By K. Richard Douglas
The broad skill sets that HTM professionals possess make them ideal sources for decision-making input. With mechanical, electronics and even technology acumen, biomed technicians and leadership are the go-to resource for any process that may occur in health care, including new construction or renovation projects. HTM brings a perspective that capitalizes on knowledge that other stakeholders in the project may not embrace or possess.
One reason that HTM can be an important voice and stakeholder in construction projects is that biomeds can point out pitfalls that others may overlook.
These insights can include valuable input in the areas of cybersecurity, connectivity, interoperability, space, environmental conditions, utility requirements, ease of use, warranty coverage, clinical and technical training and consumables.
The construction or renovation of health care facilities has evolved and there is a much greater emphasis today on health IT resources, modular and prefab options and sustainability. Projects have to be carefully planned so there is uninterrupted patient care and safety is always maintained. With an aging population, expansion of facilities is necessary.
With all of the construction and renovation-specialty companies and contractors, architects and engineering consultants, who might be involved in any project, those tasked with equipment management know about considerations that might otherwise be overlooked.
While HTM has much to offer that comes out of organic knowledge and experience, there is always something more to learn from those who have stared down the challenges of large or complex projects.
To that end, we have assembled some tips and considerations that should prove useful the next time a new construction or renovation project presents itself and HTM is called in for consultation.
It is easier to employ knowledge going into a challenging situation than having to learn it through mistakes, missteps or learning through experience. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”
Knowing What You are Working With
In a 2018 story titled “Construction Excitement and Pitfalls,” TechNation interviewed Matt Royal, MS, CTM, CHSP, CHFSP, CHEP, CHTM, CLSO-M, CHC, CHFM, CBET, director or biomedical engineering for Eskenazi Health.
“Get the inventory of all new equipment correct, this is the time where you have all the purchase orders, pricing, PM schedules, warranties, etcetera,” Royal said in 2018.
This is an important part of the process and requires an effort by HTM or the services of a third-party provider.
At the time, Royal also said that, “Additional resources are needed. It takes a toll on the team when they are required to not only continue to support an old facility but oversee the installation of new equipment and the movement of existing equipment to the new hospital.”
That sentiment is echoed by Tim Michener, vice president of sales and marketing at Asset Services in Kansas City.
Michener says that there are some considerations during a renovation or new construction project that revolve around an accurate assessment of inventory.
“HTM departments need to evaluate the equipment that they have in their current spaces and determine if any or all of the equipment can be used in the new or renovated areas. They need to perform a detailed equipment inventory to have an accurate understanding of the types and quantity of different assets they currently have on-hand,” he says.
“They also need to perform space planning to determine that the new spaces are large enough to accommodate their large equipment and ensure the proper power requirements have been taken into account. Even if equipment is functional and can be used in the new area, it may not be feasible because the equipment may be needed in the current facility right up until ‘moving day,’ and there will not be time to relocate larger or non-mobile equipment,” Michener adds.
Michener’s firm provides an initial outfitting and transition (IO&T) equipment inventory to aid in determining assets that can be re-used during these projects.
He says that IO&T inventories provide an accurate snapshot of what is located in the current facility/area.
“It will identify the type of equipment as well as details such as manufacturer, model, serial number and physical condition of the equipment. It can also identify dimensions of equipment in order to assist the architects in designing storage locations for items such as crash carts, laundry baskets, etcetera. This detailed inventory provides information for the HTM department in order for them to determine what equipment they can reuse or what equipment they will need to purchase in order to be ready to operate efficiently when the newly constructed or renovated area is ready to be operational,” Michener says.
Colin Construction Company Chief Operating Officer Kevin Cook shares his outlook.
