HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
Volume 37 Issue 3
Kingston-area hospital's design, approach to care enhances quality of life for patients
Thinking Lean in Healthcare Sniffing Out a Deadly Superbug Improving Safety with Wearable Technology
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CANADIAN HEALTHCARE FACILITIES Volume 37
Stephanie Philbin email@example.com
EDITOR/RÉDACTRICE Clare Tattersall firstname.lastname@example.org PRESIDENT/PRÉSIDENT
Kevin Brown email@example.com
SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR
Annette Carlucci firstname.lastname@example.org
PRODUCTION MANAGER/ Maria Siassina DIRECTEUR DE email@example.com PRODUCTION CIRCULATION MANAGER/ Aashish Sharma DIRECTEUR DE LA firstname.lastname@example.org DIFFUSION
38 Weathering Climate Change Checklist helps hospitals prepare for unexpected
Editor’s Note President’s Message
10 Chapter Reports 14 Announcements
FEATURE SERIES 18 Innovation at the Water’s Edge Providence Care Hospital raises the bar for patient-centred care 24 Putting Patients First Lean methodology streamlines processes to improve delivery of services
CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY. SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.
CHES Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
MAINTENANCE & OPERATIONS
42 All Charged Up A sustainable approach to electrical maintenance
44 A Wise Investment Saskatoon hospital enjoys upgrade paybacks thanks to building operators’ input
VICE-PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR
Mitch Weimer Preston Kostura Peter Whiteman Craig. B Doerksen Sarah Thorn Donna Dennison
Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Roger Holliss Quebec: Michel Brisson Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Peter Jarvis British Columbia: Steve McEwan FOUNDING MEMBERS
28 A Dog’s Life Special spaniel tracks down superbug at Vancouver hospital
H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski CHES
4 Cataraqui St., Suite 310, Kingston, Ont. K7K 1Z7 Telephone: (613) 531-2661 Fax: (866) 303-0626 E-mail: email@example.com www.ches.org
30 Beyond the Badge Un pendentif pas comme les autres
Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530
South Health Campus | Calgary
Committed to service excellence and designing better performing buildings. Structural Engineering Building Science Parking Facility Design Structural Restoration rjc.ca 4 CANADIAN HEALTHCARE FACILITIES
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JOURNEY OF DISCOVERY THIS SUMMER, my little family of four is taking a road trip. Our first stop is Sandbanks Provincial Park in Prince Edward County, Ont., followed by a scenic drive along Loyalist Parkway to Kingston, which is home to one of the first hospitals in North America to fully integrate long-term mental health, complex care, palliative care and rehabilitation in the same building, with both inpatient and outpatient services. While we won’t drive directly by the newly opened hospital on our way to the nation’s capital, we’ll have a good view of it from the city’s largest urban waterfront park where we plan to picnic. I’m excited to see Providence Care Hospital, even if it’s just the exterior, after reading about the state-of-the-art healthcare facility in Innovation at the Water’s Edge. The story is one of four in this issue’s Feature Series section, which builds on the 2017 CHES National Conference theme, “Quality Healthcare by Design: Putting People First.” Other articles cover the use of lean 3P principles in the redevelopment planning of Victoria Hospital in Prince Albert, Sask.; the adoption of the world’s only superbug-sniffing dog at Vancouver General Hospital to detect infection; and the implementation of wearable technology at Southlake Regional Health Centre in Newmarket, Ont., to improve staff safety and provide a sense of security. From here we move on to Sustainable Healthcare, which continues to be a hot topic. In this section, we look at what healthcare facilities can do right now to increase their resilience to climate change. Despite naysayers, it is not going away so hospitals must adapt and be prepared for its impacts. Rounding out this issue is our focus on Maintenance & Operations matters. In All Charged Up, we look at a sustainable approach to electrical maintenance, while A Wise Investment delves into how critical facility upgrades at Royal University Hospital in Saskatoon, will ultimately be funded from utility savings. If you’re interested in contributing to the magazine or there’s a topic you’d like to see covered, please don’t hesitate to contact me. Clare Tattersall firstname.lastname@example.org
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.
6 CANADIAN HEALTHCARE FACILITIES
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.
TIME FLIES WHEN YOU’RE HAVING FUN IT SEEMS LIKE ONLY yesterday that I was preparing my very first message for the Journal as president of CHES National, and now I’m penning my last. With summer in full swing, it’s only a short time now until the 2017 CHES National Conference in September, when I will turn over the presidency to president-elect Preston Kostura. Having worked with Preston over the last several years, I know he will be a great leader and ambassador for CHES. At this time, we will also welcome a new secretary to the national board. It has been an honour and privilege to represent CHES over the past two years, during which time I’ve had the pleasure of working with a fantastic and dedicated group of individuals from across Canada. As I’ve travelled the country, CHES members from coast-to-coast have welcomed me with warm hospitality and enthusiasm. The organization continues to stay strong thanks to the energy and vibrancy of its chapters. Serving as president has been extremely rewarding. I would like to thank national and chapter board members, the national office, committee members and conference planning teams who have all worked so hard to make CHES what it is today. I would also like to thank CHES’s past president, Peter Whiteman, for his support over the past two years. CHES is now truly a coast-to-coast organization. In the past four years, we’ve seen the formation of two new chapters in Saskatchewan and Quebec, as well as the creation of the Canadian Certified Healthcare Facility Manager (CCHFM) program and the doubling of our webinar offerings. I know that CHES will remain steadfast as it works with its many partner organizations. On the international front, we continue to work closely with the International Federation of Hospital Engineering and American Society of Healthcare Engineering. In Canada, we are forging strong ties with the Canadian College of Health Leaders, Canadian Coalition for Green Health Care and CSA Group. We have recently begun to work more closely with several other organizations, including Infection Prevention and Control Canada, the Coalition for Healthcare Acquired Infection Reduction and International Association for Healthcare Security and Safety, among others. It is through these partnerships that CHES is able to bring multidisciplinary education and support to the complex issues we face in healthcare. It is a challenging yet exciting time for healthcare in Canada — changes and innovation abound. I am excited for the future of CHES and the role members will play in the development of a stronger healthcare system. We must continue to share information and learning as we work together to solve the issues of the day. I urge all members to consider taking part in the operations of CHES at either the local or national level. Mitch Weimer President, CHES National
EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Summer 2017 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to https://www.surveymonkey.com/r/C78C8DJ to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.
8 CANADIAN HEALTHCARE FACILITIES
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SASK ATCHEWAN CHAPTER
BRITISH COLUMBIA CHAPTER
The Saskatchewan chapter has undergone a great change with the recent resignation of chair and long-standing member, Al Krieger. Al worked tirelessly throughout the years to see the Health Facility Resource Council of Saskatchewan become a CHES chapter, which came to fruition in fall 2015. Al has been a great advocate for CHES, constantly promoting the value of participation and demonstrating its benefits. Al’s transition to a new career has left some big shoes to fill. He will most certainly be missed. Times are also changing for the province as Saskatchewan begins to transition to a single health authority. This certainly makes for an exciting and unnerving time for CHES members across the province. I firmly believe we can turn this into an opportunity for the organization, and CHES will continue to provide great value to the new Saskatchewan Health Authority and its industry partners. Amid the changes, the executive team continues to work toward putting on a great conference in Regina, Oct. 1-3. The challenge before us is by no means small but the chapter executive is committed to and excited about the event, so I’m certain it’ll be a success.
The B.C. chapter conference planning committee pulled off another successful event. Held May 28-30, at the Penticton Trade and Convention Centre, this year’s conference theme was “Transforming Healthcare’s Aging Infrastructure; Facility and Workforce.” President and CEO of the Interior Health Authority, Chris Mazurkewich, commenced the conference with his keynote address. The education program was one of the best yet with 12 tracks. The trade show sold-out in a record 11 days and we managed to sell out all the sponsorship categories. The education committee sponsored 23 delegates under the chapter’s grassroots program, which brought the total number of registrants to more than 400. The president’s banquet also soldout with 350 guests. During the banquet, the membership committee presented plaques to 23 members for their long-term dedication to the B.C. chapter. Entertainment was provided by Nearly Neil, featuring Neil Diamond tribute artist Bobby Bruce. This was a shift from our normal comedian but enjoyed by all, including CHES National president Mitch Weimer who kicked off the dancing. I’d like to acknowledge my companions on the 2017 conference planning committee for putting on a spectacular event: Norbert Fischer (conference chair), Wendy MacNicoll and Linda Williams (conference coordinators), Rick Molnar (education/ planning committee), Sarah Thorn, Mitch Weimer, Mark Swain, Ken Van Aalst and Arthur Buse. A special thanks to Wendy for all her hard work and dedication in coordinating our conferences over the years. She has been a key part of our conference success and has set the bar high. Wendy has stepped down as our conference coordinator, handing the role over to Linda. Next year’s conference will be in breathtaking Whistler, B.C. Planning is already well underway. Following this year’s conference, the chapter hosted the Canadian Healthcare Construction Course (CanHCC), which garnered 26 attendees. The education committee has been approved to fund the enrolment of chapter members in all 2017 CHES National webinars. In addition to the webinars, the education committee has already approved seven education grants this year.
—Jim Allen, Saskatchewan chapter chair
ONTARIO CHAPTER The chapter’s conference planning committee is in the final stage of preparing for the 2017 CHES National Conference. All major items have essentially been addressed as we transition to the registration portion of our committee activities over the summer months and into early September. We are excited about the conference program and look forward to seeing everyone at the Falls, Sept. 17-19. It still surprises me how fast time flies. Here we are again in an election year. The Ontario chapter is looking to fill the roles of vicechair, treasurer and secretary. The nomination deadline was July 4. The technical subcommittee on medical gas systems went through more than 200 public review comments earlier this spring at a twoday face-to-face meeting and have forwarded the output to the CSA technical committee for approval. All indications are the CSA will release the next edition of Z7396-12, Medical Gas Pipeline SystemsPart 1: Pipelines for Medical Gases, Medical Vacuum, Medical Support Gases and Anesthetic Gas Scavenging Systems, soon. I’d like to thank everyone who took the time to provide feedback. Informally, it was agreed that this was the most public review comments ever received on the medical gas standard and it made a difference. The Ontario Centres of Excellence’s (OCE) expression of interest for funding in support of technologies that will reduce/eliminate the release of greenhouse gases via anesthetic gases exhausting into the atmosphere has cleared the first of three approval hurdles. The second stage of approval, which includes the participation of 16 hospitals, was filed in May. Early unofficial feedback from the OCE is that it’s impressed with the chapter’s submission. Fingers crossed. —Roger Holliss, Ontario chapter chair 10 CANADIAN HEALTHCARE FACILITIES
—Steve McEwan, British Columbia chapter chair
s The Ontario chapter will host the 2017 CHES National Conference in Niagara Falls, Sept. 17-19.
NEWFOUNDLAND & LABRADOR CHAPTER
The Manitoba chapter is sponsoring a session again at the Manitoba Building Expo. This year’s event will take place Oct. 17, at the Victoria Inn Hotel and Convention Centre in Winnipeg. The focus of the sponsored presentation is the new Selkirk Regional Health Centre, which opened its doors to the public in June. The chapter is covering the cost of attendance to the session and trade show for all Manitoba CHES members. Registration information will be sent to all chapter members soon. The chapter is already working on next year’s education day. If you would like to submit a topic or have any suggestions, please contact a member of the executive team. The chapter executive is currently pursuing various educational opportunities and partnerships with other organizations, including the Winnipeg chapter of Construction Specifications Canada (CSC), the Winnipeg Construction Association (WCA) and the Manitoba chapter of the American Society of Heating, Refrigeration and AirConditioning Engineers (ASHRAE). 2018 is an election year. CHES members that are considering joining the chapter executive are encouraged to convey their interest as soon as possible. The chapter’s current vice-chair, Tom Still, will take over as chair at the CHES Manitoba 2018 Education Day. This leaves the role of vice-chair open, as well as the treasurer and secretary positions. There have been some changes to the chapter’s representation on CHES National committees, as follows: Reynold J. Peters, governance; Craig Doerksen, partnerships and advocacy; Coram Lalonde, professional development; James Kim, communications; Reynold J. Peters, membership; and Bill Algeo, healthcare standards.
