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Natural disasters have caused death and damage in many places, with the health sector particularly vulnerable to such havoc. Hospitals have collapsed, or been so severely damaged that they have had to be evacuated. It appears that many of them have suffered a distinct lack of disaster mitigation planning during the design and construction phases. To ensure that healthcare facilities can continue to operate after a disaster has struck, at the very moment when they are needed most, the design methodology discussed in this article should be adopted. A successful outcome also demands strong collaboration from all participating construction professionals.

In recent decades, the construction industry has developed a range of procurement strategies to overcome perceived problems of inefficiency in the hospital building process.

Few would argue that maintenance is not a problem. Practices do not eliminate problems, but only proper practice makes perfect maintenance. To master management of building services maintenance, there is no better teacher than experience. You must plan your maintenance system thoughtfully and try it out together with your professional knowledge. The system outlined in this article gives a systematic procedure in setting up a workable maintenance plan. The tedious management work and the inconvenience caused to a busy or new maintenance department will probably mean greater pressure of work for the maintenance engineer in the first year, but thereafter the pressure will be less than before and benefits of an organised system of maintenance will repay the effort of introducing it. It is essential that the paperwork be as simple as possible and very flexible in operation so that amendments can be made easily. Preparation of paperwork is by no means easy. It is highly likely that your schedules and programmes will have to be rewritten two or three times before arriving at the optimum plan. My management lecturer once told me: "Without a plan and a programme, you don't know whether you have done all the things that you need to do, and you will end up with many problems." Good planning gives you confidence, but take my advice--do not over plan. Too much paperwork can be just as bad if not worse than too little paper. Information will be of no use if it cannot be read, digested and used in practice.

Readers are recommended to make good use of the concepts of "Failure Model Effects and Criticality Analysis" as discussed above. These should provide a more comprehensive study of reliability and availability of building services. The assessment methodology presented in this article is to a certain extent subjective. It is considered that a more quantitative and comprehensive study based on reliability and availability data from similar hospitals over recent years will help the analysis. Building services maintenance involves risk. Risks must be assessed before a design is fully implemented. The risks associated with building services installation have to be assessed at all stages, from concept to dismantling and disposal. This will ensure that risks are acceptable and manageable within the parameters defined by the overall cost and engineering requirements, statutory obligations and good practice.

The benefits to be gained from the application of both value engineering (VE) and quality systems--e.g. quality assurance (QA), and total quality management (TQM)--to the management of building services maintenance have yet to be realised by the building services industry. These concepts are particularly applicable to complex hospital engineering services.

The procurement of complex and highly serviced hospital buildings is always fraught with the expensive and complicated problem of inadequate coordination of building services. Obviously, this problem is detrimental to the success of any project. All project practitioners must respond positively to increasingly complex building design and construction and higher expectations of their clients. To give greater value improvement in construction, the present way of managing building services design and installation must be "re-engineered" whether we use traditional or nontraditional procurement methods. This will require a cultural shift in our industry as a whole, away from adversarial relationships to more cooperative and partnering relationships. The author's research based on case studies in Hong Kong indicates that there is no best procurement practice. Rather, there is appropriate management of building design and construction. The results also show that good building services coordination can only be achieved by a good building team having a fully integrated and coordinated design, an appropriate integrating mechanism, a fair contract, effective management of coordination, mutual trust and respect, highly integrated supply chain management, greater co-operation and involvement, efficient managerial control of the whole design and construction process and the use of re-engineering of construction. All these attributes can give significant improvement in time, cost and quality performance needed by each member of the building team.

