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JFM PRACTICE BRIEFING

7,2
Audit assessment of the facilities
maintenance management
142
in a public hospital in Malaysia
Maisarah Ali
Centre for Built Environment,
Kulliyah of Architecture and Environmental Design,
International Islamic University, Kuala Lumpur, Malaysia, and
Wan Mohamad Nasbi Bin Wan Mohamad
Enhealth Sdn. Bhd, Kuala Lumpur, Malaysia

Abstract
Purpose – The purpose of this paper is to assess the existing facilities maintenance management
practices and processes in public hospitals, in accordance with the concession agreement (CA), in order
to identify the current performance status.
Design/methodology/approach – A case study is conducted in one district hospital in Malaysia to
assess five key elements: leadership; policies, plans and procedures; training and orientation;
monitoring and supervision; and service performance. Data are collected through questionnaires,
guided interviews, documentation review and retrieval, archival records review, and direct
observations.
Findings – The status of facilities maintenance management in the hospital is categorised as
“maturing”, which implies that there has been a good planning and management with all essential
requirements and compliance with regulations. Nevertheless, analyses of findings indicate that the
maintenance organisations in the hospital still do not realise the importance and benefits of effective
facilities maintenance management.
Research limitations/implications – Findings reveal that continuous involvement of all
organisations is rudimentary to provide guidance and direction to the maintenance function.
Practical implications – This research has gained an insight into the management practices and
processes exhibited by a maintenance organisation in executing contractual and regulatory
requirements of privatised facilities maintenance services in a public hospital. It has also gained an
insight into the practice of a maintenance management audit, which was conducted with a view to
identifying areas of weakness such that recommendations can be derived to improve the maintenance
performance.
Originality/value – This research has introduced a set of key ingredients and effectiveness
measures for successful facilities maintenance management. It also explores opportunities for
improving facilities maintenance management in public hospitals.
Keywords Facilities, Maintenance, Hospitals, Malaysia
Paper type Research paper

Journal of Facilities Management Introduction

Vol. 7 No. 2, 2009
pp. 142-158 Facilities management (FM) is seen as a strategic function and makes a positive
q Emerald Group Publishing Limited
1472-5967
contribution to business growth and organisation success (Alexander, 2003). Gelnay
DOI 10.1108/14725960910952523 (as cited in Shohet and Lavy, 2004) considered healthcare FM as one of the key
elements for the successful delivery of healthcare services. Generally, hospitals and Facilities
health-care facilities are among the most complex, costly and challenging buildings to maintenance
manage and, as a result, the FM function is relatively well developed (Loosemore and
Hsin, 2001). Essentially, the goal of the facilities maintenance organisation in a hospital management
environment is to achieve zero defects in the hospital’s physical operation, particularly
in areas where small problems can have huge consequences and be a matter of life
and death. One of the main challenges of managing hospital facilities is the highly 143
diverse network and range of functions which are needed to maintain operations and
the complexity of services which are required to support them (Loosemore and
Hsin, 2001).
In 1997, the Government of Malaysia took the initiative to implement a major
privatisation project (Project) for the provision, maintenance and management of
hospital support services (HSS) of public hospitals throughout the country. Collectively
referred to as HSS, it comprises five services packages, as described in Table I. The
project was instigated in line with the following objectives to:
.
implement the government’s privatisation policy;
.
improve the level of health care provision and the quality of service in public
hospitals;
.
improve efficiency and reliability of the provision, maintenance and
management of HSS; and
.
promote, embed and improve the culture of comprehensive planned preventive
maintenance (PPM) in public assets and facilities.

Three concession companies (contractors) were selected to initially take responsibility

on a total of 123 hospitals and four health institutions (contract hospitals) throughout
the country (currently 146 hospitals), on a fixed price and period basis. The project is
administered by the Ministry of Health (MoH) through a special regulatory unit within
the engineering division, with support from a government-appointed independent
consulting company (consultant).

