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Healthcare
Integrated healthcare facilities facilities
maintenance management model: management
case studies
107
Sarel Lavy
Department of Construction Science, College of Architecture, Received July 2008
Texas A&M University, College Station, Texas, USA, and Accepted September 2008
Igal M. Shohet
Department of Structural Engineering, Ben-Gurion University of the Negev,
Beer Sheva, Israel

Abstract
Purpose Increasing demand for healthcare services world-wide creates continuous requirements to
reduce expenditures on non-core activities, such as maintenance and operations. At the same time,
owners, users, and clients of healthcare expect a high level of built-facilities performance and
minimized risks. The objective of this research is to develop an integrated facilities management (FM)
model for healthcare facilities.
Design/methodology/approach The paper presents a case study analysis of an Israeli acute care
hospital, in which the integrated healthcare facilities management model (IHFMM) was implemented,
and the findings were examined and evaluated three years later. The case studies investigated the
effectiveness of the developed model in terms of maintenance and performance management. The
robustness of the model was also examined by applying sensitivity analyses to its parameters.
Findings Both of the case studies show significant results in predicting FM-related aspects, such as
the level of performance and the required maintenance budgets. The findings reveal a high correlation
between the two phases of the case studies in terms of financial outcomes and performance
predictions.
Originality/value The core of the model is based on the strength of identified effects of certain
parameters, such as maintenance expenditure and actual service life, on the performance and
maintenance of healthcare facilities. The proposed IHFMM addresses two core topics of FM:
maintenance and performance, for strategic FM decision making.
Keywords Facilities, Health services, Cost analysis, Modelling, Israel, Resource allocation
Paper type Case study

Introduction
Increased competitiveness in the business sector puts considerable pressure on
companies to reduce expenditures on non-core activities, such as maintenance and
operations. This encourages buildings owners and users to raise their expectations
and requirements of facilities. Facility managers are thus expected to attain lower
operational costs and risks through effective and efficient design, construction,
management, and maintenance of facilities, without compromising their performance.
Over the past three decades, the field of facilities management (FM) has witnessed Facilities
significant development, mainly due to the following five global trends: Vol. 27 No. 3/4, 2009
pp. 107-119
(1) increased construction costs; q Emerald Group Publishing Limited
0263-2772
(2) greater recognition of the effects of space on productivity; DOI 10.1108/02632770910933134
F (3) increased performance requirements by users and owners;
27,3/4 (4) contemporary bureaucratic and statutory restrictions; and
(5) recognition that the performance of facilities is highly dependent on their
maintenance (Shohet, 2006).

As a result, the traditional maintenance manager has become a facility manager,

108 and FM practices have been enriched with methodological procedures particularly
implemented with key performance indicators. The facility manager makes strategic
and operational facilities-planning decisions that affect the organizations business
performance. This is particularly true in healthcare facilities, which are considered to
be among the most complicated and difficult types of facilities to manage, maintain,
and operate.
This paper illustrates the implementation of the integrated healthcare facilities
management model (IHFMM), as developed in the frame of this research, using a case
study. The results and the conclusions of this case study are presented and discussed.

