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Attendee Comments

     
  "Getting decisions to stick and how it related to projects"                    
     
  "Amount of real information, no sales pitches."  
     
  "The fact that it's local... no travel required."      
     
  "Speakers were awesome, learned a lot!"   
     
  "It was convenient."   
     
  "Size."  
     
  "The roundtable discussions."  
     
  "The meeting management discussion by Page was helpful as was the heads up on the new FGI."    
     
  "Hearing information from all sides of the industry (not just design/construction)."        
     
  "Content."  
     
  "I was only able to attend after lunch, but found the panels very intriguing."  
     
  "Getting Decisions to Stick  --- OUTSTANDING!!!"   
     
  Presenters and Networking  
     
  "Quality presenters: All were smart, informed & articulate."  
     
  "The setting and opportunity to network."  
     
  "Presentations moved quickly and were well done; Location and venue was good; One-day format is good."  
     
  "Size, time, content."  
     
  "Diverse groups attending."        
     
  "I preferred the individual speakers to the panels."  
     
  "Getting Decisions to Stick and afternoon panels; They contained information that pertains to my job."   
     
  "Great Summit! I would do table 1-on-1 conferences / 30 minutes?"   
     
  "A good mix of topics for a comprehensive package of updates & trends in the healthcare market."  
     
  "The room was filled with expertise."  
     
     
     
     
     
     
     
     
    Dallas 2017 - Post Summit Recap
 
 

 

 

 

Key Takeaway Messages

 
  Recap of North Texas Hospital, Outpatient Facilities and MOB Summit, June 2017, Dallas
  Reported by Linda Stallard Johnson, a freelance writer/editor based in the Dallas area and veteran of The Dallas Morning News and Houston Chronicle
   
 
  An Insider’s View of Facilities Guidelines Institute (FGI) Changes for Hospitals and Outpatient Care Facilities
  Doug Erickson, CEO of Facility Guidelines Institute
  TAKEAWAY MESSAGES
  • “Safety risk assessment is our bread and butter at this time.” That means putting thought into design to prevent falls, medication errors and the spread of infections. Behavioral health and security are also major safety considerations – “elements that we’ve got to think about building in into our healthcare facilities.”

  • Patient mobility is key to the healing process, and is affecting how hospital rooms are laid out. Traditional rooms have made it awkward to move around, see TVs, position chairs or for patients to access the call buttons. “We are forcing them into the bed.” But the lives of thousands of patients “could be saved if we ambulate them over the course of their stay.”

  • In approaching a project, “we have a history of not looking at benefits but only looking at initial costs instead of life-cycle costs.” Erickson advises transforming the cost-cutting committee into the benefit/cost committee “because if we do something right to do it from the clinical perspective, over the life cycle of that building you will end up saving time, money, et cetera.”

  • Hot topics for the 2018 guidelines include addressing patients, visitors and others “of size,” a term not limited to weight. For example: Beds, waiting room furniture and doors for the 8-foot-tall person. Other topics address the flow of traffic through facilities to ensure sterile conditions and more tightly defining an exam/treatment room, a procedure room and an operating room.

  • “Telemedicine is the wave of the future,” but the privacy issues it raises are paramount. Cameras, microphones, acoustics, lighting, windows and any other uses of the room will need to be in HIPAA compliance.

  • FGI is adding a separate book of guidelines for outpatient facilities for 2018.

 
  Getting Decisions That Stick and Eliminating Wasted Resources on Your Projects
  Kurt Neubek, Principal/Healthcare Sector Leader, Page
David Morgareidge, Associate Principal/Predictive Analytics Leader, Page
  TAKEAWAY MESSAGES
  • A decision that sticks “is more about facilitating people’s ability to make a decision than it is about construction.” Give decision-makers just the info they need and no more so that you don’t cloud the process.

  • Know the individual and organizational decision-making styles: autocratic, consulting, delegating or a group process. Personal learning styles – visual, auditory and kinesthetic – also factor in. Take a lesson from the Boy Scouts: Explain (auditory), demonstrate (visual), guide (kinesthetic) and enable (teach) to get information across in a variety of styles.

  • Decisions are fragile and need to be protected. Find out who could derail a decision – it might be a spouse – after it’s been made. Let people overrule the naysayer: “We followed a process and put $50,000 into this decision, and you just can’t upend it!”

