By Dan Hounsell

Healthcare facilities have long presented complex challenges for managers responsible for their operations and maintenance, and the last two-plus years have only made these challenges more complex. Facilities managers responsible for compliance face expanded regulations and standards, and must ensure compliance using systems and resources upended by the pandemic. 

Where does healthcare facilities compliance stand now? To bring managers up to speed on new and existing compliance issues and to offer strategies for ensuring facilities’ compliance, Healthcare Facilities Today asked two firms with experience in healthcare facilities management to offer their insights. The participants: 

- Douglas King, National Healthcare Sector Lead, Project Management Advisors 

- Medxcel — Kathy Neal, Director of CMMS and Data Ops, and Ryan Indorf, Life Safety Code Specialist  

What are the biggest challenges healthcare facilities managers face in ensuring the compliance of their facilities and operations?  

King: Many healthcare facilities are challenged with a lack of knowledgeable staff with prior healthcare experience. The pandemic caused many former healthcare facilities workers to reevaluate their lives and careers, mirroring the changes that happened in the healthcare provider space and on a greater societal level. Finding experienced and available healthcare facilities professionals has become a roadblock in executing projects. On the financial side, healthcare systems are spending more for traveling nurses and other providers, which reduces their budgets for everything else, including facilities management staff and ongoing maintenance. 

Less-experienced facilities workers are being put into an environment where regulations are rapidly changing, hardware and other materials are in short order due to supply chain issues, and audits are falling behind due to lack of staff. It’s creating a significant challenge in terms of compliance and actually completing projects as all these issues come to a head simultaneously. 

Medxcel: A couple of areas come to mind, especially in the past years. From a building standpoint, aging infrastructures at current facilities and then at both current facilities and new construction: It is the delays with supply chain — building materials, replacement parts, etc. There is also the labor shortage that everyone is experiencing, and facility leaders might be forced to reduce their FTEs with roles dedicated to compliance. This not only adds strain on daily operations but also makes it especially difficult to maintain a strong compliance posture. For all these reasons, it is critical to have strong compliance programs and processes in place with buy-in and champions from executive leadership and C-suite. Additionally, it can be extremely beneficial to have periodic internal and especially external compliance reviews, surveys and inspections. Working in the same building every day causes us to become numb to our surroundings over time. A second look from an external source can shed light on issues we might have become blind to. 

What compliance issues should be top of mind for healthcare facilities managers today? 

Medxcel: Infection control is a large part of what we look at. It can be anything from ensuring that the proper pressure relationships are in place for a space, that temperatures and humidity meet the standards required and to leaks that cause ceiling tile discoloration, rust or chipped counter tops. All this plays into infection control. Worker Safety is always on top of everyone’s mind, including the requirements that fall under OSHA, including PPE and training. 

Construction safety is important, with the focus being on ensuring that the environment, the workers, patients, staff and visitors are kept safe through the pre-construction risk assessment. Facility leaders put significant effort into developing and reviewing management plans, policies, and procedures regarding construction or the pre-construction risk assessment. Construction projects often call for multi-disciplinary teams across the healthcare spectrum to discuss, assess and mitigate risk. Facilities typically put significant time and effort into completing assessments and developing a risk mitigation plan in compliance with their own policies. However, too often these risk mitigation measures are not strictly enforced or not well documented and can be easily overlooked when daily operations are low on manpower. Many times, mitigation efforts are not taken credit for. Managers will communicate the details of a construction project to a group of department leaders but might not have established a way to document it. In addition, having infection control be a key part of our construction and renovation process through the infection control permit so everyone understands the impact of the project on the patients in the area or that might be impacted by a part of the construction process, including noise, dust and vibration. 

King: Healthcare facilities have ramped up their infection control efforts in the aftermath of COVID-19, yet they are under more scrutiny than ever as the entire population has become an expert in disease transmission. Hospitals are motivated to demonstrate they maintain a safe environment for visitors and patients. So much effort is invested in this endeavor. Visitors, patients, staff and providers are all hypervigilant about this subject, creating a kind of sanitation theater that is not unlike the security measures in airports that were put in place after 9/11—highly visible, yet not always effective. 

While more attention to infection control is essential to maintaining the health of building occupants, renewed public focus might cause healthcare systems to similarly prioritize visible efforts, like frequent cleaning and wiping of surfaces, over those efforts that are both effective and compliant, like improving air circulation. While assuaging the concerns of the broader population is important, healthcare facilities managers also need to be mindful of the compliance-mandated changes that perhaps aren’t as visible. 

Editor’s note: This is part one of a two-part series on healthcare facilities compliance. 

Dan Hounsell is senior editor for the facilities market. He has more than 25 years of experience covering engineering, maintenance, and grounds management issues in institutional and commercial facilities.