HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
Volume 42 Issue 1
Cortellucci Vaughan Hospital first all-new healthcare facility to be constructed in Ontario in more than 30 years
Scorecard reveals trends in greening of healthcare Ontario hospital's water efficiency strategy pays off Climate resilience guidelines for health facility planning
* Results reflect the opinions of more than 300 engineers polled in a recent Webcast exit survey.
CANADIAN HEALTHCARE FACILITIES Volume 42
Clare Tattersall email@example.com EDITOR/RÉDACTRICE
PUBLISHER/ÉDITEUR Jason Krulicki firstname.lastname@example.org PRESIDENT/PRÉSIDENT
Kevin Brown email@example.com
SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR
Annette Carlucci firstname.lastname@example.org
GRAPHIC DESIGNER/ GRAPHISTE
Thuy Huynh email@example.com
PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE firstname.lastname@example.org PRODUCTION
DEPARTMENTS 6 8
Editor’s Note President’s Message
10 Chapter Reports
HEALTHCARE DEVELOPMENT 12 Smart Hospital Designed Through the Patient’s Eyes Un hôpital intelligent conçu à travers les yeux du patient 18 Designing for the Future New guidelines inform climate-resilient healthcare facilities
CIRCULATION MANAGER/ Rob Osiecki DIRECTEUR DE LA email@example.com DIFFUSION
EMERGENCY PREPAREDNESS & RESPONSE 24 Don’t Leave Disaster Recovery to Chance The right restoration services contractor plays an important role in business continuity planning 26 Kick into Conservation Mode Markham Stouffville Hospital’s water efficiency strategy reduces consumption, costs
SUSTAINABLE HEALTHCARE 30 Going Green in Healthcare Report reveals leadership key to implementation of sustainable initiatives
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
PRESIDENT VICE-PRESIDENT PAST PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR
Roger Holliss Craig Doerksen Preston Kostura Kate Butler Reynold Peters Donna Dennison
Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Mike Linn British Columbia: Norbert Fischer FOUNDING MEMBERS
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: firstname.lastname@example.org www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530
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ADAPTING IN THE FACE OF CHANGE IT WASN’T LONG AGO that I thought the holidays were going to be different than 2020. If I were a betting woman, I would’ve put money on it. But I’ve since learned not to gamble on COVID. The newest variant has spread fast and furious, quickly putting an end to Christmas plans. What the virus has in store for 2022 is anyone’s guess. However, after two years of the pandemic, I remain hopeful that we are nearing its end. Unfortunately, Canada’s healthcare system has suffered greatly and it will take years to recover from the damage wrought by the pandemic. Burnt-out nurses that have been pushed beyond their limits are quitting in droves and there’s a backlog of more than half a million surgeries. Perhaps never before in history has a single event exposed the fragility of our healthcare system. While not broken per se, much needs to be done to make the system more resilient to future shocks. This includes not only subsequent pandemics but the effects of climate change, bringing us to Designing for the Future. In this article, author Rebecca Melnyk delves into the Climate Resilience Guidelines for Health Facility Planning and Design in British Columbia, which were recently developed to help ensure new healthcare facilities are better equipped to deal with the increasing challenges of climate change, including extreme heat and humidity, air quality impacts, flooding and extreme events. But to begin is our cover story on Cortellucci Vaughan Hospital. The first all-new hospital constructed in Ontario in more than 30 years officially opened as a full-service hospital in June 2021, after exclusively being dedicated to the COVID-19 response. For four months, the state-ofthe-art healthcare facility operated to alleviate the significant strain on the province’s hospital system, housing critically ill COVID patients. Another Ontario hospital spotlighted is Markham Stouffville Hospital. The 329-bed facility deserves kudos for its water efficiency strategy, which has reduced consumption by more than 20 per cent. The hospital’s manager of energy and infrastructure, Allan Kelly, details the program in Kick into Conservation Mode. Rounding out this issue, we explore the importance of working with the right restoration services contractor and how to find the best fit in Don’t Leave Disaster Recovery to Chance. We then close with top trends in green healthcare, based on data collected from the Canadian Coalition for Green Health Care’s Green Hospital Scorecard.
Clare Tattersall email@example.com
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.
2022 Webinar Series Time:
0900 BC/1000 AB & SK*/1100 MB/1200 ON & QC/1300 NS & NB/1330 NL One hour in length *SK – 1000 during Daylight Savings time; otherwise 1100
Wednesday January 26, 2022
Humanization of Long-Term Care
Speakers: Tariq Amlani, P. Eng. Senior Principal, Global Healthcare Sector Lead, Stantec Leonora Leclerc, Architect AIBC, Principal, Vancouver Healthcare Studio Lead, Vancouver Integrated Healthcare Design Studio Wednesday February 23, 2022
Managing Virus Threats with Proper Air Filtration Speakers: Jason Turner, Camfill Canada Inc. Wednesday March 23, 2022
Infection Control Red Flags During New Hospital Construction Speakers: Jim Gauthier, Diversey Wednesday April 20, 2022
Ventilation and isolation room design in the COVID-19 era Speaker: Jessica Fullerton, B.Sc., M.Sc., CIC Nick Stark, P. Eng., CED, LEED AP, ICD.D Wednesday May 18, 2022
Z317.1 Plumbing Installation in Health Care Facilities - Update Session Speaker: TBD Wednesday June 22, 2022
The Brave New World of Infection Control during Construction – CSA Z317.13-22 Speaker: Gordon D. Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC Wednesday October 19, 2022
CSA C282 Emergency electrical power supply for buildings for Designers and Changes for 2019 Edition
Speaker: Ken Blazey, Power Solutions Consultant, CSA TSC Member & 2021 Award of Merit Recipient Wednesday November 16, 2022
Z32-21 Electrical Safety and essential electrical systems in health care facilities Update Session Speaker: Kevin Cheong, CSA TSC Member Simon Aspinwall, CSA TSC Member
CHES Member: Single: $30 (per webinar) plus 13% HST Series: $150 (per series) plus 13% HST
Registration Register online:
Non-Member: Single: $40 (per webinar) plus 13% HST Series: $180 (per series) plus 13% HST
“IT ALWAYS SEEMS IMPOSSIBLE UNTIL IT’S DONE” HOW MANY OF YOU have taken a moment to reflect on how our facilities now operate versus early 2019? If you haven’t, you should. It’s impressive how much we’ve changed and how well we’ve executed the transformation. Similarly, CHES has adapted to our new world. Through necessity, CHES is more agile, adopting more digital methodologies to support the primary mandate of “for member benefit.” Our use of webinars throughout 2021 increased as we converted typical face-to-face interactions and received regular offers to add to our already strong lineup of webinars. And even though we all prefer meeting in-person, our webinars continue to be well-received and attended. Thanks to all who took the time to modify these sessions. Although modest at this point, lost CHES members are returning to the organization. Hopefully this is the start of a movement that will take us back to our pre-COVID membership status. As mentioned in the last issue, we held our first (and hopefully last) virtual national conference. Early feedback from attendees and contributors has been surprisingly positive with better than expected numbers. This is certainly testimony to the effort of the conference planning committee. We’re now ramping up our planning for the 2022 International Federation of Hospital Engineering Congress, which will be held in conjunction with the 2022 CHES National Conference in Toronto, Sept. 17-21. The international planning team remains confident there will be a fullblown, face-to-face event in the fall. More details will be available in early 2022. Hopefully everyone has already marked the dates in their calendar. With that, I wish you all well. Your commitment and perseverance to the success of your specific facility, as well as the healthcare sector overall is very much appreciated. Roger Holliss CHES National president
EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2021/2022 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 www.surveymonkey.com/r/DJ8SZ82 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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CHAPITRE DU QUEBEC
The fight against COVID-19 continues with the emergence of a new variant. The province’s health network is facing new roadblocks, especially in relation to staffing. Government is working on many incentives and projects to boost up the network and prepare it to face all the delays in appointments and surgeries. During 2021, the Quebec chapter only offered online education sessions. Specific topics pertaining to healthcare facilities were chosen for members and non-members. In 2022, there will be a return to in-person meetings and conferences, whenever possible. We will monitor the situation and adapt our offerings, as needed. CHES will host the International Federation of Hospital Engineering Congress Sept. 17-21, in Toronto. This will be an incredible opportunity for all healthcare facility managers and workers who attend. The Quebec chapter’s focus continues to be to increase our membership and offer various activities in accordance with our mission to “build member expertise in Canadian healthcare engineering.” A new calendar of events should soon be available online. Do not forget to follow us on social media and regularly check the Quebec chapter page on the CHES website for updates.
