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Sisters of Mercy Health System

Planning, Design & Construction

Healthcare Construction Education

Date:

Planning, Design and Construction

14528 S. Outer Forty, Suite 200

Chesterfield, MO 63017

Tel (314) 628-3656

Fax (314) 628-3471

Form 8334 – CF490

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Presentation / Discussion Outline Introductions /

Meeting Objectives

Understanding the Healthcare Organization

Owner’s Expectations for Construction

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The Business of Health Care

Improving the Health and Well Being of People

Requires Multi-Disciplined Team

Highly Regulated

Very Competitive

Challenging to Maintain Financial Stability

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Typical Health Care Organization

P h ys ic ia n 'sG ro u ps

E m e rg e n cyIm ag ingL a bsM e d ica l S ta ffP h a rm a cyS u rg e ry

C lin ica lS e rv ices

A d m iss io nsH u m an R e so u rcesF in an ce

G e ne ra lB u s in e ss

C e n tra l S e rv icesC lin ica l E n g ine e ringD a ta /Te le com S ys te m sD ie ta ryF a c ilit ie sH o use ke e p in g /L a un d ryIn fe ctio n C on tro lR isk M a n ag e m e n t/S a fe tyS e cu rity

S u pp o rtS e rv ices

A d m in is tra tion

B o ard o fT ru s te e s/D ire c to rs

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Typical Health Care Customers

Sick People Diagnostic Tests Elderly / Frail / Behavioral patients Respiratory Problems Scared / Confused Patient Family, Friends, Visitors Low Imune Patients Hearing/Vision impaired Emergency Patients Burn Patients

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Elements / Services Needed

Safe Environment (Dust/ Mold for resipitory patients, Noise for Mandatory rest patients,

Smells for imune defiecient patients, air partiticle from burn patients and infection from cnst safe for handicap)

Restful Environment (Reduce noise, dust, vibration, smells, water leaks, Unplanned outages)

Clinical Areas of Specialty (Mri protect from vibration/Dust, Lab equipment protect from vibration

and samples from contamination, MRI from interference, Several sterile enviroments)

Infection Control (Infection control measures to protect Patients from staff and other

infections and problems while they are in the Hospital)

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Regulatory Requirements

Applies to Healthcare Facilities, including Hospitals Ambulatory Care Behavioral Health Long Term Care / Assisted Living

Includes Local, State, and Federal Requirements Notable:

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ; (HIPPA)

U.S. Department of Health and Human Services (HHS) Center for Medicaid & Medicare Services (CMS)

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Regulatory Requirements

Design and Construction Related: Guidelines for Design and Construction of Hospital

and Health Care Facilities (AIA Academy of Architecture for Health)

Environment of Care Requirements (JCAHO) Centers for Disease Control & Prevention (CDC) Occupational Safety and Health Administration

(OSHA) American Society of Heating, Refrigeration and Air-

Conditioning Engineers, Inc. (ASHRAE) Local City and States review Boma

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Special Systems Used in Healthcare Delivery

Telemetry Monitoring Patients Hearts

Pneumatic Conveying Tubes meds, bloods and samples to labs for testing

Exhaust Air/Isolation units Haz exhaust, Mandatory air exchanges, Isolation rooms

Radiation X-ray equipment, Hot labs, MR Magnets, Accelerators, Digital images &

Records

Infant Abduction Paging/Antenna systems

Calling code teams, emergency announcements, Doctors Pagers

Emergency (Code/Crash, Flood, etc.) Emergency power, Trauma Elevators, Medical Gases

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Typical House Rules

Know and Understand Organization’s Mission Show Care and Concern for Patients,

Families/Visitors, and Property Ensure Patient Confidentiality Contribute to Teamwork Demonstrate Respect for Fellow Co-Workers Be Courteous and Friendly Maintain an Appropriate Appearance Respect existing facilities

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Mercy Service Standards Treat Everyone as a valued individual Seek out and address customer needs Make eye contact, greet and welcome

everyone Display a positive presence Keep customers and co-workers informed Work as a team Maintain privacy and confidentiality Keep a clean environment Live the mercy spirit

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Guaranteed Issues for Project Team Members

“You Are a Guest in Our House” Use Effective Communication – NO SURPRISES! Demonstrate Respect for Owner’s Facilities

Parking (Use designated parking areas)

Public Spaces – Cafeteria, Restrooms, etc. Behavior

Require All Members to be Accountable for Their Actions

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Hospital Operational Modes - Summary

Patient care is a driving force Patients are our customers. This is our business

Heavily regulated Our reimbursement is tied directly to our ability to serve patients and

maintain a safe environment

Risk management oriented We need to provide risk Assessments for all our activities which

is regulated by the State Performance/process improvement oriented

We must maintain a pan for improvement on facilities which is reviewed by State (Jacho)

Physicians are an integral part of the hospital

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Hospital Challenges - Summary

