Health care facilities are designed, constructed and maintained differently than other occupancy types and require special attention and reverence.

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Health care professionals are driven to serve others and surpass expectations even when resources are scarce, time is limited and energy levels are depleted. Most people who work in health care will tell you they do it for the people. Some professionals stay in the field to serve the patients, and others stay to serve the people or buildings that serve the patients.

Until very recently, limited formal education and training have been available to those entering the health facilities profession. Most knowledge is amassed through on-the-job experience rather than classes, books, publications and other educational sources. 

Most of that on-the-job experience is reactive. Lessons are learned, and skills are advanced in a high-risk environment where mistakes can be extremely costly. Formal education, however, is proactive. The fundamental knowledge is shared before it must be applied in the field, ultimately reducing mistakes and risk.

Fortunately, the health care field is positioning itself to provide formal education and training resources for workers at every level in the organizational chart. Formal education is no longer reserved for academics and leaders. Skilled tradespeople have access to more health care training than ever before that goes beyond union offerings, certification programs and trade schools.

Education groundwork

Organizations like the American Society for Health Care Engineering (ASHE), the United Brotherhood of Carpenters and Owensboro Community & Technical College in Kentucky have laid the education groundwork, and the library of resources continues to grow each year.

It’s important to understand the need for health care-specific education and training. Health care facilities share commonalities with other building types — they are constructed according to building codes, served by municipal utilities and provide a multifunctional space for their occupants. 

They’re also remarkably different. Health care facilities serve the most vulnerable population: the immunocompromised, injured and those unable to self-preserve. Consequently, health care facility construction and operation are adapted to the patient population. 

This discussion explains five key differences between health care and other types of facilities and provides resources that health care facilities professionals can use to overcome health care's unique challenges:

1. Emergency management

Hospitals operate 24/7 regardless of extreme weather events, fire and community disasters. Most commercial building owners can choose to close their doors when disasters occur and set regular office hours for their workers and patrons.

Hospitals are a place of refuge for the communities they serve, and patients are evacuated as the last resort. Therefore, they must plan for emergency provisions, be equipped with essential electrical systems that provide emergency power to life-preserving and critical equipment, and be constructed in a way that smoke and fire do not spread throughout the building. 

Health care professionals should be educated about these emergency provision requirements, specialty systems and life safety features so they can properly design, construct, install, maintain and operate them. They should also know how to respond during a fire alarm, active shooter, flood and other catastrophic events.

Field application. Hospitals are designed to burn with people inside of them, which is the opposite of almost every other building type. Many patients are unable to self-preserve due to their physical condition and are often connected to life-preserving equipment. 

Because moving patients would be a tremendous risk to their health, an escalated evacuation plan is exercised during a fire. If necessary, patients are evacuated from one smoke compartment to an adjacent smoke compartment, known as horizontal evacuation. If the smoke spread is too severe, patients are relocated to at least one floor below the fire, known as vertical evacuation. The last resort is complete evacuation, which involves moving all occupants out of the building. 

Health care workers and contractors might be called upon by the nursing staff to help with patient evacuation. During a fire, workers should respond using the “RACE” steps: rescue or remove patients from immediate danger; activate the nearest fire alarm pull station; confine the fire and close doors to contain the flames and smoke; and extinguish the fire with an extinguisher (if possible) and evacuate occupants from the affected area. Workers and contractors should be educated on RACE, locating a fire extinguisher, using a fire extinguisher and other defend-in-place concepts as part of their orientation to health care.

Related resources. Emergency management resources available to health facilities professionals include:

2. Infection prevention

Infection prevention and control are other key differences in health care and, therefore, necessary education topics for health care workers. As within all other buildings, transmission occurs through contact, airborne and waterborne sources. However, health care facilities differ because patients are exceptionally vulnerable since their ability to fight off infection is already compromised from illness, injury or surgery. 

Education topics like hand-hygiene practices, air distribution systems, water management programs, and infection control risk assessments and implementation measures are essential for health care workers. 

Field application. Before working in an occupied patient care area, skilled tradespeople should understand how their activities could impact the spread of infection. Carpentry, plumbing and HVAC work are especially risky inside patient care areas, so workers must be trained on their limitations when working in a patient room or around patients. 

Generating dust, disassembling plumbing fixtures and breaching HVAC systems can create hazardous conditions for patients. Also, to protect the workers, they should be trained on proper personal protective equipment to reduce their risk of infectious airborne or waterborne pathogen exposure.

Related resources. Infection prevention resources available to health facilities professionals include:

3. Regulatory environment

Even though all building types are subject to building inspections, health care facilities are significantly more regulated than other building occupancy types and therefore experience more frequent inspections from numerous regulatory organizations. Health care professionals must know how to prepare for an inspection and behave during an active building survey. 

Field application. Health care facilities managers are responsible for ensuring compliance with safety and physical environment requirements. Their employees and contractors should be educated about these requirements to promote a continuously safe environment during maintenance and construction activities. Additionally, they should be trained as appropriate to inspect, test and maintain equipment to satisfy regulatory requirements and document these activities so they can be supplied during a survey as requested.

Related resources. Regulatory resources available to health facilities professionals include:

4. Patient experience

All health care facilities are patient-centric, which is a noticeably different approach than the consumerism of commercial spaces. Not-for-profit health care systems are especially different from commercial businesses in that they are philanthropic organizations with very low operating margins. 