The chapter is back in full force now that it has filled the long vacant positon of vice-chair and found a new treasurer. Carlson Way (Western Health) and Doug Kennedy (Amec Foster Wheeler Americas Ltd.) have assumed the roles, respectively, after a vote by the chapter membership. The chapter executive is excited about the new perspectives they will bring to the committee table. At the same time, the team is saddened to see long-time CHES member Bill Squires leave his seat as treasurer. Bill won’t be getting off the hook that easy as the chapter executive is counting on his support with planning the 2018 CHES National Conference in St. John’s, Nfld. Newfoundland and Labrador is facing tough financial times. Government strategies to improve the province’s fiscal situation have resulted in job losses, which has directly impacted the chapter with the loss of four members. At present, membership sits at 39. The chapter is pushing recruitment of vendors/suppliers, consultants and other healthcare dependents to improve membership enrolment. While the province is working to contain a deficit, the chapter is sitting in a solid financial position. The executive team is looking at investing in the professional development of chapter members by sponsoring conferences and/or educational reimbursements. This year’s professional development day was a resounding success. Not only was the new venue, lineup of vendors/presenters and sponsors, and presentations well-received but the education forum set a record for the largest attendance in the chapter’s history. I’d like to personally thank CHES National president Mitch Weimer for attending and surviving the unsavoury weather during his visit.
—Reynold J. Peters, Manitoba chapter chair
—Colin Marsh, Newfoundland & Labrador chapter chair
National Healthcare Facilities and Engineering Week October 15 - 21, 2017 Recognize yourself, your department and your staff during Healthcare Engineering Week. Make sure everybody knows the vital role played by CHES members in maintaining a safe, secure and functioning environment for your institution. Visit the CHES Website www.ches.org/resources/ for downloadable material to help you with plans to celebrate!
SUMMER/ÉTÉ 2017 11
The Alberta chapter held the 2017 Clarence White Conference & Trade Show in April. By all accounts it was a huge success with approximately 185 delegates in attendance and 60 vendor booths on display. The theme of the conference was “Succession Planning Legacy: What are you Leaving Behind?” The technical sessions were educational, informative and left the audience with many take-away items to consider. The presentation given by the facilities maintenance and engineering team at Northern Lights Regional Health Centre in Fort McMurray, Alta., was particularly moving. Team members shared their personal experiences during the 2016 wildfire that resulted in the emergency evacuation of not only the hospital but the city. This year’s conference was the first held in Alberta since the chapter hosted the 2015 CHES National Conference. I’d like to thank the vendors for their support and sponsorship, which made the event a great success. The chapter held its annual general meeting following the conference, which saw the election of a new chair (Peter Jarvis, Alberta Health Services north zone), treasurer (James Prince, Covenant Health) and secretary (Cora Husoy, Alberta Health Services north zone). Nominations are closed for the vice-chair position. The deadline to vote on the two candidates was July 7. The Alberta chapter recently awarded two prizes for a trip to the 2017 CHES National Conference in Niagara Falls, Ont. This is an amazing opportunity for members to experience CHES on a national level, network with other province attendees and see what the organization has to offer. Both winners have never attended a national conference before and are very excited to do so. We plan on offering this prize each year at the Clarence White Conference & Trade Show. With the release of CSA 317.13, Infection Control during Construction, Renovation and Maintenance of Health Care Facilities, it was time to provide an update to users of the standard. On June 6-7, Mike Hickey hosted sessions on the fundamentals of the standard and how to effectively implement it. The two-day course was offered again in late June. The chapter will host the Canadian Healthcare Construction Course (CanHCC) Oct. 17-18, at the Renaissance Edmonton Airport Hotel. It is an opportunity to learn about the unique challenges related to design and construction in the healthcare sector and how to overcome them. The two-day course covers a wide range of topics, from risk assessment and infection control to electrical and medical gas systems. Going forward, the chapter will seek to strengthen itself by increasing the number of executive meetings. This will allow the team to stay better connected since members are spread across the province. The executive also wants to build on its relationship with the professional development committee so that it can offer more educational opportunities to members, and is interested in exploring new member benefits and ways to further promote the chapter. Alberta chapter members who wish to share their ideas are encouraged to reach out to any member of the executive team.
The CHES Maritime 2017 Spring Conference & Trade Show was one of our most successful conferences to date. Held at the Delta Hotel in Halifax, May 14-16, the event kicked off with world-class motivational speaker Bill Carr who brought a lot of laughs and even a few tears. The theme, “Adjusting to Changing Times in Healthcare,” was well-received, as were the speakers and session topics, which included energy management, wrap recycling in operating rooms, sprinkler and fire alarm system inspections, waterborne pathogens and their impact on patient safety, healthcare security, containment testing of fume hoods and commissioning of healthcare facilities. After two outstanding days of seminars, a stellar trade show and a splendid night of socializing at Durty Nelly’s Irish pub, attendees left empowered and recharged to take on the challenges at their respective facilities. I’d like to congratulate Keith Fowler, who happens to be the New Brunswick vicechair. He won the grand prize trip for two to the 2017 CHES National Conference in Niagara Falls, Ont. I have the privilege of working with some great individuals on the chapter executive. Unfortunately, the team finds itself without a vice-chair and is actively looking to fill the role. Among other responsibilities, the vice-chair leads the planning of the chapter’s spring conferences. Next year’s conference will be held in Moncton, N.B. This year, the Per Paasche bursary recipient was Sabrina Goobie, a 17-year-old Grade 12 student at École L’Odyssée in Moncton. Sabrina will be continuing her education this fall at the Université de Moncton, studying civil engineering. Sabrina’s father, Bill Goobie, accepted the $1,000 grant on her behalf at the chapter’s spring conference. The bursary, renamed in 2014 in memory of Per Paasche who dedicated his career to the advancement of engineering and helped establish the Maritime chapter, is presented annually to a family member of a Maritime chapter member to assist with their post-secondary education. Planning has begun for this year’s fall education day. Amherst, N.S., seems to be an excellent central location for the event. The theme and potential speakers will be discussed at the executive team’s next meeting. The chapter is pleased to offer these types of learning opportunities to frontline staff members at hospitals and long-term care facilities in the region..
—Peter Jarvis, Alberta chapter chair 12 CANADIAN HEALTHCARE FACILITIES
—Helen Comeau, Maritime chapter chair
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CHES ADDS NEW CHAPTER IN LA BELLE PROVINCE
THE CANADIAN HEALTHCARE Engineering Society (CHES) is now a truly national organization with representation in every province. In March, the Society welcomed the Quebec chapter into the fold during a national board meeting, adding another 28 members to the more than 1,100 healthcare professionals, engineers and suppliers that support the esteemed association. “I couldn’t be happier,” says Pierre Prince, head of the chapter’s education committee who has staunchly promoted the formation of a local chapter for more than 10 years. In 2015, Prince came close to seeing this vision become a reality but the cause suffered a setback when the Quebec government passed a reform bill that saw an extensive reorganization of healthcare institutions in the province. “The reform put a damper on the formation of a local CHES chapter,” says Quebec chapter secretary Serge Laurence who has been a member of CHES since 2012, when he attended his first national conference in Montreal. But provincial politics couldn’t stop the momentum that a group of active CHES members, including Prince, Laurence, René Nadeau and André Lavallée (now head of the chapter’s membership committee), put into motion years prior. In 2016, Geneviève Houle (now chapter treasurer) and two members of the healthcare sector joined the team to fill the roles of chair (Michel Brisson, CIUSSS de l’Est de I’lle de Montreal) and vice-chair (Bassam Ajam, McGill University Health Centre), making the timing right to officially launch the chapter at the first annual CHES Quebec Dinner & Technical Session. Held May 30, at the École des Métiers de la Restauration et du Tourisme de Montreal, the event was by all accounts a success. Nearly 40 attended, including CHES National past president John J. Knott (simply known as J.J. to his peers) who was an honoured guest. The evening kicked off with a cocktail reception, providing an opportunity to network with fellow guests, followed by a sit-down dinner and hour-long education session on medical air quality requirements, presented by Busch Vacuum Technics’ operations manager, Nadeau. “Having a local technical session dedicated to (Quebec) healthcare facilities (provides) an outstanding chance to discuss actual needs, issues and solutions,” says Laurence. With this in mind, the chapter is already planning another event for this fall. Between now and then, the executive committee is focused on sending at least two chapter representatives to the upcoming CHES National Conference in Niagara Falls, Ont., to promote membership. The goal is to double the number of chapter members by June 2018. “It’s a matter of getting people to know what the organization can do for them,” explains Prince. “Having a local chapter allows members to access national knowledge. Sharing and understanding what other people are doing in other provinces makes things much easier for the people (of Quebec).” 14 CANADIAN HEALTHCARE FACILITIES
LA SOCIÉTÉ CANADIENNE d’ingénierie des services de santé (SCISS) est maintenant une organisation vraiment nationale, représentée dans toutes les provinces. En mars, la Société a accueilli la section québécoise au cours d’une réunion nationale du conseil, en ajoutant 28 membres supplémentaires aux quelque 1,100 professionnels, ingénieurs et fournisseurs qui soutiennent l’association. “Je ne pourrais pas être plus heureux,” déclare Pierre Prince, responsable du comité de formation qui a promu pendant plus de 10 ans la création d’une section locale. Sa vision a failli se réaliser en 2015, mais elle a subi un revers lorsque le gouvernement du Québec a considérablement réorganisé les établissements de santé de la province. “La réforme a retardé la formation d’une section locale,” a déclaré Serge Laurence, secrétaire de la section du Québec et membre de la SCISS depuis 2012, lors du premier congrès national de la Société à Montréal. Mais la politique provinciale n’a pas pu briser l’élan d’un groupe de membres actifs, dont Pierre Prince, Serge Laurence, René Nadeau et André Lavallée (maintenant chef du comité d’adhésion). En 2016, Geneviève Houle (maintenant trésorière de la section) et deux membres du secteur de la santé ont rejoint l’équipe pour remplir les rôles de président du conseil (Michel Brisson, CIUSSS de l’Est de l’île de Montréal) et vice-président du conseil (Bassam Ajam, Centre de santé universitaire McGill), ce qui a permis de lancer officiellement la section lors du premier souper annuel et session technique de SCISS Québec. Cet événement, tenu le 30 mai à l’École des métiers de la restauration et du tourisme de Montréal, a été un franc succès. Près de 40 personnes y ont assisté, y compris le président sortant du SCISS John J. Knott (surnommé J.J.) qui était un invité d’honneur. La soirée a commencé par un cocktail, suivi d’un souper et d’une séance de formation d’une heure sur les exigences médicales de qualité de l’air, présenté par René Nadeau, directeur de l’exploitation de Busch Vacuum Technics. “Avoir une session technique consacrée aux établissements de santé (québécois) (offre) une chance exceptionnelle de discuter des besoins, des problèmes et des solutions réels,” explique Serge Laurence. Dans cet esprit, la section prévoit déjà un autre événement pour cet automne. D’ici là, le comité exécutif se concentre sur l’envoi d’au moins deux représentants de la section au prochain congrès national de la SCISS à Niagara Falls, Ont., pour promouvoir l’adhésion. L’objectif est de doubler le nombre de membres de la section d’ici juin 2018. “Il s’agit de faire savoir aux gens ce que l’organisation peut faire pour eux,” explique Pierre Prince. “Une section locale permet aux membres d’accéder aux connaissances nationales. Comprendre ce qui se fait dans d’autres provinces rend les choses beaucoup plus faciles pour les gens (du Québec).”
