Promoting the value of facilities operations

Teaching stakeholders about the department’s impact on patient care, safety and operational efficiency helps secure necessary support and resources.

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In the dynamic and often challenging health care environment, managing expenses while maintaining the highest standards of patient care is paramount.

The facilities operations department — often called simply “facilities” — is not merely a cost center but a strategic asset that significantly enhances operational efficiency, patient satisfaction and the overall hospital reputation. It encompasses a broad range of functions, from maintaining the physical infrastructure to ensuring that medical equipment performs optimally.

An important role of facilities managers is to elevate and promote the indispensable contributions of the facilities team, recognize its value and provide a comprehensive understanding of its role within health care institutions.

Catastrophic consequences

If the facilities team did not exist, the immediate consequences would be catastrophic, with structural decay, rampant infections due to poor maintenance of hygiene-critical areas, failing medical equipment and a general inability to provide a safe and functional environment.

The absence of facilities would lead to operational chaos, increased risk and, ultimately, a collapse in the quality of patient care. It’s called “critical mission support” because nothing else is more critical when it fails.

Hospitals rely heavily on the integrity of their physical infrastructure. Buildings, plumbing, electrical and heating, ventilating and air-conditioning (HVAC) systems must be maintained meticulously to ensure a safe and efficient environment.

These systems can fail without regular maintenance and timely repairs, leading to unsafe conditions. For instance, the failure of HVAC systems can lead to inadequate ventilation, increasing the risk of airborne infections. Similarly, plumbing issues can result in unsanitary conditions, and electrical system failures can disrupt medical procedures.

Medical equipment, from diagnostic machines to life-support systems, require regular maintenance and calibration to ensure accuracy and reliability. Without a dedicated facilities team, the likelihood of equipment failures increases, jeopardizing patient care. Imagine a scenario where an MRI machine breaks down in the middle of a critical diagnostic procedure or a ventilator fails during surgery. The implications are dire, compromising patient outcomes and exposing the hospital to significant risks.

The facilities team plays a crucial role in maintaining cleanliness and hygiene standards, ensuring that operating theaters, intensive care units and patient wards are regularly cleaned and sanitized. Without these efforts, the risk of health care-associated infections increases, leading to extended hospital stays, higher treatment costs and worse patient outcomes.

Recognizing contributions

Facilities personnel have traditionally stayed out of the limelight and worked behind the scenes to ensure patient care and business continuity are maintained. However, facilities operations departments cover a wide range of activities and include an equally wide range of individuals who should be lifted to a more significant level of visibility within institutions. Aspects of this includes:

Promoting the department’s role in resource allocation. The facilities team ensures that resources are used efficiently, saving costs and improving the hospital’s overall functionality. For example, by prioritizing preventive maintenance and proactive problem-solving, costly emergency repairs and downtime are avoided. This involves regular inspection and servicing of equipment and infrastructure to identify and address potential issues before they become significant problems. This is far more cost-effective and less disruptive than reactive maintenance.

Improving internal perceptions. Often, the work of the facilities team goes unnoticed until something goes wrong. But it’s possible to shift internal perceptions by highlighting the measures taken to keep the hospital running smoothly.

Recognition of the facilities operations department’s contributions fosters respect and appreciation from other departments, promoting a more collaborative and supportive work environment.

Celebrating National Health Care Facilities and Engineering Week, which will be Oct. 19-25 this year, provides an excellent opportunity to showcase the critical role and achievements of the facilities team, enhancing visibility and appreciation within the organization.

Promoting the department’s role in enhancing the hospital’s external reputation. A well-maintained hospital serves its patients better and builds a more substantial reputation in the community. The facilities team is crucial in achieving this mission. A clean, safe and efficient facility is a testament to the hospital’s commitment to quality care.

Educating stakeholders. Stakeholders, including executive leadership, medical leaders and clinical staff, must understand the vital role of the facilities team. Promoting the department’s impact on patient care, safety and operational efficiency helps secure the necessary support and resources for ongoing and future initiatives. For example, the facilities team’s expertise in crisis management is invaluable, helping to navigate challenges and maintain operational continuity. During regional and national emergencies, utility failures and extreme weather conditions, the facilities team becomes the primary conduit for operational condition updates. Its role is to ensure the incident command team operates with real-time infrastructure and asset functionality updates, which ensures informed decisions regarding patient care capabilities and represents a calming voice during chaotic times.

