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
Accreditation 360 and Top Life Safety Findings Explained
Accreditation 360 is coming January 1, 2026, and hospitals are asking the same questions: What changes matter most, and what are surveyors actually citing?
In this episode of Healthcare Facilities Network, Steve Van Ness, Vice President of Planning and Design at CREF, and Thomas Grice, Vice President of Corporate Real Estate and Facilities at CREF, share field insights you won’t get anywhere else. They break down the top life safety findings hospitals are seeing, highlight common pitfalls, and offer practical strategies to help teams prepare for the new standards.
Whether you manage facilities, compliance, or hospital operations, this episode gives you an actionable view of what matters most. If you want the insider perspective on Accreditation 360 before it hits, this is the conversation you can’t afford to miss.
🚨 Subscribe to the Healthcare Facilities Network Podcast to gain awareness about the rewarding career of healthcare facilities management: / @healthcarefacilitiesnetwork
👥 Connect with Peter: https://www.linkedin.com/in/peter-martin-6284363b/
Today's Guests:
👥 Connect with Stephen | https://www.linkedin.com/in/stephen-w-van-ness-a8356017/
👥 Connect with Thomas | https://www.linkedin.com/in/thomas-grice-msfm-bba-chfm-chop-779a5713/
✅ Important Links To Follow:
👉 Cref: https://cref.com
👉 HFN Website: https://healthcarefacilitiesnetwork.com/
👉Watch on YouTube: https://healthcarefacilitiesnetwork.com/
👉Listen on Apple Music: https://podcasts.apple.com/us/podcast...
👉Listen on Spotify: https://open.spotify.com/show/3vWorrUkfsBprrg5S2TUjZ
✅ Stay Connected With Us!
👉 LinkedIn: https://www.linkedin.com/company/healthcare-facilities-network/
👉 Instagram: https://www.instagram.com/healthcarefacilitiesnetwork/
👉 Facebook: https://www.facebook.com/profile.php?id=61572807523974
👉X: https://x.com/HFNPodcast
📬 For Business Inquiries: pmartin@cref.com
=================================
Disclaimer: We do not accept any liability for any loss or damage which is incurred by you acting or not acting as a result of listening to any of our publications. For all videos on my channel: This information is for general & educational purposes only. Always consult with an attorney, CPA, or financial professional for advice based on your specific situation. Copyright Disclaimer: Under Section 107 of the Copyright Act 1976, allowance is made for "fair use" for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. Fair use is a use permitted by copyright statute that might otherwise be infringing. Non-profit, educational, or personal use tips the balance in favor of fair use.
© Healthcare Facilities Network.
Okay, I'll give you one and it'll it'll have a couple with it. Stain ceiling tiles. I know that sounds you know, you see them everywhere. Crack ceiling tiles, voids in your ceiling tiles. You know, if if it's unseated or or or whatever, it's avoiding your smoke barrier because we use those suspended ceilings as our smoke barrier throughout our our hospitals. Most of them do. As an example, we were touring a hospital in a NICU, a very busy NICU, and we came up to the soiled room. I took my manometer to check the soiled room, and the soiled room was more positive than a OR. I mean, it was extremely positive. I opened the doors, I always do, to check everything, and I look up, and um, there is a ceiling tile in there that was had lots and lots and lots and lots of growth. Don't know, we can't say what we think it is because we didn't test it, but I uh I know what it was, you know what it was. Um, so not only in the NICU did we have a positive room, but we had a contaminant in that room that was obvious that was positive to the NICU core. A lot of times people don't put two and two together, but that made that a very high-level finding immediately.
SPEAKER_02:There's a major crisis facing healthcare facilities management. We have aging employees, aging buildings, and aging infrastructure. We've created the healthcare facilities network, a content network designed specifically to help solve for these three pressing issues in healthcare facilities management. We bring on thought leaders and experts from across healthcare facilities management, all the way from the C-suite to the technician level, because at the end of the day, we're all invested in solving the aging issue. Thanks for tuning in. Look at our videos, you will find that is a theme across our content. This is the Healthcare Facilities Network. I'm your host, Peter Martin. I have two of my colleagues here today. We're going to be talking about accreditation 360, we're going to be talking mock surveys and findings, we're going to be talking education. So a wide-ranging conversation with my colleagues all around compliance and accreditation 360. So very timely with all that's coming up. We'll dive into that. But before we do that, I would like each of my colleagues to introduce themselves. Tom, why don't we start with you, please?
SPEAKER_01:Hello, I'm Tom Grice. I'm vice president of regulatory and facilities for KREF. Um, I've got over 35 years of healthcare facility management experience. Uh been working in for-profit, not-for-profit, third-party. Um I have a master's degree in facilities management, and good to see you all.
SPEAKER_00:Hi, I'm Steve Ness. I'm vice president of planning, design, and construction for Kraft in the East Region. I'm actually based in Fort Lauderdale. I'm also a vice president uh and on the board of the local AMFE chapter. It's a great organization. I'd encourage anybody that uh would like to join your local organization to do so.
