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HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 34 Issue 1

CHES 2013 Awards



Humber River: A Hospital for the Modern Age Enter: The National Energy Advisory Committee Case Study: Cross Cancer Institute Maximizing Mobility

Fall/automne 2013



















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Canadian Healthcare Facilities Volume 34

Number 1

Canadian Healthcare facilities IS published BY under the Patronage of the canadian healthcare engineering society


Steve McLinden e-mail:


Matthew Bradford e-mail:

Advertising Sales

Sean Foley


MediaEdge Communications 416-512-8186 e-mail:


6  Message from the Publisher By Steve McLinden 8  Message from the President By Peter Whiteman 10 Chapter Reports


Jennifer Carter

production Manager

Rachel Selbie

Articles 12 CHES Wayne McLellan Award Profile: Sunnybrook Health Sciences Centre 14 CHES Hans Burgers Award Profile: Phil Langford


Humber River: A hospital for the modern age

23 Add Heat, Yield Hazard: Flame Retardants Can Form Deadly Chemical Combos


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25 Green Best Practice Case Study: Cross Cancer Institute 27 Maximizing Mobility: How mobile technologies are enhancing the healthcare industry 30  Enter: The National Energy Advisory Committee: CHES members help make energy efficiency group a reality

Steve McLinden e-mail:


Rédatric intérimaire Matthew Bradford



Sean Foley

MediaEdge Communications 416-512-8186 e-mail: Pubicité

Annette Carlucci

COORDINATEUR de production

Rachel Selbie

CHES Canadian Healthcare Engineering Society


Société canadienne d'ingénierie des services de santé


Peter Whiteman


Mitch Weimer

Past President

Michael Hickey


Robert Barss


Randy Cull

EXECUTIVE DIRECTOR Donna Dennison Chapter Chairmen Maritime: Denis Pellichero Alberta: Preston Kostura B.C.: Mitch Weimer Ontario: Allan Kelly Manitoba: Reynold Peters Newfoundland & Labrador: Brian Kinden Founding Members H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski


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Publisher's Message

Celebrating excellence and innovation in 2013 It seems like just last issue we were welcoming a new year in Canadian healthcare, and now we're preparing to say goodbye. No doubt, 2013 provided many reasons to celebrate and we're proud to showcase some of the highlights in the pages ahead. First and foremost, congratulations to CHES organizers for the success of 2013's National Conference in Niagara Falls, Ontario. CHF is proud to have been a part of the event and I am thankful to have had an opportunity to meet many of you in person. CHF is also pleased to profile two honourees from this year's show: the team at Sunnybrook Health Sciences Centre, winner of the 2013 Wayne McLellan Award for Excellence in Healthcare Facilities Management, and Phillip Langford, recipient of 2013's Hans Burgers Award for Outstanding Contribution to Healthcare Engineering. 2013 was also a significant year for healthcare projects. We've turned our spotlight on a few of these in our Green Best Practice Case Study: Cross Cancer Institute report, care of Doug Dunn and Brian Phillips with the CCI's MacKenzie Hospital Campus; our profiles on Lakeridge Heath's energy efficiency project; and the Humber River Regional Hospital's new acute care complex. Within these pages, you'll also find a report on the newly formed National Energy Advisory Committee, the issues surrounding flame retardants, and the mobile technologies enhancing the delivery of healthcare services across the country. These are just a sampling the many people and innovations driving the industry forward. If you have ideas, suggestions or would like to submit a story idea for future editions, please email me at the address below.

Steve McLinden Publisher

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor. Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) $25 per issue Canadian Healthcare Facilities (non members) $30 per issue Canadian Healthcare Facilities (non members) $80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees. La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice. Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 $ par numéro Journal trimestriel (non-membres) 30 $ par numéro Journal trimestriel (non-membres) 80 $ pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS. 6 Canadian Healthcare Facilities



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Message from the President

Planning for tomorrow's industry It is my pleasure to introduce this issue of Canadian Healthcare Facilities magazine as your new CHES president. Sustainability of our healthcare system from a facilities management perspective will be the focal point during my term. Recognizing sustainability has a wide array of possible meanings. For me, sustainability means progress, growth, and the ability to live and learn within our resources in a manner that strengthens our communities and our physical environments for our clients, patients’ staff, and visitors in a manner for future generations to enjoy. Healthcare as it exists today has evolved in response to its current needs. Preparation for future state requires an understanding of all the influences that shape our service requirements, from environmental effects to increasing age and life expectancies, all the way through to the convergence of engineering, architectural, and management of the physical assets in our attempts to optimize human and natural resources with finite economic resources. Infrastructure sustainability plans require a long-term, collaborative approach to meet future state infrastructure needs. The scope of these plans looks for ways to accommodate present use and future growth, covering a wide range of very specific healthcare services which are critical to meeting the needs of the community. This forward planning provides an opportunity to develop infrastructure in a new way—one that lessons our impact on the environment and promotes economic opportunities benefitting current and future generations. Theoretically, our collective infrastructure knowledge will advance sustainable designs. It is through these necessary changes that we will ultimately create the foundations for sustainable communities that will not deplete our natural and/or economic resources. Consequently, it is also my belief that renewable resources will play heavily in our future infrastructures plans, and that this transition will also require us to embrace renewable resources. I'm looking forward to witnessing these advancements as the possibilites are endless and the potential is great. We’ve never been more challenged nor better prepared to meet these challenges. I encourage everyone to work hard and play hard. Sincerely

Peter Whiteman CHES National President

8 Canadian Healthcare Facilities


Hello from the province of Alberta! It has been a very interesting and trying year due to the extreme weather and the unrest caused by another healthcare reorganization in Alberta. In times of such duress, it is our role to step up, which has been the case in so many communities throughout our province. We must always keep this in mind as the main reason we are here is our patients. Our provincial region has initiated the second part of E-Facilities which encompasses the Facility Maintenance & Engineering group and the Clinical Engineering group. In this phase we will, have standardized preventative maintenance procedures, work order process, and a provincial equipment inventory. A large amount of work has been completed by our vendor plus an extreme amount of work is being completed at site levels. Congratulations and thank you to the teams that have led us into the new age. Planning for the 36th Clarence White Conference and Trade Show is well underway. We hope to see you in Red Deer for this great event on November 18 to 19, 2013. This is a great opportunity to network and see what new and exciting things are happening in the facilities world. For 2015, the conference will be held in Calgary. In the meantime, have a safe and happy remaining 2013.

manitoba CHAPTER

Chapter Reports

CHES Manitoba will be holding its 2014 Annual Trade Show and Education Conference at the Victoria Inn again in Winnipeg, Friday May 9, 2014. Some of the topics that are being reviewed for the day are a basic, intermediate and advanced review of AHU’s, filters, heat pumps, cooling and various other areas as they are directly related to AHU’s in healthcare facilities; and HVAV building systems and automation. Once again, we are approaching Manitoba Hydro to partner with us for the Education Day as well as to present some points in respect to the topics for the day. After the May 2014 Education Day, I will be stepping back (not down) as chair of CHES Manitoba, as my two year (two-and-a-half actually) term is complete. The current vice chair, Craig Doerksen, is taking on the role of the chair, and I will assume the position of past chair for the next two years. I look forward to working closely with Craig and the new executive. It will also be time next May to elect new members to the MB Chapter Executive. Nominations are open for the vice chair, secretary and treasurer positions at this time. We look forward to bringing some new members into the executive as well as hopefully keeping some of existing executive involved. The Manitoba Chapter is still looking to fill vacant spots for Manitoba representatives for the national committees. Vacant positions currently include those for the partnership and advocacy and communications committees. The Manitoba Chapter is in the best financial position it has been to date and we look forward to promoting the chapter further through initiatives like our education days and sessions throughout the year. Congratulations to the team from the Ontario Chapter for putting on a fantastic 2013 National Conference this past September in Niagara Falls. We are looking forward to next year's conference in Saint John, NB! I would like to thank the other members of the Manitoba Executive for their ongoing involvement and direction with the chapter as we work toward promoting the chapter across the province. They include Craig Doerksen (vice chair), Tom Still (treasurer), and Gary Yuel (secretary).

