By Kyle Christiansen / Special to Healthcare Facilities Today

Healthcare facilities are expected to lead the way in almost every major facility management category. Expectations for hospital facility-care and facility management well exceed the standards of any other building type. In 2020, COVID-19 has pushed the bar even higher. Hospitals are not only managed for normal facility operation, they are also expected to exceed industry expectations in at least five categories – accessibility, sanitation, air quality, wayfinding/safety, and asset management.

Hospital facility managers not only have the challenge of setting and meeting high standards, but they also have the challenge of managing increasingly complex technology, aging facilities, and increasingly decentralized facilities. Facility managers must rely on outside consultants and centralized asset management to keep up with the demands of public, as well as scientific, and governmental expectations and regulations. 

Healthcare facilities are expected to have:

1. An increased level of accessibility

The United States Access Board notes: “The standards require a higher level of accessible parking at hospital outpatient facilities. At least 10 percent of patient and visitor parking spaces that serve such facilities must comply. This applies to those units in hospitals that provide regular or continuing medical treatment without overnight stay. Other types of medical facilities not located in hospitals, including doctors’ offices and independent clinics, are not subject to this requirement but to the regular scoping table.” 

Records show that lawsuits related to the Americans with Disabilities Act (ADA) are on the rise for healthcare facilities. Enhanced accessibility is expected in both public spaces and patient spaces. Hospitals are the quintessential public space. Parking, pedestrian walkways, signage, door operation, lobby space, reception areas, elevators, restrooms, patient rooms, staff spaces, corridors, and signage must all meet accessibility standards at their highest level. As our population ages, accessibility expectations and needs are continually increasing. 

2. An increased level of facility sanitation

“High-touch surfaces are inanimate objects or surfaces in patient care areas that are handled frequently by various users, causing them to become more contaminated. The Healthcare Infection Control Practices Advisory Committee and the Centers for Disease Control and Prevention recommend disinfecting high-touch surfaces more frequently than other surfaces.”  

3. An increased level of air quality

With COVID-19, hospital and nursing care environments have been under increased scrutiny for cleanliness. Requirements for cleanliness and safety in healthcare environments extend to operations, equipment, and furnishings to avoid spreading infection. 

An article on the Consulting-Specifying Engineer website states, “Because hospitals are filled with patients who have a variety of ailments, there is a much higher likelihood that some of these patients can release infectious contaminants that can impact indoor air quality. Most scientists agreed that the cloud of infectious pollutants in a cough could travel 200 feet, but the new study found that ’droplets 100 micrometers in diameter can travel five times farther than previously estimated, that droplets 10 micrometers in diameter can travel 200 times farther, and that droplets less than 50 micrometers in size can remain airborne long enough to reach ceiling ventilation units’.”

Prior to COVID-19, air quality in hospitals was subject to increased regulation and scrutiny. Meeting all air quality goals is a challenge for facilities that provide service continuously seven days a week. New regulations require specialized controls on ventilation systems to maximize patient comfort and healing. These new regulations impact humidity control, air filtration control, lighting controls, and ambient temperature controls.

4. An increased focus on safety through wayfinding

Operational quality is enhanced by effective wayfinding and is discussed in a 2010 article: Effective wayfinding improves hospital quality and outcomes, Shoemaker et al. The article notes the following benefits of effective wayfinding in hospitals:

• Reduces staff stress and fatigue,
• Increases effectiveness in care delivery,
• Improves patient safety,
• Reduces patient and family stress while improving patient outcomes,
• Improves overall healthcare quality,
• Improves overall hospital operating performance.

Hospitals have grown into complex mazes of corridors and departments. If these complex facilities are not managed well, the result can be an increase in patient and visitor stress. Directional wayfinding is a critical enhancement for hospitals for multiple reasons including life safety, security, and operational quality.  

Life safety requirements for effective wayfinding are set forth by the 2012 edition of the National Fire Protection Association and Life Safety Codes. The Center for Medicare and Medicaid Services partners with state agencies to assess facilities and to reinforce compliance with the life safety code requirements. Security requirements are enforced by various influencers, including OSHA privacy standards. 

 5. An increased focus on centralized asset management

“Facility managers need a system-wide operational realignment and panoramic view in order to implement any positive changes in a cost-effective manner. Of course, this is easier said than done: realigning all plans and combining them with other facilities can present logistical and occasionally human conflicts as facility managers or decision makers need to give up some facets of their system structures in order to achieve operational excellence throughout all the linked facilities.” 

In recent years, healthcare systems have been driven to mergers and acquisitions that expand the number of locations and assets that a facility manager must manage. Large hospitals are often being replaced by ambulatory surgery centers, free-standing emergency clinics, and micro-hospitals in local communities. Thus, healthcare systems are now managing a portfolio of facilities as well as the system assets within each facility. 

All facility managers are expected to understand corporate mission and strategy to align organizational mission and strategy with operational budgets and maintenance.  In the 21st century, standards of excellence, efficiency, and energy compliance are common in all facility types. This is already a high bar. Streamlined planning, forecasting and prioritization of capital allocation can help a facility manager determine: 

1.  Current state of assets

• What do I own?
• Where is it?
• What condition is it in? What is its performance?
• What is its remaining useful life?
• What is its remaining economic value?

2. Required level of service (LOS)

• What is the demand for my services by my stakeholders?
• What do regulators require?
• What is my actual performance?

3.  Assets critical for to sustained performance

• How can it fail?
• What is the likelihood of failure?
• What does it cost to repair?
• What are the consequences of failure?

4. Best Operating and Maintenance (O&M) and Capital Improvement Plan (CIP) investment strategies

• What alternative management options exist?
• Which are the most feasible for the organization?

5. Long-term funding strategy

Give your hospital a physical

Prioritizing maintenance and management of facilities requires a robust asset management inventory and strategic plan. Facility Condition Assessments (FCAs) for healthcare facilities and networks can help bring facility managers and corporate leaders together to streamline planning and enhance forecasting, enabling prioritization of capital allocation to meet the challenges of 21st century facility management. Giving your facility a physical can help a facility manager and asset manager improve maintenance, management, and operations of a healthcare facility. Giving your facility a physical examination is the first step towards building an asset inventory and creating a centralized database for management and budgeting of healthcare operations.

 Kyle Christiansen, R.A., is a senior facilities consultant in Terracon’s D.C. Metro North office.