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The impact of facilities management on patient outcomes
MAY, D. and PINDER, J.
Available from Sheffield Hallam University Research Archive (SHURA) at:
http://shura.shu.ac.uk/907/
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Published version
MAY, D. and PINDER, J. (2008). The impact of facilities management on patient
outcomes. Facilities, 26 (5/6), 213-228.
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1
The impact of facilities management on patient outcomes
Daryl May
Senior Research Fellow
Facilities Management Graduate Centre
Sheffield Hallam University
7242 Stoddart Building
City Campus
Sheffield
S1 1WB
Tel: + 44 (0) 114 225 4104
Fax: + 44 (0) 114 225 4038
Email: d.may@shu.ac.uk
James Pinder
Senior Research Fellow
Facilities Management Graduate Centre
Sheffield Hallam University
7242 Stoddart Building
City Campus
Sheffield
S1 1WB
Tel: + 44 (0) 114 225 4652
Fax: + 44 (0) 114 225 4038
Email: j.a.pinder@shu.ac.uk
2
The impact of facilities management on patient outcomes
Abstract
Category: Research paper
Purpose of this paper
The aim of the study was to investigate the extent to which practicing NHS facilities managers
thought that the contribution of FM could be measured in terms of health outcomes.
Design/methodology/approach
A questionnaire was distributed to NHS facilities or estate managers from the majority of NHS
trusts in England and Wales.
Findings
In general, there is little or no evidence from pre-existing research to prove the contribution of
FM in terms of health outcomes. However in spite of this 59% of facilities managers in the
NHS believe that the contribution of FM could be measured yet only a relatively small number
of Trusts (16%) have attempted to measure the contribution of FM. The analysis of the
secondary data does not show any conclusive evidence of a correlation between FM and
health outcomes.
Research limitations/implications
The scope of the study did not extend to collecting empirical evidence to prove the
contribution of FM to health outcomes - it was only focusing on whether facilities managers
thought it was possible, and if so how they would measure the contribution. However, as part
of the project some secondary data were tested for a relationship between FM services and
health outcomes.
What is original/value of paper
This is the first time any study has gathered opinion from facilities managers as to whether
they believe their contribution can be measured in terms of organisational outcomes, in this
case patient care or health outcomes. It provides a useful starting point in order to develop a
future study to prove the contribution from FM to health outcomes.
3
Introduction
Ever since the discipline emerged, facilities managers have been searching for the 'holy grail'
of how to measure their contribution to the core business or strategic goals. Price (2004)
argued that to move the facilities management (FM) discipline forward to one that is seen as
business critical, rather than a low risk support service, facilities managers need to produce
evidence that demonstrates their contribution to business. He highlights a few published
studies starting to emerge which link the office environment to productivity (Laframboise et al.,
2003 and Bootle and Kaylan, 2002), however he states there are relatively few other
examples, NHS included.
Looking specifically at the NHS, in recent years there has been a change in attitude towards
facilities services and its contribution to healthcare. For example, in the 2005 general election,
'clean hospitals' were one of the key battle grounds.
The NHS Plan (Department of Health, 2000) can now be seen as one of the catalysts that
propelled FM from the background to a more prominent position within healthcare. The NHS
Plan set out a 10 year programme of modernisation for health and social care to improve the
standard of services for patients. The consultation exercise that took place prior to The NHS
Plan being published showed that the public ranked the cleaning standards and quality of
hospital food as high among their priorities:
"People want to see the basics put right. Half of people think the condition of
hospital buildings needs to be improved. Few people are complimentary about
hospital food. One survey found almost a third of patients needed help eating meals
but did not always get it. Dirty hospitals are a big concern. Patients are concerned at
mixed sex wards." (The NHS Plan, p.135 - 136)
Chapter Four of The NHS Plan outlined the investment that would take place in healthcare
facilities. This included more beds, new hospitals and a commitment to clean wards and
better hospital food. It was these last two items that resulted in the Department of Health
launching the "Clean Hospitals" and "Better Hospital Food" initiatives.
The Clean Hospitals (www.cleanhospitals.com) initiative was co-ordinated by NHS Estates.
Each NHS Trust had to submit action plans to improve their patient environment. Following on
from the NHS Plan, the Department of Health issued a number of policy documents which
focused on hospital cleanliness; National Standards of Cleanliness
1
(2001), Winning Ways:
Working together to reduce Healthcare Associated Infection in England (2003a), Standards of
Cleanliness in the NHS (2003b), A matron's charter: An action plan for cleaner hospitals
(2004a), NHS Healthcare Cleaning Manual (2004b) and Towards cleaner hospitals and lower
rates of infection (2004c).
