CFMD October 2022

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PRAIRIE REGIONAL HOSPITAL CREATES CAPACITY FOR CARE AND CONNECTS PATIENTS TO

DARK SIDE OF

MONITORING INNOVATIONS

THE GREAT INDOORS

THE FUTURE SHOPPING EXPERIENCE

MAXIMIZING LIGHT IN HOSPITALS

PHOTO BY KLASSEN PHOTOGRAPHY

observations

OCTOBER 2022 Volume 37, Issue No.3

COMFORT ZONES

Well-being is a predominant theme within the pages of our healthcare issue. Given the demand hospitals are facing across Canada, understanding how the physical environment directly affects the health and comfort of patients and staff has become an even more crucial undertaking.

On our cover, we take a look at Alberta’s new Grande Prairie Regional Hospital which opened this year. Designer Adrian Lao, from DIALOG, noted how exciting it was to create a space where people have a really strong sense of the outdoors—the prairie landscape, natural light, the big open sky— without having to leave the hospital if their condition prevents them from doing so.

We also look at new technologies that could smooth the burden of staffing shortages while optimizing the patient experience. Other articles discuss psychological ergonomics, as well as trauma-informed care, a well-known practice in clinical settings, which is currently on the radar of workplace strategists who are creating office spaces in the aftermath of pandemic trauma.

There is lots more, including our trending products, with a deeper dive into how flooring can maximize light in healthcare spaces.

Enjoy the magazine!

REBECCA MELNYK

EDITOR, CANADIAN FACILITY MANAGEMENT & DESIGN REBECCAM@MEDIAEDGE.CA

EDITOR: Rebecca Melnyk rebeccam@mediaedge.ca

SENIOR DESIGNER: Annette Carlucci annettec@mediaedge.ca

GRAPHIC DESIGNER: Thuy Huynh roxyh@mediaedge.ca

PRODUCTION MANAGER: Ines Louis Inesl@mediaedge.ca

CONTRIBUTORS: Paul Baratta, Judith Carlson, Jessica Fullerton, Marianne Lee, Aaron Miller, Susan L. Monroe, Brendan Murphy, Marcia O’Connor, and Alexandra Stinson.

CIRCULATION: Adrian Hollard circulation@mediaedge.ca (416) 512-8186 ext. 234

PRESIDENT: Kevin Brown kevinb@mediaedge.ca

GROUP PUBLISHER: Sean Foley seanf@mediaedge.ca

DIRECTOR OF DIGITAL MEDIA: Steven Chester stevenc@mediaedge.ca

Canadian Facility Management & Design (CFM&D) magazine is published five times a year by MediaEdge Communications Inc., 2001 Sheppard Avenue East, Suite 500 | Toronto, Ontario M2J 4Z8 Tel (416) 512-8186; Fax 416-512-8344 email: circulation@mediaedge.ca

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GREEN ACCOLADES

Four health care facilities gain new bragging rights as Canada’s Green Hospitals of the Year with the recent announcement of top results from the annual benchmarking exercise tracking energy and water savings, waste reduction, pollution prevention and environmental leadership. Winners, achieving the highest scores in each of the four categories of participants, include:

Royal Victoria Regional Health Centre, Winnipeg, Manitoba, in the community hospital category;

Hamilton Health Sciences/Ron Joyce Children’s Health Centre, Hamilton, Ontario, in the teaching hospital category;

Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, in the non-acute hospital category; and

Four Counties Health Services, Newbury, Ontario, in the small hospital category.

NET-ZERO GUIDANCE

Newly released project management guidance promises to help local governments and community-based proponents deploy their community energy and climate action plans. Two Canadian environmental advocacy groups, Pollution Probe and QUEST Canada, have developed a six-step framework for setting priorities, identifying stakeholders and needed resources and building partnerships.

The developers of the framework suggest it could help local groups overcome some of the challenges of translating visionary documents, which may be contingent on policies and measures that are outside their control, into a workable program for change. The City of Burlington, Ontario, has signed on as a pilot community to give it a try.

MUSEUM RELOCATION

Following an international competition, the Montreal Holocaust Museum selected architecture offices KPMB Architects and Daoust Lestage Lizotte Stecker Architecture to design the new downtown building. The museum will have a broader impact in galvanizing communities throughout Quebec and Canada to fight all forms of hatred and persecution. Construction begins in the fall of 2023, with opening scheduled for 2025.

WORKPLACE INSIGHTS

The number of people who prefer a hybrid or full-time remote working model. In Adaptavist’s global Reinventing Work Study, only 44% of respondents surveyed work for an employer who allows these choices.

The number of Canadian employees who see significant gaps between the culture their companies claim to promote and the actual reality of the workplace. In LifeWorks Mental Health Index, supported by TELUS Health, workers are also facing increased mental strain from being around a negative office culture.

RJC Engineers

Ontario Tech University Shawenjigewining Hall | Oshawa, ON

management memo

BY MARCIA O’CONNOR FROM

BACKROOM PROFESSIONAL TO ESSENTIAL TEAM MEMBER

How FM skills have become more recognized

Throughout the last cou ple of years, facility man agement professionals have seen a large shift as upper management and co-workers took more notice and came to understand the significant role that FMs undertake in their respective facilities.

Many FMs were placed in sensitive and unprecedented situations in support of business operations and customer care, and staff and customers came to appreciate these efforts.

Roles and priorities included overseeing and ensuring that the built environment continued to comply with health and safety regulations.This entailed air quality,

protocols for facility entry, workplace space design, hygiene, and personal safety measures. Our knowledge brought a greater appreciation of our skills and experience because we quickly offered all our stakeholders a workplace standard.

FMs became leaders, executors, and advisors, recognized as part of the team.

They participated in many discussions that impacted all stakeholders of the facility and were recognized as equal peers, offering essential services that helped keep the building environment in good condition to continue with business practices.

People acknowledged FMs’ ability to pivot quickly during a crisis with agility, flexibility, and their wisdom to balance all the moving parts, adapt to immediate situations and produce practical solutions.

Now, as pandemic protocols begin to wane, FMs must continue to shine and maintain the profile they earned and the renewed relationships built and established throughout the past two-plus years. Ensure your roles and responsibility garner the respect that you created.

Continue to be proactive,to communicate and share ideas and recommend required services. Some ideas may be new or may not have previously materialized; however, now is a great time to pitch your idea.

Demonstrating adaptability, agility and quick responsiveness has given FMs a voice at the team table versus being the backroom professional. It boosted our ability to provide exemplary services. Our hidden talents were spotlighted along with a better understanding of our skills and communication in the FM field.

Use your newfound relationships created during the pandemic and continue to be seen as peers and an essential part of the management team to make an impact on your company and your FM role. | CFM&D

Marcia O’Connor is president of AM FM Consulting Group. She is a strategicminded leader with more than 20-plus years of progressive experience in corporate real estate, asset management, and integrated facilities management.

Marcia has a passion for mentoring young professionals and helping people, teams, and organizations see their potential. She is the lead instructor for the University of Toronto School of Continued Studies’ facilities management courses, including the FM Certification Program and many others.

education

BY JESSICA FULLERTON & MARIANNE LEE

THE DARK SIDE OF WATER

Healthcare facilities are places of healing, with a burden of responsibility on architects, designers, engineers, contractors and managers to design, maintain and operate them as safe buildings to support patient care and minimize the transmission risk of healthcare-associated infections (HAIs).

