Uploaded byArun Sebastian
HEALTHCARE ENGINEERING RECOMMISSIONING.pptx
Healthcare construction renovations present unique challenges including safety concerns, technical challenges, and budgetary constraints. Extensive planning is required at the project initiation phase to properly envision space needs and operational requirements over the long term. Detailed design then requires generating site-specific drawings with input from user groups to streamline the design. Throughout the execution, monitoring, and control phase, regular progress reporting and risk assessment is important to ensure objectives are achieved on time and on budget while maintaining safety and compliance.
More Related Content
Similar to HEALTHCARE ENGINEERING RECOMMISSIONING.pptx
HEALTHCARE ENGINEERING RECOMMISSIONING.pptx
- 1.
- 2. Retro-commissioning of HealthcareFacilities – Overcoming the challenges Er. Arun Sebastian
- 3. Challenges in Healthcare Construction Ina Live facility •Operationa l Technical Risk management incl Delays Safety Changes in Programme Resource Mobilisation and availability Infection control Compliance Drawings and documents Healthcare construction renovations present unique challenges, including safety concerns, technical challenges, and budgetary constraints. Healthcare environments are sensitive settings where the planning and performance of renovation and construction projects require additional preparation and consideration.
- 4. Stages of HealthcareFacility Construction in a live environment Patients First Working Together Always Improving Project Closeout & Post Occupancy Commission & Handover Execution, monitoring & control Detailed Design Phase Project Ideation & Initiation
- 5. Project Initiation Challenges • Includingall necessary designs for patient privacy safety and comfort • Arriving at patient volumes planned • Gathering existing data including old building drawings or site surveys-site specific data • Optimal Sizing of the spatial requirements • Envisaging for at least 10-15 years • Staff efficiency and comfort • Procurement strategy and timelines • To achieve long-term best value • the decommissioning and isolation of the existing facilities Project Ideation & Initiation
- 6. Process Group Solutions/MitigationTools and techniques Project Ideation & Initiation (Feasibility and Planning) • Deriving a strong functional program • Understanding constraints • Applying EBD and Innovations • Understanding OPRs • Deriving Project Objectives and Goals using the SMART method • Preparing an execution strategy and a strong functional program • Tailor fit design as per our facility • Close Collaboration with users • Preparing a project charter and a deliverable schedule • Functional Program • Evidence-based Designs • Robust Communication • Focussed meetings • Extensive site survey • End User surveys • Applying Project management Techniques • Previous experiences • Assessing risks
- 7. The Personal Approach • Evena department renovation needs to be analyzed in terms of the functional flow of the entire hospital on integration into the existing facilities • Preparing a master plan for the facility can help to see the whole picture • Use of a value engineering or value analysis process can reduce renovation costs considerably. • Extensive planning and understanding of the OPR will help the team to arrive at the right concept
- 8. Functional Program A pre-design documentdescribing the functional requirements of a building or renovation in sufficient detail to initiate schematic design. • Concise and written at the level of detail which allows for ready translation into facility and planning requirements • Provide sound methodology for analysis and projection of activity • Incorporate detailed listing of the functions • Comprehensive to allow the development of operational management plans • Incorporate fixed and loose equipment elements Functional Program Development A tool for the Key Stakeholder/Client - it documents scope of service(s), - objectives and basic operational methods of the specific component; - specifies the human, technical, and building resources necessary to function as intended A communication tool ⁻ It outlines what each component intends to do and why, and assists in securing the necessary resources and project approvals to proceed with the project - Base for design
- 9. Functional Program Functional Relationships External tothe component – e.g., diagram/descriptions describing critical relationships to other programs/services/components within the facility (e.g., patient transport from emergency department to component, material management flow to and from the component, etc.); and to the facility - relationships with other facilities to provide the program context within the greater health care system (e.g., patient transport for specialized diagnostic procedure, sending/receiving lab specimens). Internal relationships of sub-units within the component space (e.g., location of nursing station to patient rooms, waiting area to reception) to facilitate flow, functionality, etc. within the component; and visual matrices/conceptual diagrams, not floor plans. Locations - specify whether component must be adjoining to another program (share common wall), adjacent (within the same physical area) or accessible (via corridor/elevator).
- 10.
