Defects in Malaysian hospital buildings

Abstract

Purpose
Hospital building maintenance management constitutes a pertinent issue of global concern for all healthcare stakeholders. In Malaysia, the maintenance management of hospital buildings is instrumental to the Government’s goal of providing efficient healthcare services to the Government's citizenry. However, there is a paucity of studies that have comprehensively explored all dimensions of hospital building defects in relation to maintenance management. Consequently, this study seeks to evaluate the defects of hospital buildings in Malaysia with the aim of proffering viable solutions for the rectification and prevention of the issue.

Design/methodology/approach
The study utilised a quantitative approach for data collection.

Findings
The findings indicated that cracked floors, floor tile failures, wall tiles failure, blocked water closets, and damaged windows were some of the flaws that degrade hospital buildings. The study’s outcomes reveal that defects not only deface the aesthetic appearance of hospital buildings but also inhibit the functionality of the buildings and depreciate the overall satisfaction.

Research limitations/implications
Considering the indispensable role of hospital buildings in the grand scheme of healthcare service provision and ensuring the well-being of people, the issue of defects necessitates an urgent re-evaluation of the maintenance management practices of hospital buildings in Malaysia. Previous studies on the maintenance management of hospital buildings in Malaysia have focused primarily on design, safety, and construction.

Practical implications
This is particularly important because defects in hospital buildings across the country have recently led to incessant ceiling collapses, fire outbreaks, ceiling, roof collapses, and other structural failures. These problems are typically the result of poor maintenance management, exacerbated by poor design and construction. These disasters pose significant risks to the lives of hospital building users.

Originality/value
This study offers invaluable insights for maintenance organisations and maintenance department staff who are genuinely interested in improving hospital buildings’ maintenance management to optimise staff's performance and enhance the user satisfaction of hospital buildings in Malaysia and globally.

Full text

Defects in Malaysian
hospital buildings
Christtestimony Jesumoroti, AbdulLateef Olanrewaju and
Soo Cheen Khor
Department of Construction Management, Universiti Tunku Abdul Rahman,
Kampar, Malaysia
Abstract
Purpose –Hospital building maintenance management constitutes a pertinent issue of global concern for all
healthcare stakeholders. In Malaysia, the maintenance management of hospital buildings is instrumental to the
Government’s goal of providing efficient healthcare services to the Government’s citizenry. However, there is a
paucity of studies that have comprehensively explored all dimensions of hospital building defects in relation to
maintenance management. Consequently, this study seeks to evaluate the defects of hospital buildings in
Malaysia with the aim of proffering viable solutions for the rectification and prevention of the issue.
Design/methodology/approach –The study utilised a quantitative approach for data collection.
Findings –The findings indicated that cracked floors, floor tile failures, wall tiles failure, blocked water
closets, and damaged windows were some of the flaws that degrade hospital buildings. The study’s outcomes
reveal that defects not only deface the aesthetic appearance of hospital buildings but also inhibit the
functionality of the buildings and depreciate the overall satisfaction.
Research limitations/implications –Considering the indispensable role of hospital buildings in the grand
scheme of healthcare service provision and ensuring the well-being of people, the issue of defects necessitates
an urgent re-evaluation of the maintenance management practices of hospital buildings in Malaysia. Previous
studies on the maintenance management of hospital buildings in Malaysia have focused primarily on design,
safety, and construction.
Practical implications –This is particularly important because defects in hospital buildings across the
country have recently led to incessant ceiling collapses, fire outbreaks, ceiling, roof collapses, and other
structural failures. These problems are typically the result of poor maintenance management, exacerbated by
poor design and construction. These disasters pose significant risks to the lives of hospital building users.
Originality/value –This study offers invaluable insights for maintenance organisations and maintenance
department staff who are genuinely interested in improving hospital buildings’maintenance management to
optimise staff’s performance and enhance the user satisfaction of hospital buildings in Malaysia and globally.
Keywords Amenities, Critical success factors, Implementation, Requirements, Structural failure, Services
Paper type Research paper
1. Introduction
Hospital buildings are confined spaces that serve the specific purpose of ensuring the health
and wellness of people with highly sophisticated facilities used for treatment; this
characteristic distinguishes them from other types of buildings (Garip, 2011). Hospital
buildings provide a serene and enabling environment that facilitates the efficient delivery of
medical services and patients’social connections (Amos et al., 2020;Zhang et al., 2019). This
condition is critical because the state of a building has a significant impact on the health of the
occupants and the environment (Abd Rani et al., 2015). This makes the maintenance
management of hospital buildings one of the most complicated tasks in the field of
maintenance, as hospital buildings are complex, highly functional, costly, and cumbersome
to maintain and manage (Fore and Msipha, 2010;Muchiri et al., 2011;Maletic et al., 2012;
Macchi and Fumagalli, 2013).
Defects in
Malaysian
hospital
buildings
The research has been carried out under the Fundamental Research Grant Scheme Project (No: FRGS/1/
2018/TK06/UTAR/02/5) provided by the Ministry of Higher Education of Malaysia. The authors are
grateful for the grant.
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/2398-4708.htm
Received 15 December 2021
Revised 17 February 2022
8 April 2022
26 April 2022
Accepted 27 April 2022
International Journal of Building
Pathology and Adaptation
© Emerald Publishing Limited
2398-4708
DOI 10.1108/IJBPA-12-2021-0166

