Hospital Case Study: A Holistic Treatment
By Anne Cosgrove
Published in the May 2011 issue of Today’s Facility Manager
When built in 1987, the Portsmouth Regional Hospital, located in the Seacoast region of New Hampshire, represented a significant expansion of the health care offerings of the community. Replacing a 100 year old facility, the new hospital (which had recently become part of the Hospital Corporation of America) housed the region’s first cardiac catheterization lab, introduced neurosurgery, lithotripsy, pain management, and occupational health specialties, and offered mobile MRI services.
In the years that followed, the hospital continued to add medical staff and specialties. Areas of service included: a Heart & Lung Center; cancer care; weight loss surgery; maternity care, bone and joint care; neurosciences; and diabetes and endocrinology. Meanwhile, the population in the area also increased, and demand for services grew. As a result, in 2006 the hospital’s leadership decided a major renovation and expansion of the facility was in order. The multiphase project was completed in October 2010, and the past several months have given the staff and patients alike time to enjoy the new and expanded offerings.
A Chat With William Duffy, P.E., Vice President of Engineering and Facilties Management, Portsmouth Regional Hospital
How long have you worked at Portsmouth Regional Hospital? How many years have you worked in the facility management profession? I have worked at the hospital for eight years and have been in facility management for 31 years.
What are your responsibilities at Portsmouth Regional Hospital? I am responsible for Environment of Care Management, which entails safety, utilities, hazardous material and waste, security, fire and life safety, and medical equipment. Additionally, I handle engineering (facilities), facilities/plant operations, environmental services, and real estate management.
What notable changes have occurred in facilities management during your tenure in the profession? [Notable changes include] the growth of EPA environmental regulations, particularly in the hazardous waste category. Greater regulatory oversight and in-depth inspection scope of agencies like CMS [Centers for Medicare & Medicaid Services] and TJC [The Joint Commission] are other developments that have occurred.
What challenges have these changes presented to you? How have the changes made your work easier? The main challenges we face are with keeping our staffs current on changing regulations and improving our processes to meet the regulations. The changes have made our programs much stronger, but not necessarily easier.
William Duffy, P.E., vice president of engineering and facilities management at Portsmouth Regional Hospital, was the in-house manager of the project, and he explains that hospital stakeholders were included in every phase of the design process to ensure each program met the expectations of the end user.
“Determining the elements of the project was a combined architect, engineer, and hospital driven process,” says Duffy. “Many hours were dedicated by [our] staff to discuss needs, processes, and goals. And although this process was laborious, the end product reflects the high degree of involvement by hospital staff—which was key to the overall success of the project.”
He also mentions the role of the building contractor—RJ Griffin & Company of Atlanta, GA—in ensuring a coordinated construction schedule that presented minimal disruption to operations. “JSA is well versed in working in a hospital environment, and that made life a lot easier for us,” he explains.
“During construction, our main challenges revolved around coordination issues,” continues Duffy. “Replacing key mechanical systems or working in the middle of a functioning health care unit, while remaining fully operational, required tremendous dedication and flexibility of the engineering, construction, operator (facilities and IT/IS), and user (mainly nursing) staffs.”
A Full Facility Approach
In order to equip Portsmouth Regional Hospital for its next era of service, it was determined this project should encompass virtually all areas of the facility. This included expansion of medical/surgical spaces, upgrades to infrastructure (including energy efficiency and other “green” measures), and changes to aesthetics and wayfinding systems.
To craft a plan that would result in effective improvements, the hospital hired H*Works, The Advisory Board Company, a consulting firm that specializes in the health care industry, to identify industry trends, on both a national and regional level. This process helped to determine what types of services and specialties were needed in the region, which compelled the hospital to decide to expand some of its programs while realigning others.
Cites Duffy, “As a result of our research, some outpatient programs were relocated off campus, nearby, to make those services more convenient to our outpatient population. At the same time, moving selective outpatient services off campus—such as the mammography center and the rehabilitation facility—freed up space and provided opportunities within the hospital to focus on acute care inpatient space needs, like converting all semi-private patient rooms to private rooms.” Meanwhile, this also helped to decongest parking at the hospital.
Freeing up space inside the existing facility was an important part of the construction plan, Duffy explains, because the site is very close to natural wetlands, which dictated the hospital largely pursue a vertical expansion rather than horizontal. “We did very little to expand the facility’s footprint,” he says. “We did expand the loading dock area and a small section of the power plant. But overall, it was minimal.”
