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System transferability of Facility Management

Dr.-Ing. Mandana Banedj-Schafii

Karlsruhe Institute of Technology (KIT); Institute for Technology and Management in
Construction, Facility Management, Germany
mandana.banedj-schafii@kit.edu

Prof. Dr.-Ing. Dipl.-Wi.-Ing. Kunibert Lennerts

Karlsruhe Institute of Technology (KIT); Institute for Technology and Management in
Construction, Facility Management, Germany
kunibert.lennerts@kit.edu

Abstract

Can Facility Management be transferred? Is it possible to use learned and employed systems in
one country and adopt them in another one? These were the first questions of a young scientist,
once she had to establish the first FM department in the Building and Housing Research Centre
in Iran - after having lived and studied for more than twenty years in Germany.

A research project started to find out the grade of transferability between different countries.
The research was done based on the research project OPIK (Optimization and Analysis of the
Processes in Hospitals) which has been successfully running since 2001 with cooperation
partners from science, hospitals, professional associations and industry at the KIT, Germany.
Three processes that were analyzed in the OPIK-Germany project (laundry management,
maintenance and repair of technical facilities and medical equipment) were chosen exemplarily
and compared with their pendants in the OPIK-Iran project which was implemented in three
hospitals in Tehran. With the perceptions of the process analysis and the comparisons of the
hospital management, the health system and country-specific conditions nine main parameters
were recognized which influence the transferability of facility management. These are
management, economy, politics, culture, judicative, education, public and private institutions,
infrastructure and geography. By using system theory, models were defined and specific
analysis and methods were developed to rank these main parameters. Based on those results
proposals were worked out for the implementation of facility management in the Iranian
hospitals. The assessment with the help of the transferability methods however can only serve
as a guide or a "trend barometer". The level of the ranking indicates the degree of importance.
It gives a direction, which parameters should be considered for the successful transferability of
a FM-system. Facility management is dynamic; the system must however be matched to the
boundary conditions and be adapted to the specific situation in the country or even in the
hospital to which it is applied. Concluding from this comparison; a transfer of knowledge,
information and know-how took place which led to the start of a dual Master Course at Tehran
University and a Facility Management Competence Centre.

Keywords: facility management, hospital, system theory, transferability, process optimization

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1. Introduction

The increasingly globalizing markets offer beside transfer of products also transfer of services.
This is valid for management systems like Facility Management as well. This modern
management system have been being implemented and used in more and more countries
worldwide in the recent years. Different markets, regions or countries however have their own
conditions and frameworks, so that the understanding and the implementation of Facility
Management can vary from one region to the other one. The question which arises here is
which parameters and factors play key roles in this subject. To answer this questions this paper
describes an analytical approach to investigate and verify the parameters of influence for the
transferability of Facility Management from one country to another one. After having lived and
studied for more than twenty years in Germany a young scientist started to work in Iran and
took the responsibility to establish the first FM department in the Building and Housing
Research Centre in Tehran. Having started the work it turned out to be enormously difficult to
apply the knowledge of the German Facility Management. To find out the differences a
research project started, to analyze the transferability of Facility Management using the project
OPIK [Optimizing and Analyzing of the Processes in Hospitals].

2. The research project

2.1 The research project OPIK

The huge cost pressure on the German hospitals, especially with the implementation of the
“Diagnosis Related Groups” (DRG) in 2003, made the detailed analysis of the hospital
processes necessary.

This was the birth of the research project OPIK which started in 2001 initiated by the
University of Karlsruhe (TH) in cooperation with the Professional Union for Hospital
Technology (Fachvereinigung für Hospitaltechnik (e.V.) (FKT)). To fulfill the requirements
and to guarantee a quick market access of the research results additional cooperation partners,
hospitals and the industry were involved. The heterogeneous character of the participating
partners guaranteed “an interdisciplinary exchange of specialist knowledge which created a
unique connection between practice and research in the Health Care System of Germany”
(Lennerts 2002).

To be able to optimize the processes four steps had to be taken. In the first step the processes
were described, visualized and standardized by a group of experts. Then the cost- and quality
factors were determined theoretically for every process step and the related interfaces to the
“primary processes”- the core business in the hospital- were defined. In the third step data for
the cost and quality factors were collected in the participant partner hospitals. This data that
formed the core of the process analysis was finally evaluated in the fourth step.
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Figure 1: OPIK-partners (based on Lennerts, 2002a)

Figure 2: The idea of OPIK (based on Lennerts, 2002b)

The standardization of the process results was implemented in three phases:

1. Analysis and optimization

2. Verification
3. Development of a standard process
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The results were discussed in regular workshops with the partners and the process
standardization was progressed in this way. Studies and censuses in the different hospitals were
conducted by the scientific staff and supported by research studies and theses.

