hls presentation hospitals 2013
TRANSCRIPT
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r e s e n t a t i o n O u t l i n e
HLS
• Personnel
• Statutes, Rules & Regs
• Policies & Procedures
• LSO HLS Mgmt Report
Facilities & Projects
• Facilities by HC Type
• HLS History
• Projects per Year
• Reviews/Inspections
• Queue Metrics
• 3rd Party & Jurisdictions
Process Changes
• Triage Review
• Deliverables
• Project Database 2.0
Discussion
• Cost-Scope-Schedule
• Timing of Submittals
• Prelim/Final Combined
• Reduce Final Reviews
• Future Improvements
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
Healthcare Licensing
& Survey
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S - P e r s o n n e l
• Wyoming Department of Health – Aging Division
• Heather Babbitt – Senior Administrator (Aging Division)
• Healthcare Licensing & Survey (HLS)
• Ron Pearson – Administrator (HLS)
• Life Safety & Construction Branch
• Todd Wyatt – Chief
• Milt Werner – Engineer
• John Bruner – Engineer
• Jason Jensen – Life Safety Surveyor
• Healthcare Surveillance
• Laura Hudspeth – Chief
• (2) Lead Surveyors + (10) Surveyors
• Business Office
• Tammy Schmitt – Chief (Licensing)
• (2) Certification Specialists + (1) Website Administrator
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S - P e r s o n n e l
Ron Pearson
Todd Wyatt
Milt Werner
Pat Davis
Jeffrey Shahan
Laura Hudspeth Tammy Schmitt
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S - P e r s o n n e l
• Heather Babbitt – Senior Administrator (Aging Division)
• Started on April 8, 2013
• MPA (Master of Public Administration)
• Ron Pearson – Administrator (HLS)
• Started on December 15, 2011
• MHA (Master of Healthcare Administration)
• CFAAMA (American Academy or Medical Administrators)
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S - P e r s o n n e l
• Todd Wyatt – Chief of Life Safety & Construction Branch• Started at HLS on 5/2012
• Education : University of Illinois • Architecture : Bachelors 1990 & Masters 1993
• Professional• 1990 - 1996 : Gary Anderson Architects (Rockford IL)
• 1996 - 2004 : H+L Architecture (Denver CO)• Role : Project Architect + Project Manager
• Ivinson Memorial Hospital (Laramie, WY)
• St. Mary’s Hospital (Grand Junction CO)
• Great Plains Regional Medical Center (North Platte NE)
• Children’s Hospital (Denver CO)
• 2004 - 2009 : EUA (Milwaukee WI)• Role : Quality Assurance Manager
• Production/PM/Design/Staff Development/Data Management
• Risk Mgmt : reviewed (25) projects during SD/DD/CD phases
• 2010 - 2011 : H+L Architecture (Denver CO)• Role : Senior Project Architect
• Children’s Hospital (Denver CO)
• Licensed Architect (CO 2003)
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S - P e r s o n n e l
• Milt Werner – Engineer : Started at HLS on 11/1991
• Pat Davis – Engineer : Started at HLS on 11/2013
• Engineer #3 : To be hired in 1Q of 2015
• Certifications for Life Safety & Construction Branch Staff• Certified Plan Examiner
• Certified Fire Plan Examiner (CFPE - NFPA)
• Building Plans Examiner (B3 - ICC)
• Mechanical Plans Examiner (M3 - ICC)
• Plumbing Plans Examiner (P3 - ICC)
• Certified Fire Inspector• Fire Inspector I (66 - ICC)
• Commercial Building Inspector (B2 - ICC)
• Commercial Mechanical Inspector (M2 - ICC)
• Commercial Plumbing Inspector (P2 - ICC)
• (8) Plan Examiner & Fire Inspector Tests = +6000 pages of codes
• Centers for Medicare & Medicaid Services (CMS)• Principles of Documentation
• Basic Life Safety Course
• NFPA 99
• FSES/HC
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
S t a t u t e s, R u l e s, & R e g s
• Statutes
• Formal written enactment of a legislative authority.
