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Citation: Chan, D.W.M.; Sadeq, D.A.;
Sarvari, H.; Edwards, D.J.; Parsaei, A.;
Javaherikhah, A. Determining the
Essential Criteria for Choosing
Appropriate Methods for
Maintenance and Repair of Iraqi
Healthcare Building Facilities.
Buildings 2023,13, 1629. https://
doi.org/10.3390/buildings13071629
Academic Editor: Hugo Rodrigues
Received: 15 April 2023
Revised: 23 June 2023
Accepted: 24 June 2023
Published: 27 June 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
buildings
Article
Determining the Essential Criteria for Choosing Appropriate
Methods for Maintenance and Repair of Iraqi Healthcare
Building Facilities
Daniel W. M. Chan 1, Dher Abdulhadi Sadeq 2, Hadi Sarvari 1,2 ,* , David J. Edwards 3,4 , Alireza Parsaei 2
and Amirhossien Javaherikhah 5
1Department of Building and Real Estate, The Hong Kong Polytechnic University, Hung Hom, Kowloon,
Hong Kong, China; daniel.w.m.chan@polyu.edu.hk
2Department of Civil Engineering, Isfahan (Khorasgan) Branch, Islamic Azad University,
Isfahan 81595-39998, Iran; d.abdulhadi@khuisf.ac.ir (D.A.S.); a.parsaie@khuisf.ac.ir (A.P.)
3Department of the Built Environment, Birmingham City University, City Centre Campus, Millennium Point,
Birmingham B4 7XG, UK; david.edwards@bcu.ac.uk
4Faculty of Engineering and the Built Environment, University of Johannesburg,
Johannesburg 2092, South Africa
5Department of Civil Engineering, Polytechnic University of Madrid, 28031 Madrid, Spain;
amirhossein.javaheri@alumnos.upm.es
*Correspondence: h.sarvari@khuisf.ac.ir
Abstract:
Today, building maintenance and repair (M&R) is a neglected aspect of the construction
business throughout a building’s entire life cycle. Selecting appropriate M&R strategies is crucial,
particularly for emerging economies like Iraq with severely constrained resources. This study seeks
to identify the primary selection criteria for M&R methods of healthcare building facilities (HBFs)
in Iraq. A comprehensive desktop literature analysis was undertaken to extract and determine the
essential selection criteria for the most suited M&R approaches to buildings in general. Then, two
rounds of the Delphi survey were conducted to consolidate the specific selection criteria to suit the
circumstances of Iraq and HBFs. A total of 21 sub-criteria were identified and divided into six main
groups. The main criteria and the associated sub-criteria were then analyzed and ranked using
the fuzzy analytic hierarchy process (FAHP) technique. The ranking of the various main criteria
revealed that the “cost” criterion was ranked first in terms of importance, followed by the “human
resources” and “quality” criteria. The fourth, fifth, and sixth main criteria are “reliability/flexibility”,
“safety/risk/environment”, and “facilities/technology”, respectively. The overall ranking of the
sub-criteria placed “optimization and cost reduction” in the first position and “extending the life
of the equipment and preserving their initial quality” in the bottom place. It is anticipated that
the key findings and effective recommendations of this study will considerably contribute to the
improvement of building maintenance and repair management practices in developing nations while
enhancing different stakeholders’ understanding of the most important selection criteria for M&R
methods, particularly with regard to healthcare building facilities in Iraq.
Keywords:
selection criteria; maintenance; repair; healthcare building; Delphi survey; fuzzy
analytical hierarchy process (FAHP)
1. Introduction
In the 21st century, sustainable global development requires structural engineers to
design durable infrastructures, long-lasting and efficient. This means focusing on creating
structures that are resistant to wear and tear, easy to maintain, and capable of withstanding
extreme weather conditions. To achieve this, businesses must transition from traditional to
electronic maintenance procedures that use advanced technologies such as the Internet of
Things (IoT) to monitor and diagnose equipment problems in real time. By adopting new
Buildings 2023,13, 1629. https://doi.org/10.3390/buildings13071629 https://www.mdpi.com/journal/buildings
Buildings 2023,13, 1629 2 of 20
technologies and sustainable development practices, we can create an infrastructure that
is efficient, reliable, and eco-friendly, meeting the demands of today’s competitive global
marketplaces [1].
Maintenance is essential for the safe and efficient operation of healthcare building
facilities in Iraq. It helps to proactively identify and address potential issues, extend the
lifespan of facilities, and ensure compliance with regulatory and safety requirements. On
the other hand, maintenance and repair (M&R) encompass a vast array of operations and
are among the numerous construction processes with their unique tasks [
2
]. Controlling the
first phases of demolition and preventing the failure of building components requires M&R
techniques. Choosing appropriate solutions will allow for more efficient budget allocation
and limit building performance degradation over time. The comparison of maintenance
plans depends heavily on performance, minimum quality, service life, and the frequency of
maintenance activities [3].
During the life cycle of the building, including planning, design, calculation, exe-
cution, and operation, the owners or users of the building must also consider optimal
building maintenance; meanwhile, effective building use extends the building’s useful
life. In general, M&R comprises around 95% of a building’s life cycle, beginning with the
conception of its construction and continuing until its demise. The current purpose of
the maintenance department is to maintain the intended operational levels of machinery,
buildings, equipment and devices, buildings, and facilities [4].
Today, companies address the life cycle of their physical assets to better manage costs
and maximize asset value, and the physical asset management system is a successful
solution in three areas: optimal asset performance, cost reduction, and accident elimination.
The maintenance method plays a crucial part in the amount of building operating costs,
and by using the system and selecting a suitable maintenance method, large-scale repairs
are avoided, resulting in a significant reduction in excessive expenditures [
5
]. On the
other hand, in the absence of a proper maintenance system, structures and equipment
deteriorate, resulting in significant problems and costs for reconstruction, unanticipated
accidents, a decrease in the number of clients and their trust, and ultimately a decline in
the organization’s credibility [6].
Buildings are the most valuable national assets because they provide housing and
facilities for homes and workplaces. Nevertheless, the enhancement of the life cycle of
buildings necessitates implementing M&R procedures, which are essential for maintaining
a building’s value and quality [
7
]. In this vein, experts underline the importance of
selecting the most appropriate and most efficient maintenance method for public facilities,
which should be done by considering several factors, such as (1) the type of building
structure; (2) the number of buildings and sections; (3) the density and complexity of
mechanical installations; (4) the density and complexity of electrical installations; and
(5) the type of use and the nature of the facilities. Consequently, governments spend a
significant amount of money yearly on M&R projects, around 50% of the total revenue of
the architecture, engineering, construction/facility management (AEC/FM) industry. As
a result, researchers have become increasingly focused on determining the proper M&R
procedures that can minimize the M&R costs of buildings; this is because using an effective
M&R practice significantly reduces M&R expenses [8].
The M&R of buildings is a critical aspect of building management that can significantly
affect the lifespan and performance of buildings. In HBFs, M&R is even more crucial due
to the impact that it can have on patients’ health and safety. On the other hand, healthcare
building facilities (HBFs) require a higher level of M&R management than other types of
structures due to their nature of use and the requirement to provide a variety of healthcare
services continuously and efficiently. However, despite its importance, there is a lack of
comprehensive research on primary selection criteria for effective M&R methods. This issue
is particularly significant in developing countries such as Iraq, where building maintenance
management has not received enough attention. The existing regulations and standards in
Iraq only specify the inspection periods for various components based on their usage type
Buildings 2023,13, 1629 3 of 20
and do not address other critical issues. This gap highlights the need for more research
to identify the most important selection criteria for M&R approaches in Iraqi HBFs. The
current study addresses this existing gap by examining the criteria for selecting the optimal
M&R approach in HBFs in Iraq. The study will investigate the specific maintenance
needs of healthcare buildings, the factors that influence M&R decision-making, and the
most effective M&R approaches for HBFs in Iraq. The findings of this study are expected
to contribute significantly to the improvement of HBF maintenance and management
practices in Iraq. The results will provide a transparent and clear maintenance philosophy
for healthcare buildings, enabling more effective and efficient decision making regarding
M&R activities. The study’s outcomes will also have broader implications for building
management and maintenance practices in developing countries, emphasizing the need for
comprehensive research to support effective building maintenance management practices.
