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
Flagship vs. Community Hospitals: Breaking Silos, Building Partnerships
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How can healthcare facilities teams build stronger partnerships between flagship and community-based hospitals?
In this episode, Healthcare Facilities Network brings together Christopher Bolton, Jason Kime, and Joshua Ashlock for a conversation about the evolving challenges of healthcare facilities management across the Houston market.
The discussion explores the differences between managing facilities at a large flagship medical center and operating within community-based hospitals, from workforce availability and specialized staffing to capital investment, operational funding, and rapidly changing patient demand. The group shares how community hospitals are adapting to unprecedented growth while flagship facilities navigate the complexity and scale of massive healthcare campuses.
The conversation also examines how facilities teams can break down organizational silos and build stronger partnerships across departments, campuses, and trade partners. As workforce shortages continue to put pressure on facilities teams, the discussion turns to the importance of versatile technicians, technology, automation, and using operational data to prioritize what truly needs attention.
From managing thousands of connected devices and alarm conditions to maintaining clean, actionable data for future AI applications, the guests discuss why data integrity and collaboration will become increasingly important to the future of healthcare facilities management. They also consider what the next generation of facilities professionals expects from their workplace and why organizations need to create opportunities that attract and develop that talent.
For healthcare facilities professionals, this episode offers a look at how flagship and community-based teams can learn from one another, strengthen partnerships, and tear down the silos that can stand in the way of better operations, better patient experiences, and a stronger future for the profession.
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New Hospital Demand Outpaces Planning
SPEAKER_02With our campus as it was planned, obviously you don't want to overbuild, you don't want to underbuild. So we built the overall hospital chassis. We built out the seventh floor totally for 64 med surge bed with shelled floors within the building. Within two weeks of opening, we were already hitting capacity for lack of a better term and beginning to hold in the ED. So very quickly, we had to go get funding to we're building out another complete med surge floor right now. We're expanding our ICU, we're expanding our food service area, we're expanding more ORs to meet the demands within this community. And would love to say it's unique to the Cyprus area, but every one of our community hospitals is going through the same thing. So, you know, fighting for those capital dollars to be able to expand and keep meeting the need or exceeding the expectations of the community. And with us here at Cyprus being the newer hospital, we leveraged as much technology and innovation as we could within the hospital. But even with some of the stuff we leverage, we're still just building as quick as we can to get more beds online to meet the demand.
Aging Facilities And The Network Mission
SPEAKER_04We 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.
Guest Introductions And Roles
SPEAKER_04We are recording on a Friday morning, so we were all talking before. Everybody's relieved that it's a Friday. It's a great Friday. We have a great discussion coming up, and what I would ask my uh esteemed guests to do is to introduce themselves, please, and then we'll get into the topic for the day. But uh Josh, why don't we start with you, please?
SPEAKER_00Hello everyone. My name is Josh Ashlock. I'm the director of building systems with UTMD Anderson. Uh, been with the organization almost four years. It'll be four years in August. Uh absolutely love the mission of the organization and everything that they do, and I'm pleased to be a part of today's presentation.
SPEAKER_01Good morning. Uh my name is Chris Bolton. I'm Director of Operations and Maintenance for UTMD Anderson. Uh, this is going to be for our Houston area locations and our off-site locations, all of our uh remote uh community centers. And uh been with the organization right at two years now. Um, but uh very happy to join everybody. Thank you for having me this morning.
SPEAKER_02Thank you, Chris. And I'm Jason Kaim. I'm Director of Facilities and Emergency Preparedness for Houston Methodists, currently at the Cyprus Hospital location, one of our community hospital locations within our organization, and been with Houston Methodists now for a little over 18 years.
SPEAKER_04So thank you, Jason. Jason, that is a nice looking building in the background there.
SPEAKER_02Uh it is the newest hospital within our organization. It's only been open about, well, we opened March of 2025, so a little over a year now.
SPEAKER_04A little over a year. So it's
Flagship Campuses Vs Community Sites
SPEAKER_04interesting. So I'm up here in Boston, as you may have surmised. My three guests are down in Houston. And, you know, whenever I see those hospitals that you guys build in Texas, they they look like you have apartments or beautiful, you know, beautiful hotels. We're up here, we're landlocked, there's no room for anything. And they do a great job, but it's it's so interesting to me as you go to different areas of the country. Like you guys all deal with the same problems, but but you know, different areas that they vary so much by geography. And you guys, well, it's like an arms race down there, right? To uh to build and expand it to get that footprint. And that's kind of the genesis of this discussion. Josh is Region 4 director for TAFM, Texas Association Healthcare Facilities Managers, and we were down management. And so at the TAFM conference, Josh and I were talking, and one of the things we talked about was the differences between, you know, the big medical centers that are located in the city and the off-site and the satellite uh hospitals. And so that was the genesis of this. And Josh is like, hey, I know a couple of guys, maybe we can get on, we can do a podcast to talk about that. And that's kind of where we wanted to start the discussion today, is the big main medical centers and then the outlying. And as the gentlemen introduced themselves, you see that they all have different little scopes of uh accountability. But we're gonna start with Josh first because it was your idea, Josh. And you're at the big MD Anderson in Houston. You're at the flagship on the main campus. For folks who don't have a sense, everybody knows MD Anderson, but can you give us a sense for the scope and the scale of the Houston location, the main hospital location?
