Is my healthcare property healthy

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Is my healthcare property healthy?
Zurich 2007 Risk Engineering Conference
Michael Widdekind, Beth Moreland, Steve Wing Risk
Engineering Conference Orlando, Florida
September 20, 2007
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Risk Engineering

• Health, Safety and Environmental

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HSE industry practice leader role (IPL)

• Oversees the Zurich HSE healthcare customer
  programs
• Coordinates the HSE healthcare customer seminars
• Develops healthcare resources and reference
  materials
• Assists the Zurich HSE healthcare team
• Insures the HSE healthcare activity responds to
  Zurich philosophy and initiatives

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HSE healthcare team

• 12 Zurich Risk Engineering healthcare
  professionals
• Geographically dispersed throughout the U.S.
• Expertise in hospitals, long term care and home
  health

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HSE healthcare services

• Risk analysis
• Resource and reference materials
• Benchmarking tools
• Ergonomic evaluations
• Industrial hygiene services (noise and air
  exposures)
• Return to work assistance-eZTransition
• JCAHO and CARF guidance
• Healthcare seminars
• Fleet safety program assistance
• Zurich Hazard Analysis (ZHA)

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Top casualty loss leaders

• Workers compensation
• Strains, particularly related to patient care
• Falls
• General Liability
• Patient losses related to falls and care issues
  (handled by Specialties)
• Visitor falls
• vehicular/fleet losses are usually low in
  frequency severity

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Patient care activities causing strains

• Repositioning
• Lifting objects
• Lifting patients
• Transfers
• Transporting patients
• Pushing/pulling objects
• Aggressive patients

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Strain prevention program key components

• Patient handling equipment/devices
• Safe lift policies
• Patient lift teams
• Hands on training
• Patient assessments
• Supervisory employee accountability

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Employee visitor fall risk factors

• Surface composition
• Foreign substances
• Level changes
• Obstructions
• Visibility
• Stairs
• Human factors
• Code and other emergency activity

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Common fall prevention activities

• Design surfaces for expected traffic and
  conditions
• Address cleaning and waxing issues
• Include floor surface review as part of
  environmental rounds
• Stress strong maintenance and housekeeping
  procedures
• Locate spill stations wet floor signage
  strategically
• Limit surface changes highlight level changes
• Limit obstructions, hall storage and excess
  supply storage
• Assure adequate lighting and color/pattern
  contrast
• Maintain slip resistant edging, railings and
  surfacing
• Design areas to accommodate rapid movement

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Risk Engineering

• Property and Boiler Machinery

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Bringing value to our HC customers

• Exposure specific information/guidance
• Provide detailed appraisal of CAT and non-CAT
  exposures
• Fits with hazard vulnerability analysis that
  JCAHO accredited facilities must complete
• Can expand to a Zurich Hazard Analysis

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Bringing value to our HC customers

• Coordination of risk engineering services
• Multi faceted long range property loss control
  program, Life safety - infection control - new
  construction CAT analysis - plan review HSE
  fleet safety

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Bringing value to our HC customers

• Stewardship reports
• Progress report on RE issues which provides a
  discussion between Zurich and the broker/customer
  
• Provide benchmarking information that our
  customers have told us is important information
  to them
• Track effectiveness of the RE programs that have
  been put in place

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Survey procedures and report notes

• CARF - Commission on Accreditation of
  Rehabilitation Facilities
• Hospitals that have an accreditation with CARF
  are required to have an insurance company
  inspection and a fire marshal inspection at least
  once every year.
• During our facility assessment, we meet with the
  rehabilitation director and tour the rehab areas
• A separate paragraph in the Activities and
  Observations section of our report is added
  stating that we met with the rehab director,
  toured the rehab areas and comment on any
  specific recommendations or maintenance type
  items

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Regulatory update notes

• The Joint Commission
• The Joint Commission's Board of Commissioners
  approved a proposal to conduct all regular
  accreditation surveys on an unannounced basis
  beginning January 2006
• Rationale of unannounced surveys is so the
  facility is focused on the next patient and their
  operational systems, not the next survey
• Hospitals with more than 200 beds receive a Life
  Safety Code Specialist the first day. This person
  has experience as a facility director, safety
  officer or fire marshal
• Laboratories still will receive a separate
  survey within six months prior to the
  laboratorys accreditation due date

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Regulatory update notes

• The Joint Commission
• Beginning January 1, 2008, all hospitals will
  receive a Life Safety Code Specialist the first
  day
• For hospitals with more than 750,000 sq. ft., the
  LSCS will conduct a two day survey

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Regulatory update notes

• LSC Specialist
• The LSC Specialist has the following
  responsibilities and scope within the survey
  team
• EC.5.20, compliance with the LSC
• EC.5.40, maintenance of fire safety equipment and
  building features
• EC.5.50, development and implementation of
  interim life safety measures (ILSM)
• EC.7.40, maintenance of emergency power systems
• EC.7.50, maintenance of medical gas and vacuum
  systems

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Regulatory update notes

• The Joint Commission
• As of July 2007, Statement of Conditions (eSOC)
  documentation will be required to be filed on The
  Joint Commissions Web site
• Programs are needed to interface (upload)
  existing computer software data to The Joint
  Commission site

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Regulatory update notes

• The Joint Commission
• Beginning January 1, 2006, JCAHO will be
  implementing an enhanced
• survey process to evaluate emergency preparedness
  in hospitals
• Review the organizations hazard vulnerability
  analysis (HVA)
• Emergency Management Plan
• Results of Emergency Management Exercises

