2018 Fall Conference Speakers

Leadership Lessons from The Finest Hours

Michael J. Tougias, NY Times bestselling author and co-author of The Finest Hours

On February 18th, 1952, an astonishing maritime event began when a ferocious nor’easter split in half a 500-foot long oil tanker, the Pendleton, approximately one mile off the coast of Cape Cod, Massachusetts. Incredibly, just twenty miles away, a second oil tanker, the Fort Mercer, also split in half. On both fractured tankers men were trapped on the severed bows and sterns, and all four sections were sinking in 60-foot seas. Thus began a life and death drama of survival, heroism, and a series of tragic mistakes. Of the 84 seamen aboard the tankers, 70 would be rescued and 14 would lose their lives.

In his keynote presentation, Tougias will describe the harrowing attempts to rescue the seamen, focusing on four young Coast Guardsmen who must overcome insurmountable odds to save the lives of 32 crewmen stranded aboard the stern of the Pendleton. Tougias will share the leadership and decision-making lessons from this event that can help all of us in our job performance, as well as how the true life hero of this story overcame adversity in his professional career to go on and achieve real success.


Challenges of the Emergency Helipad: Handling the Noise of a Relocated Helipad

Marc Newmark, MS – Principal Consultant, Acentech

Marc Newmark has a wide range of experience in acoustics and vibration from a background in healthcare facility design, sensitive lab design, transportation noise, vibration analysis, outdoor sound modeling and product testing.

Benjamin Davenny, LEED AP BD+C, EDAC – Principal Consultant, Acentech

Ben Davenny is a principal acoustical consultant providing leadership and client direction on a variety of projects concerning healthcare, worship, commercial, and residential buildings. His responsibilities involve architectural and environmental acoustics, and HVAC noise and vibration control. Ben excels at applying the appropriate acoustical criteria and context to the diverse spaces that he works on, including inpatient hospital buildings, medical office buildings, laboratories, K-12 schools and multi-family condominium buildings.

Abstract

In this session, Acentech will discuss some of the challenges faced by the need to relocate the Brigham and Women’s Hospital (BWH)’s emergency rooftop helipad, including the potential inadvertent disruption to patients and clinicians inside their healthcare facilities. Through the analysis of existing conditions near and directly below the institution’s Center for Women and Newborns existing helipad, researchers at Acentech were able to generate an understanding for how future sites can mitigate disturbances caused by this life-saving route to bring patients to receive critical care. It is understandably difficult to allocate resources to developing building design that are amenable to inaudible helicopter noise transmission. A delicate balance of feasibility, perception of noise and vibration, and cost can help set realistic noise goals for an issue of this magnitude. Attendees of this session will learn how the impact generated from a helicopter comes from more than the vehicle’s engine and the whirring of propeller blades—the intense, pulsating air pressure generated from helicopters also contributes to structureborne noise and vibration concerns for hospitals. In turn, attendees will also learn what can be done to evaluate and mitigate this common problem within the modern world of patient care.


Infrastructure Design for Reduced Patient Readmissions

Thomas L. Tsaros, BS and MS – Mechanical Engineering, University of Massachusetts Lowell, Fitzemeyer & Tocci Associates

Mr. Tsaros is a Senior Associate at Fitzemeyer & Tocci. As a practicing engineer for over 30 years, he focuses on improving building infrastructure and energy efficiency in healthcare and other settings.

 

 

Terence Boland, BS – Mechanical Engineering, Syracuse University, Fitzemeyer & Tocci

Mr. Boland is an Associate Principal at Fitzemeyer & Tocci. He serves as the head of the company’s mechanical discipline team and leads a broad spectrum of challenging healthcare projects.

 

 

 

Joseph J. Sziabowski, Hardaway | Sziabowski Architects

Mr. Sziabowski is President of Hardaway|Sziabowski Architects, a healthcare design firm with a special emphasis on ambulatory care facilities. His commitment is to provide practical, functional, aesthetically pleasing, and patient centered environments.

 

Abstract

Reducing healthcare associated infections (HAIs) is of paramount importance in the operation of a hospital. Research has shown that the likelihood of readmission is greater for patients who experience HAIs compared to those that experience no adverse events. Annually, 1 in 5 Medicare beneficiaries is readmitted within 30 days of discharge, costing $26 billion per year with $17 billion of that considered avoidable. The Centers for Medicare & Medicaid Services has instituted payment-related policies which reduces payments to hospitals with excess readmissions. Readmissions of patients ultimately cost healthcare providers out of their own pockets, decreasing capital available for vital patient services and infrastructure needs.

This presentation will include recommendations, insights, best practices, and examples illustrating how smart infrastructure investments can help to reduce avoidable patient readmissions and ultimately improve the overall finances of a healthcare organization and the health and safety of their patients, providers and visitors. Topics include air handling and sterile fields, air infiltration and disinfection, design and management of sterile spaces, water treatment, and improved patient healing environments. The goal is to highlight where facility management can go beyond the code and standard practices and focus on transforming the existing paradigm of health care facilities infrastructure design to improve patient treatment, care and general wellbeing.


Micro-Hospitals: Key Considerations for Planning and Design

Jason Carney, AIA – E4H Environments for Health Architecture

Jason’s 18 years of healthcare experience encompass a broad range of facility sizes and project types. Jason is a leading computer specialist and is dedicated to integrating cutting-edge technology into design to improve process and create value for the client.

