Transforming

medical
equipment
planning
By: Jill Worley, Director of Product Marketing, Attainia, and Christine Chadwick, Global Strategy Officer & Managing Director, AECOM, Canada

T
he success of healthcare design and construction projects Conference at Hospital Build & Infrastructure Exhibition and Congress,
is greatly dependent on a strong focus on the patient held in Dubai on 4 June 2014. Here, planning professionals from
experience combined with the application of technological AECOM, RTKL, and Attainia share their collective thoughts.
solutions and strict control of budget and schedule. With
30-50% of the total cost of a hospital build project allocated to the THE CRITICAL ROLE OF THE MEDICAL
procurement, installation and commissioning of medical equipment and EQUIPMENT PLANNER
associated technology, the involvement of strong clinical consultants, As we look to create projects that keep pace with rapid advances
medical equipment planners and biomedical engineers is critical. in technology while remaining within the constraints of budget and
The role of Medical Equipment Planning on healthcare construction schedule, medical equipment planning should be seen as a core
projects and in ongoing management of healthcare facilities will be requirement, a ‘nerve centre’ of sorts, critical to the success of today’s
explored in depth at the Transforming Medical Equipment Planning and tomorrow’s healthcare facilities.

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University of Kentucky, Albert B. Chandler Hospital, Lexington,

KY, US, mater planning and design by AECOM
All images © AECOM

Medical equipment planning is an ongoing and iterative task with a successful technology and equipment planning programme.
that evolves throughout the lifecycle of a project and beyond into The impact of not incorporating dedicated healthcare technology
ongoing operations. The best time to bring a medical equipment planning early in the project process can be considerable. As design and
planner onto a project is at the inception stage. This way, functional construction progresses, the details provided by a healthcare technology
programmes and business cases can accurately depict the current planning team are invaluable. When no information exists around the
and future demographic and clinical needs with viable technology, project’s ‘what ifs’, there is an inherent, but unknown, additional capacity
equipment and costing options. to the building that will account for significant additional cost. Change
Medical equipment planners act as a single source of information orders during design or construction are costly. The medical equipment
between various disciplines and provide the latest information on the planner helps to streamline decision-making, hit deadlines imposed by the
state of healthcare technologies to the stakeholders. They are responsible design and construction teams and mitigate risks against change orders or
for the management and dissemination of the myriad details associated cost overruns. The clinical consulting team members will also

[Link]
 work alongside the facilities, operations and finance teams to ensure large meetings had to be planned and facilitated, often requiring weeks of
that budgets for new or reused equipment are in place and accurate, and preparation and more delay in documenting and disseminating updates
maintain this throughout the lifecycle of the project. to plans and specifications. Every day of delay results in additional cost,
loss of revenue for the owner of the facility and lack of provision of
THE IMPORTANCE OF COLLABORATION AND healthcare services for the local community.
EFFECTIVE DECISION SUPPORT Clearly, while performing such a critical role, there is a risk of the
As healthcare technology and clinical IT systems become much more Medical Equipment Planner becoming a bottleneck. Project teams on the
tightly integrated and the timescales and costs become much more larger and more technologically advanced projects often include subject
compressed, the medical equipment planner must be aware of, and matter experts on virtual teams around the world. Although the advent of
work with, the requirements of clinicians, operations and facility the internet, email and even shared databases (e.g. SharePoint) has opened
managers, construction and MEP contractors, procurement and finance up and enhanced communication between project stakeholders, healthcare
staff, clinical IT and integration specialists, biomedical engineers as well technology planners are still striving to improve their ability to share a
as various acoustic, vibration, fire and safety experts. broad spectrum of information utilising real-time, on-demand tools.
Despite the improvement in equipment manufacturer websites, there
continues to be a lack of practical information to support the clinical TRANSPARENCY, STANDARDISATION AND
stakeholders in their equipment selection processes. As a result, clinical STRATEGIC SOURCING
staff tend to either default to technologies they are already familiar with, or There was a time when strategic sourcing simply meant that the best price and
randomly browse the internet looking for viable options. Today’s healthcare delivery terms were negotiated. Today, strategic sourcing demands the best
technology planners require a wealth of information in order to keep up with possible aggregation of planned purchases, maximum utilisation of available
new and innovative working practices in diagnostics, intervention and patient contracts, optimal negotiation of payment terms, and careful timing of delivery.
care. They must digest a tremendous number of diverse product technology Historically, planning medical equipment within the silo of
assessments, be conversant in patient outcome studies, and develop total construction and facilities management limited strategic sourcing
cost of ownership and return on investment calculations. opportunities, resulting in higher costs for the equipment and potentially
It is a delicate balance facilitating both clinical and non-clinical different equipment standards in each facility. Corporate healthcare
stakeholders through an equipment specification and selection process, facility management executives today strive to aggregate not only project
while simultaneously managing installation requirements and delivery equipment purchases, but also routine and replacement equipment.
dates driven by a construction schedule that cannot be delayed. The Standardisation of equipment purchases also reduces clinical
impact on project costs and timescales of assumptions made by one risk through more efficient training time and staff familiarity, lowers
stakeholder and conflicting decisions taken by another are significant maintenance costs, creates fewer service contracts, results in smaller
and require a good deal of discussion and collaboration. replacement parts inventories and increases equipment availability.
Traditionally, detailed lists and mountains of paper and electronic This level of transparency requires synchronisation of product
documents were drawn up and delivered to the various contractors selection, approval and procurement, across multiple projects as well as
and stakeholder groups working on a project. This required an army of in conjunction with routine and replacement capital forecasting processes.
resources to ensure that documents held by each party were up-to-date This synchronisation is difficult for most organisations, regardless of size or
and aligned, and that the impact of any changes made or clarifications infrastructure, as the processes are often disparate and/or decentralised.
provided were correctly assessed and managed through the process. In Finding an efficient means of tracking, normalising and analysing this
order to ensure that everyone was working from the same information, information extends beyond the typical spreadsheet or database.