• Command or prohibit something, or declare policy.
• Regulations
• A written order containing rules having the force of law.
• Prescribed by authority, especially to regulate conduct.
• Rules
• Details of how a statute or a regulation is put into effect.
• Governs conduct, action, procedure, or arrangement.
• Policy & Procedures
• Identifies the responsibility, authority, and accountability
of individuals within the framework of the department.
Difficult
Easiest
Easier
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
S t a t u t e s, R u l e s, & R e g s
• Statutes
• TITLE 35 - PUBLIC HEALTH AND SAFETY
• Chapter 2 - Hospitals, Health Care Facilities and Health Services
• Article 9 - Licensing and Operations W.S. 35-2-906.
• Rules & Regulations
• Chapter 3 : Construction Rules and Regulations for HC Facilities
• Chapter 2 : Hospitals, Health Care Facilities and Health Services
• Chapter 12 : Rules and Regulations for Licensure of Hospitals
• Policy & Procedures
• C-007 - Plan Review and Inspection Policy
• C-026 - Protocol for Acceptable Plans
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 2 - Hospitals, Health Care Facilities and Health Services
• Article 9 - Licensing and Operations
• W.S. 35-2-906.
• Requires proposed HC facility construction projects be reviewed and approved prior to commencing with construction.
Chapter 9 - Fire Protection
• Article 1 - Department of Fire Prevention and Electrical Safety
• W.S. 35-9-121.1.
• Passed in 2003 … gives the Office broad jurisdiction over “all aspects” of construction, except for electrical installations (where jurisdiction resides with the DFPES or delegated local government).
• This statute also requires the Office to adopt certain construction codes and it allows the Office to delegate plan review and inspection responsibilities to local governments.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 2 - Hospitals, Health Care Facilities and Health Services
• Article 9 - Licensing and Operations
• W.S. 35-2-906.
• Construction and expansion of facilities; exemption.
(a) A licensee who contemplates construction of or alteration or
addition to a health care facility shall submit plans and specifications
to the division for preliminary inspection and approval prior to
commencing construction. Significant changes to the original plans
must also be submitted and approved prior to implementation. The
plans and any changes shall indicate any increase in the number of
beds.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 2 - Hospitals, HC Facilities and Health Services
• Article 9 - Licensing and Operations
• 35-2-901. Definitions; applicability of provisions.
• (a) As used in this act:
(x) "Health care facility" means any ambulatory surgical center, assisted living
facility, adult day care facility, adult foster care home, alternative eldercare
home, birthing center, boarding home, freestanding diagnostic testing center,
home health agency, hospice, hospital, intermediate care facility for people with
intellectual disability, medical assistance facility, nursing care facility,
rehabilitation facility and renal dialysis center;
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 9 - Fire Protection
• Article 1 - Department of Fire Prevention and Electrical Safety
• W.S. 35-9-121.1. • Health care facilities; jurisdiction; delegation; rules.
• (a) The department of health has jurisdiction over all aspects of construction and remodeling, except electrical installation, of any state licensed health care facility as defined in W.S. 35-2-901.
• (b) The fire safety code requirements for the construction and remodeling of any state licensed health care facility shall meet the minimum requirements established in the National Fire Protection Association 101 Life Safety Code or any other code required to meet federal fire and life safety certification. If any code requirements for federal certification conflict with the code of any other state or local governmental entity, the code required for federal certification shall prevail.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 9 - Fire Protection
• Article 1 - Department of Fire Prevention and Electrical Safety
• W.S. 35-9-121.1.
• Health care facilities; jurisdiction; delegation; rules.
Continued …
• (c) The department of health shall promulgate rules and regulations for all aspects of construction and remodeling of health care facilities except electrical installation. For aspects of construction and remodeling included in codes adopted by the council pursuant to W.S. 35-9-106, the rules and regulations shall be based on and not exceed the standards of these codes except where federal certification requirements dictate otherwise.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 9 - Fire Protection
Article 1 - Department of Fire Prevention and Electrical Safety
• 35-9-106. Powers and duties of council.
