Challenges of Maintenance of Properties in Public Hospitals

A Case Study of Komfo Anokye Teaching Hospital


Bachelor Thesis, 2018
91 Pages, Grade: 3.65

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TABLE OF CONTENT

Content

Acknowledgement

Abstract

Table of Content List of Tables List of Figures

Glossary of Abbreviations

Chapter One: Introduction
1.0 Background of the Study
1.1 Problem Statement
1.2 Research Aim
1.3 Research Objectives
1.4 Research Question
1.5 Significant of the Study
1.6 Scope of the Study
1.7 Limitation
1.8.0 Organisation of the Study

Chapter Two: Literature Review

2.0 Introduction
2.1 Concept of Maintenance
2.2 Definition of Maintenance
2.3 Component of Maintenance
2.4 Classification of Maintenance
2.5 Maintenance Management
2.5.1 Approach to Maintenance Management
2.6 Maintenance Policy
2.7 Challenges of Maintenance
2.8.0 Definition of Building 19
2.8.1 Definition of Health Facilities
2.8.2 Input of Property Managers in the Design Stage of Building, Buildability, Sustainability and Maintainability of Health Care Facilities
2.8.3 The Effect of Buildability on Healthcare Maintenance Management
2.9 Factors Preventing the Need to Carry out Maintenance

Chapter Three: Research Methodology
3.0 Introduction
3.1 Research Design
3.2 Justification of Case Study
3.3 Research Methodology
3.4 Sampling Size
3.5 Sampling Technique
3.6 Data Analysis

Chapter Four: Analyses and Discussions
4.1 Profile of Respondents
4.1.1 Profile of Estate Officers
4.1.2 Profile of Out-Sourced Contractors
4.1.3 Profile of Occupants or Tenants
4.2 Identification of Maintenance Policies Available at KATH
4.3 Assessing the Effectiveness of the Maintenance Policy
4.3.1 Move in and Move Out Inspections and Maintainability of Properties
4.3.2 Rent Paid by Residents Tenants Occupying KATH’S Residential Properties 37
4.4 Challenges Associated with Maintenance Practice and Policies 42
4.5 Summary 46

Chapter Five: Summary of Findings, Recommendation and Conclusion
5.1 Introduction
5.2.0 Summary of Findings
5.2.1 Identification of Maintenance Policies Available at KATH
5.2.2 Assessing the Effectiveness of the Maintenance Policy
5.2.3 Challenges Associated with Maintenance Practice and Policies
5.3 Recommendation
5.4 Conclusion

References

Appendix

Appendix

ACKNOWLEDGEMENT

Glory is to God, Lord of the universe for giving the intellect and ability to discern. Glory unto Him also for the health and for all of His other favours. A lot of people have contributed to the success of this project; however, I take responsibility for any inaccuracies in the form of omission or commission. I am particularly grateful to my family for their financial support of this research work. I am highly indebted especially to my supervisor Mrs. Grace Angela Kobbina and the entire Department of Estate Management who made numerous useful suggestions and criticisms that led to a successful execution of this work. I am also grateful to the Estate Department and tenants of KATH, and the various out-sourced contractors for helping with the case study area.

Special thanks also go to my family once again for their prayers, advice and encouragement. Finally, I am grateful to all who contributed in many ways for my successful stay in the University. May God bless you all.

ABSTRACT

This study concentrates on identifying the challenges of maintenance of properties in public hospitals using Komfo Anokye Teaching Hospital (KATH) as a case study. It identifies the maintenance policies available in the Hospital, assesses the effectiveness of maintenance policies, and identifies challenges associated with the maintenance practice and policies. In achieving these objectives, opinions of estate officers, out-sourced contractors and tenants were solicited by administering a questionnaire to them and data were collected and analysed by using descriptive statistics. The study showed that, the mode of maintenance management for the Hospital is planned preventive maintenance. The study also revealed that, the approach to maintenance of properties by KATH is the hybrid (that is the combination of both in-house and out-sourced contractors). Funding of maintenance activities in the Hospital was by both Internally Generated Funds (IGF) and budgetary allocation for the year. In assessing the effectiveness of the maintenance policy, the study found out that building maintenance objectives which are the bases for developing maintenance policy must be considered in relation to organisations objectives and hence, ranked first (1st) as the most important factor in assessing the effectiveness of the maintenance policy of KATH’s residential facilities. Training of maintenance personnel was ranked second (2nd) as personnel are trained in the form of workshops, seminars, and among others to keep them abreast with current property management of health facilities. Availability of adequate maintenance funding, and quick response to maintenance need of the building when old tenant moves for new tenant to occupy were both ranked 3rd. However, for the challenges associated with maintenance practice and policies, the study established that, the bureaucratic reporting process is the major challenge associated with maintenance practice and policies and hence, ranked first (1st). Financial delays were ranked second. In addition, contractual delays were ranked (3rd) Incompetent Staff was ranked fourth (4th). Also, the poor quality of materials and spare parts was identified as a challenge of maintenance and was ranked 5th. The lack of implementation of maintenance policy, lack of maintenance culture, and inefficient inventory system were challenges of maintenance in the Hospital. The study recommends strategies to be formulated in line with systems and components of properties, to ensure that the apartments or blocks remain operational in a safe manner. To gain optimum benefits from preventive maintenance, property managers should be more proactive by incorporating preventive maintenance tasks into a work-order system and keep systematic maintenance records, either by computer or manually. In addition, the length of bureaucratic level of reporting and approval for maintenance works to be done within the Hospital should be reduced.

LIST OF TABLES

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LIST OF FIGURES

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GLOSSARY OF ABBREVIATIONS

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CHAPTER ONE

INTRODUCTION

1.0 Background of the Study

One of the challenging problems facing most landed properties in Ghana is poor maintenance practice. Maintenance is deemed as an unproductive venture by individuals, organizations and even the government as a whole. This is because, it is considered as a drain of resources. Mallam (2013) added that, the deterioration in buildings and other fixed equipment is inescapable; for this reason periodic attention is required to keep them in good state so that they can continue to perform their required functions and also sustain the level of utility and value derived from them.

Maintenance is therefore the combination of all technical and administrative actions, including supervisions, intended to retain an item in, or restore it to, a state in which it can perform a required function (Abed, 2010). Property managers mostly in public hospital embark on maintenance by preparing a maintenance plan and policies for the hospital, supervise maintenance works and undertake contract negotiation relating to the landed properties among others. Most hospitals in Ghana most especially Komfo Anokye Teaching Hospital (KATH) do not have effective maintenance plan and policies in place, and it has resulted to the deterioration of most their facilities or properties.

Maintenance policy is defined as a strategy within which maintenance decisions are made. This may be considered as a set of ground rules for the allocation of resources between the various types of maintenance action that can be taken. Maintenance policy should be considered in the widest possible context throughout all the phases in the life cycle of a building or facility (Chanter and Swallow 2007). The emphasis of maintenance policy should be to maximize planned and cyclical maintenance works and reduce unplanned maintenance. The absence and recognition of maintenance policy in the overall organizational policies of most public hospital in Ghana has resulted in a higher cost when it comes to maintenance, because the initial stages of damages in most properties are ignored and this has led to a complete breakdown of either parts or the whole equipment or facilities (Cobinah, 2010).

Maintenance practice is usually confronted with challenges in most public hospitals in Ghana because of lack of recognition by top management. Most hospitals do not see the need for this practice in their facilities or institutions and it has usually affected the cooperate image of most public hospitals in Ghana. The high maintenance estimated cost associated with repairs, servicing, renovation, refurbishment and rehabilitation that is required to finance it and keep the hospital’s facilities in its best shape, deters most public hospitals to include them in their activities and budgets. This is because, most public hospitals deem it as unproductive venture as compared to their core mandate (Amankwa et al, 2013).

Therefore, property managers of public health institutions need to address these challenges of maintenance of properties in public health institutions to keep facilities or properties in a very good shape. From this background, the study investigates the challenges of maintenance activities in public hospitals using the Komfo Anokye Teaching Hospital as the study organisation.

1.1 Problem Statement

The studies of Afrane et al (1999), Amankwa (2013), and Cobinah (2010) revealed that issues related to defects in the facility or building are not promptly reported by staff or users particularly in the use of hospital facilities in most developing countries. Consequently, they wait till complete breakdown or shutdown of the asset before they report. This leads to the deterioration of most of the facilities that could helpboost the level of productivity and hence increases the cost of repairs or maintenance of such items that has been spoilt.

In addition, funds that are needed to be released on time for urgent and emergency works to be done to keep the property running are usually delayed as a result of bureaucracy. This affects prompt maintenance delivery because, by the time that funds will be approved and released, prices might have increased as a result of inflation( Adenuga, 2012; Adejimi, 2005).

Furthermore, the study of Cobinah (2010), revealed that, there are inadequate logistics in terms of tools, equipment, and technology needed to ensure that works are actually delivered on time. That notwithstanding, most hospitals in Ghana do not stock their estate department with the needed logistics to facilitate their work delivery.

Moreover, there is inadequate or lack of staff in terms of supervisors and their respective artisans to respond to maintenance works when the need arises (Atinga et al, 2011). This has an impact on maintenance works to be done as the works exceed the human resource available. Adenuga (2012) further found out that, the staffs are not mostly trained periodically in the form of workshops, seminars, and among others to enhance them. So they are not mostly abreast with modern maintenance management practices. The aforementioned challenges of maintenance posit a great deal of limitation to keeping property up to the needed standard in its operation, and therefore this study has been structured to identify which of these challenges affect the implementation of the maintenance policy in the Komfo Anokye Teaching Hospital (KATH), especially given that previous research works have not focused attention on the challenges of maintenance policy implementation.

1.2 Aim of the Study

The study is to identify the challenges of maintenance policy implementation in the in public hospitals.

1.3 Research Objectives

The objectives of the study were:

1. To identify the maintenance policies available in the Hospital.
2. To assess the effectiveness of maintenance policies.
3. To identify challenges associated with the implementation of the maintenance policy in the Hospital.

1.4 Research Question

In other to identify and evaluate the challenges of maintenance practice in public hospital in Ghana, specifically KATH, there following questions were formulated:

1. What are the current maintenance policies in Komfo Anokye Teaching Hospital?
2. How is effective are the maintenance policies in the Hospital?
3. What are the main challenges affecting the implementation of the maintenance policy in the Hospital?

