Amy and Jon chat with Steve Weipert, Vice President of IFM at HHS, about facilities management programs and how they play a critical role in a hospital's delicate ecosystem.
Everybody, welcome to this week's episode of Let's Talk Solutions: Candid Conversations with Healthcare leaders. I'm Jon Amos.
And I'm Amy Fritzer. And this week we'll be discussing what a facilities management program is in a healthcare facility and how it plays such a critical role in a hospital's delicate ecosystem, especially in terms of creating a healthy and healing environment for the patient.
It's almost like running a city and most people don't really understand all that's involved.
And today we're going to be joined by Steve Weipert, VP of Facilities Management with HHS.
He has over 30 years of experience in various leadership roles in facilities management and support services in healthcare. He's been everything from a self-employed facilities consultant to a director of support services, to a safety officer to regional VP, as well as a hospital administrator. So lots of experience, and we're super glad to have him on the podcast.
All right. Well, welcome, Steve. Thanks so much for joining us today on the podcast so let’s get started. We just kind of wanted to hear about you and your background and how you got into facilities management.
Well, thank you, Jon. Back in 1987, I graduated from Michigan State University and found myself working in a hospital, which wasn't my original plan. But it ended up becoming a lifelong pursuit and I have been working in hospitals since 1987.
I've run everything from facilities management to the kitchen services, all the support services as well as construction. So over the course of those years, having received a lot of certifications and education in the facilities side of the business, that's really where I've honed my expertise.
You're kind of a jack of all trades.
I am. And I've actually been a hospital administrator.
Oh, you really have done everything.
Yeah, I didn't know that. What did you study in Michigan State?
You're going to laugh…psychology and criminology.
Really? So what did you want to do before you got into facilities management?
Well, and I was actually doing well. I was going to college. I was a police officer for a while and I always said, there was 5% complete and total boredom and 95% sheer terror. So yeah.
So going into facilities management was not as, you know, terror driven.
No, and once I got into the facilities management for hospitals, it really became a natural fit to go in, learn about how to engineer. A facility runs, you know, very much like the human body.
You have your facilities run, it has a lifestream that runs through it. So it has the air conditioning system as water systems, power systems. So like your beating heart, you have these mechanical rooms that encompass the components that run the hospital.
Very much like a city runs and in fact, I often equate a hospital as like a small city because they have to run 24-7, 365, they don't ever shut down for holidays. And if portions of the facility are not working, then you are putting people and patients in jeopardy.
On the components of facilities management...
Yeah, so Steve, since we're talking about, you know, facilities management and programs and like you said, making the facilities run, can you break down or explain what exactly is involved? All the components of a facilities management program for a facility, I know you mentioned the boiler rooms and water systems, electrical systems and stuff, but there's obviously more to it than just that.
Well, there's a tremendous amount to the facilities. In fact, most people don't even ever see what is behind the walls running those facilities. So you have very costly equipment. There are large components within those facilities, like boilers, chillers to keep the water and to keep the air conditioning going.
There's emergency generator power. You have all of your electricity coming into the facilities. You have medical gasses and medical air equipment that maintain the facility and patient safety all of those items are installed and equipped to provide a suitable environment that helps patients to recover. You also have to do it in such a way because a lot of those patients can't ambulate out of the facility by themselves.
So you have to build these facilities in such a way as to protect the patients in the event of a fire or any other type of emergency. Facilities go through a lot of planning for utility interruptions for natural disasters because you can't just evacuate patients. It's just not possible. So the components that run those facilities are critical to maintaining and operating efficiently and play a strategic part in the outcome of patients.
On contingency plans...
I'm curious to know since there's so much emergency preparedness that goes into having a facilities management program.
I wonder if you've got any stories just about either a contingency plan coming through and working or not working. I'm sure you've got some, some horror stories, but anything off the top of mind that you wouldn’t mind sharing.
