DEVELOPING A KNOWLEDGE MANAGEMENT FRAMEWORK FOR FACILITIES MANAGEMENT SERVICES FOR THE CONTROL OF EXOGENOUS HEALTHCARE ASSOCIATED INFECTIONS (HCAI) IN NHS HOSPITALS CHRISTOPHER MACCARIUS EJEH School of the Built Environment University of Salford Manchester - M5 4WT England - United Kingdom. Submitted in Partial Fulfilment of the Requirement for the Award of Doctor of Philosophy, January 2017 TABLE OF CONTENTS Page Table of Content ......................... ......................................................................................... …..i List of Figures………… .............. ......................................................................................... .…x List of Tables………………… ... ......................................................................................... .xiii Acknowledgement……………….. ....................................................................................... ...xv Dedication……………………………. ................................................................................. ..xvi Declaration………………………......................................................................................... xvii List of Abbreviations: .................. ………………………………………………………….xviii Abstract ....................................... ......................................................................................... ...xx Chapter 1. introduction ...................................................................................... 7 1.1. Research Background ....................................................................................................... 7 1.2. An Overview of HCAIs in the UK ...................................................................................... 9 1.3. Sources and Routes of HCAIs ........................................................................................... 12 1.4. Importance of Facilities Management (FM) in the Control of HCAIs .............................. 14 1.5. Identification of Gaps… .................................................................................................... 17 1.6. Justification for the Research ............................................................................................ 18 1.7. Research Aim………… .................................................................................................... 21 1.7.1. Research Objectives .................................................................................................. …21 1.7.2. Research Questions ....................................................................................................... 22 1.8. Scope of the Research ..................................................................................................... 23 1.9. Anticipated Contribution to Knowledge............................................................................ 26 1.10. Research Methodology .................................................................................................... 27 1.11. Structure of the Thesis ..................................................................................................... 28 1.12. Summary…………… ..................................................................................................... 29 Chapter 2. LITERATURE REVIEW ............................................................. 30 2.1. Introduction…………. ..................................................................................................... 30 2.2. The National Health Service (NHS): an overview ............................................................ 30 i 2.2.1. The organisational structure of the NHS ....................................................................... 32 2.2.2. Delivering NHS services ............................................................................................... 34 2.2.3. The NHS estate .............................................................................................................. 36 2.3. Healthcare-associated infections (HCAIs): an overview................................................... 37 2.4. Factors involved in the prevalence of HCAIs ................................................................... 38 2.4.1. Pathogens associated with HCAIs ..................................................... …………………39 2.4.2. Patient susceptibility ...................................................................................................... 42 2.4.3. Environmental factors.................................................................................................... 43 2.5. The economic and socio-cultural burden of HCAIs .......................................................... 45 2.6. The management approach to healthcare-associated infections ........................................ 46 2.6.1. The infection control team (ICT)................................................................................... 46 2.7. What is Facilities Management? ....................................................................................... 48 2.8. The Facilities Management interface in the control of exogenous HCAIs ....................... 51 2.8.1. The facilities manager’s operations at the design project management phase of healthcare facilities in the control of HCAIs ............................................................... 54 2.8.2. The facilities manager's operations at the occupancy phase of healthcare facilities in the control of HCAIs ......................................................................................................... 58 2.9. The paradigm of knowledge and knowledge management: a literature review ................ 68 2.10. The knowledge management process in facilities management services for the control of HCAIs……………… ..................................................................................................... 73 2.10.1. Hospital healthcare knowledge infrastructure capabilities .......................................... 79 2.11. Chapter summary….. ..................................................................................................... 83 Chapter 3. A Conceptual Framework ............................................................. 85 3.1. Introduction…………. ..................................................................................................... 85 3.2. Overview……………. ..................................................................................................... 85 3.3. Conceptual frameworks ..................................................................................................... 85 3.3.1. The elements of the conceptual framework ................................................................... 86 3.4. Chapter summary……. ..................................................................................................... 92 ii Chapter 4. RESEARCH METHODOLOGY ................................................. 94 4.1. Introduction…………. ..................................................................................................... 94 4.2. Research methodology – a theoretical overview ............................................................... 94 4.2.1. The Adopted research methodological process ............................................................. 97 4.3. Research philosophy… ..................................................................................................... 98 4.3.1. Epistemology ............................................................................................................... 100 4.3.2. Ontology ...................................................................................................................... 104 4.3.3. Research reasoning - axiology ..................................................................................... 106 4.3.4. Research approaches: inductive, deductive and abductive .......................................... 106 4.3.5. The research philosophy adopted ................................................................................ 108 4.4. Research strategies….. ................................................................................................... 112 4.4.1. Survey strategies .......................................................................................................... 114 4.4.2. Case study strategies .................................................................................................... 115 4.4.3. The experimental research strategy ............................................................................. 116 4.4.4. The ethnographic research strategy ............................................................................. 116 4.4.5. The action research strategy ........................................................................................ 116 4.4.6. The grounded theory research strategy ........................................................................ 117 4.4.7. The mixed methods research strategy ......................................................................... 117 4.5. The research strategy adopted - mixed methods ............................................................. 124 4.5.1. Justification for the research strategy adopted ............................................................ 125 4.6. Time horizon – longitudinal vs cross-sectional studies ................................................... 129 4.7. Research methods/data collection techniques ................................................................. 129 4.7.1. Document