The Evaluation of Performance Criteria for Healthcare...

The Evaluation of Performance Criteria for

Healthcare Facilities Services in Malaysia

Ihfasuziella Ibrahim, Mohd Khairolden Ghani,

Zuhairi Abd Hamid, Construction Research Institute of Malaysia (CREAM),

Kuala Lumpur, Malaysia

[email protected], [email protected],

[email protected]

Syahrul Nizam Kamaruzzaman,

Zairul Nisham Musa

Faculty of Built Environment, University of Malaya,

Kuala Lumpur, Malaysia

[email protected], [email protected]

Abstract— Healthcare is considered as a very important

institution for people and had been recognized providing medical

care for people. FM in healthcare need to be given priority

compared to other sectors because it’s dealing with human life.

The service delivery and performance in healthcare required

most sophisticated approach compared with other organization.

People would always express their views in media with regards to

the quality services rendered by healthcare. The issue of service

quality and performance are plaguing among the healthcare

throughout the country over the years. This paper is proposed to

identify the performance management criteria in a

comprehensive and rank this criterion by applying the Delphi

Method. This method includes three rounds of allocation

questionnaire to the experts panel in the field of facilities

management. A total of 10 experts selected to determine the

performance criteria manaegement model in healthcare. The

criteria will be used as components to develop a strategic

performance management for FM in Malaysian healthcare. The

application of this model provides the guidelines to the healthcare

in their performance management.

Keywords—; performance management; healthcare; Delphi

Method;criteria;sub criteria

I. INTRODUCTION

According to Ruslan (2007) the key issue currently

plaguing FM in Malaysia is low service quality and

performance. In fact, KPMG (2005) found that quality

performance of reputation is the main key factor which

enhanced an organization’s ability to secure new work.

According to CREAM (2011), it was found that performance

measurement in FM context in Malaysia have been divided

into six components namely fire protection and maintenance,

mechanical services maintenance, electrical services

maintenance, asset life cycle management, management policy

and administration and cleaning services. It is found that

mechanical and electrical services maintenance had

contributed major percentage to the performance management. The need for management applies in a FM context as a subset

general management is performance measurement

(Amaratunga and Baldry, 2002). Taticchi and Balachandran

(2008) have said that performance has received much attention

from researchers and practitioners. It is a topic of interest

among the academic and managerial level to fix strategies for

success, establish goals, execute activities, decision and

monitor the result in business process. Egan (1998)

recognized the need for construction and facility managers to

closely work as part of integrated team to reduce the cost of

maintenance.

This paper is intended to identify the characteristics

of performance management criteria in healthcare. More

specifically, the study is to identify and rank the performance

management criteria by selected expert panels. The Delphi

method as a qualitative approach will be applied to give a

more significant and reliable method in developing ranking for

performance management criteria in Malaysian healthcare.

II. PERFORMANCE MANAGEMENT IN FACILITIES MANAGEMENT

A. Understanding of Performance Management

Performance management definition made by Ana-

Maria et al., (2009) is a strategic and integrated approach for

sustainable organization in improving the performance of the

team and individual. Hay Group (2008) also define

performance management is about improving team and

individual performance through strategy process that links

people and jobs. They also outline performance is a shared

understanding process of what to be achieved, managing

people process and also a process to ensure the most effective

ways of people do the process. Amaratunga (2000) from her

pilot study found that, the understanding of performance

evaluation in FM remain relatively undeveloped.

The research done on performance management is

very few to assess the organizational performance. There is

less literature that relates performance management in FM per

se. However, there are trends researchers have been looking

on strategic development of performance. The quality is an

important component in dealing with performance. Quality

services for client are the part and parcel of support processes

of primary activities and organisation objectives. The goal is

Proceedings of the 2015 International Conference on Industrial Engineering and Operations Management

Dubai, United Arab Emirates (UAE), March 3 – 5, 2015

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mailto:[email protected]




to ensure that delivery meets demand, processes and

continuous quality improvements being met. The clients need

to have all necessary means such as knowledge, processes and

tools. It is imperative to measure the results in the

development over time period to improve service delivery and

processes (British Standard, 2012). The quality services will

ensure the quality delivered will fulfil the requirement, meet

the demands and satisfy within client organisation (British

Standard, 2012). Quality is a set of characteristics that will

fulfil the requirement of services. In the context of FM,

requirements are meant to be fulfilled by client organisation

including client, customer, end user and society.