Background
Facilities Management has traditionally been regarded in the old-fashioned sense of
cleaning, repairs and maintenance (Atkin and Brooks, 2000). A decade ago, FM
responsibilities broadened to encompass buying, selling, developing and adapting
stock to meet wants of owners regarding finance, space, location, quality and so on
(OSullivan and Powell, 1990). Recognition of the effects of space on productivity
stimulated the development of the Facilities Management discipline (Alexander, 1996;
Brown et al., 2001; Douglas, 1996; Granath and Alexander, 2006; Kweon et al., 2008;
Neely, 1998; Then, 1999). From the 1990s onward, there has been a trend toward more
open markets, and especially toward gradually increased competition, as a result of
globalization (Hamer, 1994). Now, at the beginning of the twenty-first century, it is
recognized that property is a cost-center that can contribute to the performance of an
organization, and as such, it requires effective management. As stated by the
International Facility Management Association (IFMA, 2004), FM is [a] profession
that encompasses multiple disciplines to ensure functionality of the built environment
by integrating people, place, process and technology.
Drivers of healthcare facilities management are discussed extensively in the
literature. Gallagher (1998), for instance, defines the following six issues as
encouraging successful implementation of healthcare FM: strategic planning,
customer care, market testing, benchmarking, environmental management, and staff
development. Amaratunga et al. (2002) demonstrate a model developed for assessing
the impact of organizational FM cultural processes (SPICE-FM) on a hospital facility.
The healthcare sector in many countries suffers from an under-investment in the
allocation of resources, as reflected in different financial reports (AHA, 2004; British
Ministry of Finance, 2003). This trend might adversely affect the non-core activities of
healthcare providers, and primarily facilities management aspects, such as
maintenance and operations. Ritchie (2002) posits that improving the delivery of
healthcare services, as well as the services performance and quality, can be achieved
by paying similar attention to the quality of service as is paid to financial issues. The
reforms made by the UK government in the National Health System (NHS) during the
1980s and 1990s improved efficiency by increasing the responsibilities given to the Healthcare
management level (Procter and Brown, 1997). facilities
From this review of literature the authors of this paper conclude that the
effectiveness of healthcare services will increase with the growth and development of management
the facilities management profession. This in turn will lead to a change in the position
of FM in healthcare organizations to being a more central part of the organization a
position that will help shape organizational decisions and processes. 109

The integrated healthcare facilities management model

The integrated healthcare facilities management model (IHFMM) was developed to
establish a deductive mechanism capable of identifying how maintenance and
performance of healthcare FM can be related to each other and synergize each other.
The model provides insight into the parameters that affect maintenance and
performance in healthcare facilities, e.g. level of occupancy, age of buildings, annual
maintenance expenditure, and level of performance. The proposed model consists of
three main interfaces: input interface, reasoning evaluator and predictor phase, and
output interface. These interfaces are divided into five phases (A to E), which are
further subdivided into 12 levels (1 to 12). Lavy and Shohet (2007b) present a detailed
description of the structure of the IHFMM.
The Input Interface requires the user to provide parameters related to the facility,
while the output interface provides the user with a review of the main topics analyzed
by the reasoning interface. The reasoning evaluator and predictor phase implements 15
procedures used by the model for computing the key performance indicators (KPIs) for
the facility in question. Two main principles outline the design of the IHFMM, as
follows:
(1) The structure of the database is object-oriented, enabling the databases
adaptability to diverse healthcare buildings.
(2) The model links topics that combine the core issues of healthcare FM. It could
be expanded to include operations and energy, business management, and
development aspects in addition to the existing modules focused on
maintenance and performance of facilities.

The following paragraphs depict the rationale, reasoning, and functions of the major
procedures, as developed in the IHFMM. These represent five out of the 15 developed
procedures, and they were selected as the core of the model. The discussion will also
assist in understanding the case study, presented in the following sections.

Building performance indicator (BPI)

The building performance indicator (BPI) aims to compute the actual physical
performance score for each system in a given building, for each building and for the
entire facility (Shohet, 2003), by providing a physical performance indicator,
measured on a 100-point rating scale. Weighting the performance indicator in a
building level is based on a life cycle cost (LCC) calculation of all the components in
that building. This means that the BPI is a combination of the physical performance
of components and their life cycle costs implications. The BPI for building i is
calculated by using equation (1):
F 10

