Mapping Knowledge Needs of Hospital Estates and Facilities Management Teams: Insights from a Delphi Study


  • Carl-Magnus von Behr University of Cambridge
  • Prof Tim Minshall Institute for Manufacturing, Department of Engineering, University of Cambridge
  • Prof John Clarkson Engineering Design Centre, Department of Engineering, University of Cambridge



Estates and facilities management, knowledge needs, Delphi study, organisational hierarchy


The role of Estates and Facilities Management (EFM) in the healthcare sector is often overlooked despite its crucial contribution to the efficient delivery of clinical services. This paper explores the knowledge needs of EFM professionals at different job levels within the National Health Service (NHS) in the UK. Using a modified Delphi-technique approach, we collected data from three rounds of online questionnaires with a total of 152 EFM professionals. With the use of content analysis and descriptive statistics, we identify the most commonly reported knowledge needs across different organisational levels. Hierarchical clustering heatmaps visualise these varying knowledge needs of different job roles and their priority levels, allowing for easy identification of target areas for professional development. We identify four key categories of knowledge areas, illustrating evolving needs as professionals progress in their careers. Within these areas, four trends emerged across various hierarchical levels. Firstly, a reliance on external Authorising Engineers (AEs) for Technical Expertise & Experience, Benchmarking & New Technologies, and Professional Development was evident, raising concerns about aligning organisational expectations with top management expertise. Secondly, the skills required for the sustainability and digitalisation agenda lack emphasis, highlighting a crucial gap between organisational strategy and practical focus. Collaborative Proficiency surfaced as important for Managers and Heads of EFM, underscoring the importance of interdisciplinary collaboration. However, at the Director of EFM level, there is a lower emphasis on networking and collaboration, which is in contrast to the current restructuring of the NHS towards Integrated Care Systems. Furthermore, the Directors of EFM have a strong focus on Financial Management skills, possibly influenced by the prevalent Board reporting structures. This focus, paired with the lack of focus on Technical Expertise & Experience and Benchmarking & New Technologies could influence the ability to secure funding for cutting-edge technologies while posing a large financial risk of relying on legacy systems. These findings underscore the need for targeted training programmes addressing these disparities and emphasise the importance of aligning organisational structures with evolving knowledge needs for effective healthcare EFM management. The research contributes to the understanding of knowledge management in organisational hierarchies and offers a framework applicable to other sectors and organisations. To enhance understanding, future studies could delve deeper into the identified trends, aiming to uncover the underlying causes and intricacies shaping the identified patterns.