HTM’s Role in Construction Planning: Best Practices Make for Smooth Sailing

The broad skill sets that HTM professionals possess make them ideal sources for decision-making input. With mechanical, electronics and even technology acumen, biomed technicians and leadership are the go-to resource for any process that may occur in health care, including new construction or renovation projects. HTM brings a perspective that capitalizes on knowledge that other stakeholders in the project may not embrace or possess.

One reason that HTM can be an important voice and stakeholder in construction projects is that biomeds can point out pitfalls that others may overlook.

These insights can include valuable input in the areas of cybersecurity, connectivity, interoperability, space, environmental conditions, utility requirements, ease of use, warranty coverage, clinical and technical training and consumables.

The construction or renovation of health care facilities has evolved and there is a much greater emphasis today on health IT resources, modular and prefab options and sustainability. Projects have to be carefully planned so there is uninterrupted patient care and safety is always maintained. With an aging population, expansion of facilities is necessary.

With all of the construction and renovation-specialty companies and contractors, architects and engineering consultants, who might be involved in any project, those tasked with equipment management know about considerations that might otherwise be overlooked.

While HTM has much to offer that comes out of organic knowledge and experience, there is always something more to learn from those who have stared down the challenges of large or complex projects.

To that end, we have assembled some tips and considerations that should prove useful the next time a new construction or renovation project presents itself and HTM is called in for consultation.

It is easier to employ knowledge going into a challenging situation than having to learn it through mistakes, missteps or learning through experience. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”

Knowing What You are Working With

In a 2018 story titled “Construction Excitement and Pitfalls,” TechNation interviewed Matt Royal, MS, CTM, CHSP, CHFSP, CHEP, CHTM, CLSO-M, CHC, CHFM, CBET, director or biomedical engineering for Eskenazi Health.

“Get the inventory of all new equipment correct, this is the time where you have all the purchase orders, pricing, PM schedules, warranties, etcetera,” Royal said in 2018.

This is an important part of the process and requires an effort by HTM or the services of a third-party provider.

At the time, Royal also said that, “Additional resources are needed. It takes a toll on the team when they are required to not only continue to support an old facility but oversee the installation of new equipment and the movement of existing equipment to the new hospital.”

That sentiment is echoed by Tim Michener, vice president of sales and marketing at Asset Services in Kansas City.

Michener says that there are some considerations during a renovation or new construction project that revolve around an accurate assessment of inventory.

“HTM departments need to evaluate the equipment that they have in their current spaces and determine if any or all of the equipment can be used in the new or renovated areas. They need to perform a detailed equipment inventory to have an accurate understanding of the types and quantity of different assets they currently have on-hand,” he says.

“They also need to perform space planning to determine that the new spaces are large enough to accommodate their large equipment and ensure the proper power requirements have been taken into account. Even if equipment is functional and can be used in the new area, it may not be feasible because the equipment may be needed in the current facility right up until ‘moving day,’ and there will not be time to relocate larger or non-mobile equipment,” Michener adds.

Michener’s firm provides an initial outfitting and transition (IO&T) equipment inventory to aid in determining assets that can be re-used during these projects.

He says that IO&T inventories provide an accurate snapshot of what is located in the current facility/area.

“It will identify the type of equipment as well as details such as manufacturer, model, serial number and physical condition of the equipment. It can also identify dimensions of equipment in order to assist the architects in designing storage locations for items such as crash carts, laundry baskets, etcetera. This detailed inventory provides information for the HTM department in order for them to determine what equipment they can reuse or what equipment they will need to purchase in order to be ready to operate efficiently when the newly constructed or renovated area is ready to be operational,” Michener says.

Colin Construction Company Chief Operating Officer Kevin Cook shares his outlook.

