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This paper explores the role of hospital cleaners and their contribution to healthcare safety. Few studies have examined the activities and input of hospital cleaners, rendering them largely invisible in healthcare research. Yet, as coronavirus disease 2019 (COVID-19) has demonstrated, this sizeable workforce carries out tasks critical to healthcare facilities and wider health system functioning.

Drawing on the work of Habermas, the authors examine the literature surrounding cleaners and quality and safety in healthcare. The authors theorise cleaners' work as both instrumental and communicative and examine the perceptions of healthcare professionals and managers, as well as cleaners themselves, of healthcare professionals and managers' role and contribution to quality and safety.

Cleaners are generally perceived by the literature as performing repetitive – albeit important – tasks in isolation from patients. Cleaners are not considered part of the “healthcare team” and are excluded from decision-making and interprofessional communication. Yet, cleaners can contribute to patient care; ubiquity and proximity of cleaners to patients offer insights and untapped potential for involvement in hospital safety.

This paper brings an overdue focus to this labour force by examining the nature and potential of their work. This paper offers a new application of Habermas' work to this domain, rendering visible how the framing of cleaners' role works to exclude this important workforce from participation in the patient safety agenda.

This research aimed to explore the prevalence of musculoskeletal disorders (MSDs) and related factors among subcontracted cleaners in a teaching hospital in Thailand.

A cross-sectional study was conducted of 393 subcontracted cleaners in a teaching hospital, from May to June 2020. Face-to-face interviews were carried out using a standard questionnaire, consisting of four parts: (1) participant characteristics, (2) stress test, (3) work characteristics and (4) standardized Nordic questionnaire, Thai version, for MSDs outcome. Multiple logistic regression analyses were performed to determine the association between MSDs and related factors.

The prevalence of MSDs was 81.9%, involving mostly the lower back (57.7%), followed by the shoulder (52.6%). Factors significantly associated with MSDs were as follows: male gender (OR = 3.06, 95% CI [1.19, 7.87]), severe stress (OR = 2.72, 95% CI [1.13, 6.54]), history of injuries (OR = 4.37, 95% CI [1.27, 15.11]), mopping posture (OR = 2.81, 95% CI [1.43, 5.50]) and task duration (OR = 1.90, 95% CI [1.01, 3.57] for 2–4 h and OR = 3.39, 95% CI [1.17, 9.86] for more than 4 h). Sick leave due to MSDs was associated with history of injuries, Thai nationality and having another part-time job.

The study findings about MSDs in terms of prevalence and related factors contributed to limited pool of the knowledge among subcontracted hospital cleaners in Thailand and middle-income country settings. With growing popularity in outsourcing cleaning services among hospitals in these countries, the study findings could raise a concern and inform policymakers and hospital administrators the importance of the magnitude and risk factors for MSDs necessitating design of preventive strategies.

This paper aims to examine the policy and guidance that was issued, either as a direct result of the NHS Plan, or part of a subsequent initiative, surrounding cleaning in the NHS.

A literature review of the Department of Health and related agency web sites was completed. In addition there was a literature review of the relevant academic journals.

There is a growing evidence base on environmental cleaning in the NHS and more specifically the relationship between environmental cleaning and infection control. This paper has examined the contradiction in the evidence in the suspected correlation between infection control and environmental cleaning. However, one thing that does appear to be consistent is that a performance measure based on an observation (visual) assessment is not a sufficient tool to evaluate the environmental cleanliness of a hospital ward.

While the clinical community recognise the contribution of environmental cleaning and the impact on healthcare, more needs to be done to have the relevant studies published in the FM domain. Conversely there also needs to be work done to allow the FM community to have a “voice” in the infection control journals. The literature reviewed suggests that a usable technological solution is required to confirm satisfactory cleaning standards in healthcare facilities.

There is relatively little published work on the importance of cleaning to operations in the NHS, particularly in the FM domain.

It is typical of public real estate benchmarking reports to show only highly aggregated benchmarks based on buildings’ floor areas. They hardly provide disaggregated benchmarks for usage clusters. The aim of this study is to show the caveats from highly aggregated benchmarking without consideration of cluster-specific characteristics.

Based on the parameters of the German facility management association 812 standards, cleaning costs and costs for the surfaces of seven hospitals have been collected and allocated to specific room clusters. Using these basic data, a calculation and simulation conducted with the aim of simulating facilities that are comparable in the sum of costs yet feature varying sub-clusters as cost drivers. In particular, during this simulation, area ratios were varied randomly and the average cleaning costs per cluster were held constant for all hospitals. Therefore, the costs per square meter in the clusters of all simulated hospitals are identical and the full costs only depend on the area ratios.

The simulation shows that highly aggregated cleaning costs lead to large spans, and thus, to misinterpretations in the field of action. In the case, the aggregate benchmark ranges from 40.6 to 66.5 EUR/m², although, for all hospitals the same costs per square meter had been used. Thus, the bias results only from varying the share of area across the clusters. This finding is caused by a well-known statistical problem: the Simpson’s paradoxon, which currently receives little attention in real estate benchmarking.

The results show, that the regular benchmarking with high aggregated data, often used in practice, cannot be recommended. The author consider using a detailed benchmarking as meaningful and purposeful. To be able to make a detailed benchmarking, it is essential to identify and collect the influencing factors. Only if all important factors, in this case, the clusters will be regarded in the benchmarking, a reasonable benchmarking and useful interpretation can be given. Using a simple benchmarking to get a rough overview is refused steadfastly.

