Trends in green hospital engineering.

When health-care facilities do pursue green initiatives, it's often because there is some incentive available to them that buys down the cost. When hospitals make claims that green does not cost more, generally, these claims are based on strategies that simply cost less, and would therefore be pursued regardless of green goals, and/or strategies implemented because of a one-time opportunity to buy-down the cost through some kind of incentive programme. Engineers who design health-care facilities are often cast as being "nay-sayers"; we can't find ways to do better systems because we are too constrained. Behind the voluminous green smoke that surrounds healthcare building, there is some real green fire.

Management map for tomorrow.

The way forward for hospital services and facilities management is examined by Francisco Castella, Doctor of Engineering and a member of the International Federation of Hospital Engineering Council. In this article, which is based on a paper presented at the 18th IFHE Congress, he draws on his experience as facility manager and director of general services in the Teaching Hospital of Badalona, Spain, and on knowledge gained through attending IFHE Congresses - representing the Spanish Hospital Engineering Association.

Prescription for change.

From the above it can be seen that, while it is still at an early stage of development, the growth of the new profession of facilities management in the NHS is already showing that it is highly relevant to the delivery of effective healthcare. Hopefully, the points raised in this article will stimulate discussion on how estates and facilities services can continue to realign themselves to embrace and adapt to changes and challenges. If facilities managers are to fulfilL their full potential in the years ahead, it is important that they keep their eyes on the shifting horizon with respect to the changes that are developing in facilities management. They will need to develop strategies that will drive their services forward, while, at the same time, continuing to manage the "here and now".

Energy management: a reemerging concern for the department manager.

The cost of energy in the average health care institution, at one time rarely more than I percent of the total budget, has amounted to 3 percent to 5 percent or more of the budget since the mid-1970s. As society gradually adjusted to these higher energy costs, the urgency for energy conservation faded, and true energy management, briefly a high priority, fell by the wayside. It is now evident that higher energy costs are here to stay, and energy supplies are becoming more limited, in some areas alarmingly so, at the same time other financial concerns are making themselves felt. Therefore, energy management is resurfacing as an active management concern. Much of energy management at the department level is a matter of awareness and attitude, and an energy-conscious manager can influence the staff toward energy consciousness.

Technology and the future of medical equipment maintenance.

Maintenance of medical equipment has been changing rapidly in the past few years. It is changing more rapidly in developed countries, but changes are also occurring in developing countries. Some of the changes may permit improved maintenance on the higher technology equipment in developing countries, since they do not require onsite expertise. Technology has had an increasing impact on the development of medical equipment with the increased use of microprocessors and computers. With miniaturization from space technology and electronic chip design, powerful microprocessors and computers have been built into medical equipment. The improvement in manufacturing technology has increased the quality of parts and therefore the medical equipment. This has resulted in increased mean time between failures and reduced maintenance needs. This has made equipment more reliable in remote areas and developing countries. The built-in computers and advances in software design have brought about self-diagnostics in medical equipment. The technicians now have a strong tool to be used in maintenance. One problem in this area is getting access to the self-diagnostics. Some manufacturers will not readily provide this access to the owner of the equipment. Advances in telecommunications in conjunction with self-diagnostics make available remote diagnosis and repair. Since components can no longer be repaired, a remote repair technician can instruct an operator or an on-site repairman on board replacement. In case of software problems, the remote repair technician may perform the repairs over the telephone. It is possible for the equipment to be monitored remotely by modern without interfering with the operation of the equipment. These changes in technology require the training of biomedical engineering technicians (BMETs) to change. They must have training in computers and telecommunications. Some of this training can be done with telecommunications and computers.

A decade of change in clinical waste treatment and disposal in Scotland.

Ten years ago there were over 150 small incinerators located on hospital premises throughout Scotland. The majority were operated by portering staff, had poor combustion and no gas cleaning equipment. At that time alternatives to incineration were in their infancy and relatively expensive. Funding for major capital projects lay with the Government, and a strategic study suggested the installation of 12 centralised modern incinerators on the mainland and three on the islands: one per Scottish Health Board. Some health boards proceeded with new installations well ahead of dead-lines for closure of old plant. Others adopted a 'wait and see' policy and were overtaken by political changes. These resulted in a cutback in government-funded capital investment and a shift of non-core services to the private sector. Clinical waste disposal was contracted out as a service contract and some private sector companies offered alternative low-temperature technologies for clinical waste treatment. As a result there is now the opportunity to compare the advantages and disadvantages of incineration, sterilization, dry heat disinfection and other techniques. Technological change has also required revised waste segregation methods within the hospitals. In parallel with this there has been an overall reduction in waste quantities. The remaining incinerator operators are now faced with more stringent emission limits to be implemented by June 2000. This is resulting in closures of incinerators that have been operating for a few years. The situation continues to change.