CHF Winter

Canadian

HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 34 Issue 2

Spotlight on Canadian Healthcare Projects

PM#40063056

Inside

CSA Standards Committees Forge Ahead Flying High at Regina General Hospital Examining Evidence-Based Design

Winter/hiver 2013

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contents

Canadian Healthcare Facilities Volume 34

Number 2

Canadian Healthcare facilities IS published BY under the Patronage of the canadian healthcare engineering society

16

Steve McLinden e-mail: stevem@mediaedge.ca

Publisher

Matthew Bradford e-mail: matthewb@mediaedge.ca

Advertising Sales

Sean Foley

Editor

MediaEdge Communications 416-512-8186

e-mail: info@mediaedge.ca

Articles

20

25

12

Examining Evidence-Based Design Making hospitals 'work' for all users

18

ealing Garden Flourishes at H Edmonton's Cross Cancer Institute An update on CCI's natural healing installation

20

Spotlight on Canadian Healthcare Projects A snapshot of industry developments

26

CSA Standards Committee Forge Ahead in 2014

28

Flying High at Regina General Hospital New heliport saves time for critically ill patients

Senior Designer

Annette Carlucci

Designer

Jennifer Carter

production Manager

Rachel Selbie

SCIss JOURNAL trimestriel publié PAR MEDIAEDGE COMMUNICATIONS INC. sous le patronage de la société canadienne d’ingénierie DES SERVICES DE SANTÉ Steve McLinden e-mail: stevem@mediaedge.ca

Éditeur

Rédatric intérimaire

Matthew Bradford

e-mail: matthewb@mediaedge.ca

publicitaire

Sean Foley

MediaEdge Communications 416-512-8186

e-mail: info@mediaedge.ca Pubicité

Annette Carlucci

COORDINATEUR de production

Rachel Selbie

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

President

Peter Whiteman

VICE-PRESIDENT

Mitch Weimer

Past President

Michael Hickey

treasurer

Robert Barss

8 Message from the President

Secretary

Randy Cull

10 Chapter Reports

Chapter Chairmen Maritime: Denis Pellichero Alberta: Preston Kostura B.C.: Mitch Weimer Ontario: Allan Kelly

Manitoba: Reynold Peters Newfoundland & Labrador: Brian Kinden

departments 6

Publisher's Message

11 Call for Nominations:

CHES Awards

EXECUTIVE DIRECTOR Donna Dennison

Founding Members H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski

Ches

4 Cataraqui Street, Suite 310

Kingston, Ontario K7K 1Z7 Telephone (613) 531-2661 Fax (866) 303-0626

e-mail: ches@eventsmgt.com

CHES Home Page: www.ches.org

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Publisher's Message

A promising year ahead 2014 has landed, and with it comes more opportunities to celebrate the projects, people, and ideas shaping the industry. Nevertheless, as we prepare to cover another landmark year in Canadian healthcare, it's important to highlight the achievements and breakthroughs from 2013 that are shaping the year ahead.

2013 was marked by a number of new projects across the country, many of which will see completion in 2014. We've showcased a handful of these in our cover story, Spotlight on Canadian Healthcare Projects, including Five Hills Health Region's new hospital development in Saskatchewan, Hawkesbury & District General Hospital's expansion in Ontario, and Institut Philippe-Pinel's retrofit in Quebec. Jenna Webb with the Regina Qu'Appelle Health Region has also contributed a story on the Regina General Hospital's new heliport, which we're sure you'll find uplifting.

Also within these pages, we return for an update on Edmonton's Cross Cancer Institute's Healing Garden initiative, and join CSA Group's Jeffrey Kraegel for a look at how CHES members have contributed greatly to CSA Standards Committees. We're also pleased to feature an insightful look at modern hospital design in, “Examining Evidence-Based Design”, by overseas contributor Regina Kennedy.

With a new year comes new opportunities to share you stories. We're always open to ideas and suggestions, so please feel free to reach out to myself at stevem@mediaedge.ca, or CHF's editor, Matthew Bradford, at matthewb@mediaedge.ca.

Best wishes for an exciting new year.

Steve McLinden Publisher stevem@mediaedge.ca

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor.

Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) $25 per issue Canadian Healthcare Facilities (non members) $30 per issue Canadian Healthcare Facilities (non members) $80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.

La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice.

Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 $ par numéro Journal trimestriel (non-membres) 30 $ par numéro Journal trimestriel (non-membres) 80 $ pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS. 6 Canadian Healthcare Facilities

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We are pleased to announce that Ventcare now monitors hospitals the We are pleased50toplus announce thatinVentcare Ontario region. now monitors 50 plus hospitals in the

75

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Labour Canada has fully “acknowledged” scopefully of Labour Canadathehas work provided in the semi“acknowledged” the scope of annual inspection program. work provided in the semiIn addition, the written annual inspection program. documentation contributes In addition, the written greatly to thecontributes hospital documentation accreditation greatly to programs. the hospital accreditation programs.

Further we are always pooling the knowledge resources Further we are always poolingof Infection Control and Engineering the knowledge resources of Groups like CHES, the ventilation Infection Control and Engineering inspection is in a constant Groups likeprogram CHES, the ventilation evolution meet future needs for inspectiontoprogram is healthcare in a constant patients and staff. evolution to meet future healthcare needs for patients and staff.

The location and inspection of the hospital ventilation fire doors may be part of The location and inspection the Some hospital your building audit thisofyear. of ventilation fire doors may be part of you have already taken advantage yourofbuilding auditsoftware this year. program Some of our new youwhich have already taken advantage in conjunction with our of patented our newrobotics, softwareallows program us which in conjunction with our to minimize ceiling access patented robotics, allows us requirements. to minimize ceiling access requirements.

