Yale New Haven Health earns ASHE award for excellence in health care facility management

Like many major hospital networks, Yale New Haven Health System (YNHHS) — Connecticut’s largest health care system that includes seven hospitals — had a facilities management efficiency problem. So, over the past several years, it worked to better manage its built environment by thoroughly streamlining its systemwide processes, enhancing its software ecosystem and standardizing data.

This endeavor resulted in a dramatic digital transformation of YNHHS’ facilities and delivery networks. By clarifying and aligning processes across departments, implementing an integrated suite of software packages, digitizing workflows to better track projects and organizing all information around recognized health care data standards, YNHHS has significantly improved efficiencies, increased staff satisfaction and upgraded data reliability.

These and other efforts helped YNHHS win the American Society for Health Care Engineering’s 2020 Excellence in Health Care Facility Management Award, which recognizes individuals or facility management departments that implement new or innovative programs or processes to optimize the physical environment and improve patient care.

Timeline of Progress

In a hospital system as large as YNHHS, where five separate delivery networks each have their own applications and procedures, productivity and workflows can get bogged down. 

YNHHS leadership acknowledged this problem and made a strategic choice to invest in digitally upgrading its facilities and real estate department and put an end to this outdated siloed network situation. The initiative was underway by 2016, but it would take over three years to complete.

“Years ago, we were tracking projects across the system in a very old-fashioned way, using individual Microsoft Excel budget spreadsheets and Microsoft project schedule sheets,” says Stephen Carbery, BE, MBA, vice president of corporate facilities for YNHHS. “We quickly realized that the world of facilities management was linked through big data in a way we had not thought of.”

Carbery and crew took a closer look at periodic inspection, testing and maintenance (ITM) and how these linked to projects and spatial constraints. “It became apparent we needed to do our ITM program first to set the stage for the other two legs of the stool,” he says. “Once that was identified as a priority, we knew we wanted to not only make the program useful and easy to use for our facilities engineering team but also easy to use for our staff.” 

The project’s initial focus was to consolidate five segmented computerized maintenance management systems (CMMS) into one cohesive platform. Workgroups represented by facilities engineering staff from each delivery network were formed to represent the larger team in the planning and implementation efforts. Much of 2017 was spent carefully selecting vendors, redesigning disparate workflows to align with industry best practices, and mapping and standardizing data before migration and going live.

“Alongside facilities engineering, our facilities design and construction team worked on systematizing processes across delivery networks into well-defined reliable workflows needed to successfully navigate through the life cycle of a project,” says Ann Monks, MSHA, CHC, who was brought over from YNHHS’ information technology system (ITS) department to serve on this project as facilities project manager for the facilities design and construction department. “During this time, building information modeling (BIM) and space standards were also being developed to ensure that BIM models created by our third-party architects could easily be ingested back into the hospital’s master models.”

By March 2018, e-Builder was picked as the project management information system that would be integrated with Infor, the existing enterprise resource planning system. This strategy divided the project into two phases: one consisting of non-cost-related processes and the other focused on full cost module and integration. Phase 1 was completed while the team concurrently worked with its ITS and finance partners on the integration build and data mapping.

Fast-forward to November 2018, when e-Builder Phase 1, the new systemwide CMMS, and the new client request portal (named FaciliNet) officially went live, allowing employees across the entire health system to request facilities services from a single location for the first time. By summer 2019, the e-Builder Phase 2 rollout was underway, and the project team as well as third-party architects, engineers and contractors could fully manage the capital construction portfolio in e-Builder. It wasn’t long before the data analytics platform was turned on, enabling the team to start reporting on the key performance indicators identified three years earlier.

Reaching Crucial Goals

“From the start, we set important objectives,” Carbery says. “First, we wanted to do the right thing — not the easy thing. We thought we would use the ITM standards from our academic medical center, but we soon found out that the measures used there were outdated, so we threw it all out and started from scratch.” 

The team also aimed for a single source of reliable data to ensure that finance department numbers matched up with what was budgeted. “With a solid partnership between finance and ITS, we were able to build links between our enterprisewide finance systems and project tracking system,” he says. 

What’s more, they wanted their systems to over-deliver on value to the organization. “There needed to be a return on investment, whether that was freeing up latent capital or man-hours or providing tools the organization never knew it needed,” Carbery says. “I think we’ve hit the mark on all of these goals.”

The group also consistently followed a proven plan: Have a clear data strategy from the start. “We decided from the beginning to align our data sets with industry standards so that all our data improvement efforts would lead to more consistency across the health system,” says Matthias Ebinger, MS, PMP, CHFM, LEED AP, senior director of digital solutions for Enstoa, the New York City-based technology consultants recruited by the team. “We established classifications for assets and spaces that were then applied when existing data was migrated or when new data was collected. That way, all data that flowed into the new system was consistent.”

Originally, the team set out to accomplish all its objectives over three years. However, a few unchecked boxes remain, including 3D-scanning of the complete portfolio of YNHHS’ main hospitals. “COVID has pushed us out a year later from our schedule, delaying the completion of this scanning effort, but we are comfortable taking the time to do it right,” Carbery says.

A new portal 

Perhaps the most anticipated component of the digital transformation project is the new FaciliNet client request portal, which Monks describes as a “one-stop shop for all facility services, similar to what someone would experience when visiting Amazon.”

