improving facility management of public hospitals in iran

Scientia Iranica A (2020) 27(6), 2817{2829

Sharif University of TechnologyScientia Iranica

Transactions A: Civil Engineeringhttp://scientiairanica.sharif.edu

Research Note

Improving facility management of public hospitals inIran using building information modeling

A. Alvanchi� and A. Seyrfar

Department of Civil Engineering, Sharif University of Technology, Tehran, Iran.

Received 4 January 2018; received in revised form 12 September 2018; accepted 8 January 2019

KEYWORDSBuilding informationmodeling;Facility management;Public hospitals;Hospital building.

Abstract. Improving management of complex and congested facilities in hospitalbuildings is a potential point for both reducing money spent and enhancing quality level ofthe medical services provided in public hospitals of Iran. Although Building InformationModeling (BIM) is identi�ed as an e�ective tool for improving Facility Management (FM),use of advantages it o�ers to the FM processes of hospitals has been neglected thus far inthe country. To address this issue, this research aims to investigate the BIM capabilitiesand the supporting organizational structure of public hospitals in Iran which can helpimprove their FM processes. A comprehensive literature review of applicable capabilitiesof BIM to the FM processes was conducted. Hierarchical FM structure of public hospitalsin the country was recognized through a review of the related regulations. A public hospitalcase was chosen for in-depth recognition of FM process operations and validation of theproposed BIM-based improvements. It was argued that the use of BIM capabilities couldsubstantially improve the FM processes of public hospitals. Reduced duration of FMactivities, improved facility layouts, enhanced communication and coordination, facilitatedtraining, and improved emergency management are some of the expected outcomes.

© 2020 Sharif University of Technology. All rights reserved.

1. Introduction

Hospitals are complex organizations with various stake-holders, facilities, and materials closely linked andworking together to accomplish their vital missions,i.e., curing patients in need and improving publichealth. The complex combination of people withdi�erent organizational roles and various types of ma-terials and facilities working together with a variety ofsensitive medical procedures makes operating costs of

*. Corresponding author.E-mail addresses: [email protected] (A. Alvanchi);[email protected] (A. Seyrfar)

doi: 10.24200/sci.2019.50186.1562

hospitals the highest among the public service organi-zations [1,2]. As World Health Organization [3] reports,government expenditure on health exceeds 14% of totalgovernment's expenditure globally. Despite the highcost of di�erent hospital operations, a single slight aw in any parts of this complex organization maycause dire consequences and signi�cant dissatisfaction.Therefore, attempts to improve di�erent parts of hos-pital management with the aim of quality enhancementand cost reduction are invaluable to the society.

Meanwhile, a variety of medical and non-medicalequipment pieces used in hospitals and the demand fordiverse medical utilities and services make the utilitysystems of hospitals the most congested and complexutilities among public buildings [4]. Furthermore, thehigh pace of advances in medical equipment technolo-

2818 A. Alvanchi and A. Seyrfar/Scientia Iranica, Transactions A: Civil Engineering 27 (2020) 2817{2829

gies in recent decade compels hospitals to continuallyinstall new medical equipment to maintain their oper-ability and competitiveness in this highly competitivemarket. Cost-e�ective modi�cations to the utilitysystems become necessary to support new medicalequipment. Poor hospital Facility Management (FM),though, can add to the costs of these modi�cations.Prolonged activities, frequent disruption of regularhospital operations, and short or excessive supply ofutility services are mere some of the instances thatresult from poor FM during new equipment installationand utility modi�cation [5]. A proper FM not only con-siderably contributes to operational cost-e�ectivenessfor hospitals, but also improves the quality of medicalservices provided.

According to Gallaher et al. [6], retrieving equip-ment speci�cations and its past records in the �eld ofFM takes a considerable amount of time; expeditingaccess to this information can improve FM perfor-mance. However, without a reliable tool, a considerableportion of valuable historical equipment records is lostor becomes di�cult to access over the equipment'slifecycle [6,7]. Use of dependable information man-agement infrastructure can considerably improve FMprocesses [8]. Meanwhile, research e�orts have demon-strated that Building Information Modeling (BIM) ex-pedites access to the building components informationand assists the hospital FM team to promptly decideand respond to the problems occurred [9]. Research�ndings indicate that the operation and maintenancephases of constructed structures absorb major costsspent over their lifecycles [10,11]. Nevertheless, mostBIM research studies have focused on applications ofBIM in design and construction phases [12]. Identi�edcapabilities of BIM make it a suitable tool applicable tovarious aspects of FM processes such as quality control,energy management, maintenance and repair, andequipment installation and supervision [5]. With thisperspective, the large building structure and congestedutility system components of hospitals and delicateservices provided for them justify the e�orts to properlyapply BIM capabilities to improving FM processes inhospitals.