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Message from the President

Planning for tomorrow's industry I want to take this opportunity to wish everyone all the best over this holiday season.

May this new year of 2014 bring only the best of health, happiness, and prosperity for you, your family, and loved ones.

This past year has certainly been filled with challenges, changes, and opportunities. I am excited by the changes I see on the horizon and truly looking forward to seeing how we adapt our healthcare systems to meet these demands.

Change is a constant within the healthcare industry and everyone involved is continually evolving, adjusting, and adapting to meet the ever changing needs of our clients and the people we serve. Service pressures and volumes have never been greater; technological advancements are being made at an astonishing rate; environmental extremes are becoming more frequent and more significant; and all this is taking place alongside organizational changes that appear to be occurring exponentially. Still, I never cease to be amazed by the resiliency and resourcefulness of healthcare personnel in raising the bar to meet these challenges. I find this endlessly inspirational.

Stakeholders have made clear that “healthcare sustainability” is at the top of mind for stakeholders across Canada and our facilities management personal are well positioned to meet these needs and challenges.

Having recently returned from the CHES Alberta Chapter conference in Red Deer—or the “Clarence White Conference and Trade Show, as it is known out west—I want to congratulate their team for the exceptional job they did delivering this tremendous educational opportunity for so many. I particularly enjoyed the keynote speaker, Henry “Gizmo” Williams, and his keynote address, entitled “Overcoming Challenges & Team Work”. This certainly exemplifies the world of healthcare today from a facilities perspective; the collaborative and cooperative manner in which we contribute and the importance of our role in healthcare service delivery.

I would also like to report that CHES has met all the new requirements in the “Not for Profit” Legislation Act and we are now in complete compliance, having sent a letter to Corporations Canada along with a copy of our revised bylaws which were approved by the membership in attendance at the recent annual general meeting. Nothing more needs to be done at this time. This task relied on a tremendous effort by everyone involved and I want to express my appreciation for a job well done. Great work everyone, and thank you.

Have a great year! Work hard and play hard.

Peter Whiteman CHES National President

8 Canadian Healthcare Facilities

Canadian Healthcare Construction Course Presented by the

Canadian Healthcare Engineering Society in partnership with ASHE.

St. John’s NL – May 21-�22, 2014 Penticton BC – June 4-�5, 2014 Toronto ON – October 21-�22, 2014 Check website www.ches.org for other dates & locations that may be offered in the future.

Registration is available online.

For further information:

Tel: 613-�531-�2661 | Fax: 866-�303-�0626 ches@eventsmgt.com | www.ches.org 4 Cataraqui Street, Suite 310 Kingston ON K7K 1Z7 Canada

www.ches.org

ALBERTA CHAPTER

Greetings from the CHES Alberta Chapter. I'm proud to say the 36th annual Clarence White Conference & Tradeshow was a success, and I would like to personally thank our committee members that volunteered their time to make this event a success, including Jeff Smith (chair), Randy Badry, Cora Husoy, Don Mayer, Geri Sklenar, Bruce Andrusiak, Jim Schmidt, and Mark Vasicek.

Highlights of the event included words of wisdom from CHES National President Peter Whiteman; a tradeshow featuring 58 companies; the donations made by companies to subsidize our snacks, meals, beverages, and opening and closing speakers; and the attendance of 175 registered guests and several walk-in registrations.

As we look forward to 2014, we have confirmation of meetings and tours at a variety of locations, including the Central Alberta Cancer Centre in Red Deer, Chinook Regional Hospital in Lethbridge, Lac La Biche Health Centre in Lac La Biche, and a training session at Sylvan Lake.

On behalf of the CHES Alberta Chapter, we wish you festive greetings and look forward to seeing you in 2014.

Newfoundland & Labrador Chapter

Chapter Reports

Over the past couple of years, CHES NL has hit some bumps in the road with its annual Professional Development Day (PD Day). However, I'm excited to report that PD Day 2014 will be going ahead in April in St. John’s, Newfoundland, and we are currently working on topics and speakers for the event.

We will be working with our corporate sponsors to complete vendor based education, as well as utilizing the great experience and education from our sponsors to educate CHES NL members on a broad base of topics from mechanical systems, architectural systems, air filter requirements, and the control of legionella. We hope to see everyone there.

Preston Kostura, Alberta Chapter Chair

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Planning is underway For the CHES Ontario, 2014 Conference and Trade Show in Huntsville, Ontario from May 25 -27, 2014.

The conference will be held at the Deerhurst Conference Center and Resort. The team will be sending delegate packages once the education tracks are put in place. Look for more information to follow.

CHES Ontario continues to support the Canadian Coalition for Green Health Care (CCGHC), and is proud to be a partner in these initiatives that will benefit healthcare institutions across Ontario and, hopefully, nationally. J.J. Knott is leading the HELO program (Healthcare Energy Leaders of Ontario), which will provide four energy managers to hospitals in Ontario on a short term basis to help with the energy savings and preparing business cases.

This will be great for Ontario hospitals.

This is very exciting news and I would like to thank Linda Varangu and Kent Waddington from the CCGHC on their hard work for putting this together with such short time lines; as well as Kady Cowan, Ron Durocher, J.J. Knott for their input and guidance.

The Ontario had its first face-to-face meeting in Toronto at the OHA. Planning strategies were discussed at this meeting and minutes will be posted on the website. The engineers session was great this year, and featured Sick Kids Hospital discussing their in-house energy program.