Another interesting issue added to the clean hospitals debate are hospital acquired infections
(HAI), and most notably MRSA (methicillin-resistant staphylococcus aureus), being linked, in
the public's mind, directly to cleanliness. A recent poll by the British Medical Association
2
(BMA) confirmed the findings from The NHS Plan, in that the public are concerned about
hospital cleanliness and MRSA. The survey asked 2000 patients to rank 10 NHS spending
priorities, and clean hospitals came out top. Clean hospitals are one contributory factor in the
spread of MRSA, however other factors are more important such as staff washing hands and
the access to single bedded wards. In fact Jones
3
(2004) goes even further and claims that
there is very little scientific evidence to suggest that clean hospitals reduce infection.
The Better Hospital Food (www.betterhospitalfood.com) initiative, again co-ordinated by NHS
Estates, introduced a new menu designed by leading chefs, a 24 hour catering service and
ward housekeepers to manage the food service on the wards. Apart from the initial criticism
surrounding the new menu, the Better Hospital Food initiative did not attract the same high
1
Listed as an NHS Estates report
2
From the BBC website http://news.bbc.co.uk/1/hi/health/4620471.stm
3
From http://www.hdmagazine.co.uk/storyprint.asp?sc=2026005
4
level media and public attention that the Clean Hospitals initiative did - this is reflected in the
BMA survey which ranked Better Hospital Food as 9
th
out of the 10 spending priority options.
Changes made following the review of the Department of Health's (DoH) arm's length bodies
(ALBs) (Department of Health, 2004d), resulted in NHS Estates - the agency that was
previously responsible for co-ordinating support for facilities and estates managers in the
NHS - being disbanded. Its responsibilities were split across other organisations, however a
core team was retained by the DoH to concentrate on delivering policy on engineering, design
and asset & property management.
Interestingly the objective for the DoH's new Estates and Facilities Directorate is "To ensure
the strategic development of a flexible and responsive environment for health and social care,
delivering improved health outcomes through innovative estates and facilities solutions that
enable high quality, safe patient care." Unfortunately the six work-streams that provide the
detail behind the strategic objective do not make explicit reference to improving health
outcomes, but instead focus on capital investment, asset management, estates knowledge,
sustainable development and the developing capacity agenda.
One of the major outcomes from the review of the ALBs was that the National Patient Safety
Agency (NPSA) took over responsibility for the delivery and implementation (but not the policy
or monitoring) of cleaning, better hospital food and safe hospital design. Their responsibilities
for these areas are at a relatively early stage. However, in terms of a research programme
looking at cleaning and food and the impact on patient outcomes, it appears the NPSA
agenda is focused elsewhere.
Before being disbanded NHS Estates managed the small programme of research focused on
estates and FM, and the responsibility for this has now passed to the new Estates and
Facilities Directorate at the DoH. The programme
4
for funding is currently encouraging
research in the areas of: the impact of standardisation on the built environment; designing out
infection; ventilation; and the appropriate selection of maintainable finishes. Unfortunately
they do not specificy a research agenda focusing on the impact of FM services on patient
outcomes.
What perhaps is even more worrying is the actual level of funding allocated directly from the
DoH for estates and FM research. According to figures from NHS Estates (2003), the NHS
has the largest property portfolio in Europe - 25% of the NHS spend is on estate and facilities
management. Yet the provisional figure for the financial year 2005 - 06 for the etsates and FM
research and development fund was £372,000. This is compared to the £650m million
allocated for clinical research in 2005 - 06. It is therefore hardly surprising that there is a little
evidence linking FM and health outcomes.
In January 2006 the DoH published the report Best Research for Best Health: A new national
health research strategy. This outlined the direction of NHS research and development over
the next five years. While it appears the focus is to fund and support research which leads to
improved outcomes for people, it is difficult to see the agenda facilities and estate related
research.
The recent disbanding of NHS Estates and the resulting split in support responsibilities has
left estates and facilities services at a cross-road. Some elements that support the service
have already transferred over to more clinically focused organisations, for example the NPSA
as discussed above, and the Chief Nursing Officer who is now responsible for policy issues
related to cleanliness and food. It could be argued that it is now critical for NHS estates and
facilities services to demonstrate their ability to contribute to health outcomes in order to avoid
becoming even more fragmented.
