Health Facilities Management-February 2015

DESIGNS FOR SENIOR CARE p.22 // RESPONDING TO WATER SHORTAGES p.27 // FLEXIBLE FACILITY PLANNING p.
38
OPTIMIZING DESIGN, CONSTRUCTION+OPERATIONS

www.HFMmagazine.com FEBRUARY 2015 // VOL 28 ISSUE 2
Trading
SPACES
2015 HOSPITAL CONSTRUCTION SURVEY
Hospitals repurpose
units as some functions
move off-site
p. 15
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For reprints please contact the Publisher.
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2014 INVISTA. All Rights Reserved. Antron and the Antron family of marks and
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FEBRUARY 2015 | VOL. 28 ISSUE 2
4 INSIDE HFM
The morphing medical
center.
6 UPFRONT
New federal program
to help hospitals build
resiliency.
Phone triage, early

treatment may curtail
flu cases, CDC reports.
22
27
31
Use of mobile devices

continues steady climb.
Prefab elements cut
costs, time from new
hospital project.
PLUS
Off-site Industry events
Toolbox Online resources
Checklist Codes+standards
10 INTERVIEW // Smith
Seckman Reids Debbie
Gregory on merging health
care design and technology.
12 SOLUTIONS // On our
15 Trading spaces
Hospitals repurpose units as

some functions move off-site.
MARKETPLACE
31 Finer fixtures and fittings
ARTICLE BY REBECCA VESELY
Plumbing products address

infection prevention, water
conservation and more.
DATA BY SUZANNA HOPPSZALLERN
BY NEAL LORENZI
INTERIORS
COMPLIANCE+OPERATIONS
22 Settings for seniors
Designs to answer the challenges

of an aging population.
BY MARY E. TURGEON, AAHID, LEED AP
Radar and wayfinding

products.
35 ASHE PERSPECTIVE
36 AHE PERSPECTIVE
43 ADVERTISER INDEX
38 Building a flexible future
44
Strategies to keep
health facilities relevant.
BY ED AVIS
ID+C; REBECCA DAY DILLON, AIA, LEED

AP BD+C; AND DEIRDRE L. PIO, CSI, CDT
INFRASTRUCTURE
27 High and dry
Preparing for hospital

water supply disruptions.
BY DAVID STYMIEST, PE, CHFM, CHSP, FASHE
ENVIRONMENTAL SERVICES
41 Preventing pest problems

Locating, identifying and
stopping infestation dangers.
BY JIM FREDERICKS, PH.D., AND
MISSY HENRIKSEN
44 LAST DETAIL // Rush

University Medical Centers
open-air terrarium lights the
way.
ON THE COVER // Photo by Rebecca Lomax
HFM ONLINE
SPECIAL REPORTS
For links to all

of these stories
or to subscribe
to HFMs free
digital edition
and five e-newsletters, scan
the QR code or log on to
www.HFMmagazine.com/online
Trends in health care
Disaster preparedness
This report looks at the role of technology

in driving efficiency and accuracy for those
involved in hospital design, construction and
operations.
This survey polled hospital and health system

executives to find out the most recent trends
in health facility emergency planning and
management.
ONLINE ONLY
Moving out
The concept of separating inpatient and outpatient
services has been so successful for some health
care systems that many more are adopting the
practice. If done correctly, creating a separate
outpatient site gives a health care system an opportunity to enhance its brand and increase overall
market share, creating a positive effect on the
systems bottom line.
SLIDESHOW
TRENDING STORIES
1
2
3
4
5
Designing hospitals
that are resilient
to the elements
New strategies in
hospital emergency
department design
Codes and guidelines
for behavioral health
construction
Controlling project
spending on medical
equipment
Technology to help
prevent infant
abductions in hospitals
E-NEWSLETTERS
HFM offers five e-newsletters:

HFM NEWS //
Spotlights the latest
industry news
Previews features in
the monthly magazine
HFM INSIDER //
HFM DESIGN // Covers health care

design and construction
Focuses on
environmental services and infection
prevention
HFM ES NEWS //
HFM INFRASTRUCTURE
Covers hospital engineering

and technology
NEWS //
Forward-focused furnishings
Take a look at furnishings, wall systems and carts designed to help hospitals
integrate technology into their everyday patient and visitor environments.
//
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Youre looking at one of the

industrys most innovative,
state-of-the-art breakthroughs.
(were referring to the raceway.)
Sure, it may look like other raceway products.
But the STARLINE Plug-In Raceway has
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reconfigure circuits, receptacles and wiring.
To learn more, visit StarlinePower.com.
EDITORIAL
The morphing medical center
Mike Hrickiewicz
Editor
ver the past few years, the editors of Health Facilities

Management (HFM) have dedicated much coverage to
the health care organizations move off the main hospital campus and into the community.
Indeed, this was covered extensively in last years Hospital Construction Survey as well as an entire Trends in Health Care issue in
December 2013.
One of the more interesting aspects of these initiatives is the
ingenuity employed by health facilities professionals who, in many
cases, repurpose existing retail outlets, office buildings and other
facilities to provide health care services. Of course, these moves also
leave empty spaces in the resulting leaner and higher-acuity hospitals that also need to be redeployed.
Explored more fully in this years Hospital Construction Survey,
conducted by HFM in conjunction with the American Society for
Healthcare Engineering (ASHE) and sponsor Forbo Flooring Systems, it seems health care organizations are spending a great deal of
energy figuring out how to reconfigure parts of their existing acute
care facilities. The survey, which is the focus of this months cover
story, finds that inpatient spaces are being repurposed for administrative, ambulatory and observational uses, among others.
While such projects are practical and economically sound, they
also bring to mind the need for health facilities professionals to consider all possible uses when the next generation of new acute care
hospital projects come off the boards and onto the construction sites.
One of the themes of ASHEs International Summit & Exhibition
on Health Facility Planning, Design & Construction, which will be
held next month in San Antonio, is that flexibility has become a
health care design goal as future needs become more difficult to
predict. As covered in this months Compliance+Operations article,
this flexibility goes far beyond the basic floor plan of a building to
include site planning and infrastructure requirements as well.
Although most health facilities professionals currently have their
hands full with off-campus construction and adaptive reuse of existing spaces, flexible design will continue to gain popularity as the
industry turns its attention back to new hospital construction.
EXECUTIVE EDITORIAL DIRECTOR
Michelle Hoffman | mhoffman@healthforum.com

EDITOR
Mike Hrickiewicz | mhrickiewicz@healthforum.com

SENIOR EDITORS
Jeff Ferenc | jferenc@healthforum.com

Bob Kehoe | rkehoe@healthforum.com
CONTRIBUTING EDITORS
Dale Woodin (ASHE)

Patti Costello (AHE)
John Grattendick (ACHA)

Julianna Spear (AAHID)
COPY EDITOR AND PROOFREADER
Susan Edge-Gumbel | sedgegumbel@healthforum.com

MEDIA SPECIALIST
Genevieve Diesing | gdiesing@healthforum.com

DESIGN & PRODUCTION
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PRODUCTION MANAGER
Martin Weitzel | mweitzel@healthforum.com
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Content2015
is copyright
FEBRUARY
Amy Mosser | amosser@healthforum.com
CHAIR William D. Petasnick

DIRECTORS Rhonda Anderson, R.N. | David L. Bernd
Darren Black | Jeannette G. Clough | Teri G. Fontenot

Ed Ginia | Todd Linden | Maryjane Wurth
protected and provided for personal use only - not for reproduction or retransmission.
2015
Environmental Services
Department Year
OF
THE
Your chance to shine!

To recognize the outstanding achievements of hospital environmental services
and housekeeping teams, Health Facilities Management and the Association for
the Healthcare Environment announce the ninth annual Environmental Services
Department of the Year Award.
Open to all U.S. hospitals, this program recognizes high levels of performance in
13 critical areas. Awards will be presented to the winner and honorable mention
recognition will be issued depending on applicant scores.
ENTER NOW
Application instructions
are available at
www.HFMmagazine.com/
2015ESDepartment
DEADLINE
June 26, 2015
The winning ES team will be profiled in Health Facilities Management and

recognized at the Association for the Healthcare Environment conference in
September. For more information on the AHE annual conference or to register,
visit www.ahe.org.
HEALTH FACILITIES
M Afor
NAG
EMENT
Content is copyright protected and provided for personal use only - not
reproduction
or retransmission.
DESIGN
New federal program to help hospitals build resiliency
//
Content2015
is copyright
FEBRUARY

protected and provided for personal use only - not for reproduction orwretransmission.
w w.HFMmagazine.com
PHOTO COURTESY OF OUR LADY OF LOURDES MEMORIAL HOSPITAL, A MEMBER OF ASCENSION
ealth & Human Services (HHS)

is urging health care systems to
prepare for the impact of climate
change and future outbreaks of severe
weather like the ones that ravaged parts
of the nation in recent years by making
their facilities as resilient as possible.
To help achieve that goal, HHS
launched the Sustainable and Climate
Resilient Health Care Facilities Initiative
to provide tools and information in the
form of a guide and website.
The initiative, part of President
Flood walls protect Our Lady of Lourdes Memorial Hospital in Binghamton, N.Y., during
Obamas Climate Action Plan, was
flooding in the area.
launched at a White House meeting in
December attended by HHS leaders
and other administration officials. The
developing and maintaining data on
leading health care facility designer and
leaders of several hospitals across the
climate hazards and infrastructure vulnersustainability advocate.
United States and the American Hospital
abilities;
In addition, HHS is developing a suite
Association also attended the meeting to
constructing or retrofitting infrastrucof online resilience tools for health care
support the initiative and to encourage
ture in a manner that is sustainable and
facilities to supplement the Obama
other hospitals to increase resiliency at
better at withstanding future events;
administrations Web-based U.S. Climate
their facilities.
prioritizing resilience measures for
Resilience
ONLINE RESOURCES
Dale Woodin, CHFM, FASHE, senior
high priority, vulnerable functions and
Toolkit, which
For links to the resources includes a topic
executive director, American Society for
areas.
referenced in this article, called Building
Healthcare Engineering (ASHE), noted
It also offers best practices shared by
view the online version at Climate Resilthat AHA and ASHE have long supported
hospitals and health care facilities that
integrating sustainable practices into the
successfully have withstood severe weath- www.HFMmagazine.com
ience in the
health care environment.
er by designing for resiliency.
Health Sector.
Improving the resiliency of health care
The peer-reviewed report was co-auThe new information, which will be
facilities to natural disasters and epidemthored by Robin Guenther, FAIA, susavailable in coming months, will include
ics is part of nearly every discussion on
tainable health care design leader and
health and health care-related fact sheets,
health care facility planning and design,
principal at design firm Perkins+Will,
resources and case studies on how faciliWoodin says. Each
New York City,
ties have addressed the range of climate
of these discussions
and John Balbus,
change-related hazards. It also will offer
Improving the resiliency of health M.D., senior adviser more detailed guidance on affordable
focuses on preserving the core health
measures to ensure that the health care
care facilities to natural disasters for public health,
care mission proNational Institute
facilities are more resilient.
and epidemics is part of nearly
viding patient care to
of Environmental
Together the guide and toolkit can
those in need.
Health Sciences,
every discussion on health care
assist health care providers, design proTo help health
Bethesda, Md.
fessionals and others to assure the confacility planning and design.
care facilities, rangThis guide
tinuity of quality health and human care
ing from multifacility DALE WOODIN // ASHE
allows people to
before, during and after extreme weather
campuses to single
see the whole
events across the spectrum of facilities
outpatient providers,
picture of why hosfrom campuses to outpatient service proHHS released at the White House meetpitals fail in cold weather, hot weather,
viders and nursing homes.
ing a guide titled Primary Protection:
in storms, in tornadoes as well as underThe guide and toolkit are components
Enhancing Health Care Resilience for a
stand what similar facilities have done to
of Obamas Climate Action Plan launched
Changing Climate. The guide focuses on:
become more resilient, says Guenther, a
in 2013. // BY JEFF FERENC
MARCH 1518 // 2015 International Sum-
typically lasts about 13 weeks. He characterized this season as a difficult one,

especially for those 65 and older and for
those with underlying medical conditions.
Thats what we expect for a season
where H3N2 is the predominant strain.
H3N2 is a nastier flu virus than the other
flu viruses and years that have H3N2 predominance tend to have more hospitalealth care providers may need
izations and, sadly, more deaths, he said.
For those 65 and older, hospitalization
to set up phone triage lines to
rates were rising sharply last month. While
facilitate the early treatment
the hospitalization rate was 52 per 100,000
of high-risk influenza patients to cut
in the week prior to the conference call, it
down on hospitalizations related to the
had risen to 92 per 100,000 a week later.
illness, says Tom Frieden, M.D., director
Frieden projected hospitalization rates
of the Centers for Disease Control and
for that age group could
Prevention (CDC).
2014 influenza
Establishing triage
reach as high as 183 per
lines would enable clini- hospitalization rates 100,000 by the end of
(per 100,000 population)
cians to discuss patient
the flu season, similar
symptoms and start anti- 100
to the 201213 season
04 years
viral medication sooner,
when H3N2 was the
517 years
Frieden said during a
predominant virus. The
80
conference call Jan. 9 to
next highest hospitaliza1849 years
update the media on the
tion rate this flu season
5064 years
60
201415 flu season.
is children up to 4 years
65+ years
Frieden emphasized
old who were hospitalthe importance of highized at a rate of 16.5 per
40
risk and severely ill per100,000 as of Jan. 9.
sons with flu symptoms
In terms of the overall
taking antiviral mednumber of flu cases,
20
ication to begin early
studies suggest that
treatment of the flu and
anywhere from 5 to 15
0
to be able to do so with- Week 41 43 45 47 49 51 53 percent of the entire
out an outpatient visit
country gets flu in an
SOURCE: FLUVIEW: INFLUENZA
HOSPITALIZATION SURVEILLANCE NETWORK, average flu year, Frieden
if possible. Antiviral
CDC. ACCESSED ON JANUARY 13, 2015
drugs ideally should be
said. That means tens
administered to patients
of millions of influenza
The age group 65 and older is far
within the first two days
cases occur annually,
and away the one most affected by
the current flu season.
of contracting the virus,
resulting in hundreds of
he explained.
thousands of hospitalizaAntiviral treatment can mean the diftions per year, he said.
ference between a milder illness and a
Because about two-thirds of H3N2
stay in the hospital or intensive care unit
viruses analyzed this season are different
or even death, he said.
from the H3N2 virus thats included in
The CDC is working extensively in difthis years flu vaccine, protection with
ferent areas of the country on new ways
vaccination against these drifted, or difto treat patients more quickly, he said.
ferent, H3N2 viruses probably will be
Frieden did not elaborate on the proposal
reduced, according to the CDC.
but said the CDC would release more
During 200708, drifted H3N2 viruses
information as it became available in the
circulated during the flu season. Vaccinaweeks following the Jan. 9 call.
tion effectiveness against H3N2 during
Frieden said the nation was about
that season was 43 percent, CDC officials
halfway through the flu season, which
said. // BY JEFF FERENC
INFECTION PREVENTION
Phone triage, early

treatment may curtail
flu cases, CDC reports
mit & Exhibition on Health Facility Planning,

Design & Construction; Henry B. Gonzalez
Convention Center, San Antonio
MAY 57 // Lightfair International; Javits
Center, New York City
MAY 12-15 // CleanMed2015; Oregon Con-
vention Center, Portland

JUNE 1517 // NeoCon, the National Expo-
sition of Contract Furnishings; Merchandise

