CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
Identifying Key Performance Indicators for Facilities
Management in Hospital Buildings
Dr LAI, Joseph Hung Kit,
Department of Building Services Engineering, The Hong Kong Polytechnic University
(email: bejlai@[Link])
Dr YUEN, Pak Leung,
The Institute of Healthcare Engineering and Estate Management (Hong Kong Branch)
(email: info@[Link])
Abstract
Quality health services entail not only competent healthcare professionals but also effective management
of the underpinning facilities. Realizing the importance of quality facilities management (FM) services
for hospital buildings, research in this area has grown. But the absence of a credible, scientific method for
systematic evaluation of hospital FM performance remains a live issue. Intended to develop such a
method, a multi-stage research project has commenced. At the first stage of the project, as reported in this
article, a review of relevant literature was conducted to identify indicators that are applicable to assessing
hospital FM performance. The 61 indicators identified fall into 6 aspects: financial, physical, safety,
patience experience, environmental, and functional. Using the phase-hierarchy (P-H) model, which is a 2-
dimensional matrix comprising three phases (input, process and output) of facilities services delivery and
three hierarchical FM levels (operational, tactical and strategic), the safety indicators were systematically
classified. The majority of them, for measuring the output of a facilities services delivery process, are
useful to FM practitioners at the strategic and tactical levels. This method, to be used for classifying the
indicators in the remaining aspects, can also be applied to similar future studies on key performance
indicators (KPIs).
Keywords: facility, healthcare, hospital, KPI, performance
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
1. Introduction
Facilities in hospital buildings need to be properly managed in order to perform their intended functions.
Performance evaluation, which is a facilities management (FM) tool, is essential for ensuring effective
operation of facilities. Without a proper performance evaluation, it is not possible to know how well the
facilities have been managed. Underperformance of facilities, if undetected, undermines hospital
operations, resulting in operational standstills or even fatalities (O’ Mahony et al, 1990; The Telegraph,
2015).
Realizing the importance of quality FM services for hospital buildings, research in this area has grown in
recent years. But a credible method developed on a scientific basis for systematic assessment of hospital
FM performance remains unavailable. Healthcare FM professionals are, therefore, confronted with the
difficulty of providing concise yet holistic reports on the performance of the facilities they manage.
Aiming to tackle this problem, a research study has commenced.
Given that Hong Kong is built with hospitals that are under intense demand from its large population
(Hospital Authority, 2014), the city serves as a suitable place for the study. To enable performance
measurement of the most essential hospital FM services, the fundamental part of the study is to identify
performance indicators that are applicable to the services.
As reported in the next section, a review has been made on the major studies on FM performance
indicators in the past. Then, the research process of the current study and the model developed earlier for
systematic classification of performance indicators are described in Section 3. In Section 4, the
performance indicators found to be applicable to hospital buildings are reported and how the above-
mentioned model was used to classify such indicators is illustrated. After discussing the findings, the final
part (Section 5) provides the conclusions drawn from the work completed and the work needed in future.
2. Major past studies
Key performance indicator (KPI) is a widely adopted model for measuring FM performance (Meng and
Minogue, 2011). Over the years, in fact, many attempts have been made to identify performance
indicators for managing facilities in existing buildings. For example, Hinks and McNay (1999) found that
FM performance could be measured by as many as 172 indicators, which can be grouped into 8
dimensions: business benefit, equipment, space, environment, change, maintenance/service, consultancy,
and general.
In the study of Shohet (2003a), the condition of the buildings in 17 public healthcare facilities in Israel
was assessed using a building performance indicator (BPI). Afterwards, three more key performance
indicators (KPIs): manpower sources diagram (MSD), maintenance efficiency indicator (MEI) and
managerial span of control (MSC) were applied to case study analyses (Shohet, 2003b; Shohet et al.,
2003).
In an attempt to evaluate the FM performance of public hospitals in Hong Kong, Chan (2004) introduced
a facilities performance indicator (FPI). Each component of the FPI, scored on a 0-100 scale, is weighted
according to their life-cycle costs. This scoring system, as the author remarked, was in its infancy and
required further improvement.
A review on the estate performance measurement for nine international healthcare organisations, which
identifies the attributes and KPIs in use, shows that there is a common set of attributes and KPIs adopted
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
by the majority of the organisations (Rodriguez-Labajos et al., 2016). The large number of KPIs identified
were grouped into different attributes and then different dominions; in total, there are 7 dominions:
financial, physical, safety, functional, patient experience, environment, and others.
Aimed at developing KPIs for building operation and maintenance (O&M), a study was conducted by Lai
and Yik (2006). In that study, some common examples of KPIs were given to illustrate that the
performance of O&M services can be assessed by referring to the different stages of a facilities services
delivery process and the different hierarchical levels of an FM organization.
