Fire Door Products Fire Door Services

Transcription

Fire Door Solutions has developed products and services to assist hospitals and medical
facilities with adhering to the new 2012 Life Safety Codes as it applies to inspecting,
repairing and maintaining fire rated doors. We are committed to providing products and
services that ensure your fire rated doors are compliant with the new Life Safety Codes.
Fire Door Products
Door Caulk
Door Thru-Bolt
 Fire Door Shims
 Door Gap Gauge
 NFPA 80 Inspection Kit
Fire Door Services
 Fire
 Fire
 Fire
 Fire
Door Inspections
Door Repairs
 Fire Door Field Labeling
 Inspection Training
repairing and maintaining fire rated doors. We are committed to providing products and
services that ensure your fire rated doors are compliant with the new Life Safety Codes.
Fire Door Products
Door Caulk
Door Thru-Bolt
 Fire Door Shims
 Door Gap Gauge
 NFPA 80 Inspection Kit
Fire Door Services
 Fire
 Fire
 Fire
 Fire
Door Inspections
Door Repairs
 Fire Door Field Labeling
 Inspection Training
T H E O F F I C I A L M A G A Z I N E O F T H E A M E R I C A N S O C I E T Y F O R H E A LT H C A R E E N G I N E E R I N G
• S P R I N G 2 0 16
InsideASHE
www.ashe.org
CEUs
EARNREADING
WHILEIDE ASHE
INS more
Learnage 10
on p
TACKLING
THE
TRIPLE
AIM
Improved
population health
Better patient
experiences
Lower per capita costs
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Helping you
solve safety.
For healthcare.
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Tyco SimplexGrinnell partners with healthcare facility managers, architects and
engineers to help design, install and service advanced fire and life-safety systems.
Together with ASHE members from across the United States, we work to provide a
safe and secure environment for patients and staff; improve Joint Commission
reporting, documentation and compliance; reduce costs; minimize noise and
disruptions; and enable higher patient satisfaction.
See how Tyco SimplexGrinnell solutions allow you to solve the
biggest fire and life-safety challenges for healthcare institutions.
Visit the healthcare page at www.TycoSimplexGrinnell.com.
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W W W . S T I F I R E S T O P. C O M
THE FIRESTOP AUTHORITY
InsideASHE
8
SPRING 2016
Letter from the president
By Terry Scott, MBA, CHFM, CHSP, SASHE
10
12
13
14
What’s new
ASHE at a Glance
HAIs through better facility design
By Linda Dickey, RN, MPH, CIC
Tackling the Triple Aim
By Deanna Martin
Celebrating teamwork:
The 2016 Vista Award winners
14
By Deanna Martin
17 Mobile emergency management
rooms: Using engineering and equipment
18 Operating
planning to create successful spaces
By Jeff Henne, CHSP-FSM, CHEP, SASHE
By Krista McDonald Biason, PE, Jeff Harris, PE, LEED AP and Dave Sawchuck
24
Working toward the same goal: Tips on gaining
infrastructure funding before systems fail
26
30
35
38
Improving thermal comfort and the patient experience
40
41
Member spotlight
By Ed Avis
By Ed Avis
18
Putting the “process” into sterile processing departments
By Shanna Wiechel, AIA, EDAC, LEED AP
Focusing on the supply side: A new energy approach
By Judson Orlando and Michael Cozzi
From big box retail to community clinic: How adaptive reuse
opened the door for Seattle Children’s newest clinic
By Sandra Miller, Victoria Nichols and Taka Soga
26
Skip Gregory
Advertisers’ Index / advertisers.com
InsideASHE
is the official quarterly publication of
the American Society for Healthcare
Engineering of the American
Hospital Association
155 N. Wacker Drive, Suite 400
Chicago, IL 60606
P: 312-422-3800, F: 312-422-4571
www.ashe.org, [email protected]
ASHE PRESIDENT
Terry Scott, MBA, CHFM, CHSP, SASHE
System Director of Engineering Services
Memorial Hermann Health System
ASHE STAFF
Senior Executive Director
Dale Woodin, CHFM, FASHE
[email protected]
Deputy Executive Director of Advocacy
Chad E. Beebe, AIA, SASHE
[email protected]
Deputy Executive Director of Operations
Patrick J. Andrus, MBA, CAE
[email protected]
Director, Administration and Governance
Sharon Autrey, MPA, CAE
[email protected]
Director, Leadership Development
Tim Adams, FASHE, CHFM, CHC
[email protected]
Communications Manager and
Inside ASHE Managing Editor
Deanna Martin
[email protected]
For a complete staff list, please go to
www.ashe.org/about/staff.html.
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PUBLISHED MARCH 2016 •
ENV-Q0116 • 2644
An interactive
digital version of
InsideASHE
is available at
www.ashe.org
www.ashe.org 7
Letter from the President
T
Terry Scott, MBA,
CHFM, CHSP, SASHE
ASHE President
System Director of
Engineering Services
Memorial Hermann Health System
hank you, fellow ASHE members, for allowing me to serve as ASHE president
in 2016. I’m looking forward to the exciting opportunities 2016 holds for us as
facility professionals and ASHE members.
This year, the ASHE Board of Directors and I will be continuing our focus on ASHE’s
three strategic imperatives: succession planning, member value, and sustainability.
While all three of these are important efforts, my passion lies in sustainability.
As we face changes and challenges in the health care field, it is critical for facility
managers to get on board with efforts to become more efficient. Becoming energy
efficient is a way we can deliver value to our organizations. My system, for example,
saved $65 million over six years through greater energy efficiency. I am fortunate
enough to be part of a health system that includes eight Energy Star Certified
Hospitals. Becoming more efficient also shines a spotlight on the value of facility
professionals. Sustainability is more important now than ever before, and I’m proud
that ASHE is providing tools to help members thrive in this area.
The Energy to Care benchmarking program, for example, is a tremendous
opportunity (www.energytocare.com). This free program can help you track
and visualize your facility’s energy use. Benchmarking is the first step toward
understanding your energy use and then
working to reduce it. The Sustainability Roadmap
for Hospitals (www.sustainabilityroadmap.org)
provides step-by-step instructions on
sustainability projects proven to work in the
complex health care environment. The Energy
to Care Awards—including a new Energy
Champion Award being launched this year—
recognize the important work being done by
facility professionals to save valuable hospital
financial resources.
I am also looking forward to some terrific
education programs scheduled in 2016. Our International Summit & Exhibition on
Health Facility Planning, Design & Construction (PDC Summit) takes place March
20–23 in sunny San Diego, and the ASHE Annual Conference is in Denver July 10–13.
These events are opportunities to learn about the latest information in our field while
building your network, and I encourage you to attend.
In addition to the national conferences, there also will be a variety of education
programs available across the country in 2016. Visit www.ashe.org/education to find
a program. ASHE will also be expanding e-learning opportunities, giving members an
opportunity to continue their professional education without leaving home.
There is a lot of exciting work being done at ASHE this year. It is important to
remember that ASHE is a community of members, and we’re always looking for new
volunteers to help move our organization forward. Please consider volunteering your
time and talent to help advance the field of health care facility management. If you
would like to volunteer, please submit a volunteer application form online at
www.ashe.org/volunteer.
As we face changes and challenges
in the health care field, it is critical
for facility managers to get on board
with efforts to become more efficient.
Becoming energy efficient is a way we
can deliver value to our organizations.
8 INSIDE ASHE | SPRING 2016
What’s New
ASHE at a glance
New Energy Champion award recognizes
efficiency leaders
A
SHE has long
recognized
efficient
hospitals with the
Energy to Care awards
given to hospitals that
reduce their energy use by 10 percent. This year, ASHE
has created a new award—the Energy Champion Awardthat will be given to a single facility that exemplifies
what it means to lead the way in sustainability. Watch for
an announcement about the winner in the next edition
of Inside ASHE.
Additional compliance resources posted
A
SHE continues to post compliance resources as
part of its Focus on Compliance project with the
Joint Commission. The latest resources include
information and tools related to maintaining a safe,
functional environment and fire safety equipment and
features. Visit www.ashe.org/compliance to view the
latest offerings.
ASHE has also added a “Give Us Your Feedback”
button at the top of the left column on Focus on
Compliance pages. You can let ASHE know what you
think about the various tools, and can upload your own
tools, policies, and checklists if you would like them to
be considered as additional resources shared on the
Focus on Compliance site.
Case studies highlight efficiency success stories
ASHE has started sharing success stories of energy
efficient hospitals on the Energy to Care website (www.
energytocare.com). Visit the site to check out case studies of
hospitals that have reduced energy use and saved hospital
resources. To submit your own success story for publication
consideration, visit www.ashe.org/publish.
Earn continuing education units
through Inside ASHE
A
SHE members can earn free continuing
education units (CEUs) by reading this
spring edition of Inside ASHE and passing
a quiz based on articles in this issue. Those
wishing to earn 0.1 CEU (1 contact hour) from
the American Hospital Association should follow
these instructions:
1. Read this edition of Inside ASHE and understand
the articles.
2. Go online to www.prolibraries.com/ashe and
create a ProLibraries account if you have not
already done so.
3. Click on “Continuing Education” in the left
column to access and take the online quiz.
4. Members who pass the quiz will be able to print
a CEU certificate for 0.1 CEU (1 contact hour).
Step-by-step instructions for registering
with ProLibraries are available at
www.ashe.org/insideasheceus.
Eligibility information
• To earn CEUs through the spring 2016 edition of
Inside ASHE, you must be an ASHE member as of
March 1, 2016. Members who joined after that
date will not be eligible for CEUs through Inside
ASHE until the summer 2016 edition.
• Quizzes for this edition must be completed by
June 1, 2016. After that date, the quiz will no
longer be available.
ASHE Annual Conference
coming to Denver in July
B
e sure to register for
the 53rd ASHE Annual
Conference and Technical
Exhibition in Denver from
July 10- 13. The conference
will feature peer-reviewed
educational sessions, unique
networking opportunities, and
an exhibit hall packed with
solution providers. Visit
www.asheannual.org to
learn more.
