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Smart Hospitals Toolkit SMART HOSPITALS TOOLKIT A practical guide for hospital administrators, health disaster coordinators, health facility designers, engineers and maintenance staff to achieve Smart Health Facilities by conserving resources, cutting costs, increasing efficiency in operations and reducing carbon emissions S A LU O T R E P O P A P H S O N I O D V I M U N This page is intentionally left blank SMART HOSPITALS TOOLKIT A practical guide for hospital administrators, health disaster coordinators, health facility designers, engineers and maintenance staff to achieve Smart Health Facilities by conserving resources, cutting costs, increasing efficiency in operations and reducing carbon emissions This page is intentionally left blank TABLE OF CONTENTS Acknowledgements . 1 Introduction . 3 Using this Toolkit . 5 Section I – The Hospital Safety Index . 9 Section II – Baseline Assessment Tool . 13 1 . Criteria for selecting a health care facility for green retrofitting . 14 2 . Patient/Administrator Occupant Satisfaction Survey . 14 3 . Baseline Information Requisition Checklist . 16 4 . Property Condition Evaluation . 26 Section III – The Green Checklist and Discussion Guide . 39 • Green Checklist . 40 • Discussion Guide – Renovations . 47 • Water . 47 • Energy and Atmosphere . 48 • Materials and Resources . 51 • Indoor Environmental Quality . 54 • Discussion Guide – Operations . 57 • Chemical Management . 57 • Solid Waste Management . 61 • Environmental Services . 66 • Food Services . 68 • Environmentally-Preferable Purchasing . 70 Section IV – Cost-Benefit Analysis Methodology (Coming Soon!) . 75 Section V – Bibliography . 77 Section VI – Training Aids (Coming Soon!) . 79 Annex 1 : Sustainable Construction: Designing for the Future . 81 iii ACKNOWLEDGEMENTS any individuals and organisations have contributed to the development of the Smart Hospi- tals Toolkit. This Toolkit forms part of the Smart Hospitals Initiative, funded by UKaid from the MDepartment for International Development (DFID). The Pan American Health Organization would like to thank all those who have contributed their time and expertise, in different ways, to the development of this Toolkit, including by hosting a work- shop, providing expert input and feedback on various drafts, approving funding or by sharing data from the demonstration component of the Smart Hospitals project, which provided the framework for the final version of the Toolkit. Specifically, we would like to acknowledge the following: Project coordinator: Dr. Dana van Alphen, PAHO/WHO. Principal authors: Ms. Marissa Da Breo, St. Vincent and the Grenadines; Mr. Ronnie Lettsome, British Virgin Islands. Contributors and reviewers: Mr. Tony Gibbs, (Barbados); Dr. Judith Harvey (Barbados); Dr. Mark Bynoe, (Belize); Ms. Simone Bannister and Mr. Roger Bellers, U.K. Department for International Development (DFID Caribbean); Ms. Sharleen DaBreo, (British Virgin Islands); Ms. Patricia Bittner, (USA). Peer review: Members of the Disaster Mitigation Advisory Group (DiMAG). Web design: Ms. Rosario Munoz, PAHO/WHO. 1 INTRODUCTION he Caribbean region is prone to a wide variety of natural hazards such as earthquakes, tropical storms and hurricanes. The impact of climate change, which causes rising sea levels and coastal Terosion and disrupts rainfall patterns and the supply of fresh water, is expected to further com- pound these threats. This reality poses a significant threat to health facilities in the Caribbean. When 38 hospitals in the English-speaking Caribbean were assessed, 82% fell into Category B (measures are required in the short term to reduce losses) and 18% fell into Category C (urgent measures are required to protect the life of patients and staff). Weaknesses in both functional and non-structural issues (e.g. risk of damage to roofs, water and gas supplies, etc.) tended to be the predominant cause of increased vulnerability. Forty percent of the assessed facilities took some measures to improve their safety score. At the same time, health care facilities are also leading consumers of energy, with a large environ- mental footprint. Energy prices in the Caribbean are among the highest in the world. This money could be put to better use to improve health services. A resilient health sector is vital to the functioning of society in the face of natural and manmade disasters. Health care facilities are ‘smart’ when they link their structural and operational safety with green interventions, at a reasonable cost-to-benefit ratio. A SMART (safe and green) health facility: a) Protects the lives of patients and health workers; b) Reduces damage to the hospital infrastructure and equipment