SPEAKER_02:Thank you, Steven. We thought, you know, um it was timely to have this conversation with the changes coming up with Joint Commission, uh, the accreditation 360 program starting January 1st, 2026. Tom, before I kick it over to you to kind of ask for, in your opinion, the practical implications of that and and and what it means for facilities, just if people aren't familiar with it, I'd say there's a couple of resources. Number one, we on the Healthcare Facilities Network just released uh or have released an interview that we did with Jim Grana. Jim is field director at the Joint Commission, and our conversation, and you can find it here on our YouTube page, that conversation really is the the nuts and bolts of what they're doing and the program. They're not changing the conditions of participation. Um, according to Jim, they're not going to be changing that survey process. What you've done is what you'll do. The the big, you know, one of the big changes, obviously, and Tom can dive into this, is is the new chapter that they're creating, a reduction in standards. The new chapter is what, the PE chapter. Um, so they're going from it briefly, and I want to go to the expert. So on the life safety side, they're going from 23 standards and 260 EPs. That's current. So life safety, 23 standards, 260 EPs, and this is right from the guys at the Joint Commission. On the EC side, there's 21 standards and 195 EPs. So that's significant. They are going, they're getting rid of those chapters, going into what they're calling the PE, the physical environment. Physical environment will have 12 standards and 67 EPs. So a significant reduction goes into effect January 1st, 2026. I'm not the expert. Those are the facts. Tom, given all that, though, you're the expert, you're out in the field, you worked in hospitals, you've been through hundreds, if not thousands, of surveys. What's the practical implication of this change?
SPEAKER_01:So I I think the practical implications is it's it's going to clear up a lot of disparity between CMS and the Joint Commission, right? So CMS does come in and and they follow up Joint Commission, and many times the standards don't line up. So Joint Commission may not have cited something that would be a conditions of participation with CMS, or vice versa, right? So it really kind of melds them together. And there's a bunch of crosswalks and so forth on uh the Joint Commission websites that you can kind of go and look to see what the standard was, what it is now. Uh we we do uh process maps, and we had done process maps for uh environment and care and life safety for everything that had a documentation standard. Um so so now we're we're process mapping the new uh standards. There's a few that like don't fit, but that's because they they kind of just went over to another chapter. Uh but you know the survey process, as you said, is not changing. Um what the hospitals are required to are required to do now, they're still required to do moving forward. Um it also does uh separate out if there's something that the joint commission is requiring, excuse me, joint commission is requiring. Yeah. Get rid of the right joint joint commission is is requiring that's above the the conditions of uh participation. And and those are those kind of surface now. You you kind of see where they are. Um you know, I I think that's really it, but it's a big change, right? Because we've been used to all the EC chapter, the the LS chapters, all the EPs, we've set up all of our documentation as it relates to that, we set up our policies as it relates to that, our our management plans. So, you know, really in preparation for January 1, which it's going to be a learning curve for both the joint commission, both joint commission and the hospitals, I think just to take a proactive approach and start looking at your policies to make sure that they're not referenced in an environment of care or or or a life safety, take a look at your management plans. Um and you know, start setting up your documentation books based on the new standards. And, you know, again, like I said, there's crosswalks out there. We we also have our crosswalks and so forth. So you if you do it before January 1, then you're ready for the new year, right? So, and I don't know that any of the um the vendors yet that we've been we've been kind of monitoring have new there's some vendors out there that that do provide binders, right? Uh for your documentation. I don't think that they started printing those yet. So, you know, I I would just start thinking about you know how do we how do we manage our documentation? Because that's really the biggest change, um, you know, than then than anything. So that's kind of that that's kind of, you know, and and and really there's a lot of resources on the Joint Commission what website, and we're also available for any type of uh of consultation that you may have as well.
SPEAKER_02:Right. One of the things, Tom, that I've heard, and I don't know if you have, you know, while you're out there in the field, is some folks are a little fearful that, you know, we had all those standards, we had all those EPs, and and the the the guardrails were there, right? I've talked to some folks who are who are a little worried now that we're you know we've reduced the standards, reduced the EPs, now we have this one PE that they're calling. They're worried that there's gonna be more findings over time because some of those guardrails have disappeared.
SPEAKER_01:What do you think about that? I I don't necessarily see that. And I'll give you an example is the DMV has always had the PE chapter, um, you know, outside of joint commission, different accrediting body. And and and it actually it it pulls more leadership in to make sure that that you know, so so it it's there there's a lot more leadership involvement with just a blanket standard, you know, 12 standards in the in the PE chapter, and there's a lot of stuff that fit in there. I know there's a fear out there that that, well, it gives a surveyor now. We can point out, well, the standard says this, right? And it's very descriptive. It gives them a little bit more latitude to make their own conclusion on a finding or or whatever. And and you know, it if you think about it, you know, I I always say this um is the code books, code books are like the Bible. It's it it's up to the interpretation, right? It's it's the the surveyor, and we if I say surveyor dependent one time or ten times on a survey, because each each surveyor does have their own interpretation. So I I don't see it really making more findings, especially if you are on top of it, right? So if you're if you're if you have a constant readiness or a readiness program within your hospital and you're doing what you should do, you know, and you're educating staff and you're communicating with staff and so forth, it should not be an issue.
SPEAKER_02:That was one of the points that Jim made during our conversation. He said, and it sounds like you agree with him. He's like, if your last survey, you had a good survey, and you're still continuing to do everything you did on from the last survey to this one, then you're gonna be okay.
SPEAKER_01:Correct.