Preston Kostura, Alberta Chapter Chair

Reynold J. Peters, Manitoba Chapter Chair

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12-03-05 10:08 AM

CALL FOR NOMINATIONS FOR AWARDS 2014 Hans Burgers Award For Outstanding Contribution to Healthcare Engineering

2014 Wayne McLellan Award of Excellence In Healthcare Facilities Management DEADLINE: April 30, 2014

DEADLINE: March 31, 2014 To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose • The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

Purpose • To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program, or team building exercise. Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners / About CHES / Awards Send nominations to; CHES National Office Fax: 613-531-0626

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1 13-08-06EVAC_CHF_Summer_2013.indd 1:03 PM

13-08-08 2:40 PM

Wayne McLellan Award of Excellence in Healthcare Facilities Management

Sunnybrook Health Sciences Centre By Matthew Bradford

Sunnybrook Health Sciences Centre has become the toast of Ontario's healthcare system after capping a landmark project that has positioned the facility as a leader in energy conservation and green initiatives. Dubbed the Energy & Facility Renewal Program, the project was designed and implemented by Honeywell who, along with Sunnybrook staff and management, worked in tandem over five years to implement energy efficiency upgrades under the Energy Services Company (ESCO) model. Their success paved the way for millions of dollars in annual savings and accolades from CHES, which recently awarded Sunnybrook with its 2013 Wayne McLellan Award for Excellence in Healthcare Facilities Management during its 2013 National Conference in Niagara Falls, Ontario. “Sunnybrook Health Sciences Centre is honoured to be recognized by CHES for our achievements in healthcare facilities management,” says Michael McRitchie, Director of Plant Operations, Maintenance & Security at Sunnybrook. “The $30 million Energy & Facility Renewal program has allowed us to reduce operating costs, upgrade our building systems, and improve the hospital’s environmental conditions. It is an excellent example of how facilities management and engineering are contributing to a better health care experience and it is great to be able to celebrate our successes with this award.” Sunnybrook's project was driven by the desire to make the facility a role model for environmental stewardship while improving the hospital's energy efficiency, reducing 12 Canadian Healthcare Facilities

its environmental footprint, and embarking on needed infrastructure renewal. In so doing, Sunnybrook enlisted Honeywell to help it assess, identify, and implement upgrades that have since generated significant savings for the facility in terms of energy, resources, and expenses. Luis Rodrigues, Vice President, Energy and Environmental Solutions with Honeywell, was a member of the team who worked with Sunnybrook. Reflecting on the many improvements made under the umbrella of the Energy & Facility Renewal Program, he says Honeywell is proud to have been a part of such a large-scale project. “[Sunnybrook] really wanted to demonstrate environmental leadership within the community, and this has been an excellent demonstration of that.” Facility-wide wins Launched in 2008, the project included a number of energy efficiency and facility renewal projects. Highlights include: • Replacement of chillers and cooling towers with energy-efficient models utilizing more environmentally friendly refrigerants • Upgrading and optimization of heating, ventilation, and air conditioning (HVAC) equipment • Weather sealing and repairs to the building's envelope • Implementation of a Hydroclave waste system for the disposal of biomedical waste • Installation of valves and pumps with removable thermal jackets to reduce thermal heat loss while

Michael McRitchie, Luis Rodriguez, and Lori Hunter accept their award at the CHES 2013 National Conference.

enabling future maintenance on equipment • Installation of heat reflectors on heaters to reduce heat loss through exterior walls • Installation of 1,100 low-flow toilets and urinals • Replacement of over 2300 lighting fixtures to high efficiency alternatives utilizing state-ofthe-art control strategies • Upgrading BAS to optimize energy management via new control strategies. These highlights notwithstanding, one of the most visible “wins” for the project included the installation of a 100 kW solar photovoltaic system array on the facade of the parking garage and rooftop —the first of its kind for a healthcare facility at the time, and the largest healthcare installation in Canada. “The wall mounted portion of the system stands as a highly visible example of Sunnybrook’s leadership and stewardship in energy conservation. It was named the 'Harry Taylor Solar Energy Wall' in honour of Mr. Taylor who was instrumental in blazing the trail for environmental stewardship at Sunnybrook and throughout Ontario,” says Sunnybrook. This, in combination with other conservation measures, has resulted in an annual energy savings of 7,000,000 kWh, 4,700 kW electricity, 2,900,000 m3 NG, and 185,000 m3 water— savings McRitchie attributes to the dedication

of both Sunnybrook's staff and Honeywell's team. “Throughout this energy relationship, we have relied on Honeywell’s technical expertise in providing energy solutions. They have been integral to the project’s success, helping to identify and implement a wide range of energy and water conservation measures and verifying the savings associated with each measure,” he says. Important to the success of the project was the commitment shown by Sunnybrook's executive team. From the start, Rodrigues says senior leadership members were fully supportive of the longterm initiative. “One of the key success factors was having the senior leadership team involved and part of the steering committee. Not all organizations have their senior leadership involved until the 11th hour, so having them involved on the way was a key factor in that success.” Equally important was the support shown by Sunnybrook's staff and volunteers. “The success of a project like this depends on how you engage staff to embrace the initiates that have been implemented. At the end of the day, it doesn't matter what you implement in terms of technology. If your staff is not educated on the changes and not embracing them, then the results will not be the same,” adds Rodrigues. This enthusiasm and support from all levels of the organization has aided Sunny bro ok in de ve loping its environmental sustainability even further through numerous initiatives such as its Environmental Sustainability website, annual Earth Matters summit, and Smart Energy Action Programs. “Env ironmental initiatives at Sunnybrook have taken root within the structure and culture of the organization. We are continuing to develop and implement new measures such as our

emergency generator demand response measure, which will result in further operational savings for Sunnybrook,” says McRitchie. “Senior management continues to make energy management and sustainability a priority. Employees are now more cognizant of how they impact the environment both in the home and at the hospital and feel a greater sense of pride knowing that senior leadership aims to create a sustainable organization. Sunnybrook’s Manager of Energy and Sustainability Laura Berndt is responsible for implementing, sustaining and expanding the environmental sustainability program designed to achieve savings and promote sustainable practices and behaviours.” With guaranteed energy savings for years to come, and a body of staff, volunteers, and executives committed to seeing their environmental initiatives through, Sunnybrook's Energy & Facility Renewal Program represents a health care victory for the facility and Canadian healthcare industry as a whole. Speaking to all partners who contributed to this win, McRitchie says, “As with all successful projects, one of the critical success factors is that a multidisciplinary project team be established with strong leadership and a wide range of stakeholders, including representatives from the energy performance contractor, hospital, professional engineers, sub-contractors, utility and incentive providers, and others. The success of the Energy & Facility Renewal Program is very much the result of excellent teamwork and collaboration between all parties involved.” On behalf of its partner, Rodrigues adds, “For Honeywell to have had an opportunity to work and contribute to an organization that has been selected as one of Canada's greenest employers for years in a row, is a fantastic opportunity. They are a world class organization.” Fall/automne 2013 13

