benchmarking 2.0 health care facility management report...7 benchmarking 2.0 health care facility...

BENCHMARKING 2.0Health Care Facility Management Report

A Critical Sampling of North American Health Care Facilities

Canadian Version

Laverne Deckert, Product Manager, International Facility Management Association

William L. Gregory, IFMA Fellow, PE, CFM, Vice President Facility Management, Adelphoi USA

Todd Wilkening, CHST, Director of Facilities, Ridgeview Medical Center

Steve Rees, VP Capital Management, Edmonton Zone, Alberta Health Services

Dennis Smith, MS, CHFM, CEM, CCM, Director, Facilities Management, Catholic Health Initiatives

Yuanyuan Zhang, Ph.D., Market Researcher, International Facility Management Association

© Copyright 2013 by the International Facility Management Association. All rights reserved.This publication may not be reproduced, stored in a retrieval system or transmitted in whole or part, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the written permission of the International Facility Management Association.

For more information, please contact:

IFMA Research Department800 Gessner Rd, Suite 900, Houston, TX 77024-4257 USAPhone: +1-713-623-4362E-mail: [email protected]

ISBN 978-1-883176-23-5

BENCHMARKING 2.0Health Care Facility Management Report Committee

BENCHMARKING 2.0Health Care Facility Management Report

4 BENCHMARK ING 2 .0 Health Care Facility Management Report © IFMA 2013

TABLE OF CONTENTS

INTRODUCTIONIntroductionUsing this Report AcknowledgementsAbout this ReportMethodologyDefinitions

SECTION 1

FacilityInstitutions RepresentedFacility DescriptionRegional Climate Zones Facility AgeFacility SettingOwnershipOwnership by InstitutionsDeveloped AcresDays and Hours of Operations

Central PlantExterior Gross AreaAdjusted Patient Days and DischargesSpace per FTENon-ProfitData CentersFacility ParkingDevoted AreaAlternative Power

SECTION 2

UtilitiesUtility CostsUtility ConsumptionEnergy Use IndexBuilding Automation System

6-1267 778

9-12

13-24

141415 161617171718

1819-20

21212222232424

25-32

26-2829

30-3132


SECTION 3

MaintenanceMaintenance CategoriesMaintenance CostsRoads and GroundsFacility Operating Current Replacement Value (CRV) IndexMaintenance TrackingMaintenance Management System UsedMaintenance StaffingMaintenance ManagementAdministrative SupportTotal Maintenance StaffService Provision

SECTION 4

Environmental ServicesEnvironmental Services CostsEnvironmental Services StaffingContractor Practices

SECTION 5

WasteSECTION 6

Linen ServicesSECTION 7

OperationsCost of OperationsCustomer SatisfactionProductivity Measure

SECTION 8

Risk ManagementSafety InitiativesInjury ClaimsSecurity

SECTION 9

Property, Real Estate and Construction ManagementManagementProject Delivery Models

33-46

3435-37

3839

3940

41-4344444546

47-51

48-505051

52-53

54-55

56-64

5758-6061-62

63-66

646566

67-70

68-6970

TABLE OF CONTENTS


Thank you for participating in the Benchmarking 2.0 survey. If you were a participant in the survey, you have the ability to customize, filter and review results online. From this you can harvest a wealth of information to help you manage your facilities as efficiently and effectively as possible.

Our goal has been and continues to be to help the health care facility manager add significant value to their organization and the populations they serve by better controlling underlying drivers that impact their costs and quality of service delivery.

We are pleased to have completed this significant benchmarking report for health care facility management operations as a joint effort by the Health Care Institute, an IFMA Alliance Partner, the American Society for Healthcare Engineers (ASHE), and the Canadian Healthcare Engineering Society (CHES). As a North American-wide effort, Benchmarking 2.0 sets the stage for an expanded international effort in our industry in the near future.

One of the main areas of differentiation of Benchmarking 2.0 from other surveys is the inclusion of key business drivers that enable the facility manager to provide strategic input to the core health care operation. Our survey guides the facility manager on the path of continuous improvement by helping them identify information they need to collect and know by formatting outputs into information they need to communicate to their superiors to be more effective in their roles.

On behalf of the Health Care Institute, ASHE, and CHES, we would like to sincerely thank each and every one of our participants in this exceptional effort, as well as the support staff for their efforts to make this survey and report a success.

We plan to continue to improve our surveys and processes to enhance the value of our members’ efforts in their organizations and look forward to your feedback in achieving that goal.

John J. KnottPresident, CHES

Dale WoodinExecutive Director, ASHE

Ron Kalich President, Health Care Institute, an IFMA Alliance Partner

INTRODUCTION


INTRODUCTION

Using this ReportThe information contained in the report represents a “self-report” from ASHE, IFMA and CHES members. All information was voluntarily provided and was not checked with site visits. When interpreting the data, it is important to remember that every facility is different, and every organization operates using different accounting and measurement practices. The data listed in this report will not provide a perfect comparison of your organization to that of another hospital, but it should give you a good idea how your facility fits into the range of performance.

The percentile charts in this report allow you to see how your operation ranks against other organizations. The arrows beside some charts show the “best-in-class” direction. Using your facility’s numbers for the performance indicator, determine whether your building is above or below the median (50th percentile). If your facility falls way above or below the median, you may want to examine your costs or procedures in that area. However, your hospital may differ from the median due to type of facility, climate or labor market. The data should help you identify areas where you can improve your facility operation.

Readers will see arrows pointing in an upward or downward direction next to several of the percentile charts in this report. In many cases the arrow points toward the lowest cost; however, the organization with the lowest cost may not profess to have the best practice. There may be a reason why a cost is so low. For example, a hospital building scheduled for demolition would likely apply minimal resources and thus costs would be lower.

Using this report is the first step in benchmarking. After you have identified areas where your facility operations could be improved, you should conduct additional research before reengineering the process. One should not immediately rush to find out which health care organization is “best in class” and copy their practice. Instead you should look for a more homogeneous group in which to compare.

AcknowledgementsASHE, IFMA and CHES rely on the willingness and generosity of their members to compile the data and complete this lengthy benchmarking survey. Without their data, there would be no report. We thank these dedicated participants for their contributions and support.

We would like to express our appreciation to the following individuals who have dedicated countless hours of passion to furthering the success of Benchmarking 2.0 and those of their fellow facility managers:

Steve Rees, CFM, Vice President, Capital Management-Edmonton Zone

Dale Woodin, CHFM, FASHE, Executive Director, American Society of Healthcare Engineers

Lastly, we need to express our sincere and deep appreciation to Shari Epstein, IFMA’s past Research Director who was instrumental in the development of Benchmarking 1.0. Shari recently lost her life in a tragic accident. We know that her initial guidance has made our continued benchmarking efforts possible.

About This ReportThis year was the second year the Health Care Facility Management Benchmarking survey was conducted in North America. To create this report, a committee of ASHE, IFMA and CHES volunteers with expertise in environmental services, maintenance and energy management reviewed questions posed in Benchmarking 1.0 Health Care Facility Management Survey and developed new questions to better match today’s practices. Findings are discussed in the sections that follow.


INTRODUCTION

MethodologyThe Operations and Maintenance Benchmarking 2.0 for Health Care Facilities survey was developed in summer of 2012. Based on the Benchmarking 1.0 survey questionnaire, modifications were made and new questions related to risk management, property, real estate and construction management were added. Committee members examined each question to make sure they were clear, unambiguous, concise and relevant. Questions were asked in an objective fashion in order to obtain responses that were truly representative of industry practices.

The survey was developed through IFMA’s online survey management system entitled Benchmarks Exchange (BEX). In July 2011, IFMA, ASHE, and CHES members received an e-mail directing them to a link to the online survey. Respondents were asked to provide information on the facilities they manage for a 12-month period of time. The majority chose to report the data for calendar year 2011. A total of 262 hospitals participated in the survey during a five-month period. A survey completion rate of 80 percent or above was considered usable, yielding 184 surveys being included for analysis – compared to 151 in 2009.

To ensure high quality data, highly structured coding and data verification procedures were used. In addition, all variables and values were checked to verify that they were within appropriate ranges and inappropriate outliers were corrected or removed. A full statistical analysis followed, using a professional software package called IBM SPSS Statistics. Standardized data analysis procedures included reviewing descriptive frequency counts and cross tabulations of responses for variables of interest.

To maintain the real world usability of these research findings, statistics are most often provided in terms of absolute number of responses, percentages and mean averages. Percentages may not add to 100 percent due to rounding or the acceptance of multiple responses. In many cases, some respondents did not answer all questions, so the base numbers differ among the findings. Several tables have blanks in lieu of a number because there were not enough responses to generate a valid

statistic. An example of this can be seen in the sample size for facilities more than 50 years of age. As a result, data for this category of facility age was not reported.

Additional calculations were made to determine cost and utility consumption per square meter, square meters per FTE and cost per discharge. Utility consumption data was changed to match the unit specified. The cost data with U.S. currency was converted to Canadian dollars by dividing costs by a factor of 1.01, the currency exchange rate on Dec. 20, 2012. English measures were converted to metric measures.

