Making the Argument for Asset Management in Healthcare


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  • Thank you Laura. So for today’s agenda, we will discuss the Trends and Challenges in Facilities Capital Planning and Maintenance Management that both Mike and I see when we work with our clients. I’m pretty sure that some of those items on the list may ring true for some of you. Then we will move into the Capital Planning and Project Management Process and then into the Best Practice approach to integrating Capital Planning and Maintenance Management systems. This will be demonstrated with actual screen shots of the software systems that we use.
  • So the Trends and Challenges from a Facilities Management perspective included: Increasingly competitive marketplace. Over the last few years, healthcare systems have been spending a lot of money in areas which will attract clients, for example, spending in the maternity wards to make the rooms feel more like suites or hotel rooms. Continued cost pressures from managed care environments, I think we all know about this one. Increased Joint Commission oversight: Joint Commission now has the right to do unannounced audits and many have already been hit. Also the new requirements around eSOC and JAYCO that everyone is struggling with. Need to support mission critical operations: Renewed focus on infrastructure and technology investments: slowly healthcare systems are starting to view their assets not as just being costs, but as being strategic assets that need to be properly taken care of. It use to be an easy place to cut funds but slowly that is turning around.
  • Managing the Capital Asset Lifecycle. You can see from the diagram that we thing that this is a continuous process and it is. We start with the Collection of baseline facilities information concerning the condition, functionality, inventory and renewal requirements of the facility. These include the JC requirements for section 2 and 4 of the SOC. This provides us with the information for the second part which is to analyze the data, prioritize the work, compare it against other industry benchmarks and create funding scenarios that meet the facilities and the organizations needs We can then define capital projects and plans, which are then acted upon in in projects. Having all this information in a centralized system allows for real time project reporting as well.
  • For the Asset Inventory and Condition Evaluation, we recommend that facilities professions in the architectural, mechanical and electrical fields be used to compile the facility data, including photos and CAD drawings. They will need to obtain all building information and for any requirements identified, provide a reasonable estimate for each one using standard estimating practices. We use RS Means which is embedded within our application and I will show that a little later. Also classify data by priority, prime systems, Uniformat II and other groups and this will allow you to make intelligent queries of the databases later on. For example you many want to know about all roofing issues that are priority 2 and higher that is more than £50K, etc. etc, and with the proper classifications, you will be able to quickly extract this data.
  • Evolving standards for evaluating sustainability Unfunded mandates to reduce energy consumption Volatile energy costs Determining costs & paybacks from green improvements Understanding impact of green investments on other capital programs
  • Having a centralized repository of data is absolutely crucial. Many a times we have seen clients with dozens of Excel sheets from each of their buildings and they cannot merge them together because of different structures, terminology, and even common view points. What is an old and underperforming air handler to one mechanic is a reliable and tough unit to another. Centralized DB’s also provide a complete view of the portfolio and allows for the organization’s structure to be replicated within the data heirarchy.
  • Common databases also prevent silos of information from continuing to develop and allows the organization to use the same data for both strategic and tactical requirements. Truly there is complete transparency between all the levels of the organization when they all use the same data and application across the organization, but just in different ways.
  • It is useful to have data at the system level and provide projections on the next iterative renewal requirement. When we walk into a building, we deconstruct the building into all of its primary systems and then review the way that the building was constructed.
  • For each building, we also identify all requirements that we observed in the building. We provide a category, or a reason why the work was needed, was it a code issue, or an end of service life issue. We also prioritize it and tag it to a prime building system under UNIFORMAT II. Sometimes we attached photos as well, as one photo does tell give a thousand words.
  • Reports such as these are a wonderful management tool. In this case, if you look at this bottom right hand corner of this report, you will see that the total current requirements to this facility is about £5.6 million, at which point, the facilities manager has serious heartburn as they may not have enough money to handle all the needs of the building. And that is generally true. I mean how many of you have as much money as you need to fix everything in your facilities. In this report though, take a look across the top, which is the priority and down the side which is the category…….
  • Having both current requirements and future funding needs allows us to start asking the database some intelligent funding what if scenarios. What you are seeing here is one of the most basic which is generally what we are always asked first. I know that my buildings are not in the greatest shape…… Explain FCI and the FCI line, Funding Bar.
