CFMD Summer 2023

SUMMER 2023

TOWER OF STRENGTH DIVERSE COMMUNITY INFORMS THE NEW PATIENT CARE CENTRE AT MICHAEL GARRON HOSPITAL

THE IMPACT

OF RENOS ON LTCS

INFECTION CONTROL

DURING CONSTRUCTION

PA R T O F T H E

SOLAR SAFETY P A R T

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[ contents ]

16 The Ken and Marilyn Thomson Patient Care Centre is the first phase of a larger renovation project at Michael Garron Hospital.

14 PRESCRIPTIVE MEASURES Infection control warning signs during construction, renovations and maintenance projects.

16 COMMUNITY CARE The long-awaited Ken and Marilyn Thomson Patient Care Centre opened in Toronto earlier this year.

22 DESIGNING FOR DEMENTIA

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New research from the Centre on Aging examines the role that renovations play in longterm care facilities.

26 ROOFTOP SOLAR PV SAFETY olar photovoltaics affixed to buildings are creating new hazards. Engineers who S specialize in clean energy are sounding the alarm.

columns 8 10 12 28

WORKPLACE FM TECHNOLOGY FM EDUCATION FOCUS ON HEALTHCARE 30 LAST WORD

department 4 OBSERVATIONS 6 FOUNDATIONS

[ observations ] FARSIGHTED FACILITIES

L

ong-term care is often something we think about in the long and distant future, before our loved ones are in need of a safe place to live. As we know, increasing capacity pressures, staffing shortages and residents’ well-being have taken more spotlight since 2020, bringing the future of care into present-day conversations.

The roles of designers and aging-related researchers are deeply interconnected as the quality of existing LTC environments are scrutinized and improved. A new study looks specifically at advanced dementia patients and how renovations impact residents and staff. One revelation from an article on page 22 is that best practices in evidence-based design aren’t always a one-size-fits-all approach.

Speaking of renovations, our healthcare issue also looks at infection control warning signs during construction and renovation projects. Another piece enlightens us on managing and preventing flooding issues, and our cover story takes a look inside the new Ken and Marilyn Thomson Patient Care Centre, which is part of an ongoing revitalization project at Michael Garron Hospital in Toronto.

If you flip through the pages, you’ll find many other pieces, such as how real-time data is playing a more pivotal role indoors as office occupancy rates fluctuate, an issue facility managers must plan around while balancing the unpredictable demands of buildings.

Happy reading,

EBECCA MELNYK R EDITOR, CANADIAN FACILITY MANAGEMENT & DESIGN REBECCAM@MEDIAEDGE.CA

SUMMER 2023 Volume 38, Issue No.2

EDITOR: Rebecca Melnyk rebeccam@mediaedge.ca ART DIRECTOR: Annette Carlucci annettec@mediaedge.ca GRAPHIC DESIGNER: Thuy Huynh roxyh@mediaedge.ca PRODUCTION MANAGER: Ines Louis Inesl@mediaedge.ca CONTRIBUTORS: Barbara Carss, Jim Gauthier, Jennifer Morehead, Kevin Spiers.

CIRCULATION: Adrian Hollard circulation@mediaedge.ca PRESIDENT: Kevin Brown kevinb@mediaedge.ca GROUP PUBLISHER: Sean Foley seanf@mediaedge.ca DIRECTOR OF DIGITAL MEDIA: Steven Chester stevenc@mediaedge.ca

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[ foundations ] NEW PESTICIDE REGS Groundskeeping specifications for federal properties are set to change under a new policy disallowing pesticide application for cosmetic purposes. The Treasury Board of Canada Secretariat has announced its intent, which will be enshrined in the greening government strategy, to align with a package of measures addressing pesticide management and protection of biodiversity.

WORKPLACE MACRO TRENDS Physical proximity to colleagues figures highly in office attendance decisions, data from a survey of 6,700 employees reveals. Knowing who else will be in the office has become as essential as knowing what workspaces are available. Employees have been requesting features that allow them to see if their colleagues will be present.

That also included a 60-day public consultation on proposed amendments to the Pest Control Products Regulations and affirmation of Canada’s commitment to the Kumming-Montreal Global Biodiversity Framework. As a signatory to the international agreement, Canada is expected to develop a comprehensive national biodiversity strategy and action plan and to work toward the Framework’s goals, including a significant (at least 50 per cent) reduction in the risk from pesticides by 2030.

In its Q2 Workplace Index report, global worktech company Eptura used proprietary data and an analysis of 2.7 million desks, 37,000 buildings, and 440,000 floors across more than 8,000 companies. The survey found 84 per cent of respondents in the Americas saw year-overyear increases in desk bookings.

The tension between employees’ desire to work fluidly and the need for predictability within a business continues to affect facility managers who must plan around changing occupancy rates and the erratic demands of buildings.

Other survey findings show monthly equipment inspections are rising every month with more people being at the workplace. Daily maintenance work orders tend to peak at the start of the week and daily inspections peak in the middle of the week.

LEGAL REFURBISHMENT Fredericton’s Justice Building will be refurbished into the University of New Brunswick Faculty of Law. A $62-million joint venture will turn one of the city’s most historic buildings into a LEED Gold-certified design that reduces greenhouse gas emissions by 30 per cent and makes space for 350 more students over the next five years.

Plans include new ventilation and communications systems, increased accessibility features, improved lighting, new occupancy sensors, a freshly constructed atrium, and reconfigured spaces for public and academic use.

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SASKATCHEWAN TO DESIGNATE 125 HERITAGE PROPERTIES Local councils and residents throughout Saskatchewan are urged to identify heritage properties within their communities leading up to the province’s 125th birthday in 2030. The provincial government has launched a campaign to add 125 designated sites to its roster of buildings and landmarks that have played a role in Saskatchewan’s history.

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WORKPLACE

BY REBECCA MELNYK

ORCHESTRATING COMMUNITY Workplace hospitality program transforms one of Canada’s largest office portfolios.