Annually about 6.6% of Iran's GDP is spenton healthcare and 40.4% of this amount is spent bythe government, which constitutes 17% of the totalannual governmental budget [3]. A major part of thisbudget is spent on 537 public hospitals, funded andmanaged by the government [13]. Despite the hugeamount of money spent on public hospitals, level ofsatisfaction with the healthcare system in the countryis still low. For example, the satisfaction level of20.7% about hospitals was reported by Farzadi etal. [14] and 32.8% was reported by Maharlouei etal. [15]. Despite the reported capabilities of BIM toimprove FM processes, no research study in Iran has

incorporated BIM in the FM processes of hospitals.To respond to this shortfall, this research assessedthe possibility of incorporating di�erent capabilities ofBIM in the FM processes of public hospitals in Iran.Next, Section 2 presents the research methodology anddi�erent steps taken in the research. Section 3 discussesdi�erent aspects of research e�orts for using BIM inFM processes. Section 4 brie y introduces currenthierarchical structure of public hospitals and the wayit a�ects FM processes of hospitals. Section 5 presentsan in-depth recognition and analysis in the PublicHospital case of Hasheminejad, Tehran, Iran. Section 6shows the recommended implementation architecturethat supports the proposed BIM-based FM processesof the public hospitals in Iran. Section 7 concludes theresearch.

2. Methodology

The research was conducted in �ve main steps. First, acomprehensive literature review of various advantagesand disadvantages identi�ed for using BIM in FMprocesses was performed. In parallel to the �rst step,the hierarchical structure of public hospitals and theway it a�ects the FM processes in these hospitalsin Iran were recognized. The case of HasheminejadPublic Hospital in Tehran, Iran is analyzed in stepthree to recognize operational details of FM processesin a sample public hospital. In step four, various BIMcapabilities in FM processes were analyzed and thecapabilities found suitable for the current situation ofthe hospital were proposed. A pilot implementation,then, was conducted to verify the applicability andsuitability of the proposed modi�cations in connectionwith the FM crew in the hospital. Finally, in step�ve, a supporting architecture for implementation ofthe proposed improvements in public hospitals wasrecommended. The proposed recommendations werebased on the current implementation methods foundin the literature and the current condition of the FMprocesses in the public hospitals in Iran. Figure 1summarizes di�erent steps taken in the research.

3. Use of BIM in FM processes

FM is de�ned by the International Facility Manage-ment Association [16] as \the practice of coordinatingthe physical workplace with the people and work ofthe organization; it integrates the principles of businessadministration, architecture and the behavioral and en-gineering sciences". Working commission on manage-ment and maintenance of facilities in the internationalcouncil for research and innovation in building andconstruction (CIB) considers four main scope areas ofFM. These scope areas include �nancial management,space management, operational management, and be-

A. Alvanchi and A. Seyrfar/Scientia Iranica, Transactions A: Civil Engineering 27 (2020) 2817{2829 2819

Figure 1. Di�erent steps of the research.

havioral management [17] which cover a wide rangeof activities for FM during the operation phase of abuilding. From this perspective, in hospital buildingswith complex medical services provided during theoperation phase, FM is the key support for the sensitivemedical procedures performed. Facility managers needto handle and utilize a broad range of informationon the buildings, operations, equipment, patients, andemployees [18]. A comprehensive literature review ofthe FM of the hospitals by Youse i et al. [19] identi�edthe use of information technology as the main trendin the recent research for developing cost-e�cient andreliable FM processes. Here, BIM is seen as themain platform for facilitating the communication andmaintenance of the information [19].

