Advanced Lighting and Lighting Controls for Healthcare Facilities
Director of Total Solutions, Acuity Brands, Inc.
Mike is the Director of Sales for Total Solutions for Acuity Brands, and is responsible for sales of lighting and lighting controls for the eastern region. Mike holds a BA from Siena College and an MS from Rensselaer Polytechnic Institute.
Proper lighting and lighting control is an extremely important asset in todays advanced healthcare facilities. With the rapid advance of LED, many facilities are opting for tunable white lighting fixtures to create circadian systems that mimic natural sunlight. Many studies suggest that tunable systems can help in healing and make for a more pleasant environment for both patients and medical staff. What’s equally important is the way these lighting systems are controlled. Advanced lighting controls can gradually change lighting color temperature as time progresses so as to mitigate harsh lighting changes. Also, by integrating wireless controls and advanced sensor technology, medical facilities can quickly and economically upgrade their lighting in all areas of the facility (patient rooms, corridors, stairwells, parking garages, pathway lighting, etc.) all while setting their facility on the path towards IOT (Internet of Things) integration.
Understand the basics of tunable (circadian) lighting
How tunable lighting can improve your facility and the well-being of building occupants
How advanced lighting controls can optimize energy savings and building performance
How wireless and networked controls can lead to even more advance building services (IOT).
An Exploration of Regulatory Compliance
Shaine M. Grogan, PE, CFPS
Fire Protection Engineer, Jensen Hughes
Shaine is a licensed Professional Engineer (PE) in Fire Protection with expertise in building/fire code, life safety code, healthcare, and accessibility consulting.
Joseph W. Beadle, CFPS
Senior, Fire & Emergency Management Consultant, RPA, a Jensen Hughes Company
CFPS, certified Fire Marshal 30 years CT, fire Chief 10 years Winsted FD, Winchester CT Building Office Director 5 years, RPA/JH 14 years Senior Fire & Emergency Management Consultant.
The conference theme includes “Assessing Risk while Maintaining Compliance” and this presentation is intended to cover the challenges faced with “maintaining compliance”. The presenters draw on their experience with key regulatory agencies including the Joint Commission, Centers for Medicare and Medicaid Services (CMS), state health agencies, and local building/fire departments to engage NEHES attendees for a presentation on regulatory compliance.
Through our day to day work with architects, engineers, and end users, we have a comprehensive understanding of issues that our Clients face. The presentation is intended to provide attendees with the fundamental knowledge to navigate the complexities of regulatory compliance. Specifically, we address the application of NFPA 101, Life Safety Code. As we understand that the topic of regulatory compliance is not invigorating to all, we aim to make the presentation engaging and enlightening.
The presentation will briefly detail the application of NFPA 101. We will then speak to the occupancy classifications which are so commonly debated in a hospital. We have experienced that occupancy classification is frequently misunderstood resulting in costly misinterpretations. Examples will be utilized to illustrate the confusion and provide a learning experience that will be valuable to attendees.
After detailing the application of NFPA 101, we will provide a deeper dive into healthcare code provisions. We will address code considerations that are new to the 2012 edition of NFPA 101 and other items that we have found to be of the utmost importance throughout facilities in New England. Specifically, we will discuss healthcare suiting provisions and how to fully take advantage of the benefits of utilizing suites.
To further connect our code overview with real-world application, the final part of the presentation will detail commonly cited findings. We intend this to open the audience to the discussion around certain items and cover the “hot items” that we see throughout the industry.
Understand the application of NFPA 101 to CMS participating facilities.
Review occupancy classifications of a hospital.
Obtain a fundamental understanding of the major healthcare code considerations.
Recognize commonly cited findings.
Built Environment Considerations for Patients with Behavioral & Mental Health Conditions
Lynn Kenney, SASHE, EDAC, HFL
Director of Industry Relations, The Center for Health Design
Lynn Kenney, EDAC, SASHE has more than 20 years of experience in the health care regulatory and design industries. As Director of Industry Relations at The Center for Health Design, she is dedicated to improving health care quality and outcomes within the framework of evidence-based design. She is a frequent presenter at national conferences and has published several articles and white papers. She is on the 2022 FGI health guidelines revision committee as an ASHE representative. Previously, Kenney was part of the ASHE Advocacy team at the American Hospital Association. She holds a B.A. and recently earned a diploma in Health Facilities Leadership from Owensboro College.
OSHA certified, Patient Safety and Quality certification, Grainger
Ashley Solbach is a Corporate Health Systems Sales Manager at Grainger. Ashley is certified in Patient Safety and Quality from Johns Hopkins and has several OSHA certifications. She works with some of the largest health systems on the east coast with a focus on safety, compliance, and falls prevention. She regularly presents to C-level executives to help systems implement new safety and compliance programs and she is the recipient of the 2019 Grainger Innovation Award.
Behavioral and mental health (BMH) conditions affect one of five adults in the U.S. each year, and are even more common among patients receiving care for medical conditions. Up to 45% of patients admitted to the hospital for a medical condition or presenting to the emergency department with a minor injury also have a concurrent BMH condition. These BMH comorbidities increase the risk of psychological harm associated with care. Providing these patients with a healing, therapeutic environment should be an important goal for health design. Design interventions aimed at improving the psychological well-being of patients with BMH comorbidities may be more cost-effective than they initially appear, because they can be leveraged to support improved well-being for other populations as well, including other patients, staff, and visitors.
Identify the behavioral and mental health conditions that pose risks to patients, staff, and families.
Identify specific features that improve safety, security, and health outcomes for both staff and patients with behavioral and mental health conditions.
Outline specific areas of concern for accreditation surveys.
Explore options for a universal design to promote psychological wellness.
Challenges in Maintaining Regulatory Compliance During Construction
David W. Fowler, CHFM, MEP
Senior Director, Support Services, BILH Anna Jaques Hospital
David has over 30 years of experience working in healthcare. His responsibilities include managing all design and construction projects at Anna Jaques Hospital which have included a variety of scale and complexity. Dave is an active member in several industry groups that advance the understanding of regulatory compliance in healthcare. Along with a depth of knowledge in deign and construction, he also has an extensive background in hospital safety compliance.
Corey B. Fisher, P.E.
