Only a fraction of the 40 billion square feet of roofing annually installed in the United States involves retrofit projects with sloped metal systems. However, replacement and repair continue to account for approximately 75 percent of all roofing work, and industry sources suggest that 30 billion square feet of roofs will be in need of major repairs in 2009. With the number of major roof repairs and replacements looking to increase in the coming years, it may be worth checking out a roofing contractor such as Ace Roofing Company now so you are aware of the services that they offer so you are able to contact them as soon as you start to see any damage.

A sloped metal roof was installed at Merrimack County Nursing Home in Boscawen, N.H.

Most roof retrofit work includes adding slope to an existing flat roof, which can generate a strong return on investment with lower energy costs and little or no maintenance for decades. In most circumstances, a new roof can be installed without having to remove the existing flat roof, and can even sometimes be covered by your existing home insurance policy. If yours does not cover this, go to simplyinsurance or a similar quote provider and compare what’s on offer to get the job done. Going back to roof repairs, if you have noticed some damage to your roof such as having tiles missing or has a hole in the corner which results in a leak, it could be as simple as getting in touch with professionals such as an austin roofing company (or one closer to where you live), as they’ll be able to help resolve this issue and do it the right way.

In today’s market, the cost of adding a sloped metal roof system over an existing roof is, in most cases, less than the cost of removing a flat roof and replacing it with built-up roofing or a modified bitumen roof with tapered insulation.

A slope as low as one quarter of an inch per foot is sufficient to satisfy most metal roof warranties and can be achieved by installing light-gauge steel columns in varying lengths. After the columns are installed, steel purlins are positioned between each of the columns and the necessary bracing is installed. A new metal standing seam roof panel system is then placed on top of this sub-framing system. When the job is completed, it’s almost like having a small metal building sitting atop the original roof.

If properly maintained, the exterior surface should last at least 30 years and reflect up to approximately 80 percent of the solar heat that would normally penetrate the building. Adding unfaced fiberglass insulation in the newly created cavity can further increase energy conservation and limit heat transfer to interior spaces.

Environmentally conscious building owners and managers will relish the fact that metal framing systems, roof panels and trim are manufactured from recycled materials and are more than 80 percent recyclable at the end of their life cycles.

Old Meets New

Owners who may not be looking to add slope but simply want to replace their existing sloped metal roofs can do so without the expense and hassle of removing the original roof. It’s simply a matter of positioning a light gauge structural member – notched to span over the original roof’s ribs or corrugation – directly over the building’s framing system. This is something that people like Projects 4 Roofing (for Roof Conversions) may be able to handle for you, so feel free to mention the possibility when discussing the work ahead.

The member is attached to the roof purlins through the bottom flange of the structural member and the existing roof sheet. A new standing seam metal roof is then attached to the new member. The cavity between the old and new roofs can be used to add insulation, which should allow the retrofit process to begin paying for itself quickly through energy savings.

Another reason to consider re-roofing over an existing sloped system is that the existing roof often fails to meet current code requirements for wind uplift. For metal roofs installed on pre-engineered buildings, the standard 5-foot purlin spacing often will not satisfy panel clip spacing requirements in edge and corner conditions in order to meet design loads established in current building codes.

In metal roofs installed over solid metal decks, the panel’s clips are often mispositioned to satisfy uplift loads and panel capacities. Placing the new structural members properly can correct these deficiencies without the need to remove the existing roof.

A metal-over-sloped retrofit also introduces the possibility of utilizing the newly created cavity between the old and new metal roof surfaces to provide convective cooling. By providing a continuous air gap from the eave to a ridge and venting the warmer air, the energy efficiency of the new roof assembly can be improved.

Tests at Oak Ridge National Laboratory have demonstrated that this natural ventilation can reduce heat flow into the building by up to 30 percent. Above sheathing ventilation costs practically nothing yet yields significant savings.

Other systems can also be added to metal-over-sloped retrofits to reduce energy consumption. One system that works on a similar principle as the above sheathing ventilation is solar thermal heat recovery, which integrates air heating and ventilation collectors into a photovoltaic system. The collectors use air as the heat transfer circulating fluid.