SPEAKER_02:Yes. So we'll there'll obviously be more on that to come. Um we'll see what happens, especially as we go into the new year. It'll be interesting, and we'll cover it here on the healthcare facilities network. Um, we have two great guests for me to ask this question because Steve, as you know, you've been involved in healthcare and architecture for 40 years, and you've been on the client side, you've been on the owner side, you've been on every side. Tom, same to you. Same as you. What I want to ask you about though is before we talk about the findings you find, is the critical relationship that needs to exist between FM, the facility side, and that clinical side, right? Um especially as it relates to joint commission DNV findings across hospitals. Can you just explain, Tom? I'll go to you first and Steve, feel free to jump in at any time. Can you explain how that relationship should work and how it does work and what your observations are about that the relationship between clinical FM, especially as it comes to these high pressure situations, right, where you're out there surveying.
SPEAKER_01:Right. Well, again, I I think there should always be a great collaboration with between clinical and and in clinical. I'm talking about infection control, I'm talking about quality, I'm talking about nursing, I'm talking about, you know, all the way down to EVS. There needs to be a uh a collaborative approach to the house, right? You know, and and and what I what I mean, I see that very infrequently when I'm out on survey, right?
SPEAKER_02:You see you see in Tom, you see that you see collaboration infrequently?
SPEAKER_01:Infrequently, yes. Okay, yes, kind of like pillars, right? So EVS does their own thing, and and then when you have the conversations, it's like, I don't know, that's not my department. That's that's EVS or that's that's nursing. And I I tell them a hundred times and they don't listen. And and and really what what what I do when I'm on survey, it's amazing because I ask for as many people as possible to go with me on survey. Because I love to educate, my team loves to educate. And you know, one thing we do when when people come with us, one thing we hear is, oh, I've never seen this part of the hospital, or I've never didn't even know this existed, or or what have you. But then, you know, instead of just saying, hey, I'm taking your door stop because you have your door propped open, we explain the why. And I think if more if more um organizations actually explain why you can't do certain things and why you have to do certain things, it it makes it it makes it a lot easier. And and people want to be compliant, right? If they know there's a reason, and it's just not that, you know, my door's propped open or I left my my wow in front of the med gas shutoffs or whatever, you know, explain why. You know, if there's an emergency, you know, we need to be able to shut these utility systems off immediately. You know, and you one well one and and I'll digress, but but one big thing we see is is conflicting exit signage. So you'll have an exit sign above a door, and then underneath it, you'll have a do not enter sign says surgical attire required beyond this point. Life safety, we say you can't do that. Clinical says we have to do it. We can't have someone coming in, you know. So it's kind of those types of things. So then when you explain there's an emergency in the hospital and we have to evacuate horizontally quickly, you know, and and you've got um general public out there, they're not gonna go through a sign that says, you know, uh surgical tire. They're not, even if there's a big exit sign above it. So you gotta think of different verbiage to put up to to to not stop the public, right? Anyway, uh I'll digress from that. We'll get into some of that stuff later. But again, I I I just think it it's the education piece, it's it's the communication and and the the explanation of the whys.
SPEAKER_02:Why do you think you just said the explanation of whys? This is a different why I'm gonna ask, but why do you think that after all these years, right? And we always we hear about collaboration everywhere these days. We hear about risk, we hear about cost, we hear about all of the negative things that come out when you don't collaborate. Why do you think there's not a greater sense of collaboration? What's the root, well, not the root cause, but what are some of the causes of that, do you think? And Steve, after Tom goes, love to hear your opinion too, because you've led teams.
SPEAKER_01:I I think it starts with the foundation. Uh, you know, you can collaborate or collaborate all you want to, but with turnover, with new people coming in, exiting the organization, you know, if you don't have a base, you know, some type of a standardized process for collaboration, it's not going to happen because it's not going to transfer from the population today to the population tomorrow. You know, so I I think you have to have a program of collaboration, right? It needs to be hardwired in the organization. Once it's hardwired in the organization, you know, I mean, I remember 10 years ago when we first, you know, we thought safety huddles were were, you know, cutting edge. And now every hospital does safety huddles, you know, and and now they're even doing them virtual and so forth. But you know, it it it's but that got hardwired in the organization. And now it's just a norm.
SPEAKER_00:So back to your uh your first um your first question to Tom. Um my perspective is generally a little bit before uh uh Tom's perspective, um, during the planning and design phases for projects. Uh and the the same issues there. Though there's often the planning of capital projects is done in a silo that is not connected to the silo that facilities is in, if in in many organizations. Um as Tom said, if you can hardwire that collaboration, that collaboration needs to occur throughout the um throughout the process. Capital planning, um, initial capital planning, if you don't integrate the facilities needs with your clinical needs and your your uh strategic improvements, um you're you're gonna have you're gonna have trouble once the project gets up. You don't have an accurate idea of what you're gonna need um within that project in terms of uh maybe the air handlers are out for. And uh you end up with the problems that um uh once the facilities are open operating, you end up with the the problems that Tom is describing in the uh in the uh door stop example for uh, for example. Um if uh if that happened to be a fire door, perhaps it's a uh fire door that you can put on a hold open that immediately closes, you know, sometimes. So you can address some of those issues in planning, the signs that are put up. You need to be looking at those signs during the planning phase. So you don't have to wait till Tom comes along and tells you, hey, that wording's not going to work. So so I I I think that that collaboration just extends throughout uh throughout a uh the process of a project from the from the very initiation to capital planning through the design and then into the final construction.
