Healthcare Facilities Network
The Healthcare Facilities Network podcast highlights the essential role of facilities
management in delivering high-quality patient care. Hosted by Peter Martin, this show brings you expert insights on the issues, trends, and solutions shaping the future of healthcare spaces. Learn from industry leaders and discover ways to drive positive change in your facility.
Healthcare Facilities Network
Career paths, and the Top 5 Life Safety and EC findings, with Larry Rubin
High Reliability, The Healthcare FM Podcast is brought to you by Gosselin/Martin Associates. Our show discusses the issues, challenges, and opportunities within the Healthcare Facilities Management (FM) function.
Some of the titles held by today's guest include Police Officer. School Teacher. Mechanical Engineer. Director of Facilities Management. TJC Life Safety Code Surveyor. Senior Director of Facilities Management & Support Services. Business Owner. Consultant. Mentor.
So, the @HealthcareFacilitiesNetwork welcomes Larry Rubin, Founder of Rubin Healthcare Compliance LLC, Tampa. In today's episode, we discuss Larry's unique career journey to and in healthcare facilities, which has spanned over 30 years.
- An exciting career path that led to healthcare;
- Some good things and some not-so-good things he has seen in the field, including oxygen cylinders, door wedges, and hall clutter;
- Insight into how a surveyor will perceive a hospital's environment during the survey process, including verbal and non-verbal interactions;
- the adverse impact of short staff and layoff;
- Larry's Top 5 LS and EC findings are based on his work with Rubin Healthcare Compliance.
As always, thank you for listening.
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Hello, and welcome to the Healthcare Facilities Network. I am your host, Peter Martin of Gosselin Martin Associates. And always, I thank you for clicking on this episode. And I am pleased to introduce my guest today, Mr. Larry Rubin, coming to us from outside of Tampa, Florida. Larry, good morning. Good morning. Thank you for joining. So just a Brief bit of background, not for Larry's sake, because certainly he knows it, but for listeners, Larry's been more than 30 years in healthcare facilities management. He's had a career at Cleveland Clinic, director of FM, senior director of FM at the Cleveland Clinic, both in Florida and in Cleveland. Larry had a stint at Moffitt Cancer Center, senior director of facilities management. Larry has been a surveyor. for the Joint Commission. Larry is well known. He had a vice president role, I think, in Arizona for a bit, Larry, or Candelay Healthcare for a bit?
Speaker 00:No. No. Actually, Ascension. Actually, it was in Kansas City. Kansas City. Vice president, yeah.
Speaker 01:I should always write things down. And right now, Larry is an independent consultant for his own Rubin Healthcare Compliance. Larry, what are you up to?
Speaker 00:Well, surveying hospitals, again, I really enjoy it. I like teaching. I'm a school teacher. I earned my bachelor's and master's degree a long time ago before I went into engineering to be a school teacher. And I really enjoy teaching. So when I do a survey, it's teaching. It's really, you're trying to help people. And I know facilities so well. So when I get the opportunity to help people on a survey, to me, that's the most rewarding. And I love teaching. So I make the people that are with me climb the ladders and look up the ceiling. Before I even do. And then I get up there and say, yep, you are 100% right. You saw this and saw that. And so it's all part of training. And I think that's what I really enjoy doing that.
Speaker 01:Let me ask, when you ask them to climb that ladder first and look above the ceiling before you do, what's their reaction typically?
Speaker 00:They love it. Everybody goes, I can't wait. I usually have two or three. And sometimes the women with me that are from quality, they want to go up the ladder too. I say, sure, go right ahead. Here's what we're looking for. And I tell them what to look for, and they do it. They're great.
Speaker 01:Excellent. So you left MAFE, what was it, maybe two years or a year ago now? Maybe it's two years,
Speaker 00:almost two years.
Speaker 01:God, it's amazing how quickly time flies, isn't it? How have you enjoyed the transition out of the daily grind of facilities management and compliance and everything that goes with it into your own independent consulting?
Speaker 00:You know... You're so busy when you're at work. If you're a facility manager, a facility director, a vice president, whatever, our jobs are so busy and you never know what's going to happen. When you come into work, you never know what's going to happen. You could have an emergency. It could be a, who knows? It could be a hurricane, tornado, whatever is coming. You have to be ready. You own the physical environment and your day is so full, especially now. I'm noticing it a lot. A lot of people have a lot of openings right now for help, for facilities especially. And they're tough to find. We did a fantastic job of sending all our kids to college. Now we don't have any tradesmen. And that's really hurting. So plumbers, electricians, HVAC techs, they're tough to find. They really are. So you're spending all your time training or teaching. So that's kind of a big deal right now for facility folks. They're very, very busy. teaching and explaining to others what we do. We are the most compliance-crazy industry. I worked in the nuclear industry for a while, and I thought that was bad. No, we're just as bad. I've been on a power plant, so I know what it's like. It's crazy. No hospital's worse. We have a lot more compliance issues to worry about. And you're always constantly educating. You're always explaining to others. You've got 100 balls in the air at once, and you've got to be able to capture them before they fall down I remember I had this director. I was at Brigham Women's Hospital. I had a director there that he was a really good juggler. He juggled knives, and he made this presentation. These knives are going up in the air, and he's making his presentation. He says, this is what a life is like. You're constantly juggling, and I'm going, wow, yes, you know, that really hit home. And I said, that's great. And he was juggling the knives. And he didn't get hurt. But the emergency room wasn't far away, but he didn't get hurt.
Speaker 02:That's
Speaker 00:probably the safest environment to juggle knives. You know, it's kind of funny. I started my career visiting a lot of emergency rooms, unfortunately. I joined the police department and drove a motorcycle. And, well, I have scars to prove it.
Speaker 01:Well, you know, and that's actually where I wanted to start, Larry. And Larry and I have been talking for a while. And, you know... The goal of this episode is Larry is going to discuss some of the most frequent findings that he finds when he's out surveying hospitals and some success stories and some non-success stories. But Larry also has, as he's alluded to, a very interesting type of background. We had done We've done two episodes on the Healthcare Facilities Network where I take resumes of folks who are in our databases and I blank out the name of the people, but I show their career paths. How do they get into this field? Especially now, you know, Larry, as you just said, it's so difficult to find people. We need to think beyond kind of those traditional career paths that we always think, and how do people arrive here? And on my last episode, two of the paths were one was a fire chief, And the other was a police detective. So, you know, we hear about the military folks all the time, but we had a fire chief and a police detective who both became directors of FM. Tell us a bit about yours. I mean, you were a teacher who became a police officer who became a director of FM and now has your own company. Tell us a bit about your path and how'd you end up here?
Speaker 00:I don't know. It's just one of those things that you fall into it. But so I'm teaching school all day long. And you're up here in Boston, correct? Correct. In Chelsea. Yeah, I taught the school in Chelsea, sixth grade. Did that for four years. But at the same time, I'm teaching, I'm working nights. I started way back in the Boston Police Department in 1968. I graduated from the academy in 68. Seems like a lot of time, a lot of years ago. So I did 29 years up there. And then I decided to come down to Florida to take a job in a hospital down here. It was kind of interesting. My partner up north, had his brother-in-law with the Tampa police. He says, you need to go see him so you learn the city. Tampa's a big city. So I go down and do a ride along. So you're
Speaker 01:still an officer up here in Boston at the time?
