A Study On Facility Management In Healthcare Centre Construction Essay

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According to Regterschot, 1990, A decade ago, FM was defined as the integral planning, realization and management of building and accommodation, service and resources which contribute toward the effective, efficient and flexible attainment of organizational goal in a changing environment. According to (BIFM, 2003; EuroFM, 2003; IFMA, 2003) In general, the FM discipline is perceived today as a multi-disciplinary theme that aims to integrated between people and the physical workplace of an organization. According to Nelson and Aledander, 2002, "the current trend is to view FM as the management of non-core company assets to support and increase the efficiency of the main business of the organization."

According to Dounglas, 1994; Preiser, 1995, "In the past, building performance usually dealt with issues such as energy efficiency, fire safety, comfort condition and spatial efficiency." This situation is change and the current trend of building performance is growing in significance, it is due to the fact standard has developed, as have occupants' requirements. Buildings are required to provide a stable and efficiency internal environment.

Healthcare central is the place to provide a medical treatment service to the people needs it. The sizes of healthcare central are various and depend on its function served. It can be fit in big building and also can just a small shop lot sizes. When travel over the streets, we can easily found a private clinic, which may be have only one or two doctor inside the clinic to provide a service medical treatment. In the large healthcare central may be able to accommodate more than hundred patients, they are provide various kind of medical treatment to patients.

Facilities management in the healthcare central is playing an important role in supporting the whole building delivery process. Building performance of the building would affecting the occupants inside the building whether is providing services or receiving services.

Problem Statement

Facilities Management is a profession that encompasses multiple disciplines to ensure functionality of the built environment by integrating people, place, process and technology. In Facilities Management including Maintenance Management, Performance Management, Risk Management, Supply Services Management, Development and also ICT. (Igal M. Shohet and Sarel Lavy, 2004)

Many healthcare centres just emphasize on the service they provide but ignore the building performance and building design. Bad building performance and building design will affect the process of providing treatment and recovering place to the patient. In terms of the building design, space and sensory environments, there is a growing evidence base in the relationship with health outcomes. (Daryl May and James Pinder, 2007)

Correct workplace conditions are important factors for health and performance and profitable and beneficial in every way, Indoor environment affect productivity and health problems and, therefore worker performance (Marshall et al. 2002; Fisk 2000). Poor IAQ (Indoor air quality) causes health problems related to sick building syndrome and result in uncomfortable workplace environments (Czubaj, 2002; Sinclair, 1996; Shiaw-Fen Ferng, 2002; Wilson, 2001)

In the part of ICT, the problem of FM in relation to healthcare is characterized by differences kind of data, including both numerical data and verbal data. In addition, data for most of the healthcare facilities studies was partially missing or incomplete, making the task at hand similar to giving an expert medical diagnosis. By solving this problem, Healthcare Center is use CBR (case-based reasoning). CBR was originally motivated by the desire to understand how people remember information, and it was found that people generally solve problems by recalling how similar problems were solved. (Watson, 1999)

1.3 Aims

A study of facility management in the healthcare centre, a case study in Hospital Temerloh,Pahang.

Objectives

To study the importance of building performance in healthcare centre.

To ascertain the essential of ICT application in relation to FM in Healthcare Centre.

To recommend further improvement on facility management in healthcare centre.

Scope of Study

This research will covers on building performance of healthcare center. Building performance is priority in this research and specifies more detail in process of building performance assessment through the ICT application and identify what types of ICT are suitable to apply on the subject property and the improvement on it. The study will carry on the local healthcare centre in Malaysia which is Hospital Temerloh, Pahang.

Research Methodology

Primary Data Collection

Case Study and Questionnaire:

A case study and questionnaire will conduct in this research on the local healthcare centre to gather the primary data. In questionnaire, few questions related to the study will asked the staff, customer and stakeholder to know more detail regards on the performance.

Where to get the information:

In order to complete the questionnaire, local healthcare centre which related to the study will chose as a place to distribute a questionnaire. The local healthcare centre will be visited to get the information.

What information to get:

The building performance in local healthcare and the method to improve the building performance are the main elements of carrying out this research menthod.. The objective three will achieve in this case study.

Secondary Data Collection

Literature Review:

A literature review on textbooks, journals, articles, dissertations and etc will be conduct to collect all the secondary data.

Where to get the information:

The relevant textbooks to get the secondary data will get from the Tunku Abdul Rahman College library. The articles related to my research title can found from the journals like Construction Management and Economics and Journal of Construction Engineering. Some of the relevant articles can get through from internet like emerald and etc. Besides that, senior's dissertation also one of the sources to get the secondary data.

What information to get:

By refer to the relevant literature, the information need to study are the facilities management in healthcare industry and also the need of FM in other field. Objectives one will achieve at literature review.