SPEAKER_02:But we know that those silos still exist, right? And it's created what you've just described is is the way to do it. Tom, you know, Steve was talking. I was thinking, think back to when you were actually working in, when you were uh a hospital employee, working, you know, working the day-to-day. How did you um I and I don't know what your situation was relative to silos and communication, but how did you make sure that you got that seat at the table so that, say, Steve's your architect, you can talk about some of these issues right at the very front. So you're not scrambling at the end on a life safety review two weeks before the hospital open.
SPEAKER_01:How did you make sure your voice was heard? So I I went to I asked to be uh invited to departmental meetings on on a regular basis, and we would pick a topic to review. Um and the topic that I I felt um had the most interest is when I described life safety drawings and and put them up on the board and explained why we have them, what they're there for. And when you say it's to protect this corridor right here, so you can get from here to here, they all get it. And I say if you've got this door propped open and the fire's in that room, you're now blocking the egress path, you're not going to be able to get out safely through that exit. And when you just put it in the terms that they understand, and not that they're, I mean, they're very smart people, a lot smarter than I. But but when you when you actually just put it in the layman's terms, they get it. It's like all of a sudden it clicks. And and so the the the other thing I also did is is I invited line staff to my environment of care safety committee meetings. So we actually had line staff sitting on those committees because they're the ones that are frontline, they're seeing it, they're bringing it, they're seeing the trends, and and and that seemed to work well in addition. So, so again, it's collaboration, it's involvement, and it's communication.
SPEAKER_02:So it seems like a big part of your the mode you operate, both now as a consultant and when you were in the hospital, is you're going back to the foundation. You sat at what's the why? And once you get that why out there, then everything can flow from that.
SPEAKER_01:Correct. Yes. Yeah.
SPEAKER_02:Simple. But not everybody, but not always done.
SPEAKER_00:Right. Correct. Correct.
SPEAKER_02:So uh let's transition. But before we transition, Steve, any final thoughts on the collaboration, that relationship between clinical, you know, let's break it down, explain the why, and it'll be better. But any final thoughts before we move on to these topics.
SPEAKER_00:Just the final thought. Uh it really extends to when when you're planning a project, it really extends all of it to facilities maintenance, it extends to EVS, it extends to infection control. Uh all of those, uh, all of those departments need to be included in the planning process, or or you you'll miss something. And when you open up, you'll have a non something that is not functioning correctly, uh, something that is not going to uh be able to uh be licensed. So you really have to have uh all of those folks participating in the process. Uh and you you would think that that's a lesson that everybody learns, but quite frankly, you know, um even as uh as early as the latest uh three months ago, I had a I was um brought into a project where the doctors and the business people felt they knew how to design a primary care practice, right? And fortunately it was still only on paper and not built, but there was totally an adequate EBS space, there was totally inadequate uh IT space. IT is another critical department to make sure that you uh include in the planning.
SPEAKER_02:Um, we could do uh we could probably do a whole show, maybe we should at some point, like horror stories from this, but I but you know, as as you're talking there, Steve, I'm you know, I'm just thinking to myself, like everybody wants to go faster and faster to get to market, and that's working against us many times these days, right? So it's speed to mark, speed to mark, but you miss the fundamentals, right? If you're so fast, you're gonna miss the foundation, like you say there, Tom. Yeah, it's it can be frustrating. That's why I like that's why I like talking about it rather than doing it. It's a lot easier. So let's transition. Um Tom, to you to start. Yes. You're out there, mock surveys, you get the joint you know, joint gonna say joint commission because the the is gone. People are still saying Jaco, and now they think that people are gonna drop the the from the joint commission. Well, what are the uh what are the top findings, Tom, that you are finding out there as you and your team visit hospitals?
SPEAKER_01:Well, I mean, when we go through and and you know, we probably do six to eight surveys a month, um, you know, top-down surveys, and which include also uh document review. Um, our average amount of of findings, just when you said top 10, that's you know, there's we could be here for hours, right? So I'm glad you said top 10, because we we we typically find in in a 750 750,000 square foot hospital, we'll find 500 findings. Um so and and so for the top 10, I mean it pretty that's pretty much does mirror what what joint commission has came out with their top 10 or 16 or whatever that that that they have. But it it's you know, and and I'll go down and I'll I'll explain kind of you know, one of it's it's the same stuff. It's over and over again, right? It's it's just it's the same stuff. Um, you know, we're we're seeing you know issues with fire drills. Okay, so fire drills you're required to do one per shift per quarter, you know, they can't be patterned. We see a lot of patterns, you know, to where you know, security's doing the fire drills, plan ops doesn't do them anymore. Um, and security, you know, they Bob, who works seven to three, he likes to do them all. So they do one at seven for first shift, three for second shift. He'll come in at 645 to catch that third shift. And now we've got a pattern, right? Um, and and then additionally, what where we're seeing we're really seeing a lot of this is the OR fire drills. So the OR fire drills are separate from that one per shift per quarter. And once a year, you have to at least simulate an exit drill. And so we don't see that all the time. Um, and then with that drill, there should be a critique and an after action created, you know, for uh improvements that are that are needed and and so forth. And then that needs to be filed with your fire drills. In addition to that, you need to also provide education on the OR safety risks within the OR at least annually as well. We do that. We have we have a whole program for it. We even do the critique for you. But um, so that that's that's the number one is is the fire drill piece that we see.
