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Journal of
Barriers to achieving digital twin Facilities
maintenance management of Management

constructed facilities in the Nigerian

health-care sector
David Ojimaojo Ebiloma and Clinton Ohis Aigbavboa Received 22 November 2024
Revised 30 January 2025
CIDB Centre of Excellence and Sustainable Human Settlement and Construction 16 March 2025
Research Centre, Faculty of Engineering and the Built Environment, Accepted 11 May 2025

University of Johannesburg, Johannesburg, South Africa

Abstract
Purpose – Digital twin technology offers multiple possibilities for efficient facility maintenance. However,
some challenges hinder their usage for managing constructed facilities in the health-care sector. Therefore, this
study aims to use the principal component analysis (PCA) to investigate the barriers to digital twin
maintenance management of health-care facilities in Nigeria.
Design/methodology/approach – The post-positivist philosophical perspective adopted in this study
informed a quantitative research approach using a questionnaire survey. Using a purposive sample, 442
respondents were selected from the Nigerian health-care industry. Maintenance personnel, top management
staff and heads of departments in Nigerian hospitals formulated the respondents. Descriptive analysis and PCA
were used for data analysis.
Findings – The analysis revealed that all the identified barriers ranked above the average mean, with
Insufficient research, corruption and budget allocation not systematically done, ranking the top three. PCA
clustered the variables into technical skill, management and financial barriers.
Practical implications – The study recommends conducting adequate research on digital twin usage within
developing countries, which will boost the readiness to implement the technology to maintain constructed
facilities. Due to its high cost, there is also a need for transparency and efficiency in allocating finances to fund
the uptake of digital twin technology.
Originality/value – The innovativeness and significance of digital twin technology portend the need to
explore the challenges that could hinder its easy adoption in managing constructed facilities.
Keywords Digital twin, Facilities, Maintenance management, Barriers, Hospital buildings,
Healthcare sector
Paper type Research paper

1. Introduction
Facility managers can use digital twins (DT) to decide on crucial topics like operation and
maintenance, energy consumption optimisation and building performance management (Lu and
Brilakis, 2019). The operational efficiency of the project is increased by gathering real-time data

© David Ojimaojo Ebiloma and Clinton Ohis Aigbavboa. Published by Emerald Publishing Limited.
This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may
reproduce, distribute, translate and create derivative works of this article (for both commercial and Journal of Facilities Management
non-commercial purposes), subject to full attribution to the original publication and authors. The full Emerald Publishing Limited
1472-5967
terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode DOI 10.1108/JFM-11-2024-0135

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 JFM that facilitates predictive maintenance and guarantees informed decision-making (Khajavi et al.,
2019). According to Khajavi et al. (2019), a building’s DT, for example, can allow facilities
managers to perform a “what-if” analysis, improving occupant comfort while lowering energy
use and consumption. Real-time and historical building occupancy data can be very helpful to
building management (Antonino et al., 2019). They could also enhance facility upkeep and
services. According to Gabor et al. (2016), DT simulates a real physical object to predict future
system states. The essential elements of DT are the data that connects the digital and physical
worlds and the dynamic, two-way interaction between virtual representations and real-world
objects (Tao et al., 2019). Furthermore, different types of DT are distinguished by the level of
data integration (Borgo, 2014). DT are fully integrated bi-directional data integrations between a
given physical object and the digital object, while digital shadows are independent single-
directional data flows between the physical and digital objects (Kritzinger et al., 2018). Digital
models that lack independent data contact between the physical thing and the digital object are
an example of this.
The COVID-19 pandemic fuelled the growth of the digital twin market in several sectors,
including retail, health care, energy and real estate, and this trend is predicted to continue,
according to research by Global Market Insight (2022). Therefore, several countries are
projected to use digital twin technologies to change their economies (Global Market Insight,
2022). In the same vein, numerous organisations are using DT technology to enhance their
supply chains and operational processes in an effort to recover from the pandemic’s
economic impacts (Technavio, 2022). A major factor in the current pace is the decreasing
cost of the technologies that enhance IoT and the DT. In addition, in recent years, DT has
benefited from key business applications, and it is anticipated that the technology will grow
to more use cases, applications and industries. Verdouw et al. (2021) validated this claim that
applications for DT technology have risen dramatically. In addition, cloud service providers
like Microsoft Azure and Google Cloud are introducing cloud-based DT platforms for
simple accessibility and specialised solutions. For instance, to give the manufacturing sector
visibility into processes inside their supply chains, Google Cloud introduced a supply chain
DT solution in January 2022 (Madni et al., 2019). DT technology deployment across various
applications has also accelerated with the rise of Industry 4.0 and IoT (Madni et al., 2019).
Innovative production techniques and cutting-edge technology, including cloud computing,
IoT, analytics, DT, digital scanning, 3D printing and AI, are used in Industry 4.0. Initiatives
related to Industry 4.0 heavily rely on DT technology. For asset and product lifecycle
management, more and more sectors are actively using DT solutions (Technavio, 2022).
Companies can now develop virtual versions of their goods and operations, allowing them to
foresee future decisions. Various benefits from the use of DT in the construction industry,
particularly in the management of built facilities, have been outlined by Madni et al. (2019).
Although its implementation could need a sizable up-front investment, the author claimed
that it is cost-effective in the long term and offered advantages for performance monitoring.
There are countless ways that DT technology can be used in the health-care sector
(Attaran and Celik, 2023). Research and markets (2022) explained that the health-care sector
is looking into ways to increase efficiency and cut expenses just like any other sector. The
burden to digitally alter and adjust to rising patient expectations is now on providers.
Because of this, there is growing interest in using technology like DT in the biological
sciences (Research and markets, 2022). Drug discovery and development are finding
increased use of the technology (KPMG, 2021). An experimental DT of the human heart, for
instance, was created by the software company “Dassault”. The “Living Heart” software
developed by the business converts a 2D scan of a person into a precise, three-dimensional
representation of that person’s heart. This accurate simulation of a human organ considers

