2020 Spring Seminar
Sustaining Healthcare Now and Into the Future: Improving Facilities without Exhausting Resources
Spring Seminar Speakers
Maintaining Facilities During Financial Reorganization (Chapter 11)
Jim Smith, MBA, CHFM
Director of Engineering
Springfield Medical Care Systems
Jim has been in healthcare facilities management since 2013. His experience includes plant operations, chemistry, maintenance, and performance improvement in the both the Navy nuclear and commercial nuclear fields.
More than 20 hospitals have filed for bankruptcy since 2016 and predictions indicate that we can expect more hospitals to close in the coming years. Increased competition, poorly planned mergers and acquisitions, along with lower reimbursement rates contribute to financial distress in many healthcare organizations. Chapter 11 reorganization, while protecting the organization and providing a legal opportunity for financial relief, imposes a significant restriction on finances and creates additional barriers to improving and even maintaining existing facilities. Capital projects, improvement plans, as well as any vendor-performed maintenance can come to a screeching halt in a Chapter 11 situation. Longstanding
relationships with vendors, suppliers, and contractors become strained and retaining and/or
recruiting skilled tradespeople becomes problematic. While the C-Suite works to negotiate a
better financial position for the organization, the facilities department must scramble to ensure
that compliance requirements are met and that the facilities, systems, and equipment are
maintained to ensure continued operation and safety of all involved. Healthcare facilities
professionals should be aware of the barriers and challenges created by a Chapter 11 filing.
The purpose of this presentation will be to provide insight, experience, and lessons learned from a small healthcare network including a critical access hospital undergoing a Chapter 11
reorganization. By reviewing some of the events leading up and existing facility conditions at
Springfield Medical Care Systems (SMCS)/Springfield Hospital (Springfield, VT) in 2019, this
presentation will examine the ramifications of a Chapter 11 filing on facilities management. Events and existing conditions leading up to the filing will be reviewed for context and how those conditions impacted continued operations and maintenance. Challenges in maintaining existing equipment/systems and improvement plans will be discussed. Strategies and efforts to continue relationships with vendors/contractors/suppliers will be discussed including indicators of when it may be time to part ways.
The session will conclude with a discussion of lessons learned regarding:
- The value of appreciating committed, experienced facilities staff.
- The value of well-organized and documented maintenance records and maintenance
- The value of good relationships with vendors/contractors/suppliers in the aftermath of a
Chapter 11 filing, including a discussion of how Chapter 11 affects small, local vendors
vs large commercial vendors.
- How Chapter 11 restrictions in finances can limit the ability to perform maintenance
and limit support from vendors.
- Factors to consider when faced with needing to scaling back maintenance
programs/services due to limited resources. While there is some commonality in facilities management from organization to organization, how each organization deals with the aftermath of a Chapter 11 filing may be very different; the lessons learned through the experience of SMCS is intended to be educational and thought-provoking for other facility professionals who may face a similar situation in the future.
The presentation will conclude with a high-level overview of the Chapter 11 exit strategies for
SMCS and Springfield Hospital.
- Define Chapter 11 (reorganization) and describe how it differs from Chapter 7 (liquidation).
- Examine the Chapter 11 status at SMCS and its effect on facilities operation and maintenance.
- Understand the challenges that Chapter 11 protection creates for continue operation and maintenance of healthcare facilities.
- Describe and discuss how unpaid balances with vendors/contractors/suppliers can interfere with continued operation and maintenance.
- Assess the situation at SMCS and consider changes that may need to be made at you organization to prepare for the possibility of financial restrictions up to and including Chapter 11 bankruptcy.
Gambling with Deferred Maintenance
Sales Enablement Manager; Lead Trainer on Clean Air University
Anthony Hamilton, Sales Enablement Manager, has spent the bulk of his career in the filtration industry and now leads AAF Flanders’ Clean Air University program, teaching all aspects of filtration, from engineering concepts to practical applications. Anthony highlights the importance of proper filter selection and preventative maintenance schedules enhancing significant cost savings.
Deferring maintenance is the practice of postponing system checks, repairs, and upgrades to a later budget cycle due to a lack of time, money, or both. The idea is to minimize the investment into existing systems and personnel to improve cash flow and reduce expenses. In other words, spend less get more.