Mart, Chicago
JULY 1518 // 52nd American Society for
Healthcare Engineering Annual Conference &
Technical Exhibition; John B. Hynes Veterans
Memorial Convention Center, Boston
MORE ONLINE
For links to these events, log on to

www.HFMmagazine.com/offsite
BENCHMARKING // The Health Care

Institute and Soleran are offering Benchmarking 3.0 Performance Criteria for health care
facility managers to help hospital staff explain
to C-suite-level leadership how building performance contributes to the cost per square foot,
total cost of care and cost of occupancy. It
offers dashboards that allow facility managers
to communicate on an executive level about
building performance.
HARDWARE // The Builders Hardware Man-
ufacturers Association has updated its website

with a certified products directory that allows
users access to product listings by category,
company name or keyword search. It also has
launched a new, downloadable hardware highlights feature that
delivers snapshot
summaries of
industry standards
for 25 hardware
products.
INFECTION CONTROL // Infection
Control University, a Web-based provider of
information on managing risks and reducing
health care-associated infections, launched a
new free online learning center that provides
infection control awareness training certification and information for health care facility
staff around the clock.
MORE ONLINE
For links to these resources, log on to

www.HFMmagazine.com/toolbox
FEBRUARY 2015
w w w.HFMmagazine.com
//
Use of mobile
devices continues
steady climb
martphones and tablet computers

are used by more health care facilities each year, though the adoption
of mobile technology is slow, according to
the Health Information and Management
Systems Society (HIMSS), Chicago.
Data from the HIMSS Analytics Database shows that 28 percent of all U.S.
hospitals reported using smartphones in
2014 compared with 26 percent in 2013
and 23.4 percent in 2012. On average, 169
smartphones were deployed per hospital
in 2014.
The use of tablet computers at hospitals also continues to increase but, as
with smartphones, at a slow rate, according to HIMSS Analytics. Nearly 24 percent used tablets in 2014 compared with
nearly 23 percent in 2013, 20 percent in
2012 and almost 19 percent in 2011.
CONSTRUCTION
Prefab elements
cut costs, time from
new hospital project
ncorporating prefabricated elements

into the building of SCL Healths Saint
Joseph Hospital Heritage Project,
Denver, cut costs by $4.3 million and six
months construction time compared with
using traditionally installed components.
Utilizing prefabricated elements
enabled construction firm Mortenson Co.,
Denver, to meet the health care systems
30-month construction deadline so that
the new 831,000-square-foot, 360-bed
hospital could be occupied and operational in December. Traditional construction
elements would have required six more
months to complete the project, company
officials say.
Mortenson chose to prefabricate the
exterior wall panels, bathroom pods,
//
Content2015
is copyright
FEBRUARY

While growth is slow, use of tablets has

33 percent said it would have a minimal
steadily increased from 2010 when only
level of impact on care, 23 percent said
16.6 percent of hospitals reported their
they were unsure of its impact and 8 peruse, the first year HIMSS surveyed health
cent said it could make care worse.
care facilities on the
I think across the
extent of their presence. Going mobile
board we are starting to
An average of 37 devices 40%
see there is a positive
Smartphone
were deployed per hosimpact of mobile devicpital in 2014.
es on patient care and
Tablet
30%
The findings were
work-life satisfaction of
reported in HIMSS Anaclinicians, says Jennifer
lytics 2014 Mobile Devic- 20%
Horowitz, senior director
es Study, which comof research, HIMSS North
bined information from
America.
10%
the HIMSS Analytics
David Collins, senior
2010 2011 2012 2013 2014
Database and a recent
director of health inforSOURCE: 2014 HIMSS ANALYTICS
survey of 139 clinicians, MOBILE DEVICES STUDY
mation systems, HIMSS,
including physicians,
projects that mobile
Growth in use of mobile devices in
nurses and others.
technology will continue
hospitals has been slow but steady.
Clinicians reported
to increase in importance
that smartphones and tablet computers
as the health care industry grapples
greatly enhance their ability to communiwith Affordable Care Act regulations and
cate with other clinicians and health care
implements electronic health records.
providers. They also reported that the use
Horowitz says the study reinforces the
of mobile devices is providing them with
benefits of mobile devices.
a more positive work experience.
I saw a very positive message from the
Of the clinicians who responded to the
study in terms of what smartphones and
survey, 36 percent said mobile technology
tablet computers can do for health care,
would create overall efficiencies in care,
she says. // BY JEFF FERENC
patient room headwalls and multisystem

sands of hours in labor costs, he says. Other
racks that include medical gas piping,
benefits are improved safety by eliminating
ductwork, electrical wiring and pneumatmechanical lifts to move materials and
ic tubing installed above
workers for installation.
Quality control is
ceilings.
improved because preMany of the compofabricated components
nents were built in Denare built in a warehouse
ver area warehouses and
under controlled condelivered to the construcditions rather than on
tion site; bathroom pods
the project site where
were built in Boston and
weather becomes a factor,
trucked to Denver.
Bergholz adds.
The redundancy of
Saint Joseph represents
components throughout
the first time the compathe hospital made prefabny installed multiple prerication an ideal solution,
fabricated components in
says Brandon Bergholz,
the same project, he says.
senior project manager,
An aggressive conMortenson. The number
Crane operators lift a prefabricatstruction
schedule and
of prefabricated compoed bathroom pod into place at the
a readiness to increase
nents installed included
Saint Joseph Heritage Project.
the use of prefabrication
440 bathroom pods, 346
prompted the company
exterior wall panels, 376
to incorporate more elements in this
patient room headwalls and 166 25-foot
project. We had the buy-in of everyone
multisystem racks.
Prefabrication cut costs by making conon the team and we just made it happen,
struction more efficient and reducing thouBergholz says. // BY JEFF FERENC
w w.HFMmagazine.com
PHOTO COURTESY OF MORTENSON CONSTRUCTION
TECHNOLOGY
ONE CASE OF LEGIONNAIRES

DISEASE IS ONE TOO MANY.
Hospitals making progress in eliminating infections

INFECTION PREVENTION // Hospitals reduced Clostridium diffi-
cile infections by 10 percent and methicillin-resistant Staphylococcus

aureus infections by 8 percent between 2011 and 2013, according to
the latest annual report on health care-associated infections, released
by the Centers for Disease Control and Prevention (CDC). Among other
improvements, hospitals also reduced central line-associated blood
stream infections and surgical-site infections by 46 percent and 19 percent, respectively, between 2008 and 2013. Hospitals have made real
progress to reduce some types of health care-associated infections it
can be done, says CDC Director Tom Frieden, M.D.
Joint Commission releases imaging document

BIOMEDICAL // New and revised elements of performance for
accredited hospitals, critical access hospitals, and ambulatory health

care organizations that provide diagnostic imaging services (including
ambulatory care organizations that have achieved Advanced Diagnostic
Imaging accreditation) have
MORE ONLINE
been finalized and will go
For links to these reports, log on to into effect July 1. This set
www.HFMmagazine.com/checklist
of standards previously was
announced in January 2014
and would have gone into effect in July 2014. However, the Joint Commission determined that further research and additional revisions were
needed. The new and revised standards incorporate recommendations
from imaging experts, professional associations and accredited organizations about areas that must be evaluated to ensure the safe delivery of
diagnostic imaging services.
PARTNER WITH
THE LEGIONELLA EXPERTS
Legionella and waterborne

pathogens testing
Risk assessments and

outbreak response
Water safety plans
Engineering services
Training and
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Accredited. CDC-ELITE
proficient for Legionella testing.
WWW.SPECIALPATHOGENSLAB.COM | 877-775-7284
CDC issues guidance to estimate Ebola PPE needs

EMERGENCY RESPONSE // The Centers for Disease Control and
Prevention (CDC) recently issued guidance to help hospitals and other

emergency care settings estimate and have on hand the minimum
recommended amount of personal protective equipment (PPE) for Ebola
preparedness based on the agencys three-tiered approach to hospital preparedness for patients with possible or confirmed Ebola Virus
Disease. According to the guidance, frontline facilities may wish to have
enough Ebola PPE for 1224 hours of care, while Ebola assessment
hospitals should have enough for at least four to five days of patient care
and Ebola treatment centers should have enough for at least seven days
of patient care. The CDC recommends that facilities determine a phased
approach to increasing PPE preparedness in coordination with state and
local public health officials.
Health care associations address OR humidity

ENGINEERING // As more health care delivery organizations (HDOs)
lower the relative humidity levels in operating rooms, concerns have

arisen about the impact on sterile supplies and electro-medical equipment. A multisociety communication, organized by the Association for
the Advancement of Medical Instrumentation (AAMI), aims to help
HDOs understand the issue and determine whether a lower humidity
level is appropriate for their facilities. Released in conjunction with the
American Hospital Association, the American Society for Healthcare Engineering, the Association for Healthcare Resource & Materials Management and others, the statement provides background on the issue and
presents a list of questions and key points HDOs should consider when
establishing or adjusting relative humidity levels to below 30 percent.
The statement was developed in the wake of a multiorganization meeting
at AAMI headquarters.
FEBRUARY 2015
//
BY
JEFF FERENC
Conducting innovation
in technology and design
Creating efficient, safe clinical spaces
requires accommodating new technology, the
human touch that promotes patient healing
and staff interaction as nurse and design
consultant Debbie Gregory explains.
10
//
Content is
copyright
FEBRUARY
2015

How is the growing array of technologies

affecting designers of clinical spaces?
The explosion of technology has created
significant challenges for architects and
designers, with specific regard to integration with infrastructure, space planning
and strategic management. The most
effective approach to managing these
challenges is to create a strategic technology master plan that aligns with the
vision and mission of the health system.
This plan should include:
Creating a technology governance
committee to guide and operationalize
the program.
Developing a manageable clinical
communication strategy that encompasses nurse call, mobile devices and alarm
management.
Consolidating and streamlining devices.
Reviewing current technology investments to determine optimization or
duplication. Service contract review is
important as well.
In our practice at Smith Seckman Reid,
w w.HFMmagazine.com
PHOTO BY DANA THOMAS
In designing clinical spaces today,

what are some of the keys to improving patient safety and outcomes while
optimizing workflow? What is your role
in helping to achieve these objectives?
One of the most important keys to
improving quality and safety in health
care today is interprofessional collaboration. Input from the clinical, biomedical,
pharmacy, infection control, information
technology, environmental services and
other disciplines is vital to achieve optimal healing environments.
With an interprofessional focus on the
patient, the care delivery process can be
examined and re-engineered to optimize
workflow, quality and safety. In my role,
I often serve as a bridge to connect the
right people and ask the right questions.
As a nurse and interior designer, I understand the important connection between
design and function, especially in the
clinical space.
I often feel like a health care symphony conductor in the coordination of each
component to bring about excellent care
delivery. Today, the focus is moving from
the health care incident to the health care
continuum, and clinical design is changing accordingly.
we conduct post-occupancy evaluations

on projects that have been in operation for
one year. We take the results of those evaluations to continually shape best practices
and apply them to other projects.
The Gregory file

CV
Senior clinical consultant, technology
group, Smith Seckman Reid Inc.
What are the steps to accommodating

the increasing presence of technology
in patient rooms and the OR?
Staying a step ahead of the technology
curve is a challenge, especially when
technology itself is so far ahead of practice transformation. The key to accommodating technology in the patient room
and the operating room is creating an
integration strategy.
Developing a plan for interoperability
and integration is imperative for successful clinical workflow and documentation,
particularly in a time when the real estate
of the headwall is at such a premium.
Unfortunately, vendors are not held to
an interoperability standard. It is important to identify the platform for interoperability and align with vendors that are
interested in becoming partners in the
care delivery process.
Many of our post-occupancy evaluations reveal technologies that were
purchased but not maximized, and using
technology just for technologys sake is
a costly mistake. Technology in the OR
is more about the physician and nurse
workflow, so including doctors and nurses
in the planning and design conversation
is a smart investment.
of design decisions and internal communication are key. This is a new role in
the nursing industry, and its emergence
successfully has shaped countless design
projects toward creating a more patientand staff-centered approach.
How do you ensure an adequate level

of clinical representation in the design
process? Why is clinical representation
important?
I strongly recommend creating a position on the owner side dedicated to the
project that represents the clinical voice.
This person will have the knowledge and
understanding of the health system culture and mission and can be a continuous
thread throughout the project.
Also, she or he will be an effective
advocate for the clinical perspective and
be able to educate staff related to the
architectural perspective. The Nursing
Institute for Healthcare Design is a great
resource for nurses in this position.
The ongoing historical knowledge
throughout the project, documentation
What types of technological changes do

you foresee having an impact on clinical
design in the near future?
The smartphone with its ability for
text messaging, nurse call and alarm
notification already is making dramatic
changes in clinical efficiency and communication. Telemedicine and wearable
technology are transforming the way
health care is delivered, and these areas
will continue to grow.
With my crystal ball, I see a caregiver
watch that allows nurses to communicate
and chart, and a patient gown that can
capture vital signs and other data.
Nurses are very social and enjoy a
supportive environment, and there are
downsides to the modern decentralized
environment. Many nurses feel isolated
Co-founder and past president, Nursing

Institute for Healthcare Design
Served as a nurse at the VA Medical
Center and Vanderbilt Medical Center,
both in Nashville
ACCOMPLISHMENTS
Received Healthcare Hero Award from
the Nashville Business Journal
One of five designers featured in the
article Hybrid Professionals published
in Perspective, the magazine of the
International Interior Design Association.
EDUCATION
Vanderbilt University School of Nursing,
bachelor of science in nursing
Watkins College of Art and Design,
degree in interior design
University of Minnesota School of
Nursing, doctorate of nursing practice
health innovation and leadership
(will complete May 2016)
at work and are experiencing a decreased

level of mentoring. Technology can
enhance communication but cannot
substitute for mentoring or lending a
helping hand, so considering new technology must always include an eye on the
human element.
How can health care facilities prepare
for continuous technology changes?
I cannot stress enough the importance
of allocating within the budget the time
and resources for education. With a
technology master plan in place, driven
by a technology steering committee, the
operationalizing of the technology needs
a strategic plan in place as well.
When deploying several technologies at
one time, many staff feel as though they
are drinking from a fire hose. Initial classes, follow-up classes, reminders, educational videos, best practice discussions,
and re-evaluations are all part of successful technology deployment and critical to
keeping staff members from falling back
into old processes and habits, which will
most assuredly happen without continuous education.
There is an emphasis on evidencebased design in patient rooms in new
and renovated hospitals. How do you
achieve a balance between so-called
healing design and accommodating
essential technology?
Essential technology isnt necessarily contrary to healing design. What if research
shows that patients who have access to
friends and family on Facebook or Facetime have improved outcomes? Not many
people age 18 to 30 today would want
to be hospitalized without their mobile
phone or connection with the world.
As a nurse at heart, I must emphasize
that there are no substitutes for the healing
touch, caring and empathy. These attributes cannot be built in an environment
nor embedded in technology and yet,
theres no doubt that technology will continue to play an ever-greater role in health
care. As technology evolves, we also must
evolve to ensure that the focus remains on
the human healing interaction. HFM
Jeff Ferenc is senior editor of Health Facilities
Management.
FEBRUARY 2015
//
11
COLORFUL
COVER // With a range
of colors, grains and patterns
available, column covers are
suitable for health care facilities
and can be specified for both
exterior and interior applications
for an enhanced architectural
apearance. The column covers
are fabricated from heavy-gauge
0.090-inch to 0.125-inch solid
core aluminum. Stainless steel,
and perforated and laser-cut
aluminum also are available.
Mz Designs
BUILT TO LAST //
USEFUL DATA //
Endurex 555 high-impact