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 electricity, mechanics and blood flow. The Living Heart model is currently being used on a Journal of
global scale to develop fresh approaches to the design and testing of novel tools and Facilities
pharmaceutical therapies (Dassault Systems, 2022). In addition, DT solutions are used to Management
build digital replicas of people, health-care facilities and medical equipment. Monitoring,
analysing and forecasting concerns including individualised health-care delivery, proactive
maintenance of health-care facilities and rising R&D costs are the goals (FutureBridge,
2021). The following potential advantages could result from the effective application of the
suggested DT platform for managing health-care facilities, as advanced by Madubuike and
Anumba (2023): monitoring the pressure and indoor air quality (IAQ) in real-time to avoid
any negative impacts that could be brought on by any deviation from the recommended air
quality; supplying facilities managers with the necessary pictures of the health-care facilities
and their equipment through the virtual prototyping component; early defect identification
and alerts on the potential failure of a system or piece of medical apparatus, such as the MRI
machine afflicted by inadequate IAQ, can avoid breakdown or malfunction; the ability to use
sensor measurements of the air quality to continuously monitor the HVAC system’s
operation; the ability to track mobile medical equipment with the hospital and its precise
location as shown on a 3D Revit model; the ability to cut costs that could be incurred by
unanticipated equipment failure or unneeded scheduled equipment replacement; and
scheduled maintenance reduces the cost of maintenance because it is also based on the
equipment’s performance rather than calling in a maintenance crew. Despite the benefits of
digital twin applications in health-care facilities, some challenges hinder their usage for
managing constructed facilities in the health-care sector. Hence, this study uses the Nigerian
health-care sector as a case study to explore the barriers to digital twin maintenance
management (DTMM) of health-care facilities in developing countries.

2. Review of barriers to digital twin usage for health-care facilities

During the operation and maintenance phase, several internal and external obstacles may
prevent the adoption of DT technology in the building development process. Lack of
knowledge and comprehension among building operators and management is the main
barrier to DT implementation (Ammar et al., 2022; Napp, 2022). Companies could be
reluctant to invest in DT platforms or set aside funds for employee training because of this
inadequate comprehension of the complex nature of this technology. The obstacles to DT
adoption have also included worries about potential interruptions during the transition period
or about incorporating new technology into current systems (Mavrokapnidis et al., 2021).
DT in building operation and maintenance requires close coordination and cooperation
among operational teams, facility managers and other relevant personnel (Broo and
Schooling, 2023). The execution of digital transformations may be hampered by disjointed
data management systems, redundant work and inconsistent decision-making without a
cohesive strategy. Numerous programs and systems track energy usage, evaluate structural
soundness, manage resources, ensure rules are followed and plan maintenance tasks during
this stage. However, these software packages and systems may come from different vendors
or be developed independently, resulting in limited interoperability (Fuller et al., 2020).
Another barrier encountered in this process is scope management, where the complexity of
DT projects may require diligent monitoring and control to ensure effective implementation
(Salem and Dragomir, 2022). Further, integrating DT technology with existing tools can be
challenging, as the compatibility and integration of these systems may pose technical
difficulties (Botín-Sanabria et al., 2022).
Although DT technology has numerous advantages, it now faces problems like AI and
IoT technologies. These include obstacles to its adoption and the migration of old systems, as

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 JFM well as data standardisation, data management and data security (Technavio, 2022). The
author also mentions the need to update outdated IT infrastructure, connectivity issues,
concerns about the privacy and security of sensitive data and the absence of a standardised
modelling technique (Fuller et al., 2020). The high implementation costs, higher power and
storage requirements, problems integrating with current systems or proprietary software and
the complexity of its design are among the key obstacles that are likely to impede the growth
of the digital twin business. The cost of implementing digital twin solutions is high and
includes major investments in infrastructure creation, infrastructure maintenance, data
quality control and security solutions. In addition, keeping up the DT infrastructure can be
expensive and require substantial operations investment. DT’s high fixed costs and
complicated infrastructure are anticipated to halt the adoption of DT technologies, according
to Technavio (2022).