“After having served 20 years in the Air Force as a biomedical equipment technician, starting one of the first HTM programs at David Grant Medical Center (Travis AFB) and now running a construction company that specializes in health care construction for the past 15 years, give me a strong perspective on how instrumental the HTM role is in any equipment replacement or hospital remodel project,” Cook says. “HTMs are key to understanding the hospital infrastructure of installed real property (HVAC, electrical) and installed medical equipment. They also understand the technical specifications of the new equipment being purchased. The general contractor hired to do the design and build of the project area to accommodate the new equipment works directly with the HTM to understand the as-built conditions through record construction documents and HTM’s corporate knowledge attained from sometimes years of work at the facility. The more the HTM understands the as-built condition or can share the documents attesting to that condition the more comprehensive the design and construction documents. This effort pre-construction mitigates the challenges and delays during construction and greatly improves the opportunity for an on-time and on-budget project ending with equipment delivery per the scheduled delivery date.”
The Invaluable HTM Perspective
Two years later, Royal still has views to share from experience with construction projects. He points to the importance of the knowledge that HTM professionals maintain that allows for consideration of the cost of ownership, throughout the life cycle, when commencing a renovation or new construction project.
“Two areas that have always been an area of high maintenance is radiology and sterile processing. Often minimum specifications for utilities are planned for to keep costs low during a construction project. However, that may keep the costs of the project lower, it can increase the cost of ownership of a piece of equipment and also threaten the availability of critical equipment for hospital operations,” Royal points out.
He says that for sterile processing, equipment such as sterilizers and washers, quality water and steam is extremely important for the reliability of the equipment and the quality of the instruments being processed.
“Providing quality water might include softening, reverse osmosis water systems, water filters and constant testing of water quality. With poor water quality, you can have more frequent equipment failures and discoloration of instruments. This could lead to reprocessing, unavailability or delay of instruments to a surgical area. Poor steam quality can impact sterilized instruments with wet packs which would again result in reprocessing, unavailability and delays,” Royal says.
Royal says that for an area like radiology, power quality is extremely important; this equipment is one of the biggest investments for a hospital.
“Having power conditioning or power protection can improve reliability to highly sensitive equipment. Many construction projects don’t account for this and larger investments such as UPS units to support high-voltage cabinets, gantries and MRI equipment. Although large UPS systems are expensive there is a return on investment for these systems. The radiology equipment is critical for operations of a hospital, but it can also be considered high revenue,” he says.
Not only is it important for HTM to provide important considerations for equipment reliability and longevity, but security issues and the choice of vendors require HTM input as well.
“Construction projects tend to not include HTM in vendor selections, which have implications downstream. Projects may not even include end users in some of these decisions. Architects don’t have to operate the business after the construction is done, so they don’t often think about operational issues such as contract terms, usability, maintainability or cybersecurity. Setting roles/responsibilities in your project early to ensure the right team players (including IT and HTM) are included in decision about the technology they will need to support after go live is key,” says Samantha Jacques, Ph.D., FACHE, vice president of McLaren Clinical Engineering Services (MCES) at McLaren Health in Michigan.
She says that in construction projects the term “equipment planner” doesn’t just mean that they only plan the medical equipment. Depending on scope, the equipment planner may plan all IT equipment and facilities equipment such as trash cans and sinks. Even though these aren’t typically medical equipment, HTM departments can provide insights to the locations for things such as hand washing sinks, PPE closets and even trash cans.
“I would always recommend the end users get a quick lesson in reading blueprints. It’s easy to sit in a meeting and determine which equipment needs to go into a room to meet clinical needs, but it’s much more useful if the end users are able to point equipment out on documents as they work through actual workflows. Noting the distances between patient rooms and a clean supply or med room is almost as important as ensuring the right equipment is located in that room,” Jacques says.
She says that HTM can contribute to construction projects and renovations in several ways.
Medical Equipment Planning
During a construction project, architects often outsource the equipment planning function to a third party. This third party has to learn the organizational standards and workflows, which always takes time and effort as well as significant money. Some forward thinking HTM departments have insourced this function as they are the equipment and workflow experts in their hospital.
