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The history of the development of non-clinical services in infection control (IC) dates back to the pre-modern era. There is evidence of health-care facility management (HFM) services in Roman military hospitals. With the fall of the Roman Empire, Christian beliefs and teaching shaped the development of HFM in monastic hospitals. It was not until the late Victorian era that the link between HFM services and diseases caused by “miasma”, or bad air, became established. The discovery of bacteria in the modern scientific era reduced the level of importance previously attached to non-clinical causes of infections. Today, in the NHS, HFM services continue to be treated as though they had no real role to play in IC. This paper aims to collate historical and epidemiological evidence to show the link between HFM and IC.

The evidence gathered in this research paper is primarily based on an in-depth review of research from a wide range of sources. A “within-study literature analysis” was conducted to synthesise the research materials. This involved the application of “between-source triangulation” to verify the quality of the information contained in the studies, and “between-source complementarity” to provide an in-depth elaboration of the historical facts.

Historical and epidemiological evidence shows that HFM services such as cleaning, waste management, catering, laundry and maintenance continue to play a crucial role in IC. This is corroborated by evidence gathered from the work of renowned pioneers in the field of IC. However, reforms in the NHS have failed to consider this, as HFM services have been largely fragmented through different partnership arrangements.

Among many other things, this research raises the profile of HFM staff in relation to the issue of IC in hospitals. It presents convincing evidence to show that the relationship between the clinical and non-clinical domains in controlling infections in hospitals has a long history. The findings of this research give HFM staff invaluable information about the significant role of their profession in the control of infections in hospitals.

This is one of the few studies examining the historical development of HFM services, as well as their contribution to IC. Other work in this area has mainly been framed from a clinical health-care perspective.

The purpose of this paper is to examine the research design, issues and considerations in the application of the Delphi technique to identify, refine and rate the critical success factors and performance measures in maintenance-associated infections.

In-depth literature review through the application of open and axial coding were applied to formulate the interview and research questions. These were used to conduct an exploratory case study of two healthcare maintenance managers, randomly selected from two National Health Service Foundation Trusts in England. The results of exploratory case study provided the rationale for the application of the Delphi technique in this research. The different processes in the application of the Delphi technique in healthcare research are examined thoroughly.

This research demonstrates the need to apply and integrate different research methods to enhance the validity of the Delphi technique. The rationale for the application of the Delphi technique in this research is because some healthcare maintenance managers lack knowledge about basic infection control (IC) principles to make hospitals safe for patient care. The result of first round of the Delphi exercise is a useful contribution in its own rights. It identified a number of salient issues and differences in the opinions of the Delphi participants, noticeably between healthcare maintenance managers and members of the infection control team. It also resulted in useful suggestions and comments to improve the quality and presentation of the second- and third-round Delphi instruments.

This research provides a research methodology that can be adopted by researchers investigating new and emerging issues in the healthcare sector. As this research demonstrates, the Delphi technique is relevant in soliciting expert knowledge and opinion to identify performance measures to control maintenance-associated infections in hospitals. The methodology provided here could be applied by other researchers elsewhere to probe, investigate and generate rich information about new and emerging healthcare research topics.

The authors demonstrate how different research methods can be integrated to enhance the validity of the Delphi technique. For example, the results of an exploratory case study provided the rationale for the application of the Delphi technique investigating the key performance measures in maintenance-associated infections. The different processes involved in the application of the Delphi technique are also carefully explored and discussed in depth.

Healthcare maintenance (HM) services have an important role in the control of hospital-acquired infections (HAIs). Notwithstanding, many HM managers still do not measure the performance of HM services in infection control (IC). This research, therefore, aims to establish the level of importance of critical success factors (CSFs) and performance measures in HM IC. A performance measurement tool (PMT) was also developed to improve the performance of the HM unit in IC.

The CSFs and performance measures identified in the literature were categorised into the four perspectives of balanced scorecard and analysed through Delphi. The Delphi participants were presented with 67 performance measures and asked to rate their level of importance in HM in IC. In total, they identified 53 important performance measures to control maintenance-associated HAIs. The results obtained from the Delphi study were used to categorise the performance measures into four means zones. The mean zones were assigned weights (1-4), and the level of importance of the CSFs was established through weighted average. Liaison and communication, IC practices and maintenance resource availability emerged as the most important CSFs in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC.

The following CSFs, liaison and communication, IC practices and maintenance resource availability, emerged as the most important in HM in IC. Conversely, customer satisfaction emerged as the least important. Information gathered about the CSFs and performance measures was used to develop a PMT in HM in IC.

Through the application of the PMT, performance in IC can be estimated at different levels in the HM unit. The PMT allows managers to focus on the most crucial CSFs and performance measures that drive performance in HM in IC. The PMT could also be used for benchmarking purposes.

Design and build has increased in its use for construction procurement in recent times. However, its performance as a procurement method has been widely criticized by professionals in the construction industry. This paper reports a survey of 40 architects, using a structured questionnaire to investigate the performance of contractor‐led design and build in project procurement. Although 20% of architects' private sector workload (and 8% of public sector) is derived from D&B, they perceive this procurement type to involve sacrificing product quality and design innovation. Where clients insist on a choice of D&B, architects generally prefer the use of either novation D&B or develop and construct, rather than ‘traditional’ D&B.