PurposeThe objectives of this paper are to identify and assess the factors that affect the cost of maintenance of hospital facilities.Design/methodology/approachThe authors conducted a literature review on hospital maintenance cost to identify the factors affecting the cost of maintenance and interviewed a selected group of ten experienced facilities managers of both public and private hospitals. 33 factors were identified, and synthesized in seven groups. A questionnaire survey was developed to assess the factors. Responses were obtained on the developed questionnaire survey by interviewing the facilities managers of the full population of the 40 hospitals in the Eastern Province of Saudi Arabia, 20 of which were public hospitals and the other 20 were private hospitals. The data received were analyzed to identify the level of importance for the factors. The factors were ranked according to their importance index values.FindingsThe most important factors from the perspectives of public hospitals are “transfer of problems from the construction phase to the maintenance phase for resolution”, “lack of coordination between the construction and maintenance group”, and “lack of quality control measures during the installation of systems”. These three factors were all encompassed within the construction group. The most important factors from the perspectives of the private hospitals were encompassed in the statutory requirements and the design phase groups. These factors are “duration of the maintenance contract” and “the method of classifying maintenance contractors”, “errors conducted during the design of the project” and “lack of feedback from the maintenance group to the design team”.Practical implicationsThis paper is of practical significance to hospital project managers and facilities managers, as it will prompt the management of hospital facilities to focus on the most important factors affecting the cost of maintenance and thereby reduce that cost.Originality/valueThis paper is original in the sense that the areas of knowledge and practice encompassed in the identified factors were scattered and not available in one source. The factors were derived from personal interviews with selected facilities managers of both private and public hospitals, as well as from the relevant literature.