Under relentless pressure to lower operational costs, hospitals are poised to further reduce their outsourcing, according to a poll of facility professionals.

Five out of six of those polled by the American Society for Healthcare Engineering and the Association for the Healthcare Environment say they expect the number of contracted staff in plant operations to fall.

Contractor costs tend to be substantially higher than staff costs, making it an obvious area to target. They also make up a sizable chunk of most budgets; 17 percent of those responding to the survey say their organizations outsource positions in plant operations and 31 percent do so in environmental services.

The concern of many in the field, however, is the loss of expertise and experience in many areas when contracting is slashed in deference to the bottom line. "Reducing the use of contractors puts greater pressure on in-house staff to remain current on the technologies used and effective operations, troubleshooting and repair of sophisticated equipment and systems," says Dale Woodin, executive director of ASHE. "This takes a proactive approach to training and tools, and time to work with systems."

Organizations may find it hard to financially justify adding resources for that purpose at a time when they're in cutback mode, however. Already, 40 percent of respondents say their hospitals eliminated staff positions in 2012 because of the economy or declining revenues or profitability.

"You want the skills in-house" in facilities management and skilled trades, says Dana Swenson, senior vice president of facilities and chief facilities officer at UMass Memorial Health Care. The Worcester, Mass., system cut its one outsourced facilities management position recently to save money.