Environmental Health & Engineering, Inc.
Bryan Connors, Practice Director, Healthcare, provides technical expertise for hospitals in support of Joint Commission, Hospital Pharmacy USP, OSHA and EPA compliance, infection prevention, industrial hygiene, and hazardous materials management.
Sweeping changes have been made to the Joint Commission standards and survey process. From the new “See it Cite it”, which ends decades long scoring protection from the Statement of Conditions (SOC) process, to a renewed focus on ligature risks in behavioral health setting, significant change has come to the Joint Commission. Annually the Joint Commission releases a ranking of the top 10 most cited standards. Many appear on the list year after year, with the Environment of Care (EC) and Life Safety (LS) standards still the most prevalent, typically comprising five or more of the top standards. What is missing from the list – and what would be most helpful to facility managers – is specifically what the issue was at the Element of Performance level. This session will shed light on the specific deficiencies behind the most commonly cited standards within the EC and LS, and where they are typically scored on the new SAFER matrix.
Data from nearly 50 EC and LS mock surveys and a half dozen Joint Commission surveys in 2017, under the SAFER matrix methodology, provides valuable insight into the specific issues behind the commonly cited standards and Elements of Performance. EH&E has access to this unique data set by conducting mock surveys and participating in Joint Commission surveys for hospitals across the northeast. The findings of our analysis will be shared to help facility managers better focus their resources for greater compliance and safety at their institution. The findings will be mapped to the Joint Commission’s SAFER matrix to clearly illustrate the risk and severity. This information is a useful, visual tool in communicating with hospital leadership to establish priorities and allocate the necessary time to resolve the more challenging deficiencies.
The changes present some good news for facility managers. Under the new scoring system the risk level is ranked by the specific finding – not the standard. This provides the institution with a much more realistic picture of critical vulnerabilities than the previous scoring method. Early analysis of the data illustrates this improvement in scoring. For example, missed deadlines and grace periods by vendors for testing of fire safety equipment are still prevalent in hospitals and are still cited during surveys. However, now the scoring for these types of deficiencies is ranked more appropriately when compared to completely missing the test, or relative to improper pressurization and ligature risks that present a more severe risk to patient safety.
Effective strategies and best practices for resolving the deficiencies that present the greatest risk to patients and the hospital will be discussed. Additionally, this session will review the key components of the SAFER methodology and provide participants with a picture of what they may expect during their next survey.
Lead engineer, life safety, at the National Fire Protection Association – NFPA
Ron Cote, P.E. was NFPA staff liaison to the NFPA 101 technical committees for 35 years. He is currently a NFPA technical lead developing new products and services.
NFPA 101-2012 references NFPA 80-2010 which requires yearly inspection, testing and maintenance (ITM) of all fire door assemblies (FDA); ITM records must be retained and made available to accreditation/CMS surveyors. Facility operators should prepare an inventory of all FDAs; doors that are not fire doors need to be maintained in working order like all other elements of the life safety systems but should not be added to the FDA inventory.
Attend this session to learn which doors are FDA and need to be inventoried. New and existing door openings found in health care facilities will be addressed via the requirements of NFPA 101: patient room, hazardous contents room, smoke barrier, horizontal exit; doors associated with vertical openings including exit stair enclosures, elevator hoistways, and HVAC shaft walls; and doors that serve multiple purposes like those in a corridor wall opening to a patient care sleeping suite where the corridor wall is also a smoke barrier. The session will conclude with NFPA 80 verification points for the ITM of FDA so facility operators can determine if in-house personnel have the requisite skills to perform the yearly ITM or if the work will need to be contracted to outside professionals.
Director of Plant Operations and Security at Wentworth-Douglass Hospital in Dover, NH
Dave Dagenais has been in healthcare for over 20 years and is currently the Director of Plant Operations and Security at Wentworth-Douglass Hospital in Dover, NH and Past President of ASHE and the New England chapter of ASHE. Dave has earned his FASHE designation with the American Society of Healthcare Engineers, and is a Certified Healthcare Facility Manger and a Certified Healthcare Safety Professional. He has helped lead ASHE’s advocacy work and has been involved with code development organizations to improve the codes and standards regulating hospitals for several decades. He also served as a police officer for 11 years and is a member of the International Association for Healthcare Security and Safety.
