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Unplanned shutdowns, reactive maintenance repairs, inefficient and unreliable equipment – all of these are challenges faced every day by many health care facilities across the country. Canada has numerous facilities with aging infrastructure that is, in many cases, long overdue for replacement. Not only does this result in extra time and effort spent by staff who operate and maintain those facilities, it can also have an impact on clinical staff and patient experiences.

Funding mechanisms, requirements, and processes available to support the renewal of critical infrastructure vary from one jurisdiction to another.  One common element, though, is the desire to maximize infrastructure renewal investment – not only the dollars advanced but, most particularly, the return on that spending. HH Angus, one of Canada’s oldest and largest consulting engineer firms, has been fortunate to be involved with numerous infrastructure renewal projects, and has seen many of its health care clients enjoy success with their investments – often within challenging timelines established by the bodies that set the funding rules.

These successes share several common elements in achieving the goals of realizing and optimizing infrastructure dollars:

1. Plan ahead.

Starting a project where the scope and order of magnitude budget are understood is of great benefit, particularly where timelines are tight. Performing feasibility and scoping studies in advance can help to set these guidelines and allow the team to ‘hit the ground running’.

2. Establish a master plan for infrastructure renewal that dovetails with the overall facility master plan.

Providing intelligent upgrades that do not rely only on replacing the oldest infrastructure within the facility but, where possible and feasible, support future capital projects, can positively support future redevelopment as well as ongoing facility operations.

3. Group the renewal or replacement projects by logical criteria; for example, by system and/or physical area within a building.

Infrastructure projects that work together can minimize disruption to facility operations and can also maximize return on investment by reducing the potential for re-work.

4. Maximize efficient operation of systems.

In some instances, a system may not be performing optimally.  This could be due to age or condition, or to the current state of the controls and overall set-up. Multiple renovations over the life of a building system can impact its operation and cause a departure from the original design intent. Implementing a re-commissioning process can confirm that systems are operating as intended, and can help guide renewal dollars to where they are best spent.

5. Build a good team.

Once funding is in place, there is often a great deal of pressure to get the job done effectively, efficiently and with minimum disruption. Engaging a consultant who understands how to plan work in an operational healthcare facility – maintaining services while work is being performed, construction phasing, Infection Prevention and Control – as well as how health care design standards are evolving, is an invaluable asset to the successful delivery of a project and to setting the right direction to prepare the facility for the future.

Renewing health care infrastructure can be a challenging undertaking. By putting in place the right approach, tools and team, this process can address the issues that are known today, and can also prepare the health care facility with the foundation for effective systems operation and support of service delivery into the future.

Kim Spencer, P.Eng., LEED AP, Principal
HH Angus and Associates Limited

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