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Proposal for a Hospital Infrastructure Management Model through Facility

Management for Colombia (Doctoral Project- English Version)
Research Proposal · February 2019
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Doctoral Thesis Project:
Proposal for a Hospital Infrastructure Management
Model through Facility Management for Colombia
PRESENTED TO:
Engineering PhD Advisory Committee
BY:
Manuel Madroñal Ortiz
Medellín, February 15, 2019
ESCUELA DE INGENIERÍAS
Circular 1#70-01, Campus Laureles, Bloque 11, Medellín, Colombia
Correo-e: manuel.madronal@upb.edu.co
ELABORADO POR: REVISADO POR: APROBADO POR:
Comité Doctoral Ingenierías
Acta No. _______ de__________ de 2019

______________________ ___________________________ Código de la Tesis:
MSc. Manuel Madroñal Ortiz PhD. Javier D. Fernández Ledesma
Estudiante de Doctorado Director de la Tesis Doctoral
Universidad Pontificia Bolivariana (UPB)

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Este es un documento interno de la UPB. Al recibirlo no podrá pasarlo a
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© Universidad Pontificia Bolivariana (UPB) – 2019
Propuesta de Tesis Doctoral - i. Propuesta de un Modelo de Gestión de Infraestructura Hospitalaria mediante Facility
Management para Colombia.
T ABLE OF CONTENTS
SUMMARY OF THE THESIS ............................................................................................................ 3

1. INTRODUCTION ....................................................................................................................... 4
2. FORMULATION/DECLARATION OF THE PROBLEM ............................................................. 7
3. BACKGROUND, THEORICAL, CONCEPTUAL FRAMEWORK Y CURRENT SITUATION .. 10
4. MOTIVATION AND JUSTIFICATION ...................................................................................... 14
4.1 RESEARCH QUESTIONS ………….………………………………………………….………… 15
5. RESEARCH PROPOSAL ........................................................................................................ 17
5.1 GENERAL OBJECTIVES ................................................................................................... 17
5.2 SPECIFIC OBJECTIVES ................................................................................................... 18
5.3 SCOPEE ............................................................................................................................ 18
5.4 RESULTS AND PRODUCTS ............................................................................................. 20
5.5 EXPECTED IMPACTS ...................................................................................................... 22
5.5.1 Scientific and technological impacts of the project ..................................................... 22
5.5.2 Impacts on the availability and competitiveness of the country's hospital sector.....23
5.5.3 Impacts on the environment and society .................................................................... 24
5.6 METHODOLOGY AND WORK PLAN ............................................................................... 24
5.7 CRONOGRAM ................................................................................................................... 26
5.8 RESOURCES AND BUDGET ............................................................................................ 27
5.8.1 Global Budget by Sources of Financing ..................................................................... 27
5.8.2 Annual Global Budget by Sources of Financing ......................................................... 27
5.8.3 Personal Expenses ..................................................................................................... 27
5.8.4 Trips ............................................................................................................................ 28
6. REFERENCES ........................................................................................................................ 29
LIST OF FIGURES
Figura 1. Simplification of the Crisis in the Health Sector in Colombia …………………………..…..4

Figura 2. Relationship between Asset Management and Facility Management…..………………..11
Figura 3. Central domains of FM in Health ……………………………………………….…………….20
LIST OF TABLES
Tabla 1. Relationship of Disasters with hospital service affection ….…………………………..….. 6
Tabla 2. Results, Indicators and Deadlines for the Results of the Doctoral Thesis…….…………22
Tabla 3. Chronology of the Thesis (by trimesters) …………………………………………………..26
Propuesta de Tesis Doctoral - ii. Propuesta de un Modelo de Gestión de Infraestructura Hospitalaria mediante Facility
Management para Colombia.
SUMMARY OF THE THESIS
Title: MODEL PROPOSAL FOR HOSPITAL INFRASTRUCTURE

MANAGEMENT THROUGH FACILITY MANAGEMENT FOR
COLOMBIA.
Director PhD. JAVIER DARIO FERNANDEZ LEDESMA (UPB [CO])

email: javier.fernandez@upb.edu.co
Tutorial Committee: PhD. FLAVIA T.J. CURVELO MAGDANIEL (UNIV. TECN. DELFT [NL])
email: f.t.j.curvelomagdaniel@tudelft.nl
PhD. RAFAEL LINARES HEVILLA (UNIVERSIDAD DE MÁLAGA [ES])
email: rlinares@uma.es
Author: MSc. MANUEL MADROÑAL ORTIZ

email: manuel.madronal@upb.edu.co
Kind of investigation: Applied or Technological Development
Global Cost: $ 50.000.000 (15.000€ aprox.)
Date 18 months
National Science and Biomedical Research and Health Services

Technology Program:
Possible Entities Institutions for the Provision of Health Services Providers Institutions
Interested in the Results: and State Health Companies, such as the main Clinics and Hospitals
that provide health services in Colombia and Latin America. It can be
stated that a priori said institutions are not completely aligned to meet
organizational objectives, strategies and policies with respect to new
international standards. For these institutions the application of the
possible result of this doctoral thesis would imply the introduction of
another organizational vision of maintenance, support activities and
operation of the infrastructure with respect to the current focus of quality
management and sustainability. Therefore, a model adapted to
Colombia would lead to contribute with added value by the Facility
Management, which currently operates in most of the hospital sector in
the Anglo-Saxon world more developed and settled than in the Latin
American area, with the development of new international standards.
Propuesta de Tesis Doctoral Thesis Project – Propuesta de Modelo de Gestión de Infraestructura Hospitalaria
mediante Facility Management para Colombia.
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Resumen de la propuesta:
El modelo de salud de Colombia en el cual las instituciones prestadoras de servicios de salud (IPS),
que son clínicas y hospitales de carácter público, privado y mixto, carecen de un alineamiento
normativo de la gestión sostenible de la infraestructura hospitalaria. El Ministerio de Salud y Protección
Social de Colombia está regulando en la gestión de activos físicos empezando por las fases
adquisición, mantenimiento y reposición de equipos biomédicos, pero todavía queda por regular la
gestión de la infraestructura y los equipos industriales que soportan las actividades asistencial.
Así pues, la realización de esta tesis doctoral pretende evidenciar el aporte de un valor agregado, a
la gestión de la infraestructura hospitalaria, mediante disciplinas como el Facility Management con las
actuales publicaciones de estándares internacionales relacionados para la gestión de inmuebles. Es
así que con esta investigación busca una alternativa de gestión de infraestructura que mejore las
condiciones de operación y mantenimiento de los activos físicos hospitalarios agregando un valor a
los usuarios de los servicios de las IPS colombianas.
Por lo tanto, se espera que mediante el examen de la situación actual en Colombia en la gestión de
infraestructura hospitalaria; y mediante un análisis de los estándares internacionales en Facility
Management se pueda desarrollar un modelo para las instituciones de salud colombianas,
centrándose la investigación en la región de Antioquia. El desarrollo de este modelo busca potenciar
las fortalezas y reducir las debilidades de la infraestructura del sistema de salud colombiano.
Para ello se efectuaran estancias de investigación en aquellos países que tengan más desarrollado
el Facility Management y la implantación de estándares internacionales de gestión de inmuebles
buscando la implantación de un modelo acorde con las necesidades del sistema de salud colombiano.
Asimismo, con los resultados de la tesis doctoral se propondrá como trabajos futuros para el Ministerio
de Salud y Protección Social, mediante la recomendación de modelos para una gestión sostenible de
la infraestructura hospitalaria. Estos aportarán una visión estratégica con respecto a la infraestructura
de las IPS, con el propósito de que puedan tener una mayor adaptabilidad frente desafíos tales como
la tecnología, el cuidado de la casa, la telemedicina y la salud basada en el bienestar.
Abstract of the proposal:

Colombian health model in which the health services providers (HSP), are clinics and hospitals of a
public, private and mixed nature, lacks a standard alignment of the sustainable hospital infrastructure
management. The Ministry of Health and Social Protection of Colombia is regulating the physical asset
management beginning with the phases of acquisition, maintenance and replacement of biomedical
equipment, but the infrastructure and industrial equipment management supporting the assistance
activities still needs to be regulated.
Thus, the realization of this doctoral thesis aims to demonstrate the contribution of added value to the
hospital infrastructure management, through disciplines such as Facility Management with the current
publications of international standards related to property management. In addition to, this research
seeks an alternative infrastructure management that improves the operating and maintenance
conditions of hospital physical assets, adding value to users of Colombian HSP services.
Therefore, it is expected that by examining the current situation in Colombia in the hospital
infrastructure management; and through an analysis of international standards in Facility
Management, a model for Colombian health institutions can be developed, focusing on research in the
Antioquia region. The development of this model seeks to strengthen the strengths and reduce the
weaknesses of the infrastructure of the Colombian health system.
This research stays will be carried out in those countries that have developed the Facility Management
and the implementation of international facilities management standards, seeking the implementation
of a model in accordance with the needs of the Colombian health system.
Likewise, the results of the doctoral thesis will be proposed as future work for the Ministry of Health
and Social Protection, through the recommendation of models for a sustainable management of the
hospital infrastructure. These will provide a strategic vision regarding the infrastructure of the IPS, with
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the purpose that they can have a greater adaptability to challenges such as technology, home care,
telemedicine and health based on well-being.
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1. INTRODUCTION
The institutions that dedicate themselves to the provision of health services in Colombia
are called IPS (Institutions that Provide Health Services), for which they are private, mixed
or beneficial; and ESE (State Health Companies), for which they belong to the public
administration. From now on, this study will focus on PHIs, because they have less difficulty
in showing their data, although the two usually have the same function within the
Colombian health system. The IPS are in a crisis in the health sector due to the fragility of
the economic system. As indicated by Homedes and Ugalde (2005), pointing out that
indicated by Tono (2004) that "in Colombia, since the reform, hospitals have begun to suffer
an administrative crisis unknown in the modern history of that country and many of them
are in bankrupt". And since then "it is not a secret that the health sector suffers a
permanent crisis. That is why I want to analyze, after having passed more than 10 years,
what has happened to those forces that attempt against a perfect market and how they
have affected the health system "(Caballero-Uribe, 2012).
In fact, as explained by González and Restrepo (2017), the Minister of Health and Social
Protection of Colombia recognizes the debts accumulated by the Government with the EPS
(Health Promoting Companies), but also those acquired by the IPS.
In the case of the latter, the economic problems are derived from the two premises with
which they provide their services: the first, "duty", consists in the obligation to attend to all
the patients that receive through emergencies; the second is the "security" that EPSs will
pay their medical bills. However, this second premise was broken when some companies
(EPS) left several indebted IPS, still awaiting recovery. The most serious is that several of
these EPS have continued with this practice because they can not pay and they lack the
necessary resources. Figure 1 shows this situation more clearly:
Figure 1. Simplification of the health crisis in Colombia (Madroñal M., 2018)
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This problem supports the need for IPS to optimize both their fixed costs and the variables
of non-health activities (maintenance and operation) linked to the main activity of the
institution: medical assistance. In Colombia there is Decree No. 1769/1994 in which, in
Article No. 1, "... the basic components and criteria for the allocation and use of financial
resources, 5% of the total budget, destined to the maintenance of the infrastructure and
the hospital supply in public hospitals and in private hospitals ... ". Therefore, the majority
of IPS in Colombia must allocate at least 5% of their budget to conserve their physical assets.
On the other hand, in the case of another country such as Spain, according to studies carried
out by Monge P. and Pizarro A. (2003) public hospitals represent 17% of maintenance
expenditure while in private hospitals 5% of their expenditure goes directed towards "Non-
Sanitary Centers". The main differences are that private companies have less diversity than
public ones, with consequent cost savings. In addition, maintenance in the private sector is
lower, mainly due to the lower capacity of the latter in relation to the State Administration.
Therefore, it is understandable that the fixed costs of the secondary activities of the IPS
(associated with the maintenance and support of the main activity of the institution) can
be between 5-17% of the main annual expenses of these institutions. In the same way,
Banedj-Schafii (2010) indicates, according to the German Hospital Society (DKG), that 34.6%
of expenses are included in support services (non-healthcare).
That said, during their life cycle, IPSs must face different challenges to adapt their physical
infrastructure (buildings, green areas, roads, etc.) due to new technologies and new
medical techniques, as well as organizational changes and the demographics of the
population. Related to this matter, Pinder et al. (2013) suggest that the level of adaptability
of a building varies according to a complex range of economic, political and technological
factors, whose interaction can lead to design results that are not necessarily rational or
optimal if they are analyzed in retrospect or if they are decontextualized . In addition, the
impact of modern construction methods and the concerns of stakeholders on the
commitment to the first use of a building should be weighed. Another notable point of
health facilities is that they play a very important and significant role in disaster mitigation
due to their particular role in the treatment of injuries and illnesses. Therefore, this complex
installation requires a permanent supply of electricity, potable water, liquid and solid waste
disposal services, communication services, as well as the availability of all those that sustain
the main activity of the organization, such as relates in Table 1.
For this reason, a search has been undertaken of different disciplines, methods, sciences or
specialties dedicated to managing the infrastructure or building to support the main activity
of the organization, as for centuries it has been assigned to the maintenance department
of companies . Such is the case of "Facility Management" (FM), a discipline developed in
the seventies in the United States of America, which focuses on the technical, economic
and functional management of the physical assets of the organization.
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According to Carvalho (2012), this discipline involves knowledge acquired from professions
as diverse as Construction Technologies, Systems Management and Administration to
reduce costs and optimize resources. Based on its definition, this discipline covers various
professions that allow the development of a holistic management of health institutions and,
in particular, of the main activity of medical care.
Table 1. Evaluation of Internal Disasters and Relationship of External Disasters with affection to the hospital service.
Internal Disasters External Disasters

Possible Earthquakes
Threat Probable Eruptions
Imminent Windstorms
Functional Tsunamis
Vulnerability Sttructural Floods
Non structural Fires
High Accidents
Risk Medium Technological
Low Social conflicts
In other words, the adaptation of the FM within a mixed health model like the Colombian
one, can provide the benefits that are derived from the homogenization of the
management of non-core activities, especially after corroborating the performance of this
discipline in the National Health Service (NHS) in the United Kingdom for a public health
model. Previous studies by Rees (1998), Payne & Rees (1999) and Amaratunga et al. (2002)
address the operation of the FM within the NHS and how "non-core" services
(maintenance, risk management, energy efficiency, cleanliness, security, among others ...)
are integrated under the umbrella of an FM department.
On the other hand, this discipline can improve the economic impact of the organizational
coffers (depending, of course, on the health model), since the public health sector becomes
one of the largest expenditures with respect to national GDP ( WHO Regional Office for
Europe, 2012). The FM in hospitals can play a very active role due to its potential in
improving the development of physical assets, which would mean moving from an
operational perspective to an integrating one that assumes the objectives, strategies and
policies of the institution (Støre- Valen et al., 2014).
This doctoral research aims to generate a sustainable infrastructure management model by
adapting the "Facility Management" discipline to the institutions of the Colombian Health
System, in the same way as Banedj-Schaffi & Lennerts' research (2010) carried out by
transferring the FM system from German hospitals to Iranians. This doctoral thesis can
develop a model that responds to the needs of the IPS, during the life cycle of physical
assets, and thus provide a strategic vision of the infrastructure for health institutions.
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Likewise, this model can reach what is indicated by Negrotti (2015), represent the mission,
values and principles of the organization. Since the hospital infrastructure must be built,
maintained and operated intentionally to achieve its objectives, working from the
maintenance, investments and internal management of the building.
This work aims to make a contribution to the sustainability of physical hospital assets in the
Colombian health sector, so that they continue to offer health services to the population.
Furthermore, the IPS may face the irregular payment of EPSs, which deteriorate their
financial balance and, by extension, that of the health system.
2. FORMULATION/DECLARATION OF THE PROBLEM