Operations and Maintenance Benchmarking 2.0 for Health Care Facilities is a self-report survey. All data, including respondent identification, was voluntary. As with any research, readers should exercise caution when generalizing results and take individual circumstances and experiences into consideration when making decisions based on the data. While IFMA is confident in its research, it is important to understand that the results presented in this report represent the sample of organizations that chose to supply the requested facility information. A confidence level and margin of error provide readers some measure of how much they can rely on survey responses to represent all IFMA, ASHE and CHES member organizations. Given the level of response to this survey, we are 95 percent confident that responses given by all responding organizations can be generalized to all IFMA, ASHE and CHES member organizations, in general with a margin of error of approximately +/- 7.0 percent. For example, 40 percent of the respondents reported that they conducted facility related customer satisfaction surveys. With a 7 percent margin of error for the sample size of 167, the reader can be 95 percent certain that between 33 percent and 47 percent of all managers within health care settings collect some type of facility related customer satisfaction data. It is important to note that as the sample size decreases, which occurs in many of the tables, the margin of error increases. For example, a smaller sample of 115 increases the margin of error to +/- 9 percent.


Definitions for Benchmarking 2.0for Health Care Facility Management

Adjusted Patient DaysThis figure is used as a way to standardize the per unit measure between hospitals, allowing for more valid comparisons. Adjusted patient days is calculated by dividing total charges by inpatient charges, then multiplying by the number of inpatient days and admissions.

(Gross Revenue/Inpatient Revenue) x Inpatient Patient Days = Adjusted Patient Days

Adjusted DischargesA calculation that adjusts the number of discharges (hospitalizations) to reflect the impact of both inpatient and outpatient volume. For this report, we used adjusted discharges as a means to compare costs.

(Total Gross Revenue/Inpatient Gross Revenue) x Discharges (or days) = Adjusted Discharges

AHUAir Handling Unit – a device used to condition and circulate air as part of a heating, ventilating and air-conditioning system.

Architectural DesignDesigning architecture to include the planning, designing and constructing form, space and ambience that reflect functional, technical, social, environmental and aesthetic considerations.

AverageAverage is also referred to as the mean – the sum or total of all responses divided by the number of respondents.

BASBuilding Automation System uses computer-based monitoring to coordinate, organize and optimize building control sub-systems such as security, fire/life safety, elevators, etc.

BEXBenchmarks Exchange is the website that houses IFMA benchmarking surveys and results. Once a select number of surveys have been entered into a database, participants can download customized reports based on their specific industry, facility type, geographic region, facility size and other needs.

CADComputer-aided design is the use of computer technology to assist in the design and especially the drafting (technical drawing and engineering drawing) of a part or product, including entire buildings. It is both a visual (or drawing) and symbol-based method of communication, the conventions of which are particular to a specific technical field.

CAFMComputer-aided facility management – a software program that provides integration of building design, construction and operational systems.

CAM ChargesCommon area maintenance charges – the amounts charged to tenants for expenses to maintain hallways, restrooms, parking lots and other common areas.

Canadian Centre for Occupational Health and Safety (CCOHS)The CCOHS functions as the primary national agency in Canada for the advancement of safe and healthy workplaces and preventing work-related injuries, illnesses and deaths.

CMMSComputerized maintenance and management system – a software program used to manage the operations of a building.

Central Mechanical PlantA plant that is owned by, and on the grounds of, a multi-building facility that provides district heating, district cooling or electricity to one or more buildings within the same facility. The central physical plant may be by itself in a separate building or may be located in a building where other activities occur.

Climate ZonesThe U.S. Department of Energy’s Energy Information Administration issues a Commercial Buildings Energy Consumption Survey every few years, which includes five climate zones based on its 30-year average heating degree days (HDD) and cooling degree days (CDD) for the period of 1971 through 2000. Designation of a climate zone serves as an indicator of heating and air conditioning use.

Natural Resources Canada’s Office of Energy Efficiency (OEE) regionalizes Canada into four climate zones. These four zones are based upon an average number of heating degree days during a 30-year period.

Cooling Degree

Days (CDD)

Heating Degree

Days (HDD)Climate Zone

US 1 (coldest) 2,000 < More than 7,000

US 2 2,000 < 5,500 to 7,000

US 3 2,000 < 4,000 to 5,499

US 4 2,000 < 4,000 <

US 5 (warmest) 2,000 or More

4,000 <

CN 1 (coldest) --- > 8000

CN 2 --- > 5500 to≤ 8000

CN 3 --- > 3500 to≤ 5500

CN 4 (warmest) --- ≤ 3500

INTRODUCTION


Competitive BidA method to deliver a project based upon the negotiated terms and conditions of two parties.

Construction ManagementA method to deliver a project in which the overall planning, coordination and control of a project from inception to completion is aimed at meeting a client’s requirements through a single process.

Cooling Degree Day (CDD)A measure of how warm a location is during a period of time relative to a base temperature, most commonly specified as 65 degrees Fahrenheit. The measure is computed for each day by subtracting the base temperature (65 degrees) from the average of the day’s high and low temperatures, with negative values set equal to zero. Each day’s cooling degree days are summed to create a cooling degree day measure for a specified reference period. Cooling degree days are used in energy analysis as an indicator of air conditioning energy requirements or use. (U.S. Department of Energy, Energy Information Administration)

Cost of OperationsAnnual cost of operations includes the total costs associated with the day-to-day operation of a facility. It includes all maintenance and repair costs (both fixed and variable), administrative costs (clerical, time-keeping, general supervision), labor costs, janitorial, housekeeping and other cleaning costs, utility costs and indirect costs (all costs associated with roadways and grounds).

Current Replacement ValueThe total amount of expenditure in current dollars required to replace the organization’s facility/facilities to its optimal condition (excluding auxiliary facilities). It should include the full replacement cost for all buildings, grounds,

utility systems and generating plants. Furthermore, it should meet the current acceptable standards of construction and comply with regulatory requirements. Insurance replacement values or book values should not be used. Current replacement value does not include cost of contents.

Data Systems DesignIncludes the planning, designing and construction of data-based systems to support the functional use of building space, MEP and electronic business needs.

Deferred MaintenanceThe total dollar amount of existing major maintenance repairs and replacements identified by a comprehensive facilities condition audit of buildings, grounds, fixed equipment and infrastructure needs. This estimate should not include projected maintenance, replacement or other types of work such as program improvements or new construction, as these items are considered capital projects.

Design BuildA method to deliver a project in which the design and construction services are contracted by a single entity.

Direct Digital Control (DDC)A control system utilizing voltage as a power source.

Energy TypeType of energy mass used to support a utility. Includes natural gas, electricity, steam water and sewer (sanitary). Fuel oil includes distillate fuel oil (Nos. 1, 2 and 4); but this study requested consumption of fuel oil No. 2.

Exterior Gross AreaThe area of the floor measured to the outside face of the walls that enclose the floor(s) of the building. (ASTM E1836-08)

E-WasteElectronic waste, e-waste, e-scrap, or waste electrical and electronic equipment, describes discarded electrical or electronic devices.

Facility Condition Index (FCI)An industry term that describes the process in which professionals perform an analysis of the condition of a group of facilities that may vary in terms of age, design, construction methods and materials. The industry professionals are typically engineers of various disciplines and skilled trade technicians. Architects are sometimes used as well. This analysis can be done by walk-through inspection, mathematical modeling or a combination of both. The FCI is expressed as a ratio of the cost of remedying existing deficiencies/requirements, and capital renewal requirements to the current replacement value.

Facility Operating Current Replacement Value (CRV) IndexThis indicator represents the level of funding provided for the stewardship responsibility of an organization’s capital assets. The indicator is expressed as a ratio of annual facility maintenance operating expenditure to current replacement value (CRV). (Asset Lifecycle Model for Total Cost of Ownership Management, 2005)

Facility ManagementFacility management is a profession that encompasses multiple disciplines to ensure functionality of the built environment by integrating people, place, process and technology.

INTRODUCTION


Full-Time EquivalentA measurement that standardizes the mix of part-time and full-time employees within a fiscal year. The measurement reflects the number of people necessary in terms of full-time status by dividing the total number of paid hours in a year by a factor of 2,080 hours.

Gross Square Meter (GSM)The basis used for most calculations in this report.

HVACHeating, ventilation and air-conditioning system.

Heating Degree Day (HDD)USA: A measure of how cold a location is during a period of time relative to a base temperature, most commonly specified as 65 degrees Fahrenheit. The measure is computed for each day by subtracting the average of the day’s high and low temperatures from the base temperature (65 degrees), with negative values set equal to zero. Each day’s heating degree days are summed to create a heating degree day measure for a specified reference period. Heating degree days are used in energy analysis as an indicator of space heating energy requirements or use. (U.S. Department of Energy, Energy Information Administration)

Canada: A measure of the severity of the weather. One degree day is counted for every degree that the average daily temperature is below the base temperature of 18 degrees Celsius. For example, if the average temperature on a particular day was 12 degrees Celsius, six degree days would be credited to that day. The annual total is calculated by simply adding the daily totals. (Natural Resource Canada, Office of Energy Efficiency)

Integrated Project Delivery (IPD)A method to deliver a project in which a collaborative alliance of people, systems, business structures and practices create a process that harnesses the talents and insights of all participants to optimize project results.

Interior Parking SpaceThe space used for vehicular parking that is totally enclosed within the (occupied) building envelope.

Kilowatt Hour (kWh)A unit of work or energy measured as 1 kilowatt (1,000 watts) of power expended for 1 hour. One kWh is equivalent to 3,412 Ltus.

Major Vertical PenetrationsInclude stairs, elevator shafts, utility tunnels, flues, pipe shafts, vertical ducts and their enclosing walls.