SureTrend data analysis
hurricane panels are available in a software allows health care
light panel for easier handling and management to track cleaninstallation. Both surface sides
ing-verification results, quickly
provide full impact-resistance
identify problem areas, compare
and because it is nondirectional,
multiple facilities or areas, and
the panel does not require a front
generate reports for management
or back installation guideline.
and record-keeping. SureTrends
It contains no steel,
interface and preset
MORE ONLINE reports allow managwhich eliminates the
chance of electrolysis
ers to start analyzing
Learn more about
or galvanic reaction
data immediately.
these products at
to dissimilar metals.
www.HFMmagazine. Hygiena
Nudo
com/solutions
SEA THIS // eSea, a

digital cinema underwater experience, is a plug-andplay, maintenance-free system
designed to provide the visually
soothing, therapeutic benefits of
live aquariums. The high-tech
illusion features a wall-mounted,
professional-grade LED edgelit high-definition LCD screen
embedded in a 16-gauge steel
mounting pan and framed as an
illusory window. Sky Factory
These product descriptions have been condensed from information supplied by manufacturers, representatives and distributors. They are for informational purposes
only. Product inclusion should not be construed as an endorsement by Health Facilities Management magazine, Health Forum or the American Hospital Association.
12
//
Content is
copyright
FEBRUARY
2015

w w.HFMmagazine.com
SIGNAGE+WAYFINDING
SIGN OF THE
TIMES // Venus is a flatsign system consisting of a wide
assortment of extrusion-based
options for hospital wayfinding.
The product includes a range
of insert modules to change
messages easily and the base
material is recyclable, anodized aluminum. It sets a slight
distance from the wall to create a
floating appearance. ASI Sign
Systems
MOBILE HELP //
FINDING THE
WAY // X2O Media offers

Digital interactive wayfinding solutions provide patients
interactive digital wayfinding
with directional information at
solutions that allow visitors to
home, on mobile devices and
quickly navigate a single building
on-site by utilizing a combination or multicampus health care
of mobile apps, touch-screen
facility. Utilizing the companys
kiosks and Web-based solutions
X20 platform, content managers
to improve the patient experieasily can create broadcast-qualence. This system complements
ity digital wayfinding maps using
existing wayfinding elements to
objects within the systems Chanimprove patient throughput and
nel Designer, and display them
can be scaled to meet
on touchscreens
MORE ONLINE
the unique needs of
throughout a facility.
Learn more about
any facility. Cooper
X20 Media
these products at
Signage & Graphics
www.HFMmagazine.
com/solutions
SIGN IN // The Interactive Signage Solution greets

patients and visitors with an
interactive display with touchscreen wayfinding capabilities. It
helps them to navigate a medical
building or hospital complex and
provides easy patient registration
and sign-in. In the waiting room,
the display can be used to educate patients about health issues,
services and general information,
and to provide entertainment to
help pass the time. Panasonic
FEBRUARY 2015
//
13
creating better environments
44 colors. 3 coordinated sizes.

endless possibilities.
beautiful. durable. sustainable. hygienic.

www.forboflooringNA.com/marmoleum
Trading
SPACES
ARTICLE BY
REBECCA VESELY //
DATA BY
SUZANNA HOPPSZALLERN
ith hospitals and health systems beginning to sharpen

their focus on population health, helping patients to
avoid hospitalization and moving care delivery to the
most appropriate and lowest-cost setting, there is another important related issue that is getting considerably less attention: What
is to become of existing hospital buildings and how will these
facilities need to change to accommodate care delivery system needs?
The question becomes particularly acute because many
health care systems have been cautious about building
new, more-efficient hospitals a hangover effect
from the Great Recession and, instead,
have focused on higher priorities such
as aligning their service lines through
mergers and acquisitions.
PHOTO BY REBECCA LOMAX
Hospitals
repurpose units
as some functions
move off-site
About the HFM /ASHE 2015 Construction Survey

Health Facilities Management (HFM) and the American Society for Healthcare Engineering of the
American Hospital Association surveyed a random sample of 3,414 hospital and health system
executives to learn about trends in hospital construction. The response rate was 16 percent.
HFM thanks the sponsor of this survey: Forbo Flooring Systems.
FEBRUARY 2015
//
15
REPURPOSING
CONSOLIDATION
Hospitals/health system repurposing health care facilities

NOT YET, but we are
currently assessing
space for other needs
TOP FIVE
41%
32%
YES
26%
NO PLANS
to repurpose
our facilities
Repurposing projects
Impact of health
care consolidation
and mergers on real
estate portfolio and
facilities strategy for
the next 2 years
Increase
Stay the same
Decrease
7%
62%
31%
Renovate
facilities
34%
5%
3%
Outpatient facilities
31%
55%
Medical office space
42%
50%
45%
17%
Hospital campus
Move to more
outpatient facilities
16%
Other building types (offices, retail, industrial space, movie theaters)

for medical use
5%
15%
15%
Partnering with for-profit and nonprofit companies specializing in operating a

wide range of health care facilities (i.e., cancer treatment centers, rehab facilities)
TOP FIVE
Areas for repurposing inpatient space
26%
Repurpose
facilities
38%
43%
57%
42%
Build
new facilities
Consolidate
facilities
Administrative/support/ancillary space
21%
Outpatient/ambulatory services
23%
12%
15% 13%
17%
Observation units
65%
72%
Third-party ownership
(leasing)
Sell real estate

and facilities
14%
Behavioral health services

10%
Rehabilitation services
TOP FIVE
SOURCE: HFM/ASHE 2015 CONSTRUCTION SURVEY
Areas for repurposing space in the hospital
To improve workflow, increase patient comfort and

convenience, and reduce the cost of care
19%
Decentralize support services and refocus on the point of care

in the patient room
18%
Expand to accommodate complex diagnostic and treatment areas

17%
Separate public circulation routes from those designed for patients,

staff or materials management
15%
Reintegrate departments around each point of service

13%
Easier future expansion for the most complex diagnostic and

treatment areas of the hospital
SOURCE: HFM /ASHE 2015 CONSTRUCTION SURVEY
16
//
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FEBRUARY
2015

While queries about how to assimilate such fixed

assets and how to optimize building spaces and real
estate portfolios may take a number of years to answer,
results from the Health Facilities Management/American Society for Healthcare Engineering 2015 Hospital
Construction Survey clearly indicate that many hospitals and health systems are or soon will be repurposing
existing space as they continue to move other services
off campus and into their communities.
A higher purpose
More than half of hospitals and health systems are
repurposing space or considering the idea as they
transition to value-based payment models and take the
reins of population health management in their communities, according to the survey.
Nearly 67 percent of survey respondents said they
are either repurposing health care facilities or currently
assessing space for other needs (26 percent and 41
w w.HFMmagazine.com
percent, respectively). Top current repurposing projects

were outpatient facilities at 34 percent, and medical
office space at 31 percent.
Facility repurposing increased slightly for 41 percent
of respondents in this years survey, and increased
greatly for 10 percent of those surveyed.
Construction experts say that the survey results
reflect what they are seeing in the field.
With a focus on population health management,
there is a tremendous move to the ambulatory side,
says Joe Sprague, FAIA, FACHA, principal and senior
vice president at HKS
in Dallas. In years
How organizations
past, we hadnt paid as
are financing
much attention to it in
construction projects
construction, but it is
happening now.
47%
Repurposing existing
Existing cash reserves
space in hospital con30%
struction is happening
Operations
along with thinking
21%
through the best uses
of facilities in the new
Philanthropy
realm of overall pop18%
ulation health, says
Tax-exempt bonds
Patrick Duke, managing
17%
director for health care
services at CBRE in
Bank loans/other debt
Richmond, Va. Theres
7%
the mantra of serving
Federal grants
the population and
7%
keeping people out of
the hospital, Duke says.
Design-build/operate/maintain
How do we do this in
4%
the most efficient manTaxable bonds
ner and make our real
1%
estate an asset rather
FHA 242 program
than a burden?
The online survey of
SOURCE: HFM/ASHE 2015
more than 3,414 hosCONSTRUCTION SURVEY
pital and health system
executives was conducted in October and November.
Perception Solutions prepared the study, which had a
return rate of 16 percent, or 496 completed surveys.
Respondents included general medical and surgical
hospitals (63 percent), health systems (12 percent) and
academic medical centers (7 percent). Some 21 percent
of respondents had 500 or more hospital beds.
Following the plan

Deliberate and careful planning to meet new reimbursement models and revenue challenges is happening at facilities across the country, the survey found. A
quarter of respondents said that their facility master
plan was updated in the past six months, compared
with 19 percent of respondents in last years survey.
Meanwhile, 28 percent said their facility master plan
was updated more than two years ago, down from 34
percent a year ago.
BUDGETS
Percentage of hospitals capital budget allocated
to construction projects (average)
New construction
Facility renovation
2015
34%
34%
2014
33%
34%
2013
33%
32%
2012
32%
2011
15%
2010
38%
2009
17%
2008
21%
30%
22%
Facility infrastructure
21%
21%
18%
19%
14%
35%
16%
25%
NOTE: 2015 DATA BUDGETED. INFRASTRUCTURE DATA NOT AVAILABLE BEFORE 2011
Change in percentage of the hospitals current capital

budget allocated to building projects from previous year
Increase
No change
Decrease
New hospital construction

24%
58%
18%
Hospital renovation
44%
41%
15%
Hospital infrastructure upgrades

45%
44%
11%
Off-site facilities
42%
51%
SOURCE: HFM/ASHE 2015 CONSTRUCTION SURVEY
Thats in line with what we are seeing, says Duke.

The majority of people have updated master plans.
Its around the changing business model and shifting
payment structures that require hospitals to repurpose
their facilities.
Budgeting and implementation of most facility infrastructure projects based on master plans rose slightly
to 28 percent from 26 percent in last years survey.
I think people have finally said, We need to have
a good plan and have a good idea of how to use our
space, Duke says.
Hospital construction is starting to pick up, he adds.
More projects will start to come off the shelf, Duke
predicts. You cannot keep deferring and deferring. You
have to eventually face the music.
While budgeting for new construction has remained
relatively flat, with 33 percent of respondents allocating
their capital budgets to new construction over the past
couple of years, facility renovation and infrastructure
projects are both seeing increases of 2 percent. More-
FEBRUARY 2015
7%
//
17
HEALTH CARE REFORM

Future facility development plans/construction projects
being considered in response to reduced reimbursement
rates and new payment arrangements
Expanded technology to support
registration pre-visit, education
27%
Health system-branded general

medicine and family care centers
throughout the community
24%
Medical office building expansion
22%
Ambulatory surgery centers
22%
Fitness and wellness centers
21%
New medical office building

construction
20%
Immediate care facilities

within the community
17%
Health system-branded clinics in

retail spaces
14%
Flexible, multipurpose post-acute

buildings that can accommodate a
broad spectrum of patients
13%
Freestanding imaging facilities
13%
Rehabilitation centers
12%
Freestanding emergency department
10%
Telemedicine booths (for teleconsultation

and vital signs telemonitoring)
in primary care and specialty care
9%
Remote home patient

monitoring systems
8%
Retail clinics
6%
Intermediate care facilities

(e.g., pediatric, adult)
5%
Impact of reduced reimbursement rates and new

payment arrangements on hospitals construction plans
Definitely will
proceed
Will proceed with

modifications
Re-evaluating
plans
Less likely
to proceed
Definitely will
not proceed
New hospital construction

23%
15%
24%
16%
22%
Hospital renovation and expansion

26%
23%
26%
16%
9%
Hospital renovation without expansion

28%
35%
25%
8%
5%
Hospital infrastructure upgrades

31%
35%
20%
11%
Off-site facilities
25%
27%
27%
18
//
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copyright
FEBRUARY
2015

10%
10%
3%
over, 44 percent of respondents expected capital budgets

allocated to hospital renovations to increase in 2015,
while 45 percent expected an increase for hospital infrastructure upgrades and 42 percent expected an increase
for off-site facilities. This compares favorably against
the respective 15 percent, 11 percent and 7 percent of
respondents who are expecting decreases in these areas.
Still, a full 55 percent of respondents said that facility
infrastructure projects were being done on an as-needed
basis. Duke says this is a bit discouraging. With health
care organizations becoming much larger through mergers and acquisitions, I would hope they would plan for
proper investments that can reduce energy consumption
and contribute to the bottom line, he explains.
Top inpatient functions that are being repurposed
included administrative/support/ancillary space (26
percent), outpatient/ambulatory services (21 percent)
and observation units (17 percent).
Some of the respondents verbatim comments reflect
this activity:
Were having discussions about relocating nonessential services out of [hospital] occupancy space.
As our inpatient census continues to fall because
more is being accomplished in the outpatient setting,
we are pushing forward with plans to create more private patient rooms from existing semiprivate rooms.
Were beginning discussions to master plan those
spaces soon to be vacated and are continuously looking for space for new offices in response to our business growth strategy.
Theres more talk about how to reuse existing
space over building new.
Were looking at using vacant office space for nonclinical programs and re-evaluating flow through our
main building.
Repurposing inpatient space can be a challenge, says
Randy Keiser, vice president and national health care
director at Turner Construction in Brentwood, Tenn.
In four hospitals with which Turner Construction currently works, about 80 percent of inpatient rooms are
in use. But the intensive care unit (ICU) is always full
because hospitals are becoming care centers for the
highest-acuity patients. Some hospitals are attempting
to convert lower-acuity beds, such as medical-surgical
beds, into higher-acuity space, he says.
Ive noticed that when hospitals have extra space, they
try to use it for other purposes, Keiser says. But it is a
challenge to convert a unit into an ICU or critical care
unit because of the technology and space constraints.
Outpatient and community-based facility initiatives
most often considered due to new payment models
included expanded technology to support registration
pre-visit and education (27 percent), branded general
medicine and family care centers in the community
(24 percent), ambulatory surgery centers (22 percent)
and medical office building expansion (22 percent).
Keiser cautioned against drawing major conclusions
nationwide because so much changes from region to
region. He said that states that have accepted federal
funding to expand their Medicaid programs and start
w w.HFMmagazine.com
Economic issues put strain on health care

construction project schedules and budgets
ar fewer hospitals completed construction projects on

or under budget and/or on or ahead of schedule than
were reported in last years Hospital Construction Survey
by Health Facilities Management and the American Society for
Healthcare Engineering.
In fact, more hospital construction projects were behind
schedule or over budget or both than in any year since 2006,
when the survey first began asking the question.
Just 46 percent of respondents completed projects were on
or under budget and/or on or ahead of schedule a big decline
from 64 percent in last years survey and 68 percent the year
before that.
Meanwhile, projects behind schedule jumped from
15 percent in last years survey to 22 percent in this years
survey, and projects over budget jumped from 10 to 15 percent
over the same period. A full 17 percent of projects in this years
survey were over budget and behind schedule, up from 12 percent in last years survey.
Construction experts had some theories about why more hospital construction projects are not hitting budget or timeline goals.
First is the issue of obtaining required labor and raw materials. With the national economy in recovery growing by
5 percent in the third quarter of 2014, the best quarterly growth
since 2003 and unemployment at around 6 percent, construction crews and materials are in high demand.
In 2008, when the recession hit, lots of construction guys
retired or switched to other jobs, says Randy Keiser, vice president and national health care director at Turner Construction in
Brentwood, Tenn. Now, with construction rebounding, people
arent going back into the field. The labor shortages are causing
a lot of overruns.
Joe Sprague, FAIA, FACHA, principal and senior vice president at HKS in Dallas, agrees. In 2009, it was a great time to
insurance exchanges are seeing more activity on the

delivery system side.
We have 52 offices and some are just overwhelmed
with health care work, and others are the slowest
theyve been in 15 years, Keiser says. When you peel
the onion back more, a lot has to do with Affordable
Care Act acceptance. But, in general, everyone has taken a measured look at how they invest their dollars.
Among the investments, medical office building
expansion is happening at a brisk pace because it is a
lower-cost facility construction project, says Sprague.
Medical office buildings are among the most
economical to build, Sprague says. Physicians are
becoming more aligned with hospitals and hospitals
are locating them at points of access. Medical office
is B occupancy, meaning it is about half the cost of
I occupancy a hospital. When you have a limited
number of dollars and are looking to expand capability,
medical office is go-to.
Recently completed projects that are on or