SPEAKER_00Absolutely. So our main hospital location within the Texas Middles Medical Center, it's around 12 million square feet within TMC, about 16 million square feet across all of our campus locations. My particular role, I'm building systems. So I have all of the stuff that's in every building, but none of the buildings themselves. We have six other operations and maintenance directors like Chris that take care of all of these main structures. I take care of the centralized maintenance for the things that affect all of our campus locations. I take care of our uh emergency generation equipment, incoming normal power equipment, our elevators and escalators, with the exception of Chris, as Chris gets to take care of his own. And then uh all of the building automation systems, and we manage all of the utility outages for all of our campus locations. We do right now about twelve hundred utility outages a month to keep up with renovations, normal maintenance and construct and construction efforts. Um the the MD Anderson itself, when we look at what MD Anderson is, our mission is to end cancer. And we do that through world-class patient care and research. Uh the majority of our main inpatient care and our research facilities are in the TMC. It's part of the number one cancer center in the world, the largest cancer center in the world, and part of TMC, which is the largest medical center in the world. So, from a scope perspective, it's very, very large scale, much larger than we see in most other urban populations. Uh, Houston's just a different beast all the way around. And the TMC itself is itself pretty well landlocked and where it's defined as part of the Texas Medical Center. So we're not able to expand out, we're having to expand up. The community-based locations are really important for our delivery model, especially for the people that have no desire whatsoever to come into all of the mess of the TMC. So if they can go to the woodlands or West Campus or up in Cyprus to some of these other community-based hospitals, they receive the same level of care, the same basis for the patient delivery models, same level of physician network, but they can do it at a much more convenient location with free parking, easier to access, easier to get on and off the highway systems, much less traffic. They're already dealing with so much from a patient perspective, it eliminates a lot of that additional concern. But from a scope, it's it's a very, very large system with lots of different locations and very complex levels of care.
SPEAKER_04Yeah, it's always interesting to me to talk to you guys who are at the main campus with the way you create those scopes of responsibility because you're just so massive. And you know, there's nothing better than ending cancer. We've all been uh impacted by it. So that's quite the admirable mission. Thank you, Josh. Chris, let's go. You the other side of well, not the other side, but your role at MDM. Yeah, yeah, absolutely.
SPEAKER_01I didn't want to say it that way. You can you know, I I think I think Josh gave uh a fantastic intro to that, and and kind of to parallel along with that or to add to that, you you know, we it at some point the organization, institution realized that you know, cancer care and the delivery of that model, right? This is this is a war of many fronts, right? But it but attrition and access is huge. Um, and and so how can we take the fight, right? Because that's our mission, right? We we want to to to help end cancer, right? Make cancer history. This is a battle. And so we we're trying to find ways to take that fight to the forefront of where it lives, right? Which is in in the communities that we serve. And as Josh alluded to, not all of our patients have that ability, right, to be able to access uh this incredible Texas Medical Center. And so the institution made that decision to expand out to those community areas. And so looking at the cross section of Houston, it's massive. And so we we currently have over 12 locations um spread across the the greater Houston metro area, which are a range of modalities, right? And and of those, we we have at least four major ambulatory care centers, um, and then also one oncological surgical care. Um and so, and that's growing, right? That's that's a footprint currently of uh a little over 2 million square feet right now. Um but what makes those unique, as opposed to um a flagship model or a mothership um uh business model, each of these are their own operation, right? We we don't have the benefit of having as much centralized utilities, right, or co-op utilities like you would see in a medical center. So many of the things that a hospital of any size requires, central plants, um, you know, providing hot water, providing medical gas, all of these utilities are now having to be delivered in each of these unique locations, right? And so it's um it's great because it gives us that reach. It allows us to provide access for patients all across the metro area, um, but it does add a little bit of complexity to operations, right? Because we do need to have that skill set um and and those utilities um have to be maintained, operated, um, and and funded, right, across the entire, the entire portfolio.
SPEAKER_04So does each offsite location have its own staff? Is there any staff sharing or is every you said every hospital is kind of unique and distinct?
SPEAKER_01So we we do have a blended model. Um, and so for our larger facilities, especially those that have their own central utility plant, um, we we do have on-site staff that take care of all of those daily operations. Some of our smaller satellite centers we can we can flex in and out of. And so we have done that intentionally to try to regionalize our operational model with staffing. Um, the city of Houston, it is not um uh a far-fetched um idea that you can sit in traffic for hours upon hours at the wrong time. And so we have to take those into consideration, right, for our service, our service delivery. And so we pivot out of some of our larger hubs, or some of our larger ambulatory care sites, um, and we use those as kind of the uh the hub to service everything else remotely.
SPEAKER_04Excellent. Thank you. So, Jason, non-MD Anderson, Houston Methodist, tell us a little bit about you.
SPEAKER_02Yeah, and similar to the MD Anderson model, we do have our flagship hospital within the Houston or the Texas Medical Center down in Houston. And then we have our eight community hospitals located around the community, north, south, east, west, and much like MD Anderson, bringing care to the community where people live. It's easier, it's less stressful, family can come visit easier. And you know, originally some of these community hospitals were built back when I started to feed into the medical center, but it became apparent very quickly. People don't want to go to the medical center if they don't have to. They want to stay in their community. So all of us within the industry have reacted to that, bringing care closer to home. And much like many of our partners within this community, within our community hospitals, we kind of run our own hospitals locally. We all partner together. All as directors sit on a council together within our system, and we share resources and best practices where needed. But we found each hospital in each community really operates differently because one may have a bigger labor and delivery demand versus another may have a bigger orthopedic demand. So to try to do a one-size-fits-all just has not worked. And so we kind of run independently at each of our sites with a system-level support and you know, just common goals throughout.
SPEAKER_00Jason, your site just opened within the last a little more than a year, I believe. Can you talk a little bit about the opening of your hospital and what plans your hospital has now based on community demand? I think that's an interesting story.
SPEAKER_02Very good.
