Building Management

3 steps when considering renovating a medical facility

If you own a hospital or are responsible for medical facility, you’re likely acutely aware of the shift in priorities in the last few years towards population health, bringing care to patients in a befitting location – which may not be the local medical “super center”, and support patient health up-front to reduce the need for hospitalization (HFM & ASHE). Not surprisingly, these shifts have had a profound impact on medical facilities and infrastructure and have fueled an increase in renovations and repurposing of facilities. In fact, a joint ASHE/AFM survey of nearly 550 hospital and health system executives indicates that planning for the next two years includes a strong desire for facility renovation and repurposing over building new facilities: 62% of respondents planned for increased renovation, 50% planned for the increased repurposing of facilities, while only 43% of respondents planned for an increase in building of new facilities.

So, here are three practical steps that you can take towards accomplishing your hospital’s mission into the future: maintain your facility, add details to your master plan, don’t paint yourself into a corner:

  • In order to ensure the greatest patient and worker safety and lowest overall facility cost, electrical equipment maintenance must be a priority; after you renovate or repurpose a facility, establish your Electrical Preventive Maintenance (EPM) plan and stick to it. The National Fire Protection Association (NFPA), regularly associated with Arc Flash Hazards Risk Analysis, also maintains document 70B, a document regarding electrical equipment maintenance. NFPA 70B is very clear on the topic of the urgency of facility maintenance as it lists the following direct and indirect benefits of an EPM:
    • Direct and measurable
      • Reduced cost of repairs
      • Reduced equipment downtime
    • Indirect or more difficult to measure
      • Improved safety
      • Improved employee morale
      • Better workmanship
      • Increased productivity
      • Reduced absenteeism
      • Reduced interruption of production
      • Reduced insurance costs

NFPA illustrates the direct benefits of EPM via the graph below. Notice that overly frequent inspections are expensive while infrequent inspections are also expensive. A pace of inspection of approximately 2.5 to 3 years is optimal in that it keeps overall maintenance and repair costs to a minimum. nfpa 70B maintenance and repair graph

  • Next, for those of you with aging equipment that are planning a retrofit/renovation approach, make sure your master plan either contains or references a strategic infrastructure road map. For example, we’ve seen instances where facilities with poor, or no, strategic infrastructure plan moved forward with the replacement of aged breakers with the equivalent new version of the same breakers that had essentially the same functionality as the older ones. While new breakers reduce the risk of failure in this case, solving the problem, they may well be an expensive narrowly focused asset purchase that ignore (1) other technologies or available functionality, such as advanced metering and event capture or (2) don’t fully integrate with the rest of the system. So, be hesitant to simply swap old equipment with new equipment; make sure your team either performs an entire system analysis or works with an engineering firm that can – this will cost a little money initially, but it will likely provide an intelligent CAPEX road map that can be followed for years to come to ensure an integrated system while allowing expenditures to be spread over time.
  • Lastly, if you are repurposing a facility or renovating an existing one, don’t paint yourself into a corner; identify your current load and consider your future load. As basic as this is, it is frequently overlooked for the following reasons:
    • Facility one-line drawings are not current (easy to understand given most hospitals are around 27 years old)
    • Metering data is not utilized to understand actual loads
    • The misconception that “space” is equivalent to capacity; just because there’s a spare doesn’t mean the capacity exists
    • Inexperience

If you are renovating your facility, ensure you understand your current load and adequately anticipate your future needs. If you are repurposing another facility, don’t assume the one-line diagram is correct; have a proper analysis done and confirm the existing state before you make the necessary changes to support the anticipated load growth.

For those of you considering a renovation or repurposing of another facility, (1) draft your EPM and stick with it, (2) don’t paint yourself into a corner with a myopic or incomplete master plan, and (3) know your current load, make reasonable projections for the future, and design accordingly.

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