minimizing the impact of technology on · pdf filebusiness operations. education &...

2015 ACHE-SETC Conference on Healthcare Leadership

INSIGHTS FOR HEALTHCARE PROFESSIONALS(A partnership with Medical World Americas)

MINIMIZING THE IMPACT OF TECHNOLOGY ON FACILITY DESIGN WHILE ENSURING FUTURE FLEXIBILITY

Jim FunkDirector – Strategic Procurement

Bob NimonPresident, Genesis Planning


LEARNING OBJECTIVES

• How a hospital’s Supply Chain and Technology Planning consultant can contribute to the integrated design process

• Steps that can be taken to insure the minimization of redesign work and construction change orders

The demands on today’s complex, and often fast-track, healthcare construction projects to remain on-schedule and on-budget require forward thinking by all design team members and the owner’s representatives.

This presentation offers insights on how the parties involved with managing a project’s medical capital equipment – the Owner’s Supply Chain Mgmt. and their Medical Equip Planning consultant - can work together and effectively contribute to enhancing the Integrated Design & Delivery Process.

OVERVIEW

Jim FunkDirector – Strategic ProcurementHouston Methodist Hospital

Bob NimonPresidentGenesis Planning

INTRODUCTION

Coordination of Planningwith Vendor Contracting

Why the focus on Technology?

Impact of Technologyon Design & Construction

Technology ChangeManagement

Conclusion & Benefits

Aligning Knowledge

Case Study

TOPICS FOR DISCUSSION

2015 ACHE-SETC Conference on Healthcare Leadership2015 ACHE-SETC Conference on Healthcare Leadership

WHY THE FOCUS ON TECHNOLOGY?


Why the focus on Technology?

• Medical Technology represents the second cost of today’s healthcare facility projects

• It has the greatest impact on the design of spaces within the facility

• Unlike other elements of a building, it’s evolution is rapid and constant

• It is a high coordination risk for all construction disciplines during project delivery

• It’s potential impact on today’s fast-track schedules is prominent

IT’S MANAGEMENT THEREFORE IS CRITICAL DURING ALL PHASES OF BUDGETING, DESIGN, CONSTRUCTION, AND COMMISSIONING


IMPACT OF TECHNOLOGY ON DESIGN & CONSTRUCTION



INCREASINGLY COMPLEX TECHNOLOGIES

• Universal Operating Rooms

• Robotics

• Point of Use / Mobile Devices

• Hybrid Surgical / Interventional Rooms

• Acuity Adaptable Patient Rooms

• Campus-centric Telemedicine

• e-ICU Rooms

• Facility-wide Monitoring & RFID

• Hybrid Imaging Suites

• Central UPS Systems

• OR Integration

• Sterilization Automation

• Lab & Pharmacy Automation

• Bariatric Care

DESIGN STILL FOLLOWS FUNCTION, HOWEVER

FUNCTION IS NOW DRIVEN BY TECHNOLOGY ”

“


• Space Requirements

• Structural Capacity

• Building System Infrastructure (MEP)