Abstract

Access to care and value-based economics have placed health systems in a very difficult position. The traditional destination bricks and mortar campuses are being challenged by Micro-Hospitals, which have become popular in many areas of the country particularly as a market growth and value strategy. According to US News & World Report, Micro-Hospitals are now operational in 19 states across the U.S., providing services similar to larger hospitals (ED, pharmacy, lab, radiology, and surgery) in a smaller envelope. This model offers greater accessibility and convenience for residents and is a cost-effective market growth strategy for providers. These mini-hospitals are roughly 15,000 to 50,000 square feet, open 24/7, and maintain between five and 15 inpatient beds for observation and short stay use. Recent changes to Centers for Medicare and Medicaid Services policy regarding reimbursement schedules for satellite facilities, authorizing Micro-Hospitals with dedicated emergency departments as eligible for both 340B discounted drug pricing and the Outpatient Prospective Payment System, will make Micro-Hospitals an increasingly popular option.

Micro-Hospitals require a clear strategy, a sound operational model and a clinical support strategy to be successful. There are now technologic advances in the delivery of virtual care which clinically support these models making the Micro-Hospital a realistic addition to systems strategic plans.

This session will share experiences with planning Micro-Hospitals, discuss key operational areas and illustrate clinical innovations that would support this model and make it attractive to New England hospitals.


Corridor Clutter: A Life Safety, Facilities, Nursing, and C-Suite Issue

Richard Guarino, FACHE – Lahey Hospital and Medical Center

Rich Guarino, SVP of Hospital Operations at Lahey Hospital and Medical Center, is responsible for all hospital clinical departments and operations including Facilities, Environment of Care and Life Safety.

 

 

 

Kristin Pitocco, M.P.H. – Environmental Health & Engineering, Inc.

Kristin Pitocco is the Director of Safety for EH&E’s client Lahey Hospital and Medical Center; where she manages Joint Commission compliance and ensures that acquired sites meet necessary safety standards.

 

Abstract

It’s 2018 and corridor clutter remains a frustration for hospitals. It’s always on the radar for Joint Commission surveyors – annually appearing as one of the top cited Life Safety standards. In hospitals across the country many initiatives are launched to clear the clutter but frequently fall short of solving the problem. The fact is unless facilities management has the support of senior leadership their success will be significantly limited. Lahey Hospital and Medical Center leadership rolled up their sleeves to help facilities tackle this critical safety issue, resulting in clutter-free corridors – and some other unexpected benefits too.

The common scenario is that facility managers and safety officers set out to fix corridor clutter problems and end up appearing as the enemy, always nagging nursing staff to move their equipment. At Lahey, when senior leadership stepped in to support facilities it sent a positive message. It clearly showed that this was an organization priority and communicated the urgency in resolving the issue to ensure patient, staff and visitor safety.

Not surprisingly, medical equipment, beds, stretchers and workstations on wheels were the big contributors to clutter. Lahey’s Safety department in conjunction with Nursing Leadership interviewed nursing staff and found that there were multiple reasons that these items remained in the corridor. In some cases, storage spaces were too far away, other times, they simply didn’t know where to store the equipment (either due to lack of space or knowledge). In partnership with the leadership on the units, Lahey’s facility management team identified options for storage, and helped to reclaim storage space that had previously been converted to a different use.

Senior leadership was instrumental in conducting daily rounding in all units and departments, spotting and reporting problems, and most importantly, driving home the importance of the issue. These daily rounds proved invaluable. It opened the lines of communication between nursing, the front line of patient care, and leadership. The nursing staff appreciated senior leadership taking the time to understand their issues and expressed that they felt that the leaders were a part of the team to address the issue, and not just expecting them to fix the problem on their own. The visible commitment from leadership to help greatly increased all colleagues’ engagement on the matter.

Lahey will share how they successfully got the commitment and active involvement of leadership to present a united front and drive accountability and ownership among all staff to solve the problem of corridor clutter. Additional measures implemented to keep the momentum going will be discussed including:

  • Patient transport serves as a “hotline” for moving clutter to its proper storage location.
  • Continued periodic tours of corridors by leadership maintains visibility and keeps the lines of communication open.
  • Storage requirements are incorporated into all renovation and new construction projects.
  • Monthly briefings with representatives from nursing help address any new issues.


Drones: Cost-Effective Roof/Façade Evaluations Using Unmanned Aircraft Systems (UASs)

Edward J. Stewart – Registered Roof Consultant, Gale Associates, Inc.

Edward Stewart, RRC is the Director of Building Enclosure Design and Consulting for Gale Associates, Inc. He has forty years of experience managing building renovation projects for institutional clients.

 

 

 

Christopher M. Foley – MCP, Gale Associates, Inc.

Christopher Foley, is a FAA licensed UAS (drone) pilot. Christopher has close to five years of experience as a UAS (drone) Pilot, and has completed countless UAS flight, consisting of multiple project types and disciplines.

Abstract

Investigating and evaluating the building enclosure can be challenging due to access issues. Closely observing multi-story buildings, steep sloped roofs, steeples, and spires can be very difficult, and has often necessitated the use of lifts, swing staging, rope access, etc. These methods of exterior enclosure access can be disruptive to the occupant, time consuming, and expensive.

An alternative to the traditional methods of “hands on inspections” is the use of aerial drones. A systematic visual survey of steep sloped roofs or facades can provide sufficient information as to the condition of these components including, but not limited to, the quantity, type, and locations of façade deficiencies. For instance, a drone survey of a slate roof can give almost the same information as a “hands on” inspection off a man-lift at a fraction of the costs. Zoom in capabilities can provide information on the condition of mortar joints, extent of masonry spalls or cracking, condition of sealants, and even the extent of masonry displacement.