Hans Burgers Award for Outstanding Contribution to

Healthcare Engineering Phil Langford

By Matthew Bradford

CHES's Hans Burgers Award was established in 2004 to honour those who have contributed greatly to Canada's healthcare sector and left an indelible mark on the industry and its community as a whole. It came as no surprise to Phil Langford's friends and colleagues, then, when the industry veteran and longtime CHES supporter was called on stage to accept this year's award during CHES's 2013 National Conference in Niagara Falls. “Phil's award was well deserved,” affirms Per Paasche with CHES's Maritime Chapter Executive, and one of the many CHES members who have worked alongside Langford. “He has done a lot for the Maritime Chapter and has been a great asset to the national organization.” Langford's career began in 1974, when he graduated with a Bachelor of Science (applied Physics and Math) from Dalhousie University and a Bachelor of Engineering with distinction (Electrical) in 1976 from the Nova Scotia Technical College. Soon after, he joined with Calgary Power, returning later to take up a role with Nova Scotia Power. Following this, he joined Nation Sea Products (NSP), where he rose through the ranks to become general manager of the company's engineering division. It was here where he first made an impression on Sam Elsworth, who would go on to become one of Langford's closest friends and colleagues. “Phil was a young electrical engineer when I first met him. We were doing a major design for fish plants being built all around Eastern Canada, and one of our senior electrical engineer from our consulting practice had to retire, so I had to rely very heavily on this young guy to see us through a very big projects,” recalls Elsworth, who 14 Canadian Healthcare Facilities

today serves as the project manager for South Shore District Health Authority. “Phil would come down occasionally to do electrical inspections and upgrades just to see us through the rough spots in the various jobs, and we got to be pretty good friends over that period of time.” That friendship continued when Langford left NSP to form his own computer training company for seniors and children; and later when he accepted a job to build and staff a seaweed extraction plant for Acadian Sea Products. From there, he was recruited to join Western Health Region (formerly Western Region of Nova Scotia) as its facilities and planning director for eleven hospitals throughout the region. Here, he helped guide the region through a period of transformation back to districts, even stepping in as the administrative lead for the newly formed South Shore Health District during its search for a permanent CEO. Upon the completion of the transition, he accepted the position of vice president of operations, a position he held until his retirement in 2010. As an integral part of the region's healthcare strategy, Langford amassed a list of achievements throughout his years. In addition to playing a lead role in the disaster planning, he was instrumental in developing an ongoing IAQ renovation project for the former region and district, which saw the facilities upgraded to meet and exceed modern healthcare requirements. “Phil’s foresight and leading edge attitude has provided the District with many new initiatives, including integrating and promoting wireless technology,” says Robert Barss, Manager of Facility Services for the South Shore District Health Authority.

Phil accepts his honours at the CHES 2013 National Conference.

Phil and maintenance staff employee Randall Harnish celebrate CHES's National Healthcare Facilities & Engineering Week.

In addition, Langford played a critical role in championing a Master Plan Program for the district's hospitals, and took a leadership role in other initiatives such as the Primary Health Care development, Isolation Room Study, Women's and Children's Wellness Centre, Centre for Restorative Care, and other initiatives before retiring. “Philip has the strongest work ethic of anyone I know,” affirms Elsworth. “If there was a job to be done, he was brutally task oriented and he was always cool and collected as he did it. There was no stopping him; if there was a job to do, he was going to get it done come hell or high water.” Barss is another longtime colleague and friend of Langford. Looking back on Langford's dedication to the industry and its people, he notes, “Phil is extremely intelligent and is very quick to fully understand and communicate new concepts. His commitment is unbiased and his dedication unending.” That work ethic and commitment to those around him has also carried over to Langford's work with CHES, which he joined in 1999 and continues to be an active member with today. Here, alongside the Maritime Chapter's team, he has adopted many roles including that of national secretary, on various CHES subcommittees both national and chapter related and, more recently, as interim chair during an unforeseen transitional period. “He's very conscientious and a good worker,” insists Paasche. “When we had a problem here a year and a half ago with a vacant presidency seat, Phil stepped right in and took over as acting president. He was very progressive, he got things going, and he was dedicated to improving the membership. He really took complete control.” In his capacity with CHES, Langford has worn many hats, including chair of the Maritime Chapter, and as an advocate for the chapter's numerous initiatives. Langford has also been a part of CHES's Atlantic

Executive since 2003, and served on CHES's National Board of Directors, as well as on its Communication and Canadian Healthcare Standards committees “There are a lot of very dedicated people in CHES,” says Langford, reflecting on his tenure with the association. “I can't say enough about the people who commit themselves to be members, particularly those who take an active involvement in their chapter or in any of the sub committees the chapters may have or with the national organization. If it weren’t for them, CHES would not have progressed as far as it has in recent years.” Today, Langford continues to contribute greatly to CHES at the chapter and national level. His efforts have led to the development of new by-laws for the chapter, and updates for those of the national executive. Among his many initiatives include establishing partnerships with industry organizations, and continuing to work with the Canadian Standards Association, in which he has contributed greatly to its technical committee for CSA 257, Health Care Facility Engineering and Physical Plant, and its various sub-committees, including development of the Z8000, Design and Construction of Healthcare Facilities and Z8002, Maintenance and Operations of Healthcare Facilities. In addition, he is working to establish a CHES Associate Member Advisory Council with the purpose of guiding the executive council as it evolves into the years to come. Reflecting on his contributions to CHES, Elsworth says, “He's an extremely ethical individual, and he really takes the oath very seriously. Once he signs onto something like CHES you can count on him to bring something to the table.”

“Phil has been an ardent supporter of CHES at both the local and national level,” adds Barss. Outside of CHES, Langford has been involved and taken an active leadership role in many community organizations. Among them include his role as a Boy Scout leader, member of the South Shore Regional School Board, president of the Riverport Community Centre, chair of the Riverport Board of Trade, president of the local Red Cross organization, a coach for community basketball and soccer teams, and a fundraiser for numerous non-profit initiatives. “As with any task, Phil shows unbiased commitment to his family, his community and the healthcare industry and the people it serves. He is a well-respected leader and administrator who is a supportive mentor and a team player who is deserving of this award,” says CHES. All totalled, Barss says Langford's nomination was a natural conclusion for both him and the many colleagues he's inspired throughout his career. “I have known Phil most of my life, both as a friend and colleague; and I have worked with Phil in several capacities in both healthcare and private industry. Phil has encouraged my professional development and has always been a strong supporter of my career and goals. He is understanding, compassionate and maintains a calm disposition in times of crisis. Family and friends are important to Phil. If you need him, he will be there.” As for his part, Langford is proud of his award, but says he is but one of many worthy candidates in the field he has called home for the last few decades. “All I can say is I am very humbled. It nice to know that your peers recognize you; it's a great honour. The award is humbling and rewarding but I also look at the many many people out there across the country that could have also just as well received the award,” he adds. Fall/automne 2013 15

The $1.75-billion facility will be one of Canada's largest acute care facilities, serving a catchment area of 850,000.