Master Planning An organization’s process of defining its building planning efforts or direction and to support the business in making decisions on allocating its resources to pursue a plan for renovation, relocation or construction.

MeanSee definition for “average.” Mean and average are used interchangeably, and the interpretation is the same.

Mechanical/Electrical/Plumbing Design (MEP)MEP includes the planning, designing and constructing of forms of utility systems to support the functional use of building space. Generally excludes architectural and low voltage, data and telecommunication systems.

MedianThe middle value in a range of responses. One-half of all respondents will be below this value, while one-half will have a higher value. The median is also known as the 50th percentile. The advantage in using the median is that it is not affected as much by extreme highs or lows in the range of values as is the case with the mean.

NThe number of cases supplying the data being described. It is important to note the size of the sample for the value you are comparing.

Negotiated ContractA method to deliver a project based upon the negotiated terms and conditions of two parties.

Occupational Safety and Health Administration (OSHA)OSHA is an agency of the U.S. Department of Labor. Its mission is to assure safe and healthful working conditions by setting and enforcing standards and by providing training, outreach, education and assistance.

PDAPersonal digital assistant.

PercentileIndicates dispersion of data. A specific percentile identifies where a value lies in relation to other values in a range of responses. The 25th percentile is the lower one-fourth point in the range of values in the group. The 50th percentile, also referred to as the median, represents a value of which one-half of the group falls below and one-half falls above. The median is not affected by extreme high or low values, whereas the mean could be distorted.

INTRODUCTION


Planned Gross AreaThe portion of the floor that is totally enclosed within the interior face of perimeter encroachments at the floor plane, and where there is no perimeter encroachments enclosed at the inside finished surface of the exterior walls. To obtain plannable gross area, one would subtract exterior gross to dominant portion, excluded areas, interstitial areas, restricted headroom areas, interior parking and perimeter encroachments from exterior gross area. (ASTM 1836-08)

PneumaticControl system utilizing compressed air as a power source.

Preventive MaintenancePlanned actions undertaken to retain an item at a specified level of performance by providing repetitive scheduled tasks that prolong system operation and a useful life (inspection, cleaning, lubrication, part replacement). (Cotts, Lee, 1992)

Property ManagementThe operation, control and oversight of real estate involves the processes, systems and manpower required to manage the life cycle of all acquired property as defined above including:

acquisition, control, accountability, responsibility, maintenance, utilization and disposition.

Real EstateThe business profession of buying, selling or renting land, buildings or housing. May consist of the land and the buildings on it, along with its natural resources such as crops, minerals, or water; immovable property.

Repair MaintenanceWork that is performed to put equipment back in service after a failure to extend life of the equipment or to make its operation more efficient. (Armstrong, 1996)

Site PopulationThe number of full- and part-time employees, contract workers and/or tenants located at the facility/facilities.

Stationary EngineersLicensed personnel (also called licensed engineers) assigned to operate a power plant, including the steam and hot water boilers or a chilled water plant. Some states and municipalities require licensed engineers on watch 24 hours, seven days per week. These individuals are

not allowed to leave the power plant to perform maintenance outside of the power plant.

TurnkeyA method to deliver a project that includes all of the steps involved for completion including: the site selection, negotiations, space planning, construction coordination and complete installation.

Units of Measure(for the purposes of this survey)

UPSUninterruptable power supply.

Workers Compensation Board of Manitoba (WCB)WCB is an agency of the Government of Manitoba. It is regarded as an injury and disability insurance system for workers and employers and is paid for by employers.

US Canada

Square Feet (SF) Square Meter (SM)

Cubic yards (cubic yds)

Kilograms (kg)

Pounds (lbs) Kilograms (kg)

Gallons Gallons

INTRODUCTION

SECTION 1

Facility Description

Institutions Represented

Facility Description

Locations of Hospitals

Hospitals by Region

Climate Zones

Facility Age

Facility Setting

Ownership

Ownership by Institutions

Developed Acres

Days and Hours of Operations

Central Plant

Exterior Gross Area

Adjusted Patient Days and Discharges

Space per FTE


N=184

Space within a building

Multiple buildings in multiple locations

Multiple buildings in one location

A single building

59%

8%

1%

32%

Number of Cases (N)

Percentage of SampleInstitution Definition

Academic or Research Hospital

17 9% Academic or research health care organizations are those which are often linked to a medical school and/or research facilities.

Acute Care Hospital

118 64% An institution that is primarily engaged in providing diagnostic and therapeutic services for medical diagnosis, treatment and care, by or under the supervision of physicians, to injured, disabled, or sick persons or rehabilitation services for injured, disabled, or sick persons.

Behavioral Care Facility

2 1% An outpatient treatment center for psychiatric and mental disorders, Alzheimer’s and developmentally disabled. Outpatient and psychiatric counseling for substance abuse patients.

Children’s Hospital

9 5% An institution for health care providing patient treat-ment by specialized staff and equipment, and often, but not always, providing for longer-term patient stays, which offers its services exclusively to children. Children’s hospitals are characterized by greater attention to the psychosocial support of children and their families.

Outpatient Health Care Center

6 3% An outpatient clinic where persons can receive a wide range of medical services including diagnostic services, laboratory services and imaging.

Critical Access Hospital

9 5% Critical Access Hospitals (CAH) are rural community hospitals that receive cost-based reimbursement.

Long-term Care/Nursing Home

8 4% A facility that provides rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living.

Medical Center

13 7% A large medical complex that provides a comprehen-sive array of health care services in both outpatient and inpatient settings.

Rehabilitation Center/Hospital

2 1% A recovery facility oriented toward long-term treat-ment and training of sick/injured persons so they can function in society. Rehabilitation centers specialize in physical therapy for trauma/stroke victims.

Institutions RepresentedThe adjacent chart describes the types of institutions that participated in the benchmarking study in 2012. With a total of 184 hospitals responding to this survey, the distribution of institutions represented was skewed toward large acute care hospitals.

Facility DescriptionTo provide a more accurate comparison of costs and practices, respondents were asked to report on a single building, preferably the largest or most active.

FACILITY DESCRIPTION


Regional Climate ZonesClimate and severe weather shifts can adversely affect hospitals’ energy consumption and landscaping costs. For that reason, respondents were asked to select the climate zone which best corresponded to the location of the reported hospital.

While Canada accounted for 60 percent of the survey results, it is important to note that the US and Canada have similar climate zones for a number of areas represented by respondents.

The U.S. Department of Energy (DOE) classifies the United States into five climate zones, which are derived by averaging the number of annual heating and cooling degree-days in a 30-year period. Natural Resources Canada’s Office of Energy Efficiency (OEE) regionalizes Canada into four climate zones. These four zones are based upon an average number of heating degree-days during a 30-year period.

United States

Zone 1Zone 2Zone 3Zone 4Zone 5

Canada

Zone 1Zone 2Zone 3Zone 4

Number of Heating Degree Days

Number of Cooling Degree DaysClimate Zone N

US 1 (coldest) 18 More than 7,000 Less than 2,000

US 2 7 5,500 to 7,000 Less than 2,000

US 3 17 4,000 to 5,499 Less than 2,000

US 4 14 Less than 4,000 Less than 2,000

US 5 (warmest) 13 Less than 4,000 2,000 or more

CN 1 (coldest) 2 More than 8,000

CN 2 58 5,501 to 8,000

CN 3 47 3,500 to 5,500

CN 4 (warmest) 8 Less than 3,500

18

717

14

13

2

58

478




Facility AgeSixty-eight percent of the facilities reported in this study were 21-50 years in age.

Facility Setting

50 years

7%

10%

32%

36%

11%

4%

Suburban Area

Business Park

Central Business District

Secondary Downtown

Rural Area


Acute Care Hospital

Behavioral Care Facility

Children’s Hospital


Long-Term Care/Nursing Home

Medical Center


50% 50%

83% 17%

25% 38%38%

13% 13%13%63%

8% 25% 17%50%

20% 40% 20% 20%

7% 11% 34% 46%

12% 82% 6%

2%

N=184

17BENCHMARK ING 2 .0 Health Care Facility Management Report © IFMA 2013

OwnershipThe vast majority of health care centers are owned, and owner occupied.

Ownershipby Institutions

Developed AcresIn this report, the majority of health care organizations have land masses of 20 acres (or 8 hectares) or less.

Ownership (N=184)

Note: Hospitals with a sample size of less than 5 are not included in the table.

Leased, owner occupied with

sublet space to other tenant(s)

Owned,completely

leased

Owned, owner occupied with

leased space to tenant(s)

Owned, owner

occupiedInstitution N


17 6% 12% 29% 53%

Acute Care Hospital 118 0% 1% 18% 81%

Children’s Hospital 9 0% 0% 33% 67%


6 0% 0% 33% 67%


9 0% 0% 22% 78%

Long-term Care/Nursing Home

8 12.5% 0% 12.5% 75%

Medical Center 13 0% 8% 23% 69%

Leased, owner occupied with sublet space to other tenant(s)

Owned, completely leased

Owned, owner occupied with leased space to tenant(s)

Owned, owner occupied

77%

2%1%

20%

N=141

50 acres

29%

24%

16%

22%

9%



Days and Hours of Operations

Central PlantThe majority in this survey derived power from a central mechanical plant.