Plumbing systems can contribute to the proliferation of pathogens in a facility’s water supply system and facilitate water-to-air transmission of pathogens through water fixtures, contaminated traps and aerosolization of toilet bowl contents. Special considerations impact the selection of fixtures for healthcare facilities, including cleanability, hands-free activation and laminar flow faucets, and suitable physical dimensions to facilitate proper handwashing. Designers must also balance sustainability and water conversation efforts with infection prevention and control concerns, which impact fixture flowrates, recycled or grey water reuse.

PLUMBING SYSTEM PATHOGENS

Microorganisms present in healthcare facility plumbing systems include gram-negative pathogens of medical importance, such as Escherichia coli, Klebsiella, Serratia, Pseudomonas aeruginosa and Legionella pneumophilia. Legionella replication within protozoa provides the pathogens with protection from biocides and heat used to disinfect water systems making it very difficult to eradicate once established. Major risk factors within the plumbing system include stagnation, reduced disinfectant levels and inadequate hot water temperatures. Factors that increase the risk further are the presence of scale and sediment, biofilm and pH fluctuations. Actions known to release resident bacteria are construction activities, watermain breaks, water shutdowns and changes in water pressure.

CSA standard Z317.1, Special Requirements for Plumbing Installations in Health Care Facilities, includes specific

design and maintenance requirements for plumbing systems that minimize the development and proliferation of pathogens in them.

Water conservation is a significant concern given the growing push to preserve resources and for buildings to achieve LEED accreditation involving water use reduction credits. Unfortunately, water conservation measures have been associated with an increase in bacterial contamination. To address this, Z317.1 prohibits the use of aerators and mandates a minimum flowrate of 1.5 gallons per minute for lavatory and hand hygiene sink faucets.

Another factor is energy conservation targeting domestic hot water systems through the lowering of generation and distribution temperatures, and the introduction of energy conservation devices. Z317.1 mandates hot water system temperatures and specifically addresses water preheating as part of an energy recovery strategy and prohibits it unless the healthcare facility has performed a documented risk management exercise.

In terms of maintenance requirements, the latest edition of Z317.1 contains a new clause requiring healthcare facilities to develop a documented water management plan to manage and mitigate risks to their water systems. This clause references ASHRAE standard 188 and establishes minimum legionellosis risk management requirements for building water systems. These are described in Annex E in Z317.1, and include building water systems analysis; control locations; control limits; monitoring; corrective actions; implementation; and documentation.

REMEDIAL MEASURES

When microbial contamination is identified in a healthcare facility, prompt remedial action is required. This typically involves system decontamination, either by chemical shock treatment through

Understanding the impact of poorly managed and maintained plumbing systems

hyperchlorination or thermal shock treatment (superheating). Z317.1 requires that hyperchlorination be implemented for new or significantly altered systems, or following the reactivation of a plumbing system that has been inactive or that was drained for an extended period. Annex D in the standard includes guidance on both superheating and hyperchlorination, describing the method and precautions for both.

Flushing can also be implemented as a remedial measure and as part of routine maintenance to prevent water stagnation. Flushing begins at the building service line and works systematically through the building systems to avoid introducing or moving contaminants from one location to another. The latest edition of Z317.1 includes updates regarding unused portions of a water system and requires a risk assessment be performed prior to its shutdown. For any timeframe of two weeks or more, the water system must be disinfected prior to being drained or put into an out-of-use state, or must be flushed thoroughly for a minimum of 10 minutes at least twice a week.

When a single case of healthcareassociated Legionnaires disease is detected, immediate investigation and control measures should be initiated. If contamination is identified, disinfection of the water distribution system may be necessary. If hyperchlorination is performed, chlorine should be introduced into the potable water system to maintain a minimum target chlorine contact time value of 4000 ppm-min per litre at every outlet for a minimum of three hours, but not exceeding 24 hours. Showerheads and aerators/laminar flow devices should be removed prior to system disinfection and either disinfected or replaced before reinstallation. Every outlet must then be flushed until chlorine residual returns to normal municipal water levels. It is important to prevent aerosolization of water during this work. A risk assessment should be performed to determine the need to relocate respiratory fragile patients, such as neonatal intensive care infants, due to chlorine off-gassing during disinfection.

After disinfection, approximately 10 per cent of fixtures should be resampled with measures in place to protect at-risk populations until results are received. Further testing should take place every two weeks for the following three months and then at three-month intervals.

FINAL TAKEAWAYS

Plumbing systems can contribute to injury and the spread of infectious diseases due to hazards created by improper temperatures, stagnation, leaks and inadequate drainage, and adverse conditions created by failure or improper operation.

A detailed water management/water safety plan is imperative and must take

into account patient populations and services provided, as well as the age, complexity and limitations of the plumbing infrastructure for each building. Z317.1 can assist by providing guidance on design and maintenance requirements that minimize the development and proliferation of pathogens, and ultimately reduce the risk of HAIs. Healthcare facilities should consider various situations when developing their water management plan, such as how to perform a system-wide disinfection if required, how to deal with a loss of water, the potential to run a mock code grey and determining what acceptable legionella concentrations may be. | CFM&D

Jessica Fullerton is the infection prevention and control lead for The Ottawa Hospital planning and redevelopment department. She is also chair of CSA standard Z317.13, Infection Control During Construction, Renovation and Maintenance of Health Care Facilities. Marianne Lee is a principal and senior mechanical engineer at HH Angus and Associates. She is chair of CSA standard technical subcommittee Z317.1, Special Requirements for Plumbing Installations in Health Care Facilities. Jessica and Marianne can be reached at jfullerton@toh.ca and marianne.lee@hhangus.com, respectively.

As the demand for constant sanitation of high traffic environments continues to rise, so does the need for efficiency and effectiveness in killing bacteria on surfaces.

Laboratory testing has shown that when cleaned regularly this surface:

• Reduces bacteria contamination, achieving 99.9% reduction within 2 hours of exposure.

• Delivers continuous and ongoing antibacterial action.

• Helps inhibit the buildup and growth of bacteria within 2 hours of exposure between routine cleaning and sanitizing steps.

ergonomics

BY ALEXANDRA STINSON

PSYCHOLOGICAL ERGONOMICS

What role does ergonomics play in psychological factors in the workplace?

• Increased hormone levels: after the physical aspect of work has ended, the body will still retain high levels of stress regulating hormones such adrenaline, cortisol and catecholamine as shown below in Figure 1.0.

Psychological Ergonomics: What Role Does Ergonomics Play in Psychological Factors in the Workplace?

The Cinderella hypothesis demon strates how all of the above factors when considered together contrib ute to MSDs, where one factor alone could be overcome; but when stress factors are combined, the effects are cumulative and contribute to stress on the body.

Jobs with high physical de mands are understood to result in higher-than-av erage incidents of Mus culoskeletal Disorders (MSDs); however, jobs with high cog nitive demand and/or psychological stress have also been linked to increased incidents of MSDs.

It is relatively easy to correlate the implication of high force or repetition to muscular stress; however, studies are now showing that individuals who report feeling high levels of stress are also more likely to report muscular discomfort. Psychological factors such as deadline pressures, lack of control over work, supervision responsibilities and high accountability can impact how the body behaves by increasing applied forces, awkward postures and static loading of muscular tension.To understand how this happens, we need to consider the body’s physical response to stress:

• Increased tension in the muscles: tension in the upper back, neck and shoulders can be found even before manual work activities have started and lead to extended durations of fatigue and discomfort after an employee’s shift ends.

• Less relaxation and recovery: although the physical load on the body may have a specific timeline, cognitive stress doesn’t stop at the end of the workday. After work, muscles remain under stress and are unable to relax, resulting in more hours of tension and decreased blood flow which is a much-needed component to cellular health and healing in the muscles.