Speaker 00:No, I retired. So you're 29 years is done. I retired in 97, came down here for that job. And it was kind of interesting. He said, you know, we're a 900-man department and 300 are retiring next year. And I said, whoa, that's a lot. He said, we're hoping to get some of those guys back in in the reserves. why don't you who are, who was retired, come on and join the reserves. And I go, I had to go back to my wife and said, what do you think of me? She wasn't happy about it. She said, no, I want you only working one job now. Uh, that didn't work out too well. So I wound up beginning on the reserves and I wound up being a, uh, a, a patrol leader for, for, uh, 50 guys. I wound up owning all them. That kept me busy. And these were retired Tampa sergeants. And we had a blast. We, uh, we worked together as teams and, uh, I always think of Tampa as the Wild West. It's so different than up north. And because the weather's so nice all the time, you just don't know what's going to happen. But again, I was the director of facilities here at one of the hospitals, and I really enjoyed that. All of a sudden, two hospitals became nine hospitals. It kept growing at the Bay Care, and I didn't expect that. And here I am. So I just kept growing.
Speaker 01:So you're a police officer and a director of F.M.?
Unknown:?
Speaker 01:Way
Speaker 00:back when, yes. Not now. Not now.
Speaker 01:No, I know not now.
Speaker 00:So you're doing both. And there were times that I actually worked my area, worked my hospital, and had to go into it, which was interesting. We had a bad accident in front of the hospital. I wound up going into the hospital in the ER and doing the report. And everybody knew me. They said, hey, wait a minute. What are you doing with your uniform? I said, well, it is what it is. Yeah, how do you do that? I'm not really sure because it's a 12-hour shift. Yeah. 12 hours, like say five to five, and then wound up working at six o'clock till five. It's a long day. Did that a lot. But my body was used to it. I've worked two jobs all my life. So I'm so used to it. I just didn't know. Now it's getting more difficult. Now that I'm older, a lot older, it gets more difficult.
Speaker 01:That's great. So when you were a teacher- So you were teaching and going to the academy at the same time.
Speaker 00:Actually, I was already out of the academy. I was teaching full-time and working full-time. So I was kind of an interesting story. I taught the sixth grade in a very large school in Chelsea. And I'm the only classroom out of, I think it was 48 classrooms, the only classroom that had all its windows. Because the kids would throw rocks through the windows. It was a very tough area. And they knew that I was a police officer, so they didn't break my windows. And every morning I had to shake my kids down. I had a box full of knives that would just, and one gun. Really? That's what it was like. It was a different world. So being a police officer helped me there, but I really enjoy teaching. I really, I love the kids. The kids are anywhere from 11 to 16 in my class. So you just, and I had 30 to 35 kids all the time. It was just a typical urban area.
Speaker 01:Yeah. Yeah. So did the, How did the FM world, so you're teaching, you're a police officer, now you're not. How did that arise? How did you get hooked in to facilities management?
Speaker 00:You know, it was one of those things where a friend of mine grabbed me to see if I would come in and take over a construction project he had going. And I said, I'm glad to work with you. And he's a good friend of mine. So he helped me. And I worked for one of the largest construction companies in Boston. And Boy, you had asked that question. Oh, I'm sorry. Names have left me.
Speaker 01:Yeah, it's been a long time since you've been up here.
Speaker 00:Yes.
Speaker 01:Suffolk is one of the big ones now, but you go back to when you were here, you left in 97, they weren't...
Speaker 00:Yeah, the owner of the company did a lot for Harvard University, and I'm just trying to think of his name, but it'll come to me. That's okay, I'm sorry. The president of the company was approached by the president of Brigham Women's Hospital and said, look, my director of facilities is going for heart surgery. I need somebody in there now because Joint Commission is going to be coming uh in december and this is like september and i go and so my boss comes to me look i need you to go over to brigham women's hospital don't say who you are don't say where you're working but you're going to be filling in uh for the director of engineering and i said okay i got a good engineering background i knew what i had to do so uh um off i went by the way i was teaching not only was i forgot to put all this in there Because when I left teaching school, I decided to teach engineering. So I did physics and thermodynamics. So I knew this well. I knew what I was getting myself into in engineering. So I get in there and that's what happened was that they made me a temporary employee. I was the director of engineering. I really enjoyed that for a couple of years. And that's when, that was about 1990, I forget what year it was. But in 97, I got a job down in Florida. That's how I started in the business at Brigham Wounds Hospital and Partners Healthcare, which was a lot of
Speaker 01:fun. So you decided, you know what, I'm not going to start at a small community-based hospital. I'm going to go right into some of the most prestigious academic medical centers in Boston and start there.
Speaker 00:Yeah, but I had a great team. I mean, I had two assistant directors. We had a really great team. and a lot of good people. So that's what made it nice. So when I left there to go to Florida, and I actually, when I got the job offer, I actually talked to one of my assistant directors. Hey, do you want to go down there because your daughter's going to school there? Why don't you take the job? And he said, no, I don't want to go. They don't pay any money down there. So I said to the headhunter, they don't pay down there, so he's not interested. No, here's what we're paying. So wait a minute, I'm interested. So that's the side of it. I didn't, you know, To leave Boston was difficult, but it just made sense. And my wife was excited because I was just going to work one job. She said, you're going to work one job, Monday through Friday, much better. That lasted a couple of months.
Speaker 01:How do you describe yourself?
Speaker 00:Crazy. I really enjoy teaching and I enjoy humor because you don't know what's going to happen in life. And don't take life too serious. You've got to enjoy it while you can. And I've seen so many horrible things that you can't explain to anybody what you've been involved in. And I got the scars to prove it. I mean, I've got holes all over my body. I mean, I've lost half my face. My hair's been cut off. So I've had a lot of issues and you go through some of this stuff and you just can't take it seriously. You've got to start enjoying life because you don't know when it's going to end. So what you can do to help other people, and that's what I really enjoy. And that's why I enjoy teaching because you're helping others. And that's what... That's what you're put on this earth for, really, to help others. And I've always felt in the facilities world, we're one team. I help every director. Wherever I go, I leave him. He said, look, I'm on LinkedIn. Look me up. This is my email address. You got a question, let me know. And I always help people all the time. My phone is always going off. And all the surveys, we were good friends when I left. We kept in contact. In fact, we still keep in contact because they're all good people. I got a great boss. My field director was Tim Macarjon, great guy. All the surveys were phenomenal. So, I mean, they're all good people and they're all trying to do the right thing. So, and I always try to, again, as I do the right thing of teaching, and that's what I really enjoy now consulting because now I'm helping. And I'm still helping with energy stuff that we do. My background is energy and power plants, things like that. So, I've got the craziest background. I ran a power station for 10 years. You know, I can go on forever, but my background is on LinkedIn, so you can certainly look me up and see if I'm in a psychiatric hospital or not.
