Smooth Operator

Sarah Blackman , July 12th, 2010

In the first of a series of case studies Facilities Management Middle East discovers how Sheikh Khalifa Medical City is operated and what it takes to manage a hospital in the Middle East.

The importance of FM in a hotel, office block or residential unit is significant. But, when it comes to hospitals, it is a matter of life and death.

Running a healthcare facility requires advanced systems, technical knowledge, complex solutions and a team with the ability to focus on the core medical activities.

Every single detail from lighting control down to the mopping of the floors contributes to a healing environment for patients, and services that are sometimes overlooked in regular buildings cannot afford to be neglected inside a hospital.

Fortunately, it seems that facilities management at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is in safe hands. “When you are staying at a hotel, you’re in a good mood because you don’t have to work and you have better morale. So, you will see things in a positive light.

When you enter a hospital you are sick and so our job is to provide an environment where a patient feels immediately relaxed,” explains SKMC director of facilities and construction management Stephen Bridgman.

“We are trying to use the physical environment to help with patient care."

SKMC, which is owned by SEHA, the newly established Abu Dhabi health services company, consists of a 568-bed tertiary hospital, 14 outpatient specialty clinics and Abu Dhabi Blood Bank.

It also manages six family medicine clinics, two walk-in clinics, two dental centres, and an urgent care centre, which are distributed around the emirate.

Plant, machinery and utilities
Like with any major infirmary, SKMC’s equipment is machinery monitored 24/7 and doesn’t wait to breakdown before it is fixed or replaced.

For instance, it is crucial that elevators are maintained for reasons that are specific to a hospital’s needs, as SEHA facility planning and construction manager Dr Abdelmadjid Bensalem points out: "If lifts breakdown then there is a problem because medicine, food and diagnostic results need to be delivered to patients at specific times.”

“We always have to look at travelling times and how quickly doctors and nurses are moving from point to point.”

The building’s utilities are also managed in such a way that the plant and equipment never loses power supply.

“When someone is on a life-support machine the power has to be on, it can’t go off,” explains Bridgman.

“The Abu Dhabi distribution company provides us with three different lines of power from independent places decreasing the probability of a cut off by three times. If all three of those fail then we have back up generators.

"If the worse thing happens and all the power lines and generators fail, then the life-support machines have UPS backup systems which immediately pop on if there is a complete power failure. These are complicated systems.”

Another utility, which, can lead to disastrous consequences if not properly monitored is medical gas.

This is a piped system which is responsible for supplying oxygen, nitrous oxide –supplied to surgical suites for its anesthetic functions, nitrogen – used to power surgical equipment, medical air – supplied by a special air compressor to patient care areas using clean outside air, and carbon dioxide - typically used to inflate or suspend tissues during surgery.

The pressure within each gas delivery system is constantly regulated at SKMC.

“Medical gases are very important for health, but they can also be dangerous so we have to consider safety issues at all times,” reports Bridgman.

SEHA facilities development and maintenance manager Ali Al Qamzi seconds this argument:

“Sometimes we need 100% fresh air. It is dependent on the function of the room, for example an operating theatre. You wouldn’t have these stringent requirements in a ‘normal’ building.”

Cleaning and infection control
Arguably the most important facilities services inside a hospital are cleaning and infection control, which, according to Bensalem are properly monitored at all SEHA clinics.

“The walls are coated with anti-fungal and anti-bacterial paint. Even the floor coverings are anti-allergenic.”

Bridgman and his facilities management team outsource these services to subcontractors, whose work is then monitored by the facility’s support services department.

“There are people doing the work and there is people checking, and then there are checkers of the checkers. So it’s highly integrated process and it goes from the CEO, COO all the way down to the individual people,” he says.

Contracts
Other services, such as security, are also outsourced for the benefit of SKMC.

“When you hire a company, you get the intelligence and experience of an entire company rather than one individual. Also, by outsourcing, the hospital can focus on its core activities – providing healthcare,” Bridgman adds.

Contractors are prequalified and evaluated based on technical and financial skills so that SKMC gets the best value. Also, senior electrical engineers, senior mechanical engineers and security officers within the FM department manage the subcontractors on a day to day basis.

“They work on a two year contract and if they are not meeting our requirements then we take on another contractor,” explains Bensalem.

IT systems and solutions
Building management systems and electronic monitors regulate complex heating and cooling systems, within SKMC. A hospital needs air flow to keep away infections and reduce viral and bacterial growth, and rooms need to be kept at specific temperatures.

Freezers, which store blood and bone marrow, must also be monitored, as any warming of patient samples could render them useless.

“SKMC has done a great job, thanks to SEHA’s initiative on upgrading our entire IT packages. The technology is catching up,” says Bridgman.

It is the FM team that serves as the overall building electrical systems and the mechanical systems coordinators to make sure we provide the best environment for their guests.

The director and the section head of building maintenance Ahmed Al Nuaimi are in charge of committees so any problems the hospital’s staff may have are quickly resolved.

“I have great staff so I manage them and respond to all the queries, the questions of the healthcare professionals, visitors and the patients.

Ahmed and I share duties on different committees, such as safety committees, where they need a facilities person involved,” Bridgman reports.

“All of our staff know that they can report a problem and they will see response. The key to facilities management and all the services that go with it is our response time.

Any nurse can call any of our people and we will try and get what ever problem they have solved. The people we get the most requests from are the healthcare professionals and other staff because they are at the hospital every day.”

Sustainable future
As well as SKMC, SEHA owns and operates several other healthcare facilities in Abu Dhabi including the new Mafraq Hospital, which won the best sustainable hospital project award last month at the Hospital Build Exhibition in Dubai. The environmentally sensitive 745-bed building is currently being constructed to replace the current hospital in the same area.

In addition, SEHA received highly a recommended recognition in the category of Best Hospital Design for its new Al Ain Hospital. Both hospitals are set to open in early 2014.

“We looked at using sustainable materials and cooling systems. The hospital will also be heavily shaded so the heat is kept out,” says Bensalem.

“The water will be heated by solar panels and then recycled and used to water the grass and plants in the gardens surrounding the buildings.”

SEHA’s HealthSystem also received the highly commended award for best healing environment at the event.

The organisation was honoured for reducing length of stay, having a well-managed patient flow, reducing waiting times, decreasing levels of infection, achieving good health and safety records, having a well managed patient nutrition programme and receiving positive patient feedback through testimonials.

“Our vision is to develop a healthcare system and to develop the infrastructure required to support and achieve world class standards for healthcare delivery. I congratulate our team and all our partners on this recognition which shows we are moving in the right path towards that goal,” says SEHA chairman Saif Bader Al Qubaisi.