Decoding the State of Hard FM in the UK's Healthcare Sector

The covid-19 pandemic took the world by surprise. Our healthcare systems were not prepared for it and we faced heavy consequences because of it. On the other hand, the covid-19 pandemic acted as a catalyst for digital transformation. The healthcare industry needs to take a great jump ahead in technology to cope up with the aftermath of the pandemic and to be prepared for the future.

In quite an interesting podcast, the crucial role of nursing staff in the ongoing digital transformation within the healthcare industry was highlighted. Nurses are passionate advocates of this transformation, and their involvement is critical from a patient care perspective. There is a disconnect between what FM companies think they need to deliver and the perception of nursing staff regarding maintenance tasks.

In this article, I will highlight the key points that Robert Philbrook (referred to by his friends as Bob) discusses about the future of asset performance management, particularly in the healthcare sector in the UK and how involving nursing staff or operations and maintenance teams can make a difference.

The Disjoint between FM Companies and Nursing Staff Perceptions

The tasks of the nursing staff and an engineer differ. While managing operations for healthcare, FM companies often fail to grasp the true requirements of nursing staff, resulting in a misalignment of priorities. For instance, when a nurse is asked about the tolerance on drawing 15 ml of a drug into a syringe, they respond that it should be precisely 15 ml. On the other hand, an engineer might suggest a range like plus one ml or minus two. This disparity reflects the different outlooks on tasks and responsibilities.

Despite both industries sharing similarities in maintaining equipment, there exists a substantial difference in perception. While FM companies manage mechanical maintenance, nursing staff handle physical maintenance, in healthcare human patients are assets. Understanding and acknowledging these differences are crucial for building effective healthcare facilities.

Nursing Staff Involvement in Facility Management

It is essential for FM companies to actively involve nursing staff in decision-making processes. This can lead to better asset performance and ultimately benefit patients and create better healthcare environments. Sadly, few companies reach out to nursing staff to gauge their feedback and assess areas for improvement. Fear of the potential repercussions may hinder these companies from seeking valuable insights from those directly involved in patient care.

Expert's Perspective on Healthcare Facility Management

Bob had an extensive career in quality, safety, and environmental management systems for a major construction company, and has a unique perspective on healthcare facility management. His involvement in managing the mobilization from an old estate to a new PFI hospital presented several challenges, given his limited knowledge of the FM industry.

To overcome this challenge, Bob embraced a back-to-basics approach. He focused on understanding the building's assets, their maintenance requirements, and the necessary personnel for upkeep. Bob's team, along with the construction company, proactively gathered asset information for the new PFI, starting from scratch.

As a result, maintaining new PFI hospitals demands a comprehensive and proactive approach. Starting early, embracing new technologies such as BIM, and applying cost-cutting strategies can dramatically improve the efficiency and sustainability of FM operations, ensuring that these hospitals stay in outstanding condition for years to come.

Challenges with Budgeting for New Healthcare Facilities

The asset density in modern healthcare facilities poses challenges during the tendering and budgeting processes for FM companies. Tender assessments based on the outdated "pound per meter" rule fail to consider the increased asset density, leading to underfunded maintenance budgets. This discrepancy makes it difficult for FM companies to keep the hospital in pristine condition within the allocated funds.

Advancement in hard services of UK’s healthcare

In recent years, healthcare facility management has witnessed a technological revolution that has reshaped the industry. Notably, Computer-Aided Facility Management (CAFM) systems have become more comprehensive and user-friendly, allowing for seamless integration of modules. These advancements have transformed CAFM systems into central hubs for storing critical asset information and intelligence, improving the understanding of asset performance.

Building Information Modelling (BIM) has revolutionized asset management, allowing for precise and efficient maintenance planning. By utilizing BIM models and CAFM systems, healthcare facilities can create a central hub of information, ensuring better asset performance.

The Untapped Potential of Building Management Systems (BMS)

Building Management Systems (BMS) have tremendous potential for enhancing asset management, but their utilization remains underwhelming. According to Bob, many FM companies have overlooked the benefits of BMS and fail to tap into the wealth of data they can provide. BMS offers valuable insights into critical systems, helping with remote monitoring and predictive maintenance. The challenge lies in introducing these technologies to operational teams effectively. During adoption of any new technology, there is little to no dialogue with operational teams. It is the O&M team who have to work with the technology. Engaging operational teams and technicians in technology adoption can lead to a more holistic and successful transformation and the same principle applies to the nursing staff.

Challenges in Embracing Data-Driven Decision-Making

One of the key challenges in maximizing the potential of BMS and other data-driven systems has been the lack of motivation among FM companies to use better data. Until recently, the value of data-driven decision-making was not fully recognized, leading to the underutilization of available technologies like BMS and CMMS. However, the industry is gradually recognizing the importance of data and its role in driving efficient facility management.

PFI vs. Non-PFI: Understanding the Differences

In the healthcare facility management landscape, a crucial distinction exists between PFIs (new estates) and non-PFIs (existing estates). PFIs represent new, technologically advanced healthcare centers with fresh intelligence and modern infrastructure. On the other hand, non-PFIs often struggle with outdated asset intelligence, hindering efficient maintenance.

Challenges in the UK's Healthcare and Maintenance of Critical Systems

The healthcare industry in the UK, like many other countries, has faced numerous challenges during the COVID-19 pandemic. The stress on healthcare facilities, coupled with increased patient load, has pushed assets to operate beyond their intended capacity. Addressing these challenges requires data-driven decision-making, but certain obstacles hinder the smooth maintenance of critical systems.