2. Building Maintenance and Repair Management in Healthcare Building Facilities
Companies are often operated under a significant amount of pressure to reduce spend-
ing on “non-core” tasks such as maintenance and operation as a direct result of increased
levels of competition in the business sector. This motivates building owners and users to
have higher standards and expectations for the facilities that they use. Facility managers
are therefore obliged to reduce operating costs and risks through the effective and efficient
design, construction, management, and maintenance of facilities without compromising
the operational performance of the facilities themselves. Facilities management (FM) has
undergone significant growth over the past three decades, primarily due to the five global
trends of development: (1) increased construction costs; (2) a greater recognition of the
effects of space on productivity; (3) increased performance requirements by both users and
owners; (4) contemporary bureaucratic and statutory restrictions; and (5) recognition of the
criticality of the facility’s operational performance. As a result, the traditional function of
“maintenance managers” has evolved into that of “facility managers”, and the practices
of FM have been enriched with methodical processes, especially those that are executed
with established key performance indicators. The facility manager ’s decisions regarding
the strategic and operational planning of the organization’s facilities can affect the orga-
nization’s overall business performance [
9
]. This is especially true for HBFs, which are
commonly regarded as being among the most complex and challenging types of facilities
to manage, maintain, and run.
Regarding the various aspects that impact healthcare facility management, the litera-
ture has much to say. Gallagher [
10
] cited the following six factors as those that promote the
successful adoption of healthcare FM: strategic planning, customer service, market testing,
benchmarking, environmental management, and staff development. Amaratunga et al. [
11
]
developed a model to evaluate the impact of organizational FM cultural processes on a
healthcare building facility. Allen [
12
] referred to an important issue and stated that due
to the use of less durable materials in some construction facilities, long-term maintenance
planning is essential.
Proper M&R management is an essential component of HBF management [
13
]. Build-
ing facility maintenance is an integrated strategy for operating, maintaining, enhancing,
and adapting the organization’s facilities and infrastructure to create an environment that
strongly supports the organization’s fundamental objectives. In this regard, a building
facility maintenance model has been developed by the International Building Maintenance
Association [
14
]. In the built environment, facility maintenance management is becoming
an increasingly important task, particularly for facilities and asset managers working in
hospitals, factories, schools, hotels, and other public buildings and services. Considering
the condition of the construction industry in both developed and developing nations, it
is obvious that the number of buildings and infrastructure facilities that require profes-
sional management and maintenance has increased to the same level of significance as new
construction projects [
15
]. In the meantime, building M&R management processes differ
depending on the types of construction projects [16].
Buildings 2023,13, 1629 4 of 20
According to previous studies, HBFs are underfunded and underresourced in some
developing countries [
17
,
18
]. This trend may negatively impact healthcare providers’ non-
core tasks and most significantly facility management, such as maintenance management.
Ritchie [
19
] stated that it is possible to improve the performance and quality of healthcare
services by focusing as much on the quality of the service as one does on financial concerns.
Because public buildings constitute a substantial portion of a nation’s real estate wealth,
it is necessary to conduct routine maintenance management on these structures to keep
them in adequate condition for usage. According to Shohet [
20
], condition-based mainte-
nance is a prevalent strategy for the maintenance of complex buildings in countries with
constrained economic resources. Specifically, he proposed two rating systems for assessing
the condition and planned M&R of buildings: one for individual elements and another for
the entire structure. The first scale considers the performance, physical condition, use, and
preventative maintenance of a variety of building components. The second scale examines
ten of the building’s key systems.
Shohet and Nobili [
21
] devised a performance-based contract for the maintenance of
public infrastructure by combining a KPI-based performance model, a contracting model,
and a procurement model. The application of their proposed model resulted in 20 to
40 percent improvement in the performance-cost effectiveness of maintenance. Its key
parameters are the development of a clearly defined procurement model, the incorpora-
tion of the performance model for both the owner and the contractor, and performance
control of the facilities. This framework, which is primarily based on a condition-based
maintenance approach that enables the control of desired maintenance performance levels
and costs [
22
], can generate even better results when paired with an enterprise resource
planning (ERP) system [
23
]. To strengthen the framework given by Shohet and Straub [
24
],
a more comprehensive collection of KPIs for measuring the performance of public build-
ings is required, and Lai and Man [
25
] provide a comprehensive list. Even without a
ranking, these researchers created a list of 71 factors categorized into five groups: (i) task-
and equipment-related, (ii) environmental, (iii) physical, (iv) health, safety, and legal, and
(v) financial.
According to Shafiee’s [
26
] review of M&R methods, there is always a variety of criteria
to consider when selecting the most appropriate M&R method: “Some of these criteria are
quantitative and measurable (such as hardware/software and training costs, equipment
reliability/availability), while others are qualitative and difficult to measure (such as safety,
flexibility, acceptance by laborers, product quality).” Shafiee [
26
] classified qualitative and
quantitative criteria as follows: economic, technical, social, and environmental. Notably,
these four groups are aligned with those of a recent review by Hauashdh et al. [27] on the
factors influencing M&R building in Malaysia. In this regard, Besiktepe et al. [
28
] attempted
to prioritize procurement selection criteria for building maintenance projects; the results
of the first study indicated that “Health and Safety” was the most important selection
criterion, whereas the most important selection criterion for the second study was “Price
Competition” among potential suppliers. However, the above study failed to account
for several crucial characteristics, including human resources, flexibility, and technical
capability, leaving the study incomplete. In addition, none of the studies that attempted
to prioritize the M&R technique (e.g., [
29
,
30
]) accounted for extremely constrained and
unequally distributed resources [
31
]. As revealed by Vanier et al. [
32
], selection of M&R
techniques is largely dependent on the weights assigned to elements by evaluators, which
vary based on culture and organizational necessity.
As previously mentioned, the M&R of buildings is a frequently neglected element
of the construction industry. However, maintenance management challenges must be
considered in the life cycle of a structure, especially in developing nations. In addition, it is
clear from the available information that the maintenance of government facilities (such as
health buildings) in Iraq is not in accordance with the proper maintenance management
systems [
33
]. Consequently, it is vital to create the main criteria for the selection of suitable
M&R approaches for HBFs in the developing nation of Iraq. This research examines the
Buildings 2023,13, 1629 5 of 20
essential criteria for selecting M&R approaches to gain insights into their applicability
in HBFs.
3. Research Methodology
This statement describes the methodology of a study that aims to identify the most
appropriate maintenance and repair (M&R) processes for healthcare building facilities
(HBFs) in Iraq. The study is conducted in a developing nation context, which means that
the researchers need to consider various factors specific to that context, such as resource
availability and infrastructure limitations. To achieve the objective of the study, the re-
searchers divided it into three independent steps. Figure 1provides a visual representation
of these sections. In the first and second steps, the most relevant criteria and indicators for
selecting M&R processes for HBFs were identified. To do this, a comprehensive review
of the existing scholarly literature on the subject was conducted. In the second step, two
rounds of the Delphi survey were carried out, which is a structured communication method
that aims to reach a consensus among experts on a particular topic. The Delphi survey
is particularly useful when confronting complex and uncertain issues. In this case, the
researchers used it to gather opinions from a panel of experts on M&R processes for HBFs
in Iraq. The Delphi survey allowed the researchers to identify the most relevant criteria
and indicators that experts deemed important for selecting M&R processes in this context.
Overall, the study provides guidance for decision makers in Iraq on how to select the
most appropriate M&R processes for HBFs. By identifying the most relevant criteria and
indicators for this purpose, the study can help ensure that HBFs are properly maintained
and repaired, which is essential for providing quality healthcare services. Eventually, in
the third step, the fuzzy analytic hierarchy process (FAHP) technique was used for the
prioritization of identified criteria.
Buildings 2023, 13, x FOR PEER REVIEW 5 of 20
M&R approaches for HBFs in the developing nation of Iraq. This research examines the
essential criteria for selecting M&R approaches to gain insights into their applicability in HBFs.