Building owners who install such systems are eligible for federal solar energy tax credits valued at up to 30 percent of the entire roof system, with no dollar limit. When combined with a special accelerated depreciation, the tax credits can pay for more than half of the retrofit improvements.

Another energy saving system that can be integrated into a metal-over-sloped retrofit is solar water heating, which can help to meet the hot water requirements of the building and reduce energy consumption. In fact, solar water heating can be incorporated into a solar thermal heat recovery system. With either of these systems, the new metal roof can easily accommodate the necessary solar energy hardware.

Whether you’re adding slope to an existing flat roof or re-roofing an existing sloped metal roof, a professional engineer should be engaged to perform the necessary structural assessments. Choose someone who is familiar with light-gauge framing and metal roof structural components and testing.

With proper planning, metal-roofing solutions can positively impact sustainability and the bottom line. When taken together, these factors can enable a metal roof to pay for itself quickly and to continue generating a return on investment for the building owner well into the future.

Chuck Howard is a professional engineer and roofing consultant to The Metal Initiative, a coalition of industry stakeholders created to provide information on the use of metal in construction.

The Metal Initiative

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Advance planning in case of a possible catastrophic building system failure is particularly critical. A failure of the HVAC system could represent a life-or- death situation for patients. A well-crafted, up-to-date cooling contingency plan can reduce risks, improve component redundancy and prepare the facility for the rapid deployment of temporary equipment needed to sustain critical operations. This isn’t just vital for hospitals, but many other buildings and homes. HVAC and a trane system to keep control of a building’s temperature is offered by Stuart Pro Heating and Air if you’re interested in implementing one. Some will have hired this company for Trane service if you’re interested.

A contingency plan is comprised of multiple documents that detail the electrical, physical and mechanical systems, their loads and the staff member who is responsible for maintaining the systems. It matches critical loads with temporary solutions and steps that must be executed to avoid system failure.

The benefits of a cooling contingency plan include protecting or minimizing operational emergencies, promoting the health and safety of healthcarfe providers and patients, and managing or reducing the economic, legal, and other long-term implications that could result from of a major HVAC system failure.

The first step for creating a cooling contingency plan is to address the possible consequences of a major HVAC outage.

Ask the following questions:

How dependent are critical and on-going operations, equipment facilities, information systems and other resources on comfort cooling or process-chilled water?
What effect would there be on such operations if the cooling system failed or needed to be shut down for unplanned service?
What would is the cost of not having cooling for an hour, a day or a week?
Qualify and quantify the impact and related costs.
In addition, determine which individuals understand the consequences of a failure:
Who thoroughly comprehends the interplay and dependence between the facilitys critical operations and the environmental system?
Who has in-depth expertise and experience with the details of the facility’s HVAC systems and what are the available alternatives?

The answers to these questions will help create the outline for what to include in the plan and identify the players who need to be involved. It could also outline other areas that could be improved to maintain temperatures at a stable level (such as those that you can check it out here).

The critical success factors in the development of a cooling contingency plan are leadership buy-in and support, understanding critical needs versus current needs and preparing for a worst-case scenario. A formal plan must be practiced and kept current.

Key Plan Components

Realizing the need for a plan, like any initiative, is the first critical step of the process. The second step is the assembly of a multi-disciplinary team to develop the plan.

A successful team will leverage expertise from on-staff personnel and outside experts, such as insurance providers, system and control manufacturers and consulting engineers.
The multi-disciplinary team must make sure all possible emergency situations are considered, all commercial issues are defined and documented, and the necessary equipment and resources are in place and available to be activated. This can be as simple as having haz-mat suits on site or as detailed as having contracts for contingency services and appropriately specified rental equipment and ready to deployment, should the need arise.

While examining the HVAC system during contingency plan development, the team may find areas to improve the systems operation, reliability or energy efficiency.

For instance, if critical mechanical components are aged or have become unreliable, it may be prudent to overhaul or repair them before they fail completely. There also may be a substantial benefit in upgrading or replacing existing components with reliable, more energy-efficient solutions.

These opportunities are worth investigating and could provide significant and immediate gains in efficiency and performance, while providing a strong return on investment.
For hospitals and medical centers, the successful implementation of a cooling contingency plan that can be put into action immediately and seamlessly is mission critical.