HSS component Description

FEMS Maintenance of all plant, equipment, buildings, infrastructure and landscape

through a comprehensive maintenance program
BEMS Maintenance of all medical and laboratory equipment through a comprehensive
maintenance program
CLS Cleaning of general areas as well as specialised areas including supply of
toiletries and consumables
LLS Supply of clean new tailored linen, collection, transporting and laundering of
soiled linen, repair of torn or damaged linen, and provision of curtains, cushion
covers and screens, including consumable and facilities for bagging
CWMS Supply of consumable items such as waste bins, sharps containers and coloured
bags, collect and transport waste from the source of generation within the
hospitals to the incineration plant for disposal
Table I.
Source: Concession Agreement, HSS Privatisation Project HSS components
JFM In general, the roles and responsibilities of each of the parties involved in the project
7,2 are as follows:
.
MoH. Establishment of national level policies and guidelines for the regulations,
coordination and management of all contractual matters pertaining to the project.
.
Contract hospital (hospital). Overall management and administration of the project
at hospital level in accordance with contractual and regulatory requirements.
144 .
Concession company (contractor). Provision, maintenance and management of
the project in accordance with contractual and regulatory requirements.
.
Consultant. Appointed by the government, consultant plays a very significant
role to closely supervise, inspect, monitor, evaluate and verify the performance of
contractors, and to provide necessary consultancy services to hospital.

Successful implementation of the project relies on commitment and efforts made by all
these organisations in fulfilling each specific responsibility in accordance with
contractual and regulatory requirements. After certain years of its implementation, it is
expected that the parties concerned have achieved a certain level of maturity in their
management of the services, and have fulfilled the purpose for which it was initiated.
The goal of this research was therefore to identify the maturity level of the
maintenance organisation in a specific hospital with regard to the effectiveness of their
management of facility engineering maintenance (FEM) services.
Auditing of maintenance management performance
A maintenance management audit provides an appraisal of the organisation’s
maintenance management system. The results offer management the opportunity to
appraise the overall progress being made and seek improvements for increased
efficiency and more effective utilisation of available resources. According to Askey and
Dale (1994), the factual evidence obtained from the assessment allows the management
to check whether that part of the system examined:
.
assists the company in achieving its overall objectives in an efficient manner;
.
ousts the company at risk through failure, inadequacy or poor implementation;
. is effectively implemented and fully understood by the people involved;
.
has potential for improvement and/or simplification;
.
meets the requirements of standards where these are applicable, i.e. the ISO 9000
series, contractual requirements; and
.
is capable of achieving the intended results or level of control required.

According to Kaiser (1997), the aim of the audit includes:

.
increasing awareness of the maintenance contribution;
.
pin-pointing areas where there are short-falls in the service;
.
measuring the completeness and integration of the policies;
.
highlighting the practices to be introduced or requiring change;
.
gaining involvement in setting and monitoring maintenance targets; and
.
developing an environment for continuous improvement in quality of the
maintenance service.
Furthermore, Kaiser (1997) asserts that the audit of maintenance management Facilities
functions can provide opportunities for improved program effectiveness, including: maintenance
.
increased levels of service quality and performance; management
.
guidelines for organisational restructuring;
.
introduction of management information systems to assist in meeting
productivity and effectiveness goals; and 145
.
better use of resources due to program improvements.

Kaiser (1997) further emphasises that the effectiveness analysis procedure includes a
numerical rating system to identify and measure each of the key elements. He suggests
a 25 per cent increment of the effectiveness rating scale, which assigns break points for
the ratings of poor, fair, good and excellent, as follows:
. 0-25 per cent: “Poor”;
.
25-50 per cent: “Fair”;
.
50-75 per cent: “Good”; and
.
75-100 per cent: “Excellent”.