“After having served 20 years in the Air Force as a biomedical equipment technician, starting one of the first HTM programs at David Grant Medical Center (Travis AFB) and now running a construction company that specializes in health care construction for the past 15 years, give me a strong perspective on how instrumental the HTM role is in any equipment replacement or hospital remodel project,” Cook says. “HTMs are key to understanding the hospital infrastructure of installed real property (HVAC, electrical) and installed medical equipment. They also understand the technical specifications of the new equipment being purchased. The general contractor hired to do the design and build of the project area to accommodate the new equipment works directly with the HTM to understand the as-built conditions through record construction documents and HTM’s corporate knowledge attained from sometimes years of work at the facility. The more the HTM understands the as-built condition or can share the documents attesting to that condition the more comprehensive the design and construction documents. This effort pre-construction mitigates the challenges and delays during construction and greatly improves the opportunity for an on-time and on-budget project ending with equipment delivery per the scheduled delivery date.”

The Invaluable HTM Perspective

Two years later, Royal still has views to share from experience with construction projects. He points to the importance of the knowledge that HTM professionals maintain that allows for consideration of the cost of ownership, throughout the life cycle, when commencing a renovation or new construction project.

“Two areas that have always been an area of high maintenance is radiology and sterile processing. Often minimum specifications for utilities are planned for to keep costs low during a construction project. However, that may keep the costs of the project lower, it can increase the cost of ownership of a piece of equipment and also threaten the availability of critical equipment for hospital operations,” Royal points out.

He says that for sterile processing, equipment such as sterilizers and washers, quality water and steam is extremely important for the reliability of the equipment and the quality of the instruments being processed.

“Providing quality water might include softening, reverse osmosis water systems, water filters and constant testing of water quality. With poor water quality, you can have more frequent equipment failures and discoloration of instruments. This could lead to reprocessing, unavailability or delay of instruments to a surgical area. Poor steam quality can impact sterilized instruments with wet packs which would again result in reprocessing, unavailability and delays,” Royal says.

Royal says that for an area like radiology, power quality is extremely important; this equipment is one of the biggest investments for a hospital.

“Having power conditioning or power protection can improve reliability to highly sensitive equipment. Many construction projects don’t account for this and larger investments such as UPS units to support high-voltage cabinets, gantries and MRI equipment. Although large UPS systems are expensive there is a return on investment for these systems. The radiology equipment is critical for operations of a hospital, but it can also be considered high revenue,” he says.

Not only is it important for HTM to provide important considerations for equipment reliability and longevity, but security issues and the choice of vendors require HTM input as well.

“Construction projects tend to not include HTM in vendor selections, which have implications downstream. Projects may not even include end users in some of these decisions. Architects don’t have to operate the business after the construction is done, so they don’t often think about operational issues such as contract terms, usability, maintainability or cybersecurity. Setting roles/responsibilities in your project early to ensure the right team players (including IT and HTM) are included in decision about the technology they will need to support after go live is key,” says Samantha Jacques, Ph.D., FACHE, vice president of McLaren Clinical Engineering Services (MCES) at McLaren Health in Michigan.

She says that in construction projects the term “equipment planner” doesn’t just mean that they only plan the medical equipment. Depending on scope, the equipment planner may plan all IT equipment and facilities equipment such as trash cans and sinks. Even though these aren’t typically medical equipment, HTM departments can provide insights to the locations for things such as hand washing sinks, PPE closets and even trash cans.

“I would always recommend the end users get a quick lesson in reading blueprints. It’s easy to sit in a meeting and determine which equipment needs to go into a room to meet clinical needs, but it’s much more useful if the end users are able to point equipment out on documents as they work through actual workflows. Noting the distances between patient rooms and a clean supply or med room is almost as important as ensuring the right equipment is located in that room,” Jacques says.

She says that HTM can contribute to construction projects and renovations in several ways.

Medical Equipment Planning

During a construction project, architects often outsource the equipment planning function to a third party. This third party has to learn the organizational standards and workflows, which always takes time and effort as well as significant money. Some forward thinking HTM departments have insourced this function as they are the equipment and workflow experts in their hospital.

She says that this way, equipment standards are kept up while costs can be removed from the project. The only caveat for insourcing is to discuss roles/responsibilities with your project manager to assure the architect can cover any tasks the department can’t perform.

Jacques also says that HTM can provide help in right sizing the amount of equipment purchased.

“HTM departments can aid in analysis of how many pieces of what types of equipment are required during projects. They can conduct inventories of existing equipment to recommend what can be re-used versus what must be replaced,” she says.

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