Lastly, CHES Ontario remains financially strong. Our membership chair is implementing strategies to reduce the number of unpaid memberships, and our membership is increasing thanks to the hard work from Jeff Weir.

Allan Kelly, Ontario Chapter Chair

265 Watline Avenue, Mississauga, Ontario L4Z 1P3 Tel: (888) 712-4000 5830 Côte de Liesse, Suite 100, Ville Mont-Royal, Québec H4T 1B1 TÉL : (514) 342-2121

10 Canadian Healthcare Facilities

CALL FOR NOMINATIONS FOR AWARDS 2014 Hans Burgers Award For Outstanding Contribution to Healthcare Engineering

2014 Wayne McLellan Award of Excellence In Healthcare Facilities Management DEADLINE: April 30, 2014

DEADLINE: March 31, 2014 To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose • The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose • To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program, or team building exercise.

Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to; CHES National Office ches@eventsmgt.com Fax: 613-531-0626

Healthcare Engineering Sustainable Design Plant Engineering HVAC Medical Gases

Lighting and Power Communications & Security High Voltage Energy Management

Life Safety Systems

Untitled-3 1

Winter/Hiver 2014 11 12-10-02 11:16 AM

Examining EvidenceBased Design Making hospital design “work” for all users

By Regina Kennedy Healthcare designers are increasingly focused on how people function in their environments, and in how their health and work are affected. Designers are enthusiastically embracing evidence that we can truly design with a view to improving health outcomes, reducing error, and diminishing the risk of hospital-acquired infection.

The evidence-based design approach should not, however, take away from architects’ fundamental training, which entails designing ‘spaces’ that facilitate everyday use. In a bedroom, as a minimum, you 12 Canadian Healthcare Facilities

would expect people to be able to sleep; but how well do patients actually sleep in hospitals?

When designing a corridor in an inpatient ward, if you consider patients will be told to walk up and down it in order to recover sooner, then you will provide handrails, rest stops, pictures on walls, and--with luck--a window with a captivating view at some point along the way.

healing and pain and management, studies in environmental psychology1 have shown that tolerance for noise and other stressors diminishes in people who are under stress.

Qualities of the environment

Health, in the long term, is affected by where and how we live.

Qualities of the environment are known to affect learning and attention to task, as well as mood and mental health, and even our body chemistry. Figure 1 (below) is intended to illustrate the concept of mutual impact of environment, experiential body, and behaviour, on the body itself. The illustration is based upon a schematic prepared for the author’s dissertation 2, which includes an EBD literature review.

Patient satisfaction, pain management, pace of recovery from illness, hospital-acquired conditions, and staff productivity and satisfaction have been associated with the environment of care.

This has, for instance, justified investment in natural lighting and views to nature, i.e. windows, in patient rooms, and has also put forward a good case for single-bed acuity-adaptable inpatient rooms.

A ‘user-centric’ approach

A ‘refocusing’ of functional design

A literature review permitted Roger Ulrich et al3 to conclude that: “The state of knowledge of evidence based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients and better places for staff to work.’”

The rise of therapeutic design in healthcare, followed by calls for evidence-based design, has refocused functional design. A more user-centric viewpoint is developing, with a greater focus on the ways in which people are affected by characteristics of a space given its intended use. Environmental psychology’s contribution to a knowledge base for design is changing both client expectations and the way that designs are developed.

Increasingly, good science – emanating from several disciplines – supports the idea that well-resolved design may contribute to reduced health service costs and improved outcomes. Evidencebased design is intended to support both. However, a great many good intentions may go to waste as design management grapples with conflicting design requirements.

Person-environment interactions are not simple matters of cause and effect. Consider the short-term implications of stress in recovery from injury. While the medical fraternity has found evidence of short and long-term implications of stress for Functioning in an environment, as a whole body experience.

(Source: Leonardo Da Vinci's "The Vitruvian Man" downloaded from www.upload.wikimedia.org)

Winter/Hiver 2014 13

“The way we define uses in healthcare environments, or describe the purpose of a planned space, has progressed from the mechanistic toward the experiential.”

Here we propose to take the above as a given in order to focus instead on an evidence-based, user-centric approach design management. The idea is to emphasise, during the design process, desired results in terms of how spaces are used and experienced.

Furthermore, a methodology is proposed in which the value of an intended use is deliberately agreed by design teams and stakeholders.

This contributes to a set of jointly owned values that can be deployed as moderators during the design process with a view to creating hospitals that work for all user groups.

Background

If a design brief is to be summarised in a single word, that word will define its use, be it hospital, residence, school, office, factory, temple, or theatre. There is a particular intensity to the use of hospital facilities. Symbolic value, as well as traditions or conventions, provide strong cues for the forms many buildings will take. However, in the case of modern hospital design, practical needs and functionality are the foremost drivers.

Over the past few centuries, hospital design has, in some cases, glorified national and military identities; in others, it has represented religious communities’ charity and spiritual dedication. Today, the hospital is definitively the province of modern medicine. Neither modernist machine nor renaissance era landmark, today’s hospital is a living environment – one where clinicians, carers, technologies, and facility management, come together to provide round-the-clock service, seven days a week, to high numbers of people endlessly passing through in a wide variety of states of vulnerability and physical dependency.

A ‘humanizing’ approach

Healthcare management today places a lot of emphasis on increasing patient and staff satisfaction as well as cost savings. Architectural design will best serve organizational efficacy if designers widen and humanize the definition of functionalism, and deliberately design for 14 Canadian Healthcare Facilities

better patient health outcomes and staff productivity, based on reliable information.