Humber River: A hospital for the modern age

By Matthew Bradford All eyes within Ontario's healthcare industry are trained on North York, where work is ramping up on the Humber River Regional Hospital’s (HRRH) new acute care complex. The project is being delivered under the Ontario government’s Alternative Financing and Procurement Program by Plenary Health Partnerships. Currently in construction on a 30-acre site at Keele Street and Highway 401, the 1.8-million-square-foot, 14-storey 16 Canadian Healthcare Facilities

development will house 656 beds and accommodate over 107,000 visitors per year through expanded emergency care services, state-ofthe-art equipment, and patient-centred design elements. “The hospital is embarking on an important transition to ensure it can continue to deliver the best possible care for patients and families well into the future,” reports Malcolm Lawrie, vice president of project delivery with the Plenary Group. “This transition is

“The tower increases patient capacity from 549 beds to 656 beds, enabling the hospital to provide more comprehensive inpatient hospital programs,” says Lawrie. Speaking to its construction, he explains, “The massing of the tower is an assemblage of three distinct ‘blocks’ composed to reduce the tower’s scale. Inside, the majority of patient rooms are defined by large expanses of glass and aluminum curtainwall, while others are articulated with horizontal bands of windows set in precast concrete. Masonry at the centre tower connects all these parts and achieves a harmonizing verticality.” Included in the project’s design is a South Plaza which serves as the centrepiece of the entire campus. Here, curved amphitheatre-like retaining walls, terraced plaza supports, natural accents, and outdoor seating provide visitors and staff with a sense of community and calm. Progress to date

necessary to take the organization from being a hospital constrained by the limitations of aging infrastructure and physical plant challenges, to a facility that will be nationally and globally recognized as a leader in quality healthcare services.” Once completed, Lawrie reports the new $1.75-billion facility will be one of Canada’s largest acute care hospitals, serving a catchment area of more than 850,000 people in the northwest Greater Toronto Area. The final build will be comprised of three components reflecting the facility’s core functions. These include its Ambulatory Block, Diagnostic and Treatment Podium, and the most prominent feature of the hospital, the 14-storey Inpatient Tower.

PCL Constructors Canada Inc. is the team responsible for the design and build of Toronto’s newest healthcare gem. As of summer 2013, work on the precast and curtainwall had commenced, while the hospital’s concrete structure is nearing completion. HVAC, plumbing, and electrical are ongoing throughout the lower floors. Also contributing to the project is Halsall Associates, which is providing structural engineering and building envelope consulting services. Reflecting on the build’s progress, Halsall associate Kathryn Edwards says one of the standout features of the structural design is the implementation of temporary joints. “The introduction of permanent joints would complicate and reduce the performance and reliability under seismic loading,” she says. “The solution was to introduce temporary movement joints to mitigate development of internal stress due to the shrinkage of temperature effects during the construction period. Prior to the installation the joints will be grouted solid.”

The fully digital Humber River Regional Hospital is being built with integrated systems and advanced automation technology.

Fall/automne 2013 17

The facility is being built to meet requirements for Tier 1 of the City of Toronto's Green Standard and LEED Silver certification standards.

Touching on other highlights of the build, Edwards says the foundation design itself represents an innovative approach to the project. “The bedrock extended more than 30 metres below the basement. In lieu of a deep foundation, a raft foundation was designed to support the 14-storey tower, and wide- strip footings are used for the podium structures on the north and south sides of the tower ... The design team did extensive settlement analysis to ensure that differential settlement would not have adverse effects on the functionality of the building.” A digital first

Buzz around the new Humber River Regional Hospital has been mounting ever since the project broke ground in December 2011. This is partly because the new facility is being touted as North America’s first fully digital hospital featuring fully integrated systems, advanced automation technology, and a seamless network of communication tools that will “connect systems to systems, people with people, and people with system,” according to the hospital’s website ( “As the first fully digital hospital in North America, the hospital is designed to support the latest medical technology in a completely digital environment,” says the Plenary Group’s Lawrie. “Upon entering the hospital, the ability to easily access data and information enables users to ‘connect’ from points such as kiosks situated 18 Canadian Healthcare Facilities

throughout the hospital or on mobile devices anywhere in the building. This connectivity is available anywhere an Internet link is available: home, work, or in the hospital itself.” Elements of the hospital’s digital strategy include the implementation of wired and wireless networks linking all components of patient care within the facility, from the distribution of electronic medical records and digital images, to the operation of electronic control systems, to the management of technologies such as video conference, email, and instant messaging. The hospital’s state-of-the-art strategy also calls for the installation of Integrated Bedside Terminals, allowing patients to customize their environment, order food and communicate directly with caregivers, friends, and family. Lawrie says staff and patients alike will benefit from cutting edge automated technologies. “Lab work specimens will be delivered via pneumatic tubes, with results returned to handheld mobile devices within minutes. While all this is happening, Automated-Guided Vehicles (AGVs) will deliver supplies and equipment to units and clinics, allowing caregivers to fully devote their time to patient care. (In total), 75 per cent of all deliveries in the new hospital will be done using automation.” Overall, HRRH’s goal is to empower patients to stay linked and up-to-date with every aspect of their care – all while giving medical

professionals the tools to improve the accuracy, efficiency and safety of their services. A GREEN OUTLOOK

As well as targeting a complete digital environment, the new Humber River Regional Hospital is being built to meet requirements for Tier 1 of the City of Toronto’s Green Standard (TGS) and LEED Silver certification standards. Lending to the hospital’s green build is the incorporation of a green roof, which will cover 50 per cent of the building; a high performance building exterior; automated climate and lighting controls; sustainable landscape elements featuring native and drought resistant plants; and high- efficiency plumbing fixtures which will result in the reduction of the facility’s indoor water use by 35 per cent. Furthermore, green practices during the build include the diversion of 75 per cent of construction waste from the landfill; the use of low volatile organic compound materials for adhesives and sealants, paints and co ating s, and carpets; and other environmentally focused practices. “The new hospital was designed to inextricably link health care and the environment,” insists Lawrie. “Design and construction will adhere with the guidelines and sustainability principles of the Leadership in Energy and Environmental Design (LEED) rating system, with a goal of achieving LEED Silver certification. When complete, it will be the most energy efficient hospital in North America, as determined under the ASHRAE protocols.”

Humber River Hospital to share our learnings, best practices and innovations through various leading healthcare symposia, including 2012 Healthcare Facilities Symposium & Expo in Chicago and the Healthcare Infrastructure Summit, to the benefit of other healthcare institutions who are planning their future projects,” notes Lawrie. “ T hes e k i n d s of e du c a t i on a l M&E_CHF_Summer_2013_FINAL.pdf 1 opportunities,” he continues, remind us that the AFP approach that is employed

in Ontario remains at the cutting edge of infrastructure delivery, and that it really does deliver excellent infrastructure results for patients, staff, communities, and taxpayers”. For updates on the HRRH redevelopment project, visit redevelopment. The preceding article is reprinted from the Toronto Construction Association's Builder's Digest, Quarter 3 2013. 13-07-25

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Award winning approach

To date, the hospital project has received numerous accolades from healthcare professionals across the globe. These include the award for Best Accommodation Project (HRRH), from the 2013 Partnership Awards in London, in the U.K.; the nod for Best Health- care Project (HRRH) and Best Project Sponsor (Plenary Group) in North America by the World Finance Magazine 2013 Awards; and the 2012 Silver Award for Innovation and Excellence in Public-Private Partnerships (HRRH), given by the Canadian Council for Public- Private Partnerships. Moreover, Lawrie says the facility is being recognized as a testament to the strength of the alternative financing and procurement model by which is it governed. “We have worked closely with our partners at Fall/automne 2013 19

Going Green for a Healthier Bottom Line Lakeridge Health’s Self-Funding $17.1 Million Energy Efficiency Project By Michelle O’Brodovich and Etienne deMuelenaere

Like so many other Canadian hospitals, Durham Region’s Laker idge Health (LH)—one of Ontar io’s largest community hospitals comprising four hospital sites and three emergency rooms—was feeling the squeeze of the healthcare cash crunch. LH needed to reduce spending yet also fund urgent infrastructure upgrades, all while maintaining its commitment to excellent patient care. “We knew that if we didn’t do something to cut our energy costs, we were going to be in operational trouble,” said Neil Clarke, Director of Engineering and Infrastructure at Lakeridge Health. “We were kind of in a pickle where we couldn’t move forward with a lack of capital investment funding and our infrastructure was failing.” 20 Canadian Healthcare Facilities