In terms of risk management, the advance planning and preparedness involved in developing and providing ongoing support for a cooling contingency plan is an investment against the risks that an interruption could bring to patients and staff.

Carl Shedivy is the existing building services leader for Trane.

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Hospitals and health systems have benefited this year from lower material costs and the availability of construction trade labor. If healthcare providers can obtain the necessary funds to start new projects, they will be able to build them with prices more favorable than in the last two years. Even projects currently under way may have a chance to realize savings over earlier cost projections.

The costs of concrete and steel have dropped by as much as 15 percent to 20 percent since late 2008, according to reports. The price drop is a nice boost for hospitals and health system planners who are about to begin construction on major projects and for those who may still be ordering materials.

There is no better time to plan for healthcare developments than right now, but even if hospitals have put projects on hold, they should revisit them to see if they can make budget adjustments based on pricing changes. What you don’t want to do is do nothing for the next three months or six months until the market turns around and then say, “I wish we had the drawings done so we could bid the project now.”

On average, it takes four months to get drawings completed, so hospitals and health systems shouldn’t wait. Otherwise, inflation could hit right when the drawings are done and the window of opportunity will be closed.

Capital “frosts and freezes” are a reality for many hospitals today. However, these tough economic times represent a great opportunity for health systems to take advantage of this pause period and re-evaluate the projects in their queues.

Hospitals can use this time to do a capital project review. This allows them to take a new, clean look at capital projects. As a result, when the market turns around and it is time to move forward, the project has been appropriately re-thought, re-sized or re-scaled in scope.

When a capital project review is performed, a team of experts takes a critical look at every aspect of the project. Reviews can be performed on projects at any phase of development, from the initial concept to projects under construction.

Within a short period of time — 90 to 120 days — the team develops a report to help a hospital understand whether it should cancel a project, put it on hold, or consider whether it needs a whole new destiny.

Al Seeley, executive vice president of Lillibridge, has more than 35 years of experience in medical facility development and construction.

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In the current economic climate, healthcare administrators are looking for ways to cut costs and increase efficiencies. One of the logical areas to examine is outsourcing the management of certain areas. many business and healthcare facility owners have been using the best company PEO in Texas to outsource various aspects of administration and HR and this has apparently increased efficiencies in certain areas.

However healthcare administrators can go a step further and outsource the management of their many facilities into the hands of a Facility Management company.

Facility managers look after the maintenance and upkeep of facilities and grounds, including heating and air conditioning, electric power, plumbing and lighting systems, cleaning and security.

Outsourcing facility management can save you money – it’s easy to look solely at price – but there are a number of factors to consider when evaluating your organization’s strategy. First, make sure you know exactly what services you need and to what level you need them. Needs will be dictated by facility size and age, and the demographics and the type of practice you operate.

The most important consideration is the service-level expectation of your customers and employees.

Does your facility provide the best possible level of service or does it detract from your ability to provide great service? In order to provide great customer service you must employ a facilities-management team that has the skills, time and tools to maintain your space at high standards, and that expectation must be clearly communicated up-front. It is best to utilize a firm with a depth of knowledge, experience and skill level that is competitively priced.

The same goes for your customer relationship management software too. CRM is a popular way to ensure customer and service satisfaction through a platform, such as Salesforce (see what is salesforce to learn more). The CRM system your facility uses can have a huge impact on reported levels of service satisfaction and so it pays to invest in an integrated system that can enhance your output. Does your facility use Zoho and HubSpot? If so, take a look at this useful guide to hubspot zoho integration.

The process used to evaluate and select a facility manager that meets your needs should be based on a well-documented and well-executed plan. Conduct an audit of your current facility issues, needs and challenges. Based on that analysis, if price proves to be equal or similar, use the following five strategies to weigh your options.

Reputation of Quality. Does the facility-management organization have a good reputation? Do your due diligence in checking out its track record. If their track record has a blemish on it because of a legal case, ask them about it, assuming the rest of their record is flawless. It could have been an attempt at defamation from their competitors. The facility-management organization probably took advice from a California defamation lawyer at this point, to rectify their public record but that case could still be on the record. So do not write off a client with one issue on file without the whole story. In addition, find out what types of clients it has worked with and whether the clients were happy with the services provided. If possible, ask for references that you can contact and speak with current and former clients to get a well-rounded view of the firm’s track record. Find out what service levels were provided and if they were delivered on time.

