The region’s population is expanding rapidly; the IMF estimates that by 2020, the GCC will be home to approximately 50million people. Although impressive, with the levels of demand that will be precipitated by such growth, the Gulf’s existing healthcare infrastructure is under a lot of pressure to provide more facilities.
According to a report by Alpen Capital, GCC population growth will necessitate more than 100,000 hospitals by 2018. Alpen Capital expects the GCC’s healthcare market to hit almost $70bn by 2018. If accurate, this would mean an annual growth rate of around 12%. In a recent roundtable discussion organized by the ‘FM today Magazine’, experts from the industry catering to the segment expressed the need to educate this market on the important role Facilities Management (FM) plays in the healthcare sector. The discussion also highlighted the need for training, the various challenges FM companies face while handling a healthcare facility and what kind of added value they can offer to their clients.
Maintaining a Healthcare Facility
UAE has a highly developed health service, including a sophisticated physical infrastructure of well-equipped hospitals, specialized clinics and primary care centres, when it comes to maintenance of the facility, it is important to understand whether it is any different from a commercial building. Managing facilities within a public building must always factor in customer comfort and this is really important. But in a hospital, the approach is different as the day-to-day running of the hospital is vital for easing patient discomfort during a particularly stressful time.
Eng. Ansari, General Manager,
Eng. Ansari, General Manager, Adeeb Group said that one cannot treat a healthcare facility like any commercial building. “The major difference between maintaining a healthcare building and a commercial building is how time is condensed. If something is not functioning efficiently in a healthcare facility, the response time is much shorter than in commercial buildings as more is riding on optimal facility management. In a hospital, the best facility management plan is preventative, not reactive as this decreases the risk of failure, as any issues are flagged before the problem has fully materialized,” he added.
Thierry Arnaud, General Manager,
Hestia Facilities Management
A hospital, according to Thierry Arnaud, General Manager, Hestia Facilities Management, a part of Sodexo, comprises of people (patients and staff), the various processes and the building. “It is important to note here that before taking on the contract, one must completely understand the culture at the facility and then adapt the service delivery to it accordingly,” he added.
Abhay Bhargava, Associate Director,
Regional Head, Energy and Environment,
Frost & Sullivan
Abhay Bhargava, Associate Director, Regional Head, Energy and Environment, Frost & Sullivan, voiced that from an FM industry’s perspective priority should be given to the building, and that the responsibility for the patient lies with the Hospital/ medical facility as their core function. In this context, he also posed a broader question to the group : “So the question is how is it different contractually? Especially from a service level perceptive to handle a healthcare facility here versus any other facility. We have seen varying standards for quality as compared to similar premises in other parts of the world. So how different are we seeing the healthcare sector’s demands here versus any other region?” he asked.
Joanna Saward, Head of Business
Joanna Saward, Head of Business Development, Farnek Facilities Management felt that the principles of managing an asset fundamentally don’t change. “However, it is important to understand the nature of the healthcare sector here in the UAE first, then the region and then go global. For example, private hospitals in the UK are the minority against the National Health Service; so the requirements between the two are very different. In the UAE, it is the other way around. You have the Ministry of Health Services, the government hospitals, the health care centres etc. but predominantly the sector is driven by private healthcare, so the mindset to even deliver the FM varies. It is an opportunity;
it is still about the building, the services, and the people in there. Some of the service levels will be tweaked according to the requirements but on the overall the principles remain the same,” she said. Arnaud looks at the situation differently. “At Sodexo, we believe the best way to create real; lasting value is to make people the central focus of organizations and society as a whole. Sodexo do believe that by ensuring delivery of effective FM services, we improve the Quality of Life of hospital employees, patients and visitors. Everybody knows that along with medical care, a comfortable environment and the quality of human contact are crucial to the recovery process. FM must address these issues because ultimately you need to provide comfort and supportive reassurance to patients and their visitors – from the AC, reception, guiding into the building etc. Likewise, providing excellent working conditions to the hospital staff reduces stress and increases staff satisfaction, which helps the hospital to attract and retain talents,” he said. “FM in the Healthcare is not just about maintaining the hospital building but to put Quality of Life and personal well-being at the heart of the healthcare institution! “ he added.
Noel Carpio, Director of Quality Department,
Canadian Specialist Hospital
The discussion then shed light on whether international standards are being followed at the medical facilities in the region. Noel Carpio, Director of Quality Department, Canadian Specialist Hospital, agrees that the hospitals in the region are on par with the international standards. “There are few parameters that one has to pass in order to get international accreditation. But we do need to keep in mind that a hospital is not the same as a commercial facility. For a hospital, when it comes to FM, the two main things that matter are the quality of services and the safety of the staff and patients. For example, while dealing with waste management, you have to keep in mind that there are normal and infectious wastes. Disposing of medical waste is critical. It has to be handled properly and followed with good processes as you are not only endangering the staff but also everyone else in the building,” said Carpio. Carpio goes on to add, “A hospital also has a resurgence of diseases that are more potent than before. Earlier, if there was one kind of flu now there are 30 different kinds. We have to adjust and adapt according to all kinds of diseases cropping about and the DHA is very strict about these changes and every hospital adapts accordingly to handle these changes.”
Outsourcing and training
Considering the hospital environment is sensitive and has no space for mistakes, there were dilemmas on outsourcing of its services. Bhargava drew a distinction between two aspects – to either look at outsourcing the operations of non-core medical facilities to a third-party provider or to basically outsource the key FM functions on a stand-alone basis / on a non-IFM basis. “Where you are coming from is a perspective of outsourcing the entire operations– right from the management of parking lot, greeting someone, to making sure everything is fine so that the doctors and staffs do nothing but cure. But how much are we actually seeing that here? Do we see many hospitals where they do the complete operations?” he asked.