In many past research e�orts, the identi�ed po-tential applications of BIM were tested, analyzed,and improved. Implementation challenges of BIM-based FM were also reported. Among a variety ofconstructed structures, incorporation of BIM in FM ofpublic buildings, e.g., educational building [20,21], cityhall complex [22,23], and hospital [4,9,18,24{26], hasbeen followed the most. Here, di�erent bene�ts andchallenges of using BIM in FM processes were reported.It was reported that use of BIM could improve FMprocesses in multiple directions including:

1. Shortening work order durations;

2. Analyzing multiple possible modi�cation scenariosthrough three-dimensional models of buildings;

3. Facilitating the training process of various FMstakeholders;

4. Aanalyzing emergency conditions;

5. Facilitating real-time data access by storing equip-ment maintenance history on model;

6. Attaching statutory compliance data and workstandards;

7. Controlling and monitoring energy.

Despite numerous bene�ts reported, past re-search [27{29] found BIM applications in FM stillat the initial and emerging stages and encouragedfurther research to address the existing implementationchallenges. Challenges found in these research e�ortsfor incorporation of BIM in FM can be summarizedas follows: absence of a structured method for in-corporating BIM in FM processes; lack of propertools for demonstrating BIM bene�ts to FM; limitedknowledge on types of information to be collected andon the methods and tools used for applying BIM inFM; too many detailed speci�cations required for BIMdevelopment; lack of expertise in working with BIMin public organizations; resistance to changing thepreviously adopted methods; and challenges in linkingBIM to the current tools used in FM. Furthermore, thepast research on incorporation of BIM in FM processesof hospitals was mainly focused on single hospitalcases rather than a network of hospitals. To addressthe existing gaps and challenges, this research aimedto propose an implementation method for BIM-basedFM processes for the networks of public hospitals inIran while the existing technological and organizationalchallenges are taken into account.

The global acceptance of BIM as an e�cient toolfor managing di�erent phases of the building projectlifecycle has urged developing an open data formatinteroperable among various contributing disciplines.The Industry Foundation Classes (IFCs) developedby building SMART, a non-pro�t organization, aimedto create this open �le format [30]. Since 2013,the IFC has become an international standard ofISO 16739 for data sharing in the construction andFM industries [31]. Currently, IFC is supported bythe majority of BIM software applications and it isconsidered as the main �le format in the developmentof the BIM-based FM processes [32,33]. Gathering


speci�cations of the information items in di�erentparts of the BIM models is another challenging aspectof the development of the BIM-based FM processes.The Construction Operations Building InformationExchange (COBIE) [34] is a major step taken to de�nestandard information items applicable to BIM-basedmodels of FM processes. The COBIE has a lifecycleview to the integration of BIM and building projectswith regard to the design, construction, and operationand maintenance phases. Ever since, the COBIE hasbecome a standard information items structure in manydeveloped BIM-based FM processes (e.g. [35{37]).

Proper setup of a 3D model is the initial stepin employing BIM in FM processes. New 3D modeldevelopment is required when BIM-based FM processesare applied to existing buildings with no 3D modelavailable. The 3D model development of such buildingsstarts with collecting their spatial data using eitherexisting as-built 2D drawings [38], direct measurementand observation, or new technologies such as laserscanning and photogrammetry [39]. Initial spatial dataare processed to form a 3D model with meaningful ob-jects [40]. Gradually, a variety of information cases re-quired for FM are embedded within the object-orientedBIM model, making the BIM cloud accessible to di�er-ent FM contributors [39]. Here, a major challenge iscapturing the spatial data of various concealed buildingcomponents adapted during the building's operationphase [41]. Setting up proper security managementis required to ensure that the right people will accessdata under appropriate circumstances [42]. Propersecurity management is also required to avoid di�erentproject contributors that lose interest in incorporatingtheir related data into the BIM cloud [43]. Facilitatedaccess to various building components is one of themajor capabilities of BIM-based FM processes. Toimprove this capability, BIM models bene�t from newtechnologies such as mobile augmented reality [44],Radio Frequency Identi�cation (RFID) tags [45], andeven smartphones and tablets [46].

4. FM structure of public hospitals in Iran

Before identifying the operational details of FM pro-cesses in the public hospitals, a holistic view of thehierarchical structure and current condition of FMprocesses in public hospitals was obtained. Related reg-ulations and references were studied and discussed withthe people working in the public healthcare system.The healthcare system in Iran has a unique hierarchicalstructure. In this structure, medical universities, undersupervision of the Ministry Of Health and MedicalEducation (MOHME), are responsible for providinghealth services, managing public hospitals, monitoringthe private sector, and conducting medical researchand education [47]. The dean of a medical university

