OUTSOURCING OR AN IN-HOUSE TEAM? WHAT REALLY PAYS OFF MORE, AND WHICH MODEL SHOULD YOU CHOOSE?
This is one of the questions I have been asked most frequently over the past 16 years while procuring cleaning, catering, and facility management services for hospitals, outpatient clinics, nursing homes, and other healthcare and long-term care facilities.
The answer is not straightforward, and it is almost never based solely on price.
In practice, everything depends on several key factors:
– the type of service provided,
– the available budget,
– the size of the facility and its operating model,
– workforce availability,
– the team’s competencies and the quality of management.
1. CLEANING SERVICES
Cleaning services in healthcare and care facilities are among the most critical factors affecting the safety of patients and residents.
Patients and residents form their first impression of a facility within the first few minutes of their stay.
The cleanliness of the building, consulting rooms, bathrooms, and common areas creates that first impression and very often influences how the overall quality of the services provided is perceived. Whether we like it or not, this is the reality. Based on my experience, patients form their first opinion of a healthcare facility even before meeting a physician or any member of the medical staff.
Short- and long-term care is about much more than beautifully designed clinics, hospitals, nursing homes, or senior living apartments. Above all, it is about complying with hygiene and sanitation procedures, maintaining high cleaning standards, and following infection prevention protocols that allow patients and residents to feel safe.
Today, I often hear clients ask:
“Is it worth maintaining an in-house cleaning team? I don’t want to overpay for an outsourced provider.”
My answer remains the same: it depends.
If a facility is large, has a stable workforce, and employs managers capable of effectively supervising staff and monitoring service quality, an in-house team can be an excellent solution.
However, it is important to remember that the cost of cleaning extends far beyond wages alone.
It also includes staff replacements, annual leave, training, recruitment, cleaning chemicals, equipment and its maintenance, workwear, personal protective equipment (PPE), day-to-day team management, and ensuring compliance with cleaning and disinfection procedures.
When analysing costs, I never look only at the monthly invoice or annual expenditure.
Instead, I recommend calculating the Total Cost of Ownership (TCO).
Labour costs represent only one part of the total expense. Only after taking into account management, absenteeism, training, equipment, consumables, maintenance, and operational risks can you understand the true cost of providing the service.
It is equally important to analyse the cost per bed or resident, the number of labour hours or full-time equivalents (FTEs), and the scope of responsibilities specified in the service contract.
Although the COVID-19 pandemic is now behind us, it clearly demonstrated how essential service continuity is.
While today’s circumstances are different, similar challenges may arise again in the future, particularly affecting smaller facilities.
For many private healthcare providers, outsourcing cleaning services proves to be a more cost-effective solution. A reliable contractor assumes responsibility for staffing, work organisation, and ensuring uninterrupted service delivery.
There is one important condition, however: price must never be the sole criterion when selecting a service provider.
2. NUTRITION SERVICES FOR PATIENTS AND RESIDENTS
Contrary to popular belief, choosing the right catering model is not a simple decision either.
On one hand, there is the available budget; on the other, expectations regarding quality and the facility’s operational capabilities.
This raises several important questions:
1. Do we have our own kitchen?
2.Do we have the necessary technical infrastructure?
3. Are we able to recruit sufficient staff and provide adequate cover during absences?
Operating an in-house kitchen offers considerable flexibility. It is easier to respond to the individual needs of patients and residents, update menus, and prepare specialised diets.
On the other hand, it requires substantial investment in kitchen equipment, storage facilities, staffing, and full compliance with food safety and sanitary regulations, including maintaining separate clean and dirty zones.
Outsourcing can often significantly reduce costs—but only if the service specification is well prepared and quality is monitored on an ongoing basis.
Patients and residents do not evaluate a healthcare facility solely on the quality of medical treatment or care.
They also judge it by what they see on their plate every day. Taste, ingredient quality, presentation, and serving temperature are all far more important than many organisations assume.
At a time when healthy ageing and longevity are receiving increasing attention, nutrition has a profound impact on wellbeing and the recovery process.
3. FACILITY MANAGEMENT
Building maintenance is an area that is often underestimated—until the first major breakdown occurs.
Based on my experience, a hybrid approach works best.
It is worth having in-house personnel responsible for day-to-day maintenance and minor repairs—a reliable handyman who knows the building well and can respond quickly.
However, statutory inspections required under building regulations and highly specialised maintenance services are usually best entrusted to qualified external contractors.
Building warranties are another important consideration. If the building and its technical systems remain under warranty, manufacturers often specify who is authorised to carry out inspections and repairs. Failure to comply with these requirements may result in the warranty becoming void.
This approach helps ensure safety, maintain business continuity, and support proper management of technical documentation, including building logbooks and all legally required maintenance records.
What do I advise my clients?
I never begin by asking:
“How much do you want to spend on building maintenance?”
Instead, I first analyse how the organisation operates and ask several key questions:
– how many patients or residents does the facility serve?
– how is the operation organised?
– are there employees who will manage the service?
– is the building or any of its equipment still under warranty?
– who has been responsible for technical maintenance to date?
Only after answering these questions is it possible to determine which model is truly the best fit. Very often, the lowest-priced offer does not represent the lowest overall cost. Likewise, maintaining an in-house team does not always provide greater control or lower operating expenses.
After many years of working with the healthcare sector, one thing has become clear to me:
There is no single model that works for every organisation.
Every decision should be preceded by a thorough assessment of costs, operational processes, workforce availability, and associated risks.
Only then can an organisation make an informed decision about whether outsourcing, an in-house team, or a hybrid model will deliver the best results.
Successful procurement is not about choosing the cheapest offer. It is about selecting a solution that is safe, operationally effective, and financially sustainable over the long term.