Cyprus Opens Then Hits Capacity
SPEAKER_02With our campus as it was planned, obviously, you don't want to overbuild, you don't want to underbuild. So we built the overall hospital chassis. We built out the seventh floor totally for 64 med surge bed with shelled floors within the building. Within two weeks of opening, we were already hitting capacity for lack of a better term, and beginning to hold in the ED. So very quickly, we had to go get funding to, we're building out another complete med surge floor right now. We're expanding our ICU, we're expanding our food service area, we're expanding more ORs to meet the demands within this community. And would love to say it's unique to the Cyprus area, but every one of our community hospitals is going through the same thing. So, you know, fighting for those capital dollars to be able to expand and keep meeting the need or exceeding the expectations of the community. And with us here at Cyprus being the newer hospital, we leveraged as much technology and innovation as we could within the hospital. But even with some of the stuff we leverage, we're still just building as quick as we can to get more beds online to meet the demand.
SPEAKER_04It's almost like a different world, right? And when you listen to you guys talk, I was talking to Mike Hatton the other day, and you know, Memorial Herman founds itself in the same over in
Capital Dollars And Operational Reality
SPEAKER_04Dallas. You got children's everybody down there's building. You talked about capital dollars, and this goes to all of you guys. Um, what's that struggle like to get, excuse me, the capital dollars you need to operate the building? Forget like the new construction, that's the sexy stuff. But what's it like to get funds to operate what you have? And I guess maybe we kind of talk about it from the perspective of flagship campus where you are, and then what are your challenges, gentlemen Jason and Chris, out kind of in the community? So maybe start, Josh. Start with you first from the flagship perspective and then the community perspective with Chris and Jason.
SPEAKER_00Well, with within MD Anderson, we have a total of about 12 and a half billion billion currently um allocated for expansion for new construction. And this is uh across not only our our main campus locations within Texas Medical Center, but also community sites. We're building a brand new hospital in Sugarland, Texas. Chris will be over that as well as part of the Houston area locations. And that's that's going to be our flagship community hospital. It's going to be more than double the size of anything else we have in the community now to serve a demanding population. We have a lot of demand growth for cancer care within the Sugarland population. So there's a ton of money going out. We're a little different at MD Anderson because we're part of the University of Texas and we have access to the University of Texas endowment funds. So we have to go through our Board of Regents to make those requests based on a very large-scale master plan for our facilities. What is our vision for the future and how do we go? And this is part of the first 10-year master plan. Originally it was a $10 billion program, it's expanded to 12.5. It's a significant amount of capital investment. But we have to plan for the operational need to get these buildings online. That's where we're seeing the biggest impact on our day-to-day operations. When do we bring on our staff? At what part of the project so they can get acclimated to the building and be prepared to operate them when they have the doors open and tweak the dials as we go from construction to operation. Uh staffing, the clinical side, all of the goods and services that have to be in there to start day one operations, those are all significant um operational spend. And then we won't see a reimbursement for Medicaid and Medicare and uh insurance for 90 to 120 days. So we have to cover that daily cash for operations without any revenue production for a significant amount of time. And you're bringing your staff on well before the day when the doors open and you're beginning to produce that revenue. So that means we have to be very judicious with all of the dollars we're producing with patient revenue. Uh so that's impacting us more today than anything. The the other thing that we're seeing is changes in legislation, uh, Medicare and Medicaid reimbursement rates, reimbursement rates on research are all being impacted, forcing us to rethink how we take our operational dollars and stretch them as far as we can. Because the mission doesn't change. We're still taking care of our patients. We still want to do everything we can to produce those new modalities of care and define new research methodologies. We can't do that without funding. So taking our dollars, stretching them as far as we can. We're also challenged, like everybody else in the country, with inflation. Everything costs more today than it did before. Our uh the amount that we can charge a patient hasn't changed. In fact, the amount that we're getting back from our insurance is being reduced constantly. So operational dollars increase, we've got to reduce how much that operational cost is so that we can stretch those dollars further further to help impact the patients and keep our staffing levels where they are and everything necessary to keep the ship afloat. Uh so all in all, I'm gonna try to tie this up in a boat because I went about 15 different directions here.
SPEAKER_03A lot of interesting directions, though. That's fine.
SPEAKER_00The capital and the operation are two different budgets for us. And the way we we go, the Houston Methodists is going to be totally different because everything they have is going to be either what they produce or what they borrow. We're able to borrow from an endowment and grants that which gives us access to funding that a lot of other organizations can't since we're state funded. But uh for us, we've got that capital spend, we've got the operational spend, and there are challenges in both directions. Capital costs to expand are increasing, the operational costs are increasing, the demand is not changing, in fact, the demand's growing. So stretching that the best that we can until we can get to the point where the reimbursement comes in and we realize the performance on these projects, and that becomes part of the operational budget, which is then going to flatline and keep us afloat, is is very, very important. So manage costs and plan the best we can.
unknownYeah.
SPEAKER_04You know, you were talking there, Josh, like you said, about a number of different things. The the transition to operations, you know, we're finding more and more, kind of like in my other job with craft, that transition to operations is so critical. And I think you you're kind of shining the light on. I think it's becoming not more important, it's always been important, but I think more people are realizing that that in that transition, it can really hurt you if not done correctly and properly. The only other thing I want to say, and then Chris, I want to hear your perspective at the community hospitals. Have you started? I'll bet you it's easier for the quarterback of Texas to get some NIL funds than it may be for you guys to get capital dollars at times, right? It's probably a much easier sale. Hey, we got to get this quarterback, we got to get this running back, give them a million.