From the works published in Colombia by Galeano et al. (2015) on the Management of
Hospital Assets and more specifically in the Management of Hospital Physical Assets
(Infrastructure, Biomedical Equipment, Industrial Equipment and Computing), the author
determines the possibility of applying an Integrated Asset Management System in the
hospital sector would produce a positive impact on the processes associated with health
technology.
Asset Management (AM asset management) is closely related to Facility Management (FM),
according to Trujillo (2016) both areas should consider the life cycle of assets at all angles
and be aware of the cost total property, which must be in line with the interests of the
organization. Both disciplines present similar objectives among their daily responsibilities
that must be aligned: while the MA seeks the effectiveness and efficiency of the
"productive" assets, the FM is focused on efficiently supporting the productive efforts with
which to achieve the goals of the organization. The AM and the FM develop strategic plans,
plan the risk, prepare budgets, focus on quality, manage energy and the environment, hire
third parties, use comparison tools, etc.
The problem identified, according to Borjberg & Verweij (2009), is that hospitals are more
inclined to catch up on the maintenance of the portfolio of physical assets (reactive and
preventive maintenance), instead of developing a prospective approach that considers the
real cost of capital assets in the future. Therefore, obtaining the greatest efficiency among
the different types of maintenance will depend on factors linked to the cost of "production
or service" losses with the stoppage of equipment or non-availability of spaces, the cost of
repair, environmental impact, the safety and the quality of the product or service, among
others. But aside from this, the management of the hospital infrastructure should not focus
exclusively on maintenance, since it needs a more holistic approach that involves more
areas of the organization whose activities are aligned with its objectives, strategies and
organizational plans.
Colombia with a mixed health system, is composed of a great variety of IPS, of diverse
character (mostly private, also mixed or beneficial and including public ones), with different
levels of complexity of services (I, II and III) and with different sizes (measured according to
the number of hospital beds, WHO indicator). In relation to this work, FM-based models
will be taken into account in other European countries (Bismarck or Beveridge models)
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where international FM standards have been implemented. To find the similarities with the
guidelines of objectives, strategies and plans to reach national needs of the Colombian
health sector.
At the same time new challenges for the health sector are adequate to fit a model based
on FM, due to the need for adaptability of the hospital infrastructure, taking into account
demographic and epidemiological changes, those related to technology, telemedicine,
"Homecare" and health based on well-being. According to Støre-Valen et al. (2014) these
challenges caused changes in the business plans and strategies of the organization where
the FM that is in charge of the secondary activities of the organization, must take a more
strategic role in the health institutions.
In the case of Colombia, the discipline of the FM could have a place due to the crisis in the
sector due to the intermittent payments of the EPS and the variability of the fixed and
variable expenses of the IPS that cause financial instability; the new model could evolve
towards new methodologies of work by organizational objectives that the traditional by
departments; it would enhance the importance of hospital physical assets (especially
infrastructure) and encourage maintenance and other "non-core business" activities that
enhance the main (assistance) activity of the institution.
In principle, the development of the model will be limited to the Colombian sphere and
more specifically it is intended to validate in IPS of the Antioquia region, therefore, IPS must
be sought to be willing to collaborate in this research. The implementation of other
certification models based on international standards aligned to the discipline of FM and
AM will be taken into account.
The preliminary results that support the doctorate's strategy are the research carried out
by the United Kingdom, Norway, Denmark, the Netherlands, Germany and Switzerland,
whose benefits in the management of hospital infrastructure are associated with the
application of FM. The above countries, and their health systems, will be taken into account
to adapt the development of an FM model based on international standards.
Therefore, the hypothesis that arises in this research is that hospitals in Colombia as in other
countries are working to catch up, without developing methodologies or own processes
and lasting over time, and without a prospective approach that considers the real cost of
the assets of capital in the medium to long term future. Therefore, a specific analysis of the
Colombian context is needed, for which a model of sustainable hospital infrastructure
management can be analyzed, developed and implemented. This should provide Colombia
with a model that integrates the life cycle of physical assets and support activities to achieve
added value to the organization.
It is estimated that the research strategy proposed is appropriate to the problem of hospital
infrastructure management in the Colombian context, since by relying on international
standards on FM for the development of a hospital infrastructure management model, it
can be adequately implemented in the context of the Colombian health system and even a
subsequent validation.
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This doctoral thesis aims to create various products (papers, articles, chapters and / or
books, as well as guides and complementary documents) that contribute to sustainable
management of hospital infrastructure at different levels of complexity of the IPS of the
Colombian health system. Through the use of the model, to be developed, the hospital
infrastructure based on international standards is expected to have more weight within the
strategic vision of the organization. Therefore, tools that offer adaptability of the existing
infrastructure, as well as those that are projected in the medium to long term future, should
be conceived.
3. BACKGROUND, THEORETICAL, CONCEPTUAL FRAMEWORK & CURRENT SITUATION

In economic terms it is understood that the most representative physical asset of a hospital
is its infrastructure and this can represent the most important investment for the
institution. Due to this a series of disciplines of engineering, architecture and administration
are fundamental to reform and transform the organizational structure, to help the recovery
of patients in the organizational climate and the community in general.
According to Cabrera and Martínez (2008) the term "Physical Asset Management" was a
concept in development, and that there was no established definition, even less in the
hospital sector. In the case of maintenance managers in the US had used this term to gain
greater credibility in their activities, since it has been understood as an unimportant work
in the organization, the term "asset management" seems to be more attractive and
professional, even though maintenance is a fundamental component in the management
policy of physical assets of any organization.
The discipline of asset management (AM) has now evolved developing manuals of good
practices, specifications and new international standards such as ISO 55000: 2014, which
has been published by the International Standard Association (ISO) from the PAS 55
specification of the British Standard Institute (BSI). This standard offers an overview of asset
management, its principles and terminology, and the benefits expected from the adoption
of asset management.
On the one hand, studying other disciplines are the Facility Management (FM) is according
to the German Association of Facility Management (GEFMA) is "a management discipline
that meets the basic requirements of people in their job, supports the primary processes of
organizations and increases the return of capital through the economic use of services and
infrastructure within the framework of planned, managed and controlled processes ".
On the other hand, the Spanish Society of Facility Management exposes this discipline as
"model of management of the real estate resources of the companies that has as objective
the permanent adaptation of these to the organization and human team of the companies
at the lowest possible cost, by means of the integration of all the management
responsibilities over said resources in the figure of the Facility Manager ".
On the other hand, the British Institute of Standardization (BSI) indicates that "FM is the
integration of processes within an organization (company) to maintain and develop the
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agreed services that improve and support (maintain) the effectiveness of its primary
activities" .
However, the author of this proposal agrees more with the definition of the ISO 41001:
2018 standard, which defines "the FM integrates multiple disciplines in order to influence
the efficiency and productivity of the economies of societies, communities and
organizations, as well as the way in which individuals interact with the built environment.
FM affects the health, well-being and quality of life of a large part of the world's societies
and population through the services it administers and provides. "
It is here that for the development of an FM-based model it is necessary to take into account
the complicity between Asset and Facility Management for an organization is essential as
presented in Figure 2. Taking into account that Asset Management focuses on physical
assets of the organization where the operation is carried out (in this case the health
assistance study) and, on the other hand, the Facility Management focuses on the "non-
core business" activities such as maintenance of the infrastructure and support services.
That is why between physical productive assets and those of supports have in common the
infrastructure composed of land, soil, structure and facilities, etc ...
Figure 2. Adaptation of the relationship between Asset and Facility Management (Source: PMM Learning)
That is why the FM has been selected to be implemented in the health system in Colombia,
after corroborating the benefits that this discipline has in the National Health Services (NHS)
in the United Kingdom in a public health system, but with a model of public-private
participation management (PPP), according to Rodriguez-Labajos, Thomson & O'Brien
(2016) and Rodriguez-Labajos & Thomson (2017) studies. Therefore, we will try to take into
account studies in different health systems during the development of the hospital
infrastructure management model for the FM context in Colombia.
Likewise, Shohet & Lavy (2004) point out that the arrival of FM and other disciplines to the
IPS has been growing internationally, as well as its impact on the quality and efficacy of
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health services. Even more, Gelnay (2002) considers the FM, in the health sector, a key
element for the success of health service delivery, and points out that, in most of the
hospitals examined in its studies, the Facility Manager was not involved in the stages of
planning, design and cost analysis.
On the one hand, part of this research will be centered on the four main components of
FM, indicated by Yiu (2008) and identified by Then (1999), namely:
(1) Strategic infrastructure planning,
(2) Strategic asset management,
(3) Asset maintenance management,
(4) Management of infrastructure services.
On the one hand, we must take into account the four strategic roles of the FM, identified
by Yiu (2008) to obtain benefits of the model:
- The contracting of services,
- Obtaining work space
- Obtaining funds from infrastructure facilities
- Obtaining results.
This model is crucial for the future development of FM, since it identifies the unique identity
of the FM and drains the resources to establish a distinctive knowledge base.
Therefore, in the search for FM value, as indicated by Jensen et al. (2012), these can be
found in strategic, tactical or operational aspects, since the FM has often been considered
as the management of mainly operational services, but by changing the focus the impacts
and effects of the FM in the business can appear in various levels. Therefore, it is easier to
address senior corporate management, because adding value is related to their language
and perspective.
Based on this background, the author will be aligned to works carried out by research
groups of some high-level international organizations such as:
- Department of Civil Engineering and Transportation of the Norwegian University of
Science and Technology, Trondheim, Norway. Led by professors Svein Bjørberg, Marit
Støre-Valen and Johan van der Zwart of the Department of Architecture and Planning,
through their studies on the "Impact of buildings on effective hospital services", the
"Sustainability potential in existing buildings" and "Construction of better hospitals, with
the management of added value and real estate planning".
- Management Engineering of the Technical University of Denmark, Denmark. Led by
Professor Per Anker Jensen, through his studies on "FM and Corporate Real Estate
Management as promoters of added value" and the "Role of FM in building projects".
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- Faculty of Architecture of the Delft University of Technology, Delft, The Netherlands.