Consultant, Code Red Consultants, LLC
As a consultant and project manager, Corey excels at providing timely, alternative solutions to complex problems discovered in the field. Dedicated to every project he works on, he is astute as delivering technical information to clients and quickly addressing their questions and needs. Corey has extensive experience developing in-depth code analysis and construction fire safety plans for both new and existing buildings. He also specializes in performing field surveys related to existing building evaluations, construction site inspections, and third party inspections. His project work spans healthcare, higher education, high-rise buildings, large assembly spaces, and mixed-use buildings.
Matthew A. Bluette, AIA, ACHA, AICP, NCARB, LEED AP
Associate, JACA Architects
Matthew has over 22 years of experience in healthcare architecture. A registered architect and member of the American College of Healthcare architects, he has been involved in a wide range of healthcare projects from initial design through construction. Matthew has an extensive background in helping healthcare facilities navigate projects through regulatory compliance.
Maintaining Regulatory Compliance During Construction is a serious challenge for hospitals and to maintaining patient safety and satisfaction. This discussion identifies the key problems that inherent with construction projects that limit or prevent the ability to maintain compliance with the numerous regulatory requirements that hospitals need to follow.
The focus will be on identifying the essential areas that impacted by construction and outlining an approach to mitigating each factor. Topic points will be:
Keys to establishing campus life safety drawings
Understanding differences between CMS and Joint Commission reviews
Establishing a plan for NFPA 241 Compliance
Identifying the appropriate in-house construction team
Outlining the design and constriction teams roles in compliance
Establishing an achievable ICRA plan
Communication with AHJ's throughout the process
This discussion is intended to provide real world scenarios that occur during a construction project at a hospital that impact the facilities ability to maintain regulatory compliance. Methods to understand and mitigate issues that are a challenge to compliance will be presented.
Attendees will leave this discussion with a clear understanding of the various regulatory requirements that are impacted during a construction project.
An outline of who the project team should be to manage a construction project will be provided.
A clear understanding of the roles that the design and construction team play in maintaining compliance during a construction project will be provided.
A checklist will be offered for use in planning for construction projects.
Connecticut Children’s Infusion Center: Balancing Imagination with Practicality
Reaghan Schicker, AIA
Reaghan is a Project Manager with Connecticut Children's Planning, Design and Construction team. Prior to joining Connecticut Children’s, she served as a Project Manager for both Tecton Architects and the S/L/A/M Collaborative.
Ernest E. Nepomuceno, LEED AP
Ernest is a Senior Designer with Tecton Architects, where he has designed notable projects for Connecticut Children's, Hartford Hospital and Wheeler Clinic.
One of the fastest growing trends in healthcare design is the emergence of clinical environments that don’t feel clinical. Healthcare organizations are increasingly drawing on the power of the built environment to enhance and elevate the patient journey. The challenge in crafting these enriched environments lies in establishing balance – blending creativity and practicality, harmonizing playfulness with universal appeal, and synchronizing immersive design with the core mission of providing exceptional care.
Research has shown that patient stress is reduced in environments that feel more familiar, comfortable and are easy to navigate. However, there is an additional layer of our human experience that responds when our environments enrich us. Well-designed environments can help us flourish by providing nourishment for our mental and physiological well-being. Ordinary elements of design executed in an extraordinary way can have a positive impact on our capabilities as humans to learn and remember, respond to stress, navigate our world, and take-in our environment visually and through movement.
Connecticut Children’s Medical Center has embraced this approach, with a commitment to creating patient-centered environments of care and incorporating technology beyond the procedure room. In particular, Connecticut Children’s new Infusion Center in Farmington, Conn., presents a study in imagination and investment in the patient journey. Understanding the grueling hours that children can spend in treatment for chronic conditions, the team envisioned a creative and energizing space that balances patient care and delight. Through physical and digital design features, the feeling of a mystical outdoor adventure was created, inspiring the opportunity for discovery during an otherwise repetitive experience.
Working with Connecticut Children’s staff and providers, the architecture and engineering team was tasked with creating an environment that balances creativity with the practical realities of a healthcare environment. At a minimum the new Infusion Center needed to meet minimum design standards for outpatient facilities, while making patients comfortable and staff efficient in the space. Specific concerns included:
Power – lack of access to a generator at the facility, to ensure protocols were in place for continuous power to medication fridges, pharmacy and point of care testing. The team mitigated this issue through the use of a hospital-grade Uninterrupted Power Supply system.
Visibility – the balance of patient privacy versus provider visibility was a key consideration in the design. Treatment areas were located in a circle, surrounding a central desk, to ensure oversight of patients at high risk of infection. Longer-term treatment rooms make use of graphic frosted glass windows, providing privacy and comfort, but with a subtle view to the patient room to monitor care.
Material selection – Each space harnesses the positive effects of energizing color, soft forms, natural light and biophilic imagery, to create a welcoming and reassuring environment for patients and their families. The team selected materials that both delivered on the theme, while complying with FGI Guidelines for cleanability, slip-resistance and stability of floors, walls and ceilings, where applicable.
Ventilation - consideration was given to ASHRAE standards for the ventilation of infusion centers.
Learn about the unique considerations associated with pediatric care.
Understand the effects that the surrounding environment can have on the healing process.
Identify guiding principles for integrating interactive design.
Explore the technical, physical and operational challenges in the design process.
Dealing with noise during the modernization of an active hospital building
Principal Consultant, Acentech
Over 17 years of experience in acoustics and vibration on a variety of applications including health care facilities, research laboratories, and construction projects.
Gary Valcourt, CHFM, CHSP, FMA
Associate Vice President Facilities and Capital Planning, UMass Memorial Medical Center
Over 16 years as Associate Vice President of capital planning and management for Umass Memorial Medical Center.
One challenge in the modernization of existing hospital facilities is how to accomplish improvements without sacrificing a loss of capacity and performance. Often renovations are needed due to a lack of sufficient space, which poses an even greater challenge for temporary closure of healthcare spaces. As a result, hospitals must figure out how to cope with the inconveniences of construction, such as noise, in a way that preserves quality of care and patient satisfaction. An invaluable piece of the puzzle is communication, essential for any project, between project and hospital personnel. Beyond typical notifications and updates, creating a simplified means to relate construction impacts to medical staff enable those in the clinical environment to gauge their work and relay proper expectations to their patients. On such means is the development of informational graphics thru construction testing, which has a secondary benefit of allowing the project to explore proper methods and ways to optimize cost and schedule. In this session, we will discuss an ongoing project at the UMass Memorial Medical Center and the issues they faced during a campus-wide renovation project, including the perspectives of the hospital, approaches to mitigation, and lessons learned from their experience.
