Integrating Medical Equipment Planning into the Construction Process
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Successful project planning is a dynamic processinvolving an entire team, typically comprisingclinicians, architects and project managers, whoare tasked with balancing the needs of patient care,available health care technology, and the realities of thedesign and construction process.
Medical equipment planners perform a balancing actamong those forces, while ensuring that all team mem-bers have the latest information available on the stateof medical equipment in the project.
Much like the design and construction process,medical equipment planning is iterative, meaning itstarts with a high-level view of clinical services anti -cipated and then over time focuses on details.
Typically, planning should commence no later thanthe projects design-development phase to bring the
best information on medical equipment to the projectteam. Few pieces of equipment are model- and manu-facturer-specific at this time, but just as the designincreases in detail so does the medical equipment list.
During the early stages of design, general functionand requirements of spaces and equipment are identi-fied, similar to the space-planning process. For exam-ple, facilities need to plan out the types of proceduresto be performed when designing for a new hybrid oper-ating room. Additionally, medical equipment-planninginput during master-space programming is helpful, par-ticularly when a project involves technology-intensivespaces such as radiology or surgery.
As the project moves into the late design-develop-ment and construction-documentation phase, infor-mation on site-specific drawings, utilities and installa-
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Integrating medical equipment planninginto the construction process
BY JAY TICER, CMRP
An operating roommay require input
from many surgeonsand clinicians, eachwith a unique visionof how the spaceshould look and
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For projects involving complex systems like surgical lights and booms, ensuring that every memberof the team understands the exact types, locations and quantities of equipment is paramount.
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when clinicians change from one manu-facturer and model to another and a com-pletely new object must be created.
The third major milestone involves userand project management sign-off of med-ical equipment lists and plans. This is avital point for a number of reasons. First,sign-offs can finalize selections on medicalequipment that may have been delayedfor various reasons. Second, having theteam sign off on the lists also limits thepossibility of conflict over the selectionsof medical equipment at later points inthe project. Because the sign-offs typicallyare done in an open meeting with all par-ties present, any lingering issues can bebrought up and dealt with as appropriate.
A series of somewhat smaller mile-stones later in the project are related tothe selection and purchase of medicalequipment with significant installationand utilities requirements, traditionallyidentified as Group 1 (fixed equipmentsuch as imaging systems) or Group 2(non-fixed equipment with complex utili-ties requirements).
Almost all equipment in those cate-gories have substantial utilities and in -stallation requirements that impact thedesign and engineering of a health carefacility. These pieces of equipment alsorequire considerable lead times from exe-cution of a purchase order until deliveryto the project site (e.g., 10 to 12 weeks for
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tion requirements is fleshed out, enablingthe construction team to complete itswork. Changes in the equipment list mustbe communicated to the constructionteam quickly so potential issues can beidentified and managed before costlychange orders are required.
As health care technology advances, aflexible design and construction processis important to a health care organizationlooking at trends in future patient care.
Significant milestonesMedical equipment planning tends tohave three significant milestones duringthe health facility construction process.
First among these typically is prelimi-nary budgeting for financial approvals orcertificate of need. The medical equip-ment planner, at this point, develops abudget figure based on a space programand early discussions with project ad -ministration on the vision and expectedservices for a project. This data then isincorporated with the drawing or spaceprogram package that goes to the appro-priate governing authority (e.g., board of trustees, state approval agency) togreen-light or hold the project.
A second notable milestone, or series ofmilestones, are the document submissionsassociated with the design process (e.g.,end of schematic design, end of designdevelopment). The medical equipment listshould be progressing in concert with thearchitectural and engineering design, and
at each submission point should be avail-able for issuance to the appropriate parties.
This is not always as seamless as itshould be. Occasionally, project depart-ments or spaces lag behind the design,often due to delayed decision-makingabout a particular piece of medical equip-ment. Obstacles can arise when clinicianconsensus is required or the facility needsbudgetary review on high-cost equip-ment. This is where professional medicalequipment planners really stand out. Itstheir job to notify project administrationof potential issues before they represent ahard stop on a construction schedule.Theyll shepherd the decision-makingprocess through to conclusion.
Document submissions frequentlyinclude equipment placement on archi-tectural drawings. However, with theincreasing prevalence of building infor-mation modeling (BIM) in health careprojects, the traditional process of docu-ment submissions blurs. While documentsubmissions of the equipment list are stillvital, that process as it relates to BIM isstill in transition, and may vary in styleand content from project to project.
Both architectural firms and medicalequipment planners still are identifyingroles and responsibilities in projects uti-lizing BIM, because the overall projectmodel requires a new way of creating,updating and maintaining the equipmentlist. A significant amount of work isinvolved in updating the list, particularly
It helps to have clinicians and other users visualize new spaces in which theyll beworking, especially when tech nology willbe introduced into the patient room.
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surgical lights and booms). Decisions on major medical equipment
selection cannot be delayed withoutimpact to the schedule. In many instancesthe space and utilities are driven by a spe-cific manufacturers requirements. All toooften, health care facilities put off equip-ment selection while they negotiate pric-ing or attempt to wait for the next tech-nology advances. The medical equipmentplanner must ensure that the project teamknows the perils of delaying or changingdecisions (e.g., change orders, scheduledelays, increased costs of acquisition)associated with Group 1 and 2 equipment.
Key points of successThere isnt a guaranteed formula for suc-cessful medical equipment planning.However, a number of steps can be takento improve the chances of a successfulproject and mitigate failure.
