Building a new hospital is a once-in-a-lifetime prospect, and moving there once the facility is ready is a massive logistical challenge that can require a year or more of meticulous planning. When the folks at McCune Brooks Regional Hospital (MBRH), Carthage, Mo, decided they had outgrown their 100-year-old hospital, they knew that any new medical center would have to accommodate a sea of integrated technology unlike anything builders could have imagined in the early 1900s.
Since no division knows technical requirements better than the clinical/biomedical engineering department, the management at McCune Brooks worked diligently with Wes Pool, CBET, a biomedical equipment technician for Philadelphia-based Aramark Healthcare CTS division, an independent service organization (ISO). When the job required a relocation coordinator, Pool was the natural choice. Pool had already worked at the site for 6 years and knew every nook and cranny of the century-old hospital. He knew the workflow demands of virtually every department, and what he did not know he was willing to learn.
Working hand in hand with architects and engineers, Pool met with them regularly to ensure that contractors could finish every area on time and to exacting specifications. After meeting the latest standards in power and lighting, builders installed a communication backbone that could easily handle central monitoring, wireless systems, and countless medical devices—all with the potential for expansion.
“I am the only clinical engineer here, so I would spend the workday performing my normal duties and the nights planning the move,” Pool says, who also serves as communications systems administrator and security systems coordinator. “Thinking of all the ‘what ifs’ and asking all the right questions was the difficult part. I had to determine what could go wrong and find a plan to deal with it. I mentally juggled the departments that depended on one another and fitted them into a time line for moving.”
Pool admits that the biggest headache was trying to organize diagnostic areas such as the laboratory and the radiology department. “If you shut them down, you can’t diagnose patients,” he says. “We had to make sure we had a backup plan and a way to take down a piece of machinery and move it to the new facility without any interruption of service.”
To ease the burden, and to christen the new facility with fresh machinery worthy of the high-tech digs, hospital administrators bit the bullet and purchased quite a bit of new equipment. With existing equipment serving its purpose at the old facility, manufacturers could take the time to install everything on a schedule suitable to the moving timetable. Once installation was complete, supplies and accessories could also be moved. MBRH administrators ultimately donated the old equipment or used it for trade-in purposes.
For sophisticated units that did not stay behind for donation, Bob Fitzpatrick, director of facility services with Aramark Healthcare Services at McCune Brooks, says that vendors were happy to come down, pack up the gear, and install it themselves.
“Another way to mitigate expenses was to get vendors to perform some of the relocation themselves, rather than us taking on everything,” Fitzpatrick says. “In most cases, the larger vendors of sensitive equipment—such as you might find in the laboratory—preferred to make the move themselves. It must be moved safely, and then it has to be recalibrated and tested adequately prior to use. One of the many responsibilities for Wes was to test the equipment yet again [after the vendors].”
|Pool performs preventive maintenance inspections in an ICU patient room.|
Communication: The Holy Grail
Weekly move meetings went on for about 4 months to ensure that all departments knew exactly what, when, and how the move was to progress. The meetings served as a way to identify strengths and weaknesses with the overall plan. “We held packing meetings to show people how to pack, which sounds silly but is really helpful,” Pool muses. “We shared little tips such as throwing rubber bands around pencils and putting them in a little bag. We asked employees to take all personal items home to alleviate any damage and to take some load off of the moving company.”
MBRH employees did a lot of the packing, but moving was another matter. For liability reasons, Pool says employees should never use their personal vehicles to transport hospital property. The policy also ensured that no materials accidentally got lost, a major concern when dealing with sensitive patient medical records found both on paper and as computer files. Meticulous plans were put in place with many security measures to ensure sensitive materials such as medical records and pharmaceuticals were relocated safely with no damage or loss. These plans were so tight that only a few people knew when these materials were to be transported. Pool reports that even the moving company had no idea what they were transporting. All they knew was that the materials were checked onto and off of the trucks, and they had an escort between the facilities.
Department heads knew well in advance what day, and even what hour, they should head 2 miles up the road to unpack their stuff at the gleaming new hospital, which bears the same name as the old hospital. Excellent communication ensured a smooth process.
When it came to hiring a reputable moving company, Pool did not “go cheap,” a decision he has never regretted. As a result, virtually no damage occurred during the move. “I recently spoke to the head of the moving company, and he liked that we had formed a partnership and I communicated with him all the time,” Pool emphasizes. “Any time I changed a plan, I would contact him for any feedback. I did this with all the contractors. This approach means nobody feels left out, and that will get you farther in the long run.”
The ability to communicate with so many people may admittedly not be a biomed’s strongest quality, but Fitzpatrick says that Pool ultimately grew into his role as communicator and quickly began to relish the task.
|The front entrance to the new facility|
“Biomed technicians work on machines and don’t necessarily work closely with a lot of people,” Fitzpatrick says. “For Wes to transition into working with almost every person at the hospital to coordinate this move was probably his biggest challenge. He may have hit some stumbling blocks in the beginning, but he quickly earned everyone’s trust and everyone justifiably praises the work that he did.”
It is not surprising that a 100-year-old hospital in Missouri would have deep roots in the community. Generations of families have learned the cross streets and passed the familiar signs. To avoid the specter of a wounded person rushing to a closed emergency department (ED), the public relations department flooded the community with information via television, newspaper, radio, and the Internet. When the hospital closed, the ED remained open for a while just in case anyone had managed to miss the news.
At 6 am sharp on the first day of the new hospital, city crews took coverings off of signs directing patients to the new hospital. The old signs were unearthed, unbolted, and recycled. “Existing patients received flyers with directions to the new facility,” Pool says. “On the final day, we covered up all the old signs on the hospital so you would notice that it was no longer a hospital. We didn’t want anyone to go without health care. There was no doubt that the place was closed.”