Progressing towards the experiential

The way we define uses in healthcare environments, or describe the purpose of a planned space, has progressed from the mechanistic toward the experiential. The trend dates back to post-war calls for more humane health services, and later calls for more humane health environments, as well as the 1980s’ calls for a therapeutic, uplifting, and supportive healthcare environment. Now, the evidence-based design approach demands that we justify investments in design features with scientific rigour. Ironically, Modern Rationalism’s moral dilemma with regard to beautification of hospital buildings is resolved in an entirely rational manner.

Furthermore, the 1980s and 1990s’ marketing-inspired investments in hospitality-style healthcare facility architecture can no longer be justified. Hospitals are no more “five-star hotels” than they are factories housing production lines of diagnostic procedures and surgical interventions. The hospital is utterly unique in the nature of its use, in its complexity, and in its delicacy.

Goals, principles, ideas, and conflicting requirements

The hospital design process is complex, and frequently quite lengthy. The number of people involved, and the months and years that pass until the completion of the project, pose a challenge to the realization of project objectives. In order to communicate and explain those overarching goals, key stakeholders may set out goals and guiding principles.

Here, guiding principles are understood as means to achieve the organization’s goals. They may include statements such as, “We shall provide patient and family-centred care”, or “We shall balance clinical care, research, and education”.

Guiding principles for a facility project may include

phrases such as “support a culture of safety”, “sustainable architecture”, or “encourage multidisciplinary teamwork”.

The design brief is likely to list both quantitative and qualitative requirements. It will support a clinical services plan; it will suit a budget and chosen site. It will need to respect its regulatory environment (codes and standards). In addition, it may list desirable features such as prioritizing access to v iews of nature, prov iding patients w ith environmental controls, or designing for adaptability.

Extraordinary effort will be expended in conciliating between the many, and often – conflicting, requirements of the client and clinical staff, as well as those of regulatory bodies, design standards, and guidelines. When personal views come into play – and they will – clear communication is vital. Challenge can be taken as an opportunity not to despair, but rather to innovate.

Subjectivity versus objectivity

A bid for objectivity may be made. However, it will more than likely come up against the inherent subjectivity of the design process. At every juncture, choices are made; at some, options are deliberately tabled for a debate.

When examining aspects of a design that cannot be compared via objective, similar measurement, subjective assessments are made. It is here that designs will be v i e w e d t h ro u g h t h e p r i s m o f c u l t u r a l , a e s t h e t i c , functional, environmental, human, organizational, and business values. These values w ill affect choice of direction, and guide the design process, whether or not the team is consciously applying them.

Values, therefore, lead to the selection of a preferred solution when objective measurement is not possible. This article proposes that shared or deliberately agreed values can be utilized as moderators when difficult choices arise.

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Considering sleep

A literature rev iew 4 leads to the conclusion that it is in the nature of m a j o r i n j u r y, s u r g e r y, a n d hospitalization, to adversely affect sleep. Furthermore, it indicates that re-establishing one’s circadian rhythm may actually be a relevant part of the healing process. The evidence suggests that when hospital inpatients sleep better, they are less susceptible to infection, nosocomial or otherwise.

Pain, deficient wound healing, and tumour grow th, have all been associated with poor sleep. Psychological wel l-being and gener al physical disposition benefit from good sleep, as does patient satisfaction. Therefore, it is clear that, according to our knowledge today, the value of sleep to hospital inpatients is very high.

Having established and accepted inpatients’ night-time sleep duration and quality as a moderating value for design, deliberate choices can be made in order to favour sleep quality.

Moderating values for subjective decision-making

Architects, as a matter of course, deal in diverse metrics, concurrently. They are obliged to deal in complex multidimensional problems. Therefore a degree of subjectivity, and creative resolution, is inherent to the architectural design process.5 This is not to say that design is primarily subjective. Architects do, of course, deal in many aspects of design that can be, and are, separately examined and minutely detailed. This is a practical necessity; however a purely analytical, systematic approach does not lend itself to architectural design.

On the other hand, healthcare design is a group effort requiring excellent communication between all contributors.

To many of those, creative resolution is anathema. The analytical thought process is intrinsic to most healthcare designers’ interlocutors’ training in sciences, including the applied sciences, such as medicine.

When differences arise, one would prefer to see this challenging energy channelled into a creative force.

Successful innovation should be possible provided that there is clarity 16 Canadian Healthcare Facilities

as to how designs and specifications are to be appraised. With a plethora of non-architects undertaking subjective architectural evaluation in decisionmaking roles within the design process, as well as objective detail contributions that will affect the whole, a methodology for moderating between elements that cannot be submitted to comparable measure would help to improve design resolution.

A set of joint values

A set of jointly owned or explicitly agreed values would allow members of a team to approach new information in a relatively consistent and harmonious fashion. Debate is not eliminated; values cannot be deployed one at a time; they constantly affect one another, systemically. In addition, values themselves colour our understanding of system relationships and fundamentals within that whole.

Holistic, systemic appr aisals are re quire d b e cause p e ople do not experience aspects of their environment as separate phenomena.

It is necessary to understand how parts of the environment affect one another. The way in which aspects and qualit ies of space and for m are integrated creates a whole system that is something greater than the sum of its parts.

Franklin Becker, who has written on the matter for many years, has lately coined the ter m ‘Org anizational e co l o g y ’ i n co n ce p t u a l i z i n g t h e wor kplace as a system in which physical design factors both shape and are shaped by work processes.

