In these unprecedented times, plants and factories are scrambling to increase agility while navigating highly-unusual working conditions and disrupted supply chains. Once the safety of employees and customers is provided for, we are looking for better ways to operate remotely, ensure business continuity with efficiency and cost containment - and become resilient to future disruptions.
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The mission-critical nature of hospitals and healthcare facilities requires that stakeholders build their business around a philosophy of high availability of services. At the physical level this implies the preparedness of electrical power, ventilation, and heating and cooling networks that support the availability of the facility, and ensure business continuity across all disciplines, and emergency recovery goals.
As a former Director of Estates and Facilities at a large acute hospital trust in the UK, I was responsible for maintaining the resilience not only of the electrical, mechanical and IT infrastructure, but also of our supply chain and the staff members responsible for front line internal systems and support services.
Managing emergency events requires a level of preparedness above and beyond implementing standard business continuity best practices. Below is a list of preparedness best practices that center less on technology, and more on the ability of the humans on the ground to communicate, act and maintain the resiliency of overwhelmed systems:
More detailed and holistic up-front planning – The systems and the people working at the healthcare site all impact each other. In an emergency event, resilience of the whole system is what comes into play. What happens if we lose ventilation service? What if I lose power or another utility such as telecoms? Not only does the planning entail identification of the many potential modes of failure, but it also requires an understanding of how people will react to a failure when it occurs, and how the supply chain and utilities can respond to remain intact.
Scalability of physical assets – In an unprecedented situation where facility capacities are stretched to the limit, existing facilities may have to be quickly retrofitted for a different purpose. When adding new, temporary accommodation within an existing building or changing the nature of the power, water and oxygen consumption rates of a particular wing (like adding ventilators to rooms where none previously operated), electrical systems that are capable of quickly scaling up in order to meet expanded energy demands will be required. Considerations that may affect this requirement could also include temporary, supplemental refrigeration to accommodate the need for increased mortuary capacity, for instance.
Physical security becomes even more of an emphasis – During an emergency, the situation at hospital sites may be changing constantly. New issues may present themselves around how to channel and direct large volumes or infected or infectious people (as well as large groups of media and press members) through buildings, and how to control their movements. Physical security becomes much more important during these lock-down situations in order to control movement and unwanted intrusion and to limit the risk of a contagious disease spreading.
Information access is a holistic system lynchpin – In highly fluid situations, tactical decisions rely on inputs that communicate accurate knowledge and intelligence. The quicker key decision-makers across the facility (on both the medical and physical plant sides) can access that information, the better. For example, medical gas usage (like oxygen) and power and water usage trending must be closely monitored so that experts can accurately predict what might happen next and put contingency plans into place to address the oncoming wave of new demand.
Facilities technicians will need protection too – In addition to medical professionals, hospitals also staff teams of facilities technicians. These individuals may be asked to address ventilation or drainage issues within the hospital facility during the crisis. Many will be worried about viruses being transmitted on surfaces in ventilation ductwork or in waste removal systems. When planning for these emergency situations, a full understanding and assessment of the risks that exist and the availability of Personal Protective Equipment (PPE) is essential to these individuals.
Past experience helps to build a more resilient future
Fortunately, most emergency situations, by their very nature, are temporary. With each emergency addressed comes new learnings. Although these real-life situations reveal resiliency gaps in technologies, processes and human resources, they also help stakeholders to plan for a future with better resiliency outcomes.
Click here to learn more about how modern physical infrastructure systems can help better support hospital resilience and business continuity efforts.
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Adherence to the regulatory requirements of the Joint Commission, the organization that accredits more than 21,000 US healthcare organizations, can impact the reputation and resulting success of most hospitals and health clinics. Making an effort to maintain or exceed requirements is a sound strategy not only for enhancing the comfort and safety of patients, staff, and visitors, but also for increasing the net worth of an institution and for preparing, in advance, for future regulations that may become more stringent.
With an uptick in mergers, affiliations, and integrations, how well a facility achieves or exceeds compliance can make or break a deal. As part of due diligence, hospitals need to evaluate the regulatory compliance of the practice or provider they are looking to acquire. Otherwise, hospitals may be taking on potential liability.
Regulatory compliance, particularly in the area of safety, can be complex to track and fulfill. Consider the work involved in simply determining whether a large hospital’s fire extinguishers are up-to-date and are not damaged or expired. The facility is required, every month, at a minimum, to inspect and update the conditions of their inventory of fire extinguishers. If each extinguisher has three annual inspection tags (representing the last three years of inspections) and the building has 1,000 extinguishers, then 3,000 tags need to be stored and organized. The work of sifting through these tags and organizing them in order to meet Joint Commission compliance can be overwhelming. A much easier way is to update fire extinguisher status dynamically, using a properly configured building management system, which can then produce an instantaneous report. Such a digital solution is more productive and much easier to manage.
