Planning, Design and Construction 14528 S. Outer Forty, Suite 200 Chesterfield, MO 63017 Tel (314) 628-3656 Fax (314) 628-3471 Form 8334 – CF490 Sisters of Mercy Health System Planning, Design & Construction

Healthcare Construction Education

Date: 1

Presentation / Discussion Outline

 Introductions / Meeting Objectives  Understanding the Healthcare Organization  Owner’s Expectations for Construction 2

The Business of Health Care

 Improving the Health and Well Being of People  Requires Multi-Disciplined Team  Highly Regulated  Very Competitive  Challenging to Maintain Financial Stability 3

Typical Health Care Organization

Board of Trustees/Directors Administration Physician's Groups Clinical Services General Business Emergency Imaging Labs Medical Staff Pharmacy Surgery Admissions Human Resources Finance Support Services Central Services Clinical Engineering Data/Telecom Systems Dietary Facilities Housekeeping/Laundry Infection Control Risk Management/Safety Security 4

Typical Health Care Customers

          Sick People Diagnostic Tests Elderly / Frail / Behavioral patients Respiratory Problems Scared / Confused Patient Family, Friends, Visitors Low Imune Patients Hearing/Vision impaired Emergency Patients Burn Patients 5

Elements / Services Needed

    Safe Environment  (Dust/ Mold for resipitory patients, Noise for Mandatory rest patients, Smells for imune defiecient patients, air partiticle from burn patients and infection from cnst safe for handicap) Restful Environment  (Reduce noise, dust, vibration, smells, water leaks, Unplanned outages) Clinical Areas of Specialty  (Mri protect from vibration/Dust, Lab equipment protect from vibration and samples from contamination, MRI from interference, Several sterile enviroments) Infection Control  ( Infection control measures to protect Patients from staff and other infections and problems while they are in the Hospital) 6

Regulatory Requirements

   Applies to Healthcare Facilities, including  Hospitals  Ambulatory Care   Behavioral Health Long Term Care / Assisted Living Includes Local, State, and Federal Requirements Notable:   Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ; (HIPPA) U.S. Department of Health and Human Services (HHS)  Center for Medicaid & Medicare Services (CMS) 7

Regulatory Requirements

 Design and Construction Related:  Guidelines for Design and Construction of Hospital and Health Care Facilities (AIA Academy of Architecture for Health)   Environment of Care Requirements (JCAHO) Centers for Disease Control & Prevention (CDC)     Occupational Safety and Health Administration (OSHA) American Society of Heating, Refrigeration and Air Conditioning Engineers, Inc. (ASHRAE) Local City and States review Boma 8

Special Systems Used in Healthcare Delivery

        Telemetry  Monitoring Patients Hearts Pneumatic Conveying  Tubes meds, bloods and samples to labs for testing Exhaust Air/Isolation units  Haz exhaust, Mandatory air exchanges, Isolation rooms Radiation  X-ray equipment, Hot labs, MR Magnets, Accelerators, Digital images & Records Infant Abduction Paging/Antenna systems  Calling code teams, emergency announcements, Doctors Pagers Emergency (Code/Crash, Flood, etc.) Emergency power, Trauma Elevators, Medical Gases 9

Typical House Rules

        Know and Understand Organization’s Mission Show Care and Concern for Patients, Families/Visitors, and Property Ensure Patient Confidentiality Contribute to Teamwork Demonstrate Respect for Fellow Co-Workers Be Courteous and Friendly Maintain an Appropriate Appearance Respect existing facilities 10

Mercy Service Standards

         Treat Everyone as a valued individual Seek out and address customer needs Make eye contact, greet and welcome everyone Display a positive presence Keep customers and co-workers informed Work as a team Maintain privacy and confidentiality Keep a clean environment Live the mercy spirit 11

Guaranteed Issues for Project Team Members

    “You Are a Guest in Our House” Use Effective Communication – NO SURPRISES!

Demonstrate Respect for Owner’s Facilities  Parking (Use designated parking areas)  Public Spaces – Cafeteria, Restrooms, etc.

 Behavior Require All Members to be Accountable for Their Actions 12

Hospital Operational Modes - Summary

     Patient care is a driving force  Patients are our customers. This is our business Heavily regulated  Our reimbursement is tied directly to our ability to serve patients and maintain a safe environment Risk management oriented  We need to provide risk Assessments for all our activities which is regulated by the State Performance/process improvement oriented  We must maintain a pan for improvement on facilities which is reviewed by State (Jacho) Physicians are an integral part of the hospital 13

Hospital Challenges - Summary

        Aging buildings and infrastructure  This is why we plan ahead carefully Competition  Patients have a choice in healthcare and we want that to be SMHS Technology advances Decreasing re-imbursement Lots of Changing healthcare needs and desires Community may see it as their hospital, even if there are no financial or organizational connections Financial well being of the organization No matter what happens, patient care must go on 14