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1:00 PM Final connections are made. Amico’s Medical Gas adapter* plugged into the newly retro-fitted back-body of the outlets, providing full likefor-like connections. Final electrical tie-ins are made.
9:00 AM In preparation for NuLook to be installed, the hospital opted to paint the existing walls and replace their laminate flooring. After that, the faceplates of the existing services were removed (e.g., medical gases, electrical, and fascia).
11:00 AM NuLook’s premanufactured frame was then hung. Once the frame was in place, medical gas hoses and electrical conduits were run from the existing services to their new locations on the frame. All medical gas lines and conduit with wiring are provided and pre-installed at the factory.
3:00 PM Thermofoil Laminate panels of the facility’s choosing were then attached to the NuLook frame, allowing for a near-seamless finish, which promotes infection control and maintainability. The headwall is now fully functional and ready for patients!
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INNOVATION AT THE WATER’S EDGE Providence Care Hospital raises the bar for patient-centred care By Brynna Leslie
verlooking Lake Ontario, the newly opened 270-bed Providence Care Hospital was designed with input from patients, families and frontline staff, resulting in a healthcare facility that feels less like an institution and more like home. The amount of natural light that streams into the hospital is one of the first things patients and visitors will notice when they walk through the building. At every level, off each 30-bedroom inpatient unit, there is 5,000 square feet of accessible outdoor space with terraces, gardens and views of the great 18 CANADIAN HEALTHCARE FACILITIES
lake. As architect Cameron Shantz explains, this is a reflection of a building that was designed to bring the outside in. “Hospitals tend to be big, deep buildings,” says Shantz, principal architect at Parkin Architects Ltd. “We made some very specific moves in this building to make sure there was natural light in all elements.” Much of the early design process focused on integrating the hospital into its natural surroundings, he explains. The goal was to offer a bright and vibrant atmosphere that both maximizes healing and rehabilitation
and also invites families, visitors and the community into the building as an extension of the city’s largest urban waterfront park, Lake Ontario Park. “It’s important for patients and clients to feel a connection to the community and to the outdoors, and to feel the natural landscape that they’re in,” says Shantz. “We really believe it’s important to their healing journey. There is a lot of seminal research that demonstrates the impact of views to the natural environment and how that can help in recovery.”
The best views have been reserved for patients and their family and friends. Many inpatient rooms overlook the lake or surrounding historic buildings, visible whether an individual is in bed or mobile. Each 10-bedroom corridor has access to a windowed sunroom as well as a screened porch. There are nine 5,000-square-foot terraces, equipped with barbecues, tables and gardens extending off patient dining rooms. Shantz explains that outdoor terraces have also been optimized for the distinct patient populations they serve. “For the mental health areas, we have incorporated more active type spaces, such as basketball courts,” says Shantz. “For those in complex care and rehabilitation, the outdoor terrace doubles as an extended therapy centre. Clinicians can take them outside and help them navigate different types of surfaces — smooth or rough ground on which they can circulate — and there are handrails.” By opening up the building to the natural landscape, there is a sense that patients and the community are more fully integrated, something that is at the heart of Providence Care’s philosophy, explains Shantz. “Providence Care has a mentality of ensuring that rehabilitation is at the forefront of everything it does for its patients in the interest, as much as possible, of getting patients out of the hospital and back into the community,” he says.
To that end, there is a single main entrance. Staff, volunteers, inpatients and those coming for outpatient appointments will purposely enter the building through one door.
“Whether you’re coming for a mood disorder clinic, a seniors mental health clinic or a rehabilitation medicine clinic, you’re going to one waiting room,” says Wells Pearce. “We’re not segregating people based on diagnosis.”
BREAKING DOWN BARRIERS
Providence Care Hospital is one of the first hospitals in North America to fully integrate long-term mental health, complex care, palliative care and rehabilitation in the same building, with both inpatient and outpatient services. “That was the driver of the entire planning process of this facility,” says Krista Wells Pearce, vice-president of planning and support services at Providence Care. “We very intentionally intermingled the patient populations to ensure everybody had the ability to access all amenities of the building.” SUMMER/ÉTÉ 2017 19
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Providence Care volunteer Beryl Dodd believes having a hospital that puts mental and physical rehabilitation on par with one another will put Kingston, Ont., on the map as a leader in healthcare innovation. “Everybody that’s here is working toward getting well or having the best quality of life possible,” says Dodd. “It’s very good for all patients to interact with one another, to be around one another. Sometimes there’s such a stigma around mental health but now everyone will be together and be able to see they’re all here to get well.” Wells Pearce acknowledges that the varying needs of patient populations required some critical thinking on the part of those planning the facility. Chief among those concerns was providing an environment that was accessible for all patients but also safe for everyone. The forensic mental health unit, for example, is purposely located at ground level to allow for secure patient transport, when required. The unit is also adjacent to indoor recreational facilities. “We’ve worked with the engineers to develop what we call a flexible security perimeter, which allows the secure perimeter of the forensic unit to be maintained while still allowing access to the pool and gym at designated times,” says Wells Pearce. In the rehabilitation units, staff safety has also been prioritized. Providence Care received support from the province to install mechanical lift tracks, which go directly from bed to the ensuite toilet and showers. “Your classic ceiling lift installation is over the bed and gets patients from the bed to a stretcher or from the bed to a wheelchair, but then the staff have to get them to the next room and do it again,” explains Wells Pearce. “Having a lift that goes from bedside to the bathroom reduces the risk of doing two transfers. It reduces the fall risk for patients and decreases the likelihood of staff back injuries, which is a cost avoidance measure.” FROM THE GROUND UP
There are several innovations at Providence Care Hospital that distinguish it from other Canadian healthcare facilities. Integrated bedside terminals, for example, will act as a central control system, letting patients operate window blinds and temperature, while at the same time giving online access. They have the potential for bedside charting and on-screen education, too. Inset monitors outside each patient bedroom can offer critical information to staff and visitors or be a unique electronic bulletin board for patients, themselves. As the architect, Shantz is modest about taking full credit for the interior design of the building. He is resolute in emphasizing that the drawings Parkin Architects put to blueprint represent the remarkable vision of Providence Care’s frontline staff. “Very rapidly in this process we started meeting with each one of the user groups, which is the part we enjoyed most and is a unique and fantastic part of this project,” says Shantz. “Providence Care has very committed staff who really have their patients and clients’ best interests at heart, and have offered such creative and practical input into the designs of the building.” For nearly two years, 11 employees have been seconded from frontline positions, including nurses, therapists and other clinicians. As ‘subject matter experts,’ their role has been to liaise between their teams, management and the designers. “It allows the staff to have a voice, their concerns heard and their ideas put forward,” says Andrea Almas, a physiotherapist and subject matter expert for community care. “We are the ones in contact with patients and clients the most.”
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The subject matter experts advocated for on-unit therapy rooms, for example, which increases interaction between nurses and other clinical staff. It also has the potential to give patients extended access to treadmills and other exercise equipment outside of scheduled therapy hours. Supply cupboards outside each inpatient room — another frontline innovation — means less waste, reduced chance of cross-contamination and the elimination of carts cluttering hallways. Extra wide doors to the terraces means palliative patients and their families have access to the outdoors. Even something as simple as window vents that will allow patients to have fresh air circulate in their bedrooms was central to many planning meetings, says Wells Pearce. “We had long conversations with the clinical team about whether the windows needed to be operable or not,” she explains. “Most said they’d rather maximize the view. But it was the forensic mental health team that was really vocal about having vents — not just to have the feeling of fresh air coming into your room but to smell the grass being cut, to hear kids playing and birds singing. Hearing children playing is healing in itself. For most people, when you’re at home, you can open the windows. The team made a strong argument that it was in the best interest of our patients and clients to have this full sensory access to nature as part of their healing.” Wells Pearce believes one of the exciting features is the design of the main lobby. The open concept design, with double-storey windows and a cafeteria patio that seamlessly blends into the adjacent parkland, purposefully welcomes residents and visitors to Kingston into the hospital. “This facility is our community’s facility; our municipality and residents donated funds, and our tax dollars were invested in the building,” explains Wells Pearce. “We’ve got this great space next to a fantastic park that has a lot of traffic now. The cafeteria patio, healing garden and staff memorial garden will no longer be separated from the park by a chain link fence.” “We want the public to come in and have their coffee after their morning walk,” she continues. “We want them to use our main cafeteria and shops, sit on the patio or rent the gymnasium and therapy pool. Providence Care Hospital belongs to all of us.” Brynna Leslie is an Ottawa-based communications advisor.
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PUTTING PATIENTS FIRST Lean methodology streamlines processes to improve delivery of services By Paul Blaser
n 2012, the Saskatchewan government adopted the lean methodology for the transformation and management of healthcare in the province. Lean focuses on the pursuit of value and elimination of waste, resulting in a healthcare system that puts patients first. Opportunities to make significant changes arise when planning and designing additions, renovations or new construction for healthcare facilities. This is particularly true when considering the design of an entire hospital. Lean uses a 3P approach — production, preparation, process — for this scale of systematic transformation of process. These principles were utilized in the redevelopment planning of Prince Albert’s Victoria Hospital, a regional 24 CANADIAN HEALTHCARE FACILITIES
hospital that serves a population of more than 140,000 in the city and northern Saskatchewan. Victoria Hospital conducted five 3P planning events over 16 months between April 2014 and September 2015, to lay out in detail the new patient process and related facility design for each department, and then combine the designs into a comprehensive hospital organized around the patient journey. Each cycle involved assembling a team of providers to represent the entire staff of the hospital. Typically, a 3P team consists of approximately 60 members and includes doctors, administrators, hospital executives, nurses, technicians, support staff and recent or current patients and their families.
AN EVENT LIKE NO OTHER
The lean 3P process starts with focused data collection. Each 3P event requires two full weeks to complete this task. The team, using lean tools, follows and documents the flow of patients and staff in real-time. The first week of data collection involves training team members to follow and time patients and staff through their path of care. The goal is to understand the flow of treatment and design the facility to optimize this flow. Data is collected to reveal current and future demand for the region, and the individual services in highest demand. The second week of data collection focuses on assembling this data for application to design. All data is formatted to optimize the event week.
s Three-dimensional models are built of cardboard, lumber and other basic supplies inside a warehouse to allow the 3P teams to walk through their design to discover flaws well in advance of detailed architectural and engineering work.