La lutte contre la COVID-19 se poursuit. Un nouveau variant est apparu. La course à la vaccination est toujours en cours pour les adultes et maintenant les enfants. Le réseau de santé de la province est confronté à de nouveaux obstacles, notamment en ce qui concerne la dotation en personnel. Le gouvernement travaille sur de nombreuses mesures incitatives et de nombreux projets pour dynamiser le réseau et le préparer à faire face à tous les retards dans les rendez-vous et les opérations chirurgicales. En 2021, la section québécoise n’a proposé que des sessions de formation en ligne. Des sujets spécifiques relatifs aux établissements de santé ont été choisis pour les membres et les non-membres. On reprendra en 2022, dans la mesure du possible, les réunions et conférences en personne. Nous suivrons la situation de près et adapterons nos offres, le cas échéant. La SCISS accueillera le congrès de la Fédération internationale de l’ingénierie hospitalière du 17 au 21 septembre, à Toronto. Ce sera une opportunité incroyable pour tous les gestionnaires et travailleurs des établissements de santé qui y assisteront. Le chapitre du Québec continue de se concentrer sur l’augmentation du nombre de membres et sur l’offre de diverses activités, conformément à notre mission, qui est de “développer l’expertise des membres dans le domaine de l’ingénierie des soins de santé au Canada.” Un nouveau calendrier des événements devrait bientôt être disponible en ligne. N’oubliez pas de nous suivre sur les médias sociaux et de consulter régulièrement la page de la section québécoise sur le site web de la SCISS pour les mises à jour.
—Mohamed Merheb, Quebec chapter chair
BRITISH COLUMBIA CHAPTER In late 2020, there was a glimmer of hope that provincial restrictions may be lifted and we would be able to meet again in-person. While this did not happen and we had to pivot to a virtual education event in 2021, 2022 looks like it’s going to be different. I am excited to share that planning for our conference, scheduled for June 5-7, continues. The theme is, Improving Quality through Accountability, Collaboration and Design. With COVID-19 and the recent fires, heat wave and flooding in the province, we realize the importance of working together to ensure our healthcare facilities can carry us through to the future. —Norbert Fischer, British Columbia chapter chair
The B.C. chapter's spring conference is scheduled to be held in Whistler.
10 CANADIAN HEALTHCARE FACILITIES
—Mohamed Merheb, chef du conseil d’administration du Québec
MARITIME CHAPTER The 2021 fall education sessions that were scheduled to take place in Truro, N.S., in November, had to unfortunately be postponed due to COVID. Planning for the 2022 spring chapter conference is in full swing. It will be held in Moncton, N.B., at the Delta Beausejour, May 1-3. Stay tuned for the exciting speaker lineup. The recipient of the 2021 Per Paasche bursary of $1,000 was Louis Cormier. Louis will attend the Shippigan campus of the Université du Moncton, where he will work toward his degree in health sciences. He is the son of Maritime chapter member MarcCormier, a facility manager with Vitalité in New Brunswick. The chapter is able to balance its books while offering several financial incentives to its members, including a discounted rate to the 2021 CHES National (Virtual) Conference, student bursaries, contributions to Canadian Certified Healthcare Facility Manager exam fees, webinars and the fall education day, among other rebates. —Helen Comeau, Maritime chapter chair
NEWFOUNDLAND & LABRADOR CHAPTER
As I write this chapter report, I find myself reminiscing over the events of this past year and reports previously written. Although Canadian winters can be harsh, we need to embrace it to make the best of it. There are many winter activities that we can take part in that allow us to abide by COVID-19 policies and regulations while still having fun, such as ice skating, skiing, snowmobiling and sledding. Let’s get out there and freeze our behinds off. From the chapter side, we are holding our own. Expenditures have been nil over the past year, so financially the chapter is sound. In 2022, we will continue to sponsor and support our members with respect to travel and accommodations to attend the chapter’s education forum in spring. Similar to past events, there will be many exciting and informative topics at the spring conference, which is scheduled to take place May 16-17. Vendors have been anxiously chasing us to secure a booth. The format will be new and include round table discussions. More details to come. The executive team is currently in talks about what we can offer membership in terms of sponsorship for the 2022 International Federation of Hospital Engineering Congress in Toronto. A primary goal of the chapter executive is to improve communication with our members. We aim to better deliver on virtual educational opportunities and will work harder to promote such events, as well as partner with local bodies to spread CHES news.
Planning for the 2022 Manitoba chapter spring conference and trade show is well underway. It will be held May 16-17, at the Victoria Inn Hotel and Convention Centre in Winnipeg. Education session topics will be centred on the ongoing challenges of infection control, water management, extreme heat and smoke, clinical outbreaks, loss of utility services and medical gas systems. Business coach Greg Kettner will deliver the keynote address on his WorkHappy game plan. Manitoban comedian Matt Falk will provide entertainment at the banquet, during which the 2021/2022 Facilities Management and Project Management awards will be handed out. (Nomination information will soon be delivered via e-blast.) More information to follow as the planning for 2022 proceeds. The Manitoba chapter is planning to hold the Canadian Healthcare Construction Course with the Winnipeg Construction Association at the end of May. More information to come in the new year as we finalize the two-day session. The CHES journal, Canadian Healthcare Facilities, is currently looking for article submissions. If interested, please contact anyone on the chapter executive to assist in getting your article published. I hope many of you will have the opportunity to attend the 2022 International Federation of Hospital Engineering Congress Sept. 17-21, in Toronto. The congress is being held in conjunction with the 2022 CHES National Conference. Check out the CHES homepage for more information.
—Colin Marsh, Newfoundland & Labrador Chapter chair
—Reynold J. Peters, Manitoba chapter chair
The Ontario chapter’s current focus is the continued planning for the 2022 International Federation of Hospital Engineering (IFHE) Congress in Toronto, Sept. 17-21. Less than nine months until we are gathered in-person for what should be an amazing event. The program and all associated events are coming together nicely. The two keynote speakers are former women’s national ice hockey player Hayley Wickenheiser (Day 1), who represented Canada at the Winter Olympics five times, capturing four gold medals and one silver medal, and former astronaut Dr. Dave Williams (Day 2). The opening reception will be held at the Hockey Hall of Fame, where one of the 100 Greatest NHL Players’ in history, Marcel Dionne, will be in attendance. Thanks to all the volunteers on the planning committee and various sub-committees. Online registration will open in the new year. With the IFHE Congress taking place in 2022, our next chapter conference will take place June 4-6, 2023, in Windsor, Ont. Conference planning chair Ron Durocher is heading up this event. In the meantime, I look forward to attending many of the other chapters’ spring conferences to promote the IFHE Congress. 2022 is an election year for CHES Ontario. A notice will be sent to chapter members in spring. I encourage everyone to consider running for any open position on the executive team.
There has been lots of positive feedback on the 2021 CHES National (Virtual) Conference. It was great to reconnect with members from across the country, even if it wasn’t in-person. The effort that went into the conference is greatly appreciated. CHES Alberta has partnered with the Northern Alberta Institute of Technology (NAIT) and the Southern Alberta Institute of Technology (SAIT) to provide annual bursaries of $1,500 to students within the power engineering program. These bursaries will be awarded starting in fall 2022, and end in fall 2024, with an option to renew. Planning has begun on the chapter’s annual spring conference. The executive team remains positive that it will go ahead as planned and be an in-person event. The Alberta chapter remains in good financial standing, so we continue to look for ways to support CHES members the best we can. On behalf of the entire chapter, I’d like to thank all healthcare facility staff and volunteers that continue to work hard to help provide excellent care.