1.5 Significance of Study

The research is very important because, not only will the research contribute to the body of knowledge and theory, but it will apparently contribute to good maintenance practices in public hospitals specifically Komfo Anokye Teaching Hospital (KATH). This is because, it will help the Hospital to make changes in its policies to reflect a modern status. It will also help to investigate the factors that contribute to the current state of non-maintenance of facilities of public hospitals, specifically KATH.

It will also endeavor to investigate the factors that contribute to the current state of non- maintenance of facilities in KATH, and some which have been abandoned due to its state of deterioration and proceed to recommend appropriate remedial actions that should be taken.

Furthermore, the study will help Management of KATH to be aware of the state of the Institution’s facilities and its impact of health and safety hazards on users of the facilities. In addition, put appropriate measures to keep and restore the facility in its best shape.

1.6 Scope of Study

The research seeks to explore challenges of maintenance management of Komfo Anokye Teaching Hospital’s (KATH’s) properties or facilities. The study considered how Property Managers (PM)administered maintenance management of KATH’s property or facilities. The emphasis of study was limited to only KATH’s residential buildings within the Hospital’s premises and did not include the health delivery wards or buildings.

1.7 Limitation

There were problems that were encountered or faced in the course of undertaking the research. Meeting with senior officers was quite tedious because of their nature of busy schedules and long delays in response to the questionnaires that was administered to them. In addition, records keeping were problematic for most of the facilities that was surveyed such that in some facilities, the researcher had to collate the number of buildings himself. This activity or action was very tedious in undertaken them.

1.8 Research Methodology

Primary data was obtained through the use of structured questionnaires. Secondary sources of information were also obtained from articles, books, and database.

Primary or field data was collected by the use structured questionnaires administered in person. Data was collected from KATH’s owned residential property/facilities within the Hospital’s premises only. Secondary data was collected from books, articles, from databases.

The sample frame was KATH residential buildings within the Hospital’s premises. In total, eight (8) KATH’s completed and operating residential buildings (nurses and doctors’ block or apartments) were being managed by property managers in the Hospital.

Quantitative data collected were analysed by the use of descriptive analysis.

1.9 Organisation of the Study

The study was divided into five (5) main chapters; as highlighted below.

Chapter One covered the introduction of the study which consisted of; the research aim, objectives, relevance of the study, scope of the study, limitation(s), and organization of the study.

Chapter Two dealt with reviewing existing literature by grouping authors with similar views at one side and authors of opposing views at another side. This was meant to create gaps that needed to be filled.

Chapter Three established the methodology for the study or research.

Chapter Four covered the detailed analysis and presentations of data obtained from the field survey. Chapter Five which was the final chapter dealt with summary of the research, recommendations, and conclusion.

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter reviewed the existing in-depth literature on issues relating to the concept of maintenance of building and the challenges associated to maintenance. It also covered secondary materials related to the conceptual issues as well as definition, and challenges of maintenance especially in public health facilities.

2.1 Concept of Maintenance

Maintenance is a set of organised activities that are carried out in order to keep an item in its best operational condition with minimum cost acquired. Activities of maintenance function could be either repair or replacement activities, which are necessary for an item to reach its acceptable productivity condition or these activities, should be carried out with a minimum possible cost (Abed 2010). As Herbert (2010) added that, the goal of maintenance is to prevent, or at least reduce, the degradation or deterioration of the quality of service provided by each building component over its design service life. Maintenance is not a process of improvement that may be required to meet increased expectations for performance beyond which the component was originally designed to provide. Herbert also retreated that, each building and the individual components that make-up that building, has a finite service life. At the end of that life, replacement or major renovation is required since, in the long run, it is less expensive to replace or renovate than to continue to make repairs that become increasingly frequent and costly.

According to Oladejo (2015), the main goal of maintenance is to minimise related operating costs. An all-encompassing maintenance builds in the performance of the buildings, maximises personnel safety, minimises operational costs, environmental threat and the risk of material damage. Oladejo also indicted that, maintenance is one of the main domains of knowledge with which facility or property management is faced. It involves budgeting and priority setting of different maintenance activities to suit the maintenance policy and service life planning of organizations.

Building maintenance plays an important role among other activities in building operation. Building defect and damages are part of the building maintenance, bread and butter‟ as their input indicated in the building inspection is very much justified, particularly as to determine the building performance (Issahaku 2013). The author however indicated that, quality and efficiency of maintenance management operation of building depends, to some extent, on the building condition information available and the expectation from the owners or the organization.

2.2 Definition of Maintenance

British Standard Glossary of terms (3811:1993) defined maintenance as the combination of all technical and administrative actions, including supervision actions, intended to retain an item in, or restore it to, a state in which it can perform a required function. The author also reiterated that, maintenance is a set of organised activities that are carried out in order to keep an item in its best operational condition with minimum cost acquired. Maintenance could be either repair or replacement activities, which are necessary for an item to reach its acceptable productivity condition or these activities, should be carried out with a minimum possible cost. That is, the all activities undertaken to keep a property or facility in a good and sound shape.

Francis et al. (2001) also agreed that building maintenance maintenance as an action which involves interacting or blend of technical, social, legal and economic elements that governs and manages the use of buildings. Francis further explained building maintenance as the combination of technical and administrative action to ensure the items and elements of a building is in an acceptable standard to perform its required function. As a study by Abed (2010) shows that, maintenance is the combination of both technical and administrative actions to keep a property in a good shape. However, the author further added the blend of social, legal and economic element that governs the management of the facility. That notwithstanding Mallam (2013) also opined that, building maintenance are works done in order to keep, restore or improve every facility. That is, every part of building, its services and surrounds, to a currently accepted standard and to sustain the utility and value of the facility.

Brian (1992) argued that, maintenance professionals will tell you there are two kinds of maintenance. The first is routine maintenance: regularly scheduled inspections, repairs or replacements of building components. Included are general house-keeping of the building and site. The second is termed emergency or immediate response maintenance, which requires repair or replacement of failed components. Brian defined maintenance by its types to keep the property in shape.

2.3 Component of Maintenance

According Afrane and Tutu (1999) cited in Cobbina(2010), maintenance involves a considerable amount of work which has been categorized into three components namely; Servicing, Rectification and Replacement.

1. Servicing

Servicing is essentially a clearing operation undertaken at regular intervals of varying frequency and is sometimes termed day-to-day maintenance. Daily sweeping of floors, monthly washing and cleaning of windows and regular painting for decoration and protection every four years are some examples of servicing.

2. Rectification

Rectification work usually occurs fairly early in the life of a building; but it can also occur sometime within the life span of the building. It arises from shortcoming in design, inherent fault in or unsuitability of component, damage of goods in transit or installation and incorrect assembly. Rectification represents a fruitful point at which to reduce the costs of maintenance, because it is available. All that is necessary at any rate in theory is to ensure that components and materials are suitable for their purpose and are correctly installed. Rectification work could be reduced by the development and use of performance specifications and codes of installation (Lee, 1987 P. 23). Rectification is the response to inherent defects in design, construction or installation stages of the building process.

3. Replacement

Replacements occur at all costs in buildings. It is inevitable because service conditions cause materials to decay at different rates. Much replacement work stems not so much from physical breakdown of the materials or element as from deterioration of the appearance (Seeley, 1987). This is because the extent of exposure of materials to the vagaries of the weather varies, and the weather in specific locations also vary whilst the capacity of elements of buildings in withstanding changes and different intensities of the weather vary. This therefore becomes necessary as a result of material decay due to these differential rates of weather conditions. Physical breakdown of materials or elements as well as deterioration appearance may necessitate replacements. However, it is logical therefore to extend the meaning of maintenance to cover some localized improvement (Lee, 1987). Maintenance can also embrace renovations, which consist of work done to restore a structure, service and equipment by a major overhaul to the original design and specification, or to improve on the original design. This may include limited additions and extensions to the original building.

Likewise, Zulkarnain et al., (2011) also agreed that, maintenance has been categorized into three (3) main component., namely;

- Cleaning and servicing,
- Rectification and repair and
- Replacement.

Timely expenditure on the first two can postpone the need to replace materials orcomponents, which at times can be a very expensive activity. Cleaning and servicing should be carried out regularly and may be combined with a system of reporting faults when become apparent, thereby avoiding the need for more expensive repairs or even replacement at a later stage. In the nutshell Zulkamain shares the same sentiment with Afrane and Tutu (1999 cited Prince 2010) that, there are three components of maintenance (that is servicing, rectification, and replacement). However, Zulkarnain in addition added cleaning and repairs as part of or an angle of the component of maintenance.

2.4 Classification of Maintenance

According to Adolfo (2007), maintenance could be grouped into two main types. They are; preventive maintenance and corrective maintenance.

1. Preventive Maintenance

Preventive maintenance is defined as maintenance carried out at predetermined intervals or according to prescribed criteria and intended to reduce the probability of failure or the degradation of the functioning of the equipment. Preventive maintenance can be predetermined or condition based:

- Predetermined maintenance. Preventive maintenance carried out in accordance with established intervals of time or number of units of use (i.e. scheduled maintenance) but without previous item condition investigation;
- Condition based maintenance. Preventive maintenance based on performance and/or parameter monitoring and the subsequent actions. Performance and parameter monitoring may be scheduled, on-request or continuous. Within the condition based maintenance we include the predictive maintenance that can be defined as follows:

- Predictive maintenance. Condition based maintenance carried out following a forecast derived from the analysis and evaluation of the significant parameters of the degradation of the equipment.

2. Corrective Maintenance

Corrective maintenance is maintenance carried out after fault recognition and intended to put the equipment into a state in which it can perform a required function. Corrective maintenance can be immediate or deferred:

- Immediate maintenance. Maintenance which is carried out without delay after a fault has been detected to avoid unacceptable consequences;
- Deferred maintenance. Corrective maintenance which is not immediately carried out after a fault detection but is delayed according to given maintenance rules.

Furthermore, the University of California (2018) also classified maintenance as planned, preventive, unplanned/reactive, and emergency.

1. Planned Maintenance

Planned maintenance, also referred to as "programmed" or "scheduled" maintenance, is the upkeep of property, machinery, and facilities, including buildings, utility systems, roads, and grounds. Planned maintenance is often characterized by its routine or recurring nature.