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Feature
Project aims
to reduce
HAIs
through better
facility design
By Linda Dickey, RN, MPH, CIC,
director of epidemiology and infection prevention,
University of California Irvine Medical Center
T
he health care physical environment is an
important part of infection control and
prevention, and an exciting new project will
help hospitals reduce infections through better
facility design.
ASHE is working on the project with the
Centers for Disease Control and Prevention (CDC) and the
Health Research & Educational Trust (HRET) of the American
Hospital Association on a three-year effort. The goal of the
project is to strengthen infection prevention and control
efforts in U.S. hospitals, and to specifically reduce central
line-associated bloodstream infections (CLABSIs), catheterassociated urinary tract infections (CAUTIs), Clostridium difficile
(C. diff) infections, and methicillin-resistant Staphylococcus
aureas (MRSA) infections.
ASHE’s role in the project will be to develop resources
to help design and redesign hospitals in ways that optimize
operations in order to minimize infection risks to patients and
staff. ASHE asked me to help lead this portion of the project,
and I’m excited to bring together infection prevention leaders
from several disciplines to tackle important topics related to
health care design during new construction and renovation,
as well as operations within the built environment that affect
infection outcomes.
We’re already starting to work on this project, and the issues
listed below are a sneak peek of the topics we’ll be discussing.
•
Infection control risk assessment: Creating guidance
on how to use an ICRA process during design, planning, or
construction to strengthen infection prevention efforts.
• Hand hygiene infrastructure: Addressing accessibility
and use of hand washing stations and alcohol-based hand
rub dispensers, as well as promoting a culture dedicated to
hand hygiene.
• Reprocessing: Looking at the operational challenges of
cleaning, disinfection and sterilization presented by the
design of reprocessing suites and the cleaning of mobile
equipment such as IV pumps.
• Cleaning environmental surfaces: Finding ways to promote
superior cleaning and diszinfection of environmental surfaces
in patient care areas.
• Water-related issues: Exploring water feature and plumbing
design considerations for devices and systems that carry
potential risk of waterborne pathogens.
• Flow of patients, personnel, and equipment: Discussing
ways to design spaces and departments to reduce the
potential for infection transmission and supporting rapid
isolation needs.
If you have information to share about design and operational
elements within the built environment that present infection risks
or benefits, recommendations for best practices, case studies
from effective hospitals that could be profiled, or success stories
you’d like to share related to these topics, let ASHE know by filling
out the form at www.ashe.org/publish.
ASHE will be keeping members updated about the progress
of this project. You can also learn more about the efforts during
a session at the 2016 International Summit & Exhibition on
Health Facility Planning, Design & Construction (PDC Summit) in
San Diego March 20-23.
Feature
Tackling the
Triple Aim
By Deanna Martin, ASHE communications manager
T
he future of health care is increasingly focused
on the Triple Aim: improved patient experiences,
better health, and reduced costs. Professionals
who design, build, operate, and maintain the
health care built environment can provide value
to their organizations by understanding the Triple
Aim and working to help meet these targets. ASHE has created
several resources related to Triple Aim goals.
Improved patient experiences
Patient satisfaction and scores on the Health Consumer
Assessment of Healthcare Providers and Systems (HCAHPS)
survey are more important now than ever before. HCAHPS
scores are tied to reimbursement and are made public, putting
additional pressure on hospitals to improve.
An ASHE monograph on this topic explored ways facility
professionals and the health care physical environment
are improving the patient experience. ASHE members can
download a free copy of the monograph—HCAHPS Scores, the
Patient Experience, and the Affordable Care Act from the Facility
Perspective—at www.ashe.org/monographs.
At the 2016 International Summit & Exhibition on Health
Facility Planning, Design & Construction (PDC Summit) in March,
a patient satisfaction track includes sessions on ways architects,
designers, constructors, and facility professionals can provide
better experiences for patients and spur higher HCAHPS scores.
The PDC Summit marks the first time that major groups working
on patient satisfaction are coming together to discuss ways the
physical environment can improve patient satisfaction. The ASHE
Annual Conference, being held July 10–13 in Denver, also includes
multiple sessions aimed at increasing patient satisfaction scores.
Better health
Hospital facility professionals—including architects,
constructors, and facility managers—are critical to keeping
patients safe and healthy. Several ASHE efforts are contributing
to this aspect of the Triple Aim.
ASHE announced in November that it is working with the
Centers for Disease Control and Prevention (CDC) and the Health
Research & Educational Trust of the American Hospital Association
on a three-year project aimed at improving infection prevention
in hospitals. ASHE’s role in the project is to create resources for
professionals who design, build, and operate hospitals. More
about the project can be found on page 12.
ASHE also helps keep patients safe and healthy by
helping members with code compliance issues. ASHE is
working with the Joint Commission on a project providing
resources on challenging requirements, including ventilation
and pressurization, fire protection, and life safety. Focus on
Compliance resources can be found at
www.ashe.org/compliance.
Reduced costs
Most facility professionals are keenly focused on ways to
reduce costs, and several ASHE resources are available to help
members create efficient facilities.
The Energy to Care program and Sustainability Roadmap
website can help hospitals reduce utility costs. Energy to
Care, a free benchmarking and awards program, allows
facility managers to easily track energy use over time and to
share that information with others in their organizations. The
Sustainability Roadmap includes step-by-step instructions
on a variety of projects aimed at reducing costs. Explore
these resources at www.energytocare.com or www.
sustainabilityroadmap.org.
ASHE also offers several resources on commissioning, a
process that can help hospitals save millions of dollars. The
Health Facility Commissioning Guidelines and Health Facility
Commissioning Handbook are available at
www.ashestore.com, and articles and publications about
commissioning can be found in the ASHE resource library at
www.ashe.org/resourcelibrary.
Conclusion
As hospital leaders continue to focus on the goals of better
health, improved patient experiences, and lower costs, facility
professionals have an opportunity to show how they can
contribute to these efforts. Use the ASHE resources listed above
to discover how you can help meet Triple Aim goals and become
an even greater asset to your organization.
www.ashe.org 13
Vista Awards
Celebrating teamwork:
The 2016 Vista Award winners
By Deanna Martin, ASHE communications manager
T
CO
N
ST
RU
CT
eamwork is important for nearly
any construction, renovation, or
infrastructure project, but it is
especially critical for health care
projects that have the potential
to affect hundreds of patients. The
Vista Awards celebrate health care project teams
that show a unity of purpose from pre-planning
to implementation.
The winners of the 2016 Vista Awards are SSM Health St. Mary’s
Hospital in Jefferson City, Missouri; VCU Health in Richmond,
Virginia; and Carolinas HealthCare System Pineville, in Charlotte,
North Carolina. The projects won in the categories of best new
construction, renovation, and infrastructure, respectively.
NEW
IO
N
New Construction: SSM Health
St. Mary’s Hospital – Jefferson City
Presented to an organization that has constructed a new facility essentially from the
ground up. The new facility may be connected to an existing facility, but the building must
have its own identity and be a new space.
T
he team working on the SSM
Health St. Mary’s Hospital set out
to build a facility that would support
staff and physicians while exceeding
expectations for safety, compassion,
and innovation. The new hospital,
located on a greenfield site about five
miles away from the existing facility,
includes a six-story inpatient tower, a
four-story medical office building, a
diagnostic center, emergency center,
outpatient treatment center, and other
specialty clinics.
During the course of the project,
the team faced several challenges,
including a project hold and hospital
management turnover. Planning
ahead of time for transitions and
communicating often helped minimize
these challenges. The team used lean
construction methodologies and a
collaborative approach. Project manager
representatives, the construction team,
and a full-time architect were on the
jobsite, allowing many issues to be
resolved in real time rather than through
a formal RFI process. The team also
worked closely with physicians, staff, and
community members—a reflection of
the team’s commitment to a cooperative
design and construction process.
“This collaborative design approach
required active involvement from the
owner; project manager; architects;
construction manager; and mechanical,
electrical, and equipment engineers
from pre-design to completion through
post-project evaluation,” said Brent
VanConia, president and CEO of the
hospital. “Throughout the project, the
team performed beyond expectations,
continually reviewing the project scope,
cost opinions, key assumptions, risk
factors, and adherence to the project’s
guiding principles.”
The new hospital has met its goals and
patient satisfaction scores have improved
in multiple areas. Using lean construction
helped the team complete the project
under budget and two months earlier
than scheduled, avoiding a winter move
during a high census period.
Project:
SSM Health St. Mary’s
Hospital–Jefferson City
Location:
Jefferson City, Missouri
Square feet: 432,000
Number of beds: 172
Projected budget:
$218 million
Actual cost:
$202 million
Team members:
Brent VanConia,
President and CEO,
SSM Health St. Mary’s
Hospital–Jefferson City
Mike Bock,
Director of Facilities,
SSM Health
St. Mary’s Hospital
Tim Gunn,
Vice President of
Construction,
Alberici Healthcare
Kevin Studer,
Principal,
Northstar Management
Michael Schnaare,
Principal,
Lawrence Group
Daniel C. Oakley,
Associate,
Heideman
Associates, Inc.
2016
VISTA
AWARDS
Renovation: VCU Health
Presented to an organization that has altered the existing conditions or added new space to
existing structures. The original building envelope remains essentially intact.
Project:
Emergency department
expansion and
renovation at
VCU Health
Location:
Richmond, Virginia
Square feet:
1,300 square foot
addition; 48,300 square
foot renovation;
17,900 square foot shell
space infill
Number of exam
rooms:
98
Projected budget:
$37 million
Actual cost:
$35.6 million
Team members:
Dr. Joseph P. Ornato,
MD, FACP, FACC,
FACEP, Professor
and Chairman of
the Department of
Emergency Medicine,
VCU Health
Larry Little,
Vice President, Support
Services and Planning,
VCU Health
Robert Reardon,
CHFM, chief facility
officer, VCU Health
Leslie L. Hanson,
AIA, Principal and
Senior Vce President,
HKS, Inc.