Major areas of improvement were:
- Construction of a new 20,000 square foot cardiovascular surgical center, containing three cardiovascular operating rooms (CVORs) and supporting infrastructure (e.g., a six bed PACU and administrative and storage support areas). One of the CVORs is a hybrid operating room which also supports endovascular procedures.
- Expansion of the endoscopy suite, which featured an additional lab and 11 preparation and recovery rooms.
- Completion of a new 40 bed, full telemetry nursing unit.
- Renovation of four nursing floors.
- Completion of a new entrance lobby, with full reception services.
- Corridor realignments and renovations to enhance wayfinding throughout the hospital.
While a majority of the medical/surgical improvements involved building new spaces, Duffy notes that renovating the four nursing floors had a significant impact on operations. All affected units needed to remain functional, so one of the first things built was a new 40 bed unit to serve as swing space for each affected unit to occupy during construction. This new space was added as a third level to an existing portion of the hospital, and that area eventually became the new telemetry nursing unit.
The focus on improving acute inpatient care involved adding the three CVORs and expanding the endoscopy suite. Planning for these areas also took into account improved process flow. “We located the new operating rooms close to the intensive care unit and the cath labs, which play heavily on the cardiac treatment process,” explains Duffy.
Installing building systems capable of creating the exacting standards required in a hospital environment was a must, so choosing the equipment for facility operations was key.
Says Duffy, “The infrastructure we had at the time had been built around health care procedures of 20 years prior. Back then, physicians operated in rooms that were around 70°F, and the systems were designed to ensure we could provide that temperature while keeping humidity levels within the range required by infection control standards. But as health care has evolved and practices have changed, physicians now need to be able to operate in temperatures down to 60°F to 62°F. Those reduced temperatures drive humidity levels sky high, and with the old systems it was difficult to maintain that balance between temperature and humidity.”
In specifying new HVAC and other building systems, these core considerations were the focus. Says Duffy, “This project allowed us to bring in state of the art HVAC equipment that provides several benefits. First, the new systems allow us to drive temperatures down to very low ranges and maintain the proper humidity levels using desiccant wheels. Secondly, [components of] the new system are equipped with UV light units inside. As air passes through the system, the UV light helps kill microbes that might be in the air. We also specified paint inside the HVAC units that help absorb microbes.”
Other major infrastructure upgrades involved replacing the hospital’s commercial power input. The electrical system was overhauled, which involved new wiring, transformers, and control panels throughout the facility. “The need for increased power capacity had grown over the years,” notes Duffy, “and the new equipment was put in to handle that demand.” Related to that, the emergency power system was also improved, with generators installed to provide more robust support in the event of a power outage affecting the primary power supply.
With all the infrastructure changes, Duffy took into account energy efficiency improvements. For instance, the new boiler and chilled water pumping systems were chosen with their ability to reduce energy consumption in mind. Lighting changes were made throughout the hospital to ensure energy reduction. Meanwhile, variable speed drives were installed on suitable equipment, and the exterior insulation used in the new areas of the building envelope featured energy saving qualities.
Building On Green Practices
At the time of the expansion, Portsmouth Regional Hospital had already been striving to operate according to EPA’s ENERGY STAR guidelines, so the efficiency focus was not completely new. Explains Duffy, “We already knew there are ways to improve the bottom line through savings on electricity and gas usage. Throughout this project, we continued to focus on reducing the amount of energy we use. All of the equipment we purchased for this project is far more energy efficient compared to the equipment installed 20 years prior. Choosing items like energy efficient insulation also helped decrease heat loss through the building shell tremendously. ”
The efforts to implement energy efficiency improvements were not limited to cost concerns, however. Reducing environmental impact was the other motivator. “When I first began working here,” says Duffy, “I noticed there were some things we could probably be doing better. So we were the first hospital in EPA Region 1 [New England] to conduct a voluntary full audit of our EPA and OSHA compliance internally and to disclose any deficiencies we found to EPA. We worked to make sure we were a leader in environmental compliance in EPA Region 1.”
Duffy continues, “Because of those efforts, the hospital has taken on a strong environmental view and is committed to staying in line with any EPA or state environmental regulatory issues. So, were some of the designs in this project done to meet regulations? Yes, some changes were required by new codes; however, other design changes were made on our own because they were the right thing to do environmentally.”