under budget and/or on or ahead of schedule
2012
2013
2014
68%
64%
46%
be in construction if you could afford it because labor and materials were down. Now its booming.
Shifting project plans amid uncertainty about the Affordable
Care Act and reimbursement models are another factor, some say.
I think it has to do with the shifting market, says Patrick
Duke, managing director for health care services at CBRE in
Richmond, Va. There are a lot of people doing very difficult
work, like renovation instead of new construction. A changing
scope midstream could be contributing to the problem.
Thirdly, the life of a project can be quite long, and any
changes can add to the cost or time frame, some say.
I think these findings are in alignment with challenges of
organizations today, says Ted Hood, senior vice president and
chief operating officer at GBA in Franklin, Tenn. What weve
experienced is more along the lines of trying to find ways to do
more with less and sometimes the schedule doesnt allow that.
What are the implications for being over budget and/or behind
schedule? A loss of market share, for one, if a competitor opens a
similar nearby facility sooner. Or an over-budget project could mean
that another important project doesnt receive funding, says Duke.
There are pretty big implications in a highly competitive marketplace that has taken on more retail tendencies, he adds.
Cancer centers also provide value for the dollar, he

adds. Some 18 percent of survey respondents said they
have a cancer center currently under construction or
planned in the next three years. Chemotherapy is mostly done on an outpatient basis, Sprague says. Cancer
care is still right at the top of the list for mortality but,
certainly, more people are looking at surviving now.
In open-ended comments in the survey, facility projects under construction or planned in the next three
years included call centers, freestanding emergency
departments, hospice, wellness centers, mental and
behavioral health facilities, cancer centers, outpatient
surgery and imaging.
Nearly a quarter of survey respondents said that
they have an ambulatory care center currently under
construction or planned in the next three years. And 27
percent said that imaging facilities are under construction or planned for the next three years.
Keiser of Turner Construction is seeing more con-
FEBRUARY 2015
//
19
FACILITIES PROJECTS
Currently under construction
Planned in the next 3 years
Hospital
Acute care
20%
25%
10%
9%
Specialty
6%
6%
Critical access
Outpatient
20%
16%
Medical office building
13%
9%
Ambulatory facility
6%
3%
Long-term care facility
1%
Assisted living facility
3%
Infrastructure
21%
Physical plant infrastructure upgrade 17%
9%
8%
Central energy plant
10%
5%
Parking structure
9%
5%
Data center (information services)
Services/department projects
Imaging
14%
13%
Emergency department
13%
14%
13%
13%
Surgery
13%
10%
Ambulatory care
Interventional suites (surgery + imaging)
Behavioral health services
10%
10%
9%
11%
Cancer center
8%
10%
Laboratory
8%
10%
8%
8%
Cardiology
7%
6%
Womens health/obstetrics
Critical care
6%
6%
Rehabilitation services
6%
6%
Urgent care center
5%
7%
Orthopedics
6%
5%
Isolation/clean rooms
6%
5%
4%
5%
Clinical observation units

Pediatrics
5%
3%
Wound care center
3%
5%
3%
Bariatric care/surgery centers
4%
Telehealth services (i.e., eICU, telepharmacy)
3%
3%
Wellness center
3%
3%
Neurology/neuroscience
3%
2%
Sleep disorders center
2%
3%
20
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2015

struction out in the community as well. The company

currently has 15 freestanding medical center projects
of between 30,000 and 40,000 square feet in three
states Tennessee, Kentucky and Indiana. The facilities will offer imaging, urgent and primary care, and
some specialty care.
There is a considerable focus on the outpatient side
and growing doctors practices, Keiser says.
Nearly a quarter of respondents said that health system-branded general medicine and family care centers
throughout the community are under consideration in
response to recent trends in reimbursement and efficiencies.
Technologys role
Specialty hospital
construction projects
As far as changes to
inpatient care, tech23%
nology is playing a
Childrens hospital
bigger role in facility
21%
upgrades, according to
Behavioral
health center/
the survey.
psychiatric hospital
Ted Hood, senior
21%
vice president and chief
operating officer at GBA
Cancer treatment hospital
in Franklin, Tenn., says
18%
he was not surprised to
Rehabilitation hospital
see more technology at
14%
the bedside and point
of care reflected in
Orthopedic hospital
the survey. Nearly 20
11%
percent of respondents
Heart hospital
said they are decentral11%
izing support services
Womens hospital
and refocusing point
of care in the patient
SOURCE: HFM /ASHE 2015
room, and increasing
CONSTRUCTION SURVEY
the number of services
at the bedside.
Refocusing care in the patient room is about Lean
initiatives and taking the approach to delivery of care
to improve outcomes and efficiencies with the resources they have, Hood says.
Some 30 percent of respondents said building controls/automation systems currently are being upgraded
or replaced in the next 12 months, while 25 percent
said they were upgrading or replacing security systems.
Building controls can improve efficiencies and reduce
staffing needs to save money, Sprague points out.
Twenty-three percent of survey respondents said
they were currently replacing or upgrading nurse
call systems and 8 percent said they will replace or
upgrade nurse call centers within the next two years.
Nurse call systems are very cost-effective ways to
use nursing staff efficiently, Sprague says.
Patient education systems and patient monitoring
systems were also notable trends with 8 percent and
10 percent of respondents, respectively, seeking to
upgrade in the next year.
Telehealth is another area gaining traction for inpatient and outpatient care. While telehealth systems
w w.HFMmagazine.com
INFRASTRUCTURE PROJECTS
Currently replacing/upgrading (next 12 months)
TOP TEN
Plan to replace/upgrade in the next 1324 months
Major building services equipment
28%
10%
20%
8%
15%
10%
Air handlers/ventilation
Plumbing fixtures
and piping
14%
10%
Boilers
10%
Chillers (primary)
25%
23%
Elevators
7%
Major building technology systems
30%
Electrical switchgear/
transformers
17%
13%
TOP TEN
20%
9%
Building controls/
automation system
7%
Security system
(access control and CCTV)
8%
Nurse call system
6%
Fire alarm/protection system
18%
3%
Data infrastructure
(wired, cable)
18%
3%
Data infrastructure (wireless)
13%
8%
Generators
15%
3%
Electronic health record
15%
6%
Exhaust fans
15%
3%
Network infrastructure (e.g.,

LAN, WAN, routers, switches)
16%
5%
Room pressure sensors
10%
4%
Patient monitoring system
6%
Packaged HVAC
10%
4%
Telecommunications
13%
were low on the list for upgrades (just 5 percent of

respondents said they would upgrade/replace in the
next 12 months), about 2 percent said they would add
telehealth within the next 24 months.
Telehealth is another tool to execute a population
health strategy, says Duke. Population health requires
a lot of data and analytics. Then, at the same time,
Building Information Modeling (BIM) use

Hospital capital planning
32% Yes
68% No
Project management
54% Yes
46% No
Facilities operations
45% Yes
55% No
youve got to do it in a cost-effective manner.

Hood says growth outside hospitals, in outpatient
and retail clinics, is driving the trend in part. Its a
natural progression to being able to have direct access
to specialists and do remote consultations for rural
patients, he adds.
Building information modeling (BIM) is allowing facilities to conduct not only capital planning and project
management, but, increasingly, facilities operations.
Forty-five percent of respondents said they use BIM in
facilities operations, up from about 33 percent in last
years survey. BIM for project management jumped from
46 percent in last years survey to 54 percent this year.
BIM for facility management is a growing trend
because of its availability to facility managers once

projects are complete, says Keiser. Nearly all projects
over $10 million use BIM, he adds.
It allows maintenance guys to have a model there
to do operations, he continues, such as ordering new
carpets as needed and repairing equipment. I think you
will see that continue as you see construction using BIM.
Top building service equipment upgrades for inpatient facilities being currently replaced or upgraded in
the next 12 months include air handlers/ventilation (28
percent), electrical switchgear/transformers (20 percent)
and plumbing fixtures/piping (17 percent), according to
the data.
Hood of GBA said that one trend not covered in the
construction survey is integration and interoperability
of technology systems at hospitals. There is a growth
in interoperability, and that allows health systems
to get quantifiable data to help patients, Hood says.
There are a lot of data being collected, and the next
step is making it useful for patient care.
At the forefront
As the economic ramifications of the Affordable Care
Act and market forces continue to work their way
through health care delivery, these considerations likely will remain at the forefront of the minds of health
care facilities planners, designers and builders. HFM
Rebecca Vesely is a freelance health
care writer based in San Francisco. Suzanna Hoppszallern is a senior editor of
data and research for HFMs sister publication, Hospitals & Health Networks.
FEBRUARY 2015
//
21
INTERIORS
The dining area in Oceanview at

Falmouth (Maine) retirement community demonstrates the use of safe
furniture, natural colors and subtle
patterns, and lots of natural daylight.
Settings for
MARY E. TURGEON, AAHID, LEED AP ID+C;

REBECCA DAY DILLON, AIA, LEED AP BD+C; AND
DEIRDRE L. PIO, CSI, CDT
BY
s seniors age, their mobility, senses and

preferences change. They have different
challenges with everyday activities like
eating and walking. They see, hear and
smell things differently and may have strong opinions,
especially about their surroundings.
Designing specifically for senior living communities
must address these physical and emotional changes.
Quality of life
Whether creating a whole community with varying housing and assistance options or designing a stand-alone
22
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2015

building dedicated to one area of care, many senior living communities desire the neighborhood concept.
Distinct neighborhoods generally are made up of
eight to 20 resident rooms or apartments, each promoting resident independence.
Each neighborhood may include shared areas for
interaction, such as a dining room, sitting room, spa,
kitchen, activity rooms, indoor sun porches and outdoor patios and gardens. These social areas are critical
to drawing residents out of their rooms to prevent isolation and depression.
Fighting boredom is essential for improving the quality of life for seniors. It is important that the residents
physical, mental and emotional needs are met. Studies
show that stimulating the mind can help to exercise
not only the body but the brain.
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PHOTO BLIND DOG PHOTO
seniors
Designs to answer
the challenges of
an aging population
Fitness centers are an emerging trend in senior living communities. They include exercise classes, weight
training, therapy pools and cardiovascular equipment.
Research shows that seniors who were cognitively
active were 2.6 times less likely to develop Alzheimers
disease and dementia than those who were not. To
keep the mind sharp, brain gyms are being used by
more senior living communities. These spaces may be
rooms that have computers, mind-challenging games,
hobby spaces or areas where seniors can express creativity by painting, singing and drawing.
Creating a variety of dining options is another way
to engage the resident in a pleasant dining experience.
Who doesnt like to have dining options whether it is
a casual bistro for a burger, caf for soup and salad, or a
formal dining space for a more fine-dining experience?
Other types of social areas include beauty salons,
billiard rooms and sitting rooms designed to bring residents together for an afternoon bridge game, garden
club meeting or a sports event on TV. And cozy, lightfilled, four-season porches that overlook gardens are
conducive for small gatherings.
In the last decade, country kitchens also have been
incorporated into the design of senior living communities. These kitchens are open, available to all residents
and used for group cooking sessions. They may look
like a kitchen in their own homes. In addition, these
can be therapeutic. The aromas can help to stimulate
the residents appetites and evoke feelings of comfort.
Outdoor spaces might include shuffleboard, croquet,
putting greens, walking paths or raised gardens.
Safety and accessibility
Layout,
colors,
textures
and lighting
are factors
in creating
a safe and
effective
healing
environment
for seniors.
Built-in seating
provides rest
spots for seniors
along interior
walking paths at
Seal Rock Health
Cares skilled
nursing facility in
Saco, Maine.
Every design should start with safety as a priority and

it must be balanced with how caregivers can perform,
how homelike the facility feels for residents and their
families, and how well it can be maintained by staff.
Because the functional abilities of seniors are
reduced, they can experience difficulty navigating the

built environment. Seniors may experience weakening joints, poor vision, declining spatial skills, loss of
hearing and frailty, and are at higher risk for falls and
injuries. Layout, colors, textures, lighting and many
other considerations are factors in creating a safe and
effective healing environment for seniors.
Closely related to safety, access into and around the
facility is also important for seniors with mobility issues.
Seniors tend to perceive tile and waxed floors as
being slick whether or not the floor is actually slippery.
This can make them unsteady on their feet. To help
reduce the real or perceived risk of slips and falls,
many health care facilities are minimizing waxed and
tiled flooring and are using nonglare flooring.
There are many other products that are pleasing to
the eyes and easy to maintain vinyl plank flooring
that simulates wood, for instance. With a 20-mil wear
layer and no need for wax, its extremely easy to maintain and works well in homelike environments.
Many seniors shuffle their feet, so it is critical to
create smooth transitions to reduce tripping hazards.
Some flooring manufacturers offer products that eliminate transition strips. For instance, sheet vinyl and carpet can be chemically welded at the seams, eliminating
the transition strip and reducing the tripping hazard.
To make it easier and more desirable for seniors to
keep moving, designers should consider incorporating
indoor walking paths or corridors. These paths should
be wide and free of obstacles. If possible, health care
designers should consider shorter hallways and avoiding dead ends by connecting paths. If there needs to be
an end point, it should be to a destination such as the
kitchen or another common area. Its also a good idea
to provide built-in seating to allow seniors to rest along
the way. Handrails and lean rails can allow a continuous accessible path throughout a building.
It is beneficial to position doors that lead directly to
FEBRUARY 2015
//
23
SETTINGS FOR SENIORS
Acoustics and lighting

Good acoustics means quieter environments, which
reduces stress, anxiety, irritability and confusion for
seniors and others.
To help reduce noise and create a quiet, calming
environment, designers should consider acoustical
ceilings with high noise-reduction coefficients. In some
instances, acoustic wall panels could be added to
reduce noise when reverberations may be too high otherwise, as in most dining rooms.
Ceiling clouds or suspended acoustic panels can be
used in lobby areas where there typically is hard surface flooring. Carpet also can be used to help reduce
noise in common spaces.
Seniors require environments with high lighting
levels because of changes in their vision. In addition to
reducing stress, this will provide a safer environment
for seniors.
Natural light aids vision and also can lift spirits, provide operational savings and help with the connection
to nature. Many senior living communities strive to have
at least one window in each resident room. For semipri-
vate rooms, one window per resident is a great goal. To

increase daylighting, designers should consider skylights
or incorporate half walls to allow natural light to filter
from common areas into interior circulation spaces.
Aging eyes take longer to adjust from one room to
another. Ambient light helps with this adjustment, and
making sure that light fixtures do not flicker or hum
also can aid in senior comfort and safety.
Seniors also struggle with impacts of glare in the performance of everyday activity. If painting walls, health
care facilities should select paint within a specific light
reflective value (LRV) range. The higher the number,
the more light will be reflected. For seniors, the best
paint to select has a 40 to 60 LRV range. Another way
to minimize glare is to choose window shades that provide diffused lighting and eliminate glare.
Lighting during the night also is an important consideration. It is needed to keep seniors safe, but too much
lighting can interrupt residents sleep cycles. To find
the right balance, designers should position hallway
lighting away from resident doors.
Finish choices
While safety is first and foremost in senior design,
emotional cues are important, too. How a community
looks can help families to feel confident in leaving
their loved ones in the communitys care. Residents
themselves want to be in surroundings that are familiar
and comfortable.
Evidence-based design shows a strong connection
between healing and stimulating interiors spaces
that have an interesting use of color, focus on nature
and are not too neutral.
Colors and patterns. Colors are a huge part of
Handrails and nonglare floors with

safe transitions provide fall protection at Gosnell Memorial Hospice
House in Scarborough, Maine.
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2015