SPEAKER_00Agreed, because they're gonna produce revenue day one, pretty much. It brings the money quick. That or they start dating Taylor Swift. You know, they'll do something like that, then the money starts pouring in. But uh for us, absolutely the the business case justification to spend that capital dollars and and show how we're going to create a pro forma that's going to allow that to succeed is incredibly important. And then what Jason mentioned earlier, building a facility out to the best of our ability for the plan, day one, and having space to expand without complete new capital infrastructure. We can build out shelf floors versus building entire buildings. It's a much quicker turnaround, much less initial capital, and it gets us in front of the patient faster. So that the the strategic planning on that capital side for how we're going to develop these buildings is also very, very important for not just day one, but future operations. How do we how do we continue to grow as demand uh increases? The demand in Cyprus in particular was just phenomenal. And to hear them two weeks after the day one operations go into full capacity that shows the demand in the in the community hospitals. These communities really want to have this in their community, not in the Texas Medical Center as much. There's certain things that we're not going to be able to be able to provide. community. They're going to have to go to the medical center for. But if we can do a lot of it in the community too, then we can do it very, very well. So to see that, I th I thought it was really impressive.
SPEAKER_02And to Josh's point though, we can build the building and we could have built our whole building out day one. Would we have had the patient volume? Maybe, maybe not. Could we staff it? And that's another issue is we can make these big beautiful buildings, fully equip them. Can you get the staff to the nurses, the techs, the everybody else to keep it running? Because we're all pulling out of the same pool. We're all expanding. We're all trying to get the resources, those staffing resources in and it's a finite amount. And so there is a delicate balance there of not overbuilding for what you can actually staff and successfully manage.
SPEAKER_01Jason brings up a good point, right? And I think it also ties back to what Josh was saying that, you know, I think it was I think it was actually Mike Tyson that said, you know, everybody has the best laid plan until you get hit in the mouth.
SPEAKER_05Right plus. Yeah.
SPEAKER_01And and and I think that you know building activation is very similar, right? And for us, one of the things that has been extremely beneficial and part of the reasons why we're the best cancer center in the world is is because we have that that vision aspect, right, that we can really lean on. We're very fortunate to have fantastic executive leadership team. And we have those conversations on the front end. What does it look like for us operationally to go live with this massive investment that we've just put forth in the community? And that's necessary, right? Because one of the things that we're doing now for for all of the the major expansion that we've got coming on is we're realizing you need to be immersed in these building processes to have a good understanding of the operational impacts, right? Because that's what this is all about. What is the operational impact? And to try to to Jason's point to try to staff 200, 300, 400, 500,000 square feet on a dime is becoming extremely, extremely burdensome. But even if you could, you'd now be faced with you don't have anyone that has the understanding of the subtle nuances of how that building came together, those sequences of operations, what's in the walls that you can't see that commissioning maybe ran up against and had some struggles with. And so having that exposure is extremely critical. And so that's we've been very fortunate to have you know an executive leadership team that supports that process and allows us to incur some of those expenses earlier than we typically would because they understand that that experience and that exposure is absolutely critical. In terms of access to funding one of the things I think that's made us so successful is that as an institution we've kept the the overall strategy and the mission front of mind. Right. Because when when you develop a mission like that, it's one thing to look at the strategic aspect of the mission, but you also have to look at the day to day the real in the moment right now aspect of what could potentially step in front of your mission and try to derail it. Because if you don't have those contingency plans the mission's going to be in trouble at some point. And so we've been very fortunate with that. And so I think that all of those aspects together is what's allowed us to be successful with the rapid development and expansion that we've had.
SPEAKER_04If 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. And I've said this on this podcast before and it still surprises me that so many organizations are siloed at that level that you were just talking about where you guys have the executive support so you have that seat at the table so you're not going into a building completely blind. But you still do hear and I'm sure you guys do because you're involved with TAFM you guys, you know, you get around I you still hear of the organizations where PDC and FM are siloed and some organizations where FM has to fight to even get a building commissioned, right? Because it it's it boggles the mind with the amount of money and risk that's out there that those conditions still exist. But it sounds like you guys don't have that issue at MD Anderson.
SPEAKER_01I I would be I would be lying if I said that it is a flawless delivery it's a flawless handoff. And and I I think that that is just innate to what it is that we do right there there's so many moving parts and FP and FPDC team has uh an overwhelming project you know in front of them to deliver upon. And then we have the overwhelming aspects of operations. And I think that those two will naturally sometimes I'm not going to say have friction, but there's going to be some overshoot right and some gaps there. I think what makes us unique is that from that executive leadership perspective that I was mentioning earlier, we understand that. And since we're all part of the same division, we're able to then collaborate with one another and say, hey, these are the things that we're noticing on some of these smaller projects. So for the larger ones that we have coming up, how can we kind of better partner on this right ahead of time? And it helps to break down the silos to where you're not just completely operating in a vacuum.
SPEAKER_04Yeah. Yeah. And I think being part of that same division when I was doing the recruiting for so many years, you I would talk to folks and sometimes their PDC people would be reporting to the CFO and their FM people are reporting to the COO. Right. And those people on the C level don't get along and they don't even talk to each other. Like whenever you saw that you go that's a recipe for disaster.
Supply Chain Slows Bed Expansion
SPEAKER_02Jason speaking of a recipe for disaster it wasn't a recipe for disaster but like when you're full after two weeks what are you guys thinking and that's almost mind-boggling that you've been open two weeks and you're already 100% capacity what was that like well after the initial shock wore off it was you know again digging in setting realistic expectations how quickly could we build more and you know we would love to say hey three months I can get more no we're we're about a year out and I mean for us to do a complete med surge floor construction you're 12 to 18 months if you can get all the materials you need. And you know that's another thing we haven't touched on yet not only do you have construction escalation costs, but you have supply chain problems. So we can go out with the best intentions say yeah we're going to fast track this pro this project but can I get door frames? Can I get everything I need can I get switch gear if it's needed and you know though that's the reality of what we're facing now. And so you know we we rolled our sleeves up very quickly and you know we we like many have a great partnership with our design and construction team and we got to work and said you know let let's get some numbers together. Let's get this you know before everybody get approval. We're a data driven organization. So some of it we got to show that it wasn't just uh the newness of the you know everybody want to come see the new car and how it worked and no it was sustained and it's still being sustained today. So uh you know we're moving forward as quickly as we can. What's the status currently we will current projection in October we'll get a portion of our we'll get 24 to 32 more bed med surge beds online and by January we'll have about another 86 a total of 86 beds that we brought online since our initial opening.