Ensuring value

To support this recognition and ensure the facilities operations department’s value, facilities teams must gather and process the correct data. This can be achieved with the following eight steps:

1. Use high-quality data. Facilities teams should use high-quality data developed from documentation of the in-situ conditions of the building portfolio.

Growing the trust necessary to garner the support needed to staff, own and operate health facilities is critical to success. As hard as it is to grow trust, it is easy to erode it based on subsequent failure. Consistency and transparency carry the day, and achieving them requires an equal amount of art and skill, along with a base of valid, accurate and informative data.

Recognizing that all team members are contributing to the effort and ensuring the celebration of achievements provides leadership the opportunity to better understand the importance of the work and the skill needed. Data-driven reporting and progress updates allow all stakeholders to see the improvements and track their progress.

Allowing junior team members the opportunity to create and own their portion of the reports and callouts gives leadership a clear view of competencies and the facility’s staff development and succession activities.

2. Develop the capital plan. Facilities teams should develop a capital plan aligned with the mission of the institution. They should review the mission and develop the departmental model to prioritize the team’s support.

The annual variability of available capital makes this exercise critical to the department’s success. Operational budgets are codified based on the financial capabilities of the system, and capital is earmarked for critical initiatives that support the institution’s mission.

A best practice is to align each budget request with the mission goal it supports and ensure infrastructure projects identify how the system supports patient care, research or education teams.

Identifying which physical area within the institution the specific system supports is equally essential.

Facilities teams should tie all infrastructure and equipment maintenance needs to the supported service line. Ensuring that each department team has quality data to support requests and the competencies to defend, drive activities and measure outcomes will give leadership a more profound sense of safety and security that the institution is in qualified and capable hands.

A well-developed capital plan ensures the facilities team can prioritize investments aligned with the hospital’s strategic goals, including addressing immediate needs and planning for future growth and technological advancements.

3. Align capital renewal and deferred maintenance. Facilities teams that have developed capital renewal and deferred maintenance needs aligned with mission initiatives show leadership that they understand the challenges associated with scarce resources and are well-positioned to optimize their support.

Teams should identify what capital renewal can do to improve patient throughput and optimize the efficiency of operations by reducing movement in the space, addressing patient satisfaction concerns and patient flows. They should include all internal stakeholders in the project development to ensure understanding of the initiative, the ability to operationalize the team’s role in the process and support for successful project delivery.

This is a simple solution to show leadership and obtain buy-in from constituencies. The project delivery team includes qualified individuals within their area of expertise and is augmented by third-party providers as needed. This approach prioritizes projects with the most significant impact on patient care and operational efficiency. For example, upgrading HVAC systems in patient care areas can improve air quality and patient comfort, directly enhancing the patient experience.

4. Consider life-cycle costs over first costs. When making decisions, it is essential to consider life-cycle costs rather than only the initial expenses. Facilities teams must prioritize long-term benefits and cost savings over short-term expenditures.

Hospitals can achieve greater financial stability and operational efficiency by focusing on the total cost of ownership. Investments in high-quality materials, energy-efficient systems and robust maintenance programs may have higher upfront costs but yield significant savings and benefits over time.

For instance, investing in energy-efficient lighting and HVAC systems may involve higher upfront costs, but energy consumption and maintenance savings over time can be substantial. Highlighting this approach to leadership underscores the value-driven mindset of the facilities team and demonstrates a commitment to sustainable, cost-effective operations.

5. “Lean up” the computerized maintenance management system (CMMS). After many years and thousands of work orders, CMMS data will degrade. In many cases, degradation will be severe, and leadership knows that information gleaned from the system only has limited usefulness. To clean up the dataset, a best practice is to Lean up the product by implementing an engineering best practice model or other models, such as reliability-centered maintenance.

Reviewing planned predictive and preventive maintenance procedures will identify many antiquated or ineffective procedures that can be eliminated. When this process is acknowledged to leadership and included in transparent annual reporting, stakeholders will become more confident that the work results in a more reliable and sustainable support process.

Creating a resolute process for capturing activities from the demand work order process and linking those activities back to the CMMS database to improve the information on each asset with repair/replacement investments made over time will significantly improve the data quality and grow trust capital.

