Presentation to the: North Carolina Healthcare Engineers Association 51 st Annual Conference Grove Park Inn & Resor

1. Managing a Quality Program for the Utility Management Plan • Presentation to the: • North Carolina Healthcare Engineers Association • 51st Annual Conference • Grove Park Inn & Resort • Asheville, North Carolina • Presented by: • Jack L. Waisblat, Vice President • Smith Seckman Reid, Inc. • August 7, 2003

2. Focus: What are the key ingredients to a successful Utility Management Program ? • FTE’S • Risk Based • Operating Budget • Capital Budget • Management System • Regulatory Compliance • Patients / Public Satisfaction • Organization’s Leadership

3. Agenda • Managing a Quality Program for the Utility Management Plan, What does it mean? • Predictability factors for credible capital budgeting and forecasts. • A proactive approach to Utility Management from a Compliance standpoint. • Testing, maintaining, and examining components of Utility Management. • How to maintain a complete set of documents for JCAHO and be continuously Ready. • FMEA and Utility Management; If your CEO hasn’t asked you yet, he/she will (we will email this to you). • Implementing, monitoring, collecting data and establishing Performance Measures / Indicators.

4. Managing a Quality Program for the Utility Management Plan, What does it mean? • Quality: according to Webster’s “That which makes or helps to make anything such as it is; a distinguished property, characteristic, or attribute”. • Don’t you want to feel distinguished? • Management: according to Webster’s “To have under control and direction, to conduct, carry on, guide, administer, get under due control; to move or use in a manner desired” • Don’t you want to have control and set direction? • Utility:according to Webster’s “The state or quality of being useful; usefulness”. • Don’t you want to feel useful?

5. Predictability factors for credible capital budgeting and forecasts. Learn from the past. ♦ What happened to your budget last year ? ♦ Last year, did you have to gain emergency funding, beg barrow and steal to make your year ? ♦ Were there any unexpected expenditures that sprung up last year ? ♦ Did you just submit numbers, or did you have independent professional support backup? ♦ How well did you know your CFO ?

6. Do your homework. ♦ Present historical data ♦ Do a Facility Condition Assessment ♦ Do a Risk Assessment ♦ Does your leadership think that because you live there, you’re not an expert ?, then: ♦ Obtain outside independent professional support ♦ Obtain benchmarks • Predictability factors for credible capital budgeting and forecasts.

7. Predictability factors for credible capital budgeting and forecasts. If you put too much food on your plate, you may get less to eat next time. ♦ Develop a five year capital budget plan, share it with leadership, get buy-in prior to submitting your annual budget ♦ Prioritize your five year plan and only submit that portion for which you got buy-in

8. Predictability factors for credible capital budgeting and forecasts. • 21st CENTURY MEDICAL CENTER • FACILITY CONDITION ASSESSMENT REPORT • CAPITAL RENEWAL AND DEFERRED MAINTENANCE • FIVE YEAR BUDGET PLAN • SORTED BY PRIORITIES • APRIL 11, 2003 • Item No.Item Description Facility / Building Location Floor/Site • Dept./ Cost CenterJustificationPriority:1=High 2=Med. 3=Low • Total Costs • FIVE YEAR BUDGET ALLOCATION • FY2003FY2004FY2005FY2006FY2007 • Payback(Years)Funding sourceAction

9. Predictability factors for credible capital budgeting and forecasts. • Summary • Support your claim to the piece of the pie with; Data, pictures, past events, current conditions, code and standards requirements, emergency procedures and Risk Assessments. • Paint a what if we don’t do it scenario; spell it out in writing. • Don’t put on your plate what you can’t finish eating. • Don’t scramble to submit numbers.

10. A Pro-Active approach to Utility Management From a Compliance standpoint • What needs to be Managed for JCAHO Compliance ? • A risk assessment process (EC.1.7.c) • An inclusion process for identifying critical components of utility management (EC.1.7.e) • Establishing intervals for inspecting, testing, and maintaining critical components on the inventory list (EC.1.7.g) • Critical components of piped medical gas systems (EC.1.7.h)

11. A Pro-Active approach to Utility Management From a Compliance standpoint • What needs to be Managed for JCAHO Compliance ? • Construction, modification and repair projects for medical gases (EC.1.7.I) • Maintaining main and area medical gas shutoff valves accessible and clearly marked (EC.1.7.j) • Waterborne Pathogens (EC.1.7.k) • Airborne Contaminants (EC1.7.l) • Operational plans to ensure reliability, minimize risks and reduce failures (EC.1.7.m)

12. A Pro-Active approach to Utility Management From a Compliance standpoint • What needs to be Managed for JCAHO Compliance ? • Labeling controls and maintaining floor plans, schematics and riser diagrams to make quick determinations when a partial or complete emergency shutdown is necessary (EC1.7.n) • Problems, failures, or user errors: Investigating, reporting, measuring and correcting (EC.1.7.0 & EC.4) • Orientation and education program for staff who use and maintain utility systems (EC1.7.p)