Above all else, communication is vitalamong all team members as the projectprogresses. It ensures everyone has themost complete information regardingmedical equipment in the project, andcan mitigate or avoid costly problems inconstruction. Except for sensitive issuesas noted by project administration, suchas project budget status, communicationshould be as transparent as possible. Thiscan defuse issues that arise from rivalriesbetween departments or clinicians, andgreatly reduce misunderstandings regard-ing project goals and decisions.
Strong project management with a clearvision can make a tremendous differencein a project, particularly where physicianpreferences intersect with medical equip-ment selections. While the medical equip-ment planner can guide particularly diffi-cult decisions on healthcare technology,the project management team must be thefinal arbiter of those decisions.
The wish list mind-set is an ever-presentproblem with medical equipment plan-ning. A weak project manager will find itdifficult to contain the pressure from clini-cians with strong opinions on vendors andmodels to include wish list equipment.One good way to manage this problem isby having the medical equipment plannerincorporate equipment standards, grouppurchasing organization contract itemsand other hospital-identified models andmanufacturers. This can accelerate theprocess of planning, and remove potentialissues regarding clinician preferenceswhen they are at odds with the overallhospital procurement philosophy.
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EQUIPMENT PLANNINGS growing role
Medical equipment planning is now available as a subset of servicesoffered by health care architectural firms, dedicated planning consultingfirms and, more recently, by companies that offer do-it-yourself softwaretools and systems for health care organizations. Each has varying levels of service and capabilities, so it is important for a health
facility professional to determine which services (e.g., technology visioning, equip-ment inventory, procurement support) are needed before engaging any of theseresources for a health care project.The evolution of medical equipment planning gradually has picked up speed over
the last three decades, becoming an essential part of the project team as health-care technology and facilities have increased in complexity. Historically, any equip-ment planning for a project was an outgrowth of the traditional furniture, fixturesand equipment process for typical commercial design and construction. Equipmentunder that definition included everything from copiers to surgical tables. Little forethought was given to future needs by the facility or advancements in
health care technology beyond what was necessary for the facility to operate onopening day. In fact, early attempts at medical equipment planning were often han-dled by a health care facilitys clinical engineering or materials managementdepartment or, in some cases, by knowledgeable architectural firms. To some extent, this practice of do-it-yourself medical equipment planning per-
sists even today. With those departments already performing vital tasks in the hos-pital, and architectural firms only having basic knowledge about medical equipmentacquired through vendor contacts or prior projects, the sheer volume of informationneeded for a hospital project becomes overwhelming. To put it into context, a medi-um-sized hospital project can include as many as 5,000 or more equipment items.In the face of such daunting statistics, however, its easy to see how specialized
expertise is needed.
Medical equipment planners must accommodate the ever-changing state-of-health-care technolo-gies and ensure that the project is as future-proof as possible within budgetary constraints.
Proactive review and analysis of theequipment list is key to successful med-ical equipment planning. This important,but often overlooked, process offers anopportunity to capitalize on changes intechnology, strategic vision by the healthcare organization or in the medicalequipment marketplace. However, newtechnology and equipment should bestudied carefully before being includedin a project especially a renovationproject. The risk of technology or equip-ment disrupting the space design in aproject, or operational processes of clini-cians, is always present.
In some cases, it may be prudent todecide against adding a new technology ifinfrastructure requirements or associatedoperational activities would incur addi-tional costs, or delay the project sched-ule. It may be possible to make someadjustments to the design and engineer-ing of a project to incorporate that tech-nology or equipment at a point after thenew facility opens (e.g., including conduitruns for operating room integration, butdelaying purchase of the system itself).
By doing a proactive review and analy-sis, the planner also can stave off prob-lems when there are safety or serviceissues associated with particular medicalequipment items that may not have beenpresent when selected early in a project.
Increasing the oddsMedical equipment planning can greatlyincrease the likelihood of a project meet-ing the owners vision of patient care intheir new facility. Unfortunately, manyfacility professionals who have never uti-lized a medical equipment planning con-sultant feel its a luxury. Typically, it takesonly one large project (and the myriaddetails surrounding medical equipment)that goes over budget or is delayed tochange that view.
Good medical equipment planningadjusts to the hospitals vision of the proj-ect, while steering them through the issuesof health care technology, equipment infra-structure requirements and procurementtasks. It brings the various team membersgoals and missions to bear on the equip-ment selected for a new facility, and navi-gates the always-present challenges inher-ent in any project. HFM
Jay Ticer, CMRP, is senior associate
in the Applied Solutions Group at
ECRI Institute, Plymouth Meeting, PA.
He can be reached at email@example.com.
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Vendor input on medical equipment that has a major structural, utility and operational impact,such as washer-disinfectors and sterilizers, can be invaluable for correctly sizing systems.
THE IMPORTANCE OF communication
There are numerous examples of dire outcomes when all team membersarent brought together as a cohesive group. These stories are told inhushed voices by experienced planners and architects, and frequently areused to teach those new to medical equipment planning exactly how things can goawry in otherwise normal projects. In almost every example, the issue would havebeen preventable and avoidable through more effective communication among theteam members.For one academic medical center project, miscommunication among the ven-
dors, the design team and construction management caused a significant cost toan otherwise stellar project. Because the health care organization took responsibili-ty for procurement services itself rather than assigning it to its medical equipmentplanner, the entire project team was not involved in hammering out the details nec-essary for placement of the equipment booms and radiographic system in anendovascular operating room. This led to the equipment booms and lights beingpoorly sited in the operating room, requiring them to be uninstalled, moved andreinstalled because they conflicted with the ceiling-mounted, radiographic fluo-roscopy system.On the other hand, a recently completed, acute care tower project illustrated the
benefits of open and dynamic communication during medical equipment planning.In th...