This promises better efficiency and better health outcomes but is also promises increased risk. From Aurecon’s 30 years plus of designing and managing hospital developments we have built a rich database of lessons learnt in building and operational commissioning. It is obvious from this that with increased technology complexity and integration, the risks associated with commissioning hospitals are increasing.
Commissioning is the turning point of a project into a health service. It is where it starts to become real. It is where the ultimate users begin to take the hospital into their own hands.
Failure in commissioning can have a significant impact on the users, including patients, clinicians, nursing staff and hospital engineers. Patient safety is always paramount and there is the real potential for a poorly commissioned hospital to put patient safety at risk.
In the context of the unsustainable rise in the cost of healthcare, we have the responsibility to optimise the tuning our hospitals. While building and operating hospital infrastructure typically contributes less than 10% of whole of life costs, a poorly commissioned hospital can have a negative impact on staff productivity, where the majority of the cost of healthcare lies.
“Even if a project is in all other aspects hugely successful, if commissioning goes awry, the long term repercussions can be significant and it can be seen to be a failure. The industry needs to learn from experience. The risks associated with commissioning need to be acknowledged and managed. In this paper we focus on just one aspect of managing this risk – integrated commissioning – and share what can and should be done right now. We believe that the complexity of technology and integration between health services, buildings and technology is only going to increase. So what’s next? What could commissioning look like in the future?” says Susie Pearn, Aurecon Global Expertise Leader, Health.
The terms commissioning, total building commissioning and integrated systems testing (IST) are widely used and commonly misunderstood. The importance and benefits that these processes bring to the seamless handover of a healthcare facility are frequently undervalued and often given a lesser priority in the rush to meet the project practical completion deadlines.
IST is one subset of these processes, and when done comprehensively can heavily de-risk the completion process by addressing the potential disconnection between designers and trade contractors who may design, test and commission their respective systems in silos, resulting in the overall facility operation and operation in normal failure modes not being thoroughly proven.
A robust IST process provides a holistic approach and methodology via a regimented series of testing that addresses a predefined series of operational and failure scenarios. Through this process the correct operation of all systems can be demonstrated individually and collectively to provide a predicable operational outcome.
Whilst IST is a widely acceptable deliverable concept at the practical completion stage of a healthcare project, what constitutes a pass or a fail criteria is rarely comprehensively defined. It is also common for project professionals that provide final assurances as to the completeness of IST (and commissioning) to rely upon third party statements attesting that the installation is actually complete.
Since the operation and interfaces are not physically tangible assets that can be sighted and accounted for readily, there is a risk that a financier, quantity surveyor or project manager may provide premature acceptance of the completed installation.
Carrying out IST in an unstructured, ad-hoc manner manifests in the facility experiencing unplanned downtime, resulting in reputational, program, material and financial loss or worst still, adverse impacts on occupant and patient safety and wellbeing from incorrect operation of life safety, electrical, electro-medical, security and infection control systems.