Hospital Asset Management

Refurbish or Replace the Hospital?

A case study in Saudi Arabia

Presentation by Dr. Alan Wilson

Aim for the system operating capabilities to be returned to their

original specification

An aim that the assets lives can be extended by decades

That and answer to the question - repair or replace – with

potential costs, can be given in a few months per hospital

Hospital refurbishment – three

key aspects of this MOH policy

100-150 beds 250-600 beds

100-150 beds

250-600 beds

The team was invited to carry out major

refurbishment designs for 13 hospitals

in three projects of 5, then 5, then 3

Specialist Group [Riyadh] and DMI healthcare (UK)

The Specialist Group headed the team, and:

- liaised with the Ministry of Health & Hospital Management

- added technical expertise in water / energy / drainage

- financial management & travel logistics

DMI Healthcare delivered the expertise in:

- architecture and strategic design

- mechanical / electrical / structural engineering

- the preparation of bills of quantities & contracts

- cost management

The Team

A typical plan for Five

Hospitals completed in parallel

Recreation

Centre

Swimming pool

Housing

Blocks / Villas

Main

Hospital

Housing and

Recreation Site

Diabetise /

Guardroom etc.

Roads / Walls

& Fences

Mosques

Civils

Sewage / Pipe

Networks

Energy

Air conditioning

Water

Treatment

Administration

Outpatients &

Physiotherapy

X-Ray &

Scanning

Emergency &

Resuscitation

Reception

Kitchens

Dining

Wards

Laboratory

Pharmacy

Surgery,

Labour & Delivery

Paediatrics

Hospital asset structure

- at system level (up to 70 systems)

1) First by buildings and installations

2) Then by discipline - electrical, mechanical, architectural, civils

SECTION 2.1.1 MAIN HOSPITAL

ELECTRICAL

PHASE 1 REPORT PHASE 2 REPORT PHASE 4 REPORT

Item Phase 1 Report

reference System

Location at hospital

Technical evaluation

status*

Initial recommendations

Priority Budget Cost [SAR]

Pre Tender

Estimate

BOQ Reference

Operat-

ional Needs repair

Replacement

Full Part

1 3.1.2.1 HV / LV Distribution

Main hospital

2 3.1.2.2 Distribution Boards

Main hospital

3 3.1.2.3 Containment Main hospital

4 3.1.2.4 Lighting Main hospital

5 3.1.2.5 Emergency Lighting

Main hospital

6 3.1.2.6 Small Power Main hospital

7 3.1.2.7 Telephone System Main hospital

8 3.1.2.8 Data Main hospital

9 3.1.2.9 Nurse Call System Main hospital

10 3.1.2.10 Fire Alarm System Main hospital

11 3.1.2.11 Public Address System

Main hospital

12 3.1.2.12 TV System Main hospital

13 3.1.2.13 Lifts Main hospital

14 3.1.2.14 UPS Main hospital

15 3.1.2.15 Master Clock System

Main hospital

The information deliverables

- by system level

- example for Electrical

A non-intrusive detailed condition survey

- of the systems/wards agreed with Hospital Management

- information on the existing projects & proposed changes

- discussion of the management strategies and any

special problems, e.g. number of infection control rooms

- the energy calculations and any scale-up needs of the

engineering services

- presentation of the findings and implementation plans

to the Hospital Director and Management

- a report of recommendations / more detailed costs

The Second phase was

completed by the full team

Modern replacement Chiller Main Hospital Chillers underperforming

Existing Steam Boilers in a poor

condition New steam boiler

What we have seen What we recommend

Site - Ancillary

Sheet vinyl to Ward

areas

Panel mounted clinical wash hand basin

Main Hospital

Split joints, and walls without skirtings

Chipped sanitary-ware

What we have seen What we recommend

Typical fitted furniture

Corridor suspended ceilings

Housing

Original fitted furniture

Damaged and Missing Ceilings

What we have seen What we recommend

Implementation Improvements towards CBAHI: (Central Board of Accreditation For Healthcare Institutions)

• Fire Strategy

• Isolation Rooms

• Pressure Regimes

• Control of Infection

• Patient Access

1. Of 25 beds there should be 1 of negative pressure.

2. There are no air pressure filters existing in the hospital.

3. Sometimes ventilation is not considered a requirement.

4. A number of true pressure rooms are required, one for every 100 beds.

5. A problem exists in ER - a single waiting room has a partition only and the

negative pressure facility is not working. A room near the elevator is a need.

