The CEO's role in fostering open dialogue with facilities management

An open line of communication between health care executives and facilities management leaders begins with a foundation of mutual respect.

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In today's health care environment, facilities are not just the spaces where care is delivered. They are mission-critical infrastructure that directly impact patient safety, regulatory compliance, workforce stability, financial stewardship and community trust. I've been a health care leader for 30 years, and one thing that is clear to me is that facilities work better (and consequently, the hospital better serves its community) when communication between the CEO and facilities leadership is optimized.

Here are some of my thoughts on creating healthy, productive communications between CEOs and facilities leaders.

Fundamental to that communication is regular dialogue focused on facility performance and risk. I meet monthly with Chris Van Gels, our vice president of facilities. I share with him any care system updates that his department should be aware of, and he gets the opportunity to tell me what's happening in his division and concerns he may have with any of our assets. Furthermore, if something important comes up in the time between our monthly meetings, Chris knows that he is always welcome to step into my office and talk.

Read Part Two

Empowering facilities leaders to drive essential conversations with CEOs

Another way I keep in touch with facilities priorities is by regularly walking the floors and buildings with Chris. Especially when we've been discussing a piece of equipment or infrastructure that I'm not familiar with, I take a walk with him and see it firsthand. This not only improves my ability to make decisions, but when other hospital personnel see us walking through the hospital together, it demonstrates that I take Chris's input and concerns seriously.

Underlying all my communications with Chris is mutual respect. He knows he can count on me to be curious, focused and honest about any facilities topic that needs attention. In turn, our interactions assure me that my vice president of facilities is at the very top of his game.

However, in the big picture, an effective relationship with facilities staff requires more than a solid bond; it also requires an understanding of some essential facilities issues. Among them are deferred maintenance, regulatory compliance, facilities staff competence and emergency preparedness.

Prioritize compliance 

Deferring maintenance is often tempting when budgets are tight. For example, recently a skid-steer loader that we used for snow removal broke down, and for a while we paid an outside contractor to clear snow for us instead of investing in a replacement. But eventually the math proved that it made more sense to bite the bullet and replace the skid-steer loader.

That's a minor example. Bigger deferred maintenance issues can lead to patient safety concerns, regulatory citations, operational disruptions or reputational harm.

How can those consequences be avoided? By encouraging facilities leaders to surface risks early and frame them in terms of operational, financial and clinical impact. When CEOs have that kind of information, they can make informed decisions that protect the organization and the communities it serves.

Equally critical is the CEO's responsibility to ensure organizational compliance within an increasingly complex regulatory environment. Knowledgeable facilities leaders are experts in requirements established by accrediting organizations, the Centers for Medicare & Medicaid Services and state departments of health. I expect my facilities leadership to anchor recommendations in recognized best practices, including guidance from professional organizations such as the American Society for Health Care Engineering. Clearly, few CEOs master these requirements and best practices themselves, but fortunate ones can count on their facilities leaders to do so.

Know staff inside out

Facilities workforce management is another area that depends on good leadership. At our hospital, we ensure the facilities staff is current with technological and regulatory changes by taking the appropriate training courses or attending conferences. Chris is great at cross-training his staff, so if someone is unexpectedly out, another facilities staff member can step into that person's role. Overall, we can count on a well-trained team to handle most facilities issues quickly and within budget.

But keep this in mind: There are times when outside contractors are needed. For example, if a chiller needs to be rebuilt or a parking lot needs to be repaved, I don't expect our in-house staff to handle it. The key is knowing what your in-house staff should handle (and be prepared for) and what should be outsourced.

Always be prepared

Emergency preparedness is probably the highest profile facilities issue, and it underscores why strong CEO-to-facilities communication is indispensable. Hospitals and health systems are anchors during crises. Facilities leaders should ensure that generators are tested, life safety systems are reliable, and emergency plans are current and coordinated with first responders.

The importance of this was demonstrated in 2011, when the city of Minot, N.D., experienced record flooding. We had structures within the flood zone, so I was regularly checking in with my facilities director to prioritize which assets needed protection, what resources we could bring to bear and what had to be brought out to a safe zone. The solid relationship I had with facilities leadership, and the high level of competence and preparation of their staff, saved the hospital from much greater damage.

Foster a healthy environment

This is a fundamental importance that underlies all my preceding comments: To have an effective working relationship between the CEO and facilities leadership, the CEO must foster a culture of psychological safety. What does that mean? It means facilities leaders should never worry that the boss is going to be angry if they raise concerns about infrastructure risk, regulatory exposure, emergency preparedness or any other issue.

No CEO appreciates surprises, particularly those involving building failures or survey deficiencies. Early escalation is not a sign of failure; it is a hallmark of mature leadership. Chris comes to me in a timely fashion with the information I need to make decisions. In return, I listen, ask questions and strategically consider the options he presents. This demonstrates to him and others in the hospital that facilities leadership is valued "on par" with finance, nursing and clinical operations.

Ultimately, when CEOs actively engage facilities leadership through structured dialogue, shared accountability and mutual respect, they send a clear message: the health of our buildings is inseparable from the health of our patients, our workforce and our organization.

John M. Kutch, is president & CEO at Trinity Health North Dakota.