For 24×7 readers pondering a similar move, or those looking for expertise on building a high-tech building and/or addition, Fitzpatrick and Pool are willing to offer advice and even accept visitors. “We visited several facilities that had gone through similar moves, and I recommend that,” Fitzpatrick says. “And 24×7 readers are welcome to visit McCune Brooks. Learn from everybody, and use that knowledge to develop your plan. I don’t think you can start the planning process too early. Learn from us.”
The Final Push
For the week of the move, Pool formed a small command team made up of three people stationed at the new facility and two people at the old location. “They had the schedules, they knew what departments were supposed to move at what times, and they helped the moving company—any problems they would report to me,” Pool says. “For the most part, they did not need to call because they knew the plan so well. I got few phone calls with any issues. In fact, I would just call them because I had not heard anything. Thanks to the team effort, it was on time and ahead of schedule for much of the move.”
Perhaps the longest multi-hour stretch for Pool took place on the day and night they switched over the ED. Pool estimates he arrived at 6 am on Thursday and did not leave until 6 pm—on Friday. The hospital did not force him to put in the marathon shift, but Pool simply could not rest until every detail had been covered.
At a Glance
- Place: McCune Brooks Regional Hospital
- Location: Carthage, Mo
- Old building: 85,000 square feet
- New building: 145,000 square feet
- Construction time: 18 months
- Beds: 25 with a 10-bed geriatric unit
- Planning time for the move: 16 months
- Longest workday for Wes Pool: 36 hours
- Only forgotten items: New replacement Bibles
- Visionary: Bob Copeland, CEO of McCune Brooks
- Time from idea to opening: 5 years
- Hospital: Critical access
- Fate of the old hospital: Still vacant
“I got a 2-hour nap on a cot at an empty wing in the old hospital,” Pool says. “As captain of the move, I was not going to leave until it was done. My wife said go ahead, she understood.”
If you don’t account for the year of planning and the vendor equipment set-ups, the actual physical move took just 5 days. To help everyone hit the ground running, employees stocked their own departments and as a result immediately knew where everything was. To help clinicians who relied on heavy interaction with other departments, Pool organized scavenger hunts inside the new facility, an activity that cemented the building’s geography in the minds of all participants. Mock runs for code blues and disaster drills rounded out the final bits of training.
While MBRH is a relatively small hospital, Pool believes the moving methods he used would work well for a large facility. “We have one of everything, and a bigger facility may have two or three of everything, so that redundancy makes it even easier for moving,” Pool says. “It’s like having a set of clothes at your new house. You can transition even easier. Being a small facility may have even hindered us because we had to make sure we had things both here and there.”
A little over 1 year after the massive effort, Pool still keeps his 10 legal pads full of handwritten notes filled with suggestions from hundreds of people. He also has the computer files generated from a software program called Microsoft Project, a planning program that worked wonders for resource tracking.
And speaking of resources, the most valuable entities in any health care facility—patients—well, they also had to be moved. It’s a question that Pool receives more than any other: How in the world did you move the human beings? The prospect is daunting, but it was really one of the easiest tasks. After all, hospitals transfer patients every day, and most patients had no problem taking one more ride to a brand-new room just 2 miles away.
“We made a time line, and the ambulance crew did what they normally did,” Pool says. “The only thing we had to do was staff two additional ambulances that day, and their only job was to transfer patients. We had an overlap in our ER openings. Once the last person left the ER, we closed the doors. Just to be sure, we posted employees to let any people coming in know about the new hospital, and let them know we could take them there.”
Once the departments settled in and adapted to the work space, things quickly got back to normal. However, if hospitals wish to open new departments at a brand-new facility, Pool says it is best to wait a while and keep everything business as usual, at least at first. At MBRH, a new maternity ward started up 8 months after the official opening, and soon the distinctive cry of a newborn was echoing down the halls. “We completely outfitted a new birthing center,” Fitzpatrick says. “McCune did not have a department for babies for 25 years, so that was definitely a big deal when the first birth happened at the new facility. It was cool.”
Read past department profiles in the archives.
A year and a half after the big move, Wes Pool is still in charge of 1,200 pieces of medical equipment at MBRH, with some repair duties going to OEMs and ISOs as needed.
If he had it all to do over again, there is just one thing Pool would do differently. Despite organizational software, 12-hour days, and endless communication prior to the official opening in early 2008, he neglected just one thing. “I forgot to call the Gideons and get new Bibles,” Pool says. “We did a final walk-through, and somebody opened a drawer and said, ‘Hey, where are the new Bibles?’ I don’t know why I did not think of this. I guess I just thought we would move the old ones. Luckily, our CEO had already taken care of this for me.”
Greg Thompson is a contributing writer for 24×7. For more information, contact.
|View of the front entrance from the valet parking/load/unload area|
With the exceedingly rare opportunity to build a state-of-the-art facility from scratch, Wes Pool, CBET, clinical engineering technician at McCune Brooks Regional Hospital (MBRH), Carthage, Mo, and an employee of Philadelphia-based Aramark Healthcare CTS division, wanted to be sure that all departments had a chance to share their wish lists. For employees who wanted more outlets, better lighting, new imaging systems, and perhaps just more space, Pool and Bob Fitzpatrick, director of facility services at MBRH and also an employee of Aramark Healthcare Services, were conduits to architects and engineers during months of planning.
Ultimately, the community and the employees got what they wanted. Along with larger and better operating rooms, clinicians enjoy wireless communications, excellent IT infrastructure, and an integrated nurse call system. “We built the IT backbone that we needed,” Pool says. “We now have an all-digital x-ray department and a new in-house MRI, instead of the portable one we used before.”