Canadian Health Care Facilities (CSA Z8000-11) The NEW Standard for Design and Construction of Canadian Hospitals & Health Care Facility
Canadian Health Care Facilities (CSA Z8000-11) Cliff Harvey
OAA, MRAIC, Senior Architect, Ontario Ministry of Health and Long-Term Care CSA healthcare facility technical committee
Michael Keen
PEng, MBA, Projects Planning Director, St. Michael’s Hospital Chair, CSA healthcare facility technical committee
Robin Snell
Architect, OAA, AAA, MRAIC, LEED AP, Principal, Parkin Architects Limited CSA healthcare facility technical committee
AGENDA Overview of the Canadian Healthcare System hospital funding capital planning (building) process
What is CSA Standard Z8000-11? creating a standard codes, standards, guidelines goals, objectives, overview
Z8000-11 Features & Content key features sample details & hot topics comparison with other standards
How will Z8000-11 be Implemented?
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Overview of the Canadian Healthcare System hospital funding capital planning (building) process
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Most important Canadian a) Tommy Douglas
(1)
founder of universal healthcare 1966
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(based on 2004 CBC documentary)
b) Wayne Gretzky ‘the great one’ - hockey player
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(10)
10 X E33
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Canada: Population
Source: http://www40.statcan.gc.ca/l01/cst01/demo31a-eng.htm
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Federal: Health Canada
Source http://www.hc-sc.gc.ca/hcs-sss/index-eng.php
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Provincial Systems
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Canada: Health Authorities Legend HA Z HR RHA LHIN HN DHA
Health Authority Zone Health Regions Regional Health Authority Local Health Integration Network Health Network District Health Authority
1 HA 1 HA
1 HA
4 HA
6 HA 11 RHA
5Z
18 HR 13 HR 1 HA
1 HA
14 LHIN 9 DHA 2 HN
Canada: Hospitals 10 Provinces + 3 Territories* •
86 different health region
•
+/- 874 Hospitals / Health Centre
Quebec* •
21% of the population
•
10 % of Canadian Hospital
Ontario* •
38% of the population
•
25% of Canadian Hospital
Remaining 8 Provinces + 3 Territories •
41% of the population
•
65% of Canadian Hospitals
* Preliminary study numbers subject to verification
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PROVINCE OF ONTARIO, CANADA Province of Ontario, Canada Province’s Population: 13.2 million Province’s Area: 1.07 million sq km (415,589 sq mi) Province’s Density: 3.8 /Km2 (36 / mi2) Toronto’s Population: 2.5 million Toronto’s Metropolitan Population: 5.5 million
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Human resources • • • • •
Physicians: 24,875* (2010) Registered Nurses: 115,285* (2011) Registered Practical Nurses: 39,485* (2011) Nurse Practitioners: 1,932* (2011) Pharmacists: 11,833* (2010)
•In total over 350,000** people work in our healthcare system (2005, regulated and unregulated) •
*
Data from public internet sources (regulator’s sites)
•
** http://www.health.gov.on.ca/english/public/pub/ministry_reports/hhr_05/hhr_05.pdf
Ontario health infrastructure* • • • • • • • • •
226 Hospitals (150 Corporations) (+/- 30,000 beds) 634 Long Term Homes (LTC) (+/- 76,000 beds) 969 Independent Health Facilities (IHF) 55 Community Health Centres (CHC) 334 Mental Health Programs 150 Addiction Programs 6,900 Supportive Housing Units 3,600 Homelessness Supportive Housing Units 3,400 Pharmacies
• • • • • •
Budget (estimates 2011)* $ 47 billion (Overall) $ 22 billion (LHIN) $ 17 billion (OHIP) $ 4.9 billion (Provincial Programs) $ 1.4 billion (Capital)
• •
* Data from public internet sources ** http://www.fin.gov.on.ca/en/budget/estimates/2011-12/volume1/MOHLTC.html
Capital Planning Process
http://www.health.gov.on.ca/en/news/release/2011/jul/fs_20110728_1.pdf
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Capital Planning Process
http://www.health.gov.on.ca/en/news/release/2011/jul/fs_20110728_1.pdf
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Capital Planning Process
http://www.health.gov.on.ca/en/news/release/2011/jul/fs_20110728_1.pdf
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Capital Planning Process
http://www.health.gov.on.ca/en/news/release/2011/jul/fs_20110728_1.pdf
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What is CSA Standard Z8000-11? standards overview codes, standards, guidelines goals & objectives
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Context for a new standard - Why now? • • • • • • • •
Capital spending on HCF No Canadian standard Evidence based design Shortage of planning/design skills Public awareness of safety Pandemic fears Increasing technology integration HCF definition blurring
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Health Care Facility Design Standards
“The Blue Book”
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CSA
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CSA international reputation personal safety 40 years standards development 200 existing component standards in healthcare Reputation of integrity, technical credibility, transparency in process • Balanced matrix committee, consensus process • Inclusive participation, respect for diverse interests, multi disciplinary representation • Written in code language – can be adopted • • • •
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CSA Health Care Facility Standards • • • • • • • • • •
Electrical Medical Gases Plumbing HVAC Illumination Infection Control Area Measurement Commissioning Sterilization Medical devices E33
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Standards Development Process • • • • • • • •
Request/Evaluation/Approval Establish Committee Draft Development Public Review Internal Quality Audit Balloting Translation Publication
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Standards Maintenance Process • • • • • •
Ongoing Monitoring 5 year review Committee recall as needed Revisions Amendments/New Edition Withdrawal
