Charting the future of health care design

The Erickson file

CV

• CEO of Facility Guidelines Institute (FGI)
• Senior adviser for health care, Specified Technologies Inc.
• Chairman of the 2010, 2014 and 2018 revision cycles for the FGI Guidelines.

ACCOMPLISHMENTS

• 2013 American Society for Healthcare Engineering (ASHE) Crystal Eagle Award for demonstrating leadership qualities, innovation and overall contribution to ASHE and health care engineering and facility management.
• Chairman of the 2005 and 2012 National Fire Protection Association’s NFPA 99, Health Care Facilities Code.

EDUCATION

• Bachelor of science in engineering from the University of Illinois, Urbana-Champaign.

Douglas S. Erickson, FASHE, CHFM, HFDP, CHC, chair of the 2018 Facility Guidelines Institute (FGI) Health Guidelines Revision Committee, talks about the 2018 FGI Guidelines for Design and Construction of Hospitals, Guidelines for Design and Construction of Outpatient Facilities, and the Guidelines for Design and Construction of Residential Health, Care and Support Facilities.

Where does the 2018 FGI Guidelines process stand right now?

In April, the Health Guidelines Revision Committee (HGRC), a 100-plus-member team of health care professionals, met to finalize the content for the 2018 Guidelines. The FGI staff are preparing the manuscripts for leadership approval and a final vote of the HGRC membership in August. Once approved, the manuscripts will be submitted for publication as print books and on a digital platform.

What was the rationale behind changing the FGI Guidelines from two documents in 2014 to three in 2018?

The goal in separating the requirements for hospitals and outpatient facilities was to make it easier for owners, designers and authorities having jurisdiction to identify the fundamental requirements for outpatient facilities and to provide requirements that can be adapted to new outpatient facility types as they arise. We believe the process of creating a separate document has yielded dramatically improved content in the Outpatient Guidelines.

What are some of the major changes in the Hospital Guidelines?

The Hospital Guidelines did not just get a face-lift. The Hospital Document Group worked hard to improve on existing elements, such as the clinical differences between an exam and procedure room and between a procedure room and an operating room, and how those differences influence design. Other major changes include a new minimum requirement for single-bed rooms in critical care units; differences in bariatric patient room square footage if portable lifts are used instead of fixed overhead lifts; a new classification structure for imaging rooms; requirements for both a two-room (decontamination and clean) design and a one-room design for sterile processing facilities; improved security requirements for the medical psychiatric room; and new guidance on providing sexual assault forensic examination rooms.

In addition, a rewritten chapter on mobile/transportable medical units will appear in both the Hospital and Outpatient documents. The revised chapter designates mobile/transportable medical units by class, mirroring the new imaging classification structure. Relocatable, or prefabricated, units were removed from the chapter, as they were deemed equivalent to a building and thus need to meet the requirements of a building.

What were some of the challenges when devising the Outpatient Guidelines?

As always, the greatest challenge is writing fundamental requirements for a rapidly changing industry. With outpatient organizations taking over many of the services once provided only in hospitals, the need to expand the outpatient facility requirements was imperative. Add to that the wide variety of outpatient service types and the challenge becomes keeping the Guidelines flexible and not burdensome. 

One development we’re particularly excited about is a new approach that allows users to mix and match outpatient requirements based on the unique needs of the services being provided. The committee members jokingly call this the “Frankenstein” approach, but it seemed apt in that you can pull elements from disparate chapters to best suit the facility’s needs. We believe this will be critical in helping the Guidelines meet the needs of new outpatient facility types as the trend to push procedures to outpatient facilities continues to evolve.

What is new in the Residential Guidelines?

The Residential Guidelines were completely overhauled for the 2014 edition, when the Residential Guidelines became a separate document. Therefore, most of the text did not need significant work. However, two new facility chapters were developed for 2018, one on settings for individuals with intellectual and/or developmental disabilities and one on long-term residential substance-abuse treatment facilities. The former provides minimum standards for facilities that support accountability and protection for individuals with intellectual and/or developmental disabilities. The chapter does not include larger residential health settings (i.e., nursing homes) or hospitals for these residents or patients. Instead, the standards cover intermediate care facilities, community residences and personal care homes. The chapter on substance-abuse treatment addresses facilities that provide care 24 hours a day, generally in nonclinical/acute care settings. This long-term residential treatment setting provides a therapeutic community for those with substance-abuse disorders, with the goal of resocializing individuals using a program’s entire community as an active component of treatment.

Additionally, the Residential Document Group is working to modify ADA toilet-spacing requirements to permit staff to assist in toileting. They also are addressing the CMS final rule on the “Reform of Requirements for Long-Term Care Facilities,” CMS-3260-F, “… requiring facilities … to have a bathroom equipped with at least a commode and sink in each room.”

Telemedicine newly appears in all three of the documents. What design elements are being addressed there?

While most of the new telemedicine text is appendix language and, therefore not mandatory, a task group has recommended baseline physical environment requirements. These include having space where telemedicine services are provided meet related clinical space requirements; speech and visual privacy with adjacent spaces and arrangements so monitors and screens are not visible from outside the room; acoustics and speech intelligibility to foster good communications; and features to support natural color rendition and avoid glare. 

Does FGI have a role in raising performance beyond the minimum requirements covered in the Guidelines?

Yes and no. While the primary mission of FGI and the HGRC is to establish minimum requirements for agencies to adopt, FGI is expanding its role to also offer what we are calling “beyond fundamentals.” This new line of material will provide additional resources that go beyond minimum requirements for designers, owners and authorities having jurisdiction. 

Although the Guidelines will remain a minimum guidance document, we believe that providing supplemental information for health care organizations that seek to go beyond the basic requirements is in the best interest of facilities, providers, patients and their communities. Beginning with the 2018 Guidelines, FGI will issue an ongoing series of supportive publications in the form of white papers, best practices, design templates, case studies, checklists, advisories and so on.

When do you expect to publish the 2018 Guidelines?

We are targeting late November 2017 for release of the 2018 Guidelines in both print and digital formats. We are partnering with MADCAD, a cloud-based, code reference library supplier whose digital publishing technology is improving our distribution channels. MADCAD currently offers the 2006, 2010 and 2014 editions of the Guidelines in both single-user and site license formats. Digital access to the 2018 Guidelines will be available on an annual subscription basis.

Mike Hrickiewicz is the editor of Health Facilities Management.