Maintenance is crucial for healthcare facilities in terms of both the continuity of operations and annual costs. Many maintenance issues are associated with design decisions that pave the way for added costs in later lifecycle stages. Some systems, e.g., elevators, are sources of maintenance costs; additionally, elevator outages are significant issues for multi-floor healthcare facilities. Considering the maintainability of elevators from the early design stages helps to highlight potential maintenance issues in later stages. This also assists in mitigating costs by avoiding design decisions that result in future maintenance costs. This research uses the expertise of facility managers who have experience with maintenance issues resulting from design decisions. A list of 35 elevator maintenance issues caused by design flaws is presented in this paper, based on the literature and semi-structured interviews with a representative sample of six healthcare facility management experts. Then, a questionnaire using convenience sampling was conducted with facility management professionals to evaluate and rank the maintenance issues. While 60 professionals responded, only 30 attempted the four-parameter evaluation of all listed maintenance issues. The results of the questionnaire determined elevator car jams, sudden stops, and working space conditions to be the most critical issues faced by facility managers in healthcare facilities. The output of this study can help designers of new healthcare facilities to avoid decisions that result in unwarranted maintenance issues with costly impacts.

Medical gas pipeline systems (MGPSs) are crucial for operating healthcare facilities as life-saving systems. The sustainability of MGPSs mandates optimum performance by reducing maintenance and repairs. Since faulty design is inventible, healthcare facilities endure several design-caused maintenance issues that endanger the sustainability of healthcare services and maintenance life cycle costs. These design decisions could have been avoided if proper consideration for maintenance had been applied. Eleven experts participated in semi-structured interviews guided by Staticized Group Techniques to identify and evaluate the maintenance issues. The results included identifying 52 design-related maintenance issues that pose maintainability risks. The findings primarily fall under emergency gas supply availability, future expansion readiness, and accessibility of maintenance. The most critical issue found is the excessive cutting-outs of the pipelines when upgrading the system. For new healthcare facilities, the results of this research provide practical help for designers to avoid MGPS issues. A scarcity of benchmark research and geographical factors are some limitations to this study.