| Meeta Ruparel |
When a hospital initiates a facility safety programme, an asset assessment and management programme as early as possible in the structural life cycle,- the hospital can provide protection from liability by demonstrating recognition of responsibility for hospital facility safety.
Asset re-evaluation
Asset condition reviews should be conducted to determine buildings of certain significance value and conclude on structures that can be retained, redeveloped, modified and used for an alternative purpose or demolished. For such a review measurement tools like, structural condition, site analysis, condition of engineering systems, functionality, age and potential for modification/ alternate use for optimum functionality are to be considered. Such assessments assist in defining and justifying how effectively and efficiently the existing assets meet service delivery objectives.
Re-development plan
Structural remodeling for existing hospital buildings
As per best practices globally, first and foremost the hospital management must identify the zone in which the hospital building is built/or is to be built. An analysis of type of soil/land is also to be made. On the basis of the zone analysis, evaluate the risks and take actions for vulnerability assessments (this assessment is done by qualified structural engineers) and calculate the risk factor as this shall assist in evaluating the expected damage and loss that could result in an adverse structural event.
The structural engineers assess and estimate the vulnerability and risks with a technique called as “Rapid Visual Screening”. Levels of damage range from wall cracks to possible collapse of buildings; lesser the maintenance more is the building vulnerable to damage. After this initial screen an in depth assessment is made, specific to the hospital building structure, plans, location, seismic zones, other hazard zones, etc.
Risk reduction can be achieved by replacement of a completely old structure or rehabilitation of the occupants, the decision is made based on levels of risks, damages and costs involved.
Approaches to mitigate risks for vulnerable buildings:
The first issue that needs to be mitigated is to reduce risk of structural collapse.
Replace: If the existing building is very old and evolves with high risk vulnerability assessment score, a decision may be made to completely demolish the old building and replace it with a new construction. In such a case the new design can be planned with structural failure event resistant construction considerations and the current building safety code thereby reducing risk opportunities of structural failure. Many a times such decisions have constraints due to costs/ preservation of heritage buildings, etc. In such a case structural remodeling is considered as the best approach.
Structural remodeling: This can be carried out in various stages based on the structural requirements, finances, levels of risks, project goals, etc.
One stage structural remodeling: In one stage structural remodeling the complete project is executed as one whole continuous project. Direct and indirect costs that need to be considered here are; costs of construction, costs of disruption of service during the project, design costs and engineering costs.
To justify the decision the feasibility evaluation can be related to the comparative costs and value of damages (property, equipment, etc) avoided and also, in case of an adverse structural event value of probable casualties, injuries and disruption of services that are avoided.
Multi-stage structural remodeling: In multi-stage structural remodeling the project is executed in various phases and may be spread over years. This is instrumental to address the financial constraints and may be also related to a marginal cost addition when considered as a component of planned maintenance.
The order in which the project is executed is decided based on ultimate effectiveness. Factors considered for evaluation:
- Due diligence of acquisition (e.g. Seismic screening and evaluation)
- Current use
- Accreditation and regulatory requirements
- Strategic facility plan (e.g. Prioritisation plan, emergency response plan, risk mitigation plan and system)
- Budget and funds (maintenance and investments)
- Implementation plan and system (System implementation, training and self discipline)
Three aspects to prioritise multi-stage structural remodeling project phases:
- Based on use: This is evaluated based on considerations of possible/ planned future uses of the existing buildings, as some may be planned for future expansions and some may be scheduled for demolition and some may have some other needs assessed and planned. (For e.g. shift of a department)
- Based on structural requirements: This is established based on structural assessments and their reports of respective impact on the Structural failure risk resistance of the building.
- Possible integration with other activities/ plans: Specific activities of the project can be integrated as a component of planned maintenance and other capital investments projects, resulting in shared costs of engineering, design, etc making the project a cost effective initiative.
Tools for multi stage structural remodeling
- Engineering support: Structural screening, evaluation, priority plan, design and project time PERT
- Analysis of integration opportunities based on category priority factors like:
a. Healthcare service delivery improvement
b. Fire safety improvement and/or other hazard safety improvement
c. New technology introduction
d. Building expansion/ extension
e. HVAC improvements
f. Maintenance priority (roof/basement/walls/ windows/fixtures, etc)
g. Energy saving implementation programme initiative
This analysis can be done by placing the parameters and its integration possibilities in a matrix to evaluate it further.
