lecture 9: facilities planning 469. outline introduction to facilities planning considerations in...
TRANSCRIPT
Outline Introduction to facilities Planning
Considerations in Determining Facilities Requirements
Work Simplification to Material Flow
Flow Planning Hierarchy Activity Relationship Analysis Systematic Layout Planning
Facilities Analysis Components of Facilities
Analysis Facilities Consideration in
Clinical Engineering
Functions of Facilities Management Engineering
Life Safety Hospital Safety Program Security and Resource Protection Professional Environment Medical Functionality
Facilities Design Design Issues Design/Development Process Clinical Areas
Intensive-Care Areas (ICU) General Patient-Care Areas
(GCU) Surgical Suites Obstetrical Facilities Imaging Suites
470
Introduction to Facilities PlanningConsiderations in Determining Facilities
Requirements Flow
1. lot sizes
2. material handling equipment and strategies
3. layout arrangement
4. building configuration
471
Considerations in Determining Facilities Requirements Space
1. lot sizes
2. storage system
3. production equipment type and size
4. layout arrangement
5. building configuration
6. housekeeping and organization
472
Considerations in Determining Facilities Requirements Activity Requirements
1. material or personnel flow
2. environmental considerations
3. organizational structure
4. continuous improvement methodology
5. control issues
6. process requirements
473
Work Simplification to Material Flow Eliminate flow by planning the delivery of
materials to the point of ultimate use
Minimize flow between to points by planning it to take place in few movements
Combine flows and operations
474
Flow Planning Hierarchy
1. Effective flow between departments
2. Effective flow within departments
3. Effective flow within workstations
475
Activity Relationship Analysis
Considers qualitative factors in plant layout
Relationships are evaluated and closeness rating is assigned to each pair of relationship (A,E,I,O,U, and X)
Closeness ratings represent an ordered preference for closeness
476
Rules of Thumb in Activity Relationship Analysis (ARA) No more than 5% of the closeness ratings to
be an A or C
No more than 10% to be an E
No more than 15% to be an I
No more than 20% to be an O
At least 50% to be U
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Relationship Chart
1 PresidentO
2 Costing UA A
3 Engineering IO
4 President’s Secretary
1122
33
Ordinary Ordinary closeness: closeness: President (1) & President (1) & Costing (2)Costing (2)
Absolutely necessary: Absolutely necessary: President (1) & Secretary President (1) & Secretary
(4)(4)
44
I = Important
U = Unimportant
478
Development of Layout Using ARA List all departments or activities to be
included
Obtain closeness ratings by interviewing or surveying persons involved in the activity
Determine reasons for closeness ratings and record in the REL chart
Assign a closeness rating for each pair wise combination of activities
479
Systematic Layout Planning
Goal Locate two areas with high frequency and logical
relationships close to one another using a straight-forward six-step procedure
480
Steps in SLP
1. Chart Relationship the relationships between two different areas are
established and then charted on a special form called the relationship chart.Value
A
E
I
O
U
X
Closeness Line code Value
Absolutely necessary
Especially important
Important
Ordinary closeness OK
Unimportant
Undesirable
4
3
2
1
0
-1
Relationship Ratings
481
Relationship Chart
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Admissions
Medical Records
Control Desk
Waiting Room
FSR Room
Bone Marrow Room
Lumber Puncture Room
Nursing Functions Area
Examining Rooms
IV Therapy/Recovery Rooms
X-Ray, Diagnostic
EKG
ENT
Hematology Lab
Pathology Lab
Pharmacy
Utility/Linen Room
Ladies’ Room
Men’s Room
Local Transport Office
Play Room
Computer Input/Output
X-ray, Therapy
o o oo
o
oo
o
o
o
o
ooo
o o
A A A
AA A
AA
A
A AA
E E EE
E
E
EE
EE
III II I
OI
III
I
I
IIIII
I
I
IX
XXX
X X
Code Closeness
A Absolutely Necessary
E Especially Important
I Important
O Ordinarily close
U Unimportant
X Undesirable
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Steps in SLP
2. Establish Space Requirements Square Footage
calculated based on production requirements extrapolated from existing areas projected for future expansion or fixed by legal standards, such as the ADA or
architectural standards
Kind and shape of area
Location w/ respect to utilities
483
Steps in SLP
3. Diagram Activity Relationship A visual representation of the different activities
are drawn.
Activity Relationship Diagram
484
Steps in SLP
4. Space Relationship Layout A spatial representation is created by scaling
the areas in terms of relative size.