3. Research Methodology
This statement describes the methodology of a study that aims to identify the most
appropriate maintenance and repair (M&R) processes for healthcare building facilities
(HBFs) in Iraq. The study is conducted in a developing nation context, which means that
the researchers need to consider various factors specific to that context, such as resource
availability and infrastructure limitations. To achieve the objective of the study, the
researchers divided it into three independent steps. Figure 1 provides a visual
representation of these sections. In the first and second steps, the most relevant criteria
and indicators for selecting M&R processes for HBFs were identified. To do this, a
comprehensive review of the existing scholarly literature on the subject was conducted.
In the second step, two rounds of the Delphi survey were carried out, which is a structured
communication method that aims to reach a consensus among experts on a particular
topic. The Delphi survey is particularly useful when confronting complex and uncertain
issues. In this case, the researchers used it to gather opinions from a panel of experts on
M&R processes for HBFs in Iraq. The Delphi survey allowed the researchers to identify
the most relevant criteria and indicators that experts deemed important for selecting M&R
processes in this context. Overall, the study provides guidance for decision makers in Iraq
on how to select the most appropriate M&R processes for HBFs. By identifying the most
relevant criteria and indicators for this purpose, the study can help ensure that HBFs are
properly maintained and repaired, which is essential for providing quality healthcare
services. Eventually, in the third step, the fuzzy analytic hierarchy process (FAHP)
technique was used for the prioritization of identified criteria.
Figure 1. Research flow diagram used in this study.
Figure 1. Research flow diagram used in this study.
Buildings 2023,13, 1629 6 of 20
3.1. Review of Previous Related Studies
To identify a comprehensive set of selection criteria, previous literature was extensively
searched and reviewed. Although researchers use various search engine databases, Web of
Science, Scopus, and Google Scholar are currently the most widely used databases in the
world. However, the Scopus database has attempted to dominate the market for research
data [
34
]; hence, for this study’s literature search, the Scopus database was used. Several
related articles on construction maintenance management were analyzed to determine
relevant criteria for selecting effective M&R solutions. Previous research indicates that a
choice must be made between the benefits of the comprehensiveness of findings and the
accuracy of identified studies [
35
]. On the other hand, using research tools (e.g., SPIDER,
PICOS) is advantageous for review teams with severely limited resources or time as well as
for those who do not want to conduct a full search. In light of the significance of exhaus-
tiveness to this research, the search tools were not used preferentially [
36
]. Finally, a set of
selection criteria were identified that were considered as the basis for the questionnaire of
the first round of the Delphi survey. The 22 identified main criteria and their corresponding
sub-criteria are listed in Table 1. The identified criteria were grouped into the following six
categories: (1) reliability and flexibility, (2) facilities and technology, (3) human resources,
(4) safety, risk, and environment, (5) cost, and (6) quality.
Table 1. Evaluation of the main criteria and their corresponding sub-criteria.
Main Criteria (Symbol) Sub-Criteria (Symbol) Explanations Sources
Reliability/Flexibility (RF)
Using different M&R techniques (RF1) Ability to use different maintenance
management techniques [8,30,37]
Increasing credibility and satisfaction of
users (RF2)
Increasing credibility and satisfaction of
patients/users [8,38,39]
Increasing productivity capacity (RF3)
By using the selected M&R method, the
productivity and efficiency of the system
can be increased
[8,29,40]
Feasibility and ease of implementation (RF4)
The ease of understanding, use, and
execution of the selected M&R method
by the workforce
[30,37,39,41]
Facilities/Technology (FT)
Registration of information, as built, and technical
documents (FT1)
The ease of registration and use of
information and technical documents of
an M&R method
[8,37,38,41]
Intelligent control capability—BMS (FT2)
The ability to use intelligent control
tools and sensors in the selected
M&R method
[30,37,40]
Information integration—BIM (FT3)
Synchronization of the selected M&R
method with building information
modeling
[39,41,42]
Quick access to repair records (FT4) The ease of access and use of
information records related to M&R [8,37,38,40]
Quick access to equipment spare parts (FT5)
Coordination and integration with
procurement management systems for
quick access to equipment spare parts
[30,37,38]
Human Resources (HR)
Employing M&R expert human resources (HR1) The availability of skilled labor in the
field of the selected M&R method [8,30,37,40],
Employing workforces during project
construction (HR2)
The possibility of employing workforces
familiar with the selected M&R methods
in the pre-operation stages
[8,37,40]
M&R executive culture (HR3)
The compatibility and appropriateness
of the selected M&R method with the
working culture (e.g., teamwork) of the
organization’s human resources
[8,30,38,39]
Periodic monitoring of personnel in terms of
performance (HR4)
The necessity of periodic monitoring of
personnel in terms of performance [8,30]
Buildings 2023,13, 1629 7 of 20
Table 1. Cont.
Main Criteria (Symbol) Sub-Criteria (Symbol) Explanations Sources
Safety/Risk/Environment
(SRE)
Minimizing rework (SRE1) Having specific and clear procedures to
minimize rework [12,37,39]
Personnel safety (SRE2)
Reducing the safety risks related to
executive personnel applying the
selected M&R method
[37,38,40,41]
Recognizing failure at an early stage (SRE3)
The ability to detect failure in the early
stages by using different
tactics/techniques of net management
[8,30,39,40]
Cost (CO)
Optimization and cost reduction (CO1) Having justified costs in using the
M&R method [8,30,41]
Energy efficiency (CO2) Improving energy consumption using
the selected M&R method [8,30,37,38]
Quality (QU)
Improve performance and maintain high
quality (QU1)
Improving performance and quality by
achieving the lowest rate of failure [37,38,40,41]
Increasing the life of the equipment and
maintaining their initial quality (QU2)
Increasing the life of the equipment
using the selected M&R method [8,30,41]
Existing specific maintenance instructions (QU3)
The existence of instructions related to
the selected M&R method for facilitating
the implementation
[8,30,37,38]
Compliance and maintenance of technical
standards (QU4)
The technical standards of the
equipment must be observed. [8,30,41]
3.2. Delphi Survey Technique
Before implementing a decision-making process that considers several criteria, the
Delphi method is used to define the significance of criteria and eliminate less significant
criteria. The Delphi method is a technique for systematically gathering data to reach
conclusions about qualitative issues [
37
,
43
,
44
]. The primary objective of the Delphi method
is to obtain the most reliable collection of expert opinions through a series of structured
polls with regulated feedback. As a result, the Delphi survey technique was applied in
this study to establish and categorize the criteria [
45
], just as it has in previous studies [
46
].
For instance, using the Delphi method, Kuo and Chen [
43
] created performance appraisal
indicators for the mobility of the service industries. In another study, Sarvari et al. [
41
]
evaluated risk detection methodologies for public-private partnership (PPP) projects using
the Delphi method. Using this technique, which involves the assignment of a group of
specialists, researchers can identify and prioritize issues and provide a framework for
identifying them. A Delphi survey panel should include enough experts to provide a
diverse range of opinions while maintaining a manageable size for efficient communication
and analysis [42].
Several criteria have been used regarding selecting experts known as Delphi question-
naire respondents. The criteria depend on the specific research question and the characteris-
tics of the population being studied. In particular, in this case, experts were selected based
on their experience and knowledge of M&R processes for HBFs in Iraq. It is essential to note,
however, that the quality of the specialists is more significant than their quantity, which is
often between 15 and 50 [
42
]. The number of experts is determined by sample homogeneity,
the objective of the Delphi method, the difficulty range, the quality of the decision, the
expertise of the research team, internal and external validity, the amount of time required
to collect data, and the available resources [
43
]. In prior contributions of a similar sort,
data collection was conducted using the Delphi approach. The targeted snowball strategy
is a widely used method for selecting research specialists. It is the procedure through
which a qualified participant invites specialists who meet the study standards [
47
]. For this
study, experts who have awareness and knowledge of the construction industry (including
project managers, facilities managers, maintenance and repair contractors, construction
professionals, and university professors) were invited. Typically, snowball sampling is a
Buildings 2023,13, 1629 8 of 20
steady process that continues until data are collected [
48
]. Accordingly, two experts were
selected, and after data collection, they were tasked with recommending further specialists.
When the factors became saturated, the outreach specialists were terminated. Therefore,
when no new factors were discovered during data collection, the data were considered
saturated [49].
