Edward Hood, HH Angus’ Medical Gas Specialist, recently joined an expert panel discussing the issues around medical O2 in the fight against the COVID-19 pandemic. Here is a summary of his presentation for the Canadian Healthcare Engineering Society webinar:

Challenges of increasing the numbers of oxygen outlets to an existing system with a fixed supply pipe size

Since the start of the COVID-19 pandemic, hospitals have experienced extraordinary increases in oxygen consumption due to high numbers of patients admitted to intensive care units. A complicating factor in their care has been the challenge of adding oxygen outlets to an existing zone for the purpose of treating COVID patients. Why is this a challenge? Simply put, many existing oxygen zones within a healthcare facility were not sized for large increases in oxygen flow. Many older healthcare facilities had their oxygen zones sized on oxygen outlet counts, which applied a diversity factor. That approach changed in the last few editions of CSA Z7396.1, which now focuses on understanding specific high demand zones (critical care for example), and designing robustly-sized piping infrastructure to those zones. However, the outcome is the same – many existing oxygen zones were never designed for “overflow” condition; as such, loading up existing oxygen zones by adding outlets or high flow oxygen devices must be managed very carefully.

Why is that? Substantially increasing oxygen flow in an existing oxygen zone will introduce increased pipeline pressure drops in the zone. A drop to 40 PSI at a zone valve will normally trigger the low alarm at the zone valve.

For this reason, it is important to analyze anticipated flow demand within the zone with the size of the oxygen service available in order to manage acceptable pressure losses that will not trigger alarm conditions.

Factors affecting how many COVID patients can be treated in an existing medical gas zone

In hospitals, typical patient room usage is 5 L/min of oxygen; however, oxygen usage for COVID-19 patients can be up to 60 L/min or possibly higher, depending on the types of high flow oxygen devices in use. In order to manage pressure drops within a zone and avoid low pressure alarms, table E.5 in CSA Z7396.1 provides some guidance regarding expected pressure drops per 100ft of copper piping for a given pipe size. These pipeline pressure drops are:

½ inch pipe @ 190 L/min will have .5 pressure drop per 100ft
¾ inch pipe @ 500 L/min will have .5 pressure drop per 100ft
1 inch pipe @ 1000 L/min will have .5 pressure drop per 100ft
1 ¼ inch pipe @ 1800 L/min will have .5 pressure drop per 100ft

In other words, the following occupancy adjustments should be considered:

½ inch pipe
Non-COVID use = 38 patients in a zone
COVID use = 3 patients in a zone
¾ inch pipe
Non-COVID use = 100 patients in a zone
COVID use = 8 patients in a zone
1 inch pipe
Non-COVID use = 200 patients in a zone
COVID use = 16 patients in a zone
1 ¼ inch pipe
Non-COVID use = 360 patients in a zone
COVID use = 30 patients in a zone

Concluding recommendations for ensuring adequate oxygen supply

Before admitting COVID patients to a typical patient room, facility staff need to check the zone valve to verify pipe size in order to determine occupancy limits. Larger-sized zone valves are typically an indicator of a zone having greater capacity to flow oxygen with lesser pressure drops.
Have a pandemic plan to identify where best to convert existing beds to COVID rooms. Consider the size of the oxygen zone valve serving the zone.
If you are designing for a new hospital, consider designing a pandemic floor with medical gas pipelines capable of the worst-case scenario load, and consider the pressure drops from the bulk pad/source equipment to the zone in order to keep pressure drop for the pipeline to below 5 PSI per CSA Z7396.1 requirements.

September 25, 2017.Photo by Brett Gundlock

Edward Hood, P.Eng., B. Eng.
Technical Leader and Senior Mechanical Engineer
edward.hood@hhangus.com

Send medical equipment robot technology in hospital

Interest in and implementation of Automated Guided Vehicles (AGVs) has become more common in healthcare capital projects, with clients recognizing the value these systems can bring in terms of productivity, safety and efficiency. While AGVs have been in use for some time in other industries, a hospital AGV system differs from these in that its ability to consistently achieve performance parameters and throughput is heavily influenced by both the users and the technical performance of the system. In hospitals, a large number of users from many different programs (eg., food service, pharmacy, logistics) must interact with the system. The ability to prevent backlogs and ensure critical deliveries relies on strict adherence to the AGV schedule, cart removal timing, and coordination with a central operator. The technical performance of the system is highly influenced by the space programmed, elevator capacity, programming and system capabilities, which differ among vendors.