2. Preventive Maintenance

Preventive maintenance is that portion of the overall maintenance program that provides the periodic inspection, adjustment, minor repair, lubrication, reporting, and data recording necessary to minimize building equipment and utility system breakdown and maximize system and equipment efficiency.

Preventive maintenance:

- Utilizes planned services, inspections, adjustments, and replacements designed to ensure maximum utilization of equipment at minimum cost.
- Is a program in which wear, tear, and change are anticipated, and continuous corrective action is taken to ensure peak efficiency and minimum deterioration.
- Includes cleaning, adjustment, lubrication, minor repair, and parts replacement.

All are performed on scheduled frequencies in accordance with written maintenance instructions.

Preventive Maintenance Program procedures are designed to fulfill the needs of the Facility. The purpose of the program is to produce cost savings by:

- Reducing the downtime of critical systems and equipment.
- Extending the life of facilities and equipment.
- Improving equipment reliability.
- Ensuring proper equipment operation.
- Improving the overall appearance of facilities.

3. Unplanned or Reactive Maintenance

Unplanned/reactive maintenance is the unplanned response to maintenance requests which do not have emergency status. In general a facilities organization should plan and schedule as much of its maintenance activities as possible. Work that is scheduled and planned is done much more efficiently than that done by reactive maintenance.

4. Emergency Maintenance

This defines emergency maintenance as the repair or replacement of facility components and equipment requiring immediate attention because the functioning of a critical system is impaired or because health, safety, or security of life is endangered. Emergency maintenance supersedes all other categories of maintenance.

This presupposes that, the University shares the same idea with Adolfo (2007), just that Adolfasummarised maintenance into two main types while the University of California spread them into four type but it all revolves under the same idea.

2.5 Maintenance Management

Adolfo (2007) discussed maintenance management the process of leading and directing the maintenance organization. Adolfo further indicated that, further definitions consider maintenance management as the management of all assets owned by a company, based on maximizing the return on investment in the asset. Another approach indicates how a maintenance system can be seen as a simple input-output system. The inputs are the manpower, management, tools, equipment, and among others, and the output is the equipment configured well and working reliably to reach the planned plant operation. Herbert (2010) also reiterated that, critical infrastructure and industrial facility owners and operators have adopted the term “asset or maintenance management” to describe their core role in life that is caring for and obtaining a satisfactory level of service from the physical plant, infrastructure, and associated facilities. Their concept is that, since facilities represent significant capital assets, they must be protected through well- planned and appropriately funded programmed maintenance. Herbert agreed with Adolfo in the way of managing facilities or properties through the maintenance of them to enhance their use and obtain the maximum use of the facilities to help achieve their returns of investment and the organisational goals as a whole. Moreover, Herbert further indicated that, since facilities or properties are capital asset they need to be protected by a well-planned and appropriately funded programmed maintenance so that it may not be a challenge to be maintained. By so doing, their investment can be protected.

Moreover, a study by Seeley (1985) cited in Mallam (2013) showed that, the function in this area is mainly of a technical nature and concerned with the planning and control of construction resources to ensure that necessary repairs and renewals are carried out with maximum efficiency and economy. Francis et al., (2001), goes on to define building maintenance management as an action which involves interacting or blend of technical, social, legal and economic elements that governs and manages the use of buildings; Francis further explained building maintenance as said to have been the combination of technical and administrative action to ensure the items and elements of a building is in an acceptable standard to perform its required function. Francis however concurs to a study done by Seeley as maintenance management been a blend of technical nature carried out to ensure that resources are used efficiently and in acceptable standards. Furthermore, Francis also looked maintenance management from another angle in terms of blending social, legal, economic and administrative elements that governs and manages the use of building.

2.5.1 Approach to Maintenance Management

Atkin and Brooks (2005) emphasised that, the approach to maintenance management is grouped into two. They are the in-house approach and the out-sourced approach. Consideration must be given to direct and indirect costs of both in-house and outsourced service provision so that a complete financial picture is gained, with comparison made on a like-for-like basis to enable a

decision to be taken on best value for money. Support services should represent best value on the grounds of affordability for the organisation in the implementation of the objectives of its strategic plan, irrespective of the cost of those services. By so doing will help the organisation achieve a good maintenance policy with respect to challenges of maintenance. Atkins and Brooks further reiterated that in-house approach is services that are provided by a dedicated resource directly employed by the client organisation, where monitoring and control of performance is conducted under the terms of the employer. Consequently, in-house service provision may not be the most cost-effective choice. Also, the outsourcing approach considers the involvement of an external party to undertake maintenance activities in the organisation. This approach enables the organisation to select the best service provider on the basis of wide ranging experience, quality, and speed as well as performance efficiency. That notwithstanding, with this approach, there is a lack of flexibility, contractors solely focus on cost issues and among others.

Furthermore Glenn (2015) also proposed that basically, there are three approaches to commercial property maintenance management: in-house staffing, a hybrid of in-house and outsourcing and complete outsourcing. Each company reviews its needs to determine what approach and to what extent to apply to meet its maintenance and other goals. Glenn also reiterated that Commercial companies review the key advantages and disadvantages of outsourcing maintenance with particular focus on cost, work quality, obtaining expertise, tools, equipment and technology, risk reduction and management focus on core business. Mike (2014) also indicated that there are generally three approaches to maintenance management: In-house staffing, a hybrid of in-house and outsourcing and complete outsourcing. How these may be applied and to what extent is driven by each company and their own unique needs and how they want to meet their maintenance challenges. Mike highlighted the key advantages and disadvantages of outsourcing maintenance which includes: cost, work quality, obtaining expertise, tools, equipment and technology, risk reduction and management focus on core business. This presupposes that, Glenn agrees with Mike that there are three main types of maintenance approach. They are in-house, outsourced and the hybrid approach. Both authors indicated that, the best approach to be adopted by the organisation is based on their maintenance policies that they use to suit or meet the challenges of maintenance that organisations face.

2.6 Maintenance Policy

According to BS 3811 (1992), defines maintenance policies as a strategy within which decisions on maintenance are taken. Alternatively, it may be defined as the ground rules for the allocation of resources (men, materials and money) between the alternative types of maintenance actions that are available to management. In order to make a rational allocation of resources the benefits of those actions to the organization as a whole must be identified and related to the costs involved. Issues under consideration in a policy include; objectives, benefits and policies. Yet Aldofo (2007), defines maintenance policy as the interrelationship between its maintenance echelons or lines, the items indenture levels and the maintenance levels to be applied for the maintenance of an item. Aldofo also added that, maintenance policy develops the maintenance concept within the organization and sets up solid foundations for the excellence in maintenance management.

Furthermore (Anon. 2018) defines maintenance policy as a written statement, developed by the organization's leadership team, articulating the target maintenance standard and formal commitment by the owners to that standard. The purpose of the maintenance policy is for commitment, guidance, and vision or direction. As, a study by Lee and Scott, (2008 cited Ernest 2015) showed that, Consequently, the policy of maintenance has to include with the broader statement of the mission, business strategy and the management’s policy of the organization which oversee the properties/facilities management, be it a tenant, client, or landlord. The study done by Lee and Scot viewed maintenance from the broader point of view to help address the challenges that pertains to maintenance of facilities or properties. This helps to maintain the organization’s investment and even add value to the property.

Moreover, Chun and John (2011), various maintenance policies on a multi-state deteriorating system have been investigated and such policies can be further divided into three classes. First is the replacement policy in which the only candidate of maintenance action is ‘‘replacement”. The policy is on how to schedule the inspection and when to take ‘‘replacement’’ by determining the scheduling function and the threshold state in the minimum long-run expected cost per unit time. Second, is the policies whose candidate actions are replacement and repair. This proposes preventive maintenance policy to determine at the beginning of each maintenance cycle. Thirdly are the policies with multiple choices of maintenance actions. This proposes a maintenance policy for a multistate system with multiple choices of imperfect actions through minimizing the expected total discounted cost over planning life cycle years.

2.7 Challenges of Maintenance.

According to Burns (1997), there should be ground rules for the allocation of maintenance resources available to management. Maintenance policies are beneficial to the organisation as a whole, it must relate to the cost involved for getting maintenance funding. Maintenance strategy is adopted in order to extend the life cycle of buildings and its fittings services. Maintenance personnel choose different maintenance strategies depending on allocation maintenance resources. As Plant Engineering (2012) also added that, planning maintenance work can be a challenge because it normally consists of two different types of maintenance. They are; unplanned or emergency maintenance to fix equipment breakdowns or other urgent work as it comes up, and planned or preventative maintenance to keep systems/equipment running in peak condition. Plant Engineering further included that, how does one consolidate and manage these two types of jobs? How can one allocate maintenance technicians and work hours in the daily calendar to get both types of work accomplished? Also not doing preventative maintenance on time (or not at all!) results in further unexpected equipment breakdowns and further emergency maintenance work. This presupposes that Plant Engineering agrees with Burns (1997) that allocation of resources is a challenge to maintenance practice. However, Engineering services further contributed that not doing preventative maintenance on time (or not at all!) results in further unexpected equipment breakdowns and further emergency maintenance work. This really becomes a challenge to maintenance. Facilities with their systems and equipment suffer wear and tear, damage and destruction, and must accordingly be maintained. An inadequate approach to such work can increase the risk of major incidents, damage and accidents. Responsibility for maintenance management rests with the industry Vei (2018). As Hounsell (2014) also said that, creating an effective maintenance planning function in a department will create different challenges for managers, depending on, among other factors, the type and size of the facility and the size and skill levels of the property managers. As Barretto (2016) also established that, with the rising demands in improvement of deliveries to reduction of cost, there is an increasing pressure from operational or property managers to reduce cost and improve reliability and increase availability of production systems. This has put a challenge on maintenance and reliability engineers and property managers worldwide who face a gargantuan task of improving their skill sets and analytical abilities to deepen the knowledge curve in order to keep their organisation the leader in the cost, quantity and quality. Yet Sondalini (2018) also opined that, Great maintenance planning faces three challenges: lack of time to plan; lack of work quality details; lack of communication. Sondalini further contributed that, A maintenance planner or property manager needs time to plan maintenance work details task by task, they need a planning system that saves them time, and they need to clearly communicate the job plan to the people doing the work.