B. Characteristic of Performance Management

In order to define the characteristics, few considerations need

to be taken, (British Standard, 2012);

a) The needs (e.g. subsistence, protection, affection,

understanding, participation, leisure etc.)

b) The expectation or belief (projection into the future)

which may be expressed precisely, explicitly, fussily

or implied

c) The perception (process of interpretation and

organisation of the simulation of the humans)

d) Client, customer and end user perceived value as

ration of satisfaction and/or experience over

perception of the fairness of the price

e) The various constraints (e.g. financial, resources,

legal etc) resulting in selection, filtering, prioritising

within the clients organisation and related market.

III. METHODOLOGY

There are many techniques are used to develop the

ranking of criterion. In this study, the Delphi method is used

as a method to develop performance management criteria.

According to Hsu and Sandford (2007), the Delphi technique

is a widely used and accepted method for gathering data from

respondents within their domain of expertise. The technique is

designed as a group communication process which aims to

achieve a convergence of opinion on a specific real-world

issue. The Delphi process has been used in various fields of

study such as program planning, needs assessment, policy

determination, and resource utilization to develop a full range

of alternatives, explore or expose underlying assumptions, as

well as correlate judgments on a topic spanning a wide range

of disciplines.

The objective of this method is to give an

understanding of the primary data involving perceptions and

expectations of the guest expert panel on appropriate criteria

and can be used in developing a performance management

model based on the information respondents. Data was

collected through questionnaire consists of five hospitals in

Malaysia, comprising of 2 government hospitals and 3 private

hospitals. This method includes three rounds of allocation

questionnaire to the experts panel in the field of facilities

management. A total of 10 experts selected to determine the

performance criteria management model in healthcare. The

mean score was used to identified the used of criterion.

According to Murray and Jarman (1987), the mean is

workable used to present information concerning the

collective judgements of respondents. Therefore, the analysis

below shows the method of Delphi Method used in

determining the selection criteria in performance management

model done by 3 rounds.

A. Selection of Interviewee

The criteria of performance management were validated

through 10 experts in the FM field. They are senior

management / officers from the government agencies and

practitioners. All selected respondents have been working

experience of more than 10 years onwards.

TABLE 1.0 EXPERT PANEL INTERVIEWED FOR DEVELOPING PEFORMANCE

MANAGEMENT IN HEALTHCARE

Positions Number of expert selected

General Manager 3

FM Consultant 2

Senior Engineer 2

Building Manager 2

Expert Officer 1

Total 10

About 30% of the respondents are general manager position,

20% are civil FM consultant, senior engineer and building

manager and about 10% are expert officer. They are

representative from government and private bodies. The

highest percentage is general manager position.

B. Working Experiences of Interviewee

TABLE 2.0 WORKING EXPERIENCE OF INTERVIEWED

Number of Working Experience (years) Number of expert

10-15 years 8

15-20 years 1

30-35 years 1

Total 10

Working experiences between 10 to 15 years found to be

majority in this survey which constituted about 80%. This was

followed by experienced between 15 to 20 years and 30 to 35

years about 10%.

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IV. FINDING AND DISCUSSION

A. Validation of Performance Management Criteria

1. Delphi Method Round 1

FIGURE 1.0 KEY CRITERIA ROUND 1

Figure 1 shows the eight main criteria namely efficiency of service delivery process, process management, effective communication process, physical performance, schedule performance, time schedule performance, cost performance, people skills and human and quality of building services. There are five scales that measured a very unimportant, unimportant, neutral, important and very important. Based on the Likert scale of measurement in terms of round 1 the highest percentage for the very important aspect is the cost performance criteria of 60%. For the important terms, the highest percentage is efficiency of service delivery process, effective communication process, physical performance using CMMS, and time schedule performance. A total of 10% recorded in the process management-neutral supply chain and procurement process, physical performance using CMMS and people skills and human.

FIGURE 2.0 SUB CRITERIA ROUND 1

The highest aspect for very important is 50% which is criteria

customer satisfaction and communication between service

providers and users. For the important aspect, there are 70% is

the highest for physical resources activities-soft and hard FM

services, consistency and reliability, capital expenditures and

motivating staff. The highest percentage is neutral term which

is information and analysis using CMMS, 20%. Some of 10%

of respondents stated that the criteria is not important which

are Service quality for building services, rules and regulations

set forth for policies to follow SOP / ISO quality system,

monitoring cost budget and budget for contingencies, service

quality for building services, rules and regulations set forth for

policies to follow SOP / ISO quality system, monitoring cost

budget and budget for contingencies criteria.