Legionella Risk Management, Inc.
For almost 20 years has provided unbiased engineering consulting services to the healthcare industry on Legionella related issues associated with all building water systems including; outbreak mitigation, risk management, training and control. Original voting member of ASHRAE 188. Coauthor of 2nd and 3rd editions of book titled, “Infection Control During Construction Manual: Policies, Procedures, and Strategies for Compliance”. Author of the monograph published by South Dakota Health Department titled, “Guidelines for Control of Legionella in Ornamental Water Features”.
Today you are more likely to find information regarding Legionella that is more incorrect than correct. In May of 2017 the Wall Street Journal published an article on Legionnaires’ disease (LD) based on a CDC paper. While the chart from CDC paper in the article documented the very high risk of Legionnaires’ disease associated with potable water, the article said cooling towers were the greatest risk. Since 2014, there has been a rash of guidelines and directives for control of Legionella that are as confusing and incorrect as this Wall Street article.
Equally important, standards for water and energy savings applied to a water system without the necessary design and or operational modifications can significantly increase risk for Legionella. With all this misinformation available and conflicting guidance it is difficult for a healthcare facility to make the correct choices for control of waterborne pathogens.
Following the wrong recommendations can be costly. An LD outbreak can have a significant impact on patient safety, patient family member and employee anxiety as well as facility reputation. Also an LD outbreak in a healthcare facility frequently results litigation. It can be very scary for patients, family members, and employees to think that something coming out of the water faucet can cause serious illness.
Legionnaires’ disease is a multifaceted issue. LD requires clinical controls to identify and address the illness in a timely fashion and engineering controls to identify and address the risk in building water systems.
This presentation by consulting engineer with almost two decades of experience in legionella control in building water systems and almost 40 years of experience in areas of design, operation and maintenance will:
CLEAResult Consulting Inc.
Steve Keppler is the Senior Director for the CLEAResult Critical Systems Design Build Practice.
Previous Experience: The US Department of Energy (DOE) Visiting Fellow, SD Keppler and Associates Founder-President-CEO, US Green Building Council (USGBC) LEED Program Director.
A case study style presentation on the application of a collection of strategies leveraging situations or circumstances, to address and implement standard AND deep chiller plant optimization. Touching on technologies and products generically, the session technical focus will be on ASHRAE’s 2010 90.1 Standard sections focused on water side economization and the design shift and related performance and functional benefits to integrated versus parallel water side economizer system design.
Progression of Chiller Plants to Optimization
The segment will present and discuss paths and progression of chiller plant optimization at a high level, mapping the progression from static or worst case status, to best case, fully optimized plants. The discussion will be supported by quantifiable milestones through plant optimization progression in terms of annualized system kW/ton performance (chillers-towers-pumps) to support facility executive decision making and metrics for planning and executing on plant optimization. This portion of the session will also address facility, functional, and corporate dynamics that create opportunity to begin executing on deep plant optimization.
Strategies/Technologies/Products to Arrive
Supporting the chiller plant progression discussion, the segment will touch on strategies, technologies, and products/services (in a generic manor) that take plant optimization from worst case to and through standard optimization, and those which need to be considered and deployed to achieve deep plant optimization. Topically this session will address sorting strategies, technologies, and products/services that make sense for consideration at different junctures in a facilities life that can effect and be leveraged to execute plant optimization including; major expansions, CapEx/End of Life projects, energy-sustainability program retrofits, control and system refreshes. A technical focus in this segment will be on water side economization and the design shift and related performance and functional benefits to integrated versus parallel water side economizer system design.
This segment will be a frank discussion on the known, and not so obvious, institutional and healthcare vertical barriers or paradigms that often hinder the progression to deep optimization or even standard best practices. The moderator will encourage participants to share experience and strategies on managing paradigms and breaking through barriers to success.
Economics for the C Suite
A concluding discussion about the economics of deep chiller plant optimization will be facilitated. Going beyond the obvious, concepts and methods to best present the financial benefits to executive management to fit into the context of the changing healthcare vertical business environment and how deep plant optimization can be a positive contributor to a challenged profit climate.