A study by Uche and Ogbonnaya (2013) established that, facilities or properties breakdowns found in most organisations and industries in developing countries like Nigeria and the adverse effects on the overall performance of the organisation ranging from production loss, high production cost, obvious inability to meet production deadlines, poor company’s reputation and loss of integrity which invariably reduces the share capital and the ability to compete with similar industries. The authors further highlighted that, the major challenges of maintenance in most organizations and industries are; unavailability of spares, staff technical competence, ageing equipment, poor leadership commitment and poor staff welfare. As Shohet and Lavy (2004) also contributed that, there are difficulties in forecasting organisational requirements into the future. The problem is most of the facility managers are not participating in the briefing, designing and cost analyzing stages of new building developments. Yet Nahdatul et al. (2014) concurred that as a result property managers are not engaged in the initial briefing or design of the facility, it has led to difficulties in maintaining such facilities in a good shape when they are in operation.

2.8.0 Definition of Building

Building is a relatively permanent enclosed construction composed of stone, brick, wood, or other proper substance connected together, over a plot of land, having a roof and usually windows and often more than one level, used for any of a wide variety of activities, as living, entertaining, or manufacturing. In the world all over, people spend 90% of their lives in buildings (Mallam, 2013). As Sullivan (2014) defines building, as the art or business of assembling materials into a structure and practical application of knowledge especially in a particular area; a manner of accomplishing a task especially using technical processes, methods, or knowledge. Sullivan also continued that, drawing proper construction details requires understanding building technology; so does identifying conflicts between the construction documents and the way things are being built onsite.

Furthermore, Merriam (2017) depicted that, building is a structure (such as a house, hospital, school and among others) with roof and walls that is used as a place for people to live, work, do active, store things and among others. It is also the act or process of making structures by putting together materials. Apparently, these facilities need to be initiated and managed by property managers.

2.8.1 Definition of Health Facilities

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialization centers, such as birthing centers and psychiatric care centers (Medline 2017).

WHO (2017) also opined that, health-care facilities are hospital, primary health-care centres, isolation camps, burn patient unit, feeding centres and others. The author further reiterated that in emergency situations, health-care facilities are often faced with an exceptionally high number of patients, some of whom may require specific medical care (example, treatment of chemical poisoning). These facilities need to be managed and maintained by a property manager (PM) to keep it in good shape in other to support quality health delivery.

2.8.2 Input of Property Managers in the Design Stage of Building, Buildability, Sustainability and Maintability of Health Care Facilities.

Though it is true that good patient care comes from dedicated individuals, it is equally true that the physical structures and hospital environment must address the safety and well-being of patients (Adenuga, 2012). This objective can be achieved by the property manager playing an integral role in the design, contrition and maintability of the facility. Apparently, Shohet (2003) also indicated that many factors affect the management and operation of hospital buildings. This comprise tangible hospital occupancy compared to scheduled occupancy, age of the infrastructure, building environment, managerial resources investment and labor sources for maintenance implementation (be it in-house or out-sourcing). Adunga concurred with shohet that that management of facilities in hospital requires a special attention. Furthermore, shohet further established that other factors of the facilities such as the age, building environment, labour, and management should all be taken into consideration. By so doing a good maintenance policy and can be developed to curtail the challenges of maintenance.

In addition, a study by Adejimi(2005) cited in Oti et al. (2017)showed that, although poor functioning of buildings is usually linked to inadequate maintenance management, it is arguable whether the precise maintenance issues in some buildings cannot be traced to certain intrinsic design factors and construction as well as operation of the building. Maintenance challenges, in most cases could have originated from inappropriate briefing of the proposed facilities to the architect and planning by the architect who designed it. The author further indicated that, from inception, care must be taken by the property manager to address building low points where there is the high tendency for major future maintenance needs to avert such future breakdowns . It is therefore vital to appreciate the issues and concepts that influence building maintenance management of healthcare facilities from the cradle to the grave. Therefore, the management of the facility by the property manager emanates from the initial designs and materials that will be used in the construction of the facility. This will help the PM be abreast with the facility and help reduce the challenge that maintenance faces.

More literature reviews have suggested the inclusion of property managers (PM) at the design stages of buildings help to assist and minimize future maintenance challenges (Williamson et al. 2010). The property manager comes in because, he initiates the project through the estate strategy for the organization. He is able to inform the designers (architect and engineers) about the spaces requires and the kinds of facilities that should be part in the design drawings. This helps to reduce future maintenance works of the facility. But conversely, that is not mostly so on the ground or in reality. This is because; the PM is not mostly consulted during the design of the facility and therefore leading most maintenance works of the facilities in the future. As Son and Yeun (1993) cited in Ernest (2015) also indicated that, usually designers have short term concerns specifically with regards to maintenance in the building they produce. Often they dissociate themselves from the maintenance problems or challenges that emanated from errors in design. They need to include maintenance professionals or property managers on the design team. This inclusion will help the property managers brief them about the design and spaces that will be required to control maintenance challenges.

2.8.3 The Effects of Buildability on Healthcare Maintenance Management

Buildability is the extent that the design of a building aid how easily it can be built based on the total requirement of the end product (Mbamali, 2005). This means that, there are a number of requirements and instruction to be taken into consideration in a design before it could be said to be buildable. Yet Lyet. al (2015) made mentioned that, buildability factors may not be the same for all countries as a result of site conditions differences, existing building expertise, and the accessibility of supplies, equipment and skills. As Ferguson (1989) also emphasised on the building design, therefore, the harder the maintenance or replacement of a component or element is, the better the quality of the original work should be From the point of view of Ferguson, Mbamali and Ly, not every design of a building can be built and maintained at anywhere. This as a result of location changes, environmental factors and availability of materials to maintain them when the need is required. This usually become a challenge to maintenance of facilities in most organizations.

According to Shohet and Lavy (2004), the building, management, and repairs of healthcare facilities is very complex and entails specialised consultations. Therefore, they can easily bedamaged, the design, construction and especially finishes selected must be functional, durable, and economical to maintain (Milner and Narayan 2005). Milner and Narayan share similar point of view with Shohet and Lavy with respect to the specialised human resources that are recurred to design, construct, and maintain the facilities when the need arises. The lack or inadequacy of these specialized human resource has an adverse effects on the buildability and maintenance of the facility.

The issue of buildability is important as studies by De (2007) indicate that there is a correlation between healthcare service delivery and the healthcare building. This means that, a pleasant and clean healthcare environment has a positive impact on patient satisfaction and the apparent healthcare quality experience. It furthermore increases staff performance and job satisfaction, and makes hospitals more patient friendly (Stankos and Schwarz, 2007). Yet , Atinga et al. (2011) acknowledged and agreed that maintaining good service quality of a healthcare facility produces an exceptional prospect to meet or surpass patient expectations; increases patients’ mood and morale as well as that of healthcare providers; and increases the value of other functions performed by the hospital and customer satisfaction. Chahal and Mehta (2013) also reiterated that, a well arranged bed-layout, well-equipped rooms, upholding washrooms and toilets hygiene and locating dustbins in corridors to increase patient satisfaction. This however, helps in the quick recovery of in-patients due to design and sustainability of facilities in the health care center. As Atinga et al. (2011) established that, maintaining good facilities in the hospital with respect to proper bed layout, well- equipped rooms, clean toilet facilities and among others even help quick recovery of patients and improve the output of health personnel’s. The ideas of the authors suggest that, once the facilities have been put up, once effective maintenance polices and plans are not put in place will result in the deterioration of the facilities which can be very difficult and expensive to maintain.

Furthermore, maintainability is however more manifested in healthcare physical maintenance with the service quality focusing on the hospital developing pleasant environs (Brady and Cronin, 2001). If no proper physical maintenance is done to the property it impacts negatively on their environment and even affect their institution’s image.

2.9 Factors Preventing the Need to Carry Out Maintenance

Derek and Paul (1987), identify the following factors as influencing or neglecting the decision to carry out maintenance on a building:

i. Inadequate finance-it is generally acknowledged that inadequate finance is a major constraint on effective property management, partly because maintenance budgets are the easiest to cut when money is scarce. According to Derek and Paul (1987), maintenance expenditure can be absorbed more easily in commercial and industrial organizations where it may account for as little as 0.5% of turnover, but even in these cases maintenance is taken for granted except when it threatens production or profitability. However, the situation is more serious in the public sector where damaging effects of poor maintenance are less immediately obvious. Also in the case of housing estates, it is common for organizations to emphasize the provision of new houses, with little funding provided for maintaining existing stock. Not are day-to-day repairs neglected, but efforts at improvements and rehabilitation are considered lower priority than new construction. This problem of inadequate finance indeed results in rapid deterioration of existing stock resulting in increases in the demand for new houses because poorly maintained houses are not only unpopular; but they soon reach the stage where the structure itself deteriorates and rebuilding has to be considered.
ii. Bad management- refers to the idleness and waste among maintenance personnel.
iii. Poor building design- it is not uncommon to find that buildings are inherently expensive to maintain because of inappropriate priorities applied during the design phase. Poor detailing and the specification of unsuitable components and materials are common complaints. In addition, construction errors arising from inadequate drawings and specifications, coupled with poor workmanship because of contracts awarded to incompetent contractors are frequent causes of rapid physical deterioration in buildings. Good design should allow accessibility and adequate working space for essential maintenance such as cleaning, and minor repairs to pipes, ducts and cables.

A study by Kuhl and Felten (2017) demonstrates that, the complicated nature of maintenance operations which often involves time pressure, working along with running processes, working at heights and in awkward positions, and using hazardous chemicals, and among others has resulted in a high accident rate and health problems for maintenance workers. In France about 44% of all fatal accidents in 2002 were related to maintenance. More than 50% of all accidents in the German metal sector production and one fifth of all fatal accidents in all sectors happen during maintenance. The situation regarding work related diseases is quite similar, as industrial maintenance employees have an 8-10 times greater chance of developing an occupational disease than the average population. As Blaise(2017) also reiterates that, maintenance is carried out in all sectors and all workplace. Working in the maintenance trade often means working during stop, start-up, shut-down, or disrupted operating phases, giving rise to potential risks in terms of accidents or exposure to many hazards. Blaise also added that, the work often requires maintenance workers to remove or dismantle collective protective equipment; as such equipment is not effective for their type of work. Maintenance workers have more serious and more frequent accidents than production workers. More so than for any other activity, maintenance-related accidents are characterised by their many different causes. This means that, Blaise agrees with Kuhl and Felten in a way that, the risk suffered and involved by the labour forces that are used in undertaken maintenance work actually becomes a challenge to maintenance practices. However in Ghana, are maintenance worker covered by any insurance cover or policy as a result of the risky nature of the maintenance work.