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Overview of Standards • Standards in general – Information documents – Stipulate requirements for the safety, performance and operation of products, processes, services and systems – Represent minimum requirements – Are voluntary; compliance becomes mandatory only when the standards are referenced in legislation or regulation
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CSA Z8000 - Health Care Facilities First comprehensive National Standard for HCF 33 members, 4 year development, 400 pages New construction AND significant renovation “Shalls”, “Shoulds” and Best-Practice guidance Objective and performance based Not a specification or a replacement for design innovation • Functional Approach • Reference existing CSA standards, not re-write them
• • • • • •
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Who Writes the Standard? • • • • • • • • •
Architects (RAIC rep) Functional Planners Mechanical Engineers Electrical/IT Engineers Health Canada Doctors/Clinicians Facilities Management Hospital Planners Controls Contractor
5 2 3 2 1 3 2 2 1
• Nursing 3 • Prov. Health Ministries 6 (AB, NF, ON, PQ, NB, BC, MB) • Infection Prevention & 3 Control Practitioners (CHICA) • CHES Rep 2 • Occupational Health & 2 Safety • Hospital Administration 2
(30-35 People)
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Development of the Standard June 2003 - TC Meeting Concept Discussion 2005 – Business Case 2006 – Approval to form Technical Subcommittee March 2007 – First Subcommittee Meeting April to June 2010 Public Review • June 2011 – Committee Vote • September 2011 – Publication • • • • •
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Sections of the Z8000 Standard • • • • • • • •
1-3 4 5 6 7 8-10 11 12
Scope, References and Definitions Principles Planning Site and Facility Development General Functional Requirements Specific Requirements Common Technical Requirements Building Services
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Section 4 – General Principles of Health Care Facilities Operations Accessibility Safety and Security Infection Prevention and Control Sustainability
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Healing Environment?
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OASIS - OPERATIONS • Environment of Care for the Patient – Promotes Healing, Wellness – Sensitive to Needs of Individuals
• Clinical Functionality – Effective Delivery of Care – Effective Application of Equipment – Efficiency of Operations
• Support Services to facilitate the Environment of Care and Clinical Functionality E33
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OASIS – ACCESSIBILITY • Minimize barriers, consideration of disabilities • Effective and appropriate wayfinding • Minimize patient travel • Staff workflow • Provision of supplies • Wait times • Provision for family support • Patient and patient information communication
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OASIS – SAFETY & SECURITY
• • • • • •
Errors in delivery of care Environmental hazards Equipment hazards Criminal activity Privacy and dignity Emergency conditions
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OASIS – INFECTION PREVENTION/CONTROL • Preventing transmission of pathogens between people • Preventing the creation and propagation of environmental irritants • Waste management • Application and handling of supplies, instruments and equipment • Caregiver and patient hygiene
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42
Semi-Privates – Obsolete?
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OASIS - SUSTAINABILITY • Promote patient, staff and occupant wellness • Socially responsible impact on the environment (Green) • Flexibility to accommodate future change • Appropriate for needs of the community and patient population • Total cost of operation
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Section 5 – Planning Process • • • • • • • • •
Master Program Master Plan Functional Program Design Procurement Construction Commissioning Occupancy Evaluation
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Section 6 - Site and Facility Development • Site requirements • Facility requirements – Form and function – Wayfinding – Expansion
• Key relationships and dependencies
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Section 7 - General Functional Service Requirements 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10
Planning Materials and Finishes Furniture, Fittings and Equipment Technology and Communications Infection Prevention & Control Occupational Health & Safety Safety and Security Accessibility Catastrophic Event Management Flexibility & Adaptability E33
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Functional Service Requirements Section 8 – Inpatient Section 9 – Diagnostic and Treatment Section 10 – Support Services Section 11 – Common Requirements • Table of 51 room types or spaces that occur across different areas
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Section 12 – Building Services and Environmental Design • • • • • • •
Site Systems Architectural Structural Mechanical Electrical Information Technology Security Systems
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Overview of Z8000-11 Content key features sample details & hot topics comparison with other standards
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Z8000-11
Key Features
does NOT include HCF operations
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Z8000-11
Key Features
Facility Types • Acute Care Hospital • Academic Centre • Rehab Facility • Urgent Care Centres • Ambulatory Care Centres • Long Term Care • Surgi-centres • Shopping Mall Clinics (eg Endoscopy) • Doctors and Dentists Offices • Home Care and Mobile Services
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Z8000-11
Key Features
Renovation vs. New Construction • General intent – renovation to meet the standard • Could be difficult to achieve in new construction • Difficult in renovation projects??