During the Delphi survey study, a questionnaire with two sections was distributed
among experts. Section A was related to demographic information. In section B, the
panel memvbers were asked to indicate the extent of their agreement with each identified
criterion based on the five-point Likert scale of measurement. In addition to rating the
criteria, the panel members were also allowed to add new criteria that they thought could
affect the selection of appropriate M&R processes for HBFs. This is a common practice in
the Delphi survey technique, as it allows experts to provide input and feedback that may
not have been considered in the initial questionnaire.
Feedback from the panel members was essential to refine and improve the criteria
used in the study. After collecting, analyzing, and averaging the replies of the first round
of panelists, it became clear that one of the questionnaire items (Periodic monitoring of
personnel in terms of performance (HR4)) had not been approved by experts, and this
criterion needed to be eliminated from the survey. During the second round of the Delphi
survey, panelists were handed a questionnaire containing 21 sub-criteria divided into six
groups. Panelists were asked to comment not only on whether they accepted the criteria
but also on which category they considered each criterion to fall under. All 21 of the criteria
specified in the questionnaire were confirmed by the panel members according to the
findings of this round. After collecting and analyzing the panelists’ opinions, it became
evident that they were all in accord with the specified criteria and the classes allocated
to them.
Validity and Reliability of the Questionnaire
In addition, the validity and dependability of the questionnaire were examined. Since
it is possible to add or remove criteria and sub-criteria during the rounds of the Delphi
survey technique, it is essential to evaluate the questionnaire’s validity and reliability in
the closing round of the Delphi survey [
50
]. The validity of a measuring questionnaire
relates to whether the method or questionnaire employed to assess a construct accurately
measures the desired attribute. Therefore, validity is the degree to which the conceptual
and practical meanings of a variable or construct agree [51].
In this research, the questionnaire content validity was evaluated. The methods
proposed by Lawshe [
52
] were used to determine content validity. The recommended
method of Lawshe [
52
] states that a minimum of four members is required. In addition, the
minimum validity coefficient for acceptable validity analysis is 0.60. In addition, at least
eight individuals can satisfy this requirement [
53
]. In this study, ten experts participated in
the validation of the questionnaire.
Lawshe [
52
] proposed the content validity ratio (CVR) metric in 1975. Using the
three-part Likert scale “item is necessary”, “item is useful but not necessary”, and “item
is not necessary”, the experts decide the significance of each question by analyzing the
questionnaire. The CVR is then determined based on Equation (1):
CVR =ne−N
2
N
2
, (1)
where Nis the total number of experts and nis the number of experts that selected the
required option [
54
]. The lowest admissible value for the CVR with 10 experts is 0.62, based
on the number of experts that examined the questions [
53
]. In addition, to identify the
hidden elements (criteria) for each answer to the question, “Is the grouping appropriate?”
it was included in the questionnaire so that the specialists could voice their views or make
rectification suggestions.
Buildings 2023,13, 1629 9 of 20
In addition, Waltz and Bausell’s approach is used to determine the content validity
index (CVI). The “importance”, “clarity”, and “simplicity” of each topic are determined by
experts using a four-point Likert scale. The CVI is computed using Equation (2).
CVI =The number of experts who rated the item 3 and 4
Total number of specialists (2)
The minimum permissible value for the CVI is 0.79, and if an item’s CVI is less than
0.79, it must be eliminated [
55
]. All test item scores for content validity were reviewed
and confirmed.
In addition, using Cronbach’s alpha approach, SPSS software was used to evaluate the
test reliability. Cronbach established the alpha coefficient statistical approach to determine
the reliability of multiple-question exams at Stanford University in 1951. This is the most
prevalent internal consistency reliability coefficient employed in most studies, and it shows
the suitability of a group of items for measuring a construct. Cronbach’s alpha must be at
least 0.7 or more for a question to remain in the questionnaire [
56
]. The results demonstrate
that Cronbach’s alpha for all items is equal to 0.952, confirming the reliability.
3.3. Fuzzy Analytic Hierarchy Process (FAHP) Technique
The development of computational and mathematical tools to support decision-makers
in their subjective evaluation of several performance criteria is the focus of the operations
research area known as multi-criteria decision-making (MCDM) [
57
]. In recent years,
numerous studies have used MCDM tools such as the analytic network process (ANP),
the analytic hierarchy process (AHP), and the fuzzy analytic hierarchy process (FAHP), as
well as applications, to solve area problems such as determining the criteria for making
an appropriate decision. These studies have been undertaken in numerous disciplines,
including business, science, and engineering. It is feasible to apply the analytic hierarchy
process (AHP), an efficient method for solving problems involving the use of many factors
in decision making, to the problem of M&R maintenance to gain a scientific and objective
perspective of the maintenance schedule [58–60].
It is usually difficult for the maintenance managers/engineers to choose an M&R
strategy suitable for a particular machine or a group of units. This challenge in decision
making poses a conundrum that must be resolved. It is feasible to find a solution to this
issue by employing decision-making approaches such as AHP. The AHP technique also
makes it easy to quantify the relative importance of each element, which provides decision
makers with a clearer picture of any gaps between the actual and desired conditions. A
recent study conducted by Chandrahas [
61
] indicates that a decision-making technique
known as the analytical hierarchy process (AHP) can be applied to solve the problem of
determining the optimal machine maintenance plan.
When decision makers are uncertain about how to respond to a survey result, the
AHP is incapable of dispelling any ambiguity that may arise. FAHP, on the other hand, can
account for this when comparing pairs [
62
,
63
]. In reality, fuzzy sets are more compatible
with ambiguous explanations and human language, and fuzzy numbers appear to be an
effective decision-making technique [45]. Dabiri et al. [64] demonstrated that by applying
the FAHP approach to group decisions, the fogginess associated with the common under-
standing of expert viewpoints could be dispelled. Consequently, this method is suited
for analyzing the influence of a phenomenon or concepts influencing features on a more
flexible scale. In this study, FAHP was also used to prioritize M&R’s selection techniques
for HBFs. This strategy employs pairwise comparisons established by the opinions of
industry professionals.
In this study, the criteria were evaluated using Chang’s FAHP method, and the re-
sults were ranked. The likelihood of each criterion is considered in Chang’s extension
analysis [
63
,
65
], which is used for FAHP. The relevant triangular fuzzy values (Table 2)
for the linguistic variables are placed on the inquiry form based on the responses, and a
pairwise comparison matrix is constructed for a specific level on the hierarchy. Following
Buildings 2023,13, 1629 10 of 20
the computation of subtotals for each row of the matrix, a new set of
(l,m,u)
values is
generated.
li/∑li
,
mi/∑mi
,
ui/∑ui
,
(i=1, 2, . . . , n)
values are determined and utilized as
the most recent
Mi(li,mi,ui)
values to determine the overall triangular fuzzy values for
each criterion. This is done so that the overall triangular fuzzy values may be calculated.
After that, membership functions are constructed for each criterion, and intersections are
found by comparing each pair of criteria individually. In fuzzy logic, the crossing point
is determined for each comparison, which is then followed by the membership values of
the point that correlate with its weight. This membership value can also be viewed as the
probability that the value will be used. Before the normalization process, the weight of a
criterion is determined by the minimal degree of the probability of situations in which the
value is greater than the others. This minimal degree of probability is associated with a
particular criterion. Following the collection of non-core activities performed by healthcare
professionals, the ultimate importance degrees or weights for each level of the hierarchy
are calculated.
Table 2. Fuzzy nine-point scale for valuating indicators [45].
Definitive Equivalent Linguistic Variable Triangular Fuzzy Number
1 So trivial (1,1,1)
2 So trivial to trivial (1,2,3)
3 Trivial (2,3,4)
4 Trivial to mediocrity (3,4,5)
5 Mediocrity (4,5,6)
6 Mediocrity to important (5,6,7)
7 Important (6,7,8)
8 Important to very important (7,8,9)
9 Very important (8,9,9)
In order to apply the technique that is based on this hierarchy, according to the
approach known as the extent analysis, each criterion is taken, and an extent analysis is
carried out for each criterion individually. Therefore,
m
extent analysis values for each
criterion can be obtained using the following notation:
M1
gi
,
M2
gi
,
. . .