  • What if I want to improve the condition to 0.1 which is fair but since I can’t afford to do it all this year, how about over 10.
  • That concludes our overview. I hope it’s has provided you with a better understanding of how VFA Green Building Assessment Solutions can assist your organization in identifying potential improvements to enhance the sustainability of your building operations, evaluating their costs and benefits, selecting the investments that best meet you goals, and incorporating them into your capital budget.
  • More flexibility for a desired workflow Requirements & actions “In Plan” can be modified Requirements can be added/removed from projects in plan Uncommitted projects can be added to plans Committing a plan commits all projects included in the plan Usability Edit requirements and actions within the project module Easily find project intersections Expanded Reporting Project Detail report allows selection by plan or project Requirement report allows selection by asset, plan, or project
  • Having constructed projects from the list of all of the requirements, this can now be sent over to the CMMS system for the actual implementation of the project.
  • Making the Argument for Asset Management in Healthcare

    1. 1. Making the Argument for Asset Management in Healthcare Examining the Cost-Savings Potential of Implementing a Centralised Asset Management System Presenter: Michael Kwok, P.Eng. MBA Vice President, Professional Services October 28, 2009
    2. 2. Today’s Agenda <ul><li>Introductions </li></ul><ul><li>Trends and challenges in facility capital planning </li></ul><ul><li>What is a Centralised Asset Management System (CAMS) </li></ul><ul><li>Benefits of CAMS </li></ul><ul><li>Case Studies </li></ul><ul><ul><li>Ottawa General Hospital </li></ul></ul><ul><ul><li>British Columbia Ministry of Health </li></ul></ul><ul><li>Q & A </li></ul>
    3. 3. About VFA <ul><li>Leading provider of software and services for facilities capital planning and management </li></ul><ul><li>Established 1998 </li></ul><ul><li>Headquartered in Boston, MA, USA </li></ul><ul><ul><li>Canadian subsidiary HQ in Vancouver </li></ul></ul><ul><ul><li>United Kingdom subsidiary HQ in Reading </li></ul></ul><ul><li>Integrated solution combining </li></ul><ul><ul><li>Facility assessment services </li></ul></ul><ul><ul><li>Capital management software products </li></ul></ul><ul><ul><li>Business consulting services </li></ul></ul><ul><li>400+ clients in healthcare, government, education & corporate markets </li></ul><ul><li>VFA software used to manage over 400 million square metres </li></ul><ul><li>Representative Healthcare Clients </li></ul><ul><ul><li>Ontario Ministry of Health & LTC (CDN) </li></ul></ul><ul><ul><li>British Columbia Ministry of Health (CDN) </li></ul></ul><ul><ul><li>Saskatchewan Ministry of Health (CDN) </li></ul></ul><ul><ul><li>Central Health Newfoundland (CDN) </li></ul></ul><ul><ul><li>Ottawa General Hospital (CDN) </li></ul></ul><ul><ul><li>Kingston General Hospital (CDN) </li></ul></ul><ul><ul><li>London Health Science Centre (CDN) </li></ul></ul><ul><ul><li>U.S. National Institutes of Health (US) </li></ul></ul><ul><ul><li>U.S. Navy Bureau of Medicine & Surgery (Global) </li></ul></ul><ul><ul><li>U.S. Army Medical Command (Global) </li></ul></ul><ul><ul><li>U.S. Indian Health Services (US) </li></ul></ul><ul><ul><li>New York-Presbyterian Hospital (US) </li></ul></ul><ul><ul><li>Kaiser Permanente (US) </li></ul></ul><ul><ul><li>Sisters of Mercy Health System (US) </li></ul></ul><ul><ul><li>Tenet Healthcare Corp. (US) </li></ul></ul>
    4. 4. Trends Impacting Healthcare Facility Management <ul><li>Continued cost pressures </li></ul><ul><li>Increased regulatory compliance </li></ul><ul><li>Need to support critical operations </li></ul><ul><li>Renewed focus on infrastructure and technology investments </li></ul><ul><ul><li>Underfunded over last decade </li></ul></ul><ul><ul><li>Through 2010, 75% of U.S. hospitals expect to increase capital spending annually by average of 14% [HFMA] </li></ul></ul>Nearly half of hospital CFOs surveyed by the HFMA reported their infrastructures were deteriorating faster than they could make capital improvements.
