Introduction of Safety Issues Facing a Healthcare Organization During Construction and Innovation

            Most building owners and managers would rather do something other than venture into a building construction project or - worse - a renovation project. In most healthcare facilities, construction projects are a necessary evil. Whether it's a minor finish, a technology upgrade, or a campus-wide building program, construction projects can be expensive, unpredictable, inconvenient, and seem to last forever. This paper discusses the safety issues facing a healthcare organization during construction and innovation.

The Challenges of Healthcare Construction

            In many cases, healthcare building owners and operators look to construction to solve the challenges presented by the drivers in their industry; however, construction is usually a last resort because of the challenges that arise. Issues, such as the changing government reimbursement rules and requirements of other regulatory agencies with jurisdiction over healthcare providers and their facilities (e.g. the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO] and state health authorities); the advancements in medical equipment, clinical procedures, and building technology; and the increasing expectations of the patient, not only drive healthcare providers to engage in construction to make these changes, but also make the implementation of this process difficult because they can change again during the process (Wynn, 2017).

            The most pressing issue in healthcare building programs today is capital cost and funding. Since early 2003, construction-cost escalation has dramatically increased by more than the predictable, low, steady rate of around 3 to 4 percent of the previous 10 to 15 years. Some recent studies state that the cost of a healthcare facility built today is double that of the same facility built in 2002. Where there was already a challenge in making expectations and desires for facility program growth and available funding meet, there is now an even greater disparity. To further compound this issue, the housing-lending collapse and the economic recession have made capital less available and more expensive (Kiehne, 2014).

            How is healthcare facility development more challenging than other industries? None of the drivers for renovating and building healthcare facilities have diminished - even with increasing economic pressures - like they have in many other industries. The demand for healthcare facilities continues, regardless of the economy and cost escalation. Many people claim that healthcare construction is "recession proof," but that doesn't mean it continues with the same ease as in good economic times. It means that it'll still continue to grow at a moderate pace, but will be more painful (Joshi, 2011).

Creative Approaches and Responses of Safety Issues Facing a Healthcare Organization During Construction and Innovation

        With this information in mind, it's easy to understand why healthcare facility owners and operators want nothing to do with construction. While construction will never be an unnecessary evil, there are a few things that can make it a lot less evil.

        The balance between first cost and designing for flexibility and adaptability to minimize the impact of future changes is difficult to evaluate. With increasing first costs and the consequential reductions in facility building program scopes, many providers are spending a little more on a reduced project to build in flexibility for future projects that they can't currently afford. If planned and designed wisely, these provisions can reduce the future costs and time involved in changing or adding specific or unforeseen services in upcoming years. Examples include: Building unfinished or shelled space in strategic locations or entire floors in a building tower to provide room for expansion in service areas where growth is expected; Designing and building acuity-adaptable patient rooms that are easily converted from standard medical/surgical rooms to critical-care rooms; and Building additional capacity into system infrastructure (Joshi, 2011).

        In terms of creative improvements being made on the project-delivery side to make building programs less painful and challenging, many different tools, practices, and approaches come into play. Many healthcare providers are changing the way they hire designers and builders, and are creating project-delivery teams to get more value out of their investments. An example of an innovative delivery method that's gaining acceptance is the integrated project delivery approach. It differs from traditional delivery approaches because the entire team - including designers, builders, and key design-assist subcontractors - is formed at the very beginning of the project to help the owner develop the scope and budget for the project based on the healthcare program and services being provided. The team members are selected based on qualifications, and the team is built on trust and a predetermined set of rules for sharing risk and rewards with an integrated form of agreement. The goal of this approach is to get all team members pulling in the same direction toward the common goal of a successful project. While some of the components of this approach seem radical, it's being adopted and has already resulted in successful projects for some of the major U.S. healthcare providers (Kiehne, 2014).