4
From the Department of Health website
http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/EstatesAndFacilitiesManageme
nt/EstatesAndFacilitiesArticle/fs/en?CONTENT_ID=4118973&chk=YDJzFm
5
There is a growing evidence base on the relationship between hospital design and health
outcomes, particularly through the work of Ulrich and Zimring (2004) which is summarised in
their report The Role of the Physical Environment in the Hospital of the 21st Century: A Once-
in-a-Lifetime Opportunity. Lawson and Phiri (2000) have also attempted to link the ward
environment with patient outcomes. Their study compared two wards on the same hospital
site - one newly refurbished and the other a conventional 1960s design. Their findings
showed that, unsurprisingly, the patients in the newer buildings expressed more satisfaction
with the appearance, layout and overall design. But in terms of the patient health outcomes,
such as length of stay, the data were inconclusive. There is evidence to suggest the link
between the environment and health, particularly around sensory environments. However,
what most of the studies show is that it is very difficult to move beyond anecdotal evidence.
To conclude, in terms of empirical evidence which supports the contribution of FM - and
specifically the delivery of food services and cleaning standards - to health outcomes, there is
limited, if at all any evidence. Facilities managers in the NHS are passionate about the
contribution that they make to health outcomes, however, at best this is anecdotal evidence.
With Foundation Trust status and the new Patient Choice agenda there is even more urgency
for estates and facilities departments to raise their profiles and prove their contribution to
healthcare.
One positive note from the Patient Choice and Payment by Results agendas is that the early
evidence (Taylor et al. 2004, Miller & May 2006 and Coulter et al. 2004) is suggesting that
patients will use factors such as ease of car parking, cleaning standards and food service
when making their choice of hospital.
Research aims and objectives
The aim of this study was to investigate the extent to which practicing NHS facilities
managers thought that the contribution of FM could be measured in terms of health
outcomes. In essence, the study provided a "snapshot" of opinion from current facilities
managers on whether the services they deliver to the NHS could be measured in terms of
health outcomes.
The scope of the project did not extend to collecting empirical evidence to prove the
contribution of FM to health outcomes - it was only focused on whether the above was
capable of being done. However, as part of the project some secondary data were tested for
a relationship between FM services and health outcomes.
In the context of this study, FM was taken to include the "soft" FM elements of responsibility
such as catering, cleaning, portering and ward housekeeping. Therefore the "hard" FM
elements, typically the estates functions, property management, building maintenance etc.
were not included within the study. The key objectives of the study were to investigate:
• whether practicing facilities managers in the NHS believe the contribution of FM can be
measured in terms of health outcomes;
• what type of indicators can be used, or evidence be collected, to prove the contribution of
FM in terms of health outcomes;
• if any NHS trusts have already conducted research to measure the contribution of FM in
terms of health outcomes; and
• for a relationship between the secondary data available relating to health outcomes and
standards used to measure food and cleanliness.
Research methodology
The aim of the study was to gather the views and opinions from a large sample of NHS
facilities managers. Therefore, the primary method for collecting data was through a
questionnaire. The questionnaire was distributed to NHS facilities or estate managers from
the majority of acute, mental, social care and primary care trusts in England and Wales. In
addition the questionnaire was also distributed to facilities managers working for private
6
sector companies providing support services to the NHS. A total of 783 questionnaires were
distributed, with 116 returned. This was an overall response rate of 14.8%.
The questionnaire was designed in order to be completed simply and quickly by respondents.
It was distributed via the post with a prepaid return envelope enclosed. The study was
considered to be a service/practice evaluation, and as such did not come under the existing
Research Governance Framework. The study was effectively evaluating current practice with
the intention of generating information to inform decision making. However, it was anticipated
that there would be no major ethical issues associated with the study. The research did not
involve patients or any medical intervention. A non-sensitive questionnaire was distributed
and consent to take part in the study was implied by the return of the questionnaire. Good
practice in relation to ensuring confidentiality, making the data anonymous and data security
was followed.
The secondary data analysis investigated for a relationship between health outcomes and the
standards used to measure food and cleanliness. The measures of health outcomes were
taken from Healthcare Commission
5
data. The measures of food and cleanliness were taken
from the Patient Environment Assessment Team (PEAT) scores. The PEAT score is built up
using multidisciplinary teams to assess the patient environment, including a score to rank
food and cleanliness.