The Federal Aviation Administration (FAA) has recently adopted procedures and certifications for use of Unmanned Aircraft Systems (UASs)/Drones for hobby and business use. (UAS)/Drones can capture real-time, high-resolution video and photographs, and reduce the time and money it takes to perform a typical evaluation. Drones can quickly elevate and fly to the highest edges of a building in a matter of seconds. The ability to view these heights from the safety of the ground is a huge advantage for the observer. This presentation will detail the pros and cons of drone use on facilities, privacy issues, and FAA Regulations. The presentation will also include sample videos and images.


Managing Fire & Smoke Barriers in Today’s Healthcare Environment

Mark Izsa – STI Firestop

Employed by STI Firestop for 14 years, FIT LEVEL1 and 2 Certified to teach, Attended Montclair State University, 28+ years in manufacturing and construction sales

Abstract

Managing barriers in today’s healthcare facility can be a real challenge. There is a multitude of processes related to barriers and in any given week, a variety of trades and hospital personnel come in contact with them. In many cases the approach to handling compliance issues is reactive. This approach is costly and really doesn’t provide a true compilation of work being performed. Getting contractors back to make repairs after the fact is difficult, often leaving the facility to repair these infractions themselves. Improper penetrations in barriers continue to be one of the top 10 citations by inspection professionals. While code requires anyone penetrating a barrier to seal them to a specific standard, this is often incomplete, disregarded or misunderstood by those doing the installations. Maintaining the eSOC and PFI’s can be costly. So how do healthcare facilities get a handle on this perpetual nightmare?

Taking a proactive approach to managing, documenting and inspecting barriers within a facility is best managed by utilizing a proactive approach. Implementing a standard from the conception of design. In order to implement a protocol for managing vendors, you need a process that includes task such as a permitting program. The process should document all barriers and penetrations, and ensure quality control throughout closeout inspection. The protocol should have an accurate, up to date accounting of who, what, when, where and how installations, maintenance and inspections in each barrier are performed. Exact locations of these applications are documented, providing the facility with a roadmap moving forward. With tightened budgets, increased regulatory requirements, and reduced staffing, maintaining these barriers by implementing a barrier management protocol saves time, money and resources.


Improving Patient Care through Energy Efficiency

Kara Brooks, MS, LEED AP BD+C – Sustainability Program Manager, American Society for Healthcare Engineering

As Sustainability Program Manager for the American Society for Health Care Engineering (ASHE), Kara Brooks, manages the sustainability programs and goals for the organization, including the Energy to Care Program. Kara has more than 15 years of energy engineering experience providing professional services which include design, assessment, auditing, modeling, commissioning, measurement and verification, and performance contracting. Throughout her career, she has helped facility leaders develop and promote efficiency programs. Kara has a Bachelor of Science degree in Mechanical Engineering and a Master of Science degree in Business Management both from Colorado State University.

Abstract

Energy Consumption has a direct impact on operating budgets for healthcare facilities. That impact translates directly to resources and patient care. In my presentation, I will provide an overview of energy saving tips, tactics, and case studies that are utilized across the nation. Attendees will gain a better understanding of current strategies hospitals are using to improve patient care through saving energy.


Ambulatory Health Care vs. Business Occupancy

Eugene A. Cable – Professional Engineer, Life Safety Consultants

Fire Protection Engineer specializing in Life Safety. 21 years with Dept of Veterans Affairs as a Regional AHJ and now manages an active consulting business in Joint Commission compliance Statement of Conditions, Life Safety Code equivalencies, and health care fire investigations related to litigation.

Abstract

Joint Commission has captured this requirement in a note to the LS.01.01.01 Life Safety Code SOC Standard, stating for all ambulatory surgery centers the SOC requirements apply regardless of the number of patients rendered incapable. The definition of surgery is broad and includes other invasive and diagnostic procedures involving anesthesia. The CMS Law has been around a long time, the emphasis on one patient rendered incapable is new and represents a change.
It also represents a departure from NFPA 101 intent that is much more restrictive.

Facility Designers and Managers often ask; what are the design differences between Business Occupancy and Ambulatory Health Care (AHC) and what would the impact be if we changed the design to meet AHC?. What is the impact to existing facilities if an AHJ orders the Occupancy Classification be changed to Ambulatory Health Care? And, what would be the required operational changes such as within the fire plan and fire drill requirements.

Based on NFPA 101, 2012 Edition, this presentation answers those questions, item by item, and offers a one page summary chart.


Buffer Room Renovation Strategies for USP Pharmacies

Stephen Paquin – Associate AIA, Dana-Farber Cancer Institute

As a Senior Architect at DFCI, Stephen oversees the planning, design and construction activities of over 2.7 million square feet of DFCI’s owned and leased space, including all soon to be USP 800 compliant pharmacies.

Greg Heppner – SmithGroup (formerly TRO)

Helping other people solve their problems is Greg’s favorite part of being an architect. He is the Principal Architect for the construction and renovation for 7 of Dana Farber’s soon to be USP 800 compliant pharmacies.

 

 

 

 

Frank Peropat – Grifols USA, LLC

Frank has over 25 years serving the healthcare market with a focus in pharmacy compounding & electronic health records for health providers/networks.