2.1 Review of barriers in some developing countries

There are several barriers to efficient maintenance management, as identified by studies in
some developing countries around the globe. Jandali and Sweis (2018) evaluated factors
influencing maintenance practices in health-care buildings within Jordan, and they are:
regulatory requirements, the design phase, activities carried out by the maintenance team and
community opinion regarding the maintenance operation. Abdul Razak and Jaafar (2012)
researched faulty health-care design in Malaysia and its impact on maintaining Malaysian
health-care facilities. They concluded that the lack of technical expertise of the designers
during the design stage may have been one of the factors affecting hospital maintenance
practices. They advised that hospital designers should be renowned experts familiar with the
best construction materials and techniques to improve maintenance and extend the life cycle
of health-care facilities. The study focused on only one element of the variables influencing
poor maintenance practices. Hassanain et al. (2013) highlighted and investigated the factors
affecting the maintenance expenses of hospital facilities in Saudi Arabia. Their research
revealed seven categories of factors as the primary determinants of practice: design stage,
development stage, budget for maintenance tasks, managing maintenance unit operations
and user’s impression of maintenance management. The key factors influencing maintenance
costs in public health-care facilities include the transfer of challenges from the development
stage to the maintenance stage for resolution, a lack of coordination between the
development and maintenance units and insufficient quality control measures throughout
system installation. In contrast, in private hospitals, the key factors affecting maintenance
cost were the length of the maintenance contract, errors made during project design, a lack of
communication between the design and maintenance units and the method used to classify
maintenance contractors.

2.2 Review of the adoption barriers in Nigeria

Ebekozien (2020) categorised the elements affecting public hospital building maintenance in
Nigeria: human development, management, technical, financial and other issues. Regarding the
theme of human development, inadequate training and development of maintenance department
staff concerning fundamental hospital maintenance practices is a major problem in Nigeria and
other developing countries dealing with comparable challenges (Adenuga et al., 2007; Aliyu
et al., 2016; Bajere et al., 2016). Due to a lack of emphasis on training, most public hospital
management hardly ever offers new maintenance personnel training at the start of work (Ajayi
and Adenuga, 2010; Adenuga, 2011, 2012). In addition, their job performance is significantly
impacted by the lack of qualified staff and work experience in the maintenance department,
respectively (Adenuga, 2012; Baba and Buba, 2013; Ogungbile and Oke, 2015). This will

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 impact the final product’s quality and subsequent maintenance expenses. It is important to note Journal of
that public hospital facilities must be in good physical and functional shape because they are Facilities
used for treating and managing medical issues. Are there enough maintenance experts in Management
Nigeria to oversee hospital facilities all throughout the nation? This is one of the problems that
must be answered. Most of these public health-care buildings were built by foreign firms, and
because there is equipment put in various areas, there are many technical aspects to maintenance
(Adenuga, 2012). This is one of the factors cited by Ajayi and Adenuga (2010), Ogunmakinde
et al. (2013) and Bajere et al. (2016) as to why there is a lack of training for maintenance
professionals in Nigeria to address technical building maintenance concerns. According to
Ogungbile and Oke (2015) and Olayinka and Owolabi (2015), even the few maintenance
specialists now on hand are not qualified enough to handle the modern technology needed for
hospital building maintenance.
Under the management theme, the “Cobra effect” has resulted from Nigeria’s “fire
brigade approach” to problem-solving in numerous cases, including maintaining public
hospitals’ buildings. Evidence of inadequate preventive maintenance, which should be the
preferred maintenance method for sensitive institutions like public hospital buildings (PHBs)
that house the indisposed (Adenuga et al., 2007; Adenuga, 2011, 2012; Baba and Buba,
2013), has been hampered for a variety of reasons, including lack of discernible maintenance
culture, insufficient funding and improper planning and scheduling (Ajayi and Adenuga,
2010; Adenuga, 2011 and; Ogungbile and Oke, 2015). The Nigerian health-care sector has a
history of under-performance in all dimensions, including maintenance planning and the lack
of institutionalisation, according to Adeyi (2016) and Aliyu et al. (2016). According to
Uneke et al. (2013), Nigeria’s health-care delivery system is extremely underdeveloped, and
it is imperative to increase the capacity of policymakers to implement evidence-informed
methods in health-care restructuring initiatives. This involves attending to the sector’s
infrastructure demands. Political interference in the hiring of building maintenance managers
was discovered by Adenuga (2012). This can strengthen the idea of mediocrity, which is seen
to have harmed Nigeria’s health-care system.
For the technical and professional skill theme, it was noted that the most pervasive
variables impacting building maintenance are issues with technical and professional abilities
(Adenuga et al., 2007; Adenuga, 2011, 2012; Olayinka and Owolabi, 2015). These include
challenges with working drawings, adequate design, construction oversight and material
standards. One of the problems that could make it difficult to maintain hospital buildings is
the flawed design (Baba and Buba, 2013). The authors gave hospital buildings’ ability to
maintain services, including lifts, fire protection, telecommunications and energy supply, an
extremely low maintenance performance rating. A flawed design could impede building
maintenance efforts and harm public health-care facilities’ structural and functional integrity
and individual parts. If the situation is not changed, it will quickly deteriorate. According to
research conducted in a few developing nations, including Nigeria, the leakage in
government procurement practices is a widespread problem with public hospital building
maintenance practices (Cruz and Cruz, 2019; Ebekozien, 2020). Early building flaws are
often caused by concerns with untested and subpar construction materials (Ajayi and
Adenuga, 2010; Adenuga, 2011; Baba and Buba, 2013; Ogunmakinde et al., 2013;
Olanrewaju and Anifowose, 2015). Poor building conditions are exacerbated if low-quality
materials are used and may result in serious defects (Aliyu et al., 2016).
Regarding scarce financial resources, budget allocation for public hospital building
maintenance necessitates an appropriate strategy for methodically creating a workable
budget for the long term. This has become relevant since many public hospitals either have
insufficient maintenance budgets or no budget at all. According to numerous studies