Forming part of a comprehensive study that purports to develop a scheme for evaluating the O&M
performance of commercial buildings (Lai and Man, 2017), a literature review, which found over 70
applicable performance indicators and presented a model for classifying the indicators systematically (Lai
and Man, 2018a), addressed the need of proper categorization for performance metrics (Lavy et al., 2010).
Through a further focus group study, a shortlist of 17 indicators, belonging to 5 categories (physical;
financial; task and equipment related; environmental; and health, safety and legal) were identified (Lai
and Man, 2018b). Such indicators, after refinements, became 11 KPIs in 4 main categories (Lai, 2016): (1)
physical (sub-categories: (1a) user perception, (1b) tasks related, and (1c) equipment related), (2)
financial, (3) environmental, and (4) health, safety and legal.
3. Research process and the P-H model
As described in Lai and Yuen (2018), a research project for developing an analytic FM performance
evaluation method for hospital buildings has commenced. It comprises five stages of work:
Stage 1 - Literature review (extended)
Identify measures (performance indicators) that are applicable for assessing the FM performance
of hospital buildings
Group the performance indicators into different aspects
Classify the performance indicators in a systematic manner
Stage 2 - Focus group meeting (1st)
Convene a meeting for the focus group participants to examine and confirm the usefulness of the
above-identified performance indicators in real-world applications
Refine (add, modify and/or remove) the performance indicators subject to a consensus of the
participants
Stage 3 - Questionnaire survey
Design a survey questionnaire based on the performance indicators refined in Stage 2
Distribute the questionnaire to the healthcare FM community
Shortlist the key performance indicators (KPIs) based on the survey result
Stage 4 - Focus group meeting (2nd)
Convene a second focus group meeting for participants to discuss and agree on a network
diagram that represents the relationships between the KPIs (the network diagram is essential for
the next stage of interviews and data analysis using the Analytic Network Process (ANP))
Stage 5 - Interviews
Conduct face-to-face interviews with hospital FM professionals to collect their opinions and
facilities performance data
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
Determine importance weights of the KPIs based on the opinions and data collected
Requiring an extensive review of the relevant literature, Stage 1 as a key part of the project is reported in
the subsequent sections of the current article. This stage of work is to answer the following questions:
What elements of hospital FM performance should be measured? For each element, are there any
applicable performance indicators? If so, which are useful for performance measurement?
When the applicable performance indicators are made known, they need to be classified systematically
(Lai and Man, 2018a). For this purpose, an initial step is to examine the meanings of the indicators and
group them into different aspects (e.g. financial, safety, etc.) and sub-divided aspects (i.e. facets). Using
the result of this step, the indicator will be further classified in the next step by referring to the phase-
hierarchy (P-H) model (Figure 1) of Lai and Man (2018a). Developed based on the performance
evaluation schema of Lai and Man (2017), the P-H model enables systematic classification of FM
performance indicators and it integrates two performance evaluation dimensions:
(i) the horizontal dimension covers the different phases (input, process and output) of facilities
services delivery
(ii) the vertical dimension refers to the hierarchical levels (operational, tactical and strategic) of
an FM organization
Strategic
I, S P, S U, S
(S)
Hierarchical level
Tactical
I, T P, T U, T
(T)
Operational
I, O P, O U, O
(O)
Input Process Output
(I) (P) (U)
Facilities services delivery (phase)
Figure 1: The P-H model for classifying performance indicators (Lai and Man, 2018a)
According to the P-H model, performance indicators can be classified with respect to the phase
(horizontal) dimension and the hierarchy (vertical) dimension. With three classes on each of the two
dimensions, there are nine possible classes of performance indicators: input-operational (I, O); input-
tactical (I, T); input-strategic (I, S); process-operational (P, O); process-tactical (P, T); process-strategic
(P, S); output-operational (U, O); output-tactical (U, T); and output-strategic (U, S).
4. Findings and discussion
From the preceding literature review, two studies are particularly useful for identifying FM performance
indicators applicable to hospitals in Hong Kong. The first one is Rodriguez-Labajos et al. (2016),
which reviewed the performance measurement for international healthcare organisations. The other one is
Lai (2016), from which 11 KPIs were identified. While the latter study was based on commercial
buildings, the KPIs identified are fit for the O&M practice in Hong Kong. The total number of
performance indicators, combined from these studies, is 61. Such indicators fall into 6 aspects.