Hospital building defects have a significant negative impact on the value of services and
best practices of the healthcare sector. Not only do defects in hospital buildings contribute to
structural deterioration and component depreciation, but they also significantly inhibit the
performance of hospitals (Adam and Abu Bakar, 2021). In a similar vein, the maintenance of
hospital buildings has remarkable effects on the functionality of the facilities and users’
satisfaction. Maintenance management is necessary to ensure the quality performances of
buildings and preserve their life span. However, it is a complex process that could be highly
exorbitant if not cleverly conducted to minimise cost. The maintenance of hospital buildings
must be conducted appropriately to maximise their functionality (Abd Rani et al., 2015). This
process necessitates regular extensive routine maintenance to ensure the smooth running of
healthcare facilities and their unhampered provision of essential services (Olanrewaju
et al., 2018).
To achieve best practices, critical success factors must be initiated to enhance both
positive planned and unplanned maintenance management for hospital buildings to
determine the defects and improve their services. Therefore, it is pertinent to implement
efficient maintenance management protocols in order to preempt and ameliorate the
occurrence of defects in hospital buildings in Malaysia. To accomplish outstanding
maintenance, it is crucial to have a maintenance management strategy that conforms to the
expected requirements of users (Nik-Mat et al., 2011). Hence, strategic maintenance is
instrumental to hospital buildings’productivity and user satisfaction.
Undermining hospital building maintenance management can have catastrophic
consequences, as evidenced by recent media and research reports of increased ceiling and
roof collapses, fire outbreaks, and structural decay in Malaysian hospital buildings (Tan,
2018;Olanrewaju et al., 2019;FMT reporter, 2019;Su-Lyn, 2020a,b). These adverse outcomes
help explain why Wood (2005) dubbed building maintenance the “Cinderella”activity of the
construction industry because it has historically been a neglected and abandoned technology
field. Interestingly, there has been viral news about some instructions articulated through
official government circulars (2003–2010; 1995; 1991 and 2003) in Malaysia that suggest that
the Government is taking the issue of building maintenance (BM) more seriously (cited by
Mohd-Noor et al., 2011).
2.1 Maintenance
Maintenance encompasses the technical and administrative actions required to preserve a
building in an optimal state, one in which it efficiently serves its purposes (Hashim et al., 2019;
Townsend et al., 2017). The process also entails protecting, repairing, monitoring, and
improving buildings to ensure maximum performance. It can also be described as the
precautionary measures undertaken to reduce the adverse effects of defects and maximise the
efficacy of the facility at minimum cost (L€
ofsten, 2018). The foremost goal of building
maintenance is to protect and preserve a building in its unique state to serve its purpose
efficiently (Enshassi et al., 2015). In conjunction with effective management, maintenance
preserves and improves the quality of buildings; the practical application of both practices
produces incredible outcomes. Building maintenance is caused by various factors, as
contained in Table 1 (Ogunmakinde et al., 2013;Ofori et al., 2015). To effectively curb the
incidence of defects in buildings, it is crucial to understand the causes and agents of building
deterioration.
2.2 Defects
The term “defect”in the construction industry refers to inadequacies in the planning, design,
and construction processes and other external factors such as wear and tear. Construction
and design defects are caused mainly by inefficient craftsmanship, inadequate construction
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methods, and substandard building materials (Olanrewaju et al., 2010). Defects in a building
accelerate its depreciation and shorten its lifespan. As previously mentioned, building defects
mar the expected performance of buildings, user satisfaction, the expected quality of services,
and other amenities. Defects in buildings can be either obvious or hidden (Othman et al., 2015).
The frequency of building defects is shown in Table 2, based on reported cases of building
defects in Malaysian hospital buildings from 2006 to 2017.
According to Gurmu et al. (2020), the frequency of structural defects in buildings directly
influences the subsequent reconstruction and maintenance costs, the time required to correct
the defects, the degree of user contentment, and the reputation of the service industry. In this
regard, researchers argue that to effectively classify the most prevalent root causes of
building defects, it is vital to conduct investigations regarding the rudiments and history of
the buildings (Lee et al., 2019;Gurmu et al., 2020)
Although there have been extensive efforts to classify and eradicate the leading causes of
construction defects, it is essential to note that defects do not always occur due to a singular
cause. Instead, some defects occur due to closely related causes (Aljassmi and Han, 2013). As a
result, this study seeks to proffer solutions to the challenging problem of defects in hospital
buildings in Malaysia by exploring the parameters that have not been fully addressed. Some
primary factors that cause damage to buildings include the construction of buildings on
spread-out Earth, the proximity of gardens to buildings, poor drainage systems, climatic
changes, improper foundation designs, and damaged water pipes (Gurmu et al., 2020;
Zumrawi et al., 2017). The most prevalent causes of hospital building defects include the
following: Faulty electrical systems: lack of energy, power failure, defective electrical
Common factors deterioration Design deficiencies Agents of deterioration
Ageing stock of building
factors
Ageing Stock of Building Shape and form Biological Control of material
Obsolescence Materials selection Mechanical Agent Change of use of
Building
Advent of New Technologies Design Approach Weathering a. Moisture
b. Wind
c. Atmospheric Gases
Vandalism
Rising Social Expectation and
Aspiration
Design
Maintainability
Chemical
a. Sulphate attack
b. Salt
Control of work on site
Lack of maintenance
Lack of use of Building
Source(s): Ofori et al. (2015) and Ogunmakinde et al. (2013).
Defects of hospital buildings in Malaysia Years (2006–2017) Number of defects
Ceiling collapse 7
Dampness 5
Malfunction of facilities 6
Fire accident 13
Wall crack 8
Water closets facilities failure 5
Inappropriate materials and design 5
Piping system failure 8
Heating, ventilating, air conditioning system failure 6
Source(s): Tan (2018)
Table 1.
Causes and agents of
building deterioration
Table 2.
Reported cases of
hospital building
defects between 2006
and 2017 in Malaysia
Defects in
Malaysian
hospital
buildings