,
Mm
gi
; where
gi
is
the goal set
(i=1, 2, . . . , n)
, and all the
Mj
gi(j=1, 2, . . . , m)
are triangular fuzzy numbers
(TFNs). The steps of Chang’s analysis are as follows [66]:
Step 1: The fuzzy synthetic extent value (
Si
) with respect to the
ith
criterion as follows:
This involves
Si=
m
∑
j=1
Mj
gi ⊗"n
∑
i=1
m
∑
j=1
Mj
gi#−1
(3)
1. Computation of
m
∑
j=1
Mj
gi (4)
Perform the “fuzzy addition operation” of m extent analysis values for a particular
matrix given in Equation (5) below. At the end step of the calculation, a new
(l,m,u)
set is
obtained and used for the next:
m
∑
j=1
Mj
gi = (
m
∑
j=1
lj,
m
∑
j=1
mj,
m
∑
j=1
uj)(5)
where
l
is the lower limit value,
m
is the most promising value, and
u
is the upper limit
value, and to obtain (6):
2. Computation of
"n
∑
i=1
m
∑
j=1
Mj
gi#−1
(6)
Buildings 2023,13, 1629 11 of 20
Perform the “fuzzy addition operation” of Mj
gi (j=1, 2, . . . , m)values given
n
∑
i=1
m
∑
j=1
Mj
gi = (
m
∑
j=1
li,
m
∑
j=1
mi,
m
∑
j=1
i)(7)
Then compute the inverse of the vector in Equation (7). Equation (8) is then obtained,
such that
"n
∑
i=1
m
∑
j=1
Mj
gi#−1
=
1
n
∑
i=1
ui
,1
n
∑
i=1
mi
,1
n
∑
i=1
li
(8)
Step 2: The degree of possibility of
M2=(l2,m2,u2)≥M1=(l1,m1,u1)
is defined in
Equation (9):
V(M2≥M1)=sup[min (uM1(x), min (uM2(y)) ] (9)
and
x
and
y
are the values on the axis of the membership function of each criterion. This
expression can be equivalently written as given in Equation (10) below:
V(M2≥M1)=
1, i f m2≥m1,
0, i f m2≥m1,
l1−u2
(m2−u2)−(m1−l1)otherwise
(10)
where
d
is the highest intersection point
(uM1and uM2)
(see Figure 2). To compare
M1
and
M2, we need both the values of V(M2≥M1)and V(M1≥M2).
Buildings 2023, 13, x FOR PEER REVIEW 11 of 20
Step 2: The degree of possibility of 𝑀=(𝑙,𝑚,𝑢)≥ 𝑀=(𝑙,𝑚,𝑢) is defined in
Equation (9): 𝑉(𝑀≥𝑀)=𝑠𝑢𝑝min (𝑢(𝑥),min (𝑢(𝑦)) (9)
and 𝑥 and 𝑦 are the values on the axis of the membership function of each criterion. This
expression can be equivalently wrien as given in Equation (10) below:
𝑉(𝑀≥𝑀)=⎩
⎨
⎧
1, 𝑖𝑓 𝑚≥𝑚,
0, 𝑖𝑓 𝑚≥𝑚,
𝑙−𝑢
(𝑚−𝑢)−(𝑚−𝑙)𝑜𝑡ℎ𝑒𝑟𝑤𝑖𝑠𝑒 (10)
where 𝑑 is the highest intersection point (𝑢 𝑎𝑛𝑑 𝑢) (see Figure 2). To compare 𝑀
and 𝑀, we need both the values of 𝑉(𝑀≥𝑀) and 𝑉(𝑀≥𝑀).
Figure 2. The Distance of Two Triangular Fuzzy Numbers [45].
Step 3: The degree possibility for a convex fuzzy number to be greater than k convex
fuzzy numbers 𝑀(𝑗=1,2,…,𝑘) can be defined by
𝑉(𝑀≥𝑀,𝑀,…,𝑀)=𝑉(𝑀≥𝑀) 𝑎𝑛𝑑 (𝑀≥𝑀), … , 𝑎𝑛𝑑 (𝑀≥𝑀)
=min𝑉(𝑀≥𝑀),𝑖= 1,2,…,𝑘
Assume that Equation (11) is 𝑑(
𝐴
)=min𝑉(𝑆≥𝑆) (11)
for 𝑘=1,2,…,𝑛;𝑘≠𝑖. Then, the weight vector is given by Equation (12):
𝑊=(𝑑(
𝐴
),𝑑(
𝐴
),…,𝑑(
𝐴
)) (12)
where 𝐴(𝑖=1,2,…,𝑛) are 𝑛 elements.
Step 4: Via normalization, the normalized weight vectors are given in Equation (13):
𝑊=(𝑑(
𝐴
),𝑑(
𝐴
),…,𝑑(
𝐴
)) (13)
where W represents nonfuzzy numbers. After the criteria have been identified according
to Figure 1, a questionnaire has been developed to determine the relative weight of these
criteria. To evaluate the questions, respondents merely select the relevant linguistic
variable, which is then converted into the following scale, which includes triangular fuzzy
numbers, and generalized for such analyses as shown in Table 2 [48]. The questionnaire,
including pairwise comparisons, was finally emailed to a total of 20 industry experts. This
sample size is comparable to that used in the study by Tamosaitiene et al. [8]. A month
was required to complete the distribution and collection of survey materials.
Figure 2. The Distance of Two Triangular Fuzzy Numbers [45].
Step 3: The degree possibility for a convex fuzzy number to be greater than k convex
fuzzy numbers Mi(j=1, 2, . . . , k)can be defined by
V(M≥M1,M2, . . . , Mk)=V[( M≥M1)and (M≥M2), . . . , and (M≥Mk)]
=minV(M≥MI),i=1, 2, . . . , k
Assume that Equation (11) is
d(Ai)=minV(Si≥Sk)(11)
for k=1, 2, . . . , n;k6=i. Then, the weight vector is given by Equation (12):
Wi=(d(A1),d(A2), . . . , d(An))T(12)
where Ai(i=1, 2, . . . , n)are nelements.
Step 4: Via normalization, the normalized weight vectors are given in Equation (13):
W=(d(A1),d(A2), . . . , d(An))T(13)
where Wrepresents nonfuzzy numbers. After the criteria have been identified according
to Figure 1, a questionnaire has been developed to determine the relative weight of these
Buildings 2023,13, 1629 12 of 20
criteria. To evaluate the questions, respondents merely select the relevant linguistic variable,
which is then converted into the following scale, which includes triangular fuzzy numbers,
and generalized for such analyses as shown in Table 2[
48
]. The questionnaire, including
pairwise comparisons, was finally emailed to a total of 20 industry experts. This sample size
is comparable to that used in the study by Tamosaitiene et al. [
8
]. A month was required to
complete the distribution and collection of survey materials.
4. Presentation of Analytical Results
The results of the evaluation of the data acquired from the Delphi survey using the
FAHP method were then used to rank the criteria and sub-criteria. In the same vein,
a questionnaire regarding paired comparisons was delivered to a total of 20 specialists.
Table 3presents the demographic information of the study participants.
Table 3. Description of respondents to the questionnaire of the study.
Characteristics Frequency (%)
Area of Expertise
Mechanical engineering 9 (45)
Computer engineering 1 (5)
Civil engineering 5 (25)
Academia/Research 1 (5)
Surveying engineering 1 (5)
Architecture 1 (5)
Project management 1 (5)
Medical engineering 1 (5)
Total 20 (100)
Level of Education
Ph.D. degree 1 (5)
Master’s degree 3 (15)
Bachelor’s degree 15 (75)
Diploma 1 (5)
Total 20 (100)
Working Experience in
Construction
≤5 years 0 (0)
6–10 years 5 (25)
11–15 years 8 (40)
16–20 years 4 (20)
≥20 years 3 (15)
Total 20 (100)
Working Experience in
Maintenance
≤5 years 0 (0)
6–10 years 11 (55)
11–15 years 6 (30)
16–20 years 1 (5)
≥20 years 2 (10)
Total 20 (100)
Oorganization Type
Public 14 (70)
Private (individual) 4 (20)
Private (organization) 2 (10)
Total 20 (100)
After receiving the opinions of the experts through the completion of the paired
comparison questionnaire, the geometric mean approach was used to calculate the average
and generate a merged pairwise comparison matrix. The integration of fuzzy matrices
takes the first terms of all comparisons as the geometric mean, the second terms as a group,
and the third terms as the geometric mean. The pairwise comparisons are depicted in
Table 4. Then, each row’s fuzzy numbers are combined (see Table 4).
