By Robert LoForte / Special to Healthcare Facilities Today

In an industry that was once dominated by labor unions, contractors are now increasingly incorporating open-shop labor to meet tight deadlines and cost limitations of healthcare construction projects. From smaller projects to large hospital campuses and complex healthcare facilities, open shop labor is working side-by-side with technical experts from labor unions – and this is proving to be challenging.

 Additional access to labor, in theory, can help speed up project timelines and give contractors more resources to work with, yet this diverse talent pool often lacks consistency in skill level compared to unionized workers that have an in-depth understanding and expertise working with MEP systems. The result is often a contractor having to spend additional time checking quality of work, managing teams and confirming the commissioning or retro-commissioning work done throughout the facility is of high quality.

Varying skill levels, evolving technologies for complex MEP systems and changing regulations are difficult not just for the labor force to keep up with, but also for the property owner and project manager who have to drive these efforts. Instead of trying to manage each piece of the puzzle, there are new opportunities to outsource as commissioning and project management providers evolve to take on a more ‘hands on’ role so that facilities meet all requirements.

Supporting systems that keep patients safe

Boilers, chillers and HVAC systems in healthcare facilities require increased attention to detail compared to hotels, commercial properties and others due to the critical nature and fragile health state of the individuals occupying it. Choosing an outdated, inefficient piece of equipment or system solution could lead life safety issue– rather than having a reliable hospital operation for patient comfort and safety. Regardless of skill level or labor union status, consistency is important.

Today, hospitals must maintain certain conditions to not only keep patients comfortable, but also safe. For example, maintaining a cool, dry and well-ventilated operating room is a must to ensure contagious infections, such as superbugs, are not spread to other areas of the facility. Union and non-union workers need to ensure systems are implemented and cohesive from the start, as issues with any HVAC water or other MEP system could create an environment conducive to bacterial growth which, in turn, threatens patient safety.

Commissioning metrics and analytics are the standard by which future success of these systems is determined, and how the staff will identify, prioritize and address each of these issues – meaning open-shop and union labor both need to get them right the first time. This baseline can ultimately help lower maintenance and energy costs, increase equipment lifespan and ensure all MEP systems are operating in unison at peak efficiency.

Incorporating new technologies that can help support ongoing commissioning efforts is the best defense for MEP system optimization. The entire commissioning team needs to know what solutions are available and how to best integrate them to support continuous upkeep and maintenance for systems and equipment – not just once a year or when an issue occurs. Having a team that can identify fault detection analytics and monitoring based commissioning (MBCx) solutions that will be the most effective based on a facility’s size, regulation requirements, and patient demands, helps to not only save on costs and energy, but can also ensure prioritization of issues that may impact patient health and comfort.

Understanding and embracing changing regulations

Hospitals and healthcare facilities must abide by numerous regulations set forth by the individual state, as well as larger agencies. It’s the responsibility of the contactor to ensure their workforce is upholding these requirements. Regulations range from patient-centric initiatives driven by regulatory bodies such as the CDC, to local environmental restrictions that focus on the energy and sustainability efforts of a building.

New local laws and legislation is introduced regularly, and failure to abide by these restrictions could result in paying thousands in fines. For example, in New York City, thanks to a new regulation known as Local Law 97 (LL97) which caps carbon emission limits, a 600,000 square foot hospital that goes 15% over its limit could end up paying over $574,000 a year in fines. Similar regulations have also been introduced in Boston and California and are expected to expand nation-wide.

On the federal level, the CDC began recommending continuous monitoring of ventilation systems, observing air change rates and pressure fluctuations. The U.S. Centers for Medicare & Medicaid Services also began enforcing a federal requirement over the last couple of years with which monitoring of water management systems was necessary to reduce the risk of contagious bacterial such as legionella.

These regulations change frequently, with new legislation being introduced across various markets annually. Open-shop labor may not be as familiar with the changing requirements and therefore struggles to pick technologies and implement MEP solutions that meet current and future building demands.

Driving project management with a quarterback

Whether it’s open-shop or union labor, owners need to have a team-lead or a quarterback that can close out these projects and get all systems working together in order for a healthcare facility to be up and running.   

Bringing in commissioning engineers that not only know how systems work, but also understand how to maximize their potential and the steps needed to get there. Step-by-step-guidance at this level not only takes work off of the contractor’s shoulders, but it helps to create a much more consistent end result, regardless of the team’s skill level. Each individual team member, union-labor or open-shop, would receive an in-depth understanding of what is needed to bring systems online.

The commissioning role is changing, from an authority to a liaison, providing a consultancy that can make the most challenging portion of the building and commissioning process much simpler and hands-off for the contractor. For open-shop projects, having a consultant on hand minimizes the risk associated with pursuing other cost savings avenues.

The open-shop model is one that can continue to benefit the healthcare construction industry navigate regulatory and technology-driven hurdles, saving on costs, energy and preserving the patient experience. Bringing on a commissioning liaison and not just an authority makes the process easier and more effective from the start, ensuring the right solutions are picked the first time and your systems are fully operational.

Robert LoForte is the President of Veritas Solutions Group.