Sisters of Mercy Health System Planning, Design

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Sisters of Mercy Health System Planning,
Design Construction Healthcare
Construction EducationDate
Planning, Design and Construction 14528 S.
Outer Forty, Suite 200
Chesterfield, MO 63017 Tel
[phone] Fax (314)
628-3471 Form 8334 CF490
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Presentation / Discussion Outline

• Introductions / Meeting Objectives
• Understanding the Healthcare Organization
• Owners 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
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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 Organizations 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 Owners 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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Owners 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 Organizations
• 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 Preparedness
• Risk 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, IDs, 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?