My work includes several healthcare projects at Dartmouth-Hitchcock Medical Center and Cornell University Health Services. These projects are technically complex and conducted for a demanding industry. I feel it is important to have the latest information and appropriate skill set to serve our healthcare clients, so I joined the American Society for Healthcare Engineering (ASHE) which is part of the American Hospital Association, the New England Healthcare Engineering Society (NEHES), and the Vermont Healthcare Engineering Society (VHES).
Through these organizations I learned about the Certified Healthcare Constructor (CHC) professional certification program. The CHC credential was developed by ASHE to improve leaders who work in unison to optimize the physical healthcare environment. I decided this credential would improve our contribution to our healthcare clients, so I started down the path towards becoming a CHC.
What I needed to know
My work in healthcare facilities is different from my work in other environments. Most renovation and construction projects are carried out in or near patient care areas, so it is critical for me to have a detailed understanding of the healthcare setting.
Because these projects usually occur in close proximity to patient-care activities, the multiple risks to the patient must be assessed and managed. My healthcare construction projects require knowledge of and experience in activities related to healthcare industry fundamentals, the planning, design and construction process, healthcare facility safety and financial stewardship.
Within these areas, I needed to know specific details including the business and organization of health care, how organizations communicate internally, regulations and guidelines for the built environment, special systems unique to healthcare, special scheduling considerations, sustainability, quality assurance, diagnostic and treatment equipment and project close-out and occupancy.
I also needed to fully understand the impact renovation activities have on patient safety, such as infection control, fire and life safety, utility interruption, project risk assessments, security, and workplace safety.
The CHC program includes eligibility requirements that are a blend of education and healthcare-specific experience, an examination and a renewal requirement every three years.
Reference: The CHC Candidate Handbook and Application:
The CHC Exam
Once I met the eligibility requirements for the CHC program, it was time to start studying for the exam. The scope of information that I was required to know to pass the CHC exam was extensive. The content of the CHC exam is comprehensive and requires a thorough understanding of four major areas.
Healthcare Industry Fundamentals
The healthcare system organization must be considered when scheduling and implementing construction project activity. Attention must be given to unique functions and occupants of the healthcare facilities, use of appropriate healthcare terminology in communications and the healthcare departmental relationships and functions.
The business of healthcare is an integral part of planning and implementing any construction project. The healthcare constructor must consider the impact on sources of revenue, the expense categories, the impact on hospital operation and current healthcare trends.
Planning, Design and Construction Process
Half of the exam is concentrated on this section. The PDC Process is also the most relevant to my work as a commissioning engineer. Several of the areas that I needed to have a clear understanding of included the following:
Healthcare guidelines and regulations for the built environment are extensive and crucial in successful projects. Applicable regulatory codes include: NFPA, model building codes, CMS, accrediting organizations, state health codes, OSHA, EPA, HIPAA, and ADA. Also, guidelines and standards such as: FGI, CDC, USP 797, NRC, ASHRAE, LEED, and UL are essential.
Special systems in healthcare facilities are an integral part of the overall operations. Understanding critical elements of special systems when planning and implementing construction work, such as medical gas, essential electrical, fire alarms, fire protection, HVAC (control system, filtration, pressure relationships, air changes, maintaining operability, testing and balancing, humidity controls), information technology, low voltage, building envelope and plumbing, is essential. In addition, recognition of critical elements when working around and installing medical equipment such as therapeutic diagnostic, monitoring, and electronic medical records, is important.
Internal communication protocol in the healthcare industry is well established. A healthcare constructor needs to be aware of this protocol and how to follow it.
Organizational staff must be notified of all project activities. Facilitating communication during planning and implementation of construction work is required. Communication hierarchy must be followed and adherence with the organization’s policies must be ensured.
Schedules, project logistics, sustainability, quality assurance, project close-out and occupancy planning must be carefully developed, coordinated and implemented.
Healthcare Facility Safety during Construction Projects
Healthcare facilities conduct almost constant renovation projects. Each project must comply with strict safety requirements, including:
Infection prevention. This is a priority in healthcare management. The healthcare construction team must participate in infection control risk assessment, execute an infection control site plan, inspect and monitor for compliance with the infection control plan and provide training for infection control.
Life safety requirements have recently been updated. The Centers for Medicare and Medicaid Services (CMS) has recently adopted the 2012 edition of NFPA 101: Life Safety Code. General requirements include the need to participate in life safety risk assessments, execute an interim life safety plan, inspect and monitor for compliance with the interim life safety plan, provide training for interim life safety, comply with the facility’s barrier management plan, and understand the defend-in-place concept.
Utility interruption planning and mitigation is another requirement during construction. This includes preparing, validating, and implementing an approved utility interruption plan, and ensuring utilities are shut off by authorized personnel.
Emergency planning and mitigation is required of the construction team. This includes preparing, validating, and implementing an approved emergency preparedness plan, and mitigating the impact of an emergency event.
Risk assessment and mitigation is also mandatory requiring a healthcare constructor to conduct a project risk assessment, obtain approval of risk assessment, prepare, validate, and implement a risk mitigation plan, obtain approval of a risk mitigation plan, and mitigate project risks.
Workplace safety and security is a requirement of all construction projects and mandated for healthcare projects. The contractor is required to prepare, validate, and implement a site safety and security plan, mitigate site security breaches, and ensure safety requirements related to clinical occupancies are met.
Healthcare facilities operate on very tight budgets and need detailed information to make difficult decisions. Now more than ever, as healthcare facilities are merging and financial margins are tighter, this information is essential. Providing the team with constructability analysis, value analysis, life cycle costing analysis, and identifying and evaluating alternative means, methods, systems, and materials is part of the construction team’s scope. Evaluating alternative methods for procuring equipment, services, and materials, and coordinating contractor procurement with organization policies is a challenge for the construction team.
The path to becoming a CHC was intense and involved countless hours of research and study. It was well worth the investment of time. I learned much more than I ever expected about the healthcare system and facility operations. I have a new respect for all healthcare facility personnel. I feel more prepared and allied with the needs of our healthcare clients. The industry is changing rapidly, but the core goal remains the same: to provide safe, reliable and effective patient care services. Our job is to facilitate achieving this goal through the built environment.
About the author
Before joining Hallam-ICS in 2010, Elizabeth spent 15 years in project management, public works, and environmental engineering. She has worked for the U.S. Navy in environmental program management and facilities project management. Elizabeth’s prior experience includes engineering in the areas of hazardous waste management, research and development facilities, and process systems. At Hallam-ICS, Elizabeth has worked in facilities commissioning, and project feasibility studies. Her commissioning experience includes health facilities, building systems, medical clinics, a human tissue processing facility, research laboratories, and building LEED certification
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Hallam-ICS is an engineering and automation company that designs MEP systems for facilities and plants, engineers control and automation solutions, and ensures safety and regulatory compliance through arc flash studies, commissioning, and validation. Our offices are located in Massachusetts, Connecticut, New York, Vermont and North Carolina and our projects take us world-wide.