As a result, LH is currently undergoing a $17.1 million self-funding energy retrofit of its four hospital sites using a whole building approach known for generating deeper savings. The project is allowing LH to renew critical infrastructure, cut energy costs by 23 per cent, improve conditions for occupants and reduce greenhouse gas emissions by 2,078 tonnes per year, the equivalent emissions of 310 average homes. 29 Energy Conservation Measures, Four Hospital Sites

Following a competitive tender call, Lakeridge Health partnered with Ecosystem, a Canadian firm of energy efficiency professionals, to bring the project to life through

a fully financed energy performance contract. LH will repay the project investment with incentives, avoided costs and $1,257,600 in annual energy savings within 6.4 years. Ecosystem has guaranteed these results in addition to the construction costs. “This guaranteed energy saving investment has allowed us to progress to reduce our risk of infrastructure failures and save money to reinvest into capital improvements,” said Clarke, “We are taking these steps now because when electricity prices rise we will have safeguarded our savings from these initiatives, which will offset the utility increases, ensuring we don’t impact patient care.” Cu r ren t ly u n der con s t r u c t i on w i t h a pro j e c te d completion date of December 2014, the project is composed of 29 energy conservation measures (ECMs) across four sites to reduce heating and cooling loads, increase system operating efficiency, change the mix of energy consumption towards lower-cost energy, renew poorly functioning a s s e t s a n d t a ke a dv a n t a g e o f av a i l a b l e i n ce n t ive programs. Specific measures include integrating a 1.6MW combined heat and power plant, harnessing free solar energy, and implementing an extensive lighting retrofit; several other ECMs will improve the heating, cooling, and ventilation systems.

sufficient, but rather to minimize the quantity of electricity purchased from the grid while also reducing on-site steam production. The CHP’s two reciprocating gas-fired engines are rated at 800 kilowatt electric each and have a combined efficiency of over 87 per cent, considerably higher than the conventional 25-30 per cent efficiency obtained from using separate grid power and gas-fired boilers for heating. To maximize CHP energy savings, it was essential that the engines be just the right size: specifically, not too large for heating in the summer or for electricity during the winter. “The main goal here was to maximize the uptime of the engines—and for this sizing is key,” said Thomas Falk, Ecosystem’s Project Manager. “By integrating factors such as the cross effects of energy conservation measures, the future summer heat load and the results of a maintenance simulation, we determined that two identically sized engines would provide the best compromise between savings and cost. When one engine requires servicing, another will still be able to provide both heat and electricity to the building.” “We’ll use the produced heat and power output to gain every ounce of energy out of the units,” adds Clarke. “It’s innovative in that we will run it 24/7 to maximize the savings and the return on investment.”

CHP: Sizing it Right to Maximize Savings

Central to the project is a 1.6MW combined heat and power (CHP) plant at LH Oshawa that will generate approximately 50 per cent of the total project energy savings. The CHP is fuelled by natural gas for cleaner, efficient production and will provide the hospital with an in-house source of electricity and thermal energy. The application was not designed to make LH Oshawa self-

The cost of this measure is intended to be offset by a substantial incentive from the Ontario Power Authority, which is currently being reviewed for approval. Solar PV: Making Hay While the Sun Shines

48 photovoltaic solar panel arrays have been installed on the roofs of three Lakeridge Health hospitals. The Oshawa, Fall/automne 2013 21

Bowmanville and Port Perry sites are now generating nearly 10 kW each, power that Lakeridge Health is selling back to the province’s electricity grid as part of the Ontario Power Authority’s microFIT (Feed-in Tariff ) 1.0 program. Lakeridge Health was one of the last customers in Ontario to benefit from the original $0.802 per kilowatthour produced; new installations falling under the microFIT 2.0 program will receive a much lower rate. Each of the three sites is now generating an annual revenue stream ranging from $9,000 to $11,000 and will continue to do so for 20 years, representing a substantial return on investment for Lakeridge Health. Better, Cheaper Lighting

Lighting accounted for 21 per cent of the hospitals’ electricity consumption, which made all four sites prime candidates for efficient lighting retrofits. The 24,000 tubes being replaced with highly efficient models are set to reduce Lakeridge Health’s lighting electricity consumption by 38 per cent. While the scope varies by hospital, all sites have had their T12 lighting replaced with extra-long-life high efficiency florescent tubes; not only does this save energy, but the use of a standardized tube type will greatly facilitate LH’s procurement and stocking. In addition, the simultaneous replacement of tubes and ballasts means that substantial lighting maintenance will not be required for a period of four to six years, depending on the lighting application.

In addition, the level exterior parking lots at all four sites are undergoing similar LED lighting upgrades that will save between 75 per cent and 85 per cent depending on the application and significantly reduce future maintenance costs. Other ECMs and Asset Renewal

The project was designed using a whole building approach to deliver deeper savings; it includes a diverse range of other energy conservation measures (ECMs) to optimize building performance and significantly reduce energy consumption. The savings generated by the overall project have enabled Lakeridge Health to secure alternative means of funding for $7.1 million in upgrades and asset renewal that would otherwise have been very difficult to obtain. Other ECMs include:

• Controls upgrades (three sites) • Replacement of rooftop air handling units (two sites) • New boilers (two sites) • New domestic hot water systems (three sites) • New chillers (two sites) • Addition of variable frequency drives to ventilation systems • Ventilation system optimization • Thermal network optimization including steam-to-hot water conversions • Chilled water plant upgrades • Cooling plant upgrades • A dedicated CT-Scan chiller, removal of city-water cooling • High efficiency domestic hot water Beyond the Buildings

LH Oshawa parking lot lighting retrofit and new controls reduced energy consumption by 87 per cent, improved light quality and reduced maintenance.

All non-specialized uses of incandescent or halogen light bulbs will be replaced with high efficiency and longer life LED bulbs. By switching to new LED fixtures, Lakeridge Health will save on maintenance and energy at all four sites; and the parking lots are also safer due to the vastly improved light quality, colour, and uniformity. 22 Canadian Healthcare Facilities

According to Lakeridge Health’s President and CEO, Kevin Empey, the project benefits extend far beyond building improvements: “Investing in this energy project means we’re investing in our community,” said Empey. “Not only are we reducing our impact on the environment, we’re saving money that can be put back into what really matters—health care for the families we serve.” Andre Rochette, Ecosystem’s President and CEO, agrees: “Lakeridge Health is a best-in-class example of a publicsector institution that found creative ways to fund essential infrastructure upgrades,” said Rochette. “And it’s not just about dollar savings—these deeper energy retrofits provide concrete solutions to some of the most pressing economic, health and environmental issues of our time.”