6. There is no negative pressure room in the Critical Care area.

Notes on meeting

with Head of Infection Control,

for example

Sequenced Hospital Implementation Plan – Ground Floor

• For the Theatres, if there are just 2 or 3, then 1 may be released for

refurbishment, whilst the others cover emergencies / planned

• The flow in the Theatres must provide clean access and dirty exit

• Emergency R. and Outpatients can often be divided with 50/50 availability

• The Clean & Steam room may be relocated temporarily to the Dining Area

• The Laboratory may receive support from another hospital or mobile unit

• The Blood Bank & Pharmacy may be temporarily located in the Conference

Room; and the Pharmacy moved into in the Dining area

• The Delivery Room & children’s ICU must be close to surgery for easy

transfer

• In the Wards, where occupancy is low, then up to 50% of Female and Male

Medical / Surgical may be made available at the one time

• Care must be taken on refurbishing the Wards in order to get the upper

floor and lower ceiling available at the one time

Implementation – principles

developed for making areas

available for the refurbishment

Condition

The luminaires are clean and operating satisfactorily but the end caps are cracked, they are life completed and cannot be maintained

Replacement diffusers and control gear are unavailable

Technical Evaluation

Several areas now require an improved type of luminaire that inhibits the ingress of dust or water. Sealed type luminaires are required particularly in theatres, laboratories, and food preparation areas.

Modern luminaires use less energy, are more efficient, and provide longer lamp life.

Recommendation

Change the luminaires

Provide automatic switching linked to presence detection and available daylight

See appendix 6.2.1

THE FINAL REPORTS

EXAMPLE OF REPORT ITEM:

3.1.2.4 SYSTEM - LIGHTING

AND IN THE REPORT APPENDIX 6.2.1 TYPICAL PROPOSED LIGHTING

Theatre Suite Lighting

Bed Head Lighting

Typical General Purpose Luminaire

SECTION 2.1.1 MAIN HOSPITAL

ELECTRICAL

PHASE 4 REPORT PHASE 2 REPORT PHASE 4 REPORT

Item Phase 1

Report ref System

Location at hospital

Technical evaluation

status*

Initial recommendations

Priority Budget Cost [SAR]