- 11. Design Criteria/Physical Requirements: •Special requirements of each component Space requirements and description of each space type, activities, what is contained within • Description of essential physical spaces required to accommodate the component • Sufficient detail regarding the use, occupancy and equipment to be located in the spaces to assist with the determination of the room size during the design stage • Brief description of the overall ambiance, configuration, traffic flow, and privacy issues Functional Program
- 12. Preparing Schedule ofAccommodation Room–by-room space list or schedule of accommodation of space types identifying the number or units required and the area in net square meters, with reference to the number of occupants and major equipment Schedule of Accommodation PATIENT AREAS CLINICAL SUPPORT STAFF AREAS
- 13. Equipment • Preliminary listof equipment to determine space sizes, assisting in preliminary costing, completed in detailed design (depending on the project it could be a detailed list); and • Overview of the fixed or large loose equipment (e.g., diagnostic imaging, sterile processing, medical gas/electrical service columns in patient cubicles). Impact Analysis • Impact of planned component (new or additional service) to the overall facility/system that supports it and the specific services including core services and clinical and support services • The impacted service assess the additional workload added by the service and what resources staff, space equipment, etc. is required to support the component. The following may also be included in a functional program, especially where the project is large, complex in nature, or addition to an existing facility. • Site development plan/master plan; • Project cost plan (this would normally be part of most projects); • Parking and traffic studies. Other Considerations
- 14. Challenge: Total Pictureof the dept positioning after the project Solution: Preparing Stacking SOA for Renovation KIMS MEDICITY MASTER SCHEDULE OF ACCOMODATION Doc Ref : STAT-KIMS MEDICITY- SOA- EAST COMSNG - R0 - 24-10-19 Level 11 OP Rehab, Physiotherapy Surgical Stepdown IVF Ayurveda, Holistic Medicine Wards + Post OP Patient rooms IT,Socomer, Biomedical Auditorium,Audio Visual, Simulation lab, Class Room Level 10 Patient rooms General Wards HDU Nuclear medicine- GAMMA CAMERA IP ROOMS- 15 NOS Level 09 Sleep Lab VISA Medicals (Executive rooms) Executive Health Check-Up (Executive rooms) Patient rooms- Deluxe (Executive rooms) Death/Birth Registration Restaurant Perinatology BMT IP ROOMS Level 08 Patient rooms General Wards Stroke ICU Dental Dept-OP OPG X-ray Lab TB Culture Lab Clinical Research Single Bed- 44 nos Suite Room 4 nos Junior Suite Room 14 nos Discharge Lounge Treatment Room Bystanders recreation Lounge Level 07 OPD-Neonatology (PharmacyGrp Manager cabin, Pediatric) Lab Collection Paediatric ICU + Day care+stepdown OPD-Gynaec (Pediatric) Labor Room (Pediatric) Mother & Baby ICU/Post OP (Pediatric) Pharmacy IP Billing/Discharge General Ward- Female ER Extension ward MDICU, Isolation Finance Dept (MDICU 1) IPR (Counseling,patien ts lounge) Step down Isolation Rooms Single Bed-44 nos Deluxe Room 22Nos Treatment Room 1 no Bystanders recreation Lounge Level 06 Patient rooms MICU/SDICU Plastic Surgery Dept (Nephrologist Luxury Dialysis Unit) Ophthamology Dept General Ward IT server room, Clinical Engineering Library Single Bed Surgical ICU - 12 beds Step down ICU Isolation Room (Burns unit) IP Billing Treatment Room Discharge Lounge, VIP Lounge,Pantry Level 05 Patient rooms TKR Stepdown ICU NICU 1 & NICU 2(Stepdown ICU) Neuro Dept Respiratory Medicine Dialysis ward 20 beds OT Complex Neuro ICU-10 beds Transplant ICU CSSD VIP Lounge Under construction Level 04 Surgical Suite SICU Trauma ICU Cathlabs Cath ICU Neuro ICU OT Complex CTICU Endoscopy Dermatology ,Cosmetology (Neuro / Neurologist/ Epilepsy clinic / Stroke clinic / Movement Disorder) Admission Lounge Pharmacy Gastro Dept Discharge summary NICU 30 beds+ 3 Iso.beds+Med. Preparation Labor Complex Recovery Room 5 beds Mother & Child ICU 6 + 1 beds VIP Lounge Condis Projects Purchase Level 03 Admin Nursing office OPD-Cardio OPD-Family Medicine OPD-Urology VIP Lounge Liver Transplant ICU (Urology Expansion) MDICU 1 & 2 (Acute Care Unit & ICCU) ICCU OPD- Psychiatry Bridge Emegency ward extension-10 beds