us army health facilities assessmentsenergytoolbox.org/library/infra2010/presentations/...disaster...
TRANSCRIPT
US Army Health Facilities
Assessments
Colonel Guy Kiyokawa
Asst. Chief of Staff, Facilities / Director, Facilities
HQ, US Army Medical Command / Office of the Surgeon General
UNCLASSIFIED
December 2010
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected] 2
PRESENTATION OUTLINE
PURPOSE: To provide an overview of US Army health facility assessment
processes and application to military assistance in foreign countries.
• US Army Medical Command (MEDCOM)
• Facility Life Cycle Management
• Deployable Health Facilities Expertise
• Decision Making Process
• Developing Facility Solutions Supporting a Health Care System
• Case Studies
• Ivory Coast
• US Army Kwajalein Atoll, Republic of the Marshall Islands
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected] 3 of 36
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected] 4
Planning
Owner’s Rep for DesignOwner’s Rep for
Construction
Sustainment
Programming
Medical Facilities Life Cycle Management
Commissioning
31 years
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
SMRC- HS
Mission
Provide deployable health
facilities expertise worldwide to
support the AMEDD’s healthcare
mission
• Assessments and assistance
– Engineering, architectural, equipment &
healthcare infrastructure consulting
– Design, construction, & management
oversight
– Infrastructure development in maturing
theatre
– Support to reestablish civilian medical
infrastructure
– Liaison with engineer units and staffs
• Multi-disciplinary solutions/teams
– Architects
– Engineers
– Nurses
– Biomedical Equipment Specialist
– Environmental Science Officers
– Facility Managers
– Logisticians
Readiness:
First Team: configured to support
and ready to deploy (C-1).
Second Team: Sourcing (personnel)
required from MSCs/RMCs (C-3).
Special Medical Response Contingent - Health Systems
Slide 5
Nation Building
Disaster Relief
Humanitarian Assistance
Peacekeeping/Mil Spt.
Peace Enforcement
Low Intensity Conflict
War
US Army Health Facility Planning Agency
Operational Support to Army / DoD Missions
GeorgiaGeorgia19921992
CroatiaCroatia19941994Virgin IslandsVirgin Islands19951995
FloridaFlorida19941994
HaitiHaiti19941994
KuwaitKuwait 19951995
19951995
EritreaEritrea 19961996
KazakhstanKazakhstan 19951995
EgyptEgypt 19971997
CambodiaCambodia19971997
HondurasHonduras19981998
El SalvadorEl Salvador19981998
NicaraguaNicaragua19981998
ParaguayParaguay19981998
BosniaBosnia19981998
LebanonLebanon19981998
Guinea-BissauGuinea-Bissau19981998
Ivory CoastIvory Coast19981998
RussiaRussia19991999
QatarQatar 19991999
MacedoniaMacedonia1999199920002000
KosovoKosovo199919992000200020012001
KenyaKenya 20002000
20012001
NepalNepal20012001
JapanJapan20002000
TrinidadTrinidad20002000
KwajaleinKwajalein20002000
Dover AFBDover AFB20012001
20002000
North CarolinaNorth Carolina19961996
19921992
20022002
UzbekistanUzbekistan 20022002
War
Nation Building
Peace Enforcement
Peacekeeping
Humanitarian Assistance
Disaster Relief
Low Intensity Conflict
IraqIraq 20032003
AfghanistanAfghanistan 20032003
20042004
20042004
20042004
20042004
20042004
20042004 2005200520032003 20062006
20052005 20062006
20052005 20062006
GeorgiaGeorgia19921992
CroatiaCroatia19941994Virgin IslandsVirgin Islands19951995
FloridaFlorida19941994
HaitiHaiti19941994
KuwaitKuwait 19951995
19951995
EritreaEritrea 19961996
KazakhstanKazakhstan 19951995
EgyptEgypt 19971997
CambodiaCambodia19971997
HondurasHonduras19981998
El SalvadorEl Salvador19981998
NicaraguaNicaragua19981998
ParaguayParaguay19981998
BosniaBosnia19981998
LebanonLebanon19981998
Guinea-BissauGuinea-Bissau19981998
Ivory CoastIvory Coast19981998
RussiaRussia19991999
QatarQatar 19991999
MacedoniaMacedonia1999199920002000
KosovoKosovo199919992000200020012001
KenyaKenya 20002000
20012001
NepalNepal20012001
JapanJapan20002000
TrinidadTrinidad20002000
KwajaleinKwajalein20002000
Dover AFBDover AFB20012001
20002000
North CarolinaNorth Carolina19961996
19921992
20022002
UzbekistanUzbekistan 20022002
War
Nation Building
Peace Enforcement
Peacekeeping
Humanitarian Assistance
Disaster Relief
Low Intensity Conflict
War
Nation Building
Peace Enforcement
Peacekeeping
Humanitarian Assistance
Disaster Relief
Low Intensity Conflict
IraqIraq 20032003
AfghanistanAfghanistan 20032003
20042004
20042004
20042004
20042004
20042004
20042004 2005200520032003 20062006
20052005 20062006
20052005 20062006
Slide 6
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected] 7
Facility Project
Scope and Cost
Data Collection
Mission
Market Assessment
Business Plan