—Jim McArthur, Ontario chapter chair
—Mike Linn, Alberta chapter chair WINTER/HIVER 2021/2022 11
SMART HOSPITAL DESIGNED THROUGH THE PATIENT’S Un hôpital intelligent conçu à travers les yeux du patient By/Par Rebecca Melnyk
ospitals can often feel intimidating. Deep floor plates let little sunshine through to the maze-like corridors. And medical devices can make rooms appear cold and sterile, reminding patients of their own mortality. But through the doors of Cortellucci Vaughan Hospital — the first hospital to ever rise in Vaughan, Ont. — life’s health challenges are met with comfort, safety and lots of natural light. The notion of what a hospital should be has evolved greatly over the years, where patient stress now figures highly into early planning. Such was the case as Stantec began designing this facility, which is Mackenzie Health’s second full-service hospital. A mix of inpatient medical surgical units on top of a diagnostic and treatment podium includes the emergency department, as well as core and specialized services, such as a mental health program and the integrated stroke unit. The majority of the 350 beds are single, with capacity to expand to 500 beds. A more recent addition is the 4,000-square-foot library that hosts all-age events.
12 CANADIAN HEALTHCARE FACILITIES
es hôpitaux peuvent souvent être intimidants. Les étages très vastes laissent passer peu de soleil dans les couloirs en forme de labyrinthe. Et les dispositifs médicaux peuvent donner aux pièces un aspect froid et stérile, rappelant aux patients leur propre mortalité. Mais en franchissant les portes de l’hôpital Cortellucci Vaughan — le premier à voir le jour à Vaughan, en Ontario — les défis de la vie en matière de santé sont relevés avec confort, sécurité et beaucoup de lumière naturelle. La notion de ce que doit être un hôpital a beaucoup évolué au fil des ans. Le stress des patients est désormais un facteur important dans la planification initiale. C’est ce qui s’est produit lorsque Stantec a commencé à concevoir cet établissement, qui est le deuxième hôpital à service complet de Mackenzie Health. Un ensemble d’unités médico-chirurgicales pour patients hospitalisés, situées au sommet d’un podium de diagnostic et de traitement, comprend le service des urgences, ainsi que des services de base et spécialisés, tels qu’un programme de santé mentale et l’unité intégrée
D S EYES
Photos courtesy Tom Arban
The five-year, $1.7 billion project, of which the Ontario government doled out $1.3 billion, was designed through the eyes of the patient. Much consideration was given to how patients move through the facility and how they are transferred through separate corridors, says architect George Bitsakakis. “Patients are in a very vulnerable state,” explains the senior principal at Stantec. “We wanted to make sure they get the dignity and privacy they need so they’re not exposed.” As users navigate the 1.2-million-square-foot building, light and transparency guide them right from the main entrance. The feeling of being lost is an anxiety-causing situation but in this hospital, there is a perceivable sense of control. “That natural light is both obvious and intuitive,” says Bitsakakis. “If you walk in and always have the light coming from one direction, your body (will) adjust and orient itself.” Courtyards carved into the building bring light and outdoor landscaping down to areas that are typically dark and convoluted. A
de traitement des accidents vasculaires cérébraux. La majorité des 350 lits sont des lits à une place, avec une capacité d’extension à 500 lits. S’y est ajoutée plus récemment la bibliothèque de 4,000 pieds carrés qui accueille des événements pour tous les âges. Le projet de cinq ans et de 1.7 milliard de dollars, dont le gouvernement de l’Ontario a fourni 1.3 milliard de dollars, a été conçu à travers les yeux du patient. Comme le fait remarquer l’architecte George Bitsakakis, une grande attention a été accordée à la manière dont les patients se déplacent dans l’établissement et à la façon dont ils sont transférés dans des couloirs séparés. “Les patients sont dans un état très vulnérable,” déclare Bitsakakis, directeur principal chez Stantec. “Nous voulions nous assurer qu’ils bénéficient de la dignité et de l’intimité dont ils ont besoin pour ne pas être exposés.” Lorsque les utilisateurs circulent dans le bâtiment de 1.2 million de pieds carrés, la lumière et la transparence les guident dès l’entrée WINTER/HIVER 2021/2022 13
LEFT TO RIGHT: In a single patient room, large windows bring views of roller coasters from nearby Canada’s Wonderland, a 134-hectare theme park located in Vaughan, Ont. One of the operating rooms.
cascading garden, descending 50 feet down, is visible through a glass-enclosed walkway that leads from the parking garage to the hospital and to a series of courtyards and cafeteria. Prominently situated 11-storeys up at Major Mackenzie Drive and Highway 400, glimpses of roller coasters from nearby Canada’s Wonderland appear through the building’s glass facades. As people move up the tower by elevator, this view is what they see with each stop. “It’s still a big hospital but it feels like you know where you are at all times,” says Bitsakakis. Patient care also plays out in the way rooms were designed. Upon entering, sliding wood panels seamlessly conceal ‘scary’ medical equipment and declutter the area. Natural light streaming from floor-to-ceiling windows in the critical care rooms helps patients heal and recover, as movable technologies allow care teams to rotate beds to outdoor views. Outside, walking trails loop around the facility for patients and staff to wander and reflect. They also extend to the single-family residential neighbourhood that lies directly behind the hospital to the north, one element that made for a complicated site. “It was quite a challenge,” says Bitsakakis. “With the housing behind it, we wanted to make sure we gave something back, that we were a good neighbour and gave them an amenity they didn’t have.” Two local requirements for the completed design were to take extra care of the parking garage and facility plant, which are located directly near the neighbourhood. The central utility plant was built with the same materials used 14 CANADIAN HEALTHCARE FACILITIES
principale. Le sentiment d’être perdu est une situation anxiogène, mais dans cet hôpital, il existe un sentiment de contrôle perceptible. “Cette lumière naturelle est à la fois évidente et intuitive,” explique Bitsakakis. “Si vous entrez et que la lumière vient toujours d’une seule direction, votre corps va s’adapter et s’orienter.” Les cours intérieures apportent de la lumière dans des zones qui sont généralement sombres et tortueuses. Un jardin en cascade, descendant de 15 mètres, est visible à travers une passerelle vitrée qui mène du stationnement à l’hôpital puis à une série de cours et à une cafétéria. Les façades en verre du bâtiment, situé à 11 étages de la Major Mackenzie Drive et de l’autoroute 400, laissent entrevoir les montagnes russes de Canada’s Wonderland. Lorsque les gens montent dans la tour en ascenseur, c’est cette vue qu’ils voient à chaque arrêt. “C’est toujours un grand hôpital, mais on a l’impression de savoir où on se trouve à tout moment,” dit Bitsakakis. La prise en charge des patients se traduit également par la manière dont les chambres ont été conçues. Dès l’entrée, des panneaux coulissants en bois dissimulent de manière transparente les équipements médicaux ‘effrayants’ et désencombrent l’espace. La lumière naturelle diffusée par des fenêtres allant du sol au plafond dans les chambres de soins intensifs aide les patients à guérir et à se rétablir, car des technologies mobiles permettent aux équipes de soins de faire pivoter les lits vers des vues extérieures. À l’extérieur, des sentiers de promenade font le tour de l’établissement pour permettre aux patients et au personnel de se promener et de réfléchir. Ils s’étendent également au quartier résidentiel unifamilial qui se trouve directement derrière l’hôpital au nord, un élément qui a rendu le site compliqué.