Deferring maintenance can deliver more, but not always in the ways you want. Instead, it can lead to:
- More unplanned expenses
- More downtime
- More safety risks
Why Ongoing Maintenance of HVAC Systems is Critical: Half of a facility’s energy costs are attributed to heating, cooling, and moving air. When HVAC systems are not maintained on time, they do not perform as they should. Components may begin to short cycle and wear themselves out, leading to more energy wasted and spikes in energy costs. Proper filter maintenance is essential to keeping HVAC systems operating effectively and efficiently. Compared to components like motors and compressors, filter selection and maintenance may seem simple, but there are multiple facets of the filter and the system it’s installed in that must be taken into consideration. These considerations include system airspeed, fan efficiency, filter resistance, service life, efficiency, and cost. Filters are essential to your HVAC system’s performance and can extend the life of the system components, decrease your energy spend, and reduce the labor burden of your team, saving you time and money.
Impacts of Filters on HVAC costs
- 15% to 40% of the lifetime ownership cost of an air handler unit is directly attributable to
the air filters selected.
Impacts of Filters on HVAC efficiency
- Only 0.006″ of surface buildup can result in a 16% efficiency loss for HVAC coils.
- Up to 37% more energy is consumed by AHUs with dirty coils vs. clean coils. And that’s only dollars and cents - when you put off servicing HVAC systems you significantly compromise air quality. Poor air quality is in many ways an invisible problem, and there’s frequently no early warning signs that air has become full of allergens or toxins. The resulting diseases build up quietly over time, causing serious illnesses in workers and patients without discernable cause.
Overlooking Air Filters is a Costly Mistake
Along with reducing risk and energy spending, filters can also play an important role in reducing your deferred maintenance backlog. Having an optimized program for filter maintenance and replacement is vital to a facility’s operations. The time spent on filters and related maintenance, such as purchasing, inventory, staging, removal, and installation, is highly labor intensive.
- 20 to 25 labor hours are commonly required to replace 100 bag/box filters. These filters are commonly replaced yearly.
- 10 to 15 labor hours are commonly required to replace 100 pleated filters. These filters
are commonly replaced 3 to 4 times per year.
- Spending one labor week replacing filters has an opportunity cost of 90,000 – 100,000 in deferred maintenance costs – spending that week addressing other issues would typically result in significant savings for the facility.
By failing to look at ways to analyze and improve processes, reactive Facility Managers put
themselves at risk. Short-term solutions and price-driven shortcuts may be perceived as
problem solving, but in reality they end up costing companies more.
Instead of reacting to HVAC issues in your facility, you can put in place a preventative
maintenance strategy involving long-lasting, high-quality filters and powered by software and
intelligent data to help you minimize the time and cost involved in maintaining optimal indoor air quality.
- Understand why proper HVAC maintenance is critical to energy and maintenance costs.
- Understand how proper filter selection and maintenance can reduce risk, energy costs and deferred maintenance backlogs.
- Know the true costs of filter change outs.
- Discover how the latest generation of intelligent software tools can be used to determine optimal filter selection and preventative maintenance schedules to reduce overall costs.
From West Coast to East Coast, What's Trending in Healthcare Facility Design
Keith Fine, AIA
Mr. Fine is a healthcare delivery and 3D visualization expert with over 20 years of experience working with some of the largest in healthcare on the West Coast.
Turner Construction Company
Mr. Bertain is the Healthcare Preconstruction Manager for Turner Construction’s SoCal Region. Justin manages the overall preconstruction process for his clients, in addition to estimates,
pursuits, bids and proposal responses.
Brian Hamilton, HCC
Director of Healthcare & Life Sciences
Consigli Construction Co. Inc.
Mr. Hamilton oversees Consigli’s healthcare and life sciences markets. He serves as Project Executive on some of the company’s largest healthcare projects across the Northeast.
Steven R. Doherty, AIA, ACHE
Mr. Doherty is a Managing Principal at SLAM, possessing nearly 30 years of healthcare planning and design experience for systems throughout the Midwest, Northeast, and Mid- Atlantic.
Your challenge: erect a 60,000 SF award-winning medical office building in 9 days. Oh, and bring the project in under budget. And while you’re at it, make this building act as a prototype for several others. Sounds impossible, right? At one point in time you would be
right – but not anymore. In the hyper-competitive field of healthcare, institutions and service
providers alike are being challenged with what was previously deemed impossible. It might
sound unfair, but when our healthcare providers are being challenged with the impossible every day – treating patients with diseases and ailments that once were considered impossible – why should the expectations be any different for the design and construction team?
