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The occurrence of fire accidents in hospital buildings has become a serious challenge and more serious in developing nations. The purpose of this paper intends to assess fire safety measures in Nigerian hospital facilities. The significance of this study is to ensure that the design and construction of hospital facilities enhance the safety of users and properties.

The data were collected via a case study and questionnaire survey and administered to the facility users. The study survey is to assess the respondents' perception of fire safety measures in hospital facilities and suggest possible policy measures that will be employed to enhance safety.

This paper found that 91% of the respondents have awareness of fire safety measures in hospital facilities. Electrical faults and combustible materials were identified as the frequent causes of fire occurrences in hospital facilities. This can be averted where flammable materials and electrical appliances are correctly installed, and safety rules enforced. Findings show that safety rules are lax in public than standard private hospitals.

This paper is limited to fire safety measures in Nigerian healthcare facilities. Future research is needed to evaluate the level of compliance from design, construction and post-construction of precautionary fire safety measures in hospital facilities in Nigeria.

This paper recommended that designers and hospital administrators should improve on fire safety measures via the development of fire safety management plan and education. Thus, enforcement of fire safety measures in hospital facilities as specified in building codes should be implemented and monitored during and after the design of the hospital buildings. Findings provide valuable lessons on how to improve the fire safety measures in healthcare facilities across the states and other developing countries with similar healthcare situations.

This paper demonstrates that the stakeholders, especially government agencies concern with approval and enforcement of fire safety measures in healthcare facilities need to reawaken to her responsibility because of the lax implementation across the states.

This paper aims to evaluate the level of compliance of fire safety with the legal requirements in Malaysia government hospital buildings by evaluating via fire risk management.

Five government hospitals were selected. These five hospitals were selected due to the location of Penang, which is one of the fast-growing states in Malaysia (Salleh, 2019; Ebekozien, 2019). This state is the second most densely populated state after Wilayah Persekutuan Kuala Lumpur, with an average distribution of 1,490 persons per square km. This higher population caused the higher demand on the health-care services by the public (DOSM, 2016). The observation and building audit processes are as described. Hundreds of photos were taken for qualitative analysis, and all fire safety elements were measured for the descriptive analysis for each hospital. The framework of audit elements is created based on the Life Safety Code: NFPA 101 (2018), UBBL 1984: Part VII (Fire Requirements) and Part VIIII (Fire Alarms, Fire Detection, Fire Extinguishment and Fire Fighting Access). The cross-sectional descriptive evaluation is conducted in the case studies building in accordance with Life Safety Code of NFPA, also known as NFPA 101. To conduct the study, the information needed to assess the fire safety status was extracted from the CFSES software based on the NFPA 101 standard and prepared and compiled by the researcher as a checklist. In the next stage, gathered information was analysed using Computerised Fire Safety Evaluation System (CFSES) software. This method was developed based on the NFPA 101 standard and evaluated the fire risk from four dimensions of containment, extinguishment, people movement and general safety. This software gives the risk assessment results in three areas of fire control, exits and general safety. To assess the fire risk of the commercial buildings after entering the background information (height, age, number of stories, etc.) in the software, the software first calculates the score that the building should obtain in the three aspects of fire control, exit routes and general safety (minimum score required).

The utmost zones in the case studies (44.3%) occupied by limited mobility are located at low-rise buildings or at the first floor to third floor of the hospital buildings. Hospitals managements lacked in creating the maximum exit route and egress the occupants to disclosed the building during evacuation, it correlates to the patients' mobility positions strategy to assign their categories that fell on effortless mobilisation. Surveyed hospitals were built with the non-combustible materials, even though four of the case studies were built before 1984. Hospitals were equipped with hazard separations and vertical smoke pores, and in most of the zones, sprinkler system is installed only in the corridors, equipped with communication system and system of communication with fire and relief organisations and has a fire detection and alarm system throughout the building. Results of fire risk assessment on four groups of elements were tested via CFSES revealed from 122 zones of surveyed hospitals; 102 or 84% of zones give the highest failed rate to comply the NFPA 101 requirements in terms of people movement in the building. The high-occupied Penang General Hospital contributed as the highest case study for not complying with the minimum requirements in all dimensions: people movement elements (41 zones), fire containment (31 zones), fire extinguisher (31 zones) and general safety (20). Fire extinguishment (62 zones) recorded the highest numbers of zones that complied with NFPA 101 (2013). The overall results of the fire risk assessment suggested that in terms of the fire control, egress and general safety aspects, the fire risk assessment score was unacceptable (failed) in all hospital buildings studied, and in the three areas mentioned, the general safety, egress/exit routes and fire control were in a worse status in terms of the score obtained in the software. None of the surveyed hospital received the minimum safety score in the three areas mentioned. The involvement of Emergency Response Team is crucial to overcome this egress or fire exit requirement and parameters.

Several limitations exist in this research that cannot be controlled. Firstly, the occupancy rates only determined during peak hour. Accessibility into hospital compound permitted only during daytime. Secondly, the fire safety audits and fire safety risk management in this research are not being conducted by a professional architect or engineer and as a result must be relied on the direct inspection checklist to create valid results. Thirdly, this research has some limitations which need to be noted but does not affect the robustness of the study’s findings. This study focuses only on five selected public hospitals in one state of the northern region of Malaysia and excluded data gathering from all other parts of Malaysia. The perception of hospital operators regarding fire safety issues from different state hospitals may allow comparisons.