• (a) The council shall adopt rules and regulations to:
• (i) Establish minimum fire standards not exceeding the standards prescribed by
the International Fire Code, the International Building Code, the International
Mechanical Code, the International Existing Building Code and the
International Fuel Gas Code for:
• (A) All new building construction or remodeling under W.S. 35-9-108(a);
• (B) The prevention of fire and the protection of life and property from fire and panic in
all existing buildings;
• (C) The safeguarding of life and property from hazards of fire and explosion arising
from storage, handling and use of hazardous substances, materials and devices.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H e a l t h c a r e S t a t u t e s
TITLE 35 - PUBLIC HEALTH AND SAFETY
Chapter 9 - Fire Protection
Article 1 - Department of Fire Prevention and Electrical Safety
• W.S. 35-9-121.1.
• Health care facilities; jurisdiction; delegation; rules. Continued …
• (d) Upon written request from any county or municipality, the department of health shall delegate plan review and inspection responsibilities to the county or municipality that has personnel who are certified pursuant to the applicable code. The department of health shall transfer jurisdiction and authority by letter. The department of health shall notify the governing body of the municipality or county of the minimum standards and requirements under this section and W.S. 16-6-501 and 16-6-502. The following shall apply:• (i) Any municipality or county may issue a certificate of occupancy for a health care facility.
The certificate shall reference any code applied to the construction or remodeling of the facility;
• (ii) A municipality or county which has enforcement authority under this subsection shall create its own appeals board to determine the suitability of alternate materials and types of construction.
• (e) After construction or remodeling of any health care facility, the department of health shall have jurisdiction over the fire and life safety inspections required for federal certification.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
C H 3 : R u l e s & R e g s
• Section 1 : Authority
• Section 2 : Applicability
• Section 3 : Definitions
• Section 4 : Department of Health Jurisdiction
• Section 5 : Construction Design Requirements for HC Facilities
• Section 6 : Approvals, Inspections, Tech Assistance, Interpretations and Plan Review
• Section 7 : Exist Bldg Licensure
• Section 8 : Electrical Safety
• Section 9 : Variances
• Section 10 : Severability
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
G u i d e l i n e s t o C H 3
• Intro
• Facility Types Requiring
Construction Approval
• Project Programming Phase
• Plan Reviews
• Inspections
• Technical Assistance
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S W e b s i t e
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P o l i c i e s & P r o c e d u r e s
• C-007 Plan Review and Inspection Policy
• C-008 Plan Review Follow-Ups
• C-014 Construction Project Organizational System
• C-015 Construction Plan Review Protocol
• C-016 Waiver Criteria for Construction Plan Reviews
• C-017 Electrical Plans Review Protocol
• C-018 Construction Queue
• C-021 Transfer from Construction to Licensure
• C-022 Construction Variance Tracking
• C-025 Protocol for Determining Rqmt for Design Prof. Seals
• C-026 Protocol for Acceptable Plans
• C-027 Design Professional Seals
• C-028 Minor Project Final Plan Review
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P o l i c i e s & P r o c e d u r e s
Purpose:
The purpose of having a queue system is to manage the workload and assignments and to ensure that preliminary and final plans are reviewed in the order of receipt or that projects pursuant to federal Life Safety Code requirements are prioritizedto protect the healthcare entity’s certification status.
Policy:
All preliminary plans and final plans received by HLS for review are entered into the queue and assigned to an engineer for review. The status of each project will be monitored on a weekly basis.