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 JFM (Adenuga et al., 2007; Adenuga, 2011; Ogungbile and Oke, 2015; Adeyi, 2016; Bajere et al.,
2016), this is one of the key issues with maintaining PBSs in developing nations, including
Nigeria. The successful implementation of public hospital building maintenance practices is
hampered, according to several studies, including those by Ogunmakinde et al. (2013),
Bajere et al. (2016) and Aliyu et al. (2016), by a lack of funds to pay maintenance efforts.
Evidence suggests that inadequate financing makes it extremely difficult to address problems
with public hospital building maintenance procedures. This is for various reasons, many of
which are outside the purview of this essay. Adenuga (2011) and Ogunmakinde et al. (2013)
noted that one of the key elements affecting building maintenance work is insufficient
finance. This is so that the available funding can determine the work’s scope and pace. In
some cases, the quality of the materials to be used is determined by budget. The expense of
maintaining hospital buildings is a subject of constant disagreement between the contractor
and the client. This could be because of the lump sum preparation method and systemic
corruption, according to Ogungbile and Oke (2015) and Adeyi (2016). This suggests that the
success of hospital structures and related maintenance will depend on the degree of budget
implementation. According to Adeyi (2016), poor public financial management complicates
the limited financial resources, which could lead to mismanagement, a factor in corruption.
Other matters that could not be categorised under the adapted emerging themes are
covered in this paragraph. Nigeria is one of several emerging nations that lacks a pronounced
maintenance culture (Ajayi and Adenuga, 2010; Adenuga, 2011; Faremi and Adenuga, 2012;
Aliyu et al., 2016 and; Bajere et al., 2016). This is due to a lack of maintenance culture over
time and possibly indiscipline on the side of facility administrators and users (Ogunmakinde
et al., 2013; Ogungbile and Oke, 2015). Over the years, improper political influence has
prevented attention to cutting-edge technology solutions to maintenance problems in
hospital structures. Long-term planning for the supply and service of parts for maintaining
hospital structures has been hampered by this (Adenuga et al., 2007; Adenuga, 2011).
According to the authors, insufficient funding and a lack of enthusiasm for studies on
hospital building maintenance may have contributed to the problems. According to Adeyi
(2016), “corruption” contributes to Nigeria’s health-care sector’s subpar services and
inadequate infrastructure. In addition, corruption was listed first among the variables
influencing facility managers in Nigeria’s public buildings in Ogungbile and Oke’s (2015)
study, followed by lack of funds. To enhance the health-care system, the challenges
associated with politics and policy execution must be addressed. Political leaders, donors,
financial decision-makers, beneficiaries, bureaucracies and interest groups like
nongovernmental organisations are just a few key stakeholders that must be managed to
successfully implement policies across all sectors (Campos and Reich, 2019). In this
subsection, the focus is on the dynamics of how political leaders affect the sector by
preventing the execution of legislation that will improve public hospital building
maintenance. According to Campos and Reich (2019), a poorly conceived health policy was
one of the challenges facing legislation that would have enhanced public hospital building
maintenance. For instance, politicians may make grandiose health policy promises during
elections even though they know they cannot be implemented administratively or financially.
Hence, this study made use of the following factors: insufficient funding for maintenance,
lack of discernible maintenance culture, issues from political decisions, inadequate planned
maintenance, use of poor-quality service components, non-availability of materials, budget
allocation not systematically done, corruption, insufficient research, inadequate skill and
work experience, inadequate training and development, improper planning and scheduling
and lack of collaboration among team members or professionals.

