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Rx for Growing Pains
Maintenance departments in a variety of urban facilities face similar challenges related to constant construction, space limitations and aging buildings. The maintenance department at Boston Medical Center (BMC), a non-profit urban hospital in Boston’s historic South End, has sought to overcome these challenges by combining new technology with resourcefulness.
The center “gets harder use as a result of being an urban hospital,” says Thomas Tribble, BMC’s director of facilities. It must meets the demands of serving a growing population by renovating existing buildings while helping with new construction.
“At any given time, the hospital has between 50 and 100 renovation and expansion projects under way,” Tribble says.
The 547-bed teaching hospital’s campus is comprised of 19 buildings containing 2 million square feet in only a quarter-mile radius. The center include inpatient and outpatient facilities, office buildings, and a power plant, and building ages range from 148 years to under construction.
Old Buildings, New Challenges
“The age of the buildings is a critical challenge,” says Roger Risoldi, BMC’s operations manager who oversees the maintenance department. “Some of the buildings were built in the early 1900s, and the original heating and cooling systems in these buildings were not designed to meet the demands of today.”
Tribble, who also provides engineering support for BMC’s design and construction department, says some of the older buildings have undergone significant renovations to maintain an environment that meets the expectations of the organization’s staff and patients.
For example, the building on East Concord Street that once housed the maternity ward was designed with large open spaces in the interior, Risoldi says. The building was renovated into offices.
“We had to rearrange the electrical and ventilation systems because they weren’t designed for offices,” Risoldi says. “We modified the existing heating and ventilation system and new duct work was installed to direct air into each room.”
The department is careful to preserve the original architecture on the building on East Concord Street. As part of the preservation effort, workers rebuilt the facility’s balcony and made slight modifications to windows, installing frosted glass but maintaining the original designs.
BMC’s original surgical building — constructed in the late 1930s and now home to administrative offices, also has undergone major renovations. The building, which once belonged to the City of Boston, was vacant for 20 years. But when it became part of BMC in 1996, the organization decided to renovate the facility.
“When the surgical building was constructed, the ventilation system consisted of radiators and open windows,” Tribble says. “Those were the building standards of the time.
“As ventilation systems evolved and became commonplace, people’s expectations changed and we had to retrofit the building with a new ventilation system,” Tribble says.
“We also had to beef up the electrical systems,” he says. “When the buildings were constructed, the staff’s electrical needs were not as great as today. There were fewer lights and fewer outlets. Now everyone has a computer, and electrical demands have risen significantly.”
Finding solutions to space constrictions is another major challenge for BMC.
“Everyday, we are dealing with 10 to 20 space-related challenges,” Tribble says. “Some of these situations cover one or two offices, while others cover several thousand square feet.
“We have a director of design and construction on board who is in charge of finding solutions to overcome space challenges. The maintenance department’s role varies from project to project, depending upon the scope and complexity of the plan and the needs of our design and construction department.”
Risoldi, who serves as project manager on renovation and construction projects, adds, “We’re always looking for space. Sometimes we have to work in very confined spaces.
“When many of the older buildings were built, they built the rooms around the equipment. They didn’t plan ahead for equipment replacements. So now, when a piece of equipment needs to be removed in one of these areas, finding a way to get it out can be difficult.
“In some cases we had to take down a wall to reach a piece of equipment and put it back up after the work was completed. This was the case during a chiller replacement. The chiller was inside a machine room that had a doorway smaller than the size of the chiller.”
Shrinking Land, Sharing Space
While retrofitting and renovating poses many challenges for BMC, constructing new buildings is becoming a bigger challenge as land available for new facilities is steadily shrinking in the congestion of urban Boston. New-construction projects have to satisfy critical needs, Tribble says. For example, BMC is planning construction for a new 133,000-foot ambulatory care center.
In addition, other local organizations share BMC’s site and contribute to the space crunch. BMC shares its campus, and even some buildings, with Boston University, the Boston Public Health Commission, Massachusetts’ Department of Mental Health and, soon, a U.S. National Institute of Health biocontainment lab.
The organizations don’t necessarily share maintenance priorities, which can complicate short-and long-term projects.