Modifications may be made to layout based on several reasons (ex. storage facilities, personnel requirements, bldg. features, utilities)
485
Steps in SLP5. Evaluate Alternative Arrangements
Need to evaluate the different alternatives to determine the best solution
The steps: Identify factors
deemed important. Add weights. Rate for satisfying the
factor Each rating is then
multiplied by the weight.
Sum, compare, high
487
Steps in SLP
6. Detail Selected Layout and Install handling methods, storage facilities, personnel required, building features, utilities
488
Facilities Analysis
Directed to the primary purpose of engineering and maintenance in the hospital and includes The physical plant Utilities system Major non-movable equipment items Fire protection Safety systems Electronic communication systems
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Components of Facilities Analysis1. Functional Analysis
Flow of people and materials are analyzed and evaluated
2. Analysis by Layout Determine affinity relationships among various
locations involved
490
Components of Facilities Analysis3. Support System Analysis
Includes heating, ventilation, air conditioning, electrical system, suction system, compressed air and compressed gas system Fire safety system Plumbing system Steam system Building structure others
491
Components of Facilities Analysis4. Analysis by Relationship
Concerned with the relationship of the first three components
The patient is the center of the analysis
The Patient
Temperature Humidity
Air Volumes
Electrical Systems
Sound LevelsLighting
Suction systems
Compressed gases
492
Facilities Consideration in Clinical Engineering Operating Rooms
Considered a controlled environment, where control relates to all aspects of the environment including: Cleanliness Lighting Temperature and humidity control Electrical environment Support systems Ventilation Building structural features
493
Facilities Consideration in Clinical Engineering Radiology
Begin with the structure of the radiology department itself
Controlled temperature and humidity environment must be known for the number of computer interface in the radiology department
Electrical requirements should also be known like the proper voltage and current required
Consideration of growing numbers of special procedure rooms present in the department
494
Facilities Consideration in Clinical Engineering Clinical Laboratory
Fastest growing department in terms of instrumentation
Need stabilized line voltages to operate computer-interfaced diagnostic systems
Primary electrical consideration should be that all equipment is grounded
Should safety programs for highly toxic and dangerous liquids
495
Facilities Consideration in Clinical Engineering Special-Care Units (SCU)
May be an intensive-care unit (ICU), an coronary –care unit (CCU or variations of this
In considering SCU, address the overall environment such as noise levels, light intensity, location of central nursing station and other practicalities
SCU should be supplied by emergency electrical generation system
496
Facilities Consideration in Clinical Engineering Other services
Emergency room Has the utility needs similar to operating rooms and SCU Requires special planning and analysis that must be
undertaken when considering layout and design of functional services
Nursery Has controlled environment with access limited to
nursery personnel to minimize outside environmental effects to protect vulnerable infants
497
Facilities Consideration in Clinical Engineering
Respiratory Therapy Departments Consideration should be given to the provision of
oxygen and compressed air to provide outpatient treatment in the future
Physical Therapy Departments Installation of ground fault interrupters (GFIs) is
recommended to protect patients if a fault occurs in electrical equipments that has direct contact to patients
498
Functions of Facilities Management Engineering
Ensure maintenance of the physical plant Minimize consumption of resources Prevent contamination of the surrounding environment
Life Safety Ensure reliability and safety of building systems Ensure that codes and standards are met to protect
patients, staff and visitors against undue risk of fire or other hazards
499
Functions of Facilities Management Hospital Safety
Protect facilities personnel, patients and visitors from physical and biological hazards
Security and Resource Protection Ensure maintenance of facilities to provide secure
environment Make adequate provisions for protection of
facilities, property and personnel
500
Functions of Facilities Management Professional environment
Ensure conduciveness to the delivery of high-quality medical care of the interior and exterior appearance of facilities
Medical Functionality Provide adequate space to accommodate people
and equipment with physical access for all patients
501
Engineering systems that must be controlled Medical Air
Air intended for human respiration Significant in dealing with neonates in respirators
Medical/Surgical Vacuum Systems Are required to provide vacuum pressure for drainage,
aspiration and suction during medical procedures Centrally piped and consist of two or more vacuum pumps,
operating alternately or simultaneously Each pump should be capable of maintaining a minimum
required vacuum equal to 75% of peak calculated demand
502
Engineering systems that must be controlled Piped Medical Gas Systems
Provide oxygen and nitrous oxide, nitrogen, carbon dioxide, helium and air to specifically identified outlets within procedural rooms throughout the facility
Heating, Ventilation and Air Conditioning Maintain the ambient hospital environment
503
Engineering systems that must be controlled Electrical Systems