Findings
The questionnaire was split into four sections. Section One dealt with the Contribution of
facilities management in the NHS. Section Two focused on Patient groups, and whether
respondents felt the impact of FM was different for different patient groups. Section Three
was on the Profile of facilities management in the Trust/Organisation. Section Four was titled
Contribution of facilities management within your own Trust.
The findings from the survey are split into two parts. The first part presents the findings from
the questionnaire. The second part considers the secondary data collected from the
Healthcare Commission and investigates for a correlation between:
• PEAT cleanliness scores and MRSA;
• PEAT scores and average length of in-patient stay; and
• PEAT scores and the National Inpatient Satisfaction Survey results.
5
The Healthcare Commission is the independent body responsible for collecting data and
monitoring the performance of NHS organisations.
7
Percentage of respondents who thought it was possible to measure the contribution of
facilities in terms of health outcomes.
Number Percentage
Yes
69 59%
No
14 12%
Unsure
33 28%
Total
116 100%
Y es No Unsure
Is it possible to measure the contribution of FM?
0
20
40
60
P
e
r
c
e
n
t
a
g
e
Table II - Respondents who thought it
possible to measure the contribution of
facilities in terms of health outcomes
Graph 1 - Respondents who thought it possible to measure
the contribution of facilities in terms of health outcomes
8
Ways in which the contribution of facilities management can be measured in terms of
health outcomes.
Respondents were asked to outline the ways in which they thought the contribution of FM
could be measured in terms of health outcomes. This was an open-ended question.
The most popular measure suggested was to use MRSA/HAI rates as an indicator (44% of
respondents), particularly when linked to hospital cleanliness. Some respondents made
explicit reference that when hospital (PEAT) cleanliness scores improved they noted a
reduction in MRSA/HAI rates within their trust. The next most popular measure indicated by
respondents was to use patient satisfaction survey results or the number of patient complaints
received relevant to the facilities services. This was suggested by 24% of respondents. The
next most popular measure suggested was to use the PEAT scores - this was indicated by
10% of the respondents. However the PEAT scores are not a measure of health outcomes as
such, they indicate the performance of facilities services rather than patient outcomes.
Other suggested ways to measure the contribution of FM in terms of health outcomes
included:
• Using waiting times as a measure - more FM services, for example more porters,
results in shorter waiting times.
• Measuring patient dietary intake or calorific intake as a measure of the food/catering
services.
• Measuring the relationship between average patient length of stay and cleanliness
and food standards/scores.
FM services in order of rank importance of the impact they have on the quality of the
patient experience.
0 250 500 750 1000
Sum of rank importance
Sustainable and Environmental Management
Waste Disposal (clincial and non-clinical)
Bedside communications sy stems
Portering
Car Parking
Security and Saf ety
Ward Houskeeping
Catering
Priv acy and Dignity
Cleaning/Domestic Serv ices
S
e
r
v
i
c
e
Graph 2 - FM services in the order of rank
importance of the impact they have on the quality
of the patient experience
9
Respondents were asked to rank the FM services in order of importance of the impact on the
quality of the patient experience. '1' being the most important and '10' the least important. The
above graph shows the sum of rank importance, hence if a respondent ranked a service as
the most important (i.e. number 1) then it was given the highest score of 10.
Cleaning/domestic services ranked as most important FM service on the quality of patient
experience. Interestingly privacy and dignity was ranked above the catering services.
Measures of 'health outcomes' in order of rank importance when trying to assess the
contribution of facilities management in the NHS.
Respondents were asked to indicate the three most important measures of 'health outcomes'
that were most appropriate when trying to assess the contribution of FM in the NHS. The
'health outcomes' listed as options were chosen from the measures the Healthcare
Commission use as part of their annual exercise to generate the NHS performance ratings.
The above graph shows a sum of the rank importance for each measure of 'health outcomes'.
Therefore Patient satisfaction survey results and MRSA rates scored almost double the next
most important measure (NHS written complaints).
0 50 100 150 200
Sum of rank importance
Other
Waiting time in outpatients
Deaths f ollowing surgery
Cancelled operations
Waiting time f or A&E emergency admissions
Av erage length of bed stay
Av ailable Beds
NHS written complaints
MRSA rates
Patient satisf action surv ey results
M
e
a
s
u
r
e
Graph 3 - Most appropriate measures of
health outcomes to use when trying to
assess the contribution of FM in the NHS
10
Percentage of Trusts/Organisations that a have Director of Facilities (or a Director of
Estates responsible for FM).
