## 4 Research Methodology
### Analysis and Results
However, usability analysis showed that \"Predicted maintenance ratio\", \"Percentage/Number of condition-based maintenance work\", \"Number of man hours per capacity of installation\", \"Urgent repair request index\", \"Predicted maintenance time\", \"Percentage compliance with required response time\", \"Number of deferred maintenances\", \"Significant and high risk backlog maintenance as percentage of total backlog expenditure requirement\", \"Total risk adjusted backlog maintenance\", \"Maintenance overtime\", \"Failure/Breakdown frequency\", \"Mean time to repair\", \"Number of work orders depending on healthcare service, system and equipment level\", \"Fault pattern analysis\", \"Identification of impact of maintenance and faults on energy consumption (filters, fans, pumps, cooling tower, chillers, boilers,thermostats)\", \"Managerial span of control\", \"Identification and prediction of maintenance cycle\", \"Number of preventive maintenance depending on comparison of real energy consumption with simulation results\", and \"Sustain rate\" are not important for Turkish healthcare facility management performance measurement. * Physical Aspect of Healthcare Facilities: Usability analysis showed that \"Identification of usage pattern of system-equipment in the facility\", \"Physical condition change rate for facility\", \"Percentage of properties less than 50 years\", and \"Age coefficient\" indicators are found to be unusable for Turkish healthcare facility management. * Lifecycle Cost in Healthcare Facilities: As a result of the literature review, forty-three KPIs were identified for lifecycle cost in Turkish healthcare facilities. However, \"Equipment replacement value\", \"Maintenance stock turnover\", \"O&M cost per capacity of installation\", \"Cost of equipment added or replaced\", \"Custodial and janitorial cost\", \"Maintenance cost index\", \"Normalized annual maintenance expenditure\", \"Replacement efficiency index\", \"Prediction of maintenance costs\", \"Prediction of operational costs\", \"Rates cost\", \"Pottering cost per consumer week\", \"Laundry and linen cost per consumer week\", and \"Waste cost per consumer week\" were found to be unusable as a result of usability analysis. Furthermore, shortlisted FM KPIs were evaluated by the experts in terms of organizational level and measurement frequency of FM KPIs (operational, tactical, and strategic). The results are depicted in Tables 1-6. Analysis results show that identified FM KPIs mainly intensified in the tactical level and strategic level. In the operational level, eighteen FM KPIs were found applicable. For example, U1-Indoor environmental quality changes according to occupancy schedule, outdoor weather conditions, etc. Therefore, they need to be monitored per second, per minute, or hourly by technicians. AHP integrated PROMETHEE calculations consist of two steps. In the first step, AHP calculations were performed. First of all, it was requested from responders to fill the pairwise comparison matrix for the criteria, which are used in the identification of priority order of the healthcare FM KPIs. Within this context, three criteria were determined; namely, FM response time, FM expense/costs, and service quality. Therefore, 3 \(\times\) 3 comparison matrices were completed by facility managers. Collected datasets were aggregated with geometric mean to obtain the aggregated matrix (Table 7). The normalized decision matrix was calculated as given in Table 8. After that, the priority vector was calculated by finding the average value of the normalized decision matrix rows. Additionally, values found in the priority vector corresponded to weights of criteria. After that, the priority vector was multiplied with the aggregated matrix to find the weighted sum matrix. Eigen values were calculated by dividing values of the weighted