Hospitals are dependent on electrical power
Lighting Illumination is the essential part of the medical
facility Emergency lighting system must be properly
designed to ensure health-care delivery can continue even if there is a power outage
504
Engineering systems that must be controlled Communication Systems
Essential to the safe and efficient operation of any medical facility
Fire Protection Systems Fire emergencies must be quickly contained or
controlled to avoid necessity of evacuating the entire facility
505
Life Safety Objective
Reduce the probability of injury and loss of life from the effects of fire and other emergencies or hazards
Appropriate provisions of life safety code Comprehensive statement of construction Effective inspection process Drawings Installation, testing and maintenance Annual inspection and testing Program to manage portable fire extinguishers Written fire plan Strict smoking policy Policy statements
506
Hospital Safety Program Goals
Ensure a safe environment Reduce the risk of human injury in the facility
Responsibilities of facility manager Oversee the development, implementation and
monitoring of the hospital safety management program
Manage ongoing process of collection and evaluation of hazard and safety practice information
507
Security and Resource Protection Objectives
Minimize loss, theft and damage of hospital resources
Maintain order during emergencies
Responsibility of facility manager Coordinate building security plans with local police Request police assistance in determining
appropriate security measures
508
Professional Environment
Responsibility of Facility Manager Develop a long-term plan for maintaining and
improving the appearance of the facility
Housekeeping functions should be performed in an effective and timely manner Important in maintaining the aesthetics of the
hospital Essential to provide an aseptic environment which
facilitates medical treatment
509
Medical Functionality
To efficiently allocate adequate space to accommodate both people and equipment it is necessary to Develop a facilities master plan that provides
overall view of the activities planned for the facility Establish guidelines for space utilization
Facilities master plan long range planning tool that can be used to prioritize
minor or major construction projects necessary for the operation, maintenance and future developments
510
Facilities Design Issues
Cost “What is the total cost of the project?” Includes:
architect and engineer fees cost estimating construction management Asbestos abatement (in existing spaces) Building permits Insurance Change orders Contingencies
511
Facilities Design
Not normally associated with the “traditional” duties of the practicing clinical engineer.
Usually other engineers are hires to do the job: civil, mechanical, industrial, licensed architect.
These environments range from the relatively simple surroundings of patients rooms to complex surroundings of surgery, imaging and critical care.
512
Work Flow Model of a Facilities MgmtVerbal or Written communication
1New Additions
Conducts Safety and Performance Tests
Identifies Environmental Units and Exceptional Equipment
Prepares Maintenance
Schedules Maintenance
Prepares Equipment file Worksheet
Prepares Instruction File Worksheet
Distribute Reports
3. Corrective Maintenance
Performs Maintenance
Prepares Corrective Maintenance Worksheet
Engineering Department Files
Reports Jobs OutWork Order
Jobs OutWork Order
3. Preventive Maintenance
Performs Maintenance
Records results in Work Orders
OR Records Reason Mait. Not Perf. On Jobs –Out Report
513
Facilities Design Issues
New Construction versus new renovation Factors that affect the decision to build a new facility or to
renovate an existing space include a comparison of relative costs for new versus old construction
Space “How much space is actually needed?” Published guidelines, standards or equipment
manufacturers’ recommendation have a well-established minimum space requirements
To what extent a given design goes beyond minimum requirements
514
Facilities Design Issues
Adjacencies “How does this project affect other services?” Critical factor to consider in design projects (e.g. the
proximity of medical services that interact directly) Efficiency and quality of patient care is improved as access
to adjacencies is optimized
Handicap access Design attention paid not only for physically challenged
patient but also for staff members and visitors who may be handicapped
515
Facilities Design Issues
Utility systems “What are the utility requirements of the project?” Utility services in clinical services area is
substantial Design process must be carefully evaluate the
demand level to avoid overthrow existing service capacities or provide for the expansion
516
Facilities Design/Development Process Determination of and contractual
arrangements with the appropriate planning of architectural and
engineering services
Establishment of schedule Deadlines should be establish to prevent from
taking unacceptable long period of time
517
Facilities Design/Development Process Identification of the space “footprint”
Area must conform to minimum space requirement for the function
Must satisfy requirements of adjacencies
Development of a floor plan block diagram based on function Define the functional space and quantity of individual space Produce a functional block diagram that meets appropriate
design criteria
518
Facilities Design/Development Process Development of functionality layouts
Consider specific details of equipment layouts, utility outlet quantities, styles and locations, interior finishes and any other requirements