Z8000-11
Key Features
“Call the doctor, I have acronymosis” EBD BPE BIM DB, CM ROI VE BEN
LEED P&FCC IDP BF/UA/BARI IT POA OASIS
LEAN H&W P3, AFP QofC ATT/RET EBTKS
implementation of current best practice E33
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Z8000-11
Key Features
Component gross square metres (CGSM) – that portion of a building assigned to a specific component, including net areas, internal circulation, partitions, building structure, and small mechanical shafts. Note: CGSM includes all individual net areas required by the departmental functions, circulation space necessary to link together the net spaces and area occupied by internal walls. It excludes all engineering spaces and interdepartmental circulation elements such as main corridors, stairways, elevators and dumbwaiters
Z8000-11
Key Features
Class C HCF — an HCF in which ambulatory patients a) are accommodated on the basis of medical need; b) are provided with non-invasive medical services for diagnosis, treatment, or therapy; and c) and stay for no more than 12 hours (except for residential facilities in which occasional care is provided.) Notes: Class C facilities include those facilities where patients remain capable of self preservation. Class C HCFs include outpatient clinics, dentists’ offices, doctors’ clinics, and privately run residences.
Z8000-11
Key Features
Common Language (en anglais et français) • • • •
Working in multiple jurisdictions Various HCF project types & scale Multi-disciplinary ‘peer sharing’ Common terminology amongst a diverse group of HCF practitioners and design professionals
Quiz
a) seclusion room
b) secure room
c) psychiatric IC room
d) secure observation room
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Z8000-11
Key Features
Common Language d) secure observation room Seclusion Room
Z8000-11
Key Features
Key Relationships and Dependencies • Related Programs • Components within the program impacting the relationship • Objectives • Alternatives to direct adjacency of programs
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Critical care Maternal & newborn care Medical/surgical inpatient care Mental health care Pediatric & adolescent inpatient care Rehabilitation care Specialized inpatient care Ambulatory care - general Ambulatory care - renal dialysis Ambulatory care - oncology Emergency care Procedures Allied health services Laboratory services Electrodiagnostic services Respiratory services Medical imaging Pharmacy Biomedical engineering Environmental services Nutrition and food services Materials management Plant maintenance Security & parking Medical device reprocessing Building entry & parking Heliport Exterior garden/therapy area Main hospital entry/lobby Inpatient Continuing Care
Inpatient Continuing Care
Main hospital entry/lobby
Exterior garden/therapy area
Heliport
Building entry & parking
Medical device reprocessing
Security & parking
Plant maintenance
Materials management
Nutrition and food services
Environmental services
Biomedical engineering
Pharmacy
Medical imaging
Respiratory services
Electrodiagnostic services
Laboratory services
Allied health services
Procedures
Emergency care
Ambulatory care - oncology
Ambulatory care - renal dialysis
Ambulatory care - general
Specialized inpatient care
Rehabilitation care
Pediatric & adolescent inpatient care
Mental health care
Medical/surgical inpatient care
Maternal & newborn care
Critical care
Key Relationships and Dependencies Matrix
LEGEND Critical Relationships that are critical to patient safety and clinical peformance Important Relationships which are important, but of normal base-level importance
to patient safety and clinical performance
Z8000-11
Key Features
Key Relationships and Dependencies
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Z8000-11
Sample Details
“Higher probability of a workable solution” Steve Bagworth – Z8000 committee member, architect & functional programmer
Mandatory (a) to (u) the ‘shalls’
Test Presentation
August 25, 2009
Z8000-11
Sample Details
“Higher probability of a workable solution” Steve Bagworth – Z8000 committee member, architect & functional programmer
Plus advisory Plus advisory (a) to (h) (a) to (h) the ‘shoulds’
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Z8000-11
Sample Details Z8000
macro to micro – hand wash sinks
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Z8000-11
Sample Details Z8000
macro to micro – hand wash sinks (a) to (l)
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Z8000-11
Sample Details
macro to micro – hand wash sinks
2 pages of HHS shall’s & should’s
Z8000
Z8000-11
Sample Details
Consensus
General to Specific
Example
Sound levels in an NICU
Provide a ‘quiet’ environment for the NICU including; - higher STC ratings for partitions - higher NRC & CAC ratings (ceilings) - lower NC ratings (background noise)
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Z8000-11
Sample Details
Consensus
General to Specific
Example
Sound levels in an NICU STC 55 CAC n/a
(45) (26)
(infant room)
NRC 0.75 (0.95) NC n/a (25 ??)