Become familiar with issues related to construction within an active hospital environment
Understand appropriate noise levels in the context of a healthcare setting
Implement approaches to improve communication and staff/patient satisfaction
Recognize best practices and pitfalls in planning a modernization
Energy Business Planning
David A. Rosinski, MBA, CHFM
Director of Facilities, St. Francis Hospital
David Rosinski is the Director of Facilities for Trinity of New England. Based out of Hartford Connecticut, he has responsibilites for systemization and standardization efforts througout New England.
David is a past president (2018) of the New England Healthcare Engineers Society. He continues to serve as a member of the board and is co-chair of the 2019 fall conference planning committee.
David also serves as the NEHES Connecticut Chapter Representative for the Connecitcut Healthcare Engineers Society or CHES. Currently he is working to rebuild the board and restart the educational efforts of CHES.
As a career healthcare professional, David attended college at the University of Massachusetts in Amherst where he earned his undergraduate degree in Business and Facilities Administration. He later attend American International College where he earned his Masters in Business Administration.
Steven Jalowiec, PE, SASHE, CHFM
VP Engineering Services, Hospital Energy
Steve Jalowiec, is Vice President for Engineering Services with Hospital Energy, a New Hampshire based company specializing in energy business planning and sourcing nationally for healthcare. Steve has more than 20 years of experience at several hospitals, working in facility management and engineering. Along with implementing numerous facility management practices to improve department performance and productivity, his other areas of focus throughout his career have included facility design and engineering, energy efficiency, regulatory compliance, fire and life safety, emergency preparedness and advocating for effective regulations. He is active in various healthcare and engineering organizations including the American Society for Healthcare Engineering (ASHE), New England Healthcare Engineers’ Society (NEHES) (Past President), Connecticut Healthcare Engineers’ Society (CHES) (Past President), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), and the National Fire Protection Association (NFPA). Steve was the recipient of the ASHE Emerging Regional Leader Award in 2009 and NEHES Engineer of the Year Award in 2008.
Steve is a Licensed Professional Engineer (PE), Certified Healthcare Facility Manager (CHFM) and has earned Senior Level (SASHE) designation with the American Society for Healthcare Engineers. He is a graduate of the University of New Haven with a Bachelor of Science degree in Mechanical Engineering.
President, Hospital Energy
Mark Mininberg founded Hospital Energy in 1995 to provide cost-effective, sustainable energy solutions for healthcare institutions. Hospital Energy is now the leading energy organization for healthcare in the United States. Mark is the author of numerous books and articles, including the AHA/ASHE Best Practices in Energy Procurement (2017) and Business Planning for Energy Resiliency (2018). He is a frequent lecturer on energy, healthcare and environmental matters, including invitations from the U.S. White House, the United Nations, the World Bank, the Oxford University Law Colloquium, the Yale University Center for International Studies, the Harvard Law School Negotiation Project and the Columbia University School of Public Health. He is a graduate of Wesleyan University with Honors in History, and the University of Connecticut School of Law, where he was a member of the Law Review and received the Connecticut Law Tribune Prize for legal scholarship.
Account Executive, CPower Energy Management
Philip Ciulla is an Account Executive for CPower Energy Management helping to connect power years with market revenues that are available through Demand Response. Mr. Ciulla has been in the Demand Response Industry since 2011 and has had roles in Contracting, Customer service, Operations, Metering, Project Management, Account Management, and Business Development. He uses his experience and knowledge on Demand Response to help create comprehensive and compelling demand-side management strategies to help power users in New England earn and save with the program available.
He is a graduate of Saint Michael’s College with a Bachelor of Science in Business Administration and a Bachelor of Arts in Economics.
This session will present Energy Business Planning Best Practices that help Facility Managers address the growing demand for improved energy resiliency in healthcare facilities, including a case study from a Connecticut Hospital. In an age of heightened concern about grid reliability, natural disasters and terrorism, hospitals are faced with meeting two very difficult conditions:
Hospitals now need to be ready to operate a larger array of patient care operations under emergency conditions for longer periods of time. Recent hospital resiliency failures have demonstrated that facilities should be prepared to go beyond minimum regulatory requirements and maintain more extensive operations (including maintaining temperature) in an “island” mode.
Hospitals need to allocate limited resources to resiliency despite continual financial pressure and changing regulatory and market forces. Hospital CFOs are often reluctant to meet engineering requests for power generation and central plant asset expenditures because energy is not reimbursable under Medicare. By employing a business planning approach, Facility Managers have a greater chance of demonstrating a compelling financial case for investment in energy assets that provide greater resiliency.
A primary challenge for hospital engineers is establishing campus resiliency of sufficient magnitude and duration to maintain more than minimal operations during natural disasters and possible terrorist attacks on the power grid. To be successful, the hospital will need to take a business planning approach to financial and technical resource allocation. This will involve selecting the correct technical solutions, negotiating lower cost equipment and service contracts, and knowing how to bundle financial incentives available from government, utilities, equipment providers and lenders.
Through adoption of best practices, Hospitals need to create a plan to meet its strategic energy requirements even with the loss of grid power, using a diverse mix of energy technologies, including on-site cogeneration and emergency generators run in multiple modes.
Establish the key elements of ASHE Energy Procurement and Resiliency Best Practices as the foundation for integrating an energy resiliency and sustainability strategy.
Identify the appropriate energy assets, including on-site power generation (retrofitted or new) and demand reduction capacity, to support campus and grid resiliency as well as improved ROI.
Build a business case for investment, including available grid and utility financial incentives and support.
Mobilize organizational support and resources.
From Master Planning to Operations: Integrating Compliance and Risk Management Strategies into New Construction and Major Renovation
Stephen Carbery, BE, MBA
Vice President Facilities Design Construction & Real Estate Yale New Haven Health
With over thirty two (32) years of healthcare experiences, Steve has 275 full-time employees, an annual system capital improvements budget of ~$285M and $25M operating budget.
Walter "Ted" Dow, PE, MS
Senior Fire Protection Engineer, Jensen Hughes
Ted has 14 years experience providing analysis of building, fire, life safety and accessibility code requirements. He is instrumental in developing alternative approaches/technical justification meeting the intent of the code.