Building automation both simplifies facility compliance and generates energy cost savings
When achieving Joint Commission compliance, fire extinguishers are only the tip of the iceberg. For example, air quality, which encompasses air humidity, temperature, particulate concentrations, ventilation, and air pressure (how fast the air moves through a room) is critical in a connected hospital environment. An unoccupied surgical room is required to process six air changes per hour. Then, just prior to surgery (and during surgery), the air change rate needs to accelerate to 24 air changes per hour. Records surrounding air change data must be meticulously maintained in order to produce reports that meet Joint Commission requirements. In this way, healthcare facilities are protected from possible court litigation.
As a Schneider Electric EcoXpert, our company Wadsworth Solutions supports healthcare institutions as a technology systems integrator. Integration implies the interoperability of multiple systems that don’t necessarily speak the same language. We harmonize these systems using Modbus, BACnet, LonWorks, and OPC protocols to link diverse technologies that help drive timely decisions. We are unique in the marketplace because our integrations impact multiple areas which greatly influence both health care facility compliance and energy savings:
Business automation designed around compliance simplifies accreditation – The right integrations now make it possible to embed the tracking and documentation of healthcare facility compliance requirements within the building automation. Our self-designed Healthcare Software Suite pinpoints and monitors those areas particular to building safety requirements. In addition to surgical suites and lab systems that refrigerate blood samples and vaccines, everything from a fire damper to an eyewash station, to a fire extinguisher to an exit sign is accounted for. The building automation system is then converted into a building management system and produces the dynamic reports required to achieve and maintain Joint Commission accreditation.
Just-in-time control of precision HVAC systems drives energy savings – To comply with Joint Commission standards and other regulations governing ventilation, organizations should audit their HVAC systems. The Joint Commission encourages measures that keep systems energy efficient while minimizing human safety risk. One of the ways modern building automation systems help keep healthcare facilities both safe, energy efficient, and compliant with regulations is through high-precision control of ventilation and air conditioning. By controlling just-in-time occupancy per surgical suite so that air changes are rapidly accelerated only when required, for example, significant amounts of energy are saved. Performing such tasks in the continuous flow of just-in-time processing requires systems capabilities that allow rapid switching from one task to another, in a carefully scheduled sequence. The ability to track which rooms are occupied and to control temperatures, humidity, and pressures depending upon the status of the room is another example of how energy savings are being generated. Smart energy sensors that detect motion and temperature also help in the efforts to more efficiently control hospital room environments.
Predictive failure capabilities enable operational continuity improvements – Part of healthcare safety as mandated by the Joint Commission is to maintain the integrity of critical supplies that are administered to patients like blood, tissue, plasma and vaccines. Hospital lab administrators need to be alerted to possible lab room abnormalities which could indicate the initial stages of a compressor or refrigeration unit failure. When pre-set temperature parameters are breached, early alerts allow for corrective action to be taken before lab blood, plasma, and tissue samples or vaccines become tainted. An undetected loss of one small freezer of vaccines alone, for example, can cost a hospital $50,000. A building management system that enables predictive modeling can save a hospital system hundreds of thousands of dollars every year in both compliance-related and unplanned equipment failure cost avoidance.
Such improvements to building automation systems are now possible thanks in part to open technology platforms, like Schneider Electric’s EcoStruxure solutions, that allow for easy integration of facility technology systems at the intelligent device, edge control and software and analytics layers. Now healthcare institutions, through better integrated technologies, can benefit from much simpler and more accurate ways for attaining Joint Commission accreditation.
To learn more about how digitized building automation solutions can enable modernization under an open platform, visit the Schneider Electric EcoStruxure web site. Want to see how Wadsworth Solutions, a Schneider Electric EcoXpert, is helping to drive energy efficiency in buildings? Read more here. Interested in learning about our EcoXpert partner program? Visit our website for business partner benefit details.
EcoXpert™ Partners – the Implementation Arms of EcoStruxure™
The EcoXpert Partner Program is unique in its industry and made up of a best-in-class global ecosystem of expertise. Trained and certified by Schneider Electric, EcoXperts are the implementation arms of EcoStruxure and Wiser all over the world.
Schneider Electric’s EcoXpert Partner Program unites the world’s leading technology providers, who exhibit best-in-class system integration competencies in facility optimization, reliable infrastructures and energy management, with its customers around the globe. Stronger together, this partnership cultivates collaboration, connects expertise, and delivers best-in-class services and solutions. Visit EcoXpert to learn more.
Originally posted on SE Blog
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When hospitals are confronted with a health emergency episode, the capacity, availability and resilience of physical infrastructure systems are often assumed as ready and with unlimited capacity. However, in real-life situations, inadequate planning and a misinterpretation of infrastructure capabilities and capacities leads to essential component failures, and to breakdowns in overall robustness. Without sound and operational technical systems in place, both patients and hospital staff are at risk. This is one of many lessons I’ve learned as Director of Engineering & Building Services for SA Health , a South Australian government healthcare organization.
