Infrastructure Ontario (IO) and Children’s Hospital of Eastern Ontario (CHEO) have announced the shortlisted teams to design, build and finance the 1Door4Care: CHEO Integrated Treatment Centre project in Ottawa.

HH Angus is providing Mechanical Engineering consulting services as part of the EllisDon Infrastructure Healthcare team which was named as one of the three teams moving on to the RFP stage for this project. The new facility will merge seven care locations into a single, state-of-the-art, purpose-built site on CHEO’s main campus and will include multi-use clinic space, a physiotherapy rehab gym, expanded mental health clinics, indoor and outdoor space where teachers and therapists combine education and therapy, secure space for children who have been abused, modern treatment rooms for kids with behavioural needs, advanced technology to enable virtual care, a physical link to the main building on campus, family support spaces, a new parking structure, and more.

A request for proposals (RFP) is expected to be issued in fall 2022.

Source link: Teams Shortlisted for 1Door4Care: CHEO Integrated Treatment Centre project

Medical gas panel

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.

Medical gas alarm

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.

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

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:

  1. Identify the common goals between all stakeholder parties
  2. Engage end users in depicting the use cases for technology
  3. Communicate the benefits of these use cases
  4. Recognize change champions and providing them with support and training
  5. Test technologies in advance by using pilot studies
  6. 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

Megan Angus, RN, Lean, EDAC
Division Director, Angus Connect

megan.angus@hhangus.com

We’re excited to be part of the team, led by EllisDon Infrastructure Healthcare (EDIH), that will build the new Bayers Lake Community Outpatient Centre in Nova Scotia. HH Angus’ Health Division will be providing mechanical consulting engineering services, working with Dillon Consulting in Halifax. This is the first P3 healthcare project in Nova Scotia, and will be an important facility for both the community and the entire province. According to Kim Spencer, HH Angus Health Division Director, “we’re very pleased to be able to support this new facility with HH Angus’ deep experience in the P3 delivery model, and proven track record in thoughtful healthcare design.”

The 134,000 ft2 Outpatient Centre will built on a 15-acre site in Halifax’s Bayers Lake Business Park. Planned services include primary care; clinics such as physio and occupational therapy; high blood pressure, diabetes and orthopedic assessment; 17 examination rooms; 24 dialysis stations; diagnostic imaging (x-rays and ultrasounds); blood collection; and post-surgery or post-treatment follow-up appointments.

Image courtesy of EDIH

COVID 19-Response: Creating Healthcare Spaces for COVID-19 Patients

HH Angus invites you to join The Canadian Centre for Healthcare Facilities’ (CCHF) webinar, featuring a panel of healthcare leaders from across the country, including HH Angus’ Nick Stark. The panel will be discussing how they are addressing patient needs in this new environment, some challenges and solutions, and offering opportunity for insights and discussion.

Date: May 1, 2020

Time: 10:00 – 11:00 am Vancouver | 1:00 – 2:00 pm Toronto

Register in advance for this FREE webinar:
https://us02web.zoom.us/webinar/register/WN_yS8tlKOfQJSs9jghRYu5yA
After registering, you will receive a confirmation email containing information about joining the webinar.

Panelists:
Miriam Stewart, Regional Program Director Critical Care Vancouver Coastal Health/Providence Health Care, Chief Clinical Planning Officer, St. Paul’s Redevelopment, British Columbia

Nick Stark, Vice-President, Knowledge Management, HH Angus

Scott Olsen, Provincial Lead, Asset Management & Safety, Clinical Engineering – Centre of Expertise, Alberta Health Services

John Switzer, Strategic Capital, Space Management and Real Estate

Pierre-Marc Legris, Director Technical Services McGill University Hospital, Quebec

Michael Keen (TBC), Vice-President of Facilities and Planning and Chief Planning Officer, Unity Health Toronto, Ontario

Lynn Wilson Orr, Principal, Parkin Architects Limited

Moderator:
Gordon Burrill, Teegor Consulting, Fredericton, New Brunswick and CCHF Board President