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Tales from the front: Your peers speak

How lucky would we be if we had a crystal ball at our disposal? We asked several of your industry colleagues to peer into the future of HFM and offer their thoughts, as well as their insight into the year passed and some of the trends and themes they observed. Thanks to each for their input this busy season.

 

Paul DeViller, Director of Support Services, Engineering & Maintenance, Lahey Medical Center, Peabody, MA

 Industry concerns  

* As an industry we need to do a better job of attracting and retaining new talent to the field.  

* With more and more healthcare organizations finding themselves under tremendous financial strains it is becoming harder to get funding for continuing education. The positive financial impact of an organizations ability to correctly apply codes cannot be overstated. 

2017 issues  

* While CMS’s adoption of the 2012 edition of the Life Safety Code has eased up on some of the regulations, it has also added a host of new regulations that can add substantial cost to the organization’s bottom line.  

* Staying ahead of the code changes and being able to communicate the changes to hospital leadership, with cost implications, can be challenging, but is imperative to the financial success of the organization. 

 

__________

 

Jeffrey Gustafson, Director of Facilities, Saint Alexius Medical Center, Bismarck, ND  

 2017 trends 

* More mergers, acquisitions, and implementing leaner staffing models

 2017 issues 

* Maintaining quality and customer satisfaction with fewer people

2018 predictions 

* More fine tuning and more outsourcing

Future opportunities in facilities 

* Increase in outpatient clinics, continue to decrease patient stay times 

Industry concerns 

* The squeeze between reimbursement and payer expectations

 

__________

 

Scott Aronson, Director of Strategy and Business Development , Healthcare, RPA, a Jensen Hughes Company, Fairport, NY 

* With the enforcement of the new CMS Emergency Preparedness Rule (November 15, 2017 compliance date), there will be a key focus on the ability for hospitals and nursing homes to protect the patients when on Emergency Power Systems.  A primary concern is around temperature control (heating/cooling) in adverse conditions and the fact that a substantial portion of the healthcare industry is unable to “chill” their building in high heat situations.  

Primary and alternate strategies will be discussed during CMS/accreditation surveys for patient safety with an emphasis on what the threshold is for decisions to partially or fully evacuate the healthcare facility.  This affects both evacuation planning and surge capacity strategies (when taking a large influx of patients from another healthcare facility or the community).  

 

__________

 

Peter R. Girard, Facility Manager, Dartmouth-Hitchcock, Manchester, NH    

* One of the big problems we are currently working on in good majority of our buildings is sound masking. With space constraints in our industry we are seeing an increase in sound masking needs for our patient confidentiality. This is something that needs to be addressed in any renovation work and has been a growing problem noticed throughout the healthcare community.

Sound masking wasn’t something that was considered in the past, especially in the clinical environment, where a majority of the buildings are built to business occupancy codes.

 

__________

 

Edmund Lydon, Director of Support Services, Beverly Hospital – A member of Lahey Health, Beverly, MA 

* Increasingly Facility Mangers and leaders, in general, are being asked to become more strategic in their approach to evaluating existing / new products and services. As integrated healthcare systems continue to evolve, the facility manager should always be asking, is there opportunity to bundle purchases within the healthcare system to drive price down? The days of operating independently are not strategic.   

* Budgets are fluid and margins are rigid. Adjustments will need to occur monthly based on financial data to ensure all cost delivering patient care and supporting the care environment are appropriately in line with reimbursement. This includes capital budgeted projects being placed on hold or reprioritized.   Learn to speak and work within the executive ranks by becoming data and outcome driven.  

* I am a firm believer Healthcare Facility Managers today need to be fully committed to educating oneself on the constant barrage of code, standards, and technology changes to be successful in the profession. Survival is the lifelong learner because the status quo will stymie supporting the care environment.  My advice to all Healthcare Facility Managers is to leverage your local trade society and ASHE to meet your professional needs. 

 

__________

 

Clay Ciolek, Manager-Engineering Systems, MultiCare Health System, Tacoma, WA

2017 trends

* Healthcare continues to shift and be delivered at the retail level in terms of capital and operations: walk-in clinics, stand alone ED’s, ambulatory surgery centers, and joint ventures.

* There is a premium on speed to market share, looking for quick delivery of presence.

2017 issues

* Required compliance rigor while under resourced from a personnel level 

2018 predictions

* More healthcare organizations requiring deemed status from CMS will move away from the Joint Commission to other accreditation organizations. 

* Successful Design-Build and Integrated Project Delivery methods reduces need of third party project management layer. 

Future opportunities in facilities

* Design/Architectural firms attesting they can deliver on healthcare need to take the quality of delivery to a new level. 

* Hospital systems (multiple site presence) utilizing tactical teams for a) compliance audits & readiness and b) targeted deficiency corrections.  Corporate level approach to drive consistency and best practices.

 Industry concerns

* Lacking facility management and technician bench depth leads to outsourcing without effectual succession planning.

* Growth and competing hospital interests/functions are diluting Facility/Engineering core responsibilities.  ·  

 

__________

 

Jeff Probst, Director, Facilities Services, Mercy Hospital Oklahoma City, Oklahoma City, OK 

2017 trends 

* Increased use of technology in all areas of facilities: CMMS, smart equipment, and building design (BIM and portable technology.)  I have heard many suppliers talking about tying in all equipment.