X 
LCCi;j
27,3/4 BPIi APi;j 1
j1
LCCi

where BPI is the building performance indicator, APi, j is the actual physical
performance score for system j in building i measured on a 100-point rating scale,
110 LCCi, j is life cycle costs for system j in building i, and LCCi is total life cycle costs of
the building.
This procedure acts as a physical assessment mechanism that monitors the building
and its systems and components. Nevertheless, instead of being a tool used only to
assess the physical condition of a building, it also incorporates an
engineering-economic aspect that supports the weighting of the different systems in
a building while taking their LCC into consideration. It provides the facility manager
with a novel perspective that creates a simultaneous link between physical
performance and the economic aspects of building systems. As an
economic-performance indicator, it is used in a later stage of the analysis to assess
the efficiency with which the actual performance is achieved.
Other qualitative approaches may also be considered for assessing the physical
condition of a building; however, the authors believe that these approaches are
subjective to the evaluator, and may not completely reflect the actual performance and
functionality of the building and its systems. As a result, weighting the building
systems by their contribution to the total life cycle costs of the entire building was
selected as the approach used for the purpose of this study.

Facility coefficient
The facility coefficient procedure computes the adjusting coefficient for the annual
maintenance expenditure (AME). This coefficient is affected by the type of
environment in which the facility is located (whether marine or in-land
environment), its occupancy (low, standard, or high), the actual age of the buildings
in the facility, and the individual configuration of the buildings in terms of the amount,
type, and quality of the components (Lavy and Shohet, 2007a). The coefficient
expresses the maintenance resources required for implementing a policy of preventive
and breakdown maintenance. Each building is then compared with a normative
hospital building, with the characteristics of location in an in-land environment (more
than 1,000 meters off the Mediterranean coastline), facing a standard level of
occupancy (a yearly average of ten occupied patient beds per 1,000 m2 of floor area),
and high quality of components to be installed. A facility coefficient of 1.15, for
example, represents a requirement to invest 15 percent more in maintenance activities
than in a standard hospital building, under standard service conditions.
In this research, six simulations were conducted to examine the total maintenance
requirements during the designed lifespan of a hospital building under different
service conditions (Lavy and Shohet, 2007a). The conclusions drawn from these
simulations reveal that the AME in extreme conditions may vary from 9.0 percent
lower (in-land environment and low level of occupancy) to 18.6 percent higher (marine
environment and high level of occupancy) than standard conditions. This observation
is significant, since it means that the AME in built facilities depends significantly on
factors such as the type of environment in which the facility is located, and even more,
it depends on the level of occupancy in the facility and on its actual age. Consequently,
the implementation of this coefficient elucidates an uneven allocation of resources in Healthcare
healthcare facilities; it also explains that the particular conditions of each facility facilities
should be taken into account.
management
Annual maintenance expenditure (AME) and normalized annual maintenance
Expenditure (NAME)
Annual maintenance expenditure (AME), measured in $US per square meter, expresses
111
the amount of resources spent on maintenance and replacement (also known as capital
renewal) activities during a fiscal year, and combines expenditures on in-house
personnel, outsourcing contractors, and materials and spare parts (Shohet et al., 2003).
Any activity intended to prevent a failure or deterioration of building components, to
repair a component that failed, or to replace a component as it reached the end of its
service life is included in the AME. This indicator may be used to normalize the
expenditures in a facility from one year to another, as well as to compare maintenance
expenditures between different facilities.
The normalized annual maintenance expenditure (NAME) is defined as the AME
divided by the facility coefficient. This eliminates the effects of building age, level of
occupancy, category of environment, and configuration of building components by
normalizing the annual maintenance expenditure into a value that can be compared to
other facilities of different ages and under different service conditions. This parameter
can be combined with the BPI as an indicator for the building performance to cost ratio.

