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