The Moiso File
- Director of facilities management, Pali Momi Medical Center, Aieh, Hawaii.
- Facilities manager, Kaiser Permanente, Northwest region.
- Hawaii Society for Healthcare Engineering president.
- Certified Healthcare Facility Manager.
- Certified Energy Manager.
- American Society for Health Care Engineering member.
- Association of Energy Engineers member.
- University of Hawaii West O’ahu Facilities Management Industrial Advisory Board member.
- Bachelor of Science, Linfield College, McMinnville, Ore.
Anthony Moiso, CHFM, CEM, began his career in health care facilities management 15 years ago. In 2017, he partnered with others in the state of Hawaii to restart the Hawaii Society of Healthcare Engineering. This month, he shares his motivation for restarting the state chapter, as well as the outcome of its first conference.
You entered the health care field after spending many years working in facility maintenance and management for other fields. What were some of the challenges or differences you faced upon entering health care?
I’ve worked in several industries, including some that I thought were fairly heavily regulated like integrated circuit manufacturing, but nothing really prepared me for the compliance requirements in health care. The Centers for Medicare & Medicaid Services (CMS) and the accreditation organizations have much more stringent regulatory requirements and are much more granular in how they monitor and inspect the facilities. After compliance, in general I’d say that infection control was the biggest challenge. Air changes, pressure relationships, and temperature and humidity control can be very challenging, especially in operating rooms and older hospitals.
What are some of the efficiencies you’ve been able to bring to the health care organizations in which you’ve worked?
I always start with the basics and make sure we’re properly utilizing our computerized maintenance management system. Do we have a complete inventory of all our assets with all of the needed data? Once you have that, then the next step is to ensure that an effective preventive maintenance program is in place. In two of three hospitals I’ve worked in, I completely rewrote all of the preventive maintenance procedures. Now that you know what you’ve got and that you’re maintaining it properly, you can focus on how your building is operating.
I started a process we called building tune-ups 12 to 15 years ago, and that has now evolved into recommissioning (or retro-commissioning if your building was never commissioned originally). Everyone should be recommissioning their buildings periodically. The next step is continuous commissioning, which is software that works in conjunction with building automation systems and combines real-time data collection with automated analysis techniques. It provides an ongoing process to resolve operating problems, improve comfort and optimize energy use. If you do all of this, you should be able to extend the life of your assets and lower operating costs, while at the same time improving building performance.
What were some of the resources that you leaned on to develop your career in health care?
Like many others, I entered health care with no experience in the field.
Unfortunately, the organization I started with didn’t have any manuals, training or mentors. So, if it hadn’t been for the American Society for Health Care Engineering (ASHE) and the local and state chapters in Oregon, I don’t know what I would have done.
I also leaned heavily on my peers I met in the local Columbia River Healthcare Engineering Association (CRHEA), and they became my mentors. Then I started attending all of the conferences and taking advantage of all the educational opportunities. I’m indebted to ASHE and all the people I met through ASHE who have helped me through the years.
Another resource for me has been my vendor partners. I try to stay on top of new technology, but I depend on the vendors I work with to keep me updated on the latest technologies. In fact, it was one of the vendors I worked with that introduced me to CRHEA and ASHE.
Why did you decide to resurrect the Hawaii state chapter, and who helped in this journey?
As I mentioned, I’m indebted to ASHE and its members. So, I have always strived to give back to the health care engineering community. I was an active participant and a board member of CRHEA in Oregon, and when I relocated to Hawaii, I looked to continue that. Unfortunately, the state chapter in Hawaii had dissolved. It took me a few years to get established and network within the local health care community.
But about three years ago, I teamed up with David Jimenez of Johnson Controls, and we got the chapter started. It’s especially important in Hawaii because we are the most geographically isolated place on the planet. Being on a small island in the middle of the Pacific Ocean, it’s especially critical that we have a forum for networking, getting to know each other, helping to solve problems and learning about what’s new in our field.
What are some of the goals you’ve been able to accomplish?
Our first goal was just to get the chapter started, and we did that, obviously, in our first year. In 2018, our second year, we achieved affiliated chapter status with ASHE. And, this year, we had our first annual state conference.
The conference was a huge success! We had George Mills, formerly of The Joint Commission and currently the director of health care technical operations for Jones Lang Lasalle, as our keynote speaker. Brad Taylor, ASHE immediate past president, and Rick McGuffey, region 10 board member, attended and held a presentation about ASHE. Also, Chad Beebe, ASHE deputy executive director, advocacy, attended and held a presentation on CMS Conditions of Participation and gave an advocacy update.
ASHE was very generous in allowing all three representatives to attend, and they are a big reason the conference was such a success. Another reason for our success was that we partnered with the Hawaii Healthcare Technology Management professional group. This might be a model for other small or rural states; partnering with other health care professional groups can help ensure larger attendance and vendor participation.
What are your initiatives for the coming year?
We’d like to expand our membership, especially to the neighbor islands. We’re hoping to leverage technology such as video conferencing or Skype and web meetings when we can’t necessarily get everyone together in the same room. We’d also like to follow ASHE’s lead and focus on advocacy. We’re adding an advocacy chairman to our board and forming an advocacy committee.
The state of Hawaii is still using the 2000 edition of the NFPA 101, Life Safety Code®, and the administrative rules for health care construction are even older, so those are some of the advocacy issues we’ll be trying to influence.
What advice would you give to both veterans and those who are new to the health care facility management field?
First and foremost, you have to collaborate with your health care partners. An emerging issue over the last several years has been the facility’s role in infection prevention. George Mills spoke to this at our conference: that you have to be partnered with your infection preventionist. You should be joined at the hip and working together to ensure that the physical environment is helping to prevent health care-associated infections.
Another issue that we all face is the aging of our workforce. Everyone should be working on succession planning. ASHE has a great monograph on succession planning that everyone should read, “Succession Planning: Preparing for the Future of your Facility and Your Career.” And make sure you use the worksheet included in the monograph! We’ve made this part of our divisional goals for the year.