Chapter Outline

Chapter 1: Introduction

In this chapter is to introduce the content of the research, and some introduction of Facility Management. Besides that, this chapter also contains the aim and objectives of the research. In this chapter also mention about why the research need to be conduct and what are the method to conduct this research. This chapter also shows the work programme to conduct the research.

Chapter 2: Literature Review

This Chapter is contains about the Literature Review about the Project Dissertation. The content will base on the aim and objectives of the research. Those data may able get from books, journals, articles, newspapers with relevant to Facility Management in Healthcare Centre, The important Building Performance in Healthcare Centre, and the essential of ICT application in relation to FM in Healthcare Centre.

Chapter 3: Research Methodology

In this chapter contains of the research of methodology for this dissertation. In chapter 3 contains of the planning of the research methodology and the questionnaire design. In this chapter also include the method analysis and the question sample.

Chapter 4: Data Analysis

In this chapter analyses result of questionnaire answer by the respondent. The result included Facility Management in Healthcare Centre, The important Building Performance in Healthcare Centre, and the essential of ICT application in relation to FM in Healthcare Centre.

Chapter 5: Conclusion and Recommendation

This chapter is a summary of the whole Project Dissertation. This will include the conclusion of Facilities Management in Healthcare Centre, The important of Building Performance in Healthcare Centre and also the recommend further improvement on facility management in healthcare centre.

Summarize

TOPIC

A Study on Facility Management in Healthcare Centre

INTRODUCTION

BACKGROUND

PROBLEM STATEMENT

MAIN POINT

Building Performance

AIM

A study of facility management in healthcare centre, a case study in Hospital Temerloh,Pahang.

OBJECTIVES

To study the importance of building performance in healthcare centre.

To ascertain the essential of ICT application in relation to FM in Healthcare Centre.

To recommend further improvement on facility management in healthcare centre.

SCOPE OF STUDY

RESEARCH METHODOLOGY

SECONDARY DATA

Journals

Articles

Newspaper

Magazine

PRIMARY DATA

Case Study

Interview/Questionnaire

DATA COLLECTION

ANALYSIS

Using SPSS software

Normal explanation

CONCLUSION & RECONMMENDATION

ddad

Work Programme

When the first year semester three commenced, I start searching articles which are related my interested topic like Facility Management. In the first 3 week, I suppose adjust my project title, but I delay the work until week 7 just confirm my topic because of keep revise my aim and objective and change my research topic. However, the main reason of delaying the work is because of poor time management I did, lack of confident to do some topic and also submission date of others subject assignment. In this case, I would really look into my own efficiency and try to improve my own time management to able to catch up with the subsequent progress. By follow the planned schedule, now suppose already finish my research proposal and doing my liteture review part.

After delay the work, I have to plan again my progress time to make the on time project submission. In the Plan Project Schedule I planned earlier, for the chapter 2 progresses suppose will conduct in 5 weeks time (week 7-week 11), but due to lack of time and delay the work I make it in 4 weeks time (week 10-week 13) to finish my chapter 2 Liteture Review. Other that, for the part of improvement my work suppose will conduct in 3 weeks time (week 11-week 14), but due to lack of time and delay the work I make it in 2 weeks time (week 13-week14) to do my improvement for this semester work.

Anyway, although at beginning the actual work progress is slightly behind from the planned schedule, but catch up at the end and able to finish for the interim submission. The delaying of work would not allow happened in the next semester and the subsequence chapter.

Chapter 2 Literature Review

2.0 Literature Review

2.1 Introduction

How did facility management evolve into the current profession? Only in the past thirty year has facility management become a recognized and required process of organization throughout the world that expends resources on people, their work environment, and the ways they work. Facility professionals must look ahead with minimal knowledge and be able to both perform and improve routine tasks. The desire and ability to work well with people in a service capacity, to be practical, economical, available, tactful, flexible, persuasive, responsive, and timely, are additional facility management traits and requirements.

Facilities management has traditionally been regarded as the poor relation within the real estate, architecture, engineering and construction (AEC) professions. According to (Atkin and Brooks, 2000), this is because "it was seen in the old-fashioned sense of care-taking, cleaning, repair and maintenance." According to (O'Sullivan and Powell, 1990) "A decade ago, FM responsibilities broadened to encompass buying, selling, developing and adapting stock to meet wants owner regarding finance, space, location, quality and so on." According to (Alexander, 1996; Brown et al, 2001; Douglas, 1996; Granath and Alexander, 2006; Kweon et al, 2008; Neely, 1998; Then, 1999) "Recognition of the effect of space on productivity stimulated the development of the Facilities Management discipline." According to (Hamer, 1999), "From the 1990s onward, there has been a trend toward more open market, and especially toward gradually increased competition, as a result of globalization." Nowadays, it cover real estate management, financial management, change management, human resources management, health and safety and contract management, in addition to building and engineering services maintenance, domestic services and utilities supplies. These last three responsibilities are the most invisible. The role of FM is gradually different from beginning and now, the function of FM is getting more important and critical to the organization.

