Environmental Business Council of New EnglandJuly 27, 2005

Robert CastaldoDirector, EH&S

Massachusetts General HospitalBoston, MA

Emerging Regulatory Trends and Management Issues for New England

Hospitals and Healthcare Facilities

Partners HealthCare Network

Founding Members• Massachusetts General Hospital*• Brigham & Women’s Hospital*

Other Members• Faulkner Hospital• McLean Hospital*• Newton – Wellesley Hospital• North Shore Medical Center• MGH Institute of Health Professions• Partners Community HealthCare• Partners Continuing Care

* Harvard Teaching Affiliate

                                                           

Third Oldest Hospital in US; Largest in New England

19,500 employees (includes 2,900 nurses) 3,600 member medical staff

In- Patient Services

• Available Beds: 893 • Average Occupancy Rate: 80.47%• Admissions: 44,518 • Average Length of Stay: 5.83 days • Admissions to Observe: 5,285

Ambulatory Services

• MGPO Visits: 694,268• Clinics Visits: 417,203• Health Centers Visits: 299,232• Emergency Visits: 74,905

Total Ambulatory & Emergency 1,485,608

Surgical Services

• In-Patient 17,957• Ambulatory 15,013 Total Surgical Cases 32,970

Births 3,604

MGH Mission

Clinical Care, Teaching and Research

• Almost all staff physicians are on the Harvard Medical School faculty

• Largest hospital-based research program in the US

                                                   

Downtown Campus – clinical & research

Charlestown Navy Yard - research

Community Centers - clinical

Current Operational Drivers of EH&S Programming

• Hospital Growth and Renewal• New Construction and Renovation

• New Emergency Management Demands• HAZMAT Response Readiness• Biosafety

• JCAHO • Periodic Performance Review Process • Patient Safety

• Specific Continual Regulatory Oversights• EPA• MWRA

Hospital Growth and Renewal

• Major additions on the main campus• Extensive backfill renovations• Preparations for next major rebuilding project

Impact on EH&S:

• Keeps facilities-related safety issues as an everyday priority

o Construction Impacts – internal and externalo Fire Safety Managemento Life Safety Managemento Environmental Impacts – asbestos, molds, ICRA

Emergency Preparedness and Homeland Security

• HAZMAT Response Capabilities – Greater expectations for hospitals• Chemical – Radiological – Biological Incidents: Mass Casualty Management• Biosafety and Select Agent Rules: Public Health Security and Bioterrorism Preparedness and Response Act

Impact on EH&S:

• HAZMAT Incident Response – heightened and continual readiness; mass casualty focus• More systematic oversight and control of biological research – increased security re: personnel and facilities

Chemical HAZMAT Response Teams

Risk Assessment

Recruitment

Training

Drills

Location

Visibility and Accessibility

Fleet Center

Government Center

Transportation Hubs

MGH

• Protect our patients• Protect our staff• Protect our facility• Preserve the ability

of MGH to serve the community in a large-scale disaster involving hazardous materials

JCAHO Periodic Performance Review Process

• Changes JCAHO 3-year auditing process • Now requires mid-cycle self-review• Performance Improvement Plan submission• Improvement Tracking• Engineering surveyors now on the JCAHO team • 2006 Patient Safety Goals

Impact on EH&S:

• From a once every 3 year exercise to more continual quality management process in all areas• Engineer surveyors up the ante with facilities-related management issues• Align safety functions with current patient safety goals

2006 Patient Safety Goals

• Improve Accuracy of Patient Identification• Improve Caregiver Communication• Improve the Safety of Medications Usage• Reduce Care-Associated Infections• Reconcile Medications Across a Patient’s Care Continuum• Reduce Harm from Patient Falls

Specific Continual Regulatory Oversights

EPA

• RCRA• Contingency Planning and SPCCs• Air Emissions• Real Estate Assessment

MWRA

• Mercury