a US standard for Newborn NICU Design – Feb. 2007
“a number to hang your hat on”
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Z8000-11
Sample Details
Consensus
Minimum room sizing
Operating room, general Level one recovery (isolation room), plus anteroom 1-Bed Room Suite
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Alberta Ontario Quebec 60.0 58.6 50.0 646 631 538 25.0 13.0 N/A 269 139 31.0 334
HCD 2011, Nashville
26.0 280
23.5 253
Z8000-11 55.0 592 18.0 194 27.0 291
November 15, 2011
Z8000-11
Sample Details
Bed Clearances Inpatient Beds *
Critical Care Beds *
Non-transfer side of the bed
1000 mm
1200 mm
Foot of bed
1200 mm
1500 mm
Between beds (where there is more than one bed)
1200 mm
1800 mm
Centre to centre of beds (where there is more than one bed)
1800 mm
2400 mm
* Based on a nominal bed size of 1000 mm width or 1200 mm wide for bariatric beds
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Z8000-11
Sample Details
Non prescriptive
you still need to design & specify it
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Z8000-11
Hot Topics
single bedded rooms
27.0 m2 (290 sf)
net per single room (including a 3 pc washroom)
49.0 m2 (527 sf)
net per double room (including two 3 pc washrooms)
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Z8000-11
Hot Topics
single bedded rooms 100% single rooms Length 46.5 m Area 406.4 m2
27
m2
49
m2
80% single rooms Length 45.5 m Area 397.8 m2 - 2.1% * 60% single rooms Length 44.5 m Area 388.9 m2 - 4.2% * * Area difference does not represent CGSM
GOS Acute Care Accommodation Study
Direct Capital Cost Impacts (2) 30% Private 11,280
Net Area (NSF)
•Estimates for Departmental Gross Area
60% Private 12,130
80% Private 12,620
100% Private 12,810
Options (30%, 60%, 80%,19,408 100% Private20,192 Beds) 18,048
Bldg Gross Floor Area (GFA) DGSF per Bed
20,496
23,462
25,230
26,250
26,645
564
607
631
641
Total Cost
$
11,064,087
$
11,941,852
$
12,461,485
$
12,685,050
Cost per DGSF
$
613.04
$
615.31
$
617.15
$
618.90
Cost per BGSF
$
471.57
$
473.32
$
474.72
$
476.08
Cost per Bed
$
345,753
$
373,183
$
389,421
$
396,408
$
27,430
$
43,669
$
50,655
Capital Cost over Baseline
7.93%
12.63%
14.65%
* Based on 1 washroom per double bedded room October 2007
Z8000-11
Hot Topics
Patient Lifts – should or shall?
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Z8000-11
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Hot Topics
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Z8000-11
Hot Topics
patient lift capacity
200kg
441 lb
bariatric lift capacity
453kg
1000lb
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Z8000-11
Hot Topics
Where can I store that?
