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By Bryan Semple, Vice President EMEA, Attainia
It's happened many times before: that sturdy, highly functional computer desk you saw at the store arrives in a robust looking box. After carefully separating the necessary pieces from the packaging, a master plan outlining each step of assembly is adequately provided. But many questions about what to do with this desk still remain. Where is the best location? How should the shelving be spaced? What accessories make the most sense? As you recall this familiar scenario, let's take a few moments to outline just how similar it is to planning a capital construction project.
Please note that this insightful article will blend the nuances of the common standards of this process with enlightening pearls that you may not have considered before. These creative and innovative notions provide avenues of direct application and/or help in fostering other concepts that lend themselves to the ideal capital construction project. It’s well worth your time to explore these perspectives, which we have broken down into “core considerations” and “innovative ideas.”
Let’s put our thinking caps on! It is first necessary to create a preliminary equipment list and formulate budget estimates based on square footage, preliminary plans, organisation standards, and equipment that will be made available from GPO contracts. If the project is a renovation or relocation, perform an equipment survey and create an inventory of equipment in the existing facility/department, including any warehoused equipment intended for the project.
Next, hold preliminary meetings with department heads to get feedback on equipment standards, general equipment requests/needs for the project, and what can be relocated once the project is completed. It is important to then document the approved project budget for overall variance tracking later on. Lastly, distribute the preliminary equipment list and budget reports.
Capital Offset Programmes
Tactful discovery and negotiations with all applicable suppliers may uncover that equipment will be provided free of charge if the hospital shows brand loyalty to a supplier. This type of strategy, termed a "capital offset programme," is a great way for a hospital to acquire expensive equipment without the outlay of funds. While the benefits to the hospital are obvious, the supplier also benefits; the incorporation of their capital will necessitate the use of their disposables and/or further purchases of their software upgrades. The long-term vision of the supplier is to also create a brand identity within the hospital so that when capital upgrades are desired, they will be the first source to come to mind.
Standardising to a local supplier is not often considered. Hospitals located in the proximity of companies that manufacture desired capital pieces can often leverage "buying local" and "treating local" exchanges in which the hospital purchases locally produced items in exchange for preferential patient channeling opportunities from the supplier. This idea goes beyond the normal price shopping and can demonstrate an enhanced acumen by the hospital supply chain to create innovative ways in which additional value can be obtained.
Time to design! The first step is to make sure the necessary end-users have provided feedback on the equipment in the appropriate locations. These resulting equipment configurations and ongoing updates will ensure preliminary signoffs on the optimised equipment list (types and quantities of equipment) and placement of each piece of equipment. It is then important for department heads to finalise manufacturers/models, as these will have an impact on the construction schedule and major systems (i.e. surgical lights and booms, diagnostic imaging equipment, sterile processing equipment, and patient monitoring).
Next, procure signoffs and negotiate with the appropriate vendors to prepare preliminary quotes and drawings. This step is key for critical path equipment. Architects and engineers will also be needed to coordinate equipment locations and requirements. Lastly, prepare and distribute Design Development deliverables and reports: equipment lists, specification books, budget information, and equipment placement drawings.
More companies are striving to get "green certified" at their facility to receive local and national tax breaks, as well as government enhancements on certain reimbursements. The tactful capital equipment planner will be sure to incorporate all available planning strategies into the build. If green certification is the goal, it is critical to consider that large diagnostic pieces comprise the bulk of a hospital’s energy use.
Ambience and Art
As patients continue to demand more for their healthcare dollar, they also want to experience medical treatments in a setting that does not resemble healthcare. The clinical facilities of tomorrow are finding ways in which to make medical visits feel more like hotel visits. Moving away from aseptic white walls to warm, calming, and more aesthetic settings is becoming the norm. Create a similar environment within the capital equipment areas, as well, with curtains, calming art, aquariums, and the like. Patients who merely tolerate the visit will become advocates of the hospital if the details they share with family and friends describe a more satisfying experience.
Next Generation Data Sharing
The ability to drive the sharing and evaluation of medical data continues to be at the forefront of hospital design. Equipment needs to feed data seamlessly into an EMR; that data needs to be available by both providers and patients, and ideally aggregated into forward-looking algorithms that will help clinics identify and stratify at-risk populations. When planning to purchase capital equipment items, the ease with which that equipment will interface with current systems can make the difference between zero cost or thousands of dollars in IT interface work. The forward-looking clinic will realise that a coordinated capital equipment strategy that easily shares data will facilitate the synergy of multi-nodal data sets to provide patients with a clear understanding of their diagnosis and prognosis.