    5. 5. Capital Asset Management Systems (CAMS) <ul><li>COLLECT & Maintain Facility Information </li></ul><ul><ul><li>Condition </li></ul></ul><ul><ul><li>Functional Adequacy </li></ul></ul><ul><ul><li>Inventory </li></ul></ul><ul><ul><li>Renewal </li></ul></ul><ul><li>ANALYZE Facility Data </li></ul><ul><ul><li>Priorities </li></ul></ul><ul><ul><li>Benchmarks </li></ul></ul><ul><ul><li>Funding scenarios </li></ul></ul><ul><li>DEFINE Capital Projects & Plans </li></ul><ul><ul><li>Annual and Long-term </li></ul></ul><ul><ul><li>Renewal, Maintenance, Construction, etc. </li></ul></ul><ul><li>MANAGE Projects </li></ul><ul><ul><li>Create & manage work orders </li></ul></ul><ul><ul><li>Real-time project reporting </li></ul></ul>
    6. 6. COLLECT & Maintain Facility Information Asset Inventory and Condition Evaluation <ul><li>Compile facility data </li></ul><ul><ul><li>Include photographs and CAD drawings </li></ul></ul><ul><ul><li>Create detailed descriptions of assessment findings </li></ul></ul><ul><li>Develop detailed cost estimates </li></ul><ul><ul><li>Estimate replacement values, deferred maintenance and lifecycle costs </li></ul></ul><ul><ul><li>Industry standard data (e.g., R.S. Means) </li></ul></ul><ul><li>Classify data for decision support analysis </li></ul>Resources Accuracy Budgeting Budgeting + Hot spots Budgeting + Actionable Budgeting + Actionable Statistical Modeling Facilities Audit Systems Lifecycle Assessment Detailed Facility Condition Assessment
    7. 7. Functionality Code Compliance Lifecycle Condition Efficiency COLLECT & Maintain Facility Information Include Sustainability in Condition Evaluation Water Conservation Indoor Air Quality & Environment Site Sustainability Materials & Construction Energy Efficiency
    8. 8. COLLECT & Maintain Facility Information A Centralized Repository of Asset Data <ul><li>Centralized asset database provides holistic view of the portfolio </li></ul><ul><li>Common terminology and platform </li></ul><ul><li>Data hierarchy based on organizational hierarchy </li></ul>
    9. 9. COLLECT & Maintain Facility Information A Centralized Repository of Asset Data Common database prevents silos of information, and allows the organization to use the same data for both strategic and tactical requirements .
    10. 10. COLLECT & Maintain Facility Information Building System Data <ul><li>Plan the information you want to collect prior to assessing sites </li></ul><ul><li>Consider all required assets - both vertical & utilities </li></ul>.
    11. 11. COLLECT & Maintain Facility Information Asset Requirements .
    12. 12. ANALYZE Facility Data Establish Priorities Region: 13 Campus: West Campus Asset Name: Timberlake Building Category-Priority 1 2 3 4 5 Total Air/Water Quality £0 £0 £0 £6,836 £0 £6,836 Building Code Accessibility £0 £0 £471,020 £0 £118,875 £589,895 Building Code Compliance £46,028 £393,498 £0 £0 £227,534 £667,060 Building Integrity £802,691 £1,219,480 £1,699,412 £4,630 £0 £3,726,213 Energy £0 £0 £0 £43,637 £0 £43,637 Functionality £0 £112,904 £136,187 £161,308 £1,521 £411,920 Hazardous Materials £0 £0 £0 £0 £146,626 £146,626 Life Safety £33,581 £0 £0 £6,364 £3,716 £43,661 Total £882,300 £1,725,882 £2,306,619 £222,755 £498,272 £5,635,848 Crosstabs of Requirements By Category and Priority/Asset Name Priority Description 1 Currently Critical 2 Potentially Critical 3 Necessary - Not Yet Critical 4 Recommended 5 Does Not Meet Current Standards .
    13. 13. ANALYZE Facility Data Understand Impact of Funding Options .