Overburdened Healthcare Facilities: The pandemic has resulted in healthcare facilities operating at full capacity, straining not only the nursing staff but also the infrastructure itself. Keeping up with maintenance activities amidst the intense pressure becomes a significant challenge.

Limited Resilience and Flexibility: There is a lack of resilience within the National Health Service (NHS) to cope with sudden changes in demand. As healthcare facilities cannot easily move patients to different wards during maintenance, scheduling maintenance becomes more complex.

Stringent Maintenance Regimes: Strict maintenance regimes are important for critical systems. However, some facilities develop their maintenance schedules, disregarding industry best practices and guidelines. This can compromise the performance of critical systems.

Commercial Intervention in CAFM Systems: Debate often arises over what information should go into the CAFM system, especially regarding the critical plan. Commercial stakeholders may argue against including certain maintenance activities. These contracts, however, invariably state that the equipment would be maintained in compliance with mandatory legal HDMs and best practices for O&Ms. As a result, you can't leave things out unless you mitigate them.??

Lack of Proper Documentation: Proper documentation is essential to justify maintenance decisions and mitigate risks. In cases where deviations from standard maintenance practices occur, a clear record of the decision-making process is crucial to avoid potential complications. In order to justify the approach for equipment upkeep, there needs to be a risk register. Otherwise, It goes back to the operational team to accept accountability.

Intervening Beyond Design Parameters: Healthcare facilities are under immense pressure and are full to their capacity. In such cases, maintenance interventions might occur more frequently than originally planned. Deviating from established maintenance schedules requires careful consideration and risk assessment.

Limited Adoption of Technology: Some facilities still underutilize technology, such as condition-based maintenance, despite its potential to optimize asset performance. Embracing technology can improve maintenance efficiency and enhance patient care.

Budget Constraints: Healthcare facilities may face budgetary constraints, leading to difficult decisions regarding asset maintenance. Properly documenting these decisions is essential to manage risks effectively.

In the face of these challenges, data-driven decision-making emerges as a valuable tool to optimize asset performance, enhance resilience, and provide better patient care. Collaborative efforts between operational leads, commercial stakeholders, and facility management teams are essential to overcome these obstacles and ensure efficient maintenance of critical systems in UK healthcare facilities.

The Role of Modern-Day FM Company in Healthcare Facilities

In the ever-changing landscape of healthcare, the role of a modern-day Facilities Management (FM) company has become paramount. The FM company serves as a crucial link in ensuring the smooth functioning and maintenance of critical systems within healthcare facilities.

1. Adhering to Clear Guidelines and Maintenance Regimes

FM companies ought to get back to the basic principles of general maintenance and establish maintenance regimes. Condition-based monitoring provides a strategy for maintaining critical and non-critical assets without relying on reactive maintenance. All assets should be maintained on a regular basis in order to increase their lifecycle.?

While condition-based monitoring offers valuable insights, FM companies should not use it as a replacement for regular maintenance. They should also use remote monitoring as a supplementary tool to gather intelligence on equipment performance and support proactive maintenance efforts.

2. Understanding the Changing Landscape of Healthcare

Healthcare facilities are experiencing unprecedented stress after the pandemic and evolving patient needs. FM companies have to work closely with the nursing staff to understand their needs and adapt to these changes to support the facilities effectively. FM companies should employ multiple solutions, including technology, resources, and changes in design. A collective effort is essential to find sustainable solutions and prioritize patient care.

3. Embracing Technology and Data-Driven Maintenance

FM companies should think about the long term advantages of technology. There are numerous benefits of technology and data-driven maintenance, such as condition-based monitoring. FM companies should embrace these advancements to enhance asset performance and identify potential issues proactively.

The abundance of data from CAFM systems offers immense potential for improved asset management. FM companies should harness this data to facilitate decision-making, streamline maintenance processes, and enhance overall efficiency.

4. Addressing Knowledge Gap and Retention Challenges

With senior engineers retiring, there is a looming knowledge gap in the industry. FM companies must invest in apprenticeships and training to groom the next generation of technicians to work with technology. Additionally, while bringing in technicians from other industries into the unique healthcare environment, train them to understand patient care. They have to understand the maintenance has to be done in such a way that no disruptions happen to patients and nursing staff.

Facilities management in healthcare facilities involves navigating a rapidly changing landscape, embracing technology, collaborating with operational teams, and addressing knowledge gaps. By adhering to maintenance principles and leveraging accessible data, FM companies play a vital role in ensuring the smooth functioning and well-being of healthcare facilities and their patients.

Top Recommendations for Modern-Day FM Companies in Healthcare Facilities

It is important to establish a comprehensive carbon footprint baseline. FM companies should proactively work with healthcare organizations to determine their carbon footprint and energy usage. If an organisation has to go Net Zero then they have to first determine their baseline such as their carbon footprint. Understanding the baseline is essential for setting meaningful and achievable sustainability targets, such as net-zero initiatives.

According to Bob, we will never go back to that time, and things will be difficult from now on. In the case of healthcare facilities, the FM teams and the assets that they maintain will be under equal or greater stress. The only way forward is to be able to make the best use of technology. Go back to the first principles, which are engineering, and make the most of the resources that are available with a very special focus on how you retain the knowledge.

FM companies play an extremely crucial role in driving these changes and leading the way to a better healthcare system, supporting the nursing staff and creating optimal conditions for patients. FM companies hold the perfect position to facilitate digital transformation and make the best use of these changing technologies.

Listen to this podcast episode to know more about the state of UK’s healthcare and the changing landscape for facilities management.

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