is the highest authority for all public hospitals in aspeci�ed geographical area, e.g., a province, and thedean must report to the MOHME [48]. About 75% ofIran's hospital beds are in the public hospitals ownedby MOHME, 16% are owned by other governmentalbodies, and only 9% of them are privately owned [49].It was estimated that more than 50% of hospitals inthe country were worn out, many of which were poorlymaintained [50], resulting in high maintenance andrepair costs. Public hospitals are highly demandedbecause of their low medical service prices [51], leadingto high deterioration rates. Considering that MOHMEowns public hospitals and has responsibility for makinghealth-related policies, it has recently enforced PublicHospitals to input all maintenance expense data toa web-based Computerized Maintenance ManagementSystem (CMMS). According to the estimates, this newsystem has reduced 40% of the life cycle costs ofphysical resources in public hospitals [52].

5. Case study: FM processes of HasheminejadPublic Hospital

This study investigated the case study of HasheminejadPublic Hospital, which enjoys an area more than 12,000square meters and 151 active beds in Tehran. In thiscase study, di�erent aspects of FM processes in publichospitals were recognized and the potential points ofimprovement BIM can make to FM of Public Hospitalswere identi�ed. This hospital was selected amongseveral available choices because of its reputationin its organized FM and e�ective implementation ofMOHME's new CMMS. Hasheminejad Hospital is arelatively old hospital since 1957. In 1985, it becamea national center for treating kidney diseases. Then,di�erent steps taken in this case study were explained.

5.1. Recognizing the FM processesInitial interviews with FM crews including medical-facility manager, facility maintenance supervisor, andthree members of facility maintenance team wereconducted to draw an overall view of the hospital'sFM process. Then, available FM documents of thehospital including mission and policy statement, codeof conduct, manual of procedures, and instructionswere reviewed. Finally, di�erent parts of the FMprocesses and operations were closely observed in thetwo-week shadowing period. Recognitions achievedduring the case study were presented into two parts:FM organizational structure and main FM processes.

� The hospital's FM organizationThe main organization of FM team in the Hashem-inejad Hospital is comprised of the medical equip-ment section and the Mechanical, Electrical, andPlumbing (MEP) section. The FM team consistsof 12 crew members including oxygen supplier,


construction manager, powerhouse team, electricianteam, sewage treatment plant, welder, plumber, sec-retary, and the head of the team. The main organi-zational duties of the FM team are divided into �vemain categories including preventive maintenanceand periodic inspection, calibration and qualitycontrol of equipment, repair of ruined or damagedequipment and facilities, managing changes in hos-pital spaces, facility procurement, and installmentof medical equipment and facilities;

� Main FM processesDuties assigned to the FM team were carried outthrough �ve main complementing processes inter-acting with four stakeholders outside the team in-cluding hospital manager, maintenance contractors,hospital personnel, and Iran Medical University.

The main �ve work processes identi�ed through theFM process were:1. Conducting periodical inspections;2. Report evaluation;3. Performing repair and maintenance works;4. Procurement;5. Performance report preparation.Data Flow Diagram (DFD) was used as the mainrecognition tool in this research. It is a powerfultool for capturing and structurally summarizing therecognition achieved from di�erent parts of the FMprocess. Figure 2 presents the DFD diagrams thatshow a holistic view of the entire FM processesand internal data interactions of the sample PublicHospital. A brief explanation of each process will begiven below.

Figure 2. Data ow diagram level one of Facility Management (FM) processes of Hasheminejad Hospital.


In the �rst process of FM, i.e., conducting peri-odical inspection, the FM team inspects and monitorsMEP facilities and medical equipment in speci�ed pe-riods in accordance with the standard and/ or instruc-tions set by Iran Medical University. All periodicalinspections performed are reported to the University inpaper forms. In the second process, report evaluation,reports prepared by FM team and external mainte-nance contractors, as well as the requests receivedfrom other hospital personnel are carefully read andevaluated. Further actions, e.g., maintenance andrepair activities required, are determined based ontheir priorities and constraints. Subsequently, in thethird process that involves performing maintenanceand repair work, activities assigned to the related FMteam crew are conducted according to the preparedschedule. A list of items concerning maintenance andrepair required for completing maintenance and repairactivities is prepared. In the procurement process,the price of the required items is reported to thehospital manager to receive his approval. Then, itemsare purchased and sent to the FM team to completethe maintenance and repair activities. In the �fthprocess, i.e., performance report, various maintenance,repair, and procurement activity reports are preparedin the form of performance reports and are sent to theIran University of Medical Sciences and the hospitalmanager. It should be noted that di�erent parts of theFM processes explained here and presented in the formof the DFD in Figure 2 represent the speci�c conditionof the sample public hospital in Iran. Hospitals in othercountries can bene�t from these processes. Separaterecognition steps need to be undertaken in such cases.