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Regulatory update notes

• The Joint Commission
• Revisions to EC 4.10 and 4.20 relating to
  emergency management preparedness in hospitals
  take effect January 1, 2008
• All hazards approach to emergency preparedness
• Scaleable approach to help manage the variety,
  intensity, and duration of disasters
• Stress the importance of planning and testing
  without the support of the local community

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Regulatory update notes

• NFPA 99 Health Care Facilities 2010 Edition
• Revisions to Chapter 12, Emergency Management
  and Security
• Closely follow NFPA 1600 and AIA Guidelines
• Incorporate most of The Joint Commissions new
  Emergency Preparedness requirements
• Requirements for emergency connections for
  portable generators, chillers, and boilers.
• Storage capacity for four continuous days of
  operation

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Regulatory update notes

• OSHA
• Hospital laboratories have been notified that
  they need a noise survey and employee dosimeters,
  pursuant to OSHA instruction CPL 2-2.20B, for up
  to five individuals for an eight hour weighted
  average study. Reference is 29 CFR 1910.95
• Laboratories have also requested a noise map of
  equipment located within the laboratory
• Our HSE staff can assist with hospitals needing
  this service

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Regulatory update notes

• AIA - American Institute of Architects
• 2006 edition of the Guidelines for Design and
  Construction of Healthcare Facilities - previous
  edition was 2001
• NFPA 13, 2002 edition
• NFPA 99, 2005 edition
• NFPA 101, 2003 edition

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Loss trends

• Water and liquid damage

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Collaboration with risk engineers working with
the construction division

• Large construction projects
• Over the last four years hospitals have been
  significantly expanding their operations in the
  form of major renovations, large ED expansions,
  patient tower additions and completely new
  hospitals (abandoning the existing)
• Our risk engineers working with the construction
  unit can be involved in the initial plan review
  of civil site and structural drawings,
  specifications and geotechnical reports
• Zurich RE should be involved in the design phase
  of major projects
• Some HPR features are Value Engineering (VE) out
  of the project between 80 percent and the 100
  percent bid package

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Collaboration with risk engineers working with
the construction division

• Large construction projects (cont.)
• On large projects, a risk engineering
  specializing in the construction industry should
  assist with builders risk assessments on a six
  month interval
• Our wind team members are also be involved in the
  plan review process for Zone 1 and Zone 2 areas
• Our boiler and machinery REs are involved to
  review plant operation expansions

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Improving our HC servicing to our internal and
external customers

• Risk engineering scores
• Exposure specific information/guidance
• Coordination of risk engineering services
• Stewardship reports

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Improving our HC servicing to our internal and
external customers

• Risk engineering scores
• Assessment summary scores for individual
  locations
• Looking at benchmarking scores across similar
  size healthcare organizations
• The assessment summary scores provide a basis for
  future risk engineering service
• Our subsequent assessments at each facility
  should focus on risk improvement

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Improving our HC servicing to our internal and
external customers

• Exposure specific information/guidance
• Risk engineers working with the Property division
  can assist with the Hazard Vulnerability Analysis
  (HVA) required as part of The Joint Commission
  EOC standards
• Zurich Hazard Analysis (ZHA) can be used
• After the 2005 hurricanes, pre-emergency plans,
  BCP and DR plans are being reviewed and
  thoroughly revised
• Wind team can assist our external customer with
  their HVA for hurricane and flood events

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Improving our HC servicing to our internal and
external customers

• Coordination of risk engineering services
• Specialties
• Risk engineers working in the construction
  industry
• Valuation
• Wind team
• Risk engineers working with the HSE division
• Risk engineers working with the boiler and
  machinery division
• Fleet safety (most hospitals have difficulty
  placing this coverage)
• Vendors for IR, SOC LSA and Joint Commission mock
  surveys

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Improving our HC servicing to our internal and
external customers

• Stewardship reports
• Part of the Global Corporate Value Proposition
• and now a part of our Healthcare Value
  Proposition

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Improving our HC servicing to our internal and
external customers

• Key elements to reduce and mitigate losses
• Full implementation of a cure
• Electrical testing and inspection
• Involved in plan review process for high valued
  equipment installations and replacements
• Assist with HVA (wind team)
• BCP and DR, including having claims pre-loss
  plans in place on the large accounts
• BM risk assessments, if necessary

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Property valuation

• Inflation
• Construction trends

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Property valuation -medical facility replacement
costs

• Hospital design trends
• Patient rooms
• Shared rooms
• Private rooms
• Lobbies
• Small, functional
• Large, attractive with amenities
• Square footage
• General purpose
• Smaller dedicated specialty
• HVAC
• Basic heat and AC
• Automated (contamination)
• Electrical
• Low power demand
• Sophisticated high capacity (digital imaging)
• Emergency rooms
• Open design
• Private intensive care rooms

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Zurich U.S. Property Claims
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Claims Property claims issues

• Radiology department total loss
• A. Location of the Radiology dept.
• B. Equipment issues
• C. Business interruption issues

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Claims Property claims issues
2. Major catastrophe loss A. Time
material repairs B. Equipment issues C.
Business interruption issues 3. Pre-loss
agreements
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Thank you for your participation

• To our customers We would like your feedback on
  today's session to help improve future
  presentations. Please take a moment to complete
  the survey (included in your information packet)
  and return to the room monitor.
• Risk Engineering staff will receive an electronic
  evaluation in the next few days via e-mail
• Conference presentations are available for
  download at
• www.zurichservices.com

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