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Z8000-11
Hot Topics
storage no less than 2% of the total area of the service
Example – Typical Medical/Surgical Floor – 1500 m2 DGSM
(16,146sf)
– Storage = 2% x 1500 m2 – Storage = 30 m2
(323 sf)
– Approx size of storage = 5.5 m x 5.5m (18’ x 18’)
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Z8000-11
Hot Topics
To LEED® or not to LEED®
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To LEED® or not to LEED®
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Z8000-11
other standards
Other Canadian Standards • • • • • •
• • •
(partial list)
Ontario Ministry of Health and Long term Care: Generic Output Specifications (2008) Vancouver Coastal Health Design Guidelines: Complex Residential Care Developments (2007) Ontario Long-Term Care Design Manual (1999) Quebec: Guide d’aménagement des centres d’hébergement et de soins de longue durée (2002) Alberta Infrastructure: Technical Design Requirements for Health Care Facilities “The Blue Book”, 2005 Alberta Health Services: Design Standards and Guidelines for New Construction or Rejuvenation of Long Term Care Centres and Designated Assisted Living Facilities (Draft 2009) Health and Welfare Canada Standards Family-Centred Maternity and Newborn Care: Canadian Guidelines Planning and Design Guidelines for New Brunswick Hospitals for Supply and Services
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Z8000-11
other standards
International Standards
(partial list)
• Australasian Health Facility Guidelines, 2008 • South Africa Hospital Norms (SAH Norms); National Department of Health • Netherlands • UK’s National Health Service (NHS) • New South Wales (rebranded Australasian Health Facility Guidelines) • Health Authority - Abu Dhabi (prepared in early 2011 similar to Australasian Health Facility Guidelines) • Design Guidelines for Hospitals and Day Procedure Centres, Victoria, Australia
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Z8000-11
other standards
American Standards
(partial list)
• AIA/FGI, Guidelines for Design and Construction of Health Care Facilities, 2010 • Uniform Facilities Criteria – US Army Corps of Engineers • US Department of Veterans Affairs, Office of Construction & Facilities Management – Design Manual • Environmental Standards Council; part of The Center for Health Design • SpaceMed.com, Healthcare Facility Planning Tools and Guidelines
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Z8000-11
other standards
Z8000-11, Canadian health care facilities, 2011 • • • • • •
First edition Published editions Pages Room templates (plans) Includes healthcare operations 100% single care rooms
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2011 1 393 no no yes (with exceptions)
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Z8000-11
other standards
AIA/FGI, Guidelines for Design and Construction of Health Care Facilities, 2010 • First edition
1947
1974 - 1st edition with public input 1984 - last edition published by federal government 1987 – 1st AIA edition
• • • • •
Published editions Pages Room templates (plans) Includes healthcare operations 100% single care rooms
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+/-6? 411 no No (confirm) yes (with exceptions)
November 15, 2011
Z8000-11
other standards
AIA/FGI, Guidelines for Design and Construction of Health Care Facilities, 2010 Contents 1 2 3 4 5 6
General – ‘planning, design, construction, commissioning overview’ Hospitals (p45 – 214) Ambulatory care facilities Residential Health Care Facilities Other Healthcare Facilities Ventilation of Health Facilities
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Z8000-11
other standards
Australasian Health Facility Guidelines, 2008 • • • • • •
First edition Published editions Pages Room templates (plans) Includes healthcare operations 100% single care rooms
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2006 2 +/- 1400 yes yes ???
November 15, 2011
Z8000-11
other standards
Australasian Health Facility Guidelines, 2008 Contents Part A Introduction Part B General Requirements Briefing & Planning Part C Access Mobility OHS Security Part D Infection Prevention Control Part E Building Services Environmental Design Project Implementation Room Data Sheets Room Layout Sheets Schedule Accommodation Standard Components
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Z8000-11
other standards
Minimum room sizing
Operating room, general Operating room, large Level 1 Recovery room 1-Bed Room Suite
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FGI/AIA 37.2 400 55.7 600 7.43 80 ?? ??
Ausi HFG 42.0 452 52.0 560 9.0 97 20.0 215
November 15, 2011
CSA Z8000 55.0 592 60.0 646 9.0 to 13.0 97 to 140 27.0 290
Z8000-11 ‘Leveling the raised bar’
(“leveling the playing field”, “raising the bar”)
• a planning & design resource • a practical tool for design decisions • a practical document for approvals Z 8000
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Z 8000 Z 8000
November 15, 2011
How will Z8000-11 be Implemented?
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How will Z8000-11 be Implemented? Will it be a Standard? Policy? Best Practice?
✔ ✔
? ?
? ?
✔
?
?
? ?
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? ?
?
How will Z8000-11 be Implemented? Alberta
“The Blue Book”
• Alberta Infrastructure (AI) concerned about associated costs (e.g. single rooms) • A Committee will be created to review the Standard and recommendations will be made to the Ministers on how this standard should be used in Alberta • AI project managers and the industry is already using the document (even in its draft form) • Alberta Health Service (AHS) encouraging ‘clinical liaisons’ to use the document as a reference
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How will Z8000-11 be Implemented? Ontario • A committee of the ministry’s architects and clinical specialists will review the contents of CSA Z8000 with Ontario’s Generic Output Specifications (GOS). • MOHLTC is encouraging all project teams to refer to Z8000, especially were GOS maybe silent on a particular item, and to bring forth conflicts between the documents for discussion. • The committee will bring forth its recommendation for implementation to senior management in Spring 2012.
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Canadian Health Care Facilities (CSA Z8000-11) Questions?
[email protected] [email protected] [email protected]
