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
2015 ACHE-SETC Conference on Healthcare Leadership
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?
2015 ACHE-SETC Conference on Healthcare Leadership
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
2015 ACHE-SETC Conference on Healthcare Leadership2015 ACHE-SETC Conference on Healthcare Leadership
IMPACT OF TECHNOLOGY ON DESIGN & CONSTRUCTION
2015 ACHE-SETC Conference on Healthcare Leadership
Impact of Technologyon 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 ”
“
2015 ACHE-SETC Conference on Healthcare Leadership
• Space Requirements
• Structural Capacity
• Building System Infrastructure (MEP)
• Information TechnologyScalability
CONTINUOUS TECHNOLOGY EVOLUTION
Impact of Technologyon Design & Construction
2015 ACHE-SETC Conference on Healthcare Leadership2015 ACHE-SETC Conference on Healthcare Leadership
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
Engineering Consultants
Supply Chain
ArchitectOther
Consultants
Furniture
Kitchen
Lighting
LandscapeScheduler
4 – 4.5 YEAR TIMELINE
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
CONSTRUCTION DOCUMENTATION
CONSTRUCTION ADMINISTRATION IN USE
HospitalLeadership
Transition Planner
ProgramManager
MASTER / PROGRAMMING
3 - 6 MONTHS
Low Voltage
Medical Equipment
Contractor Information Systems
Major Sub -contractors
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
5 – 6.5 YEAR TIMELINE
TRADITIONAL PLANNING PROCESSLINEAR KNOWLEDGE ON-BOARDING
3 – 6 MONTHS 6 – 8 MONTHS 6 – 8 MONTHS 38 – 48 MONTHS 50+ YEARS
SCHEMATIC DESIGN
DESIGN DEVELOPMENT
CONSTRUCTION DOCUMENTATION
CONSTRUCTION ADMINISTRATION IN USE
MASTER / PROGRAMMIMG
4 – 6 MONTHS
Medical Equipment
Low Voltage
Other Consultants
Furniture
Kitchen
Lighting
Landscape
Scheduler
Contractor Transition Planner
Information Systems
Major Sub -contractors
HVAC
Mechanical
ElectricalPlumbing
Building Systems
Cost Consultant
Engineering Consultants
ArchitectStrategic Planner
HospitalLeadership
ProgramManager
Department Staff
Surgery
Nursing
Imaging
CardiologyEquipment
Vendors
Medical Equipment Consultant
Supply Chain
EquipmentVendors
Aligning Knowledge
2015 ACHE-SETC Conference on Healthcare Leadership
Aligning Knowledge
SCHEMATIC DESIGN
DESIGN DEVELOPMENT
CONSTRUCTION DOCUMENTATION
CONSTRUCTION ADMINISTRATION IN USE
MASTER / PROGRAMMIMG
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
2015 ACHE-SETC Conference on Healthcare Leadership
COORDINATION OF PLANNINGWITH VENDOR CONTRACTING
2015 ACHE-SETC Conference on Healthcare Leadership
2015 ACHE-SETC Conference on Healthcare Leadership
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)
Coordination of Planningwith Vendor Contracting
2015 ACHE-SETC Conference on Healthcare Leadership
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
Coordination of Planningwith Vendor Contracting
Fast Track List
2015 ACHE-SETC Conference on Healthcare Leadership
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
Coordination of Planningwith Vendor Contracting
• Plumbing• IT Integration
Design Matrix
2015 ACHE-SETC Conference on Healthcare Leadership
Coordination of Planningwith Vendor Contracting
SCHEMATIC DESIGN
CONSTRUCTION DOCUMENTATION
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
2015 ACHE-SETC Conference on Healthcare Leadership
TECHNOLOGY CHANGE MANAGEMENT
2015 ACHE-SETC Conference on Healthcare Leadership
2015 ACHE-SETC Conference on Healthcare Leadership
Technology ChangeManagement
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
2015 ACHE-SETC Conference on Healthcare Leadership
Technology ChangeManagement
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
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CASE STUDY
2015 ACHE-SETC Conference on Healthcare Leadership
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
2015 ACHE-SETC Conference on Healthcare Leadership
Case Study
HOUSTON METHODIST HOSPITAL OUTPATIENT CARE CENTER
• 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
2015 ACHE-SETC Conference on Healthcare Leadership
Project Overview • $450m Project Budget• $50m Million Medical Equipment Budget• 824,000 Sq. Ft.• 4 yr. Planning & Construction
Case Study
HOW DID WE DO?
HOUSTON METHODIST HOSPITAL OUTPATIENT CARE CENTER
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
2015 ACHE-SETC Conference on Healthcare Leadership
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
2015 ACHE-SETC Conference on Healthcare Leadership
Conclusion & Benefits
• 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
2015 ACHE-SETC Conference on Healthcare Leadership
Conclusion & Benefits
CURRENT & FUTURE CONSIDERATIONS
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
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