Jobs with high physical demands are understood to result in higher than average incidents of Musculoskeletal Disorders (MSDs), however jobs with high cognitive demand and/or psychological stress have also been linked to increased incidents of MSDs. It is relatively easy to correlate the implication of high force or repetition to muscular stress, howevefr studies are now showing that individuals who report feeling high levels of stress are also more likely to report muscular discomfort (Deeney, O’Sullivan 2009) Psychological factors such as deadline pressures, lack of control over work, supervision responsibilities and high accountability can impact how the body behaves by increasing applied forces, awkward postures and static loading of muscular tension. To understand how this happens, we need to consider the body’s physical response to stress:

} Increased tension in the muscles: tension in the upper back, neck and shoulders can be found even before manual work activities have been started, and lead to extended durations of fatigue and discomfort after an employee’s shift ends.

The amount of psychological stress staff underwent over the last 2 years has been significant. Workers have been asked to relocate to their homes, work in small living spaces, give up personal space, blend the lines of work and home, miss out on connections with colleagues and, instead, spouses and children became their co-workers.

} Less relaxation and recovery: although the physical load on the body may have a specific timeline, cognitive stress doesn’t stop at the end of the workday. After work, muscles remain under stress and are unable to relax; resulting in more hours of tension and decreased blood flow which is a much needed component to cellular health and healing in the muscles.

• Increased workload perception: those employees feeling mentally overwhelmed often will categorize their jobs as being ‘hard’ and frequently report physical exhaustion at the end of the workday that can lead to higher injury reporting.

} Increased workload perception: those employees feeling mentally overwhelmed often will categorize their jobs as being ‘hard’ and frequently report physical exhaustion at the end of the workday that can lead to higher injury reporting

} Increased hormone levels: after the physical aspect of work has ended, the body will still retain high levels of stress regulating hormones such adrenaline, cortisol and catecholamine as shown below in Figure 1.0.

That, combined with increased monitoring of productivity and supervision/micromanaging to allow employers to track work progress while balancing concerns of illnesses, disease testing, and potentially poor health, has led to cognitive overload and an increase in psychological stress.

The Cinderella hypothesis demonstrates how all of the above factors when considered together contribute to MSDs, where one factor alone could be overcome, but when stress factors are combined the effects are cumulative and contribute to stress on the body.

Figure 1.0: The Cinderella Hypothesis

Psychological Stressors: Lack of control, high pace, performance criteria

Increased muscular tension / EMG

Physical Stressors: Job tasks: force, awkward postures, repetition

Increased muscular tension / EMG

Considerable increase in muscular tension

Slow unwinding

Sustained adrenaline & cortisol secretion Sustained muscle tension

Psychological Stressors: Rushed timelines (childcare, activities, meals), multi tasking (homework, meals, housework)

Raised cortisol & catecholamine secretions

PAID JOB WORKLOAD

PHYSIOLOGICAL REPSONSE DURING WORK

STRESS RESPONSE AFTER WORK

UNPAID DOMESTIC WORKLOAD (Melin & Lundberg, 1997)

Physical Stressors: Workload (housework), static sitting

The amount of psychological stress staff underwent over the last 2 years has been significant. Workers have been asked to relocate to their homes, work in small living spaces, give up personal space, blend the lines of work and home, miss out on connections with colleagues, spouses and children became their co workers. That, combined with increased

As employees and workplaces pivot once again to return employees to the workplace either full-time or hybrid, workplaces should be evaluating whether they have the infrastructure in place to assist with the psychological effects of the return to the office.

A literary review of 54 longitudinal studies concluded “that psychosocial factors should be considered as independent predictors of onset of MSDs and be relevant to prevention and intervention programmes in occupational safety and health” (Hauke, et.al, 2011). As such, workplaces should be actively working to address the psychological factors for returning to the office to prevent any further increase in MSDs. Some organizations are providing resources to assist with increasing awareness of psychosocial ergonomics and overall psychological well-being:

• Stress Assess App (OHCOW/ CCOHS): Asks employees 25 ques

tions pertaining to workload, orga nizational factors, workplace culture and health & safety.

• Psychological health and safety in the workplace (CSA Z100313): Prevention, promotion, and guidance to staged implementation

More and more emphasis is being put on employers to embrace a holistic ergonomic approach, which would include looking to, not only improving the principles of physical ergonomics by reducing physical MSD risk factors, but also tackling the cognitive stressors associated with work. Some excellent starting points would be to:

• Review job descriptions and document the cognitive demands through the completion of Cognitive Demands Assessments (CDAs).

• Provide employee training on ergo nomic and mental awareness training.

• Develop an ergonomics and psy chological health programs to sup port employees through both the muscular and cognitive workload.

Through this comprehensive strategy achieving the ergonomic ideals of higher productivity, employee retention and lower MSD injuries may be a reality for employers. | CFM&D

Alexandra Stinson R.Kin., CCPE is a Certified Professional Ergonomist and CoOwner of PROergonomics. With over 20 years’ experience across North America, she excels in solving diverse ergonomic challenges, lowering injury claims and developing sustainable ergonomics programs, policies and training programs. PROergonomics prides itself on a professional experience that is focused on a proactive, preventative ergonomics model that helps organizations move past a reactive claims-driven approach.

operations and maintenance

BY BRENDAN MURPHY

SAFEGUARDING AGAINST MOULD IN LTC AND HOSPITALS

growth are as follows: 1) a temperature range of 15-26 degrees Celsius. Regulations for temperature for longterm care facilities state a minimum of 22 degrees Celsius – right in the sweet spot for mould growth, 2) moisture, and 3) a lack of ventilation. The facility design and activities within healthcare settings can contribute to some of these conditions.

Healthcare facilities are complex buildings to manage given the criticality around their operation and occupants within. HVAC plants, kitchen and laundry facilities and, most importantly, patient care rooms and living quarters are dependent on basebuilding infrastructure to keep facilities running smoothly.

But what happens when mould and its negative consequences hits build ings that house the most vulnerable sector of the population – residents in healthcare set tings, hospitals, retirement residences and long-term care homes?

Many healthcare settings were built to a particular specification three decades or more ago. Naturally, when buildings have had their limits tested for long periods, they become more susceptible to operational problems due to sustained wear and tear.

If there are high levels of mould in a healthcare setting, which can easily go undetected, someone with immune deficiency or respiratory issues could be acutely impacted as their ability to breathe could be compromised further from mould and the negative impact on indoor air quality.

WHAT ARE THE HEALTH RAMIFICATIONS OF MOULD?

Mould can be extremely harmful. Many of the symptoms related to mould resemble that of a common cold or allergy, making the appropriate diagnosis harder to detect. However, the most common symptoms associated with mould exposure include wheezing/coughing, watery/red eyes, nasal and sinus congestion, throat and skin irritation, nosebleeds, fevers, and headaches. In more severe cases, extreme fatigue, memory loss and dizziness can be symptoms. Mould can also cause very serious conditions and can be fatal to seniors and those with previously compromised immune systems, things that are more likely to be encountered in a healthcare setting.

WHAT ARE THE CHALLENGES OF MOULD IN HEALTHCARE SETTINGS?

Some essential conditions for mould

For example, healthcare facilities are built to accommodate a large number of showers. If bathrooms are not ventilated properly, the condensation can soak into the building materials – ceiling/walls, etc. Because the laundry facilities in hospitals and longterm care centres are often running continuously, there is a higher moisture level. Sometimes elderly patients or residents, who may be forgetful, leave taps running, with water potentially infiltrating floors and walls. All of this moisture, if not attended to, can lead to potential mould problems.

Sometimes mould grows in the least expected places where it is not visible. Mould is often found behind walls, within ductwork, and behind wallpaper. With frequent cleaning in facilities, water can get trapped behind baseboards where it can absorb and draw off liquid up behind the walls.