2.10 Summary

In summary, this section explored a conceptual definition for facility maintenance, and the performance measurement framework for maintenance function and also reviewed the empirical literature relating to the causes and effects of poor facility maintenance as well as the contributions of facility maintenance. However, the niche created by the absence of empirical study in Ghana on the above literature is what this study seeks to fill.

CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

To aid in attaining the aim and objectives of the research, this chapter assesses research methods with the view of looking out to the suitable method to respond to the research questions posed.

3.1 Research Approach &Design

The Mixed Research Approach was used for the study. The concurrent nested (embedded) design was adopted for the study which meant both qualitative and quantitative data could be collected in a single research instrument.

3.2 Justification of Study Organisation

The reason for choosing KATH is that, it is the referral center in Ashanti region and even beyond. This has created enormous pressure on the existing facilities in the Hospital. As a teaching Hospital, KATH is responsible for most of their activities with little or no support from the government.

The Hospital has a lot of properties both owned and rented. These properties need to maintained efficiently and effectively to support health care delivery in the Ashanti Region and even Ghana as a whole. However, most of these facilities appear to be beautiful on the outside but really lacking the requisite maintenance in terms of renovation, rehabilitation, replacement and servicing to keep it in a good shape. This has actually become a challenge to maintenance in the Hospital.

Furthermore, the Estate Unit in the Hospital does not operate on its own or autonomous to take bold maintenance decisions and initiative to drive the Hospital forward as they would have anticipated. They need approvals from some superiors or top management who are not technically inclined to understand the pros and cons of maintenance. This usually prevents or slows down emergency maintenance works that require prompt action from the Estate Unit as a result of bureaucracy.

3.3 Data Source

In other to meet the aforementioned objectives, both primary and secondary were used as sources. Primary data was collected through questionnaires, observations and interviews. In addition, secondary data was obtained from already published books, journals, articles, news papers, and the internet. However, the research emphasised mostly on the primary data to get a firsthand experience in KATH’s real time situations.

3.4 Data Collection

Under the study, questionnaires were administered, and observation were used. For the questionnaire, both open and close ended were used for the respondents to act accordingly. Questionnaires were administered to; estate officers, tenants, and out- sourced contractors. The observation helped in pictorial evidence of the situations that was experienced on the field.

3.4 Sampling Size

The study was referred to the Officers of Estate Unit (KATH), out-sourced contractors, and tenants of the facilities for more insight. This was aimed at ensuring that the sample size highlights and add their views and perceptions about the challenges of maintenance of properties in KATH. Initially, seventy-five (75) questionnaires were anticipated to be administered to the respondents with the aim of achieving the research objectives. Out of the seventy-five (75) respondents, 10were for KATH’s Estate Officers, 5 were for out- sourced contractors, and sixty tenants (60) or occupants in KATH’s residential properties.

3.5 Sampling Technique

Thesampling techniques that wereadopted were both probability sampling and non- probability sampling.According to Britannica(2018), non-probability sampling method is based on convenience or judgment. As Trochim (2006) defines probability sampling as the method of sampling that utilizes some form of random selection. For the purpose of this research, Purposive and Snowball Sampling were adopted under the non- probability sampling. As, Simple Random Sampling were adopted under the probability sampling for the purpose of the research. TheSimple Random sampling willbe used to select the tenants or occupants in KATH’s accommodation properties, becauseit involves selecting the sample at random from the sample frame either using the computer or by adopting the lottery procedure. Furthermore, it is the probability sampling procedure that ensures that each case or element in the population has an equal chance of being included. Under the simple random sampling approach, the lottery method was adopted for the purpose of the research because the Hospital has separate apartments or blocks within the premises. KATH has an existing number of one hundred and twenty (120) tenants in the database of their Estate Department, and the research could afford seventy five (75) questionnaires out of 120 in the Hospital. For the lottery method, names or flat numbers corresponding to the names of the sample unit were written on pieces of paper and put in hator a bucket. The pieces of paper were mixed thoroughly and one was picked or selected. The content was thoroughly mixed again before the next one was picked. This process was continued for as many times before the sample size wasreached. Snow ball sampling was used to select out-sourced contractors. This wasbecause; it was difficult in reaching them or identifying members of the desired population. In addition, the research needs to; make a contact with one or two cases in the population, ask these cases to identify further cases, ask these new cases to identify further new cases, and stop when either no new cases are given or the sample is as large as is manageable. Purposive sampling was also be used for the estate officers of KATH. This is for the purpose of been judgmental in selecting experts that have the capacity to answer the research questions to meet the research objectives.

3.6 Data Analysis

For the purpose of this study, both quantitative and qualitative data was used for the analysis. The quantitative data analysis was used to analyse data that was measurable in nature. The main analytical tool was Microsoft Excel 2007 Version. This ensured that, statistical tool such as cross tabulation (of event), determination of percentiles and percentages were effective. These tools enabled the presentation of the information (analysed data) in such forms as bar graph and pie chart. Also, the format for the data presentation considered in terms of their visual (pictorial) impressions of the various findings for easy understanding. The content analysis was used to analyse data that could not be expressed by statistical tool. This was done in a written form based on the views from respondents.

3.7 Summary

This chapter discusses the method for the study and the use of the methods. The research approach used and the method of data collection were discussed, that is, the use of the survey type of questionnaire. In conclusion of this chapter, the research process discusses matters including the research area, data sources, development of questionnaire, respondents targeted, survey questionnaire scope, determination of size of sample and data analytical tool.

CHAPTER FOUR

ANALYSES AND DISCUSSIONS

This chapter presents the results, analysis, discussions and findings of the data collected. Analysis of responses was done according to the research objectives. It explains the background information of respondents, identification of maintenance policies available at KATH, assessing the effectiveness of the maintenance policy, and challenges associated with maintenance practice and policies.

The analyses represent eight (8) estate officers representing 80 percent rate of respondents, three (3) out-sourced contractors representing 60 percent rate of respondents, and fifty-six (56) tenants in KATH’s residential properties representing 93.33 percent rate of respondents.

4.1 Profile of Respondents

The presentations of the results from the survey on the background information of respondents were analysed using descriptive analysis. The goal was to present both the background information of KATH’s estate officers, occupants or tenants, and out- sourced contractors who took part in the study. Knowing the background information will help generate confidence in the reliability of data collected.

4.1.1 Profile of Estate Officers

This section of the study discusses the profile of Estate Officers managing the residential properties of KATH. Some of the major factors considered included the position(s) that they respectively hold in the Estate Department, their level or status in the department, number of years at the department, qualification and among others. These questions were to assess the state or nature of the capabilities and qualification that they have respectively acquired to handle the challenges of maintenance pertaining to the Hospital. The results of the section are presented in Table 4.1.

Table 4.1: Profile of Estate Officers.

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Source: Field Survey, 2018.

From Table 4.1, out of the total number (8) that questionnaires were administered to, the majority were maintenance officers. The dominant status or levels attained by the estate officers in the department was Senior Estate Officers constituting 75%. As the corresponding highest numbers of years that respondent has spent in the department is more than 6 years depicting 62.5%.Furthermore, the section under the estate department that most of their officers are engaged is the Maintenance and Projection Unit constituting 37.5% respectively? Yet the highest qualification attained by most of the Estate Officers is Professional Certification indicating 50%.

4.1.2Profile of Out- Sourced Contractors.

This section of the study discusses the profile of out-sourced contractors that does the maintenance works of the residential properties of KATH. Some of the major factors considered included the position(s) that they respectively hold in the company, their level or status in the company, number of years at the company, qualification and among others. These questions were to assess the state or nature of the capabilities and qualification that they have respectively acquired to handle the challenges of maintenance pertaining to the KATH. The results of the section are presented in Table 4.1.2.

Table 4.1.2: Profile of Out- Sourced Contractors.

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Source: Field Survey, 2018.

4.1.3 Profile of Occupants or Tenants.

This section of the study discusses the profile of occupants or tenants in KATH’s accommodation or residential properties. Some of the major factors considered are their respective work in the Hospital, the sex of respondent, their respective status or rank, the block or building they belong to, their rent status and among others. The results of the section are presented in Table 4.1.3.

Table 4.1.3: Profile of Occupants or Tenants.

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Source: Field Survey, 2018

4.2 Identification of Maintenance Policies Available at KATH

The research focused on identifying whether the Hospital has a maintenance policy or not. Some of the major factors or questions considered are; does the Hospital have maintenance policy, what necessitates the carrying out of maintenance on the buildings, how long does it take to respond to maintenance request/needs of occupants, the mode of maintenance management that is normally used in the Hospital and among others. The results of the section are presented in Table 4.2.0.

Table 4.2.0: Identification of Maintenance Policies Available at KATH

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Source: Field Survey, 2018.

From Table 4.2.0, out of the total number (8) that questionnaires were administered to, all the 8 officers representing 100 percent agreed that KATH has a maintenance policy. However, they also affirmed that maintenance policy is prepared by the estate department and not the top management. As dominant number of 4 officers constituting 50 percent reiterated that request made by occupant necessitate the need for carrying maintenance works in KATH’s residential properties. As a majority of 4 officers establishing 50 percent affirmed that, the Estate Department responses to maintenance request in less than a month. Yet 5 officers constituting 62.5 percent reiterated that, the mode of maintenance management for the Hospital is planned maintenance. The maintenance philosophy of KATH agreed by 4 estate officers which hold the majority of 50 percent concurred that, the philosophy is to make planned maintenance their topmost priority. In addition, 6 officers forming 75 percent said that, the approach to maintenance of properties by KATH is the hybrid (that is the combination of both in- house and outsourced). Moreover, 7 estate officers constituting a great portion of 87.5 percent also reiterated that, the residential properties of KATH are well and properly maintained. As all the 8 estate officers forming 100 percent agreed that, they take regular inspection of the residential property or facility. Also all the eight officers constituting 100 percentage, unanimously agreed that, they actually take inventory of items or assets in the accommodation property. This helps them to know the true state and conditions of the facility for the right actions to be taken. For funding of maintenance activities in the Hospital, 4 officers said that it was funded by Internally Generated Funds (IGF) whilst 4 estate officers constituting 50 percent respectively also argued that maintenance works are funded through their budgetary allocation for the year. Yet, a majority of 5 estate officers depicting 62.5 percent also indicated that technicians and managers do no receive training like workshops, seminars and among others to conduct the condition assessments of the buildings. It was also unanimously agreed by the 8 estate officers that the roles of occupants towars the maintainability of their building is to report quickly to the estate department through a requisition form for actions to be taken by the department.