The 3P event week is a hands-on process that starts with establishing the key goals of the design. The team creates hundreds of design concepts, which are presented, voted on and optimized, with all the best concepts integrated. The final two designs are divided among sub-teams of this group. These two teams, using two-dimensional layouts, further improve the designs. The twodimensional designs drive the 3-D tabletop models. The first tabletop models are created, two per team, in one-quarter inch scale, then presented and voted on. Models are built with basic supplies that include sheet plastic for the walls and clay figures for staff, and hobby-type supplies that allow the team to create such things as computers, beds and carts. The teams then vote on the best design and create a one-inch scale, 3-D tabletop model. While half the team creates this model, the other half builds full-scale sections of the model to test the design theory. Examination or treatment rooms and high-traffic common areas are commonly part of the full-scale model. These models, built of cardboard, lumber and other basic supplies inside a warehouse, allow the teams to walk through their design to discover flaws well in advance of detailed architectural and engineering work. Teams run simulations to establish that the spaces and their common and critical functions perform as they should. The purpose is to ensure seamless flow of value for patients and that staff have all the supplies, medications, equipment and information at hand to eliminate waste in the patient care process. 26 CANADIAN HEALTHCARE FACILITIES
At the end of the event week, the architect carefully photographs and documents the final design proposal, and then completes the schematic design for the building interior according to this design. After a 30-day review, the design is presented ‘as designed’ in the event week and the architect raises any issues the team must address in regards to adjustments required by code. The team also reviews the flow of patients, staff and materials, among other things, and makes any fine adjustments to the design. THE LEAN 3P ADVANTAGE
Use of the 3P process in the design of the new intensive care unit (ICU) at Victoria Hospital is a good example of how lean principles can transform care. During data collection at the existing ICU, it was discovered the average length of stay was unexpectedly low at just over two days. Upon investigation and use of a Pareto chart, the ICU team found most patients were discharged to other locations in the hospital from the ICU. Surprisingly, the second highest number of patients were discharged home. This raised the question: What are the admitting diagnosis to the ICU? It was originally thought that sepsis was the primary reason for admission to the ICU, since those are the patients who demand the most care. But, contrary to expectations, acute coronary syndrome was the primary reason for admission. People were coming to the emergency department complaining of chest pain. After the completion of several tests, many were told they weren’t having a heart attack. However, best practice dictated the tests needed to be
redone after 20 hours. Until then, telemetry observation was required. The only place in Victoria Hospital with telemetry is the ICU — the most expensive and stressful place in the hospital with the least privacy. Armed with this information, a threemonth chart review was conducted to determine the number of ICU patients that did not require ICU care if stepdown observation beds with telemetry were available. The result: Up to 50 per cent of ICU patients did not need ICU care. The design of the new facility developed in the 3P took this into account, laying out a smaller ICU with fewer beds and adding a small step-down unit. LEAN 3P HELPS GET IT RIGHT
The opportunities for improvement in lean transformation and lean 3P are not limited to new facilities. The need for a step-down unit with telemetry observation is being incorporated into the existing Victoria Hospital before the redevelopment project is undertaken. As well, Kanban supply management, interdisciplinary rounding and emergency department fast-track are among the many processes being implemented to improve patient flow and eliminate waste in the existing facility. Staff have adopted the culture of continuous improvement and are more aware of their patients and the value that is provided. Paul Blaser is the principal architect at LEAN Integrated, a consulting firm focused on continuous improvement for patientcentred healthcare. He can be reached at firstname.lastname@example.org.
A DOG’S LIFE Special spaniel tracks down superbug at Vancouver hospital
ogs aren’t generally welcome in healthcare facilities but staff at a B.C. hospital have opened their arms to man’s best friend. Two springer spaniels have been “hired” as on-site detectives, tasked with sniffing out C. difficile at Vancouver General Hospital (VGH).
28 CANADIAN HEALTHCARE FACILITIES
C. difficile is the most frequent cause of infectious diarrhea in healthcare facilities. The dangerous bacterium commonly attacks people whose immune systems have been weakened by antibiotics. Three-year-old Angus was the first K-9 to join Vancouver Coastal Health’s (VCH)
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infection fighting team in 2015. His superbug-sniffing partner, Dodger, is presently being trained in the hospital setting. Here, VCH’s Carrie Stefanson discusses how Angus helps the Vancouver hospital save lives and why VGH decided to bring the precocious canine on board. How is Angus able to detect C. difficile?
Angus is trained to detect the odour of C. difficile. What does it smell like? Only Angus knows! When Angus detects the scent, he will sit. If this occurs, the area undergoes an extensive cleaning that may include an ultraviolet (UV) light disinfectant machine. VGH has three such machines, known as R-D (Rapid Disinfector). Clinical research has shown that the machine removes more than 99.9 per cent of C. difficile spores. How often is Angus deployed to sniff out the bacterium?
Angus works full-time at VGH, which falls within the authority of VCH. He is part of a K-9 infection prevention team that includes clinicians, housekeeping staff and a second dog, Dodger. What’s a “typical” day for Angus?
A report is generated twice daily on all infections in the hospital. Angus’s handler, Teresa Zurberg, runs that report and responds accordingly. She looks at which rooms are under infection control and if C. difficile is suspected, Angus will enter. Angus does not go into rooms when patients are present but he will check the surrounding area to determine what might be contaminated nearby. Angus also does routine patrols around the hospital, focusing on areas that are known to be higher risk for C. difficile. For example, through Angus’s superior scent-tracking abilities, VGH has noticed a correlation between clutter and C. difficile. Old chairs and discarded pieces of medical equipment can be magnets for infections. By reducing clutter, VGH could potentially lower its rates of C. difficile.
Why did VGH decide to add a superbugsniffing dog to its infection fighting team?
Teresa is a nationally recognized K-9 handler who acquired C. difficile about three years ago. Her illness gave her husband Markus Zurberg, a quality and patient safety coordinator for VCH, the idea to approach the health authority about training a dog to detect C. difficile. VGH’s infection control team embraced the novel idea and in 2014, a pilot project was launched to determine if a dog could detect the superbug. Over the next two years, Angus received his VCH ID (2015), enabling him and Teresa to begin training in the hospital setting; and passed the required testing for working dogs (2016) to become “certified” to detect C. difficile. Late last year, Angus and Teresa began working at VGH. How successful has Angus been in detecting C. difficile?
VCH’s C. difficile infection (CDI) rate decreased significantly in 2016/2017. The year-to-date rate (to end of period 8) is 4.4, which is statistically significantly lower than the rate of 7.0 last year. The VGH rate is 4.08, with 76 cases of CDI for period 8. While it’s too soon to say if Angus is the reason the rates have dropped, the decrease coincides with his working at VGH. What are the benefits of having Angus in the hospital?
Besides being able to find C. difficile in areas of the hospital that would otherwise go unnoticed to the naked eye, Angus is a very friendly dog. He is soft, with floppy ears, and not in the least intimidating. Although Angus does not go into patient rooms when occupied, a larger, more aggressive-looking dog might frighten people when passing them in common areas. This is not the case with Angus. He is well-received by staff and patients alike. Teresa is constantly being stopped and asked about him, which allows for in the moment teaching. Another great feature about Angus is that he doesn’t discriminate. He doesn’t care if an area hasn’t been thoroughly cleaned and who might be responsible. He just does his job without bias or judgment.
Convince your CEO to join social media By Steven Chester If your company’s leader is still resisting social media, they’re unfortunately not alone. But as businesses evolve and attempt to attract younger employees and clients, the results of a recent Ryerson University survey should be enlightening. The survey found that 53 per cent of the country’s top CEOs are on at least one social media platform, and only 16 per cent are using more than one. Despite the many benefits, fear remains a major factor. Stories of misuse and blunders abound daily; however a desire to remain positive can go a long way. Not surprisingly the bar to entry is quite low. According to the report: • While 45 per cent of CEOs surveyed have a LinkedIn account, only 50 per cent have a profile picture, and only 33 per cent have a biography. • Only seven per cent of Canadian CEOs in the top 100 have Twitter accounts. On average, CEOs followed just 65 users – showing a high level of disengagement with the outside world. • Seventeen per cent of CEOs studied have Facebook accounts. Nine of those accounts were publicly viewable, with 78 per cent of posts being personal in nature and only two per cent promoting their business. Active CEOs were sharing several different types of content on social media, including thought leadership, philanthropy, mentorship and governance – a great game plan to play it safe and still promote your company in a positive light. It’s time for business leaders to swim with the tide. Steven Chester is the Digital Media Director of MediaEdge Communications. With 15 years’ experience in cross-platform communications, Steven helps companies expand their reach through social media and other digital initiatives. To contact him directly, email email@example.com.
30 CANADIAN HEALTHCARE FACILITIES
BEYOND THE BADGE Un pendentif pas comme les autres By/Par Marcelino Moniz & John Grajcar
ollowing an incident of workplace violence in its emergency department, Southlake Regional Health Centre began a quality improvement journey to infuse a culture of safety throughout the organization. The first step on this voyage involved setting up a corporate workplace violence prevention committee in summer 2013, to engage a range of stakeholders. The committee was charged with developing more effective tools and training to keep staff safe at the Newmarket, Ont., hospital, and continually seeking better ways to provide a safe environment for all those who walk through the healthcare facility’s doors. Made up of representatives from interprofessional clinical teams, the joint occupational health and safety committee, unions and the hospital’s senior leadership, the committee determined the education and training staff needed to improve safety throughout the organization, and developed a solution to make it easier for staff to request assistance and initiate a code white, should a violent situation arise. A code white is triggered when there is threat of violence, with the goal of bringing assistance to the affected person as quickly as possible. Accordingly, the solution needed to be readily accessible to all staff, anywhere in the hospital, and be able to immediately transmit the location of the person initiating the request, ideally without having to say a word. A wearable staff assist pendant was developed that leverages the hospital’s existing real-time locating system (RTLS). In partnership with Versus Technology, Southlake had implemented a RTLS system in 2012, to more readily locate assets, such as wheelchairs, pumps and monitors, throughout the hospital. This same system is the enabling technology that provides peace of mind to more than 2,000 staff at Southlake, while providing care to hundreds of thousands of patients each year.
la suite d’un incident de violence survenu au service des urgences, le Centre de santé régional Southlake a entrepris des démarches afin de promouvoir la culture de la sécurité dans l’organisation. La première étape a consisté à former en 2013 un comité de prévention de la violence au travail, auquel ont pris part différents intervenants. Ce comité fut chargé de développer des formations et outils renforçant la sécurité du personnel de l’hôpital de Newmarket en Ontario, et de chercher continuellement à faire de cet établissement un environnement sécuritaire pour tout un chacun. Constitué de représentants d’équipes cliniques interprofessionnelles, du comité de santé et de sécurité au travail, de différents syndicats et de la haute direction de l’hôpital, le comité a cerné les besoins de formation du personnel et a conçu une solution afin que les employés puissent plus facilement demander de l’assistance et signaler un code blanc. Un code blanc est déclenché lorsqu’il y a menace de violence pour qu’on vienne en aide à la personne le plus rapidement possible. Par conséquent, la solution devait être accessible à tous les employés, partout dans l’hôpital; idéalement, l’emplacement de la personne concernée devait être transmis sur-le-champ sans qu’elle ait à parler. Un pendentif tirant parti du système de localisation en temps réel (SLTR) existant a donc été conçu. Le Centre Southlake, en partenariat avec Versus Technology, avait intégré un SLTR en 2012 pour repérer plus facilement ses biens dans l’hôpital — par exemple, les fauteuils roulants, les pompes et les moniteurs. C’est cette même technologie qui offre désormais la paix d’esprit à plus de 2000 employés, tout en facilitant les services offerts chaque année à des centaines de milliers de patients. Le SLTR utilise à la fois l’infrarouge et les radiofréquences. Des dispositifs installés sur les équipements émettent des SUMMER/ÉTÉ 2017 31
FEATURE SERIES The RTLS tool utilizes both an infrared and radiofrequency identification sensory system. For assets and equipment moving throughout the facility, the tagged pieces emit infrared signals every three seconds and a signal every two minutes when at rest. By applying this same technology to the staff assist pendant, a person’s location can be pinpointed at the push of a button, giving staff a way to initiate a code white when they feel threatened, without having to say a word, let alone find a phone. Depressing the button on the pendant for just one second sends a message to the hospital’s telecommunications department and security showing the last location of the pendant and the person wearing it, or the last sensor passed. This allows for swift response to a code white. Not only is security immediately en route but telecommunications staff will announce an accurate location through the intercom system, prompting a response from the code white team. Implementation of the staff assist pendent was swift; however, there were unanticipated difficulties following its initial rollout in August 2013. Taking a tool that was used to locate assets and equipment and transforming it into one that allowed staff to request rapid assistance at the press of a button wasn’t as easy as it looked at the outset. One of the biggest challenges was the cultural shift. Ensuring staff always had their pendants in the correct position took some time. Pendants need to be worn at chest height and cannot be obstructed by clothing. If the pendant is obstructed, it can block the infrared and radiofrequency sensors, making it untraceable. While the tool was successful in helping to locate and track staff, with an average 20-second response rate to a code white, the early versions had design flaws that lead to the buttons being inadvertently pushed, resulting in false alarms. Southlake and Versus Technology worked together to redesign the pendant to reduce the number of times the buttons were unintentionally pushed. The pendent has evolved in subtle ways over five iterations. The button on the pendant went from being a convex button to a concave button with a ring around it to protect it from being hit when leaning over or bumping into objects. The pendant was also reprogramed to require the button be held for one second to signal a code white, so accidentally bumping the button didn’t trigger a response. Throughout the improvements, the overall number of inadvertent pushes decreased from a monthly average of 5.4 per cent for the first four versions of the pendant, to 0.3 per cent for version 5. The pendant has become a tool for not only increasing safety but providing staff with a greater sense of security. Through the collaborative efforts of stakeholders across the organization, and by leveraging a common tracking tool used in healthcare facilities, Southlake was able to rapidly implement the staff assist pendant without the time and expense of rolling out a new enterprise-wide system. Marcelino Moniz is director of facility operations and patient access at Southlake Regional Health Centre, and John Grajcar is manager of support services. Marcelino has close to 30 years’ experience in facilities management, the last 13 of which have been spent in healthcare. John has 17 years of hospital experience in various roles, including central communications, patient registration and project management.