Matt Wood,
CHC, Senior Director,
Barton Malow
David Wright,
Vice President,
WSP + ccrd
C. Nelson Williams,
IV, PE, SECB, Treasurer,
Dunbar, Milby, Williams,
Pittman & Vaughan
T
he renovation project at VCU
Health’s emergency department
encompassed more than 67,000
square feet of space on the ground
floor of the main hospital. The project
was completed in four major phases
spanning five years.
Two major challenges for the team
included first, renovating the emergency
department—operating 24 hours a
day—with minimal disruption, and
second, maintaining at least 65 exam
rooms available at all times. The team
worked to build consensus with hospital
and emergency department leaders on
a phased plan that would meet those
requirements. Midway through the
project, hospital leadership requested
a change in the phasing priorities that
resulted in a more complex phasing
plan and renovation work directly in the
middle of the emergency department,
splitting it in half. Through strong and
effective communication, the team
was able to meet this request, and the
resequencing allowed the renovated
imaging department to open almost a
year ahead of schedule.
John F. Duval, vice president for clinical
services, chief executive officer, VCU
Hospitals, said the collaborative effort
exceeded all expectations.
“The completed project is reflective of
in the input from over 300 doctors, nurses,
and staff of the ED in addition to hundreds
of other doctors, nurses, and staff that
interact with the ED on a daily basis,”
Duval said.
Infrastructure: Carolinas HealthCare System
Pineville Energy Plant
Presented to an organization that has modified or replaced major portions of the utility generations,
distribution, or control systems involving
arolinas HealthCare System Pineville
The central energy plant needed to
significant project planning.
expanded over the last 10 years to
be able to be operated unmanned, which
accommodate population growth in the
provided another challenge for the team.
Charlotte area, but the central energy plant
The team successfully built the plant
in the middle of campus was undersized to
to be operated remotely from another
support the additional square footage. Because campus, and included an advanced system
of the central location of the plant, it could not
for detecting potential problems using
Project: CMC Pineville
C. Scott Shipp,
be expanded, so the design team created a plan monitoring and control devices.
Energy Plant, Carolinas
PE, Vice President,
to replace the plant in the back of the campus.
The project came in under budget and
HealthCare System
RDK Engineers, Inc.
The team faced several challenges
has prompted significant energy savings. The
Location:
Damian Huneycutt,
stemming from the fact that there was no
plant’s chilled water system is the most efficient
Charlotte, North Carolina
AIA, Principal, Wright
downtime
for
transitioning
to
the
new
plant
within the Carolinas HealthCare System.
McGraw Beyer
Square feet:
Architects, PA
since the existing plant was serving an
“Thanks to excellent planning, coordination,
22,000 square foot
central energy plant
Terry Johnston,
operational hospital. The team established
and execution related to the critical utility
Senior Vice President,
Number of beds: 206
new normal power service for the hospital,
changeover to the new energy plan, our
Rodgers Builders, Inc.
working closely with the design team
hospital’s service and availability to patients,
Projected budget:
Larry Lockhart,
$38 million
working on a patient tower. The design of
staff, and visitors remained uninterrupted,” said
PE, Managing Partner,
Actual cost:
Bloc Design, PLLC
the new plant allows for future expansions
Carolinas HealthCare System President and CEO
$37.5 million
(work completed while at
without interrupting service. Both ends of the Michael C. Tarwater, FACHE. “Moreover, this
ColeJenest & Stone, PA)
Team members:
plant can be expanded to allow additional
team exceeded our expectations for improved
Zachary Zapack,
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chillers,
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or
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The
electrical
energy efficiency, service monitoring, reliability,
Senior Vice President,
CHFM, Director, Central
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system was also designed to accommodate
and redundancy for these critical infrastructure
Energy Plants, Carolinas
System
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systems.”
C
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Feature
Mobile
emergency management
By Jeff Henne, CHSP-FSM, CHEP, SASHE, corporate safety and emergency management specialist,
Hospital of University of Pennsylvania, Penn Medicine–University of Pennsylvania Health System
D
uring the course of my
career at the University
of Pennsylvania, I have
been involved with my
facility’s response to
several emergencies and
disasters, and have seen the evolution
of emergency management technology
over time. Now more than ever, safety
and emergency managers need to be
on the go during emergency situations.
A critical part of the ability to be mobile
is a command center to handle calls,
incoming problems, staffing, supply,
patient movement, and utility issues.
This article outlines my experience
with a mobile emergency management
system to provide an example of
lessons learned for others working in
this area.
A mobile system
We use a mobile emergency
management system purchased by the
Pennsylvania Emergency Management
Agency (PEMA). The online, websitebased system meets the requirements
outlined by the Joint Commission, state,
and Centers for Medicare & Medicaid
Services (CMS) regulations. This site is
secured to meet HIPPA regulations.
In Pennsylvania, all hospitals and
long-term care facilities have access
to the site through a hospital portal.
Hospitals only have access to their
specific information, and can see the
status of an event on the homepage. The
state and the local county emergency
managers also have access to the system,
and local police and fire departments
can update events so that those
monitoring an event are up to date.
An online, mobile-friendly system
is convenient because as long as you
have a wireless access point, you can
access the system through a laptop,
smartphone, or tablet.
Using the system
The online system is used to track
events - either pre-planned drill events
or actual incidents that might occur.
Once an incident occurs, the system
tracks its progress using the Hospital
Incident Command System (HICS) format.
Our system allows us to see operational
charts, operation logs, patient tracking
logs, reference logs, and more. A report
can be created as the incident occurs,
and by the end of the event you can
have a clear and concise record of the
event—a record that can help meet Joint
Commission requirements and create
a more cohesive hospital and regional
report for the Joint Commission and
CMS. An after-action meeting with the
command center and senior staff can
help identify what went right and what
went wrong.
Our system allows us to create “parent
events” in addition to individual events,
which is helpful for regional events.
Regional emergency management
officials can create a parent event that
links to all facilities in the region, and
hospital information feeds into the event
log. The information is collected to
create a regional after-action report that
spans multiple facilities.
In our region, facilities participating in
the same system span across state lines,
which allows for regional coordination.
The system can send out system-wide
or state-wide action requests to which
all hospitals must respond in a timely
manner so that hospitals can coordinate
bed capacities, supplies, and other
issues. PEMA and the City of Philadelphia
have watch desks to monitor the region
and state when events or incidents occur.
Another benefit of the online
system is the large section of reference
materials. We have the ability to consider
rising flood waters, traffic alerts, traffic
camera views, chemical and biological
agent safety data sheet (SDS) locations,
weather maps and alerts, road closures,
and other useful references.
Superstorm Sandy
During Superstorm Sandy in 2012, one
of our large pharmacies in Cherry Hill,
New Jersey, was going to lose power. The
leased property did not have a back-up
generator to supply the pharmacy, which
supported a chemotherapy infusion
suite. The facility held about $1 million
worth of chemotherapy pharmaceutical
supplies that could not be transported
across the bridges into Pennsylvania
because of state regulations. We reached
out to the Cooper Hospital emergency
manager through the emergency
management system and sent him a
message that we needed assistance. We
communicated back and forth, and the
incident log tracked this correspondence.
We were able to get a driver to transport
the supplies in time to Cooper Hospital,
located in Camden, New Jersey, to
house the chemotherapy supplies. The
pharmacy lost power within a matter
of hours after the supplies were moved
and was without power for a few days.
Because of the mobile system, making
the arrangements only took an hour; the
system does work well.
Conclusion
I would recommend that emergency
or safety managers look into online,
mobile-friendly systems. The systems
can help save time and resources while
helping create reports that are helpful to
have on hand.
www.ashe.org 17
Feature
OPERATING ROOMS:
Using engineering and equipment
planning to create
successful
spaces
By Krista McDonald Biason, PE, associate vice president, HGA Architects
and Engineers; Jeff Harris, PE, LEED AP, director of mechanical engineering,
HGA Architects and Engineers; and Dave Sawchuck, President / Equipment
Planner at Korbel Associates Inc.aol.com
I
These are just some of the questions
that we hear from those working in
today’s operating rooms. The overall
satisfaction with an operating room
design is highly dependent on the
equipment and how it functions, the
systems that support the equipment,
and how comfortable the space is.
Knowing what system functionality
Photo credit: Jerry Swanson Photography
’m too hot. It’s too humid. There
are not enough receptacles,
and they’re in the wrong place.
There aren’t enough devices in
the boom. Where are the general
room lighting controls? Why are
the medical gas outlets over there? Why
is the anesthesia boom at the patient’s
feet, and where is my integration system?
questions to ask a health care facility and
understanding the answers are crucial to
designing a successful operating room.
The cost to fit out an average
operating room with a basic design
and minimal medical equipment is
approximately $400 to $450 a square
foot: not a small investment. The price
goes up when more robust and flexible
engineering systems are included. The
price also increases dramatically when
additional technology and equipment
are included to accommodate multiple
types of procedures, intraoperative
procedures, robotics, or other
neurological cases. The engineering
systems, medical equipment,
architectural design, and future
provisions all need to be taken into
consideration to ensure satisfaction from
the users and to provide flexibility to
adapt to the ever-changing requirements
and demands of tomorrow’s technology.
As an electrical engineer, a
mechanical engineer, and a medical
planner, we have designed hundreds of
operating rooms. We have found many
commonalities from facility to facility
but also significant differences based on
user preferences, procured equipment,
procedures to be performed in the
space, and facility protocol. The basis
of all of our designs is, of course, code
and regulatory requirements, including
NFPA documents, Facilities Guideline
Institute (FGI) Guidelines, UL listings,
ASHRAE (American Society of Heating,
Refrigerating and Air-Conditioning
Engineers) standards, energy codes,
building codes, and local, state, and
federal requirements or laws, which
may (will) differ from state to state.
Understanding which codes, standards,
and guidelines (and which editions) are
enforced for each state or jurisdiction
is important. For the purpose of this
article, we will address current codes and
guidelines unless otherwise noted. These
are only minimum requirements and
not intended as design specifications.
In addition to our understanding of
applicable codes and standards, we also
use our judgement, experience, and
knowledge of health care best practices
in designing operating rooms.
