How to equip a new hospital from the ground up

Building a hospital is no easy task. Ensuring the facility is fully equipped to diagnose and treat patients adds many layers of complexity.

This was the challenge facing Maria Vuono and her colleagues at Niagara Health System (NHS) as it embarked on a multimillion-dollar development through Infrastructure Ontario (IO) of a new million-square-foot health care complex and cancer care facility in St. Catharines, Ont.

The new facility replaces the NHS’ aging St. Catharines General and Ontario Street sites, serving residents of St. Catharines, Thorold, Niagara-on-the-Lake and surrounding areas with acute care services. In addition, the new health complex will accommodate regional programs that have never been available in Niagara, including comprehensive cancer care at the Walker Family Cancer Centre, cardiac catheterization services at the Heart Investigation Unit and longer-term mental health beds at a new regional mental health centre.

“There are few things that are more difficult to build than a hospital,” notes Vuono, who served as the hospital’s project lead on the procurement of equipment for the new facility. “For us, it involved hundreds of hours of engagement and planning with participants across all 38 hospital departments along with several external partners, to ensure we have not only a well-designed and built facility, but also the best equipment to meet patients’ needs.”

Within the new facility, NHS has made a substantial investment in equipment for all areas – from critical care, operating rooms and emergency to cancer care, OB and endo/cysto.

In the diagnostic imaging (DI) department alone, NHS bought 36 new pieces of equipment. This includes angiography, bone densitometry, c-arm, CT scanner, digital echocardiography, digital mammography, digital radiography, SPECT/CT, ultrasound and urological imaging system to name a few.

“As a first step, before we bought any equipment, we needed to look at all of our options and bring the right people to the table,” says Bonnie Sipos, Niagara Health’s Regional Director of Diagnostic Imaging. “We also needed a great plan to keep our multi-disciplinary team on track.”

Before purchasing its new DI equipment, NHS had to determine its needs, run a competitive bid process and evaluate supplier bids. This process alone involved 16 different clinical evaluation teams, including specialists such as physicians, medical radiation technologists, nursing and others as needed. A series of supplier site visits also had to be scheduled, so the teams could evaluate the equipment and conduct clinical evaluations – a crucial step in the purchasing process to ensure the facility has the best equipment to care for patients.

To help oversee and guide it through this process, NHS turned to CAPsource, a Brantford-based program offered by St. Joseph’s Health System, Group Purchasing Organization and Medbuy, focused on capital equipment purchasing.

The program came into being 20 years ago when SJHS’ own sites, St. Joseph’s Healthcare Hamilton and St. Mary’s General Hospital Kitchener, each needed to buy a CT scanner. CAPsource has since grown into a national, not-for-profit service that facilitates large group buys of equipment for multiple hospital sites across Canada. It has been called upon by governments and hospitals looking to manage the costs of large equipment acquisitions. In the case of NHS, they were joined by eight other hospitals also in need of DI equipment.

“Rather than adding complexity, by combining this substantial volume through one process, additional efficiencies and cost savings were achieved, which wouldn’t have been realized if a single hospital had completed the process alone or started from scratch,” says Jay Ayres, Director of St. Joseph’s Health System, GPO. “Most people don’t think about how a piece of equipment arrives at the hospital, but a lot goes into the process from beginning to end.  It’s truly a multi-step, collaborative effort before it is installed.”

Niagara Health’s recent experience is a great example of the success achieved by working together notes Ayres. “Every project and piece of equipment is unique and complex in its own way, but by using an established, well-known process, we can meet a wide range of needs. The goal is always to give all the information needed to make the buying process easier and allow hospitals to make the best purchase decision for themselves. This is true even in cases where hospitals are operating under special or complex circumstances such as large capital builds that come with strictly enforced timelines.”

The process is also designed to protect hospitals. Complex purchases require significant lead time to plan and execute. There is the concern that the technology purchased may be outdated before the equipment arrives at the hospital.

So when it came time to negotiate for NHS’ DI equipment with selected vendors, special care had to be given to ensure the new hospital receives the latest technology, with an appropriate warranty, since the equipment may be installed in the new facility for several months before first clinical use.

Sipos says that Niagara Health was in a position where these concerns were addressed and the organization could issue purchase orders for new DI equipment right away. “Most importantly, we achieved results that will benefit our patients,” she says. “We’ll be able to offer new health services in our region, we’ll have advanced technology at our disposal and we’ll have equipment that’s designed with the care and comfort of the patient in mind.”

Development of the state-of-the-art facility is on schedule, on budget and on scope for completion by November 26, 2012. Following a few months for training and orientation, the new health complex will open its doors to provide patient care in the spring of 2013.