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 3. Research methodology Journal of
This study adopted a post-positivist philosophical approach to use empirical data to identify Facilities
the obstacles to DTMM of health-care facilities in Nigeria. This philosophical viewpoint Management
influenced the necessity for a quantitative research strategy using a questionnaire survey.
Creswell (2014) states that the quantitative research approach collects numerical data that
may be categorised, ranked or assessed using units of measurement. Using data from the
reviewed literature on the obstacles to DTMM, a closed-ended questionnaire was created for
this study to collect data from the target population. There were two distinct portions of the
questionnaire. While Section B concentrated on the obstacles to DTMM, Section A collected
data regarding the respondents’ backgrounds. The questionnaire’s premise was that it covers
a wide range of respondents within a short time and has been widely used in most
construction-related studies (Oke et al., 2020). Participants answered the questionnaires
using the five-point Likert scale given in the survey to rate their agreement or disagreement
with the variables. A five-point Likert-type scale was adopted to boost response rate and
quality (Joshi et al., 2015). Due to the statistical approach of the research study, a target
population was drawn, which included maintenance personnel well-grounded in digital
technologies, heads of departments and top-level management staff in the Nigerian health-
care sector. The selected professionals/respondents are builders, architects, quantity
surveyors, engineers, estate managers, health professionals, administrators and other allied
professionals in the health-care sector of Lagos and Abuja, Nigeria. These professional
groups were selected as they are directly involved in the decision process and maintenance of
constructed facilities in the health-care sector. The professionals were selected from Lagos
and Abuja since adopting technological innovations is expected to begin in these Nigerian
cities. Since the concept of DT is new to the maintenance sector in Nigeria, a Delphi study
was carried out prior to this study to ascertain the variables by selected experts.
A purposive sampling technique was adopted to ensure that only professionals directly
involved in maintaining hospital facilities were used for the study. Maintenance personnel
who are adequately grounded in digital technologies formed the highest percentage of
respondents since they are qualified through knowledge, education, experience and expertise
in the subject matter. The top-level management staff and the heads of departments were
included in this study since they are mainly involved in policy and decision-making for
maintenance projects. According to Adetayo (2001), the purposeful sampling approach is a
non-probability sampling approach based on the population’s characteristics and the study’s
objectives. According to Neuman (2006) and Aigbavboa (2014), sampling is choosing a
subset from a certain population. The subgroup then serves as the study’s sample (Neuman,
2006; Aigbavboa, 2014). Hence, the top-level management staff, head of units, and
maintenance personnel in public (secondary and tertiary) hospitals within Lagos and
Abuja—Nigeria were purposively chosen to carry out this study. After receiving ethics
clearance permission for the study, 442 copies of the 450 questionnaires that were given were
recovered. Every recovered questionnaire was examined and determined to be appropriate
for analysis. Tables and charts were used to derive statistical conclusions based on their
responses. The Statistical Package for Social Science software (version 29) was used to evaluate
the recovered replies. Principal component analysis (PCA), mean iem scores (MIS) and
percentiles and frequencies were calculated from the obtained data. The respondents’
demographic data was analysed using percentiles and frequencies, and MIS rated the variables
based on the respondents’ responses. PCA is a statistical analysis tool useful for reducing large
data into clusters by exploring the fundamental theoretical structure of the variables (Marzoughi
et al., 2018). It helps point out the relationship structure between the respondents and each
variable (Pallant, 2011; Yong and Pearce, 2013). The reliability of the research instrument was

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 JFM measured using Cronbach’s alpha, giving a value of 0.878. This confirmed that the data
retrieved using the questionnaire survey can be relied upon.

4. Research findings and discussions

4.1 Demographic information of respondents
After completing the survey, 442 responses were collected for analysis in this study. The
demographic characteristics of the respondents are broken down in Table 1. From the four
hundred and forty two (442) responses, the outcome on the respondents’ years of experience
revealed that none of the respondents had experience between 1 and 5 years, 13.6% of them
were experienced within 6–10 years, 36.2% were experienced within 11–15 years, 23.8%
were experienced within 16–20 years, 10% were experienced within 21–25 years and 16.5%
of the respondents were experienced above 25 years. This reflected that most of the
respondents had the requisite experience in working in the health-care sector; the result of the
study was ascertained adequate since those who had experience in managing constructed
facilities in the health-care sector were administered the questionnaire on an innovation
(digital twin) for improving the maintenance management of PHBs in Nigeria. Looking at
Table 1, the age distribution of the respondents revealed that none of the respondents were
between the age range of 21–30 years, 16.7% of them were between the range of
31–40 years, 50% were between 41 and 50 years, 23.3% were between 51 and 60 years,
while 10% were above 60 years. This also reflected that the conclusion of the study was
satisfactory since most of the respondents were within the age ranges that can adequately
adopt a technological tool; in the process of time, these categories of respondents will be in
active service as policymakers and implementers for the DTMM of constructed facilities in
the health-care sector. The result on the educational status of the respondents showed that
none of the respondents filled the ordinary national diploma (OND) and the higher national
diploma (HND) status, 37.1% attained the Bachelor of Science (BSc) degree, 16.5% attained
the Bachelor of medicine and surgery (MBBS), 33.5% attained the Master of Science (MSc)
degree and 12.9% had attained the Doctor of Philosophy (PhD) status. This shows that the
respondents were qualified through experience, expertise and training to give the relevant
information needed for the study.
The results on the occupation distribution of the respondents outlined that the
maintenance personnel (builders, architects, estate surveyors, quantity surveyors and
engineers) amounted to 60.1% of the total respondents used for the analysis; the medical/
dental doctors and other medical allied specialists (medical laboratory scientists,
radiologists, pharmacists, microbiologists, optometrists, to mention) amounted to 29.9%, the
nurses amounted to 3.4% and the administrators 6.6%. This means that the relevant
professionals were represented in the survey. From Table 1, it was seen that all the
respondents were affiliated to their respective professional bodies which are the Council of
Registered Builders of Nigeria (CORBON), Architects Registration Council of Nigeria
(ARCON), Estate Surveyors and Valuers Registration Board of Nigeria (ESVARBON),
Quantity Surveyors Registration Board of Nigeria (QSVRBON, Council of Registered
Engineers of Nigeria (COREN), Medical and Dental Council of Nigeria (MDCN), Nursing
and Midwifery Council of Nigeria(NMCN), and Others like Pharmacists Council of Nigeria
(PCN), Medical Laboratory Scientists Council of Nigeria (MLSCN), Optometrists and
Dispensing Opticians Registration Board of Nigeria (ODORBN), Institute of Chartered
Accountants of Nigeria (ICAN), and Institute of Health Services Administrators of Nigeria
(IHSAN), to mention. This implied that all the respondents were professionally certified and
registered and not quacks, which influenced the needed outcome of the study. The result of
the respondents in this study revealed that 9.7% were among the top management staff of