Michelle O'Brodovich is the former corporate communications manager with Ecosystem. Etienne deMuelenaere is also with Ecosystem as an energy efficiency engineer. For more information, visit

Add Heat, Yield Hazard Flame Retardants Can Form Deadly Chemical Combos By Barbara Carss

A Canadian assessment of 10 commonly used flame retardants coincides with a move to revise California fire safety requirements that critics finger for introducing more toxins and new risks into the built environment. Although a few earlier-generation flame retardants from a family of chemicals known as polybrominated diphenyl ethers (PBDEs) have now been prohibited, an extensive range of chlorinated and brominated substances continue to be added to foam, fabric, and other ignitable products. "In North America, we have more than 80,000 chemicals in the marketplace and only a limited number of them have ever been tested for long-term health and environmental effects," observes Maggie MacDonald, Toxics Program Manager with the public advocacy and research organization, Environmental Defence, and a member of the stakeholder advisory committee to the Canadian government's Chemicals Management Plan. "The question we ask is: what is necessary? There are chemicals of convenience – like in non-stick pans or wrinkle-free shirts – that really just add another element of risk." Given the association with life-safety, flame retardants might almost reflexively be viewed as necessary. However, smoke is typically the most lethal element of fire, and the chemicals in flame retardants add to its toxicity. Fire safety experts and regulators are now re-evaluating the benefits of slowing the spread of flames against health and environmental risks. Those could be either immediate poisonous repercussions at certain temperatures if chemicals in flame retardants interact with other released chemicals to create deadly combos like hydrogen cyanide, or the longer term effects of off-gassing and accumulation of chemicals in the environment and in humans' bodies.


California Governor Edmund G. Brown Jr. called for alternative approaches in February when he announced plans to study and update the state's decades-old regulations for home furnishings. "We must find better ways to meet the fire safety standards by reducing and eliminating, wherever possible, dangerous chemicals," he said. Technical Bulletin 117 from the California Bureau of Home Furnishings and Thermal Insulation, which has been the de facto standard for North American manufacturers for the past 40 years, dictates that various foams used in furniture and insulation must withstand an open flame for up to 12 seconds before igniting – a benchmark that many observers suggest was the impetus for the growth of a new category of products and marketers' subsequent efforts to promote wider applications for them. The proposed new focus would downplay this test, which is unlikely to be an immediate risk in real-life scenarios where furniture foams are covered with upholstery. Instead, standards will address the resistance of exposed material, its propensity to smoulder and other factors that could prevent flames from igniting more volatile materials and/or provide more time to evacuate before that occurs. Meanwhile, Canada's Chemicals Management Plan – under the joint auspices of Environment Canada and Health Canada – identifies flame retardants as one of nine groupings of substances to be assessed for possible future controls and/or prohibition. This process began earlier this year when all entities manufacturing or importing more than 100 kilograms or using more than 1,000 kilograms of 10 designated flame retardants were directed to provide information. (Nonspecified stakeholders were also invited to make submissions up to July 30, 2013.) Fall/automne 2013 23

In this initial screening stage, substances will be assessed for their potential to degrade, metabolize, migrate, or leach from finished products; be absorbed through skin; affect the health of humans, animals, plant, or aquatic life; or accumulate in physiological or natural systems. Results and a draft response plan are expected to be released for public consultation by late 2014 or early 2015. The assessment covers five brominated, three chlorinated, and two organic phosphate substances, some of which have become preferred substitutes for the banned products, PentaBDE and OctaBDE. Beyond furnishings and electronic equipment, flame retardants in commercial, institutional, and multi-residential buildings are most likely to be found in foam insulation, fire-stopping, cabling jackets, coatings, resins, and waterproofing. These building materials commonly contain some of the 10 retardants now under review. Notably, TCPP (Tris 2-chloro-1methylethyl phosphate), used in spray foam insulation, was recently listed under California's Proposition 65 as a substance known to cause cancer, birth defects or other reproductive harm that must carry a safety label. "It is really an infamous one and it has actually increased in use since PentaBDE was banned in 2006," MacDonald says. "It is a great thing that the Chemicals Management Plan is looking at these chemicals, but both this initiative and the changes in California are going to take some time. That's where the green building movement can be a positive force. We see that companies will act proactively to reduce chemical use if they perceive regulatory change is coming or there's market pressure." PRODUCT CHOICES AND PRECAUTIONS

From a facilities management perspective, it is relatively easy to avoid flame retardants or limit exposure to them from furniture, window, and wall coverings with informed product choices. "First, I'd look at natural products that are flame-resistant that comply with the needed fire ratings. For example, wool carpet is actually inherently flame-resistant," explains Sandra Lester, a sustainable interior design consultant and principal of the firm, Affecting Change Inc. "If that's not available, you look for something that is lower in toxins and that you can keep away from the fingers, hands and respiratory systems of occupants. With most of these substances, you either absorb them through your skin or you inhale them. Another factor to consider is whether the flame retardant is embedded in the structure of the material or if it's a coating that can come off." Chemicals could also enter the human body orally, but it's generally assumed most adults won't be chewing the furniture. Risks of inhalation come from smoke in an actual fire and also from dust. "Many years after you purchase a couch, the chemicals in it are still being released. Good ventilation and dust removal are important," MacDonald advises. Insulation presents a more complicated cost-benefits equation, particularly for green building advocates looking to a recognized superior energy efficiency measure and attempting to weigh the global warming potential (GWP) of foam products manufactured with hydrofluorocarbons (HFCs) against heightened flammability of hydrocarbon-based products. The proposed phase-down of HFCs in North America and even more aggressive actions in the European Union heralds an evergrowing number of building products made with hydrocarbons, which have lower GWP ratings, but introduce other risks. 24 Canadian Healthcare Facilities

"You are looking at making these products with a higher potential heat-release rate than there would have been in the past, and when flame retardant is added to reduce flammability it is creating the potential for increased toxic off-gassing," says Bryn Jones, Director of Building Sciences with Pinchin Environmental Ltd. Since insulation is typically sealed behind gypsum wall-board, the couch in a reception area is probably a greater source of chemical exposure in normal conditions. Thermal degradation – how materials devolve and interact as they burn – is the true risk. Among the hazards, the chemical components of insulation treated with certain flame retardants can yield hydrogen cyanide. "This happens at the lower temperature range, before combustion or post-flameout," Jones says. Theoretically, building occupants should have already evacuated by the time this occurs, but it could threaten inspectors, building staff and/or contractors who might be entering a space shortly after a fire has been extinguished. It's also a concern any time insulation is uncovered and potentially exposed to flame. "The biggest risk is probably during installation when the product is exposed and they may be doing hot-work nearby," Jones says. Meanwhile, cabling is a significant fire safety concern. Flame retardants are used in the fire-stopping that should guard any penetration through a fire-rated floor or wall, and also in the cable jacket to further protect what could be one of the most dangerous materials in a building. "When they actually ignite, they have a higher BTU rating than gasoline," notes Ryan Garner, a registered communications distribution designer (RCDD) with the IT services consultant, RYCOM. "It is really one of the few pieces that spans the whole building vertically. If you don't have fire-stopping, it is going to spread like wildfire." As with insulation, a building's core cabling network travels through well-protected risers that the majority of occupants won't encounter. More exposure risks occur in the horizontal cable runs to equipment scattered over each floor of a building. "The number of ethernet cables that are going to be under raised platforms or in the ceiling of an office space are going to increase by a huge amount in the next five years, and I think we are going to see issues around flame retardants because there is not a lot of buffer between office workers and the area where all the cabling is installed," Sandra Lester predicts. ENSURING SAFE SUBSTITUTES

A more thorough understanding of flame retardants should promote better overall fire safety. "The big issue is making sure the research on health effects is done before it gets out in the market," Maggie MacDonald stresses. "The term we use in the environmental health movement is 'regrettable substitute' when a banned product is replaced with another problematic product. What we want is a safer substitute. We want to replace chemicals with safer chemicals or with other materials that are inherently flame-resistant." For more information about the Chemicals Management Plan, see the Government of Canada's website at www.chemicalsubstanceschimiques. The preceding article is reprinted from Canadian Property Management, September 2013.