Procedure:
… all other projects will be moved up in the queue by order of date received …
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P o l i c i e s & P r o c e d u r e s
Prioritization
We prioritize submissions based on the following criteria:
1. CMS or State Related Deficiencies (from Surveys)
2. Minor Projects (recent revision)
3. Plan of Corrections (Licensure Survey)
4. 3rd Party/Delegated AHJ Approved Final Plans
5. Phased Construction Review (Foundation)
6. Modifications to approved projects1. Construction Phase
2. Final Plans
3. Preliminary Plans
7. Deferred plan submittals (fire alarm, fire sprinkler, etc)
8. Disposition responses to reviewed projects1. Final Plans
2. Preliminary Plans
9. All projects (routine maintenance, minor and major projects) placed in the Review Queue per the date of submission.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P o l i c i e s & P r o c e d u r e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
L S O H L S M g m t A u d i t
WHAT?
• Program evaluation report
• Compares what a program
is accomplishing to what
the Legislature intended
the program to accomplish
• LSO requests info from
HLS including:
• Documents
• Data : staffing/budgets
• Case Files : projects
• Questions : process
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
L S O H L S M g m t A u d i t
WHY?
• Statutes passed in 2003 required HLS plan reviews & inspections
• Increased HC project submissions during 2005-2008 caused a backlog
• 80% of construction projects come from hospitals and nursing homes
• Main issues & concerns
• Timeliness
• Consistency
• Transparency
4855
47
5664
6065
106
123
9488
68 7175
97
118
0
20
40
60
80
100
120
140
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Projects by Year
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r i n c i p a l F i n d i n g s
1. Timeliness of the Office’s work has significantly decreased in recent years.
2. Preliminary plan reviews do not assist in quicker or easier final plan reviews.
3. Combining code requirements with process criteria in rules with frequent promulgations causes confusion for Office staff and other stakeholders.
4. Office’s application of project process waivers is inconsistent and does not help manage project workload.
5. There is no clear or consistent appeals process for facilities to check the Office’s code application or interpretation decisions prior to final licensure.
6. The Office’s paper and electronic project tracking systems are cumbersome and ineffective for review and oversight.
7. The Office lacks formal internal policies to provide guidance and assist staff in consistently implementing its work processes.
8. The Office has not proactively carried out its statutory responsibility to delegate authority to local governments, contributing to additional workload and timeliness problems for the Office.
9. Coordination on electrical plan reviews conducted by the DFPES or delegated local author cities is lacking and does not ensure facilities are constructed according to appropriate codes.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
R e c o m m e n d a t i o n s
1. Re-establish reasonable timelines for review and inspections
2. Re-evaluate need for Preliminary Plan reviews
3. Codes/standards are consistently applied
4. Manage waivers effectively
5. Establish an appeals process
6. Re-evaluate its paper & electronic record management
7. Develop clear and sufficient policies to ensure consistency
8. Encourage more local governments to perform plan reviews
and inspections
9. Work with DFPES to mirror certifications of local delegation
of authority
10. Coordinate with DFPES to ensure plan reviews are performed
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
T i m e l i n e s s
1. The Office should re-establish in rules or formal policy
reasonable time lines for conducting plan reviews and
inspections; engineer staff should be monitored on their
timeliness per these time lines.
2009 HLS Response : Agreed
• An engineering manager position was created in 2010 in
order to better manage the engineering section, manage
existing policies, and to develop new policies to comply
with all the Management Audit Committee’s
recommendations.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
T i m e l i n e s s
• Facility Survey : Prelim/Final Reviews should take :
• (45) days or less (70% thought) … (30) days or less (30%)
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
C o n s i s t e n c y
2. The Office should re-evaluate the overall need for the review of preliminary plans; if upon further review the Office chooses to eliminate the requirement, it should seek statutory change if necessary.
2009 HLS Response :
• Office of Attorney General concluded that the legislature mandated a preliminary review of plans and specifications prior to the commencement of construction.
2013 HLS Response :
• Statute states “submit plans and specifications … for preliminary inspection and approval prior to commencing construction …”• Option 1
• Reduce scope of Preliminary Plan submittal
• Focus HLS energies on review of Final Plans
• Option 2
• Expand scope of Preliminary Plan submittal
• Require submittal (but not review) of Final Plans only
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
C o n s i s t e n c y
3. The Office should promulgate codes/standards and process elements into separate rules to ensure that codes/standards and processes are consistently applied throughout the duration of each project.