SPEAKER_04So we opened at 100 beds we're bringing almost double that online within good the first year of operation wow um data driven that wasn't uh let's talk about that for a sec, I guess Jason you talked about um you know at Methodist at Houston Methodist you you get you there's a system but you also operate independently from a data driven perspective is that system driven like I because I data is only good as the data that you get so I have to imagine that does the system kind of tell you or have a process for data and do you guys all do the same thing or are you uh do you track differently?
Smart Rooms And Patient Control Data
SPEAKER_02I mean data is such a broad thing right it's 12.5 billion correct and we've all got our quality standards and everything else absolutely set at the system level but I you know I mentioned we brought a lot of innovations in out here so we'll have some great ideas that'll come in through you know through employees through wherever so we try to vet them out and so Methodists as an organization we may try this idea at our Woodlands community hospital and then there's another idea we may try it down at the main flagship well here at our Cyprus location since it was greenfield construction a lot of these ideas that we had been leveraging we implemented day one. And so from a facility standpoint we've got an Alexa in every room not that big of a deal but Alexa controls the lighting for the patient Alexa controls the TV Alexa can adjust the thermostat does it in Spanish and English but then there's also QR codes in every room. So you can do it with your own device now and you know when I say data driven we look at the data the hits that we're getting in from the Alexa what are they going to? I can tell you that number one is lighting control. Right behind that is calling the nurse so you know we try to look at the data to say hey yes we invested in this technology. Number one is it being used by everybody or is it only being used by the younger generation, the older generation but you know across the board it definitely appears to be used.
SPEAKER_04And so now we'll start pushing that out to all our other campuses and you know migrating it in where we can and when we can that's some pretty cool information what Jason I mean you can get lost in data right when you can when you can get so much info but what is uh is there anything that has stood out to you or that has surprised you like as you look at the data kind of like an aha that you maybe didn't expect I would not bet that lighting control would have been the top use of you know a whether it's through QR code whether it's through I just didn't think lighting control was going to pop that high on the list.
SPEAKER_02So now it makes us start looking at though hey one of the other you know complaints we get from time to time the window shades in the room. So okay if we could do motorized shades does that help that patient experience because you know we've all been in the hospital before and you know we're some of the worst patients the people that work here and I know I would never call the nurse back to come turn a light off. I would just deal with it because I'm like I'm not going to bother them they're busy. And so it's trying to put ourselves in that bed and project what might the patient need. And so it it was interesting that was definitely you know an interesting statistic directly in the facilities world. Did I think the air conditioning control was going to get used at all? No, not really. Does it get used yeah and we're able through technology we have it they can only go down to 69 and up to 75. So we don't give them the full spectrum of what they could have within the room. But again it's a huge patient satisfier and we see that in the satisfaction scores coming back I felt more at home I felt more at ease I wasn't bothering anybody so we put some of that control back in the hands of the patient or the patient's family.
SPEAKER_00The patients can focus on getting well and the staffing can focus on the patient and it removes a lot of these unimportant functions that used to take up a bunch of time and puts it into a device in the room. It simplifies that a ton I we're seeing more and more from the the patient environment the patient education piece the patient experience being automated and uh I'm I'm pleased to see that as a movement within healthcare it it is making a difference in the patient's experience.
SPEAKER_01Yeah
Reliability Strategy With Better Data
SPEAKER_01you know that that brings up a good point uh Peter talking about data because that is a a a huge factor of what we've been really pushing for with MD Anderson here recently um and and this is in alignment with our our reliability centered maintenance strategies you know understanding the role that data plays right and and I often think of one of my first mentors you mentioned him earlier so I'll give him a little plug Mike Hatton used to always say expect what you inspect and and the same holds true for data you don't realize what is in data what what the the opportunities that it affords you if you're not looking at it. And and we've been discovering that um over our RCM um um journey that you know if you're taking all of this wonderful insight that's that's being provided either at the patient side or from the infrastructure side of the house that's not only going to provide and feed into some optimization opportunities, but it's also part of the necessity, right? Because Jason mentioned earlier just the struggles with workforce right and and that is very real. And so how can we how can we do things differently that allows us to either open our horizons to a different candidate field right to a different type of workforce or or you know in the in the unfortunate event that sometimes we have to do with a little bit lesser right of of a of a human capital side what can we augment with data?
SPEAKER_04And I think if you're not utilizing data in 2026 um you're you're you're very very behind the behind the eight ball I kind of didn't want to ask this question because we do talk about it a lot but you guys brought it up so it's your fault it's around um it's around workforce right we can
Workforce Shortage And Career Awareness
SPEAKER_04escape it. So I guess I wanted to ask out in the community is is are you finding it difficult to get people to come up? But also you hit on something interesting there Chris do you find that the younger generations like that tech they expect to be tech enabled Jason kind of what you were just describing using Alexa is there a difference in the generations as far as expectations of the use of technology and how do you think technology will attract or hopefully attract some of the younger generations who have grown up with it? Yes. That's a lot so I I anybody want to take that first go right ahead.
