Avoiding weapons of mass disruption

Before embarking on any facility construction or renovation project, healthcare provider executives generally commission a series of architectural drawings to highlight, outline and showcase what contractors need to do where and how.

The finalized blueprints should take into account more than just aesthetics and routine functionality. They should incorporate current workflow patterns and anticipated changes to those patterns, existing and new capital equipment demands as well as clinical and environmental safety and sterility concerns. Logistics also plays a key role as product brand evaluation, contract negotiation and purchasing, receiving, unloading, assembly (if needed), installation, testing and cleanup must be addressed. Of course, any products must be able to fit through the doorways — preferably comfortably.

To accomplish this requires input from a multidisciplinary group of professionals that spans administrative, clinical, financial and operational expertise. Essentially, administrators and clinicians must collaborate, working together to design a footprint that works for everyone — including patients. That includes current needs and can handle future expansion to a degree. And Supply Chain should be entrenched in the thick of discussions.

What are the key issues this group must solve before breaking ground or busting down walls? What are some of the key steps that should be taken to minimize disruption to patient care, sterility and workflow? What steps should Supply Chain take to ensure that the design, layout and equipment selections satisfy current needs but also prepare the facility for future growth?

Early intervention

Once a healthcare organization identifies a service line that requires a new or renovated footprint, provider and supplier executives both acknowledge that planning and prep work for capital equipment, as well as for infection control and sterility assurance issues (see sidebar), should be incorporated into the architectural planning stage — perhaps in tandem.

Covering as many bases as possible ahead of the curve will make the construction or renovation process work more smoothly, according to Michael Couch, Marketing Manager, Medical Casework, Seating & Care Exchange Products, Midmark.

“Before beginning any type of construction process, it’s essential to identify problems and potential solutions by observing current operations and talking with the people who work in the environment each day,” Couch said. “This helps all members of the committee dedicated to the design, planning and execution of the new clinical space not only realize the need, but also the reasons and rationale behind each decision. We’ve seen customers think the architect had considered corridor widths for the medical space, then realize much later in the process that they didn’t have enough room for all the equipment that would pass through or be stored in that area. These early discussions help to specifically spell out and identify needs.”

Discussions about desired equipment needed in the new space and the new space needed for desired equipment should occur together, Couch advised.

“As discussions about workflow and equipment begin, conversations should not just focus on what equipment is needed, but also what considerations are needed for each piece of equipment,” he said. “To truly consider the workflow of the exam room, it’s also essential to look at product integration and connectivity as part of the construction process. For example, is a facility wireless, or will equipment require network cables? If cables are needed, what type of cables? Where will outlets be placed to accommodate the length of power cords? It’s essential to work with suppliers and partners early in the process to help coordinate not only the design and planners, but also IT, facilities and other groups involved in bringing the design to life.”

To optimize effectiveness post-construction or renovation, healthcare organizations may want to avoid upgrading equipment without examining workflow, Couch noted.

“Many people silo capital equipment in the ambulatory space by category — exam chair, vitals monitor, computer system, casework, etc. — but that can be a short-sighted approach focusing only on the beautification or replacement of the same items that most likely will end up with the same workflow issues,” he said. “A more modern approach is diving deeper into how equipment connects in the room and how the newer innovative equipment can speak not only to a functional update, but to process improvement.”

Expanded scope

Ric Goodhue agreed that all service lines connected to a construction or renovation project be involved in the planning stages, even as ad hoc members. “No matter how large or small, if another service line is expected to provide support, then they need to be aware,” he insisted.

Michael Compton, AIA, LEED AP, EDAC, Healthcare Architect at RS&H, called for healthcare organizations to consider a technology’s life cycle and incorporate that intelligence into a building’s design.

“When the replacement is needed, the architecture must support the replacement without significant downtime in the unit in which it is placed,” Compton said. “Maintenance and minimization of disruption to the surrounding units is of equal importance to efficient installation. Another key consideration would be the infrastructure needed to support the new technology. Often, equipment installaion/upgrades require more in the way of electrical and mechanical demands, and thought must be given for future demands of expanded services.”

Take IT, for example.