For older facilities, moisture buildup can soak in behind wood framed windows where mould can start growing around the frames and into the adjacent walls.

HVAC ISSUES

HVAC systems can facilitate an easier spread of mould spores. It is important to have systems properly maintained and inspected to ensure they are working properly. Air exchanges and mechanical systems that were sufficient when buildings were constructed may be

considered undersized today, allowing fertile ground for mould growth.

WHEN A FACILITY FACES A MOULD PROBLEM

In the event that a manager of a healthcare facility, long-term care home or retirement residence is faced with mould, the first thing to do is act fast. The longer mould is left alone, the more dangerous it can become, particularly for people with respiratory con ditions and other risk factors.

Disruptions to a facility can drive up operational costs and create significant is sues for residents and patients – so quick action is of utmost importance. Whether a facility handles mould mitigation inhouse or seeks out a restoration company, it is crucial to develop a tailored emer gency response plan and follow that plan accordingly to ensure a quick return to normal activities in the building for those who depend on it. For larger mould in festations, it is recommended that a hy gienist be engaged to properly assess and set the scope of work for removal.

There are very prescribed methods of performing mould removal jobs in a

healthcare setting. Setting up safe con tainments for proper removal of mould is crucial. Mould guidelines from the Canadian construction industry state that “staff and patients with elevated susceptibility and those who are im munocompromised should be removed from any affected or directly adjacent area during remediation.” As part of a project scope, air quality testing must take place before, during, and after re moval to verify that the mould issue has been properly remediated.

HOW TO REDUCE THE RISK OF GROWTH?

Mould growth is a challenge for facility managers and building owners in all industries. This is especially true when there are dark, confined spaces that lack air flow and are slow to dry, and when there are high amounts of water usage in a facility.

Some forward-thinking solutions can include specifying more resilient, nonporous materials in buildings. The use

of leak detection technology, especially in areas of high water usage, is also recommended.

Minor leaks should be attended to with urgency. When buildings contain hundreds of units, the cumulative impact of minor leaks in many units can snowball into much larger issues if they are not dealt with quickly and effectively.

Finally, it’s very important for facility man agers, building owners and staff to be aware of environmental triggers that can contrib ute to mould – and the negative impacts to indoor air quality and health. Healthcare facility professionals must be on a constant lookout for signs of moisture throughout the building, and staff should be watchful of black spots or other forms of mildew that grow on the walls – the telltale giveaway of the potential presence of mould.

Through diligence and proper maintenance alongside expert mitigation, it becomes much easier to safeguard these frontline buildings from exposure to mould and other hazards. | CFM&D

Highly specialized expertise delivered with a human touch.

Brendan Murphy is the Director of client solutions for First Onsite Property Restoration.

technology

BY PAUL BARATTA

CLINICAL MONITORING INNOVATIONS

How to incorporate traditional and new surveillance technology into clinical tasks to optimize patient care and ease staff shortages.

Tele-health visits and vir tual patient monitoring are the new reality of the healthcare delivery land scape. According to data from the Canadian Institute for Health care Information, in April 2020, physi cians adapted quickly to the pandemic, with 55 per cent of patient visits, phy sician-to-physician consults and psycho therapy shifting to online or phone.

In this expanded model of patient care, hospitals are working smarter with their available resources and adding new surveillance technologies to better protect their patients. Some of the top healthcare issues today that surveillance solutions are solving include: wait times, accessibility, staff shortages, patient experiences and cybersecurity.

By incorporating traditional and new surveillance technology into clinical tasks, patient care processes are being optimized. Hospitals are able to observe the patient bed area and telemetry monitors known as the patient envelope.

Conferencing with patients and families is easier. Staff can also expedite medical response times, especially in case of emergencies.

SITUATIONAL AWARENESS AND PRIORITIZED CARE WITH CONNECTED DEVICES

These days, video cameras are often mounted to the ceiling of a patient’s room or mobile cameras attached to IV poles and wireless carts that allow physicians to monitor their patients remotely from a central monitoring system.Video cameras may be embedded with video and audio analytics to detect signs of patient distress and alert staff.

Some facilities integrate their inroom cameras with telemetry devices monitoring their patients’ vital signs. Instead of relying solely on clinical data, medical staff can see their patients’ physiology in real-time, which may reveal early warning signs of a problem. This proactive approach can result in better experiences for everyone.

There are numerous ways to use surveillance solutions for care purposes.A good example would be implementing a remote third-level monitoring system to monitor patients. Consider a room that is staffed by paramedics and contains dozens of displays that enable health care providers to track critical details for each patient as well as other activity in and around the hospital.

The hospital boards/displays then capture and share information on an array of data, including patient vitals, medical records, the acuity score of the sickest patients, paramedic assignments, emergency department traffic, what’s transpiring at other hospitals in the area, operating room activity and capacity, and graphical mapping of ambulance locations and time of arrival.

Looking at monitors is not the same as observing the patients in person. To provide an extra level of care, hospitals can integrate network cameras into an electronic medical records system such as EPIC, including a series or protocols for visual observation that will protect the privacy of patients and their families.

A camera can be added in every patient room, so a logistics centre can visually

evaluate how a patient is progressing. For example, with pediatric patients, a sudden spike in temperature or heart rate might indicate a life-threatening event, or it could simply mean that a patient is getting excited while playing a video game in bed.

When adding video monitoring to the mix, hospitals could notice a significant drop in staff racing to non-events.The technology can also help improve medical response to actual emergencies. If paramedics were able to spot a patient having a seizure just after a nurse left the room, they could send an immediate alert to the nurse and rapid response to intervene and save the patient from brain damage.

STREAMLINED RESPONSE PROTOCOLS

There are countless situations where third-level monitoring can help achieve positive outcomes for hospital patients. During pandemics, hospitals can pivot with their network cameras and video management systems to create a more touchless way of delivering patient care.

When you’re dealing with infectious diseases, or a patient with a weakened immune system, it’s critical to minimize the risk of exposure to

both the patient and staff. In this case, some hospitals have introduced mobile apps through their video management system and something like a Citrix ConnectCare environment that allows physicians to do virtual rounds.

The apps give clinicians access to the in-room cameras through their smartphones, laptops, or computers. They can digitally zoom into the bedside monitors, look at the patient’s skin tone and see how they’re behaving. The apps can also interface with mobile cameras wheeled in on wireless carts so

they can conference with the patient and their family remotely, minimizing the number of times they physically step into the room.

There are so many innovative ways to use surveillance technology and equipment beyond traditional security. Whether hospitals have already implemented virtual patient observation or are now considering it, video and audio technology can act as a force multiplier now and in the future, supporting medical teams that are doing more with fewer staff and resources. | CFM&D

Paul Baratta is the segment development manager for healthcare for Axis Communications. In this capacity, he is responsible for developing strategies and building channel relationships to expand Axis’ presence in healthcare markets.

“There are so many innovative ways to use surveillance technology and equipment beyond traditional security.”

THE MAIN LOBBY.

PHOTO BY KLASSEN PHOTOGRAPHY

THE GREAT INDOORS

At Grande Prairie Regional Hospital, Alberta’s outdoor landscape is integral to the patient experience. The new facility, which officially opened this year, brings dignity to aspects of healthcare that typically make people feel excluded.

BY REBECCA MELNYK

Outside Grande Prai rie Regional Hos pital, a therapeutic walking path links to the Muskoseepi Trail that meanders through the small city for miles. The structure’s curvy linear form follows the flow of Bear Creek that lies adjacent to the 30-acre site. Through windows of the patients’ rooms, wildlife can be seen wandering along the water’s edge—foxes, deer, coyotes.