She says that this way, equipment standards are kept up while costs can be removed from the project. The only caveat for insourcing is to discuss roles/responsibilities with your project manager to assure the architect can cover any tasks the department can’t perform.
Jacques also says that HTM can provide help in right sizing the amount of equipment purchased.
“HTM departments can aid in analysis of how many pieces of what types of equipment are required during projects. They can conduct inventories of existing equipment to recommend what can be re-used versus what must be replaced,” she says.
There is also the consideration of new technology assessments.
“Projects are often times for hospitals to look at new technology and systems to streamline workflows and enhance patient safety. HTM department involvement in RFPs and vendor assessments can help clinicians and supply chain departments make the right decisions on selection and implementation of new technology,” Jacques says.
HTM Best Practices
There is no better teacher than experience and “baptism by fire” often instills lessons not soon forgotten. Even when emergencies or mistakes are not a part of the process, the experience gleaned produces knowledge of every possible consideration to do the project right in the future.
“There are new lessons learned in each project, but I have a few best practices I like to bring with me to each project,” Jacques says.
She says it is important to clearly define roles/responsibilities as early as possible.
“With so many players in projects with architects, construction managers, sub-contractors, project managers, end users, leadership, support services, etcetera, it can be hard to know who is working on what or who is responsible for what,” Jacques says.
“Early on, the project manager should develop a document that outlines whose role is what. It should also outline the decision-making process – who has authority to make what type of decisions and who needs to be informed or consulted in that decision. Finally, a defined communication plan also has to be outlined. How issues are raised, prioritized and resolved needs to be clearly understood as well as how decisions are communicated back down once finalized,” she says.
She says that in addition to roles and responsibilities, it is important to clearly define the scope.
“Scope creep is a part of every project, but having a clear understanding of what scope is and what the process is to add or change the scope needs to be understood up front. Also, all members of the team need to be able to speak up about scope creep and be able to raise their concerns at any time,” Jacques says.
Jacques says that workflow analysis is key.
“Ensure that during the design process, the end users run through their workflows to assure the design meets the needs of the users. This should be done at least twice during the project:
The Long-Term Perspective
Royal says that the biggest disconnect for design and construction and HTM is that design and construction is short term for projects and HTM is longer term for operations; these two conflicts need to meet in the middle as many construction project bids will go to the lowest bid that might sacrifice the investment in quality utilities to the equipment.
“Often these are considered after a project has set a projected budget during the rough estimate planning. If HTM is involved in the capital budgeting with a design and construction team, they can account for these investments. However, HTM can’t expect to always be included in a strategic planning of construction projects, so it is important that a collaborative relationship is built with the design and construction team and they meet and compare notes on capital project proposals,” Royal says.
He says that often, HTM programs managed by third parties struggle with this involvement due to terms of a contract agreement; HTM contract agreements may be limited in their scope to just operational-type activities.
“However, it can be a success for a third-party HTM program to offer these as value added services to assist with capital planning. Engineering and architectural companies will sometimes offer these services to their customers, but much of their information that is valuable comes from the HTM team that has the experience with the equipment and vendors to add procurement input,” Royal adds.
As TechNation pointed out in 2018, new construction and renovation projects allow HTM to “prove their value outside of inventory, PM and repair activities.” The goal is that the considerations outlined in this article can be employed to reduce the risk of baptism by fire so that all stakeholders will be happy with the long-term results.
“As essential partners, the HTM and general contractor need to work hand in hand on any remodel or construction project. The more complex the project the more this relationship affects outcomes. HTM should be involved throughout the entire process; from equipment acquisition, through funding, into design and construction and finally equipment installation and staff applications and training. An HTM that can navigate relationships and milestones is key to the success of any hospital remodel or construction process. As a general contractor, I can speak from direct experience that we interact almost daily with HTM during construction,” Cook adds.
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