32 CANADIAN HEALTHCARE FACILITIES
signaux infrarouges toutes les trois secondes lorsqu’ils sont en mouvement et toutes les deux minutes lorsqu’ils sont immobiles. En intégrant cette technologie aux pendentifs, on permet aux employés de faire connaître leur emplacement exact et de signaler un code blanc s’ils se sentent menacés. Ils n’ont pas besoin de dire quoi que ce soit, et encore moins de chercher un téléphone. Il suffit d’appuyer une seconde sur le bouton pour envoyer un message à la sécurité et au département des télécommunications. Le message précise le nom de l’employé et l’emplacement du pendentif ou du dernier détecteur rencontré. La sécurité se met immédiatement en route, et l’équipe des télécommunications annonce l’emplacement exact à l’interphone afin que l’équipe d’intervention en cas de code blanc puisse s’activer. Cette initiative a été rapidement mise en œuvre, mais des difficultés ont fait surface à l’arrivée des pendentifs en août 2013. Prendre un gadget qui sert à localiser des équipements et en faire un outil qui permet au personnel de solliciter une assistance immédiate ne fut pas aussi simple qu’on l’eut cru. L’un des grands défis a eu trait au changement culturel. Il a fallu du temps pour que les employés aient toujours leur pendentif dans la bonne position. Ces dispositifs doivent être portés à la hauteur du thorax et ils ne peuvent être gênés par des vêtements, sans quoi l’émission des infrarouges et radiofréquences risque d’être entravée. Si l’outil s’est avéré très efficace pour aider et localiser les employés — avec un temps de réponse moyen de 20 secondes — , ses premières versions comportaient quelques lacunes conceptuelles. Le bouton était activé par inadvertance et de fausses alarmes étaient déclenchées. Le Centre Southlake et Versus Technology ont donc revu la conception du pendentif afin de réduire la fréquence des alarmes involontaires. Le dispositif a évolué progressivement et a connu cinq versions. Le bouton convexe a été remplacé par un bouton concave orné d’un anneau le protégeant et l’empêchant d’être actionné par un employé qui heurte un objet ou se penche sur un comptoir. Les pendentifs ont aussi été reprogrammés afin qu’il faille maintenir le bouton enfoncé une seconde pour signaler un code blanc; un simple accrochage n’envoie donc pas de signal. Grâce à ces améliorations, les alertes involontaires sont passées d’une moyenne mensuelle de 5.4% pour les quatre premières versions, à 0.3% pour la cinquième. En plus d’accroître la sécurité de tout un chacun, le pendentif rassure le personnel. Grâce à des efforts communs de la part de différents intervenants, et en tirant parti d’un outil de localisation répandu dans le milieu, le Centre Southlake a pu rapidement distribuer les pendentifs, sans avoir à subir les dépenses et délais typiquement associés à la mise en place d’un nouveau système à la grandeur d’une organisation. Marcelino Moniz est directeur de l’établissement et de l’accès des patients du Centre de santé régional Southlake, et John Grajcar y est gestionnaire des services de soutien. Marcelino cumule près de 30 années d’expérience dans la gestion des installations, dont les 13 dernières furent dans le domaine de la santé. John a quant à lui 17 ans d’expérience en milieu hospitalier; il y a travaillé dans divers domaines, y compris les communications centralisées, l’inscription des patients et la gestion de projets.
• 37 th Annual Conference of the Canadian Healthcare Engineering Society •
Quality Healthcare by Design: Putting People First
NATIONAL CONFERENCE CONGRÈS NATIONAL
SEPTEMBER 17-19 SEPTEMBRE SCOTIABANK CONVENTION CENTRE | NIAGARA FALLS
p o n S o r S KEYNOTE DIAMOND
Water Treatment Solutions
Reliance Worldwide Corporation (Canada) Inc.
BRONZE Abatement Technologies
SUNDAY SUNDAY SEPTEMBER SEPTEMBER 17,17, 2017 2017
2. Teach 2. Teach the core the core toolstools usedused in LEAN in LEAN Construction Construction
1. Demonstrate 1. Demonstrate in detail in detail how how LEANLEAN ensures ensures Patient-First Patient-First Planning Planning for Healthcare for Healthcare Projects Projects – Even – Even for for department department renovations renovations
09:00-16:00 09:00-16:00The The Great Great CHES CHES GolfGolf Game Game 10:00-15:00 10:00-15:00Companion Companion Program Program – Sponsored – Sponsored by IEM by IEM
3. Identify 3. Identify how how LEANLEAN Planning Planning can be canintegrated be integrated with with LEANLEAN Construction Construction Delivery Delivery to ensure to ensure a Patienta PatientFirstFirst Focus Focus at every at every StepStep to meet to meet everyevery expectation expectation
18:30-22:00 18:30-22:00Opening Opening Reception Reception – Sponsored – Sponsored by Class by Class 1 Inc.1 Inc. Reception Reception Entertainment Entertainment - The - The RoyzRoyz BandBand – Sponsored – Sponsored by Eaton by Eaton Queen Queen Victoria Victoria PlacePlace Restaurant, Restaurant, Niagara Niagara FallsFalls
4. Describe 4. Describe the process the process and results and results achieved achieved for a for Dialysis a Dialysis Unit Unit renovation renovation at Battleford at Battleford Union Union Hospital Hospital in North in North Battleford, Battleford, SK SK
MONDAY MONDAY SEPTEMBER SEPTEMBER 18,18, 2017 2017 07:00-16:00 07:00-16:00Companion Companion Program Program – Sponsored – Sponsored by IEM by IEM 08:30-16:00 08:30-16:00Student Student Program Program – Sponsored – Sponsored by H.H. by H.H. Angus Angus 07:00-08:30 07:00-08:30Breakfast Breakfast – Sponsored – Sponsored by Thomson by Thomson Power Power Systems Systems 08:30-08:45 08:30-08:45Opening Opening Ceremonies Ceremonies 08:45-09:30 08:45-09:30KEYNOTE KEYNOTE ADDRESS ADDRESS - Sponsored - Sponsored by Honeywell by Honeywell Dr. Danielle Dr. Danielle Martin Martin Acclaimed Acclaimed Physician Physician and Health and Health CareCare Expert Expert
12:00-14:00 12:00-14:00Lunch Lunch in Exhibit in Exhibit HallHall - Sponsored - Sponsored by Klenzoid by Klenzoid Canada Canada Inc. Inc. 14:00-15:00 14:00-15:00PLENARY PLENARY SESSION SESSION – TRACK – TRACK 3 3 TrackTrack 3: 3:
Understanding Understanding Indoor Indoor Air Quality Air Quality (IAQ) (IAQ) and and the Great the Great Benefits Benefits to Patients to Patients and and the Healthcare the Healthcare Industry Industry Dr. Stephanie Dr. Stephanie Taylor, Taylor, CEOCEO and Founder, and Founder, TaylorTaylor Healthcare Healthcare Consulting, Consulting, Inc, Stowe Inc, Stowe VT VT
Engineers Engineers put much put much thought thought and and workwork into into designing designing and and managing managing building building HVAC HVAC systems systems with with the the goalsgoals of preserving of preserving building building materials, materials, conserving conserving energy energy and keeping and keeping occupants occupants comfortable. comfortable. The primary The primary function function of most of most buildings, buildings, however, however, should should be tobeprotect to protect the health the health and safety and safety of people. of people. Paradoxically, Paradoxically, the intersection the intersection of Indoor of Indoor Air Quality Air Quality (IAQ)(IAQ) and occupant and occupant health health or disease or disease is one is of onetheof the leastleast understood understood subjects subjects in theinfield the field of public of public health! health! This This is notis from not from intentional intentional neglect neglect of engineers, of engineers, but from but from lack lack of medical of medical research research on IAQ on and IAQ health. and health.
