Running a hospital with surgical precision is a critical operation
Control is the key word when running a hospital. One glitch could be fatal. Huron Consulting Group explains how FM in this environment runs like clockwork.
Hospitals are likened to small cities by Judy Mitchell, managing director, Huron Consulting Group, Global Healthcare Practice.
With an intricate web of facilities, each needing to be carefully linked to another to ensure the effective day to day running of the hospital, it is crucial that the FM operation is carefully planned, managed and executed.
Huron Consulting Group was born in 2002 and has worked with 100 of the top U.S. teaching hospitals, 50 of the top U.S. integrated healthcare delivery systems and increasing numbers of hospitals and academic medical centres globally.
In addition to headquarters in Chicago, Huron has offices in Abu Dhabi, Amman, Atlanta, Boston, Dallas, Detroit, Dubai, Houston, London, New York, Portland, Riyadh, Washington DC, and Singapore.
It provides solutions for the challenges facing hospitals, health systems, academic medical centres, health science universities and healthcare related institutions.
“Managing the facilities for all clinical services and especially the operating theatre is very specialised,” said Mitchell.
“Infection control is critical to achieving good medical outcomes and must be carefully considered in all aspects of facility design and particularly in the design of mechanical systems.
The clinical support services such as pharmacy, clinical laboratories and central sterilisation are frequently overlooked but they too must be carefully planned since each of these areas plays an important role in delivering high quality patient care.”
Hospital areas don’t work independently of each other. They are tightly integrated with a centralised process centre allowing for greater control.
Huron employs approximately 1560 full time employees including over 1100 full time consultants, and it is this placing of a highly trained staff of very specific people, that allow for a hospital to run effectively, according to Mike French, also, managing director, Huron Consulting Group, Global Healthcare Practice.
“FM staff have to be able to integrate with the other hospital or clinic staff and offer services 24 hours per day and effectively communicate with other disciplines across the building.
“Traditionally the hospital was responsible for all of the FM. Now a lot is outsourced. The FM staff have to be constantly on the ball – the AC in a hospital can’t go down under any circumstances. Similarly, hospitals can’t serve food late as many of the patients have specific dietary requirements,” he said.
Jacob Chacko, design maintenance co-ordinator at City Hospital in Dubai’s Healthcare City explained why a hospital always had to be alert, and have contingency plans in place, such as a standby generator.
“These four generators provide around 75% of the hospitals electricity and are critical for when the main electricity supply in the hospital fails.
Everything in the hospital relies on electricity, and with life saving equipment, you simply can’t afford for the power to fail,” he said.
A unique process
Hospitals are the most complex of facilities to develop according to French.
“Huron assists with the consultation when planning for their development and construction, taking into consideration the local practices and the regional healthcare needs while aligning space and design with clinical, research and academic program initiatives,” he said.
When creating a new hospital or revamping an existing facility, Huron’s team has to work closely with clients and architects to ensure that the new facilities meet the goals and objectives intended.
Unlike FM companies providing services to a conventional building, it is crucial for Huron to be involved at concept stages of designing a new medical centre or hospital.
“Early design decisions can have a profound impact on the long term
operating costs of a new hospital. Ideally, any new facility design should optimise staff efficiency and also result in a financially sustainable solution,” said Mitchell.
French added: “when thinking about the infrastructure for King Fahad Specialist Hospital, we had to look at a range of factors. Would it be sustainable from a financial and operational point of view?
We helped the hospital gather data to help them fully understand critical gaps in healthcare services and how to align their clinical programs to meet those needs.
We then began working on developing their operational model with an eye toward reducing long term operating costs while also keeping a lid on capital costs.”
The multi disciplinary consulting teams frequently include experts from areas of building, systems and process design, physician and nursing in relevant medical specialties, CEOs and CFOs.
“A lot of our consultants have worked in senior leadership positions within hospitals, physician clinics and academic medical centres and are now consulting for us,” said French.
In addition to in-depth operational and financial planning, Huron supports the architectural and engineering teams throughout the design process, with physician and nurse experts in each of the medical specialties to assist in developing detailed requirements for every room.