As the trail’s northwest anchor point, the hospital, designed by DIALOG, and

its surrounding green space is the heart of the community, uniting passersby as well as the patients inside. “It becomes a destination,” says Adrian Lao, a partner at DIALOG. “Even when you’re sick and unable to go outside, you can be part of the community; you can be part of the beautiful surroundings. You don’t feel as though you’re losing that connection.”

Inside the 681,000-square-foot, $870-million facility, people can experience the landscape and natural light, even throughout Alberta’s harsh weather extremes, where

winters can dip below -50 degrees and rise higher than 40 degrees in summer. As Lao explains, wideshaped in-patient units create two internal courtyards and surround them on all four sides, creating a cloistered space that is outdoors yet sheltered from the wind.

“People can see beautiful views of the courtyards while they are inside the inpatient beds, so they feel a sense of community,” he says. “If the weather is warm or sunny, they can also be in the courtyard without

�CLOCKWISE FROM LEFT: A VIEW OF THE NORTHWEST POINT. THE CANCER CLINIC CAN BE FOUND ON THE FIRST FLOOR; NATURAL LIGHT FILLS THE CORRIDORS; INFUSION BAYS IN THE CANCER CLINIC; AND A NURSING STATION. PHOTOS BY KLASSEN PHOTOGRAPHY

having to feel the strong westerlies that blow there all the time.”

Throughout the 240-bed hospital, the outside flows into the interior as one unified aesthetic, with a warm wood look for doors and paneling, materials that bring a sense of comfort so people feel as if they’re in their own bedrooms. All rooms are single-patient with personal bathrooms. The design of the walls keeps everything quiet. “One of the best things we can do for a patient to heal is to allow them to sleep peacefully with privacy and dignity and security,” says Lao.

The layout allows for deep daylight penetration into all the care and treatment rooms, and is just one reason why the hospital was recently honoured with an International Building Award from the International Federation of Healthcare Engineering.

And it’s been a long journey to that moment. The project began in 2011 and finished in 2020, with 99 patients relocating from Queen Elizabeth II hospital as it no longer provides acute and inpatient care. The hospital officially opened this past February, but the process

took longer than expected due to a delay in construction and the struggle to find labour. Out-of-town workers travelled in from Edmonton and Calgary to finish the work. “This was also the largest project of its type and quite complex so we needed to explain the project to the authorities,” he adds. “But we had wonderful support from the mayor of Grande Prairie throughout the approvals process.”

What also helped was a ‘shared vision’ the design team created with Alberta Health Services, the city and

the community. “When you have the community excited about what you’re trying to do, it’s wonderful because you have the wind on your back; the wind is filling your sails,” says Lao.

One vision for the design was to make it warm and inviting, open to community events and celebrating life in Grande Prairie, so it’s more than a place to go when one is sick.

And for those who are unwell, an array of healthcare services can be found. Outpatient ambulatory care, emergency, diagnostics, obstetrics, surgery, pediatrics, acute geriatrics, mental health, and intensive care. There is also the muchanticipated cancer centre that serves patients undergoing chemotherapy who might otherwise have to travel to Edmonton. It’s also a first in the Alberta Health Services North zone to offer radiation therapy.

DIGNIFIED DESIGN

As the hospital came together, the accessibility of mental health care figured prominently into the design, with various components catering to different age groups with particular needs.

The unit is separated into three pods— youth, adults and seniors—to make it easier for staff to care for patients. For instance, a geriatric population may be struggling with mental health alongside chronic diseases and mobility issues.

“Every case is different, but where possible, we have doors that interlink and open for shared social programs and communal dining,” says Lao. “We designed it in such a way that is flexible with care delivery but respects the needs of these three populations, and we allow it to be done safely but together.”

A mental health garden is a therapeutic place for patients to rest—to feel the sun and fresh air, in a secure yet non-oppressive way. Unlike barbwire penitentiary-style fences, Lao says the fencing system was designed to be safe and nonclimbable, yet look aesthetically pleasing, as though it almost disappears.

“The patients love feeling like they’re in a dignified environment,” says Lao. “They feel like they’re part of the community, as if they’re being cared for and nurtured without being ostracized.”

A HOSPITAL WITHIN A HOSPITAL

For a city with a young and growing population of families, a large obstetrics hospital was designed within Grande Prairie Regional Hospital. The rooms

�FROM LEFT: A LABOUR, BIRTHING, RECOVERY AND POST-PARTUM SUITE; EVERY IN-PATIENT ROOM IN SINGLE USE; AND PATIENTS HAVE IMMEDIATE VIEWS OF THE PRAIRIE THAT CONNECTS TO MILES OF MUNICIPAL TRAILS. PHOTOS BY KLASSEN PHOTOGRAPHY.

are designed as a “one-stop resting place” for labour, delivery and postpartum recovery. There is family space, personal washrooms and walls that shield outside noise.

“Kind of like a hotel suite,” says Lao. An operating room is located within 20 feet in case of an emergency C-section. A level 2-plus neonatal intensive care unit is designed immediately adjacent to the mother.

“The whole paradigm has been reversed so the centre of focus is the patient, the baby and families,” he adds. “This is a fundamental change in the way care is delivered. The idea is to make the experience as therapeutic, nurturing, dignified and secure as possible for mother and baby.”

This patient-focused approach, where hospitals are comforting places to heal, with minimal noise,

more privacy and access to the outside is where Lao sees the future of healthcare heading—that, along with reducing energy usage and achieving net zero, as well as going beyond universal design, where a standardized approach might not be sensitive to the peculiar needs of every community.

“If you can design an environment that way and respect the community

you are doing it for. . . and make it unique—something the whole community can get behind and be proud of, and staff and patients feel comfortable going there, then you will have made the hospital a truly meaningful place for healing,” says Lao

“The hospital is ultimately for the communities we design for; it’s about them, and it’s for their future.” | CFM&D

“Even when you’re sick and unable to go outside, you can be part of the community; you can be part of the beautiful surroundings.You don’t feel as though you’re losing that connection.”

BY REBECCA MELNYK

THE FUTURE SHOPPING EXPERIENCE

Rethinking the roadside pitstop, omnichannel collisions and reanimating malls

Shopping has conven tionally been tied to consumer need or desire for material goods, but retailers are now consid ering how people spend their time, not just the money in their pockets. New theories centre on how experiences,

convenience and a sense of commu nity can draw people to a physical site.

A seminar earlier this year at the Toronto Interior Design Show tackled some of those issues. Electric vehicle charging stations, omnichannel shopping and better use of outdoor spaces were all flagged as potential influences.

ROADSIDE REIMAGINING

Ilana Weitzman, Vice President of Strategic Development at Electric Autonomy Canada, identified the transition to electric vehicles and associated evolving travel patterns as a prompt for new designs. Gas stations along the highway have mostly been stop-and-go spots where people fuel up within five minutes, whereas charging can take 20 to 40 minutes.

“These vehicles now have a range of 480 kilometres, but you do need to rest and stop, and where do you do that? This is an incredible opportunity to completely reimagine what that could look like,” she observed.

With this in mind, Electric Autonomy co-sponsored a global architecture competition for a purpose-built roadside oasis for EVs. Scottish architect James Silvester submitted the winning design concept, “More With Less,” featuring inner courtyards for relaxation and a timber-framed canopy that hangs over charging zones to shelter cars and people from harsh elements.

“You can imagine, if you’re getting out of one of these vehicles with a dog or toddler, how much more comfortable it is to not have to cross a vast parking lot along your way,”Weitzman suggested.