Biomedical Dept office Multi purpose hall Restaurant Proposed Bridge OBG OPD Neo Natal OPD Perinataology OPD Speciality OPDs ( subject to change) Radiology Sample Collection/Lab, Common Toilets VIP Waiting lobby Bystander Rooms Level 02 Main Reception, Insurance Radiology Blood Bank Sample Collection/ Lab, Pharmacy Toilets, Security / HSE office OPD-General Surgery ,Internal Medicine OPD-Paediatric (Rheumatology/Geriatric/Haematology/ Family Clinic) OPD-Endocrinology & Dibatology ENT OPD Day care Chemo - 9 beds Consultation room - 5 nos Mammography Ultra sound Examination Room Pharmacy Administration Billing,Accounts Conference room Executive Health Check Up Visa Medicals Command Centre Dining ICU Attendents Lounge with toilet 20M-17F Toilets M/F/Handicap Bystander Rooms Level 01 Ortho & Hand Surgery ED / ER OT Radiology Laundry CSSD Staff Support Building Service F & B Dept,Canteen Andhra Bank Reception PET CT-Scan Linac Radiation Room Consultation room- 5 nos Minor Procedure room Physisicts, Counseling Room Pharmacy Store Chiller Plant/Service Area, Pump room Washing Area- Kitchen Surfce Parking 69 Nos Reception,TPA/ Insurance Pharmacy, Pharmacy Store Gift Shop & retail Outlets International Lounge,VIP Waiting Lounge Space for conducting events, Waiting area for pick-up Kitchen & Store Chiller Plant Room Electrical Plant room Human resources Facility management UPPER BASEMENT Coventional Parking 104 nos Two Wheeler parking Hyperbaric Oxygen Chamber Staff Toilet 2M/2F Fire Water Pump Room STP Panel Room LOWER BASEMENT Stack Parking 102X2 =204 nos Conventional Parking 33 nos Two Wheeler parking STP Equipment & Maintenance KIMS MAIN KIMS NORTH KIMS EAST SERVICE BLOCK AVITTOM
- 15. Detailed Design Challenges • Site-specificdrawings to be generated with Consideration of existing systems • Input and feedback from the user group can streamline the design where the staff can be part of the commissioning Group • To Provide the most practical and economic solutions • Identify and schedule risk and uncertainties for project delivery • Appointment and Management of experienced PD and consultants • Budgeting approvals and Cost control plan • contract documentation • Preparing and vetting operational process flows for all connected depts to the refurbishment Detailed Design Phase
- 16. Process Group Solutions/MitigationTools and techniques Design and Contracting (Detailed Design Development & Contract Award) • Prepare a Site logistics plan • Preparing a master schedule • Setting clear Communications plan • Tracker for design deliverables and approvals, contracting • preparing PERT chart and critical Path analysis • Starting pre-commissioning activities • Extensive survey of existing facilities • Self Updation of latest technology advancements that could be feasible • Advance notices/reminders for payments as well as deliverables • Assessing material labour waste and equipment flows • PERT charts for close followup • Scheduling and planning • Surveys and feedback • Value Engineering • Implentation of LEAN • Preparing RDS/RLS • GAP Analysis • Data Collection and Audits
- 17. Detailed Planning Room DataSheets / Room Layout Sheets
- 18. RLS - OPERATINGROOM Room Layout sheet/Room Datasheet Healthcare Planning and Design | STAT Consultancy
- 19. Room Layout sheet/RoomDatasheet RLS - OPERATING ROOM
- 20. OPERATING ROOM Room Layoutsheet/Room Datasheet
- 21. ROOM LAYOUT SHEET-TYPICAL INPATIENT SUITE Room Layout sheet/Room Datasheet
- 22. Why Value engineering? •The functionality of the project is often improved as well as producing tremendous savings, in both initial and life-cycle costs. • A “second look” at the design produced by the architect and engineers gives the assurance that all reasonable alternatives have been explored. • Cost estimates and scope statements are checked thoroughly, ensuring that nothing has been omitted or underestimated. • It helps to ensure that the best value will be obtained over the life of the building 22 SavingthroughValueEngineering&AdoptionofLEAN LEAN Streamlining • Lean concepts are being implemented in order to improve staff workflow, patient care, and safety while eliminating waste. When a facility becomes operational, the expectation is improved efficiencies and lower facility costs. • But, Lean can also be implemented during the design and construction process to improve project delivery.