5.2. Analyzing capabilities of BIMThe applicability of di�erent capabilities of BIM, iden-ti�ed in the literature [5,10,24,39], was analyzed basedon the recognition obtained from di�erent parts ofthe FM. The created BIM maturity matrix [53] rep-resented a low level of BIM maturity of the hospital'sorganization. Furthermore, three main constraints andrequirements with respect to the BIM capabilities aregiven below:

� Forcing minimal changes to the existing organiza-tion to receive minimal resistance from the person-nel;

� Minimal money investment to be considered as aresult of limited public budget;

� Minimal academic engineering background to besupposed for the FM team members, since most ofthem have practical experiences rather than formalengineering training. From this perspective, FMcrew should not account for BIM model developmentand maintenance.

MOHME required hospitals to maintain the mostupdated as-built hospital drawings. In the case ofHasheminejad Hospital, since FM team member wasnot able to update 2D drawing, the hospital managerhired an engineering consulting company �ve years agoto update the 2D drawings. The hospital's architec-tural, structural, and utility systems were updatedbased on the old drawings and FM team input. Eversince, however, FM team has not updated the modi�-cations made to the hospital building. Therefore, the�rst modi�cation made to the hospital FM processeswas to develop BIM-based models of the hospitalbuilding rather than 2D CAD models. The draftingor consulting company hired for preparing the BIMmodel needs to stay linked to the hospital for theperiodical (semiannual or annual) updates based on themodi�cations made to the hospital building over time.It is expected that following the development of theinitial BIM models, updating BIM-based models costsless than the 2D model updates.

Recommendations for adoption or rejection ofdi�erent BIM capabilities in the FM processes ofpublic hospitals were made concerning the identi�edconstraints and requirements. Our analysis of adoptionor rejection of di�erent capabilities of BIM resulted inrecommending six capabilities of BIM to be incorpo-rated for improving the FM process. Recommendedcapabilities include:

1. Locating building components;2. New equipment layout and installation manage-

ment [5];3. Coordination of FM sta� [39];4. Communication with medical and other non-

technical personnel [4];5. Training contractors and personnel [5];6. Emergency management [54].

For all recommended capabilities, it was consideredthat minimal money investment and organizationalchanges imposed on the hospital and FM crew couldmanage them by attending short training sessions. Therejected capabilities include:

1. Storing equipment maintenance history;2. Attaching statutory compliance data and work

standards [28];3. Controlling and monitoring energy using BIM [55].

Implementation of these capabilities required eitherholding intensive training sessions for current FM teammembers or hiring new FM crew with a proper levelof education. Furthermore, money investment shouldbe made to equip the hospital with new computerhardware and software. A brief explanation of how


the recommended capabilities can improve the FM pro-cesses and their implementation methods is providedbelow:

� Locating building componentsCurrently, the FM team members depend on theirmemories for locating buried facilities. They havedi�culties reading separated 2D drawings of thehospital building's architectural, structural, andutility systems, which is an error-prone, time-consuming, and costly process. In some cases,the FM team was forced to cut walls, oors, andceilings to locate the facilities. For example, asper FM team member explained, mistakes made inlocating the exact location of the air ducts causedthe construction of a new washroom unit in the ICUsector to cease. Figure 3 shows another example ofthe demolition performed by FM team for locatingthe facilities during the shadowing process of theresearch team in the hospital.