Dr. Danielle Dr. Danielle Martin Martin seessees the cracks the cracks and challenges and challenges in our in health our health care care system system everyevery day. day. A family A family doctor doctor Two Two significant significant trends trends are occurring are occurring in this in century: this century: people people spend spend moremore and more and more time time indoors, indoors, and the and the and national and national media media commentator commentator on the onhealth the health issues issues that hit thatclosest hit closest to home to home for Canadians, for Canadians, Dr. Martin Dr. Martin incidence incidence of chronic of chronic disease disease is higher is higher than than ever ever before. before. Are these Are these two factors two factors related? related? If so,If how so, how can can speaks speaks with with passion passion on our on national our national healthcare healthcare system, system, defending defending and defining and defining the ways the ways we can we make can make it it indoor indoor air management air management support support occupant occupant health health and not andpromote not promote chronic chronic illnesses? illnesses? eveneven moremore worthy worthy of ourof immense our immense national national pride.pride. Objectives: Objectives: She She debated debated the merits the merits of theof Canadian the Canadian vs. American vs. American health health systems systems in a in U.S. a U.S. Senate Senate Subcommittee Subcommittee 1. Understand 1. Understand the current the current Indoor Indoor Air Quality Air Quality environment environment hearing hearing in Washington, in Washington, with with Senator Senator Richard Richard Burr Burr and Bernie and Bernie Sanders. Sanders. The video The video of herof testimony her testimony wentwent 2. Present 2. Present New New Research Research findings findings on the on relationship the relationship between between indoor indoor air management air management and and patient patient viral viral and has and since has since achieved achieved over over 1.3 million 1.3 million views. views. infections infections in hospitals. in hospitals. Microbiome Microbiome StudyStudy will be willpresented be presented with with new new data.data. (in press (in press 2016)2016) Currently, Currently, Dr. Martin Dr. Martin practices practices in theinFamily the Family Practice Practice Health Health Centre Centre at Women’s at Women’s College College Hospital, Hospital, wherewhere 3. Review 3. Review existing existing studies studies on IAQ on and IAQ occupant and occupant health health she isshe also is also the Vice-President the Vice-President of Medical of Medical Affairs Affairs and Health and Health System System Solutions. Solutions. 4. Review solutions solutions to improve to improve IAQ and IAQ maximize and maximize Patient Patient outcomes outcomes in Healthcare in Healthcare facilities. facilities. In 2006, In 2006, her first her first year year of practice, of practice, Dr. Martin Dr. Martin helped helped launch launch Canadian Canadian Doctors Doctors for Medicare, for Medicare, whichwhich 4. Review represents represents Canadian Canadian physicians physicians who who believe believe in a high in a high quality, quality, equitable, equitable, and sustainable and sustainable health health system, system, 15:00-16:00 15:00-16:00PLENARY PLENARY SESSION SESSION – TRACK – TRACK 4 4 and and chaired chaired its board its board untiluntil 2013.2013. She She wentwent on toonhelp to help foundfound the WCH the WCH Institute Institute for Health for Health System System TrackTrack 4: 4: Engineering Engineering Infection Infection Reduction Reduction at Vancouver at Vancouver General General Hospital Hospital Solutions Solutions and Virtual and Virtual CareCare – a hub – a of hubinnovation of innovation dedicated dedicated to solving to solving the health the health gapsgaps in ourin system. our system. Dr. Elizabeth Dr. Elizabeth Bryce, Bryce, Regional Regional Medical Medical Director, Director, IPAC,IPAC, Vancouver Vancouver Coastal Coastal Health, Health, In 2015, In 2015, Dr. Martin Dr. Martin was was named named Canada’s Canada’s eighth eighth mostmost powerful powerful doctor doctor by The by The Medical Medical Post,Post, and and in in Vancouver, Vancouver, BC BC 20132013 she was she was named named one of oneThe of Toronto The Toronto Star’sStar’s top “13 top People “13 People to Watch”. to Watch”. In theInmedia the media she is shea regular is a regular This This presentation presentation will describe will describe the results the results of a of pilot a pilot project project that that followed followed the microbiome the microbiome of patients of patients contributor contributor to CBC to CBC TV’s TV’s The National, The National, and writes and writes a monthly a monthly column column for Chatelaine for Chatelaine magazine. magazine. Her book, Her book, undergoing undergoing bone bone marrow marrow transplantation, transplantation, their their healthcare healthcare workers workers and their and their environment. environment. Patients Patients werewere BetterBetter Now:Now: Six Big Six Ideas Big Ideas to Improve to Improve Health Health CareCare for All forCanadians, All Canadians, was published was published in early in early 2017.2017. randomized randomized to receive to receive care care in a regular in a regular isolation isolation roomroom or a or room a room that had that been had been re-engineered re-engineered with with self-self09:30-10:30 09:30-10:30PLENARY PLENARY SESSION SESSION - TRACK - TRACK 1 1 disinfecting disinfecting material material on high-touch on high-touch surfaces surfaces and with and with ultraviolet ultraviolet C light C light in theinbathroom. the bathroom. TrackTrack 1: 1: Youth, Youth, Engineering, Engineering, and and Innovation Innovation Objectives: Objectives: Raymond Raymond Wang, Wang, YouthYouth Innovator, Innovator, Entrepreneur Entrepreneur & Non-Profit & Non-Profit Leader Leader 1. To 1. discuss To discuss basicbasic principles principles of engineering of engineering for infection for infection reduction reduction and summarize and summarize key studies key studies to date to date Raymond Raymond WangWang is a isYouth a Youth Innovator Innovator who who is passionate is passionate aboutabout science, science, technology, technology, engineering engineering and and on self-disinfecting on self-disinfecting surfaces surfaces entrepreneurship. entrepreneurship. He isHe one is of oneCanada’s of Canada’s Top 20 TopUnder 20 Under 20, and 20, most and most recently, recently, the recipient the recipient of theofGordon the Gordon 2. To 2. describe To describe the results the results fromfrom the first the phase first phase of theofpilot the pilot project project and the andpracticalities the practicalities of operationalizing of operationalizing E. Moore E. Moore awardaward for the forTop the Project Top Project at theat2015 the 2015 Intel Intel International International Science Science and Engineering and Engineering Fair Fair (ISEF). (ISEF). this type this type of study of study His His internationally-acclaimed internationally-acclaimed research research in engineering in engineering mechanics, mechanics, renewable renewable energy, energy, biomechanics, biomechanics, 3. identify To identify existing existing gapsgaps in ourinknowledge our knowledge regarding regarding self-disinfecting self-disinfecting surfaces surfaces and potential and potential waysways of of environmental environmental management management and and computer computer science science havehave mademade him him a go-to a go-to commentator commentator on youth on youth 3. To further further clarifying clarifying theirtheir role in rolehealthcare in healthcare innovation. innovation. 16:00-17:00 16:00-17:00“Happy “Happy Hour” Hour” in Exhibit in Exhibit HallHall - Sponsored - Sponsored by Trane by Trane 10:30-11:00 10:30-11:00Refreshment Refreshment Break Break in the in Exhibit the Exhibit HallHall – Sponsored – Sponsored by AAF by AAF Flanders Flanders 10:30-14:00 10:30-14:00Exhibit Exhibit HallHall Open Open 11:00-12:00 11:00-12:002 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 2A -&2A 2B& 2B
18:00-19:00 18:00-19:00President’s President’s Reception Reception - Sponsored - Sponsored by Tremco by Tremco Ballroom Ballroom CD, Scotiabank CD, Scotiabank Convention Convention Centre Centre Reception Reception Entertainment Entertainment – Randy – Randy Stirtzinger Stirtzinger – Sponsored – Sponsored by Forest by Forest Contractors Contractors
TrackTrack 2A: 2A: Contamination Contamination of Sinks of Sinks and and Drains Drains withwith Gram-Negative Gram-Negative Bacteria: Bacteria: A Call A Call for for 19:00-23:00 19:00-23:00GalaGala Banquet Banquet - Sponsored - Sponsored by Johnson by Johnson Controls Controls Solutions Solutions Banquet Banquet Entertainment Entertainment – The – The Birdtown Birdtown BandBand - Sponsored - Sponsored by Chem by Chem AquaAqua Heather Heather Candon, Candon, Infection Infection Control Control Manager, Manager, Mackenzie Mackenzie Health, Health, Richmond Richmond Hill ON Hill ON Ballroom Ballroom CD, Scotiabank CD, Scotiabank Convention Convention Centre Centre Natasha Natasha Sait,Sait, Director Director of IPAC, of IPAC, Sunnybrook Sunnybrook Health Health Sciences Sciences Centre, Centre, Toronto Toronto ON ON Lorraine Lorraine Maze, Maze, Infection Infection Control Control Practitioner, Practitioner, Mount Mount SinaiSinai Hospital, Hospital, Toronto Toronto ON ON Growing Growing evidence evidence that that hospital hospital sinkssinks and and drains drains may may be reservoirs be reservoirs for gram-negative for gram-negative bacteria, bacteria, whichwhich can be cantransmitted be transmitted to patients, to patients, has led hastoleda number to a number of interventions of interventions aimed aimed at addressing at addressing this challenge. this challenge. During During this panel this panel discussion discussion you will you hear will hear fromfrom Infection Infection Control Control professionals professionals fromfrom acuteacute care care facilities facilities in theinGreater the Greater Toronto Toronto AreaArea aboutabout solutions solutions that have that have beenbeen put input place in place to protect to protect patients. patients. Topics Topics covered covered will include: will include: how how sink sink and drain and drain design design affects affects contamination contamination rates,rates, remediation remediation techniques techniques onceonce a drain a drain is contaminated, is contaminated, preventative preventative maintenance maintenance of plumbing of plumbing and and novelnovel patient patient care care ideasideas to combat to combat this this issue.issue. The objective The objective of theofpresentation the presentation is to isincrease to increase knowledge knowledge of theofrisk the to riskpatients to patients posed posed by hospital by hospital plumbing plumbing contaminated contaminated by gram-negative by gram-negative bacteria bacteria in order in order to stimulate to stimulate thought/discussion thought/discussion around around solutions solutions that can that be canincorporated be incorporated into design into design to prevent to prevent contamination contamination of sinks. of sinks.
TUESDAY TUESDAY SEPTEMBER SEPTEMBER 19,19, 2017 2017 07:00-08:30 07:00-08:30 Breakfast Breakfast – Sponsored – Sponsored by Stantec by Stantec 08:30-09:30 08:30-09:30 2 PLENARY 2 PLENARY SESSION SESSION – TRACK – TRACK 5 5 TRACK TRACK 5: 5: Keeping Keeping the Patient the Patient in Patient in Patient Safety Safety Bernie Bernie Weinstein, Weinstein, Patient Patient Advocate Advocate at theatJewish the Jewish General General Hospital, Hospital, Montreal Montreal QC QC Patients Patients for Patient for Patient Safety Safety Canada Canada is a patient-led is a patient-led program program of CPSI. of CPSI. TheyThey are the are voice the voice of theof patient the patient (intended (intended to include to include patients, patients, clients, clients, residents, residents, customers, customers, and family and family members) members) and bring and bring theirtheir safetysafety experiences experiences to help to help improve improve patient patient safetysafety at allatlevels all levels in theinhealth the health system. system.
Patients Patients for Patient for Patient Safety Safety Canada Canada members’ members’ unique unique and and valuable valuable perspective perspective complements complements thosethose of of care care providers, providers, health health leaders, leaders, policy-makers, policy-makers, and and managers managers of healthcare of healthcare organizations. organizations. By working By working in partnership, in partnership, they they can help can help ensure ensure that patient that patient safetysafety decisions decisions and initiatives and initiatives are truly are truly patient-centred patient-centred JodyJody Hettinger, Hettinger, Manager Manager of Construction of Construction and Security, and Security, Prairie Prairie NorthNorth Regional Regional Health Health and result and result in safe in safe care.care. Authority, Authority, Battleford Battleford SK SK Patients Patients for Patient for Patient Safety Safety Canada Canada member, member, Mr. Bernie Mr. Bernie Weinstein, Weinstein, will speak will speak to theto CHES the CHES membership membership FayeFaye Wood, Wood, Regional Regional Property Property Management, Management, Prairie Prairie NorthNorth Regional Regional Health Health Authority, Authority, aboutabout his family’s his family’s personal personal experience experience with with patient patient safetysafety in theinCanadian the Canadian health health care care system. system. He will He also will also Lloydminster, Lloydminster, SK SK speakspeak aboutabout his work his work as a Patient as a Patient Advocate Advocate at theatJewish the Jewish General General Hospital Hospital and as anda member as a member of Patients of Patients for for Patients Patients are the are most the most important important in Healthcare. in Healthcare. All value All value and and wastewaste is determined is determined by them. by them. LEANLEAN in in Patient Patient Safety Safety Canada. Canada. Mr. Weinstein Mr. Weinstein will drive will drive homehome the important the important role patients/family role patients/family members members can play can play Healthcare Healthcare is a is well a well established established process process for improving for improving flow,flow, eliminating eliminating waste, waste, and and increasing increasing Value. Value. whenwhen they they actively actively contribute contribute to patient to patient safetysafety improvement improvement initiatives initiatives fromfrom the beginning. the beginning. SinceSince 2012,2012, Saskatchewan Saskatchewan has used has used LEANLEAN for Planning for Planning Healthcare. Healthcare. The next The next step step has been has been to introduce to introduce 09:30-10:15CHES CHES National National Annual Annual General General Meeting Meeting LEANLEAN for Construction for Construction to Healthcare to Healthcare Projects. Projects. We will We show will show how how LEANLEAN Planning Planning can lead can lead to LEAN to LEAN 09:30-10:15 TrackTrack 2B: 2B: LEAN LEAN - Patient - Patient FirstFirst fromfrom Planning Planning to Construction to Construction
PaulPaul Blaser, Blaser, Principal Principal Architect, Architect, LEANLEAN Integrated, Integrated, Saskatoon Saskatoon SK SK
Construction, Construction, and keep and keep Patient-First Patient-First CareCare at theatcore the core fromfrom Planning Planning to Delivery. to Delivery.
10:15-10:45 10:15-10:45Refreshment Refreshment Break Break in the in Exhibit the Exhibit HallHall – Sponsored – Sponsored by Daikin by Daikin Applied Applied
CHES ON Chapter AGM
Exhibit Hall Open
standard for selected design elements, such as single patient rooms, and recommend enhancements for continuous improvement of the standard.