Burlington Electric Department
Over the course of his public sector career, Neale Lunderville has demonstrated a commitment to put the people of Vermont at the center of his work. As the State’s Irene Recovery Officer under Governor Peter Shumlin, Lunderville brought state government together with the public to rebuild quickly and efficiently, while also employing new innovations to protect the state from future flooding. Prior to his work on Irene recovery, Neale served at Vermont’s Secretary of Transportation for Governor Jim Douglas where he developed a led an initiative to prioritize the repair and replacement of roads, bridges, and culverts that had long been deferred. As Vermont’s Secretary of Administration during the Great Recession, Neale was responsible for securing and deploying hundreds of millions of dollars in American Recovery and Reinvestment Act dollars to support Vermonters in need to mitigate the impacts of the economic downturn.
Today, Neale manages the Electric Department in Burlington, VT — the first city in America to source 100% of its power from renewable energy sources. Neale is leading Burlington Electric through a revolution in the energy industry where the center of gravity is shifting from large scale transmission and generation, to customer-focused energy services powered by small-scale renewables.
The energy industry is evolving from large scale transmission and generation to customer-focused energy services powered by small-scale renewables. This seismic shift will put customers at the heart of the industry and will improve the health and well-being of our communities.
TRO; Boston Medical Center; Code Red Consultants
As a project architect at TRO, Bernadette oversees all phases of healthcare projects, from surveying and programming to construction administration and implementation. A seasoned architect with more than 15 years of experience, Bernadette’s ability to understand the needs of a client and integrate those needs into the design has proven to be invaluable.
Space Management at Boston Medical Center
In her role as Director of Space Management at Boston Medical Center, Nancy oversees the overall planning and allocation of space for inpatient, ambulatory and administrative areas, move coordination, wayfinding, accessibility and furnishings. She also serves as the Project Advisory Team lead in BMC’s $270 million campus redesign project.
Code Red Consultants
Chris is a professional Fire Protection Engineer and founding Principal of Code Red Consultants. Mr. Lynch’s healthcare experience is diverse, as he provides consulting services directly to healthcare providers to assist with regulatory compliance issues, as well as to design teams on new construction and renovation and addition projects.
Health care projects often require renovations to take place simultaneously with an operating hospital, with no reduction to its services or capabilities. This means construction activities can occur adjacent to critical hospital operations where a sudden loud disturbance can create further stress for the patient, their supporting family, and medical staff. When Boston Medical Center (BMC) decided to consolidate their campus from two sites to one, they were faced with the compounded complexity of relocating existing, active departments into currently occupied space without interrupting or compromising patient care.
Architects, engineers, interiors, contractors, users, facilities and materials management members from the project team did a walk-through of the project to analyze existing conditions. They identified which items were important by categorizing them as either a “must have” or “wish list” item. Based on feedback from the walk-through, Architects and Interiors from the design team created intensity plans to identify the level of renovation for each area.
The intensity plans were color coded to show the different levels of renovation. Prioritizing the areas allowed the project team to analyze the space as quick as possible and evaluate their impact on neighbors. These plans were further reviewed and edited with the engineering team to include areas affected by MEP/FP needs that would have an impact on the overall scope and level of renovation required to complete the project.
Heat maps were created out of a necessity to communicate to each trade what areas they needed to learn about soonest. The heat maps were color coded to identify level of priority. Vetting existing conditions through heat maps allowed trades to do their own validation and get into many occupied spaces with proper ICRA.
After compiling information on how the renovations would impact adjacent departments, the contractor team assigned durations and created a phasing timeline. When renovating the ED, for example, surgical services upstairs and radiology in the adjacent area were going to be impacted by the construction.
By understanding the larger picture of how the renovation would impact surrounding neighbor departments, the design team was able to create a more detailed and comprehensive project scope. In turn, this gave them a better understanding of impact, costs etc.
All of the careful planning up front resulted in over 60 phases of construction and over 20 occupancy permits. Translation of this complex construction process to the authorities having jurisdiction resulted in a series of phasing plans. The phasing plans identified what areas were under construction, what areas were of existing construction, which areas had been completed and temporary construction was needed to meet phasing requirements. In addition the Life Safety professional created a set of Interim Life Safety Plans which identified temporary means to ensure code compliance during construction. The construction team, Owner, and Life Safety professional walked the site periodically to identify any items of non-compliance and what the team planned to do in order to rectify the issue, this too utilized a graphic tool that referenced back to the phasing plans.