• Information TechnologyScalability

CONTINUOUS TECHNOLOGY EVOLUTION



Aligning Knowledge

Cost Consultant

Engineering Consultants

Supply Chain

Architect

Other Consultants

Furniture

Kitchen

Lighting

Landscape

Scheduler

5 – 6.5 YEAR TIMELINE

TRADITIONAL PLANNING PROCESSLINEAR KNOWLEDGE ON-BOARDING

Strategic Planner

3 – 6 MONTHS 6 – 8 MONTHS 6 – 8 MONTHS 38 – 48 MONTHS 50+ YEARS

SCHEMATIC DESIGN

DESIGN DEVELOPMENT

CONSTRUCTION DOCUMENTATION

CONSTRUCTION ADMINISTRATION IN USE

HospitalLeadership

ProgramManager

MASTER / PROGRAMMIMG

4 – 6 MONTHS

Low Voltage

Medical Equipment

Contractor Transition Planner

Information Systems

Major Sub -contractors

HVAC

Mechanical

ElectricalPlumbing

Building Systems

Department Staff

Surgery

Nursing

Imaging

CardiologyEquipment

Vendors

Aligning Knowledge

Cost Consultant


Supply Chain

ArchitectOther

Consultants

Furniture

Kitchen

Lighting

LandscapeScheduler


INTEGRATED PLANNING PROCESSFRONT-LOADED KNOWLEDGE

Strategic Planner

3 - 4 MONTHS 4 – 5 MONTHS 4 – 5 MONTHS 32 – 36 MONTHS 50+ YEARS

SCHEMATIC DESIGN

DESIGN DEVELOPMENT



HospitalLeadership

Transition Planner

ProgramManager

MASTER / PROGRAMMING

3 - 6 MONTHS

Low Voltage

Medical Equipment

Contractor Information Systems


HVAC

Mechanical

ElectricalPlumbing

Building Systems

Department Staff

Surgery

Nursing

Imaging

Cardiology

Equipment Vendors

Aligning Knowledge

CONSTANT HIGH-LEVEL KNOWLEDGE

Clinical Operations

Business Operations

Education & Research

Design TeamContractors Medical

EquipmentInformation

Systems

Organizational Manager

SystemsIntegrator

ConstructionManager

Integrated Project Planning, Delivery

and Activation Plan & Schedule

Project Management

Office

INTEGRATED/INFORMED DESIGN, PLANNING & CONSTRUCT MODELTHE ⑦ WORK STREAMS

Aligning Knowledge

① ② ⑥④ ⑤③ ⑦

Supply Chain


TRADITIONAL PLANNING PROCESSLINEAR KNOWLEDGE ON-BOARDING

3 – 6 MONTHS 6 – 8 MONTHS 6 – 8 MONTHS 38 – 48 MONTHS 50+ YEARS

SCHEMATIC DESIGN

DESIGN DEVELOPMENT




4 – 6 MONTHS

Medical Equipment

Low Voltage

Other Consultants

Furniture

Kitchen

Lighting

Landscape

Scheduler

Contractor Transition Planner

Information Systems


HVAC

Mechanical

ElectricalPlumbing

Building Systems

Cost Consultant


ArchitectStrategic Planner

HospitalLeadership

ProgramManager

Department Staff

Surgery

Nursing

Imaging

CardiologyEquipment

Vendors

Medical Equipment Consultant

Supply Chain

EquipmentVendors

Aligning Knowledge


Aligning Knowledge

SCHEMATIC DESIGN

DESIGN DEVELOPMENT




Medical Equipment Consultant

Supply Chain

EquipmentVendors

SO HOW DO WE GET ALIGNED?

“BETTER

INFORMATION

INEARLIER

”PLANNING

HOW TOPROVIDE

…THROUGH THE UTILIZATION OF BEST PRACTICES

• Evidence Based Planning Criteria

• Value Engineering

• Drawing / Database Linking

• Price Benchmarking

• Consistent Reports for Each

Specific Workstream

• Proactive Documentation and Reviews

• Detailed for Each Phase & Effort

• Focused Change Management

Developed to:Improve Communication

Reduce Errors

Provide Accurate Information Earlier

Aligning Knowledge

FAST STRIKE LISTS

DESIGN MATRIX

EARLY CONTRACTING

CHANGE MANAGEMENT


COORDINATION OF PLANNINGWITH VENDOR CONTRACTING



Group 1 Equipment

• Imaging Systems

• Surgical Utility Booms and Lights

• Sterilization Equipment

• Patient Ceiling Lifts

• IT Integration

Group 2 Equipment

• Patient Monitoring

• Laboratory Systems

• Robotics

IDENTIFY THE PROBLEMS (THE USUAL SUSPECTS)



FAST TRACK STRIKE LIST (BEST PRACTICE REPORT)

• Developed before the project starts• Identifies key technology issues – budget / design / IT• Prioritizes decisions and timelines

① Hi-Impact Equipment

② Share with Supply Chain for confirmation of vendorcontracts and user preferences

③ Provide Fast Track Strike List to design team


Fast Track List


① Identify top potential vendors• Supply Chain narrowed the field to 2-3

vendors for each modality

② Develop ranges and outliers for all major equipment• Structural • Mechanical (HVAC)• Electrical

③ Provide to design team for flexible planning

④ Produce accurate Revit equipment families / drawings

DESIGN MATRIX (BEST PRACTICE REPORT)