Population (RAPS)
Workload (MEPRS/CHCS)
Staffing (TDA)
Capital Investment
Proposal (CIP)
Prioritization/
Submission
Constraints & Opportunities
Existing Program Capacities
Photographs
Site and Accessibility Info
Infrastructure Assessment
Architectural
Engineering Systems
Equipment
AT/FP
Facilities
Data
Space Utilization
Capacity Analysis
Architectural CADD Drawings
Site Drawings
List of Current Projects
Historical Background
Cost Option Studies
Provider Requirements
Volume Thresholds
Optimization
Functional Alignment
Planning
Scenarios
Enrollment (MCFAS)
Utilization (M2)
Capacity Analysis
Space Program
Functional Options
Health Care
Requirements Analysis
Site/Facility/
Capacity Analysis
Mission
Business Plan
Bio-Safety Levels
Research Population
Animal Population
Research Focus
Equipment-driven Space
Researcher Requirements
Phasing
Optimization
Functional Alignment
Animal Models
Utilization
Throughputs
Protocol Durations
Capacity Analysis
Space Program
Functional Options
Research
Market Analysis
Space
Requirements
Forecast
Site
Assessment
Demand
Analysis
Planning
Scenarios
Army Medical Construction Planning Process
*See back-up slides for Health Care
Requirements Analysis process
resulting in staffing leading to space
leading to cost.
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Decision Making Process
• Define the problem
• Gather the facts and state assumptions
– Physical plant assessment, understanding the health care
system, health care requirements analysis
• Develop evaluation criteria necessary to solve the problem
• Develop various courses of action (status quo is always a
course of action)
• Eliminate courses of action due to inability to execute
• Weight criteria for evaluating courses of action
• Decision matrix analyzing various courses of action. Each
course of action must address every criteria.
• Make recommendation based on the analysis
Slide 8
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Facility Solutions Supporting a Health Care System
• Political situation affecting ability to provide health care
• Health care system
– Is it affiliated with a larger facility or University? Is it a NGO or PVO organization?
– Who funds the facility? Payment system?
• Scope of Services
– What type of medical services are provided by this organization? Primary care, sub-
specialty care, OR, ICU, med-surg wards, CMS, procedures
– Ancillary: lab, radiology, pharmacy, immunizations, blood products
– Administrative: logistics/ supply, patient administration/ processing, medical records,
nutrition care, information management, security, safety, quality assurance, bio-
medical equipment maintenance / management, environmental services
– Other: Patient education, preventive medicine services, emergency services. public
health services, dental
• Health care organization staffing
– Number, Type of, and minimal educational level:
– Are there required levels of formal training for each profession?
– Is continuing education conducted/required for each profession?
– How involved are family members in the care of patients?
Slide 9
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Facility Solutions Supporting a Health Care System -
Physical Plant Assessment
• Structural / Architectural: exterior envelope (roof, walls, foundation, etc),
structural integrity
• Electrical: demand versus source and reliability of supply, back-up systems,
critical systems
• Medical gases: Source and distribution
• HVAC: Heating, Ventilation, Air Conditioning including positive and negative
pressure requirements
• Plumbing: water supply, sewer, steam / hot water, sterilization
• Life Safety: Fire safety, egress requirements
• Interior finishes
• Communications / network
• Accessibility: exterior and interior of building, access to the site (mode of
transportation and limitations), emergency vehicles
• Building maintenance program
• Waste disposal: hazardous materials, regulated medical waste
Slide 10
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Facility Solutions Supporting a Health Care System –
Health Care Requirements Analysis
• Population served including demographics
• Current utilization of services, i.e. outpatient visits per person per
month/year by demographic by service
• Current workload by provider / full time equivalent
• Provider available time in clinic
• Surgeon procedures by type
• Number of procedures and utilization of ORs
• Inpatient by type of ward: Average length of stay, admission rate,
occupancy rates, acuity measures driving staffing, nursing staff levels
• Staff interviews to validate analysis and understand clinic concept of
operations.
