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Brought to You by |
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Corporate Realty, Design & Management Institute
Health Care Institute of IFMA |
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Industry Partners |
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-Accurate Lock & Hardware
-Array Advisors
-Cambridge Sound Management
-Carpenter
Contractor Alliance of New York
-GPI-Firestop
-Jack L. Gordon Architects
-Jensen Hughes
-Koffel Associates
-LF Driscoll Healthcare
-The Mohawk Group
-Revista
-Schneider
Electric
-Specified Technologies
-Steelcase Health
-Tremco
-Turner |
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Education Partners |
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Attendee Comments |
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"Mr.
Huang's presentation"
"Varied topics"
"The technology presentation"
"The auditorium was comfortable and good acoustics. Could hear all
speakers very clearly"
"The talks were well thought out and structured in a way that told a
narrative about healthcare today"
"The NY real estate market panel"
"Networking"
"The moderator moved the program so that it did not get boring"
"Getting to know the trends in the healthcare sector"
"The water management team provided great information"
"I like the Water Safety Management section. It was fun but constructive
advice"
"Location"
"Second half more applicable to today’s market"
"NY real estate info, new technology info, new trends"
"Tool Tactics Tech"
"Good format and information"
"Variety of presentations"
"Variation of topics and expertise of presenters"
"I attended for the compliance topics"
"Location"
"Topics were varied….all in all, the Summit was good"
"Diverse content and perspective"
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Takeaway Messages
September 17,
New York,
NY
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Reported by Theresa Walsh Giarrusso, a
freelance writer and contributing editor to The McMorrow Reports
for Facilities Design and Management (www.mcmorrowreports.com)
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Where’s The Money Coming From? |
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Kevin
Holloran,
Senior
Director/
Sector
Leader
Not
For
Profit
Hospital
and
Healthcare
Group,
Fitch
Ratings
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George
Huang,
Director,
Wells
Fargo
Securities |
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The good: Credit strength, particularly as measured by
absolute levels of cash, is as high or higher than before
the Great Recession. There are multiple funding sources in
deals today, including cash/cash flow, philanthropy and
borrowing.
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The bad: Softening operations result in weaker cash flow,
meaning capital spending has to be very selective.
Competition has never been more intense due to
mergers/acquisitions.
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The uncertain: Nontraditional competitors are moving into
the sector, regulatory uncertainty abounds, and there’s a
continuing shift from volume to value.
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ACA repeal and replace efforts were disruptive to strategic
planning, so its failure is largely a positive for the
sector.
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Latest Trends & Most
Challenging Changes in Regulatory Areas |
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Tips for The Joint Commission survey
success:
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Organize testing document binder
in the same order as checklist.
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Close all open issues and place
work orders right behind the report.
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Schedule 1 fire drill per shift
per quarter. It should be three months plus or
minus 10 days, and must be more than an hour
apart. (Best Practice: Vary days)
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Place central station and FDC
checks on fire drill form; this saves time and
money and eliminates missed annual and quarterly
requirements.
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Ligature risk has become a major
emphasis for The Joint Commission in the last year.
Bernstein explained via email why: “A facility was
surveyed [first quarter 2017[, it had ligature risks
identified during survey, and before they could be
mitigated they experience two suicides.”
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The VA has good guidelines for
behavioral health. Look to them for guidance.
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Michael S. Bernstein, MSE, MBA, PE, CCE, CHFM-Life
Safety Code Surveyor, The Joint Commission |
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Assessment Tools that Better
Prepare You for a Surge Emergency |
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Surge emergencies are on the
forefront of emergency planning right now. Medical
surge describes the ability to provide adequate
medical evaluation and care during events that
exceed the limits of the normal medical
infrastructure of an affected community.
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Key considerations around medical
surge capacity include: space, continuity of care,
infection control and prevention, life safety,
staff/personnel issues, staff-to-patient ratios,
lean healthcare, staff recall and emergency
credential and privileging, supply issues (including
supply chain), 96-hour assessment, medical gas
support, supplies, food, water, linen, etc.
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There are 1,135 waivers that can
allow you to go outside the rules but you must have
the waivers.
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Be advised there are companies with
software and dashboards that can help you analyze
and plan your surge capacity/capability.
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Nick
Gabriele, Vice President, RPA Jensen Hughes Co. |
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Don’t Sabotage Your Water
Safety Management Efforts |
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David
M.
