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On May 4, 2016 Centers for Medicare & Medicaid Services (CMS) published the final rule implementing the 2012 Edition of the National Fire Protection Association (NFPA) 101 Life Safety Code and the 2012 Edition of NFPA 99 Health Care Facilities Code. The new guidelines apply to hospitals, long term care facilities, critical access hospitals, inpatient hospice facilities, and ambulatory surgery centers among others. The final rule requires facilities comply with the new rules within 60 days from when the rule is published, or July 5, 2016. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Health Facilities Accreditation Program (HFAP) have both indicated that they will survey to the new standards as of July 5, 2016.

Now is the time to verify compliance and update your compliance documents, manuals and plans, before your next survey.

A highlight of some of the many changes between the previous 2000 Edition and the 2012 Edition of the LSC are as follows:

Referenced Codes
Several codes that are in effect by reference are updated as well, those include:
• 2010 NFPA 10 – Portable Fire Extinguishers
• 2010 NFPA 13 – Installation Sprinkler Systems
• 2011 NFPA 25 – Sprinkler System Maintenance
• 2010 NFPA 72 – National Fire Alarm and Signaling
• 2010 NFPA 80 – Fire Doors
• 2011 NFPA 96 ‐ Kitchen Hood Systems
• 2012 NFPA 99 – Health Care Facilities
• 2010 NFPA 110 – Emergency Power
• 2009 NFPA 241 – Safeguards During Construction

Waivers
All categorical waivers go away – they are now part of the 2012 LSC.

Corridors
Projections into the 8’ and 6’ corridor widths in hospitals are allowed in certain conditions such as:
• Non-continuous projections not more than 6 inches (150 mm) from the corridor wall, positioned not less than 38 inches (965 mm) above the floor, shall be permitted.
• Projections into the required width shall be permitted for wheeled equipment, provided that some additional requirements are met.

Suites
The Suites section is completely reorganized and better explained.

Cooking
Within a smoke compartment, where residential or commercial cooking equipment is used to prepare meals for 30 or fewer persons, one cooking facility shall be permitted to be open to the corridor, provided that several additional requirements are met. This allowance is geared towards Long Term Care Facilities.

Alcohol Based Hand Rub Dispensers (ABHRD)
Very specific requirements now address the location, capacity, type, separation, quantity, placement and operation of dispensers and storage of the ABHRD sanitizing liquid.

Doors
Nonrated factory ‐ or field ‐applied protective plates, unlimited in height, are now permitted on Corridor and Smoke Barrier Doors.

Fire Safety Plan
A written health care occupancy fire safety plan shall provide for several factors in the event of a fire.

Draperies and Curtains
New, specific requirements are put in place for draperies and curtains including area and coverage.

Recycling Containers
Specific requirements and exemptions are in place for clean waste recycling containers including size, volume and placement.

Combustible Decorations
Requirements are established for the amount, type, quantity and location of combustible decorations, including artwork.

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The world of healthcare is like many other industries: It requires trial and error before deriving the best solution! By applying strategies often used in the design of other building types, healthcare designers are making advancements. If students and office workers perform better when interior spaces are bathed in natural light, then improved behaviors might also be observed in healthcare patients under similar conditions. Many have postulated that this might be the case and we continue to see the results play-out in hospitals.

Let’s explore this further as we look at examples where these design strategies have been implemented with remarkable results:

The University Medical Center of Princeton located in Plainsboro, New Jersey is a great illustration where creative, collaborative and corroborative techniques were applied to the new $ 500+ Million, 636,000 SF hospital. This modern medical manor focused its innovative and collaborative efforts on the most basic and core component of any hospital: The Patient Room. And with good reason, as hospital-acquired preventable adverse events still occur in the United States far too often.

So, what was improved?  For starters, all patient rooms were designed for single occupancy.   The following are benefits of private in-patient rooms:

  • Patients are more likely to sleep better
  • Patients communicate more transparently with physicians
  • Patients are less stressed and stress can inhibit healing
  • Family members are more likely to surround and comfort their ailing loved one
  • Statistics indicate that family support helps the ill and injured heal more quickly

 

Many medical professionals now view family members as part of the “healing team”.  They not only provide moral support and psychological stimulus, but they can physically assist the patient with bathroom visits and other in-patient tasks.

