Despite COVID-19 precautions remaining at the forefront of the conversation, life and needs for the building envelope goes on. Capital projects, day-to-day operations, and talent acquisition still create challenges for facility and campus operation. Focusing on the major institutional master plan and achieving a better-built environment for owners and occupants is key.

Navigating the constraints of what the pandemic has placed on supply chain bottlenecks, constant waves of COVID-19 infections that slow down revenue streams for hospitals from elective surgeries to focusing on patient care exclusively. Understanding these hurdles can help put into perspective a facility’s needs and push back critical infrastructure projects for years. Competition for capital dollars becomes more of a priority when the last two-and-half years have been a pivot to managing day-to-day operational challenges through keeping a hospital environment safe for patients and staff. The facility management industry must focus on a few hurdles in the coming years.

Technology is ever-changing and the evolution of the Internet of Things (IoT) in building automation systems is only getting more sophisticated and more expensive. In the health care sector, budgets are leaner and integration of newer technology for buildings is a push and pull scenario. FMs can sometimes find themselves in a break/fix cycle but finding the right systems to integrate with older building technology is a challenge. Managing equipment through technology is only as good as convincing the C-suite and FM leadership to improve the systems.

Merging data and minimizing technological debt can  make it work. For example, if in an 11-story hospital, and the pneumatic tubes no longer work, the organization cannot lose the ability to send laboratory items or pharmaceuticals from the 11th floor to the second floor. An FM can hire more staff members to fix the system while operating the hospital, but that cost directly affects patient care and the budget.

Digital system conversion can be expensive, for example, a 200-point data system on digital controls conversion for one hospital was US$50,000 just for the controls. Digital systems are moving more to the cloud. The price to convert to digital automation system controls or replace an HVAC unit can be a huge part of a budget and can be difficult to justify to leadership. The competition for capital dollars is fierce and FMs want to make the right decision for their stakeholders and patients. Weighing the cost benefits of fixing now or upgrading can reduce energy consumption and the hospital's carbon footprint but it is not always smart to be on the cutting edge of emerging technology without analysis, data models and cost analysis.

Cyber security has become a critical aspect of an FMs scope of responsibilities, especially over the last five years where ransomware attacks focus on hospitals and harvesting patient data. Referencing 2017’s global WannaCry ransom attack of Nation Health Services (NHS), which encrypted hospital data and demanded US$300 million in bitcoin to release the data.

Hospitals using older Microsoft operating system versions lacked the security patches which left systems vulnerable. Cyber hackers have adapted their tactics quicker and more efficiently. According to the latest figures, 295 cyberattacks are known to have been conducted in the health care sector between June 2, 2020, and Dec. 3, 2021. The attacks have been occurring at a rate of 3.8 per week and have occurred in 35 countries.

 

Building automated systems are moving to the cloud and making tasks such as data analysis, troubleshooting, monitoring HVAC and lighting schedules, start-up information easier. IoT building systems bring risks of vulnerabilities presented by VoIP telephones, sensors for HVAC systems, or office equipment, for example, creating backdoors into hospital networks. Spearheading an update of operating systems and keeping security patches up to date is a vital component but can come at a cost if networks and computers need to be updated as well. FM is not meant to be the IT department, but a partner and a conduit for cyber security solutions. FMs should analyze the security practices of their cyber security vendor and install best practices in line with the facility's IT security needs and patient data protection goals and hold cyber security vendors responsible for developing proper cyber hygiene to protect vulnerabilities. Strengthening cyber security will secure patient data, lives and protect health systems from paying unnecessary ransoms. 

 Staffing is the backbone of the health care industry, and the pandemic made staffing retention and acquiring quality talent challenging. Because the pandemic coincided with a time when older staff close to retirement left the workforce, there is a void of institutional knowledge. Organizations are challenged to find leadership and knowledgeable maintenance staff to fill those positions without loss of quality.

Some FM positions, such as maintenance and repair, experience low turnover because employees tend to be compensated well which leads to people aging in roles. However, when the highly skilled tenured employees retire, it can be difficult to find their replacement. Building security and environmental services tend to have more turnover because the positions are considered entry-level and wages are typically lower.

Preparing the next generation of FMs and trade workers has been pivotal in recognizing the need to create more industry-specific programs to prepare the next generation of professionals. However, health care FM has its own hurdles including on-the-job training and unique industry terminology. Understanding everyone's role from doctors to infection control to environmental services to FMs and where they fit in and complement each other makes for a stronger team.

Supply chain and budget issues are a critical hurdle for FMs throughout the pandemic and will continue long after the pandemic ends. The cost of materials has been rising to unprecedented levels across every industry. According to Dale Gai, research director of Counterpoint Research, chip developers  are paying 40 percent higher production fees for legacy chips that are in the shortest supply.

Bottlenecks in manufacturing, not enough workers to produce items and stretching the manufacturing sector to its max have caused a bullwhip effect. Rising costs have affected budgets and postponed projects that have been scoped and approved. Budget forecasting is becoming more complicated with rising material costs (sometimes up to 40 percent) and lead time (which has extended to months rather than weeks) for capital projects and critical infrastructure needs.

The pandemic’s disruption of impact of the supply chain created an unforeseen impact on the care of patients and investments in staff. An influx of patients caused shortages in staff from medical professionals to cleaning personnel. Sick leave, staff working overtime to cover for sick coworkers and hiring vendors to cover shortages also affected staffing budgets. However, FMs must continue planning improvements and investments because the shortage could turn into a surplus and material prices return to pre-pandemic levels.

Conclusion

FM has a tremendous responsibility to the owners, patients, and staff to ensure the environment is safe and exceeds standards for all occupants. All the while, they must also maintain their daily responsibilities of bridging old and new equipment, managing systems, navigating climate change, implementing the organizational masterplan and investing in capital needs .