THROUGH THE EYES OF THE PATIENT

At the newly opened Cortellucci Vaughan Hospital: pre-pandemic designs, a stress-free layout, and novel technology that’s changing how patients communicate with care teams.

BY REBECCA MELNYK

Hospitals often feel intimidating for patients. Deep floor plates let little sunshine through to the maze-like corridors. Medical devices can make rooms appear cold and sterile, reminding us of our own mortality. But through the doors of Cortellucci Vaughan Hospital, the first hospital to ever rise in Vaughan, Ontario, life’s health challenges are met with comfort, safety and lots of natural light.

The notion of what a hospital should be has evolved greatly over the years, where patient stress now figures highly into early planning. Such was the case as Stantec began designing this facility—Mackenzie Health’s second full-service hospital.

A mix of inpatient medicalsurgical units on top of a diagnostic and treatment podium includes the Magna Emergency department, and core and specialized services, such as a mental health program and the Sorbara Integrated Stroke Unit.

The majority of the 350 beds are single, private, with capacity to expand to 500 beds. A more recent addition is the 4,000-square-foot library that hosts all-age events.

The five-year, $1.7 billion project, of which the Ontario government doled out $1.3 billion, was designed through the eyes of the patient.

As architect George Bitsakakis, senior principal at Stantec, notes, much consideration was given to how patients move through the facility and how they are transferred through separate corridors. “Patients are in a very vulnerable state,” he says. “We wanted to make sure they get the dignity and privacy they need so they’re not exposed.”

As users navigate the 1,200,000-squarefoot building, light and transparency guide them though, right from the main entrance. The feeling of being lost is an anxiety-causing situation, but there

�Clockwise from left: in a single-patient room, large windows bring views of rollar coasters at Canada’s Wonderland; the cascading garden is located at the underground link, which connects the parking garage and hospital. The earth was scooped out to bring light down and make the connection more pleasant. Photos by Tom Arban.

is a sense of control perceivable in this environment. As Bitsakakis says, “that natural light is both obvious and intuitive. If you walk in and always have the light coming from one direction, your body always adjusts and orients itself.”

Courtyards carved into the building bring light and outdoor landscaping down to areas that are typically dark and convoluted. A cascading garden, descending 50 feet down, is visible through a glass-enclosed walkway that leads from the parking garage to the hospital, and to a series of courtyards and a cafeteria.

Prominently situated 11-storeys up, at Major Mackenzie Drive and Highway 400, glimpses of roller coasters from Canada’s Wonderland appear through its glass facades. As one moves up the tower by elevator, this view is what they see with each stop. As Bitsakakis says, “it’s still a big hospital, but it feels like you know where you are, at all times.”

Patient care also plays out in the way rooms were designed. Upon entering, sliding wood panels seamlessly conceal “intimidating” medical equipment and declutter the area. Natural light streaming from floor-to-ceiling windows in the critical care rooms helps patients heal and recover, as movable technologies allow care teams to rotate beds to outdoor views.

Outside, walking trails loop around the facility for patients and staff to reflect and heal. They also extend to the single-family residential neighbourhood that lies directly behind the hospital to the north, one element that made for a complicated site.

“It was quite a challenge,” says Bitsakakis. “With the housing behind it, we wanted to make sure we gave something back, that we were a good neighbour and gave them an amenity they didn’t have.”

Two local requirements for the completed design were to take extra care of the parking garage and facility plant, located directly near the neighbourhood.

�Clockwise from left: Magna Emergency department; an operating room. Photos by Tom Arban.

The central utility plant was built with the same materials used for the hospital, with custom perforated screens that are bent to capture the light and large walls of glass that bring educational views to the public.

“People can walk around it and get a sense of what it takes to power up a hospital—it’s not a small thing,” says Bitsakakis. “Most people have never seen equipment like this.”

Vegetated bioswales sprout through the large asphalt sheet of the parking lot as a way to capture, treat and infiltrate stormwater runoff and replenish it back into the water table. Nature also presents itself in the green roofs that top every building where, over time, planting will grow to hide the mechanical equipment.