SPEAKER_02:So, Tom, you you know, simulate an OR fire drill. Is that literally evacuating? What does it mean to simulate an OR fire drill?
SPEAKER_01:So you it it's basically like a tabletop, right? You go into the OR, you can have someone act as the patient or not, and and you know, and and you get your role through the education. You know, what what does the surgeon do? What does the anesthesiologist do? What so through the education, all those roles are kind of predefined on on if you have that position, this is kind of what you do. Um, and and you have someone not involved in in the in the drill at all critique it, right? Based on what they're supposed to do. There's you know, we have a critique form, and and I'm I'm sure many hospitals do as well. And you just critique and say, okay, they didn't shut off the mad gases, or they they brought in an ABC fire extinguisher and they shouldn't have. They they should have used the carbon dioxide, you know, all of those types of things, and you critique it. And then, you know, if it's bad enough, we always recommend doing it again, re-educating, you know, next month, do it again, do it again until you you get, you know, to where again it's hardwired within the OR staff. Um, but then the physician and and the anesthesia involvement is key. That is one thing Joint Commission looks for. If if you're taking attendance, make sure they put MD after it or CRA or whatever, um, just to make sure that that you do have that involvement.
SPEAKER_02:If you like this video, please like and subscribe to the network. And more importantly, share it with your colleagues in the healthcare industry. Together, we can solve the aging crisis that's impacting all of us. You've talked about a lot uh what's the why behind it. And and you know, when I was doing recruiting prior to joining CREF, like when an organization, let's say that they they were uh seeking a director and there was say they were they wanted a degreed person. And sometimes I would say, Well, why do you want the degree? What do you need it for? And sometimes they would just the answer was because that's how we do it, which to me wasn't really an answer because it's how we know. When you ask, like fire drills, fundamental, we see these horror stories when hospitals catch on fire, what can happen? Fire drills seem like a pretty important thing. Do you ever ask why? Like, why don't you do it? And and when you do ask those questions, what do you hear back?
SPEAKER_01:So you especially for for the OR fire drills. You yeah, because we we actually put them on and we try to schedule them. And trying to schedule anything, as you guys, I'm sure know, internet OR, especially if it's a busy hospital, it it's almost impossible. It is almost impossible. So so you know that that is not something that's on their mind. It's not on their priority list. You know, they're not they they're thinking the safety officers officers got that or security's got that. I don't have to worry about it. Um and and and that's that that's kind of you know why I think that it just kind of falls off, right? Because it's it that they're they're churning through, you know, case after case after case after case. Last thing they want to do is stop or have to come in earlier than six o'clock in the morning to simulate a fire drill, or there's always cases being added on at the end. So everyone's sitting around waiting to do the fire drill. So it's just really, really, really hard to get it, to get something like that scheduled.
SPEAKER_02:And that goes back to your early on point about hardwiring it into the process. If OR people think the safety guys got it or the safety people have it, and they don't you create that process and that then then you know you have it. Yep. Okay, so fire drills number one. What do we get after that?
SPEAKER_01:Uh blocked safety, shutoffs, equipment, pool stations, blocked electrical panels, you know, um clutter in hallways. That's that's a big one. You know, they they went to the WoWs now and they said, you know, WOWs can be in the corridors as long as they're working. Well, now they're putting stationaries' chairs in front of their WoWs. So now it's become a desk and it's in the middle of the hallway or in the middle of the corridor. Um and and and again, what what what I think is funny is like some people, you know, some people have actually put tape on the floor, or which tape's a bad thing, but you know, some type of marking on on the floor saying do not block. And I've got so many pictures, you know, do not block, and you you've got the wow right there in front of it, or or or what have you. And and you know, the again, the why is if there's a fire. I've got to get to that med gas shutoff as soon as possible after after collaborating with respiratory therapy and and whoever else you you deem. But we we need to be able to get to that. And if we can't be pushing stuff out of the way, we've got a lot of stuff in the hallways. You know, we we can't get the beds out if we have to do a horizontal evacuation into the next smoke compartment, right? And and you know the corridors are eight feet for a reason. So you can get two beds down it at one time, side by side. That that's why they're eight feet. So again, once they know the why, then they get it, right? Um and then you you explain when you put a chair here in front of your wow, I know you're tired, but now it becomes a desk because you don't only have to move your wow, you've got to move the chair. So that's and again, we see these that that's why they're the they're not necessarily the top from a risk perspective, but they're the top for a number of findings that we that we see.
SPEAKER_02:I I wonder if it goes back to just you're so busy you're not necessarily thinking. I mean, I I don't what do you think causes it?
SPEAKER_01:It's inconvenient if they're far away from you know a patient's room, they have to walk, you know, they they're on their feet all day long, right? So you know, and a lot of times, like Steve said, there's not enough places in a hospital to put the stuff. I mean, I think it's amazing that they find places to put it during survey, but but they can't during normal operations, right? So it's again, that's you know, in in the design, you know, there should be alcoves and and so on, but you know, cost per square foot to build a hospital, you don't want storage space, right? Because that's that's a that's very expensive space. I think that's the why is is well where where where else do you want me to put it? You know, I go into an OR and they've got they've got the the um um the limb panels, the line isolation monitor panels blocked. And the and but you look around, there's no place to put the stuff.
SPEAKER_02:Steve, what is your um your design, your design mind, as you're listening to Tom talk about that? Where does your design mind go?