        There are many tools being used to support integrated project delivery and Lean project-delivery approaches to healthcare construction projects. 3-D computer modeling technology can significantly improve the collaboration and performance of a project-delivery team. Using BIM technology for virtual design coordination of building systems, visualization of the design for owner review, and populating the models with schedule and cost information are the most common uses today. The technology has the potential to include much more building information in the models. Information, such as product and equipment specifications, operations and maintenance information, and any other building-related information relevant to the project, can be included in a model (Savage & Ford, 2008).

        Another approach to improving the delivery of healthcare construction projects via 3-D modeling technology involves prefabricating sections or assemblies of MEP systems in fabrication shops and then erecting and connecting them in units in the field. This approach improves quality and safety, and reduces manpower peak demands and schedules. The early coordination of all systems required in a healthcare building is facilitated by the use of 3-D modeling. This provides a level of certainty and accuracy, allowing workers to build these systems ahead of time to avoid congestion and clashes between the systems and manpower in the field. 3-D modeling and prefabrication of above-ceiling MEP systems is going to be used in the construction of the patient-room corridors of the heart tower addition at Miami Valley Hospital in Dayton, OH, to reduce manpower requirements in the field and potentially reduce the project schedule (see the photo on page 80). The hospital also expects to gain the benefits of improved quality, safety, and jobsite cleanliness (Tweedy, 2016).

        While the previous examples provided improvements in early decision-making and labor production, a final example offers improvement on the material and equipment side of construction delivery: Driven by recent increases in pricing and reductions in availability, some healthcare construction companies are re-evaluating the traditional procurement and management of the supply chain of materials and equipment. This change in approach strives to improve the sourcing, pricing, and availability of major commodity items in the construction of buildings by searching for the best available source, aggregating and leveraging purchasing volumes, and managing the supply chain to make sure it's available at the best time. This approach is similar to what many healthcare providers have done with the procurement of their supplies and equipment through group purchasing organizations (R, et al., 2010).

        There are many forces specific to healthcare that make construction necessary for it to prosper. But, there are also many opposing factors that make construction and renovation difficult and costly. Experienced healthcare facility owners and construction companies are able to overcome the challenges involved with a healthcare construction building program by developing creative ways of using old and new approaches and tools; however, the ones who create and deliver the most value on a healthcare project are the ones who work to understand the drivers and goals of each other, and identify innovative solutions together (Wong, et al., 2015).

        With the growing shortage of doctors, nurses, and other health care professionals, some hospitals are conscious of creating facilities that are more efficient and pleasing to staff. The new Memorial Sloan Kettering space includes an outdoor area on the staff level. This 14th-floor loft gives staff members the chance to step away from work and collect themselves. The space includes a lounge and dining area to spend time alone or catch up with a colleague. The new VA facility in Kentucky will incorporate public spaces that provide a greater connection to the outdoors and natural light for both the patients and staff members, said H. Lynn Speevack, MD, who serves on the design committee. “We anticipate this will improve morale and the overall experience of our staff.” The James Cancer Hospital at OSU includes patient floors with quiet, no distracting spaces where health care teams can meet and debrief after evaluating a patient. Some facilities use glass conference rooms so the team can see patients but have a private area to talk. In some cases, there are alcoves where physicians can chart immediately about the patients’ conditions and capture more accurate information instead of waiting to do a batch of charts at the nurse’s station. “Over the years we’ve seen so much progress with more hospitals adopting an evidence-based approach that now includes facility design to support outcomes for patients and staff,” Piatkowski summed up. The age of “better healing through better hospital design” has taken off (Wynn, 2017).

Innovation, Security and Life Safety Issues Facing a Healthcare Organization During Construction and Innovation

            Perhaps because they’ve been long-held concerns for health care facilities, many physical security and life safety devices tend to use more mature patient safety technologies. However, some of these systems are expanding their features as they connect to wireless and IP-enabled infrastructures. Infant abduction-prevention systems traditionally have sounded alarms when infants are moved through a doorway or near another exit point, but additional capabilities can be used to track infant movement throughout a facility as well as connect to communication platforms throughout a facility or campus. “When there’s a problem, visual and audio alarms will go off, as well as indicators associated with the nurse call system and their monitors,” says Moore. “Then, the door or elevator or whatever access point is being breached will be locked down for as long as codes allow.” Video surveillance also can be tied into the system, he adds. Another mature technology getting an upgrade through integration with other security devices is a variety of access control devices, including combination locks and card readers. Additionally, Gregory mentions biometric devices and video entry systems as new variations on the access control theme (Hrickiewicz, 2015).