Buildings 2023,13, 1629 13 of 20
Table 4. The integrated fuzzy comparison matrix for the main criteria.
QU CO HR RF SRE FT
QU
1.000 1.000 1.000 0.955 1.264 1.712 0.624 0.830 1.141 1.377 1.766 2.257 0.793 1.062 1.426 1.119 1.469 1.907
CO
0.584 0.791 1.047 1.000 1.000 1.000 0.781 1.019 1.321 0.989 1.270 1.664 1.394 1.871 2.499 1.683 2.270 2.996
HR
0.876 1.204 1.603 0.757 0.981 1.280 1.000 1.000 1.000 1.078 1.467 1.961 1.056 1.481 2.050 1.249 1.785 2.424
RF
0.443 0.566 0.726 0.601 0.787 1.012 0.510 0.682 0.928 1.000 1.000 1.000 1.531 2.071 2.715 0.785 1.050 1.443
SRE
0.701 0.942 1.261 0.400 0.534 0.717 0.488 0.675 0.947 0.400 0.527 0.716 1.000 1.000 1.000 1.596 2.035 2.627
FT
0.524 0.681 0.894 0.334 0.440 0.594 0.413 0.560 0.801 0.693 0.952 1.275 0.381 0.491 0.627 1.000 1.000 1.000
In the subsequent phase, all the numbers from the previous step are added together,
and then the process is reversed. In this stage, all fuzzy numbers will be combined and
then subtracted. According to Table 4, this inverse is then multiplied by each row of the
initial step (each row’s total) to yield the normalized integration values of each row. Each
line should now be compared to the ones beneath it. For each line to be compared to itself,
number one is assigned. Table 5shows the degree of preference for Siover Sk. The final
weights are then derived from the preceding phase. The final weight of each criterion is
equal to the minimum value in each column, also known as priority (see Table 5). Each
raw weight was divided by the total raw weight to determine the normalized weight.
The final column in Table 5displays the normalization of preferences, also known as the
final ranking.
Table 5. Fuzzy sum, fuzzy expansion, and the degree of preference for the main criteria.
Fuzzy Sum of Each
Row
Fuzzy Compound
Expansion Degree of Preference of Siover SkDegree of
Preference
Normalization
of Preferences
QU 5.868 7.391 9.442 0.116 0.187 0.303 0.893 0.933 1.000 1.000 1.000 0.893 0.2001
CO 6.431 8.223
10.526
0.127 0.208 0.338 1.000 1.000 1.000 1.000 1.000 1.000 0.2240
HR 6.017 7.919
10.318
0.119 0.200 0.332 1.000 0.964 1.000 1.000 1.000 0.964 0.2159
RF 4.869 6.156 7.824 0.096 0.156 0.251 0.813 0.704 0.748 1.000 1.000 0.704 0.1577
SRE 4.585 5.713 7.268 0.091 0.145 0.234 0.735 0.626 0.672 0.924 1.000 0.626 0.1403
FT 3.344 4.125 5.190 0.066 0.104 0.167 0.380 0.277 0.332 0.578 0.655 0.277 0.0619
In addition, it was important to examine the rate of comparison discrepancy. If the
incidence of discrepancy is less than 0.1%, the comparability is acceptable. The rate of
discrepancy was examined and certified as meeting the criteria.
Figure 3depicts the order of the criteria. In terms of relevance, the “Cost” criterion
0.2240 ranked first (0.2240), followed by the “Human Resources” criterion (0.2159), and
then by the “Quality” criterion (0.2240). (0.2001). Additionally, “Reliability/Flexibility”,
“Safety/Risk/Environment”, and “Facilities/Technologization” were ranked fourth, fifth,
and sixth, respectively.
The consistency ratio (CR) is calculated by dividing the consistency index (CI) by the
random index (RI). If the result is less than 0.1, the matrix is consistent and can be used to
evaluate data. If both the CRm and CRg indices are greater than 0.1, the decision maker is
encouraged to reevaluate the prioritization. The fuzzy matrix is compatible if both indices
are less than 0.1; it is incompatible if both indices are more than 0.1. The median (or border)
of the fuzzy verdicts needs to be adjusted by the decision-maker if the CRm (or CRg) is
the only one that is greater than 0.1 [
67
,
68
]. According to the criteria, both of these indices
have values lower than 0.1 (CRm = 0.032051 and CRg = 0.09903), which is the upper limit
for acceptable values.
Buildings 2023,13, 1629 14 of 20
Buildings 2023, 13, x FOR PEER REVIEW 14 of 20
Figure 3. The ranking of the main criteria using the FAHP method.
Using the FAHP approach, the relative importance of sub-criteria within each
category was determined. Table 6 displays the results and weights associated with the
sub-criteria. According to Figure 4, sub-criteria RF2 and RF3 rated first and second,
respectively, in terms of importance for the RF group. Moreover, RF1 and RF4 were
ranked third and fourth, respectively. FT1 sub-criteria rated first, FT5 sub-criteria ranked
second, and FT4, FT3, and FT2 sub-criteria placed third through fifth for the FT group,
respectively. In terms of relevance, sub-criteria HR1 and HR2 ranked first and second in
the HR group, respectively, while sub-criteria HR3 ranked third. The ranking of the group
of SRE criteria revealed that the SRE3 sub-criteria rated highest, followed by the SRE1 and
SRE2 sub-criteria, in that order. The CO1 and CO2 sub-criteria were also placed first and
second for the CO group. The ranking of the QU group reveals that sub-criteria QU2 and
QU4 ranked first and second, respectively, followed by sub-criteria QU1 and QU3 in third
and fourth ranks, respectively. Figure 4 depicts the overall ranking of the criteria and sub-
criteria. In a comparison of all sub-criteria, the CO1 sub-criteria ranked highest, while the
FT2 sub-criteria ranked lowest.
The sub-criteria were evaluated similarly to the primary criteria. For the sub-criteria,
the integration of pairwise comparisons, fuzzy sum, fuzzy expansion, the degree of the
preference of Si. over Sk., the degree of preference, and the normalization of preferences
for comparisons were calculated. In addition, the consistency ratio for the sub-criteria was
examined and confirmed (see Table 6).
Table 6. Determination of the final priority of main criteria and sub-criteria using the FAHP
technique.
Main Criteria CRm CRg Weight
Sub-
Criteria Weight
Rank
within the
Category
Final
Weight
Overall
Rank
Reliability/Flexibility
(RF) 0.02146 0.05725 0.1577
RF1 0.241 3 0.038 13
RF2 0.266 1 0.042 11
RF3 0.263 2 0.041 12
RF4 0.230 4 0.036 15
Facilities/Technology
(FT) 0.00840 0.02575 0.0619
FT1 0.235 1 0.015 17
FT2 0.136 5 0.008 21
FT3 0.200 4 0.012 20
0.158
0.062
0.216
0.14
0.224 0.22
0
0.05
0.1
0.15
0.2
0.25
RF QT HR SRE CO QU
Figure 3. The ranking of the main criteria using the FAHP method.
Using the FAHP approach, the relative importance of sub-criteria within each category
was determined. Table 6displays the results and weights associated with the sub-criteria.
According to Figure 4, sub-criteria RF2 and RF3 rated first and second, respectively, in terms
of importance for the RF group. Moreover, RF1 and RF4 were ranked third and fourth,
respectively. FT1 sub-criteria rated first, FT5 sub-criteria ranked second, and FT4, FT3,
and FT2 sub-criteria placed third through fifth for the FT group, respectively. In terms of
relevance, sub-criteria HR1 and HR2 ranked first and second in the HR group, respectively,
while sub-criteria HR3 ranked third. The ranking of the group of SRE criteria revealed that
the SRE3 sub-criteria rated highest, followed by the SRE1 and SRE2 sub-criteria, in that
order. The CO1 and CO2 sub-criteria were also placed first and second for the CO group.