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
As shown in Table 1, the first aspect is “financial”, of which the 21 indicators belong to 5 facets:
operational cost, maintenance cost, backlog maintenance cost, resource allocation, and productivity. The
second aspect is “physical”, under which there are 5 facets covering 9 indicators. The last aspect in Table
1 is “safety”. The seven safety indicators fall into 4 facets: accident/injury, statutory compliance, risk
associated with backlog maintenance, and fire incident.
Table 1: Financial, physical and safety indicators
Aspect Facet Performance indicator
Financial Operational cost (F1) Ratio of total O&M cost to building income; (F2) Actual
costs within budgeted costs; (F3) O&M cost per building area;
(F4) Annual operation cost; (F5) Total operating cost; (F6)
Cleaning cost; (F7) Rates cost; (F8) Catering cost; (F9) Pottering
cost per consumer week; (F10) Laundry and linen cost per
consumer week; (F11) Energy cost; (F12) Waste cost per
consumer week; (F13) Facilities management cost; (F14) Cost
efficiency score
Maintenance cost (F15) Maintenance cost per sq.m.; (F16) Total maintenance
expenditure by functional area
Backlog (F17) Backlog maintenance cost per sq.m.; (F18) Total
maintenance cost maintenance backlog cost / gross internal area (GIA)
Resource allocation (F19) Annual maintenance expenditure as a % total replacement
value; (F20) Sustain rate
Productivity (F21) Adjust treatment index (ATI)
Physical User perception (P1) % users dissatisfied
Tasks related (P2) Work request response rate; (P3) Number of completed
work orders per staff
Equipment related (P4) Availability of fire services system; (P5) Availability of lift
Physical condition (P6) Percentage of the estate to be in excellent or satisfactory
condition with evidence of only minor deterioration or above;
(P7) Facility condition index (FCI) or Condition index (CI); (P8)
Physical condition index
Age (P9) Percentage of properties less than 50 years old; (P10)
Percentage of the estate built since 1948; (P11) Average age
Safety Accident/injury (S1) Number of accidents per year; (S2) Number of lost work
days per year
Statutory (S3) Overall percentage compliance score from Statutory
compliance Compliance Audit and Risk Tool (SCART); (S4) percentage of
the estate that is required to take action in the current plan to
comply with relevant guidance and statutory requirements
Risk associated (S5) Significant and high risk backlog maintenance as
with backlog percentage of total backlog expenditure requirement; (S6) Total
maintenance risk adjusted backlog maintenance
Fire incident (S7) Number of unwanted (false) fire incident calls/ GIA; (S8)
Number of fire incidents/ GIA
The remaining indicators, as summarized in Table 2, are in three other aspects. The first of such aspects is
“patience experience”, which comprises 3 facets, embracing 6 indicators. Some of these indicators (e.g.
Pa 3), which seem to share some coverage with, for example physical indicator P1, would be reviewed in
a later stage. The second aspect in Table 2 is “environmental”, where there are 7 indicators grouped into 3
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
facets: energy performance, water and waste, and sustainability. Comprising also 3 facets (utilization,
available capacity, functional suitability), the final aspect is “functional”, which covers a total of 8
indicators.
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
Table 2: Patient experience, environmental and functional indicators
Aspect Facet Performance indicator
Patience Quality of the (Pa 1) Percentage of properties categorised as excellent or
experience building satisfactory quality in terms of amenity, comfort engineering
and design
Single bedrooms (Pa 2) Percentage of single bedrooms for patients
Patient feedback (Pa 3) Positive response to patient questionnaire on patient
rating of hospital environment; (Pa 4) Percentage of positive
response for privacy and dignity; (Pa 5) Percentage of positive
response for cleanness and tidiness; (Pa 6) Percentage for
positive response for food services
Environmental Energy (En 1) Energy use index; (En 2) Total site energy
performance consumed/heated; (En 3) Net energy consumption; (En 4)
Carbon dioxide emissions/ occupied floor area; (En 5) % of the
estate with an energy consumption of 410kWh/m2 or less
Water and waste (En 6) Water, sewage and waste carbon indicator
Sustainability (En 7) Sustainability index (SI)
Functional Utilisation (Fn 1) Space utilisation (percentage of properties categorised as
fully utilised; building area sq.m. per consumer week; % of
occupied floor area; percentage of space utilisation; required
program space vs. the existing space); (Fn 2) Utilisation index;
(Fn 3) Usage (Total replacement value/ weighted separation;
weighted separation per sq.m.; asset depreciation/ weighted
output measure of service)
Available capacity (Fn 4) Beds per 1,000 people; (Fn 5) Theatres per 10,000
people
Functional (Fn 6) Percentage of properties classified as ideal
suitability accommodation or very satisfactory; (Fn 7) Functional
unsuitability (% of occupied floor); (Fn 8) Functional
performance index
To further classify which hierarchical level of an FM organization and which phase of a facilities services
delivery process the above performance indicators belong to, the P-H model was used. As an example, the
indicators in the “safety” aspect were taken to illustrate how the classifications were made (Figure 2).