Yeah, there's probably one great example. I was working at a very large hospital with about 300 patient beds, and the chiller units were about 40 years old and really were on their last leg. We knew that at some point in time, these chillers were going to ultimately fail, and the hospital was going through a merger at that point and really didn't have the capital to invest to replace those chillers. So what we did is a risk assessment based on what happens if and when those chillers go down.
And we understood through that risk assessment that we would lose part of the laboratory, that some of the surgeries would have to be canceled and that it would overwhelm the radiology department and we would lose a lot of the equipment in radiology.
So based on that evaluation, we were able to understand what the consequences were going to be. And ultimately, instead of putting money and capital into the plant itself because they just didn't have it, we developed a risk mitigation plan. We stubbed out a chilled water pipe so that in the event it did eventually happen, where those chillers went down, we had a rental chiller on standby. So I had worked with one of our local HVAC companies. They had a chiller on standby for me and it really became a plug-and-play.
So as soon as those units went down, which was about 18 months from the time that we did the contingency plan and risk mitigation, we actually had to implement that plan and we saved the hospital from having to shut down, from canceling surgeries, from interrupting patient care.
And what people don't really think about either is how does that look or sound when it gets to the media and what does that do for the hospital's reputation? So we were able to save all of the revenue that you would normally associate with patient care and throughput and also mitigated the potential for negative media for that facility.
Well, it sounds like one of those contingency plans probably would be something that any program would have, right? I mean, obviously, the hospital doesn’t want it's chillers to go down. And I would imagine that part of, like you were saying, thinking ahead and doing the risk assessment would be important for them to say, ‘Look, in case this does happen, we should have this in place’.
Or do you think it would be important for them when they're laying out a program, for example, that they instead of waiting for, you know, obviously planning for the worst-case scenario, but maybe planning a little bit better in terms of having capital aside for a catastrophic failure like that? \
Or is it something, Steve, that you think the plan would be for just overall better maintenance of those systems so that something like that doesn't happen, that there isn't a failure, for example?
Yeah, a well-run organization with facilities understands that you have to do both of those. So, to tackle that, your first part, which is around contingency planning, you really want to conduct a risk assessment of all of your critical systems.
So we know that down here in where I'm at today, in Houston, that it's prone to hurricanes. So as a regular event, we assess and conduct risk assessments and planning in the event that a hurricane hits.
Now, if you're out in California, you would do the same thing for earthquakes, so you are always undergoing a risk assessment and have contingency plans in place. But the other part of your question, which is excellent, is how do you go through and look at all of this vital equipment that runs your facility and develop a strategic plan for the organization to understand where they are with their equipment? So whether it's a roof, a boiler, any of those items, where is it in the life cycle and how is it performing today?
And those vary from region to region. So you'll have the equipment that is exposed near the ocean that will deteriorate much quicker because of the salt air than it would if it was in the north.
So understanding where you're located, understanding the equipment, and then planning for strategic capital funding for the organization so that it doesn't become a surprise. And that they understand that, you know, this roof is 30 years old, we're starting to see a lot of leaks and we can patch it up to a certain point, but we need to plan in the next three to five years a roof replacement. And that helps when we're able to do a full facility's capital action plan, then we're able to help those organizations develop strategic capital assignment and try and take away as much of the, ‘Oh, my gosh, this just happened,’ and more of it, we're planning for this. We're making sure that we're strategically allowing and placing our capital dollars in the areas that we need them.
Yeah, that makes sense. How do you plan for a hurricane? How does a facility? How does a facility, like in Houston, how do they plan for that? I mean, obviously, we know they could hit us any time during hurricane season. So what do you do? How about a flood, you know, how do you prepare for that?
Well, one of the critical components is during a hurricane is the loss of power. So hospitals have emergency generators. So ensuring that that emergency generator is tested on a weekly basis and there are requirements around how often you need to test those emergency generators.
But knowing within the facility what equipment is on the emergency generator—so they won't put the entire facility or multiple places do not put the entire facility on generator power. So ensuring that you have, we call them the red plugs, and red plug indicates that that is on an emergency generator.