4.3.0 Assessing the Effectiveness of the Maintenance Policy.

Assessing the effectiveness of the maintenance policy of KATH’s residential properties was assessed in this section of the research with the aid of Likert Scale type of questionnaire. According to Saul (2008), a Likert- scale type assumes that the strength or intensity of experience is linear, that is on a continuum from strongly agree to strongly disagree, and makes the assumption that attitudes can be measured. Saul further added that, respondents may be offered a choice of five to seven or even nine pre-coded responses with the neutral point being neither agree nor disagree. The respondents (estate officers and out-sourced contractors) were presented with questionnaires comprising questions to confirm assessing the effectiveness of the maintenance policy. The respondents were required to choose from “1= strongly agree, 2= Agree, 3= disagree, and 4= strongly disagree” in confirmation the effectiveness of maintenance policy of KATH. The results are presented in Table 4.3.0 below.

Table: 4.3.0 Assessing the Effectiveness of the Maintenance Policy.

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Source: Field Survey, 2018.

From Table 4.3.0, out of the total respondents of (11), 90.91% representing 10 respondents strongly agreed that Building maintenance objectives which are the bases for developing maintenance policy must be considered in relation to organisations objectives and hence, ranked first (1st) as the most important factor in assessing the effectiveness of the maintenance policy of KATH’s residential facilities/properties. Training of maintenance personnel was ranked second (2nd) as 53.84% representing 9 respondents strongly disagree that they are not trained in the form of workshops, seminars, and among others to keep them abreast with current property management of health facilities. Availability of adequate maintenance funding and quick response to maintenance need of the building when old tenant moves for new tenant to occupy were both ranked 3rd, recording 72.73% respectively representing 8 of respondents each indicating how they disagree to the effectiveness of maintenance policy of KATH. Building maintenance policy needs to be agreed upon by maintenance personnel and top management before implementation was ranked fifth (5th) and recorded 63.64% representing 7 of respondents who indicated how strongly they agree to the Effectiveness of the Maintenance Policy. In addition, availability and adherence to building and structural designs was ranked sixth (6th) and recorded 54.55% indicating 6 respondents agreed to the effectiveness of maintenance policy of KATH’s residential property. Lastly, quick response to maintenance need of the building when old tenant moves for new tenant to occupy was ranked seventh (7th) recorded 45.45% establishing 5 respondents, also indicated how strongly they disagree with the effectiveness of the maintenance policy of KATH.

It is obvious that majority of the respondents are in support of the effectiveness of KATH’s maintenance policy.

4.3.1 Move in and Move Out Inspections and its Associated Maintainability of Properties

The buildings or accommodations are allocated to the personnel’s or staffs by the Estate Officer in consultation with the accommodation committee of the Hospital. The Estate department is to ensure that an inventory of the building is taken and signed by both the officer and the would-be occupant. Similarly this procedure must be followed before occupant vacates the building. The study revealed on the contrary that occupants take occupancy of the building without signing any inventory form. This has arisen largely because of the urgency with which personnel move in to take over the building on retirement or transfer of previous occupant without recourse to the laid down rules. In the case of the KATH respondents claimed they take over the accommodation of their relievers after service vehicle have brought them in without necessarily consulting the Estate Department. This development makes it difficult for the institutions to surcharge occupants who refuse to undertake internal maintenance of their building for the period of their occupancy. This has led to muchdeterioration of the facilities in terms of broken louver blades, damaged or faulty washroom equipments, faulty doors and hinges, faulty electrical appliances, leaking roofs, paints peeling off and among others.Appendix 1 shows how residential building in KATH has been left deteriorated as a result of improper inspections done to keep the properties in good shape.

All defects arising out of wear and tear are to be reported to the Estate Department which is responsible for making good such defects. The study revealed that the Estate Department does not plan building inspection but rely on report of maintenance needs by occupants to act. This process, the survey observed has not been an effective way of drawing a maintenance program for the buildings since approximately 73% of respondent claimed that the bureaucratic reporting process prevents them from reporting maintenance needs of their building unless in emergency situations such drainage system blockage, ripping off of roof, emptying of septic tanks and major electrical faults.

4.3.2 Rent Paid by Residents Tenants Occupying KATH’s Residential Properties

Rent is the amount that one pays to the owner of a property for the use and occupation of his property. The research found that not all occupants in the residential property were made to pay rent. Tenants who were exempted from rent payments were Rotation Nurses and Housemanship Doctors. They are only doing their National Service, so the Hospital provide them with free accommodation. Out of the 56 occupants who responded to the questionnaires 30 percent of them were exempted from the payment of rent to the Hospital. The remaining 70 percent of the occupants pay monthly or annual rent to the Hospital. However, the study revealed that most of the occupants who are not exempted from payment of rent do not actually pay their rent. This is because the rent is not deducted from their monthly salary. One has to pay his or her rent by himself at the end of the month, this makes them feel reluctant. The rent payable by the occupant ranges for GH₵35.00 for one bedroom, GH₵50 for two bedrooms, and GH₵85 for three bedroom apartment. Figure 4.1 below shows those who are exempted from and not exempted to pay rent in the Hospital.

Figure 4.1.Those who are exempt from rent payment in the Hospital

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Source: Field Survey, 2018.

From Fig. 4.1 staff members of the KATH accounts for the majority (70%) of the respondents were not exempt from the payment of rent while the remaining 30% including housemanship officer/doctors and rotation nurses were exempt from paying rent. Given that 30% of the occupants do not pay rent, coupled with the low rent charges mean that the Hospital could not raise enough funds for some of their maintenance activities hence calling for the deterioration of some of their facilities over time.

4.4 Challenges Associated with Maintenance Practice and Policies

With the aid of Likert scale type of questionnaire, respondents (estate officers, out- sourced contractors and tenants) were given 19 factors that contribute to the challenges of maintenance of KATH residential properties/facilities. They were to indicate the major challenges areas pertaining to maintenance and rate them choosing between 1= strongly disagree 2= disagree, 3= agree, 4= strongly agree. The results are presented in Table 4.4

Table 4.4 Challenges Associated with Maintenance Practice and Policies

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Source: Field Survey, 2018.

From Table 4.4.0, out of the total respondents of (67), 97.01% representing 65 respondents strongly agreed that Bureaucratic reporting process is the major challenge associated with maintenance practice and policies and hence, ranked first (1st). Financial delays were ranked second (2nd) as 89.55% representing 60 of respondents strongly agrees with Derek and Paul (1987) as the major challenge associated with maintenance practice and policies. In addition, contractual delays were ranked (3rd) since respondents’ constitution 88.06% representing 59 of the respondents established that this forms a major challenge to maintenance of KATH’s residential facilities or properties. Incompetent Staff was ranked fourth (4th) and recorded 83.58% representing 56 of respondents who indicated how strongly they disagree as a challenge associated with maintenance practice and policies. Also, 82.09% representing 55 respondents strongly agreed that Poor quality of materials and spare parts is a challenge of maintenance and was ranked 5th. Moreover, 89.55% representing 50 respondents also agreed that; lack of implementation of maintenance policy if any, lack of maintenance culture, and inefficient inventory system are challenges of maintenance in the Hospital, hence ranked 6th. Furthermore, 73.13% indicating 49 respondents strongly agreed that users response to maintenance works are another challenge to maintenance in the Hospital, and it was ranked 9th. In addition, 68.66% representing 46 respondents strongly agreed with Uche and Ogbonnaya (2013) that procurement of spare parts becomes difficult due to unavailable fund indicates a challenge to maintenance management of properties at KATH and was ranked 10th. Also, 67.16% representing 45 respondents agrees with Yeun (1993 cited Ernest 2015) to the fact that, lack of input of property managers at design & construction stages is another challenge to maintenance in KATH’s residential properties, hence ranked 11th. Moreover, 62.69% representing 42 respondent strongly agrees to the fact that inflation of the cost of maintenance by the operatives is another challenge to maintenance of KATH’s properties, hence ranked 12th. Also, 59.70% indicating 40 respondents strongly agree that users improper usage of facility is a major challenge to maintenance of KATH’s properties and it was ranked 13th. In addition, 64.18% representing 43 respondents strongly agrees that, natural deterioration due to age and environment is another factor of challenges to maintenance of KATH’s residential properties, therefore ranked 14th. Furthermore, 59.70% indicating 40 respondents also agrees to the fact that; on response to maintenance request, and poor work done on building is a contributing challenges to maintenance of KATH’s residential property, and it was ranked 15th.Furthermore,58.21% representing 39 respondents also agreed that, Pressure on facility or building due to number of occupants is a contributing factor to challenges of maintenance of KATH’s properties, and it was ranked 17th. Lastly, 53.73% representing 36 occupants disagreed that, frequent shortage of materials and spare parts is a challenge to maintenance challenge to maintenance of KATH’s residential properties, hence ranked 18th.

4.5 Summary

Generally, the results of the surveys as discussed were found to be a true reflection of KATH’s residential building properties/facilities. It shows that respondents responded to the questionnaires based on their experience over the years. It started by giving a profile of the respondent of the survey, and the outcome of the descriptive statistics retrieved from the field thereof. The results obviously demonstrate the challenges associated the maintenance of KATH properties.

CHAPTER FIVE

SUMMARY OF FINDINGS, RECOMMENDATIONS AND CONCLUSIONS

5.1 Introduction

The aim of the research is to identify challenges of maintenance practices in public health institutions (KATH), with the view of recommending strategies for improving maintenance management of building properties/facilities In this chapter, the research questions and the objectives were again looked at to give in detail the scope by which the study’s aim has been attained through the several levels of the study. This chapter further gives somerecommendations of the research based on the findings of the study.