Projected performance
Similar to the BPI, projected performance computes performance scores of the building,
systems, and components on a 100-point scale. This procedure, however, aims to
project the future level of performance for the different systems in a building (Lavy and
Shohet, 2007b). In order to predict the performance of each component, it is assumed
that its deterioration pattern is either linear or non-linear (Moubray, 1997). Then, each
building system is weighted according to its share in the LCC of the entire building.
The projection of a buildings performance aims at forecasting the future level of its
functional condition based on actual monitoring of its performance. In this research,
patterns of performance projection were developed for 51 main building components.
Based on this, future performance can be projected for each system in the building, for
the building as a whole, and for the entire facility that is composed of several buildings.
This study proposes the use of different patterns of deterioration not only to predict the
performance of a single element or system in a building, but to project the performance
score for the entire building and even of the entire facility, using LCC as the weighting
principle for the buildings various systems. Moreover, it allows FM decision-makers to
break each building down into its individual systems, and to analyze it at a great level
of detail, down to its components. In addition, the model is flexible and able to
accommodate any change in the patterns of deterioration. This means that if future
research reveals that the deterioration pattern of a particular component is exponential,
changes in the databases can be effected with no significant effort.
Likewise, the projected performance mechanism does not consider renovation or
capital improvement projects that may be conducted in a building. Since these types of
projects depend on the mission of the building, as well as on available resources, it is
F very difficult to plan for and incorporate them into the prediction model. Thus, the
27,3/4 authors suggest that further research is required in this area.

Maintenance efficiency indicator

The maintenance efficiency indicator (MEI) indicates the efficiency with which
maintenance activities are implemented. The MEI calculation requires three other
112 indicators: the annual maintenance expenditure (AME), the building performance
indicator (BPI), and the facility coefficient (FAC), using equation (2):
AME
MEI 2
BPI FAC y
Shohet et al. (2003) surveyed a sample of 25 public acute-care hospitals in Israel, and
defined the normative range of MEI values for healthcare facilities as:
.
lower than 0.37, representing a high level of efficiency and/or scarce resources;
.
0.37 to 0.52, representing a standard-normative efficiency; and
.
higher than 0.52, representing a level at which the available resources are not
efficiently utilized.

This procedure provides strategic level FM decision-makers with valuable information

regarding the effectiveness of maintenance implementation in different buildings and
facilities. This indicator can also be used as a decision-making criterion for the
allocation of maintenance resources in cases where limited resources are available, e.g.
public sector facilities.
Illustration of the model a case study
Method
The IHFMM was evaluated by conducting two case studies in Israeli acute-care
hospital facilities. The case studies investigated the effectiveness of the developed
model in terms of maintenance and performance management. The following
paragraphs describe one of the two case studies, as well as its results and conclusions,
and how these conclusions may be transferred into operational recommendations.
Since a hospital facility is multifaceted and consists of a large variety of complex
buildings, and in order to explain the implementation of the model in a clear manner,
one case study is discussed in detail. The conclusions drawn from implementing the
IHFMM on the second case study will be summarized at the end of this chapter.
The case study was subdivided into three main phases, as follows:
(1) An initial field survey conducted in 2001.
(2) Recording of all non-regular replacement and maintenance activities
implemented between 2001 and 2004.
(3) A second field survey conducted in 2004, similar to that carried out in 2001.
The reason for these phases was to investigate and to compare the results, obtained in
the same hospital, across a time span of three years.
The case study is a peripheral hospital located in the north part of Israel (Plate 1). Its
total floor area in 2001 was approximately 39,000 m2, with 301 patient-beds. The total
number of buildings was 24, five of which, constituting 29,070 m2, were selected for the
 Healthcare
facilities
management

113

Plate 1.
Aerial view of the hospital
used as case study

facilitys performance survey. The following paragraphs will elucidate the

built-environment parameters of this hospital, the results of applying the model to
the 2001 data, including the models policy setting, and the results from applying the
model to the 2004 data, including a comparison between 2001 projected values of
performance and the corresponding values observed in the 2004 survey. It should also
be mentioned that the financial analyses are based on the assumption of an annual
interest rate of 4 percent.

Results and analyses 2001 field survey

The main parameters and key performance indicators obtained from the 2001 vs 2004
surveys are introduced in Table I.