Electrical decisions
Many electrical decisions require user
input, including decisions on lighting
design such as what temperature lamps
are preferred and whether to address
issues of eye fatigue by adding perimeter
downlights along with the surgical
Many electrical decisions require user input,
including decisions on lighting design such
as what temperature lamps are preferred and
whether to address issues of eye fatigue by
adding perimeter downlights along with the
surgical lighting.
lighting. Also, where do elapsed time
clock controls and light switches reside
and should they be controlled by the
circulating nurse? Establishing a protocol
for the nurse call system is necessary.
Is the nurse call system used for the
required hands-free communication or
does the staff use intercoms to fulfill this
requirement? Are the surgical teams their
own code blue responders? These issues
can vary significantly depending on how
the facility functions.
Beyond these electrical user
preferences, the power distribution
option for the operating room is the
greatest variable in the electrical design.
Decisions are to be made about location,
quantity, and type of devices and
associated power, and also regarding
how that power is delivered to the
room. Article 517.19 (C) of the National
Electrical Code® requires a minimum of
36 receptacles in the operating room.
continued on page 20
www.ashe.org 19
These receptacles can be either located
around the perimeter or on the booms
or columns. We recommend ample
devices both in the booms and on the
walls because of the amount of medical
equipment in the room and the limited
physical space to park (and plug in)
said equipment. Providing devices on
the walls and the booms also limits
the dependence on a single piece of
equipment as a point of failure. Some
of the receptacles are required to be
connected to critical branch power
and at least 12 of the 36 receptacles are
to be from an alternate source, either
from a separate critical branch panel
that originates from a different transfer
switch or a normal branch panel.
Wet procedure room
The next decision requires a
risk assessment to determine if the
operating room will be designated
as a wet procedure location. This
determination will indicate whether the
receptacles are to be regular hospital
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grade devices, GFCI receptacles, or
whether isolated power panels are
used. The 2012 edition of NFPA 99
provides some guidance for defining
a wet procedure location for a health
care facility. Article 6.3.2.2.8.2 discusses
wet procedure locations in general
and Article 6.3.2.2.8.4 specifically
addresses operating rooms. Article
6.3.2.2.8.4 states “Operating rooms shall
be considered to be a wet procedure
location, unless a risk assessment
conducted by the health care governing
body determines otherwise.” If the
facility has a documented protocol
for liquid mitigation, even procedures
that require significant irrigation may
not require the wet procedure location
determination. The risk assessment
is to be completed and formally
documented. Note: this is a task for the
health care facility and not the design
engineer. The electrical engineer may
help facilitate this discussion, but
cannot by code (and should not) make
the determination for the facility. NFPA
70: National Electrical Code aligns with
this requirement and adds additional
requirements for wet locations in Article
517.20.
A wet procedure location requires
special protection against ground
fault currents and electric shock. This
protection is implemented by either
ground fault receptacles or more
typically by isolated power panels and
associated isolated power distribution.
Why does this matter? Isolated power
panels cost more and are significantly
larger than traditional panels and affect
budget and space planning (although
this should not drive the designation
of the room). Installation criteria are
different for isolated power wiring as are
guidelines on how many devices should
be connected to the same circuit. The
current standard of care is to provide
two separate critical branch panels (with
a separate critical branch source) in each
operating room to address these code
requirements, circuiting needs, and
power demands for the space.
Medical gas system
Just as with electrical device design,
a wide range of choices and cost
implications exist for the medical gas
systems. The FGI Guidelines prescribe a
minimum quantity and type of medical
gas service, but often there is a need for
a greater number of outlets to provide
for a greater degree of flexibility for
operating room use. Each operating
room will require oxygen; medical air;
medical vacuum; waste anesthesia gas
disposal (WAGD); and outlets, which
may be located on the boom, the room
perimeter, or in both locations, similar to
the electrical design. Depending on the
type of surgeries to be performed, there
often is a need for a carbon dioxide
system for insufflation, nitrogen for
powering surgical equipment, and
instrument air to move booms. The
source equipment for these services is
located in designated medical gas rooms
remote from the operating rooms. The
further away the rooms are from each
other, the greater the costs for piping,
equipment, and alarms. their cost and their fixed nature that
is difficult to change once installed.
Some prerequisites to establish,
prior to planning lights and boom
configurations, are room orientation,
personnel zones, and how flexible the
rooms need to be to accommodate
different types of procedures. (This
is where we engage architects.) The
most common configuration has an
anesthesia boom near the head of
the table, an equipment boom at the
foot of the table, and surgical lights
and displays mounted on either side:
four mounting locations in the ceiling.
This arrangement serves a majority of
cases, but clinical staff should be taken
through scenarios to test whether a
surgical case type can be performed
with a given setup. Some vendors favor
a single central mount for everything,
showing that such a setup can maximize
Equipment planner
Because there are so many options
for the location and functionality of
the engineering systems, the earlier an
equipment planner can get involved
in the process to help define and
coordinate medical equipment selection,
the smoother the design will proceed.
Without an experienced planner, things
can easily slip through the cracks. The
equipment planner will help guide
the team in exploring the options and
collaborate with the owner to define the
criteria to narrow the field of vendors
and set up presentations, site visits, and
trials. The selected vendor will provide
room-specific layouts as well as detailed
configurations of where each electrical
and medical gas outlet will be on a given
boom. This detail is almost never offered
until the vendor has either a signed
purchase order or letter of commitment
from the owner, but the initial design can
be based on preliminary drawings and
generic equipment cut sheets. Beyond
the up-front cost of the equipment,
selection should factor in service
agreements, warranties, and lifetime
costs of the equipment.
Lights and booms
Surgical lights and booms typically
warrant the most attention because of
690157_Dynalock.indd 1
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15/05/14 6:26 PM
positioning flexibility. A commonly
cited drawback to the central mount
approach is the disruption of uniform
laminar air flow over the sterile field. In
rooms that have a dedicated specialty
such as CVORs (cardiovascular operating
rooms), a third surgical light or third
boom for perfusion might be required.
Video integration
Whether the facility is a community
access hospital with a few operating
rooms or an academic medical center
with dozens of ORs, almost every
surgery suite project will have some
degree of video integration. An entry
level system allows for routing of video
images from a couple of point sources
(e.g., laparoscopic equipment) to a
few displays. A sophisticated system
will have cameras at the surgical site
as well as general room cameras and
may allow for real-time consult with
others thousands of miles away. System
complexity and cost grows with adding
more sources—PACS (picture archiving
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and communication system) images,
physiologic data, other equipment—
and more output displays. While the
essence of video integration is software
that normalizes signals so that data
can be transmitted and retrieved,
some hardware implications must be
considered. Over the last decade, the
hardware components in the operating
room have become smaller, and in
some situations the installation is fully
virtualized to a remote server.
Ceiling height
The team should also account
for ceiling height constraints—both
finished ceiling height and deck-todeck height and the structural support
required for the equipment mounts.
The location and number of ceiling
pedestals need to be coordinated in
the context of many other systems in
and above the ceiling such as diffusers,
ducts, medical gas lines, and structural
supports. Even for smaller projects
it takes time for a team to evaluate
and select their preference and fully
implement the details of that decision.
This underscores the importance of
planning the lights and booms early
enough to be coordinated with the
other aspects of the room design and
engineering systems.
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Air handling system
After evaluating the electrical
systems and the basic surgical boom
issues, the design decision that has the
greatest impact on budget and staff
satisfaction is the air handling system.
The environment of the operating room
must be kept safe for the patient and
comfortable for the surgical team. The
environment involves highly filtered
air, precise temperature and relative
humidity controls, and a high demand
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Even for smaller projects
it takes time for a team
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performance and cost need to be
decided on early in the design process.
The National Electrical Code requires
that the “supply, return, and exhaust
ventilating systems for operating and
delivery rooms” be connected to the
equipment branch source of power.
Dedicating the air handling system to
only the operating suite and limiting
the area of coverage not only allows the
ability to address the mechanical design
criteria for these rooms but also alleviates
additional demand on the emergency
systems of the facility by matching the
power demand to designated space.
Conclusion
Many additional nuances are involved
in the planning and design of the
engineering systems and equipment
needs for an operating room, but
understanding the basic design criteria
from the perspective of the engineers
and a medical planner will start you in
the right direction toward the operating
room of your dreams.
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for pressure control between rooms.
The FGI Guidelines identify minimum
criteria for filtration, air change rates,
temperature and relative humidity set
points, pressure relationships, amount
of recirculated air, and medical gas
requirements. However, the hospital
and the design team need to make a
number of choices regarding each of
these criteria, and as these decisions
involve a surgical team, facilities staff,
and the C-suite, they do not often get
resolved quickly.
The FGI has established criteria
for a Class B or C operating room as
maintaining 20 to 60 percent relative
humidity for a temperature range of 68
to 75 degrees. The Guidelines also note
that “Surgeons or surgical procedures
may require room temperatures,
ventilation rates, humidity ranges,
and/or distribution methods that
exceed the minimum indicated
ranges.” A significant difference exists
in regard to cost, space requirements,
energy use, and control complexity
between systems that can maintain
the environment in an operating room
at 62 degrees and 50 percent relative
humidity and a system that maintains
72 degrees and 60 percent relative
humidity. There is a correspondingly
significant difference in how the patient
and staff perceive the environment in
the two scenarios, with an increasing
preference by the surgical team for a
cooler, dryer environment. In recent
years, the trend has been toward
systems that maintain an environment
at 65 degrees and 50 percent relative
humidity. To save energy, the system
should have the ability to reduce total
air flow, when unoccupied, from 25
air changes per hour to six air changes
per hour without affecting the positive
pressure of the operating room to the
adjacent clean corridor. While this can
be controlled via an occupancy sensor,
most hospitals prefer a more troublefree option of an occupied/ unoccupied
schedule with an override located in
each room. The system also has the
ability to raise the operating room
temperature to 80 degrees within a 10
minute time period. Since these systems
are more expensive than “traditional”
operating room HVAC systems, their
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698122_AccuScan.indd 1
www.ashe.org 23
6/14/14 1:59 AM
Feature
Working toward the same goal:
Tips on gaining
INFRASTRUCTURE
FUNDING
before systems fail
By Ed Avis
I
f your hospital is like a pizza, the sauce, cheese, and
toppings are your clinical lines—they grab attention and
attract patients. The crust is your infrastructure—boring
to outsiders but absolutely essential. It is important not to
ignore the “crust” by under-investing in infrastructure.
