Planning, Design and Construction 14528 S. Outer Forty, Suite 200

1. Planning, Design and Construction 14528 S. Outer Forty, Suite 200 Chesterfield, MO 63017 Tel (314) 628-3656 Fax (314) 628-3471 Form 8334 – CF490 Sisters of Mercy Health System Planning, Design & ConstructionHealthcare Construction EducationDate:

2. Presentation / Discussion Outline • Introductions / Meeting Objectives • Understanding the Healthcare Organization • Owner’s Expectations for Construction

3. The Business of Health Care • Improving the Health and Well Being of People • Requires Multi-Disciplined Team • Highly Regulated • Very Competitive • Challenging to Maintain Financial Stability

4. Typical Health Care Organization

5. Typical Health Care Customers • Sick People • Diagnostic Tests • Elderly / Frail / Behavioral patients • Respiratory Problems • Scared / Confused • Patient Family, Friends, Visitors • Low Imune Patients • Hearing/Vision impaired • Emergency Patients • Burn Patients

6. Elements / Services Needed • Safe Environment • (Dust/ Mold for resipitory patients, Noise for Mandatory rest patients, Smells for imune defiecient patients, air partiticle from burn patients and infection from cnst safe for handicap) • Restful Environment • (Reduce noise, dust, vibration, smells, water leaks, Unplanned outages) • Clinical Areas of Specialty • (Mri protect from vibration/Dust, Lab equipment protect from vibration and samples from contamination, MRI from interference, Several sterile enviroments) • Infection Control • (Infection control measures to protect Patients from staff and other infections and problems while they are in the Hospital)

7. Regulatory Requirements • Applies to Healthcare Facilities, including • Hospitals • Ambulatory Care • Behavioral Health • Long Term Care / Assisted Living • Includes Local, State, and Federal Requirements • Notable: • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ; (HIPPA) • U.S. Department of Health and Human Services (HHS) • Center for Medicaid & Medicare Services (CMS)

8. Regulatory Requirements • Design and Construction Related: • Guidelines for Design and Construction of Hospital and Health Care Facilities (AIA Academy of Architecture for Health) • Environment of Care Requirements (JCAHO) • Centers for Disease Control & Prevention (CDC) • Occupational Safety and Health Administration (OSHA) • American Society of Heating, Refrigeration and Air-Conditioning Engineers, Inc. (ASHRAE) • Local City and States review • Boma

9. Special Systems Used in Healthcare Delivery • Telemetry • Monitoring Patients Hearts • Pneumatic Conveying • Tubes meds, bloods and samples to labs for testing • Exhaust Air/Isolation units • Haz exhaust, Mandatory air exchanges, Isolation rooms • Radiation • X-ray equipment, Hot labs, MR Magnets, Accelerators, Digital images & Records • Infant Abduction • Paging/Antenna systems • Calling code teams, emergency announcements, Doctors Pagers • Emergency (Code/Crash, Flood, etc.) • Emergency power, Trauma Elevators, Medical Gases

10. Typical House Rules • Know and Understand Organization’s Mission • Show Care and Concern for Patients, Families/Visitors, and Property • Ensure Patient Confidentiality • Contribute to Teamwork • Demonstrate Respect for Fellow Co-Workers • Be Courteous and Friendly • Maintain an Appropriate Appearance • Respect existing facilities

11. Mercy Service Standards • Treat Everyone as a valued individual • Seek out and address customer needs • Make eye contact, greet and welcome everyone • Display a positive presence • Keep customers and co-workers informed • Work as a team • Maintain privacy and confidentiality • Keep a clean environment • Live the mercy spirit

12. Guaranteed Issues for Project Team Members • “You Are a Guest in Our House” • Use Effective Communication – NO SURPRISES! • Demonstrate Respect for Owner’s Facilities • Parking (Use designated parking areas) • Public Spaces – Cafeteria, Restrooms, etc. • Behavior • Require All Members to be Accountable for Their Actions

13. Hospital Operational Modes - Summary • Patient care is a driving force • Patients are our customers. This is our business • Heavily regulated • Our reimbursement is tied directly to our ability to serve patients and maintain a safe environment • Risk management oriented • We need to provide risk Assessments for all our activities which is regulated by the State • Performance/process improvement oriented • We must maintain a pan for improvement on facilities which is reviewed by State (Jacho) • Physicians are an integral part of the hospital

14. Hospital Challenges - Summary • Aging buildings and infrastructure • This is why we plan ahead carefully • Competition • Patients have a choice in healthcare and we want that to be SMHS • Technology advances • Decreasing re-imbursement • Lots of Changing healthcare needs and desires • Community may see it as their hospital, even if there are no financial or organizational connections • Financial well being of the organization • No matter what happens, patient care must go on