5.2.0 SUMMARY OF FINDINGS

5.2.1 Identification of Maintenance Policies Available at KATH

The research established the following:

- The study showed that KATH has a maintenance policy, out of the total number (8) that questionnaires were administered to; all the 8 officers representing 100 percent agreed that KATH has a maintenance policy. However, they also affirmed that maintenance policy is prepared by the estate department and not the top management.
- The analyses however revealed that, a dominant number of 4 officers constituting 50 percent reiterated that request made by occupant necessitate the need for carrying maintenance works in KATH’s residential properties. As a majority of 4 officers establishing 50 percent affirmed that, the Estate Department responses to maintenance request in less than a month.
- The study also showed that, 62.5 percent constituting 5 officers reiterated that, the mode of maintenance management for the Hospital is planned preventive maintenance. The maintenance philosophy of KATH agreed by 4 estate officers whom hold the majority of 50% concurred that, the philosophy is to make planned preventive maintenance their topmost priority. In addition, 6 officers forming 75 percent said that, the approach to maintenance of properties by KATH is the hybrid (that is the combination of both in-house and outsourced).
- For funding of maintenance activities in the Hospital, 50 percent of estate officers said that it was funded by Internally Generated Funds (IGF) and budgetary allocation for the year.

5.2.2 Assessing the Effectiveness of the Maintenance Policy.

The study established that:

- 90.91% representing 10 respondents strongly agreed that Building maintenance objectives which are the bases for developing maintenance policy must be considered in relation to organisations objectives and hence, ranked first (1st) as the most important factor in assessing the effectiveness of the maintenance policy of KATH’s residential facilities/properties.
- The study further indicated that, training of maintenance personnel was ranked second (2nd) as 53.84% representing 9 respondents strongly disagreed that personnel’s are not trained in the form of workshops, seminars, and among others to keep them abreast with current property management of health facilities.
- Availability of adequate maintenance funding and quick response to maintenance need of the building when old tenant moves for new tenant to occupy were both ranked 3rd, recording 72.73% respectively representing 8 of respondents each indicating how they disagree to the effectiveness of maintenance policy of KATH.
- Also analyses as also revealed that, building maintenance policy needs to be agreed upon by maintenance personnel and top management before implementation and was ranked fifth (5th) and recorded 63.64% representing 7 of respondents who indicated how strongly they agree to the Effectiveness of the Maintenance Policy.
- In addition, availability and adherence to building and structural designs was ranked sixth (6th) and recorded 54.55% indicating 6 respondents agreed to the effectiveness of maintenance policy of KATH’s residential property.
- Lastly, quick response to maintenance need of the building when old tenant moves for new tenant to occupy was ranked seventh (7th) recorded 45.45% establishing 5 respondents, also indicated how strongly they disagree with the effectiveness of the maintenance policy of KATH.

5.2.3 Challenges Associated with Maintenance Practice and Policies

The study established that:

-0 97.01% representing 65 respondents strongly agreed that Bureaucratic reporting process is the major challenge associated with maintenance practice and policies and hence, ranked first (1st).
- Financial delays were ranked second (2nd) as 89.55% representing 60 of respondents strongly agrees as the major challenge associated with maintenance practice and policies.
- In addition, contractual delays were ranked (3rd) since respondents’ constitution 88.06% representing 59 of the respondents established that this forms a major challenge to maintenance of KATH’s residential facilities or properties.
- Incompetent Staff was ranked fourth (4th) and recorded 83.58% representing 56 of respondents who indicated how strongly they disagree as a challenge associated with maintenance practice and policies.
- Also, 82.09% representing 55 respondents strongly agreed that Poor quality of materials and spare parts is a challenge of maintenance and was ranked 5th.
- Moreover, 89.55% representing 50 respondents also agreed that; lack of implementation of maintenance policy if any, lack of maintenance culture, and inefficient inventory system are challenges of maintenance in the Hospital, hence ranked 6th.
- Furthermore, 73.13% indicating 49 respondents strongly agreed that users response to maintenance works are another challenge to maintenance in the Hospital, and it was ranked 9th.
- In addition, 68.66% representing 46 respondents strongly agreed that procurement of spare parts becomes difficult due to unavailable fund indicates a challenge to maintenance management of properties at KATH and was ranked 10th.
- Also, 67.16% representing 45 respondents agrees to the fact that, lack of input of property managers at design & construction stages is another challenge to maintenance in KATH’s residential properties, hence ranked 11th.
- Moreover, 62.69% representing 42 respondents strongly agrees to the fact that inflation of the cost of maintenance by the operatives is another challenge to maintenance of KATH’s properties, hence ranked 12th.
- Also, 59.70% indicating 40 respondents strongly agree that users improper usage of facility is a major challenge to maintenance of KATH’s properties and it was ranked 13th.
- In addition, 64.18% representing 43 respondents strongly agrees that, natural deterioration due to age and environment is another factor of challenges to maintenance of KATH’s residential properties, therefore ranked 14th.
- Furthermore, 59.70% indicating 40 respondent also agrees to the fact that; non response to maintenance request, and poor work done on building is a contributing challenges to maintenance of KATH’s residential property, and it was ranked 15th.
- Furthermore,58.21% representing 39 respondent also agreed that, Pressure on facility or building due to number of occupants is a contributing factor to challenges of maintenance of KATH’s properties, and it was ranked 17th.
- Lastly, 53.73% representing 36 occupants disagreed that, frequent shortage of materials and spare parts is a challenge to maintenance challenge to maintenance of KATH’s residential properties hence ranked 18th.

5.3 Recommendation

Based on the findings of the study, the following recommendations are made:

Strategies should be formulated by property managers charged with the responsibility of maintenance management of residential properties in line with systems and components of properties, to ensure that the apartments or blocks remain operational in functional and safe manner.

There is the need for KATH to embrace preventive maintenance practice as a high priority rather than adhoc maintenance. To gain optimum benefits from preventive maintenance, property managers should be more proactive by incorporating preventive maintenance tasks into a work-order system and keep systematic maintenance records, either by computer or manually. Property managers should evaluate the preventive maintenance program to update or improve it over time.

The length of bureaucratic level of reportingand approval for maintenance works to be done within the Hospital should be reduced. This will ensure that prompt attention and responds is given to maintenance activities in the Hospital to ensure that, properties are functional and in its best shape.

Furthermore, provision for better funding for the Estate Department should be made in subsequent years when systems and components of residential properties begin to age and deteriorate at an increasing rate. Such funds should however be monitored to ensure that they are judiciously utilized by the Estate Department

KATH should ensure that their Estate Department is adequately staffed with the requisite manpower and that employees have appropriate training to competently and safely undertake and complete the maintenance tasks expected of them.

Property managers should oversee periodic inspections of buildings’ conditions and create an inventory of buildings’ components and equipment. They should plan building inspection, since proper planning of inspection is a sure way to reduce cost of maintenance since doing so can provide insight into future maintenance needs and avoid unnecessary costs.

Property managers must oversee tenants who occupy the residential apartments of KATH. This will help prevent staffs that secretly occupy properties without the consent of the Estate Department of the Hospital and also eject tenants who are on pension or retirement who are still enjoying their stay in the Hospital’s apartments. This will ensure that, the right staffs or tenants occupy the apartment so that they can be surcharged with any damages caused in the property.

Finally, there should be a state regulation to affect national maintenance of specific building systems. A state building and maintenance code should govern building construction and remodelling. It should also affect accessibility, electricity, energy, fire protection, plumbing, space management and other mechanical components such as elevators. In addition, a National Maintenance Policy should be formulated as part of the National Housing Policy to compel people to undertake maintenance on the buildings they occupy to avoid the situation where huge sums of taxpayers’ money go down the drain through deterioration of public buildings due to lack of maintenance.

5.4 Conclusion

The importance of maintenance management is increasing. With a progressively and hastily varying nature of residential properties, the onus lies on designers, property managers, owners or institutions and tenants or occupants to improve their attitude towards maintenance management thereby guaranteeing effective utilisation of resources. By so doing, the challenges of maintenance in Public health properties can be eradicated or reduced to its best minimum.

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APPENDIX 1

PHOTOGRAPHS OF MAINTENANCE PROBLEMS OR CHALLENGES OF KATH’S RESIDENTIAL BUILDINGS

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Dirty walls

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Reinforced beams and slabs peeled off

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External walls partly broken down

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Roof leakage

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Exposed electrical exposed

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Spoilt or broken louver blades not replaced

APPENDIX 2: QUESTIONAIRES KUMASI TECHNICAL UNIVERSITY

FACULTY OF BUILT AND NATURAL ENVIRONMENT

DEPARTMENT OF ESTATE MANAGENT

CHALLENGES OF MAINTENANCE OF PROPERTIES OR PUBLIC HOSPITALS

A CASE STUDY OF KOMFO ANOKYE TEACHING HOSPITAL (KATH)

OTENG DANIEL BEM05160011

Preamble

Dear Sir,

I am a final year student of Kumasi Technical University under Estate Management Department, conducting research into the Challenges of Maintenance of Properties in Public Hospitals – A Case Study of Komfo Anokye Teaching Hospital’s residence. This is in partial fulfillment for the award of Bachelor of Technology degree in Estate Management.

Your participation in the research will be appreciated by responding to the attached questionnaire which has been designed to capture data on strategies for challenges of maintenance of properties in public hospital in Ghana.

Any information you provide will be treated with strictest confidence and would only be used for the purpose of this research without mentioning your name or organisation except if you wish to be mentioned in the main report.

I am counting on your cooperation.

.

Thank you in advance for your participation and assistance with this study.

Kind regards.

Oteng Daniel.

To be answered by the Estate Officers of KATH:

SECTION A: BACKGROUND INFORMATION

Please kindly respond to the following questions by ticking (√) the appropriate box(es) for each item and provide answers in the provided space where applicable.

RESPONDENT’S PROFILE

Name........... (Please ignore if you wish to remain anonymous)

1. Position in the Estate Unit.

-Maintenance Engineer
-Property Manager
-Accomodation officer
-Head Estates
-Other..........(please specify)

2. Kindly indicate your status in the estate department:

a) Principal [ ]
b) Senior [ ]
c) Estate Officer [ ]

Others (please specify)............