Abstract

Renovations of healthcare programs are challenging, the renovation of a hospital-based International Standards Organization (ISO)- classified pharmacy is in a class all by itself. With the December 1, 2019 deadline looming for healthcare institutions to be in compliance with the United States Pharmacopeia (USP) 797 and USP 800, developing a plan to renovate your pharmacy while maintaining compounding activities is essential. This presentation will review the pharmacy renovation strategies available to the healthcare project team and examine pharmacy case studies from Dana-Farber Cancer Institute’s (DFCI) experience renovating their cancer care facilities.

The presentation team will outline the general renovation strategies and examine in detail the pros and cons of the three options that Dana Farber Cancer Institute employed:

  1. Construction of a temporary pharmacy for use while the main campus pharmacy is renovated.
  2. Use of a temporary pharmacy trailer while a satellite pharmacy is renovated.
  3. Construction of a new, permanent pharmacy while the existing pharmacy remains open.

Due to the need to maintain strict sterile environment within the compounding pharmacies, renovation in place is not always an option. When a temporary pharmacy is created on the premises of a healthcare facility it must meet all the same regulatory requirements as the permanent pharmacy. Temporary pharmacies can be very costly as you are spending double the amount of money by building “two pharmacies”. Along with the cost of construction, there are also many operational costs & factors to consider including staffing, maintaining appropriate security, timely deliveries of pharmaceuticals, drug transport, and maintaining operations from 2 locations.

If space for a temporary pharmacy within the facility is not available, a temporary pharmacy can be built in a modular pod, located outside of the facility. Most often these pods can be leased directly from the manufacturer, stipulating certain time duration. When considering the use of a temporary pharmacy trailer, some important factors to consider are:

  • Placement of pod/trailer relative to the proximity of staff and pharmaceuticals/supplies
  • Capacity to provide shelter and secured access & security monitoring
  • Necessary infrastructure to serve this pod
  • Need for additional storage elsewhere due to limited storage in the pod

The construction of a new, permanent pharmacy will allow the existing compounding pharmacy to remain operational without any disruption throughout the construction of the replacement pharmacy. When building a new replacement pharmacy, several factors must be considered:

  • Location of the new pharmacy & adjacencies relative to long term use
  • Finding appropriate space for dislocated programs
  • Access and placement for necessary MEP infrastructure

This session will give you an inside look at the intricacies of the 3 pharmacy renovation strategies employed at DFCI, regulatory submissions and USP 797 and USP 800 compliance. We will explore the project process for each type of pharmacy option, including the development of a comprehensive team, gap analysis, risk assessment, evaluation process, operational workflow, and the planning/design phases. And review the challenges that each pharmacy project faced; including the evaluation of space requirements and cost implications.


Assessing and Mitigating Self Harm and Ligature Risk in the Behavioral Health Environment

Edmund Lydon, MS, CHFM, FASHE – Northeast Hospital Corporation a member of Lahey Health

 

 

 

 

 

Geoff Thomas, Facility Manager – Northeast Hospital Corporation a member of Lahey Health

 

 

 

 

 

 

Ed Browne, MS, CHFM, CHC, CLSS SASHE, FACHE – Vice President Support Services, Cambridge Health Alliance

Certified Health Facilities Manager and Certified Healthcare Constructor with over three decades of experience in both community hospitals and academic health centers. Senior leadership experience including strategic planning and patient focused organization.

 

Abstract

The presentation will discuss patients have the right to receive patient care in a safe setting. Hospital has an obligation to protect patients who are presenting with self-harm / suicidal ideation. The presentation will show a strategy to assess the physical environment for self-harm and ligature opportunities. The presentation will further discuss what does this mean to the facility manager and designer who takes on the responsibility to ensure the physical environment is appropriate for this patient population. The care and safety of psychiatric patients and the staff that provide that care are our primary concerns. Although the Centers for Medicare & Medicaid Services (CMS) is in the process of drafting comprehensive ligature risk interpretive guidance to provide direction and clarity for Regional offices (RO), State Survey Agencies (SAs), and accrediting organizations (AOs) the expectations for improving the physical environment is a required action now under the current published standards of care. These resources will also be explored as part of the presentation. The presentation will discuss that the ligature risk environment has been defined as anything which could be used to attach a cord, rope, or other material for the purpose of hanging or strangulation and that ligature points include shower rails, coat hooks, pipes, and radiators, bedsteads, window and door frames, ceiling fittings, handles, hinges and closures, etc.

The focus for a ligature “resistant” or ligature “free” environment is primarily aimed at Psychiatric units/hospitals. However, hospital emergency departments and general medical units are under scrutiny as well when patients with self-harm ideation are cared for in these clinical settings as well.

This presentation will discuss the current regulatory environment as well as assessing and mitigating self-harm and ligature risk in the behavioral health environment. Inpatient psychiatric hospitals, inpatient psychiatric units in general acute care hospitals, and non-behavioral health units designated for the treatment of psychiatric patients require spaces that meet the needs of the patient population and are safe and suitable to the care, treatment, and services provided. Therefore, ligature and self-harm risks must be identified and eliminated. The presentation will discuss the following:

  • Brief overview of the compliance environment
  • Performing a risk assessment to identify self-harm / ligature opportunities
  • What are examples of mitigating the physical environment
  • Working with architects and contractors

Many of the challenges facing designers and facility managers is understanding what types of building materials (exit signs, lighting, mechanical vents, etc.) are available to meet this required change to the physical environment. Understanding installation challenges and how best to approach the need to make these modifications to physical environment will be discussed. A proactive approach is encourage vs. waiting for the authorities having jurisdiction to identify deficiencies and elevating the hospital into a “risk to life status” requiring mitigation within 60 days or be placed in a condition of participation action plan. Presentation will discuss recent enforcement activities.