So if you have a ventilator, for example, you'd want to make sure that that is plugged into a red outlet in the event that you lose power and the generator comes on. You also have to make sure that you have enough fuel to run that generator for an extended period of time.
So we're normally planning for a minimum of 96 hours before we would have to refill our fuel. As part of that planning and part of the risk mitigation is making sure that you have a well-run facility emergency generator so that you're not going to lose electricity.
So that's one, and also, I've seen a lot of organizations in these prone areas that have sandbags so that they're strategically placed around entrance doors so that the flooding doesn't come into the building itself. So there's a lot that goes on and you'll find that the facilities directors, when there are events like this, they're not at home, they're at the hospital. They're trying to make sure that their hospital is running, that there's nothing that is is going to happen to the patients or to the caregivers that are there, and to address any related issues that come up.
So then, do you guys get bids on roofs too?
Well, we do. So part of our facility capital action plan—so the strategic capital planning—we go out we will actually get bids as they are today and then we'll project those out for CPI in the future.
So today a roof might cost you $100,000, but if you're planning for it in five years, you have to adjust for inflation. And then update your cost estimates based on the year in which you want to conduct the replacement itself.
On facilities management in healthcare...
I'm kind of curious, we talked a lot about obviously contingency plans, some about preventative maintenance, but I kind of want to shift gears a little bit. I'm always kind of wondering, you know, when we have these conversations, it's easy to talk about the ideal, the way things should be, the way a facilities program should be run. And then I always wonder, what's the reality of how that plays out? And I'm curious what your thoughts are on kind of the overall state of the industry in terms of facilities managed for healthcare? What are some of the challenges being experienced? Where do you think the industry as a whole can improve on? What does it do well?
As it becomes more and more competitive in the healthcare environment today and with reduced reimbursements, hospitals operate on a much lower margin than people would expect. And you'll read where a health system is making, you know, a good deal of money, but in reality it's a small portion of their overall revenue so far.
From a revenue perspective, their margins are pretty light. The facilities component of a hospital isn't really something that most people think about. They're thinking about the things that directly impact the patient. So, for example, a new cat scan or a new MRI, and I call those the ‘sexy parts of the building.’ They are the parts that the hospital can advertise and a physician can know that they have the latest and greatest pieces of equipment. And they're very, very expensive. What that does, however, is force hospitals into wanting to maintain or run their facilities infrastructure for as long as they can because that's not really where they want to put their money.
And so, I always use this analogy, you know, if you buy a beautiful brand new sports car and you pay $150,000 for that car. I can't afford that, but some people can. You could run that for, you know, quite a good period of time. But if you don't maintain your vehicle through oil changes, through fluid changes, and through tire rotations, you'll run that vehicle up to a certain point and then it's going to fail. And you've just lost that equipment, your vehicle. And that was $150,000 investment that could have lasted probably two, three, or four times longer.
So part of the facilities business that we do, is we look at how we conduct preventive maintenance to extend the life—in the likelihood that the equipment will not fail—and will actually function beyond even the manufacturer's recommendations or expectations. So we put together a very comprehensive preventive maintenance plan for all the pieces of equipment in the facility. And that means tightening belts, greasing motors, greasing ball bearings in a motor, and changing filters on a regular basis. There's a tremendous amount that goes into a well conducted preventive maintenance plan.
So we're actually helping the facility to reduce its costs, and particularly its capital costs, by maintaining the equipment at such a rate that we can extend its life. And all of that plays right back into the capital plan, where we know if we've been maintaining that equipment and doing the preventive maintenance and at some point in time, it will fail. Eventually, that $100,000 car will ultimately fail at some point in time, unless you keep it parked in the garage.
But these are pieces of equipment that run all the time, 24-7, and so we know that we can extend life through a good preventive maintenance program. But ultimately, we need to look out into the future and help those organizations strategically plan for, you know, replacements.