Speaker 01:I didn't realize the engineering part of it, you know, going back to school. Are you... Are you mechanically inclined? Like you've got a lot of different, like I'm not very good mathematics engineering. I think I'm stronger on the kind of that soft skill, the communication part of it. You seem to have both of those areas combined. Most people don't get both. You get one or the other, but it seems like you got both.
Speaker 00:It was kind of crazy. My oldest brother is an electrical engineer. So when I told him, I just, look, I'm going to Northeastern now. I want to be, he says, no, no, you're not going to be an electrical engineer. There's only one in the family. You go for mechanical. and my background and I really enjoy I'm a ham radio operator so I really know electronics well and I really wanted to be an electrical engineer but so for some reason I became I got more involved in mechanical and then when I went into a power plant I really learned the electrical side of it because we were generating power so it's a real big station so we had a lot of fun and no boilers well no pumps no equipment so that's helped me a lot especially in this field so I really know The small boilers that are in a hospital are so much different than the 1,500-pound, 1,000-degree Fahrenheit generating boilers that we had. So it's different. But still, very interesting. I understand it and certainly know how to take care of them, know how to PM them. And the same thing with electrical equipment because electrical engineering, there's a lot of electrical work. We generated 13,800 volts and how we took care of all the breakers and the problems we had. So we learned a lot. And that's helped me in my field.
Speaker 01:Yeah. Well, you know, as you listen to you talk, everything you've done, you're using now. I mean, you're really at a kind of an accumulation of all those experiences that you've had along the way. You're using each and every one of them.
Speaker 00:And you learn every day. Even when I was a facility person, you're seeing and surveying, you see the good, the bad, the ugly, and you see a lot of good things. And you see a lot of things that you always say to yourself, you can't make this stuff up. You can't. You see stuff, you go, you've got to be kidding me.
Unknown:Yeah.
Speaker 00:That's all part of the learning. And so if you can pass that learning off to others and help them, that's what it's all about.
Speaker 01:So I would like to ask you, what are some of those top findings that you find that are at the top? But before I do that, Larry, you had mentioned... And we know that there's an issue bringing people into the field. As you've been going through your career now as a consultant, are you noticing that you're interacting with more folks who don't have a healthcare background or a hospital or a healthcare background? They may be coming in from some other industry. Have you noticed kind of a demographic change?
Speaker 00:Yeah, a big change. And I'm seeing people from the hotel industry come into... I had a hotel director of facilities working in a hospital now. And... Interesting. He wanted to leave open all the stairwell exit doors. You can't do that. No, not on hospital. Okay. So we're seeing a lot of people from different industries coming in here. And I'm seeing a lot of women that are very bright. I mean, I know a number of them as now, but they're just phenomenal. So it's more attention to detail. Men sometimes don't always have that attention to detail that women have. That's what my wife tells me anyways. Yeah,
Speaker 01:there's some truth to that. I know my wife is more so than I am.
Speaker 00:And I'm excited to see that happening. It's really made a big difference. And I'm seeing now women electricians, HVAC techs. I remember at the Cleveland Clinic, we hired a woman for a tube system. She's fantastic. So you're getting people into the industry to really help. And it's really good now. So it's changing. It's... all types of people coming in now, which is great.
Speaker 01:Yeah. Do you, you know, you, you mentioned the hotel person are there and hotel would, I mean, would certainly seem, I mean, that's a huge difference just even in, in mindset, you were giving the, you know, the door example, but are there from your experience or from your yeah, from your experience, do you find that folks from one industry or, or another may transition easier into healthcare facilities management. Maybe it's out of the power plants, the nuclear plants, but are there certain fields where those people seem to have a better aptitude to come in and catch on a little bit quicker in healthcare?
Speaker 00:You know, I'm seeing the military folks that are coming in, the veterans coming in. They have been phenomenal. And I'll tell you, they have this, it's built into the veterans. They have the respect and dignity and they really, they show that respect. You don't often see that. And that's something that kind of nice, All of a sudden, I'm hearing, yes, sir, no, sir. I'm not used to that. You go, what? I'll get that done. Yes, sir. What? So that is, and the discipline is phenomenal. And that's what we really need. And having the veterans come in has been a big change. And I've always been a fan. When I was in Tampa, we would recruit from MacDill Air Force Base some people that are retiring or leaving.
Speaker 02:And
Speaker 00:they were phenomenal. The training they have is just airplane mechanics. Wow.
Unknown:Yeah.
Speaker 01:Yeah.
Speaker 00:Yeah. Yeah. As many as you can.
Speaker 01:Yeah. They've got a lot of the leadership background. They're disciplined. You know, they've had good training. One of my and I don't know if you can comment on this, but one of my frustrations occasionally in the recruiting world is, you know, you'll get somebody who maybe they've gone through the nuclear power school in the Navy, but they might not have their degree yet. But yet they've got that. They've got the nuclear background. They've been through their training. They've got the lead. And a hospital won't look at them because they don't have their degree. And I'm like, this is the person you want. Have you found that? I
Speaker 00:was at Pilgrim Nuclear Power Plant. So I taught the class. The guys just came out of the Navy. They were phenomenal, extremely bright, degree or no degree. Man, those are your leaders. And they are extremely bright. They learn fast. They're human sponges. Those are the people you really want running at your facility.
Speaker 01:Right. Yeah. And I know that's one of the frustrations, especially as we're trying to, you know, you're trying to attract people in, not close them out. You know, it's, what do you have? Not what don't you have? And if you've got this background, then you are a, you're a perfect.
Speaker 00:Do you really need a degree? You know, do you really need that degree? I don't know. What you really need is your certifications, the CHFM. So with Ashley now being certified and these guys could easily do, Easy folks, veterans, no problem. Get the CHFM, CHC. That's what you really need. And when they get that under the belt, they're good to go. They're great. Yep. So hopefully you can convince HR of that as well.
Speaker 01:I know. Well, that's the thing. I mean, you know, it's not always black and white. Sometimes there's some gray in the middle and you got to be comfortable kind of working in that gray area. you know, you can't just say no.
Speaker 00:That's right. Well, you gotta start looking at all that.
Speaker 01:Right. So let's talk, Larry, let's, let's talk about some of your, uh, your top 10 findings.
