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Why Facility-care is Critical for Healthcare

When is the last time you got a physical from a doctor? Buildings like humans are constructed with systems that wear out and need maintenance. Buildings have skin (building envelope), bones (structure), pulmonary systems (plumbing, heating, cooling, ventilation, and electrical systems), central nerve system (life safety, alarms, electrical systems). When is the last time your facility had a full physical, a Facility Condition Assessment?

Why Healthcare Facility Managers face an uphill battle

Most modern facilities face the normal expectations of managing their building assets. However, modern hospitals are typically challenged to a much higher standard. Hospitals are not only managed for normal operation, but they are also expected to provide enhanced ADA accessibility; to improve sanitation in operations, equipment, and furnishings to avoid healthcare supported infection; to provide enhanced humidity and comfort control to meet new code requirements; to improve safety and way finding to reduce patient stress; and to manage for efficiency to encourage effective patient care.

In the last century, finance directors and corporate managers were not closely linked to the facilities management staff. The mission and operating standards of the hospital were not always connected to the facility management. In the 21st century, hospitals have taken a more integrated approach to managing their resources – people, facilities, information technology, and dollars. Facility directors and hospital corporate directors can no longer afford to work in different silos.

21st century hospitals require 24/7 operations that stretch the use of all of their facility, staff, and information systems. In the 21st century, facility managers are expected to understand corporate mission and strategy to align organizational mission and strategy with operational budgets and maintenance. Facility manager for hospitals are facing the challenge of a changing regulatory environment, keeping up with asset management for aging facilities, and staying relevant with changing technology and changing strategies for healthcare delivery. Older hospitals are challenged to manage and budget for aging systems and for new technologies while maintaining a high level of efficiency and cleanliness. If a facility can’t meet this extremely high level of performance, it may be a candidate for demolition or renovation. This high level of expectation and pressure can put a strain on facility managers to maintain operations that meet these high standards.

Five Recent changes in Healthcare delivery affect Healthcare Facility Management

1. Mergers and acquisitions

In recent years, health care systems have been going through mergers and acquisitions, creating large health care systems that are replacing heathcare networks. Large hospitals are being built less often and are being replaced by ambulatory surgery buildings, more emergency clinics, and micro-hospitals in local communities. Healthcare systems are now managing a portfolio of facilities as well as the system assets within each facility. Prioritizing maintenance and management of facilities requires a robust asset management inventory and strategic  plan.

2. Managing Health Care Associated Infection, HAI

The physical environment is fourth on the list of Healthcare Associated Infection (HAI) causes, according to the CDC. While HAIs from treatment-related causes are actually decreasing, HAIs resulting from the environment of care may not be. Hospitals must consider how they can improve the design, maintenance and management of facilities — from ventilation systems to room décor — to reduce infection risks.

3. Life safety inspection requirements

Medicare and Medicaid programs require compliance with the 2012 edition of the NFPA (National Fire Protection Association) LSC (Life Safety Codes) and HCFC. CMS (Center for Medicare and Medicaid Services) partners with State Agencies (SA) to assess facilities for compliance with the LSC requirements. SAs may enter into sub-agreements or contracts with the State Fire Marshal offices or other State agencies responsible for enforcing state fire code requirements. Under these agreements, the designated state fire authority generally agrees to:

• Survey non-accredited hospitals, hospices, ASCs, SNFs, NFs, CAHs, RNHCIs, PACE, ESRD, and ICF/IIDs in accordance with schedules the SA furnishes;
• Survey accredited hospitals selected for validation surveys or surveyed as a result of a substantial allegation of unsafe conditions;
• Complete the appropriate Fire Safety Survey Report (Form CMS-2786);
• Prepare statements of deficiencies and review Plans of Correction (Form CMS-2567);
• Make recommendations to the SA regarding facilities’ compliance with program fire safety requirements; and
• Use only qualified fire safety inspectors who have received CMS training in the performance of these

Hospitals need to stay on top of life safety compliance requirement and audits. Working with outside consultants to assist with regulatory compliance can help healthcare networks keep current with code and regulatory requirements.

4. Aging and retiring Facility Directors

Recent studies have shown that nearly 40% of facilities management professionals will be retiring in the next eight years. Centralizing assets into a central data base can help hospitals manage work, prioritize budgets, and maximize staff effectiveness.

5. Shift to central data base management of assets

In 2018, the International Standards Organization finalized its 55,000 Guide to Asset Management, which  details a strategy for managing facility assets by an integrated approach. Asset management, using ISO 55,000 encourages a strategic approach to managing 21st century facilities. Centralized asset management and capital planning seeks to minimize the total costs of acquiring, operating, maintaining, and renewing building assets. Centralized Maintenance Management Software, CMMS, allows streamline planning, forecasting, and prioritization of capital deployment. Centralized asset management, using ISO 55,000 guides asset managers in navigating the challenges of integrating both facility managers and corporate leaders to:

1. Centralized asset management – an asset centric approach

1. Improve efficiency of assets to reduce cost and mitigate risk
2. Develop infrastructure that combines asset transactions, operations, utilization and lifecycle
3. Provide a holistic view of assets throughout their lifecycles

2. Data Quality and Accuracy

1. Strive to strengthen data and analytical capabilities in standard format
2. Standardize data capture and reporting across a single platform and repository to eliminate waste and redundancy
3. Improve flow of information between multiple applications and locations

3. Capital Investment Strategy

1. Monitor, measure and verify program performance to optimize portfolio
2. Develop and ensure credible information and repeatable processes

Facility Condition Assessments for healthcare facilities and networks can help to bring facility managers and corporate leaders together to streamline planning and to enhance forecasting and  prioritization of capital deployment to meet the challenges of 21st century facility management. Giving your facility a physical examination is the first step towards building an asset inventory and to create a centralized data base from which to manage and budget for healthcare operations. Terracon’s capital planning and asset management services can help your healthcare network Streamline planning, forecasting & prioritization of capital deployment in order to determine:

1. What is the current state of my assets?
   1. What do I own?
   2. Where is it?
   3. What condition is it in? What is its performance?
   4. What is its remaining useful life?
   5. What is its remaining economic value?
2. What is my required level of service (LOS)?
   1. What is the demand for my services by my stakeholders?
   2. What do regulators require?
   3. What is my actual performance?

3. Which assets are critical to sustained performance?
   1. How does it fail? How can it fail?
   2. What is the likelihood of failure?
   3. What does it cost to repair?
   4. What are the consequences of failure?
4. What are my best O&M and CIP investment strategies?
   1. What alternative management options exist?
   2. Which are the most feasible for my organization?

5. What is my best long-term funding strategy?

Terracon can assist with capital planning, facility management, and building system solutions. For more information, visit .terracon.com/facilities or call (800) 593 7777.

Kyle Christiansen, R.A., is a senior facilities consultant in Terracon’s D.C. Metro North office. He has  spent the last 30 years helping building owners in 49 states and six  countries manage their assets and plan for the future. In recent years, he has focused on complex facilities and campuses.