Management of indoor environmental quality in healthcare facilities: a multi-stakeholder approach
Creators: name: Garnawat, Prachi
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 330202
subject: Building construction management and project planning
classificationCode: 330205
subject: Building organisational studies
classificationCode: 330299
subject: Building not elsewhere classified

description: This PhD thesis reports on the development of an integrated indoor environmental quality (IEQ) management framework for Australian healthcare facilities. Although the available IEQ research primarily focuses on IEQ assessment and building performance evaluation from the user perspective, facilities management practices in Australia seem to be compliance-driven, focusing on technical know-how.

The design and management of healthcare facilities involve various stakeholders including patients, visitors and staff. Whereas much research has been conducted in evidence-based-design of healthcare facilities to improve patient recovery and experience, very limited research has been carried out to identify the indoor environmental quality (IEQ) parameters that influence staff productivity. More so, limited studies have been conducted on evaluating IEQ management practices in healthcare facilities. To address the knowledge gaps in the identification of IEQ needs, assessment, and management in healthcare, this thesis reports on the IEQ research conducted in Australian healthcare facilities. 

The aim of this research was to develop an IEQ assessment and management framework for healthcare facilities that incorporate the needs of the occupants and addresses the challenges faced by the facilities managers. This was to be achieved through the following objectives:
To identify the IEQ needs of the regular occupants of the healthcare facilities and to assess the gap between their satisfaction with respect to the identified parameters.
 
To analyse the current IEQ management practices in healthcare facilities and to identify the associated challenges in IEQ management the research was carried out on the basis of two theories the user-centred theory and the system theory. The user needs once identified through the user-centred theory would be used as an input to the 'system' or operational hospital buildings as described under the system theory. These user-centred theories allowed the identification of the users along with their needs. While the analysis of the challenges and barriers faced by the facilities managers formed the basis for identifying the system requirements of the built environment system. 

Two structured surveys were conducted in four (4) hospitals in Victoria, Australia. The staff survey identified the importance of the IEQ parameters on staff perceived productivity; and, the facilities manager survey (for the personnel responsible for building services and space management) solicited current IEQ management practices and challenges in IEQ management. Based on the survey findings, a multi-stakeholder approach was proposed for the integrated assessment and management of IEQ in healthcare facilities. This approach was reviewed by an expert panel who confirmed the applicability of the multi-stakeholder approach in Australian healthcare facilities. The expert review and the two surveys provided valuable insights into the IEQ needs and requirements of the staff previously overlooked in guidelines and management of healthcare facilities. 

Interestingly, the hospital staff validated air freshness and quality as the most important parameters in influencing perceived productivity. Thermal comfort was raised as a concern by some staff yet considered difficult to manage by facilities managers. While all the hospitals performed satisfactorily in managing majority of the operational aspects such as lighting and ventilation, key design parameters such as spatial quality and personal control were found to be unsatisfactory-which were also considered to be of low priority by the facilities managers. Further, the challenges in providing and managing IEQ in Australian healthcare facilities were analysed through a facilities manager survey. The challenges included lack of resources, managing occupant discretion, energy efficiency, cost and budget constraints and building design. 

Based on the  facilities manager survey and the expert review, it was concluded that it is important to involve the decisionmakers in IEQ management strategies. Therefore, this thesis proposes a multi-stakeholder approach and framework which includes multiple perspectives ie. the occupants' needs; operational feasibility; and the organisational decisions; to comprehensively assess and manage IEQ in healthcare facilities. 

By identifying the staff IEQ needs and facilities managers' challenges in IEQ management this thesis contributes to a better knowledge of the complicated and variable relationships between occupants and facilities managers in Australian healthcare facilities. Based on the user-centred theory and system theory, this research highlights the role of facilities managers in IEQ management and extends the user-centred theory for IEQ management.

The thesis argues that IEQ management in healthcare facilities is complex with multiple end-users and diverse needs. Informed by the IEQ needs of the healthcare staff, the thesis proposes that the IEQ management strategies in healthcare facilities in Australia should account for the IEQ requirements of the staff as much as of the patients. This research also explored the constraints in managing building IEQ defined by the facilities managers which bridged the expectation-performance gap often observed in healthcare facilities environments. Thereby, enhancing the IEQ management knowledge and practices in Australian healthcare facilities. A nuanced knowledge of IEQ management practices in healthcare facilities would inform policies and procedural guidelines framed at providing satisfactory and productive environments for healthcare facilities users. 

This thesis advances the field of facilities management by setting out an IEQ management framework which allows for the integration of the users/occupant perception in an otherwise compliance-based and technicality driven practice.