The international Facility Management Association (IFMA) now defined facility management as a profession that encompasses multiple disciplines to ensure functionality of the build environment by integration people, place, process and technology. The definition clearly illustrates the holistic nature of the discipline and interdependence of multiple factors in its success.

Process

People

FM

Place

Technology

Figure 2.1 People, Process, Place, Technology (developed by the international facility management association in the response to the evolution and the important of the technology in FM and FM customer) Eurofm.org what is FM? - EuroFM. [Online] Available at: http://www.eurofm.org/about-us/what-is-fm/ [Accessed: 19 Jul 2012].

2.2 Definition

2.2.1 Healthcare FM

FM is non-core activities to healthcare organization in the past, but now it has been growing gradually and has its impact on the quality and effectiveness on healthcare services. According to Gelnay (2002) healthcare FM consider as one of the key element for successful delivery of healthcare service. In healthcare FM management there are five core domain playing an important role as shown in the pentagon below.

Figure 2.2 Healthcare facilities management core domain [M.Shohet , I. and Lavy, S. (2004) Healthcare facilities management: state of the art review. Facilities, 22 p.210-220.]

2.2.2 Risk Management

According to O' Donovan (1997) defined the term "risk management as a process where an organization adopts a proactive approach to the management of future uncertainty, allowing for identification of methods for handling risks which may endanger people, property, financial resources and credibility. Risk management activities are designed specifically to patients' and staff safety and effective to reduce those hazards."

In hospital, different building system and component, such as fire protection system electricity and other, must exhibit high level of performance, since any minor breakdown may lead to both casualties and financial losses. Risk management can be introduced into FM at the operational and strategic levels using value engineering and value management.

2.2.3 Performance Management

According to Becker (1999) defined the "application of the performance concept in building as three-step process. First is human needs are translated into uses requirement and the requirement are transformed into technical performance requirement. The last step is these requirements are implemented in the design and occupancy phases of the building." A performance monitoring and management must be carried out based on quantitative means that will enable characterization of the facility's systems. Moreover, it may also assist in comparing the performance of a facility to other healthcare facilities, and in this way identify the points of strengths and weakness for each facility.

2.2.4 Maintenance Management

According to Jardine et al. (1997), "the main goal of maintenance is to minimize the maintenance-related operating costs." According to Vatn et al. (1996), the main objectives of maintenance are the maximization of personnel safety together with the minimization of the total cost loss, the total operational cost, the environment threat and the risk of material damage." Maintenance management includes not only the budgeting and priority setting of the different maintenance activities according to the preferred maintenance policy, but also service life planning. In order to achieve the optimal balance between minimization of cost and maximization of performance, facilities managers can implement two main alternatives which is maximization of performance level while maintaining a limited maintenance budget; or minimization of cost subject to a minimum required performance level of the building.

2.2.5 Supply Services Management

The growing dominance of requirement for cost effectiveness and high performance force the facilities manager to obtain an optimum level of resources in order to achieve the desired performance. It can be achieved by in-house provision and outsourcing of FM service. According to Francheschini et al. (2003) "the model of outsourcing is incorporate the four main phases. It was previously noted that when dealing with maintenance and non-core activities, facilities managers must find the optimal mix of maintenance proficiencies for the use of in-house and outsourcer staff. Furthermore, supply services management also means determining the best combination of other services, such as cleaning, security, gardening, catering, and laundry. FM is therefore required to find the best contractual and financial arrangements for monitoring and analyzing outsourcer performance, and to assimilate the change through organizational learning.

2.2.6 ICT Development

The development of ICT is important nowadays because it able to analyses all kind of results and deduce rapidly what step to implement next. The complexity involved in, and between, the different FM themes can be solved and better understood if ICT implemented. Although ICT play an important role in the healthcare industry, but it relatively little investment has been made in the application of ICT in this industry.

2.2.7 Case-Based Reasoning (CBR)

CBR was originally motivated by a desire to understand how people remember information for the purpose of solving their problems. Subsequently, it was recognized that people commonly do so by remembering how similar problems were solved previously (Watson, 1999).

2.2.8 POE (Post-Occupancy Evaluation)

Post-occupancy evaluation (POE) is a new tool which facility manager can use to assist in continuously improving the quality and performance of the facilities which they operate and maintain. According to Presiser,W.F.E., Rabinowitz, H.Z. and white, E.T, (1998),

POE process is systematically comparing actual building performance with explicitly stated performance criteria. POE wills feedback about how building performs and how they interact with their users.