SMARTER CARE

As the first smart hospital in Canada, technology factors into patient comfort and is subtly woven into care teams’ daily workflows. As Mackenzie Health says, smart technology ultimately becomes a digital member of the care team, offering a crystal ball into a patient’s health care journey.

Patients are given more control to help manage their own care. They can select meals, control room settings, and access their medical data from their bedside tablet.

The idea is that information systems communicate with each other to anticipate the needs of patients and health care workers. Many of these smart features were first tested and piloted at Mackenzie Richmond Hill Hospital.

Some include a real-time locating system, which involves tagging patient wristbands, health care workers’ ID badges and hospital devices with realtime locating tags, for staff to quickly track down colleagues and necessary equipment.

Inside the rooms, sensors on staff ID badges alert them to patient statistics, which are immediately displayed on a bedside tablet and TV screen. The system integrates with the hospital’s security system, as well. Electronic tags are given to patients at risk of wandering or for keeping new mothers and their babies connected.

“We are also making sure patient confidentiality is maintained, but it is an integrated information system that crucial staff have access to and patients

can control to some extent,” adds Bitsakakis.

Outside the patient rooms, tablets display crucial data, such as patient allergies or if an interpreter is needed. Inside, smart beds instantly monitor patients through an application, which integrates into other hospital applications like electronic medical records. Smart beds can weigh patients, for instance, to determine medication doses. They also send an alert to care workers’ mobile devices if a patient, at risk of falling, attempts to get out of bed.

A smartphone app prioritizes information among staff, such as code alerts, patient status and clinician availability.

Patients in medical distress, or in need of washroom assistance, can directly

“The needs and operations of hospitals do evolve, and if there’s no flexibility, they get stuck.”

connect to their care teams’ mobile devices through a sophisticated nurse call system.

More recently, the hospital became the first in Canada to roll out a digital pathology platform for speedier diagnostics. Prior to this, physical samples were couriered to outside experts if a consultation was required. Mackenzie Health says connecting digitally in this way allows its team to pull up a sample on a screen and have a team of experts view it within hours.

A PANDEMIC PLAN

Infection control also figures into smart technology offerings. Real-time locating sensors in hand sanitizers at the entrance and inside of patient rooms oversee hand hygiene compliance.

Features like this bode well with a pandemic. In fact, the hospital was designed with such a global emergency in mind, so when COVID-19 unraveled across the country last year, the hospital focused exclusively on creating more space for critical and acute care patients

�The main entrance courtyard is one of many that bring natural light and outdoor landscapes into the building. Photo by Tom Arban. and pushing its full public opening to June 2021.

As Bitsakakis explains, getting ahead of this national emergency meant establishing two command centres: the auditorium was designed for a pandemic, with a secondary centre as a back-up. Units can be isolated with vestibules to activate when a pandemic hits.

“This was already built in, and that has to be the way of the future for hospitals designed now,” he says. “A lot of us had gone through SARS, so COVID isn’t the first time we’ve been exposed to this.”

The majority of patient rooms are private, with dedicated washrooms—a key to reducing virus transmission. Inside the Magna Emergency department, every unit and pod have an airborne infection isolation room in case patients need to be treated under airborne precautions.

Some entire units also convert into negative pressure areas with separate HVAC systems that direct air outside through HEPA filtration. Care teams can subsequently separate and isolate patients by closing off a whole area.

WITH CHANGE IN MIND

Hospitals are in an ongoing metamorphosis. Imagining them as such will carry healthcare into a new era, one that thrives on change. As Bitsakakis says, “we do a lot of renovations in hospitals and what we’ve found is a lot of them have not anticipated change, so we designed a lot of flexibility into this.”

At Cortellucci Vaughan Hospital, a room could shift for postpartum or physical isolation—but at the heart is the same module and not so specific. The whole facility was located and designed to expand on site, in case a larger wing is needed. Many hospitals, notes Bitsakakis, end up with no land and must regenerate outside of town or purchase expensive properties nearby.