2009 HLS Response :
• Chapter 3 Rules & Regs were simplified in 2008.
2013 HLS Response :
• Additional simplifications will be made in Q3 of 2013.
• Separate process requirements from codes, standards & other requirements.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
Facilities and Projects
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
F a c i l i t i e s b y H C T y p e
• (8) Adult Day Cares (ADC)
• (26) Assisted Living Facilities (ALF)
• (20) Ambulatory Surgical Centers (ASC)
• (9) Boarding Homes (BH)
• (16) Critical Access Hospitals (CAH)
• (3) Community Mental Health Centers (CMHC)
• (1) Comprehensive Outpatient Rehabilitation Facilities (CORF)
• (9) End Stage Renal Dialysis Centers (ESRD)
• (13) Federally Qualified Health Centers (FQHC)
• (1) Freestanding Diagnostic Testing Center (FSDTC)
• (43) Home Health Agencies (HHA)
• (19) Hospice Center (HSPC)
• (11) Hospitals (HOSP)
• (1) Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
• (38) Nursing Care Facilities (NH)
• (1) Outpatient Physical Therapy (OPT)
• (3) Psychiatric Residential Treatment Centers (PRTC)
• (2) Psychiatric Hospitals (PSYCH)
• (2) Rehabilitation Facility (REHAB)
• (1) Rehabilitation Hospital (RHOSP)
• (18) Rural Health Clinics (RHC)
• (1) Rural Hospital (RH)
• (246) Total WY HC Providers
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S H i s t o r y
1991 to 2003
• HC Codes enforced• NFPA 101• Federal certification purposes
• AIA Guidelines • Focused on engineering,
infection control, and safety of facilities.
• Review & Inspections• Preliminary Plans
• Final Const Inspections
• Staff : (1)• Pro’s : Consistency &
Timeliness
• Con’s : Deficiencies found late in process (Post-Const) = $$$
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S H i s t o r y
2003 to 2008• HC Codes enforced
• NFPA 101 (2000 & 2006)
• AIA Guidelines
• ICC Codes
• National Electrical Code
• Review & Inspection Scope• Added Final Plan Reviews
• Added Interim Inspections
• Delegated Jurisdictions
• 3rd Party Plan Reviewers & Inspectors
• Staff : (2-3)• Pro’s : Deficiencies identified earlier
• Con’s : Consistency & Timeliness
2010 to Present• Added Chief of LS & Const Branch
• Staff : (3)• Pro’s : Engineers focus on review/inspection
• Con’s : Consistency & Timeliness
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r o j e c t s b y Y e a r
8
4
7
4
18
9
15
1
87
8 8 87
67 7
1110
2
8
5
13
65
45
87 7
2
9
7
3
0
2
4
6
8
10
12
14
16
18
20
Oct
-11
Nov
-11
Dec
-11
Jan-1
2F
eb-1
2M
ar-1
2A
pr-
12
May
-12
Jun
-12
Jul-
12
Aug
-12
Sep
-12
Oct
-12
Nov
-12
Dec
-12
Jan-1
3F
eb-1
3M
ar-1
3A
pr-
13
May
-13
Jun
-13
Jul-
13
Aug
-13
Sep
-13
Oct
-13
Nov
-13
Dec
-13
Jan-1
4F
eb-1
4M
ar-1
4A
pr-
14
May
-14
Jun
-14
Jul-
14
Projects by Month
4855
47
56
6460
65
106
123
9488
68 7175
97
89
76
0
20
40
60
80
100
120
140
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Projects by Year
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
R e v i e w s & I n s p e c t i o n s
1410
13 12
18
129
4
2117
20
13 13 1310 12
2124
1815
26
19
13
24 25 2521
17
9
19
13
28
6
6
11
7
8
58
14
10
11
13
13
6
15
3
9
64
8
8
5
3
8
2
74 10
5
7
12
17
5
16
9 11
19
0
10
20
30
40
50
60D
ec-1
1
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
Dec
-12
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
Dec
-13
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
LS Surveys Inspections Plan Reviews
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Q u e u e M e t r i c s
• How is it determined?
