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Maintaining the house while the house is in repair

Radiology Administrator's Compliance and Reimbursement Insider, January 1, 2008

Some keys to keep a radiology department functioning in the midst of renovation

It is a well-known fact: The healthcare industry is as competitive as ever. With competition comes the need to build and expand. Healthcare construction is projected to top $45 billion this year, up from $11.6 billion from 10 years ago, according to a report on cnnmoney.com.

Radiology departments are certainly a big part of those renovations, says Mike Clark, AIA, design director for H&H Systems and Design, Inc., in New Albany, IN.

“They’re renovating radiology departments because of things like HIPAA and new competition with outpatient centers,” Clark says. “Those things are forcing them to become more patient-friendly. A lot of these facilities were built 20 years ago and were not very patient-friendly.”

So how does a radiology department cope with renovations when noise, dust, and power outages can be as common as CT scans and mammograms?

Talk, prepare

It boils down to communication and preparation, say those in the field. It is also important to instill the belief that the renovation will ultimately pay off for the hospital. For example, The Center for Health Design conducted a study based on a hypothetical facility that would lose $12 million to construction of a regional hospital. But the facility would get that back in just one year from “operational improvements such as fewer patient falls and reduced turnover among nurses,” cnnmoney.com reports.

“These projects can be very cumbersome,” says Frank Heinz, CEO of H&H Systems and Design, Inc. “Planning and scheduling are the obvious challenges to overcome.”

Clark says communication is key. A radiology department director must meet daily with the contractor to discuss the work. “Quite honestly, every day, whoever is in charge of the construction project needs to touch base with whoever is in charge of the radiology department,” he says. “The radiology head also needs to let his staff know if there are going to be issues. To the best of everyone’s ability, they need to try to keep everyone as happy as possible.”

But happiness isn’t always easy. Some other disturbances can quickly make radiology department staff members restless, including:

Noise. This is the biggest problem, Clark says, “because it’s constant. As far as the real bad noise, it can usually be scheduled off-hours, but in a hospital, a lot of stuff is below you, and a lot of stuff is above you. And a lot of times a hospital is occupied 24 hours a day.” How can staff members cope? They need to know they have a person to go to who can address a noise problem, Clark says.

“Most contractors who work in a hospital know there are going to be times where you have to stop,” he says.

Clark also suggests providing a balance between disruption and schedule. The more disruption the hospital can endure, the sooner the disruption is over, he says.

Dust and dirt. Although infection control measures are in place, dirt is still tracked outside the project area, Clark says. The contractors will contain most of the dirt and dust, but the hospital maintenance staff needs to help as well. “If you see it, report it to the contractor,” he says. “The hospital needs to alert the housekeeping staff so [it] can put in a little extra effort.”

Utility disruptions. Perhaps the most harrowing prospect of hospital renovation is a power outage. When utilities are reworked, they cause outages in areas outside the project area, and temporary utilities need to be in place prior to shutdowns. This is particularly cumbersome to radiology departments.

“Identifying those areas or devices affected can be difficult due to incomplete or incorrect information,” Clark says. “Quite often, the hospital has added on to the utilities, and this information is not known until it is cut off. Hospital [staffs are] always notified of these utility shutdowns, but they also must check their areas to be sure all utilities are working, especially any life safety devices such as emergency power, medical gas, and emergency assist devices.”

Some other pitfalls for radiology departments to watch out for during renovations, says Clark, are:

The cost for a renovation project can be higher than new construction due to phasing and restrictions

Construction schedules can be longer than in shell spaces (space enclosed by an exterior building shell, but not finished inside) or new construction

Restrictions due to existing physical conditions can affect the final layouts of the space (ceiling structure height, column and utility locations, etc.)

Ultimately, a renovation can help a radiology crew keep up with the latest technological advancements and stay competitive. “The benefits in the end are better work flow and new equipment that can speed up procedures and provide better images,” says Heinz. “It’s a better work environment. Many departments have only been maintained. Fresh paint, flooring, and ceiling tiles can make a big difference in how the staff and patients feel about the procedures being performed.”

Insider sources

Mike Clark, AIA, design director for H&H Systems and Design, Inc., New Albany, IN 47150, 812/206-6147; mike.clark@hhsd.com, www.hhsd.com.

Frank Heinz, CEO of H&H Systems and Design, Inc., New Albany, IN 47150, 812/206-6190; frank.heinz@hhsd.com, www.hhsd.com.

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