In addition, the patient rooms were all made same-handed.  This means regardless of which patient the doctors and nurses are tending to, the bed, sink, medical gas, and other important features will be oriented in an identical manner. Having everything in the same location from room to room demonstrate-ably prevents medical errors.   Other valuable improvements include:

  • Shortening the distance between the bed and bathroom
  • Placing a bed-side hand-rail near the bathroom entrance
  • Adding a double-door pharmaceutical lock box for convenient and secure storage of drugs while being less disruptive to the patient; and finally,
  • Placing a large window in each room

 

The large window provides natural light and views of beautiful landscapes.  Sunlight and serene vistas have a calming-effect that further enhance the healing environment.  All of these features were built into the rooms for the new hospital, but it all started with a collaborative design effort in a mocked-up patient room.

Medical staff were engaged in the design process for a new and improved patient room. In the old hospital, a room was set aside as a model, an example of what the new hospital patient rooms might eventually become. With guidance from the design team, nurses and doctors moved post-it notes around the room until they agreed that the floor plan, orientation and major design features, were to their liking. This process occurred very early in the design process (2009-2010), years before the hospital opened its doors (May-2012) to receive its first patient. This method of bringing key stake-holders into the design process is very helpful. This process is a 2P Event (Preparation/Process). Borrowed from the manufacturing world where Lean design has its roots, it requires a substantial investment of time from doctors, nurses and hospital administrators along with the design team. The results have been very positive! Nearly everyone involved with the Princeton University Hospital project believes the effort required to “get it right” was well worth it.

Is the finished project a reflection of perfection? No, it still has its flaws (e.g. head board and controls need improvement), but the results are overwhelmingly positive. Ratings of patient satisfaction are in the 99th percentile, up from the 61st percentile before the move to the new hospital. Infection rates and the number of accidents have never been lower. Improving healthcare is an ongoing process. Yet it is highly motivating to see positive results from a project such as this.

Other References:
BioMed Search.com: Creating a Healing Environment
Harvard Business Review: Better Healing from Better Hospital Design
ExtraWise: Designing for the Healing Environment

Lean principles have been applied to the manufacturing process for decades. In fact, the idea of eliminating waste and wasted effort is rooted in manufacturing. The concepts are applicable to many types of processes, yet only within the last 10 years have they begun to gain traction in the design process for healthcare facilities. You may have heard the jargon: 2P/3P, Kaizen, spaghetti charts, value stream mapping, and flow production. But what really happens when they are applied? More importantly, how is the design process improved and what are the benefits to the patient and caregivers?

To find these answers and more, please take a look at this article.

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As a philosophy rooted in manufacturing, Lean has its most direct applications in high-volume, repetitive operations, like pharmacy, lab, and materials handling.

However, it would be wrong to assume that only back-of-the-house functions can be improved by applying Lean values. The key precepts of standardization—maximizing value, minimizing waste, pull scheduling and using triggers to stimulate flow—are relevant for every aspect of patient care.

Over the past few years, MSKTD has been applying Lean principles as it designs healthcare facilities. A client recently asked us to redesign the surgery department for their hospital. Like many of the hospitals we work with, the core of the facility was old.  The surgery department and other areas within the facility had been expanded by simply adding onto the original design without fully considering how the additions would impact the flow and efficiency of the surgeons, doctors and nurses.  The current surgery layout was inefficient and needed a major overhaul.  The hospital, with input from MSKTD, was motivated to develop a more efficient layout for the entire surgery department knowing that it would improve the care they give to each patient.

With the hospital’s cooperation, MSKTD engaged in a 4-day 2P design process. The time spent with doctors, nurses, clinicians and administrators was extensive and a major commitment of time. The investment produced so many benefits, including:

 The most efficient layout for improved flow of personnel and materials

 Every participant’s perspective was given strong consideration and implemented into the final design

 “Voice of the customer” has been heard

 Stream-lined design process, resulting in user group input and a 95% complete schematic design

100% buy-in by the hospital staff, limiting/eliminating changes in design at later stages of the process

Upon the conclusion of the week-long 2P Event, members of the team were excited.


 

“WOW! The 2P Process is a valuable tool that will forever help with construction projects in the future. The relationship and team building between the user group and design team helps pave the way for a successful project.”

Andy Raih
Director of Operations
IU Health Ball Memorial Hospital


We at MSKTD are excited about putting these Lean principles to work for all of our healthcare clients – perhaps for you and your next project?  Give us a call to find out more!