Facilities – Aging / Maintenance
An organization’s aging infrastructure and lack of maintenance can lead to several impacts including and not limiting to loss of operations, injuries, increase in waste/inventory, poor patient experience and flow, financial impact, and reputational loss. This risk can also impede an organization’s ability to meet strategic goals and objectives, and result in risk of non-compliance with regulations, codes, and standards. This Risk Profile includes building facilities and equipment-related aging and maintenance issues. This document contains information identified by HIROC subscriber healthcare organizations (acute and non-acute) in the Risk Register application to help you in your assessment of this risk.
Key Controls / Mitigation Strategies
- Strategic planning/budgeting
- Capital planning and long-term planning for anticipated infrastructure needs
- Annual capital budgeting process
- Dedicated funds allocated for upgrades of aging infrastructure and emergencies
- Infrastructure and facilities align with the organization’s strategic priorities (e.g., service excellence, safety)
- Computerized maintenance management system which provides advanced notice of replacement needs and assets nearing end of life (e.g., utilized for medical asset planning)
- Emergency Department infrastructure planning with expertise in safety and security considered
- Prioritization of redevelopment or replacement of aging infrastructure across multiple sites based on resource availability
- Funding
- Strong relationship with regional health authorities
- Regular communication with government representatives to increase awareness
- Prioritization of funding requirements
- Continuous efforts to apply for grants and funded infrastructure projects
- Internal policies and processes
- Safety and security of staff and patients are always kept at the forefront when making decisions related to capital planning and equipment purchases
- Formal committee to oversee all capital projects and emergency requests
- Regular inspections and assessments to identify potential problem areas (e.g., fire inspections, infrastructure risk assessments, life safety assessments, environmental assessments, etc.)
- Formal risk analysis (e.g., matrix) to understand impact of circumstances and urgency
- Continuous risk identification and prioritization process for infrastructure upgrades
- Grouping of similar repair costs together to get better pricing/funding
- Appropriate level of information about conditions and life expectancy of facilities and equipment are provided to decision makers
- Formal preventative maintenance program actively followed, manufacturers recommendations identified
- Access to knowledgeable and experienced maintenance team and/or engineers – on call 24/7
- Appropriately managed contracted service providers
- Monitor temperature and humidity in areas such as operating room and medical devices reprocessing, etc.
- An inventory of equipment and infrastructure assets are maintained
- Regular alerts and recalls reviews
- Infection control issues are identified and managed as required
- Inventory of all manufacturers’ warranties
- Spare parts inventory management
- Participation in groups with other facilities regarding planned maintenance
- Documented plant management to reduce the risk of knowledge loss (e.g. succession planning)
- Contingency plans/Emergency Code procedure and response plans in place including back up equipment (e.g, backup generators)
- Decommissioning of unsafe equipment
- Backup equipment (e.g. smaller cooler, additional ventilators)
- Physical controls
- Electrical improvements and red emergency power outlets
- Updated plumbing in older buildings
- Sprinkler system
- Updated fire alarm system, fire exit door replacement
- Appropriate sewers and storm drainage system
- Updated communication system
- Roof repairs
- Heating, Ventilation, and Air Conditioning (HVAC) system replacement
- Upgrade security systems such as cameras, building access, and alerts
- Oil tank replacement
- Floor plan review of current design functionality (use of space designer/architect)
- Workplace hazards monitored and addressed on a timely manner
- Signage of any hazards
Monitoring / Indicators
- % of scheduled preventive maintenance tasks completed on time
- % of reported broken/hazardous equipment reported which are within the preventative maintenance program
- % downtime or % uptime
- # of Infection Prevention and Control (IPAC) audits for specific medical equipment
- Hospital occupancy and use of isolation room (flow metrics)
- Problem areas and # of maintenance service requests
- Alerts and recalls-code/standard compliance (e.g. building codes, fire codes, Canadian Standards Association)
- # capital project requests
- Budgets/forecasting
- Missing equipment
- Workplace hazards
- Facility conditions (e.g., daily monitoring of HVAC)
- Infrastructure projects and their statuses
- Staff/patient/visitor complaints
- Building automation system to monitor equipment and report on performance
- Regular audits
- Periodic inspections by third parties to verify condition of assets
- Air quality testing results
- Emergency code testing results (i.e. code grey, red)
- # of code grey and/or loss of a critical service/equipment annually
- Accreditation results