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Sisters of Mercy Health System
Planning, Design & Construction
Healthcare Construction Education
Date:
Planning, Design and Construction
14528 S. Outer Forty, Suite 200
Chesterfield, MO 63017
Tel (314) 628-3656
Fax (314) 628-3471
Form 8334 – CF490
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Presentation / Discussion Outline Introductions /
Meeting Objectives
Understanding the Healthcare Organization
Owner’s Expectations for Construction
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The Business of Health Care
Improving the Health and Well Being of People
Requires Multi-Disciplined Team
Highly Regulated
Very Competitive
Challenging to Maintain Financial Stability
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Typical Health Care Organization
P h ys ic ia n 'sG ro u ps
E m e rg e n cyIm ag ingL a bsM e d ica l S ta ffP h a rm a cyS u rg e ry
C lin ica lS e rv ices
A d m iss io nsH u m an R e so u rcesF in an ce
G e ne ra lB u s in e ss
C e n tra l S e rv icesC lin ica l E n g ine e ringD a ta /Te le com S ys te m sD ie ta ryF a c ilit ie sH o use ke e p in g /L a un d ryIn fe ctio n C on tro lR isk M a n ag e m e n t/S a fe tyS e cu rity
S u pp o rtS e rv ices
A d m in is tra tion
B o ard o fT ru s te e s/D ire c to rs
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Typical Health Care Customers
Sick People Diagnostic Tests Elderly / Frail / Behavioral patients Respiratory Problems Scared / Confused Patient Family, Friends, Visitors Low Imune Patients Hearing/Vision impaired Emergency Patients Burn Patients
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Elements / Services Needed
Safe Environment (Dust/ Mold for resipitory patients, Noise for Mandatory rest patients,
Smells for imune defiecient patients, air partiticle from burn patients and infection from cnst safe for handicap)
Restful Environment (Reduce noise, dust, vibration, smells, water leaks, Unplanned outages)
Clinical Areas of Specialty (Mri protect from vibration/Dust, Lab equipment protect from vibration
and samples from contamination, MRI from interference, Several sterile enviroments)
Infection Control (Infection control measures to protect Patients from staff and other
infections and problems while they are in the Hospital)
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Regulatory Requirements
Applies to Healthcare Facilities, including Hospitals Ambulatory Care Behavioral Health Long Term Care / Assisted Living
Includes Local, State, and Federal Requirements Notable:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ; (HIPPA)
U.S. Department of Health and Human Services (HHS) Center for Medicaid & Medicare Services (CMS)
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Regulatory Requirements
Design and Construction Related: Guidelines for Design and Construction of Hospital
and Health Care Facilities (AIA Academy of Architecture for Health)
Environment of Care Requirements (JCAHO) Centers for Disease Control & Prevention (CDC) Occupational Safety and Health Administration
(OSHA) American Society of Heating, Refrigeration and Air-
Conditioning Engineers, Inc. (ASHRAE) Local City and States review Boma
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Special Systems Used in Healthcare Delivery
Telemetry Monitoring Patients Hearts
Pneumatic Conveying Tubes meds, bloods and samples to labs for testing
Exhaust Air/Isolation units Haz exhaust, Mandatory air exchanges, Isolation rooms
Radiation X-ray equipment, Hot labs, MR Magnets, Accelerators, Digital images &
Records
Infant Abduction Paging/Antenna systems
Calling code teams, emergency announcements, Doctors Pagers
Emergency (Code/Crash, Flood, etc.) Emergency power, Trauma Elevators, Medical Gases
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Typical House Rules
Know and Understand Organization’s Mission Show Care and Concern for Patients,
Families/Visitors, and Property Ensure Patient Confidentiality Contribute to Teamwork Demonstrate Respect for Fellow Co-Workers Be Courteous and Friendly Maintain an Appropriate Appearance Respect existing facilities
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Mercy Service Standards Treat Everyone as a valued individual Seek out and address customer needs Make eye contact, greet and welcome
everyone Display a positive presence Keep customers and co-workers informed Work as a team Maintain privacy and confidentiality Keep a clean environment Live the mercy spirit
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Guaranteed Issues for Project Team Members
“You Are a Guest in Our House” Use Effective Communication – NO SURPRISES! Demonstrate Respect for Owner’s Facilities
Parking (Use designated parking areas)
Public Spaces – Cafeteria, Restrooms, etc. Behavior
Require All Members to be Accountable for Their Actions
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Hospital Operational Modes - Summary
Patient care is a driving force Patients are our customers. This is our business
Heavily regulated Our reimbursement is tied directly to our ability to serve patients and
maintain a safe environment
Risk management oriented We need to provide risk Assessments for all our activities which
is regulated by the State Performance/process improvement oriented
We must maintain a pan for improvement on facilities which is reviewed by State (Jacho)
Physicians are an integral part of the hospital
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Hospital Challenges - Summary
Aging buildings and infrastructure This is why we plan ahead carefully
Competition Patients have a choice in healthcare and we want that to be SMHS
Technology advances Decreasing re-imbursement Lots of Changing healthcare needs and desires Community may see it as their hospital, even