Based on Figure 3.0, the highest percentage for very important

term is 80% which is physical performance using CMMS and

quality of building services. For the term of important, the

highest percentage is 90% which is process management and

effective communication process. Besides that, 50%, is the

highest percentage for neutral term for the efficiency of

service process delivery. Unimportant term and very

unimportant term is the same percentage which is 10%

(Remunerations/rewards).


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In general, respondents agreed the highest percentage for very

important term and important term is 60% and 90% which is

rules and regulations set forth for policies to follow

SOP/Quality system ISO and capital expenditures. Highest

percentage for neutral term and unimportant term are same

which are 50% which the criteria is communication between

service providers and users, physical resources activities-soft

and hard FM services, monitoring cost budget, budget

contingencies, quality plan and strategic management plan by

top leadership. Criteria of customer satisfaction will add value

to service performance and successful leader in employee

empowerment recorded, as a highest percentage for

unimportant and very unimportant term which is 50% and

10%.



Figure 5.0 shows the highest percentage for very important is

50% which is cost performance and people skills and human.

Next, for the important term, the highest percentage is 80%

which is process management.


Figure 6.0 shows the highest percentage for very important

and important is 70% and 80% which is monitoring cost

budget and customer satisfaction, rules and regulation, budget

contingencies, and human resource practices.The highest

percentage of unimportant is 10% which is motivating staff

and successful leader.

B. Ranking Importance of Performance Management Criteria

Numerical Linear Scale used in determining the importance

criteria in performance management healthcare. Table 4.0

shows the Numerical Linear Scale.

TABLE 4.0 MEAN SCORE ROUND 3NUMERICAL LINEAR SCALE (SOURCE: SIMAMORA, 2004)

Numerical Linear Scale Level of Assessment

Very not Importance

Not Importance

Moderate

Importance

Very Importance

TABLE 5.0 MEAN SCORE ROUND 1

Rank Items Mean Score

1 Cost performance based on fund availability 4.80

2 Quality of building services 4.80

3 Time schedule performance 4.70

4 Rules and Regulations set to follow SOP/quality

system

4.60

5 Human resource practice 4.60

6 Service Quality for Building Services 4.40

7 Efficiency of service process delivery 4.40

8 Consistency and reliability 4.30

9 Motivating staff -Successful leader in employee

in empowerment

4.20

10 Capital expenditures (CAPEX) 4.10

11 Process management-supply chain process and

procurement

4.10

12 Timely-complaint, breakdown, uptime, plan

preventive maintenance (PPM), corrective

maintenance

4.10

13 Effective communication process (internal and

external parties)

4.10

14 Quality plan 4.00

15 Physical resources activities-soft and hard FM

services consumption (energy, water and

material)

3.80

16 People skills and human (building capacity and

capability of competency)

3.80

17 Monitoring cost budget - Budget contingencies 3.70

18 Communication between client, service providers

and end users - Information and analysis using

CMMS

3.70

19 Strategic management plan by top leadership 3.60

20 Remunerations/rewards 3.60

21 Leave, bonuses, allowance and free vacation 3.60

22 Accessibility (site, location) 3.40

23 Customer Satisfaction will add value to Service

Performance

3.30

24 Physical performance of facilities using CMMS 2.70

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A survey of the importance criteria of performance

management in healthcare to be discussed in order to know

what extent it reflects an importance criteria in performance

management model in Malaysian healthcare applied. This is

important to measure the importance of criteria to apply in

performance management model in the future. It can also be

used as an example to other organizations in applying

performance management in healthcare. Therefore, analysis of

mean scores have helped this study reflects an importance of

criteria in performance management. Table 5.0 shows the

scores for each criterion. Number of highest risk is more

importance than others. Mean scores indicate that the 2.6 and

above considered as importance criteria and will be considered

in developing performance management model in hospital in

Malaysia.The highest criteria is cost performance based on

fund availability and quality of building services, 4.80 which

is the linear scale is very importance. Therefore, all of the

criteria used in developing performance management model as

it stands at 2.6 above and considered as important.


Table 6.0 shows the scores for each criterion. number of

highest risk is more importance than others. mean scores

indicate that the 2.6 and above considered as importance

criteria and will be considered in developing performance

management model in hospital in malaysia. the highest criteria

is also capital expenditures (CAPEX), service quality for

building services, efficiency of service process delivery and

monitoring cost budget - budget contingencies, 4.60.

