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Adding value through transforming culture in FM

Preston Gan, head of quality and performance at NHS Grampian, shares his experiences of transforming and adding value to existing GP practices and culture in FM

How do you “value add” when “doing more with less” is business-as-usual in today’s climate?

Working in the Facilities and Estates Directorate at NHS Grampian (NHSG) has certainly given me the challenge of managing and improving FM services with finite resources; across a large and diverse geographical estate affecting 14,000 staff and a population over 584,000 across Aberdeenshire, Aberdeen City and Moray regions accessing healthcare services.

THE CHALLENGE
The Facilities and Estates Directorate in NHS Grampian operates a predominantly in-house provision of hard and soft FM services with outsourcing of specialist work to contractors for 82 NHS-owned properties. While there was the continuing ambition to deliver FM services to the additional 64 privately-owned or leased GP practices, financial austerity measures have led to a reduced in-house maintenance workforce where the concentration of resources was consolidated around NHS Grampian-owned properties as the highest priority.

As a result, there was a lack of management and performance monitoring in all aspects of FM service delivery to fulfill the Service Level Agreements that were in place. Due to the increase in patient population, attention to works and maintenance being carried out to the required standards had been largely diverted.

As the GP practices are affiliated with NHS Grampian, this posed a significant risk to the reputation of the organisation. The decline in the fulfillment of service delivery caused a large number of complaints from dissatisfied clients who were on the verge of walking away and procuring FM services from private providers.

Various issues led to the breakdown of the client relationship including, but not limited to:

  • A lack of understanding of client requirements, their business strategy and objectives and how FM service provisions can add value to meet those needs.
  • Rigid geographical working locations of in-house maintenance workforce resulting in higher travelling costs and longer delays in responding to clients’ needs.
  • Low-skilled in-house workforce providing FM services resulting in high frequencies of callouts of skilled trades who were already in high demand dealing with NHS Grampian owned properties.
  • No integrated systems or a centralised helpdesk for clients to log corrective maintenance requests or other FM services queries.

THE APPROACH
I recognised that the Facilities and Estates Directorate was at risk of losing this key FM contract, allocated budget and the long-standing relationship and therefore started work on a dedicated, outsourced service for the GP practices.

It started with a survey of the GP practices to gain feedback on the existing service and establish what they needed from a new service. I also took the time to advise them on the statutory requirements for their buildings. The consultation process was the first step to improving the damaged relationship as it demonstrated to the GP practices that someone was taking the time to listen and understand.

Behind the scenes, I undertook an extensive review of internal operations, processes, systems and procedures and implemented a client focused strategy that met their expectations for the delivery of this service. This included:

  • Devising a quality and performance framework.
  • Setting up robust methodologies to enhance business processes in areas such as supplier management including regular performance reviews with all contracted services.
  • Working with the GP Practices to establish meaningful key performance indicators (KPIs) for performance management
  • Working closer with clients and the finance department on managing finance.
  • Conducting customer service workshops for staff.
  • Improved asset management and maintenance management on the CAFM system.
  • Streamlining FM services to eliminate waste in the value chain including the integration of helpdesks and developing a queuing system to manage client expectations.

To further increase performance on maintenance management, mobile devices were procured to eliminate the use of paper-based job dockets for planned and corrective maintenance tasks. Which resulted in the following benefits:

  • Real-time feedback on job statuses to customers.
  • No paperwork produced resulting in efficiency savings.
  • Automatic labour bookings reducing time consuming timesheets.
  • Eliminates travelling time to base.

MANAGING RELATIONSHIPS WITH CONTRACTORS
Initially, changing the FM service to a fully outsourced model for GP practices was met with some resistance by the in-house maintenance teams.

I demonstrated the necessity of a dedicated FM service to the Facilities and Estates Directorate by highlighting results from the customer survey and ensured the selection of the FM service provider under contract met all health and safety requirements, all accredited training qualifications for all personnel and had strong controls around managing risk when carrying out works in healthcare premises.

MANAGING CLIENT EXPECTATIONS
I had to rebuild relationships with GP practices which had been damaged by previous poor experiences and it took time for all involved parties to get used to new ways of working whilst resolving the backlog of jobs and issues from individual clients.

I introduced a client management programme for the practices where a dedicated customer account officer was recruited, acting as a liaison between the clients, service provider and NHSG, keeping the GP practices informed of progress. A response, escalation and business continuity process was in place and I continued to undertake a hands-on role in my senior management capacity to build an improved, overarching relationship with the GP practices.

THE RESULTS

  • The new service has already signed up 23 out of the 64 GP practices and is generating a recurring revenue stream for NHS Grampian, delivering £50,000 income by financial close of 2016/17. It is projected to deliver between £70,000 and £100,000 by March 2018.
  • Three new GP practices have signed up to the new service in the first quarter of 2016/17 and over the next five years, aim to have 38 more GP practices on board.
  • Client satisfaction has significantly increased with 83 per cent of practices recommending the service.
  • The new FM service has seen a significant improvement to clients’ statutory compliance and planned/reactive maintenance performance from 46 per cent to 100 per cent completion of tasks on a monthly basis since the launch in April 2014.
  • The new FM service has attracted existing clients to buy additional services offerings by meeting expectations.
  • Raising awareness to clients about their statutory obligations to ensure that their premises are fit for purpose and well-maintained has led to clients feeling more empowered, leading to improved relationships and trust.

Preston Gan will further explore the theme of adding value through transformation at Facilities Management 2017.

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