Evidence-base criteria should apply twice: ideally, evidence-based criteria will indicate the relative importance of a particular type of use. Thus, clinicians and architects may reach a mutual understanding with regards to use-values. These can then be used to moderate debates arising in the design p r o c e s s . Ev i d e n c e - b a s e d d e s i g n literature conveys the knowledge as to the env ironmental features or characteristics that can best contribute to that use. High-value uses can be deceptively prosaic, such as sleeping or walking.

The preceding article is reprinted from Health Estate, October 2013, the journal of the Institute of Healthcare Engineering and Estate Management. For more, visit www. healthestatejournal.com.

ABOUT THE AUTHOR Maria Regina Clemesha Kennedy Regina Kennedy is an architect and urbanist with a Master’s degree in healthcare facility planning and design. Her background includes almost 20 years’ licensed practice in Ireland and Brazil. The past 14 years of her career have been dedicated healthcare design, including a period of five years spent primarily in research. A former professor of architecture to students of healthcare facility management, her interest in the design of therapeutic or salutogenic environment dates back to the late 1990s.

Currently a programme manager at Hamad Medical Corporation, ‘the state of Qatar’s premier non-profit healthcare provider’, her activities at HMC include brief development and procurement of planning and design services. She will now be managing outsourced design contracts for a number of new build and refurbishment projects.

1 Evans, G. W. Environmental Stress and Health. In BAUM, Andrew et al. Handbook of Health Psychology, London, 2001; Lawrence Earlebaum Associates.

2 Clemesha, M.R. A Nova Imagem do Hospital, subsídios e diretrizes para o projeto arquitetônico, Dissertation, 2003.FAUUSP, São Paulo.

3 Ulrich R. S., Zimring C., Zhu X et al. A review of the research literature on evidence-based healthcare design.

Health Environments Research and Design Journal, 1(3), 61-125. (www.herdjournal.com) 4 Kennedy M. R. C. Sleep as a moderating value in healthcare design. Health Environments Research & Design Journal, 2012; 6(1), 123-143.12123-.

5 Lawson, B, Dorst K. Design expertise, 2009. Oxford, United Kingdom: Architectural Press.

6 Becker,F. Nursing unit design and communication patterns: What is “real” work,” Health Environments Research & Design Journal, 2007; 1(1), 58-62.

Figure 1 – Use of a facility seen as a whole body experience.

Leonardo Da Vinci’s ‘The Vitruvian Man’ (1490) downloaded from: http://wallpaperweb.org/wallpaper/ miscellaneous/da-vinci-vitruve-luc-viatour_30465.htm

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Healing Garden Flourishes at Edmonton’s Cross Cancer Institute

An update on CCI's natural healing installation

By Susan Carr

It's been a year since the Healing Garden at Edmonton’s Cross Cancer Institute (CCI) was first reported in Canadian Healthcare Facilities in its winter 2012/13 edition. Following that report, this unique legacy project was officially opened by the Honourable Fred Horne, Minister of Health, and Mayor Stephen Mandel on September 17, 2013.

Built with donated funds to commemorate the 50th Anniversary of the Cross Cancer Institute Volunteer Association, The Healing Garden was conceived by volunteers—many who either have had cancer or have been affected by cancer—for cancer patients and their families, visitors, and staff to enhance their experience at the cancer care within the Cross Cancer Institute.

The Project Design Team transformed a mundane space flanked by a parking lot, an ambulance bay, and driveways into a pleasant, barrier free garden complete with a pergola, ergonomic seating, a feature wall, coloured concrete paving, and planting beds; all artfully arranged into a symphony of lines, curves, circles, planes, and forms.

To enhance the Healing Garden, a stainless steel commemorative monument artwork was commissioned by the Volunteer Association to recognize their Project Partners and the 50 years’ service of the Volunteer Association.

Thanks to the efforts of volunteers, staff, and the Project Design Team, the Healing Garden has become a natural monument to health and rejuvenation for everyone at CCI. 18 Canadian Healthcare Facilities

Project Partners Cross Cancer Institute Volunteer Association Alberta Cancer Foundation Delnor Construction Ltd., subcontractors and suppliers Project Team Prime Consultant: HFKS Architects Ltd. Landscaper Architect: EDA Collaborative Inc. Structural Engineering: BPTEC â&#x20AC;&#x201C; DNW Engineering Ltd. Electrical Engineering: Hemisphere Engineering Inc. Cost Consultant: BTY Group Site Survey: Hagen Surveys (1982) Ltd. Geotechnical Investigations & Materials Testing: P. Machibroda Engineering Ltd. Project Management Alberta Health Services Capital Management Edmonton Zone Project Management

Susan Carr BA, is chair of the 50th Anniversary Committee, Cross Cancer Institute Volunteer Association.

Photos for this piece were provided by Bernard Tong, AAA MAPM (UK) Project Manager, Alberta Health Services.

Winter/Hiver 2014 19 Untitled-3 1

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Spotlight on Canadian Healthcare Projects A snapshot of industry developments

From Saskatoon to Nova Scotia, Canada's healthcare system is teeming with new construction, renovations, and redevelopments. And while many of these projects have been featured in the pages of Canadian Healthcare Facilities, there are also plenty more stories to tell. Here are just a few on our radar...

Aberdeen Hospital's Emergency Department and Pharmacy Redevelopment

In summer 2012, the Nova Scotia Government and the NS Department of Health and Wellness (DHW) announced the start of construction of a new emergency department (ED) and the redevelopment of the pharmacy at the Aberdeen Hospital in New Glasgow, NS. Both programs were identified in a facility role study as having issues that required immediate attention. This project will see the construction of a new addition that will house a modern ED that will act as a trauma centre hub for the surrounding area.