- 23. Pre-Construction Risk Assessment(PCRA) Healthcare facilities are required to have a PCRA process established. The PCRA is used for any healthcare facility demolition, construction, or renovation. It is a formal protocol used to identify potential healthcare construction risks and create mitigation strategies to reduce or eliminate them. There are seven components of a PCRA: • Life Safety Code deficiencies (interim life safety measures) • Air quality and pressure management (ICRA) • Utility interruptions and impacts • Noise • Vibration • Environmental services • Other safety hazards with respect to CDM Guidelines
- 24. Execution, Monitoring &Control Challenges • ensureobjectives are achieved in terms of specific performance, time, cost and quality. • compliance with Trust/NHS regulatory or audit requirements. • Budget and cost management and avoiding overruns • Identifying risks and its mitigation • Throughout the life cycle of the project produce and publish a monthly dashboard report • Keeping upto date Insurance and other policy documentations • timely certification and valuations under the contract but with accuracy • Performance manage the design and construction team • Conflicts and management • Change management Execution, monitoring & control
- 25. Process Group Solutions/MitigationTools and techniques Execution, Monitoring &Control (Construction and pre-commissioning Phase) • Giving timely, reliable, and focused key information given to the senior management • Develop a robust and effective Project Execution Plan (PEP) • Hold regular meetings with clinical, infection control and operational teams • Cost control plan • Set up and manage information flows, communication and planning within the design team • ad-hoc site inspections and check • Construction site review meetings • Give reasonable advance notice of additional capital funding required • checklisting • Dashboard and reports • Integrated Project Delivery • RACI matrix for design and execution • Ceiling closure checklists
- 26. Dashboard-ELEMENTS should be derivedfrom the Implementation chart • Key progress information • Red flags • Management decisions pending overview • Outstanding change orders • compliance/reconciliation/Approvals status • cash flow Projections • design status • Quality • Risks and early warning • requirements, outstanding information, forecast out-turn costs, • alternatives to deliver savings, • health & safety, • decisions taken • performances of the design team & contractor.
- 27.
- 28. MEP systems Commissioning -P1 Facility Handover for HFOC-P1A Soft Launch Pretesting Post- testing Verificationof SEMP Procurement master list-P1 Commissioning Road Map FF&E Orders Facility Operations High side systems commissioning All equipment Orders-Long lead P1 May 22 Obtaining final approvals Statutory Applications Snagging Training Dept. Handovers Preparing dust free areas for FFE March 22 Post commissioning August 2022 April 22 June 2022 Orders-Long lead P1 Infra dependency
- 29. Procurement master list Commissioning RoadMap- Monthly Monthly plans and their reviews with respect to commissioning dates FF&E Orders Feb 2022 High side systems commissioning ME Orders Statutory Applications 12 Verification of Master list Pharmacy TC HR Processes CAPEX Processes HR budget ME Orders- Minor
- 30. Material delivery delaysesp. Factory made non readily available items Less/ inefficient Workforce and their output – deriving catch up plans Uninspected Contractual obligations and discussions Challenges at site Any Delay in Purchase Orders or pre-purchase processes Lack of clarity of deadlines/Planning for the foreman/site team Lack of Macro and micro planning along with weekly targets
- 31. Why delays? issues •Excuses • skilled labor scarcity and supervisor incompetence • Not understanding/instilling the timelines. • Miscommunication and no Dual communication. • Psychological assumptions • Not receiving site updates. Not identifying red flags • Resources are not reallocated to ensure they continue to be matched to priorities. • Not solving clashes/issues in tandem with the construction activities. Keeping those for next day and delaying • Always keeping some works pending which always get forgotten • Construction activities not happening as per ideal/justifiable sequence and resulting in reworks and poor workmanship • Scattered construction activities leading to non- completion of areas in a direction/flow
- 32. Rework / 95%work complete scenario due to No coordination The biggest threat • Example for interior ceiling : Assuming there is approx. just 3% rework per area • 10,00,000*3% = 30,000 sq. ft. work – • Double the size of blood bank with 4 times the effort & time • Approx. average of construction is 25 man hours/ 100 sq.ft and for rework it may be more than 100 man hours / 100 sq.ft which makes it 30000 man hours /8 hours – 3750 man days or in simple terms 38 days work of 100 workers
- 33. Senior Management Team Site execution Communication challenges Client Civil PMC Head PMC MEP Client MEP PMC Interiors Operations team/Dept. owners •No collective information available with any team • PMC not bothered about Civil • Civil finishing not as per the priorities • No coordination happening between the Client MEP and PMC MEP • No coordination or follow up with Civil-MEP BME Hierarchy
- 34. Migrating to Integrated Projectdelivery Why IPD? • Collaborative Approach • Collaboration with the design team, facilities staff and medical staff that will occupy the building ensures the space meets functional requirements and results in the highest level of patient care. • IPD denotes the process of bringing together the project architects, engineers construction managers to work together to in a collaborative effort, which can speed up the project’s completion. • the integrated team institutes open, collaborative, project-oriented goals, will result in cost-effective and timely built facilities that are of the highest quality.”