The findings of this paper should make a key practical contribution to the body of knowledge. In practice, the proposed framework should expand the knowledge of public hospital fire safety management plan concerning the level of fire safety compliance with the requirements in government hospital buildings and develop a fire safety management plan framework for government hospital buildings.

This paper develops an early framework component related to the occupants’ safety which gives the basis for future research in hospital fire safety settings as it imparts early investigation into the consequence of investigating the phenomenon from the operators’ perspective as an attempt to improve public health-care fire safety performance in hospitals.

This paper has created a few measurement tools that can be applied among public hospital buildings stakeholders to perform the fire safety audit and risk management and rate the performance of Fire Safety Management in public hospitals.

Globally, several studies have shown that hospital building is charged with multiple inherent risks because a large number of users are vulnerable in tragic events. Thus, the need for the fire safety management plan (FSMP) has been proved as an instrument to mitigate fire and related risks in healthcare facilities. In Malaysia, FSMP regarding public healthcare building is yet to be explored in-depth. Therefore, this paper explores the information necessary to develop the FSMP framework for public hospital buildings.

The paper’s objectives were accomplished via a combination of five face-to-face interviews and observations of five selected public hospitals in Pulau Pinang, Malaysia. The five key participants were across the five public hospitals and collated data analysed through thematic analysis with the assistance of MAXQDA 2018.

Findings show that fire safety stakeholders practice system, fire safety action plan and fire risk management were the three main variables that promote fire safety programme and will improve FSMP for Malaysia’s public hospital buildings.

This paper’s data collection is limited to Penang, Malaysia, and a qualitative research approach was used, but this does not deteriorate the strength of the findings. Future studies are needed to consider validating findings from this paper via a quantitative approach.

The suggested framework can be employed by Malaysia’s public hospital authorities as a guideline to mitigate fire hazards in the country’s healthcare facilities.

This paper is encouraging hospital operators and other key stakeholders to improve on their FSMP for healthcare buildings across Malaysia as part of the study implications.

There is increasing recognition amongst healthcare providers on the necessity to improve fire safety management in healthcare facilities. This is possibly not yet satisfactory because of recent fire incidents in Asia. This paper set out to analyse the literature because of the paucity of systematic reviews on fire safety management of public healthcare facilities and proffer preventive measures.

Thirty related studies were identified with the support of the Preferred Reporting Items for Systematic reviews and Meta-Analyses via Scopus and Web of Science databases.

Influencing factors, hindrances to fire safety management and preventive measures for fire-related occurrence in Asian hospital buildings were the three themes that emerged from the reviewed. The factors that influence fire in Asian hospital buildings were categorised into technical, management and legislation factors.

The recommendations of this paper were based on literature that was systematically reviewed but does not compromise the robustness concerning fire safety management in hospital buildings across Asian countries. Much is needed to be known regarding fire safety in healthcare buildings across Asian countries. This paper recommended exploratory sequential mixed-methods approach as part of the implications for further studies. This will allow in-depth face-to-face interviews and increase the generalisability of future findings concerning fire safety management in hospital buildings across Asian countries to a larger population.

As part of the practical implications, this paper recommends fire safety management plan as one of the practical possible measures for addressing technical, management and legislation factors. Also recommended is training and fire safety education of healthcare staff in collaboration with safety firefighters to address major issues that may arise from management factors. The government should upgrade the safety technology equipment in healthcare facilities as part of measures to mitigate issues concerning technical and legislation factors. Also, the identified factors are part of the theoretical contributions to the advancement of knowledge and this brings to the front burners new opening.

This is probably the first systematic review paper on fire safety hospital buildings in Asia.

Frequent fire incidences in various hospitals across the globe with devastating effects on humans and other resources have multiplied. Stakeholders in the health-care sector are worried because of the yearly fire outbreak increase. However, fire safety management has been proved as a successful platform to mitigate fire in health-care facilities. How far regarding public health-care facilities is yet to receive in-depth studies in Malaysia. This paper aims to investigate the issues associated with fire safety management and proffers possible solutions to improve safety in public health-care facilities from the operators’ perception.

The objectives were achieved through a combination of case studies of five selected Malaysia’s public hospitals and a qualitative approach. Thematic analysis with the assistance of MAXQDA (software program designed for computer-assisted qualitative and mixed methods data) 2018, a type of qualitative data analysis software was used to analyse the collated data which emerged from the knowledgeable participants.

Lax implementation of safety policy, inadequate water pressure, poor maintenance, inadequate communication system, amongst others, emerged as the issues. Findings proffer five main measures to possibly improve fire safety management in public health-care buildings. This includes a feasible institutional framework, improve the emergency response team, improve the occupational health and safety system and others.

This paper is limited to exploring the issues associated with fire safety management and proffer possible solutions to improve safety in public health-care facilities from the operators’ perception. Future research is needed to engage useful information in advancing fire safety management in public hospital buildings and possibly developing a qualitative model using a generic fire response model. Also, to investigate the level of compliance with the requirements of a fire safety management plan and possibly develop a well-detailed fire safety plan in Malaysia’s public health-care buildings.

As part of the paper implications, the paper concludes that improved fire protection systems via modern technologies and training of key staff members in accident response and recovery during fire emergencies should be encouraged. This can be achieved through the enforcement and implementation of a fire safety management plan. Thus, this study is encouraging the implementation and sustainability of a fire safety management plan for health-care buildings across Malaysia.

To the best of this paper’s knowledge, this is possibly the first comprehensive paper on fire safety management in public health-care facilities that engaged operators in Malaysia. Moreover, this paper proffers feasible policy solutions to improve the fire safety management plan in public health-care buildings.