Green Best Practice Case Study: Cross Cancer Institute Re-commissioning at Edmonton facility pays big dividends By Brian Phillips & Doug Dunn

The team at Mackenzie Hospital had a challenging problem on their hands. Their Cross Cancer Institute (CCI) facility was experiencing air delivery and cooling issues during shoulder and summer seasons in the lower levels (Level 0, 1, and 2) of the building. Adding to their concern was the fact the main air handler array serving the facility had no redundancy built in, meaning an air system could not be shut down for maintenance, or any other reason, without impacting air flow to CCI thereby causing an adverse effect on clinical programs and patient comfort and safety. After numerous attempts failed to rectify the problems, including increasing existing fan flows to maximum capabilities, a request was made for a capital expenditure to fund the purchase and installation of a new air handler, estimated to cost approximately $500,000 in addition to extensive downtime and disruption to research and treatment activities at CCI. It was clear that with healthcare dollars being as scarce as they are and in such high

Re-commissioning activities related to air handling units at the Cross Cancer Institute resulted in annual energy savings of over $240,000 and greatly improved indoor environmental quality.

demand elsewhere in the system, a project of this nature would take years to be approved. In the interim, user space would continue to get worse from a ventilation perspective and occupant dissatisfaction would remain. As such, the decision was finally made to put the facility through a re-commissioning process focusing on the air handlers and the delivery of air to the lower floors in CCI. Re-commissioning is a continuous re-optimization process for existing buildings focusing on improving or optimizing system performance while at the same time identifying operational

improvements; maximizing energy efficiency, comfort, and savings. Focus was on the air handler array, a group of seven air handlers serving duct shafts to the five story, 43,366 M2 facility. Of major concern were the array pressure drops, the duct riser’s pressure profile and the operation of the terminal units on each floor. Re-commissioning, which typically focuses on low-and no-cost actions or items to achieve efficiencies, was done using in-house technical forces to keep costs to a minimum. Fall/automne 2013 25

Summary of benefits for the re-commissioning initiative: Direct: • Yearly energy savings currently in the order of $240,000 greatly lowering operating costs • Improved system performance addressing problems of proper air delivery • Carbon emissions have been reduced by 1,437 tonnes, methane emissions by 0.431 tonnes, and NO2 emissions by 12.933 tonnes • Avoidance of a $500,000 capital cost expenditure permitting retention of funds for much needed patient care programs

Areas of concern requiring attention during re-commissioning included: • High pressure drops across existing filter banks • Switching v-belt drives to more efficient cog drives • High pressure drops in fittings and take-offs on high and medium velocity ductwork • Incorrect testing, adjusting and balancing (TAB) calibrations • Inaccessible and dirty flow measuring stations • Change in user occupancy loads resulting in increased or decreased requirements

Indirect: • Improved indoor environmental quality [IEQ] for patients/staff • Elimination of need for new air handler saving capital healthcare dollars • Increased equipment life due to greatly reduced operating speeds • Recovered system redundancy reducing the impact of required • maintenance shut downs to clinical spaces

The re-commissioning process provides significant potential in health care facilities to achieve both energy and dollar savings, and improved system performance. Whether referred to as ‘commissioning,’ as in new construction, ‘re- commissioning/ retro-commissioning’ or simply ‘setting systems up to run at optimum operational levels,’ it can provide significant savings in all types of buildings including health care. As a result of this project, the Mackenzie Hospital team garnered significant cost savings and reductions in emissions, reinforcing the potential to save scarce health care dollars by continually focusing on operational improvements.

The implementation process entailed: • Reviewing of original design intent • Reviewing current operational requirements • Performing baseline testing of the air system, risers and occupied floors considering air flow and pressure drop looking for improvement opportunities • Documenting all changes and make adjustments as necessary to the digitally-controlled building management system • Continuing with ongoing assessment and monitoring

Doug Dunn is site director for MacKenzie Hospital Campus. He can be reached at Brian Phillips is manager of facilities management and engineering at Cross Cancer Institute, Mackenzie Campus. He can be reached at brian.phillips@


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Maximizing Mobility How mobile technologies are enhancing the healthcare industry By Barry Burk

Most of us now spend more time on mobile applications than we do on the internet, and global unit shipments of mobile devices like smartphones and tablets have surpassed those of PC desktops and notebooks. There can be little doubt “mobile� is the next major computing cycle and it impacts not just the way we shop or communicate, but also the way we work. Recently, IDC Canada predicted mobile workers will constitute 72 per cent of the total workforce in 2015. In the healthcare field, however, that number is much higher. One could argue, in fact, that mobile workers have always been the lifeblood of the healthcare industry. Doctors, nurses and other caregivers want to spend hands-on time with patients, not tied to a desk in front of a computer screen. Fall/automne 2013 27

There can be little doubt “mobile” is the next major computing cycle and it impacts not just the way we shop or communicate, but also the way we work. Research supports that. According to a 2011 World Health Organization study, 93 per cent of physicians and non-physician healthcare workers now access information via a mobile device. There have also been numerous studies on the number of kilometers nurses routinely walk during a shift. Increasingly, mobile technologies are being adopted to enhance clinical collaboration, improve workflow, and provide better bedside care. While this trend is helping address some of the challenges our Canadian healthcare system faces (i.e., growing expectations for better quality care, increasing patient loads, critical resource shortages and escalating costs), it also makes communication among members of a healthcare team more challenging.

To maximize efficiency, healthcare workers must be able to communicate quickly and easily with colleagues, who may be anywhere on the floor or on hospital grounds. Often that means caregivers have to stop what they’re doing, leave their patient to look for someone or place a phone call or a page--time that could make the difference between life and death in an emergency. Pagers, phones, or overhead speakers can go unheard, or unanswered, leading to repeated attempts. This is not only inefficient but creates an atmosphere where high noise levels contribute to an already stressful environment. But in Sherbrooke, Quebec—and in more than 80 other facilities across Canada – healthcare providers are implementing a new mobile communications system which

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is reducing noise levels, expediting care and improving staff efficiency. Le Centre de santé et de services sociaux–-Institut universitaire de gériatrie de Sherbrooke (CSSS-IUGS) is a short-and long-term geriatric care facility serving the needs of 760 residents. It recently equipped staff w i t h Vo ce r a h a n d s - f re e , vo i ce o p e r a te d w e a r a b l e b a d g e s t h a t p rov i d e i n s t a n t t wo - w ay vo i ce communication. The badges allow caregivers to relay simple spoken commands between each other while they’re tending to patients, and can also relay text messages and alerts. A single voice prompt instantly connects staff to the caregiver they need, thereby reducing phone tag, overhead paging, or the need to physically search for a person. The system includes an optimized speech recognition engine which responds to more than 100 voice commands. For example, the system can respond to a voice command to “Page on-call doctor” and will instantly establish a two-way voice communication between the caller and that physician, without the need to know or remember who the ‘on-call doctor” happens to be that shift. In Sherbrooke, the system was also customized to instantly alert staff when residents assigned to their care use their bedside call buttons. By next March, the system will be rolled out to cover almost all of the beds at the facility, but early trials in several wards have already seen a significant reduction in noise levels and improved response time to patients' calls. “The residents are calmer. As we spend less time moving around and are thereby more efficient, we end up spending more time with those for whom we care," says CSSS-IUGS spokesperson Jean-Claude Poirier. Sherbrooke’s system is the largest in Quebec, but across Canada other healthcare facilities have adopted this technolog y and gained benefits beyond reduced noise and improved productivity.