Some factors driving increased adoption of AGVs by healthcare clients include:

The increased floor plate associated with new hospital builds, as a result of a higher ratio of single-patient rooms and improved circulation space
Improvements in sensor technology that have greatly enhanced the performance of AGVs in areas such as collision avoidance and environment recognition, navigation, fleet management, material tracking, and the ability to conduct detailed diagnostics and maintenance of individual vehicles
A greater need to improve sanitation (cleanliness) in the hospital environment, as well as the increased priority to disinfect various spaces (i.e. UV robots) – also supporting minimizing hospital acquired infections
Increasing labour costs, and a focus on workplace injury prevention

Benefits that can be realized include:

Improved productivity. AGVs can reduce supply chain management costs and deliver reliability of supplies compared to non-automated methods.
Availability. AGVs can operate on a 24/7/365 basis. Advances in battery technology have significantly shortened battery charging times, resulting in AGV systems that can be designed to be on call throughout the entire day to respond to demand. This also means that distribution can be scheduled for off-peak hours.
Reduced damage to facilities. With improved collision detection and environmental recognition, well designed AGV systems can almost eliminate damage to doors, walls, elevators and other structures in the hospital while also ensuring safety as they are programmed to never collide with other objects (including people).
Predictability. Because AGVs are programmed to operate to a schedule, it becomes easier to schedule complementary resources within the same delivery periods.

AGVs are currently being used for a range of tasks in hospitals. These include pick-up and delivery of meals, waste, linens, sterile supplies, medications, and other supplies. The systems are quite sophisticated and are capable of activating and navigating automatic doors, signaling and navigating elevators (both dedicated and shared), delivering carts for cleaning, activating cart-washing systems, and are able to safely navigate busy spaces, such as hallways and elevators, that are shared with humans. The use cases for AGVs increase as we discover more needs they can support!

Medical delivery robots moving in hospital. Infection prevention concept. 3D rendering image.

Designing AGV Systems

In designing AGV systems for healthcare facilities, HH Angus has the specialized expertise and experience to produce exceptional results in a highly technical process that requires insight and knowledge of healthcare facilities operations and logistics, vendor experience, and a depth of networking and integration expertise. Our Angus Connect Division is a Canadian leader in delivering forward-thinking and robust digital and technology strategies, along with design and implementation for healthcare and other facilities.

At the outset, our team examines our clients’ overall business objectives and operational goals. Some of these include improved supply management for clinical services, timely medication dispensing, and reduction in portering and housekeeping steps to deliver supplies. Drawing on our clinical, building and AGV design experience, we collaborate with the client to understand their vision, and then contribute our deep knowledge of materials management, hospital flows and implementation of AGV systems to successfully tie together workflows and technical requirements. Taking time early in the design stage to fully understand the project requirements allows us to track changes in client requirements that can occur over the design and construction life of the project. Ensuring the operational assumptions and the AGV and hospital designs align with the overall goals of our clients is crucial to delivering a successful AGV system.

Through our extensive experience with the P3 (public-private partnership) model, both in proponent and compliance roles, we have developed some methodologies for success, which include:

Informed Decision Making Based on Clinical and Hospital Operations Best Practices

Our Connect team has significant knowledge of hospital operations, with the expertise of four clinicians who bring hands-on experience and consulting advisory on process flows. We also bring the knowledge gained from previous AGV and materials management work with key hospital clients, such as Providence Health Care for its New St. Paul’s Hospital, Alberta Health Services for its proposed New Edmonton Hospital, the Nova Scotia Health Authority for the QEII Halifax Infirmary Expansion, and SickKids Hospital as part of its massive Project Horizon Redevelopment project. Work on over 10 large-scale AGV projects globally has given us an in-depth appreciation for the technical and operating challenges our clients face when implementing an AGV system. Given the heavy clinical and operational implications of AGVs, clients have often extended our team’s engagement in order to provide comprehensive planning, design and compliance support.