THE NEW LOUNGE AT EDMONTON CITY CENTRE. PHOTO COURTESY OF CANDEREL.

L

obbies in major downtown office towers were originally designed to intimidate and impress, with hard surfaces and bright lighting, offering a less-thancozy place to hang out, says Brett Miller, CEO of Canderel.

His company, which manages more than 24 million square feet of real estate across Canada, is changing that approach by transforming lobbies into a boutique hotel aesthetic and fully focusing on employee needs across the entire building.

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“You used to just collect the rent and now it’s much more about running a community.”

The traditional view of locking in a tenant for 15 years and collecting the rent is outdated, he says. “Now, the office building is a community to fulfill your life. It’s a welcoming place to learn, network, connect, stay fit.”

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As companies attempt to convey the value of their office space to talent who have shifted to remote work arrangements, Canderel is rolling out a workplace hospitality program called OKKTO across its buildings in Montreal, Toronto, Ot-

OFFICE ATTENDANCE VS. EXPECTATIONS More than 55 per cent of respondents to CoreNet Global’s queries in July report that corporate personnel are not fully complying with directives to return to the office.

About 97 of the 175 large global firms participating in the survey now decree staff should work in the formal office at least three days per week, with the largest share of those

tawa, Edmonton and Calgary. The idea is to avoid back-to-office battles and mediate the conversation into a two-way dialogue.

“I think it’s a discussion,” says Miller. “To say, here is the value as to why we want you back from a company perspective and here’s what you get back as an individual.

It will be a much more complete experience.”

The transformation will add more open spaces: a conference-meeting floor with a co-working lounge, individual work pods, conference centres, and a cold kitchen for catering.

Employees can interact across various layouts with new technologies fit for hybrid meetings. “Tenants can take a little less space in the leased area because they don’t have to have a large boardroom or employee lounge,” suggests Miller.

Lobbies will be reimagined with soft seating and lighting, signature aromas, calm music, lower ceilings and a hospitality-trained concierge team.

Club-like building activities for socializing could include an art exhibit in the lobby, a lunch-time walking club through the local park or a five-to-seven p.m cocktail hour.

Spa-like gyms with mindfulness rooms, spin bikes, towel services and trainers might encourage people to swap their fitness club membership for a free pass in their office building. The program will connect with professional wellness service providers, from massage therapists to life coaches, to create a holistically healthy workplace.

companies establishing a three-day standard. About 25 per cent of the surveyed corporations still allow employees to work entirely from home, while 12.6 per cent call for five days in the office. Only 2.8 per cent have a one-day prerequisite.

Other survey findings point to general shrinking of the corporate office footprint with more than 55

per cent of respondents currently occupying less space than they did in 2021. Nineteen per cent have trimmed more than 20 per cent of their office footprint. Nearly half of respondents have redesigned their headquarters — often reducing the number of individual workstations — and upgraded air filtration and added touchless devices.

THE GYM AT EDMONTON CITY CENTRE. PHOTO COURTESY OF CANDEREL.

A smaller suburban office building may offer a few components of OKKTO compared to larger towers endowed with all amenities, such as Constitution Square in Ottawa, Edmonton City Centre and Stantec Tower in Edmonton.

Advisors are on hand to assist employers. One large tenant renewed its lease on condition that a property manager partner on animating and engaging its employees. “You used to just collect

the rent and now it’s much more about running a community,” says Miller.

Employees who took part in focus groups proposed being involved in these respective communities.

“People said the reason I want to come back to the office is I feel I can contribute to the culture of the company, training young people, being social or giving ideas,” Miller shares. “People are motivated to give back, not just take.” | CFM&D Summer 2023 CFM&D 9

FM TECHNOLOGY

INDOOR GIS DEMAND GROWS

C

anada’s top commercial real estate players have identified the growing importance of visualizing indoor building activities in real time as the use of space becomes less predictable and tenant needs evolve.

BOMA Canada and Esri Canada’s newly released survey, Navigating the future of the workplace, gathered perspectives from 212 property managers and asset owners earlier this year. More than half represent portfolios with upwards of 50 buildings across over one million square feet.

Interactive maps have primarily focused on the outside of buildings.

Forty-two per cent of respondents conveyed the usefulness of gathering insights from the real-time operational awareness of indoor spaces and building conditions.

Coordinating construction, maintenance and renovation projects (41 per cent) and responding quickly to emergencies (40 per cent) were other priorities.

INSIDE INTERACTION

There is an increasing preference for monitoring indoor building activity in real time.

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Occupancy and people movements were easier to predict pre-pandemic, but office space is more dynamic now, said Dave Monaghan, industry manager, IoT and Indoor GIS with Esri Canada. “For asset managers, property managers and building operators, trying to get a clear understanding of how their building is being used on a daily basis is a real significant challenge,” he said.

“They need a standardized platform to gather data from a variety of systems.”

Two-thirds of respondents f ind helping people get around properties somewhat challenging or a major

challenge. Traffic to these buildings is expected to climb over the next five years, according to 38 per cent, which indicates increasing pressure.

Creating a digital twin— 3D replica of a physical space— was flagged as a key solution for helping maintenance teams and employees navigate buildings.

“The process digitizes all of a building’s floor plans and connects the dots between systems within the building to monitor things like HVAC, lighting and occupancy,” the report states. “A range of sensors, including Bluetooth beacons, RFID tags, room occupancy sensors and smart devices, can bring interactive maps to life by providing real-time data and ever-changing floor plans to a mobile device.”

Lousie Morgan, executive vicepresident and partner at Archidata, stated that a GIS-generated map can be used to visualize the special structure and ultimately make better decisions.

REAL-TIME EMERGENCY PREPAREDNESS

Fifty-three per cent of respondents are already using real-time monitoring to track assets and 51 per cent are using it to analyze people movements over time.

Real-time monitoring is important for facilities, where the need for the accurate location of specialized equipment and assets is essential as they move through the structure, Morgan explained.