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the outdoors in convenient locations, such as directly

off living rooms. These outdoor areas can be secure
and have barrier-free sidewalks that encourage residents, family and staff to go outside. Placing benches
along the paths provides opportunities for rest.
To accommodate hand impairments, designers
should consider different lever handles as well as
graspable grab bars and cabinet pulls. And, because
obesity is expected to be a problem among baby boomers, designers should consider wider door openings
and beds as well as bariatric lifts.
Selecting the right furniture for senior living
urniture has both an aesthetic and functional role

in senior living facilities by providing an appealing environment and also preventing injury.
It should be durable, comfortable, the correct height
and easy to get into and out of even for those with
limited mobility. The layout of the furniture also should
allow for safe mobility, whether the residents can walk
on their own, use walkers or are in wheelchairs.
Health care facilities should select chairs with arms
that allow seniors to lift themselves to a standing position. Furniture set at the proper height and with firm
seat cushions provides assistance for standing upright.
If benches are being used in a facility, they should
have back supports and arms.
Furniture textile selection is important, especially
with regard to maintainability. Designers should select
textiles that are made from environmentally friendly

crypton material to help prevent staining and improve
cleanability from spills and incontinence over time. To
reduce the spread of disease, a moisture barrier should
be provided to prevent bodily fluids from penetrating
into the furniture assembly. For durability, furniture
textiles should have a wear surface of at least 90,000
double rubs to increase the lifetime of the fabric.
Designs for dementia patients should provide
square tables versus round. Square tables not only
define a sense of space for each resident, but they
also provide defined edges to which they can relate.
Designers should also consider selecting contrasting
edge bands for tables. These alert residents that there
is a color change from the edge of the table to the
floor, which helps to eliminate spills.
This common area at Avita of Stroudwater

memory care community in Westbrook,
Maine, provides a comfortable setting with
safe and appropriate furnishings.
aesthetics. Generational preferences and how eyes

perceive colors can vary among age groups. Seniors
typically see 20 percent less color saturation and often
have yellowing of the eye lens, which makes colors
appear yellower to them.
Colors found in nature can reduce stress levels significantly and also promote healing.
Watery shades of beach glass, topaz and blues promote peace and serenity. Blues and green wavelengths
also are easier to perceive, making them more restful.
Earthy shades of rock, stone, terra cotta, espresso and
soil connect residents to the natural world. Wood shades
of soft moss, leaves and lichen promote balance and
harmony. Air shades of linen, white and cream promote
sincerity, hope and spirituality.
Soft colors or colors of similar intensities are difficult
for the aging eye to discern; pastels will appear dull
and sometimes gray to seniors. More saturated hues
are easier for the aging eye to decipher.
Studies indicate that seniors have an aesthetic
appeal toward certain patterns and textures. Designers

should be careful about the introduction of patterns for
wall coverings and carpets though. Subtle patterns that
arent confusing are more appropriate than bold geometric forms or high-contrast graphics.
Its best to select patterns that do not encourage a
perception of visual movement. Patterns can be visually disturbing to aging eyes and can cause agitation.
Designers should avoid big floral patterns, because
these patterns appear to crawl and move. Avoiding
hard edge strips also is recommended because these
patterns appear to vibrate.
Colors as visual cues. Similar-toned walls and floors
make it difficult for aging eyes to see where one surface
ends and the next begins. To help alleviate this confusion and make the environment safer for seniors
contrasting colors should be used. Contrasting colors
between walls and floors, steps and landings, and furnishings and floors help to differentiate between surfaces and planes.
FEBRUARY 2015
//
25
SETTINGS FOR SENIORS

Similarly, designers of senior living communities
should consider introducing pops of color at key activity areas to stimulate the residents and to add definitive
destinations in corridors.
In restrooms, it is important
ABOUT THIS ARTICLE
for residents to see the color difThis feature is one of a
ferential between a white wall
series of quarterly articles
fixture and the color of the wall
published by Health
and floor. This can be accomFacilities Management
plished by introducing queuing
(www.HFMmagazine.com)
in partnership with the
walls that are a contrasting
American Academy of
color to the restroom fixtures.
Healthcare Interior
Some senior communities also
Designers (www.aahid.org).
choose to use bold-colored toilet
seats to help the resident differentiate the plumbing fixtures.
When designing memory
care communities, it is good for
designers to minimize the entry. Any doors that are not
part of the program space can be painted to match the
wall color so they blend in with the corridor. This helps
with wayfinding and minimizes anxiety. Residents can
use their indoor wandering trails without being distracted by a lot of doors.
Artwork. Selecting colorful images to which residents
can relate is a great tool for activity areas.
One option for interior designers is working with
THE BATTLE ONLY STARTS

WITH A CLEAN SURFACE.
local photographers and selecting a theme for the facility. For example, a seasonal theme could show artwork
based on nature scenes that relate to each season. One
neighborhood could be pictured in summer, fall and
spring. This is particularly helpful in memory care
facilities, where familiar images can assist the residents
by triggering memories and helping to spark conversations between caregivers and residents.
Properly attaching the artwork to the wall with
security hangers ensures that it is a safe addition to the
built environment.
Special requirements
Senior living communities have many special requirements that designers must take into consideration.
Considering demographic trends, these requirements
will be challenging to a wide swath of the health care
design community in the coming years. HFM
Mary E. Turgeon, AAHID,
LEED AP ID+C, is principal;
Rebecca Day Dillon, AIA,
LEED AP BD+C, is architect; and Deirdre L. Pio,
CSI, CDT, is project manager at Gawron Turgeon Architects, Scarborough, Maine. They can be reached at mturgeon@gawronturgeon.com,
rdillon@gawronturgeon.com and dpio@gawronturgeon.com, respectively.
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INFRASTRUCTURE
A broken underground water

line can trigger a
cascading effect
by flooding major
infrastructure
equipment located below grade as
well as causing a
loss of water.
High
and
dry
Preparing for hospital

water supply disruptions
BY DAVID STYMIEST,
P.E., CHFM, CHSP, FASHE
he loss of clean, plentiful water can have a huge impact on hospitals and
other health care facilities.
Beyond the hazards of losing water for clinical needs and operational
functions such as instrument sterilization, food preparation and environmental services (ES), a loss of water also could damage or render inoperable crucial medical
and infrastructure equipment.
Fortunately, industry leaders already have participated in broad-based planning
exercises to help health facilities professionals expand their own emergency water
supply plans (EWSPs).
PHOTO GIOREZ/FOTOLIA
Comprehensive approach
One recent analysis identified 15 different
potential causes of water disruption, and
hospital facility directors and emergency
managers have a broad swath of scenarios
to consider.
While it sounds counterintuitive, for
instance, wastewater disruption often will
result in incoming water disruption as
well. If the community sewer system fails
in the vicinity of a hospital due to a power
outage, the community likely will request
that large water users stop discharging
water. This can result in water disruption if a hospital does not have sufficient
wastewater storage capabilities.
An extra issue that often comes into
play with water disruptions is cascading

failures. For instance, water failures also
can result in electrical blackouts, such as
when a water main break floods electrical
distribution equipment.
A simplistic plan for water disruption
may merely mention that tap water and
ice are unsafe for consumption. This will
suggest acquiring bottled water, placing do
not drink signs on drinking fountains and
the like. However, a more comprehensive
approach will consider the broader impact
of more than just the loss of drinking water.
Water has many more uses in a hospital
that must be considered when planning
for a shortage, including hand washing
and hygiene, food service, laundry, central
services, cleaning and infection prevention, and decontamination and hazardous

materials response as well as patient care
needs like bathing and flushing toilets.
Infrastructure and medical equipment
dependent on water include radiology,
fire-protection sprinkler systems, watercooled medical gas and suction compressors and HVAC systems, among others.
Extra temporary backup water supplies
also may be needed for rinsing contaminated devices, dialysis, labor and delivery,
emergency departments (EDs), critical
care units and for eyewashing functions.
Water supply planning

The 2012 Centers for Disease Control
and Prevention (CDC) Emergency Water
Supply Planning Guide for Hospitals and
Health Care Facilities is an excellent reference for water shortages.
The guide recommends that a typical
EWSP team consist of internal representation from facilities management; administration or management; environmental
compliance, health and safety; infection
control and prevention; risk management;
nursing; medical services; emergency
FEBRUARY 2015
//
27
HIGH AND DRY
management; and security. Recommended external partners include local public

water departments, state drinking water
agencies, local public health departments,
local fire departments and the local
department responsible for water reclamation and purification.
At a minimum, EWSP preparation
should include assembling the team and
background documents, understanding
the issues of water use, analyzing emergency supply alternatives, developing the
facilitys plan and then regularly exercising
the plan. The minimum recommended
elements
ONLINE RESOURCES
of a comFor additional resources
prehensive
used by the author, view
plan include
the online version at
a facility
www.HFMmagazine.com
description, water
supply, water demand, pertinent facility
drawings, equipment and materials lists,
a backflow prevention plan, a description
of the maintenance plan (including valve
exercising) and copies of all contracts and
memoranda of understanding.
It also should include lists of EWSP
alternatives, operational protocols such as
water treatment and testing, implementation timelines, the plan for recovery, a plan
for post-incident surveillance and processes for evaluating and improving the plan.
Managing backup water

While some hospitals have installed
underground wells or on-site water storage tanks to provide a backup source of
28
//
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FEBRUARY
2015

water, many hospitals plan to acquire

replacement water from bottled water
suppliers. If so, procedures should specify
how much prior notice is needed to obtain
the required quantities.
Replacement water delivered via water
pumper trucks or tankers will require
external connections to the campus internal water system. The external connections should be near accessible locations
where a diesel truck engine can run 24/7
without impacting indoor air quality.
A hospital should have a clear understanding of both the initial demand and
the reduced emergency demand for
potable water and non-potable water. For
instance, a peer-reviewed paper by the
American Water Works Association questions the usefulness of tanker trucks as the
only source of emergency water depending upon the water needs of a hospital,
citing both over-the-road tanker truck size
limitations and the possibility that numerous hospitals in the same localities may
rely on the same emergency source.
According to the EWSP guide, shortterm alternatives of less than eight hours
often include bottled water for drinking,
five- and 10-gallon containers for food
preparation and hand washing, barrels for
flushing toilets and backup plans for potable and non-potable needs.
The recommended alternatives for
more than eight hours include all of the
short-term measures along with storage
tanks and identification of other nearby
sources, including tanker trucks and
bladders for storage. Organizations need
to determine whether water treatment

will be required because water treatment
can trigger many regulations requiring
detailed planning and training.
Emergency water storage can include
on-site water towers, pillow tanks, bladder tanks, onion water tanks and pickup
truck tanks.
The EWSP should be tested regularly for
different water-loss scenarios and an annual tabletop may be appropriate because of
the response details that come into play.
Exercises should include external partners
such as the local water department, health
department, fire department and environmental protection officials.
The Environmental Protection Agency
has published some tabletop water-loss
exercises such as biological or chemical
contamination of the water supply, a
water tank security breach, the hacking
of a water department control system and
other scenarios.
Establishing water quantities

When determining essential functions
that require water, an organization should
consider its seasonal water needs under
normal operating conditions in gallons
per day or gallons per adjusted patient
day; whether a process is mission-critical;
whether there are waterless alternatives;
what the reduced water needs might be
under a water restriction situation; and
whether the water use is essential to
specific operations. Operations requiring
levels of water usage that may not be
possible must cease and the EWSP should
w w.HFMmagazine.com
FROM LEFT: PHOTO BY ALAN SHEARER/CAMC MATERIAL HANDLING CENTER; PHOTO COURTESY OF READY CONTAINMENT LLC
Staff filled oneand five-gallon

containers from
a water tanker
parked outside
Charleston
(W.Va.) Area
Medical Center
Health Systems
General Hospital
during a water
emergency last
year.
PHOTO COURTESY OF HUSKY PORTABLE CONTAINMENT
Temporary
water storage
tanks may also
require temporary
pumping and
water distribution
devices.
consider how the organization would deal

with that eventuality. The audit should
consider the three basic types of water
needs in hospitals bottled sterile water,
potable water and non-potable water.
There are many options for conserving
water, including canceling elective procedures, limiting radiology developers to
essential use, using waterless hand-hygiene
products, sponge-bathing patients, using
disposable sterile supplies, transferring
noncritical patients to other facilities,
limiting the number of ED patients, using
single-use dialyzers or suspending hemodialyzer reuse, postponing hydrotherapy
and even shutting off the water supply to
noncritical buildings. A California Hospital
Association document, Guidelines for
Developing Best Practices to Assist California Hospitals in Preparing for and Responding to a Water Disruption, also includes
recommendations for reducing water usage
of some common hospital equipment.
Facilities professionals should have an
accurate inventory of flush valve locations
and riser valve locations because they may
require emergency attention. Water inventories also are required for any equipment
that must be disabled and have warning
signs affixed during the incident, including ice machines, coffee machines, soda
machines and dishwashers.
It also may be necessary to inventory pre-sterilized items and instruments
because local sterilization equipment
steam and water valves may need to be
closed. The organization may need a backup facility plan for decontamination and
Large bladder
tanks can
be placed in
many different
locations for
temporary use
provided there is
sufficient protection and security
for the hospitals
temporary water
supply.
sterilization depending upon the scope

of the disruption. This should include
training on preparing contaminated instruments for shipment to another facility.
Areas of planning
A water failure affects an entire organization and appropriate response plans are
required throughout the facility. Specific
areas of planning include:
Facilities. The impact of water disruption on mechanical, plumbing and fire
protection systems includes domestic
water booster pumps, domestic hot water
pressure booster and recirculation pumps,
fire-protection sprinkler systems, backflow preventers, cooling towers, boiler
systems, steam boiler deaerator systems,
closed-loop makeup water feeds and
closed-loop pumps.
Facilities management and maintenance professionals also should consider
the impact on other worker safety equipment such as plumbed mechanical plant
safety showers and eyewash stations.
Because the loss of water usually
restricts sanitary sewer usage, there are
well-known considerations for dealing
with those restrictions. Among them are
using small red bags under the patient
toilet seats along with effective procedures
to control, collect and replace the bags;
using portable toilets in selected locations
for staff and visitors; having temporary
signs premade for immediate posting; and
clear and rapid communication.
Direct care. There are direct patient
care impacts to consider in addition to
drinking water, ice machines and bathroom-related services.