“The needs and operations of hospitals do evolve, and if there’s no flexibility, they get stuck,” he says. “The idea of flexibility, adaptability, of regeneration, expansion and design for outbreaks—those are the themes that should now be considered for all facilities.” | CFM&D

BY PAUL AMENDOLA

GETTING DIGITAL WITH FIRE SAFETY

For the purposes of inspection, fire protection is divided into two categories: fire equipment and fire emergency systems. Fire equipment refers to tools like extinguishers that are on-hand for building occupants and emergency response personnel in the event of a fire. Fire emergency systems are built-in lines of defence, which are designed and engineered to prevent a fire from spreading, and to alert occupants and enable timely evacuation.

A Fire Watch program is imperative to protecting the facility and limiting liability. Developing and implementing effective procedures to ensure compliance and emergency preparedness will help building/facility managers oversee the many different elements of fire protection.

Obstructions marring sightlines to fire extinguishers and hoses are one of the most common non-compliance issues related to fire equipment. Fire extinguishers can be overlooked altogether during inspections, particularly if inspectors do not have an inventory to refer to as they make their rounds.

Fire emergency systems typically draw close scrutiny during inspections due to the often complicated rules governing how these systems should function and be maintained. Larger buildings, particularly high-rises, will typically have many critical systems, which must be able to perform as expected and often in tandem with each other.

Fire inspectors are tasked with ensuring: that firefighters can control and operate elevators with a keyed switch; that egress routes and ventilation are unobstructed; and that alarm systems and emergency power are operational. They’ll likely pay close attention to areas and/or systems with a high rate of non-compliance such as fire doors and sprinkler valves.

Fire-rated doors are integral to providing passive fire protection, containing and compartmentalizing a fire and safeguarding the path of egress for occupants. The door, frame, hinges, hardware, glazing, glass kit and glass beads must all be intact, secured and in good working order with no missing parts. Signage must be present and affixed securely, labels must be clearly visible and easy to read and the doors must be unobstructed.

Inspectors will check sprinkler valves for signs of physical damage or leaks, and will need to ensure that the water pressure is sufficient to extinguish a fire. Building staff need to be particularly vigilant when there is construction work in progress because sprinkler valves may be shut off to enable the work. In that case, extra checks must be performed to maintain safeguards especially if hot work is occurring in the facility.

Digital tracking and coordination of fire protection can streamline logbooks into a more manageable platform and leverage technology to help meet and stay current with regulatory requirements. That includes near-field communication to ensure that each piece of equipment is visited (reducing false reporting) and system integrations can provide alerts of near-due, overdue and deficient inspection items is an easy way to help ensure compliance.

With fire equipment, for example, a digital solution can help keep track of the inspection status for each fire hose cabinet (FHC), including remaining inspections, and take the place of inspection paperwork. Building/facility management teams are informed through automated email notifications with daily, weekly and/or monthly summaries outlining if any FHCs were missed or have deficiencies.

Digital solutions also streamline inspectors’ tasks. The digital application can alert them about required follow-up inspections. It also allows them to include photos and notes, look up manufacturing information, upcoming service dates, and instructions and information specific to the equipment they’re inspecting.

The same possibilities apply for fire doors, sprinkler valves and other fire emergency system inspections. Dynamic questions, fields and instructions can be customized according to individual components and inspection needs for each item.

Digitized inspection documents produce building/facility data in an exportable and packaged format that is secure, easily accessible and meets code retention requirements. Inspection data can be collected to generate analytics to forecast future inspection needs and associated costs, and review team performance. | CFM&D

Paul Amendola is Chief Executive Officer of Tap Report, a Toronto-based firm that specializes in creating safer workplaces through software.

MOVING AHEAD AT MJW

It’s time to look forward at the MJW Team (divisions of Metro Jet Wash Corporation). After one of the most disruptive years on record, the waste equipment cleaning specialist is eager to enter 2022 with fresh insights and renewed optimism.

“The facility and property management community hasn’t had it easy over the last year and a half,” says Linda Passarelli, Office Manager with the MJW Team. “We all had to adapt in some way or another, and now the most important thing is how we’re moving ahead.”