installations, problematic lamps, and light fixtures/sockets/circuit breakers/switches/wiring;
mold and fungi: the growth of fungi is ordinarily the consequence of excessive dampness—
fungi blossoms under favourable conditions with enough moisture and nutrients (Dahal and
Dahal, 2020); timber deterioration; poor design; poor construction; termite infestation;
dampness and excessive moisture: approximately 71% of the hospital buildings had issues
with dampness.
The most common issues include rising dampness, leakages on services, and penetrating
dampness. Dampness can occur from unintentional water caused by leaky pipes, flashings,
and gutters, which cause defects such as cracks in the concrete walls, leaking pipes, and
concrete wall dampness (Gurmu et al., 2020;Abdul-Rahman et al., 2014). Water from the leak
frequently permeates the wall, resulting in horrifying water tints (Elhag and Boussabaine,
1999). The permeation of such dampness, combined with inadequate ventilation within the
building, promotes the excessive growth of fungi and algae on the wall surfaces (Dahal and
Dahal, 2020). Table 3 below highlights some of the preceding building defects reported in
Malaysia’s hospital buildings.
Moreover, since the inadequacy and lack of compliance of standard operational
procedures for hospital maintenance management, and as such, from a survey conducted
for doctors, medical officers, nurses from government and clinics rated hospital maintenance
management as poor from codeblue reports, march 2020, over 60% are poor maintenance
practices and procedures and this caused leaky ceilings, collapsing of ceiling, fire outbreak,
structural failure, wall cracked and complaints (Su-Lyn, 2020a,b). See below overall reports
from codeblue as reported and FMT Reporters:
337 Survey conducted among doctors from government hospital
38% of doctors rate the overall maintenance of their public health facility as poor or
terrible
Year Reported cases
Year 2007 Electrical trapping in elevator in Neurology Ward, Kuala Lumpur Hospital
Year 2010 Fire accident in Tengku Ampuan Rahimah Hospital, Klang
Year 2011 Ceiling collapse in Serdang Hospital, Kuala Lumpur
Year 2012 Ceiling collapse in Serdang Hospital, Kuala Lumpur
Year 2013 Ceiling collapse in Serdang Hospital, Kuala Lumpur
Year 2014 Fire accident in Sarawak General Hospital, Kuching
Year 2015 Fire accident in Hospital Tengku Ampuan Rahimah, Klang
Year 2015 Wall cracks in Tampin Hospital, Negeri Sembilan
Year 2016 Fire accident in KPJ Sabah Specialist Hospital
Year 2016 Lift malfunction in Sultanah Aminah Hospital, Johor Bahru
Year 2016 Fire accident in Sri Kota Specialist Medical Centre, Klang
Year 2016 Ceiling collapse in Tengku Ampuan Afzan Hospital, Kuantan
Year 2016 Fire accident in Sultanah Aminah Hospital, Johor Bahru
Year 2016 Heating, Ventilating and Air-Conditioning (HVAC) System failure in Hospital Tengku Ampuan
Afzan, Kuantan
Year 2016 Lift malfunction in Sarawak General Hospital
Year 2017 Fire accident in Hospital Bahagia Ulu Kinta, Perak
Year 2017 Electrical short circuit in Shah Alam Hospital
Year 2016 Electric short circuit in Hospital (RPB)
Year 2017 Electrical short circuit in Tanjong Karang Hospital, Shah Alam
Year 2017 Ceiling collapse in Hospital Universiti Sains Malaysia, Penang
Year 2019 Leaky roofs, ceiling, power cut, water cut in Petaling Jaya
Source(s): Tan (2018);FMT reporter (2019);Su-Lyn (2020a,b)
Table 3.
Hospital buildings
reported cases and
complaints
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51 reported electricity supply interruption at medical facilities at least once in a year
10% complaining of monthly power cuts
10% claiming water cuts
60% of the problems was reported in public health facilities were related to old and
failing equipment such as tools or anesthetic machines and also infrastructural issues
like cracked walls broken lights or ceiling collapsing
80% survey of said their issues remained unresolved even after two years of filing
their complaints
44% overall maintenance survey from respondents gave fair rating
18% rated the condition of their facility good or excellent
2.3 Hospital building users
Hospital buildings differ from other buildings because they accommodate a diverse clientele
of users. These individuals include medical personnel such as physicians, nurses,
psychologists, dentists, veterinarians, patients, and other non-medical staff and visitors.
Moreover, hospital buildings provide healthcare services and treatment to the general public,
with a variety of medical amenities and utility rooms equipped with various medical
equipment. Thus, it is critical to consider the input of professional specialists and medical
physicians familiar with specialised amenities and medical equipment. Therefore, when
hospital buildings are designed, the design must be done by professionals who consult with
various authorities to ensure the function of each room is well understood (Chan et al., 2003).
Over the years, hospital buildings across Malaysia have experienced mishaps such as fire
outbreaks and ceiling collapses due to the decay in hospital buildings. These mishaps
constitute a severe safety and wellness concern for healthcare stakeholders and necessitate
urgent critical research to investigate the maintenance management practices of hospital
buildings in Malaysia (Olanrewaju et al., 2018). Given that we live in an ever-changing
environment riddled with uncertainty, there is an urgent need to reassess hospital building
maintenance planning and comprehensive maintenance techniques (Lind and Muyingo,
2012). Recent studies have shown that the maintenance sector in Malaysia is critically
unstable, with increasing incidences of maintenance failures and building defects. This
situation underlines the ineffectiveness of Malaysia’s building maintenance systems (Zawawi
et al., 2011), which is partly attributable to the insufficient allocation of time and resources to
bolster the functionality of the operational and maintenance activities of building
maintenance management (Ali et al., 2010;Olanrewaju et al., 2010).
Similarly, recent Jordanian studies identified ineffective maintenance management
practices as the primary factor affecting hospital building maintenance performance (Jandali
and Sweis, 2018;Jandali et al., 2018). According to Abd Rani et al. (2015), factors affecting
hospital performance include the building’s age, its surroundings, the availability of
managerial resources, the building’s actual occupancy, and the labour sources used to
perform maintenance work (either in-house or outsourced). They argue that numerous
organisations fail at maintenance management because of poor management planning (Abd
Rani et al., 2015). Hospital building designs and construction can also adversely affect the
maintenance of buildings, especially if the design is complex. Therefore, it is imperative to
carefully consider the future repercussions of the approaches, resources (human and
material), and the financial implications of maintenance management processes during the
design stage of hospital and facility building (Sanchez-Barroso and Garc

ıa-Sanz-Calcedo,
2019;G
omez-Chaparro et al., 2020).
Defects in
Malaysian
hospital
buildings