When we talk about outsourcing, training people to work in a hospital environment is important, says Carpio. The challenge with outsourcing, he explained, is that people change every six months and 100 percent outsourcing can lead to chaos in the functioning of the facility. “So you cannot completely depend on outsourcing. For certain functions, we do need people working in-house under a contract,” he added.
From his experience, Carpio felt that outsourcing 40 percent of services is good. Outsourcing, he said, is good only if there is supervision from the management. “We always ensure that we train a team on the complete standards of the hospital, who can then supervise the outsourced personnel. It is also important to remember that we need to keep training people on the latest trends and technology and keep them updated with the standards of the industry. While having an FM company completely look after all the processes is a welcome step, but it is also important that they understand the culture and processes of the hospital,” he said.
Eng Vazeer Husain, Asst.
General Manager,Adeeb Group
Training is something the entire panel agreed and stressed upon. Eng Vazeer Husain, Asst. General Manager, Adeeb Group, says that the facility managers working in hospitals have to be prepared to handle all kinds of situations. “As mentioned earlier, a hospital is a very sensitive area and the person working there has to be prepared and trained to handle and react immediately in situations,” he added. Behavior training is also important, said Arnaud. “Comfort is a huge part of the recovery of patients. Which is why, we need to train people extensively on behavior. How they speak and greet patients provide that added value as it provides a lasting impression on the hospital,” he said. Carpio points out that what may have been the state of the art technology five years ago may not be the same today. Even when it comes to regulations, he said, that they keep getting updated every few years. “Which is why we need to be very careful while handing over our services to a third party, as they need to be updated and clear about the regulations in each Emirate,” he added.
No matter how many years a company has been in the market, challenges still exist. No matter how many years a company has been in the market, challenges still exist. Saward said that for most companies the biggest challenge is in educating the clients in the healthcare segment. “Our biggest challenge is educating and showing our customers and clients that we do have the expertise and we are subject matter experts,” she added.
While Sodexo has been in the market for over 40 years, being present in 80 countries and currently operating in 4,300 facilities, Arnaud says that they still face challenges. “All of us do not have an offer which addresses the same part of the market. So, the key to success here is an accurate segmentation and the courage to stick to it. But the challenge of convincing the customer that FM can be a major driver of value creation as well as competitiveness and will add value is always there!” he said.
Evolving into the discussion, Arnaud informed that customers are more and more interested in the added value that FM companies can provide to them. “There are so many players in the market and clients don’t want someone who can just clean a building. They are looking for a provider which delivers excellent support services at the best possible price, allowing healthcare facilities to generate additional revenue and to find new economic balance,” he added.
So what is that added value? Arnaud explained that Sodexo can bring value in different ways. Firstly, providing comfort to the patients adds more value to the hospital as improving living conditions and well-being of patients reduce health risks, decreases admission time and improves the reputation of the hospital. “One may have the best doctors but if the patient experience is not satisfactory, the patient will choose another hospital next time he needs to find one. Healthcare is a very competitive market,” said Arnaud. Likewise, providing satisfactory working conditions to staff improve their motivation, foster the attractiveness of institutions and reduce turn-over.
An efficient FM services delivery can also generate savings, he added. “For example, at the start of a contract, Sodexo will conduct an energy audit prior to determine the condition of equipment and will then be able to determine how systems can be optimized. Finally, another way to generate savings is to ensure engineering best practices are implemented. It is common that over time, original setting have been meddled. Sodexo believes that the life of assets should be optimized and that capital investment should be done only when absolutely necessary. Where feasible, we prefer to re-calibrate equipment to their original settings and apply proper engineering practices to optimize the performance of assets,” said Arnaud.
Husain also agrees with the fact that awareness among the clients is what is lacking in the industry; hence, they will not understand the kind of cost that comes with the services that is provided. “There will always be someone who will do it for a lower price but that is when the standards will drop,” he adds.
Cost is one of the challenges that the panel pointed out. The solution to this, many believed was to have a preventive facility management plan, not reactive as this decreases the risk of failure, as any issues are flagged before the problem has fully materialized. Arnaud said his experience shows that hospitals most commonly focus on reactive and corrective repairs as opposed to building a strong risk-based planned maintenance program which can then further evolve into a predictive maintenance program. Typically, a hospital has 70-80% of its work-orders on reactive and corrective repairs and the rest on planned maintenance. “The day we reverse that, clients save a lot of money and costs are greatly optimized,” he added.
Agrees Ansari. “PPM helps in saving energy as well. Recently, as a pilot project in Abu Dhabi, we were one of the companies with a group of scientists from the Government’s side to work on where we can save energy. While there were many companies saving energy they couldn’t find the right solution and the costs were still too high. So after working together the team concluded that it was PPM that was the main source of saving costs and energy,” he explained.
Saward points out that it is easy to lose sight that facility management is a people-driven service. According to her, it is important to stay a step ahead of one’s customers in the healthcare sector, especially with the pace at which technology is growing. “In order to be able to work with the hospital it is important to be aware of what are the new trends and technology coming into the market and invest in them and adapt our practices accordingly. If we don’t evolve in our own aspirations and knowledge then we are going to be left behind and remain looking after just certain sectors,” she added.
While the industry is still in a nascent stage, the future, the panel believed, is bright in the FM healthcare sector. The discussion concluded on a note that the FM industry is at a stage where they can set benchmarks in the healthcare sector. But the real question is if companies are ready to take on the challenge the sector has to offer? There is a lot of learning that has to still take place, however on a positive note, the FM in the healthcare sector is on a right path with more hospitals are slowly opening up to the industry.