By Dan Hounsell

Editor’s note: This is the second part of a two-part series. To read part one, please click here. 

Many of the issues involved in healthcare facilities compliance have been around for decades, but nothing is as permanent as change, and healthcare facilities are no exception. Facilities managers involved in compliance face both traditional issues and a range of new and expanded regulations and standards that apply to facilities and operations. 

Where lies ahead for healthcare facilities compliance? To give managers insights into emerging issues and their likely impact on facilities and operations, Healthcare Facilities Today asked two firms with experience in healthcare facilities management to offer their observations.

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 

HFT: What recent key developments in healthcare regulations and standards do facilities managers need to be aware of? 

King: I was part of the team drafting the new U.S. healthcare standards addressing emergency response for the FGI Guidelines, which gives hospitals more direction on meeting rapidly growing patient populations. This document is a guideline in 2022 but will become the code in 2025, affecting all but a handful of states. The update focuses on adapting buildings to meet widespread healthcare challenges, like a pandemic or natural disaster that could cause a patient surge. 

During COVID-19, there was a focus on alternative care facilities to treat patient surges, but healthcare systems are now focused on meeting surge capacity within the healthcare environment. This means creating flexibility to convert patient rooms to intensive care units, and patient holding areas to be de facto patient rooms during a surge — all predicated on the facility having a flexible HVAC system. 

While the initial response to COVID-19 cases was to flatten the curve, the new guidelines emphasize the longer-term care that might be needed for pandemics or other emergency scenarios. If the issue is still a threat after 180 days, the facilities treating patients need to be compliant to all standards. So it makes sense to keep hospitals and other healthcare settings flexible to adapt to changing needs. The guidelines also address the reality that hospitals are reimbursed for the patients they treat. If people are receiving treatment offsite, the hospital is losing revenue. 

We’re also going to see a shifting priority in code enforcement. Regulators used to notice the little things like holes in the wall, but if they’re trying to help hospitals adapt to widespread disease and pandemics, those checklist items are likely to fly under the radar in favor of more robust enforcement of air change rates and other control measures. 

Medxcel: July’s update from The Joint Commission includes updates to fire drills and the importance of fire drills in our ORs, as well as MRIs, as these require specific training. The update also included a focus on the environment an emergency generator is in. With changing weather patterns and the lessons learned from past hurricanes, blizzards, ice storms, etc. the importance of having emergency power is a focus. Another key factor for our teams is knowing who your resources are. We have specialized teams for life safety assessments, life safety drawings, compliance support, and mock surveys. 

HFT: What emerging compliance issues or trends should managers be aware of?   

Medxcel: The focus on water management – how it is a team approach from leadership of the facility, infection control, environmental services, supply chain, facilities, construction and renovation. How important it is for our facility leaders to understand the operation of their building systems and equipment and where they are at risk – dead legs, new buildings or areas that have been closed where water has been sitting, new equipment like water heaters, cooling towers, etc. Once they understand that, they can better know how to mitigate those areas of risk. One of the keys to success today is communication because we really are all in this together. 

King: One of the shifts made in the early days of the Covid pandemic was to have authorities having jurisdiction (AHJ) utilize a virtual inspection process, which has stuck around even as COVID-19 subsides because AHJs are as short-staffed as any entity in the healthcare space. Much of the responsibility for diligent compliance inspection is falling on facilities. Self-monitoring is an additional responsibility for managers who are already struggling to find experienced people, so compliance with regulatory requirements must be a central focus. Managers need to ensure their people are up to the task of meeting the requirements that are in place, especially as the trend of outsourcing facilities management to large real estate conglomerates ramps up. 

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.