Laboratory contingency plans should
include shutting off all domestic water connections to laboratory equipment, whether
or not it is connected to emergency power,
as well as using distilled water for tests
and for cleaning up spills. Using off-site
labs presents its own set of management
issues, including courier management
and notifications to units about modified
response times. Additionally, plumbed
safety showers and eyewash stations will
not be available during the incident.
Medical imaging and surgical departments also are likely to be affected by a
water disruption and may choose to cancel
elective procedures. Digital imaging systems may be less affected than traditional
imaging systems during a water disruption
unless the disruption reduces the ability to
cool the imaging equipment. Surgery may
experience an ED surge depending on the
cause or results of the disruption.
ED plans should include dealing with
incoming cases such as hazardous chemical exposures requiring extensive cleanup
or decontamination of the patient, staff
and facility with limited water supplies.
Indirect care. The effects of water disruption on dietary services may include
the need to close water valves to cleaning
and rinsing equipment, convert to paper or
plastic service, and perhaps even change
menus. The organization needs to consider
that an increase in solid waste probably
will affect the ES workload. ES also must
continue with its important patient care-
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HIGH AND DRY
Utility failures affecting

hospital water supplies
ospital water utility failures

can be triggered by literally
hundreds of unforeseen events.
Here are some of the more common
scenarios:
Municipal water line failure. This
can result from aged and/or poorly maintained municipal water infrastructure,
power failures affecting municipal water
pumping stations, or construction or
demolition activities.
Municipal boil water order. This can
result from a municipal water line break
or leak that depressurizes the municipal
water lines, or power failures affecting
municipal pumping stations or water
treatment stations.
Irrigation water line failure. This
can result from excavation, vehicular
traffic over unprotected underground
piping, or simply failure of aged underground piping.
Loss of domestic water booster
pumps. This can result from mechanical
pump failure, power failure or control
system failure, and construction or demolition activities in the vicinity.
Failure of water softener. This can
result from mechanical equipment failure, power failure or control system failure as well as construction or demolition
activities in the vicinity.
Contamination of potable water
system. This can result from a municipal
system event. It also can result from any
internal loss of water pressure because
depressurized water systems should
related cleaning processes because of infection prevention issues; however, it may limit most mopping of spills in common areas.
ES should have to plan for higher quantities
of red bag and other solid waste. Again, a
reduction of eyewash stations can have an
effect on the safety of ES activities.
Materials management and central
supply departments may obtain backup
water, ice, trash bags, trash receptacles,
red bags and waterless hand cleaner from
prearranged contracts with multiple suppliers. This process will be more difficult
if the water disruption has a broader
impact than just one or two facilities.
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be presumed to be contaminated until

steps have been taken to remove the
possibility.
Domestic water line rupture or
leak. This can result from aged water
infrastructure, construction or demolition
activities, or other types of nearby utility
failures that damage these water lines.
Domestic water storage tank rupture or leak. This can result from aged
water infrastructure, construction or
demolition activities, or other types of
nearby utility failures that damage these
water lines.
Fire-protection water storage tank
rupture or leak. This can result from
aged water infrastructure, construction
or demolition activities near the storage
tank, or other types of nearby utility failures that damage the storage tank.
Fire sprinkler-head damage or
sprinkler-line rupture. This can result
from aged water infrastructure, construction or demolition activities near the
sprinkler line or head, or other types of
utility failures that damage any portion
of the sprinkler system.
On-site fire hydrant damage. This
can result from excavation, vehicular
traffic near the fire hydrant or failure of a
component.
Waste line rupture or leak. This
can result from aged waste line infrastructure, construction or demolition
activities near the waste line, or other
types of nearby utility failures that cause
damage.
Failure procedures
Robust water failure procedures should
provide details addressing water services,
cross-connects, service areas and systems, storage tanks and booster pumps.
Details should address summer and
winter usage. Instructions should include
locations and coverage areas for water
shutoffs along with tools to operate the
shutoffs. Procedures should address which
water systems and subsystems are for
potable, non-potable, fire-protection and
multipurpose water. They also should
indicate which water service connections
would need to be operated to mitigate the
impact of a sewer line break or a sewer

line backup.
A robust water failure procedure also
should include the level of pressure
drop that triggers the procedure, and
whether and to what degree a procedure
is triggered by broken hydrants, irrigation
lines or sprinkler heads; the loss of
one or multiple booster pumps or the
water softener system; tank failures;
and municipal boil water orders. The
procedures should address the impact of
fire-protection water failure on life safety
and the impact of potable water failures
on infection prevention.
The water failure procedure should
indicate where and how to internally
and externally report the failures, which
valves are needed to localize the outage,
and the impact on other utilities, areas
and services. The water failure procedure
also should include instructions for purging lines so recovery proceeds without
adverse impacts. Appliances and other
equipment such as coffee machines, ice
machines, water fountains, dishwashers, soda machines, portable dialysis
machines, reverse osmosis systems and
lawn sprinkler systems may require special treatment.
Recovery from a water disruption may
be more difficult than recovery from other
types of utility failures because the loss of
water pressure makes it necessary to flush
water lines for decontamination before
they are used again.
Recovery is a time-consuming, floor-byfloor process and shortcuts can be counterproductive. Thus, preparedness should
require a robust inventory of the valves
and outlets needed for system flushing as
well as the air bleed points. Organizations
may decide to have an extra supply of
flush valve kits on hand for replacement
of damaged or contaminated equipment.
Extra water filters also should be available.
A vital service
Hospitals and health care facilities are as
dependent on water delivery as they are on
any other important utility. A comprehensive plan to deal with interruptions of this
vital service is equally important. HFM
David L. Stymiest, PE, CHFM, CHSP, FASHE, is a
senior consultant at Smith Seckman
Reid Inc., Nashville, Tenn., specializing in facilities engineering and regulatory compliance. He can be reached
at DStymiest@SSR-Inc.com.
w w.HFMmagazine.com
BY
NEAL LORENZI
Finer fixtures and fittings
Maintaining control // The digital thermostatic technology used in this faucet offers
advanced flow control combined with precise
temperature control and bacteria resistance.
Rada, a Kohler company
Plumbing products address

infection prevention, water
conservation and more
ealth facilities professionals

must weigh a number of
considerations when selecting plumbing fixtures and
fittings. Infection prevention, conservation
and accessibility as well as meeting the
needs of the growing number of bariatric
patients are all part of the specification
equation.
In addition, there is a move away from
typical commercial-looking products.
Health care providers are seeking plumbing fixtures and fittings with a comforting
aesthetic that make patients feel at home.
Reliability, durability and lower lifetime
costs also are priorities.
With economic pressure on the health
care industry, hospitals have a heightened
awareness of areas that can be managed

better to control costs and improve the
patient environment. Plumbing fixtures
and fittings ultimately play a part in
meeting both of these goals.
Barriers to infection
The CuVerro line of antimicrobial sinks
from Elkay Commercial, Oak Brook, Ill.,
is a good example of how copper-based
materials provide the best solution for
infection control, according to Gary
Israelson, product manager for commercial faucets at Elkay. We see an increase
in copper-based products in hospitals.
This material kills 99.9 percent of the
following bacteria within two hours of
exposure: Methicillin-resistant Staphylococcus aureus, Enterobacter aerogenes,
Pseudomonas aeruginosa and Escherichia
coli 0157:H7. Copper-nickel material continuously kills bacteria, he says.
Providing another example of infection control, Zurn Industries LLC, Erie,
Pa., has developed the EcoVantage with

SilverShield antimicrobial technology for
plumbing surfaces. It features a permanent antimicrobial glazed ceramic surface, which inhibits the growth of stainand odor-causing bacteria, mold and
mildew. Suitable for health care environments, the EcoVantage product line with
SilverShield improves sanitation while
minimizing the need for harsh chemical
cleaning, the company states.
Another fixture designed to address
hygiene is the IC Sink & Faucet System
from American Standard Brands, Piscataway, N.J. It is designed to reduce
splashing when a patient, doctor or nurse
is washing his or her hands, which can
transmit germs in a hospital room.
The sink has a sloping back and an
offset drain to prevent the water from
splashing when it hits a horizontal surface, says Tony DAmato, product marketing manager for commercial fittings.
The drain is designed with a sealed
FEBRUARY 2015
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FINER FIXTURES AND FITTINGS

Falling away // The
IC hand-washing sink and
faucet system minimizes
splashing by allowing the
water stream to fall gently on
the deeply sloped back wall
of the hand-washing sink
and away from the grid drain.
American Standard
Surface
safety // The
Setting limits // The heavy-duty MDura Bedpan

Washer is built to withstand the most demanding health
care environments and designed to limit the spread of
damaging bacteria in patient rooms. Moen Commercial
overflow to eliminate an area for water

to set and stagnate. Also, a permanent
antimicrobial surface inhibits the growth
of stain- and odor-causing bacteria, mold
and mildew. The system also features
a hands-free faucet with a laminar flow
restrictor in the spout base to prevent air
from mixing with the water, and a plain
spout end to eliminate areas where minerals and debris can build up and allow
germs to grow.
Taking a different tack, AcornVac Inc.,
Chino, Calif., manufactures a vacuum
plumbing system that eliminates flush
overspray and mist that can contribute to
the spread of bacteria. Recent scientific
evidence suggests that the plume created
by gravity toilets can become airborne
and cause additional infection control
concerns. AcornVac toilets eliminate this
plume, thus preventing the migration of
germs and disease from the toilet bowl
into the surrounding atmosphere, says
Tom Zinn, engineering director.
The system also allows plumbing renovation without the need to route waste
lines with a continuous slope. As a result,
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EcoVantage with
SilverShield antimicrobial technology
features a permanent
antimicrobial glazed
ceramic plumbing surface. Zurn
Industries LLC
existing real estate with limited drainage

soap dispensers, and cleaning and fixing
easily can be converted to address the
broken faucet handles. Another trend is
needs of health care facilities, which typthat hand-washing fixtures have evolved
ically have significant drainage requireinto very clean, streamlined shapes that
ments. Because the AcornVac drainage
evoke a modern and sophisticated sensisystem maintains piping under a continbility, Haas says.
uous negative pressure, it virtually elimiHowever, it can be cost-prohibitive to
nates potential for the spread of infection
install sensor-operated faucets in every
due to leaking pipes or fittings.
patient room or doctors lounge,
MORE ONLINE
The system also provides an
according to Sarah Lindegarde,
Learn more about
opportunity for easy deconsenior product manager, Moen
these products at
tamination of the waste stream
Commercial, North Olmsted,
www.HFMmagazine. Ohio. Thats why Moen Combefore it is released to the pubcom/solutions
lic sewer system, Zinn adds.
mercial offers a specialty line of
Another equipment trend in
faucets, MDura heavy-duty colthe battle against infection and cross-conlection, to fit within a facilitys operating
tamination is touchless fixtures such as
budget. The faucets include a smooth-hansensor-operated faucets, flush valves,
dle design, without gaps or crevices,
soap dispensers, hand dryers and bedpan
which makes them easy to clean. The
washers, according to Will Haas, product
line also includes a bedpan washer.
manager, Bradley Corp., Menomonee
Similarly, there is a shift away from
Falls, Wis. Hands-free fixtures minimize
sensor-operated faucets in certain areas of
contact with germs on surfaces such as
the hospital back to mechanical-operated
doorknobs and countertops.
faucets, according to Elkays Israelson.
These fixtures also cut down on mainToday we see more surgeons looking for
tenance time spent refilling paper towel
a constant, uninterrupted flow of water
dispensers, emptying waste bins, refilling
when scrubbing up. The scrub process
w w.HFMmagazine.com
Clearing
the air //
Vacuum flush
toilets, which
come in wall- or
floor-mounted,
bariatric and
ADA-compliant
models, provide
a more sanitary
environment
by eliminating
flush plumes.
AcornVac Inc.
Nowhere to hide // Solid-surface

material used in the HS-Series Terreon
Undermount Basins features smooth,
seamless, nonporous and easy-to-clean
finishes that do not harbor bacterial
growth. Bradley Corp.
Extra protection // This

lavatory undermount sink is
made with CuVerro antimicrobial copper for added infection
protection. Elkay Commercial
takes several minutes and most sensor

faucets have a time-out feature that causes
the units to turn off during washing. Also,
surgeons want the water temperature to
remain constant. Sensor faucets can have
different temps depending on the type of
temperature valve being used, he notes.
Water savers
Water conservation is another major focus
in plumbing fixture and fitting development, according to vendors that supply the
nations hospitals. Water-conserving fixtures such as high-efficiency toilets use less
water to flush waste while dual-flush toilets
conserve water by using different amounts
of water depending on flushing needs.
Most models use 1.6 gallons per flush for
solid waste and 0.8 gallons for liquid waste.
For even greater water savings, ultralow-flow toilets and waterless urinals
may be used, while sensor-activated flush
meters can help to control water use at
peak times, says Bradleys Haas. Tankless water heaters concealed within the
pedestal of lavatory systems are another
way to increase efficiency. Tankless units
heat only the amount of water needed for

each use, which cuts down on electricity
usage by not heating an entire hot water
tank for restrooms.
Rada, a Kohler company based in
Kohler, Wis., features a line of digital thermostatic faucets and showers that combine
water conservation and safety, says Tim
Schroeder, sales engineer. Circulating temperatures, water velocities and water age
are key factors in maintaining a safe condition in a hospital plumbing system, he
explains. At low consumption, the velocity
is low and temperatures throughout the
system can fall out of recommended ranges. Low consumption can cause water to
remain in the system, which allows the
residual disinfectant to dissipate.
The Rada system allows hospitals
to maintain low usage during normal
operations. It is possible to customize
the schedule, flow rate and duration to
the specific building design and usage
pattern, which allows for high velocities,
using just enough water per application.
By integrating the thermostatic control
into the faucet, we eliminate the need for
a separate ASSE International 1070 or

1016 device, allowing full-circulation temperatures to be delivered to the end-use
fitting, Schroeder explains.
Taken further, Vic Hines, senior field
technical services representative, Charlotte (N.C.) Pipe and Foundry Co., says,
Depending on the budgets, we are
starting to see some health care facilities
using rainwater or treated gray water
for non-potable water uses everything
from irrigation to cooling tower water
make-up to water for flushing toilets and
urinals. Charlotte Pipe offers ReUze, a
pipe designed for non-potable water that
meets most local codes for pipe color and
required markings, he notes.
Fostering accessibility
Designing barrier-free and bariatric fixtures is another goal of plumbing equipment manufacturers. Achieving minimum
requirements of the 2010 Americans with
Disabilities Act (ADA) Standards for Accessible Design is the key. Common issues
include toilets located too far from the
wall, grab bars placed in areas that are
FEBRUARY 2015
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FINER FIXTURES AND FITTINGS
hard to reach and deep sinks with minimal knee space underneath the basin.
Bradley Corp. recently introduced the
HS-Series Terreon Undermount Basins,
multipurpose plumbing fixtures that
achieve a high-design aesthetic in health
care settings. The all-inclusive undermount basins are ADA-compliant and
feature a clean, flat-bottom design for
general hand washing or multipurpose
use. They are constructed with durable,
nonporous Terreon solid-surface material,
so the basins are repairable to their original finish and do not harbor bacteria.
Flexible bathroom equipment is another growing trend that aids accessibility.
Many hospitals are standardizing on
single-patient rooms, including rooms
that can be adapted to meet the needs
of each specific patient. Thus, adaptable
bathroom equipment is becoming more
of an attractive solution, says Gary David
Nowitz, president, Pressalit Care North
America, East Dennis, Mass. For example,
using height-adjustable mounting systems,
a bathroom might first be customized to
Durable design // ChemDrain CPVC pipe
and fittings are designed for chemical waste drain

systems and offer a safe, durable, easy-to-install
alternative. Charlotte Pipe and Foundry Co.
handle an orthopedic patient, and then

quickly reconfigured to handle the next
patient who might be wheelchair-bound.
Pressalit recently introduced the Matrix
sink, which can be wall-mounted in a fixed
height or mounted on a wall track. This
enables the user to reposition the sink
AMERICAS HEALTHCARE
PROFESSIONALS
STAND BEHIND
THE MIGHTY BADGE
vertically and laterally. This is especially

important to meet postoperative needs of
the elderly or people with physical disabilities, says Nowitz. Secondly, it has molded-in grasping handles along the front and
sides. This is helpful for people with arthritis, who have balance problems or who are
unsteady on their feet after an operation.
Designing a restroom to meet minimum ADA standards doesnt take into
consideration positioning dispensers,
trash receptacles and supply tables to
allow space necessary for obese patients.
Recessed dispensers and receptacles can
minimize the footprint in these areas.
Adding touchless temperature controls
with high-contrast graphics and visual
feedback to faucets, as well as ADA-compliant controls on showers and slide bars,
can improve accessibility and safety.
Durable duty
Finally, manufacturers have unveiled a
number of plumbing fixtures and fittings
that offer improvements in durability.
Among them is the MPower sensoroperated faucets from Moen Commercial
featuring a sentinel flow option that purges the waterway 24 hours from the last
use, and a cleaning mode that enables
temporary sensor deactivation for cleaning and maintenance. Also, laminar-flow
kits are available for increased sanitary
protection and an optional temperature
mixing lever allows facilities to customize
the flowing water temperature.
Charlotte Pipe and Foundry Co. produces
a CPVC laboratory waste product called
ChemDrain that is widely used in hospitals.
It provides a corrosion-resistant system
with high-temperature handling capability,
along with an easy installation method.
Hospital maintenance and facilities personnel like working with the ChemDrain
system, which requires only common tools
and pipe fitter skills to install, says Hines.
Plenty of options
Did you know that 84% of patients connect more easily with heath care professionals who wear
name badges? Theres a reason over 2 million professionals prefer our name badges. Project your
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Source: Social Science Research Solutions (SSRS)
As these technological innovations

demonstrate, health care facilities managers have plenty of options to choose from
when it comes to selecting and implementing plumbing fixtures and fittings,
and even more to look for in
the years ahead. HFM
Neal Lorenzi is a freelance health
www.themightybadge.com
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2015

care writer based in Mundelein, Ill.
w w.HFMmagazine.com
Providing operational value