Continuous improvement
After an effective asset review and redevelopment of the prevailing systems (if any), it becomes equally important to maintain and upgrade the systems to walk with the latest trends to render services of an optimal quality. Using risk analysistechniques the necessary preventative maintenance, corrective maintenance or replacement needs can be determined. Estimates can be prepared for budget purposes over the life of the asset and its functional ability.
Structural health depreciation
We consider depreciation costs for our financial statement evaluations. Depreciation is considered for assets that loses its value due to age in it’s total estimated life cycle. On an average, a building life cycle is estimated and considered somewhere between 50-55 years. Many buildings require to undergo renovations/remodeling much before this 50 year estimation, as a good life cycle depends on the structural maintenance, frequency of maintenance, materials used during construction, energy systems being used, the total usage of the structure in terms of hours per day, number of people using the structure daily (i.e. such dimensions vary for a residential building and for a commercial building and it is different for a hospital building as well), etc. In other words these factors/indicators could be divided broadly into resources i.e. materials used, technique of construction and finally operation systems or processes practiced within the structure.
Let us consider the analogy of depreciation in terms of health of that asset. Understanding the fact that any asset/ structure with age and within its estimated life cycle is required to be upgraded/ modified or replaced; we must attempt to identify criteria that are influencing the structural/ asset health, to make optimal use of the investments, enhance the life cycle by appropriate monitoring, evaluation and maintenance.
We must consider important aspects of construction that are detrimental indicators for “Structural Health” and can be termed as “Structural Health Depreciation” factors. Structural life cycle estimates of such determinants can actually help us analyse “Structural Health Depreciations” and predict its end of life status, cost and time of renovations and remodeling, or rather optimise “Structural Health Depreciation” considerations! Estimating these structural health depreciation indicators will assist us to plan and budget the remodeling phase well in advance and most importantly such decisions would be based on facts!
Structural Kaizen
Identifying these determinants, evaluation criteria and continuous monitoring of structural performance parameters can then become the key to structural good health. So can we call this approach as continuous improvement to structural good health? ‘Kaizen’ means continuous improvement; I therefore, term this methodology as “Structural Kaizen”!
The structural Kaizen strategy
The structural Kaizen strategy would comprise the input (resources), technology, techniques, the operational processes and finally the outcome measures for performance evaluations. Starting with a plan for continual quality improvement the structural Kaizen strategy should be made an integral part of the operational management in order to review the systems periodically for continuous improvement. This can be implemented by promulgating policies and procedure manuals to guide the preparation of asset registers, capital planning, service and maintenance planning for the hospital building. The assessment criteria to be considered in such guidelines are; capital cost, recurring cost, functional ability and buildability of a particular project.
The plan should be such that a balance is achieved between the capital cost, recurring cost and the functionality of an asset/ project. One must not forget that the structural Kaizen strategy is for safety, the plan should therefore include risk assessments, vulnerable building indicators, multi-hazard safety parameters, quality control measures for construction materials sourced, construction techniques used, skills used, design measures, etc.
The plan can include considerations of optimum risk free structural designs with use of design tools like simulations, design of experiments and design for six sigma initiatives, etc. A report on the asset reviewed should maintain records such as a unique asset number, the location, description, type and frequency of inspections and services, replacement date and cost, maintenance cost, required performance standards, etc.
The practice should be just as any Kaizen event. A team; necessarily comprising a structural safety engineer, hospital safety expertise and other safety influencing departmental heads like hospital administrator, housekeeping head, clinical head, nursing head, infection control head, etc., should be formed which may profess as committee and function on every structural Kaizen event month after month as a set cultural practice.
A successful implementation of such a structural Kaizen strategy would not only ensure efficient maintenance, reduced wear and tear of assets, efficacy oriented hazard resistant structures, reduced structural damage, but also ensure safe and effective structure to its optimum use of its structural life cycle.
Reference:
Excerpts from an article on Asset Management, research notations on Structural Kaizen and a chapter of a Book on “Hospital Facility Safety” written by Meeta Ruparel. The author can be contacted at meeta@meditecindia.com