Scott Aronson, MS
Principal, RPA/Practice Leader - Healthcare, RPA, a Jensen Hughes Company
Scott has worked in healthcare since 1994 on special care fires and system emergency management design concepts. He has reviewed fires and catastrophic disasters throughout the US.
As health systems are challenged to design for the future while managing the budget and timeline on projects, there can often be steps that are bypassed for compliance in the design, construction and hand-off phases. Based on lessons learned with him impact compliance challenges, Yale New Haven Health has incorporated a new process to address compliance in the early design phases to include the state Department of Health, best practices for fire attack (fire department entry and operations in a healthcare fire) and through to the conversion for the Day 1 opening and operations of the building or space.
Whether you are running hundreds of projects across a complex health system or a few projects at a small community hospital, the challenges are many when balancing compliance with the needs of the design and construction process. Having seen the review process from state and local AHJs evolve over time and the needs of the facilities engineering team expand to open and maintain the healthcare structure, Yale identified gaps in processes that would enable them to be more efficient in the design phases, construction administration and through to the opening of the building. This includes strategic partnerships for life safety code and other code reviews in the SD/DD/CD phases and onsite support for the construction teams in the Construction Administration process. The approach also integrates an approach for working with the AHJs at the 50, 75 and 90% visits through to the official hand-off for the building. Things conclude with the post-warranty surveys to ensure all issues are captured before formally moving things into the world of CMS and The Joint Commission.
Finally, when the building opens, the leadership and staff have to be trained along with your emergency response partners (and what better time to train them under realistic scenarios than in an empty structure). This is where key components take place for the design of and training on fire procedures, Joint Commission Life Safety Code compliance final assessments, the design and training on full building evacuation plan and testing of a catastrophic surge plan for disasters. These components all help bridge the gap for what the planning, design and construction team requires married together with the future needs of the facilities engineering, safety, security and emergency management teams.
Identify cost savings approaches for compliance pre, during and post-construction.
Establish a standardized process for any type of project using a threshold for when the compliance overlay is expanded upon.
Bridge the compliance gaps between master planning through to the building or space being operational (design to operations).
Incorporate an onboarding process for new construction/renovation areas to integrate fire, life safety and emergency management.
Integration of a Regional Hospital into a Healthcare Network
Robert Rose, P.E.
Vice President, A/Z Corporation
Rob’s 33 years of industry experience provides our clients with a technical resource to manage some of the most demanding and complex projects in the industry today. Rob’s expertise in corporate manufacturing, power and utility, higher education, and healthcare offers our clients the benefit of a strong reliable resource. Rob has served with A/Z for 20 years. He holds a B.S. in Electrical Engineering from SUNY Maritime College. He is a registered Professional Engineer (PE) as well as a Master Electrician in numerous jurisdictions. Rob was instrumental in A/Z being selected for the Project of the Year Award by the World Alliance for Decentralized Energy (WADE).
Alison Laas, AIA
Alison is an architect and project manager at Payette Associates with experience in unique laboratory and healthcare projects in New England and abroad. She has experience in projects that range from integrated imaging OR suites, undergraduate life sciences teaching laboratories, innovation and prototyping laboratories, high-end inpatient hospital and medical school design. Internationally, Alison led the medical planning team for Payette's winning entry for the Central South University's Fifth XiangYa Hospital competition for a 2,500 bed general and VIP hospital in Changsha, China. Most recently she has been project architect for renovation projects at YNHH Lawrence + Memorial and Westerly Hospitals for a variety of programs, including emergency department services, a geriatric behavioral health inpatient unit, and an oncology infusion outpatient clinic.
Mario Vieira, AIA
Yale New Haven Health
Mario is the Director, Infrastructure Projects, Facilities, Design and Construction at Yale New Haven Health. Before joining the health system, he worked at several healthcare architecture firms in Boston and was most recently a principal with Shepley Bulfinch, overseeing the company’s work at YNHHS. Vieira earned his bachelor’s of architecture from Boston Architectural Center and is a registered architect in Connecticut and Massachusetts.
Principal, BR+A Consulting Engineers
Steve is a Principal of the firm and has over 35 years of extensive experience in the design of HVAC systems. His diverse portfolio includes renovation and new construction projects in the healthcare, academic, and science and technology markets. Steve received his Bachelor of Science degree from the University of Massachusetts Amherst and is an active member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers and the American Society for Healthcare Engineering.
The integration of Regional Hospitals into Healthcare Networks comes with a wide variety of challenges; consistent delivery of patient care, administrative service, procurement, finance as well as facility design and construction.
The integration process always begins with detailed facility assessment that among other things includes a review of patient services and reliability of utility systems. In many cases upgrades to utility systems are urgently needed but need to be balanced against master planning, available capital and facility reliability.
Yale New Haven Health is currently well into the process of integrating L+M Hospital, Pequot Medical Center and Westerly Hospital into the Yale New Haven Health network. Our case study will outline lessons learned with regard to risk assessment (utility systems) and the path to compliance.
Facility Assessments – are required to identify shortcomings
Code Compliance – is required to meet the mission goals of reliable and safe healthcare
Master Planning – is necessary to ensure that upgrades enable future flexibility and growth
Intelligent Asset Renewals; a hospital’s wellness formula
Jean Phillippe Drouin
Mechanical Engineer, Ecosystem Energy Services
I help building owners develop and implement their energy vision through reducing energy consumption & GHG emissions, facilitating operation & maintenance, renewing assets or improving occupants experience. Past clients valued that I was committed to helping them develop creative solutions to their problems.
I am an engineer, certified energy manager (CEM), and distributed generation certified professional. I specialize in transformational energy measures and deep building retrofits such as steam-to-hot-water conversions, heat recovery chillers applications, district energy networks and combined heat and power.
Marc A.R. Couture, P.Eng, Mtg, PMP, CEM Engineer
Engineer, Project Manager and Energy Manager, Ecosystem Energy Services
As a Professional Engineer, Project Management Professional (PMP) and Certified Energy Manager (CEM), I am an expert at diagnosing complex energy ecosystems and developing transformational energy retrofits. I help clients bring their energy & sustainability vision to life with solutions that reduce energy consumption and greenhouse gas emissions, simplify operations and maintenance, renew assets, and improve occupant comfort. I am passionate about delivering the best possible outcomes using his holistic, client-centric approach, underpinned by 15+ years expertise within such diverse roles as Sustainability Co-Chair, Director of Operations, Energy Manager, Critical Infrastructure & Energy Management Project Manager, and HVAC Solutions Engineer.