This session will give you an inside look at the intricacies of project documentation, regulatory submissions and Life Safety compliance. We will review the challenges that the design team faced; including project scope and cost implications. And explore how, as an integrated team, they created visual, mapping tools to identify phases, work through the sequences of moves and construction and continuously communicate with the staff, patients, and their supporting families how they would be impacted.
PC Construction Company
Eve is a Senior Project Executive at PC Construction Company. She has earned the designation of Certified Healthcare Constructor (CHC) by the American Hospital Association.
PC Construction Company
Anne is a Project Engineer at PC Construction Company and is currently enrolled in the Leadership Development Program, rotating through Office Engineering, Scheduling, Field Supervision, Estimating and Virtual Construction
PC Construction Company
A large Regional Medical Center team had a sincere desire to improve the effectiveness of the planning, phasing and construction process for their $18M Project. After consultations with the design/construction team it was determined that by applying the Last Planner® System and Pull Planning as project delivery tools greater efficiencies would be achieved.
Pull Planning is a technique that is used as part of the Last Planner® System to develop a coordinated plan for each phase of a project. However, with practice, Pull Planning should become part of the project-delivery culture of an institution and the construction professionals serving them.
The purpose of pull planning is to design a project-based production system in conformance with lean principles. Like all aspects of Last Planner, it is a collaborative approach that includes those who are directly responsible for supervising and implementing the work on the project.
One of the keys to success in designing a production system based on lean principles is to intentionally gather all the work experts who are supervising the work, last planners, to engage and collaboratively develop a plan for each phase that includes the most effective alternatives to accomplish the work.
The Regional Medical Center team wanted to know how they would meet all the projects milestones.
They implemented this approach, in conjunction with the CM, by identifying who the last planners would be, how they would integrate into each phase of the project, what the “wave” would look like in the building, how issues would be resolved in “daily huddles” and a continual view of team milestones. The “wave” being the flow of trades moving through the building in a closely choreographed manner.
During the project deviations and errors occur! During this project, the framers started installing some v-girts that weren’t approved. The issue was identified, discussed and rectified with the team in a timely and collaborative manner. In the past issues like this could turn into major conflicts between trades but in this case, and others on this project, the team pulled together, determined the best solution and moved the process forward.
Meeting the milestones!
Milestone definitions are established by the project team for tracking and managing the project. A milestone as a set of conditions that must be satisfied for successful completion.
Last planners must understand the expected outcomes in planning the work. These outcomes are important to the completion of every milestone as they set the stage for the next phase for pull planning.
These are the critical items to add to your pull planning preparation checklist:
Tim Perrin is a Senior Account Manager with Efficiency Vermont, the state’s energy efficiency utility. Over the past decade, he has partnered with Vermont hospitals to help reduce energy costs and improve their bottom lines.
Steve Jalowiec is Vice President for Engineering Services with Hospital Energy, a company specializing in energy procurement and demand side reduction strategies for healthcare.
Director of Facilities, Northwestern Medical Center
Vice President of Support Services, University of Vermont Health Network – Central Vermont Medical Center
New England hospitals have been very successful in bending their energy cost curves in recent years, each taking a unique approach to accomplish. Although at face value the activities undertaken may seem distinctive to each hospital, there are consistent methods and best practices that have been utilized by some of the most successful hospitals in reducing energy use. Productive strategies have included:
This panel discussion will draw from the stories and achievements at various New England hospitals — as they’ve developed and formalized their energy management efforts. Panelists will share their philosophies about how they track and manage energy budgets, what motivates their efforts, elements of success, and lessons learned.
Details from each panelist will include where they focused (lighting, HVAC, plug loads, etc.), how they built their game plan, project development & implementation efforts, and measured accomplishments. These energy management programs look comprehensively at all types of energy inputs to the hospital–electricity and heating fuels–as well as what may be on the horizon for incorporating renewables and addressing transportation fuels and uses.
Some hospitals have embraced the tenets of a Continuous Energy Improvement model that is intended to adapt organizational culture to effectively institutionalize energy management activities in the same way site health and safety programs have been deployed. This approach is also substantially data-based through energy benchmarking, setting targets, and truly measuring impacts. Those measurement tools, methods, and considerations will be shared at a high-level as part of the session.