Parameter/KPI 2001 2004

Floor area (m2) 39,000 42,000

No. of patient beds 301 301
No. of buildings 24 24
No. of buildings surveyed 5 5
Percentage of floor area surveyed (%) 74.5 69.2
AME ($US/m2) 25.6 25.8
BPI 78.2 74.7 Table I.
Facility coefficient 0.6293 0.7564 Parameters and KPIs for
MEI 0.521 0.457 2001 vs 2004 surveys
F From these figures it can be seen that almost three-quarters of the built floor area was
27,3/4 surveyed in 2001, and the average BPI in the surveyed areas was found to be
satisfactory (78.2 points on a 100-point scale). The low facility coefficient (0.6293)
reflects the relatively new portfolio of buildings, in-land environment, and very low
level of occupancy. As a result, the maintenance efficiency indicator was deduced to be
in the range of values that reflect high maintenance expenditure in comparison with
114 actual performance, although the actual performance is itself relatively high. Figure 1
demonstrates this point by comparing the case study hospital to the population of all
other hospitals participating in this study, with reference to the normative range of
efficiency. This figure elucidates that the BPI vs NAME of the case study hospital in
2001 places it on the marginal line, representing low efficiency of maintenance
implementation (MEI 0:52). This finding implies that changes in the maintenance
work methods, such as considering the distribution of sources of labor, and
investigating the maintenance policies of the hospital (preventive versus corrective),
were needed. Furthermore, the major recommendation for the decision-makers in this
facility is to shift toward the MEI 0:45 line. This objective can be achieved by
improving the performance of the facility as well as reducing the expenditure for
maintenance.
Actual performance may also be broken down for each particular building, as
shown in Table II. Here, we can see that building 1 performed at a good level, building
4 at a satisfactory-marginal level, and three buildings at a deteriorating level (buildings
2, 3, and 5). The model projected that by 2004, these buildings would be found at the

Figure 1.
BPI vs NAME of the case
study hospital

Building # Actual performance 2001 Projected performance 2004 Actual performance 2004

1 88.3 82.9 81.1

Table II. 2 66.2 60.4 62.4
Comparison of 3 64.9 59.2 60.1
performance of buildings 4 75.1 69.7 81.2
between 2001 and 2004 5 65.1 59.4 63.0
surveys Total 78.2 72.7 74.7
bottom range of this performance category (building 2), or even in a run-down Healthcare
condition (buildings 3 and 5), unless substantial corrective maintenance was carried facilities
out. These results were further broken down and analyzed from a system perspective,
as well. management
Analyses of the 2001 field survey showed an actual performance of 78.2 points, an
annual maintenance expenditure of $25.6 per m2 of floor area, and a maintenance
efficiency indicator of 0.521. Assuming that between 2001 and 2004, no large 115
replacement or major capital renewal would be carried out, other than implementing
periodical maintenance activities, the predicted performance for 2004 was 72.7 points.
Assuming improved efficiency in the implementation of maintenance (MEI ranging
from 0.45 to 0.52), a predicted annual maintenance expenditure ranging from $24.7 to
$28.6 per m2 is required. This means that the annual maintenance expenditure will
vary from 3.5 percent lower to 11.5 percent higher than its value in 2001.