Forty-seven per cent are also using a real-time interactive map of the floor plan to create a safer environment. “For emergency responders, it’s no longer enough to just have a PDF of a floor plan,” noted Monaghan. “You need real-time situational awareness and that dynamic map of where things and people are right now.”

GIS also figures into the renovation process as updates to buildings increase.

Wayfinding tools promise the accumulation of time savings by streamlining the work order management process and dispatching the closest available maintenance crew to a problem.

“If that newfound efficiency saves even five minutes per work order, that could translate into savings on hundreds of billable hours each year, given some companies may experience thousands of work orders annually,” said Monaghan.

Property management executives familiar with interactive maps for decision-making purposes see the potential of using indoor GIS for additional insight.

“Rather than just guesswork you can make it a data-driven solution,” said Shawn Hamilton, BOMA Canada board member and vice-president of business development at Canderel.

“Anything that helps us understand that coefficient is extremely valuable because a lot of the times we are using people’s experience without understanding why something worked or didn’t work.”

The full report, Navigating the future of the workplace, can be accessed at: https://bomacanada.ca/wp-content/ u p l o a d s /2 0 2 3/0 7/A L L C A P S _ BOMA_FutureOf TheWorkplace_ FINAL.pdf | CFM&D

Summer 2023 CFM&D 11

FM EDUCATION

BY KEVIN SPIERS

IN DEEP WATER How to mitigate risks and overcome challenges during a hospital flood.

H

ospitals are complex facilities with multiple moving parts. Labs, medical device reprocessing (MDR) departments, kitchens, administrative offices, ICUs, operating rooms, waiting rooms and more, all serve an important purpose that keeps the hospital functioning.

For a facility that is open 24 hours a day, 365 days a year, any unplanned outage or downtime has a substantial negative impact.When a flooding event occurs, either weather-based or mechanical, the effects can be swift and devastating.

WHAT ARE THE RISKS?

When a water event occurs, one immediate risk that needs to be mitigated immediately is mould. Consider that within 48 hours of a water event, mould starts to develop and can spread rapidly. The negative effects of such growth can pose a serious threat, especially in a hospital setting where the population is already in a higher health risk category. Restoration crews have a 48-hour window to dry out affected components through very spe12

cific means or they need to be removed and replaced altogether.

Legionnaires’ disease – a severe form of pneumonia – can become a risk in these settings, when stale or stagnant water sits for too long. Water that is not properly drained or removed can quickly become a problem and Legionnaires’ disease outbreaks can become very difficult to control. This demonstrates the critical need for rigorous infection control to safeguard the hospital environment.

In certain markets where space within the hospital is highly sought after, damaging water events can cause cancelled surgeries and procedures as well as overall delays, creating a significant risk to care access. For example, in an ICU where space is limited because the care is so acute, specific, and dedicated, taking out 10 or 15 per cent of bed space means that many people will not receive the care they desperately need.

PROTECTING PATIENTS

One of the standards that restoration crews must follow is the Canadian Standards Association code Z317.13, which provides

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guidance on preventive measures to protect patients, staff, and visitors from disease transmission and other health problems during construction, renovation, or maintenance of health care facilities.

A focus on containment and controlling access to the flooded and damaged area is also key for protecting patients.Typically, a restoration crew would set up an airtight containment with negative pressure that isolates the work area from occupied areas of the hospital.These containments can be built onsite or constructed of prefabricated panels, which are aesthetically pleasing and quick to set up.

Additionally, creating a negative air / pressure environment is critical. If the environment on the inside of the containment is under negative pressure nothing escapes.

Pressure is monitored with a manometer that is displayed outside of the containment so that negative pressure can be monitored. In addition to that, exhaust is filtered through a HEPA air filtration device, and an anteroom would be in place before workers enter the impacted space.

These practices of isolating the damaged areas and work sites from the oper-

ations and human traffic flow within the hospital keep all potential contaminants within the work site and all the hospital personnel and visitors safe and unaffected from the restoration work being done behind the containment walls.

UNIQUE CHALLENGES OF THE HOSPITAL SETTING

Restoration work in a hospital environment comes with its own unique set of challenges and considerations. Unlike a typical business, there is no downtime, and the recovery process is taking place as the hospital continues to operate.

The reality is that work is happening in spaces where medical events are occurring, and it is important to remain aware and considerate of the surroundings and not cause additional stress to staff or patients. It is important to think about keeping patients safe and come up with a plan to work while other people are still in the building.

While it is vital to get the facility back up and running as fast as possi-

CLIMATE CHANGE IMPACTS IN THE WORKPLACE Knowledge about the potential impacts of climate change on workplace health and safety can be gleaned from a newly released guide, developed by the Canadian Centre for Occupational Health and Safety.

The free Climate Change: Workplace Impacts handbook advises on how to: take action to identify, assess, control and monitor climate-related hazards; take climate-related events into account when establishing policies and programs to address their impact on occupational health and safety; consider the impacts when completing workplace hazard identification and risk assessments; and approach and address climate-related workplace hazards.

The handbook is geared to anyone involved in the development and implementation of workplace policies and programs, including employers, managers and supervisors, human resources professionals, and health and safety committee members and representatives.

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ble, it is equally important to strictly follow proper procedures to ensure the safety of patients and avoid future risks. The best preparation is to have

an emergency response plan with a restoration contractor who is professionally trained and certified in this highly specialized work. | CFM&D

Kevin Spiers is the vice-president, national accounts, at First Onsite Property Restoration.

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Summer 2023 CFM&D 13

[ operations and maintenance ]

BY JIM GAUTHIER

PRESCRIPTIVE MEASURES Infection control red flags during hospital construction.

C

onstruction, renovations and maintenance (CRM) projects within healthcare settings can cause serious issues for patients and staff. For this reason, infection prevention and control practitioners (IPCPs) have become more involved in the CRM process, which requires steps be taken to ensure those on-site are protected from dust and stagnant water.

