and regulatory requirements.

Partner organizations. Partner organizations bring specialized expertise or services to the relationship. These could be management companies, technology providers or specialized clinical service providers. Responsibilities often include implementation of specific programs or services, providing operational support or managing particular aspects of the facility's operations. The partner organization's role is to enhance the capabilities of the health care system and individual facilities, bringing in best practices and innovative solutions that might not be available in-house.

While the specific roles and responsibilities can vary significantly based on individual contracts and agreements, this structure generally allows the system and individual facilities to focus on core competencies. The health care system provides the framework and resources, the individual facility delivers care, and the partner organization enhances capabilities with specialized expertise. When well-coordinated, this tripartite relationship can lead to improved patient outcomes, increased operational efficiency and a stronger overall health care delivery system.

Best practices for managing the relationship

Managing partnerships between health care systems, individual facilities and partner organizations requires careful attention to several key areas. By implementing best practices, stakeholders can minimize fears associated with change and ensure smooth operations. To effectively coordinate these complex collaborations, it's essential to address crucial components with precision and foresight.

Contracts. The partnership contract is the document that will solidify expectations, terms and scope. Clarity is key, so contracts should have clearly defined roles, responsibilities and performance expectations for all parties. Include language, if necessary, to allow for flexibility on provisions and for adjusting terms as circumstances change. Align goals to ensure the contract reflects shared objectives and incentives, and schedule periodic contract reviews to address any emerging issues.

Consider partnership perspectives when developing contracts. For example, the health care system may focus on maintaining overall quality standards and systemwide consistency, while their partner may focus on clear performance metrics and autonomy in implementing specialized services.

Change management. There are several components to solidify a healthy partnership, including the provision of a strong orientation program for all parties that establishes the system’s culture, values and expectations of all stakeholders. Introducing changes gradually will allow for adjustment and refinement, and explaining the rationale behind changes to all stakeholders will help to reduce assumptions. Establish channels for staff to voice concerns and suggest improvements and offer training to leaders on managing organizational change.

During transition and change, health care system leadership should ensure new processes align with overall strategic goals. The facilities management partner must clearly communicate the benefits of new processes and be open to adapting to the existing culture. This includes involving key staff members in the change process to foster buy-in and address specific operational concerns.

Communication. Managing communication is essential for an outsourced partnership to succeed. Routine check-ins should be scheduled (e.g., quarterly business reviews or QBRs) and involve representatives from all entities. Establish a governance model to clarify who reports to whom across the partnership and how escalations, if needed, will occur. Encouragement of direct communication when issues arise will reduce the chances of a concern escalating or getting out of control.

Both the health care system and partner need to ensure consistent messaging across all facilities and other stakeholders. They also need to maintain transparency about challenges and successes and be open to innovative ideas. 

Partnership goals and frustrations. It’s important to have transparent decision-making and clearly communicate the rationale behind system-level decisions, including goals and intent of the partnership. Ways to include staff to help alleviate fears and frustrations include holding town halls or feedback sessions to address staff concerns. Giving teams an opportunity to vocalize their concerns will help leaders understand where these fears are coming from. Also, it is beneficial to provide opportunities for staff to grow and adapt within the new structure, and to celebrate successes by recognizing and rewarding staff who successfully navigate changes.

The health care system perspective may focus on balancing systemwide efficiency with maintaining staff morale and engagement, while their partner will show value to both the system and staff through measurable improvements.

By implementing best practices, health care partnerships can navigate complexities more effectively, minimizing fears and frustrations while maximizing the benefits of collaboration. Remember, successful partnerships require ongoing effort, open communication and a commitment to shared goals from all parties involved.

Moving forward in transparency

For those who embark on a health care facilities management partnership, managing multiple interests is indeed a complex task, but one that can yield significant benefits when approached thoughtfully and systematically.

The relationship between health care systems, individual facilities and partner organizations, while fraught with potential challenges, can be successfully navigated to create a synergistic ecosystem that enhances patient care and operational efficiency.

Although challenges such as fear of change, loss of control and resistance to new ways of working are real concerns, they are not insurmountable. By implementing best practices in contract management, onboarding, communication and staff engagement, it's possible to create a good working relationship between all parties. These practices ensure that everyone is heard, valued and aligned toward common goals.

Transparent communication, clear delineation of roles and responsibilities, gradual implementation of changes and consistent feedback mechanisms are all crucial elements in building trust and fostering collaboration.

While the path to successful health care facilities management partnerships may not always be smooth, by remaining committed to open dialogue, mutual respect and continuous improvement, health care systems that choose to work with partner organizations can effectively navigate challenges and create partnerships that truly benefit all stakeholders.

Laurie Anseth, CHFM, SASHE, is a health care facilities leader with more than 25 years of experience in health care facilities management and safety. She is currently serving as a system director of maintenance and engineering at JLL with the Main Line Health system in Pennsylvania. She can be reached at Laurie.anseth@jll.com.