Dr Stanley Njuangang

Since the creation of the National Health Service (NHS) in 1948, there has been growing pressure for it to operate in a more business like fashion. By 1979 only a small fraction of private firms were doing business with the NHS. Drawing from the experience of the private sector where outsourcing was a success, the NHS was urged to work with the private sector in the provision of non-clinical services. Thus, to reduce the estimated £900 million that was required to provide non-clinical services, the governments introduced competitive tendering and market testing. The aim was to encourage a public/private sector mix and market competition in the NHS. Despite initial resistance, the NHS has grown today into a major outsourcing market in the UK. The provision of domestic cleaning services alone account for an estimated £188 million. The main aim of this research paper is to investigate the benefits and problems associated with outsourcing in the National Health Service (NHS) in the UK. The paper also examines the different government initiatives that opened the NHS market to the private sector. The findings presented in this paper are primarily based on an in-depth literature review. The main driving force behind outsourcing in the NHS has been to cut down public spending. Through outsourcing, the NHS aim to provide more efficient, innovative and cost effective non-clinical services. Outsourcing firms have a pool of expertise, knowledge, methodologies and technology upon which the NHS can rely on. There are a number of problems associated with the outsourcing of non-clinical services in the NHS. Many blame the falling cleaning standards and subsequently the high rate of Hospital Acquired Infections (HAIs) on the outsourcing of domestic cleaning services. The failure of most NHS trust to evaluate the cost of HAIs associated with outsourcing is either under or over estimating the actual benefit of outsourcing. Outsourcing in the NHS has created a two tier workforce whereby, employees in the outsourcing firm experience poor remuneration, and working conditions. In some circumstances, cost reduction has been achieved through redundancies; though at the cost of high quality in-house service provision. To outsource in the NHS, there must be sufficient evidence to suggest that it will bring value for money. A well drafted service level agreement (SLA) emphasizing performance measurement should be drawn with the vendor.

The UK Government introduced the private finance initiative (PFI) as a measure to work closely with the private sector in the provision of public projects. Despite its popularity in the 1990s, it presently faces strong criticisms for failing to deliver value for money. This chapter details the practicality of using an exploratory sequential mixed methods research design to investigate the factors that affect the reputation of PFI projects in the UK. In this chapter, the processes involved in document selection for grounded theory (GT) (qualitative) and the conduct of the GT in the qualitative strand were outlined. Similarly, it detailed the process for eliciting quantitative data through a questionnaire survey. The chapter highlighted the joint display of the results of the qualitative and quantitative phases. Subsequently, both sets of results were then used to develop a theoretical framework of factors that affect PFI/PF2 projects’ reputation in the UK.

The UK Government introduced the private finance initiative (PFI) as a measure to work closely with the private sector in the provision of public projects. Despite its popularity in the 1990s, it presently faces strong criticisms for failing to deliver value for money. Different measures, that is Private Finance 2 (PF2), by successive UK Governments have not changed the situation. The exploratory sequential mixed methods research design applied to investigating the reputation of PFI/PF2 projects in the UK is presented in this research. Grounded theory was the primary method for conducting the qualitative research phase. Thereafter, the themes were distilled and constituted the basis of a questionnaire survey using a five-point Likert Scale. The questionnaire was despatched to selected stakeholders in the construction industry and the data was analysed using the Relative Importance Index (RII) and Kruskal Wallis Test. Using the results of the RII, the most important factors affecting the reputation of PFI projects were selected for the development of a theoretical framework. Despite what appears to be disagreements amongst researchers on the true value of mixed methods research, the findings from using this approach made it possible for conclusions to be drawn from multiple perspectives. Hopefully, issues regarding the paradigmatic position of mixed methods research will be overlooked in favour of its contribution to investigating contemporary issues.

© 2018, Emerald Publishing Limited. Purpose: The history of the development of non-clinical services in infection control (IC) dates back to the pre-modern era. There is evidence of health-care facility management (HFM) services in Roman military hospitals. With the fall of the Roman Empire, Christian beliefs and teaching shaped the development of HFM in monastic hospitals. It was not until the late Victorian era that the link between HFM services and diseases caused by “miasma”, or bad air, became established. The discovery of bacteria in the modern scientific era reduced the level of importance previously attached to non-clinical causes of infections. Today, in the NHS, HFM services continue to be treated as though they had no real role to play in IC. This paper aims to collate historical and epidemiological evidence to show the link between HFM and IC. Design/methodology/approach: The evidence gathered in this research paper is primarily based on an in-depth review of research from a wide range of sources. A “within-study literature analysis” was conducted to synthesise the research materials. This involved the application of “between-source triangulation” to verify the quality of the information contained in the studies, and “between-source complementarity” to provide an in-depth elaboration of the historical facts. Findings: Historical and epidemiological evidence shows that HFM services such as cleaning, waste management, catering, laundry and maintenance continue to play a crucial role in IC. This is corroborated by evidence gathered from the work of renowned pioneers in the field of IC. However, reforms in the NHS have failed to consider this, as HFM services have been largely fragmented through different partnership arrangements. Practical implications: Among many other things, this research raises the profile of HFM staff in relation to the issue of IC in hospitals. It presents convincing evidence to show that the relationship between the clinical and non-clinical domains in controlling infections in hospitals has a long history. The findings of this research give HFM staff invaluable information about the significant role of their profession in the control of infections in hospitals. Originality/value: This is one of the few studies examining the historical development of HFM services, as well as their contribution to IC. Other work in this area has mainly been framed from a clinical health-care perspective.