In the BIM model, integration of various typesof drawings, 3D visualization of building compo-nents, and use of search and �lter options canhighly facilitate the locating process of di�erentbuilding components [5]. In this situation, FMcrew can locate various components of the hospitalbuilding by navigating a prepared BIM model andsearching for the identi�cation number of di�erentbuilding components. No trial-and-error demolitionexperiences are required anymore;

� New equipment layout and installation man-agementLayout and installation management of new medicalequipment purchased for the hospital is one respon-sibility of FM team. Selecting an adequate movingroute, �nding a proper location, and installing large-sized equipment are quite challenging for FM teamin the hospital. By using BIM model, it is possibleto visualize di�erent spaces and their speci�cationsin 3D view. It allows FM crew to check di�erent

possible moving routes and installation scenariosto �nd the best possible choices and to avoid thetrial-and-error approach. Furthermore, use of BIMhelps the FM team more easily involves relatedmedical personnel who are more familiar with newequipment's operational requirements in this processto �nd the best possible layout;

� Coordination of FM sta�FM crew needs to access a wide range of in-formation about target facilities to conduct theirmaintenance, repair, replacement, and inspectionactivities. Currently, for more complicated FMactivities that require coordination of several FMteam members, they form coordination meetings.The coordination team discuss di�erent aspects ofthe work by sharing past experiences and under-standing about the facility and outlining work stepsof each team member on pieces of papers. Use of3D views provided by BIM models facilitates thiscoordination by demonstrating di�erent aspects ofthe target facilities and assisting communication ofteam members [39];

� Communication with medical and other non-technical personnelFrequently, FM team members receive requests fromdi�erent non-technical personnel including man-agers, physicians, nurses, and administrative sta�that are neither feasible nor applicable due tothe technical limitations. Explaining these limita-tions to the hospital personnel is a big and time-consuming issue for the FM team and it is often seenas an unacceptable excuse by the hospital personnel.Use of 2D models usually does not help since FMteam members are not comfortable working withthem. Furthermore, they are barely understandablefor non-technical sta�. From this perspective, FMcrew can use 3D views provided by the BIM modelto explain existing limitations and embrace non-technical sta� for �nding alternative solutions;

Figure 3. Wall and ceiling demolition for locating the Mechanical, Electrical, and Plumbing (MEP) installations.


� Training contractors and personnelThe diversity of facilities used in hospital buildingsnecessitates the use of external contractors whoprovide di�erent types of FM services. All thesecontractors require a proper understanding of dif-ferent parts of the hospital buildings. They needto receive orientations about di�erent parts of thehospital and get trained by the FM team, whichoverall is in charge of the hospital FM. Furthermore,in the following three situations, training becomesimportant for FM team members as well [5]:1. Hiring a new FM sta� member: If a new member

is hired in the FM team, the new member mustbe acquainted with the work processes, MEPsystems, hospital equipment, and facilities;

2. Changing the work processes: If the work pro-cess in a sector or department undergoes seriouschanges, then these changes can result from theintroduction of a new instruction or standard;

3. Installing new equipment and facilities: Whennew equipment or facilities are installed in thehospital, FM team members need to be trainedin accordance with the new equipment require-ments.

The current training process is conducted with-out any auxiliary tool involved by directly takingtrainees to locations of various facilities and explain-ing related information to the trainee, which is verytime-consuming. However, through the 3D navi-gations provided by BIM models, the trainee canbecome familiar with speci�cations of many facilitiesand see the required information. In addition, theycan refer to the BIM model whenever maintenanceand repair activities are assigned to them;

� Emergency managementIn case of emergency situations, e.g., earthquake,�re, and thunderstorm, quick access to the hospitalbuilding information is vital to promptly bring thesituation under control and help the ones in need.Currently, the Hasheminejad Hospital building'sdrawings are stored inside the hospital and in paperformats, which can easily become inaccessible in caseof emergency. Use of BIM models that could also bestored in di�erent MOHME's computers minimizesthe risk of losing access to the hospital building'smodel in case of emergency. Another potential prob-lem that the Hasheminejad Hospital faces is lackof emergency plans and preparedness, which cansubstantially aggravate the hospital in case of emer-gency. It is proposed that an emergency committeeincluding di�erent stakeholders in the hospital isformed and regular emergency coordination meetingis held. A representative of FM team should attendthe meetings and walk committee members throughdi�erent parts of the hospital buildings using the

developed BIM model during the development ofoperational emergency response plans. BIM modelsare also used for conducting emergency trainingsessions, emergency tests, identifying unsafe areas,and mounting emergency signs and alerts in properlocations of the hospital building.

