In a mission-critical environment like a hospital, every system that contributes to the environment of care must serve its purpose consistently and reliably. As automation and its integration increase, systems commissioning conducted during the construction process, and afterwards as appropriate, helps to ensure strong systems performance throughout the hospital's life cycle.

Commissioning building systems

The American National Standards Institute (ANSI) describes commissioning as “a quality-focused process for enhancing the delivery of a project. The process focuses on verifying and documenting that the facility and all of its systems and assemblies are planned, designed, installed, tested, and operated to meet the Owner's Project Requirements.”

The commissioning process is critical because no two buildings are the same. To ensure that systems perform as desired, review and optimization of the systems in the individual building is a very important step. For example, life safety systems, such as the fire alarm, need to be fully operational before a certificate of occupancy can be issued for a hospital. The commissioning process and documentation prove that such systems are operating properly.

In addition to confirming proper design, installation, and operation, commissioning proves its value when the time comes to expand the facility or add new systems. At some point in a hospital's life, new systems will be installed, either because of an expansion or simply because better technology is available that provides greater value. If a building was originally commissioned as a whole, there are baseline criteria for how its systems function. Having detailed commissioning documents from the original construction, including ongoing updates, gives the owner an excellent resource for developing future projects. Whoever is installing a new system can consult the commissioning documents to check whether the system will meld with existing equipment, saving time and money.

Ongoing commissioning of HVAC and mechanical systems is embraced by most building owners because it can help provide higher-performance buildings at lower cost. In general, operating costs for commissioned buildings are reported between 7 and 20% lower than those of a comparable noncommissioned building. More importantly, systems that operate as designed allow a hospital to better control the environment to keep its patients and staff comfortable.

Commissioning integrated systems

Commissioning is even more important as building, business, and clinical systems increasingly are becoming integrated in hospitals. With the proliferation of technology and the growing demand for data exchange across multiple systems, building systems are converging with information technology and clinical systems on standard platforms, applications, and infrastructures. For technically complex projects with a high degree of integration, commissioning becomes an important step for checking whether the integration is achieving the desired results. If an alert or alarm is supposed to be passed to a wireless device, for example, the commissioning process will verify whether the device receives the alarm and check that all appropriate recording is performed to enable root cause analysis.

The commissioning of integrated systems could require coordination among a number of technologies. The nurse call system, for instance, is a clinical system that is typically supported by biomedical engineering and will reside on the IT infrastructure, which then communicates to a wireless device. The commissioning process helps to define the sequence of operation and then tests and documents those sequences.

Often a system is selected to serve a single specific purpose, with little thought given to the impact it will, or could, have on other existing or future systems. For this reason, ideally, someone with the technical expertise and authority to make decisions will be involved early in the construction process to bring an enterprise-wide approach to selecting, installing, and commissioning technology.

A new children's hospital is an excellent example. The hospital has engaged Johnson Controls to serve as the single point of contact for the installation, integration, and commissioning of all low-voltage network and building systems to ensure appropriate collaboration, optimization of technologies, and efficient installation. As the technology contractor, Johnson Controls works directly with the hospital and design team to oversee the project from concept through construction, including the commissioning of more than 20 systems on the campus. Technology systems include a building management system, as well as fire and security, network, telecom, and data systems. A wireless infrastructure being installed will allow the hospital to operate multiple technologies on a single system, and an integration platform will provide connectivity for clinical and nonclinical applications to improve workflow, staff productivity, and patient care and safety. Systems commissioning will help check whether the systems, and their interactions made possible through integration, perform as they should.

For example, the nurse call system being installed is designed to communicate alarms and messages to the right person at the right time. The system is integrated with various wireless communication devices, such as wireless phones, pagers, nurse communication badges, and cell phones. To help confirm that the call system works properly, it will be checked thoroughly before it is approved for operation. It will be tested separately to see if it functions on its own, and then will be tested in conjunction with other systems to confirm that it is functioning as part of an integrated whole.

As another example, the children's hospital will add a Radio Frequency Locator System (RFLS), which will make it easier to determine where the patient is located in the hospital. The locators will also be placed on mobile hospital equipment to make it easier for staff to find equipment, since the ability to quickly locate mobile equipment can be a key issue in providing quality care.

The RFLS will work in conjunction with a closed-circuit television system. A nurse or other healthcare worker can track a patient or important piece of equipment and view a monitor that will show exactly where that patient or equipment is located. Again, the RFLS and the video monitoring system will be checked separately first to make sure that the equipment is working, and then together to confirm that they are functioning as part of the integrated whole.

The commissioning of the RFLS system will involve a sequence of operations outlining the steps for testing the integrations between the systems. Testing across the systems can show errors in the integration and any failures to communicate. Integration errors may, for example, prevent the closed-circuit cameras from responding to a piece of equipment moving to an area that it is not supposed to go, such as an exit. The commissioning process will verify that systems performance avoids such errors.


In a perfect world, a healthcare facility's design would be ideal, with every system installed properly and running flawlessly. Without going through a commissioning process checklist, however, the building could be turned over to the owner still in need of postconstruction work, costing a healthcare facility additional money and time to correct the problems of delaying occupancy. After proper focus is given to commissioning systems upfront, the hospital's focus can be turned to where it belongs: high-quality patient care. HD

Terry Hoffmann is the Director of Marketing—Building Information Systems, Johnson Controls.