This question was included in order to establish or investigate a link between those trusts that
have a senior member (director level) of staff responsible for FM and how forward thinking the
FM department is in terms of a link between services and health outcomes. The data
presented however, is interesting and valuable in itself.
Number Percentage
Yes
82 71
No
34 29
Total
116 100
Yes No
Director of Facilities?
0
20
40
60
P
e
r
c
e
n
t
a
g
e
Graph 4 - Percentage of
Trusts/Organisations that have a Director
of Facilities
Table IV - Percentage of
Trusts/Organisations that have a Director
of Facilities
11
Percentage of Director of Facilities (or a Director of Estates responsible for FM) that sit
on the Trust board.
Number Percentage
Yes
58 50
No
28 24
Unsure
1 1
Not specified 29 25
Total
116 100
Yes No Unsure Not specif ied
Director on the Trust Board?
10
20
30
40
50
P
e
r
c
e
n
t
a
g
e
Graph 7 - Percentage of Director of
Facilities (or a Director of Estates
responsible for FM) that sit on the Trust
board
.
Table V - Percentage of Director of
Facilities (or a Director of Estates
responsible for FM) that sit on the Trust
board
.
12
Percentage of facilities departments that have attempted to measure their contribution
in terms of health outcomes.
Number Percentage
Yes
18 16
No
95 82
Unsure
3 3
Total
116 100
Yes No Unsure
Has the Trust measured the contribution?
0
25
50
75
V
a
l
u
e
s
Graph 6 - Percentage of facilities
departments that have attempted to measure
their contribution in terms of health outcomes
Table VI - Percentage of facilities
departments that have attempted to
measure their contribution in terms of
health outcomes
13
Type of organisation the respondent works for and the most appropriate measure of
'health outcome' when trying to assess the contribution of FM in the NHS.
The type of organisation the respondent worked for was classified according to the Trust
name provided. The organisation was classified as either:
• Acute/General
• Primary Care Trust
6
• Mental Health Trust
• Shared Services Agency/Partnership
7
• Private Sector Organisation
• Other
Using the Kruskal-Wallis test, there were statistically significant differences in the measures of
health outcomes to use when trying to assess the contribution of FM in the NHS, for the
available beds, waiting time in outpatients, cancelled operations and MRSA rates.
Table VII illustrates the differences in the measures of health outcomes. The higher the mean
rank, the higher the importance placed by the organisation.
Health Outcome Measure Type of Organisation Mean Rank
Available Beds Acute/General Trust 42.67
PCT 30.5
Mental Health Trust 53.5
Shared Services Agency/Partnership 64.63
Private Sector Organisation 67.17
Waiting time in outpatients Acute/General Trust 44.56
PCT 62.71
Mental Health Trust 50.67
Shared Services Agency/Partnership 43
Private Sector Organisation 43
MRSA rates Acute/General Trust 48.08
PCT 43.86
Mental Health Trust 16
Shared Services Agency/Partnership 52.92
Private Sector Organisation 29.33
6
Primary care trusts host general practitioner providers and other first contact point services.
7
In this context a Shared Services Agency/Partnership is usually a public sector organisation
set up to provide non-clinical services to a number of NHS organisations including acute,
mental health and primary care trusts.
Table VII - Type of organisation the respondent
works for and the most appropriate measure of
'health outcome' when trying to assess the
contribution of FM in the NHS
14
Secondary Data Analysis
The following secondary data has been used to further investigate for a relationship between
FM and health outcomes. All the data are from acute/general and specialist hospital trusts in
England and relates to the financial year 2004/2005
8
. The following data sources are used:
Patient Environment Assessment Team (PEAT)
Each year all trusts in England are subjected to an assessment of their patient environment
by a multidisciplinary team and provided a score known as a PEAT score. The trust receives
a PEAT score for various aspects of their patient environment, including a score to rank their
cleaning services and their catering services. The data is available on the Healthcare
Commission Website:
http://ratings2005.healthcarecommission.org.uk/Trust/Indicator/indicators.asp?trustType=1
MRSA rate per 1000 bed days
The MRSA rate per 1000 bed days relates to the financial year 2004/2005. All the bed
occupancy figures used to calculate the rates apply only to overnight admissions.