Target audience is hospital facility directors, managers, and supervisors who may be at the formative stages of starting their energy management journey, as well as those already well down the path and looking for new ideas to incorporate into their current framework. Material presented will be mildly technical when sharing some of the distinct projects pursued, and will additionally look to tie together themes and experiences from well-developed energy management programs.
As a Senior Vice President at WSP, Rick has encouraged those he works with to buck the stereotype that engineers have to be boring. He is passionate about collaborating with clients and design teams to look for creative ways to enhance project sustainability and functionality. Over his 30-year career, Rick has led project design for medical complexes, corporate high-rises and much more. Rick is a registered professional engineer in several states and an accredited LEED professional.
Nolan, a Senior Vice President at WSP, has been involved in the engineering consulting business since his high school years when he worked for the firm doing CADD work. Since then, he has been responsible for the design of all types of healthcare facilities including greenfield hospitals, major urban hospital expansions, cancer centers and LEED awarded facilities in 14 states around the country. Nolan has presented at the ASHE national PDC conference on integrated project delivery, Med Star Emergency Department conference, and been published in national trade magazines. Nolan is a registered professional engineer in several states and an accredited LEED professional.
Dan is a Senior Vice President and Senior Electrical Engineer at WSP with experience in the design of numerous new and renovation projects in the healthcare environment. Dan has been responsible for the project management and the electrical engineering design, system upgrades and feasibility studies on a broad range of projects, including numerous higher education, healthcare, corporate, science and research facilities. Dan is a registered professional engineer in several states and an accredited LEED professional.
FRAMEWORK AND DESCRIPTION
How are healthcare systems embracing LEED in the USA and other tools for measuring sustainability around the world? This presentation hypothesizes that around the world, users are moving beyond the ‘necessity’ for using measuring tools to determine if they are achieving sustainability goals towards a more holistic definition of sustainability that incorporates the concept of wellness.
They are recognizing and embracing sustainability in their everyday lives and operations as critical to quality improvement in service delivery and the patient experience, as well as creating financial efficiencies. This is now driving new ideas and process improvements to support ‘wellness’ in healthcare environments that in turn creates higher productivity levels and improves the morale of staff, visitors, patients and the local community.
Sustainability has been classically interpreted as improving efficiencies such as energy for lower carbon footprints, better material selection and water use reduction. However, the sustainability concepts and design processes at hospitals such as Dell Children’s (LEED Platinum), Birmingham Children’s (LEED Gold) and THR Flower Mound (LEED Silver), have led to greater recognition by US healthcare systems of the economic and employee ‘payback’ of applying their sustainability programs to other systems. These healthcare organizations understand that the ‘thinking journey’ that sustainability has inspired, and the tools that have been developed and applied to other daily operational processes could dramatically improve:
Unison Energy, LLC
Jack is VP of Business Development for Unison Energy, where he has been working with commercial and industrial clients for 4+ years. Prior to Unison, he was in business development at EnerNOC, working with customers on energy supply contracts, demand response, and other energy efficiency measures. Jack has a BA from Duke University and an MBA from the Amos Tuck School at Dartmouth.
Hospitals are increasingly looking to reduce their cost structure by implementing energy efficiency measures. Also, in the wake of major storms such as Sandy, hospitals are increasingly concerned about their power reliability and resiliency. Also, hospitals are looking to reduce kWh (usage) and bolster sustainability goals by multiple measures, including carbon footprint reductions.
Combined heat and power (CHP, or cogeneration) is an “old” technology that has seen new life given recent market developments (natural gas market changes, utility support, financing options, improved engine efficiencies, etc.) and increased market focus on on-site, distributed generation.
Hospitals are a natural fit for CHP, given their steady electric and thermal loads. This economics can be especially compelling on the east coast, given grid congestion and high electric rates ($/kWh). CHP, by providing electricity at the location of its use, has total efficiency levels in the 60-80% range, compared to 35-45% using traditional generation and boiler-generated heat.
That said, CHP is complex, costly, and can be time consuming. It is not as simple as LED lighting, for example. There are different solutions, different types of “vendors”, and different types of ownership. It can be a difficult path to navigate, involving decision-making from finance, engineering, facilities, legal, and utility stakeholders.