Consider Intelligent Asset Renewal as a key component to your wellness formula – a unique approach, turning large capital expenditure projects into opportunities for hospitals to invest in infrastructure, drive sustainability and efficiency, address deferred maintenance costs, and provide a measurable return on investment.
Most hospitals are forced to choose patient care or building improvement knowing all too well that the patient experience is ground-up and should never be compromised. Yet engineering and facility teams at hospitals all too often are forced to make hard choices and compromises. Reduced budgets and higher operating costs often lead to long lists of deferred maintenance projects and the lowest cost approach to capital expenditure.
However, this doesn’t need to be the case. Developing a long-term roadmap for critical asset renewal will provide the C-suite with a proactive view into unavoidable capital projects down the road. This roadmap supports the creative process of uncovering hidden value within the existing infrastructure, identifies cost savings opportunities - enough to fund projects from efficiency gains while attaching ROI to deferred maintenance to achieve desired goals and timelines.
Ecosystem Energy Services have developed and implemented comprehensive, whole-building retrofits for over 130 healthcare facilities in North America. In this session, we will discuss proven solutions designed to help hospitals use their Asset Renewal Plans as a foundation for more complex and comprehensive projects.
Specifically, we will focus on our work with Mount Sinai Beth Israel Brooklyn, Quebec City University Hospital, and Bronx-Lebanon Hospital Center. You will hear first-hand how we leveraged planned, unavoidable, and large capital expenditures to achieve larger facilities and engineering goals. Each instance, a unique example highlighting different electromechanical and thermal system renewal projects. We will discuss the challenges each project faced, from an engineering and financial perspective, and how we worked within each hospital’s unique framework to solve these problems.
For example, Quebec University Hospital Centre’s intelligent asset renewal approach was integral to the success of their most recent project. Major HVAC upgrades were required to 4 of 5 its hospitals. Using a comprehensive, strategic, and intelligent approach we achieved a collective reduction of 30% in energy consumption, 29% to utility bills and 56% in GHG emissions – including $2,734,499 in annual cost savings. These outcomes earned the project CHES’s 2017 Wayne McLellan Award of Excellence, a 2017 ASHRAE Technology Award honorable mention for Existing Health Facilities, and an Energia Award for best-integrated projects in Quebec. Using this example, we will highlight how the integrated, outcome-based approach enabled the CHU’s staff to get involved early in the process.
On top of maximizing outcomes, the approach made sure to solve the various operating issues brought out by the CHU’s staff, and it addressed as much deferred maintenance as possible. It also ensured the accountability of the design-build firm, who provided all required training to properly operate the buildings and exceed the expected outcomes. This ongoing communication between stakeholders will be discussed within a phase-by-phase account of the project (concept design, detailed study, construction, optimization, performance follow-up).
Think differently about expenditures; see them as opportunities to develop an intelligent asset renewal formula
Attach ROI to deferred maintenance costs
Find hidden value within your existing infrastructure
Energy Savings - the real advantage
Mike Bajema is a retired U.S. Army officer, Infantry-Armor combined-arms commander, joint forces strategic planner and now a leadership instructor and speaker with Echelon Front. He served over 20 years as an Armor officer with 13 years of overseas experience. Fighting alongside Leif Babin and Jocko Willink from Task Unit Bruiser as the commander of Team Bulldog from the historic 1st Armored Division’s Ready First Combat Team, he established the first combat outpost (COP) in South-Central Ramadi and successfully defeated the insurgency’s stranglehold around COP Falcon. When not leading tactical formations, Mike served as a joint forces operational and strategic planner; graduating from the U.S. Navy’s Maritime Advanced Warfighting School. He was the only Army officer selected to serve as the 2014 Headquarters, Department of the Army’s senior fellow at the George C. Marshall European Center for European Security Studies and later shaped vital European partnerships while on the Pentagon’s Joint Staff.
The capstone of Mike’s career was commanding 2nd Battalion, 12th Cavalry Regiment and subsequent deployment to the Republic of Korea just miles from the demilitarized zone with North Korea. He is the recipient of the Bronze Star for Valor, and the Navy and Marine Corps Commendation Medal for Combat Valor for actions during the Battle of Ramadi.
Upon his retirement from the Army, Mike brings to Echelon Front vast expert combat leadership, proven organizational development techniques for building foundational extreme ownership, and strategic planning experience. He serves as a leadership instructor, speaker and strategic advisor for Echelon Front.
In his keynote, Mike will share fundamental leadership principles based upon Mike’s vast expert combat leadership and strategic organizational planning experience.
Lessons Learned from Institutional Combined Heat and Power Projects
Stephen Slocomb, PE
Principal, Epsilon Associates
Mr. Slocomb is a licensed professional chemical engineer with more than 25 years of experience in engineering and environmental consulting for a variety of utilities, developers, institutions, and public agencies.
Dorothy Buckoski, PE
Senior Consultant, Epsilon Associates
Ms. Buckoski is a licensed professional chemical engineer with over 30 years of experience in environmental and project engineering, air quality, environmental compliance auditing, and due diligence.
One of the most recent trends for Institutions of all types has been the development of Combined Heat and Power (CHP) projects. CHP projects include the generation of electricity from either a turbine or an engine and usually steam for either heat and hot water and/or for supplemental electric power generation. This presentation will summarize the lessons that we have learned permitting these projects ranging from:
Air emissions limitations - SCR, oxidation catalysts, Tier 4 engines and required supplementary controls
Ambient air emission impacts modeling - including methods used to demonstrate compliance with state and federal air quality standards and stack configuration options
Noise Impact Evaluation - including background sound level measurement, modeling potential noise impacts and evaluation of Best Available Sound Mitigation
Prime Mover Evaluation - including turbines and engines and the comparison of their operational and maintenance requirements
Learning about air permitting/agency requirements for CHPs/li>
Learning about experience associated with air quality modeling issues with CHPs and with a facility's existing sources/li>
Learning about experiences associated with potential noise monitoring/modeling issues/li>
Learning about permitting as well as operational differences between prime movers for CHP facilities
Making the Most of Your Computerized Maintenance Management Software
Raymond D. Forsell, CCE, CHFM, PE(VT)
Clinical Engineer, Certified Healthcare Facility Manager, Fire Protection Engineer(VT), The University of Vermont Technical Services Partnership
Raymond is a Clinical Engineer with the University of Vermont Technical Services Partnership. He has served hospitals large and small throughout New England and New York since the late 1980's. He is married Suzanne and has four grown kids and two grandsons.
