Anyone who has tackled a home remodel knows how nerve-wracking and temper-igniting it can be. At the same time, it’s impossible to avoid renovations if you stay in your space for a long time. But, remodels and renovations don’t have to be a disaster, nor do they require physicians to close their doors.
Here are some useful tips and advice for executing a pain-free working remodel:
1. Make sure all parties are on the same page.
It’s crucial that the medical office staff, the architect and the construction crew are aware of what needs to be done, how it will be done and the work schedule. Appoint one staff person as the point person for communicating with the construction crew and architect, but hold a pre-construction meeting at least one month before any work begins in order to unearth scheduling conflicts and other potential problems. Then, hold weekly meetings among the relevant parties to discuss updates and concerns.
“In the most successful projects I’ve been involved in, from the beginning it’s been a partnership in every sense of the word,” says John Duggan, director of real estate and retail subsidiaries for Fallon Clinic, a large multi-specialty group practice of 26 clinics throughout Central Massachusetts. “No partnership should be totally driven by the [remodelers] or the users—they need each other in order to get the project done successfully.”
To make sure everyone is speaking the same language, it helps to have a contractor with experience working in a clinical space, Duggan adds. And a printed schedule that clearly delineates which areas will be worked on when should be circulated to all parties involved.
2. Have an infection-control plan in place.
Infection control is the number-one health concern in a remodel. Infection can occur when construction workers are careless about keeping toxic agents such as asbestos, dust, bacteria or mold from becoming airborne during the construction process. These agents can travel from the construction site to patient and staff areas and cause illness, particularly in immuno-suppressed patients.
“Construction infection control should be overseen by an infection-control officer, a competent, trained, experienced professional who represents the construction company,” says Al Draper, director of LVI restoration at LVI Services, an environmental and facilities services firm in Shawnee, OK.
While the construction company should have an individual who is well versed in infection-control procedures and certified by ASHE (American Society of Healthcare Engineers; www.ashe.org), it is the responsibility of each healthcare facility under JCAHO (Joint Commission of Accreditation of Healthcare Organizations; www.jointcommission.org) to have an infection-control officer, Draper says.
“This officer is commonly a nurse who has specific training in infection control and who has read and understands JCAHO’s requirements regarding infection control during construction activities,” Draper elaborates. “JCAHO accredits and certifies more than 18,000 healthcare organizations that strive to meet certain medical performance standards.”
The main aspects of infection control include:
- establishing anterooms with double doors that separate the construction area from the non-construction area and serve as a place for workers to change out of contaminated clothing before entering the patient area;
- using negative pressure units and machines that keep the contaminated air within the construction zone;
- establishing separate entry/exit points for construction workers in order to prevent contamination;
- establishing a shutdown of access between construction areas and patient areas via locked doors, temporary walls, fencing or tenting;
- and treating HVAC and plumbing systems via filters or shutdowns if necessary.
Depending on the specifics of the remodel, such procedures could cost 10 to 20% more than standard construction costs. However, the reduction in medical-acquired infections and resultant liability is well worth the additional cost.
“It always costs more to really do it right, and one should not spare the additional costs when patient health and lives may be at stake,” Draper says.
Here are two examples of what could have been horror stories if proper procedures hadn’t been in place: During an LVI renovation/remodel of a modern labor and delivery facility in the Midwest, the demolished wall cavities revealed severe, black, myotoxin-producing mold, which is considered extremely toxic to newborns and immuno-compromised individuals in particular. In another LVI case, pools of mercury (from mounted blood-pressure monometers) were found in the wall cavity of an old healthcare facility. In both cases, because proper infection-control procedures had been taken and workers adequately trained, the hazards were eliminated.
Infection control is also an issue with water systems and, if construction air is being filtered outdoors, with outdoor fountains. “Fountains are often recirculating systems, and there are concerns that these waters are being treated to an acceptable level,” says Brian Ott, managing principal at TBG Partners in Austin, Texas, which supplies architectural services for healthcare renovation projects.
Also, a charcoal filter media in the ventilation system is recommended in order to prevent airborne construction contaminants from entering the rest of the building, as well as for filtering out unpleasant odors from gas-powered saws and dirt-grading tractors, adds Billy Brockenbrough, manager of field operations for Limbach Facility Services, a Pittsburgh,Pa.-based mechanical-engineering firm that does energy-related building retrofitting for hospitals across the country.
3. Plan for all possible disruptions to patients and staff.
Think of anything that might be a nuisance during construction and decide how it will be addressed. Then make sure everyone involved (staff, construction crew, delivery service) is aware of the rules in place, either via meeting, memo or signage.
“It should be discussed where contractors are allowed to park, where they can put their equipment trailer and the equipment itself, points of egress—are they allowed to walk in through the main lobby or can they come in through a side door?” says Draper. “Does the contractor have to bring his own Porta Potties, or are there certain facilities they can use that won’t interfere with patients?”
Try to have the contractor cluster noisy activities such as electric sawing, chopping and hammering so they are done either all at once or at the least disruptive time of day (possibly lunch hour), after hours or on weekends if possible. Visual disruption can be solved with temporary fencing or walls, which can also cut down on the noise.
If patients need to be re-routed around construction, make sure you have clear signage that explains where they should and should not go. “It’s really astonishing how people who are accustomed to walking a certain route will walk around and through all sorts of stuff—even through sealed polyethylene barriers—to get where they want to go,” says Duggan. “A combination of on-site signage and communication with the other people in the building is important.”
4. Have a security plan that includes the remodeled area.
Security should not have to be compromised during a remodel. Brockenbrough says, “Leave some kind of lockable entry into the facility. In addition, if there are any partitions between the construction area and the existing building, you’ll want to keep that locked.” Building temporary lockable doors is one option for limiting access to any part of the facility.
You’ll also want to address security issues regarding any prescription drugs and medical equipment in your office. Reputable construction companies minimize the risk of theft by doing thorough background checks on their employees for safety and security reasons, according to Brockenbrough. At his firm, each worker is issued a special badge so it’s easy to identify who’s who on the job site.
And Draper recommends checking with your landlord to find out if any additional security can be provided by the building or subcontracted out during the remodel. It couldn’t hurt to check with your property insurance company to see what measures they recommend as well.
5. Keep it clean.
Make sure the construction company has methods in place for keeping the work area clean and neat, especially during office hours. While construction is a dusty, dirty job, renovators can shield patients from the messiest sights by using tarps, tents and temporary fencing and walls. They should also clean up at the end of the day, not leave any equipment or tools lying around and cover anything that might be considered unsightly.
“There’s going to be distraction and disruption, but it has to go on,” says Ott. “It’s somewhat of a housekeeping issue as well, so that the tenants and doctors in the building aren’t being inconvenienced. The sound, sight and work environment should be clean and not disrupt daily life.”
Carrie Rossenfeld is a California-based writer.