Patient room. King Khalid Medical City.

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WHAT DOES IT ALL MEAN? delivering them on budget and on schedule. A model that
The planning of medical and non-medical equipment requirements cannot will provide a wide range of significant benefits to many other
be done effectively within organisational silos. People, processes and healthcare providers in the Middle East and worldwide.
technology must be aligned to empower organisations to consolidate,
collaborate, communicate, and contain costs for capital equipment. King Khalid Medical City/AECOM approach to medical
By implementing common processes and data standards and equipment planning in Saudi Arabia
leveraging business intelligence and analytics, equipment planners For projects like the 2013 Best Hospital Design (Future) Award
can work more efficiently, build consensus more quickly, distribute winner, the King Khalid Medical City (KKMC) mega project in
information and reports more readily, source equipment more Dammam, the medical technology design took place early in
strategically and, ultimately, reduce the cost of care. the concept design phase with the assistance of the medical
equipment planning team at AECOM, the project’s architect and
CASE STUDY 1: AECOM CASE STUDY engineering firm’s headquarters in Minneapolis, USA, during a
King Khalid Medical City, Dammam, Saudi Arabia week-long series of meeting sessions involving going over room-
Project team: King Khalid Medical City Project Management Office, by-room selection of medical equipment and furnishings, guided
AECOM, Vanir Construction Management by ten design principles to realise the project vision for a smart
AECOM’s medical equipment planning service line, AEquip, was academic medical and research centre.
an important element of the integrated design team appointed by For this mega project, the selections made were then entered into
King Khalid Medical City (KKMC), illustrating the progressive use the de facto standard for medical equipment and asset management
of clinical consultants and healthcare technology planners from the system by Attainia, a cloud-based equipment planning and sourcing
onset of a project to enhance design functionality. tool whereby all the planning data and equipment specifications were
Medical cities form the foundation of Saudi Arabia’s future national captured and are readily available for the strategic equipment sourcing
healthcare infrastructure and KKMC is envisioned to be the leading and the project construction efforts. The Ministry of Health’s plans
centre of excellence for tertiary referral healthcare in the Eastern are to purchase the equipment over a number of ramp-up phases,
Region, serving seven million with a focus on integrated treatment, as their way to avoid initial high costs, equipment obsolescence, while
research and education. guarding future proofing of the facility. This early planning activity further
KKMC is the largest of the four medical cities being developed facilitated the preparations for the facility construction by having detailed
and the inevitable shifts in future healthcare provision requires medical equipment list, and specifications.
its facilities to flex. Detailed technology planning was required to Several special review sessions were carried out by the KKMC
ensure the sustainability of the design will work with the changing Project Management Office (PMO) later in the project involving
technological and modalities that are inherent in healthcare. the review of critically specialised areas, such as the medical
The sheer size and complexity of the KKMC project led to what imaging clinic spaces such as the large and technically complex
is believed to be one of the largest Building Information Modelling seven MRI suits in order to ensure the efficient and culturally
projects in history. The detailing of all medical equipment and appropriate design are in place. The KKMC PMO as the owner,
technology within the model provided an excellent implementation further requested and received independent reviews of the space
and readiness for co-ordination of all disciplines during the design MRI clinic space design from major equipment manufactures to
process and resulted in drawings that reduced opportunity for ensure that this expensive space can accommodate any number
costly change orders during construction. The detailed database and types of equipment, while safe guarding the culturally sensitive
of equipment allowed the client to have real time access to patient changing area design and the standardisation associated
all equipment information and manage change and risk to the patient flow processes.
equipment budget. These planned steps demonstrated thought leadership from the
The KKMC project demonstrates the benefits of clinical owner’s side, the KKMC PMO, and have further contributed to the
consulting in shaping future-proofed healthcare facilities and design excellence of the KKMC by for critical clinical areas

Clinic examination room. King Khalid Medical City.

