3  FM quick reads on healthcare facilities

1. Strategic Perspective Guides Healthcare Facility Investment Decisions


Today's tip from Building Operating Management: A strategic perspective guides healthcare facility investment decisions at Crozer-Keystone Health System.

Crozer-Keystone is the dominant health care provider in Delaware County, just to the west of Philadelphia. Anchored by five main hospital complexes in a roughly 30-mile circuit, the system also has an ever-growing number of satellite facilities throughout the county, including more than 600,000 square feet of physician office space.

The push for innovation and efficiency in health care delivery models at Crozer-Keystone is systemic, from the medical staff's efforts at infection control to the way patient medical records are handled. And, with Brian Crimmins, vice president, facilities planning and development, at the helm, the system's facilities have played a big role.

One key is developing a strategy to deal with increasing square footage despite limited budgets. Crimmins has a seat on the hospital's capital allocations committee, where he tries to be impartial and has to make decisions that might not always be popular with his team.

Though he's the one to have to make the tough calls, Crimmins' approach is not top-down, viewing his role less as director and more as collaborator with his team.

"I try to get them to understand the priorities of the health system," Crimmins says. "They have to take ownership in their own hospital or building, but at the end of the day they have to understand that we're going to move in the direction that is in the best interest of the health system and not of the individual facility."

For example, the main data room for the health system has been maxed out in terms of the amount of power and emergency power its facility can deliver to it. So a secondary data room is being built out to relieve the pressure and create some redundancy. "Spending the money to build that data room I'm sure raised some eyebrows with some people," says Crimmins. There's always the need for capital in a hundred different directions: new patient care equipment, new roofs, etc. The new data room will be in a more remote location, isolated from where most of the hospital would see it. But it's Crimmins' job to understand the need where others don't. "With everything becoming more and more computerized, should (the data center) have a problem, it really cripples the whole system," he says.


2.  Challenges Face Healthcare Facilities Located Off Hospital Campus

Today's tip from Building Operating Management: Challenges face healthcare facilities located off hospital campus. Once you move off the known world of the hospital campus, everything from code compliance to management strategies becomes a learning opportunity.

Over the last five years, four sleep centers have been added to the Crozer-Keyston Health System. There's a 60,000-square-foot building built almost four years ago where Crozer-Keystone holds the master lease. Immediately adjacent is another 60,000-square-foot building — the master lease of which is also held by the organization — that is being built out to house a cancer center.

"We're in the process of building a linear accelerator and a medical oncology suite in an office building that we don't own," says Brian Crimmins, vice president, facilities planning and development, Crozer-Keystone Health System in Pennsylvania. "These are things the typical office building is never involved with."

The linear accelerator, for example, sits just outside the main building envelope. It requires a vault with 5-foot thick concrete walls. The facility will require specialized HVAC and emergency power, significantly beyond that required by a typical office building.

As well, even though you can take a service out of a hospital, you can't take the regulations and level of review out of the facility housing the service. Not only will there be a cancer center in the new building, but also a gastrointestinal lab. Though it is only 4,000 square feet, the lab triggers Pennsylvania Department of Health regulatory review, which was an unexpected turn due to recent changes in what classifies as ambulatory versus business occupancy. In any situation where even one patient is incapable of self-preservation (basically whenever an anesthetic agent is being used), the facility is classified ambulatory and a whole different level of review, which was totally foreign to the developer, comes to bear. Alterations to the base building had to be made because of different fire ratings required, and fire system and emergency power testing frequencies and procedures are stepped up.

"It adds some complexities to the construction process when we're off the campus," Crimmins says. "With the hospital, you know what you're dealing with. But you get out into these communities, and it's a whole new ballgame for everyone."

3.  Changes In Health Care Bring Leaner Facility Staffs

Changes in health care bring the challenge of leaner facility staffs. That means doing more with less.

At Crozer-Keystone Health System in Pennsylvania, Brian Crimmins, vice president, facilities planning and development at operates with a lean team. There are three facilities directors over the five hospitals and 40 satellite facilities. There is also a director of real estate and a team of five in property managers that report back to Crimmins.

"For the most part, we all wear several different hats," says Anthony Salvatore, director of facilities services at Taylor Hospital and Springfield Hospital. Twenty years ago, there might have been a director each for facilities, environmental services, and safety and security. Not anymore. It's harder because there's more work. But, he concedes, "it's easier in that you can't have a disagreement between three different departments if one person is running the three different departments. There's more directed vision. You see it one way."

As services move out from the centralized hospital campus to smaller, often less complicated, facilities in the community, it creates more moving parts for Crimmins' team to track and dilutes available resources for operations and management. Recently, on a committee related to Joint Commission standards, all of the off-campus sites and who is doing what were put on one spreadsheet, which was an eye-opening experience. "It's no longer one hospital and you know what you have. We've got stuff all over the place now," Crimmins says. And with 40 and growing off-campus sites, the trick is to know who is responsible for what, especially when the Joint Commission or the Department of Health comes calling.

The number of off-campus sites presents a sheer physical logistics challenge. Currently, the set up is that each hospital's director is also responsible for the sites generally in the hospital's geographic area. For example, Salvatore has eight in his zone. "It's a challenge to give them the time and energy they deserve," he says.

When Crimmins looks to the next five to 10 years, he sees a continuation of tuning the health care facilities portfolio to meet the needs of the customers. As inpatient numbers continue to fall at the hospitals, some of the spaces might be converted to outpatient purposes. Some of the smaller ambulatory sites will be consolidated into larger sites, where you can get more critical mass and gain some staffing and operations efficiencies.

"It all goes towards finding the most cost-effective way to deliver the highest quality of care," he says.


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