SPEAKER_00:Well, um, you know, specifically to the issue of WOWs in the corridors, uh that is um very difficult in in hospitals that uh have been that were designed and built, say, more than five to eight years ago. Um mostly now what you're saying uh a lot of is providing alcoves and um really thorough design process is is is going to include you know really looking at how these um facilities operate. Uh the number of equipment alcoves um, you know, that you need in a surgery suite is incredible, plus you know, some good um solid amount of storage. Um in a nursing unit, you need to have, uh particularly if the nurses are using walls, you need to have those areas near the patient. Um there was uh a trend uh probably about six or eight years ago to provide small mini um uh remote nurse stations, which a lot of nurses uh initially tended not to like because they liked the uh having having the camaraderie of being at the nurse station with other nurses and and and centralizing. Now with the emphasis on and with the use of WOLS and with the emphasis on speed of care um or um individual care, uh you're getting more um you you don't want to build in those nurse stations. You want to build in areas where the nurse can use the computer and and um type in her um uh her reports. So um those kinds of things uh have to be incorporated into the design process when you're either renovating a space or designing a new space.
SPEAKER_02:The level of nuance, right, and sophistication and just getting it down to these minute details is so critical, especially as, as you guys were saying, nobody wants to pay for space for storage, right? But but the the level which your mind needs to go, you you gotta think everything through because everything has that impact. And Tom, you're right. We were last couple of weeks, we've been traveling quite a bit, um, hit a number of different regional conferences, and and you're exactly right. One of the presentations we went to was it was on the joint commission, and the presenter was saying that. Listen, when the joint commission's here, roll it out, roll the equipment out of the hallway. But as soon as they leave, you know it's going right back and set from the podium because everybody's struggling with that, right? It's it's not unique. So we got fire drills, we got clutter, wows, hallways. What else? What else you're finding out there?
SPEAKER_01:Uh a big one and a big one for me is uh air pressure, temperature, humidity, right? For not only your primary runes, but your secondary runes. Primary rooms being your ORs and your SPD and those types of things, secondary rooms being clean utility, sold utility. If joint commission comes and you're out of range on especially pressures, right? If if it's you're supposed to be positive and you're negative, they're giving you until they leave to fix it. But if they can't fix it, it's it's not at condition level, right? So these are these are high risk, high, high findings. The newer hospitals are better, of course, as Steve said, you know, the older hospitals is where we we struggle, you know, because things in the hospitals, you know, they remodel, they change things, they add more equipment, they've they've they've turned an office into a clean room, they've turned, you know, a soil room into an office. You know, all this stuff happens uh throughout time. Um so you know, you're you're required to to make sure that that you're monitoring it. You're you know, the so a lot of times, you know, I'll ask the question, you know, how do you know that that the room is okay to perform an operation? We'll just use uh ORs for for instance. And they say, well, we know facilities monitors it, and if they don't call us, you know, we know it's fine. Well, you can't do that. You you've got to have someone you know looking at it real time saying, okay, we're we're 0.01 inches of water column negative or a positive, we're good to go. Let you know, let's go. And and or at least do a tissue test, right? If if you don't have the the the manometers and those types of things, at least do a tissue test. If the temperature, you know, but so that's just on on the pressure piece, right? Um, so you just need to have, again, some type of system in place that you're looking at it to make sure that it's okay. You're not you're not performing an operation in a negative room, right? Or or whatever. Um, temperature and humidity, you know, that changes throughout the day. I mean, it changes based on building load, the wind outside, um, the number of cases you have, how many times this door opens, that door opens, you know, everything changes. But but, you know, and especially a lot of the surgeons like the temperature in the ORs to be very cold. And and it's okay. You know, there's a footnote in the code that says in FGI guidelines that said it's okay, you know, but document it, right? And and and monitor you your humidity, because if your temperature goes down, your humidity goes up, right? So you you have to make sure that you're you're monitoring that as well. A lot of times we don't see that happening. They'll they'll have the OR set at 60 degrees and the and the humidity is at you know 72%, you know, and and again, high humidity, things grow, low humidity, things burn, right? So it's it it really is just setting a program to where you're monitoring it. You've got facilities who's monitoring on a global basis, but you need someone also to be monitoring and documenting if they're out of range, what did they do about it, and close that loop saying, you know, in their documentation, saying call facilities, recheck it at eight o'clock, everything was fine. Type thing.
SPEAKER_00:I would add air change rates to that to that list as as as well. Um, particularly, I I think, and and this goes back partially, uh uh Peter, to the aging infrastructure issue that that we're seeing um throughout older hospitals. Um but also the the other piece to this is um as Tom was mentioning, uh the changes in use. And this where I particularly see this is uh in things like cath labs, you know, where now are interventional interventional radiology, or any of these procedures, which you know, initially uh a cat lab suite is designed for for regular cat, and now all of a sudden you're you're performing um you know much more complex procedures. And TABRS is one example, and all of a sudden you need to start having uh more of an OR environment, higher air changes, um uh directed airflow over the over the patient, uh tighter humidity and temperature controls than than what you did when when you were not doing what used to be called an invasive procedure. So I think that's another issue that uh that I see a lot. And as as we're going into and trying to remodel, replace equipment, any of those kinds of things, suddenly the types of procedures that are happening are much more much more complex and uh require much much more rigid controls than uh than the space was initially designed for.