Case study background

This research was undertaken in collaboration with the scheduled assessment of an
independent consulting company appointed by the consultant for the provision of
specialist consultancy services to the project. It is part of the company’s contractual
obligation to carry out comprehensive assessments, referred to as “Objective
Assessment” of the management of the project at selected contract hospitals to identify
the current performance level of the parties involved.
The case study hospital is located in a district within the southern region of
Peninsular Malaysia. It sits on a land area of approximately 55 acres, with a total build
up area of approximately 275,000 square feet. It has a total strength capacity of 93 beds,
with the provision of several specialist clinical services, apart from day-care clinical
services.
With regards to the management of the project, the hospital, as administrator
comprises of a hospital director, assisted by a liaison officer (LO) for each of the five
services package and respective unit/departmental heads. On the monitoring and
consultancy services, the consultant is represented by a local representative, who is not
permanently stationed at the hospital, and only makes scheduled visits twice a week.
As such, local consultant staff are also responsible for duties on another two hospitals.
The contractor’s management team consists of a customer service manager assisted by
an administrative assistant. This team is supported by a regional manager stationed in
the regional operation office located in another state.
The scope of work for the project is undertaken by three sub-contractors with each
responsible for his respective specialist services. A helpdesk is also available which is
assisted by a staff of one of the sub-contractors. Regarding the scope of FEM services,
the sub-contractor’s organisation consists of a supervisor-in-charge, a charge-man,
three mechanical and electrical service technicians, two civil works supervisors, and a
motor vehicles service technician. Normal operations of facilities maintenance
activities are carried out by these available staff, while emergency and major
JFM maintenance works are out-sourced from local sub-contractors, vendors and equipment
7,2 suppliers. Service requests and fault reporting from the users are channelled through
the helpdesk via telephone or request forms.

Methodology
The “exploratory case study” method was selected as the vehicle to carry out the
146 primary data collection as the aim of the fieldwork is to assess and determine the
current performance status of the maintenance organisation in a single independent
hospital setting. This method of approach is regarded as particularly appropriate in
situations where contextual studies are being undertaken.
Multiple techniques of data collection were adopted, utilising both qualitative and
quantitative methods, which comprise of interviews via structured questionnaires;
documentation retrieval, review and collection; archival records review; and direct
observations. In order to obtain detailed information concerning the performance of the
maintenance organisations, structured interviews were carried out with key personnel
of each organisation, categorised into three respondent groups, namely the hospital,
consultant and contractor. To provide corroborated evidence for understanding the
maintenance management practices and processes, various documents and archival
records pertaining to the operation were gathered. Observation of physical systems
and operations was also undertaken as this was important for understanding the
procedures and systems of the business, and for scrutinising the data.
The case hospital was visited for the purpose of the research following proper audit
procedures. One week was spent in the hospital on a planned basis in order to carry out
the interviews and observations, and collect and/or scrutinise documentation. During
the visit, the operations, information flow, and internal functioning of the respondents
were reviewed and relevant documentation collected and filed.

Survey questionnaire development

Questionnaires were designed to correspond to the specific functions of each
organisation in accordance with contractual and regulatory requirements, namely: the
hospital in administering the contract; consultant in monitoring, supervising and
providing consultancy to the hospital; and the contractor in delivering the services.
Hence, interview questions under a common assessment element directed to each
organisation, are not standard, and also, each schedule does not contain similar
number of questions. Each organisation within the maintenance organisation
comprising hospital, consultant and contractor was assessed based on five elements
namely:
(1) leadership;
(2) policies, plan and procedures;
(3) training and orientation;
(4) monitoring and supervision; and
(5) service performance.
The respective questionnaire constructs were based on the following:
.
standards and guidelines in managing the environment of care, as stipulated in
Juran Institute’s (1998) “Management of the environment of care standards”;
 .
Concession Agreement, HSS Privatisation Project; and Facilities
. requisites, determined as necessary from the experience of the assessors, in order maintenance
to provide effective management of FEM services. management
The questionnaire schedule consists of three different sets for assessing Elements 1 to 4,
with each set dedicated for each organisation; and one set for assessing Element 5, which
was specifically directed to contractor. Descriptions of questionnaire schedules 147
corresponding to different organisations for all the five assessment elements are as
follows.

Element 1. Leadership
This element assesses the role of leadership of the key person of each organisation to
provide direction and establish a clear focus in the overall management of FEM services:
(1) Hospital. The schedule consists of 19 questions which cover:
.
appointment of LO including official job descriptions;
. establishment of various committees for monitoring and supervision;
.
understanding of project requirements;
.
providing assistance for contractor’s facilities; and
. interaction with consultant and contractor’s key person.
(2) Consultant. The schedule consists of six questions and mainly assess:
.
leadership role of higher management;
. co-ordination between local consultant staff and zone manager;
.
management supports; and
.
roles and responsibilities of local consultant staff.
(3) Contractor. The schedule consists of 16 questions, which mainly assess:
.
leadership role of higher management and organisation leader;
.
organisation structure and job descriptions;
.
adequacy of infrastructures and facilities for operations;
.
availability and operation of helpdesk facilities; and
.
resources management and assessment.

