Design and Construction, Human Resources, Maintenance and Operations

Managing Facilities That Manage Our Health

Ask most professionals in the health care field, and they’ll tell you it can feel like working on a different planet. This goes for health care facilities management, too.

The unique features and operations of a health care facility require specialized knowledge beyond that which general facility management degree programs typically offer students, and deficiencies in that knowledge can lead to extreme consequences.

hospital health care

A new American Society for Health Care Engineering (ASHE) handbook, Introduction to Health Care Facilities Management, discusses the primary skills and concepts an HFM should use and understand, and it offers a detailed look at various types of health care facilities, a typical hospital’s structure, and the business of health care.

So what, specifically, makes health care facilities management unique from other facilities? The following article is excerpted and adapted from this new resource to answer just that question.

As a result of their direct effect on patient welfare, the planning, design, and construction (PDC); maintenance; and daily operations of health care facilities are heavily regulated by numerous, wide-ranging authorities and must respond to high-impact needs that are constantly and rapidly evolving. Most importantly, a health care facility must provide continuous patient care; if it fails even briefly, the results can be disastrous.

In non-health care facilities, you have several stakeholders to please, such as a city inspector, a landlord, or an owner and a tenant. As an HFM, you have many stakeholders to please, your top-priority stakeholders may differ from day to day, and you must keep the needs of everyone and everything in mind, from patients and staff to the various parts of the facility itself—and a great number of regulators and regulations.

HFMs must constantly remain up to date on the regulations pertaining to their occupancy type, provider type, and local codes and state laws; check to make sure their facility is in compliance with those regulations; and keep meticulously comprehensive, well-organized records of everything they do, or hire someone to do, for the facility.

Ensuring that the facility complies with all applicable codes, standards, and regulations includes being aware of the facility’s occupancy types and provider types, as well as additional requirements or contractual obligations that the organization is under (e.g., with insurance providers or physician groups). Being found out of compliance by a surveyor can affect everything from the facility’s funding, such as Centers for Medicare & Medicaid Services (CMS) reimbursements, to whether the facility is allowed to continue serving patients.

Many of the codes and standards with which HFMs need to comply provide the same or similar requirements for a facility. However, different authorities, codes, and standards can also bring in competing or contradicting requirements, which is highly challenging.

That being said, effective HFMs do not need to have every code and concept diligently memorized (although, over time, many outwardly complicated aspects of the job and how they apply to a particular facility will become second nature). There are a few broad skills, however, that are important to cultivate from the get-go: communicating, problem solving, and planning and prioritizing. The more HFMs master and incorporate these skills into their work, the fewer unnecessary barriers will crop up.

In addition to regulators and regulations, there is a wide variety of entities and departments within a hospital with specific and occasionally competing needs and priorities. HFMs are responsible for elements throughout these departments (e.g., provide medical gases, manage positive/negative pressure where appropriate), as well as address their requests and concerns. 

HFMs need to maintain high levels of communication with department leadership and staff to ensure that any work they are doing in the facility does not interrupt their operations, as well as to ensure that changes departments have planned independently will not cause safety or compliance issues. 

Of course, the most important entity that an HFM must always consider is the patient. HFMs have to be aware of the effect their projects have on the patient population. Aside from the topical example of airflow control and filtration being critical when dealing with individuals who are highly contagious or immunosuppressed, consider how vibration from construction might interfere with a newborn’s development, or how temperature and humidity could cause surgical instruments to expand and contract.

Because of these and other potential effects and risks, assessing risk and prioritizing projects is critical to supporting an HFM’s day-to-day responsibilities and when managing specific projects. There are a great number of existing tools and processes out there to assist HFMs with planning and mitigating risk, such as infection control risk assessments, preconstruction risk assessments, and hazard vulnerability analyses.

HFMs also play a key role in patient satisfaction, and not just because they keep the facility and its equipment running. Patients’ satisfaction with their hospital experience does not depend solely on their health outcome or stem only from the care they receive. In large part, patient satisfaction relates to other aspects of the physical hospital environment that the HFM can directly impact. These include, but are not limited to, temperature, lighting, ambiance, the condition of the equipment, and even the appearance of the ceilings.

So, if patients are perpetually cold or hot, can’t get good reading light, experience the furnishings and/or equipment as shabby or old, see water stains on ceiling tiles, or notice other cosmetic or structural damage, they are much less likely to provide a high-satisfaction rating.

Patient satisfaction also depends on the quality of communication between patients and front-line staff. There again, HFMs play a role. If HFMs participated in the PDC process, then they are partially responsible for the layout of the unit and the patients’ rooms. 

So, if nurses are in a rush because the built environment is designed inefficiently, then patients wind up getting less time and care from nursing staff. If the patient’s room is set up in such a way that the nurses, upon entering the room, immediately have to turn their back to the patient to wash their hands, the patient may interpret the nurses as rude.

With all these aspects in mind, it’s unsurprising that the job is always challenging and engaging. It gives HFMs ample opportunities to be a vital member of one the most important teams in their community; it gives them a never-ending supply of great stories to tell; and it leaves HFMs feeling proud and gratified to have spent their energy engaged in such a worthwhile and rewarding vocation.

The Introduction to Health Care Facilities Management handbook provides contributors’ stories describing how they found their way into the field of health care facilities management. If a reader can identify with them, or if they just sound like people who would be enjoyable to hang out with, this career might be a good fit.

Eliana Munro is the senior publications specialist and editor for the American Society for Health Care Engineering (ASHE).