    14. 14. ANALYZE Facility Data Understand Impact of Funding Options <ul><li>What-if analysis allows various funding scenarios to be evaluated </li></ul><ul><li>Industry-standard Facility Condition Index enables benchmarking </li></ul>.
    15. 15. Applications <ul><li>Now That You Have It… </li></ul><ul><li>What Can You Do With Your Data? </li></ul>
    16. 16. Asset Information Management <ul><li>Dashboards provide critical overview of </li></ul><ul><ul><li>Portfolio value and conditions </li></ul></ul><ul><ul><li>Funding needs </li></ul></ul><ul><ul><li>Key indicators such as FCI </li></ul></ul>
    17. 17. Potential Level for Certification Certified £348,993 36 Point Levels for: LEED-EB O&M Certification 34-42 Certified 43-50 Silver 51-67 Gold 68-92 Platinum Scorecards: Analyze Against Evaluation System Yes No Yes Maybe Unlikely Sustainable Sites 1 11 1 6 5 £17,501 Water Efficiency 0 10 0 4 6 £21,902 Energy and Atmosphere 2 28 2 4 24 £62,558 Materials and Resources 1 13 1 9 4 £174,446 Indoor Environmental Quality 1 18 1 7 11 £72,586 Innovation and Upgrade 1 7 0 1 6 £0 Existing/Potential Points Score 5 87 5 31 56 Category of Sustainability Existing Potential Cost
    18. 18. Portfolio FCI Comparisons <ul><li>Quickly understand condition ranges </li></ul><ul><li>Compare building types across regions / portfolios </li></ul><ul><li>Review asset or system condition variations by location </li></ul>
    19. 19. Capital Budgets Ranking <ul><li>Prioritize all needs based on organizational objectives </li></ul><ul><li>Produce multi-year budgets </li></ul>
    20. 20. Project Planning <ul><li>Assemble capital improvements into efficient projects </li></ul><ul><li>Combine individual projects into multi-year capital plans </li></ul>
    21. 21. Interface with Facility Management systems
    22. 22. Advanced Portals
    23. 23. <ul><li>Increased Flexibility to Respond to Change </li></ul><ul><li>Reduced Waste in Capital Projects </li></ul><ul><li>Reduction in Annual Material Costs </li></ul><ul><li>Reduction in Emergency Repair Premiums </li></ul><ul><li>Reduction in Overall Project Costs </li></ul><ul><li>Avoided Costs of Relocation </li></ul><ul><li>Avoided Costs of Shutdowns </li></ul><ul><li>Avoid/Targeted New Construction Build </li></ul><ul><li>Resource/Usage Optimization </li></ul>VFA Enables a Compelling ROI
    24. 24. <ul><li>Case Studies </li></ul>
    25. 25. The Ottawa Hospital <ul><li>Profile Overview </li></ul><ul><li>Academic Health Sciences Center – University of Ottawa </li></ul><ul><li>Partner in healthcare delivery in the Champlain Local Health Integration Network (LHIN) </li></ul><ul><li>Serves more than 1.5 million people in Ottawa and Eastern Ontario </li></ul><ul><li>1100+ Acute Care Beds </li></ul><ul><li>130,000+ Emergency Visits </li></ul><ul><li>51 Operating Rooms </li></ul><ul><li>12,000 staff, 2000 physicians and 1200 Volunteers </li></ul><ul><li>Budget of approximately £600 M </li></ul>
    26. 26. Physical Infrastructure <ul><li>Three Campuses </li></ul><ul><li>Civic Campus </li></ul><ul><ul><li>2.0 M square feet </li></ul></ul><ul><ul><li>18 buildings developed from 1920 -1980’s </li></ul></ul><ul><li>General Campus </li></ul><ul><ul><li>1.7 M Square Feet </li></ul></ul><ul><ul><li>One integrated building developed in 1980’s. </li></ul></ul><ul><li>Riverside Campus </li></ul><ul><ul><li>300 K Square Feet </li></ul></ul><ul><ul><li>One integrated building developed in 1980’s. </li></ul></ul>