Creating the Storyboard for Presenting Infrastructure Upgrades to Leadership

Paul Cantrell, CE, CPE, CHFM – VP, Lahey Health Facility Operations Lahey

VP of Lahey Health Facility Operations. Overseeing the MEP Infrastructure Master Planning across all Lahey Health System.

 

 

 

 

Joseph Dussault, PE, CEM, CBCP, LEED AP – BR+A. Consulting Engineers

Engineer of record and project manager for the Lahey MEP master planning effort and infrastructure upgrades described in this project.

 

Abstract

In 2015, Lahey Burlington rolled out their 5 year MEP infrastructure master planning effort at their ~1,000,000 SF facility. The infrastructure master plan included a detailed study of the AHUs, chilled water system, boilers, steam distribution system, domestic water, sanitary and electrical infrastructure. The goal of the master plan was to identify infrastructure systems that were approaching the end of their useful life, insufficient in capacity, energy inefficient, not sufficient to provide resiliency to the hospital in the event of a loss of power, and identify phased planning for major upgrades.

The master planning studies identified opportunities for upgrades across all systems. Many of the systems were approaching the end of their useful life, did not meet Lahey’s goals for resiliency, and did not provide sufficient capacity for future expansion.
The most important step in moving forward with the infrastructure master plan was to present the finding of the investigation to leadership in a clear, concise and relatable way. For this project, the diagnosis of the problems identified within the infrastructure systems were compared to those that a doctor would identify within the human body.

To help put the MEP issues in context for the leadership team, issues with the sanitary piping were compared to problems that would be encountered in a patient’s digestive system. Issues with the air distribution system were compared to issues that would be encountered in the lungs of a patient. The HVAC control system, electrical and hospital alarms were compared to the nervous system. The hot water and chilled water distribution systems, and their associated limitations, were compared the circulatory system of a patient.

Overall, the infrastructure systems were presented as the facility director’s “patient.” The leadership team was able to easily identify with the problems of the existing systems, and were able to visualize the path forward. The team quickly developed a five year strategic energy infrastructure master plan with goals of achieving over 2,000,000 kWh in savings in year 1. The team surpassed their goal, and achieved over 3,000,000 kWh in year 1. Furthermore, Lahey Burlington achieved their goal of leading by example and demonstrating that their partnership with Eversource and National Grid helped lower the hospital’s carbon footprint and stewardship of healthcare costs.

The 2016/2017 Energy Infrastructure Upgrades Project included:

  • Development of an EQUEST model to simulate the hospital operation and calculate the energy savings associated with any energy projects moving forward. This yielded credibility for the potential energy savings of the infrastructure projects.
  • The installation of a new 1,000 ton York YMC magnetic bearing chiller with new chilled water optimization sequences for significantly low kW/ton operation at low condenser water temperatures. This new chiller was installed in a location that not only optimizes the chilled water system, but also allows Lahey to make much-needed upgrades to the existing central utility plant, which in turn makes Lahey a more resilient hospital.
    Airflow setback of five 100 HP AHUs across the hospital that typically operate 24/7. New sequences were implemented to the building automation system to allow airflow setback during unoccupied hours without disrupting hospital operation.
  • Implementation of free cooling heat exchangers for winter operation. Major piping modifications were required to enable the free-cooling plate and frame heat exchangers. These heat exchangers allowed the 1,000 ton chiller that typically operates throughout the winter to be de-energized.
  • Replacement of the fans (fan wall retrofit), coils and filters for two (2) 25,000 CFM constant volume AHUs that serve the operating rooms. The VAV boxes to enabled airflow setback during unoccupied hours.


NFPA 101 2012 Edition Atrium Design: New & Existing, Retro Commissioning, Commissioning and Maintenance

Michael A. Crowley, PE, FSFPE, FASHE, Jensen Hughes, Inc.

Mike Crowley holds a BS IN Fire Protection and Safety Engineering from Illinois Institute of Technology, and an MBA from The University of Houston. Mike is a licensed professional engineer in 5 states. Professional organization involvement includes Fellow in Society of Fire Protection Engineers (SFPE), National Fire Protection Association (NFPA) Membership and activity on NFA Technical Committees including NFPA 101 – Healthcare Occupancies and Means of Egress, and NFPA 99 – current Correlating Committee Chair, among others. He is a Life Safety Code and NFPA 99 instructor for NFPA. In addition, he is a Fellow Member of the American Society of Healthcare Engineers.

Joseph Beadle, CFPS, AHJ – RPA, a JENSEN HUGHES Company

Joe has been with the company since 2006 after serving over twenty years as a fire fighter and fire instructor. For eighteen of those years, Joe served as Fire Marshall for the Town of Winchester in Winsted, CT and functioned as both the Fire Marshall and Fire Chief for over years. He is a Senior Consultant for the firm and a Certified Fire Protection Specialist (CFPS).

