Healthcare organisations are increasingly recognising the need to improve building performance in order to improve health care delivery, profits, and to reduce penalties. Hospital maintenance organisations are under constant pressure to plan maintenance work due to a shortage of funds on account of huge catalogues of defects in hospital buildings. While investments in hospital building maintenance are increasing, the requirement to increase building performance and user satisfaction is also increasing. The nature of building faults and the factors that influence hospital building maintenance management in Malaysia were explored. Primary data were collected through structured interview techniques involving six hospital maintenance organisations. According to the results of a survey interview involving six hospitals, water seepage, cracks, peeling paint, broken ironmongery, pipe leakage, damaged plasterboard, and discoloured paint are all widespread in hospital structures, according to the results of a survey interview involving six private and public hospitals. The key aspects that determine the maintenance management practise of hospital buildings are user attitudes, misuse/abuse, weather, and bad maintenance practice. The data revealed that hospital building users are demanding improved building performance through enhanced maintenance management service delivery. Implicit in the findings of this research is the lack of effective maintenance organisations. It is necessary to reorganise the hospital's maintenance organisations. From an ontological standpoint, the main findings of this study are generalizable to other hospitals and building typologies in and outside of Malaysia.