CREJ - Healthcare Properties - JANUARY 2017
The focus of this publication and many of the articles written is on the state of real estate investment, financial opportunity, design criteria and insight, construction projects, delivery methods and market types. All of which are important topics when discussing capital investment in real estate. An additional topic that is beginning to receive more attention is the role of facilities management in creating an integrated approach that also addresses operating, maintaining and improving the building infrastructure in order to create an environment that strongly supports the primary objective of the organization. In previous articles, we discussed the meaning behind projects, the elevated value of project success through teamwork and understanding of common goals, and the evolution of operating room technology. These topics are certainly drivers in health care construction and shed light on how our industry is changing. While the health care industry is experiencing vast change through the delivery of patient services, that change also is affecting the way facilities and health care campuses are being developed. And at the heart of these campuses is the facilities management group. We talk about function and design, we budget and value engineer, we contract, project and report. In all of this, where would we be without facilities management? Historically one of the problems in the building industry was a limited degree of learning from how existing buildings are being used and operated when new building projects are planned. What forward-thinking teams are realizing is that the facilities management group is the missing link to bridge the gap between building operation and building design. Savvy facilities management teams are making sure they are part of the process by developing productive relationships with every professional who plays a part in constructing the building. They recognize that early involvement and intelligent decisions will save them time and money later and can prolong the operational life of the facility. There is an incredible strain put on facilities. With 24/7 operations, systems must be manned at all times. Facilities management teams have many responsibilities: They partner with physicians and nurses to ensure high quality of care is being received inside their building; they manage capital budgets; and they strive to improve the efficiency and quality of patient care while reducing costs. In our office, an employee recently went in for surgery on his arm. The surgery start was delayed because the facility staff was working tirelessly to clear snow from a snowstorm while at the same time adjusting the operating room temperature down to 65 degrees to allow for the optimal working conditions for the surgeon and his team. In addition to the daily work tickets involved with maintaining the buildings, the facilities group takes on more – they are the enforcers, the activists, the realists, the inspectors, the creators, the managers and the technicians. They keep the facilities operational, they keep them current and they keep them compliant. This group has responsibility to Centers for Medicare and Medicaid Services, joint commission, internal corporate audit, state and local authorities, the fire department and so many more. They make sure walls meet ratings, penetrations are sealed, smoke compartments are maintained and access control is in place, in order to ensure patients, visitors and staff are all safe. And after all of this, facilities oversees the construction on campus. In health care, construction is as common as the seasonal flu. With new technologies, growing population, expansion and competition, there is always a project underway. It is from the facilities team that we learn about the existing systems, the history of changes, the manufacturers that function best, locations of shut-off valves, model numbers for the hands-free faucets that last and the effects of winter weather on mechanical systems. A critical element of most items we coordinate with facilities is patient safety. Understanding what electrical panels feed, monitoring and adjusting air supply, shut down of life safety systems and main utilities are all examples of coordination with facilities that occur daily. I recently sat in a meeting where a debate was taking place on the cost savings of vinyl composition tile flooring in lieu of sheet vinyl. The team was focused on discussing colors, looks and presentation. It was the director of facilities that ultimately stated the facts: in this particular area, there is not high traffic. Even considering the cleaning of the VCT, which takes more maintenance for waxing, VCT was a much smarter decision based upon replacement costs. Decision made. There are countless examples like this, whether discussing a medical gas outlet type and the ability to replace parts versus the entire outlet, or light fixture manufacturers, or major mechanical equipment, all of which are based upon real life knowledge. Every day, the facilities group works with the parts and pieces specified in our projects. They repair, maintain and replace everything. As a construction team, the facilities group is our lifeblood. We will never succeed on any project without assistance from the facilities group. Developing a partnership with this group is critical. We would be lost without them. Recognizing existing conditions, assistance with shut downs, managing the intricacies of any facility comes expressly from this group. The facility manager cannot be left out of the design and construction process. Facilities should be involved early in design with product and equipment specification all the way through construction with coordination, shut downs and inspections. Ensuring that facilities management plays an active role every step of the way can influence the health of patients – and the health care organization itself, strengthening and adding value to the construction process. Facilities is the heart of the medical campus.