[Link]
 and accelerated better equipment construction information for CASE STUDY 3: CARE-RTKL STANDARDISING
electro/mechanical, plumbing and other construction trades using EQUIPMENT…ACROSS CITIES
the largest building information system and likely the largest mega Taking a closer look, Care-RTKL (a leading KSA-based medical
project to extensively implement and use BIM in its complex design. equipment and technology planning firm) has applied these
methodologies to several large-scale projects in the Middle East.
CASE STUDY 2: RTKL’S APPROACH TO At the Kingdom of Saudi Arabia’s National Guard Health
COLLABORATION IN SAUDI ARABIA Affairs (NGHA) King Saud Bin Abdul Aziz University for
For projects like King Faisal Specialist Hospital, Jeddah and the Health Sciences (KSAU), one of the largest multi-city academic
Ministry of Health’s King Abdullah Medical City, Makkah, RTKL and research campus projects in the Middle East, medical
International Ltd. and Care-RTKL teamed with Saudi Diyar equipment standardisation processes have been implemented
Consultants, a leading multidisciplinary design firm with their head in order to manage the enormous implementation effort. The
office in Jeddah, to provide careful and strategic architectural challenge wasn’t easy.
design and medical equipment decisions early in the design With more than 30 combined academic, specialised hospitals
stages to support each client’s patient care model. Key decisions and health sciences research buildings distributed across campus
surrounding complex areas such as imaging, integrated surgical locations in Riyadh, Jeddah and Al Hasa, NGHA and Care-RTKL
theatres and patient care helped develop an early roadmap for developed stringent medical equipment and technology standards
equipment standardisation and sourcing efforts. and specifications across all clinical areas.
In both projects, the development of medical equipment A key success factor in the process involved NGHA forming
standards was addressed early in the design phases with input clinical technology review committees, whose responsibility was to
from each project’s clinical team rather than waiting to address review and approve all equipment and technology specifications.
standards later when construction commenced. This up- The committees were comprised of both clinical and operational
front planning significantly streamlined design decisions by the leadership to ensure comprehensive inputs were considered from
architects for critical areas and accelerated better equipment each stakeholder. Careful thought and coordination was required
construction information for electro/mechanical, plumbing and to ensure full compliance with the standards prior to commercial
other construction trades. For these projects, since all the planning bidding by suppliers.
data and equipment specifications were captured by Care-RTKL Standardisation of the equipment not only supported the
in Attainia, a cloud-based equipment planning and sourcing tool, unified academics and patient care practices at each campus,
the information was readily available to move forward for strategic but it facilitated significant strategic sourcing and delivery
sourcing and construction efforts. efforts with suppliers and allowed for consistent clinical training
across all the sites. From a biomedical engineering perspective,
standardised equipment contributes towards better on-going
equipment maintenance and specialised training, as well as
future replacement or upgrading of the equipment. All were key
elements for NGHA to manage the volume of equipment in
operation for this size project.
With approved standardised equipment specifications in-
hand, the process of commercially sourcing the equipment
became the next focused effort. The extraordinary quantity
of equipment being purchased required NGHA to aggregate
equipment sourcing across not only one campus location
comprised of multiple buildings, but across all three campus-
locations. NGHA could significantly leverage the best commercial
offering and incorporate centralised contractual terms and
conditions, warranties and training requirements. Whilst some of
the large speciality hospital buildings were on longer construction
timelines than less complicated clinical academic buildings,
identical equipment specified within multiple buildings could
be negotiated with the suppliers for staggered deliveries based
on the construction completion schedules. Since equipment
was standardised across the campuses, similar construction
methodologies by each of the different site construction teams
could also be coordinated.

AUTHOR INFO
Jill Worley is Director of Product Marketing for Attainia. Christine Chadwick
is Global Strategy Officer & Managing Director, Canada for AECOM
Additional case study materials:
Marty McIntire is Vice President, Global Services Leader for RTKL
Mounir Marhaba, Programme Director, King Khalid Medical City Project
Management Office
UC San Diego Sulpizio Family Cardiovascular Center, Thornton Hospital. Photo by David Lena.

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