- 35. Steps to achieve 1.Preparing a master schedule incorporating commissioning 2. Operations to handle the commissioning part in master schedule 3. Milestones to be shared by civil pmc and mep after internal coordination 4. Review progress every week and discuss red flags 5. Receive progress photos of discussed areas 6. Trade wise manpower report weekly chart and projections exclusively for phase 1 and related(hospital external, shaft works etc) 7. Assessing the situation and fixing priorities Type of meetings required every week 1. Weekly planning / Review meetings-top level macro level - floor /systems / Utility and occupancy and status of meeting deadline committed 2. Site coordination meetings. Between Civil,MEP and PMC with operations representatives 3. Contractor Review meetings-site level weekly targets zone/dept./block wise all site engineers and contractors 4. Design Coordination meetings to discuss open/pending items.
- 36. Integrated master schedule •Scheduling the activities and resources efficiently plays a key role in any project’s success. The project master schedule is one of the most effective tools. • Master Schedule is a summary level project schedule which includes the major project deliverables, work breakdown structure components, and key project milestones and show various inter dept. relationships / dependencies. • A project master schedule is an early communication tool among stakeholders which shows the major deliverables, key milestones and its status • Simply put, a master schedule is prepared for tracking the project at a summary level. • This can instill the target date of the project in all the stakeholders
- 37. Importance of following sequencein construction Sequencing of work has implications not only for keeping the project on schedule, but also for coordination of trades, quality control, and the potential need to dismantle or replace completed work. If the work is not implemented in the proper sequence, damage to completed work can occur if it is adversely affected by the tasks that follow. Example A new gypsum board was installed and finished to address damage from prior roof leakage. However, the contractor had not yet finished the new roof installation to address the source of the leakage, and the newly completed work was damaged and needed to be redone.
- 38. Risk of Tiledamage and rework Block 5 Lift lobby Block 5 common toilet complex Importance of following direction in construction
- 39. Sl.no Work/Task Materialdependencies Status Process owner W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 Civil Phase 1 Civil works including masonry, brick wall partition 2 MEP Shaft works Pipes and ducts lagging 3 MEP testing 4 MEP low side works including wiring, cabling, piping, ducting and fixing of back boxes/first fix etc. ducting 5 Civil masonry completion including closing of shafts and completion of cement based works lagging 6 External façade/closing, sill level finishing etc. glass panels and frames lagging 7 Doors, shaft doors , and frames doors and frames lagging 8 Floor Tiling 9 Vertical - external and horizontal expansion joint finishing joint profiles lagging 10 Making the area/Block weatherproof and debris cleaning lagging 11 Floor to floor closing of shafts checker plates and welding lagging Interior Phase 12 Interior wall finishing-plastering and paneling False ceiling pre closure checklist signoff 13 False ceiling channel and tile/board works and cutouts as per RCP 14 Second fixtures MEP and Ceiling fixtures lights, diffusers current stage 15 First round cleaning Fit out Phase 16 laminate glass / special items fixing delivery of items for the area 17 Furniture delivery and placement furniture 18 MEP second fixtures on furniture 19 Sanitary and SS fixtures installation including grab bars etc. fixtures 20 Completing furniture installation 21 Second round deep cleaning Handing over phase 22 Snagging 23 Desnagging 24 Third round cleaning 25 Handing over signoff between projects and facility engineering 26 Takeover of user dept. and familiarisation of user dept. Timeline Timeline Ideal construction sequencing
- 40. Pending civil worksduring advanced finishing stage in the same area Missing required Critical points resulting in rework
- 41. Ceiling Closure checklist Riskassociated with not signing off ceiling closure in every area
- 42. It can rain insidetoo !
- 43. AuditMethodology • Identifying Risks •Categorizing Risks • Mitigating Risks PLAN FOR THE UNKNOWN Risk management and keeping risk registers
- 44. Types of Work 1.Not conducting an Infection Control Risk Assessment (ICRA) An ICRA documented process that focuses on the reduction of risk from infection and acts through the phases of facility planning, design, construction, renovation and maintenance, provides guidance to administrators and construction personnel on proper infection control protocols. While most large renovation projects require an ICRA, smaller projects often do not. 2. Under-sizing the negative pressure system Facilities often consider negative pressure systems less important in small construction projects, and consequently they utilize the incorrect system size. The improper sizing of negative pressure systems does not allow for the recommended negative pressure of 0.01 inches of water, and can result in construction zone dust escaping into the general hospital area. 3. Conducting renovations during off hours While this may seem like an appealing option, it can quickly lead to sloppy work practices. Many healthcare facilities believe that by conducting construction during off-hours they can reduce costs and avoid the necessity of installing proper contaminant barriers; however, hospitals operate 24/7, therefore the risk to patients and staff exists 24/7. These contaminant barriers, or ICRA containment, and other preventive measures exist for a reason and their misuse can result in unnecessary contaminant exposure. Common Infection Control Mistakes To Avoid During Renovation Projects 4. Improper design of the containment barriers and anterooms • Improper placement of containment barriers and anterooms can make the difference between successful infection control and an outbreak. If the containment walls and other enclosures interfere with the placement of equipment or utilities, workers may bypass or dismantle them, which could lead to hospital-wide contamination. Personnel must consider the entire construction zone and the project flow before building these structures. 5. Failure to follow industry protocol for mold • Upon discovery of mold in a construction zone, personnel must enact specific measures to prevent the spread of mold spores. Failure to take all the appropriate steps, could place the facility at serious risk for an outbreak. • By keeping infection control a top priority before, during and after construction project, protect your patients and staff from exposure to contaminants and minimize the chances of illness.