Element 2. Policies, plans and procedures

This element encompasses written plan, policies and procedures which defines how the
organisation will manage each specific component of FEM services:
(1) Hospital. The questionnaire schedule consists of five questions which cover:
.
various procedures, such as new asset register, tracking of complaints; and
.
policy on training.
(2) Consultant. The schedule consists of three questions, which assess:
.
availability of relevant reference documents at local office;
.
document management; and
.
works planning.
JFM (3) Contractor. The schedule consists of 55 questions which cover:
7,2 .
organisation’s goals, objectives, mission statement, and written policies;
.
establishment of various procedures and documents;
.
resources planning; and
.
plant operation and maintenance; and infrastructures support.
148
Element 3. Training and orientation
This element assesses and identifies whether staff are oriented and trained regarding
specific roles in daily work, and emergency situations relative to the management of
FEM services:
(1) Hospital. The schedule consists of five questions which assess:
.
briefing and handing over of duties of key personnel;
.
training policy and programme;
.
training record; and
.
HSS training.
(2) Consultant. The schedule consists of four questions which assess:
.
staff training covering all service components and auditing skills; and
.
provision of training/briefing to hospital.
(3) Contractor. The schedule consists of 28 questions which assess:
.
availability of training policy and programme;
.
skilled and multi-skill training activities for staff;
.
training programme for users;
.
master training plan and on/off-site training programme;
.
training course contents;
.
computerised management information system (CMIS) training for staff and
helpdesk assistant;
.
training record; and
.
continuous development programme for staff.

Element 4. Monitoring and supervision

This element assesses and identifies whether the organisation’s performance
implementing the plans, policies and procedures is routinely supervised and
monitored routinely to verify that performance meets expectations, and to identify
opportunities for process improvement:
(1) Hospital. The schedule consists of ten questions, which assess:
.
monitoring of complaints/service requests;
.
inspections of services;
.
utilisation of CMIS for monitoring; documentation and records; and
.
assets register management.
 (2) Consultant. The schedule consists of 17 questions, which assess: Facilities
.
planning and schedules of monitoring activities; maintenance
.
monitoring report and performance; management
.
execution of relevant contract clauses;
.
inspection activities; and
.
consultancy services. 149
(3) Contractor. The schedule consists of 18 questions, which assess:
. planning and scheduling of inspection activities;
.
availability of monitoring checklists;
.
utilisation of CMIS for monitoring;
.
implementation of ISO;
.
monitoring of asset register historical data;
.
analysis of service performance;
.
monitoring reports;
.
monitoring of outsourcing activities; and
.
work-order implementation.

Element 5. Service performance

Element 5 is aimed at assessing overall performance of the services provided by the
contractor. It reflects the performance of the contractor in the implementation of
various policies, plans and procedures established in accordance with contractual and
regulatory requirements. The schedule for this element addresses questions in
12 maintenance sub-systems or factors, which were identified and constructed based
on the project requirements. These are:
(1) Asset register management. Assesses asset register management through CMIS.
(2) Infrastructures support. Covers all aspects related to facilities required for the
contractor’s operations such as shop floor, safety equipment, tools and
equipment, office space, and lighting.
(3) Spares management. Covers all aspects that are used to support the
maintenance department – up-to-date stores catalogue, inventory systems,
spare parts, tools list, stock control, and purchasing procedures.
(4) PPM task lists. Assesses PPM constructs, procedures and implementation.
(5) PPM scheduling. Assesses PPM planning, scheduling and its implementation.
(6) Safety management. Covers all aspects of safety such as provision of personal
protective equipment, incident record, safety training, and safety procedures.
(7) Statutory compliance. Covers procedures and compliance with statutory
requirements.
(8) Plant room management. Assesses plant room and equipment maintenance
programme, log-book system, etc.
(9) Maintenance performance. Assesses the percentage reliability engineering used
in order to analyse all down-time, breakdowns and major repairs.
JFM (10) Equipment history. Assesses the history file system and its records, equipment
7,2 covered by preventive maintenance programmes, and all reports related to them.
(11) Quality assurance. Covers the establishment and implementation of Quality
Assurance Programme (QAP), compliance with contract requirements and
performance indicators – reports, user requests, and assessments.
(12) Competency training. Assesses plans and implementation of skilled training for
150 maintenance personnel.

