Benefits of Commissioning in the Healthcare Setting

In my last POST, I outlined the following reasons a healthcare facility SPECIFICALLY needs to be commissioned by a great commissioning team:

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1. A well-functioning building protects patients.

2. Risk-reduction during the construction process.

3. Code requirements specific to healthcare facilities.

Today let’s focus on the first one on that list:

1. A well-functioning building protects patients.

Here are the examples I gave you in my first post:

• Legionnaires' disease can be caused by untreated water systems such as cooling towers, stagnant water in showers and faucets, and decorative water features (waterfalls and pools).

• Hospital acquired infections such as MRSA, sepsis, and surgical site infections may be caused by improper airflow relationships, poor air filtration, and improper maintenance of HVAC equipment.

• Low humidity levels can contribute to the spread of the influenza virus. Conversely, high humidity levels can lead to mold and bacteria growth. Careful humidity control is critical to patient health and safety.

Today let me explain more about how exactly having a great commissioning team in place during all phases of the building process can help ensure your building functions as intended and therefore doesn’t unintentionally lead to poorer patient outcomes. I'll start with a brief refresher on what Commissioning is in general, please keep in mind that all of the aspects that commissioning does to ensure building functionality is of especially critical importance in the healthcare setting.

What is Commissioning?

Building commissioning (abbreviated ‘Cx’) is a quality assurance service ensuring the building and its technical systems meet the needs and requirements defined by the Owner. Building commissioning begins in the pre-design phase and continues through the design, construction, and occupancy and operation phases. You can read more here.

Why Is Commissioning Necessary?

The main reasons commissioning is necessary in today’s buildings are:

1. Systems and equipment that are not installed and operating as intended will not perform satisfactorily. This leads to higher than expected energy costs, equipment malfunction, shorter equipment life, occupant discomfort, and significantly more time troubleshooting and resolving issues during building occupancy.

2. Systems in today’s complex buildings are highly interactive, with sophisticated and flexible controls that allow a wide range of options and strategies to provide comfort and save energy. However, if not running properly this complexity can lead to feedback loops that can be hugely wasteful. Read more here.

The Cx process ensures that your building will have systems that maintain proper comfort levels, minimize energy use, and are easily operated and maintained. Effective building operations require sub-systems and components that work effectively and reliably together, along with a building staff that has the training and resources to properly operate and maintain them.

Non-commissioned (or inadequately commissioned) buildings are turned over to Owners with too many deficiencies, and with systems and equipment that are working sub-optimally. As buildings, systems, and controls have become more complex and the specialization of labor has increased there has not been a commensurate increase in coordination and integration by technically qualified and objective parties.

Non-commissioned buildings are a time-sink and money-sink for the Owner/Operators. The cost of commissioning a project more than pays for itself in the first years the building is in operation.

Benefits of Commissioning (Cx)

Having a facility thoroughly commissioned provides benefit to all parties involved in a construction project: all the way from the design to the final occupants of the building. This is because modern buildings are increasingly complex in their mechanical systems and thorough optimization of the building systems is necessary to have any hope of a decently functioning building!

Benefits for the Design Team include:

• All key information of the building is documented which can be vital for future projects.

• The Cx Authority reviews the plans and specifications throughout design to insure they meet energy and comfort standards and maintenance and operation requirements.

• During the construction process, the Cx Authority verifies the control systems operation and reports any deficiencies.

• The Cx Authority writes and submits functional test criteria to the Owner, Designer and Contractor which detail how the systems will be tested to ensure system performance. This approach is designed to discover and correct deficiencies before the building is turned over to the Owner.

• The Cx Authority is another set of eyes on installations and operation of equipment with the intention of finding issues that could arise due to the interaction among trades and systems. These issues can then be fixed in the design phase before construction starts. Resulting in fewer issues coming back to the Design Team.

• The aim of commissioning is to improve the quality control and performance of the design process within the building services industry by identifying best practice. This will reduce the risk of design errors and omissions, improve the overall efficiency of the Design Team, and provide a built environment that better meets the needs of the client.

• Commissioning provides a framework to record and review design decisions and encourages Engineers and Architects to consider the requirements for installation, operation, and maintenance of their selected systems during the design process.

Benefits to Contractors working on-site:

• The Cx team reviews contract documents for more competitive bidding.

• During the course of the project the Contractors experience fewer delays due to design issues and oversites.

• Having a (good) Cx Authority in place minimizes punch list items at end of project.

• With a good Cx Authority catching issues during all phases of the project, Owners have reduced warranty call backs due to field issues.

• Overall, with commissioning in place the construction project runs more smoothly and a large number of issues can be addressed by the Contractors while they are still onsite for the project. This saves everyone time and money (and the headache of a Contractor needing to return to the job site after construction is complete),

Benefits for the Owner include:

• Project requirements are clearly documented including performance level and acceptance criteria for each item.

• All building systems function as designed.

• All building systems will be operating at maximum performance and efficiency levels. (A commissioned building reduces energy consumption by 8-20% compared to a non-commissioned building).

• Delivers the ability to monitor building performance, analyze system data and establish benchmarks.

• Increased equipment life because of less wear and tear.

• Improved indoor environmental quality and employee productivity.

• Fully trained O&M personnel helps maintain the efficiency and performance level of the building.

• All key information of the building is documented which can be vital for the O&M personnel to be able to maintain and operate the facility.

• Increased probability of the project being on schedule and under budget due to fewer change orders and construction delays.

• A qualified Commissioning Agent provides an Owner a degree of certainty about the actual performance of their building that does not exist in the current design and construction process.

Benefits for the patient

• A safe, healthy, comfortable environment.

• Lower risk of hospital acquired infections such as Legionnaires, MRSA, etc.

• Lower risk of surgical site infections due to proven compliance with ventilation standards in operating and procedure rooms.

• The specific commissioning practices that contribute to patient safety directly involve:

• Airflow and pressure relationships.

• Humidity control.

• Proper operation & maintenance (O&M) of the building systems.

• Additional training for building Maintenance Staff to improve their understanding of healthcare issues.

Building commissioning has been a growing part of commercial renovation and construction over the last 30 years. The need for commissioning to coordinate increasing complex systems will only increase as time goes on, and nowhere is the functioning of building systems more critical than in the healthcare setting. A properly working building keeps patients healthier!

In my next post I will expand on how commissioning services reduce the risks that are inherent to the construction and remodeling process in a healthcare setting.

Thanks for reading!

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