- 45. Containment of Dustand Debris • Controlling construction-related activities • Building shafts, chutes • Electrical and water system shutdowns • Ventilation and Environmental Control • Creating Negative Pressure Environments • HVAC system shutdowns, potential for passive ventilation • Barrier Systems • Dust and Debris Control • Envelope penetrations • Contamination Control • Removal of materials from the building • Clean Clothing and Tools Engineering Controls Safe Work Practices Daily Safety Briefings Vacuuming Debris Removal Traffic Control Worksite Cleaning Monitoring
- 46. Sealed Air Ducts MobileDust Control Devices Tight to ceiling and walls Door Closed Barrier For Dust Control Debris Removal Use Of Coveralls During Demolition Sticky mats Steps Site entry separate from hospital
- 47. Types of Work InfectionControl Risk Assessment-ICRA TYPE A Inspection and Non-Invasive Activities Includes, but is not limited to: Removal of ceiling tiles for visual inspection limited to one tile per 50 square feet painting (but not sanding) Wall covering, electrical trim work, minor plumbing and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection TYPE B Small scale, short-duration activities which create minimal dust Includes, but is not limited to: Installation of telephone and computer cabling Access to chase spaces Cutting of walls or ceiling s where dust migration can be controlled TYPE C Work that generates a moderate to high level of dust or requires demolition or removal of fixed building components or assemblies Includes, but is not limited to: Sanding of walls for painting or wall covering removal of floor coverings, ceiling tiles and casework New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity which cannot be completed within a single work shift TYPE D Major demolition and construction projects Includes, but is not limited to: Activities which require consecutive work shifts Requires heavy demolition or removal of complete cabling systems New construction Types of work Low Risk Medium Risk High Risk Highest Risk Office areas •Cardiology •Echo cardiography •Endoscopy •Nuclear medicine •Physical therapy •Radiology/MRI •Respiratory therapy •CCU •Emergency room •Labor and delivery •Laboratories (specimen) •Newborn nursery •Outpatient surgery •Pediatrics •Pharmacy •Post anesthesia care unit •Surgical units •Any area caring for immune compromised patients •Burn unit •Cardiac Cath lab •Central sterile supply •Intensive care units •Medical unit •Negative pressure isolation rooms •Oncology •Operating rooms including c-section rooms Type A Type B Type C Type D Low Risk I II II III/IV Medium Risk I II II IV High Risk I II III/IV IV Highest Risk II III/IV III/IV IV Match the type of work category to the patient risk group to determine the precaution class Patient Risk Categories
- 48. Required Infection ControlPrecautions by Class partial listing During Construction Project Upon Completion Class I 1. Execute work by methods to minimize raising dust from construction operations. 2. Immediately replace ceiling tiles displaced for visual inspection. Class II 1. Provide active means to prevent airborne dust from dispersing into atmosphere. 2. Water mist work surfaces to control dust while cutting. 3. Seal unused doors with duct tape. 4. Block off and seal air vents. 5. Place dust mat at entrance and exit of work area. 6. Remove or isolate HVAC system in areas where work is being performed. 1. Wipe work surfaces with disinfectant. 2. Contain construction waste before transport in tightly covered containers. 3. Wet mop and/or vacuum with HEPA-filtered vacuum before leaving work area. 4. Remove isolation of HVAC system in areas where work is being performed. Class III 1. Remove or isolate HVAC system in area where work is being done to prevent contamination of duct system. 2. Use critical barriers (i.e. sheetrock, plywood, plastic) to seal areas from non-work areas or implement control a cube method (i.e., a cart with a plastic covering and a sealed connection to the work site with a HEPA vacuum to clean the area prior to exit from the area) before construction begins. 3. Maintain negative air pressure within the worksite using HEPA-equipped air filtration units. 4. Contain construction waste before transport in tightly covered containers. 5. Cover transport receptacles or carts, if the cover is not solid the cover must be taped closed. 1. Do not remove barriers from work area s until the completed project is inspected by the Infection Control Department and thoroughly cleaned by the Environmental Services Department. 2. Remove barrier materials carefully to minimize spreading of dirt and debris associated with construction. 3. Vacuum work area with HEPA-filtered vacuums. 4. Wet mop area with disinfectant. 5. Remove isolation of HVAC system in areas where work is being performed. Class IV 1. Isolate HVAC systems in areas where work is being done to prevent contamination of duct system. 2. Use critical barriers (i.e. sheetrock, plywood, plastic) to seal areas from non-work areas or implement control a cube method (i.e., a cart with a plastic covering and a sealed connection to the work site with a HEPA vacuum to clean the area prior to exit from the area) before construction begins. 3. Maintain negative air pressure within work site using HEPA-equipped air filtration units. 4. Seal holes, pipes, conduits and punctures appropriately. 1. Remove barrier material carefully to minimize spreading of dirt and debris associated with construction. 2. Contain construction waste before transport in tightly covered containers. 3. Cover transport receptacles or carts, if the cover is not solid the cover must be taped closed. 4. Vacuum work area with HEPA-filtered vacuums. 5. Wet mop area with disinfectant. 6. Remove isolation of HVAC system in areas where work is being performed.