Huron handles equipment planning, and can manage the procurement process on behalf of a client or advises a client’s purchasing team on procurement strategies to maximise buying power and ensure that the equipment is of an expected quality. The Huron team can also oversee the entire installation of the equipment if the client requires.
When a member of the maintenance team needs to fix a ceiling tile in a building, he/she can just climb a ladder and do it.
Doing this in a hospital is a decision which needs careful consideration of time and health and safety, explained Mitchell.
“When FM staff need to carry out any work, it can have a big impact on hospital operations and quality of patient care. If there is a problem with a ceiling in the operating theatre, FM service providers can’t just open it up and start working on it.”
“Building systems must be specially designed to minimise the need for FM disruption within patient care areas. This typically requires centralised mechanical systems where FM staff can service equipment without interrupting medical care.
It also requires varying degrees of redundancy in system design so that mechanical and electrical service in critical areas, such as the operating theatres or intensive care is never disrupted. Routine maintenance needs to be done in a timely manner, with the proper precautions in place to avoid any later problems.”
Jad Freijy, supportive services supervisor at City Hospital, is responsible for managing all hard and soft services including catering, housekeeping, security, landscaping and environmental services.
“There is a huge difference between the facilities management in a hospital and FM in other environments,” he advises.
“In a hospital, you are facing a much bigger challenge. Patient service is a priority.”
The catering department of the hospital has to work with approximately eight different menus. From diabetic, to renal and cardiac diets, there is a certain dietary restrictions for almost every patient.
It is important that highest level of hygiene precautions are taken. As well as finding hand sanitisers located within a few yards of each other, technolologies such as knee-operated hand-wash facilities are implemented in the kitchens to prevent any contact-based bacteria from spreading.
Head chef, Christian Kilian moved to the hospital when it opened three years ago, prior to which he worked as a head chef in the hospitality sector.
“Every day is a challenge, and you have to meet each dietary requirement,” he said. As well as lots of different cultures within the hospital, there are also lots of differences within the food cultures which we have to be aware of.”
Housekeeping is another area which requires a critical level of care.
“The operating theatres and ICU carry high risk of disease and contamination,” advised Freijy.
“There is a much greater level of care that is required and certain safety measures and precautions are taken to ensure there is no cross contamination.
“Used linens need to meet certain cleaning standards. They can’t just be mixed and washed as one load because some carry blood, others are infected. They have to be treated differently under different programs. Staff handling the linens have to wear protective clothing when taking them through the laundry process,” he added.
“Our growth plans for the next 12 to 24 months are very active in all phases of our healthcare service lines from operations improvement, hospital and clinic management, due diligence to project management throughout the GCC,” said French.
IT is an area that Huron hopes to develop beyond the common stated needs of healthcare technology and prepare for new levels of internal and external data integration, encouraging clients to imagine things like connectivity between building management and clinical systems.
An example would be of an elevator to detect a patient requiring isolation so advising the integration platform not to stop on any floors besides his/her own, which would eliminate dangerous exposure for the patient.
The team also recently secured a contract with a private investment group. French said: “We have completed a market assessment and feasibility study for a day surgery, outpatient clinic and health spa for the investment group.
The group wants to build five such centres throughout the GCC with the first being in the UAE. We are also assisting the group in developing a relationship with a major US academic medical center to provide physicians to staff the program.”
Project: King Fahad Specialist Hospital, Saudi Arabia
Huron worked closely with KFSH to create a vision and strategy for building a centre of international stature.
The group was tasked with providing a feasibility study for the hospital with a goal of moving it from a clinically focused general hospital to an academic medical centre.
The vision was to build a quaternary care referral hospital including the creation of six cetres of excellence in Cardiac Sciences, Neurosciences, Metabolic and Genetic Disease, Oncology, Multi- organ Transplantation and Opthamology.
The group carried out market analysis, clinical program planning, referral and discharge strategy, academic and research program development strategy, functional programming, operational model development, space planning, equipment planning, HR strategy and business planning.
- 11,000 Total number of projects served
- $553m FY annual revenues
- 1560 Full time employees