The proximity of the hospital to natural wetlands also has made the facilities staff mindful of treading lightly on natural resources. To that end, the project included systems to handle stormwater runoff from parking lots and roofs. The plan included rain gardens to help filter and absorb those waters, plant buffers between the hospital and wetlands to slow down the water that flows to the wetlands, and pervious pavement under a newly built parking lot, which helps clean the stormwater before it travels to the wetlands.
To keep track of the quality of water that makes its way to the wetlands, the hospital installed several underground units that capture the sediment in the stormwater as it travels to the wetlands. The facilities staff maintains those water quality units to ensure the filtration function remains effective.
Reconnecting With Community
Improved wayfinding for patients and visitors was part of the goals set for the hospital’s makeover, and this began outside the facility. At the time planning began, there were five separate entry points to the facility, and this had the potential to confuse those not familiar with the hospital.
“Improving our customers’ experience through ease of hospital access and overall convenience to services was a key objective,” explains Duffy. “Through the renovation project, we were able to reduce the number of entry points to two—the main entrance and the emergency room.”
Once inside, wayfinding had also become problematic due to a combination of potentially confusing hallway configurations and cluttered or unclear signage. The new main lobby now provides access to valet, concierge, and volunteer services, pre-admission testing, lab support, and patient services.
Duffy explains, “Creating a centralized entrance with all reception functions in one area greatly enhanced our ability to provide top level customer service. And from there, we were able to widen and open up corridors leading from the main lobby to key locations.”
Reinforcing ties with the Portsmouth community and the broader Seacoast region was a key driver of this project. One way the project team worked toward this goal was to ask members of the community for input on how signage and overall wayfinding could be improved.
On an aesthetic level, Portsmouth-based JSA Inc., which provided the architectural and interior design services, created a main lobby redesign that brought in elements of the region’s seafaring culture. “The space speaks to our Seacoast roots,” explains Duffy. “It is filled with maritime art and related elements. This extends to the landscaping around the building, which features seagrass and stone walls. It brings to mind thoughts of entering a harbor.”
Now, several months after completing the expansion, Duffy and his colleagues are finding the changes a breath of fresh air for all who use the hospital.
This article was based on an interview with Duffy.
Name Of Organization: Portsmouth Regional Hospital. Type of Facility: Existing. Function of Facility: Health Care. Location: Portsmouth, NH. Construction Timetable: Completed October 2010. Square Footage: 77,000 (new construction) and 86,000 (renovation). Cost Per Square Foot: $235 gsf (includes extensive phasing and off hour labor as well as surgical and clinical environments). Budget: $42.5 million (construction). Facility Owner: Hospital Corporation of America. In-House Facility Manager: William Duffy, P.E., vice president of engineering and facilities management. Architect/Interior Designer/Lighting Designer: JSA Inc., Portsmouth, NH. General Contractor/Construction Manager: RJ Griffin & Company, Atlanta, GA. Electrical/Mechanical Engineer: I.C. Thomasson Associates, Nashville, TN. Structural Engineer: JSN Associates, Portsmouth, NH. Landscape Architect: Copley Wolff Design Group, Boston, MA. Civil Engineer: Appledore Engineering, Portsmouth, NH.
Furnishings: Carolina, an OFS Brands Co.; Nemschoff; Patrician; Steelcase (Nurture); Wieland. Flooring: Bolon LIFETEC (Comfort sheet flooring); Johnsonite (Melodia sheet flooring); Mannington (Brushworks VCT); Mirage/Granito Ceramic Tile; TOLI (Viale premium vinyl tile and mature wood plank sheet vinyl). Carpet: Shaw (Doubleknit broadloom, Movement broadloom). Ceilings: Armstrong Ceiling (ACT and Metalworks Vector with microperfs and acoustical fleece). Paint: Benjamin Moore (Eco-Spec Low VOC). Fire System Components: SimplexGrinnell (fire alarm control panel). Lighting Products: Elliptipar; Forecast, a Philips group brand; Louis Poulsen. HVAC Equipment: Cleaver Brooks; Trane. Power Supply Equipment: Caterpillar (generators). Roofing: Carlisle SynTec (EPDM). Signage: Welch Architectural Signage. Windows/Curtainwalls/Skylights: Kawneer (windows and curtainwall); Wasco (skylights). Elevators: ThyssenKrupp.