with hospital commissioning
ospitals are facing increasing pressure to cut operational expenses, and facility professionals are often
charged with finding ways to improve the bottom line.
One key way that facility professionals can provide
value to their organizations while demonstrating their own value
is through the commissioning process.
The commissioning process for buildings ensures that a facility
Deanna Martin
operates as it is designed to operate. The commissioning process
helps organizations to achieve results when building a new facility
or making changes to an existing facility.
Commissioning can be done during new construction, and existing facilities can be retrocommissioned. Its important to note that
all commissioning processes are not equal. In 2010, ASHE published
the Health Facility Commissioning Guidelines the first commissioning guidelines specifically tailored to health care facilities. In 2012,
ASHE published a companion book called the Health Facility Commissioning Handbook. This step-by-step guide provides information
on implementing the ASHE commissioning process.
A recent ASHE publication called Commissioning Insider was
sent to all members. It explains the ASHE commissioning process
and also provides snapshot examples of hospitals that have saved
through commissioning.
Saint Thomas Midtown Hospital in Nashville, Tenn., conducted a
retrocommissioning project that examined all major systems, occupied/unoccupied controls in operating rooms, programming, and
the building automation systems (BAS). The majority of the project
was completed without the need for capital funding, and immediate
cost savings were reinvested into new commissioning projects. From
2008 to 2012, the facilitys Energy Star rating increased from 13 to
72. Annual energy cost savings exceed $1.8 million, and cumulative
program savings are more than $7 million.
The
Texas Childrens Hospital in Houston conducted an energy audit
commissioning
and retrocommissioning project. The commissioning agent wrote the
process helps facilitys strategic energy plan and developed standards for HVAC
designs and BAS graphics. Actual energy cost savings exceed $1.6
organizations
million annually.
to achieve
Commissioning Insider includes additional case studies, articles
results when
and a handy matrix that shows the recommended scope of work for
building a
various types of commissioning projects, large and small.
Commissioning Insider is available on the ASHE website at www.
new facility
ashe.org/resources. The ASHE guidelines and handbook are available
or making
at www.ashestore.com. ASHE also offers an educational course on
changes to an commissioning and more information about that program is availexisting facility. able at www.ashe.org/learn.
Deanna Martin is the communications manager for ASHE.
ASHE
INSIGHTS
Important monographs
available from ASHE
Following are two recently
released monographs that can
be accessed by ASHE members as free PDFs at www.ashe.
org/resources/management_
monographs.
Life Safety Code Comparison. The 2012 edition of the
National Fire Protection Associations Life Safety Code offers new
design and compliance options
for health care facilities that
didnt exist in previous editions. It
provides an exhaustive list of the
changes in the new edition and
a detailed comparison with the
2000 and 2009 editions.
Managing Hospital Emergency Power Systems: Testing, Operation, Maintenance, Vulnerability
Mitigation, and Power Failure
Planning. Hospitals must take a
holistic approach to emergency
power systems, blending utility
management with emergency
management and infrastructure
master planning. This monograph
describes a complete EP system
management program intended to
satisfy these needs.
Design guidelines available

to industry through ASHE
The 2014 editions of the Facility
Guidelines Institutes Guidelines
for Design and Construction of
Hospitals and Outpatient Facilities
and the Guidelines for Design
and Construction of Residential
Health, Care, and Support Facilities can be purchased at www.
ASHEstore.com.
American Society for Healthcare

Engineering // www.ASHE.org
FEBRUARY 2015
//
35
Getting CHESP certification

helps us and our profession
Lisa Ford, CHESP
It is essential
that we
challenge
ourselves to
be the best
in our field.
e did not all go to college thinking we would

graduate to become environmental services (ES)
managers or supervisors. We somehow advanced
into this great profession by starting in a parttime housekeeping job or went to school for some other type of
management.
I had gone to school to learn hotel, restaurant and institutional
management and wanted to work on a cruise ship. When I found
out that I needed to have a talent like singing or dancing to work on
a cruise ship, I quickly realized it was not an option.
During my senior year of college, I interviewed for a facilities
management position in a hospital, which in ES terms meant
housekeeping supervisor. I was prepared for some aspects of
the job, but soon realized that there would be a lot of on-the-job
training. I was at my first hospital for six years, then got my first
position as an ES director in a long-term care setting. Once again, I
received a lot of on-the-job training. I soon became familiar with the
Certified Healthcare Environmental Services Professional (CHESP)
exam and certification. I took the practice exam, but did not pass it.
I soon moved into an ES director position in a hospital. I found
myself involved in the environment of care, infection prevention
and the hospital budgeting process. I was gaining a lot of practical
knowledge in our field and had been through a few tough inspections at this point in my career. Again, I decided to take the CHESP
exam, this time passing with a high score.
Throughout my career, I have attended many AHE conferences
and started to value all of the education that our profession offers. I
also found it an honor to have the letters CHESP behind my name.
This is something that we did not always have and we should
value it. I recently visited with a hospital manager I had never
met before who asked me, What are your credentials? I proudly
answered, I am a Certified Healthcare Environmental Services Professional with 21 years of health care environmental services experience. I was so happy that I actually had earned credentials.
I am so proud to be part of the ES profession, but feel that having the certification stresses the importance of the work that we do
in health care facilities. My message to everyone today is that our
profession is becoming more technical and more demanding. It is
essential that we challenge ourselves to be the best in our field.
If you are already CHESP-certified, congratulations! Be sure to
renew your certification every three years. If you are not a CHESP, I
challenge you to go for it.
AHE
INSIGHTS
Valuable resources available
AHE represents, defines and
advances the professionals responsible for care of the health care
environment to ensure high-quality
outcomes and healthy communities. Following are a few of the
resources that AHE offers.
Recommended Practice
Series: Environmental Services
Equipment and Supplies. The
equipment and supplies covered
in this booklet are essential, discrete components of safe, efficient
and productive environmental
services (ES) operations. For more
information, go to www.ahe.org/
ahe/learn/tools_and_resources/
publications.shtml.
Practice Guidance for
Healthcare Environmental Cleaning, second edition. This manual
provides evidence-based research,
guidance and recommended practices that should be considered
for inclusion in health care ES
departments. Because each health
care facility has its own needs,
this resource has been designed to
enhance an existing program. To
access it, log on to www.ahe.org/
ahe/learn/tools_and_resources/
publications.shtml.
AHE Environmental Sustainability Certificate Program. AHE
has launched a new certificate
program to acknowledge the
ongoing and outstanding environmental and ecological sustainability efforts of ES departments.
For more program information,
go to www.ahe.org/ahe/lead/
environmental_sustainability_
certificate_program.shtml.
Lisa Ford, CHESP, is corporate environmental services director and Sodexo general manager of Our Lady of
Lourdes Medical Center, Camden, N.J., and an AHE at-large board member.
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Association for the Healthcare

Environment // www.AHE.org
w w.HFMmagazine.com
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BY
ED AVIS
Building a flexible future

Strategies for keeping
health facilities relevant
hen the design professionals at Hammel, Green

and Abrahamson (HGA)
were contemplating the
infrastructure needs of the University of
Minnesota Masonic Childrens Hospital
during a renovation earlier this decade,
they did not just think about the facilitys
immediate needs. They also looked years
into the future.
The existing plant was from the 1890s,
and we had to take a large step back to
make sure the mechanical and electrical
systems would work for today and for future
expansion, says Krista McDonald Biason,
PE, associate vice president of HGA.
Planning for potential future needs,
such as HGA did with Masonic Childrens,
is becoming increasingly critical in todays
changing health care environment.
Money is scarce today, so the discussion of flexibility is becoming more
important, says Jeff Harris, PE, director of
mechanical engineering for HGA. Hospitals want to get more bang for the dollar.
It is that unpredictability that is driving

health care organizations to be flexible,
because it does not make sense to spend
$100 million on a building that may be
made obsolete by changing conditions.
And with reimbursement changing in
ways that are not yet fully realized, organizations fear that todays investment
may become a liability under a different
payment structure.
Changing landscape
Location and beyond
The changing nature of health care reimbursement, a growing senior population

and general trends in health care all are
driving the need for more flexible facilities.
Designs that make sense today may not
fulfill an organizations needs in a decade.
Health care is in a huge state of
change, obviously from pressures created
by the Affordable Care Act. But other
demographic, sociological and technological trends are also disrupting the view
of what health care is, says Arthur Kjos,
AIA, NCARB, FASHE, executive director
of facilities planning, University of Arkansas for Medical Sciences. Patient services
that have traditionally been the purview
of acute care hospitals are rapidly moving down the chain to clinics and to the
home. We cannot predict where this will
all end, but certainly it will not be what
we are doing now.
The design of a flexible health care

facility typically does not begin on the
drawing board. Often it begins before a
physical location is even determined.
For example, many patient services
are moving from central hospitals to
dispersed neighborhood locations. Since
neighborhoods change and populations
expand in various directions, a flexible
location can serve a health care organization well. Jason Busby, a senior manager
at Kurt Salmon, calls this the Wal-Mart
strategy always being ready to move
when the market moves.
As populations shift over time, it may
make sense to continually move your
facility to where the population is going
to be, Busby says.
An important element in space flexibility is deciding whether its smarter to lease
or buy. Naturally, that decision often comes
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2015

down to the use of the facility. Its easier to

find a space to lease if an organization is
opening a clinic, for example, than if its
opening a new tertiary care center.
A primary care clinic is not substantially different from a regular office building, Busby says. So why build something new if you can find something less
expensive to lease?
Being flexible regarding location is just
one early step. Another is taking on a flexible mindset about the overall project design.
Annie Coull, AIA, ACHA, EDAC, vice
president of Stantec, notes that when her
firm was developing a new hospital and
ambulatory campus for the University of
California San Francisco (UCSF), flexibility
was identified as a goal at the beginning.
Flexibility is one of the projects
guiding principles promote healing,
new approaches to care and innovation
through the adaptive use of space and
staff practice, Coull says.
What exactly flexibility means is up to
the client. The key is to define up front
the type of flexibility aspirations held by
the client, she says. The range may be
daily occupancy changes to long-term
change of space use. [The designer also
should consider] the organizations cultural response to change peoples comfort
with change in behavior to accommodate
flexibility inherent in space.
w w.HFMmagazine.com
PHOTO BY HENKE STUDIO/COURTESY OF HGA ARCHITECTS AND ENGINEERS
Identical air handling units are manifolded together to provide redundancy, flexibility and future
capacity at the University of Minnesota Masonic Childrens Hospital.
The design process
Kjos was involved in the repurposing

Knowing early on that flexibility is a key
of two big box stores into health care
desired characteristic changes how plans
facilities when he was a principal at
are made. The designer no longer can be
Clark/Kjos Architects, and those facilities
satisfied with envisioning the project on
also included some elements that allow
the day the doors open he or she must
for potential future expansion. For exambe able to imagine the next use for that
ple, an 80,000-square-foot building that
structure, and the use after that.
previously housed a Kmart was repurJack Poindexter, a project executive at
posed into a wellness center with space
DPR Construction in Redwood City, Calif.,
for a gym, physical therapy, urgent care
says that an essential part of flexible
and other services, but the facility was
design is building a design team with that
designed so that more services could be
concept at heart.
added if demand warranted.
A major challenge is to train the projThe primary life safety systems were
ect team to appreciate that health care
upgraded to a higher standard to allow
equipment and practices are constantly
for various levels of health care to be
changing, Poindexter says. It takes sevincluded, Kjos explains.
en to eight years to design and build a
Soft space adjacent to hard space. It
major hospital in California, thus major
is much easier to expand an emergency
aspects of the owners initial
department or imaging
program and equipment
department if the space next
About this series
can change. In recognition,
door is soft, such as a storThis series of tutorial
the owner, architect and
age room or office. Taking
articles is a joint project of
contractor have to build a
that fact into account during
the American Society for
team responsive to accomplanning makes the eventuHealthcare Engineering
modating change.
(www.ASHE.org) and Health al expansion much easier.
When designing for flexThats what designers of
Facilities Management
ibility, several strategies
the new hospital and ambu(www.HFMmagazine.com).
should be considered. They
latory campus for UCSF did,
include:
Poindexter says.
A building block
Designing soft spaces
approach. When HGA was
next to areas that will
designing the Masonic Chilexpand enables future
drens Hospital, it used a building block
growth while maintaining critical adjaapproach to create a flexible space.
cencies, Poindexter says.
Systems were designed and built in a
The addition of soft space beside hard
fashion that easily would accommodate
space is not always easy, however. Harris
expansion as needed. Designers adopted
notes that one of the principles of Lean
a modular mentality, which meant they
thinking is the reduction of steps between
incorporated a greater number of smaller,
work areas, so if Lean principles are
standard-sized units rather than fewer,
deemed more important than flexibility,
larger units.
its unlikely a designer will add a storage
For example, youre better off to buy
room between an operating suite and a
four or five 500,000-Btu boilers than one
recovery room.
2 million-Btu boiler and be ready to add
Architects have to take all those critemore as needed, explains Harris, of
ria into account, Harris says.
HGA. You only buy what you need now,
Another way to arrange spaces to allow
but you build in the ability to wheel in
for future construction is to make sure
more later.
the mechanical spaces are located along
In the Masonic Childrens Hospital
an exterior wall. That way the wall can
project, for example, the electrical distriget blasted out and new space added,
bution equipment was entirely replaced,
Harris says.
and an additional switch was added to
Standardized, multiuse rooms. Many
accommodate a building that did not yet
new health care facilities are designed
exist, but which is part of the campus
with standardized rooms that can be used
long-range master plan.
for multiple purposes as the need arises.
The flexibility is there if that occurs,
For example, if the infrastructure is in
McDonald Biason says.
place, a regular patient room could be
Learning more
about flexibility
ant to learn more about

flexible facilities? The
2015 International Summit & Exhibition on Health Facility
Planning, Design & Construction,
which will be next month in San Antonio, is focused on innovative ways to
adapt to an uncertain future. Several
sessions are directly related to flexible
design and construction, including:
A New Way Definition of Flexibility for Tomorrow's Health Care
Environment
Retain Market Share: Repurposing Today's Built Environment for
Tomorrow's Health Care
Meet the Goal: Flexing with
Change Without Sacrificing the Plan
Seattle Children's Building
Hope: Delivering a Flexible Design
Using Lean Planning
Collaborative Innovation for
Future-Proofing: Outcomes and Lessons Learned
Engineering a Flexible Health
Care Facility One Building Block at
a Time
Transforming a Health System
to Support Population Health and
Community
Flexible Design Solutions: Aspirations and Results in an Academic
Medical Center Replacement Project
Registration for the PDC Summit
is now open at www.pdcsummit.org.
upgraded to an intensive care space later

or, conversely, downgraded to office or
storage space.
The same goes for small exam rooms
or procedure spaces. If designed well,
their purpose easily can be shifted as
needed.
A facility that wants flexibility needs
a room type that is flexible enough to
ebb and flow when the need changes,
McDonald Biason says.
Standardized construction also can save
money, since building numerous identical
spaces is more efficient than building
numerous customized, unique spaces.
FEBRUARY 2015
//
39
BUILDING A FLEXIBLE FUTURE
At what cost?
No discussion of flexibility occurs without a discussion about cost. Adding
future capacity is not free and, in these
uncertain times, every dollar is closely
watched.
The idea of universal, modular designs
seems really good, but an issue were
starting to see is facilities that want to
build rooms all to an intensive care-level
capacity when they cant predict what
will happen three to five years from now,
Kurt Salmons Busby says. In the future,
we may see that as wasting resources
because they were overbuilding capacity.
David Chamberlain, also a senior manager at Kurt Salmon, notes that as reimbursement changes from a volume-based
model to a more value-based system
focused on population health, health care
facility space no longer can be considered
in the same light.
Conventional thinking has been to
build to the highest common denominator, but we really cant afford to take
that approach across the board anymore
because space is a fixed cost rather than

a revenue generator, Chamberlain says.
On the other hand, the concept of flexibility is intended to save money in the
long run. McDonald Biason says HGA is
working on a wing addition to a building
that is only 14 years old but does not
have the infrastructure to handle additional capacity. Consequently, much more
expensive work needs to be done now
than would have been the case had a little more money been invested when the
building originally was constructed.
There are a lot of buildings that just
wanted to put in the amount of money
needed for the moment. If this building
were working on had just upsized up
front, it would have been a better solution, she says.
Harris says the additional elements
being added to the central plant in the
Masonic Childrens Hospital project are
adding 35 percent to the cost of the
plant. Since the central plant represents
about a quarter of the total cost of the
project, those flexibility additions add up
to about 1 percent more in overall costs.

