Key Performance Indicators for Strategic Healthcare Facilities Maintenance

The salient phases in a facility’s service life that are most decisive for the effectiveness of its facilities management (FM) are the preliminary design, construction, and maintenance. The effectiveness of facilities is vastly affected by decisions pertaining to the strategy of the organization that owns or uses the facilities. The goal of this study was to develop key performance indicators (KPIs) for strategic FM that will provide a conclusive approach towards the facility’s service life conditions. Parameters were developed by means of field surveys and statistical analyses, and were validated by means of case studies. The research resulted in a series of 11 KPIs for strategic healthcare FM, which can be classified into four categories: development, organization and management, performance, and maintenance efficiency parameters. The study proposes age and occupancy coefficients as essential parameters for the assessment of large healthcare facilities needs, as an effective measure for long term facility maintenance planning, and for measuring FM effectiveness. The paper stresses that strategic healthcare facilities management must integrate quantitative performance, manpower, and maintenance indicators.     

Tracking Components and Maintenance History within a Facility Utilizing Radio Frequency Identification Technology

Limitations in data transfer between maintenance workers and a central facility management (FM) system result in lower data quality, longer service process times, and ineffective capturing of component maintenance history. Radio frequency identification (RFID) technology provides an opportunity to meet the current needs for uniquely identifying facility components, storing some maintenance history information on the component, and accessing this information on-demand within a facility. There have not been any research studies that tested the performance of active ultrahigh frequency RFID technology on facility components during operations and maintenance phase repetitively over an extended period of time. The objectives of this study were to identify how RFID technology can improve current FM processes and to determine technological feasibility of using RFID within a facility repetitively on a daily basis. The writers tagged fire valves in a facility with RFID tags and conducted a longevity test for sixty consecutive days by simulating tag identification, data access, and entry in real-life conditions. The results demonstrate that current commercially available active RFID technology performs well in a building environment where metallic objects and different obstructions are present. The observed reading distances were approximately half of the reading range expected in open air provided that there are not any massive obstructions between the reader and the tag.     

Simulation Model for Determining Maintenance Staffing in Higher Education Facilities

Expeditious repair of the unpredicted breakdown of the systems components of facilities is a crucial demand that is highly conducive to the convenience of users and to the longevity of systems. The determination of maintenance staffing, particularly the number of maintenance crews, constitutes a key decision in this regard. Judicious determination of the number of crews prevents crews from being underused or overloaded. A simulation model, using AweSim simulation language, was developed to determine the optimal number of crews for the maintenance department of a large higher education facility. The model development involved: establishing statistical distributions that reflect the stochastic nature of the generation of the repair requests as well as the service times; setting up the maintenance service model that defines the logic, sets priorities for assigning repair requests to crews, and defines performance measures; developing the simulation software; and collecting statistics of the performance measures for scenarios that represent different number of crews and crew-loading policies. The optimal number of crews was identified as being the scenario of the lowest total of the operating costs incurred by the maintenance department and costs of inconvenience to users. Finally, the model represents a robust management tool for long-term economic planning of resources.     

Simulation As a Tool to Assess the Vulnerability of the Operation of a Health Care Facility

Health care systems are classified as critical infrastructure systems when responding to disaster events. Physical damage to health care facilities or disruption of their operations or supply chains could prevent an effective response and aggravate the outcome of an emergency situation. Even if a hospital or public health facility were not directly affected by the disaster event, these facilities are required to operate efficiently during an emergency in order to manage a surge of capacity. When infrastructure systems are damaged as a result of man-made or natural disaster events, insufficient supply of resources through these systems affects their performance. In this paper, a system dynamics simulation model will be used as a tool to represent the operation of a health care facility, including the interaction between the different service areas (emergency room, intensive care unit, wards, operating room), the flow of patients inside the facility, and the condition of the infrastructure systems that supply resources (i.e., water, power, transportation of medical supplies) to maintain the operation of the facility. The results of this study may assist hospital administrators in their disaster preparedness plans, providing information regarding the level of occupancy and patients waiting to enter the service areas.     

