Building Management continues to explore the challenges experienced by Facility Managers in the region in different types of facilities. It is the turn for hospitals, clinics and health centers. Spaces in which good property management can directly influence the health of patients.
By Alejandra García Vélez
The hospital environment represents a challenge for any professional in charge of the infrastructure management of this type of facilities. Users of these types of properties include patients, doctors, administrative staff and visitors, to name just a few, each with specific needs that require special attention.
Issues such as hygiene or having the required supplies are of high relevance in this scenario, as any error in the processes can directly affect the health of patients; In addition, the facilities must be operational 24 hours a day, 365 days a year, which generates an extra challenge.
Another situation in which hospitals face unique conditions is in fire prevention. In an office building, for example, in case of emergencies the users of the building will be able to evacuate by their own means if necessary, while in a hospital bedridden patients who will not be able to evacuate in case of emergency must be taken into account, which leads to raise the protocols and systems of emergency prevention with this in mind.
Evolving hospitals
Precisely, the international journal Health Facilities Management in a study carried out in conjunction with the American Society of Health Engineering, interviewed 9,370 professionals in the sector, including architects, builders and Facility Managers, about trends in the field of hospital facility design. This study sheds some light on the most important aspects that should be taken into account in this type of properties.
According to the answers provided by these 9,370 professionals, the priority aspects in the hospital environment are: improving operational efficiency, improving the safety of both the patient and the caregiver, and the integration of information technologies focused on the field of health. These three factors drive changes in the design of healthcare facilities.
According to the study, hospitals seek to improve their levels of operational efficiency if possible, as this is reflected in the well-being of the patient. However, according to the report "some measures that are taken to improve safety/health levels are contrary to improving efficiency, so when you are thinking in terms of infrastructure management you must have a balance. You have to balance the experience of the patients, with the cost and availability of spaces."
In addition to the above, there are other aspects to take into account. Emphasis on designs that help reduce falls, facilitate mobility and have more areas for hand washing, are some of the aspects that respondents described as paramount. Similarly, there is a focus on the prevention of transmission of infections through physical elements that help in this field, such as the use of antimicrobial materials.
On the other hand, technological advances also play a role in facilities management. In the case of hospitals, facility managers are seeing a growing demand for spaces that complement the advances in technology that are incorporated into the infrastructure of the health center. For example, the expansion of mobile and cable networks for telehealth services is necessary, operating rooms tend to increase in size to accommodate more equipment, among other changes.
These are just some of the trends evidenced by the report, but no one better to share their vision on the management of medical facilities than the professionals who work in this area.
On this occasion, GERENCIA DE EDIFICIOS interviewed Pablo Martínez Vargas, head of Engineering and Maintenance at Clínica Bíblica; Maximiliano Trujillo Toro, Infrastructure and Technology Manager of the University Hospital of San Vicente Foundation; and Oscar Dario Saldarriaga, head of the Engineering and Maintenance Department at pablo Tobón Uribe Hospital.
In addition, in an effort to highlight the work of all these professionals, this edition of the magazine also includes a ranking of the 30 most important hospitals and clinics in Latin America, according to square meters, and the name of their respective infrastructure or maintenance managers.
Experiences
Oscar Dario Saldarriaga
Head of Engineering and Maintenance
Pablo Tobón Uribe Hospital (Colombia)
Built area: 54.000 m2
Saldarriaga belongs to the Engineering and Maintenance Department of the Pablo Tobón Uribe Hospital since November 1984, which means that he has 31 years of experience in this field. Its main focus has been maintenance management and administration. In addition to being a mechanical engineer by profession, he has several diplomas in management and technology evaluation and currently one of his main projects is the technical management of the Integral Development Plan of the hospital.
The hospital currently has 54,000 m2 built, but is in a process of expansion that will add another 54,500 m2 more, to reach a total area close to 110,000 m2.
It is worth noting that the Engineering and Maintenance department depends on and reports to the Administrative Division, and is divided into 4 fields of action. The Clinical division that is responsible for supporting biomedical teams; Physical Infrastructure focused on endowment, furniture and maintenance of buildings; Technical Infrastructure for everything related to technical services of support, production and maintenance of steam, medical gases, electrical substation, refrigeration, air conditioning; and finally the division of Constructions and Reforms, which as its name suggests is in charge of the reforms and constructions of the different services.
GDE: What is a day of work like for you in the infrastructure management of the Hospital?
Oscar Saldarriaga (OS): The day to day of a hospital maintenance manager is actually quite similar to that of a maintenance manager of an industrial plant or other types of service buildings such as a bank, the difference lies in the levels of demand and compliance that must be handled, taking into account that the "produced" of our economic activity is to keep human beings alive.
In general, on a day-to-day basis, the good condition of the equipment, its availability, compliance with indicators of execution and result of the scheduled maintenance activities must be ensured and, of course, the execution of budgets within the guidelines given by the general management of the hospital must be ensured.
GDE: What are the main aspects to take into account in the management of infrastructure and operations of a hospital?
OS: The main aspects to take into account in the management of the infrastructure of a hospital are to ensure safe facilities for patients, workers and visitors of the building, to ensure that both the facilities and the medical and support equipment are always in safe and reliable conditions to support the treatment of patients.