Slide 11
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Level I: Basic care
Ivory Coast – Bahoulifia Maternity Clinic
• Response to Europe Command (EUCOM) HAP Mission. Provide objective,
practical health facility assessments (Maternity Clinic one of several facilities
assessed in different locations). Determine deficiencies and prioritize. Direct
use of committed HAP Funds.
Slide 12
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Ivory Coast – Bahoulifia Maternity Clinic
• Background:
– Provides OB/GYN services to the local population.
– The clinic is staffed by a nurse and a midwife.
– Average 40 deliveries per month
• Assessment:
– A small highly productive rural clinic
– The clinic is a single story building approximately 1,000 square feet
– Lacks water (dry well), State of disrepair, Insufficient Light
– Recent (locked) latrines constructed by Peace Corps Volunteers
• Recommendations ($25k):
– Dig a well in the vicinity of the clinic. The new well should include a hand pump and a
5 cubic meter holding tank.
– Replace the roof, Repair the ceiling.
– Install fluorescent lighting fixtures and bulbs throughout facility.
– Paint interior walls of maternity clinic.
– Install shelves.
Slide 13
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Level II+ Hospital
US Army Kwajalein Atoll, Republic of the Marshall
Islands
• Mission: Analyze health requirements on Kwajalein Atoll; Develop
staffing and space needs based on health requirements; Develop and
compare facility alternatives; Recommend changes to the medical/dental
component of the GOCO Performance Work Statement; Briefly examine
the health system and status of a hospital construction project on the
neighboring island of Ebeye.
• Problem: Current facilities deteriorating. Unclear scope of clinical
services and subsequent facility to support that scope.
• Facts and Assumptions: Enduring military mission. Reliance on
local population and contractors.
– Population served, demographics, and corresponding health care demand
– Defined scope of services and staffing requirements to meet demand
– Using DoD space planning criteria developed a Program For Design defining
space based on workload demand and staffing
Slide 14
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
US Army Kwajalein Atoll
Republic of the Marshall Islands
• Evaluation criteria: Cost, Clinical operations impact, NFPA life safety code
compliance, Building infrastructure improvement,
• Courses of Action: Total replacement, Complete renovation, Partial
addition / alteration, Status quo / short-term fixes
• Recommendation: Course of Action 2, “Total Renovation.” Based on the decision matrix
analysis, a complete renovation of the existing facility would best meet the needs of improving
clinical operations, meeting National Fire Protection Agency (NFPA) life safety codes, and
improving the building infrastructure while minimizing the overall project cost.
Slide 15
CRITERIA COST $M Clinical Ops Life Safety Building Infrastructure TOTAL
COA / Weight 2 1 1 1
1: Total Replacement $33M
2: Complete
Renovation
$6.5M; Score=2; Wt
Score=43.5 3 3 13.5
3: Partial Addition /
Alteration
$0.70M; Score=3.5; Wt
Score = 72 2 1.5 12.5
4: Status Quo /
Immediate fixes
$0.30M; Score=3.5; Wt
Score=71 2 1.5 11.5
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected] 16
QUESTIONS?