I think people intellectually understand the need for adding these things,
but it does come down to cost, Harris
says. We try to provide things for an
incremental increase in cost now to get
more value later on. But there is a finite
amount of resources.
Things will change

A flexible, adaptable health care facility
is designed to accommodate changing
needs. It follows, then, that the process
for designing such a facility is not onesize-fits-all. Every project stands on its
own, and the process for getting to a flexible final facility varies.
Each organization is different, so its
hard to take a universal solution and apply
it to so many places, Busby says. Things
will change. I guarantee that. HFM
Ed Avis is a freelance writer based
in Oak Park, Ill., who was contracted
by the American Society for Healthcare Engineering to write this article.
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40
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2015

w w.HFMmagazine.com
BY
JIM FREDERICKS, PH.D.,
AND
MISSY HENRIKSEN
Preventing pest problems

Locating, identifying
and stopping
infestation dangers
ealth facilities professionals managing hospitals,

long-term care facilities,
emergency medical care centers and physical or mental rehabilitation
facilities, face many challenges to ensure
that they meet the highest level of sanitation while caring for sensitive populations.
Because pests pose a number of health
threats through the spread of bacteria and
contamination of surfaces, medical supplies
and equipment, ensuring that the facility
remains pest-free is one of these challenges.
As the size of a facility increases, so
do the risk factors for pest infestations
larger kitchens, more food being served,
more bathrooms and more visitors,
among others. Other factors include the
condition of the populations housed within the facilities and the organizational
complexity of decision-makers.
The best way to prevent a pest problem is to understand how pests gain
access, what pests are most problematic,
where infestations are most likely to
develop and how to prevent them.
PHOTO COURTESY OF ORKIN LLC
Risks of entry
Health facility pest problems can occur
because of pests that enter from the
immediate surroundings; those that are
within the structure; and those that are
brought into the facility by visitors or staff
via clothing, food, flowers or other items.
While it may be difficult to stem the entry
of pests by visitors, educating all staff
about prevention within the facility can
reduce problems.
First and foremost, facilities professionals must implement exclusion steps
to stop pests from entering via the immediate surroundings. For example, facility
entry doors should be closed at all times
and should be designed to reduce or
prevent entry of flying pests. Likewise,
windows should be properly screened
Bedbugs most often are found in patient room beds, waiting area furniture and laundry facilities.
and utility openings properly closed off to

prevent entry points.
Facilities professionals also should
remember that colder weather tends
to push many pests indoors, such as
rodents. This typically occurs through
utility openings or loading dock doors
and via vegetation, such as shrubs or
trees, planted close to buildings. Trimming landscaping can prevent rodents
from having easy access to upper levels,
windows and the roof.
A poorly maintained plumbing system
also can easily attract such pests as cockroaches and flies seeking moisture. Any
pipes with leaks or condensation can be
problematic, as can clogged bathroom
and kitchen drains. Fixing clogs, fastening
floor drains and caulking any entry points
around pipes can stop cockroaches, flies
and rodents from using the plumbing system to spread throughout a facility.
Another easy access point for pests
is via food deliveries. Thus, establishing protocols regarding the food flow
throughout the facility is an essential
component of an overall pest management program. For example, food service
employees should inspect all food deliveries for actual pests or signs of pests,
such as droppings or damaged packaging

and food. Cardboard boxes in which food
is delivered should be broken down and
immediately discarded from the facility.
Additionally, stored food items
should be kept on shelves off the floor
and away from the walls. Kitchen staff
should inspect such food items at least
twice a month and report any signs of
an infestation to facilities professionals.
Additionally, kitchen staff should ensure
that kitchen surfaces, and places under
shelves and appliances are clean and free
of food debris and moisture.
Finally, problematic pests like bedbugs
can be transported on peoples clothing,
in bags and purses, and through laundry
collection. Educating laundry and housekeeping staff is especially important in
spotting problems before a severe infestation takes root.
While these areas are at the highest
risk of infestation inside health care
facilities, the following areas also are
considered hot spots and require vigilance: employee locker and break rooms,
janitorial closets, laundry rooms, food
service areas, restaurants, coffee and
snack bars, vending machine areas, food
carts, bedside furniture in patient rooms,
FEBRUARY 2015
//
41
PREVENTING PEST PROBLEMS

floor drains and sink areas, intensive care
wards, surgical suites, kidney dialysis
rooms, autopsy rooms, trash dumpsters,
loading docks and related spots.
Problematic pests
While there are many reasons why secondary infections can occur in health care
facilities, common pests carry bacteria
on their bodies, which can directly or
indirectly impact patients either through
personal contact or through contamination of equipment, supplies and surfaces
in various parts of the facility.
The following pests present the highest
health risks:
Cockroaches. Cockroaches spread
nearly 33 different kinds of bacteria, six
kinds of parasitic worms and at least
seven other kinds of human pathogens.
As vectors for disease, cockroaches often
carry bacteria such as Escherichia coli
and Salmonella on their bodies, which
not only contaminate food, cooking
equipment and food preparation surfaces, but also compromise the sterile
environment of operating rooms and the
cleanliness of exam rooms and patient
rooms. Cockroaches also are responsible
for increasing the severity of asthma and
indoor allergy symptoms, especially in
children and the elderly. Cockroaches
are most likely to be found in locker and
break rooms, laundry rooms, janitorial
closets, food service areas, restaurants
and snack bars, vending machine areas,
food carts, floor drains and sink areas,
intensive care units (ICUs), kidney dialysis
and autopsy rooms as well as loading
docks and garbage disposal areas.
Rodents. Rodents can enter buildings
through almost any opening or crack larger than a dime. Once inside, rodents can
cause structural damage as they are able
to chew through wallboards, cardboard,
wood and plaster and through electrical
wiring, increasing the potential risk of
fire. Additionally, rodents defecate constantly and can easily contaminate any
and all food and food preparation surfaces. Facilities professionals must inspect
for rodent droppings, especially in undisturbed areas like cafeteria pantries, storage areas and along walls. Rodents typically are found in laundry rooms, food
service areas, food carts, loading docks
and garbage disposal areas.
Ants. Ants are social insects. Therefore,
spotting one ant indicates that many live
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2015

Tips for health facilities professionals
successful pest prevention effort involves every level of health care

employee and every part of the facility. Some common tips gleaned from
materials released by the National Pest Management Association and the
Armed Forces Pest Management Board include the following:
Find and eliminate sources of

moisture in various plumbing areas,
such as leaky pipes and clogged drains.
Keep food sealed and stored properly, particularly in kitchens and cafeterias.
Clean high-volume areas like public eating areas and kitchenettes, where
crumbs, food scraps and trash are more
likely to build up daily.
Dispose of garbage regularly and
store in sealed containers or dumpsters.
Inspect food delivery boxes before
storing in the kitchen.
Keep storage areas dry and
well-ventilated.
Seal cracks and holes on the
outside of the building, including entry
points for utilities and pipes.
Repair decaying exterior wood on
buildings because some insects are
drawn to deteriorating wood.
within close quarters. While ants can

contaminate food and food surfaces, the
species of ant that is most worrisome in
health care settings is the pharaoh ant.
These ants can spread more than a dozen
disease pathogens including Salmonella
and Streptococcus pyogenes and are
problematic because of their attraction to
intravenous units, medical preparations
and open wounds. Ants can be found in a
wide range of laundry areas, ICUs, kidney
dialysis and autopsy rooms.
Flies. Flies have been known to carry
more than 100 different kinds of disease-causing germs. They contaminate
food and surfaces by spreading disease
organisms picked up on the silla on their
bodies and through their saliva that is
used to break down foods. They also defecate constantly. Keeping trash receptacles
closed and as clean as possible, removing
trash frequently and keeping food areas
clean and free of food debris go a long
way in keeping these filthy pests away.
They can be found in almost every part of
a health care facility, including food service areas, food carts, ICUs and surgical
suites, autopsy rooms, laundry rooms,
Replace weather stripping and

repair loose mortar around the foundation and lower-level windows.
Look for rodent droppings in
undisturbed areas, including closets
and storage places.
Trim or remove any vegetation, such
as plants, shrubs and trees, and keep it
at least two feet from the buildings.
Regularly check for any kitchen
drain clogs as well as under such appliances as refrigerators and freezers.
Ensure that all entryways, especially in loading docks, are kept closed
and never propped open.
Use sodium vapor lights around the
immediate exterior of the facility instead
of fluorescent lights, which tend to
attract flying insects. If fluorescent lights
must be used, they should be mounted
at least 100 feet from buildings.
loading dock and garbage disposal areas.

Bedbugs. Bedbugs have made a serious comeback in the last two decades. A
2013 survey conducted by the National
Pest Management Association and the
University of Kentucky found that 33
percent of pest control professionals have
treated for bedbugs in hospitals, while
46 percent did so in nursing homes.
Although bedbugs are not considered
vectors of disease, their bites can leave
itchy, red welts and their presence can
cause anxiety and sleeplessness. In some
cases, patients also can experience a
secondary infection caused by scratching
at the bites and causing skin trauma,
allowing for a port of entry for infection.
Because bedbugs and their eggs hitchhike
in bags, shoes and on people, they easily
can be brought into a health care facility.
Bedbugs most often are found in patient
room beds, waiting area furniture, and
laundry facilities.
Programs and education

Due to the complicated physical infrastructure and organizational complexity
of health care facilities, the importance of
w w.HFMmagazine.com
educating all levels of staff and cooperation

employees play an important role in
with an experienced pest management
keeping infestations in health care facilicompany should not be underestimated.
ties at bay.
Programs that have the most success are
All staff should be educated on recogthose that have the full backing of every
nizing and reporting the presence of pests,
decision-maker in the facility and are in
no matter how miniscule a problem may
partnership with highly qualified and
seem. Whether its noticing rodent droptrained pest management professionals.
pings or one cockroach in the kitchen,
Those professionals will work with the
several ants in surgical or autopsy suites, a
decision-makers to develop and implesingle bedbug or signs of one in a patients
ment an integrated pest
room or flies buzzing around
ONLINE RESOURCES
management (IPM) program
garbage disposal areas
For links to the resources employees should recognize
that is necessary for the
sensitive populations housed in this article, view the
these as red flags for an underonline version at
within these facilities.
lying or potentially growing
www.HFMmagazine.com
IPM involves commonpest problem and report them
sense solutions for treating
immediately.
Not only should staff understand the
and controlling pests. The focus is on
prevention methods, but they also should
finding the best treatment for a pest
have a basic understanding of pest behavproblem, not merely the simplest. Pest
ior and biology as well, such as knowing
professionals utilize a three-part practice
that bedbugs hitchhike on personal
of inspection, identification and treatbelongings and cockroaches are attracted
ment. Treatment options in IPM can vary
to moisture and hide in dark places.
from sealing cracks to removing food and
Facilities professionals and administrawater sources to employing control prodtors should work with pest management
ucts when necessary.
companies to develop printed materials
As part of IPM implementation, facilthat can be posted in employee break
ities professionals and administrators
rooms and other areas where pests can
also must work with pest professionals to
get access, and distributed to staff as part
develop educational programs for facility
of pest prevention educational efforts.
staff. Because they are on-site every day,
They also should hold seminars or meetings at least twice a year to reinforce the
staffs role in maintaining a successful
pest management program.
Proactive pest control

Pest prevention and management cannot
be viewed as being unrelated to the overall safety and cleanliness of health care
facilities. Rather, it must be viewed as
critical to achieving these goals.
Establishing an effective professional
pest management program is an investment in the health of patients and staff
as well as an investment in maintaining a
sound public reputation.
The benefits of a professional pest
management program often far outweigh
any associated costs and, in the long run,
may save the facility valuable funds due
to the proactive preventive measures put
in place. HFM
Jim Fredericks, Ph.D., is chief
entomologist and vice president of
technical and regulatory affairs, and
Missy Henriksen is vice president of
public affairs for the National Pest
Management Association. They can
be reached at jfredericks@pestworld.
org and mhenriksen@pestworld.org.
HFM is proud to have these companies as advertisers and we hope you will
call, fax or email them when considering purchases of products and services.
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FEBRUARY 2015
//
43
Lighting the way

Rush University
Medical Center
LOCATION
Chicago
ARCHITECT
Perkins+Will
44
//
he Edward A. Brennan Entry Pavilion is the main entry point into Rush
University Medical Center, Chicago, and connects the health care facilitys new tower to the original building, providing access to all inpatient
areas and most surgical areas.
The focal point of the pavilion is the three-story, open-air terrarium, which
introduces an exterior landscaped space into the interior without creating air
contamination issues associated with interior plantings.
Laminated low-iron glass is curved to fit a freestanding steel pipe frame that
spans 50 feet through an aperture in the roof, which mirrors two skylights in the
lobby, to provide a sculptural element both inside the Pavilion and on its Level 4
roof garden.
The frame, a tilted elliptical cage that tapers to a circle, also provides a
means to maintain the exterior (internal) face of the point-supported glass.
Donors names are subtly added to the lower glass units for recognition.
Light studies showed that, although the terrarium provided significant daylight to the interior, illumination at its floor level would be insufficient for most
plant types. The design team developed a plant palette based on deep forest
environments, combining ferns, mosses, spring bulbs and deciduous trees.
Content is
copyright
FEBRUARY
2015

PHOTO BY STEVE HALL/HEDRICH BLESSING
FACILITY
w w.HFMmagazine.com
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DESIGNS FOR SENIOR CARE p.22 // RESPONDING TO WATER SHORTAGES p.27 // FLEXIBLE FACILITY PLANNING p.

OPTIMIZING DESIGN, CONSTRUCTION+OPERATIONS

CHOOSE A CARPET THAT

*Results based on testing of carpets of comparable construction, style and color.

FEBRUARY 2015 | VOL. 28 ISSUE 2

Phone triage, early

Use of mobile devices

Hospitals repurpose units as

31 Finer fixtures and fittings

ARTICLE BY REBECCA VESELY

Plumbing products address

DATA BY SUZANNA HOPPSZALLERN

22 Settings for seniors

Designs to answer the challenges

Radar and wayfinding

38 Building a flexible future

ID+C; REBECCA DAY DILLON, AIA, LEED

27 High and dry

Preparing for hospital

41 Preventing pest problems

BY JIM FREDERICKS, PH.D., AND

44 LAST DETAIL // Rush

ON THE COVER // Photo by Rebecca Lomax

For links to all

Trends in health care

This report looks at the role of technology

This survey polled hospital and health system

HFM offers five e-newsletters:

Spotlights the latest

HFM DESIGN // Covers health care

Covers hospital engineering

Youre looking at one of the

The morphing medical center

ver the past few years, the editors of Health Facilities

EXECUTIVE EDITORIAL DIRECTOR

Michelle Hoffman | mhoffman@healthforum.com

Mike Hrickiewicz | mhrickiewicz@healthforum.com

Jeff Ferenc | jferenc@healthforum.com

Dale Woodin (ASHE)

John Grattendick (ACHA)

COPY EDITOR AND PROOFREADER

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MANAGING EDITOR, CUSTOM PUBLICATIONS

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forum.com Fax // 312-422-4500

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CHAIR William D. Petasnick

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Your chance to shine!

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ealth & Human Services (HHS)

MARCH 1518 // 2015 International Sum-