Therefore, all of the criteria also used in developing

performance management model as it stands at 2.6 above and

considered as important.


Table 7.0 shows the important round 3 in determining the

importance of criteria to apply in performance management

model in the future. the highest criteria are cost performance

based on fund availability, 4.60 and the second highest are

motivating staff - successful leader in employee empowerment

and customer satisfaction to service performance, means score

is 4.50. however, all of the criteria used in developing

performance management model as it stands at 2.6 above and

considered as important too.

Rank Items Mean

Score




4 Monitoring cost budget - Budget

contingencies

4.60

5 Cost performance based on fund availability

4.50

6 People skills and human (building capacity

and capability of competency)

4.50


8 Timely-complaint, breakdown, uptime,

plan preventive maintenance (PPM),

corrective maintenance

4.40

9 Effective communication process (internal and external parties)

4.40

10 Communication between client, service

providers and end users - Information and analysis using CMMS

4.40


12 Strategic management plan by top

leadership

4.30

13 Rules and Regulations set to follow SOP/quality system

4.20


15 Customer Satisfaction will add value to Service Performance

4.20

16 Physical performance of facilities using

CMMS

4.20

17 Process management-supply chain process and procurement

4.20


19 Physical resources activities-soft and hard

FM services consumption (energy, water and material)

4.20

20 Remunerations/rewards 4.00

21 Motivating staff -Successful leader in

employee in empowerment

3.90

22 Leave, bonuses, allowance and free vacation

3.80



Rank Items Mean

Score

1 Cost performance based on fund

availability

4.60

2 Motivating staff - Successful leader in employee empowerment

4.50

3 Customer Satisfaction to Service

Performance

4.50


5 Strategic management plan by top

leadership

4.40

6 Monitoring cost budget - Budget

contingencies

4.40

7 People skills and human (building capacity

and capability of competency)

4.40

8 Physical resources activities-soft and hard

FM services – Resource consumption (energy, water and material)

4.40

9 Communication between client providers

and users – Information and analysis using CMMS

4.40




13 Process management-supply chain process and procurement

4.30

14 Effective communication process (internal

and external parties)

4.30

15 Timely-complaint, breakdown, uptime, plan preventive maintenance (PPM),

corrective maintenance

4.30



18 Rules and Regulations set forth for

policies to follow SOP/quality system ISO

4.20



21 Physical performance of facilities using

CMMS

4.20


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V. CONCLUSION

In conclusion, all respondents had agreed to use the entire

criterion in developing the performance management model

for FM in Malaysian healthcare. There are 3 rounds of Delphi

Method questionnaire used in the validation of criterion.

Based on analyzing the data using matrix method through

Literature, the appropriate key criteria of performance

management are cost performance based on fund availability,

Quality for Building Services, Efficiency of service process

delivery, Process management-supply chain process and

procurement, Physical performance of facilities using CMMS,

Effective communication process (internal and external

parties), Time schedule performance, People skills and human

(building capacity and capability of competency), and

Remunerations/rewards.

Otherwise, the sub criteria of performance

management are rules and regulations set to follow sop/quality

system, physical resources activities-soft and hard fm services

resource consumption (energy, water and material),

accessibility (site, location), quality plan, strategic

management plan by top leadership, service quality for

building services, customer satisfaction will add value to

service performance, communication between client, service

providers and end-users- information and analysis using

CMMS, timely-complaint breakdown, uptime, plan preventive

maintenance (PPM), corrective maintenance, consistency and

reliability, capital expenditures (CAPEX), monitoring cost

budget - budget contingencies, human resource practices,

motivating staff - successful leader in employee in

empowerment and leave, bonuses, allowance and free

vacation. The total numbers of key criteria are 9 criteria and

15 for sub criteria.

Based on the analysis of first round Delphi Method,

ranking for the highest mean score criterion is Cost

performance based on fund availability, mean scores obtained

4.80. Based on the analysis of second round and third round

of Delphi Method, the highest mean score ranking also about

cost which are Capital expenditures (CAPEX) and Cost performance

based on fund availability mean score obtained 4.60.

According to Williams (1996), in the scope of facilities, the

cost is always the main criteria need to be considered. The

cost effectiveness of facilities can control the process of

service delivery.