2. Literature review
The relevance of healthcare buildings lies in the fact that they serve a wide range of purposes
such as caregiving, treatment of health issues, as well as recuperation and rehabilitation
procedures (Lavy et al., 2014)(Evans and Etienneb, 2010). These activities suggest that
healthcare buildings are constantly in use and require regular maintenance management and
frequent modification (Enshassi et al., 2015). As a result, flexibility and adaptability are
indispensable features required to support the wide range of activities within these
healthcare facilities, including medical building maintenance management (Olanrewaju
et al., 2019).
Building maintenance management entails several components, including determining
maintenance task intervals, selecting maintenance strategies, and risk assessment; it also
consists of a building maintenance policy. This written document serves as a management
guide for the maintenance staff in establishing appropriate standards and strategies
(Jesumoroti and Cheen, 2021). Also, there are some rudiments to this: provision of
maintenance resources, defining maintenance standards, and choosing a maintenance
strategy to design maintenance policy. Maintenance strategy involves condition-based,
preventive and corrective maintenance (Chyu et al., 2015). For instance, public buildings in
Penang, Malaysia, were evaluated. Issues such as the absence of quality building
maintenance standards, non-availability of replacement parts and components, lack of
responsiveness to maintenance requests, inadequate preventive maintenance, and
insufficient maintenance funds were identified as the major causes of the poor
maintenance management reported by building maintenance organisations (Jandali
et al., 2018).
In Israel, a study that evaluated the performance of community clinics and hospital
facilities based on their maintenance culture revealed the urgent need for adequate financial
measures in building maintenance to improve the quality of service provided by healthcare
facilities (Shohet and Lavy, 2017). Hospital building maintenance safeguards the structures
and ensures that they remain in an optimal state of safety and functionality in line with
established standards. As previous research has demonstrated, the maintenance practices
used by hospitals have a significant impact on the performance of hospital buildings and thus
define the maintenance management tactics used by other hospitals (Osunsanmi et al., 2020;
Razak and Jaafar, 2012). The maintenance of buildings and their environs, or the lack thereof,
remarkably affects the performance of hospital buildings and the entire country. Hospital
buildings must be adequately maintained to maintain an optimal level of functionality and
performance (Hayat and Amaratunga, 2014;Lind and Muyingo, 2012;Vandesande and Van
Balen, 2016).
Building defects have an adverse effect on users’satisfaction, productivity, and
maintenance costs. A building defect can cause concerns to its occupants. Additionally, it
may result in the delay of a patient’s recovery process. Defects must be handled effectively
and efficiently to ensure optimal building performance and user satisfaction. Defect
management is a strategic part of maintenance management and one of the primary functions
of the maintenance organisation (Olanrewaju et al., 2022b). Building defects can manifest
themselves in the structure, fabric, services, and other amenities of the faulty structure.
Defects include cracked, broken, or degraded brick/block walls, clogged water closets, and
malfunctioning lifts. Leaking showers and faulty windows and doors are also examples of
defects. Defects are transmittable because, if not addressed promptly, they can cause havoc
on adjacent components, elements, or building pieces (Olanrewaju et al., 2022a).
Any individual, group, or organisation that uses the hospital building as an occupier,
owner, renter, or visitor is considered a stakeholder. According to Olanrewaju and Tan (2022),
users must evaluate a building’s performance and service delivery in order to continue
justifying investment or uptake in building maintenance. This type of evaluation is critical
IJBPA

because building defects impair the functionality and delivery of services. In addition,
building defects affect the occupants’/clients’satisfaction and can result in disputes and
litigation between clients/users, developers, and maintenance companies (Lee et al., 2018;
Jonsson and Gunnelin, 2019;Olanrewaju and Lee, 2022a,b).
The effect of defects on buildings’condition, appearance, and performance is determined
by the buildings’functional requirements (Olanrewaju et al.,2021). Additionally, a
malfunctioning element, component, or section of a building affects the building’s users’
safety, comfort, convenience, and health (Faqih and Zayed, 2021). However, certain factors,
such as critical success factors, contribute to hospital building defects.
The critical success factors (CSFs) refer to the fundamental factors required to ensure
that a project attains its expected functions and meets stakeholders’requirements. CSFs
analysis enables the identification of the essential aspects of a project, which are of
considerable interest to stakeholders toward the achievement of the project’sgoal
(Olanrewaju et al.,2019). Muhammad and Johar (2019) rightly contend that there is a poor
understanding of the critical success factors for buildings in developing countries like
Malaysia.
Additionally, Kuwaiti et al. (2018) noted that there are thirty-six critical success factors for
establishing healthcare projects in the United Arab Emirate (UAE), which are listed in
Table 4.
From a maintenance perspective, critical success factors encompass the diverse
maintenance processes and activities, as well as the decisions taken at each step of the
maintenance service delivery. These factors are instrumental to both strategic and tactical
decision making. Some of the factors are common and obvious, while others are ambiguous.
The most prevalent factors affecting building maintenance include an inadequate budgetary
allocation for maintenance and operation (Lam et al., 2010); idle properties (Bambang, 2006);
low maintenance operation of assets; and insufficient skilled human capacity (Adamy and
Abu Bakar, 2021). While financial constraints primarily impede building maintenance, the
issue is not always financial in nature.
Existing research outside Malaysia has addressed the critical performance indicators for
the maintenance of hospital buildings. For instance, Olanrewaju et al. (2019) identified the
following performance indicators: building performance indicators, workforce source
diagrams, maintenance efficiency indicators and managerial span of control, business
availability, urgent repair request indexes, manpower utilisation indexes, preventive
maintenance ratios, average time for repairs and maintenance productivity, and soft
indicators. However, key performance indicators (KPIs) differ from the CSFs. For example,
critical success factors refer to the processes of decision making to produce predetermined
results, while key performance indicators are used to measure results. Similarly, critical
success factors could be likened to quality assurance, whereas key performance indicators
pertain more to quality control (Olanrewaju et al., 2018).
2.1 Theoretical and Conceptual framework
The framework outlined below was developed and used throughout this study as a guide.
This framework is critical to ensuring that the research study’s goals and objectives are
met. Consequently, the primary research adopted a mixed method for data collection,
analysis, and interpretation, as illustrated in Figure 1, in order to address ontological,
epistemological, and methodological issues related to conceptualising and theorising
building maintenance management. This process took cognisance of maintenance users’
needs and building performance in decision-making, which was done systemically,
representing the process, activities, and stakeholders’value systems in hospital building
maintenance.
Defects in
Malaysian
hospital
buildings

