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Hospital Asset Management
Refurbish or Replace the Hospital?
A case study in Saudi Arabia
Presentation by Dr. Alan Wilson
Aim for the system operating capabilities to be returned to their
original specification
An aim that the assets lives can be extended by decades
That and answer to the question - repair or replace – with
potential costs, can be given in a few months per hospital
Hospital refurbishment – three
key aspects of this MOH policy
100-150 beds 250-600 beds
100-150 beds
250-600 beds
The team was invited to carry out major
refurbishment designs for 13 hospitals
in three projects of 5, then 5, then 3
Specialist Group [Riyadh] and DMI healthcare (UK)
The Specialist Group headed the team, and:
- liaised with the Ministry of Health & Hospital Management
- added technical expertise in water / energy / drainage
- financial management & travel logistics
DMI Healthcare delivered the expertise in:
- architecture and strategic design
- mechanical / electrical / structural engineering
- the preparation of bills of quantities & contracts
- cost management
The Team
A typical plan for Five
Hospitals completed in parallel
Recreation
Centre
Swimming pool
Housing
Blocks / Villas
Main
Hospital
Housing and
Recreation Site
Diabetise /
Guardroom etc.
Roads / Walls
& Fences
Mosques
Civils
Sewage / Pipe
Networks
Energy
Air conditioning
Water
Treatment
Administration
Outpatients &
Physiotherapy
X-Ray &
Scanning
Emergency &
Resuscitation
Reception
Kitchens
Dining
Wards
Laboratory
Pharmacy
Surgery,
Labour & Delivery
Paediatrics
Hospital asset structure
- at system level (up to 70 systems)
1) First by buildings and installations
2) Then by discipline - electrical, mechanical, architectural, civils
SECTION 2.1.1 MAIN HOSPITAL
ELECTRICAL
PHASE 1 REPORT PHASE 2 REPORT PHASE 4 REPORT
Item Phase 1 Report
reference System
Location at hospital
Technical evaluation
status*
Initial recommendations
Priority Budget Cost [SAR]
Pre Tender
Estimate
BOQ Reference
Operat-
ional Needs repair
Replacement
Full Part
1 3.1.2.1 HV / LV Distribution
Main hospital
2 3.1.2.2 Distribution Boards
Main hospital
3 3.1.2.3 Containment Main hospital
4 3.1.2.4 Lighting Main hospital
5 3.1.2.5 Emergency Lighting
Main hospital
6 3.1.2.6 Small Power Main hospital
7 3.1.2.7 Telephone System Main hospital
8 3.1.2.8 Data Main hospital
9 3.1.2.9 Nurse Call System Main hospital
10 3.1.2.10 Fire Alarm System Main hospital
11 3.1.2.11 Public Address System
Main hospital
12 3.1.2.12 TV System Main hospital
13 3.1.2.13 Lifts Main hospital
14 3.1.2.14 UPS Main hospital
15 3.1.2.15 Master Clock System
Main hospital
The information deliverables
- by system level
- example for Electrical
A non-intrusive detailed condition survey
- of the systems/wards agreed with Hospital Management
- information on the existing projects & proposed changes
- discussion of the management strategies and any
special problems, e.g. number of infection control rooms
- the energy calculations and any scale-up needs of the
engineering services
- presentation of the findings and implementation plans
to the Hospital Director and Management
- a report of recommendations / more detailed costs
The Second phase was
completed by the full team
Modern replacement Chiller Main Hospital Chillers underperforming
Existing Steam Boilers in a poor
condition New steam boiler
What we have seen What we recommend
Site - Ancillary
Sheet vinyl to Ward
areas
Panel mounted clinical wash hand basin
Main Hospital
Split joints, and walls without skirtings
Chipped sanitary-ware
What we have seen What we recommend
Typical fitted furniture
Corridor suspended ceilings
Housing
Original fitted furniture
Damaged and Missing Ceilings
What we have seen What we recommend
Implementation Improvements towards CBAHI: (Central Board of Accreditation For Healthcare Institutions)
• Fire Strategy
• Isolation Rooms
• Pressure Regimes
• Control of Infection
• Patient Access
1. Of 25 beds there should be 1 of negative pressure.
2. There are no air pressure filters existing in the hospital.
3. Sometimes ventilation is not considered a requirement.
4. A number of true pressure rooms are required, one for every 100 beds.
5. A problem exists in ER - a single waiting room has a partition only and the
negative pressure facility is not working. A room near the elevator is a need.
