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Commissioning Healthcare Facilities

One of the reasons facilities owners choose to commission new or renovated building systems is because they have analyzed the risk associated with not commissioning the systems. Most people agree that commissioning increases the chances of building systems operating properly at the end of construction and not after a months- or years-long “shakeout” period. What is the potential cost of the systems not working when the building is turned over for occupancy and/or use by the owner?

I have been commissioning building systems for over 15 years and have been intrigued by the evolution I’ve witnessed. The following is a chronological list of building system types that have been added over time to the category of “likely to be commissioned” facilities.

  1. Art and History Museums
  2. Research Laboratories
  3. Healthcare Facilities

The list continues on, in later years, to include K-12 schools, office buildings, and industrial facilities. However, the fact that it was the museum community that first valued their facility systems enough to believe commissioning was a worthwhile endeavor says something about our society. Without getting on a soapbox and making an impassioned social statement, I want to consider the cost/benefit evaluation performed by each of the owners of the top three facility types.

Museums: What is the cost of a poorly performing HVAC system in a museum entrusted with “priceless” one-of-a-kind pieces of artwork and/or historical artifacts? Steady humidities and temperatures are imperative for the preservation of a museum’s collection. To introduce the collection to an un-commissioned environment risks irreparable damage and the potential loss of something that can not be replaced. The term “priceless” is a misnomer, however, because, although museum pieces are one-of-a-kind, they often do have a “market” value associated with them.

Research Laboratories: The cost of unreliable mechanical and electrical systems in a research laboratory is most often characterized as the potential loss of “years’ worth of work” embodied in the contents of some researchers’ laboratories. A lot of people, including financial supporters, highly educated researchers, and people who will benefit from the eventual findings of the research stand to suffer setbacks if long-term research needs to be re-started. The cost of such a setback can readily be calculated in terms of personnel salaries, raw materials, facilities costs, and other associated expendables. This does not include the less easily calculated costs associated with delayed progress.

Healthcare Facilities: How is it, then, that healthcare facilities, i.e., those facilities that care for the health of people, come up a rather distant third to museums and research laboratories? The irony is the fact that no one wants to put a price on human life – the truly priceless. Why does the risk analysis for healthcare facilities result in anything but a positive decision regarding commissioning? Perhaps it is because the correlation between building systems performance and patient and healthcare provider well-being has not been as well understood – until recently.

Over the past few years, healthcare facilities have come under increasing scrutiny with respect to how their environments impact their mission. It is no surprise that institutions associated with medical research laboratories (i.e., those facilities management groups who were familiar with the option of commissioning through their laboratory projects) were the first to make the leap into commissioning their hospitals. They knew that commissioning would go a long ways towards improving their healthcare services. Leading this pack in the Midwest are the Mayo Clinic in Rochester, Northwestern University in Chicago, and Fairview-University Medical Center in Minneapolis.

The risks these and many other healthcare providers are looking to mitigate include:

  • Spread of airborne infection, especially in operating and recovery rooms.

  • Introduction of any contaminants into positive pressure isolation rooms.

  • Spread of infectious agents out of negative pressure isolation rooms.

  • Non-functional emergency systems that put the non-ambulatory patients at particular risk, i.e., fire alarm, fire sprinklers, smoke control, emergency power, etc.

I challenge all healthcare facility operators to carefully analyze the costs and benefits associated with commissioning new and retrofitted building systems. Also, because of the importance of continued proper operation, hospitals are excellent candidates for well planned and executed recommissioning or continuous commissioning programs throughout the life of the systems. Please refer to January, February, March, and April 2001 Getting it Right columns for more information on these topics.



Engineered Systems, July, 2003

Rebecca Ellis, PE, LEED AP, CCP, CxA
Questions & Solutions Engineering
1079 Falls Curve
Chaska, MN  55318