Lunch in the Exhibit Hall - Sponsored by Thermogenics
2 CONCURRENT TRACKS - 6A & 6B
Supporting Infection Control: Progress in a Tertiary Care Hospital Craig Doerksen, Divisional Director, Facility Management, Health Sciences Centre Winnipeg, Winnipeg MB
Today’s hospital facility manager has what appears to be hundreds of priorities, codes and standards to follow and ultimately solutions and approaches to address infection control issues. What are the priorities? And how do I engage with infection control? What are the codes and standards that I have to or should follow? And how do I keep up with them and train my staff? What are the solutions and approaches available in the industry? And how do I evaluate, choose and fund them? And to all of this – what is the real outcome? This presentation will take you on a whirlwind journey (not over the Falls) where we have jointly worked with and alongside our infection control team to navigate with some good (and celebrated) success. Objectives:
Southlake’s Story: Using RTLS to Put Patients & Staff First Moniz Marcelino, Director, Facility Operations & Patient Access, Southlake Regional Health Centre, Newmarket ON John Grajar, Manager, Support Services, Southlake Regional Health Centre, Newmarket ON
Utilizing the capabilities of the existing enhanced Real Time Locating System (RTLS) already in use for tracking assets, Southlake Regional Health Centre was able to swiftly implement a Staff Assist Solution and offer added protection to all hospital staff without the additional costs and lag time associated with a new enterprise-wide implementation. Objectives: 1. Learn from techniques and communication tools used by an organization to enhance the safety of employees and gain corporate buy-in 2. Identify opportunities to expand the use of technologies already in-house to address other corporate needs 3. Develop policies, procedures and tools to gauge success and areas of improvement in safety, efficiency, technology and corporate attitude
1. Understand how various infection control strategies employed by facility managers should be assessed.
Refreshment Break – Sponsored by HTS
2. Identify the many options and approaches to supporting infection control
2 CONCURRENT TRACKS - 8A & 8B
3. Prioritize along with infection control which strategies should be employed.
Preventing Hospital-Acquired Infections through Evidence-Based Design: Humber River Hospital Experience – Sponsored by Abatement Technologies
4. Evaluation methods TRACK 6B:
CSA Z317.14 - A New Standard for Wayfinding in Health Care Facilities Robin Snell, Principal, Parkin Architects Limited, Toronto ON Wayne McCutcheon, Partner, Entro Communications Inc, Toronto ON
CSA developed a new standard to develop and maintain wayfinding and signage systems for Health Care Facilities (HCF). The CSA Z317.14 standard is a practical guide to understand and implement wayfinding and signage systems for the HCF user’s journey to their HCF destination(s) and back again. Aligned with the conference theme “Quality Healthcare by Design: Putting People First”, the presentation will focus on the tools HCF managers and designers need to implement the Z317.14 standard. Objectives: 1. Assess the new CSA standard for Wayfinding in Health Care Facilities and its relevance for facility planners, managers and designers; 2. Describe wayfinding and signage as a system ‘from macro to micro’, from place of origin to a specific destination and back again; 3. Identify the key elements and tools in a wayfinding and signage system; 4. Discover emerging technologies for wayfinding and signage including GPS, smart phone apps, touchscreen kiosks and user specific navigation
Nataly Farshait, Director of IPAC, Humber River Hospital, Toronto ON Healthcare providers function in an environment of enormous responsibilities and constant multi-tasking. Both infrastructure and design play a vital role in supporting healthcare workers in providing the safest and the most efficient care to patients. Moreover, hospital design is an essential aspect of the healthcare preparedness to the challenges of new and emerging infectious diseases, as well as higher public expectations and awareness of healthcare-related risks. The new Humber River Hospital was built to make compliance with infection prevention and control easy by default. The principals of evidence-based design were imbedded into every aspect of the building including 80% of single-bed rooms; ventilation system with a sophisticated monitoring features; acuityadoptable rooms with dedicated equipment; room sign monitors; 82 negative pressure rooms; storage areas designed to accommodate clean and soiled flow of the mobile equipment; pneumatic disposal system; automated guided vehicles (AGVs); and dedicated hand hygiene sinks. There is a clear evidence that use of technology and a well-designed physical space plays an essential role in making our hospital safer for patients, visitors, and employees. Future research is needed to correlate clinical outcomes, specifically related to hospital-acquired infections, with the individual role of the multifactorial design interventions. TRACK 8B:
Global Health Trends: Applying Global Engineering Trends for Canadian Hospitals
2 CONCURRENT TRACKS - 7A & 7B
CSA Z8000 – Is It Making a Difference?
Kevin Cassidy, B.Eng, P.Eng, Director- National Healthcare Lead, MMM/WSP Canada, Toronto ON
Mike Keen, P.Eng., MBA, Senior Director, Planning & Development, St. Michael’s Hospital, Toronto ON
Nolan Rome, PE, LEED AP, Senior Vice President, CCRD/WSP Parsons Brinckerhoff, Dallas TX
Helene Vaillancourt, P.Eng., Ph.D, Executive Vice President, Standards Research and Planning, CSA Group, Montreal QC Extensive literature exists regarding various infection prevention and control measures intended to reduce healthcare associated infections (HAIs). CSA Z8000 standard on health care facilities has been developed by experts and was published in 2011. It provides guidance on how to best design health care facilities to make them efficient, accessible, safe, sustainable and minimize health care acquired infections. The focus of the research project is to examine various design elements found in CSA Z8000 as they relate to infection prevention and control. We now have a number of new and renovated hospitals that have implemented the measures found in CSA Z8000 and many of these facilities have volunteered to share data. The results of the analysis of this data will identify trends and confirm the effectiveness of the
Using case studies from recent international and domestic health care projects, Kevin and Nolan will look at design trends that put the patient and staff at the centre of the design process and how these international trends can be applied in Canadian Hospitals, realizing efficiencies, operational savings and enhanced clinical outcomes. Objectives: 1. Learn about technologies employed globally to mock up renovation spaces and test room layouts; 2. Utilize post occupancy evaluations to identify improvements to efficiency; 3. Identify areas where data acquisition can be employed to increase operational efficiencies 16:45-17:00
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Participating companies are listed below. Easi File Eaton ECNG Energy L.P. Energy In-hybrid Solutions Inc Follett LLC Franke Kindred Canada Inc. Garland Canada Inc. Genesis Integration Health Association Nova Scotia Hill-Rom Canada Honeywell Limited HTS Engineering Inc. IEM Industrial Electrical Mfg. (Canada) Inc. Johnson Controls Klenzoid Canada Inc. Lellyett & Rogers Co. Levitt-Safety LMCT/ISAVE Team Marathon Institutional Products Canada Masco Canada Ltd.
McGregor Allsop Limited Medical Gas Innovations MIP Inc. Miura Canada Company Ltd. Mondo USA NABCO Canada Inc. Paladin Security Systems Ltd. Pinchin Ltd. Pinnacle Group Inc. Pipe Shield Enterprises Inc. PMG Systems Ltd. Precise Parklink Inc. Rauland-Borg Canada Reliance Worldwide Corporation (Canada) Inc. Rockfon Salto Systems Inc. Sansys Inc. Schneider Electric Siemens Canada Specified Technologies, Inc. Swisslog Healthcare Solutions
Delegate Sponsorship by Union Gas Delegate Transportation Sponsored by Precise Parklink Conference App/Final Program Sponsored by Medical Gas Innovations Mobile Recharge Station Sponsored by Schneider Electric Canada Green Park Sponsored by D.H. Jutzi Limited Lanyards Sponsored by WSP Official Time Sponsored by Primex Wireless Grassroots Program Sponsored by Reliance Worldwide Corporation (Canada) Inc.
Thermal Energy International Thermal Insulation Association of Canada (TIAC) Thermogenics Inc. Thomson Power Systems Time Trackers Total Power Tower Tech Cooling Towers Longhill Energy Trane Tremco Roofing and Building Maintenance Tri-Phase Group Union Gas Universal Power Solutions Victaulic Company of Canada Ltd. Viega LLC WESCO Distribution Canada LP Windspec Inc. Yorkland Controls Limited
CONSULTING | ENGINEERING | DESIGN
Bringing the Science of Buildings into Focus.
The Future of Roof Design. Planning for Progress.
We Believe in Transparency from Concept to Completion.
Bringing Continuity to Building Design from Frame to Façade.
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SUMMER/ÉTÉ 2017 37 15-02-26 11:24 AM
WEATHERING CLIMATE CHANGE Checklist helps hospitals prepare for unexpected By Kent Waddington
38 CANADIAN HEALTHCARE FACILITIES
hen people think about the effects of climate change, they tend to picture large, catastrophic events like tornadoes, ice storms, hurricanes and earthquakes. These are, of course, the real and present dangers of living on a warming planet. But the effects of climate change can also quietly and insidiously creep up, seriously impacting healthcare facilities, even in developed nations like Canada. August 2016 marked the sixteenth consecutive month that a global heat record had been shattered. Nine years prior, Regina General Hospital and Pasqua Hospital in Saskatchewan had to cancel surgeries during an oppressive heat wave in July 2007, because intense humidity made it difficult
for healthcare workers to operate and it increased the risk of infection. A rise in temperature can also be blamed for the slow but steady spread of Lyme disease carried by the blacklegged tick. In the early ‘90s, there was only one known risk area in Ontario, Long Point Provincial Park, according to Public Health Ontario. Now, although the probability is low, it’s possible to encounter an infected tick almost anywhere in the province because the conditions are favourable for their survival and spread. The fact is healthcare facilities across the country are facing adversity due to climate change-related events, including boil water advisories, extreme heat and humidity, flooding, ice storms, wildfires, winter storms and hurricanes. Extreme weather can, and
does, damage infrastructure and physical plant operations, compromise access to supplies, food and water, and endanger the safety of patients, visitors and staff. The grim reality is the effects of Canada’s rate of warming, which is about twice the global rate of 2 C, will persist for centuries because greenhouse gasses are long-lived and oceans are heating up. The good news is there are measures healthcare facilities can take to increase their resiliency in the face of climate change so they can continue delivering the kind of compassionate care patients deserve and demand. To help healthcare organizations prepare for the coming challenges, the Canadian Coalition for Green Health Care has developed a 78-point online checklist
NEW PATHWAY TO RESILIENCE The Canadian Coalition for Green Health Care, in collaboration with the University Health Network (UHN), has launched the country’s first-ever climate change resiliency mentoring program. The ultimate goal is to provide healthcare facilities from coast-to-coast with the necessary tools, resources and guidance so that they can effectively evaluate and increase their resiliency to climate change impacts. The initiative also serves to reduce the negative impacts hospitals have on the environment, while increasing infrastructure resiliency and abilities to cope with increases in health risks. Through facilitated discussions and expert advice, program participants will be much better prepared to undertake facility assessment and resiliency actions, which will help them become critical players in responding to extreme weather events instead of being victims. Undertaken with funding support from the Ontario Trillium Foundation, participation in the mentoring program is free; however, space is limited. The Coalition’s first collaborative learning group session began in April. The second session will take place this fall. Program benefits received by participating organizations are valued at approximately $15,000. If interested in being a member of the fall cohort, contact Kent Waddington at email@example.com. For more information on the program, go to http://greenhealthcare.ca/ climate-change/mentoring. SUMMER/ÉTÉ 2017 39
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designed to assess readiness for the impact of climate change. The goal is to examine all areas within a facility to determine the level of resiliency and opportunities for improvement. Facilities can also use the checklist to learn about what other organizations are doing to become better prepared, track progress over time and benchmark this progress against other organizations as the facility’s climate change resiliency improves. After going through the checklist process, Interlake-Eastern Regional Health Authority in Manitoba determined it was on the right track from an emergency preparedness perspective; however, the checklist brought forward the idea of climate change resiliency in a way that hadn’t been considered before. The health authority now integrates climate change resiliency into the planning of response documents and procedures. In fact, it has developed a new adverse weather plan that is included in all disaster management manuals. St. Martha’s Regional Hospital in Atlantic Canada is another organization that made use of the checklist. As with many hospitals, budget is an issue when it comes to climate change initiatives; however, as a result of St. Martha’s efforts to better embrace environmental stewardship and climate change, the healthcare facility has been able to develop a better working relationship with food service, planted a garden to grow fresh herbs in the dietary department and engaged laundry services to reduce water consumption. While a climate-resilient facility is critical in order to ensure the health and well-being of staff and patients, it can also positively impact an organization’s bottom line. For instance, a healthcare facility that chooses to use local and sustainable food foregoes paying for produce to travel thousands of miles to reach the facility and can rely on those same local farmers to support it during a food shortage. Improving infrastructure by upgrading to more energyefficient lighting means the saved energy and money can be used to improve the environment of care for both staff and patients. And cutting back or eliminating the use of toxic cleaning chemicals by, for example, using copper on high-touch areas can reduce staff sick days. Kent Waddington is a freelance environmental coach and communicator, co-founder and communications director for the Canadian Coalition for Green Health Care, and a member of the committee responsible for planning the "Bon Appétit: Sustainable Food in the Health Care Environment" session at HealthAchieve 2017.
