There is a lot of misinformation swirling around about how hospitals can benefit from Facility Condition Assessments (FCAs.) Do you know what is true and what is not? Here are some of the most common misconceptions.
MYTH #1 – An FCA only evaluates Mechanical, Electrical, Plumbing, and Fire Protection systems
Many hospital administrators assume that Facility Condition Assessments only encompass Mechanical, Electrical, and Plumbing (MEP) systems. This tends to happen because their Facilities Department administers the FCA and that department maintains the MEP systems. However, areas that would typically be under the purview of the Construction Department are also important to include in an FCA.
Significant facility condition issues such as building envelope integrity, roof condition, or ADA compliance have substantial capital improvement impacts and inform MEP system decisions.
A comprehensive FCA should include a multi-disciplinary team with the following subject matter experts:
- Architect (and possibly a Structural/Civil Engineer as determined by an initial assessment)
- Plumbing/Fire Protection Engineer
- Mechanical Engineer
- Electrical Engineer
An architect on the team can determine whether the building is structurally sound and compliant with current regulations. On one western US FCA engagement, our MEP engineers initially brainstormed ways to retrofit the MEP systems for an older building. But our architect on the team realized that the building was so significantly non-compliant with seismic codes that it must be torn down. Had we not included an architect’s input, the hospital would have wasted money by implementing the MEP recommendations.
Architects and MEP engineers working together on an FCA can shorten project durations and save money. Combining their implementation efforts into a single project reduces the downtime to the affected unit, and the contractor only has to set up once instead of twice.
If MEP and architectural implementations were separate, the hospital would inconvenience patients twice, and pay for dumpsters, porta potties, and infection control twice.
MYTH #2 – The FCA is a stagnant tool that shows a single snapshot in time
Many hospital administrators struggle to find value in FCA reports that sit on a shelf and become outdated. Facilities change continually.
Even though an FCA team completes the assessment at one point in time, a cloud-based FCA reporting tool can yield an ongoing view of the future. BuildingSymphony is a living tool that helps staff monitor equipment inventory and justify capital requests.
If the hospital replaces an old chiller with a new chiller, by updating BuildingSymphony, facilities staff can see an updated deferred equipment cost. They can see which equipment across the entire campus, in order of priority, that needs replacement in the upcoming months.
BuildingSymphony provides updated capital renewal forecasts to help facility managers justify costs to their boards.
MYTH #3 – Outsiders don’t know my facility better than I do
It’s true that hospital staff and users know more about each and every hospital “symptom.” Humidity, drafts, a light flickering on and off, a broken toilet, or the sink that won’t drain. Yet, an FCA team has the ability to collect symptomatic data from a panorama of staff and piece it together to diagnose root causes at a system level.
An FCA team that spends several days touring the facility, interviewing staff, and reviewing existing documents can gain a very clear picture of the facility.
This level of due diligence combined with an outsider’s perspective helps them untangle latent and mis-diagnosed issues that would otherwise go uncaught.
MYTH #4 – An FCA only diverts money to things that are invisible, or that have no real value for the entire hospital.
When a hospital gets new finishes or furnishings, hospital staff experience a visible, tangible benefit from the expense. Because the benefits of updated engineering equipment are not visible, the they perceive those expenses as money going into a black hole. Further, staff perceive infrastructure expenses as investments in non revenue generating space.
Because building systems reside behind the scenes, they do not produce noticeable results until they break. And the consequences of broken infrastructure can be catastrophic.
If an HVAC unit fails in an operating suite, the hospital must:
- reschedule surgeries,
- mitigate its compromised ability to manage trauma incidents,
- handle the increased risk of infection,
- reschedule underutilized staff, and,
- make up for $86,000 per OR per day in lost revenue.
These consequences not only are visible, but also impact revenue. Infrastructure enables the revenue-generating space to actually generate revenue.
Hospitals can prevent equipment failures by conducting an FCA to pinpoint equipment and systems at risk. An FCA reveals systems that have exceeded their useful life span or that are in poor operating condition. It also outlines a plan to repair or replace them and the associated budgetary implications. The plan is a roadmap for breaking upgrade projects into manageable chunks of capital based upon priority and remaining useful life.
MYTH #5 – FCAs are conducted independently from Master Facility Plans (MFP)
It’s a common sight: a hospital conducts an FCA. Then a hospital conducts a MFP. Later it decides to renovate a department as recommended by the MFP. When they start the renovation they discover the air handling system cannot handle the extra air demands. Then they realize the FCA recommended air handling system upgrades that were never completed. The FCA and the MFP did not work in tandem.
The two FCA and MFP should inform one another. The planning team may propose a renovation to a given area. When the FCA team identifies infrastructure upgrades for that same area, the two teams can coordinate costs and timing. Coordinated efforts help the FCA team anticipate future capacity needs. It prevents issues such as the MFP team recommending relocating a service to a new location and the FCA team recommending replacement of that service’s infrastructure at its existing location.
This coordination allows capital projects to absorb infrastructure improvement costs. And, it minimizes the need for capital renewal funds. It also helps accurately identify how much to request from discretionary funds, infrastructure funds, and capital funds.
When competition for capital is increasingly intense, understanding how much you need from which budget and when is critical for success.
In closing
Facility condition assessments help hospitals save money, minimize downtime, and improve the patient experience. They help the hospital mitigate risk and identify capital funding priorities. Without a comprehensive FCA, capital is spent on “Duct-Tape” fixes. Over time, Duct-Tape fixes can cost as much, (if not more than) the cost to replace an item or system proactively.
Can you really afford to believe FCA myths?