“Each organization has its own maintenance employees,” Risoldi says. “The organization that owns the building is responsible for the facility’s mechanical systems including the HVAC equipment, boilers and the roof. The occupant who doesn’t own the building is responsible for maintaining the space they occupy.
“For example, BMC occupies an area on the seventh floor of the Evans building, a building owned by Boston University. If we want to paint a room or add shelving, we would be responsible for those work orders.”
Turning to Technology
In trying to clear the hurdles of maintaining an urban hospital, BMC’s maintenance department increasingly relies on technology, such as the implementation of a Web-based CMMS. Tribble says the system, which went into use a year and a half ago, has helped the department improve its record-keeping and work efficiency.
“When we were considering different systems, there were basically two task areas that we wanted the new system to achieve,” Tribble says. The department needed a CMMS that could track its equipment and routine maintenance schedule. It also needed to make the staff-request process more efficient, he says.
The previous CMMS required building occupants to submit work orders to an individual in the maintenance department. Then department personnel had to enter it into the CMMS system.
“We were completing approximately 3,000 work requests a month,” Tribble says, adding that it became obvious the department needed to update its CMMS.
“The new system allows building occupants to submit work requests from any computer,” Risoldi says. Anyone with a request submits it through the Web site, using a cost-center code to allow tracking.
“The work order is then generated in the maintenance department’s control center, the nucleus of BMC’s security and maintenance departments,” Risoldi says, adding that individuals can go to the site and check on the status of their request at any time. Senders automatically receive an e-mail notifying them when the job has been completed.
“The CMMS has been great in helping us get a clear picture of the work the maintenance department is doing,” Risoldi says. “We can generate reports that only show projects completed at a particular building, or lists requests from a particular sender.
“I can see us using the system to justify staffing,” Risoldi says, adding that documents showing a workload increase would provide the maintenance department a case for hiring additional employees.
The CMMS is just one way the maintenance department is using technology to enhance efficiency. The department recently created floor plans that highlight pieces of equipment throughout its facilities.
“We used AutoCAD digital images to produce books that show the location and pictures of the valves,” Risoldi says, adding that the department soon will create similar books showing the organization’s sprinkler system and the location of its critical valves.
“The plans help us quickly locate valves,” Risoldi says. The reference books are especially helpful for new staff and in emergency situations when the maintenance crew needs to act fast.
The department has also turned to advances in lighting technology to control rising utility costs by undertaking an energy-conservation program.
“We replaced all the light bulbs with energy-efficient bulbs, added LED exit signs, put in new energy-conserving water fixtures, and installed motion sensors in many of the rooms,” Risoldi says. “We also are purchasing energy-efficient motors and converting to variable-speed drives on our air handlers.”
Tribble says it’s not just the technology that has led to the maintenance department’s success, but also the staff’s willingness to embrace it.
“BMC is open to technology and embraces it when and where it offers advantages to the institution,” Tribble says. “But to the extent that we have gained efficiency, it is not so much due to technology, but to the flexibility of our personnel to use it, in their initiative to find it and then work together to mutually support it, each other, and the hospital,” Tribble says.
Making the Most of a Merger
Boston Medical Center (BMC) was formed in 1996 with the merger of Boston University Hospital and Boston City Hospital. As a result of the merger, two maintenance departments joined forces. As is the case in many similar situations, the two groups struggled with a range of issues, including salary levels, work methods and coping with change in general.
“The merger didn’t go over very well at first,” says Roger Risoldi, BMC’s operations manager. “There was a lot of dissension at the first meetings.
“Each department had its own way of doing things and own work habits,” Risoldi says. “For example, at one of the hospitals, the maintenance department secretary wrote down all of the work orders by hand. The other hospital had a control center that dispatched computerized work orders. Once we merged, the nucleus of the department became the control center.”
Each hospital also had a different union and pay scale.
“The lesser-paid employees were given pay increases to match the higher-paid workers’ compensation,” he says.
He offers one insight for others in this situation.
“The biggest advice I can offer organizations going through a merger is to get everyone together and talk about the issues,” he says. “Not everyone will be happy with the changes, but communication is the key to bridging an understanding.”
— Renee Gryzkewicz