“One of the often forgotten support services is Information Technology,” Goodhue noted. “Frequently, an existing space will have all the computers and associated hardware they need. However, as a result of the renovation, something as simple as moving computers from the desktop to a wall-mounted configuration requires thought — and potentially refresh of systems — that are assumed will happen as the natural course of a project. If not identified early in the planning, there may not be monies in the project, and that complicates things. Along with hardware, you have to look at low-voltage elements, including wiring for systems and the associated power. Organizations are powering up many automated systems, including communications using voice over internet (VOIP) or power over Ethernet (POE), which require a support infrastructure a lot of folks are not accustomed to having.”

Clear vision

Some organizations design their buildings “with the patient in mind,” which is admirable from a workflow standpoint but not as practical from a logistics point of view.

While healthcare organizations may consider dozens of factors, according to Bryce Stuckenshneider, Vice President, Marketing, Clarus Glassboards, “the two that seem to be most common across healthcare networks boil down to two simple questions: Will this make the patient experience better? Will it make the patient safer? These questions can encompass things like comfort, communication, infection prevention and control and ergonomics,” he said.

The flip side remains critically equivalent.

“The goal is to plan and prepare the building to accept the medical equipment,” said Christena Fournier, Technology Consultant, Mazzetti+GBA, a global provider of healthcare mechanical-electrical-plumbing engineering design and technology/information technology consulting. “This requires coordination with the architect and entire design team to identify the best location for every item. For example, if an Operating Room will have video integration, the equipment must be intricately planned with IT for proper functionality. Additionally, the medical equipment must be placed to best assist the clinician to care for patients.”

Mechanical, electrical and plumbing — or utility — requirements must specified, too, particularly as they relate to medical equipment, Fournier noted. And they have to be flexible if a piece of equipment changes or the vendor changes to avoid costly change orders for the contractor.

Understanding installation requirements ahead of time makes sense. “Advance checks for proper rough-ins can prevent problems during installation,” Fournier said. “Mapping installation pathways is also important, especially for clearance critical items like MRIs. Coordination of critical delivery pathways and schedules with the contractor can prevent costly construction delays.”

Don’t overlook the butterfly or ripple effect on operations either, warned William Stitt, CMRP, FAHRMM, CHFP, Chief, Supply Chain Management at University of Mississippi Medical Center, and Principal and Chief Operating Officer, Credibility Healthcare LLC.

“One of the things so often missed is that while the primary functional use of the space is well-determined and thought out, how all the other areas will do their part is not,” he observed. “Additionally, things like adequate power, structural load capacity, shielding requirements — when discussing imaging equipment — the available footprint to move equipment around during procedures, room turnover factors and the ability to perform maintenance, future upgrades and enhancements to the equipment is frequently not contemplated on the front end. While all the players need to be at the table — Supply Chain included — there also needs to be someone in charge who will be responsible for facilitating the requests and determining priority to come up with a reasonable space plan and budget. The ability to reuse existing equipment, be creative with technology and layout and consider workflow, which ultimately incorporates the human factor as it relates to capital, are also extremely important.”

Steve Sutton, Director, Planning and Design Group, Belimed Inc., North Charleston, SC, identified six logistical issues healthcare organizations should address, particularly as it relates to sterile processing operations.

• Can the equipment be delivered and transported to the final location without rigging or removing walls or doors?
• Does the equipment need to be delivered early to reach the space?
• How will a critical space like the OR stay operational while the sterile processing department is being renovated?
• If the department is new, what equipment will be relocated and how will it transition to the new space without interrupting services?
• Typically newer equipment has less of a demand on utilities but, this is not always the case and newer equipment could require additional utilities that are not even nearby

When adding surgical services, what support spaces will be affected? Do they have enough equipment to safely support the additional volume?

Amy Flynn, OR/CS Market Manager, Hänel Storage Systems, cautioned against overlooking one fundamental sterile processing issue.

“One key capital equipment issue is the question of how the sterile surgical trays and supplies will be stored,” Flynn noted. “Typically, this is overlooked, and the hospital uses standard racking for sterile storage, which occupies a lot of valuable floor space that could be used for additional prep and pack space, larger sterilizers, or more OR space, for example. Space allocation and workflow are keys to the success of any any hospital renovation.”