HEALTHCARE DEVELOPMENT “C’était un véritable défi,” lance Bitsakakis. “Avec les logements derrière, nous voulions être sûrs de donner quelque chose en retour, d’être un bon voisin et de leur donner une commodité qu’ils n’avaient pas.” Deux exigences locales pour la conception achevée étaient de prendre un soin particulier du garage de stationnement et de l’installation, qui sont situés directement à proximité du quartier. La centrale électrique a ensuite été construite avec les mêmes matériaux que ceux utilisés pour l’hôpital. “Les gens peuvent s’y promener et se faire une idée de ce qu’il faut pour alimenter un hôpital en électricité — ce n’est pas une mince affaire,” précise Bitsakakis. “La plupart des gens n’ont jamais vu un tel équipement.” Des écobaissières végétalisées s’ouvrent à travers la grande étendue d’asphalte du stationnement pour capter les eaux de ruissellement, les filtrer et les réinjecter dans la nappe phréatique. La nature est également présente dans les toits verts qui surmontent chaque bâtiment et où, au fil du temps, des plantes pousseront pour cacher les équipements mécaniques. DES SOINS PLUS INTELLIGENTS
The cascading garden is located at the underground link, which connects the parking garage and hospital.
for the hospital. It includes custom perforated screens that are bent to capture the light and large walls of glass that bring educational views to the public. “People can walk around it and get a sense of what it takes to power up a hospital — it’s not a small thing,” says Bitsakakis. “Most people have never seen equipment like this.” Vegetated bioswales sprout through the large asphalt sheet of the parking lot as a way to capture, treat and infiltrate stormwater runoff and replenish it back into the water table. Nature also presents itself in the green roofs that top every building where, over time, planting will grow to hide the mechanical equipment. SMARTER CARE
Technology factors into patient comfort at the first smart hospital in Canada, and is subtly woven into care teams’ daily workflows. As Mackenzie Health says, smart technology ultimately becomes a digital member of the care team, offering a crystal ball into a patient’s healthcare journey. Given more control, patients are involved in their own care. They can select meals, manage room settings and access their medical data from their bedside tablet. The idea is that information systems communicate with each other to anticipate the needs of patients and healthcare workers, and many of these smart features were first tested and piloted at Mackenzie Richmond Hill Hospital. One includes a real-time locating system. This involves tagging patient wristbands, healthcare workers’ ID badges and hospital devices with real-time locating tags for staff to quickly track down colleagues and necessary equipment.
Dans le premier hôpital intelligent du Canada, la technologie est un facteur de confort pour les patients et s’intègre subtilement dans le travail quotidien des équipes de soins. La technologie intelligente devient en fin de compte un membre numérique de l’équipe de soins, offrant une boule de cristal dans le parcours de santé du patient. En ayant plus de contrôle, les patients sont impliqués dans leurs propres soins. Ils peuvent sélectionner les repas, gérer les paramètres de la chambre et accéder à leurs données médicales depuis leur tablette de chevet. L’idée est que les systèmes d’information communiquent entre eux pour anticiper les besoins des patients et des travailleurs de la santé. Nombre de ces fonctionnalités intelligentes ont été testées et expérimentées pour la première fois à l’hôpital Mackenzie Richmond Hill. L’une d’elles comprend un système de localisation en temps réel. On appose des étiquettes de localisation en temps réel sur les bracelets des patients, les insignes des travailleurs de la santé et les appareils hospitaliers, afin que le personnel puisse retrouver rapidement ses collègues et les équipements nécessaires. À l’intérieur des chambres, des capteurs intégrés aux insignes d’identification du personnel les alertent sur les statistiques des patients, qui sont immédiatement affichées sur une tablette de chevet et un écran de télévision. Le système s’intègre également au système de sécurité de l’hôpital. Des étiquettes électroniques sont remises aux patients qui risquent de s’égarer ou pour garder les nouvelles mères et leurs bébés connectés. “Nous veillons également à préserver la confidentialité des patients, mais il s’agit d’un système d’information intégré auquel le personnel essentiel a accès et que les patients peuvent contrôler dans une certaine mesure,” poursuit Bitsakakis. À l’extérieur des chambres des patients, des tablettes affichent des données telles que les allergies des patients et la nécessité éventuelle d’un interprète. À l’intérieur, les lits intelligents permettent de surveiller instantanément les patients grâce à une application qui s’intègre à d’autres applications hospitalières comme les dossiers médicaux électroniques. Par exemple, les lits intelligents peuvent WINTER/HIVER 2021/2022 15
HEALTHCARE DEVELOPMENT Inside rooms, sensors on staff ID badges alert them to patient statistics, which are immediately displayed on a bedside tablet and television screen. The system integrates with the hospital’s security system, too. Electronic tags are given to patients at risk of wandering or to keep new mothers and their babies connected. “We are also making sure patient confidentiality is maintained, but it is an integrated information system that crucial staff have access to and patients can control to some extent,” says Bitsakakis. Outside patient rooms, tablets display data like patient allergies and whether an interpreter is needed. Inside, smart beds instantly monitor patients through an application that integrates into other hospital applications like electronic medical records. For instance, smart beds can weigh patients to determine medication doses or send an alert to care workers’ mobile devices if a patient, at risk of falling, attempts to get out of bed. A smartphone app prioritizes information among staff, such as code alerts, patient status and clinician availability. Patients in medical distress or in need of washroom assistance can directly connect to their care team’s mobile devices through a sophisticated nurse call system. More recently, the hospital rolled out a digital pathology platform for speedier diagnostics — also a first in Canada. Prior to this, physical samples were couriered to outside experts if a consultation was required. Mackenzie Health says connecting digitally in this way allows its team to pull up a sample on a screen and have a team of experts view it within hours. A PANDEMIC PLAN
Infection control also figures into smart technology offerings. Realtime locating sensors in hand sanitizer stations at the building entrance and inside patient rooms ensure hand hygiene compliance. Features like this bode well during a pandemic. In fact, the hospital was designed with such a global emergency in mind. When COVID-19 unravelled across the country in 2020, the hospital focused exclusively on creating more space for critical and acute care patients, pushing its full public opening to June 2021. Getting ahead of this national emergency meant establishing two command centres, explains Bitsakakis. The auditorium was designed for a pandemic, with a secondary centre as a backup. Units Biomedical_CHF_Winter_2017_FINAL.pdf 1 2017-10-23 4:45 PM can be isolated with vestibules to activate when a pandemic hits. “This was already built in and that has to be the way of the future for hospitals designed now,” he says. “A lot of us had gone through SARS, so COVID isn’t the first time we’ve been exposed to this.”