Critical success factors References
Top management support Dezdar and Ainin (2012),Yong and Mustaffa (2012),Almajed and
Mayhew (2013)
Commitment to project Dezdar and Ainin (2012),Yong and Mustaffa (2012), Almajed and
Mayhew (2013)
Project mission Pinto and Slevin (1988a),Yong and Mustaffa (2012)
Monitoring and feedback Abdul-Aziz and Kassim (2011),Meng et al. (2011),Yong and
Mustaffa (2012)
Project management PMI (2004),Dezdar and Ainin (2012)
Process management Al-Mudimigh (2007),Almajed and Mayhew (2013)
Stakeholder management and
involvement
Bourne and Walker (2008),Yong and Mustaffa (2012),Almajed
and Mayhew (2013)
Clear information and communication
channels
Nguyen and Ogunlana (2004), Dezdar and Ainin (2012),Almajed
and Mayhew (2013)
Effective strategic planning Hong (2009),Al-Turki (2011),Almajed and Mayhew (2013)
Change readiness Al-Shamlan and Al-Mudimigh (2011),Yong and Mustaffa (2012),
Almajed and Mayhew (2013)
Long-term demand of the project Meng et al. (2011),Osei-Kyei and Chan (2015)
Transparent procurement Jamali (2004),Yong and Mustaffa (2012),Tang et al. (2013)
Systematic control mechanisms Pinto and Slevin (1988a),Nguyen and Ogunlana (2004)
Competitive procurement Abdul-Aziz and Kassim (2011),Yong and Mustaffa (2012),
Almajed and Mayhew (2013)
Technical tasks Meng et al. (2011),Ng et al. (2012)
Troubleshooting Pinto and Slevin (1988a),Yong and Mustaffa (2012)
Adequate funding throughout the project Nguyen and Ogunlana (2004), Kamal (2006),Yong and Mustaffa
(2012)
Availability of resources Nguyen and Ogunlana (2004), Yong and Mustaffa (2012)
Accurate initial cost estimates Nguyen and Ogunlana (2004), Ralf (2012)
Community involvement/support Jacobson and Choi (2008),Yong and Mustaffa (2012)
Stable economy Li et al. (2005),Yong and Mustaffa (2012),Al-Saadi and Abdou
(2016)
Political stability Abdul-Aziz and Kassim (2011),Yong and Mustaffa (2012),Al-
Saadi and Abdou (2016)
Competent project manager Dezdar and Ainin (2012),Yong and Mustaffa (2012)
Multidisciplinary/competent project
team
Dezdar and Ainin (2012),Yong and Mustaffa (2012),Almajed and
Mayhew (2013)
Training and education Mandal and Gunasekaran (2003),Finney and Corbett (2007)
Implementing an effective safety
program
Yong and Mustaffa (2012)
Implementing an effective quality
assurance program
Pinto and Slevin (1988b),Yong and Mustaffa (2012)
Appropriate risk allocation and sharing Kemppainen et al. (2012),Almajed and Mayhew (2013),Al-Saadi
and Abdou (2016)
Client acceptance/satisfaction Pinto and Slevin (1988b)
Client consultation Pinto and Slevin (1988b)
Public/community acceptance Li et al. (2005),Yong and Mustaffa (2012)
Technology innovation Yong and Mustaffa (2012),Ng et al. (2012),Al-Saadi and Abdou
(2016)
Environmental impact of the project Tiong (1992),Jefferies et al. (2002)
Social needs considerations Murphy et al. (1974),Yong and Mustaffa (2012)
Troubleshooting Pinto and Slevin (1988a),Yong and Mustaffa (2012)
Source: Kuwaiti et al. (2018)
Table 4.
Critical success factors
for establishing
healthcare projects
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3. Methodology
Data for this study were collected using a structured closed-ended questionnaire. This
approach was adopted due to the COVID-19 pandemic, which precluded direct contact with
respondents, many of whom were extremely busy frontline workers. The survey was also
completed using a quantitative online survey approach. The data were analysed using the
Statistical Package for Social Sciences 25 (SPSS).
The quantitative method was adopted because of the need to obtain quick and precise
responses to questionnaires. This study forms part of broader ongoing research to
continuously improve hospital buildings maintenance management in the Malaysian
construction industry. To this end, an extensive review of relevant literature on hospital
buildings maintenance management in Malaysia and globally was undertaken. Primary data
was gathered through snowball sampling for online survey questionnaires due to the
COVID-19 pandemic. Snowball sampling is a non-probability sampling technique employed
when information about possible responders is limited. The technique is an inductive one. It
involves distributing the survey to as many accessible and willing respondents as possible
(Sekaran and Bougie, 2016). One of this technique’s drawbacks is that the researcher will have
no idea how many people responded. Nevertheless, while the findings may not be
generalisable, they can be representative when there are a significant number of respondents
(Sekaran and Bougie, 2016).
The respondents for the study comprised medical professionals such as nurses,
physicians, psychologists, dentists, veterinarians, other healthcare providers, and
maintenance management professionals, including mechanical engineers, civil engineers,
and builders. For different segments, the questionnaire survey used a four-point scale, a five-
point scale, and a six-point scale. For the question “How frequently do building defects occur?
”respondents’perceptions were elicited using a 4 Likert scale: 1 5Not Often, 2 5Often,
35Very Often, and 4 5Extremely Often. Respondents’perceptions of the overall building
performance were recorded using a 5-point Likert scale: 1 5Least Satisfied, 2 5Less
Satisfied, 3 5Satisfied, 4 5Very Satisfied, and 5 5Extremely Satisfied, while respondents
also rated the nature of the defect resolution in the buildings on a 6-point scale: 1 5Least
Critical, 2 5Least Common, 3 5Less Common, 4 5Common, 5 5Very Common, and
65Extremely Common.
This study focuses on the perspectives of various stakeholders on maintenance
management and the perspectives of staff members responsible for maintenance
management in hospital facilities. Perak, Penang, Kedah, Pahang, Malacca, Selangor,
Sarawak, Sabah, Kelantan, Terengganu, Perlis, Negeri Sembilan, Seremban, and Johor states,
in which Selangor has the highest number of hospitals 25.93%, followed by Kuala Lumpur,
Johor, Pulau Pinang and Perak all together making 76.39 in Peninsular Malaysia have the
Ontology: Epistemology Methodology: Technique:
Posivism Objecvism
Subjecvism
Explanatory
Exploratory
Observaon, Survey,
case studies, in tervi ew
Source(s): (Olanrewaju et al., 2019)
Figure 1.
Theoretical and
conceptual framework
Defects in
Malaysian
hospital
buildings

