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in maintenance and repair. While this is a measurement and data point, the reason for the higher cost could be multifac- eted. Operating climate zones, labor rates, quality preferences or even the amount of deferred maintenance existing or from previous years fi nally making an impact could all be factors in this $1.25 variance. Most well-established healthcare systems often have a long history of providing supe- rior patient care. This long history is often the driver for higher than normal costs as a result of deferred maintenance. As shown in the four hospital system evaluation, there is a higher-than-expected maintenance and repair cost per square foot. Even with the consideration of the other factors, deferred maintenance more often is a main cause. So much focus goes into front line patient care that often budget shortfalls lead to the cur- tailment of recommended maintenance, re- pair and replacement of facility equipment. This example goes to prove that ne- glecting facility maintenance is similar to neglecting one's health. Deferring routine procedures or replacements for patients has the same ef ect as deferring facility improve- ments. Eventually the patient will end up in the emergency room and that unplanned emergency care has a much higher fi nancial cost than a proactive approach. Maintaining facilities is the same. For healthcare systems that have a long history, eventually the deferrals of the past will show up as today's "emergency room visits" with higher cost per square foot num- bers. A proactive strategy will help to reduce exorbitant emergency fi xes. Facility cost modeling and bench- marking do not guarantee a desired or needed budget. However, it does provide a data point to demonstrate the impact deferral decisions will have. Benchmarking data is a valuable tool to be considered, but not neces- sarily mimicked. While an organiza- tion should evaluate its performance against that of the industry, it should be done in context. In the case of lowest cost, all dynamics must be considered. A healthcare organization can't cost cut its way to reliability, quality and superior performance. However, it should understand how it stacks up. Determining the "right" cost per square foot or per unit should consider more than just one cost number. Not every organization is the same. The intent is not necessarily to determine the right cost or the right decision; it is to provide leaders with the ability to derive the most informed decision. The identifi cation of a combina- tion of a few key input components and the subsequent weighting of those inputs will provide the highest potential for the successful leveraging of benchmarking data and the busi- ness decisions derived from the data. Truly attaining "best-in-class" per- formance is through the elimination of waste and defects in an organiza- tion to optimize cost and quality and still achieve superior performance. Timothy Schipper is the regional director for engineering solutions for CBRE U.S. Central, East and EMEA. He has over 20 years of experience in maintenance and operations. Schipper is a Certifi ed Maintenance Reliability Professional, Lean Six Sigma Black Belt and Reliability Centered Maintenance Practitioner. TO EVALUATE PERFORMANCE, THE BASIC STEPS IN THE PROCESS OF BENCHMARKING: > Determine what to benchmark > Measure and understand performance relative to that benchmark > Evaluate performance based on industry benchmarking data > Obtain facility cost modeling data to create "should/expected" baseline benchmark > Evaluate the process associated with that data to ensure data integrity > Plan and determine the target relative to the benchmark balancing cost and quality > Eliminate non-value- added activities, waste and defects to obtain desired cost and quality > Balance the triple bottom line of fi nancial, social and environmental responsibilities 52 Medical Construction & Design | M AY/ J U N E 2015 | MCDM AG.COM