When travelling in unfamiliar territory, it’s best to have a map in hand to guide you to your destination. The same holds true for hospital leadership when navigating a challenging economy and charting a course toward growth and development. Administrators have limited capital to invest in facilities, yet they face seemingly limitless requests for improvements. How do they decide where to allocate these finite resources to maintain, renovate, or rebuild existing structures? They need a roadmap for the future. In other words, they need to conduct a facilities assessment.

A facilities assessment is a process in which a team of experts evaluates a health system’s physical space based on a variety of predetermined criteria. The assessment produces a comprehensive report that includes information on the existing conditions of the buildings; mechanical, plumbing and electrical systems; code compliance; structural conditions; site and utility access; and future growth potential. This report serves as a guide that gives administrators the data they need to make the choices that will best benefit their institution in the future.

Why it matters
Updated and properly maintained healthcare facilities are crucial to safe and efficient patient care. It’s also critical that hospitals remain at the forefront of emerging technologies in every sector, from radiology to interior finishes to patient room comfort. Managing both of these priorities within a budget while preserving existing revenue streams is quite a balancing act.

Many institutions have deferred long-overdue improvements to their facilities while they wait for economic headwinds to shift. In that case, administrators confront a long list of necessary facilities improvements and updates, the scope of which far exceeds their resources, prompting them to decide which improvements to prioritize.

Additionally, many hospitals have evolved over the years as a series of additions and expansions. In some instances, older buildings have reached their effective service life. Rather than continue to pour capital into an outdated building that requires constant maintenance and renovation, it may be more efficient and ultimately more valuable for a healthcare system to demolish the building and start from scratch.

In today’s constantly changing economic and regulatory environment, these decisions need, now more than ever, to be informed with actual data. Knowing exactly what’s available and what condition it’s in will lead to more intelligent, successful decisions about facilities management and budget allocations.

Getting started
The first step to conducting a successful facilities assessment is determining what questions to ask. These pilot questions will govern the results, so consider exactly what information needs to be captured by the process. Here are a few examples:

  • What properties does the health system own? What is the physical condition of these properties, including the systems infrastructure?
  • Do these facilities meet the current guidelines for healthcare delivery, current codes, and clinical functionality for patients and staff? How do they compare to newer, recently constructed facilities in the system?
  • What is the total cost of the investments needed, including year-by-year escalation? Which investments are needed immediately, within five years, and in 10 years or longer? How can the costs best be distributed over a future period of five to 10 years?

The process
Typically, a facilities assessment is conducted by a team including the support services division, a project manager, an architect, several engineering firms familiar with the specific buildings, a structural engineer, a construction manager, and specific representatives from the facilities being assessed. Once the team has been assembled, hospital administrators should create a timeline for the assessment, and outline its goals.

Next, the team should establish criteria for the assessment, outlining exactly what elements of the facilities will be surveyed. This may include the cosmetic appearance of a suite, clinical functionality, code and ADA compliance, structural conditions, systems conditions, access to adequate parking, on-site space for future expansion, and access to swing space, should any of the projects be undertaken. The team should visit and survey every space, documenting its constraints according to a common scoring system.

At the same time, the engineering teams associated with the specific buildings should undertake a similar survey. Their task is to determine what the existing building systems are, what their life expectancy is, how critical the system is to the immediate function of the building, whether the system is the appropriate solution to the space, and how energy efficient the system is. Mechanical, electrical, and plumbing systems are huge consumers of a hospital’s capital energy budget allocation, and their efficiency is of the utmost importance. Hospitals run 24 hours a day, seven days a week— continuous operation needs to be highly efficient to be cost-effective.

In addition, the construction manager should conduct a cost estimate process for each of the recommendations, covering hard and soft costs, capital costs, equipment and infrastructure, and year-over-year project cost escalation. Realistically, not all of the recommended facilities updates can be completed in a single year; this cost estimation process helps to create a five-to-10-year plan that fits within a budget.

Results and lessons learned
When a facilities assessment is finished, hospital administrators are presented with a series of spreadsheets containing the data gathered by the team. Ideally, administrators can easily reconfigure the spreadsheets by campus, building, health system priority, or service line costs.

Armed with the facilities assessment reports, a health system can determine the best allocation of their resources by distinguishing between needs and wants within their institutions. Pressing questions can now be intelligently answered: whether to demolish or renovate an old building, for example, and which improvements are urgent priorities.

As they decide what updates to prioritize, administrators should also consider the impact a project will have on a functioning unit or facility. For example, if a new surgical pavilion can be completed without interruption to the existing surgical suite, no revenue will be lost. While renovating the same suite may cost less, it may also take operating rooms out of service during construction, resulting in lost revenue.

The assessment will also help administrators clearly outline the underlying costs for technological updates. For example, a common request is for a new or expanded surgical suite with state-of-the-art operating rooms and the latest digital integration systems. Oftentimes the existing mechanical or electrical infrastructure needs a major upgrade to support this renovation. The infrastructure may serve more than just the specifically impacted project area, so it’s considered an infrastructure upgrade rather than a clinical upgrade, and as a result the associated costs can be very unbalanced. The infrastructure upgrade could consume between 30-45 percent of the project budget, leaving fewer financial resources for the actual clinical objective. Delineating the allocation of expenditures clearly in a facilities assessment report can help create an understanding with clinical staff leaders.

The findings of the report also shine a spotlight on deficiencies that need to be addressed immediately, sometimes before other clinical investments can be made. The documents serve as a roadmap to the future for many hospitals and healthcare institutions, allowing them to plan specific improvements for each fiscal year, replace older systems before failure, or save money in the long-term by investin
g now in newer, more efficient facilities. In this today’s challenging economic climate, it pays dividends to know the condition of what you own, before you commit the capital.

 

Aran A. McCarthy, AIA, NCARB, is principal, healthcare, at architecture firm Francis Cauffman (Philadelphia). He can be reached at amccarthy@franciscauffman.com.

Francis Cauffman’s Aran McCarthy discussed the topic of facility assessments during a recent Healthcare Design webinar. To read more about the event, see “Facility Assessments In The Age Of Consolidation” at www.healthcaredesignmagazine.com/facility-assessments.