Relevant Experience. Find out if the company worked with an organization of your size or an organization operating in your specific healthcare sector. Look at the maximum amount of square footage that the company has managed to ensure that they have the bandwidth to meet your needs. Also, think about the issues that surfaced in your internal audit of your facility. Find out if the company has dealt with those types of obstacles in the past and what the outcomes were.

Staff and Skill Levels. Based on your audit, you should know exactly what type of coverage your facility needs, whether it is a full-time staff person who is completely dedicated to your facility or someone who comes on-site only when there is a specific need.

Make sure the management firm is has the staff to support your specific needs. Find out how many employees the company has, if they are part-time or full-time and if they will be dedicated to your facility or to multiple facilities. Be wary if you are marketed a one-size-fits-all product. All companies have specific facility needs and a blanket approach will not suffice.

Personality. Meet with the staff that will be providing services to you in order to analyze the personality of the company. Make sure that their service levels match your expectations and that you find good customer service and a ‘can-do’ attitude throughout the company. Also check out the company’s values and mission and vision statements to ensure they are aligned with yours. Choosing a company that does not have the right personality may not be a deal breaker, but your daily working relationship will be much easier and stronger if the company is a good fit.

Also ask the organization if they are able to keep a staff member dedicated to your site to meet unexpected needs. It is not uncommon for something to break and you need to make sure that your facility manager can fix it right away, no matter what time of day it may be.

Flexibility. Since your company’s facility-management needs can vary not only by month and week, but also on a day-to-day basis, choose a firm with flexibility. Hiring someone directly to oversee your facility can be very expensive and may not make sense due to the variable work load.

Some facility management companies provide permanent assignment staffing programs, offering all the benefits of a dedicated, skilled, on-site technician at your facility without any staffing hassles or costs. Under this type of program, your facility manager can oversee the sick time, vacation scheduling, benefits and other human resources headaches, while giving you reliable, on-site maintenance support only when you need it.

Your facility management company may be able to provide a technician to your company for a specified amount of time, for as little as five hours and up to 40 hours per week, for any length of time. Utilizing a permanent assignment program will save you time and money, and is sure to increase your efficiencies.

John W. Herman is executive vice president of the healthcare division at Welsh Companies. Allen Bernard is vice president of Welsh facility services at FaciliTech. Welsh is a full-service commercial real estate company with regional offices throughout the Midwest. FaciliTech is a division of Welsh Companies that provides 24-hour facility maintenance solutions and operational support services.

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Ask a group of hospital facility directors about the benefits of installing a green roof and you’ll likely hear several answers: heating and cooling cost savings, long-term building material cost savings, environmental responsibility, space maximization and aesthetic improvement. All are correct responses, and all are motivators that are fueling an increased tempo in green roof installations at new and existing hospitals.

Live Roof, a Michigan-based provider of green roofs, lists several financial benefits for going green. On sunny summer days when the outside air temperature reaches 95 degrees Fahrenheit, for example, traditional roofs can easily reach temperatures of 175 degrees or more.

A vegetated roof can reduce the roof temperature to such an extent that indoor temperatures fall by six to eight degrees, depending on the size of the building, climate and type of roof. That temperature can contribute to a 25 percent to 50 percent reduction in summer cooling expenses, according to the company.

Additionally, vegetated roof components help to protect the roof membrane from harsh weather and extand the roof life cycle.

vegetated roofs also combat the effects of land development and the loss of open space. They help to control storm-water runoff, reduce smog in metropolitan areas, conserve energy, improve air quality, and create a habitat for butterflies, insects and birds. They can also turn otherwise unused areas into meditation and therapy space.

While the size, purpose and scope of vegetated roofs at healthcare facilities vary, most possess the same basic components: a layer of thermal insulation, a waterproof membrane, a root barrier, a drainage layer, a filter mat, a specially engineered light-weight growing medium, and vegetation.

Some hospitals have embraced low-maintenance, lower-cost extensive vegetated roofs on portions of their roofs, while others have installed multimillion dollar intensive installations that completely cover the roof, are open to patients and the public, and consist of elaborate designs, walkways and water features.