higher number of hospital structures. The estimation process for determining sampling size
provides a reliable number of audiences to be targeted. When distributing the questionnaires,
this study used a “Snowball sampling”(non-probability sampling approach) as well as a
“Simple Random Sampling”(where the odds are the same for any given participant being
chosen) to gather more replies owing to the COVID-19 pandemic.
The questionnaire was generated through an extensive literature review to address the
research problems in view of achieving the aim of this study. The questionnaire was
constructed for the users of the hospital buildings or people working in the hospital, such as
nurses, physicians, psychologists, dentists, veterinarians, and other healthcare providers, as
well as maintenance management professionals, including mechanical engineers, civil
engineers, and builders. About 14 hospitals responded to the questionnaire from 14
respondents and analysed. The questionnaire was validated and tested with SPSS to
ascertain its reliability, and it was reliable. The tests utilised were t-test, reliability, validity,
mode, and standard deviation. The Bartlett test was performed to increase the equipment’s
accuracy. The sample mean’s standard error measures how close the sample mean is to the
population mean. The data collection instrument’s validity and reliability are critical for
collecting accurate data. A questionnaire must possess two critical characteristics: reliability
and validity, to be considered acceptable. The former assesses the questionnaire’s
consistency, while the latter assesses the degree to which the questionnaire’s results
correspond to reality. A lower standard error indicates that the sample mean is a more
accurate representation of the population mean. SPSS analysed the study’s data and
performed T-tests with all their associated statistics. The study validates its findings using
Spearman’s correlation; correlation quantifies the strength of a linear relationship between
two variables. Correlation is statistically significant at the 0.01 level. P 51–6£d2/n(n2-1),
where pis Spearman’s rank correlation coefficient, D1 is the difference between each
observation’s two ranks, and Nis the number of observations.
3.1 Result and analyses
All of the constructs were expressed in a good manner. The survey was adequate for the
research. The following tests were used: t-test, reliability, validity, mode, and standard
deviation. The Bartlett test was used to improve the accuracy of the equipment. The one-way t-
test showed that cracked floor, floor tile failure, wall tile failure, blocked water closet, damaged
window, damaged ceiling, damaged door locks, faulty shower, faulty fans and others are top
defects in the hospital building. The standard error of the sample mean measures how near the
sample mean to the population mean. A lower standard error indicates that the sample mean
represents the population mean more accurately. A total of 32 faults were discovered and
reported by building users, affecting buildings and engineering services.
The survey was conducted over eight months, from March 2019 to January 2020. As
shown in Table 5, the composition of respondents reveals that they had educational
backgrounds in engineering and the environmental sciences. Mechanical engineering is
ranked first in terms of respondents, followed by civil engineering, biomedical science,
nurses, and other medical professionals. According to these findings, hospitals employ both
management and engineering professionals, such as engineers and facility managers,
because they require the necessary professional skills and knowledge of management
strategies and budget planning.
Additionally, Table 5 illustrates the various ages of the buildings. It reveals that 4
buildings were less than 10 years old, and 6 were between 20 and 30 years old. Others include
1 building between 30 and 40 years old and another building that was more than fifty years
old. This information implies that regardless of the age of the hospital buildings, they must be
maintained in a good state of repair, including the older structures. The categorisation of
hospital buildings revealed that most respondents worked in private establishments, with 8
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Professional background Age of the building Classification of hospital Position in the department
F% F% F% F%
Nursing 4 28.6 Less than 10 years 4 33.36 Public Hospital 8 61.5 Nurse 5 38.5
Civil 4 28.6 20–30 years 6 50.0 Private Hospital 5 38.5 Engineer 5 38.5
Biomedical Science 4 28.6 30–40 years 1 8.3 Facilities Manager 1 7.7
Others 1 7.1 More than 50 years 1 8.3 Medical Doctor 1 7.7
Total 13 92.9 Total 12 99.9 Medical Laboratory 1 7.7
Total 13 100 13 100
Table 5.
Respondents’
background and
hospital building
characteristics
Defects in
Malaysian
hospital
buildings