Speaker 00:Before I do that, let me tell you about some of the good things and bad things that I've seen. So when you're a surveyor, you see a lot of things and I have seen a lot of good things. Uh, one of the good things that I really enjoyed, you know, uh, I was doing a hospital in Texas surveying them and, uh, Normally, when a surveyor goes into the ORs, the doctors leave because we're going to talk about OR fires. They just, see you, I'm gone. So I went to this hospital in Texas, and the doctors couldn't wait for me to get in there. And that was the first time that ever happened to me. That's happened since. But they were waiting for me, and they were so well-prepared and really knew their stuff. The anesthesiologist, the surgeon, they just... Oh, we saw the Aeon video. We know exactly what, here's what we did here. Here's the bowl. Here's the material. Whoa. And when we're done on, if this person's injured, we take right down to the, we go to the next space down, which is the, I'm trying to recovery room. And I said to you, why don't you take them to the ER? And they said, the ER, we're on the third floor. The ER is on the other side of the building, but by the time they get there, it could be more damage. We're going to treat right away. And this is where we get more help. And I said, oh, that made sense they were great i really normally i get the uh the or nurse stays there and sort of gives me all the answers what i need these are the doctors that's the first time that ever happened and now it's required uh annually to do the fire drill separate from all the quarterly drills and a lot of hospitals are actually filming it and using it so hopefully those youtube videos will be out there for everybody to see like the aeon video which was very good so who knows that was one good thing the second thing i that i saw was really I did a hospital recently that had probably the best med gas O2 setup. And what's one of the biggest problems we're seeing on findings is that co-mingling, you see the empty with the partials with a full, you can't do that. So this one hospital had six cylinders of full, six cylinders of partial and six empty. And they had on the front, there was a sign saying the exact pressures and this is full. Here's the partials, the pressure ranges, And then the empties, you know, and a great policy. And it was so good. I sent the pictures and everything to the Joint Commission to use as best practices. So it was really a great hospital. The other thing I saw that I really liked, I wish I had done this. This director, and I think it was West Virginia, that every new employee that was hired in maintenance, he put on a stretcher. He would lay them down and put them on a stretcher and wheel them around the hospital. Wow. But before we did, they said, look, I want you to look around. You're brand new. You don't know where you're going, but I'm going to take you around the hospital. Let me know what you see. If you see anything wrong that bothers you, just let me know. So they go through the hospital, and he was telling me the story of one guy. He said, we had a big bump. It was the expansion joint in the floor. He says, I can fix that. Oh, okay. And then he said, you know, you got some stained ceiling tiles here. Oh, you got some lights out. Oh, you got the Nexus sign out. And so the director said, that's when I knew I had a really good employee. He did that to everybody. I said, really? That is a great idea. Why did I think of that? Right, right. Great idea. So those are some of the good things I've seen. Well, on the bad side. So, you know, we have fire-stopping material that you have to be trained on how to put it on and how a UL assembly actually is put together and the whole bit. And there's training. I don't care if it's 3M, STI, or... healthy they train you and they do great training but i've seen some hospital i've gone in there and somebody's taken a paintbrush and painted this red stuff everywhere and i said that's not what it's for yeah but the whole wall was painted red no you can't do that then i saw a uh i was doing a um fire door right above the fire barrier and the fire damper was there and the fire damper has this to expand inside its opening and it has a flange around it to allows it to expand It floats, if you will. Well, they must have used three, four, five tubes of caulking to caulk that fire damper in there. And I said, I don't know why you did that, but that fire damper now will never work because it can't expand. It has to float. Now you've locked it in position. It will not function. And they did them all that way. The whole hospital was done that way. I'm going, whoa, that was one of the bad things that I've seen. The other bad thing was- Can I
Speaker 01:ask you a question?
Unknown:Sure.
Speaker 01:Before you go to that next, so you worked at some big organizations. You worked at the clinic and Moffitt Cancer Center, big footprints. How did you deal with the ongoing issue of penetration, fire penetrations and stopping? How did you control that in your hospitals?
Speaker 00:Through a work permit process. And that is a big deal. There should be no work going on in your facility that you don't know about. So anybody doing any work, I don't care if it's IT, security, anybody that's coming in to do any wires, running, whatever, you need to come in and get a work permit. And the work permit for me, there's three pieces to it. There's one always hanging on the wall, and one has to be hanging in the construction area, wherever they're working. So when they're all done, they come down to the facility and say, look, here's the work permit. It's closed. And I say, okay, now I make a work order out to the one of my maintenance, whether it's a zone mechanic or one of the floaters and say, hey, go and check it. Was it really done correctly? And my guys are all trained and they knew what a UL assembly looks like for sealing it. And they come back and say, not done. And I don't pay them. I will not pay the company. I said, look, I'm holding back 20%. You're going to come back here and fix those penetrations. Or if they came back and the work order was closed, I signed the PO and they were done. That's how we control. That's the only way you can control. Otherwise you're out of control.
Speaker 01:Yeah. So you're, you're, you're checking it. Well, you're having them sign in and then you're checking it in the moment. So there's no lag between, you know, well, he was here four months ago. We never checked on it. You're checking it then.
Speaker 00:Yep. Did you do the clinic? We didn't put a sticker on it. So we know exactly who made that, who sealed that penetration, their name and the date and all that. So it was done correctly. So we knew we watched that carefully.
Speaker 01:Did you do the same for like above ceiling? Did you do those permits for your, for any contractor, no matter what they were doing, coming into your buildings?
Speaker 00:Yep. You have to. Yeah. Yeah. Some stuck in, believe me, there was some security, uh, didn't want you to know anything, especially if they were setting a camera up somewhere. They were very quiet about it and they were at night, they would run the cables. Really?
Speaker 01:Yeah. Yeah. Did it, was it similar? Yeah.
Speaker 00:Oh, IT was horrible. Absolutely horrible. Everywhere. I don't care if it's Cat5, Cat6, blue wires everywhere. We'll talk more about it. Those are my top findings. You've got to be kidding me.
Speaker 01:Yeah. Well, I don't want to jump ahead to the findings. So no, I just wanted to ask that because you work big organizations. How did you control that? So that's a bad thing. What other types of bad things do you encounter?
Speaker 00:Well, it's kind of funny. Yeah. wedges i have never seen so many wedges holding doors open in my life and and we go around and there's a quick story that i did one hospital and we picked up i'm always with the chief engineer or the director of facilities and he picked up all the uh wedges whether they're plastic or wood and he puts them in a little pouch and we walk with this pouch there was about maybe nine or ten wedges in there and we walked through this corridor and we went to lunch afterwards so we're gone maybe an hour to an hour and a half Now, we took all these. Even the safety office had a wedge. So we went back. We had to walk the same way to get back to our office we were in. And the same doors were held open with wooden wedges. And I'm going, so I walked into the safety office. I said, how did you get that so fast? He said, well, we put a work order in. Then the carpenter shop knew that Joint Commission was there. They made these things quick for us. And no, you're not supposed to have these doors wedged open. Well, I didn't know that. Wow. That's what happens. Wherever we go, well, you know, it got hot in here. We need fresh air. Oh, no, no.
Speaker 01:So. Well, what's interesting about that story is, you know, the gentleman says to you, we knew Joint Commission was here. So we put the word just like reversed.
Speaker 00:You know, and everybody knows that the minute the Joint Commission shows up at the hospital, they announce it over the PA. Welcome to the Joint Commission. And that's a sign to everybody. Start moving stuff out of the way. Clear up the corridors. Do all the right things. Send your construction people home, whatever it takes. So I had one floor that I saw. Boy, we had a lot of clutter here. I said, I tell you what, let's go up to the next floor. And you're saying some of that stuff has to be there for 30 minutes. Okay, I'll come back in 30 minutes. I waited an hour, went back to the same floor. Nothing was moved. So we wrote it. I mean, you're trying to be a nice guy, but really, come on. That's clutter.