2.2 OPIK-Iran

In February 2006 the OPIK-Iran project started similar to its German origin. The Iranian
cooperation partners (service enterprises, subcontractors, management, representatives of the
Health Institute, the Medical University of Tehran and the Ministry of Health and Medical
Education [MOHME]) started the kick-off meeting and selected three hospitals in Teheran
(Vali Asr Hospital, Shariati Hospital and the Tebie - Children’s Hospital) as pilot objects. In
general and specific workshops that were accompanied by long, intensive and suggestive
discussions the theoretical part was elaborated. Here the current status of the processes (single
process steps, interfaces, responsibilities, Iranian laws and regulations) and the current
management and organization were analyzed. Surprisingly, there were significant differences
between the hospitals, although they were all public institutions under the head of Tehran
University of Medical Science in the capital. So for example one of the pilot hospitals did not
have a department for medical equipment (what reflects the situation of 90% of the country).
These tasks were administrated by university authorities. The laundry management units were
coordinated in completely different ways. Some of them had their own centers while other ones
worked with external suppliers.

Figure 3: The analyzed processes in the OPIK-Iran project (Banedj-Schafii, 2010)

The results of the data collection were 211 reports for the maintenance of medical equipment
and 976 reports for the technical facilities within 20 days. This time period was chosen exactly
equal to the German pendent, so that a precise comparison could take place.

2.3 Comparison of the Processes

The comparison of the processes began after the data collection. The Iranian processes, which
were split in single process steps, the analysis of the interfaces, the characteristic variables and
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responsibilities were compared with their German pendants. In this way the differences became
visible (see figure 4) and the verifications could start to recognize these differences.

Germany possesses a global leading position in the field of maintenance of medical

equipments. Years of experience have been reflected in numerous powerful and active unions
and federations. Numerous laws and regulations have been established that are applied to daily
processes and have proved their suitability. In Iran, however, laws and regulations have been
introduced and legislated since 2006.

Regular maintenance and repair is a part of the process in Germany. It is normally performed by
local companies and suppliers. In Iran however maintenance is very rare and is primarily
restricted to very expensive equipments. Planning, analysis and the documentation takes an
important position in the German departments while in Iran the lack of specialized staff,
insufficient training and documentation as well as missing control of equipments characterize
the medical equipment technology. It is noticeable that in Iran much more departments are
involved and integrated in single process steps, which causes more time and costs.

A similar analogy can be taken considering the technical facilities. Numerous regulations and
laws which are strictly controlled by different authorities show the significance of this field in
Germany. Very rare maintenance, lack of specialist staff, low level of documentation, a low
budget and the lack of control of the mostly elder facilities influence the situation of the
technical facilities in Iran.

Figure 4: Comparison of the processes (Banedj-Schafii, 2010)

3. Transferability of Facility Management

With the process analysis and the comparison of the hospital management and health systems
and country-specific conditions nine main parameters were recognized which influence the
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differences between the two countries. These are management, economy, politics, culture,
judicative, education, public and private institutions, infrastructure and geography.

In order to be able to apply the transfer of FM-processes or a FM-system a “FM-transferability-

model” was developed and derivated from the system theory.

3.1 Model investigation with the help of system theory

Based on the system theory that requires detailed “choice of the system boundaries and of the
perspective of the view” [MATTHIS2002], a precise description of the targets and the purpose
of the model were defined.

The Goal was the development of a “FM-System Transferability Model” that should assist
facility managers to transfer a FM system into another environment or to implement a “foreign“
FM-system in their own organization (hospital).

According to EN 15221/1 “The integration of processes within an organization to maintain

and develop the agreed services which support and improve the effectiveness of its primary
activities” the FM-system comprises the services which are provided in a hospital. In the model
shown in figure 5 these are symbolized by the Red Cross (symbol of the German FM in
hospitals) and the Red Crescent (standing for the FM services in Iranian hospitals).

Parameters of
influence
Micro level
Macro level

Figure 5: The system model (Banedj-Schafii, 2010)

Two levels of analysis were distinguished, the micro level and the macro level. At the micro
level or hospital level all processes, structures, functions and influence factors which are
decided or performed at the hospital level are investigated. The parameters influencing the FM
processes at the country or state level are however analyzed at the macro level.

As shown in figure 5, many parameters of influence act on the system, on both the micro and
the macro level. These parameters were grouped according to subject and collected under
generic names in order to make it possible to analyze their impact on the system and their
interactions with each other. The parameter groups were both quantitatively and qualitatively
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measurable and ratable; they were assessed based on their significance and influence1. Some of
the parameters have fixed values that can be reliably determined, e.g. Gross Domestic Product
(GDP) of the countries, other parameters must be estimated or are very difficult to assess, for
instance working morale, sense of responsibility, religiousness, etc..

3.2 Methods and Analysis

The idea of the creation of a transferability method started with the development of ranking
methods, to find out which parameters have higher impact and must be analyzed or considered
more precisely.

