Patient First, the UK's largest patient safety event, will return to London's ExCeL on 21-22 November 2017
Paul Lloyd, managing director of the Healthcare Facilities Consortium, examines the challenges the healthcare environment poses to estates and facilities management
When considering the challenges it faces on a day-to-day basis, it’s worth considering where the modern estates and facilities management (E&FM) function came from and why. ‘Support Services’ functions as they were known (and still are to some) were individual departments within hospitals managed by ‘a head of…’ - usually reporting to the hospital manager and accountable for their area only. This presented a number of challenges; the most important being that co-ordination of activates relied more on personalities than procedure.
A large number of direct reports across the hospital environment proved complex to manage, as did individual financial arrangements. As each function was managed by a professional head in a silo structure there was very little opportunity for staff to understand other functions, or to grow or develop without moving elsewhere with the inevitable loss of corporate memory about the site and its issues. This is particularly important with an estate and services as complex as those in the NHS. Bringing those functions together attempted to resolve many of the issues set out above. However, it came with its own drawbacks.
To succeed in the E&FM environment each professional head of department had to become more generalised and corporate in their approach. They needed an appreciation of the issues faced by each of the respective functions they managed together with a wide range of financial management skills, including the ability to determine what should be the spending priorities and where it was safe to make cutbacks or to delay or even cancel investment. Without sound knowledge, this presented obvious challenges and risks.
A demanding position
Things have moved on considerably over the years both in terms of skills, knowledge and greater integration with top management and clinical priorities. As the estate and facilities have become more complex, and the public and ministerial interest has become greater and greater in the quality of the environment for patients and staff, the E&FM professional has become a well respected and valued member of the hospital management team. However, the role now demands even greater skills in areas such as strategic planning, wide knowledge of the estate’s condition and an almost scientific approach to hospital cleanliness, catering and infection control. Compliance with an ever-increasing list of regulations places further pressure on the team managing these vital services.
Clearly many healthcare services could not be offered without the requisite estate and facilities. It is also important to recognise the financial commitment the modern E&FM department makes to the daily running of the hospital; in pure revenue terms approximately 30 per cent of turnover is vested in E&FM making it the largest cost outside of the payroll bill.
The list of guidance and legal requirements placed on E&FM teams is extensive, covering everything from hospital parking to legionella. Add to this the list of returns, surveys and inspections expected to be completed, recorded and evidenced such as ERIC, PLACE and fire risk assessments to name just a very few. Newer government initiatives such as Premises Assurance and the recent Carter Report add more pressure by expecting yet more information to be collected and analysed in the name of efficiency. While each has its value in managing the E&FM function they all add to the pressure on the department through the collection, compilation and analysis of information, all of which consumes valuable time and resources and obliges teams to choose reporting over other potential uses of their time. Such information also needs to be monitored and reviewed against defined action plans, extending the resource commitment over a longer period of time.
To add to the already significant pressure, there could also be a huge number of inspectors from CQC descend on the site either announced or unannounced to inspect everything from the hospital buildings to the trust’s procedures and records. As one would expect – and rightly so – the safety and quality of the environment is critical.
A facilities management system
So, with a myriad of legislation, guidance and compliance issues to consider as well as planned and reactive maintenance to manage, what tools are available to help with monitoring, tracking and analysing progress in each of these areas? Besides the trusty and ever-popular spreadsheet, hospital E&FM teams usually purchase a facilities management (FM) system to help keep on top of everything. There are many solutions out there, all doing similar things and spanning a wide price range. The choice of which to use comes down to the best suited for your specific working practices and that means drawing up a specification, going through a lengthy (and costly) tender process and evaluating the options by inviting potential suppliers to deliver detailed software demos.
As FM systems become more comprehensive we are seeing single systems with the capability to handle everything required by a modern E&FM department. On the face of it this sounds very attractive and efficient however there are downsides; most systems have been designed for a specific purpose and subsequently adapted to widen their reach. This can lead to sub-optimal performance in certain areas; if the system fails, everything fails and although contingency plans should be in place should such incidents occur, there is a continual risk of business interruption which can have serious consequences both in terms of cost and on service delivery.
Larger, all-encompassing systems tend to be corporately driven and local influence is not always effective when changes are requested. So, for many users it is inevitable that additional software will be required to manage and monitor specific issues and this is usually provided by a specialist organisation who understand the need and not just the technology. While this may not be ideal, tools are available to allow for the relatively easy integration of such disparate systems should they share unique identifying data elements such as location codes for example. Such integration allows for the exchange of data and the introduction of some consistency between such systems on a basic level.
Key to the success of any FM system is the quality of the data going into it. This extends beyond simply populating the database and relies on the ability of the user fully understanding what the output from the system needs to be and how it is intended to be used. All too often, this isn’t the case and the implementation of the system becomes a struggle and can fail altogether. In contrast, taking the time to build solid, flexible coding structures and adopt working methods to complement the software’s functionality, even if it means adapting or modifying your existing procedures, will result in better output and save time and money in the long-term.
Flexibility and speed
The introduction of any computer based system will inevitably involve a great deal of time and effort to build and populate in the early stages but expending that effort and taking the time to properly structure the data will quickly start to pay off. The quality and usefulness of the data coming out of an FM system is only as good as the data put into it.
It is for these reasons that getting this right from the start and working in collaboration with reliable and experienced suppliers will pay significant dividends. Ensuring you have a supplier you can trust and who understands the industry you operate in is critical to achieving that best in class performance from the chosen system; peer group pressure on suppliers to ‘get it right’ must not be overlooked. Although it was mentioned above that local variation is an important feature it must be recognised that this is more about the flexibility of the system to adapt to your local needs, at least to some degree, rather than being a ‘one size fits all’ solution from the start. After all, all healthcare E&FM professionals essentially carry out a similar role regardless of their hospital’s location or specialty.
Keeping on top of sector changes and making sure all those involved are as knowledgeable as possible is a major challenge for E&FM professionals and their teams, especially as they are expected to maintain and improve their performance and standards year on year with increasing pressure on their budgets. The routine collection and analysis of data, either through reporting or via real time dashboard systems and the like, is essential to the monitoring and improvement of performance and efficiency. Liberating even small savings from this budget makes a significant difference to the clinical funds available.
Making these critical decisions requires experience, knowledge and a wide understanding of what is possible within the hospital environment. In this time of increasing pressure on budgets, one of the first targets to make savings is often the training budget. However, this can prove to be a poor decision. E&FM is an area that is always developing, with new regulations to be met, and new case studies or guides to be absorbed and applied to keep getting the most effective use of E&FM. Without a clear understanding of the issues and challenges, including the ability to analyse costs and their implications in terms of possible savings as well as warning signs, then the trust will end up paying out more in the medium to longer term. Keeping all staff as upskilled as possible will without doubt improve performance, grow staff commitment and reduce likely costs on retention and recruitment.
A collaborative approach
It isn’t possible, however, to make these savings in isolation from other parts of the hospital system. Proper collaboration in the use of the assets and utilities is fundamental to achieving even the most modest of improvements. The E&FM director needs help from not only their departmental colleagues but from the external market bringing best in class solutions to bear, and there is definitely no shortage of companies keen to get their products into the healthcare market.
The challenge for the director is how to evaluate the range of products and services on offer. Experience and talking to existing product/service users is a common way of doing this. However, it may not be the best way to source the newest or best solutions available because each NHS body’s characteristics and drivers will be different, so E&FM directors and their teams need to invest effort in identifying and evaluating the possible options and making the best value choice.