Go for construction! But first be sure to review equipment lists, placements, and configurations with end-users. If items will not be going out to bid, finalise preferred manufacturer and model choices with these stakeholders as well. It will then be necessary for the architects and engineers to sign off on the equipment list and equipment placement drawings. Vendors should provide final drawings for critical path equipment.
Next, the all-important Construction Document deliverables should be distributed. These include equipment lists, specification books, budget information reports, and equipment placement drawings. After budgetary approval on the financial figures, ongoing snapshots of working budget pricing are used for variance tracking during procurement. In the event of an over-budget scenario, you will need to review options for other vendors, refurbished/used equipment purchases, equipment leases, or scaled back services. These adjustments will help meet facility criteria, the target open date, and services to be rendered.
Going with Quality
When it comes to selecting the right kind of capital, the classic adage "you get what you pay for" often rings true. It takes a massive amount of research and development, testing, software, and ongoing regulatory compliance for a typical piece of imaging equipment. At the same time, there are low-cost options in almost every sector of imaging equipment, all of which tout similar accuracy and reliability. With patient care at the centre of a hospital’s mission, the thoughtful planner will stay with industry-leading companies that provide current technical assistance and future maintenance reliability. There should be zero tolerance of any risk in a hospital’s capital imaging when it comes to upstart/economy options.
As wireless connectivity, bluetooth, and cloud-driven data become the norm in the IT world, it is important to produce a layout of capital equipment that will not burden other pieces or interfere with the hospital’s communication operations. It is understood that poorly planned installations can create "dark zones" in which data is neither sent nor received. Knowing the EMF signals and radiation of all capital pieces will guide the construction planner when adjusting space and sizing so that all communications channels are 5 by 5 (meaning they are of optimal signal and clarity).
Activate the space! Once the equipment configurations, options, and accessories are finalised, prepare the purchase schedule and coordinate both the lead times and ordering sequences. Department heads will act upon final vendor quotes to create and submit PO requisitions to Supply Chain for approval and processing. PO numbers for equipment purchases are documented while budget and variance reports are tracked. Equipment is sequentially and systematically activated upon delivery, while BioMed tags and tests these items in the equipment planner. Predetermined staff members receive training and an ongoing punch list is updated collectively by all stakeholders. After As Built documents are prepared and distributed, final vendor drawings are obtained to coordinate the vendor phase of the activation (with their associated delivery, installation, and testing). Coordinate and attend Owner-Vendor Contractor meetings as well as Owner-Architect Contractor meetings. Lastly, update any documentation resulting from changed orders, equipment, or architectural plans.
Patient acquisition optimising the financial return of expensive capital pieces should be considered strategically and proactively. Merely opening the doors of a new MRI centre and assuming “if you build it, they will come" is a dramatic misstep. Planning committees should properly identify all available patient referral bases, both internal and external, and account for six months of focused marketing to these sources prior to the facility’s launch. Moreover, ongoing and regular community outreach programmes need to be established so that the facility becomes part of the local community and culture. If an MRI centre cannot successfully recruit in its own back yard, how will it ever be able to motivate patients from a distance? Complimentary health screenings, free lectures on health and wellness, and active engagement with local police/fire departments will begin to create an identity for the clinic that will nurture continued patient acceptance and referrals.
Practice Makes Perfect
A soft opening with hospital staff acting as patients can be an illuminating experience. Suboptimal or outright inaccurate conditions may be found in areas that serve triage patients, sections where patient traffic was expected to be minimal, or workflow designs that are meant to move patients in a timely manner. It is better to identify operational deficiencies prior to the full clinic launch, before patient feedback and complaints can mount. In a world where one patient can affect hundreds via social media, getting off on the right foot with an internal soft opening can only help.
Your ten minutes to go through the nuances of optimising your healthcare facility capital construction build is most appreciated. Remember, this article is just a framework; expert consultants will find even more moving parts and innovative ideas not covered here.
Bryan Semple, Vice President EMEA at Attainia will be chairing the Equip conference stream of the Building Healthcare conference being held in Dubai, 11-13 September 2017.