For indicators (S1) Number of accidents per year and (S2) Number of lost work days per year, they reflect
the outcome performance of the FM team in preventing the occurrence of accidents or the consequence of
lost work days (e.g. resultant from occupational injuries). Such “output” indicators are useful to both the
strategic and tactical management levels of an FM organization.
For reflecting the outcome performance in complying with statutory requirements, two indicators, namely,
(S3) Overall percentage compliance score from SCART and (S4) percentage of the estate that is required
to take action in the current plan to comply with relevant guidance and statutory requirements, are useful.
These two indicators, same as the preceding two - (S1) and (S2), can help the strategic and tactical levels
of staff manage the output of FM services.
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17 – 21 June 2019
Phase Input Process Output More than
Level one phase
Strategic 0 2 7 2
- (S5, S6) (S1, S2, S3, S4, S5, (S5, S6)
S6, S8)
Tactical 0 2 8 2
- (S5, S6) (S1, S2, S3, S4, S5, (S5, S6)
S6, S7, S8)
Operational 0 0 0 0
- - - -
More than 0 2 7
one level - (S5, S6) (S1, S2, S3, S4, S5,
S6, S8)
Notes: 1) Boldfaced numbers denote quantities of indicators in the respective phase-level classes. 2) Italicised texts denote
indicators applicable to more than one level. 3) Underlined texts denote indicators applicable to more than one phase.
Figure 2: Mapping of the safety indicators
The size of backlog maintenance, which is the ratio of the number of overdue maintenance tasks to the
number of maintenance, can help tactical staff measure the maintenance process (Lai and Man, 2018a).
Here, indicator (S5) denotes significant and high risk backlog maintenance as percentage of total backlog
expenditure requirement and indicator (S6) denotes total risk adjusted backlog maintenance. When
calculated on a monetary (cost) basis (NHS Estates, 2004), this pair of indicators is not only useful
tactical measures for the maintenance process but also useful for assessing the maintenance output and the
strategic maintenance investment of an FM organization.
The last pair of safety indicators, belonging to the “fire incident” facet, are (S7) Number of unwanted
(false) fire incident calls/ GIA and (S8) Number of fire incidents/ GIA. Representing how well the facility
services are delivered to prevent fire incidents, they both are “output” indicators. Indicator (S7) is useful
for tactical staff to assess the extent of nuisance resultant from unwanted fire alarms whereas indicator
(S8), which shows the actual number of fire incidents occurred, is also important in the eyes of senior
management at the strategic level.
As far as the safety indicators are concerned, as shown in Figure 2, none of them falls into the operational
level of the P-H model. All the 8 safety indicators are useful to the tactical staff, and 7 of them are also
useful for strategic management purposes. Viewing from the horizontal dimension of the P-H model,
there is no safety indicator in the input phase. While only 2 safety indicators are “process” measures, all
the 8 indicators are “output” measures. Overall, 7 of all the safety indicators lie across two hierarchical
levels – tactical and strategic, and 2 indicators are applicable to both the “process” and “output” phases.
5. Conclusions and future work
Forming the fundamental part of a multi-stage research project, the study reported above, through a
literature review, identified 61 indicators that are applicable to assessing the FM performance of hospital
buildings. The 6 aspects of such indicators are: financial, physical, safety, patience experience,
environmental, and functional. In each aspect, there are 3 to 5 sub-divided facets. In terms of quantity of
indicators, the financial aspect, with 21 indicators, prevails over the other aspects.
The P-H model, which had been used to classify O&M performance indicators for commercial buildings
CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
(Lai and Man, 2018a), is also useful for classifying the FM performance indicators for hospital buildings.
As illustrated, the majority of the safety indicators, which are useful to FM practitioners at the strategic
and tactical levels, measure the output of a facilities services delivery process. Following this method,
further effort will be made to systematically classify the remaining hospital FM performance indicators
along the phase and hierarchy dimensions of the P-H model.
As it is neither practicable nor effective to use a large number of indicators to measure FM performance
in practice, the next stage of work is to shortlist the most essential indicators for use in real-world
hospitals. For this purpose, the opinions of FM experts in the hospital sector will be solicited through a
focus group meeting. Findings of such shortlisted indicators and the remaining stages of the research
project will be reported in future.
Acknowledgements
The study described in this paper was supported by a grant from the Research Grants Council of the Hong
Kong Special Administrative Region, China (Project No. PolyU 152155/17E).
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CIB World Building Congress 2019
Hong Kong SAR, China
17 – 21 June 2019
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