Abstract

Life Safety Code and Building Code requirements have changed in the atrium smoke control design over the years. This presentation will describe the major atrium design criteria from previous NFPA 101 and Building Code. Prescriptive atrium designs were allowed in the past. The test of the old designs are significantly different than the current performance criteria. In 1988, an atrium would be designed to 4 or 6 air changes per hour based on the volume. In 2018, the atrium will be designed to maintain a smoke layer 6 ft. above the highest walking surface for the time to egress, or 20 minutes. This performance design is based on potential fire size and height of the smoke layer. Testing methods for the newer designs demonstrate performance of the system complies with the design calculations. Testing does not use any form of smoke or test gases. New and existing systems will be compared. The major concern of owners is the smoke control system status. Does it work as designed? We will discuss testing for retro commissioning, commissioning or testing. We have found the owner lacks the initial start-up testing and documentation. So retro commissioning may be needed to create the documentation trail for the atrium. Annual testing should be part of the fire alarm and detection system testing. Verification of fan starts and flow rates should be confirmed. The documentation and follow-up needed will be reviewed. This presentation will cover the key issues for smoke control commissioning testing and documentation.


Middlesex Hospital Emergency Department Fire Recovery

David Giuffrida – Vice President of Operations, Middlesex Hospital

As Vice President of Operations, David’s responsibilities include Radiology and Clinical Laboratory, LEAN Process Improvement, Facility Planning, Design & Construction, Plant Operations, Facility and Property Management, Environmental Security, Safety and Emergency Preparedness Departments.

 

 

 

Steve Doherty, AIA, ACHE – Principle, The S/L/A/M Collaborative (SLAM)

Mr. Doherty has nearly 30 years of experience in the healthcare industry as a registered architect. As a Principal and SLAM’s Healthcare Architecture Studio Leader, Steve has managed numerous projects at Middlesex Hospital over the past two decades.

 

 

 

Phil Shuman – The Whiting-Turner Contracting Company

With 20 years in the construction industry, Phil has spent over 15 years working in the healthcare market. Currently Phil is one of the Northeast Healthcare coordinators for Whiting-Turner. As one of his responsibilities he oversees the team working at Middlesex Hospital.

Abstract

In today’s world security of our facilities is critical to providing our patients and visitors with a place they feel welcome and safe. However, extreme events occur that must be addressed quickly to ensure the well being of our communities and our facilities will continue to be met under times of duress.

David Giuffrida, Vice President of Operations for Middlesex Hospital, will speak about how the hospital was able to maintain services while the entire Emergency Department was closed. How the Hospital was able to work with staff, community, and business partners to restore the full operation of the ED.

Steve Doherty, Principle for SLAM, will disscuss design measures. Looking at what worked well in the original design to minimize the impact of the fire and what lessons can be taking away from the incident moving forward.

Phil Shuman, Senior Project Manager for The Whiting-Turner Contracting Company, will talk about the restoration efforts required to restore the Emergency Department to full operation.


Healthcare Facilities and Community Risk Reduction

Richard P. Bielen – Professional Engineer, National Fire Protection Association

Richard P. Bielen, P.E., is currently a Principal Fire Protection Engineer for NFPA. Mr. Bielen holds a master’s degree in fire protection engineering and a bachelor’s degree in electrical engineering, both from Worcester Polytechnic Institute. He was also the former staff liaison to NFPA 99, Healthcare Facilities Code.

Abstract

The NFPA is developing a new standard on Community Risk Reduction (CRR) called NFPA 1300, Standard on Community Risk Assessment and Community Risk Reduction Plan Development. A community can be a health care facility, a health care campus or something much larger like a town, city or state. A Community Risk Reduction plan helps communities find out what their risks are and develop plans to reduce the risks viewed as high priority.

CRR is an all-hazards approach, which can include flooding, snow storms, earthquakes, man-made events and droughts. This means that the risks that are evaluated as part of this process are not limited to one topic area. A CRR helps a community be safer by prioritizing their risks and better allocating resources to mitigate the risk. Topics to be covered are conducting a Community Risk Assessment (CRA), developing a CRR Plan and implementing and evaluating the CRR Plan. A healthcare facility will most likely be included in the Community Risk Assessment to determine their capabilities and determine how it relates to mitigation of the hazards that might affect the community. The healthcare facility’s emergency management plan can assist the community with their assessment and mitigation strategies. Other stakeholders include police, EMS, community activists, community services, city planners, faith-based organizations, and more. Healthcare facilities can play a major role in the development of a Community Risk Reduction plan.


Designing Healthcare for Generational Change

George Takoudes, AIA, LEED AP – Practice Leader, NBBJ Designs

George Takoudes, AIA, is a healthcare practice leader with NBBJ. George plans and designs a range of large, complex projects for preeminent healthcare institutions in the region including, Dana-Farber Cancer Institute, MGH and UMass Medical Center.

Abstract

We hear a lot of buzz and chatter in the media about generational differences between boomers and millennials in attitudes, habits, and preferences. Why does it matter in healthcare design?

There have always been differences between generations – yet the magnitude in this shift from one big generation to the next, one generation removed, may be larger than in the past.

Demographic changes are pulling healthcare in contradictory directions. Millennial patients, born into a mobile world, are driving investments in telemedicine, on-demand services and dispersed ambulatory care. Yet an aging population of Baby Boomers will soon require more acute and inpatient settings. Both generations are currently in the workplace – each with its own attitudes to work and workstyle.

Given these conflicting demands, what can institutions do to meet the needs of both key demographics?
Designers and planners need consider how our design of all of the environments that surround healthcare in a different way, from the perspective of generational distinctiveness. We will share what we’ve been thinking about, and hope to hear some of your opinions as well. We will first set the stage with some general characterizations of generational differences, why we think it is important to consider these differences , and ways we propose it will require new ways of thinking about healthcare workplace environments and inpatient care settings – not small tweaks, but watershed changes.

Our emphasis will be focused on the patient experience and a patient and family-centered environment.