2.3 Building Performance

Building is important for us. In the developed world the vast majority of people live and work in, if not utilize, building every day. According to (James Douglas, 1996) "Buildings therefore are important for the following reason. First, is environmental, it provide suitable internal environment which can resist the adverse effect of climatic condition for people and commodities. Second is economic factor, they are durable fixed assets with good capital growth potential. In term of functional, they enable activities and task to be carried out and commodities to be housed under controlled conditions. The fourth reason is the cultural; they reflect the architectural aspirations and historical characteristic of the community within which they reside. The last reason is legal matter. They are required to enable owners and users to comply with certain statutory requirements." Building provided a space to a people carry out a series of activities in daily life and it also a part of the human life.

According to (Clift, M. and Butler, R. 1995), "building performance has been defined in BS 5240 as behavior of a product in use." According to (William, B., 1993) "It can be used donated the physical performance characteristic of a building as a whole and of its part. It thus relates to a building's ability to contribute to fulfilling the function of its intended use. Building performance is important both in an inter-building and an intra-building sense. An inter-building evaluation is where one building is being compared against another building. An intra-building evaluation, the building is assessed on its own without direct reference to other properties.

Figure 2.3 the relationship between building performance and facilities performance

Google.com.my (n.d.) Google Image Result for http://www.emeraldinsight.com/content_images/fig/0690140304004.png. [online] [Accessed: 19 Jul 2012].

According to (Oar.state.ok.us (n.d.) 310_667-49-2.htm. [online] Available at: http://www.oar.state.ok.us/viewhtml/310_667-49-2.htm [Accessed: 26 Jul 2012]) and Unknown. (2007) Bhs 2007 Minimum Design Standards Final.

From the Figure 2.3, Point X showing which the building's performance is begins to fall below that of the facilities it is supposed to be supporting. After the position Z the level building performance is such that efficiency of the facilities themselves will be adversely affected. From this figure 2.3 we can refer that the actual building performance will drop over the time due to influences such as inadequate maintenance, inadequate maintenance and other factor.

In the requirement, the patient rooms must have a minimum of 11.2 square meters of clear floor area for single-bed rooms. For the multiple-bed rooms, 9.3 square meter of clear floor area per bed, have exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. The arrangement and dimensions of rooms should be such that there is a minimum of 0.91 meter between the sides and foot of the bed and any other fixed obstruction or any wall. In multiple-bed rooms, a clearance of 1.22 meters must be available at the foot of each bed to permit the passage of equipment and beds.

Every window is necessary have a bottom of glass elevation which is shall not higher than 91 cm above. In rooms requiring windows, the clear glass area of the windows shall be a minimum of 10 percent of the required floor area of the room. A clear unobstructed viewing distance of 6.10 meters plus 0.3 meter for each 0.6 meter rise above the first story up to a maximum of 12.2 meters shall be provided in line with the head of the patient(s) beds. Windows within a normal sight line that would permit observation into a room shall be arranged or draped to provide for patient privacy.

Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall be smooth and water-resistant. Wall construction, finish, and trim, including the joints between the walls and the floors, shall be free of insect- and rodent-harboring spaces.

Table 2.1 Sound Transmission Limitations in General Hospital.

Google.com.my (n.d.) Google Image Result for http://info.sos.state.tx.us/fids/25133169a.gif. [online] [Accessed: 19 Jul 2012].

According to Guidelines for design and construction of hospital and health care facilities, (1996).

According Table 2.1, public space includes corridors (except patient room access corridors), lobbies, dining rooms, recreation rooms, treatment rooms, and similar space.

Next, service areas include elevators, kitchens, elevator machine rooms, laundries, maintenance rooms, garages, boiler and mechanical equipment rooms, and similar spaces of high noise. Mechanical equipment located on the same floor or above patient rooms, offices, nurses stations, and similar occupied space shall be effectively isolated from the floor.

Furthermore, patient room access corridors contain composite walls with doors/windows and have direct access to patient rooms.

Table 2.2 Ventilation Requirements for Areas Affecting Patient Care in Hospitals

Unknown. (2012) [Online] Available at:http://www.filterair.info/pdf/AIA%20DHHS%20Ventilation%20Requirements%20for%20Areas%20Affecting%20Patient%20Care%20in%20Hospitals.pdf.

According to (Info.sos.state.tx.us, 1989 Texas Department of Health. [online] Available at: http://info.sos.state.tx.us/fids/25_0134_0131-3.html [Accessed: 26 Jul 2012].) and (Unknown,1996 guidelines for design and construction of hospital and health care facilities).