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 Table 1. The demographic characteristics of the respondents Journal of
Facilities
Respondents’ characteristics Frequency (n = 442) %
Management
Years of experience
1–5 years 0 0
6–10 years 60 13.6
11–15 years 160 36.2
16–20 years 105 23.8
21–25 years 44 10.0
Above 25 years 73 16.5
Respondents’ age
21–30 years 0 0
31–40 years 74 16.7
41–50 years 221 50.0
51–60 years 103 23.3
Above 60 years 44 10.0
Educational status
OND 0 0
HND 0 0
BSc 164 37.1
MBBS 73 16.5
MSc 148 33.5
PhD 57 12.9
Occupation
Builder 29 6.6
Architect 58 13.1
Estate manager 45 10.2
Quantity surveyor 30 6.8
Structural engineer 29 6.6
Electrical engineer 60 13.6
Mechanical engineer 15 3.4
Medical doctor/specialist 132 29.9
Nurse 15 3.4
Administrator 29 6.6
Professional affiliation
CORBON 29 6.6
ARCON 58 13.1
ESVARBON 45 10.2
COREN 104 23.5
QSVRBON 30 6.8
MDCN 73 16.5
NMCN 15 3.4
Others 88 19.9
Category of respondent
Top level management staff 43 9.7
Head of department/director 147 33.3
Maintenance personnel 252 57.0

Source(s): Authors’ findings

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 JFM public hospitals in Nigeria, 33.3% were heads of departments and directors and 57% were
maintenance personnel. This portrayed that the respondents needed for the study were
proportionally captured as it is normal for a few persons to ascend to the top management
level, and the maintenance personnel have been highest to meet the needs of this study
adequately.

4.2 Barriers to the digital twin maintenance management of hospital facilities

The result in Table 2 reveals the respondents’ view on the barriers to the DTMM of hospital
facilities in the Nigerian health-care sector. The results indicate that all the respondents
agreed upon all the variables as factors that could hinder the adoption of DTMM in Nigeria’s
hospitals since they all had mean scores well above the required 2.5 mean item score.
The foremost barriers are insufficient research, with a mean score of 4.74, ranking 1st
among the variables; corruption, with a mean score of 4.73, ranking 2nd; budget allocation
not systematically done, with a mean score of 4.71, ranking 3rd and lack of collaboration
among team members or professionals, with a mean score of 4.69 ranking 4th. Moreover, the
standard deviation values for all the factors revealed consistency in the responses of the study
respondents since they all had values less than 1.

4.3 Exploratory factor analysis

Exploratory factor analysis (EFA) looks for underlying variables or factors to understand the
pattern of correlations within a set of observable variables (Rehbinder, 2011). EFA is also
used to discover a small number of variables or factors that account for most of the variance
seen in a much greater number of variables during data reduction (Rehbinder, 2011).
Principal components with direct oblimin rotation were specified as the extraction and
rotation methods.
According to Table 3, the barriers to the DTMM of PHBs had a Kaiser–Meyer–Olkin (KMO)
value of 0.842, and Bartlett’s test of sphericity is significant (p = 0.000). Therefore, factor analysis
was appropriate (Rehbinder, 2011; Agumba, 2013). After carrying out the principal component
analysis, the factors are loaded into three (3) components, as shown in Table 4. However, five (5)
of the items were loaded in Component One, four (4) items were loaded in Component Two and

Table 2. Barriers to the digital twin maintenance management of hospital facilities

Standard Mean score

Barriers Mean (x̄) deviation (σx) ranking (R)