On routine maintenance...
So I think that kind of ties back to your analogy of it being a city too. Because you know the reasons people move to a city or like a city, you know, the food scene, you know, the cool bars or whatever. But without water, without power, without the infrastructure that you need, no one is thinking about that when they choose to move to Austin or move to wherever. But those things are critically important. And so I think that works that analogy too.
But that also brings me back to, I think you mentioned that in the answer you just gave, but the hospital runs 24-7, the equipment is running 24-7, and it has to keep running 24-7. And while you're putting in a preventive plan to make sure that stuff doesn't fail, so that patient care doesn't get disrupted, you also need to not do anything that disrupts patient care with the routine maintenance of it, right?
So I'm kind of curious, how do you conduct, you know, routine maintenance and those things in a way that's not disruptive? And in an environment where you know, it's busy all the time and it's running 24-7.
Great question. This is again in like New York City, you know, the city that never sleeps, right.
I thought that was Vegas.
Well, actually it is, I lived there for three years and I loved it. But the hospitals really, like you said, they never shut down and the environment itself has a significant impact on patient care and patient outcomes.
So that involves, is there a lot of noise is there? What's the air quality like? If you are working on equipment, are you doing that in a way that is less disruptive to the patient? So fortunately, for us, a lot of the equipment that we work on in facilities is either above the ceiling or in mechanical rooms that the patients are not exposed to. So, if we're changing filters in the air handling units that's done in a mechanical space, so you don't have to worry about interrupting the patient.
Now, if the TV is out, a light is out, if it's hot or cold in that patient room, then we may have to go in there and interact with the patient. What we try to do is make sure that is a very positive interaction with that patient. So we'll go in and we'll introduce ourselves. We'll tell them what we're there to do and how it's going to help now and just engage the patient.
It's bad enough being in a hospital, not really knowing what in the heck is going on with your health in a lot of cases and it's scary. So the mechanics play a critical role. If they go into the room they ask the patient, ‘How are you? How are you doing today?’ Not so much in terms of their health, but from the environment perspective and to really spend a little extra time engaging that patient and asking them, ‘Is there anything else that you need?’ ‘Well, yeah, you know that faucet over there has been dripping, you know, it's kind of bugging me.’ ‘Well, we can go take care of that right now.’
And so that open communication—talking to them. We've all had loved ones that have been in hospitals and understanding when somebody walks into that room, what it is that they're there to do and why they're there and to communicate.
What do you think are some of the perhaps popular misconceptions or thoughts that administrators may have, you being a former administrator, that perhaps you often overlook when it comes to facilities management? I mean, like you said, it's not sexy, right?
Right. Well, I think there are a number of misconceptions. The maintenance mechanics are really working decentralized, so it's not like they're sitting in a cubicle waiting for somebody to call and being able to handle that at that location. They're out in the environment, they're out on the floors, they're in the mechanical rooms. And so one of the misconceptions is that sometimes people and administrators just don't really know what it is that the mechanics are doing. That’s a function of being decentralized.
Now, we're able to overcome some of that through computerized maintenance management systems where we track work orders and we're able to demonstrate the work that is being done and conduct analytics that demonstrates the productivity of the employee.
I'll give you one example. Somebody might think, you know, well to replace a light bulb, it should take you ten minutes. Well, that light bulb might have actually been a ballast that needed to be replaced. That turns it into a whole different situation. So I think there's a misconception that somebody just spent 30 or 45 minutes working on replacing a light bulb when they were actually replacing the bulb, plus the ballast.
What’s a ballast? Is it the piece that it screws into?
It's the piece that runs the energy through the fixture. So if you have one of those four light fixtures, you'll have a ballast.
One of the other misconceptions is that the mechanics don’t play a very large role in controlling the overall utility costs for a hospital. But they're looking at and monitoring boilers and chillers, they're making sure that these are running at peak efficiencies so that you're not using as much electricity if you just let it run full blast.