Dziewulski,
Ph.D.,
Chief,
Water
Systems
Control
&
Analysis,
New
York
State
Department
of
Health |
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Girlie
Manatad,
Manager,
EC
Compliance,
New
York
Presbyterian |
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Aaron
Rosenblatt,
Principal,
Gordon
&
Rosenblatt |
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Your water testing plan needs to tell you “when your system is out of whack,” Dziewulski says. “Look at your water temperatures, both cold and hot. Where is your weak spot? Where is the hottest cold and the coldest hot? Those tepid spots are where Legionella will form. “
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FMs will need buy-in from senior management to solve water problems, and that requires digging into the problem. “You have to examine ‘why did we have a positive result? What’s going on in the building that’s the root cause?’” Manatad said.
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Don’t just file reports; work with your treatment vendor to act on testing results.
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“One of the things that created this problem in the first place was the whole idea of going with the low-cost bidder for cooling towers,” Rosenblatt said. “People don’t look for the cheapest surgeon, and FMs shouldn’t look for the cheapest way to protect their tower.”
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The water management plan on the CDC website is ASHRAE 188 for dummies.
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Design, Operations &
Compliance Q&A: Ask the Experts in Trenches |
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(left to right) Reed
Salvatore, CEO, Accurate Lock & Hardware Co.; Sukhjit Tom
Singh, Field Director, Environment of Care Compliance, New
York -Presbyterian Hospital; Michael Bernstein, The Joint
Commission; Jared Shapiro, Director Environmental Health
and Safety, Montefiore Health System |
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Pay attention to the design guides. When they have notations
there’s a reason. See if it’s a tradeoff you can make.
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Speak to people using the products on a daily basis.
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Don’t confuse value and price when it comes to
ligature-resistant products. Make sure you’re picking
products that are durable and do what they are supposed to
do.
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You can’t use spreadsheets and binders to manage hundreds of
thousands of doors. You must use IT when you are managing a
large system.
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Investing in technology goes a long way to help facility
managers know what is in their inventory.
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After major construction, we can come in and help with the
commissioning process. We’ve done several surveys where
there were the wrong doors in multiple places, says
Bernstein.
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Avoiding the Punch List
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Ken
Rein,
Cambridge
Sound
Management |
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Mark
Izsa,
Specified
Technologies
Inc. |
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Justin
Frye,
Tremco
Roofing
&
Maintenance
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The registration areas and nurse stations are critical areas
for sound masking because people are telling their life
stories and everybody in the room can hear. With the right
sound masking, it’s possible to get 50 feet of disturbance
down to 15 feet.
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A good barrier management program and above ceiling permit
program go a long way to reducing punch lists.
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Make sure your fire stop manufacturer is signing out. Have
one key person who is responsible for barrier management and
one key person issue for the above ceiling permit.
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You don’t get what you expect, you get what you inspect.
Hire a registered roof observer to watch this installation.
Do not choose someone tied to the sale.
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Purpose-Driven Maintenance:
Getting More Done with Less |
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Macro trends show us that medical
facilities have three times the amount of work than
people to manage and maintain it. However, they are
not hiring more staff and experienced people are
retiring. So, you have to leverage technology and
analytics.
-
Analytics can aid in the commission
process. It gives the ability to navigate punch list
items faster and transition to owners more quickly.
It proves the system is operating right and can be
handed over. It Informs customers of possible
warranty issues before warranty expires.
-
Improve team competency: Traditional
maintenance approaches are reactive. Analytics allow
you to pinpoint anomalies today to resolve before
something goes wrong.
-
Prioritize work based on analytical
findings: Rather than having contractors trying to
figure out why something is happening, let the
system tell you.
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Andrew
Tanskey, Regional Service Manager, Schneider
Electric |
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Technology Advancements that
Elevate Training of Healthcare Professionals |
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James Cypert, Director
Interprofessional Education Simulation Center,
D’Youville College, Buffalo |
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Tracy Nichols, Regional
Healthcare Manager, Steelcase |
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Alfred Ojukwu,
Northeast Healthcare Specialist, Microsoft |
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Elke Merz,
Architectural Specialist, Steelcase |
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Steelcase, Microsoft, and D’Youville College partnered to
create a simulation space to train doctors. One of the
leading causes of death is preventable medical errors, and
they believe these simulations can help prevent those errors.