SPEAKER_02:So, you know, it's an interesting, interesting point you guys bring up with this big, you know, air pressure, temperature, humidity changes to use. You guys are much more technical, much more intelligent than me when it comes to that. My mind goes to, and I'd like to hear what you guys think. My mind goes to, Steve, you talked about the aging infrastructures, which we know is a huge issue. We talk about it a lot here on the network. We also talk about aging employees and or the lack of employees coming in. And so, you know, this is one that concerns me from the employee perspective, especially like changes of use. We see it, Tom, I'm sure you go out there and you're dealing with folks who maybe not don't have a lot of healthcare experience. When you change the occupancy of the room, if you've lost the institutional knowledge for somebody to come there and say, hey, these are the implications of changing the occupancy all the way down to how you guys just described it. I I fear that we're losing some of that and we're not bringing in, we're not bringing in knowledgeable people. And sure, people could say, okay, we can automate things. We can put it on technology, but you guys know everybody changes the automation, everybody changes the technology. Does anybody catch the change? So I'm kind of, you know, talk a little bit, if you will, about the brain power that we're losing and the impacts it has. Because, like you said, ORs, there's a lot of money there, air pressure, you the risk is very high there, and to me, somewhat scary.
SPEAKER_01:Yes. And and you're right, you know, I mean, the when we we bring new people new people into the organization, they're still very intelligent, they're very smart. Yeah, but absolutely they don't necessarily have that institutional or that regulatory and compliance mindset, right? If if they were managing an office building or or or even even a factory or or or whatever, there's different standards, but it's it's not the healthcare standard. It's not, you know, caring for patients, caring for uh, you know, put potentials for fire and all that stuff that you don't really have to worry about that much in other industries. Um and and we are seeing that, and and we're seeing that institutional knowledge go. And we've been talking about it for 10 years, probably, that you know, the the healthcare um knowledge base is retiring, you know, they're there and and it there there's no there's there's no backfill. Um, you know, Kref, we've noticed that we actually have you know a whole curriculum on you can hire someone, you know, with good technical skills, and we'll give them that regulatory um you know, acumen and and and then follow up with them and just kind of mentor them. And it's you know, it's a program that we offer. But what organizations I feel should be doing, and we've been saying it for 10 years, and I'll just say it again here, is succession planning. Yeah, you know, you should be succession planning, you know, even if someone's you know 50 years old, just just have a succession plan. One people nowadays don't stay like they used to, you know, so there should always be some type of bench, as I call it. And and and you know, that takes work, it does take an investment, right? Because you got to spend more time and and and teach someone, but that's the best way to deal with it from an organizational standpoint. But then if you have someone leave, then you need to probably have someone, you know, come in if you can't find something. I mean, I've we we we have hospitals we work for, they've they haven't had a director in you know two years. They just can't find one because of geographic, you know, geography or or or it doesn't fit the the job description because they don't have the the the bachelor's degree or the master's degree, but yet they probably they could have had years and years of experience. But sometimes that that that plays into it. Um again, I I think that's the best way to do it, is really start looking at your team and hire in, you know, a supervisor or a working supervisor that you can mentor and come up, you know, get them involved with your safety committee, get them involved with infection control, get them involved with all these people, and and just kind of do cross-training and and and um succession planning.
SPEAKER_02:You brought up a really good point, Tom. And I and I saw this at the end as I was just doing straight recruiting for Goslin Martin, and I still see it here at CREF. We have, and when I say we, I guess as an industry, in cutting positions, like you know this, right? When you start like supervisors and managers used to be kind of that farm system for a hospital, right? Director leaves, you kind of have people moving up that ladder. So many organizations have wiped out supervisors, definitely. Managers are still there. So but we've almost eliminated that farm system that fed our future leadership. So, what is what's uh what's another one, Tom? We've got fire drills, we've talked about hallway space, clutter, wows, we got air pressure, temperature, humidity. What are we on next?
SPEAKER_01:Okay, I'll give you one and it'll it'll have a couple with it. Some I've talked about, some I haven't, but then I'm gonna give you because we we just saw this a few weeks ago. Stained ceiling tiles. I know that sounds, you know, you see them everywhere. Um, and and you you have to understand in a I'm gonna say stained ceiling tiles, uh crack ceiling tiles, voids in your ceiling tiles, what have you. A stained ceiling tile, if it looks bad underneath, imagine what it looks like on top, right? So it's it's a lot worse on top. So that's an infection control issue, not really life safety, but we we try to look at everything. You can't turn your brain off. Right, right. And and you know, plus that that ceiling, you know, if it's unseated or or or whatever, it's avoiding your smoke barrier because we use those suspended ceilings as our smoke barrier throughout our our our hospitals. Most of them do. As an example, we were touring a hospital in a NICU, a very busy NICU, and we came up to the soiled room. I I took my manometer to check the soiled room, and the soiled room was more positive than a OR. I mean, it was extremely positive. I opened the doors, I always do, to check everything, and I look up, and um, there is a ceiling tile in there that was had lots and lots and lots and lots of growth. Don't know what we can't say what we think it is because we didn't test it, but I uh I know what it was, you know what it was. Um, so not only in the NICU did we have a positive room, but we had a contaminant in that room that was obvious that was positive to the to the NICU core. A lot of times people don't put two and two and two, you know, two and two together, but that made that a very high-level finding immediately, right? Because it's blown it out and you've got those spores and all that other stuff in that room that is it could so that's that's my that's my next one. Um I think near and dear to my heart, which a lot of people don't think about, is in the kitchens. I love kitchens, by the way. I I always go in the kitchen and and they hate to see me come, but in wait, can I I don't why do you love kitchens? What is it about the kitchen that attracts you? I long time ago I used to be in hospitality, and and so it it it they really want to know because they're they're not out in the house, right? So you can go in there and really uh explain that to them and explain the why to them. You know, and there's two things in kitchens that I always find. One, natural gas, if they are uh your fryers or your or your grills or whatever on wheels and and powered by natural gas, they have to be tethered to the wall. So you can't pull them out and overextend that gas line. Because if that happens, what happens? And that's a very high-level finding if it happens. And we find it probably 95% of the time, they are not tethered. So they can just move all around. And then the other big thing in kitchens, believe it or not, is the can opener. I know it sounds trivial, but if you pull if they have the industrial can openers that fit down into the into the um uh the the little shaft and for the big for the big cans. And if you pull that out and look at the blade, it is caked with dick. And so what I do is I'll I'll take it up to the chef, or I'll take it up to someone, and I'll say, here, here, you do you do you wanna do you want to try this? And he's literally no, that's gross. I'm like, well, you're putting it in my food when you open the can. So those are just two of my two two of my uh and and and my team just hates it when I go in into kitchens because I do spend a lot of time and I spend a lot of time educating, but um, and and and the kitchens don't get a lot of lot of support either, you know.