So, we will be looking at equipment and making sure that it's running to its best optimization, which means not running at full speed all the time when it doesn't need to be drawing tremendous amounts of electricity or water. And so we have a huge impact on utility costs for the organization.
On resource reduction...
Have you noticed, just out of curiosity since you brought that up, like, if you're running some of the machines that, you know, are high efficiency and whatnot, have you noticed a significant ROI associated with that? Or like a reduction? Like, look, we've been able to reduce our electricity bill 10% or 15%, which that's a lot of money.
Absolutely. And it wasn't too long ago we switched from T12 light bulbs to LEDs. And the LEDs are a far more efficient light fixture—and it produces better lighting even—and it does so at a much lower cost. So most organizations in the last several years have gone from either T12 or T8 lamps to LEDs. And going from these to the LED lighting has had a dramatic impact on energy costs.
We'll also look at opportunities where you can put in light sensors. So lights aren't left on by mistake for long periods of time in an unoccupied room. You can look at those through a lot of different systems, there's building automation systems that help you look at the facility and understand where the energy is coming from and where you're spending the most amount of your utility dollars. But utilities that play a huge component.
Unfortunately, some of that is unregulated and purchased on the market in a lot of the facility managers are responsible for purchasing and hedging natural gas purchases. And we're hearing even today that there could be a huge spike in natural gas expense for facilities. That's something that's just based on either speculation in the market or from the economy itself. But these are all huge impacts to an organization.
On the impact of COVID-19...
So, we've made it this far without talking about COVID, but I do have a question in terms of because we're talking about, you know, advancements in technology and going, you know, green, you know, green buildings, the WELL Building Certification, all that kind of stuff.
You know, there's all these advancements going on in the commercial space, right? And Tesla and all this stuff and solar power. And you know, I know typically you see those trickle in to other industries over time, healthcare being one of them. And you know, when COVID hit, there was a lot of talk about, you know, how much this is going to accelerate the switch to digital. I mean, a lot of things, a lot of industries. And I'm wondering as far as facilities goes, if COVID had that impact in healthcare, if there is more or less or the same kind of a push to accelerate and adopt some of the technical technological advancements that we're seeing in other places?
Well, COVID had a huge impact throughout the entire healthcare industry, including the facilities components of it. Early on in the pandemic there was not a lot of guidance as to whether or not this was an airborne or a contact pandemic, and and we did learn that it is spread through droplets. And people are wearing the appropriate personal protective equipment. But most hospitals have very few or limited isolation rooms, where they have patients that are highly contagious with diseases, you know, like I mentioned earlier, tuberculosis.
And so it quickly overwhelmed the facilities in terms of their ability to house COVID-19 patients in isolation rooms. The facilities departments really jumped in at that point and had to really problem solve. ‘How do we manage this facility, these patient rooms, this wing within the hospital? So that we can convert regular patient rooms to negative pressure rooms. And how do we do that?’
And so a lot of organizations relied heavily on their facilities departments. To to really develop a plan to create negative pressure areas within the hospital that had never existed before.
So you saw modifications of patient rooms, installation of air scrubbers, and other types of machinery that you would put into a patient room and create a negative pressure environment so that it's exhausting the air. So you're you're getting your air from the building, but then you're completely exhausting it outside.
And that was a critical and really difficult time for facility managers to come up with solutions to renovate very quickly patient rooms during this pandemic because like I said, the the amount of isolation rooms are limited, and they're expensive to have.
But how do you do the best you can do in a regular patient room and create that type of environment? Where you're helping to minimize the spread of COVID or any other pandemic.
Especially, if you've never experienced it before. It's hard to plan for something like that. I would imagine maybe the future of facilities management might entail that — it might be a component of it, maybe?
So back in the earlier part of my career, I actually sat on the state of Michigan Terrorism Task Force. And in that task force, I was one of two people to represent the hospitals in the state of Michigan.