6. There is no negative pressure room in the Critical Care area.
Notes on meeting
with Head of Infection Control,
for example
Sequenced Hospital Implementation Plan – Ground Floor
• For the Theatres, if there are just 2 or 3, then 1 may be released for
refurbishment, whilst the others cover emergencies / planned
• The flow in the Theatres must provide clean access and dirty exit
• Emergency R. and Outpatients can often be divided with 50/50 availability
• The Clean & Steam room may be relocated temporarily to the Dining Area
• The Laboratory may receive support from another hospital or mobile unit
• The Blood Bank & Pharmacy may be temporarily located in the Conference
Room; and the Pharmacy moved into in the Dining area
• The Delivery Room & children’s ICU must be close to surgery for easy
transfer
• In the Wards, where occupancy is low, then up to 50% of Female and Male
Medical / Surgical may be made available at the one time
• Care must be taken on refurbishing the Wards in order to get the upper
floor and lower ceiling available at the one time
Implementation – principles
developed for making areas
available for the refurbishment
Condition
The luminaires are clean and operating satisfactorily but the end caps are cracked, they are life completed and cannot be maintained
Replacement diffusers and control gear are unavailable
Technical Evaluation
Several areas now require an improved type of luminaire that inhibits the ingress of dust or water. Sealed type luminaires are required particularly in theatres, laboratories, and food preparation areas.
Modern luminaires use less energy, are more efficient, and provide longer lamp life.
Recommendation
Change the luminaires
Provide automatic switching linked to presence detection and available daylight
See appendix 6.2.1
THE FINAL REPORTS
EXAMPLE OF REPORT ITEM:
3.1.2.4 SYSTEM - LIGHTING
AND IN THE REPORT APPENDIX 6.2.1 TYPICAL PROPOSED LIGHTING
Theatre Suite Lighting
Bed Head Lighting
Typical General Purpose Luminaire
SECTION 2.1.1 MAIN HOSPITAL
ELECTRICAL
PHASE 4 REPORT PHASE 2 REPORT PHASE 4 REPORT
Item Phase 1
Report ref System
Location at hospital
Technical evaluation
status*
Initial recommendations
Priority Budget Cost [SAR]
Pre Tender
Estimate
BOQ Reference
Operat-
ional Needs repair
Replacement
Full Part
1 3.1.2.1 HV / LV Distribution
Main hospital 2 X N/a - - -
2 3.1.2.2 Distribution Boards
Main hospital 2 X X 1 190,000 190,000 1.1 - 1.4
3 3.1.2.3 Containment Main hospital 2 X N/a - 500,000 3.1 - 3.2
4 3.1.2.4 Lighting Main hospital 1 X 3 2,980,000 4,500,000 2.1 - 2.33
5 3.1.2.5 Emergency Lighting
Main hospital 1 X 1 1,879,000 1,500,000 2.1 - 2.33
6 3.1.2.6 Small Power Main hospital 2 X X 1 811,000 1,000,000 4.1 - 4.7
7 3.1.2.7 Telephone System Main hospital 2 X X 3 70,000 90,000 5.1 - 5.5
8 3.1.2.8 Data Main hospital 2 X 1 128,000 150,000 5.1 - 5.5
9 3.1.2.9 Nurse Call System Main hospital 1 X 1 2,362,000 750,000 6.1 - 6.15
10 3.1.2.10 Fire Alarm System Main hospital 0 X 1 2,912,000 800,000 7.1 - 7.8
11 3.1.2.11 Public Address System
Main hospital 2 X N/a - - -
12 3.1.2.12 TV System Main hospital 2 X 1 80,000 80,000 8.1 - 8.2
13 3.1.2.13 Lifts Main hospital 2 X N/a - - -
14 3.1.2.14 UPS Main hospital 2 X X 1 4,000 30,000 9.1 - 9.4
2 LIGHTING
Strip out existing and provide and install new luminaires, lighting control devices, wiring devices, insulated copper cables and containment, Specification 26 0519 1.01 to 3.01, 26 0534 1.01 to 3.01, 26 0537 1.01 to 3.01, 26 0923 1.01 to 3.01, 26 2726 1.01 to 3.01, 26 3305 1.01 to 3.01 and 26 5100 1.01 to 3.01, Drawings UNZ-E-MH-6-001 and UNZ-E-MH-63-001 to 018
2.1 luminaires Type A nr 304
2.2 luminaires Type AE nr 133
2.3 luminaires Type A2 nr 459
2.4 luminaires Type A2E nr 179
The Bills of Quantities reference 2.1 to 2.33 – the Lighting Costs
for example
Specifications
SECTION 26 5100 INTERIOR LIGHTING PART 1 GENERAL
- All luminaires shall be high frequency and use new technology lamps such as LED and T5.