Computerized Maintenance Management Software (CMMS) packages are common within healthcare facilities management departments. As common as these systems are, it is my observation that they are significantly underutilized. There are a number of viable software packages which may be health care specific or borrowed from the lodging sector or other related industries. Healthcare facilities management departments can benefit by taking steps to improve the performance of their current system, or use specific criteria to assess potential new products.
The speaker has worked with CMMS systems in a number of facilities over a 30+ year period. At one time, Facilities and Biomed were the high tech bastions of technology management. This was at a time when patient records were folders and papers and x-ray films. Somewhere along the path, technology overtook us and now we are surrounded by electronic databases for health records, providers doing their notes on tablets, and patient images are immediately sent to storage and displays for professional review. Do you feel that your CMMS has kept up? Probably not.
Architects, Design Engineers, and Contractors are using Building Information Modeling to design, construct and offer management information on constructed and renovated spaces in health care. This is no longer reserved for just the most elaborate of construction projects. As Facility Managers prepare to occupy spaces where such technology has been used, we need to engage the system to obtain the data we need to successfully manage the building and its equipment.
Accreditation and licensure authorities have presented specific requirements for management of buildings and equipment. The Alternate Equipment Management (AEM) rules set forth by the US Centers for Medicare and Medicaid Services (CMS) have been a challenge to implement for both Biomedical Engineers and Facilities Managers.
The complexity of healthcare facilities systems increases every year. Staffing is limited and productivity must be demonstrated. It is rare in my observation that facilities of all sizes are truly happy with their CMMS systems. A properly designed system can address the many facets of management and documentation to improve performance of your department.
This presentation will discuss best practices and approaches to improve ANY CMMS system. Regardless of the software package, success is dependent on the architecture of the data that you put into the system. Capabilities of certain products enable paperless work order entry by the technician in the field. Systems of the near future must integrate with such systems as CAD, BIM, and building control systems.
We will discuss your specific frustrations with your current CMMS and ways to improve the function of your current system. Examples of other systems which will need to integrate with your CMMS will be presented. CMMS designers should be driven by our needs to create efficient systems that provide ease of use for staff, solid data management, and useful reporting.
Explore the history of Computerized Maintenance Management Software (CMMS) and how the needs of healthcare facility managers has changed over the past four decades.
Discuss the present state of building system and equipment data available to healthcare facility managers from equipment suppliers, architects, design engineers, and constructors that is essential to the effective use of your CMMS.
Discuss and document approaches that any facility manager or biomedical engineer can assess and make substantial improvements to their current CMMS. Much of this revolves around the architecture of the data and the way inventories and procedures are constructed locally.
Discuss and document parameters for CMMS designers to use to update software to better meet the changing demands of their customers. As we evaluate new CMMS packages, we need to demand functionality and efficiency.
Minimizing Risk, Maximizing ROI: The MC2020 Recapitalization Story
David D. Neal, AIA, ACHA
Principal, The S/L/A/M Collaborative
Mr. Neal is a Principal at SLAM, with over 30 years of healthcare design experience. David has led the architectural team on the MC2020 project.
Kathleen Hylka, AIA
Director of Strategic Space Planning, UMass Memorial Medical Center
Ms. Hylka is the Director of Space Planning at UMass Memorial Medical Center. Kathleen has led the planning effort for the MC2020 project.
Director of Healthcare and Life Sciences, Consigli Construction Co., Inc.
Mr. Hamilton is the Director of Healthcare & Life Sciences at Consigli. Brian is the Construction Project Executive for the MC2020 project.
Michael Benjamin, PE, HFDP, ASHE, LEED AP
Managing Principal, BR+A Consulting Engineers
Mr. Benjamin is a Managing Principal at BR+A. Michael has served as MEP Principal-in-Charge for the MC2020 project.
With a goal of being “The Best Place to Give Care and The Best Place to Get Care,” UMass Memorial Health Care Executive Leadership set out to explore, plan and implement transformative upgrades and improvements—the future state of health care—at the flagship academic medical center’s Memorial and University Hospital campuses. Both campuses featured an abundance of outdated buildings from the 1960s and 1970s, requiring both cosmetic and infrastructure upgrades. Leadership zeroed in on improving the inpatient experience, particularly the inpatient beds at both campuses.
The resultant options were to either consolidate nursing floors from both campuses into a new $1 billion tower, or to renovate the existing nursing floors. Leadership analyzed both scenarios, with help from the design team, and determined that the best course of action would be to renovate, instead of building new.
With this crucial decision out of the way, UMass established a “True North” charter focused on establishing key goals encompassing four categories: “Our Patients,” “Our People,” “Our Discoveries,” and “Our Long-Term Financial Health.”
The resulting MC2020 modernization project sought to increase the number of private patient beds, transition Nurses Stations into collaborative Team Stations, increase learning and discovery space at the Memorial Campus, and in general, create a more standardized person-centered experience.
Starting in 2015 and ending in 2024, the overall project would consist of 275,000-square-feet of renovated space between both campuses, touching 407 beds, creating 14 new Team Stations, adding the aforementioned classroom and learning space within the Memorial Campus, and upgrading infrastructure, including power Cogeneration and new Penthouse HVAC systems.
This application is for the completed renovations of the first phase of work at the Memorial Campus, including the West building Inpatient floors and public “Pathway” construction. This phase encompassed approximately 146,000-square-feet and touched 153 beds at UMass Memorial Medical Center’s Memorial Campus. The project and project team was awarded the 2019 ASHE Vista Award for the Best Renovation Project in the country. In this session, you will hear from members of the team (client, architect, engineers, and contractor) about the challenges faced, obstacles overcome, results achieved, and lessons learned.
Learn about the heightened stakes of construction within an occupied, active hospital campus, and how to creatively overcome these challenges to maintain compliance.
Learn how to utilized LEAN principles in the design and planning process to achieve the greatest return on investment.
Learn how to implement modular and pre-fabricated construction to improve efficiency in construction while reducing risk and waste.
Learn how to best involve stakeholders throughout the process to receive feedback, buy-in, and community support.
Myths and Misconceptions About Roofs
Erin L. Kesegi, AIA
Senior Architect, Hoffmann Architects, Inc.