This paper has examined the important responsibilities of the two organisations involved in the provision of maintenance service for the vital building services in many of our highly serviced buildings. The issues raised could be put to beneficial use in both clients and maintenance providers. All in all, the clients should work closely with their maintenance providers. Engineering services in buildings will not perform satisfactorily and efficiently if both parties do not work together and understand the maintenance tasks based on a business partnering mode. Put forward is the view that the management of the activities involved in the operation and maintenance process is a "shared commitment/involvement" between the client and the maintenance provider. It is obvious that many factors can influence the continued effectiveness of a quality maintenance scheme set up by client and provider. Some of these factors are: Change in key personnel Updates in technology Amendments to engineering practice Implementation of legislative requirements Changes in operation by client or provider Change of use of building Passage of time These factors must be fully reviewed by both parties from time to time, and necessary actions taken. A cooperative team working relationship and improved communication should be fostered by the client and his provider for the best management of services maintenance. This arrangement will contribute to better building services systems with continuous improvement; improved value for clients and higher return for the maintenance provider.

The question of whether design and build is the best procurement system is hard to tell as other procurement alternatives (main-contractor and principal services contractor coupled with project management team, and construct management method plus good building team) can also give satisfactory results. Besides, it is also known that there is no standard solution or best buy amongst procurement systems. Indeed, there is no single method of procurement which can be suitable for every project for all time. It is also accepted that the choice and use of an inappropriate procurement system is not the only reason for inefficient project management, people and experience are far more important than strategy. Coordination of building services has a direct bearing on the success of a hospital project. Services must be fully integrated and coordinated. One thing is clear, as far as building services coordination is concerned, the traditional procurement system is not conducive to effect coordination process, however, the integrated nature of D&B has relieved all the burdens on the client's design team, and, from the face of this procurement path, all coordination problems that the client would normally encounter from the traditional method will no longer exist. Of course, the technical and managerial problems in relation to coordination still exist but they would all be passed to the contractor side. To protect the contractor's interest, all coordination problems would still have to be managed and controlled by D&B contractor and his specialist contractors expeditiously. Indeed, if design is not fully integrated, and construction and services are not completely coordinated, no matter how integrated is the team, D&B method will not work. To sum up, the author's discussions can be summarized as follows: Project success can be enhanced by engendering a team spirit and a high degree of cooperation between project participants. This can be achieved by the use of non-traditional procurement systems. Building services and hospital engineering systems must be properly coordinated at both design and installation stages. Coordination must be seen as both technical and managerial issues. A professional building team can manage the complex issues of services coordination. But it is known that an integrated building team can give better result. D&B is not a panacea, other procurement paths with adequate project management can provide a better alternative than either the traditional or the design and build system.

The question of whether design and build is the best||| procurement system is hard to tell as other procurement alternatives||| (main-contractor and principal services contractor coupled with project||| management team, and construct management method plus good building team) can||| also give satisfactory results. Besides, it is also known that there is no||| standard solution or best buy amongst procurement systems. Indeed, there is no||| single method of procurement which can be suitable for every project for all||| time. It is also accepted that the choice and use of an inappropriate||| procurement system is not the only reason for inefficient project management,||| people and experience are far more important than strategy. Coordination of||| building services has a direct bearing on the success of a hospital project.||| Services must be fully integrated and coordinated. One thing is clear, as far||| as building services coordination is concerned, the traditional procurement||| system is not conducive to effect coordination process, however, the integrated||| nature of D&B has relieved all the burdens on the client's design team,||| and, from the face of this procurement path, all coordination problems that the||| client would normally encounter from the traditional method will no longer||| exist. Of course, the technical and managerial problems in relation to||| coordination still exist but they would all be passed to the contractor side.||| To protect the contractor's interest, all coordination problems would still||| have to be managed and controlled by D&B contractor and his specialist||| contractors expeditiously. Indeed, if design is not fully integrated, and||| construction and services are not completely coordinated, no matter how||| integrated is the team, D&B method will not work. To sum up, the author's||| discussions can be summarized as follows: Project success can be enhanced by||| engendering a team spirit and a high degree of cooperation between project||| participants. This can be achieved by the use of non-traditional procurement||| systems. Building services and hospital engineering systems must be properly||| coordinated at both design and installation stages. Coordination must be seen||| as both technical and managerial issues. A professional building team can||| manage the complex issues of services coordination. But it is known that an||| integrated building team can give better result. D&B is not a panacea,||| other procurement paths with adequate project management can provide a better||| alternative than either the traditional or the design and build||| system.