La irrupción del automóvil en el turismo catalán.

5.6.

The second section of the questionnaire sought to ascertain the prevailing procurement strategies and contract methods used in the delivery of hospital facilities cleaning services in the NHS and their interface with good practice knowledge management processes within the prevailing hospital culture, structure and technological capabilities in order to achieve Objective 2 and 5 of the research.

There are several procurement options available for the delivery of facilities management cleaning services in the healthcare sector. These options are broadly classified into two categories known as in-house (i.e., using directly employed staff) and outsourcing (Handley & Benton, 2009; Varadarajan, 2009; Belcourt, 2006). Outsourcing is the transfer of in-house services to a third-party service provider. It is the transfer of an operation that is outside the comfort zone of a business to a third-party provider (Southgate, 2007).

When the then UK Conservative government made the outsourcing (competitive tendering) of hospital facilities management services a policy in 1983, it was argued that such a policy would lead to the efficient use of resources in the health service. Healthcare authorities were

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required to develop systems of competitive tendering for support services such as laundry, cleaning and catering, which would involve comparing the performance of an in-house arrangement with what could be purchased from external agencies (Department of Health and Social Security, 1983). Today the evidence is seen as mixed, as attention has been drawn to perceived falling standards in the cleanliness of hospitals since the introduction of competitive tendering (Davies, 2010; Pratt et al., 2007). This development has led to questions about the influence of the various routes for procuring hospital cleaning services contracts on the incidence of HCAIs (Davies, 2005, 2010; Pratt et al., 2007).

Cleaning standards have fallen: patients, staffs, the public and the government know that since the introduction of competitive tendering of cleaning services in 1983,

standards in hospital cleanliness have fallen (Davies,

2005)

The adequate cleaning of hospital environments is acknowledged to be essential both for the health and safety of staff, and for patient recovery outcomes. It is also considered to be a significant contribution to the quality of healthcare delivery (Department of Health, 2004; Auditor General of Scotland, 2000). The question of whether there is a connection between the quality of hospital environmental cleanliness and the prevalence of healthcare-associated infections has been discussed for many years. According to Pratt et al., (2007), there is a body of clinical evidence, derived from case reports and infection outbreak investigations, which suggests an association between poor environmental hygiene and the transmission of microorganisms causing healthcare-associated infections in hospitals.

The fact that cleaning standards in hospitals have fallen as a result of contracting-out is not disputed and led to the Labour Government in 2001 ending the compulsory element of market testing/competitive tendering for

cleaning services in the NHS (Davies, 2005)

Findings from the analysis of the completed questionnaire are presented in the following sections.

The procurement strategies for the delivery of FM cleaning services in each

5.6.1.

hospital

Of the eighty-nine (85) valid questionnaires, those completed by 46 of the respondents, representing 54% of the total, reported using a combination of outsourcing and in-house strategies in the delivery of their hospital facilities cleaning services. Thirty-three (33)

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respondents (39%) delivered their cleaning services using directly employed in-house staff. Five (6%) indicated that they outsourced their services, while one respondent (1%) reported using the public finance initiative (PFI) option (see Table 5.5)

Table 5.5: Types of FM cleaning contract used

Procurement method

No. of

respondents _{Percentage (%)}

In-house 33 39

Outsourcing 5 6

A 50/50 split between in-house and outsourcing 46 54

Private Finance Initiative (PFI) 1 1

Total 85 100

Mean 2.18

According to a report published by the Centre for Health and the Public Interest (2015), the NHS now contracts out the provision of healthcare services to the private sector to the tune of over £20 billion a year, or a fifth of the total healthcare budget. It is also stated in the report that these outsourced services are mostly contracted to clinical services providers such as dentists, pharmacies, opticians and general practitioners. The proportion of the budget devoted to outsourcing non-clinical services was not stated in the report. However, it was acknowledged that ‘it is difficult to quantify how much non-medical work in the NHS has been outsourcing to date’ (Lacobucci, 2015).

Section three interpretation

5.6.2.

Managing domestic services is acknowledged to be a complex activity which requires the making of choices about where domestic staff should be based, and what their role should be (Department of Health, 2011). Having identified the popular methods of procuring facilities management cleaning services in the NHS, there is a need to further explore the reasons for the choice of a particular method. This is in order to establish how this could influence the effectiveness of the knowledge management process within hospitals' prevailing culture, structure and technological capabilities in the control of exogenous HCAIs. Therefore in the qualitative interview phase of data collection, the following closed-ended questions were asked:

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 What is the adopted procurement method in delivery of the hospital facilities management cleaning services?

 What are the fundamental reasons for the choice of a particular procurement method in the delivery of hospital facilities management cleaning services?

 What are the areas that could be improve in the adopted procurement method to enhance effective good practice knowledge management in the delivery of facilities management cleaning services in the control of exogenous HCAI?

The next section presents the findings from the questionnaire survey on the prevailing knowledge management process within the hospital knowledge infrastructure capabilities for enhancing good practice knowledge management in facilities management cleaning service delivery in the control of healthcare-associated infections