Under normal conditions, the physical infrastructure systems that provide hospitals with power, heating, cooling, ventilation and environmental controls run quietly in the background, forgotten by the vast majority of hospital facility occupants. We design and build hospitals for peace of mind, resilience, availability and business continuity. But when emergencies and pandemics hit Australia, such as SARS and H1N1, rapid hospital facility expansion was required (more beds, more medical equipment, more essential services). These can quickly overwhelm the existing capacity of core and critical infrastructure systems.
Planning for these events is part of the due diligence and duty of care of every healthcare organization. Risk mitigation strategies and emergency readiness action plans are most likely in place. However, the nature of one episode will not match another, so emergency planning should incorporate additional resources, knowledge and rapid decision-making. Having a “plan B” for the hospital’s physical infrastructure, and being able to act upon this, can be the only way to minimize the impact of a subsequent surge in patients.
Following global guidelines and regulations but with local implementation and readiness
Preparing for emergencies, such as pandemics, requires consistent long-term planning and should also incorporate compliance to both global and regional regulatory resources. As far back as 2002, the World Health Organization (WHO) has been providing hospitals and clinics across the globe with guidance for planning hospital preparedness when dealing with a pandemic emergency.
A significant portion of the WHO planning recommendations relate to supplies, technical infrastructure, engineering and maintenance, laboratory services and all the logistics supporting the delivery of well-working health care services. Some hospitals very effectively link these recommendations to their efforts to comply with local hospital accreditation criteria. It is the local emergency preparedness action plan that defines the efficiency and effectiveness of outcomes, as it applies to the specific context and potential impact relevant for each healthcare organization.
At SA Health in Australia, we’ve looked at incorporating the legislative and standard-based requirements in the emergency preparedness planning. This has enabled us to include the means for stress testing our processes, our people’s skills and ability to cope under pressure, as well as our technologies and physical infrastructure. The aim was to anticipate potential risks and failures. Resilience testing on a regular and consistent basis is an important phase of the planning as both the situation on the ground and hospital operational procedures are always dynamically changing. Being able to visualize and analyze the response to infrastructure stress for a specific scenario enabled us to work at both the process and technical levels, to pre-empt critical failures or breakpoint incidents. Desktop exercises and simulated scenario planning often go the distance; however, these testing techniques cannot account for the smallest of details. Planned and well-executed physical testing not only highlights potential technical issues in a systems’ response, but also defines the manual processes and logistics which may need to be adopted for the continuity of safe patient care. The advancement in operational technologies and digital services, which are now part of most modern hospitals’ intelligent infrastructure, allow us to visualize, prevent and predict potential failure regimes, breakpoint thresholds, reliability and uptime.
In emergencies, healthcare organizations work and coordinate their activities differently
An emergency influx of patients also requires hospitals to have a specialized Incident Command System (ICS) in place. This is a working body of experts that take control and run the operations throughout the emergency. In my experience, in addition to both professional medical and nursing experts, emergency response teams consist of representatives handling intra-agency coordination and communication, bed and surge capacity planning, human resources, supply chain and logistics support.
However, despite comprehensive organizational alignment, planning, and testing to strengthen preparedness, the unexpected can happen. This can especially be the case when the duration of an emergency is unpredictable. Experience has shown that even the best plan can have flaws. Some of the overwhelmed systems will fail and impact patient care. When they fail, the backup plan must be as detailed and as ready-to-action as the original plan. For example, during events surrounding previous pandemic incidents in Australia, it paid off to line up and train a panel of vendors and suppliers, specialized in the technology and infrastructure systems – power, water, gas. These groups were prepared to rapidly mobilize specialist resources for critical needs and restore physical infrastructure functionality and operation.
No such thing as being over-prepared
Preparedness and planning for natural disasters, mass casualties or other types of emergency events which can impact capacity planning provide good insights. In the case of a pandemic, when estimated timelines and capacity surges can often change, critical infrastructure availability, reliability and resilience will be challenged. Simple tasks such as testing the reliability of uninterruptible power supplies, network resilience, heating and cooling capacity, power quality and environmental controls are often overlooked.
These tasks highlight typical errors and faults which should become part of daily maintenance operations. Looking at the potentially insignificant and often deferred issues in technical systems through the lense of emergency readiness, puts a completely new perspective and risk profile to the management of spaces, environmental suitability for safe and secure care, availability and flexibility to extend, re-purpose and retrofit, such that you can accommodate the surge in clinical activities. In my experience, emergency readiness should holistically consider maintenance backlog, ongoing building redevelopment and retrofitting activities, as well as the impact of new construction. This allowed us to have a reasonable understanding and confidence in the actions to take, safely and securely.
In emergency situations, more than heroes, you need a solid emergency prepareness plan. This plan should include the resources and technology to predict faults and visualize infrastructure performance, with clear roles and responsibilities, and laser-sharp execution. Anything less could jeopardize safety and continuity of care.
Originally posted on SE Blog
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