Led by Professor Theo van der Voordt, through his studies on "Real estate implications
of transitions in health institutions", "Value added by health infrastructure" and
"Evaluation of patient satisfaction in hospitals".
- Institute of Facility Management of the (ZHAW) Zurich University of Applied Sciences,
Zurich, Switzerland. Led by Professor Christian Coenen through his studies on
"Management of effectiveness and efficiency through FM design" and "The relationship
of FM with added value from different perspectives".
- Department of FM of the Institute of Technology and Management in Construction,
Karlsruhe Institut of Technology (KIT), Karlsruhe, Germany. Led by Professor Kunibert
Lennerts through his studies on "Hospitals of the future", "The reduction of health costs
through the application of FM" and the "Introduction of space management in
hospitals".
- International Facility Management Association (USA) and all its national subsidiaries.
With this summary of the theoretical framework, of research at the international level, the
PhD student has begun to compose this doctoral thesis project. Thus, the starting point of
research is the management of hospital physical assets in Latin America, where FM is still
poorly developed. So, according to conversations with international experts, an ambitious
challenge is foreseen when developing research that can give importance to support
activities in health services.
Focusing on it in Colombia so far (2018) there are no documents on the discipline at the
academic level, according to the searches made in Scopus and Web of Science. With the
exception of those made by the doctoral student and his research group of the UPB,
published in journals as summaries of congresses "proceedings" on FM in health in
Colombia, these relate the need for disciplinary integration, as well as a search for key
indicators of performance to manage the hospital infrastructure in Colombia.
Although at the corporate level organizations outside the health sector companies such as
Ecopetrol, Bancolombia and Grupo Éxito Retail (among the 10 largest in the country) if they
are betting on the FM from the strategy for support activities. It should also be borne in
mind that only three years ago the Colombian Facility Management Association (ACFM) was
founded, still not formally linked to the IFMA, which is starting to hold talks and seminars
on business discipline.
On the other hand, many organizations in the United Kingdom and the United States of
America have been developing FM work in the health sector for decades and have a social
mass (researchers and professionals) that works every day in the management of hospital
infrastructure to support the main activities of health institutions.
It is expected that from the results of this thesis and the publication of other articles in
indexed journals increase the weight of Colombia in this discipline in Latin America and
therefore the credibility on the part of the IPS and the Government to invest in the
implementation of the FM in the health sector. Since traditionally the activities "non-core"
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as well as maintenance have been seen from the top management as an expense and not
an investment in the future that provides a return, even if it is social, environmental or
linked to users.
On the other hand, the importance of the health sector in Colombia, with health clusters
that are interested in "health tourism", there is a body of US origin but worldwide
acceptance called The Joint Commission International (JCI). This body is dedicated to
improving the quality and safety of health and social care organizations. Accrediting nearly
20,000 organizations worldwide that updates the standards periodically, adapting them to
changes in the health sector.
Therefore, a model aligned with JCI standards will be developed, since accreditation and
certification is very important for some IPS, since their business models are high with
patients / foreign users.
The search for documents with proven validity has uncovered the recent publications of
ISO international standards on FM discipline:
- ISO 41001: 2017 - Facility Management - Management systems
- ISO 41011: 2017 - Facility Management - Vocabulary
- ISO 41012: 2017 - Facility Management - Guidance on strategic sourcing and the
development of agreements.
- ISO / TR 41013: 2017 - Facility Management - Scope, key concepts and benefits
These first standards mark the guidelines of the model to be developed in said study,
because they already include a state of the art agreed upon by specialists at an international
level. Because they are the first broad-spectrum standards, while others are not published,
the predecessor documents of the European technical committee AEN / CTN GET19 on
property management and support services called:
- UNE-EN 15221-1: 2012, Property management and support services- Terms and
conditions.
- UNE-EN 15221-2: 2012, Property management and support services - Guidelines
for the preparation of agreements.
- UNE-EN 15221-3: 2012, Management of buildings and services - Guide on the
quality of property management and support services.
- UNE-EN 15221-4: 2012, Management of real estate and services - Taxonomy,
classification and structures of property management and support services.
- UNE-EN 15221-5: 2012, Management of real estate and services - Guide on
property management processes and support services.
- UNE-EN 15221-6: 2012, Management of buildings and services - Measurement of
surfaces and spaces in property management and support services.
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- UNE-EN 15221-7: 2013, Management of buildings and services - Guidelines for

comparative studies (benchmarking) on performance.
4. MOTIVATION AND JUSTIFICATION

The motivation to carry out this doctoral thesis is the discovery of the benefits that the
discipline of the FM can bring in the activities "non-core business" in the health institutions
for a sustainable management of the physical hospital infrastructure for Colombia. So it is
intended to follow the trends of countries that have implemented sustainable management
models that add value to organizations.
As indicated by Shohet & Lavy (2004) in his article "Facilities Management in Health: review
of the state of the art":
• In health models such as the United Kingdom (UK), Rees (1997) observed that the FM
Department was where those "non-core" services that participated in political decisions
were included.
• Payne and Rees (1999) proposed that "Facility Managers" should participate in the
political decision-making processes and that this is especially important in health
centers, although depending on each institution.
• On the other hand, Nesje (2002) examined the distribution of FM expenses in Norway,
and found that maintenance, energy and cleaning costs represented one third of the
total operating costs of the hospital; concluded that appropriate indicators were needed
for the allocation of FM resources for efficient economic management of resources.
Previously it was indicated that Banedj-Schaffi (2010) exposed that the expenses of the
services of FM around 35% of the total expenses.
• According to O'Donnovan (1997), risk management should be a priority for any health
institution and through FM it can be achieved through the management of a risk
management program, in which risks are identified, analyzed, classified and controlled.
risks.
• Gelnay (2002) considered GF in health services as one of the key elements for the
successful delivery of health services. However, in most institutions the "Facility
Manager" still did not participate in the stages of information, design and cost analysis.
• And according to Gallagher (1998) reviewing FM departments in the National Health
Service (NHS) of the United Kingdom including topics of strategic planning, customer
service, market testing, benchmarking, environmental management and staff
development. These issues reinforce the effectiveness of health services with growth
and development with the FM, with the improvement of the FM position in the health
organization and that the FM will become a central part of the organization, one that
will help to give shape their decisions and processes.
The benefits exposed by Andaleeb (1998) found in the United States of America (USA) on
the satisfaction of users of health services:
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• Level of communication between staff and the patient;

• Competence, skills and experience of service providers;
• Quality of the infrastructure;
• Positive reaction from staff to patients;
• Cost of treatment vs. Expectations of the patient.
According to surveys conducted by Meng & Minogue (2011) in the UK and USA, FM
organizations benefit from effective performance. The four main benefits for customer
organizations are identified as:
• Approach of the client or user;
• Value for money;
• High level of service delivery; Y
• Selection of offer based on performance.
On the other hand, FM service providers will benefit from:
• A better understanding of the clients' objectives;
• Continuous improvement within organizations;
• Competitive advantage over competitors; Y
• More business opportunities for customers.
The foregoing has motivated the realization of this project to understand and position the
role of infrastructure and FM in the health sector in Colombia. Subsequently, to implement
the model based on international standards for a sustainable management of hospital
infrastructure through FM in Colombian IPS.
At the same time, the alignment of the infrastructure management strategy with the
general strategy of the IPS will be strengthened by introducing the FM to senior
management. This will accompany the creation of indicators to develop, measure, compare
and eventually examine the effect of merging small units into larger assets to increase
competition among health institutions, according to Støre-Valen et al. (2014).
4.1 RESEARCH QUESTIONS