2017 issues 

* CMS adoption of the 2012 LSC increased focus on fire doors, now all hospitals have to have an inventory and an annual inspection.  There were many vendors stating they were the “only approved and certified ones” but that is not what the LSC code states.  Properly trained internal technicians can do the work.

* Water Quality Management, much like fire doors, and new regulations from CMS that went into effect July 2017.  The intent was to reduce risk caused by legionella but there are so many vendors out there selling products and programs you don’t need.

2018 predictions 

* Growth in healthcare facilities means expanded responsibilities for leaders, while facilities do more with less as the organization grows rapidly.

Industry concerns

* Shortage of new technicians wanting to enter our field: It is not as cool as a desk job or working behind a screen.  Positions are hard to fill and qualified candidates are few and far between.  Commercial trades pay better than hospitals. 

* Succession planning for leaders: We still struggle as an industry with that issue and it leads to unfilled openings in locations that are difficult to attract professionals.

 

__________

 

(Shay) R. Rankhorn, Jr, Multi Facilities Director Engineering Services, Mountain States Health Alliance, Johnson City, TN 

2017 trends 

* Facilities management related compliance is taking a larger portion of our time. Even smaller healthcare companies are now creating not only corporate but facility positions just to manage this area. Consolidation of healthcare organizations combined with changing healthcare delivery models result in the need for FMs who can quickly adapt and change to address new leadership and new healthcare models. Many FMs are moving from managers to senior level and in some cases executive level positions in order to address the fast paced changes. Those who cannot adapt are being replaced with leadership with little to no understanding of the trades and compliance issues.

2017 issues 

* 2017 was a big year for meeting the challenges of incorporating CMS and TJC adoption of newer (2012) NFPA standards. The total scope of this undertaking is still emerging. Both FM and trade specific staff retiring has created not only a labor force gap, but a skill-set gap as well. 

2018 predictions

* Regulatory compliance will continue to grow in scope and time involvement with more new standards being adopted. Staffing retention and replacement will move into one of the top 3 concerns to address. Creative means to successfully solve this will need to be determined and implemented. One facility has gone to flexible hours instead of set work schedules in order to attract and retain millennials.

Future opportunities in facilities 

* The real issue is that so few college graduates or college age adults are even aware of the great opportunities that exist in all areas of facilities management.

Industry concerns 

* They used to be shrinking budgets and growing responsibilities. (More with less) While that trend continues, the biggest concern now is how to find, hire, and retain replacement staff and facility managers. This is true not just in healthcare but in the trades. One mechanical contractor I spoke with has given three >$1.00 raises across the board this year and they are still losing staff to higher wages. Every contractor I talk to says they cannot find trades people to hire. I interviewed a CEO of one of the largest construction firms in the US said they cannot hire experienced project managers and superintendents. The retirees are refusing to come back in (even at exorbitant wages) to train their replacements.

 

_________

 

Robert L.  Hacker, Executive Director, Plant Operations and Engineering Services, Cedars Sinai-Medical Center, LA, CA 

 Industry concerns

* Cost and affordability: The overall cost of healthcare must be reduced.  No matter which side of the political aisle you favor, healthcare costs are unreasonable.  More inpatient procedures will continue to move to lower cost options (i.e. outpatient settings or competitor facilities) and payers (including patients) will be looking for lower cost options.  Reputation and quality will not override the cost concern.  Facilities Management professionals will be forced to utilize new techniques, some of which have not been implemented or even considered before, to drive costs down in their areas of responsibility.

 

__________

 

David W. McCoy, Director Facilities Compliance, Buildings and Properties, Cleveland Clinic,  Lyndhurst, OH 

2017 trends 

* Change continued to be a trend in 2017 and the coordination between CMS requirements and TJC interpretation of code has been a challenge for hospitals.  Luckily CMS, TJC, FGI, ASHRAE, ASHE, and hospital leaders have teamed up to provide clarity on many of these issues.  

2017 issues 

* Ligature risk, Legionella, and Emergency Management were all hot topics that hospitals were challenged with in 2017.  All of these changes have a cost impact to hospitals which combined with Medicare/Medicaid reimbursement uncertainty, causes hospitals to be conservative with their capital investment.  Facility Managers have to become savvy in discussing capital investing so that the C-suite understands the impact on clinical operations. 

2018 predictions 

* Many hospitals are struggling with their cost per square foot; truly understanding the cost of the facility and what should be included in the facilities cost center has been a challenge.  I think that hospitals will revise their costs in 2018 to get a better understanding and benchmark for operating our facilities. 

Future opportunities in facilities

* Many health systems continue to consolidate, anyone that has experience in merging systems will have opportunity in 2018. 

Industry concerns

* The future of the Affordable Care Act (ACA) continues to be a focal point for hospitals across the United States. We have been adapting to ACA over the last few years and we now have to rethink some of our strategies; understanding the impact on reimbursement, patient mix, and market trends. These issues ultimately affect our budgets and our ability to build, maintain, and operate our facilities. 

 

 

 

 

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