St. Joseph’s Health Care, London (Ontario) is a major tertiary patient care, teaching and health research corporation. With five major sites – St. Joseph’s Hospital, Parkwood Hospital, Mount Hope Centre for Long Term Care and Regional Mental Health Care, London and St. Thomas - and 23 community-based satellites, this public hospital comprises approximately 3.5 million square feet of managed space. St. Joseph’s is currently in the midst of a major 10-year provincial health services restructuring initiative, which, in conjunction with projected funding shortfalls and decreasing capital resources, has caused the hospital to take a closer look at the condition of its facilities. Using the ARCHIBUS Condition Assessment application, St. Joseph’s was able to identify the costs and efforts associated with upgrading major components of its portfolio, as well as the risk associated with doing nothing at all.

Upgrade…but at what cost?
The Ontario provincial government continues to open up the development and operation of long-term care facilities to the private sector. This, coupled with the need to upgrade aging facilities to meet new standards and increased demands has placed additional pressures on not-for-profit operators like St. Joseph’s. In fact, over 50% of St. Joseph’s long-term care portfolio was plagued by emerging issues such as an imbalance in the private to semi-private room ratio, physical barriers to wheelchair accessibility, the lack of meeting spaces, the structural stability of window solar shades, and the condition of sanitary piping.

The Marian Villa building of Mount Hope Centre for Long Term Care was one particular facility designated by administration for reevaluation. While this building had undergone some renovation in 2002, the hospital board wanted to understand the effort and cost it would take to maintain this facility or at least upgrade it to an ‘A’ standard facility, based on current government standards. The Facilities Planning & Development department was charged with completing a major assessment of the building’s condition including exterior wall assemblies and all mechanical and electrical systems.

“Our Physical Plant group had serious reservations about the building’s overall condition and thus its level of usability,” says Steve Ries, a Director of Facilities Planning & Development at St. Joseph’s. “Our goal was to determine the immediate and long-term costs associated with the feasibility of maintaining the status quo versus major renovation.”

Ries and the department’s Facilities Management Systems Analyst, Bonnie Monteith, also saw this project as an opportunity to evaluate the ARCHIBUS Condition Assessment application’s ability to effectively represent condition and cost information to both operational and strategic audiences. “We wanted to demonstrate that the electronic capture and presentation of information could add value to the task of assessing a building’s condition,” says Monteith. “This enhances the capabilities of our existing ARCHIBUS implementation and reinforces its value as a facility management tool. If we could go to senior leaders with a successful, meaningful assessment on this initial building, we could convincingly make the case for condition assessments across the entire organization.”

A Fast Track Assignment
The department was given 90 days to complete the assessment project, which included a field review of 128,000 square feet on four residential levels and one common services level, performed by discipline-specific technicians. These field notes were reflected in the Condition Assessment application, which integrated with the hospital’s AutoCAD® drawings and the hospital’s existing ARCHIBUS space information. “In conjunction with clinical leaders, we conducted a parallel study of the changes required to improve the building’s design standard,” says Ries. “In doing so, we determined the building’s eligibility and potential for additional operational funding.”

By the end of the project, the hospital’s consultants had performed over 3,920 assessments on everything from code compliance to occupational health and safety requirements, to the condition of the building’s mechanical, electrical and control systems. Assessments were forwarded to a cost consultant who estimated the capital costs associated with repair and/or replacement. Costs were associated with each area of the assessment so that the Facilities Planning and Physical Plant teams could easily identify the capital needed to sustain the facility.

In addition to being ranked by priority value, results were presented based on an asset’s year of replacement, and its National Master Specification (NMS)/Uniform Construction Index (UCI) Classification. A Condition Scoreboard illustrating the matrix relationship between priority value and condition, coupled with a Capital Planning Summary documenting required cashflow over a 20-year period, validated the assessment conclusions.

“The ARCHIBUS Condition Assessment application’s ease of personalization allowed our Business Partner to adjust the priority values to reflect our specific needs, and to add new fields to assist Facilities Planning in understanding the 20 year capital plan,” says Ries. “The health care sector in Canada continues to be challenged to do more with less. This Condition Assessment Scoreboard is a useful tool for presenting high-level information to senior decision makers on the long-term capital budget required to maintain a facility.”

Identifying the Options
The assessment revealed that Marian Villa was in generally good condition with very few code or building loss issues. The building was found to be capable of being upgraded to the ‘A’ Standard through a rebedding of the rooms and addition of air conditioning and sprinkler systems. However, an upgrade to meet current design standards was not deemed fiscally viable due to the extent of the renovations and necessary additions. The study concluded that a major renovation, particularly to the ‘A’ Standard, is only feasible if additional revenue or one-time capital funding is secured from the provincial government. “Senior leaders appreciate the value of having solid data when presenting their case to the provincial ministry of health,” says Ries.

Future Plans
St. Joseph’s Board of Directors has subsequently requested that Facilities Planning, in conjunction with Physical Plant, perform selective condition assessments from the hospital’s entire portfolio to determine the long-term investments that have to be made over the next 5-10 years. This will ensure that the facilities are capable of supporting St. Joseph’s diverse and evolving mission. This corporate-wide assessment will assist Facilities Planning and Finance in directing long-term capital cashflow requirements while minimizing the risk to the organization and maximizing St. Joseph’s return on its investment.

Phase one of this work—involving assessment of the corporation’s roofs via handheld PDAs loaded with the ARCHIBUS Condition Assessment—is currently in the planning stages. Subsequent phases will be conducted over the fiscal year 2004/2005 and will focus on assessment of those products and systems, which traditionally have short, design life-spans or are critical to the hospital’s core operation.

“Facilities Planning & Development concluded that ARCHIBUS Condition Assessment can effectively represent condition and cost information to both operational and leadership audiences,” says Ries. “We anticipate that the corporate-wide assessment currently underway will greatly enhance our knowledge of our facilities’ condition. It will also substantially improve our ability to plan for—and advocate for, when necessary—additional funds required to maintain our facilities into the future.”