With extensive experience in the investigation, design, and construction administration of diverse roofing systems, Erin Kesegi, AIA develops design solutions for challenging roof details and conditions.
Misinformation and misunderstandings about roof systems abound. Separating fact from fiction is important to preventing erroneous, costly, and potentially hazardous decisions. For the healthcare engineer, keeping up with the various types and configurations of roof materials and systems can be a challenge, but identifying oft-repeated roofing maxims that are doing more harm than good is the first step to improving the outcomes of reroofing projects.
This course debunks twelve common roof myths, from “new roofing systems can always be installed over existing systems,” to “there is no such thing as too much insulation,” by applying roof design essentials and narrowing in on common sources of premature roof failure. Evaluating who is best qualified to install or repair a roof, when and how materials can be re-used or re-covered, how to plan for drainage and flashing repairs, and what a roof warranty will and will not provide are some of the topics covered in this roof maintenance and replacement primer. The answers to these questions may be surprising, especially to those with years spent hearing oft-repeated, yet incorrect, maxims of the roofing trade.
Until a problem is detected, it can’t be fixed. Regular roof inspections allow healthcare engineers to correct minor problems before they become major ones, extending the roof lifespan and avoiding premature replacement. By tracking the progress of roof issues, periodic inspections can alert facility professionals to emerging conditions, allowing for prompt repairs that protect the building interior and prevent the expense and disruption of emergency roof replacement. In addition to addressing common myths, this presentation covers roof inspections, including what to look for and how to document observed conditions, from routine seasonal inspections by maintenance staff, to moisture testing, to comprehensive condition assessment by a roof design professional.
When it’s time to replace the roof, it can be hard to know whether to replace in kind or opt for another type of assembly that may be less expensive, easier to maintain, more durable, or all of the above. Although each building and situation demands nuanced, customized consideration, a general understanding of the pros and cons of different systems can help with the decision process. With at-a-glance summaries and illustrations, this session provides comparison criteria for common roof systems, from traditional metal and shingle to modern thermoplastics and built-up assemblies.
Addressing misconceptions is important to achieving a successful roof project outcome, but it can be a challenge to know how to identify the erroneous reasoning behind many common claims. Maintaining a watertight, code-compliant roof, while planning for timely replacement, demands accurate understanding of roof design fundamentals and material characteristics. This course provides tools for healthcare engineers to address misinformation and make knowledgeable choices in selecting and maintaining a roof system that is appropriate to the building and project goals.
Identify common misinformation about roof systems, design, and installation that can lead to premature roof failure and hazardous conditions.
Compare and contrast systems for low-slope and steep-slope roofs, based on configuration and characteristics, including life expectancy, durability, cost, and sustainability.
Describe roof inspection protocols for routine seasonal maintenance and comprehensive annual condition assessment, identifying conditions to note and elements outside the roof field that should be included in the evaluation.
Improve outcomes with new or replacement roofs by applying criteria for appropriate system selection, incorporating custom details for penetrations, flashings, drainage, and other key components, and following manufacturer stipulations for installation.
Kent Buzard began his career in the Industrial and Medical gas industry in 1980 with Airco/BOC. HIs industry experience included time with CTR and Chart industries before founding Compass Cryogenics in 2011.
David Sterrett, ASSE
Partner, Compass Cryogenics Inc.
Dave Sterrett began his career in Industrial and Medical Gases with Airco/BOC in 1982. His industry experience included management positions with Linde and Airgas before becoming co-owner of Compass Cryogenics Inc in 2015.
In July of 2016 CMS and the Joint Commission adopted the NFPA 99 - 2012 edition that contained the new requirements 22.214.171.124.3.1. "Manufactured Assemblies Employing Flexible Connections Between the User Terminal and the Piping System".
This session explores why this language was included in the code; what facilities are include under the code; and options for Health Care facilities in complying with the code. We will explore why the code section was written, what assemblies are included and what are not, and what inspections are needed to be in full compliance with the code. We will also discuss the inspection interval and what might need to be addressed in the facilities risk assessment.
Participants will learn why the new requirements were included in the code.
Participants will learn what facilities and what assemblies need to to be inspected under the code and what do not.
Participants will learn what inspections are necessary to fully comply with the code and at what interval the inspections should be preformed.
Participants will learn what documentation should be kept on site for review by the governing Jurisdiction
Nitrous Oxide as Anlgesia: Two Exposure Risk Case Studies
Ed Browne, MS, CHFM, CHC, SASHE, FACHE
Vice President Support Services, Cambridge Health Alliance
In over 34 years, Ed has managed dozens of building projects, hundreds of renovations, and millions of square feet in a variety of healthcare settings.
John Kannas, Jr., MSPH
Director of Environmental Safety, Dartmouth-Hitchcock Medical Center
John leads a team responsible for the identification, evaluation and control of occupational and environmental stressors, assessing worker exposure to hazardous materials including anesthetic gases, hazardous drugs, and heavy metals.
Business Development Manager, EBI Consulting
Bob comes from a diverse background, serving clients at the intersection of healthcare and engineering for the last 15 years. He brings an innovative perspective and valuable experience to clients.
The inhaled, self-administered blend of 50% nitrous oxide (N2O) and 50% oxygen is a common form of analgesia long used in other developed countries, but until recently has been available at only a few institutions in the United States due to occupational exposure concerns.
Managing anesthetic gases in the hospital is not an unfamiliar challenge. OSHA estimates that over 200,000 health care professionals—ranging from anesthesiologists, nurse anesthetists, surgical and obstetric nurses, operating room technicians, nurse’s aides, surgeons, anesthesia technicians, post-anesthesia care nurses, dentists, dental assistants, dental hygienists, veterinarians, veterinary assistants, emergency room staff, and radiology department personnel—are potentially exposed to waste anesthetic gases and at risk of occupational illness.
Over the years, there have been significant improvements in the control of anesthetic gas pollution in healthcare facilities accomplished through the use of and improved design of scavenging systems, installation of more effective general ventilation systems, and increased attention to equipment maintenance and leak detection, as well as more careful anesthetic practice. However, occupational exposure to waste gases still occurs.
OSHA further outlines the preventive measures in anesthetizing locations and PACUs—where employees are at risk of exposure to waste anesthetic gases—that should be taken to prevent exposure:
Effective anesthetic gas scavenging systems that remove excess anesthetic gas at the point of origin;
Effective general or dilution ventilation;
Good work practices on the part of the healthcare workers, including the proper use of controls;
Proper maintenance of equipment to prevent leaks; and
Periodic personnel exposure and environmental monitoring to determine the effectiveness of the overall waste anesthetic gas control program.