Institution N Hours/Day Days/Week

Academic or Research Hospital 17 24 7

Acute Care Hospital 118 24 7

Children’s Hospital 9 22 7

Outpatient Health Care Center 6 21 7

Critical Access Hospital 9 24 7

Long-term Care/Nursing Home 8 22 7

Medical Center 13 21 7

N=184

Decentralized Plant

Centralized Plant

38%

62%


Exterior Gross AreaTo provide uniformity, all of the annual costs reported are divided by exterior gross area. Exterior gross area is defined as the area of the floor measured to the outside face of the walls that enclose the floor(s) of the building. For the rest of the report, square meter is referred to as gross.

Numbers reported vary greatly based upon the types of services and supporting departments located within the reporting health care organization.

Facility Size (GSM) N Total Adjusted Patient Discharges

Less than 23,225.6 61 4,068.15

23,225.7-46,451.1 14 19,831.00

46,451.2-69,676.7 10 177,994.90

69,676.8-92,902.3 6 93,116.67

92,902.4-185,804.5 9 99,366.89

More than 185,804.5 9 38,602.00

Overall 109 37,329.30

PercentileGSM/Discharge

(N=102)

90 125.67

75 96.41

50 56.87

25 26.43

10 10.30

Mean 84.89

PercentileGSM

(N=171)

90 151,216.83

75 64,192.77

50 13,656.63

25 6,239.97

10 3,646.97

Mean 52,564.20

Exterior Gross Area (N=171)

Less than 23,225.6 GSM

23,225.7-46,451.1 GSM

46,451.2-69,676.7 GSM

69,676.8-92,902.3 GSM

92,902.4-185,804.5 GSM

More than 185,804.5 GSM

57%

12%

9%

5%

9%

8%



While the Academic or Research Hospitals reported the largest gross square meters, the Acute Care Hospitals had the largest gross square meters per adjusted discharge.

Note: Hospitals with a sample size of less than 5 are not included in the tables.

GSMInstitution N Mean Median

Academic or Research Hospital 16 193,998.61 173,082.87

Acute Care Hospital 112 36,849.41 11,043.48

Children’s Hospital 8 79,640.75 60,610.55

Outpatient Health Care Center 5 19,580.73 4,972.69

Critical Access Hospital 9 8,594.02 8,185.06

Long-Term Care/Nursing Home 7 7,967.86 6,688.96

Medical Center 10 77,380.99 49,702.71

GSM/DischargeInstitution N Mean Median

Academic or Research Hospital 11 855.88 662.94

Acute Care Hospital 64 1062.20 618.00

Children’s Hospital 5 541.40 299.39

Critical Access Hospital 7 303.21 297.05

Medical Center 7 699.49 736.99



Adjusted Patient Days and Discharges Unlike other industries that rely exclusively on dollar per square meter as a metric of operational efficiency, hospitals also use cost per adjusted discharge and cost per adjusted patient day.

Respondents were asked to provide adjusted discharges and adjusted patient days, as these figures help standardize the per unit measure allowing for more valid comparisons. Here are the calculations used for these two indicators:

Adjusted Patient Days(Gross Revenue/Inpatient Revenue) × Inpatient Patient Days

Adjusted Discharges(Total Gross Revenue/Inpatient Gross Revenue) × Discharges (or days)

For this report, adjusted discharges were used as a denominator for costs and other consumption data.

These charts indicate the number of Total Adjusted Patient Days and Total Adjusted Discharges reported from survey respondents.

Space per FTEEven though hospitals are more likely to use adjusted patient days and adjusted discharges as a means to measure throughput, this report also includes a space per person measurement.

This chart indicates the mean for the number of Adjusted Discharges supported per Full Time Equivalent.

More than 100,000

75,001-100,000

50,001-75,000

25,001-50,000

Less than 25,000

Total Adjusted Patient Days (N=122)

20%

6%

12%

8%

54%

More than 30,000

20,001-30,000

10,001-20,000

Less than 10,000

Total Adjusted Discharges (N=110)

21%

6%

14%

59%

SQ Meters per FTEPercentile N=101

90 75.25

75 58.62

50 44.13

25 32.89

10 23.13

Mean 48.68

Percentile Adjusted Discharges/FTE

90 87.83

75 24.09

50 11.19

25 5.95

10 4.16

Mean 37.96



Non-ProfitThe majority of the hospitals that participated in this survey were non-profit organizations.

Data CentersApproximately 2/3rds of health care organizations do not have on-site data centers.


N=184

N=184

No67%

Yes33%

Non-Profit98%

For Profit2%


Facility ParkingSurface parking remains by far the most used type of parking.

Is the Maintenance and Operations of this Parking Structure/Lot Included in Your Departmental Budget? (N=184)

No30%

Yes70%

Facility Parking (N=184)

92%

24%

14%

Surface lot

Separate structure

Underground building




Devoted AreaAverage square meters reported by survey respondents for supporting three questioned areas.

Alternative PowerMore than 50 percent of today’s health care organizations can operate 100 percent on alternative power with nearly 100 percent of their facility being cooled or heated.

Area Devoted To N SM

Operating Suites 116 3,427

Parking Structure(s) 70 35,220

Data Center 51 190

N=184

55%

97%

Can operate on 100% of

alternative power

Is air-conditioned/heated

SECTION 2

Utilities

Utility Costs

Utility Consumption

Energy Use Index

Building Automation System


Utility CostsUtility costs are associated with the provision of electrical power, potable water, central heating and cooling and sewage service. The utility categories provided were those most commonly used: electricity, fuel oil, natural gas, chilled water, steam, water and sewage. About 86 percent of the respondents reported sewage costs embedded in water costs, as they were unable to separate the two. The overall utility cost does not equal the sum of the separate utility costs because of different sample sizes. Here utility costs are broken out by square meters and adjusted discharges.

Based on the results for cost per gross square meter (GSM) for utilities, electricity remained as the biggest contributor to the total cost of utilities.

UTILITIES

$/GSM

PercentileTotal

Utilities Electricity Fuel Oil #2Natural

GasChilled Water Steam

Domestic Water Sewer

90 52.17 35.68 0.69 13.31 24.22 16.39 6.45 4.05

75 43.27 30.22 0.38 10.84 4.88 13.86 4.73 2.70

50 35.55 24.95 0.15 9.01 2.53 12.74 3.03 1.54

25 25.89 19.24 0.11 6.47 0.82 8.90 1.84 0.98

10 13.38 10.93 0.05 2.53 0.33 2.09 0.60 0.21

Mean 34.29 24.42 0.31 8.59 10.74 11.15 3.42 1.97

N= 169 156 57 144 9 8 146 24

$/Discharge

PercentileTotal


GasChilled Water Steam

Domestic Water Sewer

90 478.11 364.37 2.54 136.82 99.09 209.59 52.35 26.20

75 349.11 249.07 1.40 77.78 33.14 106.18 28.54 17.90

50 187.62 127.55 0.66 42.45 12.15 83.50 15.31 5.11

25 89.30 59.44 0.17 15.20 1.51 14.95 8.40 3.75

10 14.21 16.38 0.12 3.63 0.75 11.28 1.65 1.05

Mean 227.49 163.63 1.08 60.52 31.86 92.43 20.97 10.46

N= 109 97 44 92 10 9 94 18

Utility Costs per Discharge by Percentile

Utility Costs by Percentile

BES

T I

N C

LASS

BES

T I

N C

LASS


Institution NTotal


Gas SteamDomestic

Water Sewer

Academic or Research Hospital 16 31.96 23.59 0.41 7.48 -- 3.35 --

Acute Care Hospital 111 36.65 25.66 0.30 9.18 1.85 3.44 2.08

Children’s Hospital 8 50.43 30.35 0.26 8.04 -- 5.58 --

Critical Access Hospital 9 21.44 17.75 -- 5.90 -- 2.30 --

Long-term Care/Nursing Home 6 21.55 13.25 -- 5.27 -- 3.51 --

Medical Center 10 27.54 22.69 0.24 8.53 -- 2.89 1.92

Utility Costs by Institution

Utility costs are affected by a variety of factors including: climate, region, facility use and the presence of a central plant. These charts show the differences in utility costs for a variety of settings.

Colder environments have their advantages. According to the results from this study, organizations with the highest utility costs per gross square meter are in the warmer climate zones. This is likely due to their higher demands for air conditioning.

While newer buildings are amongst the lowest in utility costs, the oldest are also. Middle aged buildings demonstrate a higher operating costs.

Presence of a Central Plant

Central Plant N $/GSM

Yes 109 35.38

No 62 36.55

Utility Costs by Climate

Climate Zone N $/GSM

US 1 (coldest) 16 28.14

US 2 7 19.82

US 3 17 32.42

US 4 14 36.68

US 5 (warmest) 10 36.93

CN 1 (coldest) -- --

CN 2 54 40.14

CN 3 45 32.33

CN 4 (warmest) 5 28.98

Utility Costs by Region

Region N $/GSM

Canada 102 36.20

New England -- --

Northeast -- --

Mid-Atlantic 13 35.38

Southeast -- --

Midwest 6 36.05

North Central 12 24.45

Heartland -- --

South Central 8 42.19

Mountain 5 28.36

Pacific 10 24.35

Utility Costs by Facility Age

Facility Age N $/GSM

Less than 5 years 12 31.78

5-10 years 15 37.91

11-15 years 13 37.48

16-20 years 6 40.21

21-30 years 51 33.90

31-50 years 64 34.83

Note: Hospitals with a sample size of less than 5 are not included in the table

UTILITIES


In 2012, approximately 50 percent of health care organizations experienced up to a 10 percent increase in utility costs.