The ranking of the QU group reveals that sub-criteria QU2 and QU4 ranked first and second,
respectively, followed by sub-criteria QU1 and QU3 in third and fourth ranks, respectively.
Figure 4depicts the overall ranking of the criteria and sub-criteria. In a comparison of all
sub-criteria, the CO1 sub-criteria ranked highest, while the FT2 sub-criteria ranked lowest.
Table 6.
Determination of the final priority of main criteria and sub-criteria using the FAHP technique.
Main Criteria CRmCRgWeight Sub-Criteria Weight Rank within
the Category
Final
Weight
Overall
Rank
Reliability/Flexibility (RF) 0.02146 0.05725 0.1577
RF1 0.241 3 0.038 13
RF2 0.266 1 0.042 11
RF3 0.263 2 0.041 12
RF4 0.230 4 0.036 15
Facilities/Technology
(FT) 0.00840 0.02575 0.0619
FT1 0.235 1 0.015 17
FT2 0.136 5 0.008 21
FT3 0.200 4 0.012 20
FT4 0.204 3 0.013 19
FT5 0.224 2 0.014 18
Human Resources
(HR) 0.00138 0.00358 0.2159
HR1 0.398 1 0.086 3
HR2 0.302 2 0.065 5
HR3 0.300 3 0.065 6
Safety/Risk/Environment
(SRE) 0.00145 0.00451 0.1403
SRE1 0.350 2 0.049 9
SRE2 0.259 3 0.036 14
SRE3 0.391 1 0.055 8
Cost
(CO) Not applicable Not
applicable 0.2240 CO1 0.564 1 0.126 1
CO2 0.436 2 0.098 2
Quality
(QU) 0.03338 0.09792 0.2001
QU1 0.226 3 0.045 10
QU2 0.364 1 0.073 4
QU3 0.100 4 0.020 16
QU4 0.311 2 0.062 7
Buildings 2023,13, 1629 15 of 20
Buildings 2023, 13, x FOR PEER REVIEW 15 of 20
FT4 0.204 3 0.013 19
FT5 0.224 2 0.014 18
Human Resources
(HR) 0.00138 0.00358 0.2159
HR1 0.398 1 0.086 3
HR2 0.302 2 0.065 5
HR3 0.300 3 0.065 6
Safety/Risk/Environment
(SRE) 0.00145 0.00451 0.1403
SRE1 0.350 2 0.049 9
SRE2 0.259 3 0.036 14
SRE3 0.391 1 0.055 8
Cost
(CO)
Not
applicable
Not
applicable 0.2240 CO1 0.564 1 0.126 1
CO2 0.436 2 0.098 2
Quality
(QU) 0.03338 0.09792 0.2001
QU1 0.226 3 0.045 10
QU2 0.364 1 0.073 4
QU3 0.100 4 0.020 16
QU4 0.311 2 0.062 7
Figure 4. The ranking of the sub-criteria using the FAHP method.
5. Discussion of Analytical Results
Both industrialized and developing nations yearly contribute billions of dollars to the
development of the construction industry. This budget includes cash for maintenance and
repair efforts. M&R has therefore always been necessary and will continue to be so in the
future. Despite recognizing the importance of maintenance, the industry is experiencing
escalating maintenance costs. However, the budgeted amount influences the quality of
maintenance tasks. For a building’s maintenance procedures to be effective and to
maintain an acceptable quality level, sufficient manpower and financial resources are
necessary [69]. In order to obtain the intended results, maintenance stakeholders such as
building managers, building owners, and clients must make informed decisions regarding
acceptable and optimal M&R practices and prioritize the allocation of maintenance
resources.
Existing structures require various decision-making M&R technique consideration
factors. HBFs demand a larger degree of M&R management than other buildings due to
the nature of their usage and the obligation to provide various health services around the
0.23
0.266 0.263 0.241 0.224 0.235
0.2 0.204
0.136
0.3
0.398
0.302
0.391
0.35
0.259
0.564
0.436
0.364
0.226
0.1
0.311
0.036 0.042 0.041 0.038
0.014 0.015 0.012 0.013 0.008
0.065
0.086
0.065
0.055 0.049
0.036
0.126
0.098
0.073
0.045
0.02
0.062
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0
0.1
0.2
0.3
0.4
0.5
0.6
RF4 RF2 RF3 RF1 QT5 QT1 QT3 QT4 QT2 HR3 HR1 HR2 SRE3 SRE1 SRE2 CO1 CO2 QU2 QU1 QU3 QU4
Rank within the group Overall rank
Figure 4. The ranking of the sub-criteria using the FAHP method.
The sub-criteria were evaluated similarly to the primary criteria. For the sub-criteria,
the integration of pairwise comparisons, fuzzy sum, fuzzy expansion, the degree of the
preference of Si. over Sk., the degree of preference, and the normalization of preferences
for comparisons were calculated. In addition, the consistency ratio for the sub-criteria was
examined and confirmed (see Table 6).
5. Discussion of Analytical Results
Both industrialized and developing nations yearly contribute billions of dollars to the
development of the construction industry. This budget includes cash for maintenance and
repair efforts. M&R has therefore always been necessary and will continue to be so in the
future. Despite recognizing the importance of maintenance, the industry is experiencing
escalating maintenance costs. However, the budgeted amount influences the quality of
maintenance tasks. For a building’s maintenance procedures to be effective and to maintain
an acceptable quality level, sufficient manpower and financial resources are necessary [
69
].
In order to obtain the intended results, maintenance stakeholders such as building man-
agers, building owners, and clients must make informed decisions regarding acceptable
and optimal M&R practices and prioritize the allocation of maintenance resources.
Existing structures require various decision-making M&R technique consideration
factors. HBFs demand a larger degree of M&R management than other buildings due
to the nature of their usage and the obligation to provide various health services around
the clock. The distribution of resources to healthcare services is underinvested in many
countries, and this tendency may have a detrimental influence on the noncore activities
of healthcare providers, particularly maintenance and operations connected to facilities
management. Therefore, it is essential to determine the best M&R approach for HBFs. The
outcomes of this study indicate that cost, human resources, quality, reliability/flexibility,
safety/risk/environment, and facilities/technology are among the variables that must be
addressed while choosing the right methods for Iraqi HBFs. When we consider that the
market for building maintenance management lacks information on how to handle common
building problems, these results are important [
70
]. Developing and implementing a proper
building maintenance program reduces the frequency and severity of breakdowns and
facilitates their repair.
According to the presented results, the main criteria for selecting M&R methods are
as follows: CO, HR, QU, RF, SRE, and FT. In this regard, Lam et al. [
71
] found that safety
and cost were the most important considerations in M&R evaluations. The rating of the
current study is partially consistent with what they discovered after analyzing the results
of 110 M&R management firms in Hong Kong.
Buildings 2023,13, 1629 16 of 20
In contrast, the results of the current investigation are roughly consistent with the
classification offered by Shafiee [
26
]. This holds true when examining the classification.
While this scholar proposed dividing M&R evaluation criteria into (i) economic, (ii) techni-
cal, (iii) social, and (iv) environmental, this work proposes dividing them into six groups.
A comparison of the two classifications demonstrates a relationship between the two
economic and technical terms; the environmental theme of Shafiee [
26
] is present in the
SRE classification, while the social theme can be considered part of the HR variable. The
classification in the current study, in contrast to Shafiee [
26
], concentrates on the internal
components of an organization that might perform M&R operations. In actuality, while the
proposed classification appears exhaustive of all internal aspects of the organization but
not of any external ones, Shafiee’s [
26
] categorization appears to include a portion of both
internal and external elements without being exhaustive of either.