working in private hospitals and 5 in public hospitals. A closer examination of Table 5 reveals
that the respondents included 5 nurses, 5 engineers, 1 medical doctor, 1 mechanical engineer,
1 facility manager, and 1 medical laboratory technician. This uneven distribution of
specialised professionals suggests the critical need for additional professionals in various
departments.
4. Discussion
The location of the hospital buildings is shown in Table 5; they were from six states.
Additionally, it reveals the respondents’educational background. All respondents were
educated, holding either an undergraduate or postgraduate degree. This observation proves
that one needs to have a relatively high educational qualification and requisite knowledge to
work as a hospital engineer or facility manager. Two of the thirteen respondents had a
postgraduate degree, while nine had an undergraduate degree. Table 6 illustrates the number
of years the respondents had worked in their hospitals; 10 have less than 5 years of
experience, while 3 have between 11 and 15 years of experience.
According to the survey’s descriptive data, more than 40% of customers reported
experiencing problems but remaining overly satisfied or extremely delighted with the
building’s components. Although 60% believe that defects do not occur frequently, 15%
believe that defects do arise with building maintenance management. The reliability and
validity of the pooled data were 0.505 and 0.575, respectively. These findings corroborated
the one-sample t-test results, indicating that all structural problems were present. This was
sufficient because a value less than 0.000001 implies multicollinearity and Hinton (2014)
affirmed this as well. According to this study, the most frequently occurring errors in hospital
buildings are multidimensional. The commonalities were all greater than 0.5, indicating that
the faults showed several common variants.
Additionally, the frequency of various flawsin construction components is given in Table 6.
Not frequently occurs at 3, very frequently occurs at 2, frequently occurs at 7, and quite
frequently occurs at 1. The findings indicate that the average respondent confirmed thatfaults
frequently occur in their properties. Similarly, the performance and user satisfaction ratings of
the buildings shown in Table 6 indicate the following: 3 are least satisfied, 7 are less satisfied, 2
are satisfied, and 1 is extremely satisfied. This result suggests that the average respondent
believes their building’s performance and overall user satisfaction are below the desired
expectation. Thus, the study argues that a comprehensive approach should be taken to the
maintenance practices and management of hospital buildings to optimise their performance
and functionality while also exceeding users’expectations and overall satisfaction.
Defects occur in the
building
Academic
background Work experience
Overall building
performance
F% F% F% F%
Not often 3 21.4 Bachelor 8 57.1 Less than
5 years
10 71.4 Least
satisfied
3 21.4
Very often 2 14.3 Master 2 14.3 5–10 years 1 7.1 Less
satisfied
7 50.0
Often 7 50 Diploma 3 21.4 11–15 years 2 14.3 Satisfied 2 14.3
Extremely
often
1 7.1 7.1 1 92.8 Very
satisfied
1 7.1
1 7.1 1 1 92.9
13 92.9
Total 14 99.9 14 99.9 14 92.8 14 92.8
Table 6.
Respondents’
professional
characteristics and
perception on
buildings’performance
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Tables 5 and 6show that over 92.9% of the respondents were qualified professionals with
the requisite academic background and work experience in the relevant departments. The
percentage age of the buildings stands at 85.7%, and the classification of the hospitals and the
locations, were 92.9%. The determinants of defects were 92.9%, and the lack of building and
service register and the absence of clear maintenance objectives are recorded as 85.7%. The
cumulative mean score is 3.295 and the cumulative standard deviation is 0.121. This indicated
that the mean ±1 standard deviation (SD) is 70%, the mean ±2 standard deviations are 95%,
and the mean ±3 standard deviation is 99%. The cumulative mean score of 3.30, and
cumulative standard deviation 1.30.
The mean for the highest and lowest rankings were 3.429 and 1.520, respectively, with
3.214 and 1.040 being constant. This indicates that the defects in the buildings principally
occur due to the negligence of maintenance management based on the results of this study.
The standard deviation value indicates the distribution of scores around the average mean.
The smaller the standard deviation, the nearer it is to the average score. Table 7 below
contains the average standard deviation of the overall defects in the hospital buildings, which
is 1.229. This figure indicates that the structures are in a deplorable condition and, therefore,
Ranking defect in hospital buildings Mean Std Deviation Rank
Faulty fans 3.420 1.348 1
Faulty fire alarm 3.357 1.109 2
Fire heat extractor 3.357 1.109 3
Damaged roof structure 3.357 1.230 4
Damaged taps 3.357 1.230 5
Pipes Leakage 3.357 1.288 6
Faulty Elevator/lifts 3.357 1.288 7
Faulty electrical circuit 3.357 1.288 8
Faulty sanitary appliance and
fittings
3.357 1.342 9
3.357 1.109 10
Faulty fire extinguisher 3.357 1.288 11
Faulty Elevator/lifts 3.357 1.230 12
Troubleshooting 3.357 1.230 13
Staircase handrail damage 3.357 1.109 14
Faculty fire extinguisher 3.286 1.278 15
Cracked staircases 3.286 1.220 16
Lifts failures 3.286 1.278 17
Faculty air conditioning
system
3.286 1.278 18
3.286 1.385 19
Failed furniture and fittings 3.286 1.385 20
Blocked water closet 3.214 1.206 21
Damaged ceiling 3.214 1.264 22
Faulty Frames 3.214 1.264 23
Weather and climate condition 3.214 1.264 24
Sink leakage/blocked 3.214 1.372 25
Collapse drains 3.214 1.372 26
Damaged/cracked walls 3.214 1.319 27
Damaged door locks 3.214 1.472 28
Damaged window 3.214 1.319 29
Floor tile failure 3.214 1.472 30
Cracked floor 3.214 1.520 31
Average mean 3.3 32
Table 7.
Ranking defects in
hospital buildings
Defects in
Malaysian
hospital
buildings

