The First Facility Management Blog

Walt Neilson, maintenance team leader at Mercy Hospital in Grayling, MI has worked at the 99-bed hospital for 36 years. With winter upon this facility in northern Michigan, Neilson discussed with TFM his department’s purchase of snow melting mats from HeatTrak, a Paterson, NJ-based manufacturer of electric outdoor heated matting products.

TFM: Where on the Mercy Hospital property do you use HeatTrak matting products?

Neilson: We have been using them at two modular outbuildings on our campus—one is a clinic and one is an office. And for this winter, we just ordered mats for a third building—a specialty clinic which is a permanent structure.

The HeatTrak heated mats used outside of three Mercy Hospital buildings in Grayling, MI.

TFM: When and why did you first purchase the heated mats?

Neilson: We bought them two years ago for the modular buildings. There were cement steps leading up to one of the clinics, and with the snow and ice we get here in the winter our staff had to put a lot of salt down to keep the stairs clear. Well, in addition to the labor expended on this task, the salt also ate up the concrete. So we removed the concrete and put down treated lumber steps, along with a handicap ramp. We ran into a problem with the treated lumber, because it would get very slippery when wet. So that was an issue.

At that point, someone suggested heated mats and we found HeatTrak. That was when we first ordered them, and they have worked out great. The first order was for the clinic with the treated lumber steps; this facility is used by staff. We use a combination of the full mat along with the stair mats. The company will make the mat to fit the number of stair treads you have and will join them with the landing area, so you only need one power outlet. Another nice feature is that the products have grommets, so we can screw them down to the wood deck and leave them there for the duration of the cold season. Then, when spring arrives, we roll them up and put them in storage.

Heated stair mats in use at Mercy Hospital

And the mats don’t have to be on 24 hours a day. They are thermostatically controlled, so when the temperature drops to our preset temperature, the mats turn on. It’s automatic.

These technologies are very useful, because here in Michigan, temperatures can drop 40 degrees in one day. We’ve gone from 70 degrees to 30 degrees in 24 hours.

TFM: Why haven’t you installed the heated mats around the main hospital building?

Neilson: In front of the hospital, we have heated sidewalks with piping underneath. We installed those three years ago as part of an emergency room addition. This radiant heating approach was used from the ER entrance all the way to the main entrance. Turning those on and off is also controlled with temperature sensors.

TFM: Any other comments on how the heated mats have affected your operations?

Neilson: For just one slip and fall avoided, it’s worth it to prevent the injury and a possible lawsuit. For instance, for the clinic with three ramps, the groundskeeper would be clearing or salting one ramp and someone might be walking on the second ramp that hadn’t been cleared yet and then, oops, there’s a fall. You cannot clear or salt all three ramps simultaneously to prevent it. So that’s where these heat mats have been very beneficial to our maintenance operation.

RNs from the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) have filed an urgent plea with the state of California to step in and force Sutter Solano Hospital to provide nurses with proper safety equipment when they care for patients infected with the H1N1 “swine flu” virus. The nurses fear that the unsafe procedures at the hospital create a danger of infection for every patient at the facility as well as for the surrounding community.

The plea comes as nurses are actively caring for hospital patients infected with the virus. And with up to 10 RNs from the facility experiencing severe respiratory illness in recent weeks that their physicians have called “probably” the swine flu, many have been left physically unable to work.

The nurses requested assistance from the California Division of Occupational Health and Safety just days after the World Health Organization re-classified H1N1 as an “unstoppable” Level 6 pandemic, with the number of confirmed cases worldwide approaching 100,000, and 170 confirmed deaths in the United States alone.

Sutter Solano has purchased so few of the proper N95 masks that most nurses working with patients are unable to procure an adequate supply of disposable masks. The union has raised its concerns with management.

The hospital has supplied new masks that did not properly fit, making them useless for stopping the virus. Management responded by ordering the nurses to wear a contact mask on top of the ill-fitting N95 masks, but the nurses raised concerns because doing so can increase carbon dioxide retention in the mask wearer. Previously, management had given nurses a single mask in a plastic bag with instructions to re-use it repeatedly, rendering the mask useless for infection control purposes.

Compounding these problems, some rooms with infected patients lack appropriate HEPA filters, and proper isolation protocol is not being followed, with visitors moving in and out of contact with infected patients.

“Nurses will be on the front line of the fight against the H1N1 virus. However, if hospitals refuse to take basic safety steps to protect them from exposure, then infected RNs will be physically unable to continue working and may well become a vector for further infection. We nurses are shocked that hospital management is exposing us to this risk. It endangers every other person we come into contact with—our patients, our family, even management. This is not a time for finger pointing, this is the time for Sutter Solano management to do their job and provide nurses with basic safety protections,” said Sherry Ramsey, a RN at Sutter Solano.

Hospital management has claimed that there is a national shortage of the appropriate masks, a charge not verifiable in any way: neither the Centers for Disease Control nor the mask’s manufacturers have reported any shortage, and other hospitals are able to provide their nurses with this safety protection.

“Sutter Health is an outlier with their refusal to protect nurses against the H1N1 virus. They must immediately move to safeguard these nurses, because we have a very busy and deadly flu season coming up, and hospitals must meet safety standards,” said Deborah Burger, RN, a diabetes case management nurse and co-President of CNA/NNOC.

In an effort to eliminate the challenge of surgeons, nurses, and support staff from fumbling with ID badges through scrubs or forgetting them, Promedica Health System’s (PHS) Sylvania, Ohio-based hospital’s surgery room grants door entry access through hypoallergenic/ antimicrobial coated biometric hand readers. The access control system increases entry speed in critical situations and most importantly creates a highly secure entry beyond card swipe technology that also allows PHS central security personnel to monitor and record through the hospital’s Frontier access control system software from Matrix Systems.