peser les patients pour déterminer les doses de médicaments ou envoyer une alerte aux appareils mobiles du personnel soignant si un patient sujet à des chutes tente de sortir du lit. Une application pour smartphone permet de hiérarchiser les informations entre les membres du personnel, comme les alertes de code, l’état des patients et la disponibilité des cliniciens. Les patients en détresse médicale ou ayant besoin d’une assistance aux toilettes peuvent se connecter directement aux appareils mobiles de leurs équipes de soins grâce à un système d’appel infirmier sophistiqué. Plus récemment, l’hôpital a mis en place une plateforme de pathologie numérique pour accélérer les diagnostics, ce qui constitue également une première au Canada. Auparavant, les échantillons physiques étaient envoyés par messagerie à des experts externes si une consultation était nécessaire. Mackenzie Health affirme que cette connexion numérique permet à son équipe de faire apparaître un échantillon sur un écran et de le faire examiner par une équipe d’experts en quelques heures. UN PLAN DE LUTTE CONTRE LA PANDÉMIE
Le contrôle des infections fait également partie des offres de technologies intelligentes. Des capteurs de localisation en temps réel dans les stations de désinfection des mains à l’entrée du bâtiment et à l’intérieur des chambres des patients garantissent le respect de l’hygiène des mains. De telles caractéristiques sont de bon augure en cas de pandémie. En fait, l’hôpital a été conçu dans l’optique d’une telle urgence mondiale. Lorsque la COVID-19 a déferlé sur le pays en 2020, l’hôpital s’est concentré exclusivement sur la création de plus d’espace pour les patients en soins critiques et aigus, repoussant son ouverture publique complète à juin 2021. Pour faire face à cette urgence nationale, il a fallu créer deux centres de commandement, explique Bitsakakis. L’auditorium a été conçu pour une pandémie, avec un centre secondaire de secours. Les unités peuvent être isolées avec des vestibules à activer en cas de pandémie. “Cela était déjà intégré et cela doit être la voie de l’avenir pour les hôpitaux conçus aujourd’hui,” dit-il. “Beaucoup d’entre nous avaient traversé le SRAS, donc la COVID n’est pas la première fois que nous sommes exposés à cela.” La majorité des chambres des patients sont privées, avec des toilettes dédiées, ce qui est essentiel pour réduire la transmission des virus. À l’intérieur du service des urgences, chaque unité et chaque bloc dispose d’une chambre d’isolement contre les infections transmises par voie
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HEALTHCARE DEVELOPMENT The majority of patient rooms are private, with dedicated washrooms — key to reducing virus transmission. Inside the emergency department, every unit and pod have an airborne infection isolation room in case patients need to be treated under airborne precautions. Some entire units also convert into negative pressure areas with separate HVAC systems that direct air outside through HEPA filtration. Care teams can subsequently separate and isolate patients by closing off a whole area. CHANGE IN MIND
Hospitals are in an ongoing metamorphosis. Imagining them as such will carry healthcare into a new era, one that thrives on change. “We do a lot of renovations in hospitals and what we’ve found is (many) of them have not anticipated change, so we designed (considerable) flexibility into this,” says Bitsakakis. At Cortellucci Vaughan Hospital, a room can shift for postpartum or physical isolation, but at the heart is the same module and not so specific. The whole facility was located and designed to expand on-site, in case a larger wing is needed. Many hospitals, notes Bitsakakis, end up with no land and must regenerate outside of town or purchase expensive properties nearby. “The needs and operations of hospitals do evolve and if there’s no flexibility, they get stuck,” he says. “The idea of flexibility, adaptability, regeneration, expansion and design for outbreaks, those are the themes that should now be considered for all facilities.”
aérienne, au cas où les patients devraient être traités avec des précautions contre ce type d’infection. Certaines unités entières se transforment également en zones de pression négative avec des systèmes CVC séparés qui dirigent l’air vers l’extérieur par le biais d’une filtration HEPA. Les équipes de soins peuvent ensuite séparer et isoler les patients en fermant une zone entière. UNE MÉTAMORPHOSE
Les hôpitaux sont en pleine métamorphose. En les imaginant ainsi, nous ferons entrer les soins de santé dans une nouvelle ère, une ère qui se nourrit du changement. “Nous effectuons beaucoup de rénovations dans les hôpitaux et nous avons constaté que (beaucoup) d’entre eux n’ont pas anticipé le changement, c’est pourquoi nous avons acquis une flexibilité (considérable) dans ce domaine,” explique Bitsakakis. À l’hôpital Cortellucci Vaughan, une chambre pourrait se transformer pour le post-partum ou l’isolement physique, mais au cœur se trouve le même module. L’ensemble de l’installation a été situé et conçu de manière à pouvoir être agrandi sur place, au cas où une aile plus grande serait nécessaire. De nombreux hôpitaux, note Bitsakakis, se retrouvent sans terrain et doivent se développer en dehors de la ville ou acheter des propriétés coûteuses à proximité. “Les besoins et les opérations des hôpitaux évoluent et s’il n’y a pas de flexibilité, ils restent bloqués,” conclut-il. “L’idée de flexibilité, d’adaptabilité, de régénération, d’expansion et de conception pour les épidémies, voilà les thèmes qui devraient désormais être pris en compte pour toutes les installations.”
WINTER/HIVER 2021/2022 17
DESIGNING FOR THE FUT New guidelines inform climate-resilient healthcare facilities By Rebecca Melnyk
atastrophic weather events like wildfires are prompting more awareness of how climate change could affect operations in healthcare facilities and the staff and patients who inhabit these buildings. The pace of rising temperatures and heavy rain events, however, has been slowly manifesting for some time, and newly released guidelines in British Columbia offer a standard for approaching the planning and designing of capital projects from a resiliency perspective. The Climate Resilience Guidelines for B.C. Health Facility Planning and Design culminates more than a year of multi-sector collaboration to develop practice-based guidance for B.C.’s health authorities. It arises from a series of reports and a provincial climate risk assessment, all with roots in the CleanBC plan, which was tabled in 2018 to meet legislated climate targets of reducing greenhouse gas (GHG) emissions. “Prior to the guidelines, the process in deliverables may have varied from project to project,” says IBI Group associate director Doug McLachlan, who was on the task force that helped prepare this document. “There is now a framework established for how we can
18 CANADIAN HEALTHCARE FACILITIES
address climate change and look at going beyond LEED Gold or code minimum requirements on a project.” McLachlan spoke at a seminar, Planning for Climate Resilience in Healthcare Facilities, in May, hosted by the Canadian Centre for Healthcare Facilities. As new request for proposals begin referencing these guidelines, the discussion covered how they align with key design stages and how climate resilience can be actualized in facility design. PRIORITIZING RESILIENCE
The guidelines include six overarching principles, from anticipating changes associated with climate hazards to prioritizing flexible design strategies and considering co-benefits related to GHG mitigation and pandemic preparedness. There is also a studied, yet flexible, climate risk and resilience assessment process with four steps to be reflected in every project design stage. These steps are first actualized with an exposure screen to incorporate hazards right into the budget at the masterplanning stage. This informs what hazards the site is exposed to now and in the future. From there, a funneling process refines what is most vulnerable, prioritizes high-risk impacts,
such as the quality of patient care, and confirms what design will move forward — making sure it aligns with other goals like COVID response. Ultimately, the design should comply with any resilience objectives that were flagged for reducing climate risks. Since the guidelines are relatively new, no project has implemented all four steps yet. But there are many ways to realize them on the ground. Lisa Westerhoff, principal at Integral Group, shared her experience, speaking as a member of the project team that developed the guidelines. When her team conducted a hazard output for a long-term care facility in B.C., they examined various climate data sources, the site itself and the planning context to narrow down the scope of hazards and understand how expected changes in climate will affect them over time. “We then cross-checked that list with hazards required to be considered by LEED, so we could support the achievement of the resilient design pilot credit IPpc 98,” she says. “We were able to look at a broad range of hazards and make sure we achieved compliance with other goals as well.” IPpc 98, Assessment and Planning for Resilience, encourages project teams to
TURE determine potential vulnerabilities at the project location. With recent revisions, risks that must be considered as part of this credit now include sea level rise, extreme heat and more intense winter storms. To earn the credit, project teams must identify risks related to the effects of climate change. (This consideration was previously considered optional.) “We need to be aware of the responsibilities of these key deliverables that will now be included on projects, such as climate risk assessment, perhaps additional concept designs early on and energy model options,” says IBI Group’s McLachlan, who laid out some resilient design strategies for healthcare facilities. From a site perspective, flooding can overwhelm local stormwater drainage capacity after an extreme rainfall — an event expected to increase in severity and frequency due to climate change. “Many cities, such as Vancouver, had established minimum flood construction levels in flood-prone areas based on climate data,” he says. “As designers, we need to be aware because they are going to determine the ground floor elevations for access to and egress out of the underground parking