According Table 2.2 the ventilation rates is cover ventilation for comfort, asepsis and door control as well in areas of acute care hospitals that will straight affect patient care on healthcare facilities being predominantly "No Smoking" facilities. If smoking may be allowed, then the ventilation rates should be making some adjustment.

In the design for the ventilation system shall provide air movement to clean areas. If any form of variable air volume or load shedding system is used for energy conservation, it must not settlement for the corridor-to-room pressure balancing relationships or the minimum air changes required from the table.

To meet exhaust needs, the important should be need is replacement air from the outside. It would not attempt to describe specific amounts of outside air to be supplied to individual spaces except for certain areas such as those listed. For the arrangement the outside air, added to the system to balance required exhaust, good engineering practice is most important. While the system is in operation must sure remain constant the minimum outside air quantities.

Number of air changes will be reduced if the room is cannot occupied if provisions are made to make sure the number of air changes indicated is re-established any time the space is being utilized. Adjustments must be done such as provisions so the direction of air movement should be remaining the same when the number of air changes is reduced. Areas not indicated as having continuous directional control may have ventilation systems shut down when space is unoccupied and ventilation is not otherwise needed, if the maximum infiltration or ex-filtration permitted is not exceeded and if adjacent pressure balancing relationships are not compromised.

Figure 2.4 Degree of performance predictability

Google.com.my (n.d.) Google Image Result for http://www.emeraldinsight.com/content_images/fig/0690140304005.png. [online] [Accessed: 25 Jul 2012].

From the figure 2.4 we realize assessing performance of whole building is a completed due to high complexity and difficult to conduct an assessment. Vice versa identified the performance of material is easier and faster. The performance data and the specification of the product could get from the manufacturers' product brochures.

The wrong material used in the healthcare centre is critical to the building performance. The case happen which the new healthcare central was grow bacteria on the wall of the building. By investigate and identify the fault material used so can do the make good on the problem.

2.4 POE (Post-Occupancy Evaluation)

"Post-occupancy evaluation is the process of systematically comparing actual building performance, i.e., performance measure, with explicitly stated performance criteria. These are typically documented in a facility program, which is a common pre-requisite for the design phases in the building delivery cycle. The comparison constitutes the evaluation in term of both positive and negative performance aspects."

In the past, changing of the building is relatively slow, the method of evaluate the building performance is informal. The knowledge about the performance was passed on from generation to generation of building specialist. This specialist normally is a man with multiple skills and the well known which the client operated as far as cultural, social, economic and technical parameter were concerned. Nowadays these situations were totally changed with increasing of the specialization of work and also the complexity of the building is getting higher. According to Eberhard,J.P, (1965), "since major building decision are made by committees, and an increasing number of technical code and regulatory requirement are placed on facilities, it is ease to see that the performance of the facilities is something that need to be well articulated and documented, usually in the form of the facility programme." That way, all participant in the building delivery process have a clear understanding of what type and level of performance should be achieved in a facility.

Figure 2.5: The performance concept in the building delivery process

Unknown. (2012) [online] Available at: http://www.emeraldinsight.com/content_images/fig/0690131103002.png.

A generally common set of problem in building performance, even for new buildings; there is health and safety problem, security problem, leakage, poor signage and way finding problem, poor air circulation and temperature control, handicapped accessibility problem, lack of storage, lack of privacy, hallway blockage, aesthetic problem, entry door problem with wind and accumulation of dirty, inadequacy of designing space for equipment, maintainability of glass surface.

Figure 2.6: Building performance evaluation framework

Unknown. (2012) [online] Available at: http://www.emeraldinsight.com/content_images/fig/0690200706001.png.

According to Peter Barrett and David Baldry, second edition, "the benefit of POE as below:

Short term

Identification of and solutions to problem in building facilities; Improved space utilization based on feedback from use; Improved attitude of occupants through active involvement in the evaluation process; Understanding of implications on building performance dictated by budget cut; and informed decision making during design.

Medium term

Built-in capacity for building adaption to organizational change and growth; Significant cost savings in the building process and throughout the building life cycle; Accountability for building performance by design professionals and owners.

Long term

Long-term improvements in building performance; Improvement of design databases, standards, criteria, guidance and benchmark successful concept; Improved measurement of building performance through quantification.

0690131103004.png

Figure 2.7 Post-Occupancy Evaluation (POE) Process Model

Unknown. (2012) [online] Available at: http://www.emeraldinsight.com/content_images/fig/0690131103004.png.