The number one contributor to changes in utility costs was driven by rate changes.

UTILITIES

>10.0%

5.1-10.0%

0.1%-5.0%

0

-0.1-5.0%

-5.1-10.0%

29BENCHMARK ING 2 .0 Health Care Facility Management Report © IFMA 2013

Utility Consumption The tables below capture consumption data for electricity, fuel oil, gas, water and sewage. Electricity, domestic water, and sewage were key contributors to the overall utility intensity in health care.

The average number of kilowatt hours (KWH) per patient discharge is 1,829.04 KWH. Based upon the average number of KWH used per day (30.16 KWH) in US homes as provided by the US Energy Information Association, each patient discharge is equal to more than two months of electricity in our homes.

Annual Consumption/GSM

PercentileElectricity

kWhFuel Oil #2

GallonsNatural Gas

ThermsChilled Water

Ton HoursSteamM-LBS

Domestic WaterGallons

SewageGallons

90 368.33 0.19 25.21 342.67 3.71 767.03 718.49

75 311.45 0.12 21.25 24.66 1.75 567.36 587.82

50 261.85 0.05 16.54 3.89 1.11 379.62 314.99

25 199.70 0.03 10.10 0.02 0.75 205.07 57.36

10 126.80 0.01 1.62 0 0.02 24.92 0.98

Mean 254.07 0.08 15.55 74.02 35.24 413.32 378.04

N= 146 49 137 12 12 141 26

Annual Utility Consumption by Percentile

Annual Consumption/Discharge

PercentileElectricity

kWhFuel Oil #2

GallonsNatural Gas

ThermsChilled Water

Ton HoursSteamM-LBS

Domestic WaterGallons

SewageGallons

90 3380.40 0.72 190.72 898.47 838.84 5583.76 4106.94

75 2455.43 0.42 126.17 307.84 12.36 3724.04 2403.96

50 1463.77 0.19 62.59 4.71 5.53 1889.20 671.46

25 827.56 0.05 22.31 0.12 1.63 671.99 51.35

10 368.04 0.03 1.41 0.0009 0.73 33.03 8.58

Mean 1829.04 0.28 92.30 295.29 463.20 2529.97 1559.70

N= 94 41 89 9 9 90 23

Annual Utility Consumption per Discharge by Percentile

UTILITIES


Energy Use Index Consumption for electricity and gas can also be measured using an Energy Use Index (EUI). To derive the EUI for electricity, kilowatt hours are multiplied by a conversion factor of 3.415 creating kBtus. The new number is divided by gross square meters. To calculate the EUI for natural gas, therms (100 CF) are multiplied by a factor of 100 and divided by gross square meters.

UTILITIES

Climate Zone NElectricityKBtus/GSM

Gas KBtus/GSM

US 1 (coldest) 12 899 1,198

US 2 4 -- --

US 3 15 967 921

US 4 13 1,055 1,437

US 5 (warmest) 4 -- --

CN 1 (coldest) -- -- --

CN 2 51 928 2,141

CN 3 41 743 1,551

CN 4 (warmest) 5 661 1,073

Gas & Electric EUI by Climate

PercentileElectricitykBtus/GSM

Gas KBtus/GSM

90 1,258 2,523

75 1,064 2,126

50 894 1,655

25 682 1,011

10 433 163

Mean 868 1,557

N= 146 137

Gas & Electric EUI by Percentile

Institution NElectricityKBtus/GSM

Gas KBtus/GSM

Academic or Research Hospital 14 892 942

Acute Care Hospital 103 866 1,810

Critical Access Hospital 6 790 1,026

Long-Term Care/Nursing Home 5 633 748

Medical Center 6 927 859

Gas & Electric EUI by Institution



%Practices N=184

Replaced existing light fixtures with new lights 68%

Retrofitted existing light fixtures 61%

Installed energy-efficient motors 32%

Installed occupancy sensors 35%

Set back thermostat 20%

Installed energy management system 17%

Installed energy-efficient chillers 22%

Installed energy-efficient ventilation equipment 16%

Installed energy-efficient heating equipment 16%

Recommissioned building systems 15%

Energy-efficient plumbing fixtures 22%

Energy-efficient windows 10%

Improved building shell insulation 4%

Retrofitted building envelope 3%

Adjusted HVAC operating hours 41%

HVAC flow reduction strategies 20%

Other 12%

Utility Conservation Practices

Given the double digit increases in utility rates, maximizing energy efficiency is a priority within the health care sector. Here are some of the ways in which survey respondents have reduced their utility usage. “Replaced existing light fixtures with new lights” and “retrofitted existing light fixtures” remained the top two choices for energy efficiency in this survey.

In general, hospitals with a larger facility size were more likely to have sustainability or energy management programs than those with a smaller facility size.

Facility Size (GSM) NHave Sustainability or

Energy Management Program?

Less than 23,225.6 97 20%

23,225.7-46,451.1 21 33%

46,451.2-69,676.7 15 53%

69,676.8-92,902.3 9 44%

92,902.4-185,804.5 16 75%

More than 185,804.5 12 75%

Overall 170 35%

Facility Size (GSM) N

Energy management program overseen by a

formal green team?

Less than 23,225.6 19 26%

23,225.7-46,451.1 7 57%

46,451.2-69,676.7 8 38%

69,676.8-92,902.3 4 60%

92,902.4-185,804.5 12 50%

More than 185,804.5 9 56%

Overall 59 44%

UTILITIES


%BAS Type N=85

Pneumatic 36%

Direct Digital Control (DDC) 62%

Direct Digital Control (DDC)/Pneumatic Retrofit 48%

Type of BAS Used

Building Automation System Forty-seven percent of the hospitals managed their utilities using a Building Automation System (BAS) in this survey.

The majority of the hospitals in this study reported using Direct Digital Control (DDC) technology.

UTILITIES

BAS Usage

Facility Size (GSM) N BAS Used

Less than 23,225.6 66 21%

23,225.7-46,451.1 27 41%

46,451.2-69,676.7 25 68%

69,676.8-92,902.3 24 71%

92,902.4-185,804.5 28 71%

Overall 170 47%


Does your BAS trend utility utilization and provide energy

management summary reports?

Less than 23,225.6 27 22%

23,225.7-46,451.1 13 38%

46,451.2-69,676.7 11 36%

69,676.8-92,902.3 6 17%

92,902.4-185,804.5 12 58%

More than 185,804.5 8 50%

Overall 77 35%


Does your BAS serve as a single integrated system

for multiple buildings?

Less than 23,225.6 27 48%

23,225.7-46,451.1 14 43%

46,451.2-69,676.7 11 73%

69,676.8-92,902.3 6 83%

92,902.4-185,804.5 12 83%

More than 185,804.5 8 63%

Overall 78 60%


Does your BAS have the ability to compare multiple building

energy performances with one another?

Less than 23,225.6 27 4%

23,225.7-46,451.1 14 29%

46,451.2-69,676.7 11 9%

69,676.8-92,902.3 6 17%

92,902.4-185,804.5 12 42%

More than 185,804.5 8 63%

Overall 78 22%

SECTION 3

Maintenance

Maintenance Categories

Maintenance Costs

Roads and Grounds

Facility Operating Current Replacement Value (CRV) Index

Maintenance Tracking

Maintenance Management System Used

Maintenance Staffing

Maintenance Management

Administrative Support

Total Maintenance Staff

Service Provision


Maintenance CategoriesThe survey divided maintenance costs into five distinct categories which are defined below.

External Building Maintenance• Roof

• Skin (siding, masonry, sash, glazing, window washing, external doors)

• Exterior signage

Interior Systems Maintenance• Electrical systems (primary and secondary

systems, emergency electrical systems, UPS, lighting systems, egress signage, master clocks, fire/life safety systems, alarms and remote monitoring, elevator maintenance/repair)

• Mechanical systems (HVAC, chillers, boilers, plumbing, extinguishing systems, back flow prevention, refrigeration and non-process related pumps)

• Building and general maintenance (interior walls, doors, ceilings, partitions and interior finishes, pest control)

• Interior signage

• Administrative support services

• Trouble desks

Roads and Grounds Maintenance• Roadways, sidewalks, parking lots (paving repairs,

sealing, striping, parking, roadway lighting, power washing), snow removal, de-icing

• Landscaping (planting, mowing, irrigation)

• Parking structures (surface repairs, sealing, striping, lighting and drainage systems)

• Storm sewers (catch basins, manholes, sub-surface drainage systems)

• Underground fire systems and hydrants

Utility/Central System Maintenance• Electrical (generation/distribution)

• Mechanical (steam, hot and cold water systems)

Process Treatment and EnvironmentalSystems

• Process cooling water systems

• Process gas systems

• Air discharge scrubbers

• Waste water systems

• Water treatment plants

• Incinerator operation

• Solid waste management system

MAINTENANCE


$/Discharge

PercentileTotal

MaintenanceExternal Building

InteriorSystems

Roads and Grounds

Utility/Central Systems

Process Treatment andEnvironmental

Systems

90 612.56 13.67 223.61 30.11 83.96 8.81

75 451.93 8.43 154.68 14.92 36.06 4.93

50 231.63 2.82 77.37 8.40 10.10 1.18

25 81.23 1.78 24.39 4.33 3.16 0.56

10 24.62 1.14 9.49 2.54 1.34 0.30

Mean 287.68 6.11 100.78 12.32 25.49 5.70

N= 82 35 43 44 27 31

Maintenance CostsAnnual maintenance costs, also broken out by square meters and adjusted discharges, include all repair, preventive, materials, direct labor and contract costs. Similar to the utility cost data, the costs listed in the “Total Maintenance” column do not equal the sum of the component costs due to the different sample sizes for each category.