Speaker 01:You know, with your background as a teacher, so you're reading, you know, you're reading your kids and their body language. And then as a police officer, and certainly you're encountering everything in the world and you're reading people in their body languages and their non-verbals and you're director of FM and as a surveyor, do you, when you walk into a hospital in your surveying mode or now in your consulting mode, can you quickly pick up based on kind of non-verbals and how people interact with you? Are you formulating something in your mind really quickly? And how often does that hold that you're actually accurate? You find that what you thought is what you experience?
Speaker 00:100% of the time. It's amazing. The minute I walk into a hospital, as I'm walking towards it, I see cigarette butts. Or if I go through the front door and I feel that I'm being sucked into the building, I know this is going to be a bad survey. And usually when you meet the people, and especially the team that you're sitting down with, that's the hospital COO or the CEO or whatever, you can tell if it's going to be a good survey or a bad survey. Yeah. I try to find out how nervous everybody is. If the director of facility is very nervous, I'm going, okay, calm down. It's not that bad. Yeah, that can be pretty interesting.
Speaker 01:Is there a... Is there a major tell in your mind? Like, for example, when we used to travel a lot on the recruiting signs prior to COVID and when you could travel everywhere, going into a hospital, I could usually tell just even interactions with hospital employees. Like some hospitals, they'll always say the employees will always greet The straight, hey, how you doing? Can I help you? Others don't. They're just walking blinders on. And you experience that quickly as you just walk in those main doors. For you, is there a tell, a specific? You talked about if they're avoiding you, but is there another one that you pick up on right away?
Speaker 00:I'd say I've been doing a couple of VA hospitals recently. And the VA hospitals, the people are very friendly. And they're kind of like, whoa, I'm not used to that. Yeah. And it's always a yes, sir, no, sir, good morning. I'm walking with people who don't work there. These are people that are getting treatment there. They say, good morning. I see these guys in wheelchairs and whatever. And I'm going, this doesn't happen in the whole hospital. The VA is the friendly places. And you don't hear a lot of good things about them. But as I go to them, the people are nice. The patients are really respectful and nice. I think that's the military background. Yeah. Everybody's that way. And even the most of the people that work there are veterans. So they're just, for me, it's been a really refreshing change.
Speaker 01:It is amazing the small impact that friendliness can have. It's one of those things that doesn't cost anything, but it's very impactful.
Speaker 00:And when you get that, you want to help more. If you stop a speeding person who in this vehicle and you pull them over in the whole bit, it all depends on how they treat you. And you look at it right away. If you really get some bad stuff, you go, let me see if I can find more things wrong. And that happens. So when you get a place that's really nice to you, you sort of want to help them. How can I help you? And how can I make it better for you? And how can I teach you different things? That's what it's all about.
Speaker 01:Yeah, yeah. I mean, you mirror what you get.
Speaker 00:Yep, exactly right.
Speaker 01:You reflect
Speaker 00:that back. One of the things I really try to do on every survey, I try to make sure that everybody talks about, it's not just facilities. It's really, you know, it takes a village to make this hospital work well and be ready for a survey. You know, it's every three years. And when you think about it, it's always the last six months before a survey. All of a sudden, you get hundreds of work orders. Hey, can you paint this? Can you fix this? Why not do continuous compliance? Why not be ready all the time? And they're not, really not. So it's really frustrating sometimes. And you have so many great people working in the hospital. If you work as a team and become the village, if you see something, say something. You walk by a drip on the ceiling, say something. If you see something, let facilities know. There's a work order system. You can certainly call somebody. They just don't do that. So it's kind of like frustrating to facility folks that, or they, I love when they say to me, I've seen this many, many times. I've sent in hundreds of work orders Really? And you go research it, you find nothing. And that door's been broken forever. Well, did you put a work order in? Oh yeah, many, many. Yep, I always do that. And we research it, we can't find a work order. And it's just, really?
Speaker 01:Yeah. Don't
Speaker 00:lie to us.
Speaker 01:Right, right. Do you think, you know, as you were saying that relative to the work order, do you think that in some organizations, I know it was kind of similar with us, a work order for a person putting in the work order, it could be, hey, I passed him in the hall and I asked him, that's a work order. Or work order is a text these days because everybody texts. They don't, it's going back to like process. You know why those military people are so good? Because they are used to process and that's what they do.
Speaker 00:Yep, exactly right.
Unknown:Yep.
Speaker 00:And I see that all the time. You know, hey, they see Joe, the plumber. Hey, you know, my sink's been leaking for a long time. You take care of that. And of course, Joe, he'll go fix it. Right. No work order. So there's no record of anywhere. And that's a problem. So, yeah, we always tell the guys, hey, please, if somebody tells you something, call it in, put the work order in and go and let somebody else let it get issued to you or somebody else.
Speaker 01:Do you miss any of that day to day?
Speaker 00:Yeah, I do. You do. Which is why I like surveying because I get back into a hospital and if I see something, I'm always looking to save them energy. So I'm always looking at, hey, have you thought about this? Have you thought about that? And try to change their processes.
Speaker 01:Yeah, are they, do you find like you as a consultant, do you sometimes have to catch it? Because you just listen to you talk, kind of your natural nature is to educate people and to help. Do you find sometimes you have to just say in your own mind to accomplish what you need to accomplish? I kind of need to at least not back off, but like stay on task so that I get done what I need to get done as opposed to trying to help them all over the place. Does that happen to you?
Speaker 00:Yeah, it happened just recently. I had to go back at night in a hotel and I was doing all the writing and I'm up to a hundred findings. I'm going, You know, I spent so much time talking, I didn't hit all the areas I wanted to hit. So the next day I said, look, let me concentrate on this now. Let's concentrate on all the things I did not see that you try to lead me away from. Oh, that's what you're doing. So I
Speaker 02:said,
Speaker 00:all right. I still want to help everybody. So all of a sudden now, I miss those areas. I'd like to get them done. And they said, are you sure you really want to go in there? I said, yes. That's what it's all about. Right, right. Then they admitted to me on the way in there, it's not the best shape. Yeah, okay, let's take a look at it. Right. It's no sense hiding it. I'm there to help you. I'm not a Joint Commission surveyor. I'm here to give you some help. So let's get it fixed.
Speaker 02:Yeah, I mean,
Speaker 01:maybe I, you know, maybe you don't see it, but if I don't take you there, but the Joint Commission is going to see it. I mean... What am I paying you for? And
Speaker 00:I tell them, I said, look, I know you have, they'll give me a sheet with all this information on it that they checked, whether it's been an eyewash station for weekly check or whatever. But I said, you know, you need to have a different eye on this. It's not that I don't trust you. It's just that I don't trust you. And you have to stop looking at that now. That almost looks like it's been pencil whipped. So you really think these are being checked? You know, you've got to make sure that This is your hospital. You are held accountable for it. If something happens in this hospital, you're the one going to court. So is the work really being done? Are the PMs really... And then I show them. I went down and looked at the fire pump with them. This PM is not being done. Can't you see it? The Zerk fittings are sealed. No one's taking the cap off. They're brand new. And the pump's been in there for a long time. Nobody's done any work on that pump in a long time. So... He outsourced it. And if you outsourced it and the vendor didn't do his job, you need to be looking at that and saying, it's not being done right. And that's why you do a survey. That's why you're there. Is everything really being done right? Are you really doing all the PMs? When you start looking and looking at electrical switchgear, you're looking at all the breakers and they're full of dust. Is somebody really taking care of that? A lot of stuff. So you got to make sure that your site is really being, again, if something happens, you have a fire or you have an explosion or whatever it happens to take, everybody comes down to see you. OSHA, you name it. And you wind up being in court and you don't want that.
