Rental housing landlords sometimes think of themselves as the most regulated real estate operators, but healthcare engineers and facilities managers make a good case for claiming that title. Responsibility for ensuring consistent service provision for a large, varied and vulnerable occupancy comes with many complex specifications.

“There is a never-ending barrage of codes and standards,” John Marshman, director of engineering and plant operations with the William Osler Health System, told seminar attendees at the recent PM Expo in Toronto.

He, and co-presenter Roger Holliss, director of engineering and biomedical services at St. Mary’s General Hospital in Kitchener, Ontario, outlined operational directives that address everything from infection control to project financing, and elder-friendly design to energy-use reporting. Three CSA standards — 8000, 8001 and 8002 — provide the guidance backbone of how healthcare facilities should be built, commissioned and operated, but dozens more have bearing even if they aren’t outright statutory requirements.

“It’s hard to argue due diligence if something happens in the absence of following a standard,” Holliss noted. At the same time, standards such as the CSA ‘big three’ are often embedded in provincial codes making them de facto regulations.

While keeping up with the regulatory landscape is a sectoral challenge in itself, the presentation highlighted other emerging trends affecting healthcare operations. Some, such as infection control requirements and expanding electricity loads from energy-intensive medical equipment, arise from healthcare’s core purpose — treating patients. Others relate to government-imposed actions. Ultimately, though, Holliss emphasized the underlying professional objective.

“It’s our job to create a clinical environment so clinical specialists’ time is focused entirely on patients,” he said. “We want to maximize the clinical utility of doctors and nurses.”

Focus on older facilities

Current concerns and new demands for infection control can present a particular challenge in older facilities. For example, Marshman noted that the older buildings in William Osler’s portfolio, which includes sites in west Toronto and Brampton, have considerably fewer isolation rooms than is now the norm for new healthcare construction.

“It (infection control) drives a fairly onerous infrastructure regime around systems that are typically fairly hard to control,” he observed. “That’s driving some significant changes to how we approach HVAC systems and the layout of certain areas.”

After an era of active new construction in the 1990s and early 2000s, the Ontario government’s focus has turned to retrofits and upgrades of older existing facilities, via the provincial Health Infrastructure Renewal Fund. Marshman traced this shift in priorities to the Facility Condition Assessment Program launched in 2008.

“I think the output of that exercise was pretty terrifying for the government in terms of deferred maintenance that was discovered,” he suggested.

This influx of retrofit funding comes in sync with recent new guidelines for financing and procurement in the broader public service (BPS), which also apply for  municipalities, school boards, universities and colleges. BPS guidelines mandate an open RFP for any capital project with a budget in excess of $100,000, and the Minister of Health’s approval for any capital project valued at $10 million or more. Cost must also be given the greatest weight among bid evaluation criteria.

“On procurement, we are very restricted,” Marshman said — adding that the process brings added pressure for bidders, who must now comply with the so-called two-letter system requiring separate technical and financial proposals.

Energy management urgency

Requirements under Ontario’s Green Energy Act to report annual energy consumption and carbon emissions have now exposed healthcare operations to new kinds of scrutiny. Marshman noted that it’s not uncommon for patients and/or visitors to comment on the facility’s energy-use intensity, which can be found online.

While philosophically supportive of public accountability — “I have an obligation as the facility manager to spend the taxpayer’s money as best I can,” he asserts — the numbers alone don’t necessarily provide for a fair comparison of facilities, given the diversity of building vintages and the energy-intensive equipment, like MRI machines, that some house.

Healthcare operators face challenges similar to those experienced in the commercial building sector in absorbing the Global Adjustment charge in Ontario’s electricity rate structure. Large facilities could have the 5-megawatt electricity load to qualify as a Class A customer, but have less flexibility to take advantage of options to reduce costs.

Class A consumers are charged a Global Adjustment rate prorated to their energy use during the five hours of the year with the highest total provincial demand — a formula that tends to benefit consumers with the means to cut energy loads during those times. “Industry has the flexibility to be able to shut down. We don’t,” Marshman said.

This is helping to make a business case for investing in on-site cogeneration. “It gives a lot of flexibility in terms of dodging the Global Adjustment and load-shedding off the grid into gas-fired,” he explained.

However, Ontario’s new cap-and-trade system might make that a short-term prospect. While healthcare facilities are not designated emitters now, that could change as the emissions cap drops. Cap-and-trade emission allowance costs will also flow through to all natural gas purchasers, as has already begun to occur in Quebec.

Professional development

All these demands heighten the relevance of professional associations like the Canadian Healthcare Engineering Society (CHES) and a new accreditation program recently launched as an equivalent to the longer established American Society of Healthcare Engineers (ASHE) certification for operations personnel in healthcare facilities.

Holliss, who serves as chair of the Ontario chapter of CHES, and Marshman already report an increasing number of professional engineers, like themselves, working in the sector. Both also reiterated that it’s a rewarding career.

“What drew me to healthcare was the opportunity to get out of bed every day and say: I’m going to help make sick people better,” Marshman reflected.

Barbara Carss is the editor-in-chief of Canadian Property Management.