Field survey results and analyses 2004 survey

The main parameters and key performance indicators obtained from the 2004 survey
are introduced in Tables I and II and in Figure 1, and can be compared to the
observations from the 2001 survey. The FM department invested moderately in
replacement and capital renewal during the years 2002 to 2004. In these three years, the
total floor area of the hospital expanded by approximately 7.7 percent in comparison
with the reference floor area observed in 2001. However, no change was observed in the
total number of patient beds. In order to be consistent with the performance
comparisons, the same five buildings were surveyed in 2004 as in 2001, with a built
floor area constituting 69.2 percent of the hospitals total floor area. The annual
maintenance expenditure in 2004 was similar to the value found in 2001. The actual
performance score in the facility was 74.7 points, which indicates a marginal level of
performance. The facility coefficient in 2004 shows an increase of more than 20 percent
in comparison with the coefficient computed in 2001, indicating growing needs for
maintenance due to ageing of the existing portfolio of buildings. Consequently, the
maintenance efficiency indicator in 2004 reflects improved efficiency, which falls into
the range of values that indicate a reasonable use of maintenance resources (Figure 1).
The actual performance score of the hospital for the 2004 field survey is higher by
2.0 points in comparison with the predicted performance, yet, 2004 actual performance
is lower by 3.5 points than the actual performance found three years earlier. With
performance scores broken down for particular buildings, it can be seen that for
buildings 1, 2, and 3, the performance measured in 2004 is comparable to the values
projected in the 2001 survey. Substantial differences between the predicted
performance for 2004 and the actual scores were found in buildings 4 and 5. These
differences were caused by a large renovation project that took place in Building 4, in
which $5,500,000 was invested in most of the building systems, and by an
improvement of the electricity system and its components in building 5.

Case study 2 summary and conclusions

The second hospital has a total floor area of 57,186 m2 occupied with 444 patient beds.
The total number of buildings is 23, five of which, constituting 40,246 m2, were selected
for the facilitys performance survey. The total annual maintenance expenditure in
2001 was found to be $2,025,000, which means $35.4 per m2, or $4,561 per patient-bed.
F The actual performance score in the facility was found to be 82.8 points, indicating a
27,3/4 good level of performance. The facility coefficient in 2001 was calculated as 0.8327
(in-land environment and a very low level of occupancy), and as a result, the
maintenance efficiency indicator was 0.514 close to 0.52, meaning that the
maintenance expenditure is high in comparison with the actual performance.
The total actual performance in this hospital was predicted to decrease by 5.4 points
116 during the three years between 2001 and 2004, causing deterioration in the condition of
the facility from good (82.8 points) down to a satisfactory level of performance (77.4
points). However, a substantial investment in installation, replacement and renovation
projects of more than $8,700,000 in the five buildings (excluding all regular
maintenance activities), which equals more than $215 per m2 of these buildings, led to a
2004 actual performance (82.7 points) similar to the value found in 2001. One building
(out of the five surveyed) was found to have a 2004 performance score similar to the
predicted performance score for this year. This is the only building in which regular
maintenance activities (no major replacement and renovation activities) were solely
implemented during the three-year period. This value strengthens the validity of the
model, and reinforces its results.
The annual maintenance expenditure was predicted to be in the range of $30.6 to
$35.0 per m2. However, the annual maintenance expenditure in 2004, also affected by
the high level of performance, was found to be $42.9 per m2, which means a lower level
of maintenance efficiency. Therefore, the maintenance efficiency indicator (MEI) in
2004 was found to be higher by more than 14 percent in comparison with the 2001
value, meaning that the department did not improve its efficiency, but actually lowered
it, particularly due to the high maintenance expenditure observed in 2004 that reflects
poorer efficiency.