With regards to total maintenance expenses, the average mean was $54.25 Canadian dollars per gross square meter with 45 percent being spent on interior systems.

On a cost per patient discharge, only an average of 35 percent was spent on interior systems.

Maintenance Costs per Discharge by Percentile

BES

T I

N C

LASS

$/GSM

PercentileTotal


InteriorSystems

Roads and Grounds

Utility/Central Systems

Process Treatment andEnvironmental

Systems

90 96.45 3.57 43.55 6.80 15.19 1.68

75 78.18 2.20 34.38 4.87 5.98 1.05

50 51.33 1.01 24.05 2.79 2.73 0.59

25 29.94 0.63 8.26 1.34 1.28 0.24

10 14.91 0.29 4.06 0.98 0.82 0.11

Mean 54.25 1.52 24.43 3.44 5.41 0.76

N= 140 47 56 58 34 36

Maintenance Costs by Percentile

BES

T I

N C

LASS

MAINTENANCE


MAINTENANCE

Maintenance Costs

This survey indicates that demand maintenance, repairs, and breakdown maintenance increase as a building ages. This is consistent with increases in the total costs of utilities as a building ages.

Maintenance Costs by Region

Region N $/GSM

Canada 83 59.15

New England -- --

Northeast -- --

Mid-Atlantic 13 39.82

Southeast -- --

Midwest 5 42.16

North Central 10 50.82

Heartland -- --

South Central 7 25.51

Mountain -- --

Pacific 8 54.61


$/GSM

Institution NTotal


InteriorSystems

Roads and Grounds

Utility/Central

Systems

Process Treatment and Environmental

Systems


13 39.37 1.18 28.25 2.88 8.90 0.65

Acute Care Hospital 89 59.36 1.80 24.89 3.48 6.03 0.70

Long-Term Care/Nursing Home

7 36.20 1.93 26.95 4.18 -- --

Medical Center 9 43.13 0.74 -- 1.89 1.57 0.62

Maintenance Costs by Institution

N% Target planned

maintenance% Target demand

maintenanceFacility Age

Less than 5 years 11 77% 23%

5-10 16 64% 36%

11-15 13 58% 42%

16-20 8 60% 40%

21-30 57 56% 44%

31-50 62 53% 47%


Maintenance Costs

N% Preventive

Maintenance/Discharge% Repair/Breakdown

Maintenance/DischargeFacility Age

Less than 5 years 10 0.02% 0.01%

5-10 10 0.02% 0.02%

11-15 11 0.01% 0.01%

16-20 5 0.02% 0.03%

21-30 25 0.09% 0.08%

31-50 38 0.04% 0.07%

NAnnual Year’s

Depreciation Expense ($)Facility Size (GSM)

Less than 23,225.6 22 1,557,831.19

23,225.7-46,451.1 10 3,671,396.22

46,451.2-69,676.7 5 6,552,576.57

69,676.8-92,902.3 2 6,856,415.75

92,902.4-185,804.5 8 17,801,178.84

More than 185,804.5 4 57,324,842.21

Overall 51 9,591,583.57

NNet Depreciated

Plant and Equipment ($)Facility Size (GSM)

Less than 23,225.6 19 8,213,987.55

23,225.7-46,451.1 10 22,716,205.12

46,451.2-69,676.7 4 36,838,395.33

69,676.8-92,902.3 1 46,862,998.00

92,902.4-185,804.5 8 168,393,602.16

More than 185,804.5 3 534,400,622.60

Overall 45 79,436,846.17

Age of Facility N $/GSM% PreventiveMaintenance

% Repair/Breakdown

Maintenance

Less than5 years 10 43.98 70% 30%

5-10 14 43.03 58% 42%

11-15 12 53.65 53% 47%

16-20 6 54.71 41% 59%

21-30 45 54.29 47% 53%

31-50 48 57.37 45% 55%

MAINTENANCE


Climate Zone $/Developed Acre $/Developed Hectare

US 1 (coldest) 5,579 13,786

US 2 6,758 16,699

US 3 7,708 19,047

US 4 3,830 9,464

US 5 (warmest) 2,430 6,005

CN 1 (coldest) -- --

CN 2 8,655 21,387

CN 3 8,691 21,476

US 4 (warmest) 6,796 16,793

Facility Setting $/Developed Acre $/Developed Hectare

Central business district 9,415 23,265

Secondary downtown location 7,837 19,366

Suburban area 6,360 15,716

Rural area 4,006 9,899

Facility Use $/Developed Acre $/Developed Hectare

Single Building 6,065 14,987

Multiple buildings, one location 6,511 16,089

Multiple buildings, multiple sites 7,663 18,936

MAINTENANCE

Roads and Grounds The maintenance of roads, grounds, parking surfaces and structures are also represented as dollar per developed acre or hectare. Snow or lack thereof, impacts the cost of maintaining roads and grounds as demonstrated by the climate zone chart.

$/Developed Acre $/Developed HectarePercentile N=48 N=48

90 15,477 38,244

75 9,332 23,060

50 4,725 11,676

25 2,129 5,261

10 1,064 2,629

Mean 6,493 16,045

Institution $/Developed Acre $/Developed Hectare

Academic or Research Hospital 10,654 26,327

Acute Care Hospital 6,424 15,874

Long-Term Care/Nursing Home 6,244 15,429

Note: Hospitals with a sample size of less than 5 are not included in the table..

Note: “Space within a building” is not included in the table because the sample size is less than 5.

Note: Business Park is not included in the table because the sample size is less than 5.


Facility Operating Current Replacement Value (CRV) IndexThe CRV index represents the level of funding provided for maintaining an organization’s portfolio of capital assets. This percentage is derived by dividing total annual maintenance by current replacement value and multiplying 100. The 1990 National Research Council report Committing to the Cost of Ownership: The Maintenance and Repair of Public Buildings recommends a budget allocation for routine maintenance and repair to be in the 2 percent to 4 percent range of aggregate current replacement value.

Maintenance TrackingIt is clear that facilities departments are getting their primary number of work requests electronically, which can include email. Direct telephone communication also ranks as a key means of obtaining work requests.

CRV Index %Percentile N=52

90 1.92

75 1.50

50 1.20

25 0.89

10 0.51

Mean 1.25

How Do Customers Request Work? (N=184)

Send request electronically

Contact a call center or help desk

Personally tell maintenance personnel

Fill out a paper request

Contact the individual FM function needed

Other

61%

40%

38%

16%

2%

35%

MAINTENANCE


MAINTENANCE

Maintenance Management System UsedIn this chart are key productivity measures being collected by facilities departments. Staffing levels and the backlog of corrective work remain as top focus points.

Percentage

Maintenance Productivity Data Collected N=184

Response time for work requests 31%

Percentage of work orders closed on time 39%

Cost per square meter 38%

Number of service complaints 26%

Maintenance staffing per square meter 55%

Percentage of budget spent on breakdown (unplanned) maintenance 12%

Corrective backlog and PM completion 55%


Maintenance StaffingRespondents were asked to complete a detailed worksheet indicating the number of workers employed or contracted in the respective hospital operation. The worksheet was split into three categories: maintenance workforce (trades), maintenance management and administrative support. Custodial workers and groundskeeping staff were not included in this maintenance headcount. The data provided shows the number of FTEs based upon facility size, provision of labor, and number of shifts and days worked. Variation swings may be explained by cross training of different trades.