Speaker 01:Right. Right. Yeah. I mean, it's just such a, you know, number one, it's for patients, but it's so visible and there's no, you just don't want it. You don't want to be on the newspaper and the TV. Have you seen Larry, you know, in your years relative to compliance and surveying and now consulting, how has the process changed or, and I'm not asking like, how they do it but what are some how has it evolved from you know very early on if it was you know a slap on the wrist all the time to now where you're trying to educate and bring them on how has that whole thing changed or has it
Speaker 00:and it has changed yeah i think originally way back when i first got involved with the uh joint commission we started i think a joint commission survey started in 2005 and uh it was uh again it was a learning time for everybody and uh About 2010 or so, everything changed a little bit where CMS was getting more involved and saying, you know, our surveys go out and we find many more findings than your guys do in two days. How come? And I remember George Mills saying, hey, wait a minute. You have five surveys going out for a week. Of course they're going to find more. You're only there for, it's one guy for two days, actually a day and a half. he's not going to find up all the stuff that you find. So a lot of pressure on 2012, 2013, 2014, we were always getting a lot of pressure. Hey, you got to find more. You got to find more. So that's where it really changed. And it became more, less teaching and more trying to find things wrong. And that's kind of sad because the whole goal was to make your hospital safer. Well, if you teach people to keep it safe, that's what they do. And to whack people on the head just didn't work.
Speaker 01:Yeah. Yeah. Do you, do you feel it's going, shifting back? I mean, obviously CMS is still that elephant in the room and it doesn't seem like there's, you know, they're not laying off. I don't, laying off the pressure, but are you sensing maybe a little bit of a shift towards that education model?
Speaker 00:I think it's coming back. There's so many new, you got to remember now when there was like way back when before COVID, we had 80 life safety surveys and about 40%, 40 of them didn't come back. So a lot of new faces in there, a lot of new people, and they came in gung-ho. They're raring to go, and they're very knowledgeable, and they want to teach. So they want to make sure everybody's making this place safe. So I'm seeing teaching coming back again, which is really good.
Speaker 01:To be good at compliance, it sounds a little goofy, but do you need to have that education mindset at your core to be– that continuous learner and kind of inquisitive. You would
Speaker 00:think so. You're an engineer. You understand that you're always digging. I understand now they've hired some OSHA people, which are safety people and emergency management people. So we've got a wild array of what's out there now, which is really good. So you know what you're going to get. So but they're learning, too, because as you do more and more surveys, you learn a lot, too. So I think that's helping.
Speaker 01:And that's probably going to be the blueprint going forward, because as we've said, you're going to have to attract people from other fields into it. I mean, there's simply not enough folks.
Speaker 00:And they're coming in. Yeah, yeah.
Speaker 01:So I kind of took you off track a little bit when you were talking about some of the negative findings or the bad things you've seen. Did I interrupt your list at all?
Speaker 00:Well, let's go for the top five of life safety and the top five of EC. And these are my things. These are not... In the past, in 2023, I did 18 or 19 hospitals. And when I surveyed them, these are the ones that I found as being top. And I've always, and as we're finding the findings, I'm always going to the staff. I'm always surrounded by people. I have usually quality, safety, and of course the manager or the director of facilities with me. And I'm always saying, you know, this is something that really the Environment and Care Committee or you have, You do more rounding or you do more traces. But it's got to be not just facilities finding and doing this stuff, but everybody. It's team effort. So I always take the opportunity. So I'm going to do that as I look at the top five life safety findings I found. We try to share them. And I've done this in a couple of presentations to hospitals. Our number one was life safety 2135 EP4, the wires on sprinkler pipes. Man, that is... And we have spent a fortune... to put these wire racks in the ceiling during construction so that when you run the wires, put it in the wire rack. That's not where they're going, unfortunately. And we get tons of pictures out there that the blue wire, the famous IT group just puts wires on the pipe. We saw one as almost like a barber pole wrapped all around the sprinkler pipe for quite some distances. You've got to be kidding me. How did you do that? And nothing can be touching a sprinkler pipe. We had a conduit that was really, onto the pipe and you got to move the conduit. It's sitting on the pipe. It's pretty heavy. So you got to be kind of careful. So those are the things that you really, that's where the work permit process really comes in handy. Hey, let's take a look at IT's running some wise. Where did they put them?
Speaker 02:Yeah.
Speaker 00:Yeah. That vendor ran a piece of conduit. Did it right? Right. Is it correct?
Speaker 01:Are you finding that in newer construction as well, or just in the older, older, older?
Speaker 00:Yeah. The older new one, no one gets it. That's good. Because they're new. Let some time go by. Right, right, exactly. Our number two was the Life Safety 2135 EP14 blocked fire extinguishers. Well, how can you do that? But you're seeing it. And I tell everybody, hey, why not paint around it a three-foot rule with some tape or something, or put on it, do not block fire extinguishers. And actually, we found the blocked fire extinguisher with the sign there and the...
Speaker 01:So... What's the craziest thing you've seen blocking a fire extinguisher?
Speaker 00:A move and cool unit. Really? And that was the HVAC department did that. Really? They know better. They really should know better. But they didn't. The third one is the Life Safety 2110 EP14 firewall penetrations. And the big thing right now is the scab patches. And the scab patches over years have been, they're everywhere, man. There's a lot of them. And that's something everybody's challenged with. And obviously your group can't find you because they have to go above the ceiling, but that's where the issue is. And that's where that work permit process again, hey, there shouldn't be any patches used at all. Do it right. Run the wire or pipe correctly and you won't have that problem. So that's been a big deal. And again, train your staff. on the UL assembly, how it's done, why it's done, and they can then notify you that, hey, that company that was just there used a scab patch. They should have done it. No, that's not allowed. And that's been allowed for a long time. So there's a lot of hospitals, a lot of scab patches. Big job.
Speaker 01:Do you find, and I think this is human nature, like when you go into a hospital, if you don't see penetration, so if you see that they're doing a good job controlling, as a surveyor, do you naturally... start to not, you're not letting them off the hook, but are you, it's kind of like we talked, if you're treated well, you want to treat other people well. Does it build upon itself if you're seeing all these penetrations and then you just become, you're going down a route where it's not going to end well. Does that happen?