Consequently MRSA bacteraemias in patients who are not admitted overnight, e.g., in renal
units, may make a Trust's rate look falsely high, as these patients will feature in the numerator
but not in the denominator. The data is available on the Department of Health Website:
http://www.dh.gov.uk/assetRoot/04/12/79/21/04127921.xls
MRSA banding results
The MRSA banding results relate to the financial year 2004/2005. The indicator is a
combination of the overall MRSA rates, as well as improvements in the rate and presence of
near patient alcohol gel on the wards. The indicator contains the three measures, which have
been combined to determine the level of performance. Acute Trusts that exhibit a small
number of MRSA reports (12 or fewer) have been given a 'Data not available score' i.e. it has
been left blank. The banding results are as follows:
Good Band 5
Band 4
Band 3
Band 2
Poor Band 1
The data is available from the Healthcare Commission Website:
http://ratings2005.healthcarecommission.org.uk/Downloads/MoreInformationPageDocs/'1348'
!A1
Average Patient Length of Stay
The average inpatient length of stay data relates to the financial year 2004/2005. The mean
(average) and median (middle in ranking) of the spell duration in days. A spell is a period of
continuous admitted patient care within a particular NHS trust, calculated by subtracting the
admission date from the discharge date. The data is available from the HES Online website:
http://www.hesonline.nhs.uk/Ease/servlet/DynamicPageBuild?siteID=1802&categoryID=212&
catName=Hospital%20providers
National In-patient satisfaction survey data
Over 88,000 patients were involved in the 2004 in-patient survey. The survey asked patients
from 169 acute and specialist NHS trusts across England about their recent experience of
inpatient care. The patients surveyed were discharged Sept, Oct and Nov 2003. The data
used from the in-patient survey related to Questions 13 - 15.
8
Apart from the National In-patient satisfaction survey data. The patients surveyed were
discharged Sept, Oct and Nov 2003
15
Question 13: In your opinion, how clean was the hospital room or ward that you were in?
Question 14: How clean were the toilets and bathrooms that you used in hospital?
Very Clean Fairly clean Not very clean Not at all clean
Question 15: How would you rate the hospital food?
Very good Good Fair Poor
Data from the Healthcare Commission 2004 National Inpatient Survey is available from:
http://www.healthcarecommission.org.uk/assetRoot/04/00/78/31/04007831.xls
The following variables were tested for any kind of statistically significant correlations:
Variable Variable Test
a. PEAT cleaning score and
MRSA rate/1000 bed days Spearman's
b. PEAT cleaning score and
MRSA Banding Result ANOVA
c. PEAT cleaning score and
Average length of in-patient stay Spearman's
d. PEAT cleaning score and
National In-patient satisfaction survey data
(2 questions relating to cleaning standards)
Spearman's
e. PEAT Food Score and
Average length of in-patient stay Spearman's
f. PEAT Food Score and
National In-patient satisfaction survey data
(1 question relating to food standards)
Spearman's
a. PEAT cleaning score and MRSA rate per 1000 bed days
There is an overall negative correlation between the PEAT cleaning score and the MRSA rate
per 1000 bed days i.e. as the PEAT cleaning score increases the MRSA rate per 1000 bed
days decreases. However, the correlation is not statistically significant.
b. PEAT cleaning score and MRSA banding result
As the PEAT cleaning score band increases there is also an upwards trend for the average
MRSA Band results. The results are not statistically significant, however table VIII below does
show a noticeable difference in the mean MRSA Band results for the different PEAT cleaning
scores.
The table shows that for the PEAT cleaning scores 2.0 - 4.0 the mean average MRSA Band
result was between 3.5390 and 3.6412. Those Trusts that had a PEAT cleaning score of 5.0
had a mean average MRSA Band result of 4.1131 (MRSA Band 5 = Excellent, MRSA Band 1
= Poor).
c. PEAT cleaning score and average length of in-patient stay
Cleaning
Score Number
Mean MRSA
Band result
2.0
21 3.5390
3.0
90 3.6315
4.0
18 3.6412
5.0
11 4.1131
Total
140 3.6567
Table VIII - PEAT cleaning score and
MRSA banding results
16
Using either the mean or the median average length of stay for in-patients, there is no
statistically significant correlation between this and the PEAT cleaning scores.
d. PEAT cleaning score and national in-patient satisfaction survey data.