In the following point some questions are formulated in which the importance, the
resources, the originality, the alignment of criteria and the characteristics of the doctoral
thesis project that is presented below are argued:
Why is the problem important?
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According to bibliographic searches and technological surveillance on the subject, it is

shown that hospitals, both in Colombia and in other countries, are working on updating
themselves without developing their own methodologies or processes and lasting over
time, and without a prospective approach that considers the real cost of capital assets in
the medium-long term.
Why should time and resources be invested in this research?
The investment of time and resources in this research can benefit the Colombian health
system, providing sustainability and efficiency of the IPS through high quality standards in
the development of their health services. On the other hand, the opportunity to develop
research on the Colombian hospital real estate park through new disciplines that are just
disembarking in the country. In this case, the FM opts for operational, tactical and strategic
vision of the infrastructure, within the management of physical assets, of health
organizations.
What is the original contribution of the proposal in knowledge or know-how?
The contribution of this proposal is the use of the benefits of international standards on
FM by the IPS of the Colombian health system. In fact, with the introduction of this
infrastructure management model for IPS, it will enhance sustainability holistically in
current IPS general service departments. This will increase the adaptability of the
infrastructure and lengthen the useful life of physical assets in health institutions.
On the other hand, the theoretical contribution of this research is to contribute with new
disciplines, methodologies and protocols that support the research groups in the Faculties
of Architecture, Engineering and Administration in Colombia. This may be the case of the
creation of new curricular models of technological studies (professional training),
undergraduate and postgraduate studies related to the management of the building for
different faculties.
Why should this research be carried out in the manner proposed?
The methodology, better explained in the following point, has been agreed by the doctoral
student and advisors so that it can be executed in a more accessible way. And therefore,
achieve the objectives of the research through the analysis of international standards on
FM and the current state of the Colombian health system. So that through the
development of the model of infrastructure management and support services can be
implemented in the health sector in a way suitable for a discipline that is barely beginning
to be used in the country in other sectors.
What criteria, differences or similarities can the infrastructure management model of
the Colombian health system have with that of other countries?
The model that is generated from this research will be based on the international
standards published up to now (ISO) and adjusted to other precedents (UNE-EN), and
therefore can have a great similarity with any model that can be created for others.
countries Although for the creation of this model a methodology of elaboration has been
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selected that is not indicated in said standards. Now, since the research focuses on the
Colombian health system, the model will face different economic, legislative, political and
cultural frameworks.
What tendencies lead the development of the model and the possible transferability and
implantation within the Colombian health system?
The hospital infrastructure management model to be developed must be within the
tendencies of the Ministry of Health and Social Protection of Colombia on the sustainable
management of physical assets. Therefore, the development of the model with the
collaboration of agents of the health system (IPS) will be very important, including that the
structure of this model can be validated by international experts as a final part of the
investigation.
To what extent can you objectively and critically validate the results of research beyond
statistical analyzes and reports?
Taking into account that the result of the research will be the development of a model, to
manage hospital infrastructure and its support services, based on recently published
international standards, a validation of the results is foreseen. That is to say, the author of
the study tries to validate the structure of the model by means of advanced statistical
techniques, so that it can guarantee a correct exposure of the results due to its importance
at the time of a future implantation.
Is this thesis aligned with some of the national trends for information from the health
sector and / or Colombian administration?
This doctoral thesis may have as a result a series of products (papers, articles, chapters
and/or books, as well as guides and complementary documents) to strengthen the
tendencies of the Ministry of Health and Social Protection of Colombia, due to the fact that
it is currently focused on in the sustainable management of hospital physical assets.
According to Colombian regulations these are composed of: industrial equipment,
infrastructure, telecommunications and information technology and, finally, in which
documents and guides are already being developed, are biomedical equipment. Therefore,
in the medium term after the conclusion of the thesis, it is foreseen the need for research
that can reinforce the guidelines that health institutions must take to carry out a more
sustainable management of their infrastructure.
5. RESEARCH PROPOSAL
5.1 GENERAL OBJECTIV
The general objective of the doctoral research is to develop a sustainable model of hospital
infrastructure management and its support services through international standards of
Facility Management that add value to the strategic, tactical and operational vision of IPS
in Colombia .
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5.2 SPECIFIC OBJECTIVS
The specific objectives described below are those achievements that you want to
achieve to meet the general objective of the research. Each of these specific objectives
delimit the actions to be undertaken so that progressively the general objective of the
study to be achieved is achieved.
The specific objectives presented below are concrete, brief, clear and precise
statements of the goals to which the research is directed. These goals have been
formulated considering the specific resources and the deadlines set for doing so.
Therefore, the objectives designed to achieve the scientific contribution of the proposed
research on the sustainable management of hospital infrastructure and its support
services for Colombia are:
1 # Determine the state of the art of hospital infrastructure management and its
support services in the context of the international and Colombian health system.
2 # Conceptualize about the use of international standards (ISO and UNE-EN) to create
a model of sustainable management of quality in the hospital infrastructure and its
support services.
3 # Develop a model based on a matrix between the areas covered by the FM and the
functions of each of them. So that each of the interactions of the infrastructure
management model and its hospital support services can be related.
4 # Validate the structure of the model by using advanced statistical techniques.
These objectives are well achievable with the adequate management of available
resources, with the coordination of the researchers related to the research project and the
time to carry out this doctoral thesis. In addition, there is a direct correlation between each
of the objectives and subsequently of each of the results or products that are expected to
be achieved with the research.
5.3 SCOPE
In the scope of the doctoral research the specifications of each of the specific objectives
are detailed, this may allow verification of compliance according to the available resources.
Therefore, the scope of each of them is consistent with the time frame and what is
specified for a doctoral thesis so that knowledge can be generated to the scientific
community and to the current departments that are responsible for the physical
infrastructure of the hospital. In this way, to verify that the objective of the FM "is to
provide optimal support for the central process of a company, the requirements of the
management of the facilities are defined by the main processes that it supports" according
to Lennerts (2009).
In this case, the scope of this study is divided into several points:
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• Know and determine the needs, strengths and weaknesses of hospital infrastructure
management in Colombia and internationally to understand the needs of the level
of development of support activities tools.
• Understand and specify the characteristics that contribute strengths and
weaknesses of the different international FM standards, in order to conceptualize
the information gathered to take the support activities of the Colombian health
system to a more advantageous position.
• Create a model based on the information conceptualized in the previous point, by
creating a matrix between the areas that comprise the FM and the functions of each
of them. Also, controlling the linking of the elements of the matrix for a sustainable
management of hospital infrastructure.
• Finally, the aim is to validate the structure of the infrastructure management model
and its hospital support services using advanced statistical techniques, in order to
obtain reliable results.
The research project aims to achieve a strategic alignment of hospital infrastructure
management with the general strategy of the institution, through Facility Management
linked to the activities "non-core business" and with the support of top management of
the IPS.
On the one hand, it is sought to analyze that this discipline facilitates the adaptability of
the infrastructure throughout its useful life, so that it can have a life cycle cost (LCC,
acronym in English) that is more sustainable over time. Especially because infrastructure
and support services are the main investments and expenses of IPS.
On the other hand, it is intended to evaluate in the conceptualization the importance of
certain quality management models such as: ISO-9001, ISO-14001, ISO-13485, EFQM, The
Joint Commission International, ACSA (Agency of Andalusian Health Quality) and others .
In addition, it seeks to verify the practical and effective influence of its integration with
infrastructure management and Facility Management in the different health institutions.
Therefore, its subsequent applicability in the Colombian health system can be
demonstrated. In other words, an analysis is sought of the strengths, weaknesses, threats
and opportunities that may arise from the implementation and development of the new
model. Also try to identify and categorize the binomial "efficiency-sustainability", in terms
of infrastructure management and quality management that best suits Colombia.
In fact, it is intended to take advantage of the knowledge, research, facilities and contacts
with health centers in Europe that contribute to the specific objectives of the project. In
the same way, this project is expected to adjust to the new challenges that arise in the
health sector for greater adaptability of infrastructure to organizations.
Therefore, this study aims to evolve the conclusions of Shohet and Lavy (2004) where they
presented a model of FM for health in the form of a pentagon (Figure 3), with five
interconnected sections. This "Integrated Facility Management Model" (IFMM) represents
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that the action of one of these sections will affect the others and will be added the sixth
section that are the TIC's presented in that review. The model that he intends to propose
in this doctoral work, like the IFMM, must provide an integrated and sustainable
knowledge base environment for the management of hospital infrastructure through FM
in health, based on international FM standards.
Figure 3. Central domains of FM in Health (Shohet & Lavy, 2004)
5.4 RESULTS AND PRODUCTS
The results and products that are intended to be obtained during the remaining doctoral
research period are approximately 8 quarters, with a certain number of exhibitions at
national and international congresses, research articles and other written products (book
chapters, books, guides, etc...)
As a general rule, it will be studied which type of products is most convenient to
disseminate the results of the research project, whether it is aligned with the host
university or the host university during the period of doctoral internship, such as:
• Presentations at the National Congress, is the means of oral dissemination of the
preliminary or final results of the investigations, in a national scope on the topic chosen
for the research, where researchers from the same field are related to be able to discuss
the subject of research.
• Presentations in International Congress, is the means of oral dissemination of the
preliminary or final results of the research, in an international field on the subject
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chosen for the research, where researchers from the same field are related to discuss
the subject of research.
• Short article, it is the method of dissemination written with the lowest repercussion,
by means of which they publish the preliminary results of the research disseminated in
the congresses. As a rule it is usually a book where all the summaries or "conference
papers" about the research are collected.
• Research Article, is the method of dissemination written with the greatest impact, it
is the medium which publishes the partial or final results of a research project. This type
of publication is usually standardized by national or international journals with different
degrees of impact. And as a general rule, those journals that are more related to the
research topic and that have a greater impact on dissemination are usually chosen.
• Book Chapter, is a partial work based on the results of research projects, together
with previous contributions from other authors through original articles, reflection or
systematic reviews of a reduced bibliographic review. It is usually included in a book
that is a complete work. Or, where appropriate, Libro, is the work that brings together
the results of research projects, together with previous contributions from the authors
through original articles, reflection or systematic reviews and a broad bibliographic
review on the subject, among others.
• Guides or other complementary documents, are all those works that are the result of
research that has the purpose of becoming technical documents, so that it can help
entities, organizations and companies to manage the infrastructure according to the
conclusions obtained in the investigation.
In principle the verification of these products will be on the part of the thesis director and
the tutorial committee, as well as the agencies, entities or publishers that publish these
results so that they can be verified as shown in Table 2:
Table 2. Results, Indicators and Deadlines for the Results of the Doctoral Thesis
FROM THE QUARTER
RESULT VERIFIABLE INDICATOR
(No.)
Presentations at National Congress Presentation Certificate 1
Presentations at International Congress Presentation Certificate 1
Short Papers Publication by editorial or congress 2

