How Healthcare Contracts are Different from All Others
Think most contracts are pretty much the same? Well, certainly not in the Healthcare sector according to our Head of Operations and Healthcare Sector Guru Chris Murphy, as he explains the unique challenges and considerations that go into carrying out work for Healthcare contract clients.
Everything from the site induction to waste disposal has to be carefully planned and accurately executed when working in the healthcare sector. Client expectations are always very high, timescales are usually very tight, and our work is highly visible.
But we always rise to the occasion and get the job done right.
After many years and numerous successful contracts working in healthcare, I can say that these types of contracts are very different from your run-of-the-mill property refurbishments.
An Extremely Comprehensive Site induction is Always Needed
Okay, there always needs to be a detailed site induction at any given site. But with healthcare contracts, the site induction needs to be extremely comprehensive due to the complexity of the site and the work involved.
Uniquely, certain areas within healthcare settings are no-go areas due to biological hazards, radiation hazards, asbestos etc.
These areas require either separate inductions and/or special permits to work.
|Obviously, this needs to be communicated to the team and the fact it has been communicated also needs to be recorded too.
Site inductions within healthcare environments also need to include any specific details regarding the work area with emphasis that we are nearly always working within a live environment and potentially near patients in- situ.
Some of those patients may be seriously ill and each team member must be mindful and considerate of this at all times.
Working in Live Environments
One of the key differences in healthcare is that we are nearly always working in live environments as the hospital is a 24/7, 365 day per year operation.
“Firstly, Novus need to ensure dignity and compassion is demonstrated as much as possible.”
|Any works within a live environment will by its nature impact on the day to day running of that department /ward. Our job is to minimise it.
Dialogue with the ward manager, confirming what works are being undertaken is vital as often what is planned by others doesn’t necessarily suit what the ward is looking for or indeed expected.
Firstly, Novus need to ensure dignity and compassion is demonstrated as much as possible.
Considering and reducing the impact of the construction works on the primary function of the hospital and various departments.
An accidental fire alarm could lead to the evacuation of elderly or infirm patients causing unnecessary distress and disturbance.
|Extensive planning & preparation are required when carrying out hot works or potentially dusty works.
Control measures maybe required to isolate or change fire detection which then requires permits, thorough communication etc.
Novus operatives and subcontractors may have to adopt the hospitals fire and emergency procedures for each specific department if the works are not in isolated construction areas.
Areas of work need to be kept clean at all times to ensure there will be no build-up of rubbish and that fire escapes from the surrounding buildings are clear at all times.
“We need to have a flexible approach when planning and also be aware that as we are working in a ‘live’ environment, works sometimes have to be delayed or even postponed due to the needs of the patients and staff.”
The impact of using solvent based substances need to be thought about to ensure that fumes do not impact upon the various settings & alternative products need to be considered.
Whilst any disruption will be kept to a minimum, works need to be coordinated with the input from the ward manager through daily dialogue of what actions are to be undertaken.
We need to have a flexible approach when planning and also be aware that as we are working in a ‘live’ environment, works sometimes have to be delayed or even postponed due to the needs of the patients and staff.
Most hospitals operate a permit-to-work system with specific lead in times before tasks can be undertaken, this needs to be factored in when programming works.
|Notifications of works also need to be in place to ensure the wider hospital trust staff and relevant departments are aware, this again can impact programme if not planned effectively.
Electrical and mechanical isolations on general construction sites can be easily managed with something being switched off that shouldn’t not normally a great cause of concern.
On sites such as a hospital however, accidently turning off power within certain areas could potentially cause massive disruption within that and surrounding departments.
Especially considering surgical departments and areas where expensive medical equipment may be running, which may not be covered by essential supplies.
Extreme care therefore must be taken in the planning prior to any electrical isolations.
Logistics and Waste Disposal are Different
The roads around the hospital are constantly busy with private, commercial & public transport and deliveries & the management of waste disposal and deliveries to the site areas of equipment and fittings need to be planned, authorised, and carried out in in a safe manner and accordance with the infection control requirements.