- 49.
- 50.
- 51. Operational and EngineeringCommissioning Challenges • analyzing and arriving at practical completion • Conflicts or differences in opinions • Coordinate the technical commissioning • Lack of Total snagging with participation from user depts • Coordination issues Commissioning
- 52. Process Group Solutions/MitigationTools and techniques Operational and Facility-Engineering Commissioning • Intense Coordination and followup of bottlenecks and obstacles • Participation from all user and relevant support teams • Early identification of issues • Risk assessments during construction stage • Snagging, desnagging and rectification • Mock drills and TAT Evaluation • PERT Charts • Action Plans • Implementation chart • Robust communication • Key information flows • Trello or similar software for collaboration
- 53. Engineering Commissioning • Developmentof Utility Management Plan • FormalAcceptance • Comprehensive training for maintenancestaff • Commissioning of • Engineeringsystems • MedicalEquipment • IT–Communication system • Signage-InternalExternal
- 54. OPERATIONAL COMMISSIONING Formation of HFCCore Committee Deriving action plan for each department Implementation chart Coordinated Timeline-Master program Monthly milestones and progress review Execution Stage Planning Stage • Physical activities programme • Operational policies • Human resources strategies • Communication plan • Furniture, fittings and equipment activities • Occupation activities • Decommissioning of previous facilities • Budget allocations • Risk management
- 55. Commissioning Meetings TEAM Members •Client Directors • Client Engineering heads CIVIL and MEP • PMO • PMC/PD Representatives • Client Admins HR Contracts • Client Procurement team • IT-Engineering heads • Clinical Heads • Utility-support services heads
- 56.
- 57. PROCESS RELATIONS DIAGRAM STATCONSULTANCY 57 > > > > > > > > > > > > > > Management approval > > > > Series start > > > > > > All concerned IT Digital Housekeeping Marketing HR Clinical Engg Safety PARCO HOSPITAL Operational commissioning PERT CHART : Master Procurement Projects Pharmacy Clinical Quality Nursing
- 58. STAT CONSULTANCY REFERENCE ONLY Sl.noProject Phrase Cx Task Description Status/Remarks Timeline- Latest end Commissioning Task (w.r.t Master schedule. To be filled by STAT) 1 SOA analysis Schedule of Accomodation to be shared for analysis completed 31-Aug-19 2 Care planning Areas of care to be identified by key team completed 15-Sep-19 3 a)Inpatient completed 15-Sep-19 4 b)Outpatient completed 15-Sep-19 DOCUMENT REF NO : STAT-IND-KL-KIMSE-CMNSNG-OPT-APLN-NURSING-R0-19-7-19 DOCUMENT REVISION : REVISION 0 DOCUMENT ISSUE DATE: 19-07-2019 PROJECT : KIMS EAST HOSPITAL COMMISSIONING AGENCY : PROJECT LOCATION:TRIVANDRUM, KERALA DOCUMENT TITLE: ACTION PLAN FOR OPERATIONAL COMMISSIONING TARGET DEPARTMENT :DEPT. OF NURSING Pre-commissioning
- 59. STAT CONSULTANCY 5 Dept.planning Organogram and Staff hierarchy completed 22-Sep-19 6 Manpower planning Completed. Submitted to HR 7 Adoption of Standard Operating Protocols extension only Not applicable 8 Setting of communication protocol extension only Not applicable 9 a)Intra department extension only Not applicable 10 b)Interdepartmental extension only Not applicable 11 Duty timings extension only Not applicable 12 DNO communicated to HR COMPLETED 13 HR. planning Staff strength as per the Care areas communicated to HR COMPLETED Setting up REFERENCE ONLY
- 60. STAT CONSULTANCY 14 Nurseto patient ratio communicated to HR COMPLETED 15 a) Inpatient Rooms communicated to HR COMPLETED 16 b) ICUs communicated to HR COMPLETED 17 utilization of students communicated to HR COMPLETED 18 Facility planning verification / concurrence of infrastructure planning 15-Sep-19 19 Facility setup Verification of nurse call system 15-Nov-19 20 Operations setup Dress codes 30-Nov-19 21 SOP planning Hospital emergency code team setup 15-Feb-20 22 Training Induction Training 15-Mar-20 23 Training SOP Training 22-Mar-20 REFERENCE ONLY