Research Papers Publishing by editorial 3
Book or Book Chapter Publishing by editorial 3
Guides and/or other documents Publication by Organization or Editorial 6
5.5 IMPACTOS ESPERADOS

At this point, the quantification of the expected impacts is considered, upon completion
of the doctoral thesis, which can be expressed as:
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5.5.1 Scientific and technological impacts of the thesis

• Training of human resources in research, new technologies and technological
management, through research projects associated with the doctoral thesis, it can
be formed an eminently formed group for the development of new processes in the
management of physical assets.
• Registration and technical documentation of Know-How, which has been acquired
through study, collaboration and development of new protocols, methodologies and
models with the research groups associated with this doctoral thesis.
• Development of design capabilities in the University or Research Group, based on the
development of this management model and learning in real estate management
disciplines, new research groups could be created on these topics.
• Consolidation of capacities to carry out research activities in the University, from the
development of this management model in hospital physical assets and learning in
real estate management disciplines, would strengthen the investigative capacities in
the health sector, administration, engineering and architecture with other research
centers at the international level.
• Development or consolidation of Research Groups, from the development of this
model of hospital management and learning in real estate management disciplines,
would strengthen the research groups that will collaborate on this thesis such as
Bioengineering and Technology Management .
• Development of information networks and scientific-technological collaboration,
based on this work, a network can be formed with research centers in hospital
infrastructure in Spain and it is also possible in other countries that are studied as
United Kingdom, Holland, Norway, Denmark , Germany, Israel and USA. Being able
to enrich Colombia with first line research.
• Improvement in the offer of technological services, which can be offered by doctoral
students and collaborators of this doctoral thesis, being able to create strategic
alliances with national and international companies.
• Others
5.5.2 Impacts on productivity and competitiveness of the productive sector of region or

country
• Impacts on the productivity and competitiveness of the Institutions that Provide
Health Services (IPS) and therefore in the health sector, due to the fact that this model
is oriented towards an adequate management of the physical resources of the
organizations. So that they can gain in efficiency, effectiveness and sustainability
throughout the useful life, and therefore profitability of this.
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• Access to new national or international markets, in case this model is suitable for
Colombia, there is the possibility of adapting the model so that it can be used in
different countries depending on the type of health system. Further strengthen the
health cluster of the region and Colombia.
• Employment generated, within the applicability of this management model could
generate employment from the creation of consulting companies and audit of physical
hospital assets management.
• Improvement of productivity and quality, through the follow-up of the lines of action
of the model, advances would be made in the different areas of the physical
infrastructure of the IPS, so that among its purposes are economic savings,
environmental sustainability and benefits of the social groups associated with these
entities.
• Prosperity of the organizational culture, is one of the essential points of this
infrastructure management model that without the improvement of personnel
conditions could not function properly.
• Communities benefited by the thesis, would be the IPS that adopted this management
model as an integral part of the management of physical assets with the unconditional
support of the top management of the organization.
• Others
5.5.3 Impacts on the environment and society

In what entails the management of the infrastructure and the discipline of the Facility
Management, it includes the technical, administrative and economic management of
the health institutions, so some impacts are expected in:
• Reduction in the consumption of energy and water, through sustainability policies
you can get to see substantial savings of these resources, which are the largest
expenses at the economic level of health institutions.
• Improvement of the contracting of support services, called Facilities Services
"through the appropriate use of indicators (KPI) and service levels (SLA) between the
parties, which as a rule promote long-term contracts with a" win-win "philosophy .
• Reduction in the generation of emissions, discharges and solid waste, by means of
sustainability policies.
5.6 METHODOLOGY AND DOCTORAL THESIS PLAN
At this point, the methodology that is linked by the specific objectives of point 5.2 above
is defined. Therefore, each of the points clarifies the basis for carrying out the scientific
and technological activities to be developed in order to achieve the objectives of the
research.
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Later during the course of the thesis development, each one of the techniques to be used,
statistical designs, simulation, tests, tests and others will be specifically determined.
Thus, the following methodology is shown, linked to each of the specific objectives 5.2, as
follows:
1 # Determination of the state of the art of hospital infrastructure management and its
support services in the context of the international and Colombian health system.
Through a search in the literature and information offered by International
Organizations and Associations, the Ministry of Health and Social Protection of
Colombia, as well as other agents of the Colombian Health System, so that deficiencies
in the management of hospital infrastructure can be detected by the Institutions that
Provide Health Services in the country.
2 # Conceptualization about the use of international standards (ISO and UNE-EN) to create
a sustainable management model of quality in the hospital infrastructure and its
support services. Obtaining this way the information of the studied documents that are
in the international panorama on the FM according to the technological surveillance of
the management of the sanitary infrastructure. In this way, from the experience
gathered from the interior point for the understanding of developing an own idea
about the FM based on international standards. This will allow laying the foundations
of a theoretical framework for property management and its support services.
3 # Development of the hospital infrastructure management model based on a matrix
between the areas covered by the FM and the functions in each one of them. The
relationship between each of the interactions of the elements will shape the model of
infrastructure management and its hospital support services more appropriate for the
context of the health system and the Colombian IPS.
4 # Validation of the structure of the resulting model by means of advanced statistical
techniques. This validation offers arguments for the selection of the modality of
statistical analysis for the empirical verification of this hypothesis. The statistics will
make it possible to ensure that the inexcusable condition is fulfilled in its formulation
so that it can be solved, that is, with the collected data it is possible to reach the
expected answers. Therefore, we expect a model proposal that can solve the research
problem, weaknesses in the management of hospital infrastructure in the Colombian
health model. And therefore the possible implementation of this model resulting in IPS
in Colombia, to achieve adequate sustainable management of the hospital
infrastructure.
The planning of the thesis will be correlated to the schedule marked between the student
and his tutorial committee in the next 8 quarters remaining for the expected completion
of the doctoral research. During the first two quarters, a doctoral research internship is
being carried out at the University of Málaga (Spain) and, from 2019, research will continue
in Colombia with specific stays abroad. So the programming will be adjusted depending on
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the progress in the research and the agreement between the thesis director and the
tutorial committee.
5.7 CRONOGRAM
The following schedule of activities of the doctoral thesis is shown with the four most
important points, which coincide with the specific objectives of the project, in this table
shows an approximation of the times for the development of each activity in the different
quarters. This temporary planning can be modified depending on the progress of the
investigation and the agreements between the student, the direction and the tutorial
committee showing the disposition in Table 3:
Table 3. Timeline of the Doctoral Thesis (per quarter)