Semi-intensive vegetated roofs – a mixture of extensive and intensive green roof spaces – are also planned or installed at some hospitals.

Extensive Green Roofs

SSM St. Clare Health Center, a newly opened hospital in suburban St. Louis, recently finished the installation of a 4,000-square-foot vegetated roof atop the facility’s emergency services department.
Access to the vegetated roof is not open to the public, but it can be viewed from family lounge areas and east-facing patient suites. The garden contains 22 varieties of sedum, a plant commonly found in green roofs because of its succulent, water-holding nature.

All of the vegetated roof plants were chosen based on extreme drought tolerance, disease and insect resistance, life cycle, low maintenance and beauty, says Debbie Parker, spokesperson for the hospital. Beyond normal rainfall, the plants need irrigation only in prolonged hot, dry, sunny weather.

Working with a vendor, installation took only one day. Plants were placed in modules and grown to maturity in a greenhouse off site before they were shipped to the hospital. The modules were then lifted to the roof by a crane, placed on a smooth-surfaced rubber slip sheet and snapped into position. Should the hospital need access to that area of the roof, the modules can be removed.

Maintenance needs require an annual soil check and periodic weeding. However, the plant system discourages weed growth.

Other areas of the hospital’s rooftop were designed to hold similar gardens, and when funds become available, the facility may expand the green roof space. A $55,000 grant from the Home Depot Foundation funded the initial project.

Intensive Green Roofs

The Vince Lombardi Charitable Funds Healing Garden and the Agnes and Morland Hamilton Healing Conservatory on the roof of the patient tower at Aurora St. Luke’s Medical Center in Milwaukee is an example of an intensive vegetated roof.

With the aid of a local roofing service similar to Trusted Roofing, the recently completed project at the 943-bed hospital consists of an elaborate 12,000-square-foot space that includes an indoor area, 19 ornamental trees, 381 flowering and evergreen shrubs, and more than 1,100 perennials.

While the core hospital was built in 1903, this newer part of St. Luke’s was constructed in 2004 with a roof of this caliber in mind, says Mike Connor, regional director of facility operations for Aurora Health Care.

“The fact that this is newer construction helped us to avoid installation challenges that could have occurred in an older facility – where a conversion of an existing roof with the help of a company similar to 99Roofers would have been necessary,” Connor says.

The roof also includes wide, wheelchair-accessible walking paths made from Minnesota limestone and an herb garden with herbs that will be used to create hospital meals. The $5 million project was funded entirely by philanthropic funds.

Converting existing space

While green roofs are becoming a standard in new hospital construction, some facilities have successfully converted older, existing roof spaces.

The Christ Hospital, a 555-bed acute care facility in Cincinnati recently converted approximately 4,000 square feet of space across three separate areas of rooftop built in 1929 and 2003 from gravel to an extensive green space.

Similar to SSM St. Clare’s green roof, each section of the Christ Hospital’s space is lined with specially designed trays planted with sedum that grows in an absorbent granular material that sits above a felt-like membrane that retains water.

The plants can draw on that water as needed, while any excess goes into the storm drains. The plants were grown to maturity elsewhere and then lifted to the roof using a crane.

“The roof was scheduled to be replaced, so we opted for a green roof,” says Rick Perkinson, facilities director for the Christ Hospital.

The vegetated roof was approximately $15 more per square foot than a conventional roof. Structural engineers were heavily involved in the process to determine if the existing structure could hold the weight of the plant materials.

The hospital plans to install another 27,000-square-foot intensive vegetated roof that will be accessible to patients and families if pending reports indicate the roof can hold the weight of the project.

Common Roots

Successful green roofs have a few common roots. First, like other hospital construction projects, careful planning can mitigate unforeseen installation challenges. Structural engineers, architects, plumbers and irrigation contractors should be involved in pre-planning and experienced green roof vendors should be called for consultations. Permit issues should be considered, and native plants should be researched.

“The weight of the system should be your biggest consideration,” says Thomas Cox, president of Bi-State Roof Systems of Valley Park, Mo., which oversaw the installation of SSM St. Clare Health Center’s green roof. “Make sure the structure can take the added weight of the specially engineered soil, plant life and water retention from the rain.”