  • Develop a protocol in which once a decision is made, it’s adhered to down the line, and be sure everyone involved knows that. Also give people boundaries on decisions – such as they don’t get to choose the fixtures – and they will generally play by the rules.

  • Get out of the boardroom early on and talk with the staffers doing the jobs in the facilities. Mockups, both 2-D and 3-D, and computer simulations can catch problems before it’s too late.

  • When all else fails, flip a coin. That will tell you where your heart is.

 
  What’s Driving the North Texas Healthcare Real Estate Market?
  Wes Huff, Vice President of Real Estate, Baylor Scott & White
Rich Couturier, Vice President of Development, Ryan Companies
Tania Bolla, Director of Healthcare Services, Champions DFW Commercial Realty
 

TAKEAWAY MESSAGES

  • How hot is the Dallas-Fort Worth market? “Too hot,” says Huff. “It’s on fire,” says Bolla. From a developer’s long view, says Couturier, “it’s a moment in time.”

    As in 2006-07, “anything can change,” Couturier says. But see the situation from physicians; they’re looking at ways to offset reimbursement pressures and reduce the costs of running their businesses.

    Bolla urges prospective buyers to be well-informed, cautious and do lots of due diligence. “Look at your options – joint venture, single ownership, leasing. It’s really important to explore the options and not jump too quickly,” she says.
     
  • Independent practitioners are banding together to form physician groups. “They’re aware there’s power in numbers,” Bolla says. A group allows them to cut costs as they centralize call centers, billing and back-of-the-house work. “They’re realizing that’s the only way to turn a profit.”

  • The sweet spot is about 6,000 square feet for medical buildings for smaller groups and up to 30,000-40,000 square feet for larger, multi-specialty groups.

  • A larger building may work out better than a 6,000-square-foot one for small practices. “If you develop a 6,000-square-foot building, the market is good but not as good as if you had a larger building with other investors,” says Couturier – especially when physicians consider the time taken away from running a practice.

  • Most physicians have never built medical office buildings, so the risk is high because of lack of experience. But teaming up with a developer who knows the process can minimize that risk.

 
  Connecting the Dots Between Real Estate, Design, Construction and Building Materials in Medical Buildings
  Derek Watson, Senior Director/Facilities and Real Estate Planning, Design, Construction & Sustainability, Children’s Health
Jeffrey C. Stouffer, Executive VP, Global Healthcare Director, HKS
Chris Peck, Senior Vice President/Dallas Office Leader, JE Dunn Construction
Cynthia Hubbell, Vice President/Healthcare & Senior Living, The Mohawk Group
 

TAKEAWAY MESSAGES

  • Everything rolls back to the patient in the bed.

  • Start with an integrative team – attorneys, contractors, architects, designers, suppliers and others involved. The result will be better value to the bottom line and to the patient, who is the ultimate customer.

  • Bring contractors to the table early. It streamlines the process and prevents redesigns and increased costs. Opportunities for prefabrication can be lost if contractors aren’t on the integrated team from the get-go.

  • Trust but verify on every work team. Train staffers and crews to double-check work handed off to them in case the previous person got something wrong. Call a timeout if something seems off.

  • Projects that start out thoughtful and intentional at the top may fall behind schedule or have cost overruns at the end. That makes it tempting to switch out materials for something cheaper, but know why the product was selected in the first place, such as flooring designed for memory care or autism patients.

  • Establish a budget. If the budget is a moving target, the design is a moving target. With a budget, a project that comes in costing less than expected can have enhancements added.

 
 

Shifting From a Hospital to a Healthcare System

  Jon Sullivan, Vice President, Real Estate Operations, Texas Health Resources
Nkem Okafor, Vice President, Strategy & Planning, Methodist Health System
Tony Caputo, Principal and Practice Leader for Design, Array Architects
Jason Signor, CEO & Partner, Caddis Healthcare Real Estate
 

TAKEAWAY MESSAGES

  • In an effort to deliver quality care and service but also hold down costs, hospitals are moving toward ambulatory, outpatient services. They are looking at smaller footprints such as micro-hospitals, day facilities and short-stay facilities.

  • Over the next 30 years, as the over-85 population soars, the market will trend toward facilities that cost less per night for a patient stay. That will encourage shifts from a hospital stay of up to $20,000 a night to senior housing that could cost as little as $150 to $200 a night.