Many hospitals rely on reimbursements from the Centers for Medicare & Medicaid Services (CMS) for their revenue — up to 80% in some cases. CMS uses patient outcomes to determine a hospital’s eligibility for reimbursements. Patient outcomes are measured using publicly reported surveys called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS, pronounced “H-caps”). 

Health care workers benefit from knowing which HCAHPS scores they influence, such as room temperature, cleanliness, quietness and communication, among others. Noise and poor lighting levels, for example, not only negatively affect a patient’s experience but also impact their ability to heal.

Field application. Quint Studer revolutionized the patient experience 20 years ago with his book, Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference. The AIDET model is the most popular outcome of Studer’s book and teachings, and it’s been adopted by many health care organizations across the country. 

AIDET is an acronym for announce, introduce, duration, explanation and thank you. It’s a communication framework for health care workers to use with patients and their visitors. It is a simple tool that can be taught to health care workers during orientation, practiced during everyday activities, and reinforced with visual aids and coaching from leadership. When used correctly, the model significantly improves patient satisfaction and experience. 

Similar initiatives include the 5-foot and 10-foot rules originally established by Walmart's Sam Walton. Under these rules, workers should make eye contact with the patient or visitor to acknowledge them when 10 feet away, and greet them and smile when 5 feet away.

Health care engineering workers have another layer of customer service that requires training and education. Not only do they serve patients and visitors, but they also serve other departments. 

Facilities management departments are responsible for most of the building and equipment maintenance activities. When equipment breaks or malfunctions, they receive work order requests to address and resolve the issue. Customer service skills are essential to a facilities management department’s success. 

A distressed customer reporting an issue can be reassured of their concerns by receiving a timely, friendly response and communication, explaining the next steps or resolution. Health care departments must collaborate often to ensure a high-quality patient experience, so building positive interdepartmental relationships is important for them to achieve their shared mission.

Related resources. Patient experience resources available to health facilities professionals include:

5. Leadership

Health care facilities are dynamic, high-risk environments that require leadership skills to operate safely and smoothly. Change can occur very quickly and suddenly in health care, so it’s important for health care leaders to know how to effectively direct their teams during change and unknown conditions. 

Even though leadership is required in all organizations for them to be successful, the stakes are higher in health care. Without effective and cohesive leadership at every level within a hospital, patient safety is jeopardized. Leaders must be able to communicate clear expectations to their team, coach them to deliver desired outcomes and ensure quality throughout all operations. 

Field application. Staffing models vary widely throughout the health care industry. Some organizations have a strong preference for insourcing, others require outsourcing and most still operate with a blended model. Turnover is especially common in health care because it’s a high-stress environment that historically reports uncompetitive compensation packages for its skilled facilities positions.

It’s difficult to engage employees who are not loyal to the organization, which is why leadership training is so necessary for health care leaders. Contract employees and insourced staff must all understand the reasons for what they do every day (“the why” as coined by author Simon Sinek), which requires strong leadership and coaching from those who already understand and appreciate the criticality of the patient care environment.

Related resources. Leadership resources available to health facilities professionals include:

Specialty systems

In addition to the key differences in health care explored here, hospitals are equipped with specialty systems that do not exist in other buildings, such as nurse call, pneumatic tube, medical gas, medical vacuum and essential electrical systems. 

Hospital workers should be trained to operate these systems and understand their responsibility thresholds. For example, certification is required to breach a medical gas system, so significant maintenance activities are performed by individuals with ASSE International’s 6040 certification, and separate certifications are required to install, test and verify these systems. It’s critical that maintenance technicians, plumbers and plant mechanics do not breach the system unless they are qualified to do so.

Everyone who works in health care should be appropriately trained to understand the key differences that exist in these critical environments. Health care facilities are designed, constructed and maintained differently than other occupancy types and require special attention and reverence. 

Health care professionals have more access to contemporary educational resources today than ever before, and many of them are available in digital formats, making it more convenient than ever to get up to speed. 

For all the details about ASHE’s current educational offerings

FAQ resource provides information on a variety of health facilities topics

Legacy FM LLC, a Phoenix-based empowerment through education company that specializes in health care facilities management, recently launched an interactive frequently-asked-questions (FAQ) webpage that is free and accessible to the public.

Legacy FM’s FAQ page empowers everyone to research any topic related to the health facilities management field, including equipment and system information, management topics, compliance issues, hospital construction and more. 

Search results automatically populate once a topic is entered into the search bar. FAQ posts are tagged with keywords and category-based tags, so it’s easy and convenient to search by a specific topic. Search results are provided in plain language in the “Key Takeaways” subsection so developing health care professionals don’t need to know all the technical jargon, acronyms and initialisms for which the field is known. They also have the option to dive deeper into the technical details in the lower subsection of the search results.

Because the database is interactive, everyone can share an FAQ on the major social media platforms and via email, subscribe to updates on a specific topic, post comments to an FAQ search result and submit a new question. Legacy FM’s Empowerment Squad typically responds to new question request forms within 48 hours and posts them on the webpage so information can spread to those who need it.

About this article

This is one of the series of articles contributed by the American Society for Health Care Engineering’s Member Tools Task Force.

Lindsey Brackett, CHC, CHFM, SASHE, Certified Health Care Physical Environment Worker, is chief empowerment officer at Legacy FM LLC, Phoenix. She can be reached at