Data analysis
The effectiveness analysis procedure includes a numerical rating system to identify
and measure each of the key elements. To arrive at this rating, the cumulative mean
ratings for all assessment Elements 1 to 5 were added up and then divided by five,
since all elements carry equal weight. The cumulative mean ratings for all assessment
elements were plotted in a polygraph having five axes; each axis represents one of the
five assessment elements. Apart from effectiveness measure, the performance of
the maintenance organisation with regard to each element can also be deduced from
the polygraph corresponding to an audit-grading scheme.

Audit-grading scheme
The grading scheme used in this research was recommended by Juran Institute (1998),
and modified by the assessors (Table II). Description for each stage was designed by
the assessors to correspond to the level of compliance of the maintenance organisation
with the contractual and regulatory requirements of FEM services. Higher
effectiveness rating means higher performance, corresponding to the respective stage.

Findings and discussion

Performance of maintenance organisations by elements
Element 1. Leadership. As shown in Figure 1, hospital, consultant and contractor are
operating at higher maturity levels with regard to leadership function, with a rather

Level Stage Rating range (%) Description of stage

1 Infancy 0-20 Very little planning, mostly reactive, to manage FEM

2 Developing
3 Transitional
4 Maturing
5 Desired
Table II.
Audit grading scheme
services and to comply with contractual
requirements
21-40 Some planning with efforts have been made to
manage FEM services and to comply with
contractual requirements
41-60 Many of the basic elements required to manage FEM
services, and to comply with contractual
requirements have been established and
implemented
61-80 Good planning and management of FEM services,
with all essential requirements and regulations
complied with
81-100 Very effective planning and management of FEM
services, with all or almost all requirements complied
with
 Element 1 Leadership Facilities
maintenance
88%
100% 82% 80% 83% management
80%
60%
151
40%
20% Figure 1.
Organisations ratings and
0% mean rating for Element 1
Hospital Consultant Contractor Mean

consistent score ratings of 82, 88 and 80 per cent, respectively. Analysis of cumulative
mean score revealed that overall performance of the maintenance organisation, with a
rating of 83 per cent, is operating within the “desired” stage. Nevertheless, there were
still some pertinent areas of weakness revealed from the assessment, which need
improvement. These were as follows:
(1) Hospital:
.
Unavailability of official job description and untimely attendance and
resolution of ongoing issues.
(2) Consultant:
.
Lack of support from the management, especially in providing a permanent
working base in the hospital which resulted in his presence and services are
not visible to the key hospital staff.
.
Status and purpose of official visits and records on monitoring and
supervision were not properly documented.
(3) Contractor:
. Ineffectiveness of maintenance organisation. Contractor has to rely heavily
on their sub-contractor to provide all necessary resources to execute the
works, which are not having sufficient key technical personnel to maintain,
supervise and monitor daily operations.
.
Lack of support from higher management in providing direction and
assistance to operations staff. Existing infrastructures and facilities were
inadequate and improperly managed.

These findings indicate that there was still lack of efforts made by leaders of the
organisations, particularly the contractor, in influencing their team in attaining the
objectives of the maintenance programme to ensure a smooth implementation of
the services. The functional level of the contractor’s organisation needs to review the
organisation structure, including that of the sub-contractor, in order to improve
the service delivery. Ingalls (as cited in Cholasuke et al., 2004) states that how efficient
the maintenance function operates also depends highly on the maintenance of
organisational structure, since organisational structure controls the manpower, the
hierarchy of communications and maintenance resource allocation with the right
capabilities in the right maintenance areas is essential.
JFM Element 2. Policies, plans and procedures. Figure 2 shows that the hospital and
7,2 contractor were not adequately implementing the contractual requirements on policies,
plans and procedures for the effective management of facilities maintenance.
The consultant scored the highest rating of 89 per cent, followed by contractor at
49 per cent, and hospital with the least rating of 30 per cent. Analysis of cumulative
mean score, with a rating of 56 per cent, revealed that the maintenance organisation in
152 this hospital is operating within the “transitional” stage. While there was no significant
finding on part of consultant, the following findings need to be significantly improved
by the other two parties, respectively:
(1) Hospital:
.
a written policy on staff training was not available; and
.
many procedures to facilitate smooth implementation of the service activities
were not available.
(2) Contractor:
.
very little emphasise was placed on safety management;
.
inadequate procedures, schedules and implementation plans for PPM;
.
inadequate procedures on implementation of work order systems; and
.
inadequate policies and procedures on engineering plant operations and
maintenance with very less emphasise placed on safety.