2019 2020
ACTIVITY
T1 T2 T3 T4 T5 T6
Determine the state of the art of hospital infrastructure
management and its support services in the context of the X X
international and Colombian health system.
Conceptualize about the use of international standards (ISO
and UNE-EN) to create a sustainable management model of X X X
quality in the hospital infrastructure and its support services.
Develop a model based on a matrix between the areas
covered by the FM and the functions of each of them. So that
each of the interactions of the infrastructure management X X X
model and its hospital support services can be related.
Validate the structure of the model by using advanced

X X
statistical techniques.
5.8 RESOURCES AND BUDGET

5.8.1 Global Budget for Sources of Financing
The overall funding budget for this doctoral research consists of per diems and research
grants such as impressions, presentations and specialized advice, since for the most part
this project is of a theoretical nature. Therefore, it is not expected that large investments
will be needed.
The funding of this research is reserved according to the Colciencias scholarship, consisting
of an amount of 50,000,000 COP $ (15,000 € approx.), Used exclusively for the execution
of the project approved to the doctoral student by the director and Doctorate Council in
Engineering from the Universidad Pontificia Bolivariana. After the approval of this Doctoral
Thesis Proposal, the amount in the indicated period may be requested from the
Universidad Pontificia Bolivariana, and therefore they will have 50 million COP $ for the
next semester. This amount must be allocated exclusively to the points referred to in the
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call 727/2015, being exempt from the support of the doctoral student, which is already
designated by another means of said call.
The global budget can be provisionally distributed as follows:
- Travel expenses ==> 20,000,000 COP $ (5,500 € approx.)
- Displacements ==> 10,000,000 COP $ (3,000 € approx.)
- Printing Costs ==> 2,000,000 COP $ (600 € approx.)
- Presentation and diffusion ==> 3,000,000 COP $ (900 € approx.)
- Technical Advice (External) ==> 15,000,000 COP $ (4,000 € approx.)
5.8.2 Personnel Expenses
Personnel expenses, of which only the doctoral student and the collaborators of the
doctoral project linked to the Universidad Pontificia Bolivariana, the University of Málaga
and perhaps other organizations are available. Due to this, expenses attributable directly
to the research project have not been taken into account. As far as possible, free
collaboration will be sought in the project, recognizing the pertinent merits of the
members and collaborators in the products that can be published in magazines, congresses
and seminars.
5.8.3 Equipment
In principle, the need for the use of any type of equipment is not estimated, since the
research will be theoretical, the consultation will be taken into account through semi-
structured surveys and personal interviews with the infrastructure managers of various
hospital centers and Facility Managers. related to international standards. For the
validation of the theoretical proposal, the use of specialized equipment is not foreseen. So
you only need the use of a personal computer, print orders, use of computer tools in the
majority of open access (Open Access) and an internet connection for the development of
most of the research, which will be provided by the universities or by the doctoral student.
5.8.4 Trips
A PhD research stay is currently being carried out at the University of Málaga (Spain),
where the problems identified in the Colombian health system are being identified, with a
duration between 9 and 12 months. In Spain, he will be in contact with hospital managers
and Facility Managers who will guide the trends of adaptation of international standards
to the current management of physical assets (infrastructure) of public (and possibly
private) hospitals in the region of Andalusia. . During the research internship (and later),
trips between different Andalusian provinces are planned using public transport (three,
bus, metro or shared car). For this reason it will be necessary to travel several times
between Colombia and other places to achieve the conclusive results of the investigation
and the validation of it. During the investigation, the matrix components of the
Hoja: 28 de 29
infrastructure management model will be developed in a Colombian health system based