SPEAKER_01Yeah I'll I'll I'll start with that because you're absolutely right um and to answer your question does does this generation have a different expectation 100% and and I think that we're seeing that in some of the the Bureau of labor statistics data that's coming out and I I saw it um a model the other day I can't remember exactly but talking about the the the shortfalls for the um operations and maintenance roles in healthcare over the next five to six years is massive right like 38 40%. And so you know that that puts a responsibility on us to find ways to make um operations and facilities maintenance um more attractive right how can we make this something that that the that the newer generation sees as this is an opportunity for me to step into some really cool stuff and learn some new things I think that it's it's going to include that data component, right? Because we didn't grow up with that right we we we were introduced to it well into our adult you know years. Yeah the kids now I mean from the moment that they're able to learn to read and write have technology in front of them. And so if we're not using that as as a training opportunity or as an operational opportunity then we're we're going to struggle we're going to struggle with with attracting new candidates.
SPEAKER_02Again expanding on you know for us in the community hospitals our techs as we call them maintenance techs whether it's entry level mid-level senior level they have to do a little bit of everything versus when you're down in a flagship hospital you may have a tech that does HVAC or he does controls or he does a pneumatic tube. Well the techs I have out in a community hospital because I don't have the scale to support it they're doing chiller rounds they're doing you know basic bed repairs they're doing tube system repairs they're changing ballots so they're an electrician they're an HVAC and so our model then we end up having to contract out some of the bigger stuff and partner with our trade partners but you know our tech so when we're trying to recruit that staff I'd love to get people out of the flagship hospital with years of experience but honestly they get out here to the community hospital and they're bored because we don't have the scale to support their little niche that the that they trained in. So it's almost now like you say trying to get the the younger generation engaged with some of the technology because again even when I started we weren't as controls heavy as we are today. We've always had controls but what I do with my BA system at Cyprus is different what I did with the BAS system at Woodlands which is only seven years old now which is different from what we did down at the Sugarland campus where I started. So it keeps evolving so we have to keep growing and and keep talking about it. And it's been interesting to me because I have a son in mechanical engineering right now at you know one of the local universities and there's really not a career path talked about for our field. Nothing it's it's always we're out doing all this other stuff but no one's really represented and yes healthcare's a growing but just office buildings in general and everybody's like oh that's a maintenance job. Well it's so much more than a maintenance job anymore. It's not just plunging toilets or you know changing light switches. There's so much more to it and that goes you know unappreciated. So we've got to do a better job selling our industry.
SPEAKER_04You hit on so many good things there with that answer. You know it's funny I was thinking back to when you were talking there Chris um Lamar Davis I I I I use this line a lot. So Lamar you may know Lamar probably do by the way you're smiling. So great guy up at the Chicago area but Lamar I was talking to Lamar he was on the show and and he just said something that was so true. He's like you know kids don't grow up wanting to be directors of FM. Kids grow up playing Cowboys and Indians well I'm using cowboys and Indians because I'm cops and robbers like all of those things that we did. He's like nobody even knows this field exists and you hit on it there Jason that's part of the reason we started to do this is because there's just no uh it's just not publicized enough and how if people don't know it exists how do you get them into it? I I need to ask you Jason obviously your son knows that this path exists.
SPEAKER_02Definitely there's interest and you know many of us through TAFM are you know our local Ashey chapter and we're starting to partner with even community colleges and the universities in the area trying to wait raise that awareness, get some partnerships, maybe even do internships within the hospitals and you know in healthcare we've done a great job on the clinical side with internships and other things we've been a little slow on what I'll call support services side.
SPEAKER_04Josh to you we were talking about data employees kind of you know using data to attract what from the flagship perspective what's uh what's your perspective?
SPEAKER_00I can remember when I started my career and many some of the people that are on this uh watching this will not remember these days but we had work orders that were triple carbon copy you you write it out on the front one you tear off the bottom the cheer record that you turned it in the technician takes the pink sheet the facility manager keeps the white sheet to sign it off when it's done and where we've come in those last 25 years is phenomenal. I remember 10 years ago when we were trying to transition from printed work orders onto mobile devices and having some of our uh technician population that had standard phones they didn't want a smartphone they didn't want an iPad this technology's voodoo I don't want any part of it but as we've developed more technology people have become more familiar a lot of the older generations within facilities have been less um resistant to that change they now have smartphones and are familiar with it and we're seeing more and more compliance with using mobile devices having immediate access to blueprints to work orders to the lots of information that they had to go back somewhere to a computer station to find before they can get in the field. That also gives us a ton more data we can use in in the management of these teams to see where where are our hotspots where are the the points of uh training needs uh technology growth where can't they get this information what parts of the hospital don't have Wi Fi access and then mechanical rooms outside generator locations things of that nature where we're doing this work are some of our vulnerable areas so can we work offline and it would reconnect and upload the information that they collected once they get back into the Building so we can capture all that data. It helps us with compliance. We can automatically create compliance reporting versus having to go back and redo and print and put in binders. We can now automatically generate the compliance documentation and do the validation in a much shorter time frame than previously done before. So we can stay more regulatory compliant, which keeps our staff and patients safer. So there's lots of uh we measure everything. We don't necessarily realize how much we measure. Uh areas that I'm currently working on since I've got the system BAS is how do we take that information and understand where our fail points are, do more uh continuous commissioning on our systems, and improve the way our systems operate day to day. We've implemented tools and technologies uh through our energy department under our director of energy and utilities, Greg Norris, uh Clockworks, which is a facility diagnostic tool that helps us understand where some of our fail points are, and we can create actionable work from that to improve our systems rather than going back later, years later, after this has been operating inefficiently for years, doing an energy study, having a consultant come through and tell us where our problems are and then try to fix it. We can actively see with the data we're already collecting where our fail points are. One of my big goals now is how do we triage our alarms more effectively? We generate tons and tons of alarms every day. We see all of this information come in, but it's more of an acknowledge if it's not critical, call out if it is, and then somebody that creates a work order, somebody goes and takes a look. But what are the alarms really telling us? Can we triage the hundred alarms we have to one root cause and go fix that root cause? So that that's kind of the direction we're looking at now, taking the data that we've got, being more efficient and effective with it, and uh reducing our need because our we're not our staffing's not going to grow well enough to handle it as it is today. We have to find ways to use that data better, so we're putting our efforts where it's most effective.
