Ascension Health, based in St. Louis, was founded in 1999 when three major Catholic health organizations merged. Over the years, the system has added more health systems – or "ministries" – to include 34 today. Ascension Health includes 81 hospitals and just over 55 million square feet of space (35 million of which is acute care facilities) from coast to coast in its network.
McCoole joined Ascension in April 2006, to run the newly formed Facilities Resource Group. "Leadership wanted to form a group that focused on capital projects nationwide," he says. Design and construction was the main charge to start, but "we've pushed the fences out as needs have arisen," says McCoole. "As we see areas where we can bring value, we point them out and present to leadership. When we see repetitive struggles in the ministries, we look at how we can solve those struggles for the whole system."
The FIP and the organization's environmental goals are two of the ideas that arose as a way for the Facilities Resource Group to add value to the organization at large. Ascension Health operates under what it calls a "distributed leadership" model – meaning each ministry operates semi-independently. The Facilities Resource Group is the central facilities organization – it is a repository for facility data (i.e. energy), and it maintains standards, best practices, and lists of preferred vendors, architects, engineers, and consultants.
"The original charter for our own group was overseeing major design and construction projects," says Dan Scher, a director with the Facilities Resource Group. "But the Facilities Infrastructure Pool came into existence when we'd visit sites, and the facility managers would say ‘Hey, can you help us out with this chiller?'"
In the first year of the FIP, because of a backlog of projects, priority was given to equipment that, if not addressed, was at risk of failing or meant a risk to the level of patient care. Those were the two most important criteria. As an example, at two hospitals, emergency generators did not pass routine required tests of the systems. Those were funded.
"In addition, both of these hospitals had aging electrical distribution switchgear," says Gerry Kaiser, a director with the Facilities Resource Group. "Our procedure in FIP is to examine overall systems – not just replace pieces of equipment like for like." So more than just the emergency generators were replaced – the projects became multi-year phased projects to upgrade the obsolete switchgear and provide a code-compliant system with high reliability.
McCoole offers another example: A ministry will ask for a new piece of equipment – say, a pump because they're not getting the proper level of cooling in their operating rooms. "We'll go and visit and find out if it's the pump they thought it was, or if it's a bigger issue. So we help them refine the projects," he says.
Part of the Facilities Resource Group's charge is to provide expertise and engineering (from a list of preferred vendors), as well as to help individual ministries by leveraging the buying power of the organization as a whole.
"The Facilities Resource Group helps us understand if a project fits within their guidelines," says Jim Wild, administrator of engineering, maintenance and biomedical services for St. John Providence Health System, one of Ascension's ministries. "They help us figure out what's feasible and if the cost we've estimated is appropriate."
Each year, each ministry nominates at least three projects – though they can suggest as many as they want, says McCoole, which is why the FIP list usually extends into the hundreds. FIP is now in its third year of being funded, and McCoole says most of the projects involving the biggest threats of equipment failure or risks to patient care have been completed. That means another criterion also has become more important for prioritizing FIP projects: energy efficiency. "In the first year, we were thrilled if the projects also had an energy efficiency component, but it wasn't the main criterion," says McCoole. "As we've addressed projects that fit our risk-to-operations and possibility-of-failure criteria, and there were a number that had built up, now we are considering energy efficiency."
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