While green roofs can cost more initially, experts say the payback comes with reduced air-cooling expenses, extended air conditioner life due to reduced load, and the extended life of the roofing materials.

“The secret is to discuss the concept with your engineers when you’re designing your facility,” says Don Wojtkowski, executive director of design and construction for SSM St. Clare Health Center. “[An extensive] green roof is just another way of ballasting the roof. It’s no heavier than rock ballast.”

Connor says when a green roof is up for consideration, it will play into facilities’ storm water management plan. Less guttering may be needed, and green roofs can reduce infrastructure costs.

Numerous local and state governments and utility companies offer rebates and tax incentives for green roof initiatives.

“This type of roof is more expensive,” Connor says. “But with time, costs will likely decrease. You have to consider the appropriateness of a project of this caliber. Look at the situation and determine if it has a positive effect on patients and betters the environment. If it does, than it’s there for consideration.”

The post From the Top Down appeared first on HCO News.

Since space is one of a hospital’s most valuable commodities, particularly in operating rooms, adequate space for A/V equipment must be allocated early in the design process.

Equipment location is important for maintenance access. If the racks are in a sterile area, technicians will need to scrub up and gown in to work on the equipment. Ventilation must also be considered, since most equipment generates heat.

The format and resolution of the signals will determine the maximum distance the processing and distribution equipment rack can be from the source and display equipment. The higher the resolution of the signal, the shorter the distance it can typically travel. This distance increases with twisted-pair technology, which converts A/V signals for distribution over category-type (CAT-5, CAT-6) cables.

When more costly fiber-optic technology is used, the distance is increased and is usually no longer a factor. Because of the disparate costs of these two technologies, early planning is critical.

Speech must be audible and intelligible in the operating room, so equipment noise levels need to be appropriate. The acoustical consultant may need to review air-distribution systems and interior room acoustics so that high velocity airflow and excessive room reverberation times don’t affect open microphones.

Operating rooms can be particularly challenging, considering that all acoustical treatments must be sterilized, and required air recirculation systems usually have high noise levels.

In-Room Entertainment

With the trend toward large, single-patient rooms, televisions in patient rooms must be considered.

Televisions are often too small for the distance from which they are being viewed, especially when patients need to read text.

When a family area is part of a room, hospitals should consider extending the entertainment to that area. The television should be large enough and placed so visitors can view it, or facility operators should consider a second television.

Television manufacturers are moving away from cathode ray tube monitors to flat screen displays. In a hospital, the lower profile allows screens to be recessed into the wall so cables are not visible.

However, if the overall entertainment and education systems require a set-top box, the screens don’t provide a platform and additional placement coordination is required.

Patient entertainment systems are becoming more sophisticated, and some hospitals are including DVD players and iPod docking stations in rooms. With all this extra A/V equipment, hospitals must coordinate the placement with access to cable and power.

Wayfinding

Hospitals are also using A/V technologies to alter the ambiance of medical and support spaces. Video projection can turn the wall of an MRI room into a scenic image or an interactive image that responds to the patient’s actions. The main consideration when incorporating A/V in a diagnostic space is its placement so it doesn’t interfere with medical equipment.

Digital signage combines information and entertainment — wayfinding, announcements, advertising, television feeds and more — on one screen to replace static bulletin boards and signs.

These systems can be scalable and can be as simple as a flash memory media player and display screens, or a complex interactive kiosks that ask patients and visitors for feedback. Regardless, placement of the displays should consider foot traffic patterns and common gathering or waiting spots, as well as cabling infrastructure and power requirements.

With this new A/V equipment in operating, diagnostic and patient rooms, as well as lobbies and hallways, healthcare facilities must take note of the effects that the constant electronic chatter can have on staff and patients.

To complement A/V technology planning, hospitals should work with acoustics consultants so the equipment meant to improve a hospital for patients, visitors and staff doesn’t impede the quality of care.

Choosing the Right Partition

For the last decade, healthcare providers have worked to reduce the way verbal communications carry into other spaces due to HIPAA safeguards against improper transmission of personal health information.

While this is an important part of acoustical planning, hospitals should also look at how electronic and mechanical noises are conveyed throughout a facility.