“If you look at most hospitals, the front ends are fairly
updated, but behind the scenes you can be surprised at what you
see,” said Mark Kenneday, vice chancellor, campus operations, at
the University of Arkansas for Medical Sciences.
“It’s always been difficult to fund infrastructure projects,
because they generally don’t generate revenue,” said Mark
Etheridge, a senior project manager at AKF Group LLC,
a consulting engineering firm based in New York. “The
infrastructure might support multiple clinical projects, but no one
thinks about them from a money-generating perspective.”
Keeping your hospital’s infrastructure up to date and
well maintained requires a thorough understanding of your
current situation, a good relationship with the C-suite, and
an infrastructure improvement plan that aligns with your
hospital’s overall strategy. By focusing on these areas, facility
professionals can work together with hospital and health
system leaders toward a common goal of providing safe
healing environments.
Start with an audit
Getting a handle on the depth of your infrastructure
problem is a good first step. Jonathan Flannery, senior
associate director of advocacy for ASHE, has served as a
facilities manager at three hospitals. He said that the first thing
he did when he started each of those positions was a thorough
audit of the hospital’s infrastructure.
“When you first start at the facility is a key point in time,”
Flannery said. “It’s very easy to do a facility condition index and
determine all the deferred maintenance in the facility.”
Flannery said that audit—which could be done at any
time during a facility manager’s tenure if it wasn’t done at the
beginning—involves a thorough examination of every system.
“For example, you inspect all the air handlers and evaluate
their current condition,” Flannery said. “You measure the
resistance through the electrical portion of it, you verify the
fan speed, and you compare the original manufacturer’s
specifications to the current condition.”
The data from that audit can then be compared to the
hospital’s facility management plan, if one exists, to see how
well the plan has been followed.
The audit also establishes a baseline to which future audits
can be compared. “That’s the goal—you want to be improving
the picture, reducing the deferred maintenance,” Flannery said.
“So you have to set the baseline.”
And of course, the audit also may uncover serious problems
requiring immediate attention. For example, Flannery
remembers when his initial audit at one facility determined
that the medical air and vacuum system was near failure. He
presented his findings to the hospital leadership, but the
budget had already been done for the year and there was no
cash for a replacement. Unfortunately, Flannery was right: The
air and vacuum system collapsed within four months, requiring
an expensive emergency replacement.
“At that time, guess what? The money was found,” Flannery
said. “The fallout is that an emergency replacement costs
significantly more than a replacement that is planned
and scheduled.”
Build the relationships
As was the case at Flannery’s hospital, shaking loose the
money for infrastructure improvements is not always easy. But if
you have a good ongoing relationship with the C-suite, it may go
more smoothly.
Remember, too, that the C-suite thrives on data.
“You need to do your homework and understand your
facility and have the data to have those discussions. That’s
the real key,” he said. For example, Flannery said that at
one facility he worked for, the chief nursing officer felt the
facility management department was overstaffed, so he
found benchmarking data to show that they were actually
understaffed. And later, when complaints arose that facilities
issues were taking too long to get fixed, he used data to
pinpoint the problems and effectively create solutions.
“The one thing that drives CEOs and CFOs crazy is if the
only time you show up in their office is when you have an
emergency,” Flannery said. “A lot of us think of CFOs as bean
counters, but in fact they are vital members of your team. They
can be your best friends.”
One of Flannery’s strategies for building those relationships
is taking the C-suite on a tour of the physical plant.
“Most CFOs have never seen an air handler. Have them walk
through it, understand what it does, and how it impacts the
patient,” Flannery said. “That has to be something you do on a
regular basis.”
Developing a relationship with the C-suite also means
gaining their trust. When they believe your assessments and
feel your requests are credible, you are more likely to get the
funds you need.
“I’ve worked hard to build that trust, so that when I show up
in front of the board, they know we’re not just being needy,”
Kenneday said.
Of course, not every facility manager makes requests before
the board of directors. Many requests start at the facility manager
level but percolate up the chain of command, which means
having good relationships within the whole chain is important.
“The capital process is generally the same at most places,”
Etheridge said. “The directors and vice presidents put forth
their budget requests, and they go through the process, and
at the end of the day the budget is given to the board. So the
question is, how do you get past those gates? If the facilities guy
needs a new boiler, how does he get it into the VP’s budget?”
Tie Infrastructure Requests to Strategy
Hospital C-suites are big on strategy: they much prefer
funding items that have a direct tie to an established goal
or initiative. That means that an infrastructure improvement
funding request has a much better chance of success if it’s
connected to strategy.
“We certainly try not to present anything that doesn’t align
with the strategic plan,” Kenneday said, adding that he has
successfully updated a large amount of aging infrastructure by
tying the upgrades to energy efficiency initiatives.
Similarly, Etheridge said he encourages his firm’s clients to
eschew the “gloom and doom” type infrastructure requests
that seek funding only to avert disasters and instead make
infrastructure requests part of the long-term planning process.
He said his firm is developing metrics that guide hospitals to
budget a specific amount of infrastructure funding based on
the amount of funding for clinical objectives.
“I want to create an atmosphere where infrastructure is
part of the process,” he said. “One of our clients, Northwell
Health (in Long Island, New York), has a large infrastructure
plan that works with the numerous clinical objectives they
have. The infrastructure is planned out and funded so those
improvements happen at the right time to support the
clinical objectives.”
The master plan Etheridge’s firm has created for
Northwell Health includes guidance for infrastructure
support of current projects, planned projects, and potential
future projects. He said that it is more efficient to plan
the infrastructure with that long view than to make
improvements only for current projects.
“As a facilities director you want to be perceived as a
person who has it all together,” Etheridge said. “You want to
be proactive and not reactive. Planning a long-term strategy
elevates the position of the person who does that from the
guy who is crying that the sky is falling to a professional who is
planning out the future of the facility.”
Speak the language
Flannery said it’s important to understand the language
of the C-suite. For example, a ratio the C-suite commonly
uses is the “average age of plant,” which is the accumulated
depreciation divided by the depreciation expense. This ratio is
tracked by the AHA and rating agencies such as Moody’s and
S&P. Another term that a facility manager should be familiar
with, Flannery said, is the “facility condition index,” which is the
deferred maintenance divided by the cost of replacement.
Use what you get wisely
Finally, when the decisions are made and dollars are
allocated, a smart facility manager makes the money go a
long way.
“You have to understand that you will not get all the
money you need,” Flannery said. “You will never have enough
money. So take the resources you have and use them to your
absolute best ability to address the key issues. That builds your
credibility.”
www.ashe.org 25
Feature
Improving ther
and the patient experience
By Ed Avis
hen facilities
managers at
Carolinas
HealthCare
System’s Lincoln
Hospital retrocommissioned the
building in the summer of 2014, the
goal was to reduce the hospital’s energy
consumption. But they got a bonus: The
efforts also improved the thermal comfort
of the building.
“Since this was developed as an
energy-saving project, and we didn’t
foresee our hot/cold calls going down,
it was not measured scientifically, but
it is something that staff has noticed,”
said Michael D. Roberts, PE, CHFM,
CHE, a senior specialist in the Facilities
Management Group of Carolinas
HealthCare System (CHS). “The staff
who work the floors and the facility
manager at the hospital said that it has
been noticeable enough that they have
commented without being asked about
it. This was an added benefit to the
energy project.”
Improving the thermal comfort of
a health care facility, whether it’s part
of an energy-saving project or a standalone project, can pay large dividends
to a hospital. Patients, staff, and visitors
are more comfortable and, in some
cases, scores on the Hospital Consumer
Assessment of Healthcare Providers and
Systems (HCAHPS) survey may improve.
But achieving better thermal
comfort—which ASHRAE Standard 55
defines as a “condition of mind that
expresses satisfaction with the thermal
environment”—can be a challenge, and
it definitely involves more than turning
up the heat or the AC.
“Some hospitals take an ‘all-hands’
approach to thermal comfort,” said Lynn
Kenney, a senior analyst for ASHE and
author of the ASHE monograph HCAHPS
Scores, the Patient Experience, and the
Affordable Care Act from the Facility
Perspective. “The whole concept is it’s not
just the nurse doing something or the
facility manager doing something—
everyone plays a role.”
The importance of comfort
Patient satisfaction is a key issue
among hospitals today. Not only
are happy patients more likely to
use the facility again when needed
and recommend it to others, but
their satisfaction scores on the
HCAHPS questionnaires may affect
CMS reimbursement rates. The
category “Patient Experience of Care”
represents 25 percent of the HCAHPS
scoring in 2016.
ermal comfort
“Facility managers can leverage their
building and systems knowledge to
play a critical role in improving HCAHPS
scores and increasing reimbursement
rate,” Kenney wrote in her monograph.
Thermal comfort clearly plays a role
in patient satisfaction. Patients who are
hot or cold are simply not comfortable,
no matter what else is going on. “If you
poll facilities managers, they will tell you
that one of the top concerns of patients
is thermal comfort,” Kenney said.
A recent post on an ASHE LISTSERV
asked facilities managers what
percentage of patient calls concern
thermal comfort. Responses ranged from
zero (at a facility that has a thermostat in
each patient room) to 30 percent of calls.
The average among the five respondents
to the post was 13 percent.
However, no question on HCAHPS
asks specifically about thermal comfort.
Two questions regard the physical
environment—one about cleanliness
and one about noise level—but nothing
about being hot or cold. Nevertheless,
it stands to reason that if a patient is
unhappy because of a temperature
problem, she could reduce her
evaluation of some other category.
