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Capital Projects with Serious Implications Knowledgeable Contractors a Must in Health Care Settings
May, 2007
By Gordon D. Burrill
Some time ago, health care facility managers recognized the need for construction personnel to have a heightened awareness of the health care environment. Nowhere is this more evident than in those publicized situations where construction work has caused or been a contributing factor in patient deaths, or adverse reactions with the patients in hospitals.
Notably, in January 2001, construction in the nursing unit of one Ontario facility required the shutdown of the hospital's oxygen system. The shut down was scheduled, all of the known contingencies were put in place and the work began, but, as soon as the pipes were cut, caregivers realized that a patient outside of the construction area had also been affected. The patient's oxygen supply was severed by the construction work, and the unfortunate turn of events ended in the untimely death of this patient.
Health care engineers and infection prevention and control professions have also come to realize in the last decade that construction dust may have been directly or indirectly responsible for approximately 400 to 600 deaths in Canadian hospitals each year. A study released by Health Canada in 2001 highlights these challenges in the health care facility construction environment.
Health care facilities engineering and maintenance departments continually work with construction personnel to limit the impact of construction related activities in patient occupied environments, but there are always new developments that make it difficult to keep all of the players updated. The Canadian Healthcare Engineering Society (CHES) and the American Society for Healthcare Engineering (ASHE) are now partnering to offer a recognized program, initially developed for contractors in the United States, to the Canadian construction community.
Although the ASHE two-day training program was designed for working in the US system, the technical aspects of working in a health care environment are similar no matter where in the world the health care building may be located. Through the CHES-ASHE partnership, the course has been adapted to meet Canadian health care system needs and requirements.
The Healthcare Construction Certificate (HCC) program provides the attendees with the most recent knowledge concerning construction's impact on the health care environment. Participants learn about the management structure of health care systems and the interrelationships between the various departments. They also learn about the codes and standards that affect and regulate the health care environment, and how construction impacts the occupants of the facility. With a requirement for renewal on a biannual basis, the HCC ensures that the individuals remain current in the dynamic world of health care construction.
PROVEN PERFORMANCE
Some health care facility managers are now musing about whether they should make the HCC a requirement to bid on projects within Canadian health care facilities. This is something that many healthcare counterparts in the US have already implemented.
Bill Payne, Director of Facilities, Engineering and Safety at the Alamance Regional Medical Center in Burlington, North Carolina, recently had a scenario to test the HCC program's effectiveness when he managed two significant construction programs occurring almost simultaneously - a new Neonatal Intensive Care Unit (NICU) and a project in the Physical Therapy Outpatients Department.
Given the critical nature of the NICU project, and that the project had difficult logistical issues such as transporting debris through sensitive patient care areas, he short listed three contractors and conducted interviews to determine their level of knowledge of the life safety issues, the patient care environment, and the challenges of preventing the spread of fungal and bacterial contaminated particulate generated by the construction activities. The interview process revealed that the construction company demonstrating the best knowledge in Payne's area of concern had key people who had attended the HCC program among other learning opportunities. Meanwhile, for the Physical Therapy project, a company that had not attended the HCC program was selected.
In both projects, Payne reported that the chosen companies were reputable and that he believed that both were trying to do a good job. However, hospital staff overseeing the project spent considerably more time with the construction workers who did not have the HCC training to ensure the necessary coordination and enforcement of site requirements. Payne estimates that he spent half the amount of administrative time with the contractor whose personnel had gone through the HCC program.
"The biggest difference was that the NICU contractor understood why we were asking for various things," he reports. "It was much easier to maintain compliance due to the level of understanding that this contractor had."
CANADIAN CONTEXT
The first Canadian HCC training program occurred in Richmond, BC, in February 2007, with a mix of health care facility managers, designers and builders from BC, Alberta, Saskatchewan and Ontario in attendance. Two of ASHE's educators also attended as instructors.
Leo Gehring, the Vice Chancellor of Campus Operations at the University of Arkansas for Medical Sciences, and the 2007 President of ASHE, has experienced significant construction growth at his own facility, and spoke to the group about the challenges associated with changes in technologies. Tim Adams, ASHE's Associate Director of Engineering and Compliance, spoke about the unique nature of health care with its safety and security issues and expectations from the patients and governing bodies, as well as some of the unique electrical systems within a healthcare building.
Gordon Burrill, immediate Past President of CHES, focused on Canadian codes and standards. The session also addressed special HVAC, medical gas and infection control requirements that health care facilities face every day.
Attendees participated in an exercise intended to highlight the importance of communication during health care construction projects. In the simulation, groups of attendees were asked to build a small construction project, while confronting the barriers to communication that commonly occur in health care projects.
The program ended with a discussion of challenges that the attendees are facing in their current projects. With the mix of attendees, and differing points of view, this discussion was particularly valuable to help everyone involved in the health care construction process develop stronger relationships and develop a better understanding of the roles of various parties involved in a project in the health care setting.
Successful health care construction can be described as those projects in which construction personnel are best equipped to work in the unique environment, health care staff understands the construction process, and, most importantly, the occupants of the building are not adversely impacted by the necessary construction work.
Gordon Burrill is President of Teegor Consulting Inc., specializing in health care engineering codes and standards, and education in the field. For more information, about the Canadian Healthcare Construction Certificate, see the Canadian Healthcare Engineering Society web site at www.ches.org. The preceding article was adapted from articles published in Canadian Healthcare Facilities, Winter 2006 and Spring 2007.
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