A/V equipment in patient rooms can impact adjacent spaces with noise and vibrations. Acoustical consultants should evaluate partitions and make recommendations.

The noise level heard through a barrier is dependant on a number of factors, including type of noise and partition, and size of the rooms on both sides.

Partition materials selection is particularly important when amplified speech or music is present. Most hospital lecture rooms have public address systems, so proper partition construction is key to minimizing disturbance in adjacent areas. In some hospitals, the lecture rooms double as movie theaters.

An acoustical consultant will choose a partition to sufficiently reduce the low frequency noise that will be produced in these spaces. This may require specialty construction, such as concrete masonry unit block or isolated floor or ceiling partitions.

Proper Equipment Installations

As obvious as it seems, properly installing medical or building system equipment is critical to acoustical design. Hospitals can sometimes avoid space redesigns for noise and vibration abatement issues simply by checking that each component is in place on the equipment and within the architectural construction.

At Johns Hopkins Bayview Medical Center in Baltimore, RTKL was asked to mitigate acoustical issues in a conference room one floor below an MRI suite. The MRI machine was being upgraded from a 1.5 to s 3 Tesla model, and the hospital wanted to confirm that doubling the MRI field strength wouldn’t double the noise and vibrations in the conference room below, which was used for daily videoconferencing.

RTKL’s acoustical consultants estimated that the 90 decibels of existing noise in the MRI room would increase to 110 decibels, or more, with the installation of the new MRI unit. However, they found that the noise level in the conference room below could actually be reduced significantly because improper installation of the existing MRI unit caused the noise to be structurally transmitted to the conference room below.

By correctly integrating vibration isolation pads into the MRI magnet installation, installing additional ceiling treatments to the conference room’s perforated metal ceiling, and providing additional acoustical absorption in the MRI suite, the conference room now experiences lower levels of equipment noise from above.

The incorporation of A/V technologies follows the same basic rule as any other process for adding equipment: planning is critical. A hospital wouldn’t use an X-ray without lead shielding, and they shouldn’t use A/V equipment without the necessary acoustical planning. With the right use of materials, hospitals can be sure their users are reaping the full benefits of the healthcare audio-visual experience.

Michael D. Davis and Melvin L. Saunders IV are associates with the special systems design group in the Dallas office of architectural and engineering firm RTKL.

RTKL

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BOSTON — Know what it’s like to run a large metropolitan hospital and make decisions that affect hundreds of people? It can drive you to blog.

Since 2006, Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, has maintained a blog to “share thoughts about hospitals, medicine and healthcare issues.”

The blog, “Running A Hospital,” made national news in March when Levy candidly explained the hospital’s financial struggles in a deteriorating economy, and projected a $20 million loss for the year. He also detailed cost-cutting measures and asked employees to attend town-hall style meetings to discuss alternatives to layoffs.

“For BIDMC, our hoped-for 2 percent FY09 operating margin (about $18 million) has disappeared,” Levy wrote. “The state has reduced Medicaid payments by over $7 million, our major insurer is paying us less than we had hoped, and research funding has also fallen short by several million dollars. In addition, patient volumes are substantially lower than budgeted as people in the community defer or forego medical visits and treatments.”
It’s not the first time Levy’s openness about the inner workings of his facility has drawn attention in the press. Levy received criticism from other executives, but overall his missives from the summit of power within the structure of the hospital’s operations have been positively met.

“I applaud your refreshing and candid communication especially in regards to your employees and medical staff,” writes Suzanne Dewey, who described herself as a former employee of BIDMC whose department was eliminated before Levy became CEO. “Even though we knew the medical center was struggling, there was very little information that flowed in our direction, so we simply waited in the dark. Our input was not sought and it was an uncomfortable time.”

Dewey’s comments were followed by current employees who posted encouraging words online and have made suggestions to save money or offered to make necessary sacrifices to close the budget shortfall.

Levy says the elimination of scheduled 3 percent pay raises, mandated furloughs and pay cuts could eliminate the need to layoff workers. He announced he would take a 10 percent pay cut and not receive a bonus.

Levy also asked senior vice presidents, vice presidents and the chief operating officer to take voluntary 5 percent pay reductions in addition to eliminating all bonuses for the year. He also set up town-hall style meetings and an Internet chat room so employees could participate in the discussions to close the budget gaps.