Facility Size (GSM) N Number of FTEs % In-house % ContractNumber of

shifts per dayNumber of

days per week

Less than 23,225.6 23 1.05 87% 13% 1.0 4.5

23,225.7-46,451.1 18 1.51 94% 6% 1.2 5.0

46,451.2-69,676.7 10 3.20 91% 9% 1.3 5.3

69,676.8-92,902.3 7 2.21 86% 14% 1.3 5.0

92,902.4-185,804.5 11 4.45 97% 3% 1.3 5.2

More than 185,804.5 10 8.18 100% 0% 1.4 5.3

Electricians



days per week

Less than 23,225.6 13 0.80 95% 5% 1.2 4.8

23,225.7-46,451.1 15 1.05 100% 0% 1.1 4.9

46,451.2-69,676.7 6 1.90 100% 0% 1.4 5.8

69,676.8-92,902.3 7 1.64 86% 14% 1.1 5.0

92,902.4-185,804.5 11 3.18 100% 0% 1.3 5.2

More than 185,804.5 9 6.78 100% 0% 1.3 5.3

Plumbers



days per week

Less than 23,225.6 8 0.61 81% 19% 0.9 4.1

23,225.7-46,451.1 5 0.82 100% 0% 1.0 5.0

46,451.2-69,676.7 3 0.87 100% 0% 1.0 5.0

69,676.8-92,902.3 3 1.70 67% 33% 1.0 3.7

92,902.4-185,804.5 7 2.71 86% 14% 1.0 5.0

More than 185,804.5 6 3.95 83% 17% 1.0 4.2

Controls & Low Voltage

MAINTENANCE



MAINTENANCE



days per week

Less than 23,225.6 21 1.04 89% 11% 1.2 4.6

23,225.7-46,451.1 14 2.27 100% 0% 1.4 4.8

46,451.2-69,676.7 10 2.23 99% 1% 1.5 5.5

69,676.8-92,902.3 5 5.12 100% 0% 2.3 6.5

92,902.4-185,804.5 8 7.38 100% 0% 1.7 6.0

More than 185,804.5 9 8.51 89% 11% 1.7 5.6

HVAC & Central Plant Operators



days per week

Less than 23,225.6 11 1.59 100% 0% 1.7 5.6

23,225.7-46,451.1 11 3.57 100% 0% 1.3 5.8

46,451.2-69,676.7 7 6.57 100% 0% 2.3 6.5

69,676.8-92,902.3 4 7.24 100% 0% 2.4 6.2

92,902.4-185,804.5 11 11.64 100% 0% 2.2 6.6

More than 185,804.5 8 11.00 100% 0% 2.4 7.0

Stationery Engineers



days per week

Less than 23,225.6 11 0.84 90% 10% 1.1 4.2

23,225.7-46,451.1 11 1.57 100% 0% 1.0 4.9

46,451.2-69,676.7 7 2.08 83% 17% 1.2 5.3

69,676.8-92,902.3 5 1.80 100% 0% 1.0 5.0

92,902.4-185,804.5 8 2.88 100% 0% 1.0 5.0

More than 185,804.5 9 5.14 100% 0% 1.0 5.0

Carpenters





days per week

Less than 23,225.6 76 2.39 99% 1% 1.2 5.1

23,225.7-46,451.1 14 4.96 100% 0% 1.3 5.4

46,451.2-69,676.7 12 4.80 99% 1% 1.9 5.9

69,676.8-92,902.3 5 7.80 100% 0% 1.8 5.8

92,902.4-185,804.5 8 18.05 100% 0% 1.9 6.1

More than 185,804.5 7 10.86 100% 0% 1.7 6.0

Generalists



days per week

Less than 23,225.6 4 0.42 71% 29% 1.0 5.0

23,225.7-46,451.1 5 0.59 80% 20% 1.0 5.0

46,451.2-69,676.7 6 0.89 80% 20% 1.2 5.8

69,676.8-92,902.3 6 1.00 100% 0% 1.0 5.0

92,902.4-185,804.5 4 1.40 100% 0% 1.0 4.5

More than 185,804.5 9 1.67 100% 0% 1.0 5.0

Locksmiths



days per week

Less than 23,225.6 10 0.77 95% 5% 1.1 3.9

23,225.7-46,451.1 9 0.91 89% 11% 1.0 5.0

46,451.2-69,676.7 6 1.46 84% 16% 1.25 5.0

69,676.8-92,902.3 6 2.00 92% 8% 1.2 5.0

92,902.4-185,804.5 9 2.00 100% 0% 1.0 5.0

More than 185,804.5 11 4.18 100% 0% 1.3 5.1

Painters

MAINTENANCE


Facility Size (GSM) N Number of FTEs % In-house % Contract% Exempt (Salaried)

% Non-exempt (Hourly)

Less than 23,225.6 16 0.72 94% 6% 69% 31%

23,225.7-46,451.1 12 1.10 92% 8% 69% 31%

46,451.2-69,676.7 9 3.67 100% 0% 38% 62%

69,676.8-92,902.3 6 1.67 100% 0% 71% 29%

92,902.4-185,804.5 11 2.45 100% 0% 57% 43%

More than 185,804.5 11 4.64 100% 0% 30% 70%

Facility Size (GSM) N Number of FTEs % In-house % Contract% Exempt (Salaried)

% Non-exempt (Hourly)

Less than 23,225.6 65 0.47 98% 2% 94% 6%

23,225.7-46,451.1 19 0.97 95% 5% 100% 0%

46,451.2-69,676.7 12 1.29 100% 0% 100% 0%

69,676.8-92,902.3 5 1.77 100% 0% 100% 0%

92,902.4-185,804.5 12 2.50 100% 0% 92% 8%

More than 185,804.5 11 3.95 100% 0% 90% 10%

Group Supervisor

Operations and Maintenance Manager

MAINTENANCE

Maintenance Management

Administrative Support

Facility Size (GSM) N # of FTEs

% In-house

% Contract

Less than 23,225.6 7 1.00 83% 17%

23,225.7-46,451.1 3 2.00 95% 5%

46,451.2-69,676.7 6 1.67 83% 17%

69,676.8-92,902.3 6 1.00 100% 0%

92,902.4-185,804.5 7 4.41 100% 0%

More than 185,804.5 9 2.78 98% 2%

Help Desk


% In-house

% Contract

Less than 23,225.6 37 0.41 97% 3%

23,225.7-46,451.1 17 1.01 97% 3%

46,451.2-69,676.7 9 0.91 92% 8%

69,676.8-92,902.3 5 1.20 100% 0%

92,902.4-185,804.5 12 1.90 97% 3%

More than 185,804.5 11 3.97 100% 0%

Administrative Assistant


Total Maintenance StaffBecause of the different sample sizes for each type of maintenance staff, the total maintenance staff does not equal to the sum of the numbers of all maintenance staffing categories.

Hospitals with a facility size of less than 23,225.6 GSM reported 0.005 maintenance staff per adjusted discharge, the highest number among all hospitals of different facility sizes.

While the critical access hospitals had the lowest number of maintenance staff per adjusted discharge (i.e., 0.001), Acute Care Hospitals reported the highest number of maintenance staff per adjusted discharge. This variation may be due to the number of reporting organizations that were Acute Care Hospitals, representing nearly 70% of the data sampled.


Less than 23,225.6 94 4.12

23,225.7-46,451.1 20 14.59

46,451.2-69,676.7 14 19.73

69,676.8-92,902.3 8 26.00

92,902.4-185,804.5 15 46.42

More than 185,804.5 11 83.50

Total Maintenance Staff by Facility Size

Total Maintenance Staff per Discharge by Facility Size

Facility Size (GSM) N Total Maintenance Staff/Discharge

Less than 23,225.6 59 0.005

23,225.7-46,451.1 13 0.002

46,451.2-69,676.7 9 0.001

69,676.8-92,902.3 5 0.001

92,902.4-185,804.5 8 0.001

More than 185,804.5 9 0.002

Institution N Total Maintenance Staff/Discharge

Academic or Research Hospital 11 0.002

Acute Care Hospital 66 0.004

Children’s Hospital 6 0.002

Critical Access Hospital 6 0.001

Medical Center 7 0.002

Total Maintenance Staff per Discharge by Institution Type


Institution N # of FTEs

Academic or Research Hospital 15 63.05

Acute Care Hospital 113 11.75

Children’s Hospital 9 26.64

Critical Access Hospital 8 4.77

Long-term Care/Nursing Home 8 3.23

Medical Center 13 26.69

Total Maintenance Staff by Institution Type


MAINTENANCE


MAINTENANCE

Service Provision The majority of the study respondents (80 percent) rely on a separate department such as biomedical or clinical engineering to handle maintenance for medical equipment.

Medical Equipment Management Performed By (N=167)

In-house, separate biomedical or clinical engineering department

In-house, part of facilities operations

Contracted (not included in the facilities operations budget)

Contracted (part of facilities operations)

80%

4%

10%

5%

SECTION 4

Environmental Services

Environmental Services Costs

Environmental Services Staffing

Contractor Practices


ENVIRONMENTAL SERVICES

Environmental Services CostsEnvironmental services costs are the costs associated with the cleaning of patient rooms, offices and work areas, restrooms and common support space. Also included in this cost are wages, benefits, staff support, supervision, administration, supplies, paper goods and non-capital equipment. Labor is the major component of the cost, therefore any change in wages can affect the overall cost significantly.

Percentile $/GSM $/Discharge

90 88.60 722

75 62.36 329

50 47.91 159

25 28.58 81

10 19.65 32

Mean 53.44 273

N= 77 62

Environmental Services Costs by Percentile

BES

T I

N C

LASS

EnvironmentalServices Performed by: N $/GSM $/Discharge

In-house staff 60 56.52 259

Contracted service 5 43.77 196

Combination by both 12 42.39 256

Environmental Services Costs by Staff or Contract

Institution N $/GSM $/Discharge

Academic or Research Hospital 13 49.30 364.20

Acute Care 32 53.33 210.23

Children’s Hospital 5 36.65 282.28

Critical Access Hospital 8 27.94 85.87

Long-Term Care/Nursing Home 6 84.89 --

Medical Center 7 49.72 270.44

Environmental Services Costs by Institution Type



Environmental Services CostsUnlike the cost of maintenance and utilities, the cost of Environmental Services falls as the building ages.

Facility Age N $/GSM $/Discharge

Less than 5 years 11 71.08 231

5-10 10 54.93 279

11-20 12 54.82 193

21-30 15 48.23 398

31-50 25 43.77 293

Environmental Services Costs by Facility Age

Environmental Services Costs by Region

Country/Region N $/GSM $/Discharge

Canada 24 61.62 424

Mid-Atlantic 12 57.69 322

Midwest 5 24.22 --

North Central 11 34.63 134

Mountain 5 55.46 155

Pacific 8 77.34 125

Note: Regions with a sample size of less than 5 are not included in the table.