• Average of ALL projects in
Review Queue
78 78
63
72
84
91
97
104
100
6769
64
7574
54
4243
4647
50
39
52
4647
43
47
50
46
53
6058 57
43
4847 47
51
54
60
5453 53
4644
46
51
43
49
5352
57
52
41
34
39 3938
46
4142
54
47
43
31
37 38 37 38
35
42
38
4142
43
47
51
6058
59 59
62
57
44
49
43
38
35
32
3634
40
37
40
43
46
53
61
69
60
51
55
58
61
70 71
79
74
81
88
100
94
107
39
20
0
15
30
45
60
75
90
105
120
06
/01
/12
06
/15
/12
07
/09
/12
07
/23
/12
08
/13
/12
08
/27
/12
09
/11
/12
09
/24
/12
10
/08
/12
10
/22
/12
11
/05
/12
11
/19
/12
12
/03
/12
12
/17
/12
12
/31
/12
01
/14
/13
01
/28
/13
02
/11
/13
02
/25
/13
03
/11
/13
03
/25
/13
04
/08
/13
04
/22
/13
05
/06
/13
05
/20
/13
06
/03
/13
06
/17
/13
07
/01
/13
07
/15
/13
07
/29
/13
08
/12
/13
08
/26
/13
09
/09
/13
09
/23
/13
10
/07
/13
10
/21
/13
11
/04
/13
11
/18
/13
12
/02
/13
12
/16
/13
12
/30
/13
01
/13
/14
01
/27
/14
02
/10
/14
02
/24
/14
03
/10
/14
03
/24
/14
04
/07
/14
04
/21
/14
05
/05
/14
05
/19
/14
06
/02
/14
06
/16
/14
06
/30
/14
07
/14
/14
07
/28
/14
08
/11
/14
Days in Queue by Week
• Today (Monday’s) - Day
submitted = Days in Queue
• Goal = 30 - 45 days
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Q u e u e M e t r i c s
39 3938
46
4142
54
47
43
31
37 38 37 38
35
42
38
4142
43
47
51
6058
59 59
62
57
44
49
43
38
35
32
3634
40
37
40
43
46
53
61
69
60
51
55
58
61
70 71
79
74
81
88
100
94
107
39
20
0
15
30
45
60
75
90
105
120
Days in Queue by Week
PD’s First
Day
(11/04/13)
JJ’s Last
Day
(02/21/14)
JS’s First
Day
(05/05/14)
JB’s Last
Day
(09/26/13)
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Q u e u e M e t r i c s
75
49
20
15 15
30
2521
59
64
0
10
20
30
40
50
60
70
80
1-1
3
14-2
7
28-4
1
42-5
5
56-6
9
70-8
3
84-9
7
98-1
11
112
-12
5
126
-13
9
140
-15
3
154
+
Number of Projects by DIQ
48
54
40
79
58
50
6971
67
32
4549 48
43
5356
19
43
5957
32
72
0
10
20
30
40
50
60
70
80
90
Oct
-12
Nov-1
2D
ec-1
2Ja
n-1
3F
eb-1
3M
ar-1
3A
pr-
13
May
-13
Jun-1
3Ju
l-13
Aug-1
3S
ep-1
3O
ct-1
3N
ov-1
3D
ec-1
3Ja
n-1
4F
eb-1
4M
ar-1
4A
pr-
14
May
-14
Jun-1
4Ju
l-14
Average DIQ by Month
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Q u e u e M e t r i c s
• Disadvantages of Metrics from “Spreadsheet”
• Difficult to differentiate project types & reviews/inspections
• Projects :
• Major vs. Minor,
• New Facility, Addition, Renovation
• Reviews :
• Inquiries
• Triage, Routine Maintenance, Prelim, Final
• Dispositions
• Revisions
• Inspections :
• Interim, Final, Follow-Up, Plan of Corrections
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
3 r d P a r t y & J u r i s d i c t i o n s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
Process Changes
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
H L S T a s k s
• Pre-Construction
• Preliminary Plan and Final Plan reviews
• Permission to proceed with construction
• Construction
• Interim inspections of the project as it is being built
• Post-Construction
• Final Construction Inspection and provisional licensure for
facilities to begin using the construction space for rendering
healthcare services.