Silvester’s design will be built in the next two years by the Canadian convenience store operator and independent fuel retailing company, Parkland Corporation, the competition’s other co-sponsor. The design is also modular so it can also be scaled to other types and sizes of retail venues.

Other concepts submitted to the competition integrated outdoor public spaces, incorporated rooftop solar to augment the power supply, or included leisure space with shopping pavilions, stations to view internet streaming and somewhat more upscale restaurants than a gas station’s typical fast-food offerings. Meanwhile, the transition to EVs is expected to broaden the base of fuel retailers since it will no longer be tied to the storage and dispersal of flammable substances containing hydrocarbon contaminants.

“We’re not just talking about the vehicles themselves. We’re talking about the built environment and how that built environment is going to change, adapt and pivot for this new technology,”Weitzman asserted.“Now, smart retailers can get into this space.”

OMNICHANNEL COLLISIONS

Stanley Sun, design principal and cofounder of Mason Studio, sketched out the potential for mobile retail and how it might bridge bricks-and-mortar

with online purchasing, while filling a community support function. It’s part of an ongoing effort, undertaken with his studio partner, Ashley Rumsey, to explore how physical spaces can create enhanced experiences for omnichannel shopping.

For example, the Calgary retailer, Fresh Fruits, has re-purposed retired city buses to take purchasing opportunities to areas of the city that lack physical food retailers or segments of the population that don’t have access to online shopping. As well, Sun proposes underused parking lots as

venues for pop-up retail and “curated windows” from which passersby could choose and order products.

“When you’re scrolling your phones, as you’re lying in bed shopping, what is that physical experience around you to actually facilitate that?” Sun mused. “Right now, we are talking about digital environments, but you’re also in a space, so how do we create spaces that actually facilitate digital interactions?”

The design partners envision what they term the “omnichannel collision”

�PHYSICAL SPACE IS DESIGNED TO FACILITATE A NEW RETAIL EXPERIENCE. PHOTO COURTESY OF MASON STUDIO.

through spaces that offers connections to retail, but not necessarily in an explicit way. That space could also help create social and community connections — drawing people into a situation where they can talk about their needs and preferences, and discover common objectives.

“Retail has so much more value than we are giving it,” Sun maintained. “It’s an opportunity to bind people. It becomes the social glue and an opportunity for collision.”

SHOPPING CENTRE SHIFT

Demalling is the buzzword for

transforming and reanimating shopping centres. Supreet Barhay, principal at WZMH Architects, shared some examples from her firm’s work.

That includes Promenade Shopping Centre, located in the Thornhill suburb of Toronto’s neighbouring city, Vaughan, where a phased intensification project is slated to add 18 infill residential/mixeduse towers over the next 20 years.Within Toronto city boundaries, Shops at Don Mills — the now teenaged redevelopment of a former enclosed mall into an openair concept — represents another futureproofing option.

“Shopping centres are becoming new community hubs,” Barhay remarked.

At Shops at Don Mills that’s seen in summer concerts, winter skating and the many restaurants that pull in local patrons. Yet, where demalling is not necessary or feasible, shopping centres are still evolving with changing times and consumer demands.

Barhay suggests food and experiential retail have become even more of an attraction as society eases out of the COVID-19 pandemic and many mall operators are expanding what was conventionally about 15 to 18% of the retail offerings. They are also harnessing digital technologies to gather more insight into shoppers’ routines and preferences, and to offer a new range of services.

For example, WZMH Architects recently partnered with Microsoft Research’s Urban Futures Workshop through its Sparkbird innovation lab to retrofit a portable trailer where neighbourhood residents can directly learn about their local air quality. Wayfinding apps also help shoppers effectively use their time, providing route guidance and real-time information about store occupancy levels.

Other trends are carryovers from the pandemic when empty parking lots became catalysts for outdoor commerce and engagement such as drive-through entertainment, food trucks with temporary seating or a hub for pick-up and return of products. Parking lots might also contribute to the mall’s energy supply, such is now being tested in a demonstration project where solar canopies integrated with battery storage have been installed.

Barhay cited a Deloitte survey on postCOVID attitudes that found customers are increasingly looking for green features. They want biophilic designs, good air quality and natural light. They also want to see more local Canadian products and parking options for bikes and EV chargers. She suggests there could be positive results from welcoming bike paths to traverse the site and positioning the mall as a destination on those routes.

“Creating variation will attract customers back into the shopping centres,” Barhay submits. “We need to take it to a completely different level.”

TOP TO BOTTOM: AN EV-CHARGING STATION, DESIGNED BY JAMES SILVESTER,

PIT-STOP WITH RETAIL OFFERINGS

SPACES FOR REST AND RELAXATION. PHOTOS COURTESY OF

CANADA.

Building Owners

and

Managers

BY JUDITH CARLSON

REALIZING TRAUMA-INFORMED CARE IN THE BUILT ENVIRONMENT

Trauma is defined broadly as an emotional response to an overwhelming incident or series of events. When our subconscious ability to cope is overwhelmed, we exhibit a number of cognitive and behavioural symptoms that may indicate a form of psychological trauma. While many have potentially traumatic personal experiences, collective trauma, or the sum of psychological reactions to a traumatic event from a large group of people, has also become increasingly recognized over the last 50 years.

It’s clear that no event in the last century has had a more collec tive impact on society than the COVID-19 pandemic over the last two years. The scale of the issue, compounded with the disrup tion of social life, loss of friends and family, and solitary lockdowns, led to intense feelings of helplessness, uncer

tainty and stress. Society as a whole has had to adjust to the new and rap idly changing reality of our current situation.

The standout element here is control — or our ability to make meaningful decisions that impact our surroundings, providing us with the ability to achieve specific goals or desires. In healthcare,

trauma-informed care (TIC) is an approach that recognizes and actively addresses the symptoms and underlying causes of trauma in patients, empowering them to heal in a safe environment.

The environmental factor is critical for success, and contemporary designers are working diligently to create spaces that take into account both society’s recent collective trauma and the tenets of TIC.

The realization of TIC in the built environment can take many forms, but ultimately boils down to creating spaces that take its principles into account.

Trauma-informed design integrates the principles of TIC into design, leading to the creation of physical spaces that promote safety, well-being, and healing.

The method itself consists of five guiding principles: safety, choice, collaboration, trustworthiness and empowerment. As

physical space affects a host of personal attributes, including our identity, worth, and dignity, it’s become even more important to create environments that lead to greater empowerment and healing for those who have experienced challenging times.

As a collective wave of trauma-related symptoms such as fear, anxiety, and isolation has swept over North America, and workplace strategists have begun to tackle the challenge of creating office environments that help with healing through trauma-informed design.

These considerations largely take the form of enhanced control in day-today decision-making. For some team members, having a respite space may be just as important as a vibrant area for collaboration. Others might seek out a social environment following a large meeting, and still others require an enclave to decompress after a stressful experience.

The ability to choose between a variety of space typologies, layouts, and general settings offers a modicum of control that is helpful in managing negative feelings associated with long-term trauma.

Gathering information from companies’ individual workforces allows strategists to provide tailored recommendations and create a customized workplace experience based on the perceived needs of employees. This allows organizations to maximize the number of workspaces that promote safety, well-being, and healing for the particular space’s inhabitants.

Trauma-informed design at its core is about conceptualizing environments that promote a sense of calm, safety, dignity and overall well-being for all occupants to increase levels of satisfaction. These outcomes can be achieved by adapting spatial layout, creating visual interest, artwork, biophilic design, etc.