As A/E/C professionals, we don’t save lives, but we do provide the facilities where lives are
saved on a daily basis. Every advantage gained by the systems we work for has an impact on
the institution’s bottom line, and in turn, the healing outcomes provided to the community. With rapidly changing technology, techniques, and treatments, “keeping up with the Joneses” is
tougher than ever. This panel will provide attendees with a high-level overlook of the biggest
trends in healthcare facility planning, design, and construction – trends that can be easily
understood and implemented.
Working for some of the most renowned healthcare systems in the world, including Kaiser
Permanente, the Mayo Clinic, Johns Hopkins Medicine, UCLA Health, Yale-New Haven Health, Trinity Health, and many others, the panelists that make up this discussion will share lessons
learned on the most cutting-edge projects recently completed and underway across the country. Made up of healthcare planning, design and construction professionals, the panel will give
attendees an in-depth look at topics like modularity and prefabricated construction, lean design, tying nature into the built and landscape environment, and technology including operational
advancements as well as tools in the design and construction process. These tools include
Virtual and Augmented Reality, and how these tools once thought of as mere marketing tools
can actually improve the decision-making process for Owners, as well as enhance the
construction delivery process through use by contractors and construction administrators.
Coming out of this session, attendees will gain a better understanding of how the tools,
techniques, and technology discussed can provide greater flexibility, increase operational
efficiency, improve patient outcomes, and boost the institution’s bottom line. An interactive
session utilizing some of the very technology discussed, attendees will be able to communicate with the panel throughout the session through the use of mobile devices, culminating in a lean
data report at the end of the session. Staying ahead of the curve may be challenging, but this
panel will help you navigate the road ahead.
- Learn about the benefits of modular, prefabricated design, including speed-to-market,
cost savings, and greater facility flexibility.
- Learn about the newest facilities and operations technology, and how it can be
implemented in your project to increase efficiency.
- Learn how to utilize 3D visualization from Schematic Design through Construction administration.
- Learn how to utilize nature in the built environment to improve healing outcomes, while
helping connect to the community in wellness and health education initiatives.
Investigate-Design-Build Approach for Challenging Repair Projects
Business Development Manager,
STRUCTURAL, A Structural Technologies Company
John has worked closely with facility and property managers on projects focused on the
maintenance and repair of critical infrastructure. His experience spans over several industries, including healthcare, higher education, and commercial properties.
Business Development Manager,
Vice President for Corporate Sales, Structural Technologies
Dennis Sanschagrin is the Vice President, Corporate Sales for Structural Technologies. He has over 27 years of experience in the repair and restoration of existing healthcare structures, including corrosion mitigation, structural strengthening, post tension repair and façade restoration. Dennis assists all types of commercial owners with their design-build projects around the country. He has experience teaching about integrated product delivery systems and how to procure them to small groups of owners at their facilities as well as presentations for larger groups at association meetings. He is active in several AEC organizations, including national and local chapters of ASHE, APPA, BOMA, Building Congress, NPA, and COAA. Dennis has a BS in Civil Engineering from the University of Maryland and an MBA from George Mason University.
Design-Build and Integrated Project Delivery are growing delivery systems
for major new construction projects. However, similar and additional benefits can be gained in
using an integrated Design-Build approach for both small and larger repair projects where there is a need to identify the degree of the problem and the root cause before developing the proper repair design. For these types of problems, a team IDB (Investigate-Design-Build) approach
extends the advantages of Design-Build to the investigative stage and also enhances the results during the design and construction phases.
This presentation outlines:
- Key elements of the IDB approach
- Advantages in each stage of the process
- Particular types of projects where it is most appropriate
- Ideas on how to determine if IDB is right for you
- Case study of IDB in action with a public / private owner
- How to apply an investigative front-end step to create a design-build procurement
approach for major repair and renovation projects.
- Step-by-step description of investigate-design-build (IDB) approach for structural repair,
retrofit and upgrade projects.
- Analysis of each stage of the IDB process and pros and cons for several typical project
- How an IDB approach can create the lowest total cost for major repair or renovation