13. A Pro-Active approach to Utility Management From a Compliance standpoint • What needs to be Managed for JCAHO Compliance ? • • Performance Monitors (EC.1.7.q) • • Emergency Procedures (EC.1.7.r) • • Annual Evaluation • • Reliable Emergency Power System (EC.1.7.1) • • Maintenance, testing and inspections of Utility systems (EC.2.10.4) :

14. A Pro-Active approach to Utility Management From a Compliance standpoint What needs to be Managed for JCAHO Compliance ? • Emergency power systems are maintained, tested and inspected (EC.2.10.4.1): Generators, SEPSS, ATS’S, Battery operated exit and egress illumination units • Other Environmental Considerations (EC.3) : Positive self-image (EC.3.1), space and equipment (EC.3.2), designing the building environment (EC.3.2.1), privacy (EC3.3), patients interest skills and personal growth (EC.3.4)

15. A Pro-Active approach to Utility Management From a Compliance standpoint What needs to be Managed for JCAHO Compliance ? • Education and Improvement in the environment (EC.4) • Monitoring conditions in the hospital’s environment (EC.4.1) • Analyzing identified environment issues and developing recommendations (EC.4.2) • Implementing recommendations to improve the environment and monitor effectiveness (EC.4.3)

16. A Pro-Active approach to Utility Management From a Compliance standpoint • How do I get it done without anything slipping through the crack ?

17. A Pro-Active approach to Utility Management From a Compliance standpoint • Manage with tools • Manage with Education • Manage by accountability • Manage with alarms • Manage with Rewards for Success

18. A Pro-Active approach to Utility Management From a Compliance standpoint • Tools:

19. A Pro-Active approach to Utility Management From a Compliance standpoint • Education: Annual Utility Management Knowledge Test 47. If the hospital experiences an interruption of electricity or water outage, you should:         A-Inform patients we are experiencing a power outage      B- Bring battery operated equipment from home        C- Inform your immediate supervisor and conserve water 48. If electrical power has been lost, you may:        A-Use ice machines and obtain drinking water from the faucet B- Use red outlets powered by emergency generators        C-Open windows to promote ventilation use 49. When the hospital experiences a telephone system outage, you will report this information to PBX (communication dept) and   A- Departments will pick up a hand held radio in Security B- Employees will use their cell phones C- administrative staff will pick up telephones for distribution

20. A Pro-Active approach to Utility Management From a Compliance standpoint • Accountability:

21. A Pro-Active approach to Utility Management From a Compliance standpoint • Alarms:

22. A Pro-Active approach to Utility Management From a Compliance standpoint • Rewards for success:

23. Inspecting, Testing, Maintaining and Examining components ofUtility Management • Definitions: • Inspecting: By licensed or certified person • Testing: Operational function • Maintaining: Performing routine maintenance / repair as established by organization or required by codes & Standards • Examining: Observing and recording conditions

24. Inspecting, Testing, Maintaining and Examining components ofUtility Management • When and how to do it ? • Assign specific duties and responsibilities • Provide Frequency chart streamed-lined to the task/s • Predetermine schedule for the entire year • Set alarms in your schedule if individual is more than 48 hours late in completing the task • If multiple individuals are involved in a task, appoint one as the task leader to be held accountable • If a test can not be completed (broken amp meter on generator), don’t accept “meter broken” entry in test log • Don’t Rely solely on building automation systems • Develop check lists

25. How to maintain a complete set of documents for JCAHO and be Continuously Ready • Contrary to what we learned as kids, do judge a book by it’s cover • Keep a book for each of the minimum of the tasks, preferably white 3 ring binders with content description on front and side • Implement an automated EOC management program that collects and aggregates data electronically • Enter data for Periodic Performance Review (PPR:2004 EOC requirement for 18 month self assessment) on a regular basis • Aggregate data quarterly (at a minimum) and review if you are on target

26. Implementing, Monitoring, Collecting data and establishing Performance Measures / Indicators and Performance Improvement recommendations • Definitions: • Performance Measures: An instrument (graph, chart, raw data) by which to measure the success or failure of an EOC task: Typically compares this year to last years performance • Performance Indicator: Provides data to where an EOC task is at present in terms of achievement • Performance Improvement Recommendation (mostly known as a “PI”): Establishes a goal for improvement in the coming year based on an evaluation of providing the most value to an organization (needs to be approved by the leadership of the organization)

27. Implementing, Monitoring, Collecting data and establishing Performance Measures / Indicators and Performance Improvement recommendations • Establish with leadership who is responsible • Automate the system • Review and Report Measures Quarterly • Establish performance Indicators (no specific requirement from JCAHO as to the number of measures) • Establish a minimum of two performance measures for each of the seven EOC management plans • Establish your performance improvement recommendation (only one required for the EOC annually) among EOC management team members who will carry the torch

28. Implementing, Monitoring, Collecting data and establishing Performance Measures / Indicators and Performance Improvement recommendations

29. Thank You! From SSR JWaisblat@SSR-Inc.com