For Passarelli and the team at MJW, one of the biggest takeaways from the global pandemic has been the need to double down on workplace health and safety.

“We’ve always had very strict rules when it came to cleaning, wearing personal protective equipment, and following hygiene protocols on-site because our jobs take us to some of the dirtiest places in buildings and facilities,” she notes. “That being said, the pandemic reinforced how important those measures were to keeping everyone safe, including the clients and building occupants we encounter every day.”

Certainly, adds Brian De Carli, Vice President with MJW, “The MJW Team has always been very strict and has always strongly enforced health and safety measures prior. We’re defi nitely evolving more and more each day as a company and not stopping now.”

ADAPTING TO CLIENTS

Health and safety considerations have become a chief focus for facility management teams. As a result, MJW has seen a surge in demand for its power washing and cleaning services, be it for compactors, chutes, drains, catch basins, or underground garages and parking lots. Moreover, says MJW Team Division Lead Andrew De Bartolo, clients are requesting more extensive and frequent cleanings in order to stay ahead of health risks: “More and more, we’re being asked to go in there and we’re disinfecting chute doors and fl aps on every fl oor just to give occupants that extra level of protection.”

As Metro Jet Vac Division Lead Cassandra Mammoliti notes, “When things are visibly clean, it makes everybody feel that the environment is safer and more comfortable to live in. It also gives facility managers (FMs) that extra peace of mind, so it’s a win for all.”

For added peace of mind, MJW has rolled out several promotions and campaigns aimed at helping facility management teams tackle their enhanced hygiene obligations. Today, the corporation off ers yearly cleaning and maintenance packages, cleaning bundles, and discount off ers for new and current customers to make its cleaning services as worry-free and cost-eff ective for its clients.

“FMs have got enough to deal with. There’s so much on their plates managing these buildings, so if we could somehow cut a good portion

of that and take care of it and then make life easy for them, then that’s our goal,” says De Carli.

HYBRID COMMUNICATIONS

Face-to-face customers interactions aren’t over, but business communications aren’t likely to return to “normal” any time soon. With many property teams still split between on-site and remote offi ces, service providers like MJW have adapted to a more “hybrid” approach to customer contact.

“Before the pandemic, we were mostly communicating with property managers in person. Now, though, a lot of those people are working digitally, so we’ve also started doing digitally, so we’ve also started doing things a lot more digitally or over things a lot more digitally or over the phone while trying to keep that the phone while trying to keep that personal touch wherever possible,” personal touch wherever possible,” says De Bartolo. says De Bartolo.

Nevertheless, there is a sense that Nevertheless, there is a sense that the work-from-home life is growing thin among facility managers and their staff who have spent a bulk of their time off site in 2021 and are anxious to get back into action.

“A lot of people want to get back into the offi ce or have done so already, so we’re working with a mix of digital and in-person communications,” he adds. “The priority on our end is to recognize how our customers prefer to interact and make it as easy as possible for them to do so.”

BUILDING MOMENTUM

2020 and 2021 have kept the MJW Team on its toes. That’s to be expected for a team that specializes in keeping people’s homes, offi ces, and working spaces clean. And while the job has been far from easy, Mammoliti says it helps to have a solid crew: “We’re lucky in that we have an amazing team that communicates well and

spaces clean. And while the job has lucky in that we have an amazing team that communicates well and has remained positive throughout this whole crisis. So, while it has been one of our busiest years, we’ve been able to pull together and be there for our clients.”

As for what comes next, De Bartolo adds, “We’re continually looking forward and asking ourselves how we can better serve our customers? How can we make the job easier for a facility manager? Like a lot of companies out there, it’s all about evolving and continually learning how we can be better.”

Adds Passarelli: “We’re excited for what’s ahead.”

Learn more about The MJW

Team (divisions of Metro Jet

Wash Corporation) at www. mjwcanada.ca or contact the team directly at 416-741-3999 or toll free at 1-844-669-3999.