- Ensure the final calculations use the correct lamp type for clinical areas.
- All luminaires to be chosen to minimise spares and spares be available. - Where luminaires have integral emergency lamps fitted, these shall be
factory fitted by the luminaire supplier.
- The drawings detail the type of luminaire required in each area and approximate quantities. Luminaire supplier to use the drawings and provide a fully compliant scheme.
Drawing UNZ-E-MH-6-001
Bills of Quantities – In Arabic format
جـــدول بيــان الأعمـــال والكميـــات وحدة الكلى الصناعية
AKU Bill Of Quantities
الاعمال الكهربائية
Total amount (SR) إجمالي البند بالريال السعودي
Unit Price (SR) سعر الوحدة بالريال السعودي
Quantity الكمية
Unit الوحدة
Description وصف الأعمال
Item رقم البند
Written كتابة
Digit رقما
Written كتابة
Digit رقما
1 وحدات الاضاءة
LIGHTING
ـــــــــ ـــــــــازالة وحدات الاضاءة الموجودة حاليا وتوريد وتركيب وحدات اضاءة جديدة تحتوى على الكابلات النحاسية المعزولة واجهزة التحكم
وذلك وفقاً للمواصفات الفنية المخططات الموضحة بالبند عام
Strip out existing and provide and install new luminaires, lighting controls, insulated copper cables and containment, Specification 26 0519 1.01 to 3.01, 26 0534 1.01 to 3.01, 26 3305 1.01 to 3.01 and 26 5100 1.01 to 3.01, Drawing UNZ-E-AKU-6-001
Preamble
E 1.1وحدة اضاءة طراز بالعدد 40
luminaires Type E
1.2 وحدة اضاءة طوارىء بعلامة الخروج بالعدد 8
emergency exit lights
2 نظام انذار الحريق
FIRE ALARM
ـــــــــ ـــــــــمقاومة ( ذات اللون الاحمر)ازالة الموجود حاليا مع توريد وتركيب نظام إنذار ضد الحريق وحساسات مع تمديد كابلات شيلد نحاسية
للحريق وذلك وفقاً للمواصفات والمخططات الموضحة بالبند عام
Tranche 2 Phase 2 Phase 4 % change
Hospital 6 BIL 98,386,150 80,062,000 -18.62%
Hospital 7 BSH 221,962,000 197,808,000 -10.88%
Hospital 8 FAR 98,740,350 82,217,000 -16.73%
Hospital 9 NAM 106,609,800 94,124,000 -11.71%
Hospital 10 UNZ 242,138,000
767,836,300
1. For every hospital the estimated refurbishment cost reduced after the .
2. Of the 13 hospitals some were considered for replacement.
3. Answers to the changes required were recommended for all the assets
above the ground and below the ground, with estimated costs.
4. Our view is that at the hospital design and purchase stage:
the trade-off between asset quality, reliability, and cost should involve the
input of O&M personnel
and the asset life expectations.
In our opinion, did the
project meet the expectations?