Figure 6: Parameter of influence model (Banedj-Schafii, 2010)

In this way, nine main parameters management, economy, politics, culture, judicative,
education, public and private institutions, infrastructure and geography were compared in the
first step. “The parameter of influence model” describes the relationship between the main
parameters and defines the direct and indirect influences between them (see figure 6).

1
The assessment depends on the viewer und can fluctuate with country and perception
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In the next step the “matrix model” and the “share model” were developed. Both models
compare the nine defined main parameters. While the matrix model works with digits, the share
model reflects the relation between the parameters.

Economy,
financial strength /
monetary potential
Infrastructure
Policy,
Figure 5: The idea of OPIK (based on Lennerts, 2002b)
strategy planning

3.3 FM-transferability model

Geography, climate, Management,
environmental organisation,
conditions administration

Public and
private Education and
institutions research

Culture,
social structures Judicative, legal
regulations

Figure 7: The share model (Banedj-Schafii, 2010)

After the development of the different ranking models, the analysis of the parameters started.
To weight the single parameters qualitatively and quantitatively indicators were defined and
compared. The “indicator analysis” is mostly based on OECD and WHO indicators. So for all
nine main parameters indicators were defined for the macro level (country and health sector)
and the micro level (hospital and department), as can be seen in Table 1.

Another approach to acquire detailed information is the expert analysis. The advantage of this
method is its low time consumption and that the results are based on expert’s opinions that have
many years of experience in the specific working field.
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Indicators of the macro level:

Country Health sector
• GDP (per capita) in US $ • Portion of the expenditures for health of GPD in %
• Economic growth to sectors • Per capita government expenditure on health at
(real, %) average exchange rate US $
• GDP – emergence (%) • Expenditures for medicine (per capita) US $
• Unemployment rate (%) • Cost structure of ambulant health facilities
• Inflation rate (%) • Expenditure for rehabilitation
• Foreign depts. (Bil. US $)
• Export/ import • Total expenditure for health in US $ per capita
• Currency, monetary value
Indicators of the micro level:
Hospital Department (e.g. medical equipment)
• Costs of the hospitals according to cost
• Expenditure of material, personnel, training
type and hospital size range
• DRG-case-based lump sum, revenues and • Budget of the department
benefits
• Budget for maintenance/ repair
• Income • Budget of purchase
Table 1: The indicators for the economy parameters (Banedj-Schafii, 2010)

3.3 The transferability method

After having the different models and parameter and indicator analysis a final result should be
achieved. Each ranking of the models (parameter of influence model, share model and expert
analysis) is compared with the others, so that a final ranking can take place. This assessment
serves as a guide or a "trend barometer". The level of the ranking indicates the degree of
importance. It gives a direction which parameters should be considered for the successful
transferability of a FM-system. Table 2 shows the result of the transferability method used for
the FM of hospitals between Germany and Iran.

Rank Transferability parameters

high Management Economy Politics
middle Culture Judicative Education
low Infrastructure Public and Private institutions Geography
Table 2: Result of the transferability method (Banedj-Schafii, 2010)

It must be considered that the systems are dynamic and especially the expert analysis carries the
risk to have a subjective opinion which may not reflect the real situation.
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4. The practical application of the theory

4.1 Post graduated training courses

Concurrent to the research work, the World Bank project "Facility Management and Healthcare
Management" was implemented at the University of Karlsruhe (TH) in 2004 and 2005. This
post graduated trainee course was designed for 250 high-ranked employees of the Iranian
Ministry of Health and Medical Education (MOHME). Beside the content of the different
lectures which were held in these courses, the acceptance, the handling and transfer of the
participants helped to understand transferability of new ideas and systems.

Figure 8: The world bank project 2004/05 (University of Karlsruhe, 2005)

4.2 The Master Course FM and the FM-Competence Centre in Iran

In 2009 the cooperation project "FM for health objects" supported by German Academic
Exchange Service (DAAD) started. The development of the Master course FM should take
place in three steps. Additionally, a German-Iranian Competence Center should be founded that
should support the knowledge exchange and information transfer between universities, research
centers, public authorities and the economy (industry, service suppliers, ..) within the country
and across the borders.

The start is done, the implementation is in action, the filed is very stony but the first offspings
are growing and will hopefully develop to a strong and fertile plant.
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References

Banedj-Schafii, M. (2010): System transferability of public hospital facilities management between

Germany and Iran, KIT Scientific Publishing, Karlsruhe 2010

Lennerts, K., Abel, J. and Pfründer, U. (2002a): Hospital Facilities Management – the OPIK
research project, IFMA, World Work Place Congress, Paris, France, July 2002

Lennerts, K., Abel, J. and Pfründer, U. (2002b): Optimisation and Analysis of processes in
hospitals (OPIK) – a research project May 2002, IFHE, Bergen, Norway

Matthies Michael Prof. Dr., Einführung in die Systemwissenschaft, WS 2002/2003,

Studiengang Angewandte, Systemwissenschaft an der Universität Osnabrück, S.2