areas, as well as determine location for equipment.” Using the best available climate data for rainfall events will help plan a hospital for a lifespan of 50-plus years, he notes. The design should look at the intensity duration frequency curves for the year 2100, and how those affect a site — exceeding a city’s requirements for its integrated stormwater management plan. This can also impact mitigation strategies like permeable pavement and green roofs. Reusing stormwater on-site for non-potable uses should be considered early on as some elements will affect the location of retention tanks. Prolonged periods of abnormally hot weather and higher humidity with increased frequency and intensity figure into a longterm climate reality. “For patients and staff, it’s going to become increasingly more difficult if facilities are not designed for future climate conditions,” stresses McLachlan. The design of the cooling plant, mechanical rooms, shafts and HVAC systems are affected. “As a principal on recent projects, we’ve looked at infrastructure that would be impractical to retrofit in the future, such as chilled water piping, to make sure that it is
sized for 2080 peak cooling conditions and there is space in the mechanical room for chillers and pumps to be added in the future,” he says. Since deep floor plates can create internal heat gains and little natural light, it’s advised to avoid them where possible and incorporate interior courtyards and multi-storey atriums to bring natural light as deep into the space as possible. Doing so will help avoid using artificial light and mechanically removing the resulting heat gain. Studies also point to a correlation between natural light access, quicker recovery and staff well-being. “By building a more efficient building envelope we can (also) reduce the electrical load and therefore GHG emissions,” says McLachlan. “This is one of those co-benefits or synergies on the project.” McLachlan highlighted the benefits of improving the thermal performance of the windows with triple glazing, such as reducing peak heating loads, GHGs and annual energy use, and better visual and thermal comfort for occupants. ANTICIPATING CLIMATE STRESSORS
Another project team member, Robert WINTER/HIVER 2021/2022 19
Bradley, who is director of energy and environmental sustainability at Vancouver Coastal Health, deciphered between climate shock (extreme events like a heat wave) and climate stressors (prolonged events like a drought or increasing temperatures). In response to specific stressors like air quality and extreme heat, Gordon McDonald, principal and director of engineering for Integral Group, touted more passive design solutions, rather than cutting-edge technologies. “I do believe for a building to be resilient, it needs to be simple,” says McDonald, who is also a project team member. To build resilience to warmer summers and longer periods of hot weather, emphasize passive design solutions, such as building orientation, exterior shading and maximizing window-to-wall glazing ratios, says McDonald. Orientating a building from east-west rather than north-south removes problematic solar control on the west facade, which leads to large cooling loads. Solar shades above windows are efficient for high sun angles, while planting deciduous trees provides shade in summer and allows sun penetration in winter. Glazing can also control solar heat gain with photovoltaic glass that limits the amount of heat coming into a building. While reducing cooling loads, buildings must remain resilient in even 2080, when temperatures are no longer at their current levels. There are weather files now available that designers can refer to when calculating how many chillers will be needed in the future, says McDonald. To avoid replacing broken equipment, the idea is to install them at a later date, while making sure there is ample space in a mechanical room, enough electrical capacity and that chilled water piping is sized for the future to avoid costly and disruptive retrofits throughout the facility. Design solutions to protect against forest fires and airborne viruses include vestibules on all main entrances and tighter envelopes to hinder air infiltration, reducing outdoor contaminates. There should also be space allocated for the installation of future filters, intake louvers on different facades and increased humidity levels of 40 to 60 per cent, as viruses spread more easily in lower humidity ranges. The minimum CSA range stands at 30 per cent. Minimizing the energy associated with buildings comes down to passive design methods like massing, orientation and solar shading, and building better envelopes, roofs and windows, which also reduce carbon emissions. “On the West Coast, we’ve seen Passive House get some traction recently, not necessarily in healthcare but residential, institutional and commercial (settings),” says McDonald. “What this is doing is driving down those energy targets, so we’re using less energy inside the building.” Since healthcare facilities move a lot of air throughout the building, a portion of which is outdoor air, the idea is to ensure the energy associated with heating and cooling is minimized. This translates into heat and energy recovery ventilation, thermal wheels or active heat recovery, which involves taking energy from the air, sending it through heat pump technology and using that to preheat domestic hot water or heat/cool a building. In B.C., where electricity is hydrogenated, McDonald is seeing a trend where more buildings are choosing heat pump-driven technologies to achieve low emissions. “The move is to green the grid,” he says. “And if we could move to a more electric building solution that would make us more resilient in the long-term.” 20 CANADIAN HEALTHCARE FACILITIES
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Call for Nominations
CHES Board of Directors Executive Positions CHES is seeking nominations for CHES National executive positions. Members are invited to submit nominations for the following: • Vice President • Secretary • Treasurer Members in the regular membership classification are eligible for office, providing they meet the bylaw requirements in Article 6; Governance, Item 6.3.3 Eligibility.
Nominations can be received either by: • Members identifying and nominating eligible qualified candidates • Members who are interested in standing may submit their own name as a candidate Candidates must be active in and a participating member of CHES for a minimum of two years. Candidates shall be in compliance with all provisions of the bylaws and have the ability to carry out the fundamental duties of the assignments of the board. Candidates shall obtain the approval of their superior to serve on the board.
Nominations must be received by April 30, 2022 They should be sent to: CHES National Office firstname.lastname@example.org
Please refer to the eligibility requirements (Bylaws 14th Edition, Article 6: Governance, Item 6.3.3 Eligibility) regarding the call for nominations on the CHES website at www.ches.org or contact the National Office at 613-531-2661. WINTER/HIVER 2021/2022 21
BUILT TO BETTER SERVE Kelowna Vernon Hospitals bring higher quality healthcare to British Columbia
he Kelowna Vernon Hospitals Project was a major initiative launched in 2007 by the Interior Health Authority (IHA) and the Province of British Columbia to modernize facilities and enhance patient care. Today, the two refurbished hospitals speak for themselves with state-of-the-art equipment, superior infrastructure, and new and improved services that better meet the healthcare needs of Okanagan residents. Featuring a new patient care tower, a new University of B.C. Okanagan campus and parkade at Kelowna General Hospital (KGH), and a new patient care tower at Vernon Jubilee Hospital (VJH), the capital cost for the project was $432.9 million. Black & McDonald is one of four private partners that make up Infusion Health, the consortium of companies selected by IHA to fulfill all facets of the contract.
Since July 2009, Black & McDonald has been at the helm of both KGH’s and VJH’s facilities management. “We take care of both the new and existing buildings — everything to do with the facilities other than providing patient care,” explains David Frost, Division Manager. “Our team of 70 technicians, admins and project managers oversee maintenance, building repairs and lifecycle issues, renovations to existing areas, including any changes to the functionality of a space. We also help with fundraising efforts, providing support where we can for initiatives that raise money for the purchase of new equipment. Essentially, we play a role in every aspect of the physical assets.” Now more than ten years into the 30-year contract, Frost and his fellow team members feel right at home, having weathered the challenges that typically
go hand-in-hand with taking over a new facility — particularly one with multi-generational buildings. “When you’re dealing with different eras of technologies, systems and machinery with unique designs and controls, there’s a steep learning curve,” says Myles Brumpton, Operations Manager. “Gaining that familiarity with the sites takes time. The hard part is getting things under control from a maintenance perspective in those early days.” That said, the performance-based contract spanning three decades has incentivised the FM team to work as efficiently and effectively as possible, always driving them to aim higher and produce the best results. “I’d say our quality of service, the speed with which we respond and our level of accuracy when we make repairs, has helped elevate operations above what they once were,” says Frost. “Our recordkeeping and administrative practices are very precise, and we are always striving to improve our procedures, modifying and tweaking our levels of service to achieve and deliver more.” After taking over from the previous administration, Frost says the reception from the hospital staff was predictably mixed, but it didn’t take long for the Facility Management Team to prove themselves. “We conduct regular customer surveys to solicit feedback on our performance and assess our operational activities and the response has been very positive”, says Frost. “There’s a sense of community at the hospitals, and everyone seems to get along well.” In terms of how improvements at the operational level have impacted the end user, Frost says it all comes down to a greater ability to provide superior service and patient care. “As the flagship facilities on the leading-edge of technology for this area, KGH and
PROJECT SCOPE Conducted in three phases from December 2009 through 2012, the Kelowna Vernon Hospital Project included the construction of four new LEED Gold facilities and important upgrades at both sites: • A six-storey, 33,500 square-metre patient care
tower at KGH, featuring a modernized emergency department with expanded capabilities and services;
• A two-storey, 3,200 square-metre UBC Clinical Academic Campus building, housing a 180-seat lecture theatre, distance education rooms, clinical skills rooms and a library; • A multi-level parkade at KGH; and • A seven-storey, 16,800 square-metre patient care tower at VJH, including a modernized emergency department with expanded facilities and services.