15. Owner’s Expectations - Construction • Risk Assessment/Management • Manage Risk such as, Noise, Smells, Vibrations, Hazardous areas, Dust, sterile areas, Disruptions • Communication/Coordination of Activities • Plan activities well in advance, Communicate to all co-workers, Manage disruptions to minimize impacts, Be transparent • Quality Assurance • Follow policies and Standards, Control moisture in facilities, wrap ductwork, air testing, Infection control measures

16. Risk Assessment/Management • Environment of Care (EC) • We do not evacuate in fire we retreat to safe zones. • signage, train staff on exits, Maintain sprinkler/alarm systems • Infection control, Risk assessment, Cnst related infections • Interim Life Safety Measures (ILSM) • Temp exiting, Emergency room access, Fire protection systems, Smoke zones, Doors latching, firewalls/Penetrations, fire watches • Infection Control Risk Assessment (ICRA) • Negative pressure, daily checks, Water, dust, sealed partitions, Tracking dirt in facility, filter changes log • Other Construction Site Risk Issues • Sealed barricades, Traffic control, Temp Signage, Guass fields, Radiation, Power disruptions, Isolation room, Access for codes, Monitoring systems, Ceiling tile dust

17. Environment of Care - Definition Provides a … • Safe • Accessible • Effective • Efficient Environment Consistent with Organization’s … • Mission • Services • Applicable Laws • Applicable Regulations

18. Life Safety Code Compliance • NFPA 101 (Provide For a Fire-Safe Environment) • Equivalency Approved by JCAHO • Statement of Conditions • Includes Basic Building Information • Assessment of Existing Conditions • Plan for Improvement • Building Maintenance Protocol

19. Interim Life Safety Measures (ILSM) • Used During Significant Construction Project • Method to Offset Recognized Code Shortcomings • Contains Eleven (11) Administrative Measures • (Egress, exterior access, fire alarms, suppression, Temp Partitions, Fire extinguishers, No smoking policy, storage, fire drills, Hazardous surveillance, Hot work, Re-assessment • Requires Constant Monitoring

20. Infection Control Risk Assessment (ICRA) • Initiated in Design Phase • Provides for a Safe Environment of Care • Determines Potential Risk of Transmission of Various Agents in Facility (Viruses, Bacteria, Toxins) • ICRA Conducted by Panel of Experts Including Infection Control, Risk Management, Facility Design, Construction and Ventilation Safety

21. ICRA – Key Elements Addressed • Impact of Disruption to Essential Services • Patient Placement or Relocation • Placement of Barriers to Protect Susceptible Patients from Airborne Contaminants • Air Handling and Ventilation Needs • Need for Additional Protective Environment Rooms • Domestic Water System that Limits Legionella and Waterborne Opportunistic Pathogens

22. Other Construction Site Risk Issues • Patient Privacy/Confidentiality (HIPPA) • Theft • Adjacencies to Imaging Equipment • Unidentified Hazards in Construction Area • Accidental Disruption to MEP Services • Disrupt surgery, Life support, Oxygen, Contaminant gases, cooling in burn unit, Radiation exhaust, isolation room exhaust,

23. Communication/Coordination of Activities • Exchange of Construction Related Information • Keep administration informed, Train/Inform staff of changes to their areas, Security rounds needed • General Conditions Items • Traffic control, clean up, Safety, infection control, • Planning for Facility Interruptions • Notify departments, move critical patients, provide temp transport, temp O2 added staff to manage patients • Project Emergency Preparedness Risk assessment, notify adjacent department if affect their egress, fire protection systems, HVAC, Fire wall breach

24. Exchange of Construction Related Information • Constructor Orientation and Education Program • Emergency Contact Information • Frequency of Progress Meetings • Meeting Note Distribution List • Process for Handling Unexpected Situations

25. General Conditions Items • Security Items (Employee Access, ID’s, Secure Area, etc.) • Temporary Utilities • Procedures for Deliveries and Trash Removal • Standard Policies (Smoking, Radios, etc.) • Acceptable Support Services (Restrooms, Food, etc.)

26. Planning for Facility Interruptions (Shut-Downs) • Determine Coordination Process to be Used for MEP Systems with Facility Manager • Determine Notification Process to be Used with Affected Parties • Be Proactive, Anticipate Facility Interruptions!

27. Project Emergency Preparedness Plan • Fire • Weather • Internal/External Disaster

28. Quality Assurance • Communication • Teamwork • Customer Service • Technical • Creativity/Value

29. Owner Review of Construction Items • General Conditions, ILSM, ICRA • Pre-Installation Reviews • Users of Future Space • Regulatory Inspections • Facility Management Inspections

30. Proactive Versus Reactive Issue Resolution • What Challenges Do We Face? • Are We Organized For Success? • What Options/Techniques Do We Need To Consider?