A discussion of regulatory requirements and air dispersion modeling approaches applicable to U.S. chemical demilitarization facilities

Owners of hazardous waste treatment, storage, and disposal facilities, and certain major air pollution sources, must conduct several separate ambient air dispersion modeling analyses before beginning construction of new facilities or modifying existing facilities. These analyses are critical components of the environmental permitting and facility certification processes and must be completed to the satisfaction of federal, state, and local regulatory authorities. The U.S. Army has conducted air dispersion modeling for its proposed chemical agent disposal facilities to fulfill the following environmental regulatory and risk management requirements: (1) Resource Conservation and Recovery Act human health and ecological risk assessment analysis for the hazardous waste treatment and storage permit applications, (2) Quantitative Risk Assessment to support the site-specific risk management programs, and (3) Prevention of Significant Deterioration ambient air impact analysis for the air permit applications. The purpose of these air dispersion modeling studies is to show that the potential impacts on human health and the environment, due to operation of the chemical agent disposal facilities, are acceptable. This paper describes and compares the types of air dispersion models, modeling input data requirements, modeling algorithms, and approaches used to satisfy the three environmental regulatory and risk management requirements listed above. Although this paper discusses only one industry (i.e., chemical demilitarization), the information it contains could help those in other industries who need to communicate to the public the purpose and objectives of each modeling analysis. It may also be useful in integrating the results of each analysis into an overarching summary of compliance and potential risks.     

Developing O&M Plans for Homeowners Associations: Case Study

This paper presents a case study of a town-home community in Atlanta, and describes the development of an operations and maintenance (O&M) plan for the maintenance of the exterior building components of the superstructures, grounds, driveways, and landscape of the property. Included in this O&M plan is a current conditions assessment of the facility exterior maintenance and the financial budget associated with process improvements and the projected maintenance requirements.     

Development and psychometric properties of the Ethics Environment Questionnaire

OBJECTIVES: The author reports on the development and the psychometric properties of the Ethics Environment Questionnaire (EEQ), an instrument by which to measure the opinions of health-care providers about ethics in their clinical practice organizations. The EEQ was developed to increase the number of valid and reliable measures pertaining to ethics in health-care delivery. METHODS: The EEQ is a 20-item self-administered questionnaire using a Likert-type 5-point format, offering ease of administration. It is applicable to a cross-section of health-care practitioners and health-care facilities. The mean administration time is 10 minutes. The EEQ represents testing on 450 respondents in acute care settings among a cross-section of acute care facilities. RESULTS: Internal consistency reliability using Cronbach's alpha coefficient is 0.93, and the test-retest reliability is 0.88. Construct, content, and criterion validity are established. The scale is unidimensional, with factor loadings exceeding the minimum preset criterion. Mean score is 3.1 out of 5.0, with scores of 3.5 and above interpreted as reflective of a positive ethics environment. CONCLUSIONS: The EEQ provides a measure of ethics in health-care organizations among multi-practitioners in clinical practice on a valid, reliable, cost effective, and easily administered instrument that requires minimum investment of personnel time.     

Adding Value to Constructed Facilities: Facilities Management Hospitality Case Study

This paper discusses recent research on the benefits of facilities management (FM) in the hospitality industry and how the application of FM can contribute to the derivation of value by users, hotel owners, and employees. The paper also discusses the research instrument used, which is comprised of a survey questionnaire and the repertory grid technique. The term, practice and research into FM, has been more prevalent in environments where constructed facilities form part of the non-core activities of the organization. In hotels, a very large proportion of the product relates to the management of the core activities that center on built facilities. There is a need for life cycle planning of these facilities, their capacity, use and proactive maintenance policy, as well as the resources needed to cope with changing demands. Factors such as life cycle costing, productivity, performance values, and legislative change drive FM. This paper argues that owners/owner managers in the hospitality business, who are more proactive in the management of their constructed facilities, achieve higher occupancy rates, profitability, and repeat of business.     