There were two questions included in the 2004 National In-patient satisfaction survey that
related to cleaning:
• Question 13: In your opinion, how clean was the hospital room or ward that you were in?
• Question 14: How clean were the toilets and bathrooms that you used in hospital?
In their response to the above questions, patients were asked to indicate whether they
thought the rooms were either:
Very clean
Fairly clean
Not very clean
Not at all clean
Statistically there was a weak correlation between the PEAT cleaning score and the in-patient
satisfaction survey results, for both questions. There was a positive correlation between the
PEAT cleaning scores and patients who thought the rooms or toilets were very clean i.e.
those Trusts with a higher cleaning score had a greater percentage of patients indicating that
the rooms or toilets were very clean. However, there was a negative correlation between the
PEAT cleaning scores and patients who thought the rooms and toilets were fairly clean, not
very clean or not at all clean. This would be expected for the categories of not very clean or
not at all clean. However one might expect to observe a positive correlation between the
PEAT cleaning score and those patients who thought the rooms or toilets were fairly clean.
e. PEAT food score and average length of in-patient stay
Using either the mean or the median average length of stay for in-patients, there is no
statistically significant correlation between this and the PEAT food scores.
f. PEAT food score and national in-patient satisfaction survey data.
There was one question included in the 2004 National In-patient satisfaction survey that
related to food:
• Question 15: How would you rate the hospital food?
Patients were asked to indicate whether they thought the food was either:
Very good
Fairly good
Fair
Poor
Statistically there was a moderate correlation between the PEAT food score and the in-patient
satisfaction survey results related to food. There was a moderate positive correlation between
the PEAT food score and the patients who thought the food was either very good or good i.e.
those Trusts with a higher food score had a greater percentage of patients who thought the
food was either very good or good. In addition to this, there was a moderate negative
correlation between the PEAT food score and the patients who thought the food was either
fair or poor i.e. those Trusts with a higher food score had a smaller percentage of patients
who thought the food was either fair or poor.
17
Conclusions
In terms of the building design, space and sensory environments, there is a growing evidence
base in the relationship with health outcomes. However, it seems there is little or no evidence
from pre-existing research to prove the contribution of FM - and specifically the food and
cleaning services - in terms of health outcomes. This lack of evidence is hardly surprising,
due to the relatively small amount of research funding directly allocated to the area. However
in spite of this 59% of facilities managers in the NHS believe that the contribution of FM can
be measured. It is then a little disappointing to find only a relatively small number of Trusts
(16%) have attempted to measure the contribution of FM.
Unfortunately the analysis of the secondary data does not show any conclusive evidence of a
correlation between FM and health outcomes. Using the PEAT scores as a measure of FM
performance, there is no correlation between the cleaning scores and average length of in-
patient stay (mean or median). Nor is there any correlation between better hospital food
scores and average length of in-patient stay. In addition, there is no correlation between the
PEAT cleaning scores and MRSA rates. The only variables that displayed any statistically
significant correlations are those between the PEAT cleaning/better hospital food scores and
the national in-patient satisfaction survey. One possible explanation for the lack of correlation
is to question the validity of the PEAT scores as a measure of FM in the NHS, however there
may be other reasons.
The challenge for NHS facilities directors is to prove the contribution of FM to patient well-
being, especially if they want to make an impact at board level. This is important as the
medical profession are, for obvious reasons, a scientific facing community; here the
randomised double blind control trial is the gold standard. For facilities directors and
managers in the NHS, the problem is not only deciding what appropriate measures to use, but
also how to conduct a scientifically valid study - it would not be acceptable to deliberately
serve poor food or leave a ward dirty in order to make comparisons between good and bad
wards. In addition, it would be difficult, if not impossible, to control for any extraneous
variables, and therefore difficult to infer any statistically significant correlations that are purely
down to FM factors.
So where does this leave NHS facilities managers who want to prove, using scientific
evidence, the contribution of FM to health outcomes? This paper probably poses more
questions than answers, and certainly can't provide the way forward. One possible way
forward is through patient choice. The early research findings from patients exercising choice,
suggests they are considering the hospital cleanliness and quality of food when deciding
which hospital to attend. NHS facilities directors need to build upon these positives and
exploit the contribution that FM can make to patient care. Another way is to observe and learn
from the medical community in terms of what they consider, "scientific research." This may
require facilities managers to work more closely with clinical research teams in order to
design studies which are acceptable, and hold currency, with the medical community.
18
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www.npsa.nhs.uk