Insufficient research 4.74 0.459 1

Corruption 4.73 0.473 2
Budget allocation not systematically done 4.71 0.493 3
Lack of collaboration among team members or professionals 4.69 0.536 4
Use of poor-quality services components 4.50 0.510 5
Inadequate skill and work experience 4.49 0.500 6
Non-availability of materials 4.49 0.500 6
Inadequate training and development 4.47 0.535 8
Lack of discernible maintenance culture 4.46 0.559 9
Issues from political decisions 4.24 0.465 10
Inadequate planned maintenance 4.24 0.465 10
Insufficient funding for maintenance 4.22 0.511 12
Improper planning and scheduling 4.21 0.532 13

Source(s): Authors’ design

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 Table 3. KMO and Bartlett’s test for barriers to the DTMM of PHBs Journal of
Kaiser–Meyer–Olkin measure of sampling adequacy 0.842
Facilities
Management
Bartlett’s test of sphericity
Approx. Chi-Square 6,845.731
Df 78
Sig. 0.000

Source(s): Authors’ findings

Table 4. Total variance explained by the barriers to the DTMM of PHBs

Extraction sums of Rotation sums of

Initial eigenvalues squared loadings squared loadings a
% of Cumulative % of Cumulative
Component Total Variance % Total Variance % Total

1 7.283 56.024 56.024 7.283 56.024 56.024 6.336

2 1.998 15.370 71.395 1.998 15.370 71.395 2.256
3 1.681 12.930 84.325 1.681 12.930 84.325 5.629
4 0.557 4.283 88.607
5 0.354 2.720 91.327
6 0.279 2.143 93.470
7 0.254 1.956 95.426
8 0.197 1.515 96.940
9 0.135 1.040 97.981
10 0.083 0.635 98.616
11 0.077 0.594 99.210
12 0.057 0.439 99.649
13 0.046 0.351 100.000

Note(s): Extraction method: principal component analysis

Source(s): Authors’ findings

four (4) items were loaded in Component Three, as shown in Table 5. All the items had loading
factors greater than the minimum recommended 0.4 (Agumba, 2013).

4.4 Discussion of findings

As presented in Table 2, the findings reveal the respondents’ views on the barriers to the
DTMM of constructed facilities in the Nigerian health-care sector. The results indicated that
the respondents agreed upon all the variables as factors that could hinder the adoption of
DTMM in Nigeria’s hospitals, based on their group mean. The foremost barriers are
insufficient research, corruption, budget allocation not systematically done and lack of
collaboration among team members or professionals. Other barriers that the professionals
agreed to have a very high impact in the DTMM of facilities in the Nigerian health-care
sector are inadequate skill and work experience, inadequate training and development,
improper planning and scheduling, insufficient funding for maintenance, inadequate planned
maintenance, use of poor-quality service components, non-availability of materials, lack of
discernible maintenance culture and issues of political decisions.
Based on exploratory factor analysis of the barriers to DTMM of constructed facilities in
the Nigerian health-care sector and the inherent relationships among the variables under each

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 JFM Table 5. PCA extraction and factor loading for DTMM barriers

Component
Barriers 1 2 3

Non-availability of materials 0.941

Inadequate skill and work experience 0.940
Use of poor-quality service components 0.911
Inadequate training and development 0.903
Lack of discernible maintenance culture 0.857
Issues from political decisions 0.933
Insufficient research 0.839
Corruption 0.838
Budget allocation not systematically done 0.743
Inadequate planned maintenance 0.922
Insufficient funding for maintenance 0.896
Improper planning and scheduling 0.828
Lack of collaboration among team members 0.793

Source(s): Authors’ findings

component, the following interpretation was deduced to represent the underlying dimensions
of the components. For instance, component 1 was labelled Technical Skill Issues,
component 2 was labelled Management Issues and component 3 was themed Financial
Issues. These names were derived based on their interrelated characteristics and combination
of variables with high factor loadings. The first principal component, as shown in Table 5,
reported high factor loadings for the variables: non-availability of materials (94.1%),
inadequate skill and work experience (94.0%), use of poor-quality service components
(91.1%), inadequate training and development (90.3) and lack of discernible maintenance
culture (85.7%). The brackets indicate the respective factor loadings, which assume the
variable’s relative importance in the component’s data set. The component (cluster of the
listed variables) accounted for 56.024% of the variance explained, as shown in Table 4.
Without difficulty, the component was themed Technical Skill Issues. The second principal
component (PC2) reported factor loadings for the variables: issues of political decisions
(93.3%), insufficient research (83.9%), corruption (83.8%) and budget allocation not
systematically done (74.3%) and accounted for 15.370% of the variance explained as shown
in Table 4. Subsequently, after critically examining the latent characteristics of the variables,
the component was labelled Management Issues. Component (PC3) accounted for 12.930%
of the variance. The reported factor loadings for the variables are inadequate planned
maintenance (92.2%), insufficient funding for maintenance (89.6), improper planning and
scheduling (82.8%), and lack of collaboration among team members (79.3%), and without
difficulty, the component was labelled Financial Issues.
This outcome is largely consistent with the findings of previous studies advanced by
(Adenuga et al., 2007; Ogunmakinde et al., 2013 and; Ebekozien, 2020). This outcome also
agrees with studies carried out in other developing countries by Jandali and Sweis (2018),
Abdul Razak and Jaafar (2012), and Hassanain et al. (2013), who highlighted those issues
around legal requirements, design/development stage, budget for maintenance task, managing
maintenance unit activities and user’s perception as effective maintenance management
challenges. For Nigeria and other developing countries that are dealing with similar
challenges, inadequate training and development of maintenance department staff regarding
fundamental hospital maintenance procedures is a major problem (Adenuga et al., 2007;