20 Canadian Healthcare Facilities

Typical Chem-­‐Aqua Copper-­‐Silver System installation in a hospital

Once emptied, the current location of the ED will be redeveloped into a modern pharmacy. These two projects will provide modern life saving services to the area as well as become a centre for clinical pharmacy services.

Chem-Aqua's P3 success

Chem-Aqua, a Nor th American prov ider of water treatment solutions, is setting the stage for an international P3 success thanks to its participation in the King Edward VII Memorial Hospital (KEMH) in Bermuda.

The estimated $260 million project is being handled by Paget Health Services (PHS) for Bermuda Hospitals Board and delivered through a design, build, finance, and maintain (DBFM) model. It will include renovations to extend the existing facility’s life to 2029 and keep the existing facility in operation day and night while the structure is upgraded. The project will also see the construction of a new facility which will connect to the existing hospital and house various acute care services, including 90 single-patient rooms, a new emergency department, diagnostic imaging, and ambulatory care services including oncology, same-day surgery and dialysis, and a central utility plant.

In preparation for the project, Chem-Aqua’s engineering and new construction teams, together with Black & McDonald, developed a complete water treatment package including equipment for water pre-treatment and chemical treatment, pre-operational and treatment chemical

products, as well as an FM package for monitoring and maintaining water treatment services.

The company looks forward to incorporating a “Total Systems” approach to KEMH's facility and applying their experience and expertise to future P3 projects in the Canadian market.

Five Hills Health Region's New Hospital

The Five Hills Health Region (FHHR) has star ted construction on a new regional hospital to enhance healthcare service and delivery in Saskatchewan. Slated to open in December 2014, the new facility is currently being developed over 30 acres on Diefenbaker Drive in Moose Jaw, Saskatchewan by a team comprised of Stantec Architecture, Devenney Group Architects, Graham Construction, The Boldt Company, and Black & McDonald.

Five Hills Health Region's new regional hospital gets underway in Saskatchewan

Fall/automne 2013 21

Hawkesbury & District General Hospital redevelopment to include renovations and new construction

The project will utilize Canada's first Integrated Lean Project Delivery (ILPD) approach― a construction model that engages architects, engineers, general contractors, key trade contractors and owners early in the process so as to maximize value to the owner. Regarding design, the facility is being constructed to foster multidisciplinary integrated team care, aka “cellular care”. As such, the hospital will be organized into different clinical zones, including the Universal Care Unit, which will provide standard care environments and allow healthcare professionals to visit patients in their rooms, rather than requiring them to come to them; the Fixed-Technology Zone, an area housing major procedural processes; the Inpatient Unit Platform, a zone for overnight and longer-stay patients that will include space areas for family and providers; and the collaborative care unit, a zone that will accommodate same-day outpatients needing phlebotomy, dialysis, patient education, and related therapies.

Looking ahead, the hospital will also acommodate the future needs and population of the region, thanks to the intigration of demographic population modeling and forecasting in its overall design.

“The innovative and collaborative approach used on this project will ensure a better health care experience for patients and their families,” said Don McMorris, Saskatchewan's former Minister of Health at the official announcement of the project.

proposal seeking a construction firm to aid it in an expansion and redevelopment project.

The project will see the Ontario hospital outfitted with a new features and renovations. New construction will include a consolidated ambulatory care centre featuring specialty clinics, hemodialysis, cardiology services, and medical day care; an expanded complex continuing care unit; a new perioperative department; an expansion of emergency services; and additional acute care inpatient beds.

In addition to new construction, the Hawkesbury & District General Hospital project will include a number of renovations to the existing hospital. These include a new mental health in-patient unit, an expanded medicalsurgical unit, expanded diagnostic services, and new operating room.

At time of print, six companies have been shortlisted for the project following a request for qualifications in May 2013.

“With the issuance of the [request for proposal], HGH has completed a lengthy and complex planning cycle. We have successfully reached this critical milestone by working diligently with our partners, Infrastructure Ontario and the Ministry of Health,” said Sébastien Racine, Chairman of the Board of the Hospital, adding, “The redevelopment of the hospital will allow us to meet the growing needs of the community and offer cost-effective care.”

Hawkesbury & District General Hospital's Expansion

Institut Philippe-Pinel's Energy Retrofit

Big changes are coming to the Hawkesbury & District General Hospital (HGH). In winter 2013, the facility teamed with Infrastructure Ontario to release a request for

Since its foundation in 1970, the Institut Philippe-Pinel has been a staple of Montreal's healthcare system. Located on the eastern tip of Montreal, Quebec the Institute houses

22 Canadian Healthcare Facilities

292 beds and offers a complete range of specialized services to treat and rehabilitate psychiatric patients. Its stewardship in mental health services – particularly in the field of forensic psychiatry – has garnered the facility and its staff international acclaim.

In a move to keep the institute thriving into the future, Trane paired with hospital staff to implement a $1.8 million energy retrofit. The project included a heating plant retrofit, the optimization of its chilled water distribution system, a building automation system recommissioning, and lighting upgrade. All combined, the project has imbued the institute with an annual energy savings of over $250,000, and is poised to increase those savings in 2014.

Since the project's implementation, Institut PhilippePinel has received numerous accolades for its ongoing energy-saving initiatives. Among them include a 2013 nomination for the "Prix Innovation" for its energy performance initiative, and a current nomination for the AQME's (Association québécoise pour la maîtrise de l'énergie) Best Energy Savings Project for Existing Buildings in the Institutional Sector.