Six factors
When people think about thermal
comfort, their first thought is
temperature. If a patient is hot, turn up
the air conditioning; if he’s cold, turn up
the heat.
But temperature is only one of six
factors that affect thermal comfort. The
others are humidity, air speed, radiant
temperature, the clothing worn by the
occupants, and the activity level of the
occupants. Each of these factors affects
comfort separately, and, unfortunately,
nearly every occupant of a building can
sense thermal comfort differently.
“Controlling the first four factors—
the humidity, air speed, temperature,
and radiant temperature—is hard to do
in any environment, but a real challenge
is dealing with people,” said Andrea
Love, AIA, director of building science
for Payette, a Boston-based architecture
firm that frequently designs health care
facilities. “For example, the patient may
be lying there in bed in a johnny, while
the nurse is running around the floor.
They will have very different comfort
factors, and adjusting the thermostat
for one of them may negatively affect
the other.”
And the situation can change as a
person moves about the hospital, Love
said. A patient who was comfortably
warm in bed with a blanket may be
freezing when she is wheeled into the
imaging suite and has to remove the
blanket for an MRI, and conversely the
patient who was comfortable doing his
physical therapy in the gym may feel
overly hot when he returns to his room.
How can a facility deal with so many
factors? Love said her firm is trying to
figure that out by studying six hospitals
Another design feature that can enhance
thermal comfort is allowing patients to
control some elements of their space. An
obvious one is the thermostat.
in different thermal geographies in the
United States.
“We’re measuring the problematic
spaces in the hospitals and seeing what
adjustments they can make to improve
the situation,” she said.
Evaluating the situation
Love said that the first thing her
firm does when evaluating a hospital’s
thermal comfort situation is to take
measurements. She uses a tool called
a thermal comfort meter/logger. This
elaborate device measures temperature,
humidity, air speed, and radiant
temperature, and allows the operator
to input values for clothing worn by
occupants (CLO) and the metabolic rate
of occupants (MET).
“To measure comfort indoors there
are two measures that are used—
percentage of people dissatisfied (PPD)
or predicted mean vote (PMV)—both
of which are measured by the tool,”
Love explained. “PPD gives results as
the percentage of occupants that we
would anticipate to be uncomfortable
in a space. Because it is hard to
please absolutely everyone at once,
anything less than 10 percent of the
people dissatisfied is considered to be
comfortable. The other metric is PMV,
which is the anticipated average vote
of comfort for a space on a 7-point
scale with –3 being cold, 0 being
comfortable, and +3 being hot. Any PMV
between –0.5 and 0.5 is considered to
be comfortable.”
Then they try to determine what
is causing discomfort in a particular
space. Sometimes a draft from a vent is
www.ashe.org 27
blowing into a room, other times radiant
heat may be emanating from a piece of
equipment. Sometimes those problems
can be addressed with an easy fix, such
as a fan or a local heating device.
In the case of CHS Lincoln Hospital,
which is only six years old, the retrocommission revealed that the air
handling units were not performing as
well as they could be.
“We discovered that we had a lot
of simultaneous heating and cooling,”
Roberts said. “Rewriting control
sequences on the air handling units
helped. Now we are getting discharge
temperatures on the air handling
units closer to the space needs, rather
than overdoing it and compensating
with reheating. This results in better
control—less swing in the space. As
the thermostat gets satisfied, it stays
satisfied longer.”
Those changes to the air handling
unit, though designed to save energy,
have made occupants of the hospital
more comfortable too, Roberts said.
Finding the overlap
Fixing the physical problems related
to thermal comfort is part of the
solution; another is trying to find the
zone that pleases the most people.
In any space where people are
experiencing different activity
levels—a hospital definitely qualifies
as such a space—the thermal comfort
zone of the different groups probably
varies. For example, the patients lying
in bed may want the heat set at 75
degrees, while the nurses who are on
their feet all day prefer 65 degrees.
The key to making more of them
thermally comfortable may be
determining if there is common
ground between them.
“The patients and doctors and
nurses have different clothing and
activity levels, so we look for where
their comfort levels might intersect,”
Love said. “Is there a spot that will
satisfy most people? If there is no
overlap in comfort zones, what can
we push or pull in the space to get
them to overlap? Can someone adjust
clothing? Or do we need to add a fan
or local heating?”
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Another step in evaluating the
thermal comfort situation is examining
the activity level of the occupants
and what they’re wearing. Do the
physicians, for example, wear lab coats
and ties? Could they possibly dress
more comfortably so the heat could
be turned up? Do patients complain
about the cold in the hallways while
they are being moved to treatment
areas? If so, could they be given
warmer clothes or a blanket?
03/03/14 3:47 PM
But temperature is
only one of six factors
that affect thermal
comfort. The others are
humidity, air speed,
radiant temperature,
the clothing worn by
the occupants, and
the activity level of the
occupants.
Options in design
Naturally, if a space is being designed
from scratch or being extensively
renovated, thermal comfort issues can be
thoroughly addressed.
A high-quality façade is an important
start, Love said. “The design of the
façade makes a big difference because of
radiant heat,” she said. “If you’re getting
a lot of heat from the sun, you’ll feel
warm. But if you have a leaky façade with
a low R value, you’ll feel cold.”
Of course, the heating and ventilation
system also plays an essential role.
Making sure the air is not blowing
directly onto people and that the air
speed overall is gentle are two ways to
increase comfort.
“Radiant temperature can have a big
impact on thermal comfort, as can air
speed,” Love said. “Those are two factors
that are often not measured and not
accounted for.”
Patient control
Another design feature that can
enhance thermal comfort is allowing
patients to control some elements
of their space. An obvious one is the
thermostat.
“One of the things that really plays
into HCAHPS scores is giving patients a
sense of control over the environment.
That is a big theme right now in patient
satisfaction,” Kenney said, “so allowing
patients to have bedside controls, even if
it’s just a couple of degrees up or down,
can make a difference.”
Allowing patients to remotely control
the window shades is another option,
Kenney said. “What if it’s a hot sunny day
and the patient has to wait for the nurse
to come in and draw the shades? Being
able to do that themselves may help.”
Little things matter
Kenney notes that not every solution
to thermal comfort needs to be a major
fix. Making sure the hospital has an
efficient work order system, for example,
can make things better.
“Having a system that really enables
the staff to get that request from the
patient and be able to act on it quickly is
huge,” she said. “That’s an easy fix.”
And as she noted above, sometimes
the “all-hands” approach is all a hospital
needs. “It might not be that the system
itself needs to be adjusted,” she said. “If it’s
a cold call, what can people right there in
the room do? Can the nurse offer a warm
blanket? Or if it’s a hot call, can she put an
ice pack behind the patient’s neck? It’s just
the whole concept of patient-centered
care—talk to the patient and ask them what
would make them comfortable.”
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23/12/13 1:23 PM
Feature
Putting the “process” into
STERILE
PROCESSING
departments
By Shanna Wiechel, AIA, EDAC, LEED AP, principal and director of operations, Christner Inc.;
and Diane Desmond, activation lead/project manager, BJC HealthCare
Photo credit: Christner Inc.
L
ean process improvement is often used in
emergency departments and inpatient units
where it directly influences patient experience
and nursing staff efficiency. Sterile processing
departments (SPDs) are just as critical to patient
care, but because of their behind-the-scenes profile
are often overlooked for improvement projects. If sterile
processing departments work well, they get very little attention.
If they don’t, they can put patients and the hospital at risk. The
prescriptive flow and repetitive nature of sterile processing
makes the SPD an ideal candidate for lean process improvement.
The following “symptoms” may indicate that your SPD is due
for a process improvement initiative:
1. Flash sterilization is a regular occurrence.
2. Surgical nurses insist on cleaning their own instruments.
3. The SPD routinely runs out of supplies.
4. Supplies in SPD often expire.
5. Instruments are late or missing.
These indicators reflect a breakdown in one of the SPD’s
core work processes. Lean process improvement events get
SPD staff together with representatives from surgery, materials
management, and administration outside of their day-to-day
routines to question how work is being done, why it is being
done that way, and if there is a way to perform work better
or more efficiently. Although the steps in sterile processing
are standardized from a regulatory standpoint, aspects of the
design will differ based on the specific needs of the hospital:
number and type of surgical specialties reported, number of
inpatient beds supported, experience level of SPD staff, and
culture of the facility. A representative from each department
that is a supplier or a customer of SPD should be included in
the improvement process, including materials management,
surgery, and of course leadership and technicians from the SPD.
Because the flow of the sterilization process is inherently
prescribed, it might seem that the design of an SPD would be
straightforward and identical from one facility to the next. The
diagrams (at the top of page 31) show how a linear process flow
can be carried out in a variety of plan configurations. The ideal
layout is often one like the switchback where the flow is circular
soiled
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because it places the soiled drop-off and sterile pick-up in close
proximity for ease of transport. This type of layout also creates
the opportunity for visual management of SPD functions from
within supervisor offices and makes these offices convenient to
both the clean and sterile entrances for staff convenience.
However, these diagrams only illustrate the flow of the
instrument sterilization process. A number of other processes
can occur within an SPD such as scope processing, sterilization
of surgical linens, cleaning of durable medical equipment, as
well as storage, processing, and distribution of materials for
surgical procedures or even for an entire hospital. Because
the department is part of a larger process flow with surgery
and the dock, its location, size, and configuration are often
affected by its interaction with other departments. For
instance, whether breakdown (removal of packaging materials)
will occur within the department or at the dock, whether
sterile instruments and supplies will be stored in SPD or
surgery, and whether scopes will be cleaned at their point of
use or centralized within the SPD are questions that should be
answered with input from other departments.
Case study
Based in St. Louis, BJC HealthCare is one of the largest
health care providers in the United States. They were an
early implementer of lean process improvement in design
projects and operational improvement initiatives within
existing construction.
