There are similarities in the way healthcare is provided and administered and the way buildings and building services in the healthcare sector are often currently run. Mike Melina, managing director of Energy Solutions Associates, investigates.
Proactive healthcare and screening should be the priority of a good healthcare system, to Identify the symptoms early and hopefully avoid costly, long term reactive treatments.

This doesn't happen to the extent it should as we are told comprehensive screening 'costs too much'. This is often the approach to commissioning and maintenance in building operational régimes, not just in healthcare but in other sectors as well.

Both require more resources up front and pump-priming investment, but this is neglected and symptomatic of an attitude of short-termism. This hardly fulfils the ambition of achieving the necessary steps to moving to a more sustainable society.

In building services engineering we know a good planned preventative maintenance régime leads to fewer breakdowns in plant and services and extends the life of the equipment in the building. This is similar to a good preventative healthcare system. The anatomy and pathology of the human body and the structure and function of our buildings do share some similarities. Complex systems are often inter-related and subject to knock-on effects when things are thrown out of balance. Heating and cooling; pumps/the heart; pipe work/ arteries and veins; valves; air handing units/lungs; the brain/building management system and so on. In fact we could learn much by studying the natural world and how nature balances so many systems and relates it to the way we live and breathe.

Neglecting our bodies and buildings only stores up trouble for the future.

Education needed

Finance directors need to be educated to pay more attention and investment to planned preventative maintenance. This will pay dividends in the longer term by lessening the burden of a reactive and costly system to deal with breakdowns.
I subscribe to a theory known as the Gaia principle (named after the Greek primordial goddess of the earth). This was proposed by Dr James Lovelock and puts forward the hypothesis which describes the earth as a single organism.

The Gaia principle is an ecological hypothesis proposing that the biosphere and the physical components of the earth are closely integrated to form a complex interacting system that maintains the climatic and biogeochemical conditions on earth in a self-regulating balance. There are similarities with building services, in that our planet is very good at commissioning.

In fact, mother nature is one enormous piece of self-regulating kit. She is superb at balancing a number of natural processes, such as the water, carbon, oxygen and nitrogen cycles. Upsetting just one of these has a big impact on the environment.

This principle can be applied to buildings. Maintaining a good balance of the air and water services provides a better environment, one which is efficient, cost effective and will minimise the impact on the wider environment. This means building services have to be properly commissioned, then subjected to planned maintenance and periodic re-commissioning.

We use more than 40% of our use of the earth's raw materials in the processes of construction and occupancy of our buildings. Statistics like these are responsible for more interest in sustainable design and construction. People are making a concerted effort to learn how to create buildings utilising sustainable technology, renewable resources and systems designed to reduce energy consumption and carbon emissions. Many of these principles can be put forward in the design and construction of hospitals and other healthcare facilities.

As a building type, hospitals are relatively heavy users of materials, energy and water. This heavy usage drives up the operating costs of most hospitals and results in increased expenses for the lifetime of the building.

At the same time, research has also shown that a good quality environment aids the treatment and healing process. So a sustainable approach to healthcare buildings design, refurbishment and operation should be a priority. But, there still seems to be a lot of uncertainty about implementing this approach. It always seems to revolve around initial costs, the construction schedule and return on investment. Yet, with an educated and organised design and operational approach, implementing all these best practices and methods will become less costly and become more the rule than the exception.
An equal priority is to get the brains working correctly, ie the building energy management system (BEMS), then at least you can synchronise all systems to stop them competing with one other.

Poorly commissioned

Unfortunately, heating and cooling working against each other is something we see far too often. Poorly commissioned or inadequately maintained systems that have consequently drifted from their original set position are common. Occupants at one end of such buildings are too hot so are opening windows to let the heat out, while others are too cold and bring in electric heaters. This means the building operator is paying several times over for energy.

Most facilities managers do not know how to get to the root cause and end up fire fighting with a series of short-term solutions just to keep occupants happy. Unless they have a good grasp of the overall picture, they will not think to engage a contractor to re-commission the building services because they find it hard to see the difference adjusting dampers, valves and systems can make.

A basic examination of air and water systems will show in most cases they are catastrophically out of balance. This is relatively easy to correct if you call in the right people. Having your main services unbalanced means your heating system, for example, will operate only in patches and hot water will fail to reach all areas of the occupied zones, or, as in many healthcare facilities, the heating is operating more than necessary to compensate. Again if air services are out of kilter, ventilation fans will be overworking to redress the balance, and air conditioning systems will consume enormous amounts of electricity without delivering the controlled conditions expected.

Commissioning engineers can almost sense where the problems are simply by walking into an unbalanced building. They can feel the airflows are not as they should be, but putting that right takes technical expertise and patience. End users could also do with a little basic education. Why do people behave irrationally in the workplace when it comes to controlling temperature and ventilation?

Many commissioning firms find building managers and facilities managers are simply at a loss to understand why their highly specified heating and air-conditioning systems are not delivering the required comfort conditions. By applying their engineering skills and adjusting valves and dampers, commissioning engineers can relatively quickly put a building back on a balanced footing. As a result the building will be more energy efficient with the desired indoor climate conditions being achieved.

Importantly, the workforce will be happier and more productive and the patients who use the healthcare facilities will get well quicker.