Institute Philippe-Pinel's staff, patients, and visitors are set to benefit from the project in months and years ahead.

Markham Stouffville Hospital's renovation

2013 was a transformative year for the Markham Stouffville Hospital (MSH). In its continuing goal to meet the evolving growing needs of its growing community, MSH's staff and partners collaborated on the opening of renovated facility.

Institute Phillippe-Pinel undergoes $1.8M energy retrofit

Opened to the public on March 10, 2013, the new facility features 385,000 sq. ft. of additional space, doubling the previous space with a total size of 710,000 sq. ft. After the new building was opened, the hospital immediately began extensive renovations to its existing facility. When completed in August of 2014, the hospital will have a total of 309 inpatient beds. The renovated facility also sports cutting-edge automation system, high-efficiency plumbing and fixtures, a new reverse osmosis system, a green roof covering, and a host of other features which have contributed to the newly expanded area's LEED silver certification.

While the full benefits of MSH's new facility are still being tallied, staff look forward to continuing their energy savings and practices well into 2014. Already, the project has accrued numerous accoldates, including obtaining the Ontario Hospital Association's (OHA) Water Conservation Nomination, OHA's Energy Efficiency Nomination, and as first runner up in OHA's Green Hospital of the Year Nomination. In addition, Accreditation Canada awarded MSH with its Accreditation with Commendation award in September 2013.

Staff and patients are looking forward to continuing their energy savings winning streak well into the new year.

Markham Stouffville Hospital renovations to bring more benefits in 2014

Fall/automne 2013 23

reporting at least one HVAC issue, including too much heat, too little heat, stale air, etc. Capital Health is committed to becoming a better steward of the environment; and to that end, Siemens Canada undertook a facility-wide inspection of all mechanical systems and will be repairing all deficiencies and optimizing wherever possible.

Queens General Hospital's PHC centre and In-Patient Redevelopment

Nova Scotia Rehabilitation and Arthritis Centre receives HVAC upgrades

Nova Scotia Rehabilitation and Arthritis Centre's Recommissioning

Capital District Health Authority has commenced a recommissioning process for the Nova Scotia Rehabilitation and Arthritis Centre. An initial investigation was done in 2012 to identify opportunities and determine the scope of work, after which the project was approved and funded this fiscal year by the Department of Health and Wellness and is currently underway.

The main focus of the work is on calibrating and optimizing the facility's HVAC system to serve the functions of the Centre as they exist today. This work is expected to result in cost avoidance of approximately $115,000 per year in gas and electricity.

During the initial 2012 investigation, a number of issues which have had a profound effect on staff and patient comfort and energy performance were uncovered. Most areas of the building were Queens General Hospital redevelopment slated to open in spring 2014

24 Canadian Healthcare Facilities

Another new development is taking place in Nova Scotia. In construction since May 2010, the Nova Scotia Government and the NS Department of Health and Wellness (DHW) are overseeing the development of the Queens General Hospital Primary Health Care (PHC) and in-patient redevelopment. This need was identified for the community of Liverpool, Nova Scotia, and its surrounding area. The DHW worked with the South Shore District Heath Authority (SSDHA) and the local community to develop a master plan for the Queen's General Hospital which also identified a need to upgrade the current in-patient unit (IPU). This project saw the development of a new PHC centre as well as the redevelopment and expansion of the 22 bed IPU to current program standards.

Construction began in early 2012 and is slated to be complete in spring 2014. The PHC centre was developed as a multi-disciplinary team Collaborative Care Centre where local physicians can be collected in the hospital to work with other health professional and visiting health authority specialists. The IPU will see a dramatic improvement for the existing 22 beds with a mix of private and semipr ivate rooms. Two rooms w ill prov ide bariatric capability and two others will be airborne isolation rooms.

The local community and local donors were the major contributors to the support of this project; and all parties look forward to cutting the ribbon on the upgraded facility.

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CSA Standards Committees Forge Ahead in 2014

By Jeffrey Kraegel Last year was a busy year for the CSA committees developing standards for health care facilities, and as we enter 2014 there is more good work ahead. This work is being led by the Technical Committee on Health Care Facilities, and the CHES members on this committee and its subcommittees continue to play a vital role by bringing their accumulated decades of knowledge, experience, and expertise to the meeting table; and producing better standards as a result.

In 2013, CSA published Z8001 -- Commissioning of health care facilities. This standard builds on the general commissioning standard for buildings (CSA Z320) and adds the necessary health care-specific requirements to ensure that systems are in place and working to protect patient and staff safety. This standard replaces the old CSA Z318 commissioning standard, but why the number change? It was to bring this standard into its logical place in the Z8000 series. This series covers every phase in the life of a health care facility: from planning, design, and construction (Z8000); to commissioning (Z8001), operation, and maintenance (Z8002 currently under development).

The CHES members involved with the new Z8002 standard know it’s going to be an exciting addition to the standards portfolio. Z8002 – Operation and Maintenance of Health Care Facilities is designed to apply to facilities of any size and should be a useful tool not only for planning and organizing, but for making the case to health care facility management that O&M is a serious matter that can’t be treated as an afterthought or a “nice to have”. The safety of patients and staff depends on wellmanaged and well-maintained facilities, and that needs good planning and adequate resources—including trained personnel, stable operational funding, and periodic capital expenditures.

Draft Z8002 was posted on the CSA website (www.csagroup. org) for a 60-day public review in April 2013, where it generated about 300 comments and suggestions. The committee reviewed the comments in August (after a delay caused by the Calgary floods in June), and the standard is due for publication in spring 2014.