Registration is a two minute process in Flower Hospital’s security center. Surgery room personnel enroll with a biometric hand scan by an identical model of the Hand Key II by Ingersoll Rand Security Technologies (IRST). The hand scan template is processed and attached to the employee’s security ID profile in the Frontier access control software. Matrix Systems’ PHS account supervisor, William Kuebler, engineered the project and coordinated firmware writing by Matrix Systems’ engineering department. Consequently, the interface between the IRST’s Hand Key II software and the access control software was seamless and now enables Flower Hospital’s security manager, Jonathan Jones, easy control over the enrollment procedure. Once enrolled, the employees enter the surgery room via the Hand Key II’s keypad code followed by a biometric hand scan in a process that spans five seconds or less.  

While the surgery room access is a success, PHS’ lock shop is used as a beta site to test biometric hand readers for future applications, which will be brought on line in additional sensitive security locations in the future. 

Biometrics is just one example of security that Donald Sullivan, security system technology specialist, and James Hofbauer, security director, both of PHS’ Central Region, are continually incorporating into the eight hospital, not for profit healthcare organization that services 27 counties in northwest and west central Ohio and southeast Michigan.

Another example is the Toledo Hospital campus’ 145 space physician parking lot/garage. Previously physicians had to swipe ID cards or punch in ID numbers at an access control card reader to enter the facility. Now physicians have windshield attached transponders that allow a more convenient and quicker entry. Because the wireless RF system sends entry information directly to the security department’s access control workstation, physicians are logged in immediately upon entering the campus. “If there’s an emergency and a need for a particular doctor, we know if that doctor is on campus,” said Hofbauer. “Plus, doctors are our customers too, so this is also a convenience for them because they no longer need to worry about remembering ID numbers or cards.”

A report released today from The Joint Commission offers guiding principles and actions for the hospital of the future to meet the challenges of older and sicker patients, patient safety and quality of care, economics, and the work force. As these challenges evolve, hospitals can lead the effort to meet these demands.
 
Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future contends that hospitals must respond in new ways as escalating health care costs are hitting record highs and the conditions and care needs of hospitalized patients are growing more complex. The report is the work of a panel comprising hospital executives and clinical leaders, as well as experts in technology, health care economics, hospital design, and patient safety. The roundtable analyzed how socioeconomic trends, technology, the physical environment of care, patient centered care values, and ongoing staffing challenges will impact the hospital of the future.
 
“The importance of hospital based care will not diminish in the future, but hospitals will have to meet the high expectations of the public and all stakeholders in an increasingly challenging environment,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “As they have been in the past, hospitals must be equally transformative as the future unfolds. The Joint Commission urges hospitals and public policymakers to use the principles in this report to achieve that aim.”
 
“The Joint Commission has brought together broad expertise in health care to point to directions for optimizing health care in hospitals. Hospitals have an enduring role in the delivery of health care and have provided major contributions to enhancing the treatment of disease,” says Herbert Pardes, M.D., president and CEO, New York Presbyterian Hospital and New York Presbyterian Healthcare System and roundtable chair. “Looking forward, this report describes issues ranging from technology to personnel, patient relationships, and fiscal and architectural design among many other ways hospitals can enhance health care for all patients.”
 
The report recommends action in five core areas:

Economic Viability
While some hospitals today enjoy healthy profit margins, many hospitals continue to be unprofitable. There is a growing gap between the have and have not hospitals. An aging population and a continuing decline in employer sponsored insurance means that hospitals can expect increases in publicly insured patients and uncompensated care. This is expected to create more competition for the fewer patients to whom costs may be shifted. For hospitals to be economically viable in the future, the following principles must be pursued by hospitals, health care stakeholders, and policymakers:

• Align performance and payment systems to meet quality and efficiency related goals
• Use process improvement tools to increase efficiency and reduce costs
• Pursue coverage options to ensure patient access to, and affordability of, health care services
• Address how general acute hospitals and specialty hospitals can both fulfill the social mission for health care delivery

Technology Adoption
Information technology plays a major role in improving health care quality and safety, and can help support the migration of hospital based care into the community and even the home. The technological transformation of health care also invites the redefinition of the hospital, according to the report. To address technology in the hospital of the future, the expert roundtable suggests the following:

• Make the business case and sustainable funding to support the widespread adoption of health information technology
• Redesign business and care processes in tandem with health information technology adoption
• Use digital technology to support patient centered hospital care and extend that care beyond the hospital walls
• Establish reliable authorities to provide technology assessment and technology investment guidance for hospitals
• Adopt technologies that are labor saving and integrative across the hospital

• Make adoption of patient centered care values a priority for improving patient safety and patient and staff satisfaction
• Incorporate patient centered care principles into the activities of hospital oversight bodies and transparency initiatives
• Address barriers to patient and family engagement, such as low health literacy and personal and cultural preferences 
• Eliminate disparities in the quality of care for minorities, the poor, the aged, and the mentally ill 
• Improve the quality of care for the chronically ill through coordinated, multidisciplinary care
• Use robust process improvement tools to improve quality and safety

Staffing
Work force shortages have persistently plagued hospitals over the last several years. To address the fact that demand for certain health care professionals outstrips supply and to meet the needs of patients in the future, the report makes the following recommendations:

• Establish fair migration and compensation policies for countries facing shortages of health care workers
• Expand health professional education and training capacity to accommodate the growing demand for health care workers
• Create workplace cultures that can attract and retain health care workers
• Develop professional knowledge and skills necessary in a more complex health care environment 
• Educate health professionals to deliver team based care
• Develop the competence of health professionals to care for geriatric patients