BJC’s Barnes-Jewish Hospital began lean process improvement
initiatives shortly after moving into a new 18,600 square foot
sterile processing department on South Campus. The staff held
regular workshops to discuss organization of their space to
better support work flow and then tried out solutions to test the
results. High-density shelving in sterile storage was replaced with
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www.ashe.org 31
23/06/15 12:59 AM
Paper dolls:
A lean
process
technique
Lean process improvement is a technique used by a group of
diverse stakeholders to better understand an existing work flow
(i.e., the current state) and to develop an ideal work flow (i.e., the
future state). These stakeholders work together to define the
criteria needed to achieve the ideal future state.
Numerous techniques can be used as part of the lean process
to create and evaluate ideas for improvement, but my personal
favorite is what I call “paper dolls.” We cut out a color-coded
“paper doll” of each programmed room or area at the same
scale as a background that shows the footprint available and any
known monuments such as stairs, elevators, structural columns,
or other existing building infrastructure that cannot be relocated.
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The group breaks into three multi-disciplinary teams (to
prevent a yours/mine scenario) and each team develops a
layout using these dolls, tape, scissors, and markers. When the
mock-ups are complete, each team’s spokesperson outlines
the key features of their layout, and then the entire group
votes on how well the layout meets each of the predefined
criteria. If time permits, each group may then revise their
layouts and reevaluate.
By making architecture accessible to the stakeholders that
will be using the finished space, architects are able to gain
valuable insight into the real needs and priorities of those who
will be affected by the design.
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grocery-style aisles of shelving, organized and labeled by service,
to allow case carts to be stocked in just one aisle.
Another improvement was to insert a card near the back of
each supply bin with a specific quantity (par level) of the item
remaining behind the card. As staff pulls the last item before this
card, they remove the card and hang it on a pegboard so that
the item can be reordered. Because each supply is intentionally
stocked from the back and pulled from the front, the chance
that goods will expire before use is greatly reduced. This process
also reduces time spent inventorying supplies for reorder and
reduces the chance that a supply will go out of stock.
By improving their efficiency, Barnes-Jewish hospital
was able to redeploy over 2,000 hours of labor per year to
productive functions.
In 2014, this same group reconvened for the design of
an SPD for the campus renewal project at the north end of
campus. By understanding the lean design principles applied
to the operation of the South Campus department, they were
able to design a new space where the entire layout was driven
by the lean flow of work and materials. One surprising design
objective was visibility between decontamination, assembly,
and sterile storage which are separated by large sterilization
1
5
2
4
3
9
1
2
3
4
5
6
7
8
9
equipment. This was important for communication between
team members in different areas, but also for security during
late night hours when only a few staff would be working in the
large department.
In the fall of last year, BJC had yet another opportunity
to design an SPD for the new Barnes-Jewish West County
Hospital (BJWCH). The previous two examples had used
a case cart system where all instruments and supplies are
stored in the SPD with specific items needed for each surgical
case selected and sent to the appropriate operating room
in a closed “case” cart. At this hospital, they decided to store
the inventory of sterile instruments and supplies within the
surgery department. This allowed instant access for surgical
nurses to the items needed. Decisions about how this process
would be handled had to be made early in the design process,
because of its implications on space allocation between SPD
and surgery which were on different floors of the building. It
also affected the staffing compliment and the types of carts
needed for instrument transport.
Going through lean process improvement as a group
yields more than a winning option; it provides insight into the
issues that are driving inefficiency in current processes and
into the key interactions between departments. It also helps
to build the support and buy-in from all of the stakeholders
that will be affected. (Surgery staff might stop hoarding their
surgeons’ favorite instruments if extra instrumentation can
be purchased and stored in the SPD where it will be ready
for use.) By participating in these events, architects can
better understand the priorities of these stakeholders,
so design decisions can be made based on how well
they support the group’s ideal work flow.
The best advice for SPD design is to make
7
the space as open and flexible as possible
within the confines of the prescribed
flow. For example, choose movable
storage and work table
6
solutions instead of built-in
8
options. Adjustable-height
workstations and sinks are also
highly recommended to allow staff
to adjust for better ergonomics. The only
constant is change, and once constructed, most
sterile processing departments must accommodate
changes over a very long period of time.
SPD Process Flow
Soiled items are transported to Decontamination where the initial “gross” cleaning occurs.
Instruments pass through Washer/Disinfectors into Assembly where they are prepared for sterilization.
Package instruments flow through Sterilizers and are stored with other sterile goods.
Case carts are cleaned by Cart Washers and then staged for redeployment.
Scopes are cleaned with special Processors in a dedicated set spaces.
In Breakdown, packaging materials are removed from all supplies before they enter Sterile Storage.
Case carts are delivered to surgery via elevator. Other items are retrieved at the pick-up window.
Staff Lockers provide access directly into the Sterile Storage area.
Staff Lounge, Offices and Conference are conveniently located for staff access and supervision.
www.ashe.org 33
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Feature
Focusing on the supply side:
A new energy
approach
By Judson Orlando, senior director, facilities development & engineering, Children’s Health;
and Michael Cozzi, managing principal, Bridgevue Energy Services, LLC
consumption reduction by investing
in energy efficiency projects to reduce
electric demand and consumption at
their facilities. While it is important for
most hospitals to focus on demand-side
reductions, a number of hospitals have
not focused as much time and resources
on supply-side energy purchase
optimization initiatives. Children’s Health
was no different until management
decided in 2014 to focus on optimizing
supply-side energy procurement of
natural gas, electricity, and renewable
energy. Children’s Health concentrated
on supply-side energy cost savings
because the incremental cost savings
potential available from supply-side
energy initiatives was projected to be
faster and greater than that of demandside energy initiatives. In addition,
Photography credit: Aaron Leitz.
ith ever-rising
health care
costs and lower
reimbursements to
most hospitals in the
United States,
Children’s Health in Dallas, which
includes the nation’s seventh-largest
pediatric hospital, wanted to find new
ways of addressing cost increases.
In 2014, the system’s facilities group
decided to take a different approach to
addressing rising energy costs by hiring
an outside energy management expert,
developing a comprehensive energy
management strategy, embracing new
ideas, and becoming more socially
responsible regarding the environment.
Many hospitals have rightfully
focused on demand-side energy
the supply-side energy cost savings
initiatives did not require any up-front
capital investments, unlike many
demand-side energy initiatives.
In 2014, Children’s Health embarked
on a strategic energy management plan
that contained several strategic thrusts for
implementation starting in 2015 and 2016.
One of the main thrusts for 2015 was a
supply-side energy management initiative
with the following key elements:
• Electricity supply purchase
optimization
• Natural gas supply purchase
optimization
• Demand response
• Renewable energy supply portfolio
• Other utility structure opportunities
The main objective of the supply-side
energy management initiatives was to
procure energy by the most efficient
means possible while balancing an
acceptable level of risk for the system.
The Children’s Health facilities team
selected Bridgevue Energy Services,
LLC, to assist with developing and
implementing supply-side energy
procurement optimization initiatives.
After several meetings to determine
goals and objectives, the system’s
historical and projected energy
consumption and energy cost data were
assessed. One of the system’s main goals
was to acquire lower-cost retail electricity
supply at a reasonable risk tolerance, and
www.ashe.org 35
electric supply that contained at least
10 percent renewable energy from an
identifiable source (on-site or off-site). In
addition, the renewable energy needed
to be cost effective.
Total annual electricity consumption
at all Children’s Health facilities is
approximately 90 million kWh per year.
Annual peak electricity demand, which
occurs in the summer months, is about
15,500 kW during the summer season.
The total square footage of all facilities is
1.725 million square feet.
A majority (more than 98 percent) of
Children’s Health sites are located in a
region of Texas that is deregulated for
electricity supply, which enables the
system to competitively select from
multiple retail electric providers (REPs),
and select from a variety of electricity
supply products. Prior to 2015, Children’s
Health did not really optimize electricity
supply purchases, but would enter into
a fixed-price contract with a provider
based on whatever price was available at
the time of contract execution.
A request for proposal (RFP) was
developed using a scorecard algorithm
and issued for the competitive selection
of a retail electric provider that could
meet the system’s objectives. The
scorecard included attributes and
weighting factors for each attribute. The
attributes included power price, product,
credit-worthiness, off-site renewable
energy (solar/wind) capabilities, and risk.
A retail electric provider was selected
that offered a block-and-index electric
product that would enable Children’s
Health to lock in 75 percent of future
electric quantities for five years at a very
low fixed block price, and would also
enable the system to purchase future
quantities (up to 25 percent) of off-site
renewable energy supply at wholesale.
In spring 2015, Children’s Health locked
in 75 percent of its forward electric
supply for five years at an attractive low
fixed price that yielded more than a 23
percent reduction in electric cost savings
compared to the prior electric contract.
Another area that Children’s Health
was interested in exploring was
sustainability and becoming more
socially responsible concerning the
environment and energy. Through
research, the team found that the total
renewable consumption for the health
care industry as compared to other
industries in the United States was very
small and somewhat concerning. The
team did not fully discover why, but
some anecdotal evidence indicated
that the health care industry had some
misperceptions about renewable energy.
Some of the misperceptions included
power reliability and economic concerns.
Information from Bridgevue
indicated that off-site renewable energy
solutions could be as equally reliable
as conventional power supply (e.g., no
loss of power supply to the hospital)
and the economics could be on par
with conventional energy. A variety of
renewable energy sourcing options were
assessed, including on-site and off-site
solar energy, off-site wind energy, offsite landfill gas to power energy, and
combinations of off-site wind and solar
energy. In late summer 2015, Children’s
Health secured 25 percent renewable
energy supply commencing July 2016 for
a term of seven years at a fixed price that
was on par with conventional energy.
The 25 percent renewable energy
portfolio contained both wind energy
and solar energy from off-site wind and
solar farms located in West Texas, and
provided the lowest energy cost of all the
options investigated.
The 22,500 megawatt hours of
green electricity will be backed by
renewable energy credits to offset the
environmental effect that otherwise
would occur because of the use of
non-renewable fossil fuels. This action
is equivalent to removing more than
16 million pounds per year of carbon
dioxide from the environment. For
perspective, the average Texas home
uses 14.5 megawatt hours per year
of electricity, so the commitment to
renewable electricity is the same as more
than 1,500 average Texas homes going
100 percent green.