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ALL CHARGED UP A sustainable approach to electrical maintenance By Roger Grylls
n effective electrical maintenance program ensures power systems and their components perform predictably and safely. Keeping detailed records, documenting equipment history and continuously evaluating performance is key to program success. However, an effective and sustainable maintenance program seeks to find an ideal balance between the effort spent on maintenance and the value it provides when looking to maximize the overall investment in power system equipment. Proper management of electrical assets optimizes performance and safety of an electrical system while minimizing the cost of ownership over its useful life. With this in mind, there are a number of big picture considerations to take into account prior to executing routine maintenance that will help realize the best possible return on investment to maintain systems of equipment. Canadian legislation defines the requirements for the installation of electrical equipment and requires owners of electrical systems to identify hazards involved when operating and working on or around electrical equipment. The 42 CANADIAN HEALTHCARE FACILITIES
Canadian Electrical Code (in conjunction with regional building codes) governs installation practices, while guidance around the identification of hazards and selection of appropriate personal protective equipment (PPE) can be found most commonly as part of industry standards and best practices. CSAâ€™s Z462 standard, Workplace Electrical Safety, is essentially a toolkit of work practices, definitions, equipment requirements, equations, look-up tables and sample forms. It was developed by a technical committee specifically to address shock and arc flash hazards related to electrical equipment in the workplace. It has become an invaluable tool for owners and operators of electrical systems for the development or enhancement of electrical safety programs. Shock and arc flash are the primary hazards related to an electrical installation. Effectively evaluating a system will reveal opportunities to mitigate hazards through engineering controls, procedures and selection of PPE. However, it is important to note these analysis and mitigation strategies are entirely dependent on the installed
equipment operating exactly as designed. If protective devices are not set as designed or interrupting devices do not operate within their expected operating times, incident energy may increase as a result. This is why properly maintaining and routinely evaluating equipment is key to reliably predicting risks related to electrical installations. According to CSA Z462, sites shall have procedures and practices in place to manage the integrity of electrical equipment. The standard also recommends referring to CSA Z463 for guidance related to electrical maintenance strategies. CSA Z463, Guidelines on Maintenance of Electrical Systems, provides preferred practices and strategies for maintenance of electrical equipment. Similar to CSA Z462, this guideline was developed by a technical committee and can be used as a practical tool to enhance quality management systems and safety programs to provide practical guidance and specific examples for the development of electrical maintenance programs. The act of maintenance itself involves two separate concepts: mechanically maintaining equipment (visually inspecting, cleaning and lubricating components); and performance testing electrical components and systems (measuring key indicators such as contact resistance, insulation resistance, capacitance, wear markings and response times). These two concepts should be applied in unison, as one is not a substitute for the other. However, how much testing, mechanical maintenance and inspection is required is dependent on many factors. Some considerations may include system criticality, age, environment, history, availability of downtime and budgets. Applying efforts optimally and selecting the most suitable maintenance strategies will return the best value. Although most common in industry, timebased shutdown maintenance is not the only strategy available. There are numerous
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alternatives that can be employed as part of an overall maintenance program, including continuous online equipment monitoring, running equipment to failure (then replacing it) and strategic hybrids of the two. A strategy’s effectiveness is primarily related to the predictability of events to which a system is required to respond. In every case, best programs of maintenance subscribe to the idea of continuous equipment performance evaluation and history assessment; these are the two key drivers of maintenance program evolution. At the core is the fundamental idea that a program of maintenance is not a static platform, set out at the beginning of the service life of a system of equipment. Rather, it is dynamic. A maintenance program should undergo continuous improvement based on performance input, observation, re-evaluation of operational needs and analysis of event history throughout the system’s life cycle. All equipment or systems of equipment eventually reach an end of practical service life. This happens as equipment wears out, breaks down or becomes unserviceable or obsolete. Ensuring all key components of a power system are being evaluated and maintained creates the best opportunity to plan for these inevitabilities. Strategic replacements and upgrades, at a component level, will help to maximize the service life of a system of equipment and may prolong or avoid the need for significant system replacements, as long as practical. Good visibility of equipment condition, proper hazard identification and risk control provides valuable input to the operational staff required to interact with electrical equipment. Constraints such as process limitations, budgets or delivery of replacement parts may all factor into decisions to delay repair or equipment replacement. Mitigating hazards that may arise between maintenance cycles or allowing for equipment with known functional deficiencies to remain in service until appropriate time and/or resources are available can be feasible if appropriate controls are implemented to reduce risk to an acceptable level. Proper records of the operational condition of the equipment also allows easier transfer of system knowledge to new maintenance and operational staff, or contractors that may be required to interact with a facility’s electrical system. Training
employees on the appropriate standards, operational procedures, as well as identification and communication of the current state of electrical equipment are all necessary functions of an effective maintenance program. Regulatory compliance, safety and reliability are all interrelated concepts that need to be considered together as part of a well-structured maintenance program. Good maintenance practices and strategic upgrades can extend the life of equipment, improve performance and safety, and prolong equipment replacement as long as practical. An effective maintenance program will yield the best equipment life and provides the best value for that investment. Knowing equipment will reach end of life in
two, five or 10 years allows for proper budgeting and affords the time to get the most competitive replacements in a nonurgent time frame. Best performing and sustainable maintenance programs are dynamic, constantly improving and utilize the best practices in industry to achieve maximum value. Getting informed and having the desire to improve performance, safety and reliability are the first steps toward maintenance success. Roger Grylls is vice-president of Magna IV Engineering. Roger has more than 19 years’ experience working with high voltage power systems. He leads a working group on electrical maintenance with the CSA Z463 technical committee.
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LEGISLATION / LAWS / CODES
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PROGRAM OF MAINTENANCE
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SUMMER/ÉTÉ 2017 43
MAINTENANCE & OPERATIONS
A WISE INVESTMENT Saskatoon hospital enjoys upgrade paybacks thanks to building operators’ input By Rebecca Melnyk
ocated on the University of Saskatchewan campus in Saskatoon, Royal University Hospital (RUH) is a seven-wing, seven-storey facility that raised the standard of medical treatment in the province when it was built in 1955. Over the years, aging infrastructure and outdated, energy-wasting fixtures needed to be improved, not only for the health and well-being of patients and staff but also to help mitigate the building’s environmental footprint. After completing significant hospital upgrades last year through an energy performance contract (EPC) with Johnson Controls, the 1.6 million-square-foot hospital is now seeing a huge payback, almost doubling the expected savings from energy, water and operational improvements. RUH invested $13.6 million to ultimately save $1.4 million per year. In the first two reporting quarters, the total savings is already tallied at $899,192, surpassing the target guarantee by 48.2 per cent or $433,304. Two team members from Johnson Controls, Randy Taylor, account executive of building efficiency, Western Canada, and Vincent Russell, strategic 44 CANADIAN HEALTHCARE FACILITIES
market accounts manager, Saskatchewan, along with other contractors, engineers and consultants, used energy analysis and on-site survey information to compile a list of measures to improve energy consumption at the facility, which is now in a measurement and verification phase. “A lot of measures are not specifically unique for this facility; however, the facility operations teams under Brian Berzolla, the facility director (Saskatoon Health Region), are knowledgeable about how the hospital runs and the dynamics of the building,” explains Taylor. “When engaging with them, they have unique perspectives of what equipment could be turned on and off and what upgrades we could do.” QUALITY IMPROVEMENTS
Besides more standard measures with lighting, water and the building envelope, the team installed a fan wall. All fans in the wards, operating and general rooms were at the end of their life cycle, costing facilities management ongoing money to repair. This measure is to replace the seven existing coaxial fans with 62 modular fans within three fan wall systems. Each fan module is controlled by its own variable fan drive.
“From an operating point of view, the new fan system allows the maintenance team some redundancy to conduct service work on smaller individual fans but, more importantly, it keeps the facility running no matter what maintenance needs to be done,” says Taylor, who, when conducting an audit, found several pumps and fans were running on a constant basis. Now, the fans run for significantly reduced hours, extending their life while decreasing service costs and downtime. “The EPC allowed us to find dollars to do a whole pile of improvements and be paid back by the money we would have spent on utilities,” Berzolla said in a previous interview with Johnson Controls. “We’re saving more money than was anticipated and making payments on the loan, but we have extra funds to go back into hospital operations.” Other upgrades include replacing steam traps to reduce losses and keep the system working efficiently to meet the required temperature and use less fuel. “I’ve been in some of the steam tunnels and if we didn’t have the cooperation of the staff we probably wouldn’t have found 50 per cent of what we needed to find,”
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says Russell. “Some things that really needed to be done were steam trap replacements that are difficult to find and isolate, and changing toilets from 1955 that were wasting water but logistically very difficult to get to.” Untitled-1 1 2016-11-22 10:48 AM After more than 16,000 lighting fixtures were reviewed, lamps and ballasts of older lights were retrofitted because • Trust adjusting existing fixtures offered greater savings with little occupant impact. • Reliability Incandescent or compact fluorescent • Innovation lamps were replaced with LEDs to reduce • Performance energy use and provide long service in hard-to-reach spaces. Common areas are no longer dark and dreary; light now TENTE Canada, Inc. • ON 519.896.7500 • QC: 514.708.7000 brightens high-traffic areas where staff TENTE Casters, Inc. • USA 859.586.5558 • www.tentecasters.ca and visitors move through on the way to patient care or treatment centres. Johnson Controls also switched antiquated, inefficient toilets for low-flow CHF Ad Aug 20162.indd 1 2016-07-15 9:33 AM and efficient faucet, shower and urinal fixtures to decrease water use by 60 per cent. This amounts to an annual savings of about 29 Olympic-size swimming pools. Insulated covers were also installed on 325 portions of the steam distribution system to reduce wasted heat energy, making the system work less to meet the required temperature. Since certain areas of the campus are unoccupied at night and weekends, occupancy sensors were connected. Digital controls provide operators with better information to control the environment, such as adding schedules to the HVAC system.
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46 CANADIAN HEALTHCARE FACILITIES
The process to a more efficient facility hasn’t come without challenges, such as shutting down air handling equipment that may be coming from a lab and considering what kind of containment is needed from a safety aspect. “One of the other big challenges was the location of the hospital on a river bank,” says Taylor. “There are also two
wings built in different years and the technology was old. Also, next door, they’re building the Saskatchewan Children’s Hospital, so getting material in and out of the facility without hampering hospital operations was a big challenge.” “Hospitals are very challenging environments due to the fact they operate 24-7, are big users of energy and a little more complicated than an office (building) or school,” adds Russell. “So, it was a key win to take everyone’s ideas, boil them down and put them to action, on time and on budget.” Once all improvements were made, the team worked to attain more savings by looking at fresh air intake, equipment schedules and sequencing, and other measures. Going forward, maintenance staff will now have to service variable frequency speed drives, a device connected to an electric fan or motor that reduces frequency so the motor slows down and efficiency is gained. For example, fewer staff in an area means less air. As staff increases, the speed drive provides more air. The process prolongs the life of equipment and saves run time. Along the way, on-site maintenance staff were crucial for planning around a busy healthcare environment, helping to organize work after hours or during downtime so it wouldn’t affect day-to-day operations. “A large part of this project was the scheduling of time for when the contractors could perform their work,” said Berzolla. “The region’s capital planning and project management staff was instrumental in making sure the right people were in the right place at the right time so that patients and staff were minimally impacted.” Rebecca Melnyk is an online editor with the Remi Network. This article originally appeared on www.reminetwork.com.
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