Increasingly, hospitals considering CHP look to outsource it; that is, contract with a developer/owner which will handle all aspects of the system design, installation, permitting, operation, maintenance, etc. Unison is such a company, with a target geography of the east coast and California.
Life Safety Services
Thirty-eight years of facility management experience, Tennessee Healthcare Engineering Association President 2 years, Secretary/Treasurer 3 years, and presented the Dan Roop Award by his THEA peers for contributions to THEA.
Some people think of barrier management as just sticking some red caulk in a hole in the wall. Barrier management is a system of rated assemblies that include the wall construction material, sealants for gaps & penetrations, dampers, and doors. These assemblies not only protect occupants and structures from fire and smoke but also can be useful for infection control, safety, and security if they have been maintained and are working properly.
NFPA and IBC codes include required inspections and documentation for barrier walls, smoke/fire dampers and doors. With the adoption of the 2012 Edition of the NFPA 101 Life Safety Code by CMS, more emphasis is being placed on barrier management and being surveyed more thoroughly.
This session will provide information on code & standard required inspections, testing, and documentation to maintain the effectiveness of the barriers. Specific code references will be given to help the attendee understand the requirements like what is required, how to meet the requirement, and for future references. Also included are real world answers to the question of why the maintenance of each individual assembly is important other than “the AHJ makes us do it”. This helps the attendee understand the intent of the code, why it was written, and how it helps to protect occupants and structures.
Another part of the session is how you can use your normally passive dampers and doors as defensive devices for other safety and security uses such as bio hazards, storms, and active shooters. Walls without penetrations can help with infection control and bio hazards like chemical spills. Properly closing smoke dampers can also be used to help prevent the spread of a bio hazard in an emergency situation. Properly latching fire doors can be used proactively at the beginning of a severe storm or tornado warning to help protect occupants in a severe weather event if part of the building is compromised. Properly latching fire doors in corridors also help to protect occupants during an intruder situation by reducing line of site shootings and slowing the intruder down by having to stop and open doors instead of wide open corridors that they can see down and run from one end to the other.
This is a lecture PowerPoint type presentation with encouragement for audience participation during and after the presentation. Humor and interaction with the attendees help keep the session from being one of those bla, bla, bla hour long naps. The session includes information for all levels of facility management and is presented by a retired healthcare facility management director with CHFM and CHEP certifications.
Mario is a principal in Shepley Bulfinch’s healthcare practice. He works with clients to develop comprehensive project budgets, evaluate regulatory needs, and align project scope to meet their strategic goals.
With more than 18 years of experience, Scott has worked extensively in NICU, ambulatory, and inpatient settings, marrying his passion for medical planning with his desire to create patient and staff-friendly spaces.
Imagine going to an outpatient surgical center for a total hip replacement in the morning and returning home the same day to sleep in your own bed at night. Hip replacement, total joint replacement and other procedures traditionally thought of as being performed in the inpatient realm are now ripe for transition into outpatient surgical settings. Cutting-edge approaches to what have traditionally been inpatient surgical procedures are now possible thanks to carefully designed advanced ambulatory surgery centers (AASC). The concept is so new that surgeons and administrators are still clarifying how to maximize the benefits of this idea for patients and their operations, but a major contributing factor will be the programming and design of the physical space. Topics that differentiate an AASC from a traditional ASC that will be discussed include:
Secondarily, the presenters will explore a series of supporting topics related to the design and planning of this facility that further contributed to this unique development, including:
Using the new Center for Musculoskeletal Care McGivney Surgical Center at Yale New Haven Health in New Haven, Connecticut as an example, this session will discuss the design considerations necessary to enable complex surgical procedures on an outpatient basis while maintaining a first-class patient experience and a cost-effective care model. Slated to open in the fall of 2018, a complete renovation of the existing McGivney Building will transform the former cancer center into a state-of-the-art AASC that rivals a traditional inpatient surgical setting. Incorporating 6 operating rooms, 24 patient prep / recovery spaces and areas for patient education, academic teaching and multi-disciplinary collaboration; the facility will be a welcoming space that raises the bar for future AASC development. Presenters will discuss the evolving design process that will result in this leading-edge facility.