Abstract. Sustainability is seen as a far-reaching issue now, and one which the facilities management [FM] profession cannot overlook. This paper explores current sustainable facilities management [SFM] knowledge and practice with specific focus on performance as part of a research focus toward proposing a sustainable FM performance management framework for sustainable healthcare waste management in Malaysia. This paper utilized a review of extant literature on the subject of SFM, FM performance and FM development in Malaysia as source of information. Findings reflect the increasing recognition of the need for the strategic FM function, and how facilities managers are best positioned to drive organizations' sustainability agendas. In Malaysian context, this recognition is barely evident as findings show FM practice is still immature and predominantly operational. Unlike developed FM markets, FM relevance in Malaysia is being driven by the public sector. Also findings show a disharmony between organizations' sustainability priority areas and the responsibilities for facilities managers to execute them where the sustainability policy of organizations prioritize one FM service and the facilities managers' responsibilities prioritize another. As most of SFM implementation is driven by legislation this seems to strengthen the position that, organizations continue to view support services as non-value-adding, as unavoidable liabilities. The implication of this is the pressure on the FM function to continually express its strategic relevance to organizations by tangible value-adding performance output. This creates a new perspective to measuring and managing facilities performance. This paper therefore elevates the importance of FM performance management in SFM context taking into account the peculiar position of the facilities manager. This is seen as a way forward for FM to better express its value to the organization .