“Our mission is to make life better for
children, and we have a responsibility
to help give children the right start in a
healthy environment,” said Christopher J.
Durovich, president and chief executive
officer of Children’s Health. “Reducing
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our carbon footprint directly contributes
to that mission and leaves a healthier
planet for future generations.”
When the plan is implemented in
2016, Children’s Health is expected to
use more renewable energy than any
other pediatric health care system in
the country, and is expected to be the
second largest health care system user
of renewable energy in the nation,
and the largest in Texas, according to
data collected by the Environmental
Protection Agency. Children’s Health will
continue to source the same amount of
renewable energy—including off-site
solar and wind—through June 2023.
Children’s Health started with the goal
of being more socially responsible. The
system was able to secure a renewable
energy mix of solar and wind power that
was on par with conventional energy
pricing, which will allow Children’s
Health to focus on long-term sustainable
solutions as the system continues to grow
and expand.
Additionally in 2016, the hospital
system is committed to identifying
new ways to reduce overall energy
consumption, improve waste
management, and source products made
with sustainable, non-hazardous materials.
The Children’s Health Sustainability
Council, which is composed of individuals
from a wide variety of positions and
backgrounds within the organization, will
continue to identify proactive ways for
the system to create long-term goals for
environmental sustainability.
In addition to the retail electric supply
cost reductions, Children’s Health will
also realize significant cost savings and,
from optimized procurement of natural
gas supply, financial incentives from
participating in several demand response679456_TSI.indd
programs and other opportunities to
reduce regulated demand charges.
The overall cost savings impact
from all of the supply-side energy
management initiatives is expected to
be more than $1.5 million per year. These
annual savings are expected to continue
for the next five years. Incidentally,
these savings do not include any cost
savings from demand-side energy
efficiency management initiatives that
are going on in parallel to the supply-side
management initiatives.
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UNDERSTANDING,
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1
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www.ashe.org 37
28/09/15 7:10 pm
Feature
From big box retail to community clinic:
How adaptive reuse
opened the door for Seattle
Children’s newest clinic
By Sandra Miller, director of facility planning, design and construction, Seattle Children’s; Victoria Nichols, associate partner,
ZGF Architects LLP; and Taka Soga, principal, ZGF Architects LLP
s the modern health care
model increasingly focuses
on whole-person care,
the health care field is
changing along with it.
Many hospital systems
today establish outpatient care locations,
that is, clinics, in once-underserved
suburban communities to decentralize
care opportunities. The strategy brings
preventative health care to the patient,
with the hope that the patient will
require acute care less often.
These new suburban clinics are
often located in highly visible areas—
retail strips and power centers—with
easy access to public and private
transportation. In some cases these
medical facilities have revitalized
suburban retail development while
offering premier care in close proximity
to patients’ homes and workplaces.
From the facilities planning perspective,
locating ambulatory care and its
accompanying parking to a location
with lower leasing rates benefits
patients while reducing operational
costs. Choosing a site for such a clinic
is contingent on proximity to a strong
medical center’s resources and avoiding
redundancies by not building too close
to other clinics’ service areas. When
Seattle Children’s sought to expand its
service to new communities south of
Seattle in Federal Way, Washington, in
2013, the opportunity to adapt a vacant
big box retail store—a former Circuit
City—emerged.
Seattle Children’s was cognizant
of other hospital systems’ adaptive
reuse of big box stores, but the hospital
had no experience executing such a
renovation. Despite initial reservations,
Seattle Children’s realized that elements
of the 37,000 square foot former store,
including that it was one level with wide
spans between structural columns,
offered ready-made features that
would actually advance clinic goals. The
store’s footprint facilitated a floor plan
later designed to centralize services
within an open, flexible system of
efficient workspaces and modules that
incorporate principles of lean design.
Located in a shopping center in a
transit-oriented area, the former Circuit
City also lent itself to a high degree
of visibility, an important quality
considering its location near major
highways and arterials. Shopping centers
provide ample parking and existing
site features, such as opportunities
for signage, entrance and egress, and
proximity to other retail destinations that
make the site convenient for the families
Seattle Children’s serves. Although
Federal Way lacked proximity to nearby
support facilities, the sheer amount of
usable, flexible space would facilitate
incorporating laboratories, general X-ray,
ultrasound, pharmacy, and rehab therapy
functions into the design. That flexibility
solved the issue of being a bit far from a
hospital’s resources to supplement the
clinics’ outpatient services.
Along with these positive attributes
of the space, however, challenges did
arise in this case that wouldn’t typically
be encountered in a health care tenant
improvement. For instance, adapting
the building required significant
infrastructural upgrades, environmental
abatement to Circuit City’s former
site, and collaborating with a property
manager uninitiated to the requirements
of health care projects.
The flexible qualities of the
building, the location of its site, and the
opportunity to bring economic equity to
the community they would be serving
led Seattle Children’s to proceed with the
decision to convert the empty big box
into the clinic serving the South Puget
Sound region. Construction began in June
2014, and, as expected, upgrading the
infrastructure proved to be among the
project’s biggest tasks. A retail store is not
designed with the extensive electrical and
mechanical systems necessary for exam
rooms or labs; those utilities would need
to be added or overhauled. Facilitating
these upgrades in a space with a 25foot floor-to-ceiling height included the
creation of an internal frame to support
infrastructural improvements. Ultimately,
the space included three identical clinical
modules consisting of 10 exam rooms and
a team room per work area.
Construction was staged so the
interior tenant improvement work
occurred at the same time as the site’s
abatement. The building is located
adjacent to a dry cleaners, requiring
Seattle Children’s to work with the
business owner to create an environment
that would be not just up to EPA
standards, but to exceed them to a point
where the hospital could feel confident
about the quality of the air surrounding
a pediatric clinic. Concurrently, Seattle
Children’s worked with the Federal Way
Police Department and the property
manager to ensure a safe environment
and a supportive relationship with
nearby businesses in the retail complex.
While there was undoubtedly a
learning curve that came with developing
the building, the Seattle Children’s South
Clinic opened in August 2015, under
budget and on schedule, providing
outpatient services to families in two
of Washington state’s most populous
counties. The success of the project allows
the main Seattle Children’s campus in
Seattle to focus on acute care services.
Considering that the previous
Seattle Children’s Federal Way clinic
was located on the third floor of an
aging medical office building, this
adaptive reuse tenant improvement
provided a significant upgrade, both
for the quality of health care available
in the South Sound region and for the
spectrum of care offered by Seattle
Children’s. While Seattle Children’s
could have chosen to expand to another
city or via a more traditional design
build process, the choice to adaptively
reuse an existing building of a different
typology proved to be the best choice.
As health care continues to move in a
preventative-care direction, adaptive
reuse has established itself as a viable
option for providing stellar health care
in decentralized areas.
Advantages
of lean
functionality
As in previous Seattle Children’s
projects, the design team for
the South Clinic in Federal Way
incorporated a lean approach,
holistically integrating all hospital
functions by placing equal emphasis
on function, program, experience,
and identifying opportunities
to minimize waste and improve
efficiency and patient outcomes.
Taking note of the lean approach
used in Seattle Children’s Bellevue
Clinic, the design team analyzed
what elements of the Bellevue Clinic
design aided a productive workflow
and which hindered one.
One of the key takeaways from
Bellevue Clinic was the importance
of unifying the arrangement
of work modules. By designing
uniform workspaces—a single team
workroom attached to a set of 10
exam rooms in this case—clinic
staff could work more efficiently
throughout the building, as each
member was familiar with the setup
regardless of the facility location.
Not only does this approach result
in more efficiency within the South
Clinic, but it facilitates staff from
other Seattle Children’s locations
such as the Bellevue Clinic being
able to work at the South Clinic with
little adjustment.
When posting job listings for
the South Clinic, Seattle Children’s
received a high amount of interest
from staff from other Seattle
Children’s locations, including the
main hospital, undoubtedly in part
because the transition from another
Seattle Children’s practice location
to the new one would be smooth for
nurses, doctors, and administrators
already familiar with the approach.
Considering the expense of hiring
and training medical staff for a
new facility, the incorporation of
lean functionality across the entire
Seattle Children’s resulted not just in
staff and operational efficiency, but
financial advantages as well.
www.ashe.org 39
Photography credit: Aaron Leitz.
Member Spotlight
Skip Gregory
Skip Gregory has long worked to improve the codes
and standards regulating hospitals and other health
care facilities. Gregory is chair of a National Fire
Protection Association (NFPA) subcommittee working
on life safety issues, and has helped keep ASHE
members updated about critical changes in the Life
Safety Code. In his former role as an authority having
jurisdiction, he was an active member of ASHE who
took an open-minded and principled approach to
interpreting code documents. He regularly attends
NFPA technical sessions to vote on critical issues
affecting hospitals and other health care facilities.
Most recently, he helped produce ASHE’s e-learning
course on the FGI Guidelines.
ASHE’s member spotlight
highlights ASHE members
making significant
contributions to the field of
health care engineering and
contributing to our mission
of optimizing the health care
environment. If you would
like to nominate someone to
be featured in the member
spotlight, contact Inside
ASHE managing editor
Deanna Martin at
[email protected].
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FIRE PROTECTION SYSTEMS
Specified Technologies Inc. .............6
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Tyco Simplex-Grinnell ......................4
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FIRESTOP CONTRACTORS
Isave Team.......................................9
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FLOORING
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BUILDING COMPONENTS
BUILDING MANAGEMENT SYSTEMS
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CONSULTANTS/CONTRACTORS
AccuScan...................................... 23
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Russelectric ...................................11
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ENERGY/ELECTRICAL
Weishaupt Corporation ................. 40
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HVAC
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MECHANICAL INSULATION
Isave Team.......................................9
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Legionella & Pathogen Testing
MEDICAL EQUIPMENT/SUPPLIES
EMSE Corporation ........................ 42
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PATIENT SAFETY
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TECHNOLOGY
AccuScan...................................... 23
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TELEVISIONS
RCA Commercial..............................5
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WATER HEATERS
PVI Industries................................ 20
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