The New Stamford Hospital – A Case Study in the Implementation of the Newly Required Destructive Firestopping Special Inspections

Christopher Lynch – Principal, 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 and special inspection 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.

 

 

Michael A. Smeriglio, MBA, FABC – Executive Director Facilities Management, Stamford Hospital

Michael Smeriglio is the Executive Director of Facilities Management at Stamford Health. He is responsible for Facilities Management, Biomedical Engineering, Real Estate and Construction for more than 45 separate locations throughout lower Fairfield County.

Stanley Hunter – SVP, Colliers International

Stan was Project Director for the Stamford Hospital’s $450M New Hospital Program. Previously, he was Project Executive for Baystate’s 640,000sf Hospital of the Future project, and is now SVP at Colliers International providing OPM services for hospitals.

Abstract

Far too many healthcare facilities have experienced firestopping issues after opening new construction areas during post occupancy regulatory inspections. Stamford Hospital had a goal to avoid this issue when constructing their new 12-story, 650,000 SF hospital that opened its doors in September of 2016. They elected to implement firestopping special inspections on the project utilizing ASTM E2174 and ASTM E2393 to ensure that they were getting what they paid for – listed and approved compliant firestopping assemblies.

While Stamford elected to implement these standards on the project, they are now specifically required for all new construction projects by the building code in healthcare occupancies in all New England states except New Hampshire. The goal of this presentation is to help owners, facility managers, contractors, and designers become aware of this new inspection process and the potential significant implications it has on cost and schedule. Lessons learned and specific best practices will be identified that attendees can implement on their next project.

ASTM 2174 and ASTM 2393 prescribe a new level of inspection not typically experienced in the construction industry. The inspection process outlined in the standards involves destructively inspecting or witnessing the installation of a percentage of the firestop assemblies. The inspectors are required to compare the installed firestopping to listed firestop assemblies or approved engineering judgments that the contractor has submitted on the project. The comparison to a listed assembly dissects all aspects of the firestop assembly to ensure it is consistent with the listing. This includes the wall or floor type, the details of the penetrating item(s), the firestop material utilized, and the amount of annular space. The inspection process has uncovered that a vast majority of firestop installations are not being performed to a listed assembly. Most installers were simply applying the same firestopping product at an unspecified thickness around all openings and penetrations.

The challenges experienced on the Stamford Hospital project in implementing this process, while not uncommon, were still painful – several trades were not aware of the difference between a firestopping product and a firestopping assembly, submittals did not match actual installation details, engineering judgments were not obtained proactively, and coordination between trades that contributed to a single firestop assembly were not occurring. As construction evolved, Stamford Hospital worked in collaboration with the fire stop inspector and the construction manager to create and implement enhanced quality control procedures on site to improve knowledge and performance. The result was a project that was ultimately completed on schedule and firestopping installation that has passed inspections by the City of Stamford, CT Department of Public Health and Safety, and the Joint Commission without any citations relating to quality of firestopping installed. Also, the firestopping installations are well documented for future inspections and reference long past the tenure of the project personnel.

This case study will be presented from multiple perspectives. Christopher Lynch of Code Red Consultants will speak from the inspector’s point of view and will provide an overview of the firestopping requirements contained in the building code, outline what an approved firestopping assembly actually is, and the process for special inspection outlined in the ASTM standards. Michael Smeriglio and Stan Hunter will speak from the owner’s perspective on administration and management process to successfully integrate this role in the construction process. The presenters have collaborated to provide a detailed and specific list of best practices and actions that were derived out of their experience to share with the audience.


Facility Managers Managing Change Through Leadership

Marc Fournier, MBA, MHA, FACHE, CHSP, CHCM, EDAC, CHFM – Southern Maine Health Care

Marc is an experienced senior level healthcare facility planner/administrator who brings his graduate school adjunct faculty experience to engage participants in active dialog around change management.

Abstract

Not unlike many other career paths today, the role of the healthcare facility manager in our current climate has become one that requires a razor focus on meeting organizational objectives while navigating a Sea of Change. Requirements from regulators, accreditors, insurers, patients, staff and other stakeholders place a seemingly high demand on a facility manager’s skill set in ensuring overall successful team performance. Our world today would suggest that change is ever present. The perception is true. The reality is that change is not new. The difference is in how change impacts each of us. Through this workshop participants will gain greater insights regarding the concept of change management through a case study approach built upon the power of story and the four key roles of a manager: Planning; organizing; leading; and controlling.

Current literature such as the Harvard Business Review suggest that many facility managers have reached their current role because they have gained tenure and do a great job technically in their field. They are the process go to person in their department. This is a great starting point for a manager. Unfortunately, these same sources note that 85% of these managers who don’t focus on gaining the knowledge and skills of a manger end up failing as a manager. New managers quickly realize that their superb tactical and operational skills are not enough. Management requires the ability to bring a group of people together under one coordinated mission, one vision to effectively implement organizational objectives. Consider Management as its own field, its own career path. Managers spend their management time initially focused on managing people issues and therefore require people skills. Participants will have a chance to explore the value that culture, communication, listening, appreciation, respect, trust and yes accountability play in setting the stage for successful change implementation; successful management.

Change simply exists. It is sometimes perceived as good and sometimes as bad. The same change may be viewed in completely opposite manners. The workshop will next explore the various levels of change that staff and organization’s face. The case study approach will set the stage for incorporating the four key roles of a manager into leveraging a successful change process. How can a manager prepare their staff for an upcoming change? Do we change too much or not enough? What can a manager do ahead of time to ensure staff successfully adapt and adopt the change? Why do connectedness, perspective and past experiences influence the change outcome? Why does resistance happen and how can it be overcome? How does leadership fit in? Change needs to be lead. Participants will come to appreciate how their past experiences influence the likelihood of a successful change initiative. We will explore the concept of setting a vision for change and ways to gain and sustain change momentum. We will explore a model of change based on the concept of continuous improvement that can help guide managers consistently through the change process.