Sensing and Field Data Capture for Construction and Facility Operations

Collection of accurate, complete, and reliable field data is not only essential for active management of construction projects involving various tasks, such as material tracking, progress monitoring, and quality assurance, but also for facility and infrastructure management during the service lives of facilities and infrastructure systems. Limitations of current manual data collection approaches in terms of speed, completeness, and accuracy render these approaches ineffective for decision support in highly dynamic environments, such as construction and facility operations. Hence, a need exists to leverage the advancements in automated field data capture technologies to support decisions during construction and facility operations. These technologies can be used not only for acquiring data about the various operations being carried out at construction and facility sites but also for gathering information about the context surrounding these operations and monitoring the workflow of activities during these operations. With this, it is possible for project and facility managers to better understand the effect of environmental conditions on construction and facility operations and also to identify inefficient processes in these operations. This paper presents an overview of the various applications of automated field data capture technologies in construction and facility fieldwork. These technologies include image capture technologies, such as laser scanners and video cameras; automated identification technologies, such as barcodes and Radio Frequency Identification (RFID) tags; tracking technologies, such as Global Positioning System (GPS) and wireless local area network (LAN); and process monitoring technologies, such as on-board instruments (OBI). The authors observe that although applications exist for capturing construction and facility fieldwork data, these technologies have been underutilized for capturing the context at the fieldwork sites as well as for monitoring the workflow of construction and facility operations.     

Integrated Development of Facilities Design and Services

Leading manufacturers are shifting towards innovation strategies where goods and associated services are developed jointly. A similar approach to construction would imply stronger input from facilities management into design. The purpose is to investigate paths for integrating the development of facilities design and services, assuming that the determining force is economic efficiency from the viewpoint of facility owners. Current organizational contexts for facilities managers are identified. Design is seen to reconcile supportive and protective features of facilities. Transaction cost reduction, as caused by the progress in technologies that allow remote monitoring of systems and components, is highlighted as an integrating force for manufacturers and service providers. Integration possibilities associated with current information technology tools related to computer aided design, building automation and computer aided facilities management are reviewed. Integration often has to handle portfolios of old and new buildings in multiple locations. Finally, the need for a strong design element in the education of future facilities managers is identified.     

Papaya glutamine cyclase, a plant enzyme highly resistant to proteolysis, adopts an all-beta conformation

STUDY OBJECTIVES: To examine and describe the relationship between age and disposition in patients undergoing mechanical ventilation. DESIGN: Retrospective analysis of a statewide database. SETTING: All acute-care hospitals in New York State. PATIENTS: All patients (n=10,473) aged > or = 18 years discharged from hospital during 1993 with a final diagnosis related group (DRG) coding of 475. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The final disposition, according to six codes (other acute-care facility, residential health-care facility, other health-care facility, home, home health-care services, and death) were examined for the whole population. Cost per case was assumed to equal the average statewide Medicaid rate. An inverse relationship between survival rate and age was observed and this resulted in an age-related increased cost per survivor. Also, survivors in older age groups have an increasing rate of hospital discharge to residential health-care facilities. CONCLUSION: Patients who undergo mechanical ventilation are expensive to care for. The older they are, the less satisfactory is the outcome both from clinical and economic perspectives.     

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis

OBJECTIVES: To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. DESIGN: This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. PARTICIPANTS: Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. MAIN OUTCOME MEASURE: Financial performance, as measured by the ratio of reimbursement to average costs. RESULTS: Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. CONCLUSIONS: The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement, resulting in greater equity in the reimbursement of inpatient medical rehabilitation hospitals.     