Allows design flexibility & procurement leverage


• Plumbing• IT Integration

Design Matrix



SCHEMATIC DESIGN


OPENING DAY

Place OrdersDeliver Pre-install Items

Design Matrix

Final Shop Drawings

Initial Drawings

Installation

Strike List

DESIGN DEVELOPMENT

MOVING DECISIONS UPSTREAM

Group 1 Bidding & Negotiations

Vendor Agreements

CONSTRUCTION ADMINISTRATION

Typical TimeframeIntegrated Planning Timeframe


TECHNOLOGY CHANGE MANAGEMENT




Vendors Shop Drawings Submittals

A/E RFIs

Change Management

May 2012 August 2012

Drawings Verification

Impact Confirmation and Approval

A Collaborative Approach that Streamlines the Flow of Key

Technology Information

CHANGE MANAGEMENT PROCESSBest Practice Procedures and Reports

• Monitoring Technology Changes• Forum for User Requests• Streamline Impact Assessment• Quick Turnaround of Submittals• Team-wide Coordinated Changes



TECHNOLOGY ASSESSMENT COMMITTEE

• Program Manager• HMH Facilities • Supply Chain• Architect & Engineer• Contractor• Med Equipment Consultant

Comprised of:

Objectives• Assess new and/or changes in technology• Identify potential impacts to construction, budget or IT• Provide recommendations to owner


CASE STUDY


Case Study

Expansion & Redevelopment Program

• $450 Million Project

• 824,000 Sq. Ft.

• $50 Million Medical Equipment

Key Technology Features

• Universal Operating Theaters

• Integrated Video & Data Systems

• Flexible Imaging Suites

• Flexible Clinic Spaces

Major Components

• 14 Universal OR’s

• Video Integration for OR’s

• 4 OR’s Adaptable for Imaging

• OR’s Adaptable for Navig & Robotics

• 3 Linear Accelerator Vaults

HOUSTON METHODIST HOSPITAL OUTPATIENT CARE CENTER

- Complex Project

- Long Schedule

- High Technology Costs

- Critical Project for HMHOperational Goals


Case Study


• Imaging

Systems

• Surgical Booms and Lights

• Sterilization Equipment

①Hi-Impact Strike List

• GE Medical• Siemens• Philips

• Stryker• Bechtold• Skytron• Steris

• Steris• Getinge• Belimed

③Design Matrix

⑥Layout Drawings

• GE Medical• Siemens

⑤Final Awards

• Steris

• Steris

④Bidding &

Contracting

②ProbableVendors


Project Overview • $450m Project Budget• $50m Million Medical Equipment Budget• 824,000 Sq. Ft.• 4 yr. Planning & Construction

Case Study

HOW DID WE DO?


D&T Components• 14 OR’s / 14 Shell• 2 Linear Accelerator Vaults (Shell)• 2 MRI’s / 4 Shell; • 3 CT’s / 3 Shell• 4 Rad Rooms• 3 Nuc Med• 2 PET Scan (Future)

Technology Items• 18,000 Total Line Items• 114 Fixed Equip Locations• 80+ Pre-installation Components

1 Change OrderToshiba 320 Slice CT

• Dual Power Source• Larger Equip Room

Why Missed?o Late user requesto 1st on the Marketo No planning data available

at time


CONCLUSIONS AND BENEFITS


Conclusion and Benefits

HOW DO YOU PLAN TODAY FOR 2-3 YEARS IN THE FUTURE?

• Contract Med Equip Planning Services Early in Planning

• Assign Contract through Supply Chain (for procurement related work efforts)

• Identify Major Equipment and Probable Vendors

• Develop Strike List and Design Matrix for A/E Team

• Establish a Technology Review Committee- Monitor Clinical Requests, Technology Trends and Impacts

• Initiate Procurement / Contracting in Early Planning Phases

• Engage and Utilize Vendors Experience and Planning Advice- Planning Meetings- Construction Readiness- Early Confirmation of Install Schedules