        A less-common patient safety measure is lobby and visitor management systems, according to Thomas A. Smith, CHPA, CPP, president of Healthcare Security Consultants Inc., Chapel Hill, N.C. These allow staff to run checks on visitors against organization or public databases. “I tend to look at them in my practice when I’m doing assessments and looking at what people can do to tune up their physical security and operational security measures,” Smith says. “I think they are now becoming more mature and more fully integrated with their current security management systems.” While fire alarms are required to be on their own systems by code, they also are interfacing with newer equipment to improve patient safety, such as mass notification systems. “I would say the Virginia Tech shootings spurred more interest in mass notification systems,” says Geoffrey King, principal at Smith Seckman Reid in Dallas. “But they can be used for situations like inclement weather, too.” Touting their flexibility, King says mass notification systems can be configured to make announcements via mass text messages, overhead speakers or digital signage (Hrickiewicz, 2015).

        Another emergency response technology that’s getting attention for new construction projects is distributed antenna systems (DASs), which allow first responders to communicate within a building during an emergency, Moore says. Driven by the communication problems that plagued first responders on 9/11, and the RF-resistant materials used in new construction, DAS also can be used by hospital security and other departments using radios, Moore adds. Another huge component to a DAS is incorporating cellular systems. “Cellphones are a critical part of the communication systems within our health care facilities,” he says. “In order to have coverage inside the building, running them over the DAS becomes a requirement” (Hrickiewicz, 2015).

Conclusion on Safety Issues Facing a Healthcare Organization During Construction and Innovation

        In a nutshell, effectively managing and improving patient safety depends on a range of activities that are as broad and varied as the work of healthcare itself, and span all the way from the front lines of care to organisational boards, policymakers and regulators. Key aspects of patient safety management in healthcare organisations involve building effective cultures of safety, engaging effectively with patients, ensuring leaders prioritise safety, continually measuring and monitoring safety, developing effective teams, designing safe facilities and useable technologies, and educating and training staff effectively. All of this takes place within a complex system of patient safety regulation that lays out the core safety requirements and standards that healthcare staff and organisations must meet. A range of tools, methods, models and evidence for patient safety improvement are widely used in healthcare. These help organisations implement effective and integrated systems of patient safety and ensure that safety can be continually prioritised and improved in all areas of healthcare.

References of Safety Issues Facing a Healthcare Organization During Construction and Innovation

Hrickiewicz, M., 2015. Infrastructures to improve patient safety. [Online]
Available at: https://www.hfmmagazine.com/articles/1827-infrastructures-to-improve-patient-safety

Joshi, S., 2011. Safety Management in Hospitals. s.l.:Jaypee Brothers Publishers.

Kiehne, H., 2014. Healthcare Hazard Control and Safety Management. s.l.:CRC Press.

R, P. et al., 2010. Risk management systems for health care and safety development on transplantation: a review and a proposal. Transplant Proc, 42(4), pp. 1014-6.

Savage, G. T. & Ford, E. W., 2008. Patient Safety and Health Care Management. s.l.:Emerald Group Publishing.

Tweedy, J. T., 2016. Healthcare Hazard Control and Safety Management. s.l.:CRC Press.

Wong, J. Y. Y., Gray, J. & Sadiqi, Z., 2015. Barriers to Good Occupational Health & Safety (OHS) Practices by Small Construction Firms, Brisbane: chool of Civil Engineering and Built Environment, Queensland University of Technology.

Wynn, P., 2017. New Hospital Design Focuses on Safety, Patient Experience. [Online]
Available at: https://news.aamc.org/patient-care/article/if-we-build-good-hospital-they-will-come/