By combining our clinical and technical skillsets and AGV knowledge, we were able to deliver a design that was highly commended by the hospital.

The significance of this was put into particular focus during our proponent role for the New St. Paul’s Hospital. We were able to support the hospital in defining their scheduling and operational assumptions, developed a well-thought out AGV design that recognized infection control and staff safety requirements, and applied LEAN design principles to optimize workflows, creating optimal efficiency for supply chain management across the site. By combining our clinical and technical skillsets and AGV knowledge, we were able to deliver a design that was highly commended by the hospital.

Rendering of New St. Paul's Hospital BC — New St. Paul's Hospital BC (Rendering courtesy of PCL & Providence Health Care)

Elements of a Successful Implementation

A key to a successful AGV system is fully defining the operational processes of the AGV users in concert with the AGV system design. It is heavily dependent upon the human interfaces with the system, such as users respecting the design of the AGV Cart Matrix, prompt removal of carts upon delivery within the design time parameters, keeping all AGV areas free of obstacles, cart alignment, and having a central operator who monitors the system, proactively ensuring on-time deliveries and preventing system backlog. It is critical that the AGV and associated departmental operations, policies, procedures and staffing are reflected in the basis of design. In addition to these operational impacts, throughput of an AGV system is also significantly influenced by the design of the system, including space (including corridor widths, send/receive locations, and elevator lobbies), design of routes, the technical capability of the system, proper maintenance, WiFi, Local Area Network (LAN), elevator capacity, and integrations with the fire alarm and access control systems.

There are key differences between the implementation of AGVs in new builds versus existing sites. To name just a few, AGVs require wider corridors and pathways that support their turning radius’, specially-designed elevator lobbies that support not only the AGV navigation but also the cart-associated workflows, elevator type and capacity, battery charging locations, maintenance rooms and ‘send and receive’ locations within programs. The required space is driven by the AGV schedule and cart quantities, thereby making early planning critical to the end success of the system. While new builds can incorporate these requirements into early planning by ensuring the programmed space captures these, there are limitations to retrofitting existing hospital buildings with an AGV system due to narrow hallways, non-compliant elevators and WiFi limitations. While a thorough examination is needed to determine the options available to existing sites, there have been promising advances in Automated Mobile Robots (AMRs) that can help automate certain supply management services such as food, medication and supply delivery. AMRs do not require the same space requirements as AGVs and therefore can mitigate the need for renovations, making it a cost-effective technology for organizations interested in automating their supply chain management processes or implementing just-in-time deliveries.

Our team has experience developing AGV business cases, cost estimates, cart matrixes, specifications, and technical design on several large AGV-related projects, including SickKids, New Edmonton Hospital, Halifax Infirmary, and the New St. Paul’s hospital. These projects have provided us with a wealth of lessons learned and experience, allowing us to provide expert consulting for the successful planning, design, implementation, ongoing operation and maintenance of your AGV system.

For more information about how our AGV experience can help your healthcare facility, please contact:

Megan Angus, RN, MBA, Lean
Division Director, Angus Connect
megan.angus@hhangus.com

Robyn Munro, RN
ICAT Analyst, Angus Connect
robyn.munro@hhangus.com

Aujourd'hui, nous lançons notre site Web en français pour fournir des informations concises et pertinentes pour soutenir notre présence croissante au Québec au cours des 11 dernières années. Nous vous invitons à visiter le site en utilisant le lien ci-dessous.

Today we're launching our French website to provide concise and relevant information to support our growing presence in Quebec over the last 11 years. We invite you to visit the site using the link below.
www.hhangus.com/fr

Internet of things low poly smart city 3D wire mesh.

The world continues to embrace the Internet of Things (IoT), and emerging technologies are taking on a growing importance within built environments.