5.3. Pilot implementation of the proposedimprovements

In order to test the applicability of the proposedFM improvements, they were applied to the surgicaldepartment of Hasheminejad Hospital located on the�rst oor with seven operating rooms and nine recoverybeds. The surgical department was selected since ithad a complex set of highly sensitive facilities to beoperated and maintained [56]. Furthermore, fairly ac-curate as-built 2D drawings to be used for BIM modeldevelopments are available. Several modi�cation planswere made to this department for near future whichcould bene�t from the proposed improved capabilitiesof BIM. The department's ventilation system did notallow di�erent surgical rooms to independently adjusttheir temperatures according to the speci�c needs andconditions of patients. Besides, the ventilation systemwas also crucial to preventing the transmission of theairborne infection to the patients [57]. Upgradingthe ventilation system to an independently adjustablesystem was desired. Furthermore, all entries to andexits from this department were made through theonly existing door at the department, which did notproperly support the tra�c. No emergency exit wasalso built for the department. Building a new doorfor this department that could facilitate better tra�cmanagement and be used for the emergency situationswas also another planned modi�cation.

The BIM model of the surgical department wasdeveloped in Revit 2017 software by a collaborat-ing drafting company based on 2D architectural andMEP CAD drawings with input from the FM team(Figure 4). In order to evaluate the applicability ofthe proposed improvements in the FM processes, thedeveloped BIM model and its navigation capabilitywere presented to the FM team members on both com-puter screen and papers (Figure 5). Implementation ofeach proposed improvement in FM processes was thenreviewed by FM team members. The team was quitewelcoming and positive about the applicability andbene�ts of the proposed improvements that could bringto the FM processes of the hospital. In an exercise, theBIM model was used for locating the best place for thesecond door of the surgical department by involvingseveral other stakeholders to help them determine thelocation of the door. In another practice, FM teammembers were encouraged to use the model to analyzethe ventilation system and air channels and assessrequired modi�cations to meet the patients' needs.


Figure 4. 3D view of the Building Information Modeling (BIM) model of the surgical department.

Figure 5. 3D views and navigation feature of thedeveloped Building Information Modeling (BIM) modelsof surgical department to the Facility Management (FM)team members.

6. Implementation architecture

Since the nature of activities conducted in FM pro-cesses is quite di�erent from those implemented inthe design and construction of buildings, integrationof BIM technologies in FM processes requires dif-ferent implementation architectures than design andconstruction phases [58]. Here, we divided the imple-mentation architecture of BIM in FM processes intothe three following main parts: 1) de�ning applicableinformation items of BIM models for FM processes,2) providing proper platforms to support BIM modelsfor di�erent sta� working at di�erent levels of the FMorganization in di�erent Public Hospitals, and 3) deter-mining the methods in BIM software and operationaldata created in FM processes which were updated and

maintained over the building's lifecycle. Di�erent partsof the implementation architecture were recommendedaccording to the speci�c condition identi�ed for thepublic hospitals in the country and recent achievementsreported in the literature.

In the �rst part of the BIM implementation ar-chitecture, applicable information items of BIM modelsfor FM processes were determined. Many practitionersadopted COBIE standard in their BIM-based FMprocesses (e.g. [35{37]). However, since the use ofBIM in FM processes in many cases happens with nopast records of BIM, many researchers prefer usinga customized data structure for integrating BIM inFM processes [33]. Meanwhile, a review of di�erentrelated research e�orts indicated that a wide rangeof tools were used for linking BIM and FM computersoftware (or CMMS) while the spreadsheets and third-party middleware (e.g., EcoDomus, Onuma Systems,and FM Interact) were the two main approachesadopted [21]. IT and engineering background weak-nesses of the current FM crews in the public hospitalsand budgetary limitations of public hospitals werethe main constraints considered for the recommendedarchitecture. From this perspective, holding expensivelong-term training programs for the current FM crewsor hiring new high-paid quali�ed FM personnel able towork with BIM models were discarded for the initialimplementation. Therefore, in the initial stage of BIMimplementation, it was recommended that minimumchanges were made to the current organization andminimum possible information items were added tothe BIM models. Maintenance operations applied tovarious hospital facilities identi�ed in the 3D modelscould be recorded in the existing CMMS using the sameidenti�cation numbers. Nevertheless, gradually, inte-


gration level of FM processes with the BIM models mayincrease as the BIM maturity level of the organizationincreases [29].

The rapid growth and publicity of high-speedinternet and the distributed nature of building compo-nents have encouraged major BIM software developersand many researchers (e.g. [58{60]) to develop web-based BIM 3D navigation platforms run on portablesmartphones and tablets. In addition to the facilitateduse of 3D models in this approach, the dependency ofFM processes on the expensive standalone BIM soft-ware programs installed on high-performance desktopcomputers is reduced and multi-purpose and widelyaccessible smartphones and tablets take the place. Inmost public hospitals, currently available computersand high-speed internet connections can support theweb-based approach. Use of this web-based approachwas recommended in the second part of the implemen-tation architecture.