GDE: What are the main challenges and differences with other types of facilities?
OS: The main challenge is the levels of reliability that must be achieved in hospital facilities, which is crossed with the low levels of economic resources that hospitals have for this purpose.
The radical difference is that in an industrial facility if the infrastructure fails, then the production chain or the process will be stopped, but make an idea that in the middle of an open heart surgery the electricity supply infrastructure fails, for example, or the oxygen supply, just to mention an example.
GDE: What technological tools does the hospital have for infrastructure management?
OS: The Pablo Tobón Uribe Hospital has for the administration and maintenance of its assets both in equipment and in buildings with a maintenance management software called "A.M". Also, within the normal operation of the building, we rely on closed television systems, access control, automation of electromechanical equipment, etc.
The above elements are tools that facilitate the operation of the institution and also increase the levels of security of the same, we have more than 6,000 teams associated with the care of our patients and our building currently has 54,000 square meters and a floating population of 16,000 people / day, without these tools it would be impossible to manage it.
Pablo Martinez Vargas
Head of Engineering and Maintenance
Biblical Clinic (Costa Rica)
Built area: 76.525 m2
The second guest of this edition is a civil engineer who has an experience in the field of maintenance and management of hospital infrastructure of 23 years. Since 1993 he has been working in this field, after having started his professional practice in the area of design, drawing and construction of roads.
He is in charge of the management of Clínica Biblíca, a medical center with more than 70,000 m2 of built area. Among the areas under his responsibility are an old building built in 1927 of more than 1,000 m2 that is currently used for administrative activities and as a cafeteria. In addition, the complex also has different constructions carried out in the 70s, 80s, 2000s and 2010s.
Building Management (GDE): What is a day's work like in hospital infrastructure management?
Pablo Martínez (PM): We started the day with the review of emails from the night before, reviewing pending tasks with the supervisors of the different disciplines including the systems supervisor, medical equipment supervisor, conservation supervisor, new construction supervisor, among others. Inspection tours are carried out, assessment of the different activities either preventive maintenance, corrective, and new construction.
The review of requests for preventive, corrective maintenance, and new construction is also done. Finally, budgets are prepared and reviewed for subcontracting, purchase of equipment, spare parts and materials.
GDE: What are the main aspects to take into account in the management of infrastructure and operations of a hospital?
PM: Let's take into consideration that a hospital operates 24 hours a day, 365 days a year, so the infrastructure should never stop, for example the electricity supply systems, drinking water, medical gases, telecommunications and networks should never fail.
Secondly, the maintenance of medical equipment must be constant and invariable as recommended by the manufacturer and the conservation of the work must be frequent to achieve a pleasant living environment. Those are the main aspects to keep in mind.
GDE: What are the main challenges and differences with other types of facilities?
PM: In our maintenance and new construction management, norms and standards are always implicit where life safety is aimed at our patients, customers, visitors and collaborators.
GDE: What technological tools does the hospital have for infrastructure management?
PM: We have a program of our own design called MPC, which is focused on preventive and corrective maintenance, having a control of ballots generated by the system which yields a variety of statistical data, obtaining a valuable evaluation tool.
Maximilian Trujillo
Infrastructure and Technology Manager
San Vicente University Hospital Foundation (Colombia)
Built area: 66.000 m2
Maximiliano Trujillo, our last guest for this article, has as a profession Biomedical Engineering, in addition to a specialization in business administration and Master in Biomedical Engineering with emphasis in Clinical Engineering. His experience in the sector is 12 years.
The San Vicente Foundation University Hospital, located in the city of Medellín, Colombia has 66,000 square meters built, distributed in 17 different blocks. While a new headquarters recently built, Specialized Centers of San Vicente Foundation, has a lot with an extension of 106,000 m2, of which 67,000 m2 are built.
GDE: What is a day's work like for you in hospital infrastructure management?
Maximiliano Trujillo (MJ): Review of the day's agenda, review and response to emails, follow-up to projects, tasks, activities of all areas, solution of activities and problems, follow-up to strategic plans (weekly activity), meeting with suppliers, needs assessment.
GDE: What are the main aspects to take into account in the management of infrastructure and operations of a Hospital?
MT: Planning, management of human and financial resources, optimization of resources, prioritization and opportunity in the solution of needs
GDE: What are the main challenges and differences with other types of facilities?
MT: In the specific case of the hospital, which has a hospital infrastructure with 102 years, it is a hospital with horizontal infrastructure, architectural heritage of the nation, so the provision of health services presents limitations in architecture. In addition, the executions to the architecture must be done without stopping the operation, since the lives of the patients are at stake.
GDE: What technological tools does the hospital have for infrastructure management?
MT: The University Hospital of San Vicente Foundation has management of maintenance activities through the SAP system, through which preventive maintenance activities are scheduled, request for corrective maintenance activities, monitoring of maintenance activities. There are also some access control systems in some areas.
In the case of Specialized Centers of San Vicente Foundation, maintenance activities are also managed through SAP, but being a new building, it has access control systems in all areas and automation of the systems through BMS, which has a monitoring center with responsible personnel 24 hours.
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