An indicative POE provides an indication of major failures and successes of a building's performance. This type of POE is normally will be conduct within a very short time span, from two or three hours to one or two days. An indicative POE presumes that the evaluator / evaluation team is experienced in conducting POEs and is familiar with the building type to be evaluated, as well as the issues that tend to be associated with it. Some data-gathering methods are typical of an indicative POE such as Performance Issues, Walk-through Evaluation, and Interviews.

An investigative POE is more time-consuming; more complicated, and requires many more resources than an indicative POE. Often an investigative POE is conducted when an indicative POE has identified issues that require further investigation, both in terms of the facility physical performance and the occupants' response it. The results of an indicative POE emphasize the identification of major problems. While the major steps in conducting an investigative POE are identical to those in an indicative POE, the level of effort is higher. Much more time is spent and more sophisticated data collection and analysis techniques are used. Unlike the indicative POE, in which performance criteria used in the evaluation are in part based on the evaluator's or evaluation team's experience, the investigative POE uses researched criteria that are objectively and explicitly stated. The investigative POE can cover more topics in greater detail and with more reliability. It generally require 160-240 man-hours, plus staff time for support services. In the investigative POE, the evaluation criteria are explicitly stated before the building is evaluated.

A diagnostic POE is a comprehensive and in-depth investigation conducted at a high level of effort. It follows a multi-method strategy to evaluate each important building performance aspects. It includes: Questionnaires, Surveys, Observations, and Physical Measurements. The diagnostic POE may take from several months to one year or longer to complete. The results and recommendations are long term oriented, aiming to improve not only a particular facility but also the state of the art in a given facility. Diagnostic POE are usually large-scale projects, involving many variables. Diagnostic POEs use sophistication in both data collection and analysis techniques exceeding that of investigative and indicative POEs. ‰

Diagnostic POEs hold the potential for making fairly accurate predictions of building performance and for adding to the state of the art knowledge for a given building type through improvements in the design criteria and guideline literature. Diagnostic POE are usually large-scale projects, involving many variables. Diagnostic POEs use sophistication in both data collection and analysis techniques exceeding that of investigative and indicative POEs. Diagnostic POEs hold the potential for making fairly accurate predictions of building performance and for adding to the state of the art knowledge for a given building type through improvements in the design criteria and guideline literature.

Figure 2.8: POE evaluation process model

Unknown. (2012) [online] Available at: http://www.emeraldinsight.com/content_images/fig/0690200706006.png.

Evaluation the performance by using POE model is divided into three phase. These 3 phases is planning the POE; Conducting the POE and applying the POE. Each phase consist of three step.

Phase 1 Planning the POE, The planning phase provides guidance for initiating and organizing the POE. There are several preliminaries to observe in initiating and organizing a POE project prior to the on-site data collection.

The client must be briefed on the nature of POEs, the type of activities involved and the resources needed.

Agreement is reached on which type of POE to conduct.

Historical and other background information that may assist in planning the evaluation is identified and obtained.

Coordination with user groups within the building begins and potential benefits for participants are outlined.

Resources for conducting the evaluation are organized, and a preliminary schedule, work plan, and budget are established in which project team members' tasks and responsibilities are defined.

Research methods and analytical techniques are determined, and sources for evaluation criteria are identified.

There are three steps included in this phase: reconnaissance and feasibility, resource planning, and research planning. For every step, the evaluator should set out and/or state: the purpose of the step, justification for this step, activities involved in conducting this step, resources necessary to conduct this step, and the expected result of this step.

Phase 2: Conducting the POE, there are three steps included in this phase which is initiating the on-site data-collection process; monitoring and managing data-collection procedures; and analysis data. For every step, the evaluator should set out and/or state: the purpose of the step, justification for this step, activities involved in conducting this step, resources necessary to conduct this step, and the expected result of this step.

Phase 3: Applying the POE, In this phase of the POE, findings are reported, conclusion drawn, recommendation made, and eventually the resulting actions reviewed. The steps involved in the applying phase of POE are reporting findings; recommending actions; and reviewing outcomes. For every step, the evaluator should set out and/or state: the purpose of the step, justification for this step, activities involved in conducting this step, resources necessary to conduct this step, and the expected result of this step.

2.5 Information and Communication Technology (ICT)

The current development of computer applications in the area of Facilities Management (FM) is still slow, particularly due to a lack of the as-built information required by such applications (Yu et al., 1997). However, increased interest on the part of the healthcare sector in artificial intelligence (AI) and ICT which can be found in more practical applications than ever before (Clark and Metha, 1997; Waring and Wainright, 2002).