if there are no financial or organizational connections
Financial well being of the organization No matter what happens, patient care must go
on
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Owner’s Expectations - Construction
Risk Assessment/Management Manage Risk such as, Noise, Smells, Vibrations,
Hazardous areas, Dust, sterile areas, Disruptions
Communication/Coordination of Activities
Plan activities well in advance, Communicate to all co-workers, Manage disruptions to minimize impacts, Be transparent
Quality Assurance Follow policies and Standards, Control moisture in
facilities, wrap ductwork, air testing, Infection control measures
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Risk Assessment/Management
Environment of Care (EC) We do not evacuate in fire we retreat to safe zones. signage, train staff on exits, Maintain sprinkler/alarm systems Infection control, Risk assessment, Cnst related infections
Interim Life Safety Measures (ILSM) Temp exiting, Emergency room access, Fire protection systems,
Smoke zones, Doors latching, firewalls/Penetrations, fire watches
Infection Control Risk Assessment (ICRA) Negative pressure, daily checks, Water, dust, sealed partitions,
Tracking dirt in facility, filter changes log
Other Construction Site Risk Issues Sealed barricades, Traffic control, Temp Signage, Guass fields,
Radiation, Power disruptions, Isolation room, Access for codes, Monitoring systems, Ceiling tile dust
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Environment of Care - Definition
Provides a … Safe Accessible Effective Efficient
Environment Consistent with Organization’s … Mission Services Applicable Laws Applicable Regulations
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Life Safety Code Compliance
NFPA 101 (Provide For a Fire-Safe Environment)
Equivalency Approved by JCAHO
Statement of Conditions Includes Basic Building Information Assessment of Existing Conditions Plan for Improvement Building Maintenance Protocol
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Interim Life Safety Measures (ILSM) Used During Significant Construction
Project
Method to Offset Recognized Code Shortcomings
Contains Eleven (11) Administrative Measures
(Egress, exterior access, fire alarms, suppression, Temp Partitions, Fire extinguishers, No smoking policy, storage, fire drills, Hazardous surveillance, Hot work, Re-assessment
Requires Constant Monitoring
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Infection Control Risk Assessment (ICRA)
Initiated in Design Phase
Provides for a Safe Environment of Care
Determines Potential Risk of Transmission of Various Agents in Facility (Viruses, Bacteria, Toxins)
ICRA Conducted by Panel of Experts Including Infection Control, Risk Management, Facility Design, Construction and Ventilation Safety
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ICRA – Key Elements Addressed
Impact of Disruption to Essential Services Patient Placement or Relocation Placement of Barriers to Protect Susceptible
Patients from Airborne Contaminants Air Handling and Ventilation Needs Need for Additional Protective Environment
Rooms Domestic Water System that Limits Legionella
and Waterborne Opportunistic Pathogens
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Other Construction Site Risk Issues
Patient Privacy/Confidentiality (HIPPA)
Theft
Adjacencies to Imaging Equipment
Unidentified Hazards in Construction Area
Accidental Disruption to MEP Services Disrupt surgery, Life support, Oxygen, Contaminant gases,
cooling in burn unit, Radiation exhaust, isolation room exhaust,
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Communication/Coordination of Activities
Exchange of Construction Related Information Keep administration informed, Train/Inform staff of changes to their areas,
Security rounds needed
General Conditions Items Traffic control, clean up, Safety, infection control,
Planning for Facility Interruptions Notify departments, move critical patients, provide temp
transport, temp O2 added staff to manage patients
Project Emergency PreparednessRisk assessment, notify adjacent department if affect
their egress, fire protection systems, HVAC, Fire wall breach
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Exchange of Construction Related Information
Constructor Orientation and Education Program
Emergency Contact Information
Frequency of Progress Meetings
Meeting Note Distribution List
Process for Handling Unexpected Situations
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General Conditions Items
Security Items (Employee Access, ID’s, Secure Area, etc.)
Temporary Utilities
Procedures for Deliveries and Trash Removal
Standard Policies (Smoking, Radios, etc.)
Acceptable Support Services (Restrooms, Food, etc.)
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Planning for Facility Interruptions (Shut-Downs)
Determine Coordination Process to be Used for MEP Systems with Facility Manager
Determine Notification Process to be Used with Affected Parties
Be Proactive, Anticipate Facility Interruptions!
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Project Emergency Preparedness Plan
Fire
Weather
Internal/External Disaster
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Quality Assurance
Communication
Teamwork
Customer Service
Technical
Creativity/Value
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Owner Review of Construction Items
General Conditions, ILSM, ICRA
Pre-Installation Reviews
Users of Future Space
Regulatory Inspections
Facility Management Inspections
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Proactive Versus Reactive Issue Resolution
What Challenges Do We Face?
Are We Organized For Success?
What Options/Techniques Do We Need To Consider?