Realizing and implementing these components can greatly contribute to the happiness and success of teams operating within these environments. In the age of work-from-home, it’s never been so crucial to provide adequate space for employees to use as they please. This has the two-

fold benefit of taking residual pandemic trauma into account, while simultaneously serving as a primary draw to bring the workforce back to their respective offices.

As we move toward the future of trauma-informed design, we will likely continue to see an increased emphasis on easy-to-navigate spaces, multifunctional furniture arrangements, and purposeful use of colour to create a calming effect with an abundance of natural light.

New environments will be designed with an emphasis on safety of the user, whether it’s increased transparency or a highlight on wellness, so the future of our spaces will not only focus on the standard designs we typically see, but will prioritize end-users (and their emotions) themselves.We can continue to prioritize the implementation of tenets of TIC by creating diverse, agile environments in all fields that limit stressors and contain the ability to adapt to the ever-changing needs of users | CFM&D

Enhance

visitor experience

Judith Carlson is Senior Workplace Strategist at Ted Moudis Associates.

BY SUSAN L. MONROE

MAXIMIZING LIGHT IN HEALTHCARE SETTINGS

Specifying Flooring to Harness the Benefits of Light

It has been proven that exposure to sufficient levels of light in health care facilities – daylight or bright artificial light – has a strong positive impact on the patient experience, aiding in wayfinding, promoting com fort, mental wellness and physical heal ing, and reducing the length of stay in hospital for some. Lighting has its benefits for healthcare staff, too. It has been found to increase job satisfaction, contribute to adaptive circadian rhythms, lower stress, improve mood and decrease the poten tial for medical errors. Given this, it is important to incorporate flooring with high light reflectance values into various hospital spaces to help harvest natural sunlight and increase illumination.

VISUAL COMFORT AND GLARE

All materials reflect light. Light-coloured floors reflect more light than dark ones. And smooth surfaces reflect light directly, while textured surfaces scatter the light causing it to be less bright in one area. When a large amount of light is directionally reflected, glare can result. The eyes perceive glare when the luminosity in the visual field is greater than that which they are adapted. This can result in discomfort, visual impairment or both.

There are two types of glare: direct and indirect. Direct glare results when a high light source like the sun is present in the field of view. Indirect glare is caused by the reflection of high brightness in a polished surface, such as the reflection of the sun off a mirror. Smooth surfaces are more likely to cause direct glare than textured surfaces.

In most healthcare settings, flooring with textured, non-glossy or matte finishes are preferable to highly polished

surfaces. This is especially true in senior or assisted living facilities. With age, less light reaches the back of the eyes, pupils get smaller and the lenses inside the eyes become thicker, absorbing and scattering more light and adding a ‘luminous veil’ over images on the retina. These vision impairments raise safety concerns for seniors. They reduce the contrast and sharpness of objects, vividness of colours and require considerably more light for seniors to see properly than their younger counterparts. Because those 65 and older need higher light illuminance, freedom from glare and enhanced luminance or chromatic contrasts, flooring surfaces in corridors and common areas of senior living facilities should not contain strong or highly contrasting patterns nor highly reflective flooring.

FLOORING LIGHT REFLECTANCE VALUES

Bright spaces aren’t just about light sources – they are about integrated systems. The use of flooring with high light reflectance values increases operational efficiencies in a healthcare facility by maximizing the inputs of the artificial and natural light sources to increase illumination in the space without the use of additional

energy. In fact, the use of flooring with high light reflectance values can decrease artificial lighting needs resulting in energy cost savings.

Traditionally, it has been believed that wall and ceiling reflectivity more significantly impacts the luminance of a space than flooring, but research indicates flooring is an effective surface for efficiently reflecting light.

While hospital beds, equipment and patient room furniture do cover areas of the floor, they do not provide complete coverage nor interfere with the floor’s ability to reflect light any more than curtains and mounted equipment impede the reflectivity of walls against which they are placed.

Light Reflectance Value (LRV) is the total quantity of visible and usable light reflected by a surface in all directions and at all wavelengths when illuminated by a light source. LRVs of flooring and other surfaces within the space significantly impacts both natural light and artificial lighting distribution. On a scale from zero to 100 per cent, a LRV of zero represents total surface light absorption and 100 indicates total light reflection. When higher reflectance flooring is used, more light, from all sources, is reflected back into the space and luminance levels are increased. Rather than adding more lighting assemblies or increasing the intensity of existing units, utilizing light reflective surfaces is a cost-effective way to improve illumination.

The Illumination Engineering Society of North America recommends that LRVs for flooring be 20 to 30 per cent in operating rooms. Flooring products that have at least a 25 per cent surface LRV can contribute to LEED credits.

A recent study by Pennsylvania State

University looked at the impact of flooring with high LRVs on the operating lighting energy and lighting quality in a healthcare setting, such as a hospital or medical facility. The study covered four different types of spaces: a corridor, patient room, exam room and cardiac catheterization lab. In each of these settings, researchers assessed the horizontal and vertical illuminance levels of a representative area of the spaces. Horizontal illuminance is the amount of light falling onto a horizontal surface like the floor, and vertical illuminance describes the illuminance landing on a vertical surface, such as a wall.

For the study, lighting conditions in each of the settings were measured for floor reflectance values of 10, 30, 45 and 60 per cent; wall reflectance values of 20, 40, 60 and 80 per cent; and ceiling reflectance values of 60 and 80 per cent. Differences in the average values were evaluated to determine the potential for energy savings as the floor reflectance changed, relative to the expected performance with a 20 per cent reflectance floor. Study results indicate as the LRV of the flooring increased, so did the illumination levels of the spaces. The findings conclude that higher reflectance flooring can increase illuminance levels for a given lighting system, reducing energy consumption and resulting in energy savings for a space design that is finely tuned to achieve a specific target illuminance level.

The lighting improvement will be more substantial in spaces that have higher reflectance ceilings and perimeter walls. As the study shows, illuminance increases steadily as illuminance of ceilings and walls increases. The greatest increases in luminance occurred in spaces where the ceiling and walls had reflectance values of 80 per cent. It’s not so much the lighting or the light source that effectively increases luminance but the amount of light available for the space. This can be increased from floor reflectivity.

REDUCING ENERGY COSTS

Lighting is one of the single largest

consumers of electricity in hospitals, representing an average of 16 per cent of total energy consumption and about 27 billion kilowatt hours or 43 per cent of annual electricity use. Specifying flooring with high LRVs provides opportunity to reduce energy costs by maximizing available light throughout the space.

To ensure light is sufficiently reflected throughout the space, select lighter coloured flooring. Avoid extremely dark coloured flooring materials as these surfaces can require more installed lighting power to meet illuminance levels, resulting in higher costs. Reflectance will vary based on the type and colour of the surface.

In a hospital corridor, where the LRV of flooring material was raised from 20 to 30, 45 and 60 per cent in the Penn State study, electricity savings amounted to between three and 22 per cent of the lighting energy that would otherwise be consumed depending upon the reflectance of the ceiling and walls.

Wall reflectance can increase the interreflections within a space, which has a significant impact on high reflectance flooring. When the wall reflectance is 80 per cent versus 40 per cent, the savings between a 20 and 60 per cent reflective floor more than doubles.

FINAL INSIGHTS

While healthcare facilities are lit by a combination of electric lighting and natural daylight, there is a strong preference for daylight. Electric light is needed throughout all parts of the building to illuminate spaces where natural light cannot be present. However, the need for artificial lighting can be reduced, not only by efficient utilization of sunlight wherever possible but by the use of flooring with high LRVs. Through the use of daylight, which is delivered at no cost, and flooring with high LRVs, healthcare facilities can improve patient outcomes and staff performance and reduce their electricity usage, positively impacting the facility’s bottom line. | CFM&D

CAPITAL PROJECTS COLUMN SPONSORED BY

The art of heritage conservation

Conserving and restoring Canada’s heritage buildings is a means of preserving our unique and compelling story for generations to come. And as the practice of restoring and rejuvenating Canada’s aging building inventory grows, it’s important to understand what heritage conservation truly means and what services are required to accomplish this goal.