Construction of models (prototypes) Mock-up with exact dimensions, draw-in utilities,
and moveable equipment should be made to correct both discrepancies between design drawings and anticipated final product
519
Facilities Design/Development Process Termination of design process
Desirable to obtain agreement, in writing, for user groups involved
End the possibility of further discussion Recognize that the design represents the best
efforts of the entire design team to accomplish specific goals within limitations of available space and resources
Limits the duration of the design process Prevents the likelihood of change orders that
could occur during the actual construction
520
Facilities Design/Development Process Construction documents
Detailed design information are transformed to specification books and blueprints
Used by local building authorities to issue building permits Used by hospital design team for cost estimating and
competitive building purposes Used by construction contractors to build the facility Should be reviewed to ensure correct and accurate
information are translated into the final specification and prints
521
Clinical Areas
Intensive-Care Areas (ICU)
General Patient-Care Areas (GCU)
Surgical Suites
Obstetrical Facilities
Imaging Suites
522
Intensive-Care Areas
Concentrated care are rendered to seriously ill patients under where more continuous monitoring and intensive treatment could be offered
Common needs in ICUs Bed space Support Functions Medication Preparation Utility Services
523
Bed Space Space allocation are based on
Open area Has the advantage of greatest visibility Least amount of space required per bed Other considerations (e.g. ventilation control, privacy and
equipment maneuverability) makes it less than ideal for most modern applications
Cubicle Provides for solid partitions with viewing panels between beds, a
solid headwall and open space in the direction of nursing station Offers greater degree of privacy while maintaining substantial
visibility and accessibility Control for ventilation and noise abatement may be problematic
524
Bed Space
Individual room Maximizes privacy and ventilation control Requires the most space, the greatest investment in
floor space and highest construction cost Often impedes visibility Space required for each bed is directly related to the
severity of the patient’s illness or injury
525
Support Functions
Nursing Station Command post of the ICU Must be sized, configured, equipped and located
to accommodate all the activities situated and come from this station
Activities in nursing station Communications
Space for telephones, nurse call consoles, intercoms, data terminals, printers and also verbal communication with nurses, physicians, visitors and ancillary support staff
526
Support Functions Clerical
Adequate space for the record-keeping requirements of the nursing unit staff
Includes open writing space for forms, records and references
Central Monitoring Monitoring systems incorporate central station displays and
recorders normally located at the nursing station Position should allow for ready access and proper visibility
Visual access to patients Nursing station should be located in a way that could provide
visual access to all patients within the unit and equidistant from all beds
527
Support Functions
Charting Activities Maintenance of patient charts and medical
records performed by nurses, physicians and allied health personnel
Separate charting area should be considered not too far from nursing station since most of the charting are made in the nursing station
528
Support Functions Medical Preparation
A separate area for the stocking and preparation of necessary medications
Areas for medical preparation Clean utility activities
Storage space for sterile medical and surgical supplies, additional intravenous (I.V.) solutions and other “clean” items
Should include a sink and adequate counter space as well as storage cabinets and shelves
Soiled utility activities Separate, compartmentalized space for holding normal trash,
biomedical waste, reusable items and bagged soiled linen Should include a utility sink, a clinical sink and bedpan sanitizer
529
Support Functions Nourishment Station
Small pantry for special needs (e.g. reheating food) Provision should be made for refrigerator, a small heating or
microwave oven, an ice machine, a hand washing sink and minimal storage cabinets
Linen Storage Space for storage of clean linen
Equipment Storage Storage for equipment needed for the unit Space is determined by the amount and type of equipment stored
Staff Lounge/Lockers Space for staffs to take breaks, write shift change reports and
conduct in-service education sessions Changing areas , lockers and lavatory facilities
530
Support Functions
Visitor Waiting Space Space for the visitors to wait since visiting times are
restricted Head Nurse’s and Assistant Head Nurse’s Offices
Office space for the head nurse to do administrative task that requires privacy or isolation
Housekeeping Functions Space for the equipment and supplies required by
housekeeping personnel to keep the unit clean Should include janitorial closet large enough to keep all
appropriate supplies
531
Support Functions
Utility Services Electrical power
Receptacles It is important to provide adequate number of receptacles It is critical to analyze probable locations of devices and
distribute receptacles accordingly
Circuits Analysis of total loads should be made Circuits should have a rated capacity and protection of 20
amps or more Use of emergency power and the consequences of circuit
failure should be determine
532
Support Functions
Emergency Power Should be considered in the basis of