6. Develop a unified platform. Facilities teams should develop a single platform for planning, design and construction to streamline data and improve understanding of capital needs and priorities.

The CMMS represents the everyday data collection for operations to succeed with limited downtime and for regulatory compliance. Every institution and system has myriad projects in play each cycle that are developed with the intention of disruptive innovation, space, systems and places of respite.

Facilities operations departments should ensure the planning, design and construction source of information properly informs the CMMS to optimize operations in perpetuity. For technicians managing the CMMS, most project data are just disruptive and do not arrive in a usable and consistent fashion.

Finding a unified platform for project delivery and handoff from construction to operations is critical to growing trust capital and providing leadership with a valuable and accurate information stream.

7. Document outcomes and lessons learned. Facilities teams should document all outcomes and lessons learned, publicizing them to internal and external stakeholders. They should avoid benchmarking with anyone outside the organization until the internal evaluation is completed. There is a level playing field within, and internal benchmarking can be conducted effectively.

Departments should ensure all benchmarks utilize transparent ASTM International, ASHRAE, American Institute of Architects, Environmental Protection Agency and American Society for Health Care Engineering standards. They should be cautious before aligning with a third party that utilizes proprietary, non-transparent benchmarks and key performance indicator (KPI) standards.

8. Develop an annual report. Facilities teams should develop an outcome-based annual report with visual graphs and diagrams depicting the department’s successes and accomplishments. They should publish the report and put it into the hands of every stakeholder to ensure visibility of achievements and support for the mission while also encouraging understanding of the role of support in the future.

Allowing each department to develop KPIs, track and trend outcomes and hold itself accountable is a very effective way to grow its stature in the facility and with leadership. A best practice is to standardize the report within the facilities divisions so that lessons can be learned from peers and the value of transparency can be recognized.

Cornerstone of success

The facilities operations department is a cornerstone of hospital success. Its work ensures that the hospital environment supports optimal patient care, safety and operational efficiency.

By recognizing contributions, supporting resource allocation, improving internal and external perceptions and educating stakeholders, the facilities team can be elevated in status and secure the necessary support for critical work.

Emphasizing the strategic value of facilities operations helps ensure that hospitals are well-equipped to meet the challenges of today’s health care landscape, providing high-quality care to patients and maintaining a solid reputation in the community. 

Related article // Strategies for promoting facilities

The following strategies are essential for elevating the visibility and impact of the facilities operations department within the health care institution. By implementing these initiatives, organizations can strengthen operational resilience, improve patient care outcomes, enhance quality scores and ensure a supportive environment for staff and visitors:

• Develop strong communication channels. Departments should establish regular updates and reports highlighting the facilities team’s contributions and successes. These communications should inform stakeholders about ongoing projects, upcoming initiatives, preventive measures and innovative solutions implemented by the facilities team. Clear and consistent communication ensures the broader organization understands the facilities’ critical role in supporting hospital operations.
• Engage in continuous education. Departments should prioritize training and development opportunities for facilities staff to stay abreast of the latest technologies, trends and best practices. Investing in staff education enhances skills and efficiency and underscores the organization’s commitment to maintaining high facilities management standards. Well-trained teams are better equipped to handle challenges and contribute to operational excellence.
• Leverage data and analytics. Departments should utilize data-driven insights to demonstrate the facilities team’s impact on hospital operations. Metrics such as cost savings derived from preventive maintenance programs, reductions in emergency repairs, improvements in patient and staff satisfaction and enhancements in quality scores are invaluable in illustrating the department’s tangible contributions. Transparent reporting of these metrics reinforces the value of facilities in achieving organizational goals.
• Foster a culture of collaboration. Departments should encourage collaborative efforts between facilities and other departments within the organization. Joint projects, cross-functional teams and regular meetings facilitate a deeper understanding of each department’s roles and challenges. By working together, departments can optimize resource allocation, enhance operational efficiency and collectively contribute to the organization’s success. 

Richie Stever, MHA, SASHE, is vice president of real estate and construction at University of Maryland Medical System in Baltimore, and Mark Kenneday, MBA, CHFM, CHC, FASHE, is director of market strategy and development for health care at Gordian in Greenville, S.C. They can be reached at rstever@umm.edu and m.kenneday@gordian.com.