Over the years, RJC Engineers’ Building Science, Structural Restoration, and Structural Engineering teams have proudly delivered industry-leading heritage conservation services for projects at existing buildings and new additions to heritage sites. In every collaboration, we aim to present solutions that prioritize the preservation of the site’s historical significance and value while considering economics and engineering efficiencies. We draw from our firm’s experience, people, and tools, we work with project teams to repair, rehabilitate, or restore physical aspects of a heritage resource in ways that honour their past and prepare them for future generations.

At RJC Engineers, our philosophy for heritage conservation is the same for every project we touch: Creative Thinking, Practical Results. Learn more about RJC’s services and see past heritage project successes at www.rjc.ca

Susan L. Monroe is director of environmental, health and safety, and product stewardship and quality at Armstrong Flooring, a leading global manufacturer of flooring products. Susan can be reached at slmonroe@armstrongflooring.com.

A HEALING TOUCH

The latest healthcare furniture and flooring puts patient comfort on a pedestal as designers explore ways to make hospitals feel more like home.

The West Elm Health Collection from Steelcase Health takes iconic workplace furniture and modifies it for healthcare environments. The collection, which includes Slope, Sterling, Mesa and Lucas, combines products with clinically appropriate features such as a recline, metal legs, crumb sweep and high-performance fabrics suitable for health. The furniture is intended for lobbies, reception, waiting spaces, transition spaces, cafes, clinician respite, physician offices, consultation, outpatient centres, and virtual care spaces.

Rühe by Allseating is a new multi-range seating and table collection designed to evoke a home-like vibe. Every model features inverted curves in the arms to provide a natural cradle feel. Lounge and guest pieces accommodate for a broad range of body types and come available in single, double, and triple sizes.

The Easton Collection from Herman Miller offers a versatile range of seating and tables for waiting areas, with optional integrated power. The seating comes with four-inch moulded foam seats and contoured backs for long-term comfort. Durable metal construction and a convenient clean-out design stand up to rigorous use and frequent cleaning.

The Pli Task Chair from Allsteel is both highly responsive and makes motion easy. Pli comes with a four-point seat suspension system that dynamically responds to the user’s natural shifts in seated postures, as well as a backrest that is engineered to reduce the perception of a rigid perimeter. Pli is offered in task and stool height configurations with two arm styles, fixed and height adjustable. The chair comes in five mesh back colours and four base/ frame colours in nature-inspired neutral tones.

The Innate Collection, new from Shaw Contract, won a Best of NeoCon Award in healthcare flooring. The bio-based resilient tile and sheet products come in two 16-inch by 34-inch patterns. Stria (pictured) is a linear abstract pattern available in greys, blues, and neutral colours. The flooring is designed to resist scratches and degradation from UV light.

Pattern of Time, a new product from Mohawk Group’s Large & Local LVT platform, won this year’s Best of NeoCon Award for Hard-Surface Flooring: Vinyl/LVT. Pattern of Time combines the comfort and tradition of wood grain visuals with a unique emergence of colour throughout each 9.25-inch by 59-inch plank style, while offering improved floor-to-floor acoustics, enhanced durability and performance.

Patcraft expanded its homogeneous sheet collection, Holistic, with two new styles designed for high-demand environments. Holistic Shades and Holistic Thrive come available in 72 colourways for versatility, wayfinding and space definition. Bright hues infuse energy into a space. Soothing neutrals can evoke a sense of comfort. The products are easy to heat weld and flash cove for seamless installation and resistant to gouges and abrasions, as well as chemicals and damage from alcoholbased hand sanitizers.

Another Best of NeoCon Award winner, Open Range from Mannington Commercial is inspired by the rugged American West. Rustic wood visuals in a rubber plank format bring realistic detail and rich texture. Tonal patterns provide high variation from plank to plank for added authenticity.

BY AARON MILLER

AN UNHEALTHY TIPPING POINT

Amid the increasing demand for health care service coupled with a shrinking workforce is a system that can be reimagined through collaboration, digital health and design thinking.

The Canadian health care system is at a tipping point with rising de mands for service, record levels of job vacancies, and increasing public and political pres sures. This, combined with an aging population, increasing opioid deaths, a rise in mental health conditions, and increasing food insecurity and poverty, all put a strain on the health care sys tem. Hospitals are now over capacity and health care services are temporarily closing in rural and remote communi ties due to lack of staffing.

In 2009, the Canadian Nursing Association predicted that Canada could see a shortage of over 60,000 fulltime nurses by 2022. Fast forward to the second quarter of 2022 and according to Statistics Canada there were 136,000 job vacancies in the health and social assistance sector, up 29 per cent from the previous year and driven by nursing vacancies.

Compounding these high levels of job vacancies are increasing demands for health services throughout the country.

These issues present challenges for any organization, even more so within the Canadian health care system, which is highly politicized and fragmented with provincial and regional approaches, challenged in recruitment and retention of trained staff and physicians, and lagging in the areas of digital health and innovation.

There are three areas of opportunity to support the Canadian health care system to thrive and meet the demands of the diverse Canadian population: collaboration, digital health, and design thinking.

COLLABORATION

Strengthening collaboration both

within each province and federally, including collaboration with other government ministries, universities, and other organizations can enhance delivery of health care services. For example, partnering with universities can improve forecasting and projections for the future human resource demands, proactively increase the number of available seats and provide incentives for those choosing health as a career path.

Ministries of education can further build basic health education into school curriculums to provide the foundation for children to understand the social determinants of health to learn healthy behaviours that will help them in the future.

DIGITAL HEALTH

Digital disruptors are rapidly changing the health care landscape.This accelerated during the pandemic. As individuals are becoming more comfortable using virtual platforms, digital companies are innovating to reduce the distance between patients and health care providers. For example, the NHS in the United Kingdom has created virtual hospitals where patients are cared for in their homes using wearable technology and are supported by a remote health care team of nurses, physicians, and other health practitioners. Other Canadian digital disruptors are re-imagining what healthcare can be and creating new opportunities not thought possible even a few years ago.

Through collaborative partnerships, there is an area of opportunity within

the health care system to better innovate with digital organizations to create a system that can be predictive, preventative, personalized, and participatory by using technology to increase care delivery.

This includes formally shifting care outside of a clinic or hospital setting to virtual platforms that provide equitable access and care regardless of where individuals live.

DESIGN THINKING

Design thinking is the concept of using human-centred techniques to understand the obstacles within the health care system and challenge assumptions to create innovative solutions. This includes redefining the purpose of health care institutions, and rethinking what is health and where it can be provided and who can provide it. It is understanding the underlying motivations to improve performance, and limiters to innovation and the responsibilities of the patient within the health care system.

By taking a design thinking approach there can be collaboration from different industries to test ideas, and look at new opportunities that can be found and shared across multiple provinces and territories to have substantial improvements to the entire health care system. A design thinking approach can be the backbone to reexamine the health care system and advance how and where health care is provided in Canada| CFM&D

Aaron Miller is an ergonomics consultant based in Kelowna, B.C. As a Canadian Certified Professional Ergonomist (CCPE), and president of the Canadian College for the Certification of Professional Ergonomists, Aaron specializes in leading design and corporate initiatives to improve organizational efficiency, effectiveness, and opportunities for change. Aaron can reached at aaronmiller764@gmail.com

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