This year, the CSA subcommittee on HVAC expects to complete the new edition of CSA Z317.2 – Special requirements for heating, ventilation, and air conditioning in health care facilities. In developing this edition, the subcommittee has been looking at the changing face of healthcare-- particularly, the increasing number of medical procedures taking place outside of traditional hospitals--and making the necessary adaptations to keep the standard current. Most of that development work has been done and current plans are for the draft to be posted for its 60-day public review in January. After that, it will go through the necessary comment resolution, reviews, and editing; and the HVAC subcommittee hopes to have it ready for a vote in the summer, with completion around December 2014.

26 Canadian Healthcare Facilities

Work will also continue in the CSA subcommittees on new editions of the CSA standards on plumbing, waste management, illumination, and area measurement in health care facilities. All of these projects are in the early stages, and the focus is on building the committees and identifying the major areas that need to be developed in the new editions.

In addition to its regular work, the Technical Committee on Health Care Facilities has taken on responsibility for the CSA standard on patient lifting devices, CAN/CSA Z10535—Hoists for the transfer of disabled persons – Requirements and test methods. The first meeting of the new committee on this topic is taking place in January.

An intriguing new area for the CSA health care facility committees is “wayfinding” in health care facilities. Everyone has likely found themselves occasionally lost or turned around in a hospital, and maybe even thinking at the time, “There’s got to be a better way.” While this standard is still in the planning stages, one thing is already clear: It won’t be just about signs. Wayfinding is a complex topic that combines many elements and disciplines, including architectural design, human factors, the use of colour, shapes, and landmarks, electronic aids, and human assistance (for example a reception desk) where needed. The committee is just being formed for this work, but it’s certain to be an interesting process to develop this new standard.

Last, and certainly not least, work is expected to begin this year on the next edition of Z8000-- Canadian health care facilities.

The first edition, published in 2010, has been well received, but like any standard, it has to be updated periodically to stay current.

CSA and the Technical Committee have received a number of questions and suggestions from users; and as well over the past two years the CSA committee chairs have been meeting periodically with provincial and territorial regulators and capital planners to find out how Z8000 is working for them and what they would like to see improved.

The CSA committees working on health care facility standards are made up of people from all types of disciplines and all types of organizations. They include engineers, architects, designers, manufacturers, infection prevention and control personnel, regulators, medical staff, and contractors.

These are real-world professionals and they know that changes in health care are inevitable. Their challenge, which they take on at every meeting, is to find ways to anticipate and respond to changes while maintaining their unwavering commitment to patient and staff safety.

Jeffrey Kraegel is Project Manager for Health Care and Community safety with CSA Group. He can be contacted at jeffrey.kraegel@ csagroup.org.

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Flying High at Regina General Hospital New heliport saves time for critically ill patients

By Jenna Webb

28 Canadian Healthcare Facilities

R e s i d e n t s o f s o u t h e r n S a s k a tc h e w a n a re n ow benefitting from the first rooftop heliport in the province, saving precious minutes transporting critically ill patients to hospital.

In partnership with the Ministry of Health and the Shock Trauma Air Rescue Society (STARS), the Regina Qu’Appelle Health Region began construction on the $3.4 million project in May 2013, and it was completed in November.

Staff were then trained to maintain and secure the helipad area, coordinate landings and patient transfers, and ensure safe operation of a federally-regulated aircraft landing site.

The heliport became fully operational in mid-December 2013 and is estimated to save about 15 minutes of critical time for patients, versus ground ambulance transport from the airport.

The project itself was very unique compared to the typical hospital renovation. Heliport consultants with experience in other provinces were engaged to assist in this challeng ing project and ensure Transpor t Canada regulations would be met. Analysis of the site soon determined that building on the sixth floor roof of the Regina General Hospital (RGH), which is located in the heart of Regina’s downtown, was the best solution.

Adding a rooftop heliport came with its own unique challenges—particularly since it was added afterwards, whereas most heliports today are constructed at the same time as the rest of the building.

“Building so high up required extra considerations, such as cranes and equipment to pump concrete all the way up there, lifting steel that high; and of course the impact that the project had on the hospital during the summer months,” said Barry Rorbeck, Executive Director of Facilities Management with the Regina Qu’Appelle Health Region. “We were also working with an open roof over an occupied floor, and it rained a lot this summer.”

“That being said, we were able to provide a good design solution, and once we confirmed that the existing structure was sufficient to support the added weight, we were able to upgrade and utilize existing elevators that already went to the roof,” Rorbeck adding, noting, “We had a very capable contractor, PCL Construction Management, who finished the project on time and on budget” STARS, which has been operating in Saskatchewan since the spring of 2012, estimates flying about one mission a day from its Regina base. Those patients will be flown to Winter/Hiver 2014 29

the RGH, which is the dedicated re ce iv i n g h o s p i t a l f o r s o u t h e r n Saskatchewan. “In the setting of trauma, it is estimated that for every 11 patients that STARS transports by air and save time, we save a life,” said Dr. Terry Ross, STARS medical director and transport physician. “As an ER doctor, there are few things in medicine where I can tell you that every time I do something 11 times, I save a life.”

Ross adds that being able to bring critical care skills to the patients in a flying intensive care unit, and then h av i n g i m m e d i a te a cce s s to t h e hospital and care teams at the General Hospital, is an important part of that equation.

Jenna Webb is with the Regina Qu'Appelle Health Region.

“Adding a rooftop heliport came with its own challenges, particularly since it was added afterwards.”

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