Interview with Walt Vernon on health care codes and standards

Photo by Kaitlyn Lange

Walt Vernon, PE, CEO and principal at consulting, program management and engineering firm Mazzetti, has worked with organizations that impact standards and codes, which, in turn, influence design. He also has worked with other groups that impact sustainability. Here he talks about the state of the industry.

You’ve noted that the relatively slow pace of code development in a rapidly changing health care industry can be a serious problem. How can this be addressed?

First, model codes generally follow a three- or four-year cycle. Once the model code is complete, the states must adopt it. Once states adopt a code, they are often slow to adopt another. So, when you add the time it takes to create the model codes, and then the time it takes to adopt them, and then the time it takes to design, permit and build according to their rules, the codes have a very long impact, even if they were cutting edge at the time they were created. And, if they only change every three, four or five years, in practice, the ability to change and to innovate is very slow.

People say that medical innovations take about 10 years to diffuse into general practice. I think medical building code changes take about as long. The American Society for Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) has tried to solve this problem by using a continuous maintenance process, but that presents its own problems because states can’t adopt every addendum that ASHRAE publishes. One idea suggested by one of our Facility Guidelines Institute advisers was to create a process similar to that used by the Food and Drug Administration for investigational drugs or investigational devices. That is, we could create a process for investigational design that would provide opportunities for learning and, maybe, more frequent revision.

You represented the American Society for Healthcare Engineering (ASHE) on the committee that wrote the ASHRAE Standard 188 on Legionellosis: Risk Management for Building Water Systems. Why is there a special focus on health care?

Legionella is an opportunistic pathogen, attacking those with reduced immune systems. Many in ASHRAE and on the committee felt like health care posed a special threat because of the vulnerable population.

On the other hand, health care organizations have a range of infection prevention strategies and expertise already in place that other facilities don’t typically have. So, the standard tries to take these things into consideration.

Are there any special requirements for health care regarding Standard 188? Why is ASHE working with the Association for Professionals in Infection Control and Epidemiology (APIC) on the standard?

ASHE and APIC share the perspective that a narrow focus on Legionella ignored the much larger threat of other pathogens in general, and other waterborne pathogens in particular. Another issue is documentation; hospitals already are required to document many compliance issues.

We tried to write Standard 188 so that the documentation already being created could serve the needs of 188 as well and avoid creating more paper. My blog has more details on this at www.mazzetti.com/blog/ashrae-standard-188-legionella-risk-management-in-a-wider-context.

What are the goals of the proposed ASHRAE/ASHE Standard 189.3 on the design, construction and operation of sustainable, high-performance health care facilities?

This standard is nearing completion. It is intended to be a model Green Building Code for health care facilities. The International Construction Code has a general Green Building Code called the IGCC (International Green Construction Code). It does not work well for health care facilities. Standard 189.3 is tailored specifically to the unique needs of and opportunities for these facilities.

How can behavioral change improve energy efficiency and waste management in hospitals?

Most obviously, people can pay attention. I have one client who is working with its security staff to make sure the lights are turned off at night when they do their rounds. I have another client who is training users about the acceptable ranges of temperature and avoiding hot and cold calls.

Other facilities are using the power of transparency to change the way facility operators manage their energy. The ASHE Energy to Care Program is a behavior-change tool using free data, competition, awards, positive reinforcement and other levers to encourage the entire industry to change its behavior, and it’s working.

Hospital mergers and acquisitions are increasing. What organizational challenges must be solved to ensure that larger systems work efficiently from an operations standpoint?

The issue of centralized vs. decentralized power seems ever-present in human institutions of all kinds. I have watched large health care organizations centralize operations while others decentralize operations because they were not happy with the results they were getting.

We are seeing more and more health facilities become absorbed into larger and larger organizations. When this happens, pressure builds to make purchasing decisions centrally, even though the service organizations available to the various facilities vary widely in capacity and competence. There are a lot of great organizations that are learning to do centralization right; it’s just often harder than it looks.

Are there missed energy-saving opportunities for health care facilities? How does the American Hospital Association’s (AHA’s) Sustainability Roadmap for Hospitals address this challenge?

It is very clear that hospitals can do a lot to save energy. The AHA and ASHE have done a great job to help their members through the Roadmap and the Energy to Care Program. Energy to Care launched one year ago. In the past year, we have had 400 hospitals and 600 ambulatory facilities join the program. An estimated $67 million has been saved since 2009. This is money that can go back into these organizations to help them provide better health care. ASHE is going to use these two programs to accelerate this improvement, and it’s going to make a difference.

At the same time, many hospitals have serious capital shortages, especially in the wake of health care reform. As a result, they have older, less-efficient equipment. There are many financial strategies available to hospitals, particularly PACE programs, and other third-party financing vehicles, that can help them to achieve their energy and cost-reduction goals while saving capital. The Roadmap points out those strategies.

One other issue is the growing complexity of our buildings and the decreasing number of available staff. Engineers like to design sophisticated buildings that can do a lot — but they are becoming so complicated that they can be beyond the ability of many facility operators to make them work.

I see the health care industry moving into a world where they are reimbursed based on their outcomes. I think that we designers and suppliers owe it to our health care clients to help them with solutions that also pay for performance. 

Jeff Ferenc is a senior editor with Health Facilities Management.