  • With the move to outpatient settings, medical office buildings are getting more complex, adding operating rooms and full imaging suites. There is also a trend toward flexible designs, which provide the option of shifting to different medical services as the needs of the surrounding population changes.

  • Time-shares offer more efficient use of medical buildings that may otherwise go empty when a doctor is in surgery.

  • Joint ventures, even with other healthcare systems, are on the rise but also increase the complexity of transactions.

 
  Technologies Reshaping Design, Operations & Performance in Healthcare Facilities
  Jana Gerber, Strategic Account Director, Schneider Electric
 

TAKEAWAY MESSAGES

  • The Internet of Things, or IoT, refers to systems of Internet-connected devices. In healthcare, the installed base of IoT devices is projected to grow 680 percent by 2020. They enable facilities to better monitor building conditions and prevent breakdowns.

  • Connected devices in hospitals include temperature sensors, circuit breakers, monitoring devices and lighting fixtures. By collecting data from connected devices on pressurization, air changes and temperatures, IoT can also aid infection control. Additionally, IoT holds the promise of improved patient satisfaction.

  • IoT allows facilities to take preventive steps before, say, a transformer blows. By connecting sensors to the electrical system components, the facilities manager can see indications of a failing transformer. Better utility management also provides cost savings.

  • Cybersecurity is a real threat as IoT spreads rapidly.

 
  Repair & Renovation Construction: A Better Way
  Mike Coberley, FMP, Brown & Root
 
TAKEAWAY MESSAGES
  • Job Order Contracting (JOC) is a concept developed by the Army Corps of Engineers in 1985. It’s not a product but a method of accelerated procurement. JOC is appropriate for repairs, renovation and construction but not for a building a brand-new facility.

  • A JOC is competitively bid, with fixed prices by task. It typically has a 1-year base with multiple option years and a unit price book establishing costs up front. Terms and conditions, contractors’ markup and costs are already set and fixed, and it satisfies the requirements for competitive bidding.

  • JOC is “like a hamburger,” with a customer able to order extra meat and no lettuce – in other words, it can be tweaked to fit needs.

  • Advantages include the customer making one call to find out the status of all projects in a facility, reduced procurement costs for small projects, quicker response times and faster completions.

  • JOC can improve opportunities for small minority businesses. Because they are working for the JOC primary, they don’t have to carry the bond, and they get paid by the JOC primary, which means they don’t have to handle accounts receivable.

 
  Don’t Pay Twice! How to Avoid Costly Problems When Acquiring Medical Facilities
  Frederic Lastar, Vice President/Healthcare Solutions, JLL
 
TAKEAWAY MESSAGES
  • Mergers and acquisitions are increasing in healthcare, but the decisions are generally made in the C-suite based on business needs, not building conditions. Not assessing a building’s condition early in the game can turn into a costly mistake.

  • Before a merger, consider: Is the building up to code and ADA compliant? Look at the building shell, roof, walls, windows, doors; the mechanical, electrical and plumbing systems; security and fire systems; the capability for technology updates; and signs and branding that may need to be redone.

  • Acquirers tend to talk to clinicians but not the facilities management people or the housekeepers to find out their concerns. With deals taking 18-24 months to complete, the seller may have stopped doing maintenance during that time.

  • Hospital interiors take a beating. Look at flooring, ceiling tiles, furnishings and equipment. Also watch for asbestos, mold and mildew.

 
  Tips, Tricks and Traps to Avoid
   
  James Bryant of Camfil:

Tip: Purchase air filters based on energy consumption rather than cost. For every $1 a facility spends on a cheap filter, it spends $7 on fan energy to move air through it.

Trap: A March 2016 mandate requires that all air filters be tested by the manufacturer. But some manufacturers are still selling air filters that haven’t been tested, creating a liability issue for health facilities that buy them. Make sure air filters are tested and keep the documentation.

 

     
 

Kelly Mason of Specified Technologies:
 

Trap: Holes sometimes develop in walls around cable sleeves, a fire hazard and a violation of the NPFA Life Safety Code. A retrofit device, with a two-piece split design, fits around the sleeve to bring the wall back into compliance.

 

Tip: Install a cable firestop device that is sustainable and exempt from maintenance and inspection requirements. It eliminates headaches.