Owner’s Expectations - Construction

   Risk Assessment/Management  Manage Risk such as, Noise, Smells, Vibrations, Hazardous areas, Dust, sterile areas, Disruptions Communication/Coordination of Activities  Plan activities well in advance, Communicate to all co workers, Manage disruptions to minimize impacts, Be transparent Quality Assurance  Follow policies and Standards, Control moisture in facilities, wrap ductwork, air testing, Infection control measures 15

Risk Assessment/Management

    Environment of Care (EC)    We do not evacuate in fire we retreat to safe zones.

signage, train staff on exits, Maintain sprinkler/alarm systems Infection control, Risk assessment, Cnst related infections Interim Life Safety Measures (ILSM)  Temp exiting, Emergency room access, Fire protection systems, Smoke zones, Doors latching, firewalls/Penetrations, fire watches Infection Control Risk Assessment (ICRA)  Negative pressure, daily checks, Water, dust, sealed partitions, Tracking dirt in facility, filter changes log Other Construction Site Risk Issues  Sealed barricades, Traffic control, Temp Signage, Guass fields, Radiation, Power disruptions, Isolation room, Access for codes, Monitoring systems, Ceiling tile dust 16

Environment of Care - Definition

Provides a …     Safe Accessible Effective Efficient Environment Consistent with Organization’s …     Mission Services Applicable Laws Applicable Regulations 17

Life Safety Code Compliance

 NFPA 101 (Provide For a Fire-Safe Environment)  Equivalency Approved by JCAHO  Statement of Conditions  Includes Basic Building Information    Assessment of Existing Conditions Plan for Improvement Building Maintenance Protocol 18

Interim Life Safety Measures (ILSM)

 Used During Significant Construction Project  Method to Offset Recognized Code Shortcomings   Contains Eleven (11) Administrative Measures  (Egress, exterior access, fire alarms, suppression, Temp Partitions, Fire extinguishers, No smoking policy, storage, fire drills, Hazardous surveillance, Hot work, Re-assessment Requires Constant Monitoring 19

Infection Control Risk Assessment (ICRA)

 Initiated in Design Phase  Provides for a Safe Environment of Care  Determines Potential Risk of Transmission of Various Agents in Facility (Viruses, Bacteria, Toxins)  ICRA Conducted by Panel of Experts Including Infection Control, Risk Management, Facility Design, Construction and Ventilation Safety 20

ICRA – Key Elements Addressed

      Impact of Disruption to Essential Services Patient Placement or Relocation Placement of Barriers to Protect Susceptible Patients from Airborne Contaminants Air Handling and Ventilation Needs Need for Additional Protective Environment Rooms Domestic Water System that Limits Legionella and Waterborne Opportunistic Pathogens 21

Other Construction Site Risk Issues

 Patient Privacy/Confidentiality (HIPPA)  Theft  Adjacencies to Imaging Equipment  Unidentified Hazards in Construction Area  Accidental Disruption to MEP Services  Disrupt surgery, Life support, Oxygen, Contaminant gases, cooling in burn unit, Radiation exhaust, isolation room exhaust, 22

Communication/Coordination of Activities

    Exchange of Construction Related Information  Keep administration informed, Train/Inform staff of changes to their areas, Security rounds needed General Conditions Items  Traffic control, clean up, Safety, infection control, Planning for Facility Interruptions  Notify departments, move critical patients, provide temp transport, temp O2 added staff to manage patients Project Emergency Preparedness Risk assessment, notify adjacent department if affect their egress, fire protection systems, HVAC, Fire wall breach 23

Exchange of Construction Related Information

 Constructor Orientation and Education Program  Emergency Contact Information  Frequency of Progress Meetings  Meeting Note Distribution List  Process for Handling Unexpected Situations 24

General Conditions Items

 Security Items (Employee Access, ID’s, Secure Area, etc.)  Temporary Utilities  Procedures for Deliveries and Trash Removal  Standard Policies (Smoking, Radios, etc.)  Acceptable Support Services (Restrooms, Food, etc.) 25

Planning for Facility Interruptions (Shut-Downs)

 Determine Coordination Process to be Used for MEP Systems with Facility Manager  Determine Notification Process to be Used with Affected Parties  Be Proactive, Anticipate Facility Interruptions!

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Project Emergency Preparedness Plan

 Fire  Weather  Internal/External Disaster 27

Quality Assurance

 Communication  Teamwork  Customer Service  Technical  Creativity/Value 28

Owner Review of Construction Items

 General Conditions, ILSM, ICRA  Pre-Installation Reviews  Users of Future Space  Regulatory Inspections  Facility Management Inspections 29

Proactive Versus Reactive Issue Resolution

 What Challenges Do We Face?  Are We Organized For Success?

 What Options/Techniques Do We Need To Consider?

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