Skunkworks Approach to Project Management

Three new product development programs attempting to meet challenging targets for time-to-market, quality, and cost were in urgent need of space and facilities. A decision was made to reengineer a light commercial building 50 miles from the main research and development and manufacturing facility. This satellite facility that housed a supplier of electroformed parts to another original equipment manufacturer would need to be entirely retrofitted to accommodate the research and development and manufacturing requirements of the four groups. The existing corporate facilities engineering group was unable to deliver the array of requests generated by the product development programs. This included 31 different projects, ranging from clean rooms and labs to air handling systems and offices. A project management team was spun off with the directive to meet customer requirements on time and within budget—even if it meant breaking rules. The project had many of the earmarks of a “skunkworks,” the concept originally developed by Lockheed Martin, as a way to quickly develop solutions by bypassing some of the time-consuming bureaucracy and allowing the team to make ad hoc decisions. The skunkworks project management team was able to deliver the projects on time and within budget by: (1) adhering to a clear focus on their mission; (2) including extensive up-front planning efforts; (3) critically analyzing customer needs; (4) leveraging project overlaps; (5) involving suppliers early; (6) empowering the team; and (7) breaking rules. Many of the lessons learned from this project are being treated as organizational learning and are currently being incorporated into other facilities engineering groups to improve their operations.     

Serious infections due to Pseudomonas aeruginosa

Infections due to Ps. aeruginosa are a problem in the tropics as in other parts of the world. Over a four year period, 15 patients attending University College Hospital, Ibadan, were proved to have septicaemia due to this organism and 13 patients died rapidly as a direct result of the infection. The two patients who survived the acute episode had received immediate treatment with at least one antibiotic active against Ps. aeruginosa: a third patient, who received immediate appropriate antibiotic therapy, was already suffering from aplastic anaemia and died rapidly despite treatment. The remaining patients received inappropriate antibiotic therapy because pseudomonas infection was not suspected at the time the diagnosis of septicaemia was made. Patients most at risk appear to be the very young and those with pre-existing malignant or other conditions affecting the defence mechanisms of the body: it is suggested that routine initial management of such patients should include a blood culture, followed by immediate treatment with an antibiotic combination that includes at least one agent likely to be active against Ps. aeruginosa. The development of medical services can lead to the introduction of ophthalmic or other operations on tissues that are highly susceptible to infection before facilities are provided for the maintenance of a pathogen-free environment. Following an outbreak of eye infection after cataract extractions, carried out in an old and unsatisfactory theatre, wide-spread room contamination was demonstrated with the same strains of Ps. aeruginosa that had been responsible for the clinical infections. Chemical disinfection of the theatre floor failed to eliminate the organisms, although other experiments suggested that the drying effect of air-conditioning would be successful in this respect. The wisdom of introducing such operations before the provision of adequate facilities is seriously questioned.     

Reaching out: marketing strategies for organ donation awareness

The current competitive health care environment has intensified the need for data that provide a snapshot of the realities of clinical practice. As decision making moves from a clinically based perspective to one grounded in scientific data, health care providers are increasingly being challenged to document the extent of a problem and the effectiveness of its management. This is especially true with pressure ulcers, which are viewed as high-volume, high-risk problems in most health care settings. Moreover, in long-term care facilities, regulatory agencies have designated the development of pressure ulcers as an indicator of quality of care provided to patients. Thus, it is essential that data related to the scope and severity of pressure ulcers in a facility be gathered accurately. The aim of this article is to describe a methodology for determining prevalence and incidence of pressure ulcers that accurately measures the effectiveness of preventive intervention. The importance of risk assessment and of clear operational definitions of the population and a case will be addressed.     

Fuzzy Parametric Programming Model for Integrated Solid Waste Management under Uncertainty

Solid waste management (SWM) is increasingly becoming a challenging task for the municipal authorities due to increasing waste quantities, changing waste composition, decreasing land availability for waste disposal sites, and increasing awareness about the associated environmental risk. This paper presents a fuzzy parametric programming model for the selection of the treatment and disposal facilities and optimum capacity planning and waste allocation under uncertainty associated with the long-term planning for SWM. The model dynamically locates the facilities and allocates the waste considering fuzzy waste quantities and capacities of waste-management facility in a multiperiod planning for integrated SWM. The model addresses uncertainty in waste quantity as well as uncertainties in the operating capacities of waste-management facilities. An example problem has been presented to demonstrate the usefulness of the proposed model in making the planning decisions related to SWM and achieving an efficient plan. The model is solved at different levels of membership function for the alternative solutions with respect to objective. The example problem reveals that the uncertainty in the waste quantity is likely to affect the planning for waste treatment/disposal facilities more as compared with the uncertainty in the capacities of the waste-management facilities. The relationship between increase in waste quantity and increase in the total cost involved in waste management is found to be nonlinear. The modeling results are useful for generating a range of decision alternatives under various economic conditions. They are valuable for analyzing the existing waste-management practices, the long-term capacity planning for the city’s waste-management system, and the identification of desired policies regarding waste generation and management.     