on Facility Management and its international standards.
6. REFERENCES
The bibliography taken for the realization of this proposal has been taken into account
different sources of information such as books, research articles, articles of dissemination
and "conference papers" that are listed below:
Papers, Conference papers and Books:
Amaratunga, D., Haigh, R., Sarshar, M., Baldry, D., (2002) "Application of the balanced score‐card concept to develop a
conceptual framework to measure facilities management performance within NHS facilities", International Journal
of Health Care Quality Assurance, Vol. 15 Issue: 4, pp.141-151.
Andaleeb, S. (1998). Determinants of customer satisfaction with hospitals: a managerial model. International Journal of
Health Care Quality Assurance, 11(6), 181-187.
Banedj-Schafii, M., & Lennerts, K. (2010). System transferability of Facility Management. In CIB W070 International
Conference in Facility Management–FM in the experience economy, conference transcript (pp. 435-445).
Banedj-Schafii, M. (2010). System Transferability of Public Hospital Facility Management Between Germany and Iran (Vol.
4). KIT Scientific Publishing.
Bjørberg, S. and Verweij, M. (2009), “Life-cycle economics: cost, functionality and adaptability”, in Rechel, B., Wright, S.,
Edwards, N., Dowdeswell, B. and McKee, M. (Eds), Investing in Hospitals of the Future (ISBN 9789289043045), The
European Observatory on Health Systems and Policies, World Health Organization, Copenhagen, pp. 145-166.
Caballero-Uribe, C. V. (2012). Las crisis del Sector Salud. Salud Uninorte, 28(2), 7-12.
Cabrera C. y Martinez I. (2008), Conference: “Business Continuity Plan: Es el momento de asegurar la continuidad del
Negocio”, Administración de Riesgos KPMG, 2008.
Carvalho, J.A. (2012). Facility Management. Una nova realidade na gestâo de edificios. Ed. Vida Inmobiliaria.
Feingold, V. (2012). El libro del Facility Management pp. 13-19. SLFM, Argentina, 2012.
Gonzalez, J. C. & Restrepo, G. L. (2017). Ante un nuevo paradigma en la salud en Colombia. Carta Comunitaria. Vol. 25.
Número 143. Abril – Junio de 2017. Revista ECO, Fundación Universitaria Juan N. Corpas. Colombia.
Galeano, B. J., Escobar, N., Cuartas, D., & Botero, J. C. (2015). Modelo integrado de gestión de activos hospitalarios
basado en la PAS 55. Revista Ingeniería Biomédica, 9(18), 95-102.
Gallagher, M. (1998), Evolution of Facilities Management in the Health Care Sector, Construction Paper No. 86, The
Chartered Institute of Building, Ascot, pp. 1-8.
Gelnay, B. (2002), “Facility management and the design of Victoria Public Hospitals”, Proceedings of the CIB Working
Commission 70: Facilities Management and Maintenance Global Symposium 2002, Glasgow, pp. 525-45.
Homedes, N., & Ugalde, A. (2005). Las reformas de salud neoliberales en América Latina: una visión crítica a través de
dos estudios de caso.
Jensen, P.A., van der Voordt, T., Coenen, C., von Felten, D., Lindholm, A. L., Balslev Nielsen, S., ... & Pfenninger, M. (2012).
In search for the added value of FM: what we know and what we need to learn. Facilities, 30(5/6), 199-217.
Lennerts, K (2009), Chapter 9 of Book, “Investing in hospitals of the future”. World Health Organization, 2009.
Meng, X., & Minogue, M. (2011). Performance measurement models in facility management: a comparative
study. Facilities, 29(11/12), 472-484.
Monge Lozano, P., & Pizarro Gómez, A. (2003). Características de los hospitales españoles. CIRIEC-España, revista de
economía pública, social y cooperativa, (46).
Negrotti, A. (2015). Ponencia VII Congreso Mundial de Mantenimiento y Gestión de Activos: Curso Fundamentos para el
Mantenimiento de Edificios Industriales y Corporativos. Facility Management (FM) 2015.
Nesje, A. (2002), “Management, operation and maintenance costs of hospital buildings”, Proceedings of the International
Federation of Hospital Engineering, Bergen, pp. 290-96.
O’Donovan, M. (1997), “Risk management and the medical profession”, Journal of Management Development, Vol. 16
No. 2, pp. 125-33.
Payne, T., & Rees, D. (1999). NHS facilities management: a prescription for change. Facilities, 17(7/8), 217-221.
Pinder, J., III, R. S., & Saker, J. (2013). Stakeholder perspectives on developing more adaptable buildings. Construction
Management and Economics, 31(5), 440-459.
Rees, D. (1997), “The current state of facilities management in the UK National Health Service: an overview of
management structures”, Facilities, Vol. 15 No. 3/4, pp. 62-5.
Hoja: 29 de 29
Rees D., (1998) "Management structures of facilities management in the National Health Service in England: a review of
trends 1995‐1997", Facilities, Vol. 16 Issue: 9/10, pp.254-261.
Rodriguez-Labajos, L., Thomson, C., & O'Brien, G. (2016). Exploring the attributes and KPI's adopted by international
healthcare providers to measure the performance of their estates at the strategic level. In Proceedings of the 32nd
Annual ARCOM Conference (pp. 5-7).
Rodriguez-Labajos, L. & Thomson, C. (2017). Perspectives of senior stakeholders on the role of strategic performance
measurement for healthcare estates. In Proceedings of the 33rd Annual ARCOM Conference (p. 62).
Shohet, I.M. & Lavy S. (2004) "Healthcare facilities management: state of the art review", Facilities, Vol. 22 Iss: 7/8,
pp.210 - 220
Støre-Valen, M., Kathrine Larssen, A., & Bjørberg, S. (2014). Buildings’ impact on effective hospital services: The means
of the property management role in Norwegian hospitals. Journal of health organization and management, 28(3),
386-404.
Then, D.S.S. (1999), “An integrated resource management view of facilities management”, Facilities, Vol. 17 No. 12/13,
pp. 462-9.
Tono T: La crisis de los hospitales de Colombia. Paper presented at the Conference: The Innovations in Health Financing,
April 20–21, Mexico City. 2004, Accessed May 14, 2004.
Trujillo G. (2016). Facility Management (FM) y Asset Management (AM) – Diferencias y Áreas en común: http://fhm-
conference.com/sitio/facility-management-fm-y-asset-management-am-diferencias-y-areas-en-comun/
World Health Organization (2012) WHO strategy on research for health
(http://www.who.int/phi/WHO_Strategy_on_research_for_health.pdf?ua=1)
Yim Yiu, C. (2008). A conceptual link among facilities management, strategic management and project
management. Facilities, 26(13/14), 501-511.
Normative o standards:
DECRETO 1769 DE 1994, (agosto 3) Diario Oficial No. 41.477, del 5 de agosto de 1994. Ministerio de Salud. Colombia
ISO 55000:2014, Asset management -- Overview, principles and terminology, International Standard Organization (2014)
ISO 41001:2018, Facility Management – Management systems – Requirements with guidance for use, International
Standard Organization (2018)
ISO 41011:2017, Facility Management – Vocabulary, International Standard Organization (2018)
ISO 41012:2017, Facility management -- Guidance on strategic sourcing and the development of agreements,
International Standard Organization (2018)
ISO 41013:2017, Facility Management – Scope, key concepts and benefits, International Standard Organization (2018)
PAS 55-1:2008. Asset management. Specification for the optimized management of physical assets. PAS 55-1:2008, BSI,
U.K., 2008
UNE-EN 15221-1:2012, Gestión de inmuebles y servicios de soporte– Términos y condiciones, UNE – Normalización
Española (2012)
UNE-EN 15221-2: 2012, Gestión de inmuebles y servicios de soporte – Directrices para la elaboración de acuerdos, UNE –
Normalización Española (2012)
UNE-EN 15221-3:2012, Gestión de inmuebles y servicios – Guía sobre la calidad de gestión de inmuebles y servicios de
soporte, UNE – Normalización Española (2012)
UNE-EN 15221-4: 2012, Gestión de inmuebles y servicios – Taxonomía, clasificación y estructuras de la gestión de
inmuebles y servicios de soporte, UNE – Normalización Española (2012)
UNE-EN 15221-5: 2012, Gestión de inmuebles y servicios – Guía sobre los procesos de gestión de inmuebles y servicios de
soporte, UNE – Normalización Española (2012)
UNE-EN 15221-6: 2012, Gestión de inmuebles y servicios – Medición de superficies y espacios en gestión de inmuebles y
servicios de soporte, UNE – Normalización Española (2012)
UNE-EN 15221-7: 2013, Gestión de inmuebles y servicios – Directrices para los estudios comparativos (benchmarking)
sobre el rendimiento, UNE – Normalización Española (2013)
Figures:
Figura 1. Realizado por el autor del Proyecto de Tesis Doctoral. Manuel Madroñal Ortiz
Hoja: 30 de 29
Figura 2. Adaptación de PMM Business School. (2017) Conference: Estándares en Facility Management:
http://bit.ly/2bTxoDM , (Acceso, Septiembre 2017).
Figura 3. Shohet, I.M. & Lavy S. (2004) "Healthcare facilities management: state of the art review", Facilities, Vol. 22 Iss:
7/8, pp.210 - 220
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Proposal for a Hospital Infrastructure Management Model through Facility

Research Proposal · February 2019

Modelo de gestion hospitalaria View project

The user has requested enhancement of the downloaded file.

Engineering PhD Advisory Committee

Manuel Madroñal Ortiz

Medellín, February 15, 2019

Acta No. _______ de__________ de 2019

Universidad Pontificia Bolivariana (UPB)

© Universidad Pontificia Bolivariana (UPB) – 2019

SUMMARY OF THE THESIS ............................................................................................................ 3

Figura 1. Simplification of the Crisis in the Health Sector in Colombia …………………………..…..4

SUMMARY OF THE THESIS

Title: MODEL PROPOSAL FOR HOSPITAL INFRASTRUCTURE

Director PhD. JAVIER DARIO FERNANDEZ LEDESMA (UPB [CO])

Author: MSc. MANUEL MADROÑAL ORTIZ

Kind of investigation: Applied or Technological Development

Global Cost: $ 50.000.000 (15.000€ aprox.)

National Science and Biomedical Research and Health Services

Abstract of the proposal:

Figure 1. Simplification of the health crisis in Colombia (Madroñal M., 2018)

Internal Disasters External Disasters

2. FORMULATION/DECLARATION OF THE PROBLEM

3. BACKGROUND, THEORETICAL, CONCEPTUAL FRAMEWORK & CURRENT SITUATION

- Faculty of Architecture of the Delft University of Technology, Delft, The Netherlands.

- UNE-EN 15221-7: 2013, Management of buildings and services - Guidelines for

4. MOTIVATION AND JUSTIFICATION

• Level of communication between staff and the patient;

4.1 RESEARCH QUESTIONS

According to bibliographic searches and technological surveillance on the subject, it is

5.2 SPECIFIC OBJECTIVS

Figure 3. Central domains of FM in Health (Shohet & Lavy, 2004)

5.4 RESULTS AND PRODUCTS

Presentations at International Congress Presentation Certificate 1

Short Papers Publication by editorial or congress 2

Guides and/or other documents Publication by Organization or Editorial 6

5.5 IMPACTOS ESPERADOS

5.5.1 Scientific and technological impacts of the thesis

5.5.2 Impacts on productivity and competitiveness of the productive sector of region or

5.5.3 Impacts on the environment and society

5.6 METHODOLOGY AND DOCTORAL THESIS PLAN

Table 3. Timeline of the Doctoral Thesis (per quarter)

Validate the structure of the model by using advanced

5.8 RESOURCES AND BUDGET

5.8.2 Personnel Expenses

infrastructure management model will be developed in a Colombian health system based

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