Dust can carry mould spores, such as Aspergillus species, and stagnant water can have microorganisms like Legionella species.The control of dust during CRM is vitally important.The amount of dust, or the duration and complexity of the CRM activity, can indicate what level of precautions are

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required. As for water, remediation after a flood needs to be performed in such a way that mould does not have a chance to proliferate.

CRM projects require an infection control risk assessment that analyzes what is to be done and where. This is conducted by a multi-disciplinary team to ensure the safest outcome is provided to both patients and staff.

ON THE LOOKOUT

An IPCP will frequently do a walkaround during a project to assess safety from their perspective. Most IPCPs also tour their entire site to remain visible and to help with other aspects of infection prevention.

During these walk-abouts, IPCPs are looking for red flags. Finding

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a hose hanging from a ceiling and draining into a bucket is an indication there is a leak. Once the area has been dried, the IPCP will become involved in the remediation. Seeing dusty footprints or the dusty tire track of a wheelbarrow are also red flags that something is happening without proper precautions.

In the case where the infection control r isk assessment has determined barriers are required for the CRM, the IPCP will inspect these frequently, even daily in higher risk or long projects. If the construction zone is to be under negative pressure, the pressure differential will also be regularly monitored. The negative pressure can fluctuate based on numerous issues with hoarding, the air

handling devices, or improperly sealed doors and windows.

Contractor meetings can help bring issues to the IPCP’s attention.

Meetings can address infection control issues early in the agenda to free up the IPCP who may be handling the project along with routine day-today duties. Regular updates can help keep the IPCP in the loop on larger maintenance projects being done by the facility’s staff.

Other red flags are walk-off mats that are either no longer sticky (if using sticky mats) or saturated with dust (if using a short pile car pet). Dur ing the demolition phase of a project, dust control will be audited through several means.

The simplest is to wipe surfaces outside the construction zone daily with a white wipe to see if dust has escaped the previous day. (A background of ‘daily’ dust can be established before the project gets started.)

Ductwork needs to be kept sealed as much as possible before, during and after installation. Use of HEPA filtered air blown into the ductwork can create a positive pressure to keep dust out of ducts during subsequent CRMs. Wet drywall or cement board is another red flag. It can occur before the building is sealed to the elements. Any wetness that is not dried within 24 to 48 hours will allow mould to grow. This should not be encapsulated within walls during CRM activities.

Gross construction dust should never be covered within wall cavities.

The IPCP will need to inspect wall cavities before they are insulated or sealed, as well as ceiling elements.

This may require the IPCP to have fall arrest training in order to use scissor-lifts.

Insulation should never be cut on a dusty floor because this will allow dust to be sealed into the walls.

Electrical and computer cabling should be protected as much as possible from dust during and after installation.

The IPCP role is to keep patients and staff safe from infectious agents, which can be liberated during CRM activities.

Almost none of these trained professionals are skilled in any of the building or maintenance trades, so questions need to be addressed, even if they seem simplistic to a tradesperson. Once all involved in construction and maintenance understand everyone’s role, red flags will not pop up.| CFM&D

Jim Gauthier is senior clinical advisor, infection prevention, with Diversey Inc., a manufacturer of cleaning and disinfection products. He is also a microbiology technologist and board certified in infection control.

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FACILITY DESIGN

COMMUNITY CARE The Ken and Marilyn Thomson Patient Care Centre brings healthcare into a new era for Toronto’s East York neighbourhood.

BY REBECCA MELNYK

PATIENTS, FAMILIES AND STAFF, INCLUDING THE MENTAL HEALTH COMMUNITY, WILL ENJOY MUCH-NEEDED OUTDOOR ACCESS. PHOTO COURTESY OF B+H ARCHITECTURE.

FACILITY DESIGN

FROM LEFT: FLOORS ARE FILLED WITH NATURAL LIGHT AND A WALL OF THANKS TO THE DONORS; THE MICHAEL MACMILLAN AND CATHY SPOEL TERRACE. PHOTOS COURTESY OF B+H ARCHITECTURE.

E

arlier this year, on a chilly mid-January morning, a crowd of people gathered inside Michael Garron Hospital to celebrate a ribbon-cutting ceremony for the new Ken and Marilyn Thomson Patient Care Centre in Toronto’s east end.

As part of the largest campus redevelopment project in the hospital’s history, the eight-storey facility was about to open the following week and usher in a new era of healthcare.

Standing at a podium, Former Mayor John Tory shared what it meant for more than 400,000 residents of the diverse East York community, many who face increasing health and social care needs, “many who have been newcomers with different experiences overtime of the healthcare system,” he said.

“Many people [with whom] you have to earn trust and form different kinds of relationships.”

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The 550,000-square-foot facility broke ground in 2018 on an old parking lot, and was designed by Diamond Schmitt, B+H Architects and CannonDesign.

The Ministry of Health, Infrastructure Ontario and EllisDon partnered on its construction.

“Having had the chance to be part of the project from the onset, I can say that community engagement has been integral to the project’s development,” Ilinca Popa, healthcare architect and senior associate with B+H, shared in a recent correspondence with CFM&D. “From open houses, to mock-up engagements, to events held in the nearby farmers’ market regarding furniture selection, they have all been instrumental in hearing the diverse range of voices in the community.”

Design features of the tower incorporate community-specific elements, such as integrating the facades into the scale of the neighbourhood and adjoining houses.

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Unique characteristics of the population itself are at play. Due to the area’s higher occurrence of chronic disease than the Toronto city average, three of the hospital’s largest chronic illness outpatient programs converge together within an easy-to-access chronic disease unit.

Also in the three-storey podium are outpatient clinics and an ambulatory procedures unit for minor care, the Moez & Marissa Kassam Food Court for families to relax together, centralized patient registration services, and a lobby brimming with natural light.

“The entire entry sequence, with an ample lobby area and double height, acts as a gathering space, extending the spaces available to the hospital for large events,” says Popa. “This was purposefully thought out during the early stages of the project.”