- 61. STAT CONSULTANCY 24 TrainingSafety training 30-Mar-20 25 Training Technology training-software and Command center 15-Apr-20 26 Training Equipment training by BME/Vendor 30-Apr-20 27 Training Mock drills 5-May-20 28 Equipment Handling Signoff Equipment acceptance after training 10-May-20 29 Equipment Handling asset management for allocated FFE 10-May-20 30 Equipment Handling Departmental allocation of Equipment as per equipment schedule 10-May-20 31 Equipment Handling Checklists for Equipment Maintenance 10-May-20 32 Site tour Site tour of inducted staff after handover 25-Apr-20 33 Snagging defects identification and rectifications 1-Apr-20 Training Handover Pre occupancy REFERENCE ONLY
- 62. Start up plan Equipment installationplan Onboarding Plan Infra readiness- dust free zones Identifying and scheduling dept. startup Forming a multidisciplinary team 62 34 Training and trials Interdepartmental relationships and indenting procedure 1-May-20 35 Pre functional Patient acceptance trials 5-May-20 36 Facility handover Signoff Signoff facility handover for care areas 15-May-20 Pre occupancy training Implementation chart • Consolidated Action plans streamlined as per the OPR • Prepared after the finance department approval as per the allocated budget Start-up and transfer Plan
- 63. Close Out & PostOccupancy Project Closeout & Post Occupancy Conducting lesson learned adding to policies based on lessons learned Taking responsibility to make sure the project is to the required standard of quality and within the specified constraints of time and cost.
- 64. Family zones inpatient rooms which encourage closer observation of patients reduce the number of patient falls. Value Additions of EBD Patient safety EBD can achieve efficient workflow through decentralized workstations, which bring nurses, physicians, and supplies closer to patients by distributing stations throughout the unit. Natural light and Views of the outdoors can elicit positive emotions and distract patients from pain Increase Staff Efficiency Decrease Patient Need for Medication Conducting Evidence-based Design(EBD) studies Evidence-based design (EBD) is a decision-making approach that provides research-backed information for decisions made during the design process.
- 65. EBD Design Process Measure –KPIs Noise Light Traffic Aesthetics Staff satisfaction Patient healing rate Average bed occupancy rates
- 66. THANK YOU! Diligent, Proactivecoordination and management can achieve the desired Quality within the Cost before the Time anticipated of a project & exceed theOPRs in a live healthcare Construction environment Lets Create a positive resonance!
Editor's Notes
- #9 Premise(s) for the future, upon which the project is required (e.g., occupancy at 90%, population growth, and change in treatment protocols); Descriptive overview of the change in the organization to address the project; The supporting rationale that identifies the factors driving the need and the planning work done to date; Summary of needs assessment findings; and key cost, schedule and implementation assumptions. Provides a detailed description of component activities and functions - what is done (e.g., inpatient care, ambulatory care, diagnostic imaging, patient transport, building cleaning, laundry, food services, human resources), by whom, when and with what resources. It includes specific components within the major activities/functions (e.g., Human resources would be further broken down – labour relations, payroll, accounting, etc.) and describes any transfer of activities/function from one component to another component.
- #12 (e.g., access, security, privacy, noise control, natural light, infection prevention and control, safety, work environment, change and flexibility, sustainability, critical dimensions, overall layout, special needs population);
- #25 EMC
- #37 If Master Schedule is there, We will not approach with prejudice that the project wont get completed anytime sooner More clarity on items and dates
- #47 46
- #55 The process of commissioning a facility relates not only to the management of time, costs,supplies, equipment and the quality of buildings, but also to the management of people,systems and organizations to ensure that the facility is utilized effectively at the same time ensuring safe environment for patient, staff and visitors.