A confluence of innovation in big data processing, ultra-low power wireless networks, embedded sensor technology, and energy management has accelerated the emergence of smart buildings. As these become widespread, we have witnessed a reciprocal, or better yet, exponential growth in the planning activities to successfully introduce the sophisticated automation and enhanced user experiences they promise. In particular, hospitals, commercial offices, entertainment, retail, airports and education facilities all have clients who will be directly impacted by these advances in technology. This paper highlights the opportunities to provide a proactive change management plan for a redevelopment or capital project.

A redevelopment project provides an opportunity to introduce a large range of new technologies; however, the ‘big bang’ approach that is associated with the opening of a new facility can hinder the adoption. The role of technology should be understood from a functional perspective long before the walls and bricks are in place, so that proper infrastructure exists to support the smart building.

Any successful Digital Strategy and Transformation Project must consider aligning a change management approach to engage users to be prepared for opening day. The vast amounts of change can overwhelm staff when they move into a new building with new technologies, from new floor layouts and different staffing models, to the introduction of more mobile technology, more paperless systems, and automation of tasks that staff previously performed manually. It is imperative to address the capacity for change well in advance of the Opening Day.

The principles of Change Management and what is unique about a redevelopment project

Change really occurs when it is done at scale – throughout the organization - across all levels and stakeholder groups. There are several industry-recognized principles listed below for adopting change in large organizations. However, given the degree of complexity, number of stakeholders and length of project, there are unique factors that need to be considered with redevelopment.

The Principles

Change is Rolled Out

Redevelopment Project Considerations

Redevelopment projects have many external stakeholders as well as internal stakeholders; employees and project delivery teams have creative authority that can turn into resistance

Change Starts at the Top

The redevelopment project cycle covers many years and the leaders may change; executives are often insulated from the reality of day-to-day operations by layers of the organization

Change is Engineered

A change management program can be planned, coordinated and monitored; however, it is not like a construction project in that it involves breaking new ground and cannot be predetermined fully in advance

With So Many Stakeholders, What Matters Most?

With the variety of stakeholders involved in a capital project, such as end-users, executive team, information technology department, facilities/operations teams, government oversight and taxpayers, there are differing and opposing drivers for each of these groups, which include expected benefits, cost containment and scope definition. There is a need for a framework to define a course of action and for leadership to remain committed to it. Finding the common goals between all the stakeholders will be critical to the long-term success.

In a redevelopment project, the ideas and inspiration for change often come from parties outside the end-user stakeholder groups, such as the design team, the information technology department, facilities engineers, or other support services. Ideally, these ideas are then sponsored by the executive leadership with input from users; however, this is not always the case. It often happens that use cases for the functionality of technology are brainstormed by someone “higher up” or by the IT department, and then rushed straight into design. There is no wrong party to support idea generation; however, the important component is to ensure that end-users have been engaged and have faith that the new technologies will create a better environment. One method of engaging these users is to visualize the changes, and to write and approve the use cases for their workflows. This approach uses Lean thinking and iterative cycles to build consensus. It is critical that time be set aside to ensure that these use cases are considered by end users and validated.

It is important to note that not all parties will see the changes as necessary, especially if they don’t belong to the organization or share the same vision. To address this, create a cross-functional project team, map out the impacted stakeholders and address their unique needs. You will likely appreciate that some people are not able to easily adapt to new technologies. Doing so requires both willingness and capability; mindsets get in the way of actually making use of the technology. Therefore, it helps to have champions and support available. There will also be employees in the organization who are very keen to embrace change that results in a more automated and sophisticated building. Support these individuals in advance of the redevelopment projects by leading change on a smaller scale; for example, by introducing new mobile technologies or smart boards in meeting rooms.

Engineer standing in front of a presentation screen and pointing to it while explaining details to the audience.

Change Starts at Every Level

IT IS IMPORTANT THAT EMPLOYEES
CONTINUE TO SEE AN IMPACT AND BE
INVOLVED IN KEEPING UP THE MOMENTUM.