SPEAKER_04You guys have brought up uh so many good points, uh man, but we're coming up to our hour, so we we could talk forever, but I want to uh there's two things I would like to ask before um we go.
AI Expectations Cybersecurity And Governance
SPEAKER_04The first is around uh data again. Uh at TAFM and really, you know, I was at FIA a couple of weeks ago, all the conferences you go to, you can't escape AI, right? It's everywhere. And so my question is not, are you using it? My question, I always I get to talk about things. I don't have to do anything, so I I don't envy what you guys do. So I'm kind of in a better position. But you know, at the C level, there's such a focus on AI, there's such a focus on data. But you guys know running a hospital, you kind of know the status of your data, right? Sometimes you can only implement these things, you can only get efficiencies if you have good data. And sometimes it's not your fault that you don't have good data because you may have infrastructure issues. You have old equipment that's been there 40 years. Is it difficult or not? Is it difficult? How do you kind of navigate the reality of what you have and what you're managing, age, equipment? Maybe not everything is into your um your systems, versus the expectation of leadership that we're gonna utilize AI, we're gonna utilize it effectively. Does that question make sense? Is there a disconnect there? Because you can't utilize it effectively if the data's not good. Does that question make sense?
SPEAKER_00It it does. What I would say with with MD Anderson in particular, we have a strong structure. We have strong owner design guidelines for how things are created. And we have better definition than a lot of organizations that are much smaller, especially uh singular community-based hospitals. They may not have that structure. They they go out to a design team, they expect the design team to create those specifications, and whatever comes out of that project buyout is what they receive and they have to maintain. We have a lot more influence on how that's structured and what's included in those buyout packages, so we know what we're getting and we can model it into what's existing and use that as a collective data set versus a desperate data set. Um that that helps us a lot. But when you when you have less of that initial structure up front, you're going to have much more desperate information on the back end. They may not communicate well, they may not be structured in the same way, and if it's bad data in, you're getting bad info out. Right. So ha having a good upfront structure and spending the time to get that structure proper will determine your outcomes and determine how well you can use that data, period. A lot of institutions, and I've been a part of other institutions where this was a reality, you have tons and tons of data, but none of it can talk to each other, and none of it makes sense to each other. So you really can't use it use it very effectively. So I think that initial structure is very, very important. Um the uh the other part of it is being able to communicate with that C-suite on how you can utilize that data.
SPEAKER_05Yeah.
SPEAKER_00Uh we at MD Anderson in particular are very cybersecurity aware. Our our leader, Dr. Peter Pisters, is very, very concerned about the way uh attackers are coming after healthcare institutions. And with the brand recognition that we have, we're a big target.
SPEAKER_05Yeah.
SPEAKER_00So we're very, very cautious about how we implement AI within our uh clinical side and our operational sides, what systems we can use, where we our data can be uh placed into. We have uh Microsoft Copilot, for instance. We use the segregated section of that that doesn't communicate with the rest of the world. So our data is what we use to create that machine learning versus everything else that exists out there. Their data can't come in and our data can't go out, just to make sure that we protect the integrity of the institution's data. Not that BAS data is going to go and tell everybody a whole bunch of information that's going to harm our patients or give them money, but it could give them a route to get to that information. We want to make sure that's all segregated and separate. Um so that limits us to how far we can expand with our data and how much we can learn with our data. We're only learning with our own information currently. That that will over time improve and it'll be really good with our data set, but it lacks the ability to see everything else that's happening within the ins industry in other locations. We're not going to be able to compare ourselves to other organizations openly rather than like a chat PT GPT model where you can see the rest of the world's data compared to yours. Uh so that I think that's a limitation to an extent, but it's also a needed protective measure, so we're not creating vulnerabilities that are are impactful. We will see much more use day one on the clinical side with AI because of how that's impacting our research models and our patient care models than we will on the operational side, in my opinion. That's what I'm seeing currently. The focus is definitely more on the patient care-driven uh AI uses. Uh, because we do have so much data being generated on the research side in particular. Uh there's definitely more focus there.
SPEAKER_04Yeah, I was gonna say, Jason and Chris, you guys jump in, but just a statistic I heard, and I I need to double check it, but it's Fia, one of the uh speakers said that 48% of AI dollars in healthcare are going to the clinical uses, uh nothing to the to the FM. So, anyways, I thought that was interesting. Jason, I think I cut you off. I think you were gonna go.
SPEAKER_02Yeah, I was just gonna build on what Josh was saying. We're in much the same boat with the AI, you know, with us, same thing, worried about cyber attack, so co-pilot as well, we're segregated. So, what we try to do is, and and Josh mentioned it, one of his goals is BAS alarms. We we got a great specification, we implemented all this stuff. Now I get over a thousand alarms a day. What's it really telling me? And so trying to filter through that noise. And, you know, kind of I catch myself now, even when I'm doing presentations to my C-suite, they're not necessarily alarms, they're off-normal conditions. It's telling me something's not quite right, but it's not gonna say the system's not gonna fix itself in 10 minutes. So you don't want a knee-jerk react and send guys out there to go work on it. It may be, hey, a chiller just rotated and you know, the water's cooling back down. You know, everybody relax a little bit. So starting to take that data and filter out some of that noise of, you know, and I'm not gonna say nuisance alarms because it's doing exactly what it's supposed to do, but giving the system time to react and do what it needs to do, then digging in to say, okay, like you said, it do I have one bad sensor that's causing all this downstream impact? So really digging into the data to say what's driving these 50 alarms versus let's go look at each 50 individually.