中压断路器几种常用操动机构的性能分析

真空断路器的合闸、分闸可靠性主要取决于操动机构的性能和可靠程度,结合变电所高压开关柜的操动机构的现状,对几种常用操动机构的工作性能及优缺点进行分析比较,重点分析了新型永磁机构的发展和动作原理,认为在操动机构改造中,永磁机构是电磁机构良好的升级替代,在配电网实现自动化和免维护中起到了重要作用。     

Facility Maintenance Performance Perspective to Target Strategic Organizational Objectives

While facility design is increasingly playing a role addressing strategic organizational objectives, issues pertaining to facility maintenance have typically been left out of the decision-making process. Reasons include the traditional disconnection between facility design and facility maintenance, mainly originating from the lack of a modality to meaningfully represent facility maintenance information during design decision making. This paper discusses two sets of facility maintenance indicators that have the potential to bridge this traditional divide. The objective of this paper is threefold: (1) to illustrate how maintenance performance indicators can support higher-level decision making; (2) to explain how the methodology could be mapped across building sectors; and (3) to show how facility maintenance could play a crucial role in informing strategic decision making. Two types of indicators are introduced based on: (1) normative models in biophysics and physiology and (2) empiricist models of environment-behavior studies. Using examples from hospital, courthouse, and office building design, the paper articulates the manner in which facility performance indicators could be developed and used to support organizational strategic decision making. The paper demonstrates that facility maintenance indicators could be developed for all types of buildings and could be meaningfully represented for consideration during strategic decision making. Moreover, using an example of a healthcare setting, the paper emphasizes how facility maintenance strategies have an impact on higher-level organizational objectives, and vice versa, thereby underscoring the importance to consider maintenance performance during strategic decision making. The paper shows how the two sets of key performance indicators—the hard and the soft—are designed to address different scales of decision making, thereby allowing facility maintenance performance to be considered at all phases of a procurement cycle.     

Model based optimisation of highly automated industrial batch annealing operation

Abstract

Modern batch annealing operations are highly automated facilities, equipped with online sensors, model based control and a production management system to archive material, process and quality parameters. In these operations, efficient models and algorithms are used to allocate the resources, schedule the operation and design process cycles of individual stacks. The present work endeavours to enhance the productivity of a highly automated batch annealing facility, operating well above its rated capacity. This was achieved by intelligent analysis of production data and a critical assessment of the prevalent thermal model used for designing the process cycle of the individual stack. Two major limitations, namely, the inability to capture non-isothermal kinetics and the stiff radial conductivity model, of the prevalent thermal model were identified. These limitations were eliminated by designing process cycles with an integrated process model, where phase transformation kinetics is incorporated. Implementation of these process cycles has enhanced the productivity of the batch annealing operation by 7–9%. These benefits have been validated through rigorous laboratory experiments and plant trials.     

A probabilistic approach to evaluate creep and fatigue damage in critical components

The subject of reliability assessment of plant components is of considerable importance to maintenance and operations engineers. There exist different degradation mechanisms such as creep and fatigue in the plant components operating under conditions of high pressure and temperature. Hence, the safety issue of these components must be addressed by a realistic reliability model so that the frequency of in-service inspection activities can be optimized. In this work, a probabilistic module based on first order reliability method and Markov model is used in order to calculate different failure state probabilities of an in-service thermal power plant pipe-bend. This procedure helps in online risk assessment of critical plant components. The method of determination partial safety factors of the above component for optimum design based on a target reliability level is also discussed.