Robustness of the model

The robustness of the model was examined by applying sensitivity analyses to its
parameters. Within these analyses, two principal parameters were studied by
examining the sensitivity of the core outcomes to inaccuracies in the performance
scores used as input, as well as to the hypotheses of the components patterns of
deterioration used to project future performance and the AME.
Analyzing the sensitivity of the outcomes to inaccuracies in the performance rating
revealed that the output of the model is slightly sensitive to inaccuracies in the
performance ratings of four systems. This finding coincides with the central limit
theorem (CLT): as the distribution of a variable composed of a sum of multiple
variables is normal, its variance equals the variance of the parent variables divided by
the sample size. This is attributed to the large number of components sampled in the
survey.
The second sensitivity analysis studied the effect of different patterns of
deterioration of two building components. One assumption of this research states that
the performance of all building components, apart from the components in the
Structure system, deteriorates in a linear pattern during the designed life cycle. This
analysis examines this hypothesis for two out of 51 components existing in the ten
building systems. Conclusions of this analysis may be summarized as follows:
.
The sensitivity of the predicted performance to diverse patterns of deterioration
was found to be low for a single component and very low for the total BPI.
 Replacing the linear pattern of deterioration with either intensive or moderating Healthcare
patterns of deterioration revealed that for the two examined components, a facilities
maximum effect of 3.2 points in the predicted performance was found within a
period of three years. Furthermore, it was found that the maximum effect on the management
facilitys total predicted performance is less than 0.11 points, which represents
less than 0.2 percent of its performance score.
.
The sensitivity of the predicted annual maintenance expenditure to diverse 117
patterns of deterioration was found to be very low. Substituting the linear
pattern of deterioration with either intensive or moderating patterns of
deterioration revealed that for the two examined components, a maximum effect
of 3.5 per m2 in the predicted maintenance expenditure was observed. This
result represents less than 0.15 percent of the total predicted Annual
Maintenance Expenditure, and as a result, is negligible.

Conclusions
Existing methods for facilities management decision-making are limited, particularly
at the strategic level of facilities management. This research focused on identifying
principal parameters that affect the performance and maintenance of facilities
throughout their service life. An integrated healthcare facilities management model
has been developed, which proposes simultaneous analysis of the complexities
involved in the field, such as resource allocation and setting of maintenance policy for a
given level of performance, or improving efficiency with which the implementation of
maintenance activities are carried out. These complexities are dealt with by almost all
facility managers of public as well as private facilities; nevertheless, this point is even
more crucial and significant in healthcare facilities that operate 24 hours a day, seven
days a week, provide care and treatment services, and support critical infrastructures
of healthcare such as medical gas and power for operating theatres.
The model developed in the research includes 15 procedures, out of which five core
procedures were discussed in the frame of this paper: building performance indicator,
facility coefficient, annual maintenance expenditure, projected performance, and
maintenance efficiency indicator. The implementation of the methodology was
illustrated by two case studies that confirmed the viability of the model. Both of these
case studies show high correlations and significant results, by predicting different
FM-related aspects, such as the level of performance and the required maintenance
budgets.
The models robustness was examined using sensitivity analyses. Two principal
factors were considered: inaccuracies in the performance scores, and sensitivity to the
hypothesized deterioration patterns of building components. Robustness of the
predictions of the model is achieved primarily due to the central limit theorem.
The present research enables an analytical hierarchical process for facilities
maintenance strategic and operational decision making by simultaneous analysis of
facilities maintenance core parameters. The core procedures are illustrated in this
research with the building performance indicator, facility coefficient for the adjustment
of the maintenance resources to prevailing building environment and occupancy, and
maintenance efficiency, as expressed by the ratio between expenditure on maintenance
and performance.
F References
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About the authors

Sarel Lavy is a faculty member in the Department of Construction Science, which is one of four
departments in the College of Architecture at Texas A&M University. He also serves as the
Associate Director of the CRS Center for Leadership and Management in the Design and
Construction Industry, as well as a fellow of the CRS Center and of the Center for Health Systems
and Design in the College of Architecture at Texas A&M University. Dr Lavys principal
research interests are: facilities management in the healthcare sector, maintenance management,
and performance and condition assessments of buildings. Sarel Lavy is the corresponding author
and can be contacted at: slavy@archmail.tamu.edu
Igal M. Shohet has the principal research interests of: maintenance and performance
management of complex infrastructures such as healthcare, laboratories, and transportation
facilities; extreme events engineering and management in the built environment; procurement
methods; and construction safety. Dr Shohets maintenance and performance management
models are implemented in the last decade in healthcare facilities in Israel, and in civil
infrastructures in Israel and in the US. Prior to joining Ben-Gurion University in 2004, Dr Shohet
served as a faculty member and senior researcher in the faculty of Civil and Environmental
Engineering and the National Building Research Institute in the Technion for eight years.

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