As shown in Table 7, even though the cost criterion is one of the most significant criteria
in most countries, comparing the prioritization of the main criteria between developed and
developing countries reveals several disparities. For example, contrary to the results of
the current study, the findings of the study conducted by Besiktepe et al. [
72
] advocated
that “Health and Safety”, “Code Compliance”, and “Condition” generate a larger impact
in industrialized nations when picking M&R ways (i.e., U.K.). While in this study, it has
been determined that CO is the most important criterion, Sodangi et al. [
73
] discovered that
the most important criterion in Malaysia was maintenance staff training and expertise—
equivalent to the HR category of this work; however, this result contradicts the one by
Chua et al. [
74
], who identified “price competition” as the most important criterion for
the procurement of M&R in Malaysia. Ali [
75
] discovered in Malaysia that the important
factors that building managers consider when distributing maintenance costs are funding
availability, customer demand, and economic conditions. Amani et al. [
76
] acknowledged
the maintenance cost as the main criterion for selecting M&R techniques for wastewater
system maintenance in Iran.
Table 7.
A comparison of the most important criteria for selecting M&R techniques between devel-
oped and developing countries.
Main Selection
Criteria
Developed Countries Developing Countries
United Kingdom
[72]Hong Kong [71] Malaysia [73–75] Iran [8,26,76]Iraq [Current
Study]
Reliability/Flexibility
Buildings 2023, 13, x FOR PEER REVIEW 17 of 20
Table 7. A comparison of the most important criteria for selecting M&R techniques between
developed and developing countries.
Main Selection Criteria
Developed Countries Developing Countries
United Kingdom [72] Hong Kong [71] Malaysia [73–
75]
Iran
[8,26,76] Iraq [Current Study]
Reliability/Flexibility
Facilities/Technology
Human Resources
Safety/Risk/Environment
Cost
Quality
6. Conclusions and Implications of the Study
This study aimed to identify and rank the evaluation criteria for HBFs to establish
suitable M&R processes that can satisfy overlapping requirements. A total of 21 essential
criteria were selected, categorized into six categories, and ranked using the FAHP
technique. Cost, human resources, quality, reliability/flexibility, safety/risk/environment,
and facilities/technology were placed first to sixth, respectively. The results revealed that
optimization and cost reduction (CO), increasing the life of the equipment, and
maintaining their initial quality (QU2) are the most to the least important sub-criteria for
M&R operations of HBFs in Iraq.
In terms of practical ramifications, this study aempts to inform M&R decision-
makers of the following: First, managers responsible for M&R method selections should
examine the expenses associated with M&R techniques since the initial building
development analysis. The evaluation of these costs must adhere to the principles of
sustainable development and account for the energy embodied in the materials and
construction as well as initial and continuing maintenance. To accomplish this, numerous
budgeting approaches for M&R operations have been developed; they can be classified as
(1) plant value methodologies; (2) other formula-based methodologies; (3) life-cycle cost
methodologies; and (4) condition evaluation methodologies. Second, it is recommended
and noted that all six types of selection criteria are essential for M&R decision making.
These categories should be systematically evaluated when making M&R decisions; if the
management fails to do so, the chosen M&R process will lead to overlooking other critical
variables (e.g., risks) that, if not analyzed, can result in catastrophically poor outcomes. In
this regard, multicriteria approaches must be used. The context-specific nature of a
criterion’s weight should be considered by managers responsible for selecting appropriate
M&R methodologies. Therefore, it is proposed that future research may investigate the
implications of the crucial elements (main criteria and sub-criteria) in other countries and
regions, both developed and developing, as well as in other economic sectors.
The two fundamental limitations of this study are the small number of survey
respondents (20) and their country of origin based in a single developing nation (Iraq), as
well as the incompleteness of the disclosed criteria to contain all relevant significant
factors for selecting and assessing various M&R methods pertaining to healthcare
building facilities.
Author Contributions: Conceptualization, H.S. and D.A.S.; methodology, D.A.S. and H.S.; software,
D.A.S.; validation, H.S., D.W.M.C. and D.J.E.; formal analysis, D.A.S.; investigation, H.S.; resources,
D.J.E. and D.W.M.C.; data curation, D.J.E. and A.P.; writing—original draft preparation, D.A.S. and
H.S.; writing—review and editing, D.W.M.C., A.P., A.J. and D.J.E.; visualization, D.W.M.C., A.J. and
D.J.E.; supervision, H.S.; project administration, H.S.; funding acquisition, D.A.S. All authors have
read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.
Facilities/Technology
Buildings 2023, 13, x FOR PEER REVIEW 17 of 20
Table 7. A comparison of the most important criteria for selecting M&R techniques between
developed and developing countries.
Main Selection Criteria
Developed Countries Developing Countries
United Kingdom [72] Hong Kong [71] Malaysia [73–
75]
Iran
[8,26,76] Iraq [Current Study]
Reliability/Flexibility
Facilities/Technology
Human Resources
Safety/Risk/Environment
Cost
Quality
6. Conclusions and Implications of the Study
This study aimed to identify and rank the evaluation criteria for HBFs to establish
suitable M&R processes that can satisfy overlapping requirements. A total of 21 essential
criteria were selected, categorized into six categories, and ranked using the FAHP
technique. Cost, human resources, quality, reliability/flexibility, safety/risk/environment,
and facilities/technology were placed first to sixth, respectively. The results revealed that
optimization and cost reduction (CO), increasing the life of the equipment, and
maintaining their initial quality (QU2) are the most to the least important sub-criteria for
M&R operations of HBFs in Iraq.
In terms of practical ramifications, this study aempts to inform M&R decision-
makers of the following: First, managers responsible for M&R method selections should
examine the expenses associated with M&R techniques since the initial building
development analysis. The evaluation of these costs must adhere to the principles of
sustainable development and account for the energy embodied in the materials and
construction as well as initial and continuing maintenance. To accomplish this, numerous
budgeting approaches for M&R operations have been developed; they can be classified as
(1) plant value methodologies; (2) other formula-based methodologies; (3) life-cycle cost
methodologies; and (4) condition evaluation methodologies. Second, it is recommended
and noted that all six types of selection criteria are essential for M&R decision making.
These categories should be systematically evaluated when making M&R decisions; if the
management fails to do so, the chosen M&R process will lead to overlooking other critical
variables (e.g., risks) that, if not analyzed, can result in catastrophically poor outcomes. In
this regard, multicriteria approaches must be used. The context-specific nature of a
criterion’s weight should be considered by managers responsible for selecting appropriate
M&R methodologies. Therefore, it is proposed that future research may investigate the
implications of the crucial elements (main criteria and sub-criteria) in other countries and
regions, both developed and developing, as well as in other economic sectors.
The two fundamental limitations of this study are the small number of survey
respondents (20) and their country of origin based in a single developing nation (Iraq), as
well as the incompleteness of the disclosed criteria to contain all relevant significant
factors for selecting and assessing various M&R methods pertaining to healthcare
building facilities.
Author Contributions: Conceptualization, H.S. and D.A.S.; methodology, D.A.S. and H.S.; software,
D.A.S.; validation, H.S., D.W.M.C. and D.J.E.; formal analysis, D.A.S.; investigation, H.S.; resources,
D.J.E. and D.W.M.C.; data curation, D.J.E. and A.P.; writing—original draft preparation, D.A.S. and
H.S.; writing—review and editing, D.W.M.C., A.P., A.J. and D.J.E.; visualization, D.W.M.C., A.J. and
D.J.E.; supervision, H.S.; project administration, H.S.; funding acquisition, D.A.S. All authors have
read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.
Human Resources
Buildings 2023, 13, x FOR PEER REVIEW 17 of 20
Table 7. A comparison of the most important criteria for selecting M&R techniques between
developed and developing countries.
Main Selection Criteria
Developed Countries Developing Countries
United Kingdom [72] Hong Kong [71] Malaysia [73–
75]
Iran
[8,26,76] Iraq [Current Study]
Reliability/Flexibility
Facilities/Technology
Human Resources
Safety/Risk/Environment
Cost
Quality
6. Conclusions and Implications of the Study
This study aimed to identify and rank the evaluation criteria for HBFs to establish
suitable M&R processes that can satisfy overlapping requirements. A total of 21 essential
criteria were selected, categorized into six categories, and ranked using the FAHP
technique. Cost, human resources, quality, reliability/flexibility, safety/risk/environment,
and facilities/technology were placed first to sixth, respectively. The results revealed that
optimization and cost reduction (CO), increasing the life of the equipment, and
maintaining their initial quality (QU2) are the most to the least important sub-criteria for
M&R operations of HBFs in Iraq.