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 Aliyu et al., 2016 and; Bajere et al., 2016). Due to a lack of emphasis on training, most public Journal of
hospital management hardly ever offers new maintenance personnel training at the start of Facilities
work (Adenuga et al., 2007; Adenuga, 2011, 2012). In addition, their job performance is Management
significantly impacted by the lack of qualified staff and work experience in the maintenance
department, respectively (Adenuga, 2012; Baba and Buba, 2013 and; Ogungbile and Oke,
2015). This will impact the final product’s quality and subsequent maintenance expenses.
Budget allocation for public hospital building maintenance necessitates an appropriate
strategy for methodically creating a workable budget for the long term. This has become relevant
since many public hospitals either have insufficient maintenance budgets or no budget at all.
According to numerous studies (Adenuga et al., 2007; Adenuga, 2011; Ogungbile and Oke,
2015; Adeyi, 2016 and; Bajere et al., 2016), this is one of the key issues with maintaining hospital
buildings in developing nations, including Nigeria. The successful implementation of public
hospital building maintenance practices is hampered, according to several studies, including
those by Ogunmakinde et al. (2013), Bajere et al. (2016), and Aliyu et al. (2016), by a lack of
funds to pay maintenance efforts. Evidence suggests that inadequate funding makes it extremely
difficult to address problems with public hospital building maintenance procedures. This is for
various reasons, many of which are outside the purview of this study. Adenuga (2011) and
Ogunmakinde et al. (2013) noted that one of the key elements affecting building maintenance
work is insufficient finance. This is so that the available funding can determine the work’s scope
and pace. Based on the findings of this study, a model was generated to depict the cluster of
barriers to implementing DTMM in the Nigerian health-care sector, as shown in Figure 1.

5. Conclusion and recommendations

This study evaluated the barriers to achieving DTMM of constructed facilities in the
Nigerian health-care sector. A field questionnaire survey was used to accomplish this
objective. Findings revealed that the barriers to the attainment of DTMM of constructed
facilities in the Nigerian health-care sector, which are equally applicable to other developing
countries, included insufficient research, corruption, budget allocation not systematically
done, lack of collaboration among team members or professionals, inadequate skill and work
experience, inadequate training and development, improper planning and scheduling,
insufficient funding for maintenance, inadequate planned maintenance, use of poor-quality
service components, non-availability of materials, lack of discernible maintenance culture
and issues of political decisions. The principal component analysis revealed that all the
identified barriers ranked above the average mean, with Insufficient research, corruption and
budget allocation not systematically done, ranking the top three. PCA clustered the identified
barriers into three components: technical skill barriers, management barriers and financial
barriers. The top three barriers reflect the reality of innovations in Nigeria and other
developing countries; there is a need to conduct adequate research on digital twin usage
within developing countries, which will boost the readiness to implement the technology to
maintain constructed facilities. Due to its high cost, there is also a need for transparency and
efficiency in allocating finances to fund the uptake of digital twin technology. The
capabilities of digital twin technology are enormous; therefore, it is critical that the numerous
stakeholders in the health-care sector of developing countries be made aware of these
capabilities while formulating a solution to the identified barriers hindering its adoption.
The result of this study adds to the body of knowledge, already available in maintenance
management studies. It will serve as a roadmap for research into smart maintenance
management within developing countries. It will also serve as a resource for lecturers who
instruct classes in maintenance management in higher education institutions. The information
advanced in this study will enlighten the authorities and management of health-care

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 JFM

Figure 1. Barriers to DTMM of constructed facilities in the health-care sector

Source: Authors’ design

organisations of the factors that can hinder the DTMM of their facilities. It will provide
guidance for decision-making that will influence a smart, sustainable and efficient maintenance
management of facilities. Future research should investigate variables connected to the present
study’s limitations. First off, more thorough and in-depth measuring scale testing in Nigeria and
other developing nations would advance the understanding of the barriers to DTMM. Some
scales that were created for hospital facilities and used in the current study might not be
appropriate for use in other organisational contexts. The model constructs can be improved by
advancing other complexities of DT and the barriers that can hinder the attainment of DTMM in
Nigeria and other developing countries. Additional populations must be used to replicate these
findings. While some key aspects of DTMM might be universal across cultures and locations,
others might not.

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Corresponding author
David Ojimaojo Ebiloma can be contacted at: [email protected]

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