The study highlights that a comparison with public benchmarking reports (operation costs) must be taken with great caution. The author has quantified the bias from the aggregated benchmarking and have shown, that the Simpson’s paradox fully explains the consequences.

The purpose of this paper is to investigate the extent to which practicing National Health Service (NHS) facilities managers thought that the contribution of facilities management (FM) could be measured in terms of health outcomes.

A questionnaire was distributed to NHS facilities or estate managers from the majority of NHS trusts in England and Wales.

In general, there is little or no evidence from pre‐existing research to prove the contribution of FM in terms of health outcomes. However, in spite of this, 59 per cent of facilities managers in the NHS believe that the contribution of FM could be measured yet only a relatively small number of Trusts (16 per cent) have attempted to measure the contribution of FM. The analysis of the secondary data does not show any conclusive evidence of a correlation between FM and health outcomes.

The scope of the study did not extend to collecting empirical evidence to prove the contribution of FM to health outcomes – it was only focusing on whether facilities managers thought it was possible, and if so how they would measure the contribution. However, as part of the project some secondary data were tested for a relationship between FM services and health outcomes.

This is the first time any study has gathered opinion from facilities managers as to whether they believe their contribution can be measured in terms of organisational outcomes, in this case patient care or health outcomes. It provides a useful starting point in order to develop a future study to prove the contribution from FM to health outcomes.

Presents the findings of a study of female hospital cleaners in Sweden. Uses participatory research i.e. discussion and analysis of issues in groups to show how potential is often under utilized within such teams. Outlines the strengths which exist in subordinate groups in spite of structural obstacles. Focuses on models and methods to emphasize such strengths.

Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non‐core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services – one of the most critical areas.

This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service.

The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win‐win context, it is hoped to continually drive FM services towards organisational excellence.

This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts.

A systematic method for improving hospital FM services is presented.

The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

The main purpose of this paper is to present some of the findings of a PhD research project. The findings are related to issues of integration of the key players in the control of healthcare associated infections (HAI) in FM services. Out of the FM services, the focus of the study was limited only to domestic services.

Most of what is put forward in this paper is based on a PhD research project which is at its final stages. The findings are grounded on a case study approach and a questionnaire survey approach, carried out as part of the research. Informal interviews with infection control experts in the national health service (NHS) in Scotland and a thorough review of literature also provided useful insights to make conclusions of this paper.

It is evident from a thorough review of literature that the integration between the clinical teams and domestic teams is vital in order to ensure well maintained standards in the control of HAI in domestic services. However, the findings of the case studies and questionnaire survey suggest that, at present, there is less integration between domestic teams and clinical teams (mainly infection control team members). This is mostly due to the fact that the clinical teams and domestic teams consider themselves as two separate entities. This is obvious especially when the domestic service is managed by an external party (e.g. PFI contractor). However, many UK government studies have shown that there is no correlation between contracting‐out and HAI. Therefore, the solution (to control HAI) is not to rush and bring cleaning contracts back in‐house, but to take steps to create and improve communication and coordination between the domestic teams and clinical teams. More empirical research is, therefore, needed to resolve the issue of “integration” in order to create a “friendly” and a “coordinative” environment in hospitals.

Targeted guidelines on the role of domestic services in the control of HAI as well as the paucity of relevant literature on related areas could be considered as limitations.

The cultural issues between the clinical teams and non‐clinical teams (particularly domestic teams in this study point of view) are major implications to adopt a team‐based approach in the control of HAI.

The paper focuses on one of the major issues in healthcare, i.e. HAI. Few have taken an FM perspective on this issue. It is worthwhile to note that, at the time of this research, there was only a handful of literature on the aforementioned issue. Besides, none of the literature has discussed the issue of involvement and integration particularly with regard to control of HAI in domestic services. Many of the case study participants and survey respondents also commended the in‐depth interest taken on the aforementioned issue. This paper, therefore, adds a significant value to healthcare research and research on FM.

The purpose of this paper is to refine and expand technology adoption theory for a healthcare logistics setting by combining the technology–organization–environment framework with a business process management (BPM) perspective. The paper identifies and ranks factors impacting the decision to implement instances of technologies in healthcare logistics processes.

A multiple case study is carried out at five Danish hospitals to investigate the bed logistics process. A combined technology adoption and BPM lens is applied to gain an understanding of the reasoning behind technology adoption.

A set of 17 factors impacting the adoption of technologies within healthcare logistics was identified. The impact factors perceived as most important to the adoption of technologies in healthcare logistics processes relate to quality, employee work conditions and employee engagement.

This paper seeks to understand how managers can use knowledge about impact factors to improve processes through technology adoption. The findings of this study provide insights about the factors impacting the adoption of technologies in healthcare logistics processes. Differences in perceived importance of factors enable ranking of impact factors, and prioritization of changes to be implemented. The study is limited to five hospitals, but is expected to be representative of public hospitals in developed countries and applicable to similar processes.

The study contributes to the empirical research within the field of BPM and technology adoption in healthcare. Furthermore, the findings of this study enable managers to make an informed decision about technology adoption within a healthcare logistics setting.