Hospitals, day surgeries, laboratories, blood banks – maintenance on healthcare buildings is literally life-saving, writes SUE CARTLEDGE. No light responsibility for the facility manager!
Professor Ian Forbes, adjunct professor at Sydney University of Technology’s (UTS) Faculty of Design Architecture and Building, and director of the research group for Health Architecture and Planning, insists proper maintenance is important not only for the health of the facility, but also for the health of people within that facility.
“Maintenance should be framed as a risk management exercise,” he says. He is supported by two facility managers who know from years of experience what they‘re talking about.
Steve Watts, Spotless national operations manager Health, has been with Spotless for seven years, but has been in the maintenance industry for much longer. Spotless maintains three hospitals under PPP (public-private partnership) arrangements: Royal Children’s Hospital, Melbourne, and the $214 million redevelopment of the Bathurst and Orange Hospitals in New South Wales Central West.
It also has maintenance contracts with St Luke’s private hospital and aged care facility, Sydney, and at the post-WWII Repatriation General Hospital, Adelaide.
Jason Booker, Thiess Services, is facility manager for the Royal North Shore Hospital and Community Health Services PPP project in North Sydney. Thiess Services is contracted to provide hard facilities management for a 28-year project period.
PREVENTATIVE MAINTENANCE IS RISK MANAGEMENT
“Preventative maintenance through facility-specific programs is the best method of preventing potentially dangerous or even disastrous incidents from occurring,” says Watts. “It’s a question of risk management and risk mitigation. The risk of essential services failing and the costs of remediating the damage should outweigh the cost of regular maintenance.”
Booker agrees. “If maintenance is done on a purely reactive basis, as well as not being good practice, especially in healthcare facilities, it can lead to situations that develop into disasters, disasters that could have been avoided.”
Both cite the following areas of greatest risk, requiring continuous back-up and contingency plans in the event of failure:
- air-conditioning
- electrical
- hydraulics, and
- medical gases.
Horror situations that Booker has encountered in healthcare facilities in past years include:
- air-conditioning failures in medical laboratories that need to maintain constant negative pressure
- freezers containing critical experimental material breaking down with no warning, and
- hydraulic failures, causing flooding.
Even something as simple as drains need correct ongoing maintenance to avoid problems, Watts points out. Following recent heavy rain in Melbourne, blocked drains caused flooding in an underground level of one of the Alfred Hospital buildings. The Spotless cleaning team was the first in; it pumped out the water and cleaned up the mess, “using time and resources on a situation that need not have happened”.
“As an asset manager, your ultimate focus is to achieve a comprehensive asset management plan [so everything runs smoothly], but you need to have reactive maintenance systems in place to deal with unforeseen problems,” Booker says.
MAINTENANCE HASSLES IN OLDER BUILDINGS
Both Booker and Watts are experienced in hard maintenance on older buildings, and are very aware of the major problems.
- Out of date drawings: If the building drawings haven’t been updated when the building is modified, maintenance engineers can run into technical and safety issues. For example, if the switchboard is not correctly labelled, the engineer won’t know if a circuit is live or dead, or what services it serves. “This problem with out-of-date drawings applies to all services, and it’s difficult to know what services are where, and whether the alterations have impacted on any services, with the result that everything has to be traced, which is both risky and very time consuming,” Booker says.
- Asbestos: After out-of-date drawings, the big issue with older facilities, such as Adelaide’s 60-year-old Repat General, is asbestos as a building material. “When refurbishing a ward, if there is asbestos in the floor, it’s possible to lay a new floor over the top of it,” Watts explains. “But if it’s in the walls, we need to take those out. We subcontract this to an expert in asbestos removal, who provides a risk minimisation estimate to us before doing the work.” Uncertainty about where the deadly fibre might be is a reason for extreme caution, Booker warns. “We can look in every nook and cranny where asbestos might be, but you can never really say, hand on heart, that you know where every piece of asbestos is. There’s still the risk of someone drilling into asbestos.”
- Cooling towers: Older cooling towers need to be rebuilt to prevent problems with Legionella, Watts reminds us. “The existing tower is relined and refurbished to bring it up to standard. Even though the water supply is regularly checked and treated to keep bacterial levels at zero, over time the cooling tower will deteriorate and need to be rebuilt under preventative maintenance.”
IMPROVING QUALITY
How can the maintenance industry be improved and drive up quality?
According to Jason Booker:
- asset managers should move to comprehensive programmed maintenance, rather than purely reactive maintenance
- a comprehensive asset management plan based on the life cycle program for each piece of equipment and service should be developed
- vigilance is required in preventative maintenance programs, and
- it is necessary to think ahead with contingency plans for critical systems: how to stop a breakdown and how to get the system or equipment up and running quickly.
Steve Watts believes, “Budget constraints often lead to poor maintenance. If sufficient funds are not allowed to ensure regular preventative maintenance, the cost of repairs and replacing equipment is generally higher than the cost of regular maintenance. This is not cost-effective.
“It’s a question of risk management and risk mitigation. The risk of essential services failing and the costs of remediating the damage should outweigh the cost of regular maintenance.”
According to Ian Forbes:
- maintenance should be framed as a risk management exercise
- ongoing maintenance to keep the building looking schmick for all users leads to product quality and longer-lasting facilities, and
- it’s important to understand the maintenance regime for specific surfaces, finishes and equipment.
Sue Cartledge is a freelance journalist from CONTEXTualise editorial services.
