Environmental Business Council of New England July 27, 2005

1. Emerging Regulatory Trends and Management Issues for New England Hospitals and Healthcare Facilities Robert Castaldo Director, EH&S Massachusetts General Hospital Boston, MA Environmental Business Council of New England July 27, 2005

2. Partners HealthCare Network • Founding Members • Massachusetts General Hospital* • Brigham & Women’s Hospital* • Other Members • Faulkner Hospital • McLean Hospital* • Newton – Wellesley Hospital • North Shore Medical Center • MGH Institute of Health Professions • Partners Community HealthCare • Partners Continuing Care • * Harvard Teaching Affiliate

3. Third Oldest Hospital in US; Largest in New England • 19,500 employees (includes 2,900 nurses) • 3,600 member medical staff • In- Patient Services • Available Beds: 893 • Average Occupancy Rate: 80.47% • Admissions: 44,518 • Average Length of Stay: 5.83 days • Admissions to Observe: 5,285

4. Ambulatory Services • MGPO Visits: 694,268 • Clinics Visits: 417,203 • Health Centers Visits: 299,232 • Emergency Visits: 74,905 • Total Ambulatory & Emergency 1,485,608 • Surgical Services • In-Patient 17,957 • Ambulatory 15,013 • Total Surgical Cases 32,970 • Births 3,604

5. MGH Mission Clinical Care, Teaching and Research • Almost all staff physicians are on • the Harvard Medical School faculty • Largest hospital-based research • program in the US

6. Downtown Campus – clinical & research Charlestown Navy Yard - research Community Centers - clinical

7. Current Operational Drivers of EH&S Programming • Hospital Growth and Renewal • New Construction and Renovation • New Emergency Management Demands • HAZMAT Response Readiness • Biosafety • JCAHO • Periodic Performance Review Process • Patient Safety • Specific Continual Regulatory Oversights • EPA • MWRA

8. Hospital Growth and Renewal • Major additions on the main campus • Extensive backfill renovations • Preparations for next major rebuilding project • Impact on EH&S: • Keeps facilities-related safety issues as an everyday • priority • Construction Impacts – internal and external • Fire Safety Management • Life Safety Management • Environmental Impacts – asbestos, molds, ICRA

9. Emergency Preparedness and Homeland Security • HAZMAT Response Capabilities – Greater • expectations for hospitals • Chemical – Radiological – Biological Incidents: Mass • Casualty Management • Biosafety and Select Agent Rules: Public Health Security • and Bioterrorism Preparedness and Response Act • Impact on EH&S: • HAZMAT Incident Response – heightened and • continual readiness; mass casualty focus • More systematic oversight and control of biological • research – increased security re: personnel and • facilities

10. Chemical HAZMAT Response Teams Risk Assessment Recruitment Training Drills

11. Location Visibility and Accessibility Fleet Center Government Center Transportation Hubs MGH

12. Protect our patients • Protect our staff • Protect our facility • Preserve the ability of MGH to serve the community in a large-scale disaster involving hazardous materials

15. JCAHO Periodic Performance Review Process • Changes JCAHO 3-year auditing process • Now requires mid-cycle self-review • Performance Improvement Plan submission • Improvement Tracking • Engineering surveyors now on the JCAHO team • 2006 Patient Safety Goals • Impact on EH&S: • From a once every 3 year exercise to more continual • quality management process in all areas • Engineer surveyors up the ante with facilities-related • management issues • Align safety functions with current patient safety goals

16. 2006 Patient Safety Goals • Improve Accuracy of Patient Identification • Improve Caregiver Communication • Improve the Safety of Medications Usage • Reduce Care-Associated Infections • Reconcile Medications Across a Patient’s Care • Continuum • Reduce Harm from Patient Falls

17. Specific Continual Regulatory Oversights • EPA • RCRA • Contingency Planning and SPCCs • Air Emissions • Real Estate Assessment • MWRA • Mercury