Findings for this element signified that leaders of the organisations are not placing
much emphasise on the planning and dissemination of processes and procedures for
proper implementation of the services. Johnson (as cited in Cholasuke et al., 2004)
asserted that many researchers verified that the lack of linkage between maintenance
policy and overall corporate strategy of maintenance organisation leads to poor
maintenance performance. The maintenance organisation in this hospital needs to
endeavour establishment of necessary written policies, plans and procedures to ensure
that there is a uniform approach in the implementation of the services.
Element 3. Training and orientation. As evident in Figure 3, the consultant scored
the highest rating of 63 per cent, followed by the hospital at 60 per cent and the
contractor, who scored the least rating of 40 per cent. Analysis of cumulative mean
score, with a rating of 54 per cent indicated that the maintenance organisation in this

Element 2 Policies, plans and procedures

100% 89%

80%
56%
60% 49%

40% 30%

Figure 2. 20%
Organisations ratings and
mean rating for Element 2 0%
Hospital Consultant Contractor Mean
 Element 3 Training and orientation Facilities
maintenance
100% management
80%
60% 63%
54%
60%
40% 153
40%

20% Figure 3.
Organisations ratings and
0% mean rating for Element 3
Hospital Consultant Contractor Mean

hospital is performing within the “transitional” level. From the assessment, major
findings regarding this element on the maintenance organisation in this hospital were
as follows:
(1) Hospital:
.
Unavailability of handing-over of responsibilities of key personnel to ensure
continuity of the project implementation.
(2) Consultant:
.
Inadequate training activities regarding FEM services, and operation and
maintenance best practices were inadequate.
(3) Contractor:
.
Inadequate training programmes for the users regarding FEM services as
required by the contract.
.
Inadequate training programmes for staff, especially technical staff to
properly perform FEM services.

These findings indicated that all organisations do not seem too aware of the importance
of training and orientation with regard to facilities maintenance. Training is meant to
provide a clear understanding of the roles and responsibilities of personnel in
implementing the plans and processes associated with the management of FEM
services. These are also important in creating awareness of the correct procedures to
follow in crisis or emergency situations, in order that life threatening situations can be
avoided. The maintenance organisation in this hospital should be more proactive in
realising the needs for training in line with contractual and regulatory requirements.
Proper implementation of this requirement will result in more in-depth explanation and
practical demonstration in specific areas of the multifaceted hospital facilities.
Element 4. Monitoring and supervision. Results for this element reveal that
consultant scored the highest rating of 76 per cent, followed by hospital at 75 per cent,
and contractor at 69 per cent (Figure 4). Generally, results show that all organisations
are performing at almost the same level with regard to monitoring and supervision
functions. Analysis of cumulative mean rating of 74 per cent showed that the
maintenance organisation in this hospital is performing within the “maturing” stage.
JFM Element 4 Monitoring and supervision
7,2
100%
75% 76% 74%
69%
80%

60%
154
40%
Figure 4. 20%
Organisations ratings and
mean rating for Element 4 0%
Hospital Consultant Contractor Mean

Nevertheless, there existed some areas of weakness revealed from the assessment as
indicated by the following major findings:
(1) Hospital:
.
there were no systematic procedures for monitoring and tracking of
complaints;
.
lack of awareness of the relevant project documents by all users; and
.
minimal usage of CMIS for monitoring and supervision of the services.
(2) Consultant:
.
no record on identification of critical problem areas, and on provision of
recommendations and consultancy services to hospital.
(3) Contractor:
.
monitoring of data was not compiled and analysed to assess the service and
maintenance performance and trends in asset history; and
.
poor documentation and implementation of QAP resulted in frequent plant
and equipment breakdowns.