Capacity of the alternate power source Likelihood of a total external power outage versus
internal distribution failure
Equipotential grounding Needed to protect patient from micro shock hazard
533
Support Functions Lighting (For specific values look at Ergonomic standards
table) General Illumination
Various level of lighting are required in ICU that depends on Flexibility in lighting could be achieved with multi-switched bulbs
or fluorescent dimmers Color spectrum of room lighting should be considered
Task illumination Performance of visual task of low contrast over prolonged period
of time may require increased luminance Night lighting
Provide an area of high-contrast task lighting for nurse charting off to the side of the room
Natural lighting Design should incorporate exterior windows in proximity to patient
spaces
534
Support Functions
Plumbing fixtures Hand washing sinks
Should be installed in each patient room and at every major functional space
Toilets Space provided for early ambulation or providing staff with
convenient waste disposal
Heating, Ventilation and air conditioning Design to supply air or to remove air from ICU must
meet common and specialized criteria Should provide air movement from “clean” to “less clean”
areas
535
Support Functions
Piped Medical Gases Significant consideration to the overall design, is the
availability of a continuous supply of oxygen, medical vacuum and other piped gases
Quantity and location of appropriate piped gas outlets should be determined in relation to the patient and the number and types of devices that will require the simultaneous supply of these gases
Outlets should be configured in a way that it could prevent unintended connection to the incorrect gas
536
Support Functions
Communications Provisions should be incorporated into the design for a
number of definite or possible communication lines Communication system includes
Nurse call Telephones Bedside monitors Entertainment/education Other data transmission Paging systems
537
General Patient-Care Areas
Design Criteria Size
Total space for each patient bed in GCU is smaller than in ICU
Total number of patients are larger than in ICU Density of utility services
Utility services smaller than in ICU since there is less equipment and fewer and less complicated procedures
Increased patient awareness Less acutely ill or recuperating patients are much more
aware of their surroundings
538
Surgical Suites
Design for operating rooms are the most complex since medical standards associated with surgical procedures are carried over to room design specifications
Design must accommodate four distinct user groups: Patients Surgeons Anesthesiologists Surgical nurses and technicians
539
Surgical Suites Design Factors
Size Standard minimum size is 400 sq. feet Room dimensions are determined by equipment and
personnel access factors Utility services
Requires high-density utility services such as: Electrical power
Almost all of the equipment used needs electrical power Number of receptacles are determined by the equipment
load Electrical outlets are often suspended from the ceiling to
avoid tripping from power cables Abundant number of circuits should be available throughout
the room
540
Surgical Suites
Lighting High level of general illumination is required for
visual tasks of low contrast and are of very small size
Plumbing Need for fixtures for specialized applications
and for significant plumbing requirements (such as scrub and utility sinks and instrument processing systems)
541
Surgical Suites
Medical gases Greatest concentration of the medical gas
outlets in the hospital occurs in the operating room
Most gas supplies are suspended from the ceiling
Communications Data terminals and telephones should be
provided but should not be within the operating room
542
Surgical Suites
Heating, ventilation and air conditioning Specifications include
1. positive pressure in relation to adjacent room and corridors
2. Minimum of three room changes per hour of fresh air and a minimum of 15 room changes per hour of total air with high filtration
3. No recirculation by room units
4. Relative humidity of 50 to 60 percent
5. Temperature control of 70 to 75 oF
543
Surgical Suites
Finish Materials Walls should be hard, relatively seamless,
nonporous and easy to clean Floors should be hard, seamless, nonporous
and easy to clean Finish ceilings should be washable and
prevent debris from the utilities or slab above from filtering into the operating rooms
Cabinets for storage should not interfere on available floor space
544
Obstetrical Facilities Design criteria required are similar to the operating room, but the
primary difference in design criteria is in the current attitudes toward childbirth process
Design is based on the notion of permitting the mother to progress through the first three major steps of childbirth in the same room and the same bed
Needs to accommodate first and foremost the mother and her spouse Obstetrical nurse Obstetrician Baby Equipment used for child birth
Number, location and style of utility service outlets are determined by personnel and equipment used
545
Imaging Suites
Design features for imaging rooms are determined primarily by the specific imaging technologies involved
Designed around equipment that is big, heavy and expensive
546
Mini-Case: get a host hospital and do the following Choose a specific department in the hospital Document the current layout and get the
information/ material flow of the current layout using SLP
Make a recommended layout to increase the efficiency and productivity of the department
Create an analysis by relationship with the patient as the center: with the new layout and incorporate the support system analysis
548