Speaker 00:Yep. I just did a VA hospital that I couldn't find a penetration, a problem. So I'm up on the top floor, I'm on the next floor, next floor, next floor. And I'm going after five or six floors, I'm going, wow, you guys, you have your act together here. Really nice job. Well done. I'm not finding any, which is so unusual. The smoke barriers were correct. The fire situation, everything was well done. So I'm going, I'm stopping. However, on the other side, if I start seeing floor 10, 9, 8, I'm getting a lot of penetrations. I stop after three or four floors. This is widespread. You have a problem.
Speaker 01:Yeah, you're just going to extrapolate. I mean, if it's that way on three floors, what's going to be different?
Speaker 00:Oh, and I could tell that with this hospital, this VA hospital, they had the stickers there. So I knew that they had dated everything. So this was a done deal. I wasn't finding any. It was kind of frustrating to me because I could find them. But they were good. And when I see that, like... They'll send a person up. He'll look for us. And I said, no, can't find it. And I go, yeah, it's not that I don't trust you, but I don't trust you. I'm going up. And I said, you did a good job. There were none. And I checked for wires on pipes. I looked for open junction boxes. I wasn't finding anything. I said, you're frustrating me here. We got to find something. But you have to have some fun. And that's part of the humor. That's part of it. But they're great. And they all enjoy doing it. So it was a good time. But that was kind of a, we usually find a lot of scat patches. To find none this time was interesting, but that's good. It's a good sign. The fourth top life safety thing that I found was the life safety 2110 EP11. And that's what I talked about before, our wedges. Wedges, we have latches that don't work on doors. I always like to press against a patient room door. And if it goes open, I go, let me try that again. Close it. It doesn't hold. There's a lot of latches that fail and just nobody checks them. And for the first time, I'm noticing a lot of hospitals They have those kickdowns. Remember the kickdowns thing you see at the bottom? It kicks down and locks that door in place. And a lot of hospitals say, look, I've had that kickdown there for 20 years. No one's ever said a word before. Well, they're not allowed in hospital. Really? No one else caught it. You got lucky. Right, right. You just never know. The fifth thing that was kind of fun is the last thing is really for life safety. 2135, EP5, very common, missing discussions. And if he can spell it, I always ask him, can you spell his
Speaker 01:questions?
Speaker 00:That's a tough one to
Speaker 01:spell on meeting notes. You got to get it
Speaker 00:right the first time and just copy and paste. Exactly. So I see a lot of that dirty sprinkler heads. And we always go to the loading dock, especially up north. It's a dry system usually. And just being outside in the salt air, those sprinklers get corroded. So they've got to be replaced. And we always ask them, we said, look at how long have those quick response been in there? And they say, oh, a long time. Well, at 20 years, you've got to take a look at them. Should you replace them? You have to check 10%. Did you know all that? And they said, no. And if you're over 50 years, which many hospitals are well over 50 years, on the normal response, have you changed those out yet? And they said, oh, I didn't know that. Take a look at 99. You've got to take a look at that. In 72, you've got to take a look at changing out those sprinkle heads. And then they finally do it. But I catch them on it every time. Yep. Top EC1s, really, and again, using other people, not just facility folks, but what help can you get from your rounding, your EC rounding, and, of course, your village? All this. EC261, probably the most common of everything. 261EP1, which is your stained ceiling tiles. And I like to stick around when I see a badly stained ceiling tile. And usually right behind us is the guy with the ladder, and he's got brand-new ceiling tiles. We're going to go in. And I always watch them, how they take it out. It's how you take that stained ceiling tile out. It's got all kinds of, could have mold growing on it, whatever. How are you taking that out and protecting the people in the hospital, the patients? Because there's spores on that. So if you start taking it out and there's a lot of, there's always airflow running on everywhere in the hospital, do you bag it immediately or do you take it off? And every time they take it down, they put it down the base of the ladder and they put the brand new tile. I said, whoa, wait a minute. Now that's an IC finding. What? Yeah, because the spores did. It just went everywhere, thanks to you. Now, if you bag it immediately, and that's what the surveyor stands around. I always play Mickey the Dunce and say, I'm just waiting here to see what happens. And sure enough, that's exactly what he did every time. You never know. And you can see damaged walls. You can see the nurse cord, the pull cord, pull station inside the bathrooms. It's wrapped around the... I said, this is stuff that really... your environmental care committee or nurses or everybody else is walking around the hospital, if you see it, let us know. If it's a damaged wall or it's whatever it happens to be, rust anywhere. We saw some ceiling tiles with black mold growing on them. I said, doesn't somebody say something?
Speaker 02:Yeah.
Speaker 00:That's one that the environmental care committee going around doing traces can really be a big help to you. The second one that's a lot of fun is EC251EP9. That came back to life again. that is the uh spares being in the on position and that's a problem because you don't know what they're feeding it's also we're also finding that the uh you have to label your main emergency shutoffs so if you have a natural gas line coming to the hospital is that labeled main gas shut off how about water main water shut off main power shut off so uh especially on a on a boiler room you want to know what that gas valve is to shut if there's a crisis sometimes so Everything has to be, all utilities should be labeled. The FDCs outside, fire department connections have to be labeled so people know how to find them quickly. And we're seeing a lot of people just not doing it. So they go set it up.
Speaker 01:I think especially these, I mean, obviously it's critical, but even more so with, I mean, some of that built in, and again, it's not a good excuse, but the person who might've known what that served, they could be gone. I mean, you're losing so much staff How do you learn? I mean, you can't learn by trial and error.
Speaker 00:Everything has to be labeled today. If you don't label it, your turnover is so great, you have to label everything. Where is the gas shutoff? Where is the main water shutoff? Where is the electric? How do I kill power? So those are all important things that we just have to get out there.
Speaker 01:Yeah, yeah, absolutely.
Speaker 00:That's important. The third one was EP, EC, 255EP6, and that's our favorite one. It's a lot underneath there. That has to be 100% of your non-high risk PMs must be done. That is a struggle for every hospital right now. The high risk and infection control, they try to get done because that's the first, at the end of the month, they try to get it done. It's the non-high risk. Many hospitals are 60 or 70%, they're not 100%. Just can't get that. You don't have the staff, you're missing people. And let me tell you that, well, we contracted out, but the contractors are having the same problem that we're all having. They can't get the right people. They just don't exist.
Speaker 02:So
Speaker 00:in their training, they're in training or they may not do the best job. When you have an in-house team, they have ownership and they want to make sure that it's done correctly. Well, somebody from the outside may not have that same ownership.
Speaker 01:Are you finding, Larry, more PM slippage as we've... Yeah. Yeah. Yeah. And that's something...
Speaker 00:It's because they don't have the staff. And every time you hear it over and over again, don't have the trained staff or... It's been a huge problem. And this has been... There's many things on this EP6, from blocked electrical panels, freezer temperatures, your emergency lights being done, egress lights. It's a lot of things that you have to keep doing all the time, and you may not have the staff for it. And that's what hurts everybody.
Speaker 02:Yeah, yeah.