These findings indicated that there are still pertinent areas being overlooked by all
organisations. Monitoring and supervision of the service provisions should be a
continuous exercise that looks at the whole services. Moreover, monitoring and
supervision of the implementation of processes and procedures by all parties provides
a more orderly means of identifying and channelling feedback on overall service
quality. This would in turn facilitate resolution of problems in a timely manner.
Element 5. Contractor’s service performance. As shown in Figure 5, the contractor
scored the highest rating for statutory compliance at 75 per cent. This was followed by
equipment history (60 per cent) and maintenance performance (57 per cent). The
contractor scored 50 per cent each for asset register management, spares management,
PPM scheduling, and quality assurance; and 38 per cent for infrastructure support.
These were followed by PPM tasks list, plant room management and competency
training, each scored 33 per cent. Safety management scored the least rating of
25 per cent. Analysis of overall contractor’s service performance, with a cumulative
mean rating of 46 per cent, revealed that the contractor is operating within the
“transitional” stage. These findings clearly indicate that the contractor has not made
much effort to establish and implement proper maintenance policies and strategies in
 Element 5 Service performance, 46% Facilities
Asset register management, 50% maintenance
100%
Competency training, 33% 90% Infrastructure support, 38%
management
80%
70%
60%
Quality assurance, 50% 50% Spares management, 50% 155
40%
30%
20%
10%
Equipment history, 60% 0% PPM task lists, 33%

Maintenance performance, 57% PPM scheduling, 50%

Figure 5.
Plant room management, 33% Safety management, 25% Sub-elements scores and
mean score for Element 5
Statutory compliance, 75%

accordance with the contract. It implies that the contractor had not fully recognised the
importance and benefits of effective facilities maintenance management, particularly
within the multifaceted hospital facilities.
From the results, it was apparent that the contractor needs to improve in almost all
areas of their service performance. Major findings from the assessment were as
follows:
.
Poor asset register management. In particular, there was very poor maintenance
of updating data in the CMIS. Some major assets were not captured, recorded and
tagged, which had affected the PPM planning and implementation for these
assets.
.
Inadequate infrastructures support. Stores and workshops were found to be
small and improperly managed, and also insufficient tools, instrument and
equipment for general maintenance activities.
.
Poor spares management. Very few spares are kept on site for emergency
maintenance, and these are only minor spares.
.
PPM task lists were not comprehensive. Existing PPM task lists were not made
available for all equipment, and quantitative portion of PPM checklists was not
administered frequently.
.
Poor PPM planning and scheduling: PPM routes, procedures and intervals were
not well defined. Very weak manual and computerised history files record
containing only rough descriptions of the type of work done on the equipment.
Therefore, it was difficult to retrieve PPM history of equipment, difficult to know
the equipment specification, and difficult to extract reports regarding any
equipment. Equipment also were not ranked or classified according to its
criticality based on PPM maintenance level.
JFM .
Very poor safety management. Lack of provision of basic safety equipment.
7,2 Systematic procedures on conducting equipment maintenance and repair works,
particularly a “Permit to Work” system were not established.
.
Poor plant rooms’ management. All plants and equipment were found to be in
poor condition, which was primarily due to improper maintenance planning and
implementation. Records showed that these plants and equipment were not
156 maintained in accordance with manufacturers’ recommendations, relevant
standards and/or best practices. Although logbooks are available in all plant
rooms, plant-operating parameters were not recorded.
.
Very poor planning of competency training for staff. Records indicated that there
was insufficient training for staff scheduled for the year. There was in fact no
record of skilled and competency training planned for technical staff.