FaciliNet provides an entry point to request space, maintenance work, locksmith services, and minor and major construction projects. It also helps clarify the processes needed to ensure that requests are handled in a timely and consistent manner and that requesters will be kept updated as the status of their request changes.

While outsiders may regard FaciliNet as a software and data solution — it is, after all, an integrated suite of software packages — internally it’s valued even higher for its human attributes. 

“First and foremost, FaciliNet allows us to clarify processes throughout the department as well as our interactions with partnering departments. This ensures that all team members understand their roles in the team and appreciate the work performed upstream and downstream in the asset life cycle,” Monks says. “Alignment with clinical partners is now clarified, for example, during project design and operationalization, and there are improved communications between clinical personnel and facilities in the department’s management of customer work requests.”

John M. Potkaj, facilities project coordinator in the facilities design and construction department, says the ongoing COVID-19 pandemic put FaciliNet to the test, “especially when it came to aligning project cash flows with the finance department’s projections,” but it passed with flying colors.

“Without FaciliNet and the software packages, we could not have given accurate data to steer the organization in the right direction during COVID-19 as well as handle any future challenges,” Potkaj says.

FaciliNet also provided clarity on existing conditions and enabled the facilities team to map out scenarios for responding to the quickly changing coronavirus crisis. For instance, it helped guide the team on how to best amend the ongoing construction program and document changes to the patient care environment while carefully monitoring material and labor expended to respond to the crisis.

Reaping the benefits

Workers across the Yale New Haven Health System have benefited significantly from these efforts. “The feedback we’ve gotten from the users of our FaciliNet system, for instance, has been nothing short of spectacular,” Carbery says.

Additionally, digitizing workflows has made work easier for facilities engineering team members and other hospital staff, according to Nicholas Zauner, executive director of facilities engineering for YNHHS. “Now, all customer work requests and ITM work orders can be assigned as soon as they are generated,” Zauner says. “This process is much more efficient than previously, resulting in quicker completion times and increased staff satisfaction. It’s great that anyone who creates a work order request is now provided with real-time updates that are automatically generated as the status of the work order advances to completion.”

More reliable data is another dividend gained. “Prior to this project, we estimate that we were only able to capture the data on approximately 30% of the work completed by our team members,” Zauner says. “Now, based on current information available in our database, 87.5% of the average eight-hour work shift is being charged to a work order. This increase in data reliability allows us to confidently strategize, schedule and forecast as well as identify opportunities for improvement.”

Rewarding achievement

Shay Rankhorn Jr., SASHE, CHFM, CHC, co-chair of the task force that chose the 2020 Excellence in Health Care Facility Management Award, says YNHHS stood out among a worthy field of entrants for its efforts in bringing facilities management into the 21st century with real-time data analytics and connectivity.

“Their project embodied the essence of this award. They set a standard of excellence for the rest of the field to follow,” Rankhorn says. “Their focus was not just on the betterment of their own facilities management department but the betterment of the other departments and patient experiences in their facilities. And it’s impressive that they were willing to collaborate outside their system for the benefit of all health care facilities management.”

Task force co-chair Gary Hamilton PE, LEED AP, seconds those sentiments. “This project allowed once-siloed systems to be integrated into one platform, which will help with process alignment, software ecosystem tools improvement and data standardization,” Hamilton says. “It exemplifies an out-of-the-box approach to driving operational efficiency and goes beyond solving a single hospital problem to solving a national health system problem.” 

To be recognized as “best in class” is extremely gratifying and the “cherry on top” of all this hard work, Carbery believes. “A lot of people devoted a lot of time to this project — countless hours of meetings, all while doing their regular day jobs. We are very proud of what we have accomplished and are happy to share our lessons learned with our colleagues,” he says.

Steps for digital transformation of health facilities management

Members of the Yale New Haven Health System digital transformation initiative team say they hope their project’s achievements will motivate and encourage other hospitals and health systems to implement similar needed improvements. But they caution that such an ambitious endeavor requires careful preparation, including the following recommended steps:

• Create a well-versed team. “Early on, we established a steering committee that consisted of executive representation from several departments. These folks met monthly to review progress and provide direction and alignment on open decisions and risks,” says Ann Monks, facilities project manager. “Resources from each of these departments were then assigned to form the project team that met on a more regular basis. This team was accountable for design and implementation and given the authority to make important decisions needed to keep the project on budget and schedule.”
• Integrate systems carefully. “Facilities management worked very closely with our finance and information technology system departments to align funding, budgets, commitments and actuals across our software platforms, identifying the source of truth for each component,” Monks says.
• Build a discrepancy report. A discrepancy report built within the analytics platform should contain the cost data from each system and quickly highlight when information in any system is not consistent. “We monitor this report daily to quickly correct any discrepancies and keep our reporting as accurate as possible,” Monks says.
• Follow the data strategy needs. Let the data strategy needs drive how asset and space information is generated. The strategy for facilities data should be generated by the teams that eventually have to use the data as well as the space management team. “Once these teams have their standards finalized, they should be shared with the capital construction teams to ensure that each project generates a consistent set of information to update existing building master information records,” says Matthias Ebinger, senior director of digital solutions for Enstoa, New York City.
• Aim for continuous improvement. If a process is not operating as designed, evaluate what is and isn’t working and make changes as needed.

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This article was originally published in the February 2021 edition of ASHE's HFM Magazine.