Aging buildings and infrastructure This is why we plan ahead carefully

Competition Patients have a choice in healthcare and we want that to be SMHS

Technology advances Decreasing re-imbursement Lots of Changing healthcare needs and desires Community may see it as their hospital, even

if there are no financial or organizational connections

Financial well being of the organization No matter what happens, patient care must go

on

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Owner’s Expectations - Construction

Risk Assessment/Management Manage Risk such as, Noise, Smells, Vibrations,

Hazardous areas, Dust, sterile areas, Disruptions

Communication/Coordination of Activities

Plan activities well in advance, Communicate to all co-workers, Manage disruptions to minimize impacts, Be transparent

Quality Assurance Follow policies and Standards, Control moisture in

facilities, wrap ductwork, air testing, Infection control measures

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Risk Assessment/Management

Environment of Care (EC) We do not evacuate in fire we retreat to safe zones. signage, train staff on exits, Maintain sprinkler/alarm systems Infection control, Risk assessment, Cnst related infections

Interim Life Safety Measures (ILSM) Temp exiting, Emergency room access, Fire protection systems,

Smoke zones, Doors latching, firewalls/Penetrations, fire watches

Infection Control Risk Assessment (ICRA) Negative pressure, daily checks, Water, dust, sealed partitions,

Tracking dirt in facility, filter changes log

Other Construction Site Risk Issues Sealed barricades, Traffic control, Temp Signage, Guass fields,

Radiation, Power disruptions, Isolation room, Access for codes, Monitoring systems, Ceiling tile dust

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Environment of Care - Definition

Provides a … Safe Accessible Effective Efficient

Environment Consistent with Organization’s … Mission Services Applicable Laws Applicable Regulations

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Life Safety Code Compliance

NFPA 101 (Provide For a Fire-Safe Environment)

Equivalency Approved by JCAHO

Statement of Conditions Includes Basic Building Information Assessment of Existing Conditions Plan for Improvement Building Maintenance Protocol

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Interim Life Safety Measures (ILSM) Used During Significant Construction

Project

Method to Offset Recognized Code Shortcomings

Contains Eleven (11) Administrative Measures

(Egress, exterior access, fire alarms, suppression, Temp Partitions, Fire extinguishers, No smoking policy, storage, fire drills, Hazardous surveillance, Hot work, Re-assessment

Requires Constant Monitoring

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Infection Control Risk Assessment (ICRA)

Initiated in Design Phase

Provides for a Safe Environment of Care

Determines Potential Risk of Transmission of Various Agents in Facility (Viruses, Bacteria, Toxins)

ICRA Conducted by Panel of Experts Including Infection Control, Risk Management, Facility Design, Construction and Ventilation Safety

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ICRA – Key Elements Addressed

Impact of Disruption to Essential Services Patient Placement or Relocation Placement of Barriers to Protect Susceptible

Patients from Airborne Contaminants Air Handling and Ventilation Needs Need for Additional Protective Environment

Rooms Domestic Water System that Limits Legionella

and Waterborne Opportunistic Pathogens

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Other Construction Site Risk Issues

Patient Privacy/Confidentiality (HIPPA)

Theft

Adjacencies to Imaging Equipment

Unidentified Hazards in Construction Area

Accidental Disruption to MEP Services Disrupt surgery, Life support, Oxygen, Contaminant gases,

cooling in burn unit, Radiation exhaust, isolation room exhaust,

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Communication/Coordination of Activities

Exchange of Construction Related Information Keep administration informed, Train/Inform staff of changes to their areas,

Security rounds needed

General Conditions Items Traffic control, clean up, Safety, infection control,

Planning for Facility Interruptions Notify departments, move critical patients, provide temp

transport, temp O2 added staff to manage patients

Project Emergency PreparednessRisk assessment, notify adjacent department if affect

their egress, fire protection systems, HVAC, Fire wall breach

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Exchange of Construction Related Information

Constructor Orientation and Education Program

Emergency Contact Information

Frequency of Progress Meetings

Meeting Note Distribution List

Process for Handling Unexpected Situations

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General Conditions Items

Security Items (Employee Access, ID’s, Secure Area, etc.)

Temporary Utilities

Procedures for Deliveries and Trash Removal

Standard Policies (Smoking, Radios, etc.)

Acceptable Support Services (Restrooms, Food, etc.)

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Planning for Facility Interruptions (Shut-Downs)

Determine Coordination Process to be Used for MEP Systems with Facility Manager

Determine Notification Process to be Used with Affected Parties

Be Proactive, Anticipate Facility Interruptions!

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Project Emergency Preparedness Plan

Fire

Weather

Internal/External Disaster

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Quality Assurance

Communication

Teamwork

Customer Service

Technical

Creativity/Value

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Owner Review of Construction Items

General Conditions, ILSM, ICRA

Pre-Installation Reviews

Users of Future Space

Regulatory Inspections

Facility Management Inspections

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Proactive Versus Reactive Issue Resolution

What Challenges Do We Face?

Are We Organized For Success?

What Options/Techniques Do We Need To Consider?