Throughout the other six storeys are the Carswell Family Medical Education Centre, with classrooms and living

quarters for on-call residents, and a simulation centre to further train health care providers.

Acute care and two inpatient mental health departments are much-needed additions, with 215 new in-patient beds, 80 per cent of which are private. All patients, even those in double rooms, have their own private bathroom and a pull-out couch or sleeper chair for family and friends.

The healing journey extends to spacious outdoor areas for both patients and staff. Designed as a cascading set of terraces, the green space also acts as an extension of community outdoor amenities, says Popa. “This vision was very well articulated from the beginning of the project, and it emphasizes the important role the hospital will play in the community and how the outdoor space will create opportunities for gathering and children’s play.”

WIDER CORRIDORS AND LARGER PATIENT-CARE SPACES. PHOTO COURTESY OF B+H ARCHITECTURE. Summer 2023 CFM&D 19

FACILITY DESIGN With updates to the existing hospital underway until 2024—this includes decommissioning of outdated wings and new greenery and landscaping,—the new tower is already reflecting a future-forward vision.

Looking ahead, Popa notes how design will be experiential and focus more on the user experience. “The future of hospital design will also focus on adaptability of the built environment as we progress our thinking towards a more resilient and sustainable future.”

Before COVID-19, the project team, including MGH’s Infection Prevention and Control team, were already mindful of integrating pandemic and disaster management requirements.

“They proved invaluable when thinking about the future facility design and future proofing of healthcare in post-pandemic times,” she says. “The design includes a lot of flexibility in use. This includes a dedicated inpatient pod that can be isolated during a pandemic, an ambulatory care area that can be operationalized during a pandemic, and entrances that clearly separate the flows of patients and staff, limiting unnecessary interactions.”

B FROM TOP: LARGER ROOMS, PRIVATE BATHROOMS AND NATURAL LIGHT ALLOW FOR OPTIMAL HEALING AND PATIENT-CENTRIC CARE; ART INFLUENCED BY PEOPLE THROUGHOUT EAST TORONTO ADORN THE WALLS. PHOTOS COURTESY OF B+H ARCHITECTURE.

H

ow nature aids in the recovery of mental healthcare users has long been touted as a primary element of such complex environments. Built between wings of the existing hospital in a phased approach, the outdoor space includes the staff and visitor terrace, but also a mental health patient terrace.

“The mental health unit is one of the most interesting units in the hospital as it had to respond to several factors,” Popa explains. “First, the team has aimed to create spaces that destigmatize mental illness and disorders.

Second, the unit design had to accommodate a Paediatric Intensive Care Unit, an adult acute unit, and a dedicated zone for elder patients with onset of dementia all in one racetrack unit.

The design team aimed to create flexibility all while respecting the flows and dignity, not only of the patients, but also for staff,” she adds.

“There are many ways to address the needs of patients, but it’s also critical that we address the needs of staff in these environments and ensure they have spaces for breaks and rest.”

S

uch is a vision that transpired with help from a supercharged donor system. The Heart of the East capital campaign raised more than $100 million over four years, including 28,281 pledges inspired by Peter and Diana Thomson.

Overall, the campus project brought in $498 million from donors, the hospital and the Ministry of Health.

20 CFM&D | Part of the REMI network | www.REMInetwork.com

ack in January, before opening day, Shelley Darling, chief of operational readiness at Michael Garron Hospital, stood in a bright new corridor and shared how a very detailed and coordinated process was in place to smoothly transition patients and staff from some of the oldest parts of the hospital to brand new spaces.

Her team led the logistical planning for the move, which involved a proactive and comprehensive training program for staff to ensure teams were comfortable working in the new facility. Workflows were tested and new travel routes inspected to counter potential issues once patients were welcomed in.

She said the new tower is a big improvement. “The windows and natural light are so conducive to healing and that in-patient experience is so much more improved in this facility,” she shared.

“Our staff benefit from that as well; it has improved and increased space in the rooms to provide care, but also at their team stations where they can collaborate, either through conversations or through technology that has been enabled in this building to help improve care.” | CFM&D

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Summer 2023 CFM&D 21

REFURBISHMENT

BY REBECCA MELNYK

DESIGNING FOR DEMENTIA New research on renovations in long-term care facilities focuses on persons with advanced dementia and their care teams.

T

he quality of life awaiting future residents within Canada’s longterm care facilities is facing scrutiny as researchers closely examine how these spaces are being reimagined for the better. While there is more focus on incorporating residentially-scaled elements, evidence is lacking as to which design features are most successful.

There are dozens of LTC facilities in the province designed around a very institutional model, says Michelle Porter, director of the Centre on Aging at the University of Manitoba. “We are not going to be able to replace all of these spaces in the next couple of years with a different design, so being able to look at what could happen with a renovation is really important.”

She was presenting her new coauthored paper, Renovations of a Long-Term Care Center for Residents with Advanced Dementia—Impact on Residents and Staff, during an online

discussion hosted by the Canadian Centre for Healthcare Facilities.

The multi-method study analyzed pre- and post-renovation data over a fiveyear period, looking at residents with advanced dementia and staff at a special care centre in the Canadian Prairies.

By the end of the project, research showed that meeting residents’ needs was “partially successful,” while work conditions among staff improved.

the University of Manitoba, described how this could help LTCs attract initial funding for upgrades.

To invoke a home-like feel, fifteen resident units were separated into smaller five-person “households.”

The single large dining/recreation and lounge spaces per unit were replaced with three smaller lounge/ dining spaces. Post renovation, overall noise levels were “significantly quieter” in the units, but flagged as “still louder” than what is fitting for a residential space.

Circadian lighting in the dining and lounge spaces, where residents spend ample amounts of time, mirrored outdoor conditions, with cooler bluish light at mid-day and warmer colour light in the mornings.