Price & Warranty Protection



• ALIGNMENT OF TECHNOLOGY DECISIONS WITH TRUE CLINICAL REQUIREMENTS

• ELIMINATION OF WRONG TECHNOLOGY SELECTIONS

• ACCURATE BUDGET ESTIMATES EARLIER IN PLANNING

• INTEGRATION OF TECHNOLOGY WITH DESIGN CONCEPTS

• FLEXIBLE FACILITY DESIGN SOLUTIONS

• REDUCTION OF DESIGN REWORK

• MINIMIZATION OF CONSTRUCTION CHANGE ORDERS

• IMPROVED SCHEDULE COMPLIANCE

• OPTIMAL PROCUREMENT AND ADOPTION STRATEGIES

• BEST VALUE TECHNOLOGY PACKAGES



CURRENT & FUTURE CONSIDERATIONS


PRESENTERS

James (Jim) Funk joined Houston Methodist as the Director, Strategic Procurement in Corporate Supply Chain in late 2014. In this role, his responsibilities include Supply Chain Contracting, Capital Equipment Contracts and Purchases, Equipment Planning/Purchases for major renovations and new construction, and Purchased Services Vendor Contracts.

Prior to joining Houston Methodist, Jim held the position of Director – Contracts & Strategic Sourcing for the MultiCare Health System in Tacoma, Washington and Network Account Executive and Contract Officer for Oregon Health & Science University in Portland, Oregon. Prior to joining the health care industry, Jim was a Senior Law Clerk and Associate Attorney with firms in Bloomfield Hills, Michigan, and Portland, Oregon and before that he was a Golf Professional and Director of Operations at the Fenton Farms Golf Club in Fenton, Michigan. He earned a Bachelor of Arts degree from Michigan State University and a Juris Doctorate from Michigan State University College of Law, both in East Lansing, Michigan, and an MBA from Marylhurst University in Marylhurst, Oregon.

James A. Funk, JD, MBADirector – Strategic Procurement

Juris Doctorate – Michigan State University

Master of Business Administration & Organizational Behavior – MarylhurstUniversity

Bachelor of Arts in Anthropology – Michigan State University

Jim FunkDirector – Strategic ProcurementHouston Methodist8100 GreenbriarHouston, TX 77054

[email protected]@gmail.com

D: 281.667.5492 M: 281.744.5979

Bob is the managing director of Genesis Planning, with over twenty-eight years in health care consulting and hospital operations experience. Bob has successfully completed more than 300 planning assignments and numerous strategic initiatives for clients on a domestic and international basis. His expertise covers the range of facility programming and planning, business and finance, technology and operational issues. He also has the added experience in the development of new healthcare ventures.

Prior to Genesis Planning, Mr. Nimon was a member of the DeBakey Consulting Group and also provided consulting services for Deloitte & Touche’s national health care practice. Additional professional experience included serving as Director of Medical Technology Planning at The Methodist Hospital and Texas Children’s Hospital.

Bob’s combination of both domestic and international experience in non-for-profit academic facilities and for-profit hospital groups brings unique insight and creativity to his planning engagements. Additionally, his in-depth knowledge of technology as a critical component of hospital operations and performance provides clients with enhanced decision making capabilities.

He has also pioneered a strategic technology approach that integrates issues of long-range planning, capital management, operations and the adoption of future technology. He is often called upon to discuss and present on issues such as Technology Trends and ‘Operating Rooms of the Future’ subjects.

Robert C Nimon, BSN, MBAPrincipal – Managing Director

Master of Business Administration & FinanceUniversity of St. Thomas

Bachelor of Science NursingD’Youville College

Bob NimonManaging Director - PrincipalGenesis Planning LLC1001 McKinney, Suite 1300Houston, TX 77002

[email protected]

G 713.297.7500 D 713.366.4081 M 713.545.8498

genesis-planning.com

PROFESSIONAL AFFILIATIONS

American College of Healthcare ExecutivesInternational Society of Technology Assessment in HealthcareAmerican Association of Cost EngineersHealthcare Financial Management AssociationNational Council on Systems Engineering

Q & A

MINIMIZING THE IMPACT OF TECHNOLOGY ON FACILITY DESIGN WHILE ENSURING FUTURE FLEXIBILITY

Gary WagnerVice President, Supply Chain Management, Houston Methodist

Bob NimonManaging Director - Principal, Genesis Planning

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