Pre Tender

Estimate

BOQ Reference

Operat-

ional Needs repair

Replacement

Full Part

1 3.1.2.1 HV / LV Distribution

Main hospital 2 X N/a - - -

2 3.1.2.2 Distribution Boards

Main hospital 2 X X 1 190,000 190,000 1.1 - 1.4

3 3.1.2.3 Containment Main hospital 2 X N/a - 500,000 3.1 - 3.2

4 3.1.2.4 Lighting Main hospital 1 X 3 2,980,000 4,500,000 2.1 - 2.33

5 3.1.2.5 Emergency Lighting

Main hospital 1 X 1 1,879,000 1,500,000 2.1 - 2.33

6 3.1.2.6 Small Power Main hospital 2 X X 1 811,000 1,000,000 4.1 - 4.7

7 3.1.2.7 Telephone System Main hospital 2 X X 3 70,000 90,000 5.1 - 5.5

8 3.1.2.8 Data Main hospital 2 X 1 128,000 150,000 5.1 - 5.5

9 3.1.2.9 Nurse Call System Main hospital 1 X 1 2,362,000 750,000 6.1 - 6.15

10 3.1.2.10 Fire Alarm System Main hospital 0 X 1 2,912,000 800,000 7.1 - 7.8

11 3.1.2.11 Public Address System

Main hospital 2 X N/a - - -

12 3.1.2.12 TV System Main hospital 2 X 1 80,000 80,000 8.1 - 8.2

13 3.1.2.13 Lifts Main hospital 2 X N/a - - -

14 3.1.2.14 UPS Main hospital 2 X X 1 4,000 30,000 9.1 - 9.4

2 LIGHTING

Strip out existing and provide and install new luminaires, lighting control devices, wiring devices, insulated copper cables and containment, Specification 26 0519 1.01 to 3.01, 26 0534 1.01 to 3.01, 26 0537 1.01 to 3.01, 26 0923 1.01 to 3.01, 26 2726 1.01 to 3.01, 26 3305 1.01 to 3.01 and 26 5100 1.01 to 3.01, Drawings UNZ-E-MH-6-001 and UNZ-E-MH-63-001 to 018

2.1 luminaires Type A nr 304

2.2 luminaires Type AE nr 133

2.3 luminaires Type A2 nr 459

2.4 luminaires Type A2E nr 179

The Bills of Quantities reference 2.1 to 2.33 – the Lighting Costs

for example

Specifications

SECTION 26 5100 INTERIOR LIGHTING PART 1 GENERAL

- All luminaires shall be high frequency and use new technology lamps such as LED and T5.

- Ensure the final calculations use the correct lamp type for clinical areas.

- All luminaires to be chosen to minimise spares and spares be available. - Where luminaires have integral emergency lamps fitted, these shall be

factory fitted by the luminaire supplier.

- The drawings detail the type of luminaire required in each area and approximate quantities. Luminaire supplier to use the drawings and provide a fully compliant scheme.

Drawing UNZ-E-MH-6-001

Bills of Quantities – In Arabic format

جـــدول بيــان الأعمـــال والكميـــات وحدة الكلى الصناعية

AKU Bill Of Quantities

الاعمال الكهربائية

Total amount (SR) إجمالي البند بالريال السعودي

Unit Price (SR) سعر الوحدة بالريال السعودي

Quantity الكمية

Unit الوحدة

Description وصف الأعمال

Item رقم البند

Written كتابة

Digit رقما

Written كتابة

Digit رقما

1 وحدات الاضاءة

LIGHTING

ـــــــــ ـــــــــازالة وحدات الاضاءة الموجودة حاليا وتوريد وتركيب وحدات اضاءة جديدة تحتوى على الكابلات النحاسية المعزولة واجهزة التحكم

وذلك وفقاً للمواصفات الفنية المخططات الموضحة بالبند عام

Strip out existing and provide and install new luminaires, lighting controls, insulated copper cables and containment, Specification 26 0519 1.01 to 3.01, 26 0534 1.01 to 3.01, 26 3305 1.01 to 3.01 and 26 5100 1.01 to 3.01, Drawing UNZ-E-AKU-6-001

Preamble

E 1.1وحدة اضاءة طراز بالعدد 40

luminaires Type E

1.2 وحدة اضاءة طوارىء بعلامة الخروج بالعدد 8

emergency exit lights

2 نظام انذار الحريق

FIRE ALARM

ـــــــــ ـــــــــمقاومة ( ذات اللون الاحمر)ازالة الموجود حاليا مع توريد وتركيب نظام إنذار ضد الحريق وحساسات مع تمديد كابلات شيلد نحاسية

للحريق وذلك وفقاً للمواصفات والمخططات الموضحة بالبند عام

Tranche 2 Phase 2 Phase 4 % change

Hospital 6 BIL 98,386,150 80,062,000 -18.62%

Hospital 7 BSH 221,962,000 197,808,000 -10.88%

Hospital 8 FAR 98,740,350 82,217,000 -16.73%

Hospital 9 NAM 106,609,800 94,124,000 -11.71%

Hospital 10 UNZ 242,138,000

767,836,300

1. For every hospital the estimated refurbishment cost reduced after the .

2. Of the 13 hospitals some were considered for replacement.

3. Answers to the changes required were recommended for all the assets

above the ground and below the ground, with estimated costs.

4. Our view is that at the hospital design and purchase stage:

the trade-off between asset quality, reliability, and cost should involve the

input of O&M personnel

and the asset life expectations.

In our opinion, did the

project meet the expectations?