Speaker 00:So here's a common finding. EC221EP5 is probably another one that's so common. That's your eye washers and showers. Are you really... Do you really need the eyewash, first of all? Do you have a risk assessment on it? And again, that's part of your team needs to know risk assessment together. Make sure you get the 10 seconds. Make sure that I always like hearing that the staff that wanted the eyewash there actually every week checks it and actually does the PM. So they got a chance to throw the lever down. It runs it. You got a chance to see the caps blow off and you keep it clean, of course, and make sure that it's tepid water from 60 to 100 degrees. All the right things. And then once a year, I want to see the annual PM done by facilities to make sure that it's the right flow or the 0.4 gallons per minute, the whole bit. So those are a common finding. And you would think that by now we learned all this. No. And there are eyewashers everywhere. People have gone out of control. You're putting them for every reason. No. What are you doing? Well, I could get blood. Well, that's not what it's for. It has to be caustic or corrosive. So it's the risk assessment. And yes, you can have it if the risk assessment and you all agree. And usually I use the EC committee because it's a multidisciplinary group that has, it's in the room says, yes, they do need it or they don't need it. So don't waste the money. So a lot of time and effort and maintenance. And the last one, that's kind of a, that I've seen a lot of is the EC259, EP12, the O2 cylinders. It's not just the co-mingling and the unsecured. They've got to make sure that if you have them outside, you don't want them sitting on the ground. You don't want them rusting away. You want to make sure everything is done correctly. And boy, we see a lot of... I've seen O2 cylinders on heaters in the room. I've seen them on stretchers on the top, on beds. You see holding open doors. really oh yeah you see the craziest thing is it wouldn't find a wedge that's a wedge but those are really the top 10 that i see the most out there and i think that's something that we again people could help you with that if they see something like that call you see somebody putting the uh a bottle on top of a stretcher shouldn't just say something to somebody and say can i help you
Speaker 02:yeah
Speaker 00:can i move it down to something And the bottom of a stretcher, it's got an actual holder for the O2 cylinder. So it's an E cylinder. Put it on the holder. Have you found
Speaker 01:a full cylinder holding a door open?
Speaker 00:Yes.
Speaker 01:Really?
Speaker 00:More than once.
Speaker 01:Wow.
Speaker 00:Damn. You would be surprised. Some of the stuff, you almost say to yourself, I can't make this up. And the people that are with me are taking pictures. And I said, gee, can I get a copy of that picture? That's really good. You don't always see that. It's craziness. But people are in a rush and you have so many. And the clinical staff is really has changed a lot. They're constantly leaving and coming back. We lost a lot after COVID. So you have a lot of new people and they're all learning. So mistakes can be.
Speaker 01:Yeah. And it sounds, you know, as you just listen to you talking, I'm sure you think this is your you know as you're out there it's not like you can't solve for one issue it's multiple issues that all play a role in this right everything from education to turnover to time and it's uh it's a tough one
Speaker 00:and it's not just these findings it's uh So much else that's going on. It's workplace violence. It's the active shooter and all that training. There's so many things going on in the hospital at all times. And now you've got all the world situations that are going on that has people upset. So you've got so much going on. Times are crazy.
Speaker 01:And the hospital really is. It's the epicenter of the community because everything that happens in society, if it's a negative, it's going through that hospital.
Speaker 00:Exactly right.
Speaker 01:Yeah. Do you find Larry and last question and, and, and Larry, how would, if, if somebody wanted, I know you're have a great presence on LinkedIn, but if somebody wanted to reach out to you, LinkedIn, the best way to do it.
Speaker 00:Yeah. My, my email's there. It's a LF Ruben on hotmail.com. They can always get ahold of me that way, but it's on there. And, and if I can help somebody with what it's all about, it's what's the name of the game here.
Speaker 01:Yeah. When, when you're not, when do you sleep? But last question, and you touched on it a bit. We had done a survey. just we do one every fall, just healthcare facilities management survey. That's among our network. But one of the comments that I read was, and I'm interested in your opinion on it, is that there is so much on our plates now. It's really, they're worried about compliance specifically, and they've mentioned compliance specifically, that there's so much relative to sustainability, active shooter, everything you've just talked about. Do you worry about that too, that there's so much on the plates of these folks that it's becoming even more, I'm just gonna use the word burdensome, you did, but even more difficult to stay on top of things? I'm seeing
Speaker 00:burnout. Yeah. I did a survey not too long ago with a facility manager who was really, I could tell this guy's gonna burn out. He's so good. He's really, it's a 24 by seven job. So what it means is you could call us one, two o'clock or three o'clock in the morning. I've got many of them. My wife always used to kid me. How do you go back to sleep after that? She hears me at one o'clock in the morning. Yeah, make sure you turn this thing on, turn that on, do this, do that. Then they go back to bed. How do you do that? It's years of doing it. It's so... But you got to be careful. Don't burn yourself out because there's so much going on. You can't do it all. You need help. And trying to find the right people, hire them for a while. Hire a consultant for a while to help you. And then you got to convince leadership, you need somebody here. I can save this money from the consultant by hiring somebody in-house. Does that make sense? And most of the time, it actually works. I've done that a lot.
Speaker 02:Yeah, yeah.
Speaker 00:It's a tough job. This is not an easy job. There's a lot on your plate. And if you make a mistake, I mean, you know, you can get fired. Right. Careful.
Speaker 01:Right. Yeah. And, and you could potentially cost somebody their life even more drastically. So Larry, anything else we're doing? This has been a fantastic, fantastic session. Anything I know you, you had taken some items that you wanted to get anything we didn't touch on that you want to close
Speaker 00:with? I think you hit them all. And I can remember the pressure on even the facility directors that I had a nurse manager come down to me way back when, when I was in Boston saying that you just killed this patient. And I mean, that really puts a lot on you, but that's our job is to keep people safe. This was a BMT patient. The ceiling got wet from a leak. And obviously this is a BMT bone marrow transplant patient. That's very sensitive to that. So that really makes you really do your job. And to me, in my brain, it's always been the patients are number one. what that's why we're there so are we really keeping everybody safe so when i do a survey i don't if i don't feel comfortable i will tell the the manager director look i i'm not feeling comfortable your patients are not safe here are you doing all the right things what can i do to help you that's kind of the biggest thing that's what that's what it's all about that's what every manager has to deal with all the time
Speaker 01:yeah do you ever get it last do you ever get or have you ever said that to a manager and has Like, have you ever received a reply that kind of floored you or made you take a step back and think, oh, boy, has that ever happened to you?
Speaker 00:No, not really. No, I've been pretty lucky. I think I was really floored when this nurse manager said that to me. And I think that really changed my focus a lot. And that was like in 1990. And I think I remember that so well that it always keeps me focused that I will never let that ever happen again.
Speaker 01:Yeah. Yeah. Wow. Well, Larry Rubin, thank you for your time today. I really appreciate it.
Speaker 00:Okay. Thank you so much. Yeah,
Speaker 01:no, this was great. What a remarkable career and it's still going.
Speaker 00:It still is. I'm not going to give up. I love
Speaker 01:it. Peter Martin for the Healthcare Facilities Network. Thank you for tuning in. And Larry, that was fantastic. Thank you so much.
Speaker 00:Thank you. You take care. Have a great day. You too.