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Through Surface Hub, students can simulate medical
procedures. Sessions are recorded so students can spend time
with a facilitator to discuss what happened: emotions,
mistakes, how they could do better, what they did great, and
how it can be reinforced. On the fly, the team can mark the
video and debrief.
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A four-camera view of the healthcare environment is possible
with Surface Hub. It can look like surgery, an office for a
dietician, a PT environment, and more. The walls are
magnetized and have slots that allow users to completely
change out the environment and hang cameras anywhere.
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Among many other things, physicians can use the Surface Hub
for conference Skype calls, to work with teams with
wide-angle HC cameras and displays, to connect with patients
who are miles away, to take notes on patients and have that
sessions data wiped after the meeting ends.
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Future of New York’s
Healthcare Real Estate Market |
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(left
to
right)
Mike
Hargrave,
Principal,
Revista;
Steve
Leathers,
Managing
Director,
Capital
Markets
JLL;
John
Winer,
Sr.,
Managing
Director
&
Chief
Investment
Officer,
Seavest
Healthcare
Properties |
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MOB + Hospital market now totals 37,680 buildings, 2.9
billion square feet with a value exceeding $1 trillion.
-
Hargrave said the buyer landscape is changing to more
investor/private and hospital and health systems owners
instead of REITs (REIT investors dropped from 42 percent in
2017 to 8 percent in 2018). The REITs’ cost of capital has
gone up. Private equity firms that had money sitting on the
sidelines have been waiting for this opportunity, and now
private investors are the big players.
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Most active MOB construction markets: 1. New
York-Newark-Jersey City, 2 Atlanta-Sandy Springs-Roswell,
GA, 3. Chicago-Naperville-Elgin, IL-IN-WI.
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“Medical facilities are not necessarily in the center of
town,” Leathers said. “For most of these suburban locations,
you have the tenant in tow. Seldom do they kick off a
project without a tenant. That’s why vacancy rate is very
flat.”
-
“I would argue that in our space right now, there are no
spec facilities,” Winer said.
-
“You’re going to see home healthcare continue to grow.
Procedures will move out of outpatient and into the home.
It’s coming and we’re seeing the tip of the iceberg,” Winer
said.
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Building the Next Generation
of Outpatient Care Facilities |
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Christopher
Zelisko,
Principal,
Jack
L.
Gordon
Architects
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Richard
Alvarez,
VP &
Construction
Executive,
Turner
Construction |
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-
There are pressures from mergers and acquisition to push
your presence further out. Many health systems now do it by
building smaller facilities just to have a presence in the
community.
-
Doing test-fits for clients as they scout new locations is
an efficient way to help evaluate compatibility with needs,
before a long-term commitment is made.
-
When a clinician team wants to replicate what they did
before, they can get to market faster by using prefab walls
with all the amenities. “We have prefab bathroom pods,
prefab corridors, or prefab mechanical rooms. Those are not
seen heavily in the city yet,” Alvarez said. “You can also
speed up your schedule by simulating the buildout by using
cardboard mockups. With mockups, surgeons and other
end-users can come in and tweak it to avoid pitfalls showing
up after construction.”
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Tools, Tactics, and
Technologies to Reduce Renovation Project Timelines |
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Michael
Reilly
Jr.,
Project
Manager,
Facilities
Design
&
Construction,
New
York
-
Presbyterian
Hospital |
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John
Haught,
Project
Executive,
LF
Driscoll
Healthcare
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To reduce construction time on a new inpatient renovation,
“We frontloaded before we even took over the space. By
scanning ahead of time, while the floor was still occupied,
popping ceiling tiles and scanning for early coordination
drawings, we cut 12 weeks out of the schedule,” Reilly said.
-
“We brought everybody to the table before we got the space,”
Reilly said. “Engineers and subs and I … we’re all in a
room, that way we were releasing the sheet metal drawings as
we progressed through the space. Decisions were made at the
time, cutting out idle review process that takes weeks.”
-
Mockups can help prepare adjacent users for what they can
expect during construction. “How loud is a jackhammer going
to be at 2 a.m.? Sometimes you have to go back to the
drawing board. For one job, they were allowed to jackhammer
for 15 minutes and then had to stop for 45 minutes, but the
nurses and doctors knew it was coming up and then would let
up,” Haught said.
-
We do baseline particulate counts ahead of time. “Often our
area is cleaner than [what’s] around us,” Haught said. “I
don’t think many people know their baselines.”
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