• Upon gaining state licensure, some facilities choose to
become certified for federal Medicare and Medicaid service
reimbursement.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
T r i a g e R e v i e w
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
T r i a g e R e v i e w
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
D e l i v e r a b l e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
D e l i v e r a b l e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
D e l i v e r a b l e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
D e l i v e r a b l e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
D e l i v e r a b l e s
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r o j e c t D a t a b a s e 2 . 0
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r o j e c t D a t a b a s e 2 . 0
• Old Database
• HLS Engineers & Chief can all input information
• Emails : add summaries in notes, print to TXT file
• No reports (spreadsheet on steroids)
• New Database
• Gmail : Cc each other, searchable by project # (YYYY-###)
• Reports : mine for project data• Projects List : A summary report of several (or all) projects grouped by
filtering categories.
• Project Info - Summary : A summary report of a single project.
• Project Timeline : A detailed report of a single project's timeline.
• Notes - Single Project : A list of all notes for a single project
• Contacts - Single Project : A detailed report of all the contact info
• Contacts - Multiple Projects : A list of third parties and/or jurisdictions sorted by project and/or project type.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
Discussion
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Cost – Scope - Schedule
• One side of the triangle cannot be changed without affecting the others.
• A trilemma is a difficult choice from three options, each of which is (or appears) unacceptable or unfavorable.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Cost – Scope - Schedule
• Option 1
• Design something quickly
• and to a high standard,
• but then it will NOT be cheap.
• Option 2
• Design something quickly
• and cheap,
• but it will NOT be of high quality.
• Option 3
• Design something with high quality
• and cheap,
• but it will NOT occur quickly.
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
S u b m i t t a l s - T y p i c a l
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
S u b m i t t a l s - I d e a l
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
P r e l i m / F i n a l C o m b i n e d
Schematic
Design
Design
Development
Contract
DocumentsConstruction Occupancy
Preliminary
Review
Final Plan
Review
Final
InspectionCurrent
Preliminary
Review
Final Plan
Review
Final
InspectionOption
A
Preliminary
Review
Final Plan
Review
Final
InspectionOption
B
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
F i n a l P l a n R e v i e w s
• Final Plan Reviews (FPR)• Required for …• New Facilities & Additions & Renovations > 4500 sf
• Optional for …• All other project types
• Facility may OPT out
• Eliminate FPR’s?• Make preliminary plan reviews (PPR) the “final” review
• Require level of completion per FPR’s for PPR’s
• Advantage• (1) submittal = Improved timeliness
• Disadvantage• 3rd Party Review would be reduced • HLS has to review “prelims” per statute
• Risk Mgmt : Design Teams could design down the wrong path
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
F u t u r e I m p r o v e m e n t s
• 2012 ICC Adoption
• Adopted by DFPES
• Enforced by some WY jurisdictions
• Designers are familiar with this edition
• HLS Newsletter
• Educate facilities & designers on code issues
• Improve transparency
• Plan Review Queue
• Weekly version saved to WDH website, accessible to public (?)
• Documentation Mgmt
• Online, project portal• Newforma
• Email Mgmt
• Eventual replacement for database
Healthcare Licensing and Surveys (HLS) ● Wyoming Department of Health (WDH)
Improving the ProcessLife Safety Reviews &
Inspections of HC Facilities
T H A N K Y O U