While on the surface these self-administered devices appear to be of little relative risk given the lower concentrations used when compared with other applications, they also present some challenges for the areas in which they are used—rooms with low air change rates and little design consideration for ventilation of waste anesthetic gases. Therefore, risk assessments can provide crucial information about the areas in which the devices will be used to ensure staff are not exposed to potentially harmful levels of the gases released.
We will present an in-depth look at the results of two independent case studies measuring risk to staff. Delving deeper, we will explore the study variables and staff concerns, and the ways risk assessments can be useful to other institutions when evaluating this and other potential exposure risks, particularly those arising from ventilation concerns.
Identify devices or processes that warrant evaluation via risk assessment
Identify key variables to be part of the risk assessment evaluation
Successful identification and incorporation of stakeholder interests
Proper presentation and use of study results
Phase 1 Patient Handling and Movement Needs Assessments and Planning Challenges
Theresa Harris, AIA, NCARB, EDAC, LEED AP BD+C
Principal, Director of Healthcare Planning, Isgenuity LLC
Theresa has 23 years of experience in planning, programming and design of a wealth of large health care facilities. Her broad portfolio of work includes both new construction and renovations for ambulatory clinics, inpatient units, surgical and Hybrid ORs, cancer centers and pharmacies. She received both her Bachelor of Science and Master of Architecture from the University of Michigan.
Jacki Chechile, PT, MSPT
Safe Patient Handling Clinical Coordinator, Beth Israel Deaconess Medical Center
Jacki Chechile received her Bachelor of Science in Rehabilitation Science and her Master of Science in Physical Therapy from Northeastern University. Jacki has worked as the Safe Patient Handling Clinical Coordinator at Beth Israel Deaconess Medical Center for the past eleven years.
Caitlyn Angelini, PE
Senior Code Consultant, AKF Group
Caitlyn’s expertise includes code consulting for existing buildings and new construction projects; her specialties lie in healthcare, science, and technology. A graduate of WPI, Caitlyn is well-versed in building, fire, life safety, and accessibility codes for various market segments.
Compliance with current FGI guidelines, as adopted by Massachusetts, compels health care institutions to undertake a Patient Handling and Movement Assessment (PHAMA) as part of initial planning before design and construction in their facilities. This is driven by the updated Patients of Size requirements on the “DPH checklists” issued by the Division of Health Care Quality.
In this session we will review the process of how a PHAMA takes place. In order to perform the PHAMA, a multidisciplinary team must be assembled. This team will assess key critical risks with respect to staff safety, who are at risk of musculoskeletal injury from the manual lifting and movement of patients. It will also assess the specific patient population who themselves may be at risk of falls and accidents, or who may be dependent on equipment for their mobility and care needs; this could be due to their size, disability, or other factors. The PHAMA will review equipment, storage, and spatial needs, accounting for experience and advice of end users, nursing staff, infection control experts, ergonomics experts, facility maintenance and operations staff, purchasing staff, and many more stakeholders. They will consider as evidence a wide variety of data-driven factors, including obesity statistics and future projections, as well as historical records from within the institution or practice. Each PHAMA is unique and tailored to the particular unit, site, and location.
As there is no one-size-fits-all approach, this poses specific challenges and places PHAMA into potentially uncharted territory, especially for smaller facilities who may be new to the process. We will introduce various tools and checklists published in the FGI’s 2010 White Paper on PHAMA, as well as other matrices and guidelines, and how they can be used in the decision-making process. In our panel discussions we will discuss opportunities and challenges, and we will attempt to open our imagination to new approaches.
As part of the PHAMA, existing facilities must account for significant challenges when retrofitting to address the results of the PHAMA process. In the built realm, for example, the sheer amount of space that is needed to accommodate the movement of patients – especially patients of size – has skyrocketed. Widening corridors, widening doors, reinforcements of toilets and sinks and the layout of those fixtures, are all affected by the results of the PHAMA. On the equipment side, early decision-making must occur to assess the types of lifts that will be used, as these decisions directly impact the space-planning process, and by extension, the budgeting for projects. We will provide background of how of the FGI guidelines determined and crafted the current clearance requirements through mockups and testing, and we will provide examples from the FGI guidelines as to how this has directly played out in the regulations.
Designers also face specific challenges when trying to address conflicts between requirements of accessibility and “patient of size” during the planning process. One example is that of grab bars in toilets; another is corridor widths, door widths, and door swing approaches. We will discuss ways that designers and facilities have tried to resolve such issues.
Explain key elements of a Patient Handling and Movement Assessment (PHAMA), what it is, who is involved, when they are undertaken, why they are important, and how and where they should take place.
Describe existing tools and current best practices for undertaking a Patient Handling and Movement Assessment.
Identify some of the biggest challenges existing facilities face in retrofitting to meet the new requirements listed in the FGI guidelines.
Describe specific examples where accessibility codes conflict with the specific checklist requirements for patients of size, and potential approaches to resolving the conflicts.
Retro-Commissioning for Resiliency and Code Compliance
Matthew Wheeler, PE, CXA, LEED AP
Principal | Commissioning Service Leader, Fitzemeyer & Tocci Associates
Matt serves as the overall supervisor of the project and the primary contact to clients throughout project development. He ensures that all client requirements are met by developing a strong client relationship.
Chris Wyscoczanki, PE
Mechanical Group Leader, Fitzemeyer & Tocci Associates, Inc.
Chris coordinates entire systems from concept through construction, conducting site visits, systems evaluations, cost estimates and specifications.
Healthcare facility organizations operating budgets are tight and thus improvements in the planning, cost effectiveness, and return-on-investment of infrastructure budget spending can significantly affect the overall organization’s capability to serve their patients. This guide will present strategies and case studies that illustrate how effective use of retro-commissioning activities can help facility engineers make the best use of their existing operating budgets and effectively plan for capital needs in the future, lighting for better sleep patterns, safety from ground faults, and several other topics with evidence of improved healing environments will be explored.
Attendees will learn how retro-commissioning can help create more predictable operating budgets.
Attendees will learn how retro-commissioning can ease burden on limited operation staff.
Attendees will learn how retro-commissioning can reduce operating costs.
Attendees will learn how retro-commissioning process has
on the healing environment?