SPEAKER_00Because we we don't have the manpower of the time, and then the all 50 won't get looked at. No, we don't.
SPEAKER_01We don't. And and the the thing that I would add to that, you know, I think it uh alarm conditions is uh a big priority for everybody. It's one of the biggest projects that I'm working on right now. And uh I think that it's important for for all organizations to understand part of the gap with AI right now is I think everybody still doesn't know how to use it.
SPEAKER_02Right?
SPEAKER_01They're they're still understanding what does this mean for me. It it's it's a big, robust, shiny word right now. And the the the suggestion that I would have, understand that there's an accountability there because we are building our own models every single day with thousands of connected devices, right? Um, and and the a big part of that responsibility is data governance, um, both on the accuracy, you know, the the cleanliness, the accuracy, and the consistency of that data. And so with all of these projects that we do, we're constantly adding assets to the CMMS, we're adding points to the BAS, right? We're adding fault detection, we're adding this, we're adding that. And the responsibility of making sure that those are structured cleanly, properly, to where they can be queryable, to where they can be actionable in an in a data set is extremely important. And I think that we're just seeing just the very tip of the iceberg right now.
Decentralized Operations Need Trust
SPEAKER_01Yeah.
SPEAKER_04Is there anything we didn't get to? Is there anything I didn't ask? I want each of you to kind of have that final word because we we had a script, but we went off the script, which is good. And that's why I love doing these things. But final word, anything you thought you would add that you just didn't get the chance because we veered off. Chris, I'll go to you first, then Josh, then Jason. We'll give the Houston Methodist guy the last word.
SPEAKER_01So I guess in the spirit of the topic, right, talking about regional and community-based um facilities, understanding that operating in a decentralized model um, I think is more of a necessity than it is a strategy. Um as institutions grow and as organizations grow, um, you have to increasingly become um hyper-focused on developing cross-departmental trust, right? Because one of the things with my team is we know that we have um that flagship support, right? We're we're disconnected, we're decentralized, but it gives my team the added level layer of peace of mind and confidence to their tool belt to where they know that they can work on complex issues. And if it if you know, if if the situation starts to degrade, it's just a phone call away. And so um, I think that that's really important as we as we continue down this path of um um shrinking workforce you know capacities, understanding that becoming decentralized um is is going to be a necessity in that. And so developing that trust is huge. Nice.
SPEAKER_04Thank you, Chris. Josh?
SPEAKER_00The the one point that I would like to make is uh the differences in utility infrastructure between the community-based versus the medical center. Uh the medical center itself is structured far more robustly. It's defined and designed specifically to cover the amount of health care locations that are there on the electrical side, the chill water uh side. We we buy for most locations in the medical center from Texas Energy Company, which is called Tico, we is what we call them, uh Chill Water and Steam. We don't produce a lot of that internally for the majority of those buildings. And it's a very robust, very redundant system. It hardly ever goes down. And if it does, it's looped in such a way that usually it doesn't impact the hospital for very long. When you get into the community, the power grids are not at the same level that they are. They're overhead after 10 miles of residential lines that have come off of it. We see every squirrel and every limb that touches it, and it takes a uh you know, four millisecond uh blip at 80% nominal load to drop out your chillers, drop out DI equipment, and create significant impacts to the patient care that's happening in that building. And a lot of the people going to these community hospitals came from the medical center. They're used to not seeing that. So what changed? Why didn't you build this to that same standard? It's because the community-based infrastructure isn't at the same level. It wasn't designed to support to that level that it was in the medical center. So we we see a lot of that operational impact that we have to plan for, talk through with our leadership on site, and make sure that they're prepared to uh respond to that when it's going to occur, not if.
SPEAKER_02We've touched on it throughout, but the partnerships we have to forge, whether it's with our trade partners, but most importantly, we mentioned the silos earlier. You know, yes, I've got partners in design and construction, but more than that, we've got to partner with clinical more than ever. We've got to partner with IT more than ever. You know, I know more about networking than I ever wanted to know, but you know, it it is what's required. And so learning that we don't have to go it alone, it doesn't have to be adversarial, but build those partnerships early and often and get the right people at the table. You know, I don't try to speak for IT. If we start going down a road, I'm like, let's get my partners in here with us because you're talking geek speak, I don't understand. And so it's understanding we're not gonna know it all. We just have to build those partnerships and not be afraid to tear down the silos.
SPEAKER_04When you mentioned Alexa, I I immediately kind of thought of IT, security, integration. I'm like, I'm not gonna ask anything because we're gonna go down a rabbit hole that we're not gonna get out of and we're not gonna talk about this stuff. But you're right, it's why you know, Chris, you and we were talking before. There are so many stories out there in the healthcare facilities world. And we touched, we didn't even touch the tip. Whatever the term is about the iceberg.
Closing And How To Participate
SPEAKER_04We touched it, I guess there's a lot beneath. But I want to thank Chris Bolton, Josh Ashlock from MDM, MD Anderson, Jason Kime from Hewth MS, Houston Methodist. Guys, thanks for your time this morning. I uh enjoyed our discussion. We've got to have you back on because there's a lot we can still talk about. Thank you so much. Thank you. Appreciate the action.
SPEAKER_00Thank you.
SPEAKER_04My pleasure. Thank you, gentlemen. Have a great day. 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.