Resident rooms did not undergo major changes, although wayfinding was an important element that included personalizing room entrances, biophilic wall murals in the common areas, a more centralized nursing station, and camouflaged exits; for instance, a vinyl mural of a bookcase hides a doorway and, ultimately, creates a safeguard.

HOME-LIKE RENOVATIONS

IMPACTS ON STAFF’S WORK CONDITIONS

Creating a home-like atmosphere was a key objective throughout the renovation, with a focus on reducing agitation, aggression and exit-seeking behaviours. Boosting biophilic and wayfinding elements, independence, physical and social activity, and the well-being and work conditions of staff, were other goals.

Designers and administrators also used the project as a testing ground for innovative technologies. Laura Funk, study co-author and professor of sociology at

Staff members conveyed how the renovation improved their “enjoyment of time with residents.” Digital photographs outside of rooms was one added feature that provided moments for interaction. A newly installed staff communication system was another highlight of the project, garnering positive comments for saving time, the ability to call for help in an emergency and easier communication.

Of the physical environment, staff said it was slightly more positive post

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REFURBISHMENT renovation. The aesthetic appearance and privacy levels of the primary work area, along with noise associated with conversations or patient vocalizations, figured into this perspective.

Job satisfaction and the stressfulness of work showed little change. The amount of personal care staff provided nearly doubled, possibly from new staff training models.

Most staff also felt there was ‘no impact’ on work safety, although 33.3 per cent conveyed this area as being more positive and 16.7 per cent reported it as negative or very negative.

After the dining room was separated, proper monitoring of choking hazards among all residents became a huge safety concern. Staff also reported that the smaller spaces kept some residents closer together during meals, which could have accelerated conflict. There were also fewer behaviours involving leisure, as space constraints may have figured into the ability to facilitate visits with family and friends. Another worker stated that the “nursing station looks like teller window at a bank and central location; can trigger responsive behaviors.”

Although the overall scores reflected a setting that wasn’t “significantly worse,” staff wished they would have been consulted more in the actual design of the spaces.

“We are not going to be able to replace all of these spaces in the next couple of years with a different design, so being able to look at what could happen with a renovation is really important.”

vation, mainly, residents’ autonomy and independence, engagement, their mobility, dining experience, and physical activity or safety. Aggressive behaviour remained unchanged, contrary to what designers had initially expected.

Staff response remained neutral in other survey areas. Renovated dining areas were deemed challenging for group activities, but also quieter, without the need to use resident rooms. Fewer individuals in each dining area, with less clustering, meant fewer Protection for Persons in Care Office reports to complete; however, closer proximity among residents meant they had “nowhere to go to get away from each other, leading to negative interactions.”

Some staff felt the lay-out remained hospital-like. Others strongly expressed a lack of safety, stating the design was geared around higher functioning residents.

IMPACTS ON RESIDENTS

The renovated space ultimately reflected both pros and cons. Various items contributed to a home-like feel; notably photographs in display cabinets, windows with views, quiet spaces and customized doors were seen as positive additions.

Staff primarily described the new space as being a “better environment for residents,” with “homey-like decor and less stimulation overload,” and “more space for wandering and walking.” Other positives showed improved quality of life, along with mental stimulation, emotional well-being, interaction among family, staff and other residents, access to recreational opportunities, and lower elopement.

Other areas showed no “noticeable difference” compared to pre-reno-

RETHINKING EVIDENCE-BASED DESIGN STRATEGIES

One idea that emerged throughout the project, with several staff suggesting so, is that “perhaps some of the evidence of best practices in design is not applicable to residents living with advanced dementia,” said Funk.

Different perceptions can shape design elements. In this case, workload and staffing concerns led to designs that distract, separate, control or divert

residents from risky situations. There were also stigmatizing ideas, such as the belief that persons with advanced dementia don’t benefit as much from social engagement or group recreation as other residents.

While multiple methods of data gathering were used over time, from self-reported questionnaires and staff surveys to behaviour mapping, which measured space use and behavioural patterns in the physical environment, precise outcomes proved challenging to decipher due to an array of factors, such as a new staff training program.

“It really becomes challenging to say was it this design feature that led to this change or was it the fact they changed the staffing models,” said Porter. “There were some education workshops introduced during the time the renovations were occurring. . . it is hard to say anything was directly related to the actual physical environment.”

Going forward, the authors propose a greater role for researchers in evidence-based design. “More highquality longitudinal studies are needed to determine whether renovations have intended outcomes for both residents and staff of dementia care units,” the study concluded.

The full study, Renovations of a LongTerm Care Center for Residents with Advanced Dementia—Impact on Residents and Staff, can be accessed at: https:// www.tandfonline.com/doi/full/10.108 0/26892618.2022.2151544 | CFM&D

The research was recently presented during a seminar hosted by The Canadian Centre for Healthcare Facilities. CCHF is on mission is to improve healthcare environments for better care. For more information, contact ritamezei@cchf.net and visit www.cchf.net.

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[ energy management]

BY BARBARA CARSS

ROOFTOP SOLAR PV SAFETY Wiring and workmanship spark inspectors’ concern.

R

ooftop solar photovoltaics can help real estate owners/managers lower energy costs, boost operational resiliency and meet ESG commitments, but proponents of the technology caution that it also packs a potentially lethal electrical charge. Vigilant maintenance and risk management are critical for what is, in essence, a power plant affixed to a highly valuable asset.

Clean Energy Associates (CEA), a consultancy providing project management, engineering and technical services for solar, green hydrogen and energy storage systems, is sounding the alarm after safety audit data from more than 600 rooftop solar PV installations worldwide revealed a disconcerting magnitude of fire hazards. Just 3 per cent of audited sites were completely clear of safety concerns, while nine of the 10 most prevalent issues surfaced in more than one quarter of the inspections.

“This is frightening: one, for your buildings; and two, for the industry,”

Chris Chappell, CEA’s senior director of engineering services, asserted during a recent online presentation.