Managers can and do handle change each and every day. These changes are learning opportunities. The workshops focus will be on having managers view the work they do as that of mentor, facilitator and guide. Truly the role of the manager in planning, organizing, leading and controlling is that of being the change agent for their staff, department, division and organization. Managers must choose to manage change before it manages them.


Understanding Regulatory Codes

Lennon Peake, P.E., SASHE, Koffel Associates

Lennon Peake is a Director at Koffel Associates, a fire protection engineering and code consulting firm headquartered in Columbia, Maryland.

 

 

 

 

William Koffel, P.E., FSFPE, President, Koffel Associates

Bill Koffel is President of Koffel Associates, a fire protection and life safety engineering design and consulting firm headquartered in the Baltimore-Washington metropolitan area.

Abstract

Audience members will be asked to respond to a series of multiple-choice questions regarding the requirements of several NFPA codes, including but not limited to NFPA 101®, The Life Safety Code® (2012 and 2015 Editions); NFPA 72: National Fire Alarm and Signaling Code (2010 Edition); and NFPA 99: Health Care Facilities Code (2012 Edition). The number of participants for each question would be displayed during the presentation, along with the percentage of correct responses. A low percentage of correct responses would trigger an explanation of the code requirement in addition to an open discussion with participants. If the percentage of correct responses is high, the participants would be simply be provided with the correct answer and code reference. The questions will be asked one at a time, allowing a focused discussion without a hard time constraint. This interactive lecture format allows content to be customized to the needs of participants based on the responses to the questions posed. If not all the questions are addressed during the presentation, a list of questions, answers and referenced code sections will be electronically distributed to the participants.

While most questions will be from NFPA 101, NFPA 72, and NFPA 99, some questions from other Codes (i.e. NFPA 10, NFPA 80, and NFPA 105) will also be included. The open discussion will encompass background justification of changes to specific requirements and examples of requirements applied in the health care industry. Questions regarding NFPA 101 will address both new and existing construction.

The attendees will be actively engaged with the participatory lecture by answering questions one at a time. A low percentage of correct responses would trigger an explanation of the code requirement in addition to an open discussion with participants. If the percentage of correct responses is high, the participants would be simply be provided with the correct answer and code reference.


The 2018 FGI Guidelines – Are You Ready for Change?

Dana Swenson, P.E., MBA – Senior Vice President and Chief Facilities Officer, UMass Memorial Health Care System, Worcester, MA

Dana E. Swenson was appointed Senior Vice President and the Chief Facilities Officer for the UMass Memorial Health Care System in March 2004. In this role he is responsible for all construction, space planning, real estate, plant operations, public safety, environmental health and safety, food services and housekeeping–specifically for the flagship Medical Center Campuses and as a resource to the Community Hospital entities. In addition, Dana plays a key role in Strategic and Capital Planning, using systems thinking to view and develop health care delivery.

Previously Mr. Swenson was the Vice President for Facilities at the Beth Israel Deaconess Medical Center in Boston. Prior to BIDMC he was the Director of Patient Care Facilities at the University of Texas, M. D. Anderson Cancer Center in Houston and before that position the Director of Facilities at the Medical Center Hospital of Vermont (now University of Vermont Medical Center).

Mr. Swenson received his BS in Mechanical Engineering in 1979 from the U.S. Naval Academy in Annapolis, MD, he is registered as a Professional Engineer in Electrical Engineering, and received an MBA from Sam Houston State University in 1999. Mr. Swenson began working in health care in 1987 and prior to that performing mechanical and electrical design for commercial and health care facilities. He has served as an officer in the U.S. Navy and holds a rank of Commander (Retired).

Heather B. Livingston, Director of Operations, Facility Guidelines Institute (FGI)

Heather B. Livingston is the director of operations for the Facility Guidelines Institute (FGI) and managing editor of the 2022 edition of the Guidelines for Design and Construction of hospitals, outpatient facilities, and residential health, care, and support facilities. Heather served as consulting editor for FGI from 2011 through 2016 and was a freelance writer from 2006 through 2016. Prior to that, she was an associate editor for the American Institute of Architects and director of the Business Week/Architectural Record awards program. Her work has appeared in This Old House, Cadalyst, Architectural Record, AIArchitect, and other design publications.

Abstract

The FGI Guidelines for Design and Construction documents are the design standards most often employed by medical planners, designers, and owners of hospitals and outpatient facilities. Authorities having jurisdiction (AHJs) in 42 states enforce some edition of the Guidelines, but even states that haven’t officially adopted the documents often refer to them to help determine their own minimum standards. The States of Massachusetts, Connecticut and New York are considering the adoption of the 2018 edition. This session will highlight the key factors influencing the proposed changes in the draft 2018 Guidelines. Public input and understanding of the development process is imperative to the continued success of this series of documents vetted by the multidisciplinary Health Guidelines Revision Committee (HGRC).

These changes include requirements for recovery spaces; imaging, procedure, and operating rooms; and satellite sterile processing spaces in hospitals and outpatient facilities. Learn how these and other revisions may affect the planning and design of new construction and major renovation projects. This session will also review the HGRC’s benefit/cost analysis.