SPEAKER_02:So well, so you're a facilities guy at heart, uh hospitality guy, too. We just learned we can't end on a kitchen. Give us one more.
SPEAKER_01:Okay. How about um handling the medical gases?
SPEAKER_03:There you go.
SPEAKER_01:So medical gases, we're always finding e-cylinders, you know, just sitting in a corridor, sitting in a storeroom, not in a rack. Um, but more than that, with with them, we we often find them commingled. Um, a lot of times we'll go into a facility shop and people don't really think about this a lot, but you know, they're not using their their torches every day. And that's acetylene and that's oxygen. So that's sitting over on a shelf. Well, what do you have? You know, you you've got an oxidizing gas that you know can catch on fire because it's in storage and they're and they're they're together. They always are in a in a torch kit. So we we always try to educate that when it's not in use, they need to be separate, you know, and and and and and not stored together. The co-mingling mingling of gases, the the more than 12 e-cylinders in a smoke compartment, you know, full or empty, they can't be more than 12. We're all we're always finding more than that. The sheer amount in some storage rooms that that aren't built for you know for you know anything over 300 uh cubic cubic feet. So um that that's that's really we see a lot of that, especially when we go into like uh areas of respiratory therapy where they might have their emergency management supplies or you know, emergency prep supplies and everything, and they'll have hundreds and hundreds and hundreds of e-tanks in there, and the exhaust isn't right, the electrical isn't right in there, it's it, you know, no door closer, you know, those types of things. So, really managing, and we were just at a hospital, and they said, You're not gonna find one e-tank, and that was this week. They did we're not gonna find one in e-tank because we did a whole hospital sweep. We found six that were unsecured.
SPEAKER_02:So, Tom, this is the last question, and this is Tom Grice, VP of Regulatory and Facilities for Craft, and Steve Van S, VP of Design and Construction for Craft. Um, this may be one that you've already mentioned, Tom, or maybe you didn't get to. What is the biggest head scratcher to you that you most commonly find?
SPEAKER_01:Mine is walking into active construction and not talking construction construction, and I'll explain. And not seeing an ICRA infection control risk assessment done, or an ILSM. Um, and I don't understand because when we do document review, we see some of it, but it's uh it's never not, I shouldn't say never, it's rarely complete to their policy, right? Um walking down the hall a couple weeks ago, people think that sometimes I I think people think that ICRAs and and ILSMs are for construction only. They're not thinking about general maintenance, everyday maintenance. And walking down a corridor, you know, on a patient floor, and they had a painter with a sander sanding the door frames, no containment, no nothing, no ICRA, no one knew it was happening. So, and and that happens because when you think construction, that's or when you think ICRAs and and pickers and ILSMs, you're thinking about construction, but you generate dust and you have life safety um um systems that are impaired all the time. And and I just don't I don't understand why you've got the policy, you do it for construction, but you can't do you you just don't do it for general maintenance.
SPEAKER_00:I I would I would add that that uh sometimes in construction projects you have areas where oh, we're just gonna do cosmetics in that area, right? And so we don't really need to to make sure we have our our ERICRA and our ILSM in place. Not true. Not true. Uh all of those uh issues of the Tomsies that are related to regular maintenance happen when um folks are trying to speed things up, trying to take shortcuts uh to get to get a facility open on time, um, or or uh just trying to uh to save some cost and some administrative time. Um same things that it it's not not just regular maintenance where we see that occur. We see that occur uh in construction projects as well.
SPEAKER_02:Now that is one to end on, not the kitchen. Despite Tom, your love of the kitchen in the ILSM. That's for this, that's for the audience. So, Tom Grice, Steve and S, thank you for your time today.
SPEAKER_01:Thank you all. Thank you.
unknown:Bye.
SPEAKER_02:If you want to be a guest on a future episode of the Healthcare Facilities Network, go to Healthcarefacilities Network.com and let us know who you are and what you want to talk about because together we can solve this critical aging issue.