For the public hospitals, speci�c instructions andmandates are set by the government to input FMoperational data through currently developed CMMS,which are supposed to be followed in the third part ofthe recommended implementation architecture. Fur-thermore, it is recommended that MOHME centrallymaintain the most updated BIM models and provideweb-based access to the 3D views of the updated BIMmodels to the hospitals. This approach takes theadvantage of the centralized management and owner-ship of public hospitals by MOHME and helps PublicHospitals overcome IT and engineering backgroundweaknesses of FM crews. Figure 6 represents the

Figure 6. Recommended implementation architecture ofBuilding Information Modeling (BIM)-based FacilityManagement (FM) of public hospitals.

recommended implementation architecture of the BIM-based FM of public hospitals.

7. Conclusion

In this research, the applicability of various identi-�ed improvements that Building Information Modeling(BIM) can bring to the Facility Management (FM)processes of public hospitals in Iran was investigated.Data were collected from di�erent aspects of Iran'spublic health system and a case study of Hashemine-jad Public Hospital in Tehran, Iran was conducted.Budgetary constraints and low IT and engineeringbackground level of FM crew were the two maincriteria identi�ed for the proposed BIM-based FMprocess. It was argued that use of capability of BIMmodels in conjunction with the existing ComputerizedMaintenance Management System (CMMS) would im-prove the FM processes in terms of locating buildingcomponents, coordination of FM, layout planning ofnew facilities, communication with medical and non-technical hospital personnel, training new FM crew,and emergency management. Applicability of theproposed improvements to the pilot BIM model ofthe hospital's surgical department was evaluated andthen, incorporating FM team members in the imple-mentation of di�erent improvements was proposed.The proposed improvements were welcomed by FMcrew and they acknowledged the viability of the modelin the FM process. Finally, to apply the proposedimprovements to FM processes of di�erent public hos-pitals in the country, an implementation architecturethat would suit the current organizational structure ofpublic health system and consider its main constraintswas recommended.

Forcing drastic changes and high investment costswere two main constraints frequently seen during theimplementation process of new IT-based systems [60].Although various BIM features could improve FMperformance, it was expected that sudden changes tothe processes resulted in high resistance from di�erentstakeholders as well as in slowing down or even blockingthe implementation of the new processes. To avoidfacing this problem, minimal changes to the currentFM processes were considered.

This research is the �rst study to have incor-porated BIM in the FM processes of the network ofhospitals and it opens a new era for future improvementof FM processes of the network of public or private hos-pitals. With the current extent of FM activities in theaging public hospital buildings in Iran, the proposedimplementation architecture can bring considerablesaving to HOHME's costs in a long run. Furthermore,it should be noted that the proposed improvements inthe research are only the beginning of the long wayof incorporating BIM in the FM of public hospitals.


Advanced features of BIM can gradually merge withthe FM processes, while BIM culture is built amongFM team members and other hospitals' personnel. Ofcourse, before engagement of these new features inpublic hospitals' FM processes, further research needsto be conducted to analyze feedback from the im-plementation of the currently proposed improvementsand plan for implementation of new features. Resultsachieved in this study are presented to Ministry OfHealth and Medical Education (MOHME) decision-makers to cajole them into applying the proposedimprovements to the public hospitals.

Acknowledgement

We would like to express our appreciation to Farda FanPars Engineering Consultant Co. which helped us withdevelopment of BIM models used in the case study.

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Biographies

Amin Alvanchi has been an Assistant Professor atthe Department of Civil Engineering, with specializa-tion in construction engineering and management, atthe Sharif University of Technology, Tehran, Iran sinceFebruary 2013. He has received his PhD in Construc-tion Engineering and Management from the Universityof Alberta, Canada in 2011. His area of research focuseson building information modeling, construction projectmanagement, construction operation simulation, andcontract administration.

Abolfazl Seyrfar is an MSc graduate student at Con-struction Engineering Management, the Sharif Uni-versity of Technology since September 2015. He hasrecently been admitted continuing his studies at thePhD level at the University of Illinois, Chicago, UnitedStates.

improving facility management of public hospitals in iran

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