VGH are growing and expanding with new programs all the time. The Black & McDonald FM team works closely with the hospitals to understand their evolving needs, and rapidly responds with solutions that ensure continuous improvement. I know I speak for all of us when I say we feel extremely fortunate and proud to be involved.” A trusted, proven facility services provider Black & McDonald operates and maintains several world-renowned healthcare facilities and laboratories across Canada. Through the innovative management and delivery of quality facility services, B&M is able to reduce the cost of ownership and streamline operations within these critical environments. We are committed to always operating our facilities safely and efficiently, while delivering service excellence and driving value at all facilities under our care. To help you identify opportunities to enhance your facility, or for a tailored solution to meet your specific requirements, please visit: www.blackandmcdonald. com/services/facility-services/
DON’T LEAVE DISASTER RECOVERY TO CHANCE The right restoration services contractor plays an important role in business continuity planning
By Jim Mandeville
he restoration industry in Canada is one of the most diverse in the world, with contractors ranging in scope, scale and training from single person owner/operator to complex multi billion-dollar global firms. The most important factors in selecting a contractor in the healthcare sector should be experience, training, specialized equipment and scope/scale. 24 CANADIAN HEALTHCARE FACILITIES
EXPERIENCE AND TRAINING
To protect the most vulnerable, adherence to policies and procedures in a healthcare facility is critical. What would normally be a simple lapse in adherence to policy could have dire consequences. Because of this, it is essential to become familiar with the hospital’s vendors and partners. It should be a requirement that the facility’s contractor is intimately familiar with
all relevant government regulations, specifically CSA Z317, Infection Control during Construction, Renovation and Maintenance of Healthcare Facilities, as well as industry standards from the American Society of Heating, Refrigerating and AirConditioning Engineers, National Air Duct Cleaners Association, Institute of Inspection, Cleaning and Restoration Certification, and Restoration Industry Association. The
EMERGENCY PREPAREDNESS & RESPONSE
contractor should also be able to complete a detailed infection control risk assessment for all portions of the work. In addition to being versed in these standards, the contractor should consider key project personnel. Does the project management team and key field supervisors have appropriate training and experience in healthcare-related restorations? Do individual workers have this training? Are these people comfortable participating in a multi-disciplinary infection prevention and control team to complete the work? The best time to get familiar with these key personnel is now, not while in the midst of trying to respond to a major issue in the facility. SPECIALIZED, DEDICATED EQUIPMENT
Restoration in healthcare facilities also requires specialized, dedicated equipment. It is critical to understand the vendor’s procedures around equipment and material handling. For instance, is equipment coming to the facility cleaned, inspected and verified prior to shipment? In the restoration industry, equipment required for mitigation in healthcare facilities could also be used on a wide variety of other projects. These projects commonly include hazardous material abatements and fire damage restorations. Failure to properly decontaminate equipment in-between projects can present a major risk if it is placed into a healthcare facility inadvertently. It is preferable that the vendor maintain a separate stock of equipment that is dedicated to this sector to minimize or eliminate these cross-contamination threats. Additionally, it is important to understand whether the equipment is owned and maintained by the vendor or provided by a third party. And whether that third party adheres to the vendor’s quality assurance/ control policies around material and equipment handling. Again, this equipment could come directly from ‘normal’ construction projects in what is considered a
‘clean’ condition, which, of course, is not even close to that required within a healthcare setting. Then there is material handling itself, which is often overlooked. Where and how material is stored and transported are critical factors. Porous materials like drywall and plywood that have been stored outside under a tarp may be acceptable for some types of construction projects but should never be considered for installation within a healthcare facility. Once this material is verified, check to see if there is a procedure or plan in place to move that often large and bulky material around the facility without interrupting normal operations. For instance, separate exterior access like through a window with a crane or lift would be ideal. It is essential to understand what assurances the vendor can provide on availability of critical equipment during area-wide events and catastrophic situations. Is the healthcare facility first on the list? What other clients are key priorities? Healthcare facilities are absolutely crucial to the safe operation of communities, so the same level of attention and dedication needs to be placed on this philosophy by all vendors. SCOPE AND SCALE
Once this data gathering has been completed, the facility is better positioned to move forward with the vendor (or not) and come up with a series of formal response plans. While seemingly simple and obvious, these plans can allow for a much more seamless response to critical incidences like water escapes or small fires. From basic things like all parties understanding how and where workers will enter and exit the facility, to more complex topics like traffic management for main corridors and the finer points of the infection control risk assessment’s requirements will greatly speed response, reduce downtime and help provide an overall feeling of reassurance to the entire facility in the event of a disaster. Questions to ask include: Is the facility’s vendor the right size? And can the firm offer
sufficient scale of personnel and equipment to get the facility back in operation as quickly and safely as possible? Professional restorers can have the most dedicated and skilled team behind them in the world. Yet, if that team consists of a dozen people, there is physically only so much they can do. Operators with large facilities should not only consider the scale of firm required for their day-to-day small water and environmental losses, but also potentially catastrophic events like fires that impact numerous units on multiple floors or wings, or even the entire facility. After all, contractors are normally not judged by the everyday small challenges. Instead, it is what they do when responding to the ‘once in a career’ major issue. BETTER PARTNERSHIPS
Having a trusted partner that is experienced, trained and has the right resources is a critical part of any business continuity plan within a healthcare facility. Developing a familiarity with the vendor and working with them as a true, trusted partner should be a priority for healthcare operators. Otherwise, operators are just gambling the success of a response/ restoration on assumptions and expectations. Know the vendor and find security in their capabilities and quality control practices. Failure to develop these partnerships on such a level can almost always result in seemingly small floods, fires or environmental issues drastically impacting immediate and longterm healthy operation of the facility and its community. Jim Mandeville is the senior project manager, large loss, North America, for First Onsite Restoration. Jim has 18 years of experience in the restoration industry and holds three master restorer designations from the Institute of Inspection, Cleaning and Restoration Certification, as well as a wide variety of safety-related certifications. Specializing in the management of very large and complex healthcare, manufacturing, retail, industrial and mining losses, he has been involved in every major Canadian catastrophe since 2003. WINTER/HIVER 2021/2022 25
KICK INTO CONSERVATION MODE Markham Stouffville Hospital’s water efficiency strategy reduces consumption, costs By Allan Kelly
onsidered one of the leading community healthcare facilities in Ontario, Markham Stouffville Hospital (MSH) has implemented a number of initiatives in recent times to reduce its environmental footprint. One of them involved partnering with Markham District Energy (MDE) to use energy and water more efficiently, as part of York Region’s Industrial, Commercial and Institutional (ICI) Capacity Buyback Incentive program. Through the program, the regional municipality offers a water audit at no cost to high water users. The purpose of the 26 CANADIAN HEALTHCARE FACILITIES
program is to identify long-term water-saving opportunities. In 2017, a representative from York Region conducted a water audit at the 329bed hospital, to determine the water-consuming processes in the facility: MDE, domestic usage and open loop cooling system (walk-in freezer and fridge compressors, autoclaves and air conditioners). The results were summarized in a report and included the process water balance, water-saving opportunities that required plumbing work and sufficient process load, estimated investment required, gross sav-
ings, payback period and eligible incentive amount from York Region, based on installed eligible benefits. The water balance was prepared based on water meter readings, direct flow measurements using an ultrasonic flow meter, observation and information provided by MSH. The three largest water-consuming processes identified in the facility during the pre-audit were MDE (37.3 per cent), domestic (13.6 per cent), and water-cooled fridge and freezer compressors (12.5 per cent). Subsequently, MSH retained its own consultant to conduct a feasibility study of the
CHES Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
CALL FOR NOMINATIONS FOR AWARDS 2022 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2022
2022 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2022
To nominate: Please use the nomination form posted on the CHES website and refer to the terms of reference.