as well as the surrounding envi- ronment; c) Continues to function as part of the health network, providing services under emergency con- ditions to those affected by a disaster; d) Uses scarce resources more efficiently, thereby generating cost savings; e) Improves their strategies to adjust to and cope better with future hazards and climate change. This Toolkit is comprised of previously developed instruments such as the Hospital Safety Index, which many countries are using to help ensure that new or existing health facilities are built or retro- fitted in such a way that they are resilient to the effects of natural and manmade hazards. The Green Checklist and other accompanying tools support the Safe Hospitals Initiative and will guide health officials and hospital administrators in achieving Smart health care facilities. Experience in the Caribbean has shown that even low and middle-income countries can improve the safety of their health facilities, provided that, at a minimum, there is political commitment and 3 multi-sector participation. Building upon this experience, this Toolkit will aid health care facilities to incorporate ‘climate-smart’ standards. Mitigation strategies are also recommended to integrate envi- ronmental performance and disaster resilience in health care facility planning. GREEN + SAFE = SMART To achieve ‘SMART’ (safe + green) hospitals, one has to make both buildings and operations more resilient, to mitigate their impact on the environment and to reduce pollution. There are several ‘win- win’ ways to accomplish this, which, in the process, also save costs, reduce greenhouse gas emissions, and achieve adaptation, risk reduction and development benefits. These include: Improving the structural safety of health care facilities; Reducing energy and water use; Boosting energy security with low carbon, renewable sources; Improving air quality and reducing harmful emissions; Strengthening disease surveillance and control; Equipping structures with efficient and environmentally friendly appliances and fixtures. Other measures, such as the use of eco-friendly flooring, paints, furniture and furnishings will fur- ther contribute to increased sustainability and risk reduction. Health facilities that ‘green’ their opera- tions by using less paper, recycling, generating less and properly disposing of waste (solid and other- wise) and pharmaceuticals, using environmentally-benign chemicals, and more locally and sustainably produced food will also improve ‘smartness.’ The ‘Smart’ Hospitals Initiative builds on the Guidelines for the Evaluation of Small and Medium- sized Health Facilities, the Caribbean version of the Hospital Safety Index, the centerpiece of PAHO/ WHO’s disaster risk reduction programme, which is now a global tool. SMART HOSPITALS TOOLKIT SMART HOSPITALS 4 USING THE SMART HOSPITALS TOOLKIT he Pan American Health Organization, under the DFID-funded SMART Hospitals Initiative, devel- oped this comprehensive Toolkit. It provides guidance on achieving a balance between safety and Tan environmentally-friendly setting in health care facilities in the Caribbean, thus contributing to the goal of climate-smart and disaster-resilient hospitals – a balance that is achieved by targeting in- terventions that lessens the vulnerability of health facilities to natural hazards and the potential effects of climate change, while reducing their carbon footprint as well. The Toolkit was designed for hospital administrators, health disaster coordinators, health facility designers, engineers and maintenance personnel associated with the overall management and opera- tions of health care facilities in the Caribbean. It incorporates climate-smart and safety standards for health facilities. Several strategic and guidance documents, previously developed by PAHO to reduce vulnerability in health care facilities, have been incorporated into the Toolkit, making it more compre- hensive in assessing both green and safe components. This Smart Hospitals Toolkit includes the follow- ing sections: SECTION ONE: The Hospital Safety Index The Hospital Safety Index is a tool that helps to determine the probability that a hospital or health facility will continue to function in emergency situa- Hospital Safety Index Guide tions, based on structural, non-structural and functional factors. By determin- for Evaluators ing a hospital’s safety score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. How- ever, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country’s investment in hospital safety. The Hospital Safety Index takes an in-depth look at health facilities and is best suited for hospitals with more than 200 beds.
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