The removal of waste materials may need to be undertaken on an out of hours shift and deliveries planned outside of the peak travel times.
From time-to-time, lifting operations and road closures may be necessary. If this is the case, extensive communication is required with the client, site security, and adjacent building users.
In addition, traffic management needs to ensure that the primary function or operational requirements of the hospital is not disturbed.
The hospital has many vulnerable patient groups. There are specific restrictions in working methods etc. which are governed by Infection Prevention.
Works need to be organised to ensure compliance in these areas and to ensure adherence to Workplace Exposure Limits for individual operatives.
Novus Property Solutions have to aim to minimise the dust generated during construction activity and second, to prevent dust infiltration into adjacent patient care areas.
- Control measures can include:
Non-essential persons being excluded from area where works are being undertaken creating dusts, noise, or vibration.
- Erection of airtight plastic and dry wall barriers around the work area (where feasible)
- Use of negative-pressure ventilation in the construction area,
- Suppression of dusts with water
- H class/ M class extraction to tools appropriate to the risk
- Covering of all air intake and exhaust vents in the construction zone to prevent the introduction of contaminated air into the hospital heating, ventilation, and air conditioning systems,
- Redirection of construction traffic away from patient areas,
- Regular removal of the construction debris from the site in sealed containers or at least covered by a damp cloth
- The use of sticky mats and damp cleaning
Housekeeping whilst working in live environments is key we mustn’t lose site of the fact that not only can we carry infection onto wards we can also pick up infection whilst on the wards and potentially pass on to work colleagues and family members.
The work areas are all predominantly within live hospital settings with a large volume of staff, patients and visitors having access/thoroughfare to most areas.
As such, the hospital maintains security on a 24/7 basis.
All work areas are always required to be kept safe, secure, and segregated.
If works are required outside of designated site boundaries, then appropriate exclusion zones need be established around the work areas with appropriate barriers or fencing to ensure protection for patients, staff & visitors.
All contractors & personnel are briefed to be extra vigilant and ensure that, tools are secure always.
Lockable tool chests or storage need to be utilised to ensure that sharp or dangerous tools are not left unattended.
A Greater level of Communication
Because the works have the potential to affect hundreds/thousands of people communication with the client is of the upmost importance.
This is the most vital part, effective liaison with the client lead and end user in honest and open dialogue will ensure works are completed to the satisfaction of all.
On a typical construction/refurbishment project the workforce normally come into contact with people or situations they see on a day to day basis.
“effective liaison with the client lead and end user in honest and open dialogue will ensure works are completed to the satisfaction of all.”
In healthcare however, the workforce may enter some areas such as children’s wards, Palliative care wards, end of life wards, A&E etc. where they may encounter distressing scenes which can upset even seasoned health care staff.
This kind of information needs to be communicated, managed and monitored regularly to address any issues.
There are protected meal times to consider, in which works can’t be done due to wards having protected meal times.
These must be adhered to within the planning of works around live wards.
Logistically, it can be challenging to set up welfare arrangements as required under CDM regulations due to the congestion or volume of buildings on healthcare sites.
This in itself can take several weeks and meetings to resolve.
Often overlooked, but under CDM regulations the client has a duty to provide the contractor with an area to set up welfare and storage.
This is even more critical at this time with social distancing under COVID-19 regulations.
Most projects take extensive planning in regards to simply being able to commence onsite.
We need to consider the impact of any mechanical, electrical, data isolations, and we may need to carry out temporary works just to facilitate isolating some services. For example bringing in temporary generators to isolate electrical services.
Isolation, identification, and protection procedures need to be strictly adhered to.
Installing temporary ventilation, installing new fire detection or temporary fire compartments.
Early engagement with the end user and listening to any concerns they have will contribute to the smooth running of works.
Our Work in Healthcare
We have extensive experience working with some of the largest names within the healthcare sector.
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