The University of Ottawa Heart Institute (UOHI) is the first Canadian hospital to integrate this system with a HIPAA-compliant smar t-phone application, which e n a b l e s c l i n i c i a n s to u s e t h e i r personal mobile devices to text, access and share clinical information and images on a secure database, without any confidential patient information becoming stored or resident on their personal device. “This new system enables our teams to respond faster, ensures that our patients and their families benefit from the best care possible, and saves time and money on our system. The integration of new technologies in our everyday doings is crucial to the efficiency of our healthcare system,” said Dr. Robert Roberts, president and CEO of UOHI. Kingston General Hospital started with a small pilot of the system on one of its surgical floors but when that netted results including a 45 per cent reduction in time looking for others, a 61 per cent reduction in time to respond to phone calls, a 54 per cent reduction in time looking for assistance and a reduction in frequency to trips to a telephone from 6.8 times per shift down to 2.9 times per shift, the facility decided on a full-scale implementation. Mobile technologies have advanced to the point where they are truly pervasive. And while other technologies are now common in healthcare – robot-assisted surgery, digital medical imaging, even basic m o n i to r i n g e q u i p m e n t – m a ny organizations are still struggling with basic communication systems. Paging disturbances, inability to locate resources, dropped calls, and staff safet y concer ns are a challenge mobile technologies can address.

Barry Burk is Vice-President of Healthcare Industry for IBM.

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Enter: The National Energy Advisory Committee CHES members help make energy efficiency group a reality By Kent Waddington

30 Canadian Healthcare Facilities

Thanks to volunteer CHES members from across Canada, and numerous others interested in furthering the cause of enhanced energy management in health care, the Canadian Coalition for Green Health Care has been able to assemble a National Energy Advisory Committee (NEAC) to support work by the Coalition and CHES in advocacy efforts to improve energy efficiency in the Canadian health services sector. This includes work on refining and introducing initiatives that support the greening of Canada’s health care building stock from an energy conservation perspective. The committee will ensure high professional standards are maintained and continuous quality improvements are made in relation to all of the Coalition’s energ y management and energy promotion initiatives and activities. Further, it will make recommendations and prov ide guidance on the planning , de ve lopment, evaluation, deployment, and marketing of initiative and activities as deemed appropriate, and in keeping with the Coalition’s mandate and governance policies. Members of the committee come with varied backgrounds and bring with them a strong combination of skills and exp er ience in health ser v ice facilit y eng ineer ing , operations, and management, providing the best possible critical peer group influence and leadership to the sector. NEAC members work to showcase energy efficiency leadership and promote how energy efficient initiatives are being used to reduce operating costs and mitigate environmental impacts by identifying and reducing barriers that impede the adoption of energy efficiency in health care facilities. They also work with other institutions to bring awareness of the human, economic, and environmental benefits of energy efficiency, and to gain support for energy efficiency and its relationship to climate change. In addition, the committee helps recruit Canadian health care facilities into the world of sustainable health care. “Working with the Coalition has greatly assisted me in my role and responsibilities keeping me informed regarding trends, best practice, and generally up-to-date on products and services that will help us meet our sustainability objectives,” says CHES president Peter Whiteman. “It is truly an honor to represent the Saskatchewan healthcare industry on the National Energy Advisory Committee. I know from past experience that the successes we can achieve by putting a national unified voice forward are tremendous.” JJ Knott, Director of Plant Operations at Norfolk General Hospital and Energy Lead on the joint Coalition/ Fall/automne 2013 31

C H E S O n t a r i o e n e r g y s e r v i ce s initiative, Healthcare Energy Leaders Ontar io (HELO), hop es the committee can finally assemble a clear pic ture of w hat Cana da’s national health ser vices sector’s energy use profile looks like. “Having a credible national energy use profile for Canada’s health sector, including the value of operating dollars assigned

to that profile, will put us in a much stronger position to talk about the overall environmental and financial impact of care delivery. It will also allow us to better make the argument to decision-makers that investing in energy efficiency will have significant benefits in terms of dollar savings and, more importantly, human health.”

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Deanna Fourt of the Vancouver Island Health Authority represents British Columbia. She says BC Health Authorities are pleased to participate in the National Energy Advisory Committee, adding, “We see it as a great opportunity to share best practices, advance innovation and collaborate on advancing the energy a g e n d a . T h ro u g h t h e Prov i n c i a l Environmental Technical Team, the BC Health Authorities and Provincial Government meet monthly to discuss the Carbon Neutral Agenda. We hope through our participation in NEAC we can have similar collaboration nationally." “I know that the decision-makers at Capital Health are always looking for ways to publicize their hard work on reducing the energy bills and I see this committee as an excellent way to start getting the good news out. I’m always interested in reading case studies and the results of initiatives in other regions,” claims new member Dave Bligh, an embedded efficiency specialist with Efficiency Nova Scotia. “Being connected with the people involved in many of these projects is invaluable.” For member Kate Butler sharing knowledge in an environment with like-minded objectives can only be a win/win for healthcare stakeholders across Canada. As the energy manager with FacilicorpNB, she is looking forward to sharing her knowledge on topics ranging from new energy efficient technologies to energy management tools and staff engagement initiatives as well as ways to collaborate to deliver higher performance health care facilities. FacilicorpNB, the New Brunswick Shared Services Agency, is supporting the Regional Health Authorities to develop and implement a cost-effective strategy for energy management. Butler says her membership in NEAC will be extremely valuable to discuss energy in a forum where the primary focus is energy efficiency, but notes the underlying goal is to maintain and potentially even increase patient care and comfort. “The National Energy Advisory Committee will be a forum for all health are facilities across Canada to share energy management challenges, success, initiatives, and learning. It will be instrumental as all the participants gain better understanding of

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the energy usage in health care facilities, benchmark, and set goals.” Coalition initiatives with a focus on sustainable energy management include: EcoAction GHG Emissions Reduction - In partnership with CHES and Synergie Santé Environnement (SSE), the Coalition has embarked on a three-year GHG and water reduction initiative across Canada with targeted outreach and education collateral, and training modules to incite organisations to adopt sustainable environmental practices. Climate Change Resiliency Toolkit With research and technical support from Health Canada, the Health Care Facility Climate Change Resiliency Toolkit helps organizations improve their ability to withstand the negative impacts of climate change. www. g r e e n h e a l t h c a r e . c a / climateresilienthealthcare/ Green Revolving Fund for Health Care Energy Efficiency - The Coalition recently launched a Green Revolving

Fund pilot project, to research and test a new funding model for energ y projects. Implementation is under development and the Coalition is actively looking for funding partners. www.g energy/greenrevolvingfund Healthcare Energy Leaders Ontario (HELO) - When fully operational, the HELO project team will provide free onsite assistance to facilities with activities such as energy assessments, developing business cases, applying for incentives, and helping implement a culture of conser vation. www. Achiev ing env ironmentallyresponsible health service delivery requires a collaborative approach, clearly articulated in the Joint Position Statement – toward an Environmentally Responsible Canadian Health Sector available at: images/pdf/jps.pdf To learn more about the National Energy Advisor y Committee visit

w w w. g re e n h e a l t h c a re . c a / n e a c o r c o n t a c t K e n t Wa d d i n g t o n , Communications Director for The Canadian Coalition for Green Health Care at or 613-756-0435. The Canadian Coalition for Green Health Care, Canada’s premier green health care resource network; a national voice and catalyst for environmental change. For over twelve years, the Coalition has been helping those working in health care f a c i l i t i e s, n o n - g o v e r n m e n t a l a n d governmental organizations, individuals, students and businesses to share green health care best practices and to become better equipped to deal with the growing demands placed upon them to be environmentally responsible health service workers and individuals. Together with our members, volunteers and supportive health care community, we strive to reduce health care’s ecological impact from compassionate care delivery while providing a nurturing platform upon which to discuss and promote best practices, innovation and environmental responsibility. www.greenhealth

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