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Dome - When a building becomes a hospital

November 2011

When a building becomes a hospital

Date: November 14, 2011

Now the official owner of the new clinical buildings, Johns Hopkins powers toward opening day.

Exterior of the new buildings
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With the construction complete, Hopkins begins an incredibly complex transition plan for moving patients, staff, equipment, medications and furniture; training 9,000 personnel in dozens of new procedures and processes; and preparing for new financial responsibilities.

Since 2006, David Nelson, an electrical engineer in The Johns Hopkins Hospital facilities department, has concentrated on the planning, design and construction of the electrical power system for the Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center.

A well-worn hard hat and a fat book of electrical blueprints speak to Nelson’s long hours and expertise. Lately, though, his work has required an even greater level of attention. On many nights after the construction crews have left, Nelson and his colleagues have been crawling along miles of the new clinical buildings’ electrical conduit system, testing every switch and transformer and entering any glitches on a portable tablet computer.

As Hopkins prepares to take possession of the new buildings from general contractor the Clark Construction Group on Nov. 15, it’s crunch time for Nelson and 36 fellow commissioning team members who are working around the clock to ensure that the connected towers are structurally sound; that their mechanical, electrical and fire alarm systems are running smoothly; and that all work complies with stringent safety standards. “The deadline is coming up on us fast,” Nelson says.

The team’s methodical scrutiny exemplifies Johns Hopkins Medicine’s commitment to a new era of health care that prizes patient- and family-centered care, innovative research and an engaging medical education that’s grounded in human diversity.

Yet, the labor-intensive commissioning process is merely the prelude to “activation,” the period leading up to April 29 and 30, 2012, when the first patients will move to the new buildings. “Ownership is an important milestone in the journey to becoming a hospital,” says Sally MacConnell, vice president of facilities. “But there’s a tremendous amount of work that we still need to do to get the buildings ready.”

A mammoth to-do list

Activation will bring with it an incredibly complex transition plan for moving patients, staff, equipment, medications and furniture; training 9,000 personnel in dozens of new procedures and processes; and preparing for new financial responsibilities.

Four years in development, the plan is the work of hundreds of medical center staff who teamed up in dozens of work groups to create a massive matrix of tasks and a coordinated timeline for their completion. Collaboration is critical. Each step toward the finish line hinges on a slew of other steps, rendering the overall process all the more challenging.

The installation of medical devices and other equipment, for example, poses a logistical challenge because some items will be purchased new and others will be recycled from former locations in the hospital’s historic building.

“We had to think about how to take a physiological monitor connected to a patient, then connect the patient to a portable monitor and install the permanent monitor in the new buildings, but not necessarily in the same patient’s room,” MacConnell says. “Then each device has to be checked out and recalibrated by the clinical engineering team.”

Traffic in and out of the new buildings will pick up as soon as Hopkins takes ownership of the space and will accelerate in December with the delivery and installation of imaging equipment, scrub downs by Environmental Services, and on-site training for more than 240 employee volunteers who will conduct guided tours for staff and VIPs beginning Jan. 3.

From December through January, the facilities department and the Clark Construction Group will continue to work through a “punch list” of items that might require anything from a paint touch-up to adjusting the sprinkler system and that must be completed to meet the contract’s terms. “We go through each and every room and point out any work that has not been performed by subcontractors or according to specifications,” MacConnell says.

Also, at the end of the year, clinical and nonclinical staff will begin to enroll in instructor-led courses and online programs to receive training in new processes, procedures and equipment, such as the MedSled for evacuating nonambulatory patients, or upgraded medication dispensing software. A series of videos that feature the new buildings’ amenities, layout, safety and security, as well as expectations for service excellence, will be required viewing for the entire Hopkins workforce, once they are uploaded on the My Learning intranet site.

In early 2012, training becomes hands-on as each unit or department conducts a “day in the life” exercise to familiarize staff with equipment, procedures and the layout of their new workplace. Those exercises will be followed in February and March by two hospital-wide “dress rehearsals” for testing communication, operations, work processes and interdependent services throughout the buildings.

Plans for moving office furniture, equipment and supplies have already begun. Office moves begin in March, and the current clinical areas will be the last to go, cutting down on clinicians’ commutes between the new and historic buildings prior to the patient move.

Accounting for cost

Although ownership sets in motion expensive strategies for training, increased staffing and other start-up necessities, fixed costs won’t escalate significantly until April. “When the first patients receive treatment and you have your first productive use, we will need to recognize a much higher level of expenses associated with depreciation and interest,” says Ron Werthman, chief financial officer for the Johns Hopkins Health System. The resulting cost to the hospital will be approximately $10 million in the current fiscal year and grow to $60 million annually starting in FY 2013. Adding to the expense, it’s estimated that it will take $12 to $13 million annually to cover energy costs in the expanded facilities. 

Speaking for the legions across Hopkins who orchestrated the move, MacConnell says that all were driven by the monumental demands of opening day: “The moment they bring a chopper in and it’s carrying a very sick neonate, we have to have the heliport open, we have to have the emergency department open, we have to have some of the operating rooms open and the associated ICU open. It all starts to happen very quickly.”

—Stephanie Shapiro