The second round of Delphi Method, respondents

also suggested additional criteria related to the performance

management. The addition of these criteria are remunerations /

rewards for key criteria and the addition of sub criteria are

leave, bonuses, allowance and free vacation. This is the way

how such organization like hospital and healthcare centre need

to appreciate staff on their works with such rewards. For the

second round of Delphi Method, the highest mean score

ranking is Capital expenditures (CAPEX) which mean score of

4.60.

However, the service delivery and performance in

healthcare sector required most sophisticated approach

compared with other organization. People would always

express their views in media with regards to the quality

services rendered by healthcare. The issue of service quality

and performance are plaguing among the healthcare

throughout the country over the years. Therefore, a strategic

model of performance management of FM healthcare project

will be established to address these issues. It can be concluded

that all the key criteria and sub-criteria have been identified

and will be used in developing a performance management

model in Malaysian healthcare.

Table 8.0 shows the key criteria and sub criteria of

performance management.

TABLE 8.0 KEY CRITERIA AND SUB-CRITERIA IN RELATIVE IMPORTANCE

ANALYSIS

Type Key Criteria Sub Criteria

Physical

Process management-supply chain process

and procurement

Rules and regulations set

to follow SOP/quality

system

Physical performance

of facilities using CMMS

Physical

resources activities-soft

and hard FM

services Resource

consumption

(energy, water and material)

Accessibility

(site, location)

Quality of building

services

Quality plan

Strategic management

plan by top

leadership

Non Physical

Efficiency of service process delivery

Service quality

for building

services

Customer

satisfaction will

add value to

service

performance

Effective

communication process (internal and

external parties)

Communication

between client, service

providers and

end-users- Information

and analysis using CMMS

Timely-

complaint

breakdown, uptime, plan

preventive

maintenance (PPM),

2589

corrective

maintenance

Time schedule performance

Consistency and reliability

Cost performance

based on fund

availability

Capital

expenditures

(CAPEX)

Monitoring cost

budget - Budget

contingencies

People-skills and

human resource

(building capacity and capability of

competency)

Human

resource

practices

Motivating

staff -

Successful leader in

employee in

empowerment

Remunerations/rewar

ds

Leave, bonuses,

allowance and

free vacation

Acknowledgment

The research project is fully funded by Construction

Industry Development Board of Malaysia (CIDB) and

Construction Research Institute of Malaysia (CREAM). The

authors would like to thank the expertise in Facilities

Management from government agencies and private sectors

for their kindly co-operation and also all the support received

from relevant parties till the success of this research.

Moreover, the authors are also grateful to the anonymous

referees for helpful comments and numerous suggestions to

improve the paper.

References [1] N. Ruslan, “Campus Facilities Management Experience. NationalAsset

and Facility Management Development,(NAFAM),” KualaLumpur, Malaysia, 2007.

[2] KPMG, “International Survey of Corporate Responsibility Reporting”, University of Amsterdam and KPMG Global Sustainability Services, Netherland, 2005.

[3] CREAM. “A Report on asset and FM workshop and forum”. Kuala Lumpur, 2011.

[4] D. Amaratunga and D. Baldry, “Performance measurement in facilities management and its relationship with management theory and motivation”, Journal Facilities Management, Volume 20, Number 10 pp 327-336, 2002a

[5] P. Taticchi, and K. R. Balachandran, “Forward Performance Measurement and Management Integrated Frameworks”, International Journal of Accounting and Information Management, Volume 16, No. 2, pp 140-154, 2008

[6] Egan, “Rethinking Construction, Department of Trade and Industry”, 1998.

[7] G. Ana-Maria, B. Constantin, and R. Catalina, “The strategic performance management process,” The Journal of the Faculty of Economics, University of Oredea, Issue 1, Volume 4, pp 276-279, 2009.

[8] Hay Group , “The Process of Performance Management, presentation to State of Kansas” January 24, 2008, www.da.ks.gov/pmp/perf mgmt presentation.pdf, assessed on 11th January 2013. 2008.

[9] BSI. “Asset Management Part 1: Specification for the optimised management of physical assets”, (Vol. PAS 55-1:2008, pp. 24). United Kingdom: British Standards Institution, 2012.

[10] D. Amaratunga, “Assessment of Facilities Management Performance, Property Management”, Volume 18, No. 4, pp 258-266, 2000

[11] A Sandford and C. Hsu, “Practical Assesment, Research and Evaluation”, The Delphi Technique: Making sense of consensus, Oklahoma State University, 2007.

[12] B. Williams,. “Cost-Effective Facilities Management: A Practical Approach,” Journal of Facilities, Volume 14, Issue 5, pp 26-38. 1996.

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