Constraint-based analysis and programming was developed mainly in order to solve scheduling problems. These problems contain constraints that must be fulfilled and other preferences that are to be satisfied (Fahle et al, 2002; Hopegood, 1993). Fuzzy logic is a methodology based on an input vector that computer an output vector by applying a set of linguistic conditional statements or rules (Costa et al, 1996). It also can deal with multi-variable, non-linear, and time-varying processes (Stylios and Groumpos, 1999). Genetic algorithms are a search and optimization technique based on genetics and inspired by natural evolution (Leite et al., 2002; Lingtas, 2001). In order to solve a problem, the optimum is sought within several possible required solutions (Goldberd, 1989). Logic programming is a combination of logic and procedures, and consists of the following components:

An alphabet of symbols;

A set of deduction rules;

A set of axioms;

A definition of functions within the logic( Cercone and McCalla, 1987; Garcia and Chien, 1991).

Telemedicine, a relatively new discipline, uses ICT to provide medical information and services in the healthcare industry. Waring and Wainwright (2002) criticized the effectiveness and success of ICT in NHS (National Health Service), citing the neglect of political and organizational issues through the technical implementation of ICT to be among the reasons for its lack of success.

Ng and Li (2003) reviewed the relationships between organizations' knowledge management and ICT using the Hendriks model for knowledge management, which claims that the concept of knowledge management can be fully understood only as a management concept. It was stressed that ICT fits in better with a knowledge management strategy aimed at codification of the knowledge.

Sigala (2003) examined the productivity of ICT in the hotel industry, concluding her research with the conclusion that a more strategic approach to ICT implementation and management is required in order to optimize ICT value. The study found that all three ICT capabilities (information, systems integration and architecture) should be managed and aligned with business strategy and operations.

ICT employs a wide range of technologies. Recent studies that researched the effectiveness and the efficiency of this discipline in information- intensive industries found that ICT can be optimized when its implementation is aligned with the business strategy and operation. Although ICT plays an increasingly important role in the healthcare industry, relatively little investment has been made in the application of ICT in this industry, this trend can be attributed to the individual basis on which healthcare organizations operate, and the lack of codified methods for management. ICT implementation in healthcare FM would be enhanced by the development of quantitative methods as well as structured, strategic means towards healthcare FM. (Igal M. Shohet and Sarel Lavy, 2004)

Gallant (1994) outlined the main objectives of AI as the creation of applications that perform as well as humans on tasks involving learning, vision, language, and robotic motion. During recent years, a great deal of interest has been expressed in AI techniques, which are being introduced increasingly into various practical applications (Clark and Metha, 1997). The current development of computer applications in the area of FM is, however, still slow; primarily due to the fact that it requires comprehensive, structured as-built databases (Yu et al., 1997). AI is often developed in terms of various methodologies, such as constraint-based programming, fuzzy logic, genetic algorithms, logic programming, ANN, and CBR, all of which were developed over the past three or four decades (Watson, 1999). In the following, we will examine the different AI techniques, and consider AI's potential applicability in resolving FM problems:

Fuzzy logic can be considered as a methodology that computes an output vector from an input vector by applying linguistic rules or statements (Costa et al., 1996). The fuzzy rules are read as IF-THEN conditions. Thus, fuzzy logic can successfully deal with multi-variable, non-linear, and time-varying processes (Stylios and Groumpos, 1999; Ligas and Ali, 1996). The architecture of the problem in this research that includes performance and risk evaluation cannot be characterized using linguistic conditional statements; consequently this methodology is deemed unsuitable.

Genetic algorithms are a search and optimization technique based on genetics and inspired by natural evolution (Lingras, 2001; Leite et al., 2002). Genetic algorithms belong to the category of probabilistic algorithms, and their problem-solving process requires several feasible solutions (Goldberg, 1989). Since the problem in this study is not an optimization problem (except certain parts of it, e.g. the maintenance policy), and since the scope of data in FM is limited, this technique is inappropriate for successful implementation here.

Logic programming combines logic and procedures (Cercone and McCalla, 1987). Garcia and Chien (1991) described the following four elements that make up logic programming: an alphabet of symbols, a set of programming: an alphabet of symbols, a set of definition of functions within the logic. The FM problem consists of qualitative and quantitative data, and as a result, no axioms can be defined. Thus, logic programming may be suitable for solving part of the problem, e.g. risk management, but is not suitable for resolving the FM problem presented in this research

The development of ANN was started 60 years ago by McCulloch and Pitts (1943), and was motivated by a desire to try to both understand the brain and imitate some of its strengths. The ANN technique is inspired by biology, and similar to the human brain, it consists of a network of interconnected processing elements (also called neurons, units, cells, and nodes). Its memory uses a weighting system that connects neurons together in several layers (Fausett, 1994; Flood and Kartam, 1994; Garrett et al., 1997; Chao and Skibniewski, 1998; Edwards et al., 2000). The application of ANN has several drawbacks, namely, its ability to deal only with numerical figures, and its requirement of a large body of data sets (Yau and Yang, 1998a). The FM problem is characterized by a limited number of cases, and by missing and incomplete data; therefore the use of ANN is unsuitable.