“These things are happening on your roofs right now.”

Canada was among the 14 countries in North America, Europe and Asia-Pacific where the safety audits were conducted. Nearly half the examined installations — 49 per cent — were improperly grounded in some places, posing risks for on-site personnel and compromising equipment performance, while 47 per cent of the installations sported cracked or soiled modules, creating shock and fire hazards in addition to diminishing operational performance.

CONNECTORS EMERGE AS A HAZARDOUS LINK

A large share of the identified risks relate to connectors — or the wiring and cabling connecting the modules, racking and inverters — of which there may be hundreds or thousands in a rooftop installation. Faulty con-

26 CFM&D | Part of the REMI network | www.REMInetwork.com

nectors could be the source of arc flashes, an opening for water infiltration or an ignition source should they overheat, melt and drop down onto the roof ballast. Chappell and his colleague Ankil Sanghvi, CEA’s engineering manager, cited examples of all those occurrences during the presentation.

“The 10 most common items that we found, these are not equipment-related per se. These all have to do with workmanship,” Chappell maintained.

“The modules, inverters and racking are all integrated with wires and it’s these little things that are the biggest issues that we see on sites.”

Sloppy or perilous practices include: pairing the positive and negative sides of connectors from two different assemblies; placing wiring over sharp metal edges that can inflict damage as they expand and contract in fluctuating temperatures; and over-torquing connectors or other kinds of aggressive handling that can cause cracks in components. Manufac-

turers’ specifications typically state the required type of DC connector, but safety auditors found that instruction had been flouted at 41 per cent of the sites they examined.

Connectors were improperly installed in about the same portion (40 per cent) of systems.

“These connectors are UL listed and come as an assembly. You can’t cross and mix parts, but it happens a lot, more times than not, because the threads (from different assemblies) are the same,” Chappell explained.

“This is a big no-no. We have seen, a lot of times, connectors burning because of cross-mating,” Sanghvi concurred. “With all DC connectors, please follow the manufacturer’s manual very closely and please make sure that you are using the right tools while assembling the connectors.”

HOTSPOTS IMPLICATED IN ARC FLASHED AND IGNITIONS

In some cases, lurking fire hazards should first become evident through a drop in power output. For example, damaged, soiled or shaded modules can cause a mismatch in voltage that will result in underperformance and can also lead to hotspots where one cell is operating at a higher temperature than those surrounding it.

Such hotspots could potentially ignite nearby organic material and/or cause the backside of the module to melt, increasing the risk of arc flashes.

Shading could occur if modules are crowded too closely together. Natural elements — including wind, hail, lightning and animals — and on-site personnel could cause other types of damage.

In the latter case, Sanghvi chides some marketers for misleading messaging.

“We see module manufacturers advertising their modules by walking on them and showing people: Look how strong they are,” he recounted. “Every time they walk on the module, they break the cells.”

“Those cracks are going to grow and grow and grow,” Chappell added. “Tell the teams up on your rooftops: Do not walk or kneel on the modules.”

“Tell the teams up on your rooftops: Do not walk or kneel on the modules.”

CEA’s safety audit data shows hotspots detected on modules at 31 per cent of the inspected sites. As well, hotspots were recorded in enclosures encasing solar batteries at 19 per cent of sites.That’s in part attributed to improper termination of wiring to enclosures, which was found at 40 per cent of the audited sites.

Sanghvi recommended infrared scans as part of the maintenance schedule with scans of all enclosures at a maximum interval of six months. As part of daily operational oversight, he suggests keeping watch for “inconsistencies” with connectors and obvious damage like cracks and broken pieces. Nevertheless, potential hazards are often difficult to detect through cursory visual scrutiny and impossible in some cases. For example, he recalled physically opening an enclosure during one field inspection and finding some questionable splices.

“A lot of these decisions are made on the side by a technician or an electrician,” Sanghvi reflected. “For this particular site, no one knew the splices existed in this box. No one knew there was something bad going on in this box. Luckily, we found this before it became a major incident.”

TIMELY RISK MANAGEMENT REMINDER FOR ENVISIONED NEW PROJECT DEVELOPMENT

Vigilant safety monitoring programs could be particularly important for building owners/managers who acquire rooftop solar PV systems through a transaction and have had no input into its design and installation.

In any case, some aspects of that process can become murky through the

chain of contractors and sub-contractors involved. For new installations, Chappell sketches out some basic parameters.

“What you want to do is control your installers with design,” he submitted.“In your notes and your design drawings, you want to tell everyone: This type of connectors is acceptable; cross-mating is not. Then you meet with that EPC (engineering, procurement and construction) and you reiterate: Do you understand?”

A risk management reminder is timely as jurisdictions throughout North America and around the world encourage new solar PV installations in an effort to increase renewable supply and promote distributed energy resources (DERs) that can help alleviate demand pressure on the electricity grid. In Ontario, for example, a regulation was enacted last year to permit third-party net metering, freeing prospective clients, such as commercial and multifamily landlords and condominium corporations, from upfront capital investment and ongoing operating costs.

This aligns with the Ontario government’s vision to tap into an estimated 10,000 megawatts of DER capacity, as outlined in the clean energy plan it released earlier this summer. “Eligible third-party ownership arrangements now include leasing, renting and financing options with energy service providers as well as power purchase agreements with a licensed third-party generator, making rooftop solar and other DERs accessible to more Ontarians looking to better manage their energy costs,” it states. | CFM&D

Barbara Carss is the editor-in-chief of Canadian Property Management.

Summer 2023 CFM&D 27

FOCUS ON HEALTHCARE

PATIENT COMFORTS Wellness-inspired additions to healthcare design support a vast array of needs facing today’s patients.

Elara is a new product from Carolina, an OFS Company.

Meaning moon in Greek, the curves and wide frame of the lounge piece are crafted with comfort, durability, and cleanability and fit for behavioural health, senior living, workplace and healthcare. This Best of NeoCon Award winner recently earned Gold in two categories: Furniture Seating: Sofas and Lounge and Healthcare Guest & Lounge Seating.

