Hospital Maintenance Strategies

Most healthcare organizations recognize that a well-maintained, well-operated facility makes a huge difference when it comes to creating a positive physical environment of care. At the same time, they face a wide range of challenges to implementing a maintenance strategy that aligns with the organization’s mission and critical operating requirements.

InnovénTeQ 2 stage maintenance strategy

When managing a hospital understanding the allocation of costs is key; especially if attracting new capital is needed to renovate or expand your existing facility and technical infrstructure. The table below shows -calculated over a timespan of 40 years- the cost distribution.

From this chart we can learn that:

• the costs of operations are by the largest of all costs of building and operating a hospital
• the costs of design and constructionrepresent only 23% of the total

• Operating environment – Energy costs are rising, the healthcare regulatory environment is in flux, budgets are tight and the pressure is on to make every investment pay for itself. Facilities teams need to develop a keen understanding of their hospital’s mission and goals and how high-performance building technologies and operating practices can contribute to the organization’s success.

It is also important to understand the building and how it is currently operating. Facility managers need to ask themselves a series of questions:

• What are the most critical building systems and components?

• How are they working today?

• What happens if they fail or underper-form?

Candid answers to these and similar questions set the stage for developing a mission-centric maintenance strategy.

Most hospitals benefit from conducting a critical systems audit (CSA) to assess how well heating, ventilation and air conditioning (HVAC) and other building systems are operating and identify potential problems before they can cause a costly system failure.

An audit also provides insights into how and where the hospital is using – and perhaps wasting – energy, which can help the staff identify, select and prioritize energy conservation measures. As a result, CSAs usually pay for themselves in energy savings.

• Operating risks – Information gathered during a CSA helps healthcare facility professionals identify and address potential building system issues. The remedy may vary depending on the problem that was identified. For example, the hospital may choose to overhaul or replace a mission-critical HVAC system component before it has a chance to break down and cause a serious problem, but it may choose not to repair a less-critical piece of equipment until it shows signs of imminent failure.

The high-performance building approach to maintenance helps organizations recognize the “real” costs of a building system failure, balanced against the cost of a preventive, predictive or results-centered maintenance plan. In a hospital setting, the real impact goes beyond the substantial expense of replacing or repairing equipment in a reactive mode to include the costs of the disruption caused by an unplanned system failure. Such costs could include lost revenue, unproductive staff time or even compromised standards of care and potential lawsuits; avoiding these costs more than justifies the expense of adopting an effective maintenance strategy.

In evaluating risk, facility professionals also need to examine equipment warranties and existing service agreements to understand exactly what they cover and, just as important, what they do not cover. Actions may be required to fill in the gaps and provide extra levels of protection for mission-essential systems.

Finally, hospitals need to have effective contingency plans to ensure that they can respond immediately and recover quickly from an unforeseen system failure without impacting the quality of patient care.

• Traditional maintenance options – Most hospitals today use a preventive maintenance strategy in which facilities staff members or their service partners perform prescribed maintenance tasks at scheduled intervals recommended by original equipment manufacturers.

Meanwhile, technology advancements have enabled predictive capabilities that technicians can use to gather and analyze performance information so they can perform maintenance tasks when they are needed, rather than on a predetermined schedule. For example, instead of changing HVAC system air filters on a set schedule, it is now possible to monitor air quality and replace filters when they are no longer doing their job.

Fault detection and diagnostics, predictive modeling and other analytical tools let technicians address system performance issues before they can cause serious problems. For example, advanced diagnostic tools can continuously monitor motor performance and vibration levels, compare findings to aggregate data on the same motor type and alert service personnel if performance varies from the expected range.

Through their existing building automation systems, most hospitals already have the technology backbone in place to implement a predictive maintenance model. Today’s advanced building automation systems provide facilities teams and their service partners with a wealth of actionable information that can be accessed from any computer with an Internet connection.

Building commissioning, recommissioning and continuous commissioning are effective ways to restore building systems to their original design specifications. Re-commissioning sometimes enables a building to perform better than when it was first built, according to the Lawrence Berkeley National Laboratories (LBNL). The LBNL studied nearly 650 facilities before noting that “most buildings drift, often ‘invisibly,’ to lower performance over time, indicating a need for ongoing performance monitoring and fault detection and diagnosis during routine operation.”

• Building performance – Technology advances and the availability of real-time building system data are reshaping the way that healthcare organizations think about maintaining their high-performance hospital buildings.

For decades, the focus has been on restoring or maintaining original design performance levels. With a building performance model, the structure is managed to deliver specific outcomes that are tied to the organization mission, rigorously defined, supported by predetermined performance standards and continuously measured and evaluated.

Using an intelligent services approach, a building is managed to perform within acceptable tolerances of an established set of performance standards. In a healthcare environment, these standards might include unit-specific air quality, temperature and humidity levels; HVAC reliability and uptime performance; or agreed-upon levels of energy and water consumption or environmental compliance.

Among other advantages, the building performance approach to maintenance enables hospitals to make better-informed decisions, collect data over long periods of time to inform the decision-making process, track variables to enable better performance and document progress toward high-performance building status.

These are challenging times for health-care administrators and facilities teams as they strive to do more with less while creating the best possible physical environment of care.