Facility management in Swiss hospitals

The aim of this study was to investigate Facility Management [FM] in terms of cost, value and image-building instruments in acute somatic hospitals in German-speaking Switzerland in the light of continuously increasing health expenditures and patient expectations and the imminent introduction of the world-renowned Diagnosis Related Groups [DRG]. This remuneration system DRG demands reforms, which shall lead to cost transparency and increased efficiency. Therefore also FM departments are expected to organise their structures and processes accordingly, and this should be achieved with a given, limited, amount of resources. A fundamental precondition for efficiency and effectivity is FM’s room for manoeuvre and managers’ sense of responsibility; whereby constraints, rules and regulations given from the cantonal authorities as well as facility managers’ own perceptions had to be ascertained. Thus, obstacles which prevent FM in becoming the panacea for cost explosion, inefficiency, image-building and problems of quality, had to be identified.
As a result, the role of facility manager does not exist in its pure form and a culture difference between providing services and being responsible for real estate is obvious. Facility Managers have to serve several stakeholders, some of whom are in a diametric position, meaning that their interests diverge In addition to such challenges hospitals’ facility managers are their own “worst enemies” and prevent senior management and peers valuing their work.
Furthermore, outsourced services are far from being a synonym of FM as the predicted outsourcing wave in hospitals failed. The sluggish development of outsourcing per-formances is surprising as the cost and quality ratio showed that three-quarters of the surveyed hospitals services are better than or at least on a similar level to their in-house production. Moreover, service providers were not familiar with the challenges of the DRG implementation; some were undecided whether they would want to enter into this market, others were not averse to new ways of cooperation e.g. establishing a subsidiary. And finally, cantonal head officials are reluctant to support FM activities. The principal conclusion is that FM needs a thorough organisational redesign on all levels, including the financial framework, and in particular a holistic approach by all stakeholders to increase potential and efficiency. In addition, professional facility managers need to be trained on specific hospital management issues instead of simply slipping into the industry by default. On strategic and operational levels managers should consider if in terms of FM services; such services with predetermined quality and price performances are deemed as “too much of a good thing”. Service providers have to understand their services as a business based on trust between equal partners, consequently, service providers may have to act as a long-term oriented investor and partner of the management. In order to meet this objective hospitals ‘culture, requirements and processes need to be understood by all stakeholders.
To avoid continuous discussions, which fail to reach a consensus, an underlying definition of FM in hospitals, uniform activity mapping, and clear classification of FM tasks as well as a consistent understanding of facility managers' position were prepared.