The Soul Collection from WIELAND Healthcare is a multi-functional design that maximizes patient room square footage and was created with clinicians, patients and families in mind. The Soul Sofa is a nod to hospitality, with an open base, allowing daylight to pour in. The Soul Mate converts from a stowable ottoman to a comfortable guest chair in one step. During a code situation, double wheel swivel casters allow for moving out of patient zones quickly without getting up. When the sofa is in the sleep position, the ottoman can be used as a nightstand.

Another Best of NeoCon Winner, earning a Gold in Textiles, is Wellness Essentials by C.F. Stinson. The nature-inspired design focuses on clean lines and simple geometry, with a full range of high-performance coated fabrics curated for healing environments and overall wellbeing. The collection also includes two privacy curtains and a woven texture that is bleach-solution cleanable.

Kirei Ink from Kirei is a collection of custom-printed acoustic recycled PET panels and products that can be used in various healthcare settings, including patient rooms, waiting areas and nurses’ stations. They come available in 48 prints, on bleach cleanable recycled PET felt, and are designed to reduce noise levels in interior spaces and promote relaxation and healing. Customized options can fit baffles, wall tiles and allow for wayfinding and logos.

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The oneNEST™ from Umano Medical is a versatile support surface that offers superior comfort, pressure redistribution, deep immersion, and envelopment. The oneNEST™ creates a healing environment by assisting in the prevention and treatment of all stages of pressure injuries, without compromising on patient comfort and dignity.

Laminam added new earth-tone-inspired colours to its line of Italian surfaces, which are ideal for environments where maximum hygiene is required. They can be used for the interior or exterior. A Toronto-based hospital features the product in its wall cladding. As a natural product, the anti-graffiti surfaces are entirely recyclable. They are resistant to scratches and deep abrasions and their properties do not change when subjected to intensive use and frequent cleaning.

S U B S C R I B E

TO OUR E-NEWSLETTER

PRODUCED BY

Summer 2023 CFM&D 29

[ last word ]

BY JENNIFER MOREHEAD

CHAMPIONING DIVERSITY AND INCLUSION The new leadership challenge.

F

acility management departments need to be nimble and responsive to the rising emphasis on diversity and inclusion.

Since FMs oversee service providers and supervise teams of staff, they hold the power to impact numerous employees according to the culture their organization values.

FMs may find themselves working with chief diversity officers (CDOs) who are increasingly at the forefront of this transformation, leading various strategies to engender a more inclusive work environment that strengthens staff retention.

True inclusion extends beyond diverse employee representation by constructing a work culture where all employees feel nurtured, respected, and empowered to contribute to the company’s achievements. A genuinely inclusive workspace is a hotbed for innovation, productivity, and employee loyalty.

The initial step is crafting a holistic diversity and inclusion strategy.

This process involves examining the current corporate state, pinpointing deficiencies in existing policies, and setting quantifiable goals. With a well-defined plan, CDOs can then introduce policies and initiatives that foster an inclusive atmosphere.

EMPLOYEE RESOURCE GROUPS

A beneficial approach includes setting up employee resource groups (ERGs) to cater to different demographics within the company. ERGs provide a platform for employees to connect, exchange insights, and support each other, thereby enhancing a sense of belonging and encouraging collaboration among diverse teams.

Advocate for open communication and dialogue within the organization.

By establishing feedback mechanisms and listening sessions, ensure employ-

ees feel valued and heard. Handling conflicts in a fair and transparent way further strengthens facility management’s commitment to diversity and inclusion.

To enhance open communication, organize town hall meetings, workshops, and focus groups, providing employees a forum to voice their ideas and suggest ways to improve the workspace. These platforms foster a sense of engagement and ownership among employees, leading to a more inclusive culture.

REFINING RECRUITMENT OF DIVERSE TALENT

Recruitment practices must be assessed and improved to ensure fairness and eliminate biases. Implementing blind recruitment techniques, partnering with organizations endorsing diversity, and diversifying the interview panel can aid in achieving this goal.

In addition, creating a supportive onboarding experience for new hires, offering mentorship and career growth opportunities for diverse employees, and implementing diversity-centric leadership development programs can assist in retaining top talent. These measures also equip employees for future leadership roles, thereby contributing to a more inclusive work environment.

Recognizing and addressing unconscious biases is pivotal for an inclusive workplace. Regular training and workshops for employees and management should be provided to raise awareness about these biases. Monitor the impact of such training on the work culture to identify areas needing improvement and promote continu-

ous advancement.

Moreover, CDOs should collaborate with HR and management to incorporate diversity and inclusion into the organization’s performance management systems. This action encourages employees at all levels to contribute actively to building a more inclusive environment.

CDOs should also champion a culture of allyship and support. Providing resources to help employees improve their allyship skills and recognizing and celebrating the efforts of allies in the workspace can reinforce a supportive and inclusive culture.

Monitoring progress and ensuring continuous improvement is another integral aspect of diversity and inclusion promotion. Define key performance indicators (KPIs) to track progress and ensure initiatives remain relevant and effective. Sharing success stories and best practices within facility management can further encourage progress and promote a more inclusive workplace.

ESTABLISHING PARTNERSHIPS

STRATEGIC

Establishing strategic partnerships with external organizations and experts in diversity and inclusion can provide valuable insights and support.

By participating in industry forums and conferences, CDOs can stay updated on the latest trends and best practices.

Ongoing improvements, open communication, and collaboration, can lead to significant impacts and workplaces where everyone feels valued and included.| CFM&D

Jennifer Morehead is the CEO of Flex HR, a human resource outsourcing and consulting firm located in the Metro Atlanta area. Morehead is an entrepreneur, sales and marketing expert, and an independent board member. She is the co-author of Make Your Business Social and the author of CEO From Home. For more information, visit flexhr.com

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Summer 2023 CFM&D 31

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