3. What section in the estate department are you involved with.

a) Maintenance [ ]
b) Projects [ ]
c) Facilities [ ]
d) Premises and property [ ]
e) Others (please specify)..............

4. Number of years in department.

- Less than 1 years
- 1-3years
- 3- 7 years
- Other .......... (Please specify)

5. Highest qualification (please do not tick more than two boxes)

- PhD
- MSc/Mtech
-BSc/Btech
- HND
-Professional qualification (please specify)
- Other.................. (Please specify)

SECTION B: Identification of Maintenance Policies Available at KATH

6. Does your institution have a maintenance policy?

a) YES [ ]
b) NO [ ]

7. If yes, who developed the policy?

a) Estate Department
b)Top management

c) Please if any specify.......

8.What necessitates the carrying out of maintenance on the buildings?

a) Upon inspection [ ]
b) Upon request [ ]
c) Upon occupancy of new tenant [ ]

Other (please specify)............................

9.How long does it take to respond to maintenance request/needs of occupants?

a) Less than a month [ ]
b) 1-3 months [ ]
c) 6-12 months [ ]
d) More than 12 months [ ]

Other (please specify)................................

10. Please kindly indicate mode of maintenance management that is normally used in your sector:

- Planned maintenance
- Preventive maintenance
- Planned preventive maintenance
- Routine maintenance
- Emergency maintenance
- Planned inspection
- Other .................................. (Please state type)

11. Please indicate the type of maintenance management strategy that you personally believe is most effective for your sector of operation.

- Planned maintenance
- Preventive maintenance
- Planned preventive maintenance
- Routine maintenance
- Emergency maintenance
- Planned inspection
- Other ..................................... (Please state type)

12. Please which one of the following is the maintenance philosophy of your sector?

- To ensure continuous uninterrupted usage of all our properties/facilities
- To make planned preventive maintenance our topmost priority
- To ensure maintenance financing does not hold back our effort to ensure effective use of our properties/facilities
- To encourage our facility users/tenants to report request for maintenance early to ensure our early response
- To respond promptly to request for maintenance by our tenants/users
- Other.................................

(please describe accurately)

13. Please kindly indicate how maintenance work is organised within your sector.

- In-house approach
- Out-sourced approach
- Hybrid approach
- Other....................................(please describe)

14. Please indicate average response time when maintenance request are received by occupants/users.

- Less than one week
- More than one week
- Less than one month
- 1-3 months
- 6-12 months
- More than 12 months
- Upon release of financial/material resources
- Other (please specify)..............................

15. In your opinion are the buildings well maintained? [ ] Yes [ ] No. please give reason(s) for your answer

............................................................

............................................................

...................................

16. Do you inspect the building to determine its maintenance needs? If yes how often and if no please assign reasons.

............................................................

............................................................

...................................

17. What is the responsibility/role of the occupants towards the maintenance of the building?

............................................................

............................................................

...................................

18. Does the estate/maintenance dep’t undertake regular inspection of the building?

YES/ NO

Please give reasons for your answer

............................................................

............................................................

...................................

19. Does the institution take inventory of the state of the building on occupancy of new tenant/personnel?

............................................................

............................................................

...................................

20. How is maintenance funded?

IGF [ ] Rent payment [ ] Surcharging Government [ ] Budgetary allocation.[ ] Others please specify

............................................................

............................................................

...................................

21. Do technicians and managers receive training to conduct the condition assessments of the buildings?

Yes [ ] No [ ]

SECTION C: ASSESSING THE EFFECTIVENESS OF THE MAINTENANCE POLICY.

24. In your experience, which of the following policies in KATH shows how effective maintenance policies are?

Please rank in order of importance by ticking (ü) as: 1= strongly agree, 2= Agree, 3= disagree, 4= Strongly disagree

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SECTION D: CHALLENGES ASSOCIATED WITH MAINTENANCE PRACTICE AND POLICIES

25. The following factors have been identified as major influencing factors that cause impediments or challenges to the achievement of effective maintenance of public hospital. In your experience, indicate the extent to which these factors influence the challenges of maintenance of properties in your organization. Please rank in order of importance by ticking (ü) as: = strongly disagree 2= disagree, 3= agree, 4= strongly agree

Challenges of maintenance in public health institutions.

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To be answered by out-sourced maintenance contractors of public buildings (KATH):

SECTION A: BACKGROUND INFORMATION

Please kindly respond to the following questions by ticking (√) the appropriate box(es) for each item.

RESPONDENT’S PROFILE

Name.......................... (Please ignore if you wish to remain anonymous)

1. Position in the company.

- Civil engineer
- Architect
- Quantity Surveyor
- Other......................................(please specify)

2. Kindly indicate your status in the maintenance department:

a) Senior [ ]
b) Intermediate [ ]
c) Junior [ ]

Others (please specify).

3. Number of years in the company.

- Less than 1 years
- 1-2years
- 2 – 5years
- More than 5 years

4. Highest qualification (please do not tick more than two boxes)

- PhD
- MSc/Mtech
- BSc/Btech
- HND
- Professional qualification (please specify)
- Other (Please specify

SECTION B: IDENTIFICATION OF MAINTENANCE POLICIES AVAILABLE AT KATH

1. Please indicate what necessitates the carrying out of maintenance on the buildings?

- Upon inspection
- Upon request
-Before occupancy of new tenant
- Other (please specify)............................

2. Please indicate average response time when maintenance request are received by the company from KATH.

- Less than one week
- More than one week
- Less than one month
- 1-3 months
- 6-12 months
- More than 12 months
- Upon release of financial/material resources
- Other (please specify).............................

3. In your opinion are the residential buildings of KATH well maintained? [ ] Yes [ ] No. please give reason(s) for your answer

............................................................

............................................................

...................................

4. Do you inspect the building to determine its maintenance needs? If yes how often and if no please assign reasons.

............................................................

............................................................

............................................................

...................................

5. Does the estate/maintenance dep’t undertake regular inspection of the building during the commence of your work at the Hospital?

YES/ NO

Please give reasons for your answer

............................................................

............................................................

............................................................

...................................

6. How is maintenance work funded?

IGF [ ] Internally generated fund [ ] Surcharging Government [ ] budgetary allocation.[ ] Others please specify

............................................................

............................................................

...................................

7. Do technicians, engineers and managers in your company receive training to conduct the condition assessments and maintenance of the buildings?

Yes [ ] No [ ]

SECTION C: ASSESSING THE EFFECTIVENESS OF KATH’S MAINTENANCE POLICY.

8. In your experience, which of the following policies in KATH shows how effective maintenance policies are?

Please rank in order of importance by ticking (ü) as: 1= Very Strong, 2= Strong, 3= Very weak 4= Weak

Abbildung in dieser Leseprobe nicht enthalten

SECTION D: CHALLENGES ASSOCIATED WITH KATH’S MAINTENANCE PRACTICE AND POLICIES

9. The following factors have been identified as major influencing factors that causes impediments or challenges to the achievement of effective maintenance of public hospital. In your experience and work with KATH, indicate the extent to which these factors influence the challenges of maintenance of KATH’s residential properties. Please rank in order of importance by ticking (ü) as: strongly disagree 2= disagree, 3= agree,

4= strongly agree

Challenges of maintenance in public health institutions

Abbildung in dieser Leseprobe nicht enthalten

Please if there is any other specify...................

To be answered by occupants or tenants of KATH:

RESPONDENT’S PROFILE

Name............. (Please ignore if you wish to remain anonymous)

1. Position in organization:

- Doctor
- Nurse
- Non-medical staff
- Other.....................(please specify)

2. Sex of respondent.

Male [ ] Female [ ]

3. Kindly indicate your status in the Hospital.

a) Senior [ ]
b) Intermediate [ ]
c) Junior [ ]

Others (please specify)...............

4. What building or block do you belong to.

a) Nurses block [ ]
b) Housemanship block [ ]
c) Doctors block [ ]
e) Others (please specify)......................

5. Number of years in Hospital’s accommodation.

- Less than 1 years
- 1-2years
- 2 – 5years
- More than 5 years

6. Do you pay rent? Yes [ ] No [ ]

7. If yes, how much do you pay per month?................

SECTION B: GENERAL QUESTIONS ON MAINTENANCE OF BUILDING AT KATH

8. How long have you stayed in the building? ...................

9. Did you take inventory of the state and facilities in the building before occupying? Yes [ ] No [ ] Please assign reason(s) for your response

3. Does your institution undertake regular inspection of the building? Yes [ ] No [ ] Please give reason for your answer

..

..

4. Does the maintenance/estate department come in to do maintenance work on the building without request? [ ] Yes [ ] No

5. If yes, when is it done? [ ] Quarterly [ ] Annually [ ] Biannually [ ] other (please specify)

.....................

6. Who is responsible for the maintenance of the building? Self [ ] Estates Unit [ ] PWD [ ] other please specify

.....................

7. How long does it take for maintenance request to be responded to? less than a month

[ ] 1-3 months [ ] 6-12 months [ ] More than 12 months [ ] other please specify

8. In your opinion is the building well maintained? [ ] Yes [ ] No. please give reason(s) for your answer

............................................................

...................................

9. Please indicate in your opinion the reasons/factors responsible for the present state of your building

............................................................

............................................................

...................................

10. How does the current state of your building affect your stay/life in the building?

............................................................

............................................................

............................................................

...................................

11. What role do you play in the maintenance of your building?

............................................................

............................................................

............................................................

............................................................

12. How much do you spend annually if any activities of maintenance are done by you?

............................................................

............................................................

13. How will you rank the following as the major challenges of maintenance of KATH’s residence? Please rank in order of importance by ticking (ü) as: strongly disagree 2= disagree, 3= agree, 4= strongly agree

Thank you.

[...]

91 of 91 pages

Details

Title
Challenges of Maintenance of Properties in Public Hospitals
Subtitle
A Case Study of Komfo Anokye Teaching Hospital
Course
Estate Management
Grade
3.65
Author
Year
2018
Pages
91
Catalog Number
V503429
Language
English
Tags
challenges, teaching, anokye, komfo, study, case, hospitals, public, properties, maintenance, hospital
Quote paper
Oteng Daniel (Author), 2018, Challenges of Maintenance of Properties in Public Hospitals, Munich, GRIN Verlag, https://www.grin.com/document/503429

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