Status of maintenance management performance

Overall, performance ratings for the five assessment elements with regard to the
management of FEM services in this hospital are shown in Figure 6. A rating of
83 per cent reflects the high-maturity level of the maintenance organisation in this
hospital in providing necessary leadership functions in the management of FEM
services. Nevertheless, the maintenance organisation is still lacking in fulfilling
contractual and regulatory requirements to establish and put into practice the
necessary policies, plans and procedures to facilitate implementation. This was also
true with regard to training and orientation. Both elements scored a rather low rating
of 56 and 54 per cent, respectively. On the other hand, the maintenance organisation
has managed to monitor and supervise the service activities, as evidenced by a rating
of 74 per cent. On the contractor’s service performance, the rating of 46 per cent
Overall performance, 64%
Leadership
100%
83%
90%
80%
70%
60%
50%
Service 40% Policies, plans and
performance 30% procedures
46% 20% 56%
10%
0%

Figure 6. 54%
Overall maintenance
management performance 74%
Monitoring and Training and
ratings
supervision orientation
obtained indicates that the contractor has not fulfilled the necessary services Facilities
requirements in accordance with the contract. maintenance
Consequently, these five elemental ratings resulted in an overall effectiveness rating
of 64 per cent with respect to the management of FEM services in this hospital. Based management
on the audit-grading scheme, the maintenance organisation in this hospital is operating
within the “maturing” stage. This implies that there are still many pertinent areas
regarding the contractual requirements have not been established for the successful 157
management of FEM services. It should be noted however, the effectiveness rating
obtained was mainly contributed by the efforts made by the consultant and hospital, as
evidenced by major findings from the assessment, whilst it should have been those of
the contractor, who is the service provider. This gives the impression that the
contractor does not attain the right capability to successfully undertake the
management of FEM services, especially in a hospital setting with all the complexity of
hospitalisation buildings, and the high criticality of mechanical and electrical systems.
As evident in Figure 6, the overall management performance of FEM in this case
study was predominantly influenced by Elements 2, 3 and 5. The three elements are the
areas of weakness of the current maintenance management processes and practices of
the maintenance organisation in the hospital.

Recommendations for improvements

It was obvious from research findings that the maintenance organisation in this
hospital has not fully complied with contractual and regulatory requirements for the
successful management of FEM services. The following recommendations need to be
considered by all organisations concerned, particularly contractor, in order that
improvements can be made to the current management processes and practices:
.
Efforts must be made to fully develop and implement comprehensive and
systematic policies, plans and procedures.
.
Emphasise must be placed on training and skill development activities.
.
Contractor must emphasise on proactive approach to maintenance.
.
Contractor must allocate sufficient maintenance resources and provide working
environment conducive to accentuate works efficiency and effectiveness.
.
Establishment, assignment and training of the maintenance planner/scheduler in
contractor’s organisation.
.
Understanding of hospital maintenance management, particularly contractor as
the service provider, must understand the principles of maintenance
management.
.
Continuous improvement through benchmarking with other hospital or other
contractors.

Conclusions
This paper presents the results of an audit assessment conducted on the maintenance
organisation undertaking facilities maintenance management in a public hospital.
Five elements were assessed based on three respondent groups, namely: hospital,
contractor, and consultant. results on the contractor’s performance indicated many
areas of weakness with regard to the assessment elements, namely: policies; plans and
JFM procedures; training and orientation; and service performance. The effectiveness rating
obtained from the radar diagram revealed that the maintenance organisation in the
7,2 case study hospital is operating within a “maturing” stage.
The result suggests that the maintenance organisation in the case study hospital
has still not realised the importance and benefits of effective maintenance
management. It was apparent from the research findings that the maintenance
158 organisation had not made much effort to accomplish their roles and responsibilities
towards successful implementation of FEM services. Successful implementation of a
project of this nature depends largely on commitment and synergy of organisations
concerned towards realising the project objectives. Results from data analyses and
findings from the assessment revealed that overall management performance of FEM
services in this hospital was primarily influenced by three functional elements:
Element 2 – policies, plans and procedures; Element 3 – training and orientation; and
Element 5 – service performance of the contractor. This signifies that these three
elements are the areas of weakness of the current maintenance management processes
and practices of the maintenance organisation in this hospital.
Analyses of findings from the research indicate that the maintenance organisation
in the case study hospital is indeed required to take remedial actions in order to
improve the overall management performance of FEM services. Of particular concern,
the contractor as the service provider should endeavour to take necessary steps, as
mentioned in previous section, in order to improve its service performance.

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Corresponding author
Maisarah Ali can be contacted at: maisarah@iiu.edu.my

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