Two workers inspect medical scanning equipment

Getting in on Ground Floor of a Hospital HTM Upfit

 

By JP Stewart

When MarinHealth Medical Center opened its new Oak Pavilion in the fall, we moved all the medical equipment into the new hospital in less than 12 hours.

Actually, make that 12 hours – plus more than three years of planning.

When it comes to upfitting a healthcare facility with sophisticated medical equipment in everywhere from operating suites to patient rooms, the real work happens in the years, months and weeks leading up to Day 1. And every minute that you spend in that planning stage is critical to ensuring that your hospital maintains quality care and limits patient risk from Day 1 and beyond. In fact, for patients, the experience should be no different than being transported for X-rays or to a therapy room.

I arrived at MarinHealth more than three years ago, shortly after the groundbreaking and just as contractors were erecting the steel framing for the 260,000-square-foot complex. Keep in mind, this replacement hospital was being built on the same campus, as MarinHealth expanded its clinical services within the former hospital, which made this project the most local of moves. As we watched the building come to life, I prepared for its first day of patient service. I had near-daily meetings for facility readiness, along with ad hoc sessions to address things such as technical implementation checklists and equipment mock-ups for every space. Across the organization, different teams were managing different assignments related to opening successfully, but my focus was solely on moving and installing the therapeutic and diagnostic equipment in the Oak Pavilion – and making sure it functioned as intended.

In the process of getting the new hospital ready from tip to tail, so to speak, we took multiple tours of the facility at different stages to isolate where medical equipment would be installed. This wasn’t my first medical center move, and I brought past experiences and incorporated in-the-moment lessons learned to ensure an effective transition. Below are a few critical learnings as you prepare for your next move.

1. Understand – and closely follow – the local rules. In California, hospitals must comply with regulations from the Office of Statewide Health Planning and Development, which had broad oversight across most pieces of this project. Bear in mind, most of your hospital staff might never be part of a move, but recognize that an organization such as OSHPD regularly works with facilities like yours to ensure both continuity of care and that your new facility – and everything within it – is ready to take on that patient-care responsibility. In California, this oversight includes reviewing every new piece of equipment to be purchased and where it would be installed. In the immediate days after the move, OSHPD inspectors confirmed our execution delivered on the highest levels of patient safety. Our healthcare technology management (HTM) program scored perfect marks.

2. Know your equipment and what it takes to function. When you’re dealing with people’s health and lives, you can’t risk losing any equipment, and you can’t afford to interrupt a task to track something down – like, you might do if you lose your car keys in the house. One of the first tasks is to validate your existing equipment inventory, which is a pretty straightforward task for our TKA teams as we have every device, and comprehensive reporting on it, in TEAMnet, our customizable Computerized Maintenance Management System (CMMS). We started with nearly 6,000 devices in that inventory.

As we all know, medical equipment is a costly investment, and each device has a designated lifespan based on both its age and the technology that it uses. In the years and months leading up to our transition, while the Biomeds were continuing their core functions of equipment upkeep and repair, I started analyzing our TEAMnet information and recommending whether to move or replace each item. MarinHealth was keeping the existing facility in service, and our planning extended to determining what equipment was staying, what was going and where about 2,000 new assets would be assigned between the two campus sites.

A unique element to this transition is that the MarinHealth leadership had purchased select equipment during the planning stages, which meant that some devices – such as sterilizers in the Sterile Processing Department (SPD) for the operating suite – already were two to three years old at the time of the move. The task for TKA was to put that equipment on our inventory and keep every device in shape for the next seven to 10 years.

Adding another layer of complexity was that ahead of the move day, MarinHealth made a 10-year commitment to a new manufacturer of patient monitoring systems. That entailed another set of plans for how we deployed those monitors, telemetry units and other devices at the patient bedside. We opted to implement that network in the existing hospital, rather than adding one more step to the move.

3. Develop a detailed Plan A, Plan B and Plan C – and be ready to deploy any step of any plan at any time. You probably already have Plan A and Plan B, so you want to think about Plan C as preparing for the worst-case scenario. This provides you with move and installation schedules outlined for every scenario.
That planning and contingency planning drove our efficiency, as we moved 95% of all clinical technology on Day 1. In fact, we moved and upfitted the entire Emergency Department, which now filled a space three times its previous size, in only two hours because we knew what to do, when to do it and where to install the equipment.

While you’re heads-down making those plans, you also have to consider the practical side of building a new facility. Construction crews, for example, didn’t know exactly how each space would be outfitted at the end of the project. A common issue we’d find on a walkthrough, for example, would be a designated space for a wall defibrillator, but there’s no electrical outlet nearby. So we’d put in a change order. Don’t overlook building on-site walkthroughs in your planning, so you not only know where equipment will go, but that it will be operational ready – starting with electricity, as state inspectors will validate – once in place.

4. Invest time with providers to make the move go quicker. In the three months before our official patient move-in day of Sept. 29, we were meeting constantly with specialty providers and their staff. We gathered nurses, engineers, biomedical engineering and environmental services for nearly daylong working sessions to review every single piece of equipment they need for patient care. By involving the right people in that collaborative process, you ensure everyone is on the same page and that every function is fully supported on the equipment side.

Over the course of our meetings, conference room walls became dotted with sticky notes: one for each device, along with time-based scenarios. Our goal was to have providers walk into their new treatment or surgical space and know exactly where everything is, know that their equipment works as needed, and know they wouldn’t miss a beat inpatient care.

5. There’s no such thing as overplanning. The most complex assignment surrounded six surgical suites in the new hospital, because we were also keeping eight ORs running in the existing facility. During planning meetings for that mission-critical space, we evaluated what equipment would transition from the current ORs and what new equipment was coming in.

In reality, a very small percentage of equipment needed to be permanently installed and ready for patient care in advance, but their significance could not be overlooked, as they are pieces of life-saving equipment. A great example in the surgical suite is the requirement of two sterilizer sets, with one serving as a backup. The original plans, drafted seven years earlier, called for moving both to the new facility. The catch? Seven years is the life span of those devices, and you don’t want to risk putting outdated equipment in a new facility and have it break down. That led to an unexpected – though justified – expense of $200,000 for new equipment. We had to coordinate over a weekend to install a new sterilizer in the existing building, have it meet state inspection, then move it to the new building. That’s the behind-the-scenes work that TKA delivers to make this a seamless experience for administrators and providers.

I take my job and this responsibility personally, something I expect the same of with my colleagues, and I hope to lead by example in my passion, compassion and work ethic. As we go about our daily work and special projects like this move, I think about my son, who is now 32 and a doctor. When he was only 4 weeks old, he needed surgery. That experience has stayed with me, and I often use it as a reminder for what I would expect a hospital to deliver in terms of safety if he were a patient again today. Having a facility operate at the highest standard, that I could trust for my family, is the bar I set for our performance.

The biggest takeaway from a move of this magnitude, where your success is critical to saving lives, is that communication and collaboration must be your guiding tools. Everyone at MarinHealth had the same shared goal of a smooth move into a new facility. Making that happen required everyone to remain open to different ideas at every stage from concept to planning to execution. No one has all the answers, but by keeping the lines of communication open and working together, you will get to the right and best solution for your hospital.

 

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