To nominate: Please use the nomination form posted on the CHES website and refer to the terms of reference.
Purpose: The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.
Purpose: To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program or team building exercise.
Award sponsored by
Award sponsored by
For nomination forms, terms of reference, criteria and past winners www.ches.org/About CHES/Awards Send nominations to CHES National Office email@example.com Fax: 613-531-0626
SAVE THE DATE
June 8-9, 2022 Metro Toronto Convention Centre North Hall, Toronto Ontario, Canada Proudly Owned and Operated by:
For additional information on exhibitor/sponsorship opportunities, please contact Chuck Nervick, Senior Vice President at firstname.lastname@example.org | 416-803-4653 WINTER/HIVER 2021/2022 27
Water consumption: Selected period vs. Normalized baseline 13,000 12,000 11,000
Water consumption, m3
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existing chilled water system (MDE cooling loop) serving building A, and to identify the year-round cooling requirements. The scope of the study was to review the existing chilled water system connected to these process loads and to optimize energy usage when the system is running in the non-cooling season. The study also identified equipment that was using domestic water for once-through process cooling. This included compressors in the elevator machine and mechanical rooms, five fridge/freezer compressors that serve the kitchen and biomedical waste fridge compressor located at the loading dock. All equipment was cooled by once-through water that drained directly into the sanitary sewer system. Those in the elevator machine and mechanical rooms were estimated to use 11,673 cubic metres (m3) of water per year. The compressors that serve the kitchen and the biomedical waste fridge compressor were estimated to use 18,805 m3 and 468 m3 of water per year, respectively. Through the feasibility study, it was recommended that MSH decouple the process cooling loads from the main chilled water system to reduce energy usage, resulting in two chilled water loops. The primary chilled water loop serves the air handling unit (AHU) cooling coils and fan coil units, running only during the summer season. The secondary chilled water loop serves the 24-7 cooling loads throughout the facility and runs fulltime all year long. This chilled water loop is tied into the MDE heat exchangers for chilled water supply and return. MSH disconnected the municipal water inlet pipe and connected the three air con-
28 CANADIAN HEALTHCARE FACILITIES Trane_CHF_Fall_2021.indd 1
ditioners, five fridge compressors and one biohazardous fridge compressor to the MDE cooling loop. With the new connections, the cooling water is recirculated and no municipal water is being used for cooling the compressors. Now, the three largest water-consuming processes (identified in the facility during the post-audit) are MDE (46.7 per cent), domestic (17 per cent) and autoclaves (9.6 per cent). No water has been required for the water-cooled fridge and freezer compressors and AHUs. MSH implemented all water-saving measures identified in the water audit and feasibility study over a two-year period, completing in February 2019. By disconnecting the potable water use equipment from the domestic cold water supply and connecting them to the MDE cooling loop, MSH has reduced its total water consumption by more than 20 per cent. This amounts to a reduction in water consumption of 30,946 m3 annually, which equates to a direct savings of $138,267. The hospital has enjoyed additional savings of more than $38,000 annually, from a reduction in related electricity costs. Demonstrating leadership in environmental sustainability, MSH is continuing to explore additional water conservation opportunities. Currently, there are three autoclaves and one bench autoclave that use once-through domestic water to create steam for the sterilization process. To reduce water waste, this process will be investigated to see if it can be plumbed into the 24-7 chilled water loop. Allan Kelly is manager of energy and infrastructure at Markham Stouffville Hospital.
CHES Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
CALL FOR GRANT SPONSORSHIP & SUBMISSIONS 2022 Young Professionals Grant DEADLINE: May 23, 2022 CHES is seeking both sponsors and candidates for the 2022 Young Professionals Grant (YPG). The application forms for sponsors and candidates are available on the CHES website.
Call for Sponsors: • The YPG sponsorship application form must be completed by the sponsoring organization/company and submitted to the CHES National Office. • The CHES National Office will invoice the sponsoring organization/company for $2,000 once candidate applications have been received and approved.
Call for Candidates: • Young professionals who are or will become architects, engineers (i.e. mechanical, electrical, power and civil), technicians or similar technical disciplines are eligible. • Eligible candidates are those working within a healthcare organization or a company supplying goods or services to healthcare facilities or organizations. • Eligible candidates must be working in the healthcare field for less than 5 years. • The YPG application form must be completed by the eligible candidate and submitted to the CHES National Office. In this form, the eligible candidate will be required to provide information on their recent employment and future career aspirations. • Confirmed candidates will receive complimentary registration for the 2022 CHES National Conference and complimentary membership for the remainder of the 2022-2023 membership year.
For nomination forms, terms of reference, criteria and past winners www.ches.org/About CHES/Awards Send nominations to: CHES National Office email@example.com Fax: 613-531-0626
GOING GREEN IN HEALTHCARE
Report reveals leadership key to implementation of sustainable initiatives By Krishna Akella
ealthcare is a fundamental societal service. And while delivering compassionate care is the prime mission, doing no harm to the planet is equally important. But as hospitals provide health services 24-7, they consume copious amounts of products and natural resources. Thankfully, with innovative strides in healthcare technology and a growing awareness of environmentally responsible practices, there is ample opportunity to reduce the health sector’s ecological footprint. For the past eight years, the Canadian Coalition for Green Health Care has hosted a free national environmental performance benchmarking program for hospitals called the Green Hospital Scorecard (GHS). Participants are evaluated on their environmental performance across multiple categories like leadership, energy, water, waste, pollution prevention and energy behaviour. Recently, 10 newly-revealed trends based on the GHS data were identified. While more hospitals are gaining awareness of the need for environmentally sustainable health systems, the trends indicate there is still much room for improvement. Leadership, for instance, plays a key role in driving organizations forward; the GHS gauges their commitment to environmental sustainability. Data revealed that, on average, less than 50 per cent of participants had a dedicated budget for staff engagement and outreach programming in areas such as energy conservation, water conservation and waste management. Moreover, only 56 per cent had a dedicated green team on-site. While these engagement values are an improvement over the previous GHS, there is a need for leadership to make a stronger commitment to supporting and promoting environmental sustainability in health service delivery.
30 CANADIAN HEALTHCARE FACILITIES
Results also point to a pronounced lack of improvement in waste intensity (WI) — a metric that captures a site’s waste generation as a function of its area. The average WI was computed to be 0.02 metric tonnes per square metre, which is a notable jump from the previous WI of 0.014 metric tonnes per square metre. Hospitals are generating more waste in relation to their size and it is only expected to increase given the tremendous amount of personal protective equipment waste being generated due to the COVID19 pandemic. Hospital leadership should invest in initiatives that address this increase in waste creation. In addition, two equally serious elements are pollution prevention and climate change, both of which are measured in the GHS survey. The former emphasizes the selection of less toxic and more environmentally preferred materials for use within hospitals. While half of survey respondents had a policy for environmentally preferable purchasing, only 20 per cent have actively implemented such a policy. As for climate change, just 23 per cent of GHS participants indicated that climate risks have been identified in specific policies at their site. This circles back to leadership, a role that holds great weight in determining a hospital’s approach to green-
ing healthcare and the degree to which they either embrace it or are allowed to embrace it. One of the first steps that hospitals can take to improve their environmental performance is to commit to scheduled tracking of their relevant data. This will allow for visual feedback on their performance, in addition to better facilitating a comparative data analysis with their peers. Having tangible data on-hand can catalyze leadership’s willingness to act, resulting in improvements over subsequent benchmarks. When there is a consistent commitment from leadership, hospitals tend to see better GHS scores and, more importantly, a continual improvement in their environmental performance. Furthermore, to educate participants on best practices, the annual GHS awards webinar includes presentations from winners on their latest projects and initiatives. This promotes a collaborative environment where participants can learn from each other and improve their overall environmental performance. Krishna Akella is manager of digital marketing and online programs for the Canadian Coalition for Green Health Care. He can be reached at firstname.lastname@example.org.
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