in urgent need of maintenance. Cracked floors and defective floor tiling are prevalent defects
across hospital buildings. Respondents indicated that these defects impair their buildings’
performance and raise users’concerns about safety, as it could result in tragic accidents.
Thus, it can be concluded that these two defects significantly affect the performance of
buildings (Rotimi et al., 2015;Paton-Cole and Aibinu, 2021). Additional deficiencies in hospital
buildings, such as faulty fire alarm systems, malfunctioning lifts, blocked water closets,
damaged ceilings, and malfunctioning door locks, irritated users, who expressed frustration
over random water supply outages and safety concerns about collapsing ceilings and
malfunctioning door locking systems (Tan, 2018). The following section summarises several
of the most serious defects and the defects rationality Table 8.
Numerous factors contributed to defective windows, including a lack of protection,
materials, design, workmanship, and design (Ismail et al., 2011). The findings indicate that
most building users agree that the windows should be repaired regularly. According to some
users, the building’s performance required maintenance, while others asserted that door
malfunctions are relatively common in the structures. This finding appears counter-intuitive,
given the rarity of hospital windows being open. Defective windows were caused by poor
design, incompatible materials, and poor craftsmanship during manufacturing and
installation (Ismail et al., 2011).
Defect Validity
Damaged ceilings 0.565
Cracked floor 0.642
Damaged door locks
Peeling paint on walls
0.458
0.687
Water closet 0.667
Damaged taps 0.787
Showers 0.656
Fans 0.798
Sanitary appliance and fittings damages 0.632
Floor tile s 0.798
Faulty air conditioning systems 0.573
Roof structure damages 0.562
Sinks 0.465
Damaged/cracked walls 0.421
Faulty bulbs 0.343
Faulty towel rail 0.425
Weather and climate conditions 0.487
Faulty frames 0.515
Faulty elevator/lifts 0.558
Lifts failures 0.437
Cracked staircases 0.686
Pipes leakages 0.735
Wall tiles 0.625
Doors 0.756
Failed furniture and fittings 0.554
Drains 0.582
Staircases handrails damage 0.456
I Faulty electrical circuit 0.423
Algae on concrete floors 0.345
Windows 0.421
Cracked walls 0.478
Faulty fire alarm 0.522
Table 8.
Showing correlation of
defects
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Similarly, clogged water closets are produced by throwing useable materials into the
closets, which causes leakage. Most leakages are caused by usage or misuse, exacerbated by
inadequate maintenance. It could, for example, result in water seepage, tile failure, and water
waste. This could wreak havoc on the users’ability to use it. As a result of the blockages in the
water closets, the users become irritated. The blocked water closets issues are less critical
issues that, if rectified immediately, would avoid further deterioration and depreciation of the
facilities and lengthen the useful life of the building (Ahzahar et al., 2011).
Similarly, hospital buildings can suffer from high maintenance costs, including replacing
defective components. These additional costs frequently result in underfunding other sectors
and the use of substandard materials, all of which contribute to maintenance issues. Defects
in hospital structures appear to have a negative impact on the buildings’conditions, mainly
because they can lead to accidents or disasters, as well as higher maintenance costs in the
long run.
The incidence of defects such as defective floors (floor tiles/floor finishes), walls (finishes/
painting), columns (finishes/painting), ventilators, doors, lighting bulbs, operable alarm bells,
and lamps ceilings, among others, should be avoided, according to this study (Salleh et al.,
2020). The survey results show that majority of the users resolved that walls tiles slightly or
fairly critical occurred. About some percentage stated that defect walls tiles fairly critical
occurred. Cracks on internal walls can be caused by poor materials, poor maintenance, usage
and initial design (Olanrewaju and Tan, 2022). This finding implies that all the respondents’
responses touched on the extensive nature of defects in the hospital buildings, which
reinforces this study’s assertion about the pertinence of adopting a more proactive approach
toward addressing the issue of defects in hospital buildings.
Numerous reports from several maintenance organisations suggest that budgetary
allocations are often determined based on previous financial records. Although this approach
significantly eliminates the allocation of unnecessary maintenance budgets, it is highly
disadvantageous. For example, if unexpected expenditures for hospital building defects
exceed the pre-planned budget, quickly obtaining additional funds could be challenging,
escalating the problem. The practice of solving maintenance problems based on mere
assumptions is a problematic and widely contested issue. The complaints from hospital users
about the defects in their buildings and evidence from media and government reports
demonstrate the retrogressive and impractical nature of such an approach to maintenance.
Moreover, the prioritisation of costs over the urgency of maintenance and the inherent
risks that defects pose to users of hospital buildings is highly worrisome. Unless the older
hospital buildings in Malaysia are refurbished and upgraded, they cannot compete with their
global contemporaries that adopt innovative maintenance services. Likewise, since the
construction technique of buildings plays an indispensable role in their lifespan, it is vital to
take elements such as the design, patterns, environmental standards, and available space into
consideration as they remarkably influence the progression of defects in buildings. The
prevalence of defects in hospital buildings can be solved foundationally by utilising durable
and superior quality materials that would extend the lifespan of the buildings and drastically
decrease the rate of deterioration. It is also imperative to use excellent quality and durable
resources in hospital building maintenance to eradicate building defects. Additionally, to
ensure that buildings do not depreciate rapidly, proactive maintenance approaches should
adopt to preempt defective building components such as peeling wall paint, water leakages,
drainage issues, as well as electrical and mechanical problems. Furthermore, the following
defects in the hospital buildings are faulty fan, faulty fire alarm, fire heat extractor, damaged
roof structure, troubleshooting, damaged taps, pipes leakage, faulty elevator/lifts, faulty
electrical circuit, faulty sanitary appliance and fittings, faulty fire extinguisher, faulty
elevator/lifts and staircase handrail damage. If the defects parameters greater than average
mean it showed the significance level of defects in the hospital building performance.
Defects in
Malaysian
hospital
buildings

Each of the defects has significant effects on the hospital performance of each variable on
the mileage. The defects devalue hospital performance would be tilted or reduces its
appearances and functionality. Therefore, the listed defects must be given adequate attention.
5. Summary and recommendation
This study sought to examine the defects in hospital buildings in Malaysia to proffer viable
strategies to solve the highlighted problems and ameliorate the proliferation of maintenance
problems. Data were collected through quantitative survey questionnaires administered to
professionals in various specialisations within the healthcare industry to achieve this goal.
As previously stated, hospital buildings are complex and challenging to maintain. Therefore,
it is pertinent to take cognisance of problems such as user satisfaction, long-term durability
and performance, as well as unforeseen circumstances during the design planning stage to
preempt untimely defects and the consequences thereof. Technically speaking, the
determinants of defects in the hospital buildings or required were found both in public
and private hospitals. However, when compared, the rankings of the defect determinants
differ in public and private healthcare facilities. According to the mean and standard
deviation ranking, the defective hospital conditions identified include the following: cracked
floor, floor tile failure, wall tile failure, blocked water closet, damaged window, damaged
ceiling, damaged door locks, faulty shower, and faulty fans. Hospital building maintenance
remains a grave issue of concern, one that is further complicated by the fact that hospitals
operate twenty-four hours round the clock.
Nonetheless, the effective maintenance of hospital buildings cannot be overlooked as it
considerably impacts their operation, functionality and quality of the healthcare service
delivery. Hospital maintenance aims to professionally manage and maintain the hospital’s
physical building and its component by providing excellent services to customers at reasonable
charges. This would provide a conducive environment for healthcare professionals to perform
optimallytheir delivery of healthcare services, which will motivate them (Jesumoroti and Draai,
2021). Thus, there is an urgent need to control, monitor, and measure the maintenance
performance of hospital buildings using proactive and innovative approaches.
As previously mentioned, this study constitutes part of a more extensive ongoing
research. Hence, it is burdened by several limitations, such as the global COVID-19 pandemic,
the availability of respondents, building details, and further identification of feasible
solutions to ameliorate defects and alleviate hospital buildings’performance. Additional
research areas include the identification of innovative renovation and corrective maintenance
methods, the influence of rework, and equitable distribution of responsibility for the
production of high-performing hospital buildings. This study offers invaluable insights for
maintenance organisations and maintenance department staff who are genuinely interested
in improving hospital buildings maintenance management to optimise their performance and
enhance user satisfaction of hospital buildings in Malaysia and globally. This study does not
only contribute to the existing body of knowledge, but it could also prove indispensable for
further research regarding the redefinition of building maintenance efficiency and the
performance of hospital buildings which voids of defects.
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Corresponding author
Christtestimony Jesumoroti can be contacted at: christtestimony@yahoo.com
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Defects in
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