“But the bottom line is the bottom line,” he says. “If you don’t like these ideas, please help us come up with others.”

Levy’s blog:  www.runningahospital.blogspot.com

The post CEO Blog Reveals Struggles, Requests Employee Suggestions appeared first on HCO News.

The latest addition to the Sanford USD Medical Center campus, designed by Ewing Cole architects of Philadelphia, is a five-story, 146-bed children’s hospital staffed with more than 60 pediatricians, 150 family medicine physicians and 350 pediatric staff.

Located on the ground floor of the building, the specialty clinic has pediatric sub-specialists in more than 20 disciplines, and 38 exam rooms with a dedicated hematology/oncology area that includes five private infusion bays for pediatric cancer patients.

Designated pediatric and maternal-fetal transport teams will be available 24 hours a day to communities in South Dakota, North Dakota, Minnesota, Iowa and Nebraska, officials say.

Sioux Falls-based Henry Carlson Co. built the castle of care, which was financed by donations. A story and coloring book, “Legend of Sanford Castle,” was developed for children as a facility program that describes five different lands and animals found throughout the hospital.

“Patients and visitors will know which theme they are entering once they step off the elevator and are greeted by animal murals from the respective land,” says Jan Haugen-Rogers, vice president of Sanford Children’s.

Other elements include a storybook room, royal balcony and playrooms. The playrooms feature castles with cutout windows, computers with Internet access and plug-ins for children who need medical equipment to leave their rooms, according to hospital officials.

Older children can utilize a teen room that doubles as a classroom for the hospital-based school program. The food menu was also customized for kids with items such as “Fruits Fit for a Queen.”

The rooms were designed with input from the Sanford Children’s Family Advisory Council. Each room has a sleeping area for parents and a curtain for privacy. Each floor has a welcome center for families that provides a kitchenette, showers and computers with Internet access. Not many hospitals have computers in the rooms for children to use, however, this hospital wanted to make their young patients as comfortable as possible. By giving them internet access, the patients can play computer games, such as this persona 4 rom, to keep them occupied and happy whilst they receive treatments.

Medical technology at the hospital is also safeguard with child-friendly designs. A mobile radiology unit shaped like a fire engine travels to patient rooms and a CT machine is decorated with a three-dimensional mural.

“From color schemes to artwork and physical structure, the entire five-story building has been designed to promote healing and improve outcomes,” says H. Eugene Hoyme, chief medical officer for Sanford Children’s Hospital.

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The new center — a $151 million project built with $129 million in bond money, $15 million from the San Jose Redevelopment Agency and money from the Valley Medical Center Foundation, among other sources — replaces the previous facility that was aging and burdened with more patients than it was built to handle, according to hospital officials.

“While we face very challenging fiscal and budgetary issues, VSC is a key component in our ability to provide vital healthcare services, and to do so in a more efficient, effective and responsible way,” says Kim Roberts, CEO of the Santa Clara Valley Health & Hospital System.

The center, designed by San Francisco-based Anshen + Allen architecture firm, was planned to increase efficiencies by keeping doctor and staff offices near clinical areas. Services are streamlined to eliminate the need for patients to travel to several locations for appointments, lab tests and other services. The design also allows for reconfiguration of space to accommodate new equipment, according to hospital officials.

In addition to saving patients time, the building is designed to save energy. Pacific Gas and Electric Co.’s saving by design program, which provides incentives and resources to designers for building energy-efficient structures, was used to integrate energy-saving features, according to designers.

“Through a variety of energy conservation measures, including energy-efficient mechanical systems, exterior solar shading devices and natural daylight in interior spaces, the building will use 18 percent less energy than equivalent buildings designed to meet state Title 24 minimum energy standards,” says Peter Schlosser, an architect at Anshen + Allen. “As a result, VSC will conserve natural resources while creating an interior environment that enhances comfort, health and productivity for its users while reducing its overall operating costs.”

More than 500 employees, including 300 physicians, work at the Valley Specialty Center. The building has 850 rooms, including 190 dedicated exam rooms. Annual patients visits are expected to be about 265,000 per year, according to hospital officials.

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