Hospital-acquired infections (HAIs) are a major problem in the United Kingdom (UK) and worldwide. The UK has one of the worst rates of hospital-acquired infections (HAIs) in Western Europe. One reason for such poor performance is the failure of healthcare officials to tackle the root causes of HAIs in the National Health Service (NHS). The position of healthcare officials is that HAI is mainly a clinical issue; requiring the attention of clinicians. As a result, most of the infection control policies and guidelines do not sufficiently address the non-clinical causes of HAIs in the NHS. There is strong epidemiological evidence suggesting that HAIs can also occur because of the poor performance of facilities management (FM) services. An example of an FM service that has a strong link with HAI is healthcare maintenance. Despite being linked to such infections as aspergillosis, legionnaires etc, healthcare maintenance services (HMSs) in the NHS have nonetheless failed to attract the attention of healthcare authorities. In this study therefore, we examine the methodological approach in identifying the key performance indicators and measures in HMSs in infection control. This study is divided into two main sections. In the first section, we examine different research paradigms, as well as, the rational for choosing interpretivism in this study. The second section, which is on the research design, examines the research methodology and research methods applied in this study. Addressing these methodological issues is important in identifying the key performance indicators and measures in HMSs in infection control. © 2013 American Society of Civil Engineers.

© 2015, Emerald Group Publishing Limited. Purpose – The purpose of this paper is to improve overall healthcare maintenance (HM) service performance in NHS infection control (IC). Hence, the authors identify critical success factors (CSFs) and key performance measures in maintenance-associated infections. These infections occur because of the poor performance of HM service in IC. Design/methodology/approach – In the first Delphi exercise, complete CSFs and performance measures were presented to the Delphi participants for refinement and modification. Delphi round 1 data were analysed manually and used to refine the rounds 2 and 3 Delphi instruments. In subsequent Delphi rounds, the results were analysed through descriptive statistics. Findings – In total, eight CSFs and 53 key performance measures were identified for reducing maintenance-associated infections in hospitals. For example, establishing clear communication between the infection control team (ICT) and HM unit is important for preventing maintenanceassociated HAIs. Dust prevention is also identified by the healthcare experts as an important measure to prevent maintenance-associated HAIs in high-risk patient areas. Originality/value – The findings provide CSFs and key performance measures for measuring performance in HM in IC. Reducing the rate of maintenance-associated infections will have important socio-economic and health ramifications for hospitals. It will reduce cost and free up additional resources for alternative projects. It will also raise confidence among healthcare users about the quality of services provided by hospitals.

© 2016, © Emerald Group Publishing Limited. Purpose: Healthcare maintenance (HM) services have an important role in the control of hospital-acquired infections (HAIs). Notwithstanding, many HM managers still do not measure the performance of HM services in infection control (IC). This research, therefore, aims to establish the level of importance of critical success factors (CSFs) and performance measures in HM IC. A performance measurement tool (PMT) was also developed to improve the performance of the HM unit in IC. Design/methodology/approach: The CSFs and performance measures identified in the literature were categorised into the four perspectives of balanced scorecard and analysed through Delphi. The Delphi participants were presented with 67 performance measures and asked to rate their level of importance in HM in IC. In total, they identified 53 important performance measures to control maintenance-associated HAIs. The results obtained from the Delphi study were used to categorise the performance measures into four means zones. The mean zones were assigned weights (1-4), and the level of importance of the CSFs was established through weighted average. Liaison and communication, IC practices and maintenance resource availability emerged as the most important CSFs in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC. Findings: The following CSFs, liaison and communication, IC practices and maintenance resource availability, emerged as the most important in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC. Originality/value: Through the application of the PMT, performance in IC can be estimated at different levels in the HM unit. The PMT allows managers to focus on the most crucial CSFs and performance measures that drive performance in HM in IC. The PMT could also be used for benchmarking purposes.

Purpose: This study aims to examine facility management practices in the Nigerian healthcare sector, exploring approaches and identifying challenges facing effective healthcare facilities management. The purpose is to contribute to the development of a framework for enhancing healthcare facility management efficiency in Nigeria. Design/methodology/approach: The study employs a sequential in-depth exploratory qualitative research approach. The data collection involved conducting semi-structured interviews with 15 facility managers from diverse healthcare organisations in Nigeria. The qualitative data collected were analysed using thematic analysis. Findings: The study reveals scheduled, unscheduled and mixed approaches as the three facility management approaches used in Nigeria. It also substantiates the underdeveloped nature of facility management in Nigeria's healthcare sector, exacerbated by challenges such as socioeconomic, operational, technological and regulatory challenges. Practical implications: The study uncovers systemic issues affecting have attainment of Sustainable Development Goal 3 (Good Health and Well-being) and advocates for a comprehensive approach to enhance healthcare infrastructure, contributing to improved health outcomes and sustainable development. Originality/value: This research uniquely uncovers the hidden challenges facing effective healthcare facility management in Nigeria, providing a foundation for stakeholders to formulate solutions and rescue the struggling state of healthcare facilities in the country.