Yu et al. (2000) perceived that "future FM software must be more integrated so that facilities can be managed in a more comprehensive manner during their life cycle". FM usually requires an analysis of a considerable amount of data, which makes it very difficult to obtain and produce appropriate and suitable knowledge (Christian and Chan, 1993). As can be seen from the characteristics of the above techniques, they are inadequate or only partially suitable for implementation in an integrated FM model. Therefore, we will next examine a potentially suitable AI technique, namely, CBR.

2.5.1 Case-Based Reasoning (CBR)

A different problem-solving paradigm approach is known as CBR. CBR was originally motivated by the desire to understand how people remember information, and it was found that people generally solve problems by recalling how similar problems were solved (Watson, 1999). CBR is capable of utilising the specific knowledge obtained in previously experienced concrete cases; thus, it is a technique that solves a new problem by retrieving previous cases from a "bank" of classified cases, using sets of indicators and rules (Kim and Han, 2001). Aha (1998) described five main steps for achieving a solution to a new problem:

retrieve a set of stored cases decided to be similar to the description of the new problem;

reuse one or more solutions from these cases;

revise: adjust these solutions in order to solve the current problem;

review: assess the results attained from applying the proposed solutions to the current problem; and

Retain: evaluate if the new problem is appropriate to be added to the library of cases as a new case.

The literature cites many researchers that have been known to use the CBR approach in solving complex problems, with the majority of applications being in the field of medicine (Ozturk and Aamodt, 1998). In construction engineering CBR has been used in various applications, including: a steel bridge members plant where it was used to examine and recommend corrective actions for manufacture errors (Roddis and Bocox, 1997); the selection of retaining walls (Yau and Yang, 1998b); the assessment of its application in a house-renovation funding system (Brandon and Ribeiro, 1998); solving of scheduling problems (Dzeng and Tommelein, 1997; Burke et al., 2000); in a study on the bidding behavior of contractors in the procurement of different projects (Chua et al., 2001)

Arditi and Tokdemir (1999) compared the two approaches, CBR and ANN, in order to predict the effectiveness of the techniques in solving construction litigation problems. They found the CBR approach to be more successful, especially due to the kind of information it provides (which includes different definitions of features). In CBR, each case is represented by a number of fields that take on various forms, such as numerical, logical, alphabetical, and strings. Yau and Yang (1998a) concluded that "a CBR application's input and output are more readable than that of a neural network application". One important advantage of CBR is its suitability for implementation in cases in which the interactions and relations between variables are not clearly formulated and understood (Cunningham and Bonzano, 1999).

Many studies can be found in the literature that use the CBR approach to solve complex problems with the majority of applications being in the field of medicine (Ozturk and Aamodt, 1998). However, in the last decade, CBR has also been used for a variety of purposes in construction engineering (Brandon and Ribeiro, 1998; Burke et al., 2000; Chua et al., 2001; Dzeng and Tommelein, 1997; Roddis and Bocox, 1997; Yau and Yang, 1998a, b). There are, however, no CBR applications that deal with healthcare FM.

2.6 Conclusion

As a summary, FM is necessary to the healthcare central and playing important role in term of maintaining a good building performance. The five core domain of FM in healthcare central is risk management, performance management, maintenance management, supply service management, ICT development. These five domains are closely interconnected. It would be impossible and unacceptable to attempt to separate maintenance management and supply services management or performance and risk management.

The building performance shall fulfill the function of its intended use. In a healthcare central, the air quality in the building must be good, the lighting must be sufficient and other functions suppose to be performance by the building. The healthcare central building should comply with the minimum standard of the requirement. When the peoples are wishing to have a higher performance of the building, but the tangible is the building performance will keep lower or drop when the time is increase or long time.

POE is the comparison of client's goals and performance criteria against actual building performance, measured both subjectively and objectively. POE also is a diagnostic tool and system which allows facility managers to identify and evaluate critical aspects of building performance. This is valuable in allowing the generation of a design data base, but the more immediate benefit to the user is the ability to fine tune the built environment. Furthermore, POE is benefit to the FM in short term benefits, medium term benefits and also long term benefits. Basically, POE process separate to three phases which is planning, conducting and applying; every phases is divided in three level also. In this process, the night step needs to run in the process to keep improving the building performance.

ICT is one of the important parts in the FM. Like the human body, constructed facilities are system-intensive entities in which the malfunctioning of one system propagates to other systems. Since CBR has exhibited high efficiency in the field of medicine, it may indeed also prove itself to be a promising approach for diagnosing and treating built facilities

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