And we looked at how we would deal with not necessarily a pandemic, but a chemical attack. And so anthrax or other types of terrorist events, which ultimately helped us to have some of these plans sort of in place for the pandemic.
So we've seen some really, really bad flu years with influenza. COVID made this far worse than any time since 1917. And in the facilities, managers really jumped down and completed the modification of patient rooms, took out windows, and put up plexiglass or boards and exhaust units to create a negative a negative pressure relationship.
It's almost like they were the unsung behind-the-scenes heroes.
Well, you know, I would say that anybody and everybody that worked in a hospital during this time is a hero, and that includes the facilities maintenance mechanics. But the housekeeping staff, the nurses, anybody and everybody that went into those environments to help during that pandemic are, to me, our heroes.
Why facilities management is important...
So to simplify things a little here, Steve. Why is a facilities management program so important?
Well, you know, that's a great question, and I guess the best way for me to really bring this home is we've all had family members that have been in hospitals. But I had a pretty unique situation personally when my youngest daughter was five years old.
She went into atrial fibrillation and all of a sudden I found myself being not the hospital administrator, but the parent. And it really puts you in a different place. And you understand how important everything is to the care of, in this case, my five year old daughter.
And of course, being in the business, I'm hypersensitive to everything and, you know, very critical of anything that potentially would not be — in my eyes — helpful to my daughter's recovery. And I'll stop there just briefly and say everything worked out fine. At the end of the day, she is now 27 years old and a wildlife biologist living her dream on the island of Kawai.
But that was a result of the incredible care provided by the Childrens Hospital in Detroit at that time. And then I'm ensuring that my daughter had the ability to be treated and recover. I even wanted to make sure that my wife and I were at least in an environment that was not making us feel worse.
The last thing that we needed was to think about or have to think about the building, whether it's hot or cold weather, is the air circulating properly, whether there's electricity flowing consistently throughout that facility, etc.
Knowing that the facilities department there — and I know a lot of them personally — that they were professionals, they knew how to do their job and they provided that environment that the only thing I had to be was a parent with a sick child.
And so I could concentrate on what was really important. But if the building had been overly hot, if anything had gone wrong in the building that had an adverse impact on my daughter's recovery — that would have stuck out.
But by it not occurring, that's why I call everybody who works in these facilities heroes. They provided that environment and I didn't have to think about it.
It's all about the patient and the healing.
So did that experience kind of change your perspective in your approach to your job and your role in health care facilities management?
It did and in a way that I have taken forward today as a mentor to new facilities managers. And so what I did at the facility that I was working at at the time, shortly after all of that, I actually got on a stretcher and had people push me through the building so I could see from the patient's perspective what the building looked like.
Are they looking at stained ceiling tiles or are they looking at leaks? Or are they looking at vents that are clogged with dust? So I really wanted to take another look at the facility from the patient's perspective and oftentimes we in health care — we got our blinders on a little bit because we're so busy trying to to fix or repair that we're not thinking about the perception or how other people are perceiving their surroundings.
That's why I also encourage all of our mechanics to take the time to engage the patient or the patient's family. To make sure that they are comfortable. And let them know that we care.
That's great. Well, Steve, for someone listening to this, what would you say are kind of the biggest takeaways you'd want to leave them with in terms of the importance of facilities management for a hospital?
Well, the importance is making sure that you have a strategic plan and outlook on your facilities. You want to make sure that you are looking at and maintaining your facilities to the best of its ability to to extend the life of the equipment.
You have to have a good, solid program, well trained mechanics and employees, well-supported and staffed, and to allow them the ability to make the repairs and corrections that they need throughout the facility.
You also need to give them the voice to assist an organization not only from a strategic financial perspective, but also from a day to day operational perspective for energy utilization. And we're getting more and more green as we go along. And that has a significant impact on the organization. And just finally, we should always be looking at the facility itself from the lens of the patient or the patient's family.
And we make sure that we have good communication with the with the maintenance staff and understand the challenges that they go through.
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