Environmental Services CostAlthough labor is a major component of the environmental services cost, it only accounted for 46 percent of the total cost in this survey.

The second major component of the total cost fell into the “other” category. This may be contracted services, capital equipment, or sustainability activities.

(Note: respondents were not asked to specify, “other”)

Environmental Services StaffingEighty-two percent of the institutions represented in this study hired predominantly in-house employees to staff the environmental services function. Nine percent used contracted staff to perform this function, and another 9 percent used a combination of both.

Facility Size (GSM) NNumber of Environmental

Services FTEs

Number of In-House Employees Supervising Contract

Less than 23,225.6 32 11.20 1.0

23,225.7-46,451.1 15 34.30 1.1

46,451.2-69,676.7 9 53.41 1.0

69,676.8-92,902.3 5 91.34 --

92,902.4-185,804.5 8 140.83 2.0

More than 185,804.5 10 211.42 1.5

Number of Environmental Services FTEs/Discharge

Facility Size (GSM) N Mean

Less than 23,225.6 25 0.008

23,225.7-46,451.1 11 0.003

46,451.2-69,676.7 7 0.003

69,676.8-92,902.3 5 0.005

92,902.4-185,804.5 6 0.005

More than 185,804.5 9 0.006

Note: Results for the number of in-house employees supervising contract per adjusted discharge are not reported because the sample size is less than 5 for all facility size categories.

Labor

Cleaning Supplies/Paper Products

Supervisors/Staff Support

Day-porters/Matrons

Non-Capital Equipment

Other

N=174

46%

6%

3%

3%

2%

40%


Terms of Contract (N=19) Contractor PracticesWhen contracted, health care organizations are mixed in terms of paying for performance or based upon tasks and frequencies.

Health care organizations who choose to contract out services tend to stay with a contractor for longer terms.

Contractor Provides (N=31)

Background Checks

Supplies

Equipment

Paper Products

48%

45%

39%

35%

Number of Years Contract has been in Place (N=18)

Tasks and frequencies

Performance based

11+ years

6-10 years

5 years

3-4 years

Less than 3 years

58% 42%

34%

22%22%

11%

11%


SECTION 5

Waste


Waste UtilizationWaste management has become increasingly important, as waste is often viewed as a measurement of overall business performance. The ability to manage and reduce waste impacts the bottom line.

WASTE

$/Discharge

PercentileSolid

WasteInfectious

Waste

Hazardous Waste

(Non-Pharma-ceutical)

Hazardous Waste

(Pharmaceu-tical)

ChemoWaste

Compostand Food

Recyclables (co-mingled) E-Waste

90 16.90 13.46 5.27 6.57 1.12 2.10 4.08 1.47

75 8.44 6.29 3.42 3.19 0.87 1.24 2.23 0.53

50 5.28 1.98 1.61 0.94 0.20 0.66 0.99 0.14

25 1.72 0.70 0.63 0.40 0.07 0.29 0.15 0.04

10 0.78 0.26 0.28 0.21 0.03 0.27 0.09 0.02

Mean 8.15 4.58 2.30 2.20 0.53 1.00 1.71 0.44

N= 42 26 26 27 14 7 14 8

$/KG

PercentileSolid

WasteInfectious

Waste

Hazardous Waste

(Non-Pharma-ceutical)

Hazardous Waste

(Pharmaceu-tical)

ChemoWaste

Compostand Food

Recyclables (co-mingled) E-Waste

90 0.35 3.63 15.68 14.14 8.73 2.26 0.33 1.65

75 0.24 1.67 3.60 6.91 5.34 0.17 0.17 1.19

50 0.15 0.89 1.80 3.26 1.17 0.13 0.11 0.65

25 0.11 0.72 1.09 0.93 0.61 0.11 0.04 0.46

10 0.07 0.46 0.46 0.74 0.56 0.09 0.02 0.30

Mean 0.20 1.45 5.21 5.97 3.71 0.83 0.15 0.89

N= 34 23 25 25 10 6 14 7

Cost per Pound

BES

T I

N C

LASS

Cost per Adjusted Discharge

BES

T I

N C

LASS

SECTION 6

Linen Services


Is Linen Processed and Laundered at this Facility? (N=172) Linen ProcessedHealth care organizations by far contract out laundry services.

The table below shows annual linen processing cost by kilograms and by adjusted discharges.

LINEN SERVICES

Percentile $/KG $/Discharge

90 2.19 225.04

75 1.85 197.40

50 1.41 131.27

25 1.11 48.36

10 0.80 18.75

Mean 1.45 127.32

N = 37 34

Annual Linen Processing Costs

BES

T I

N C

LASS

No67%

Yes33%

SECTION 7

Operations

Cost of Operations

Customer Satisfaction

Productivity Measure


Cost of Facility OperationsCombining the utility, maintenance and environmental services costs together will provide a facility’s cost of operations, another indicator of performance. These annual costs are broken out by square meters, adjusted discharges and FTEs.

Outpatient health care centers and long-term care/nursing homes rank amongst the highest. The total cost of operations is much lower for critical access hospitals.

Percentile $/GSM $/Discharge $/FTE

90 166.90 1,287.05 8,440

75 129.30 822.17 6,495

50 101.57 537.92 4,616

25 60.34 231.95 3,085

10 34.53 63.17 1,445

Mean 102.42 599.11 4,930

N = 170 109 100

Cost of Facility Operations by Percentile

Institution N $/GSM $/Discharge $/FTE

Academic or Research Hospital 16 104.01 765.91 4,496

Acute Care Hospital 111 99.65 572.46 5,266

Children’s Hospital 8 116.33 585.29 5,309

Outpatient Health Care Center 5 141.09 620.82 4,757

Critical Access Hospital 9 74.37 221.09 2,760

Long-term Care/Nursing Home 7 127.49 -- 7,368

Medical Center 10 101.14 562.59 3,495

Cost of Facility Operations by Institution


OPERATIONS


OPERATIONS

Customer SatisfactionOnly 40 percent of those surveyed conduct customer satisfaction surveys, the vast majority are doing them yearly using web based tools.

Conduct Satisfaction Surveys? (N=167)

No60%

Yes40%

Satisfaction Surveys: If Yes, How Often? (N=66)

Daily

Weekly

Monthly

Quarterly

Yearly

69%

9%

9%

2%

11%

Survey Format (N=67)

Web-based survey tool

CMMS generated

In-house electronic form

Paper

54%

15%

22%

43%


Customer SatisfactionCommunication of work status, delays of work, and comfort rank as the top three customer complaints.

Electronic Hand-held DevicesOnly 12 percent of the hospitals reported using electronic hand-held devices for documentation of work orders and PMs

Most Common FM Complaints or Concerns (N=67)

Do Service Staff Use Electronic Devices for Documentation of Work Orders and PMs? (N=165)

Type of Hand-Held Device Used (N=20)

Communication of work status

Delays of work

Thermal comfort

Timelines

Aged equipment

Parts not available

Coordination of work

Number of repairs

Unpredictable failure

Inability to perform in-house

52%

40%

40%

37%

30%

10%

7%

7%

4%

4%

Yes12%

No88%

OPERATIONS


OPERATIONS

Help Desk Do You Utilize a Help Desk? (N=182)

Is the Help Desk Integrated Across Multiple Departments? (N=81)

What is the Output of the Help Desk?(N=82)

Departments Supported by the Help Desk (N=53)

Yes45%

Yes65%

No55%

No35%


KPIs Tracked Percentage (N=184)

Financial variation 58%

Service response 21%

Delays of work 5%

Man hour productivity 26%

Process variation 0.5%

Market rents 3%

Current Replacement Value (CRV) Ratio 28%

Preventive Maintenance (PM) 72%

PM completion rate 47%

PM accuracy 20%

FTE per square foot/meter 45%

FTE per piece of equipment 4%

Compliance 48%

Safety events 35%

Percent of vacant space 8%

Facility Condition Index (FCI) 34%

Waste audits 10%

Energy use 42%

Utility failures/Disruption avoidance 40%

OSHA logs 15%

Adjusted discharge 13%

Adjusted patient days 16%

Key Performance IndicatorsThis chart represents the number of health care organizations conducting key performance indicators in the referenced areas.

Which of the Following Departmental or Organizational Key Performance Indicators (KPIs) Do You Track?

OPERATIONS


CAFM SystemOverall, 41 percent of the hospitals participating in this survey reported using a CAFM system. When facility size was taken into account, the results show that, in general, the larger hospitals were more likely to use a CAFM system than the smaller hospitals.

Based on the results from this survey, computerized maintenance management system (CMMS), space management, construction or project management, and asset management (FFE) were the top four applications for which the hospitals used a CAFM system.

OPERATIONS

Use CAFM System?Facility Size (GSM) N Yes No

Less than 23,225.6 97 25% 75%

23,225.7-46,451.1 21 38% 62%

46,451.2-69,676.7 15 60% 40%

69,676.8-92,902.3 9 56% 44%

92,902.4-185,804.5 16 81% 19%

More than 185,804.5 12 92% 8%

Overall 170 41% 59%

Does Your Organization Use a CAFM System?

CAFM Application Percentage (N=72)

Construction or Project Management 39%

Space Management 47%

Computerized Maintenance Management System (CMMS) 69%

Leasing 24%

Move Management 5%

Energy Management 14%

Asset Management (Fixtures, Furniture and Equipment (FFE)) 36%

Telecom 5%

Personnel Plans 11%

Security Plans 5%

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