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Back-up Slides
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
The Process for Space Planning
Space
Requirements
Problem ID Demand
Analysis
Scenarios:Staffing
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Planning Process
1. What’s the problem versus the symptom?
– Not enough space in the waiting room
– Not enough exam rooms
2. Data collection and Demand Analysis
– Distribution of demand (unique characteristics of clinic)
• Sick call TMC
– Distribution of the supply (provider staffing and template mgt)
• Permanent providers and support staff
– Roadblocks to increased productivity
• Maximize provider time
– Support staff
– Two exam rooms per provider
• Ancillary support: Lab, Xray, Pharmacy
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Planning Process (cont’d)
3. Planning Scenarios
• Targeting increased enrollment
• Driving demand through appointing
• Number of providers in clinic based on above demand
• Number of support staff in clinic based on above demand
4. Space Requirements
– Based on staffing, use space planning criteria to generate
space requirement
– Prioritize space requirements
– Compare to existing space
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Planning Process
1. What’s the problem versus the symptom?
– Lack of available appts
2. Data collection and Demand Analysis
– Distribution of demand
Avail Wks/Yr * Days/Wk
Avail
Hrs/Day Clinic Hrs/Yr
Aver
Visits/Hr
Provider
Visits/Yr (b)
Family Medicine (A) 44 X 5.0 X 7.0 = 1,540 x 2.9 = 4,404
Family Medicine (B) 44 X 5.0 X 6.0 = 1,320 X 2.9 = 3,775
Avg Visits per
year (c )
(c ) / ( b) =
provider FTE
required
Acutal
provider
FTE
Family Medicine (A) 35,443 8.0 8.0
Family Medicine (B) 35,443 9.4 8.0
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Distribution of Supply
Weeks/ Yr Hrs / Yr
Annual Compensated Time 52 2080
Time away from Work Center
Annual Leave 4 160
Sick Leave 2 80
Civilian Holidays 2 80
Professional / Cont. Ed. 1 40
Military Tng. / Ed. 1 40
Training Holidays 0.8 32
Available Time in Work Center 41.2 1,648
Less Admin. / Conference 206
Available Time for Direct Patient Care 1,442
Avail Clinic Average Provider
Admin Clinic Clinic Procedures Wks / Yr Hrs / Yr Visits / Hr Visits / Yr
Primary Care 1.0 7.0 5.0 0.0 41.2 1,442 3.0 4,326
Avail Hrs / Day Days / Week
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Avail Wks/Yr * Days/Wk
Avail
Hrs/Day Clinic Hrs/Yr
Aver
Visits/Hr
Provider
Visits/Yr (b)
Family Medicine (A) 44 X 5.0 X 7.0 = 1,540 x 2.9 = 4,404
Family Medicine (B) 44 X 5.0 X 6.0 = 1,320 X 2.9 = 3,775
Avg Visits per
year (c )
(c ) / ( b) =
provider FTE
required
Acutal
provider
FTE
Family Medicine (A) 35,443 8.0 8.0
Family Medicine (B) 35,443 9.4 8.0
3. Planning Scenarios• Targeting increased enrollment
• Driving demand through appointing
• Number of providers in clinic based on above demand
• Number of support staff in clinic based on above demand
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Planning Process (cont’d)
4. Space Requirements
– Based on staffing, use space planning criteria to generate
space requirement
– Prioritize space requirements
– Compare to existing space
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Requirement
Family Practice & Wellness
Room Description Staff Clinic Clinic w /SDS/MB
Qty. NSF Total
Direct Care Space
Exam Rooms 42 100 4200
Isolation Room 2 100 200
Isolation Toilet 2 60 120
Procedure Rooms 4 150 600
Colposcopy Room 150 0
Flex Sig Room 150 0
Toilet 60 0
TPR w eights and measures 2 200 400
Vascetomy Room 150 0
ENT Exam Area 0 100 0
Behavioral Science 0 100 0
Immunization Room 1 200 200
Holding Area 1 200 200
Patient Toilet 4 60 240Patient Resource Center 1 140 140
Sub-Total - Net Square Feet 15,188
Department Circulation 30% 4,556
Net-to-Gross 10% 1,974
TOTAL DEPT GROSS SQUARE FT 21,719
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Space Requirements
• Required Space
– DoD Space Planning Criteria (space allocation)
– Guideplates (layout)
• Patient Flow
• Room Adjacencies
• Factors to Consider
• Prioritize Requirements
• Overlay over existing layout
Medical Facilities Life Cycle Management
UNCLASSIFIEDCOL Guy Kiyokawa / MCFA /(703) 681-8221(DSN761) / [email protected]
Cost
• Gross Square Feet x costing factors
• DoD uses specific factors based on type of building,
location, size, etc.
• Incorporate Info Mgt, Force Protection, built-in medical
equipment, oversight / management
• Initial Outfitting with medical equipment and transition from
existing operations