Long before shovels are in the ground, the organization’s leaders are visioning what the new facility will look like and how it will operate. However, project cycles of up to 10 years can be a significant deterrent for senior leaders seeing their vision through to completion. On one hand, they may perceive what seems to be ample time to prepare for the coming changes; on the other hand, they may also feel that getting ready for a change so far in the future is futile. Therefore, it is important that employees continue to see an impact and be involved in keeping up the momentum.

Communication and setting the stage for the ultimate change may be the most critical factor in successful deployments. This requires an engineered approach to obtaining buy-in. To ensure the cultural ‘soil’ is ready before planting the seeds of change, develop a bi-directional communications plan that allows questions to be addressed. The objective is to prepare employees to understand the benefits of the change, as well as the necessity of the change, and for them to be emotionally ready to execute the change. This requires a two-way dialogue to give staff sufficient time to provide feedback. Employees who fully support the change can be invited to co-develop a plan to describe the benefits and address concerns with sufficient support and training.

Conclusion

FACILITATING CHANGE DOESN’T NEED TO
BE DIFFICULT OR ONEROUS.

As a final consideration, recognize that silos in your organization may create barriers to disseminating your plans. I have often seen change initiatives fall apart when different groups that are equally impacted refuse to take ownership for action. They wait for the other department to come up with a plan and take the lead, while their own group sits back and provides “constructive criticism”. This reveals a culture that is resistant to change. It is important as a leader to break down these barriers. Bring employee groups together to understand the shared objectives and then identify what barriers may get in the way. It may be that both departments are experiencing the strain of increased workload from a large volume of change. However, facilitating change doesn’t need to be difficult or onerous. Following Lean principles, create small batches of work, and plan to stretch these batches out over time.

6 Steps to Successful Technology Change Management

As a strong leader, you can set the stage for successful technology change by adopting these six Change Management steps:

Identify the common goals between all stakeholder parties
Engage end users in depicting the use cases for technology
Communicate the benefits of these use cases
Recognize change champions and providing them with support and training
Test technologies in advance by using pilot studies
Bring together stakeholders to voice their concerns

A change management program needs to be adapted to its unique situational factors. Multiple stakeholders - from financiers, end users, IT, facilities, architects and engineers - can make implementation of your plan more challenging, but by following the steps above, you can ease the process.

If you have questions or would like to learn more about change management, we are happy to start a conversation to see how we could help.

Megan Angus, RN, Lean, EDAC
Division Director, Angus Connect
megan.angus@hhangus.com

June 3rd, 2021
1:00 PM – 2:15 PM EDT
Panel Discussion including live Q&A

Bedroom for patient in a hospital, Empty bed and wheelchair on hospital ward

COVID-19 treatment has created a sharp increase in the need for isolation rooms now and in future expansion and redevelopment plans. As a follow-up to its March session on “Isolation Room Design” that outlined design principles and strategies, the Canadian Centre for Healthcare Facilities is bringing together a multi-disciplinary panel in a special session to share insights and answer audience questions. The panel of subject matter experts will share their experiences and insights in healthcare settings from planning, design, architectural, maintenance and operations perspectives. The audience will have the opportunity to share comments and ask questions, in order to better understand the unique considerations at hospitals and other care settings as the need for Isolation Rooms increases during the current pandemic and in plans going forward.

To register, go to www.cchf.net or click on the link below.
https://us02web.zoom.us/webinar/register/WN_vIlOFdjHQmqjqcCchGhH4A

Panelists:

Gordon Burrill, P.Eng., FASHE, CHFM, CHC
President, Teegor Consulting & CCHF Co-founder, Board of Directors' President

Craig Doerksen
Divisional Director, Facility Management, Health Sciences Centre, Winnipeg

Jessica Fullerton, M.Sc. CIC
Construction Lead – Infection Prevention and Infection Prevention and Control, The Ottawa Hospital

Scott Patterson, P.Eng., PMP
Senior Director, Facilities Planning and Development, Sinai Health

Robin Snell
Principal, Parkin Architects Limited

Nick Stark, P. Eng., CED, LEED AP, ICD.D
Vice-President Knowledge Management, HH Angus and Associates

Moderator:

Rita Mezei, MSc.
Executive Director & Co-Founder, CCHF