    27. 27. Facility Management Overview <ul><li>Aging Infrastructure </li></ul><ul><ul><li>Many buildings over 60 years old </li></ul></ul><ul><li>Facility condition varies across campuses </li></ul><ul><ul><li>No consistent documentation/updates </li></ul></ul><ul><li>Past assessments were focused </li></ul><ul><ul><li>No overall view into all infrastructure </li></ul></ul><ul><li>No analysis tools to understand data or proactively plan where investments should be made. </li></ul><ul><li>Lacked fully integrated plan </li></ul><ul><ul><li>Capital and associated operating plans were not fully integrated </li></ul></ul><ul><ul><li>Difficult to prioritize and develop long-term plan </li></ul></ul><ul><li>Master Plan Development – no quantifiable data to develop business plans/cases to renovate or replace infrastructure. </li></ul>
    28. 28. “New Approach” <ul><li>Comprehensive Facility Management Tools </li></ul><ul><li>Facility Condition Assessment Tool (VFA) </li></ul><ul><ul><li>Detailed assessment of all infrastructure - 5 categories. </li></ul></ul><ul><ul><li>Quantifies investment required in each category and provides Facility Condition Index. </li></ul></ul><ul><ul><li>Development of 10 year plan. </li></ul></ul><ul><li>Work Order Management System (TMA) </li></ul><ul><ul><li>Ongoing preventative maintenance of assets linked to VFA/Capital Plan. </li></ul></ul><ul><ul><li>Allows for integration with labor/operating plan management. </li></ul></ul><ul><li>Space management tools </li></ul><ul><ul><li>Link assets to locations in space management module. </li></ul></ul><ul><li>As Built Documentation </li></ul><ul><ul><li>Essential link to VFA and TMA tools when implementing capital development projects and renovation projects. </li></ul></ul>
    29. 29. Benefits and Challenges <ul><li>Benefits </li></ul><ul><ul><li>Complete infrastructure “picture” and “planning” </li></ul></ul><ul><ul><ul><li>Good reporting functionality. </li></ul></ul></ul><ul><ul><ul><li>Prioritization of investments - impact of deferred maintenance. </li></ul></ul></ul><ul><ul><li>Integrates well with other facility management tools. </li></ul></ul><ul><ul><li>Master Planning </li></ul></ul><ul><ul><ul><li>Internal 25 year capital plan </li></ul></ul></ul><ul><ul><ul><li>Business case assessments - Ministry Submissions. </li></ul></ul></ul>
    30. 30. The Future <ul><li>Standardized provincial Facility Condition Assessment Tool </li></ul><ul><ul><li>Facility Blue-Print </li></ul></ul><ul><ul><li>Benchmark comparisons (FCI Indicator) </li></ul></ul><ul><ul><li>Prioritization of investments within organization/region </li></ul></ul><ul><li>Operational benchmarks and planning linked to Facility Condition Assessment tool </li></ul><ul><li>Systems integration – one integrated platform </li></ul>
    31. 31. Sample Clients The British Columbia Ministry of Health Services
    32. 32. British Columbia Ministry of Health Profile <ul><li>30 million square feet </li></ul><ul><li>500 sites </li></ul><ul><li>Complex, mixed portfolio </li></ul><ul><li>Project started with one region (pilot) and scaled to six regions in a 4 month period </li></ul><ul><li>Health care special requirements (e.g. infection control) </li></ul>
    33. 33. British Columbia Ministry of Health Approach <ul><li>Multi-stakeholder steering committee </li></ul><ul><li>Legacy data </li></ul><ul><li>Multiple team deployment </li></ul><ul><li>Use of local partners </li></ul><ul><li>Visual inspections & modeled assets </li></ul><ul><li>Scheduling flexibility required </li></ul><ul><li>Type and ownership of data </li></ul><ul><li>Proactive project management </li></ul>
    34. 34. British Columbia Ministry of Health Results <ul><li>Support capital renewal needs </li></ul><ul><li>Standardized assessment methodology and centralised database </li></ul><ul><li>Track changing condition of facility elements </li></ul><ul><li>Benchmark, forecast and track hospital conditions and expenditures </li></ul><ul><li>Accurate, consistent, actionable, secure and conflict-free data </li></ul><ul><li>Performance standards and targets for facilities conditions </li></ul><ul><li>Secure access to assessment data and reports for users </li></ul>
    35. 35. Questions? Michael Kwok, P.Eng. MBA VFA, Inc. phone: (617) 772-8170 email: