Speaker 1: Kirk Kaiser
Speaker 2: Mickey Eberts
Speaker 3: Art Huber
Speaker 4: Danielle Young
Speaker 1 (00:00):
Glad you could join us on FM After Hours, the ultimate podcast for all things facility management. We’re here to take you on a journey into the ever-changing world of fm. Don’t forget to check out our gracious sponsor, remediate your trusted partner and fire and life safety compliance. And with that, let’s dive in.
Speaker 2 (00:19):
Hey, welcome back to FM after hours. I’m one of the hosts, Mickey Eberts. Alongside me are the ever knowledgeable art Huber, Danielle Young and Kurt Kaiser. I’d also like to thank our sponsor Remediate. Remediate is the answer to all of your life safety needs. On our last podcast, we covered part one of a two-part series related to the joint Commission. Part one being what do you do if you’re dropped in the middle of a mess and respond to do the best you can through a joint commission survey. Today we’re going to cover part two, which is how do you create a programmatic approach to ensure success. I’ll turn it over to Kirk and Danielle to help facilitate the discussion.
Speaker 1 (00:59):
Thanks Mickey. Hey, we’re switching it up here today because we want Mickey to talk more
Speaker 2 (01:03):
And
Speaker 1 (01:04):
We figured out when he was hosting he didn’t want to talk as much. That’s true. That’s very true. I think our was saying we’re going to regret that. Oh,
Speaker 3 (01:11):
You will definitely regret that. Yeah. We’ll see. We may switch it back.
Speaker 1 (01:17):
Yeah. So with that, let’s just dive right back into the topic. So maybe why don’t we start out with what the expectations that you need to go through and set with administration. So again, trying to work towards developing a program and what’s sort of that high level 10,000 foot view that you’re going in to look to try to do.
Speaker 3 (01:39):
So I was just going to say one of the things that we talked about last time was about different levels of sophistication within the facilities management realm, if you will, and new versus been there a long time and all that change around that. We talked about last time. And one of the things that for a new person coming into this role or even been around a little while, you have this expectation that you’re going to go through joint commission and perfectly. And so I think where you were probably going to go Mickey, but I want to just kind of set, it’s like there ain’t no perfect in this regard. I mean you’re going to have findings, things are going to happen. And I think what you’re talking about setting the expectations with administration of what’s going to happen and some realities about it. Right. That’s
Speaker 2 (02:27):
Exactly right. And there was a second point I was going to make. I’ll revisit the first a little bit. So as a facility leader, you want to be perfect. This is just sort of your mentality. You don’t want any safety issues in your hospital, but it’s not going to happen. And the joint commission changed the way, what do you want to call it? Rank the seriousness of findings. So they have something that’s called, it’s literally low on the matrix and that’s where you’re going to have those and you want to educate your administrators. You’re going to have ’em, right. What you want to stay away from is the high level, high serious findings, right? Widespread findings. And then the second piece of it is, and we talked about this in the last episode, I would either, well, I would hire a partner to do an assessment to give you a list of where, basically a map of where you’re at.
Speaker 2 (03:24):
And then I would educate the administrators because some things, no matter what you do, you’re going to get a finding. So an example is if the person before you did not test the smoke detectors and it’s passed a year and 30 days, even if you test them, you’re going to get a finding. When they come back, they’re going to look back. So it sort of gives you a get out of jail free card, but it also allows you to create a plan. And a lot of times when I worked in the hospital, art was my administrator and I would come to him with, Hey, here’s our risk and here’s the things we’re going to do to mitigate that risk. So he would know and what to expect going into a survey.
Speaker 1 (04:03):
So is the administration, is there a lot of like, oh my gosh, once they finally get the inspection report or is what is that?
Speaker 3 (04:14):
Well, let’s talk about facilities versus administration in a hospital. What do you think administration’s thinking about
Speaker 2 (04:22):
Patients? Nurses,
Speaker 3 (04:23):
Not facilities. They think we just got it. Everything’s cooking along and when the joint commission comes there, all that facility stuff’s going to be just fine.
Speaker 3 (04:34):
And I’m going to tell you as an administrator myself, as Mickey said, I was an administrator at some points in my career. I got involved in all levels of the joint commission survey and it was, it was certainly eye opening, but almost shocking to me where I was sitting on the side with administration and I would go with the clinical surveyor and do chart reviews. Chart reviews are when they look at a chart and make sure all the i’s are dotted and t’s are crossed on a chart for a patient. There’s all kinds of rules. I mean, I am not going to go through any of them today, but there’s all kinds of rules that they have to follow. And a doctor or nurse charts for a patient and these administrators or nurse or doctor for the joint commission will go through these charts and look at ’em in detail looking for all the I’S and dotted i’s and cross T’s.
Speaker 3 (05:20):
Well, they would find all kinds of mistakes or omissions mostly you didn’t write a time down or you didn’t write a date down or you didn’t stop a restraint in the amount of time it’s supposed to be stopped. And I’m kind of giving the hint about what they’re looking for or some of the things they look for. And there’d be a lot of ’em. I mean, I was sitting with this durst or doctor going through the chart and I’m going, oh, so we go to the, I’m jumping way ahead, but we go to the exit summary and we’re sitting there and facilities got their findings and they talk about ’em like the world is ending, the safety and people’s lives are at risk and all this stuff. And we’re not even talking about a patient here, we’re talking about the building. Then they go and talk about the closing of the nursing side or the clinical side.
Speaker 3 (06:09):
And it was like, yeah, you had these findings and it was so many of ’em and whatever. And it’s like I’m sitting there going, but you said we’re all going to die because of facilities and the patient stuff. So it was really quite shocking in that regard that there was a big focus and for good reasons, but it seemed a little bit unbalanced to me. And because it was a nurse or a doctor doing that part of the survey, and nowadays with the surveyor being a facility person, usually the life safety surveyor, there’s a little bit of balance going on now where they understand the reality of the facility side. But a nurse or a doctor who saw these all one penetration above a ceiling’s, like, oh my gosh, there’s a penetration.
Speaker 4 (06:51):
It’s
Speaker 3 (06:51):
Like there’s penetrations, there’s all kinds of things happen we can’t control. So I mean I’m babbling on, but that’s the kind of stuff that you want to set expectations, you want to have them understand, and we will talk about this at another session another time, but we get back into finance. You want set in front of your C-F-O-C-E-O, probably the CNO as well as chief nursing officer and say, Hey, you got anything funds? I can get a really low score mean as far as non number of findings because I can fill the building with facilities, guys walking around, checking everything every hour, but that won’t still have findings. But they’ll be really, really small ones. We know you don’t have any unending funds in a
Speaker 5 (07:34):
Hospital
Speaker 3 (07:35):
And it’s certainly not going to facilities. It’s going to MRIs, CT machines, surgery suites and all that kind of stuff. So that’s kind of where those expectations come in.
Speaker 2 (07:45):
And just a couple of interesting points there. When I was a surveyor, there were two surveys that I ended up getting pulled into clinical areas because the survey was so rough on the clinical side. And so I had finished mind and the clinical surveys, surveyors are panicking. And so I did some radiology chart reviews, I did some nutritional chart reviews, things like that that again, they’re shocking when you read. And again, I probably shouldn’t say this, joint commission’s not going to want this out there because I probably shouldn’t have been doing that. But the surveyor showed me how to do it and said, if we’re going to cover this, somebody’s got to do it. And art’s right, the facility Life Safety code surveyors. Now they do bring a level of balance, sit in with the administration team and I will tell them, you are going to have findings. Those of you administrators that are sitting there thinking you’re going to get a clean report, get that out of your head. I’ve barely walked your hospital. I promise you I’m going to have 20 findings a day.
Speaker 1 (08:51):
And I think throughout my career, our phone would ring after the joint commission or the other accrediting bodies roll in, and then we get the phone calls. And so often it’s like, well, I didn’t get hit with this last time and now I got hit with it and I didn’t do anything any different. And I think a big piece of it is it is individualistic as to who the surveyors are that are coming in, what their background is, the level of attention that they pay on it. And so just because you’ve had a clean bill of health or had something in the past doesn’t necessarily mean that that’s going to be that way going forward. And that’s part of the problem is it just becomes that false narrative. I think that is in our heads that’s like, well, I’ve been good in my fire barriers. Well now I don’t have to worry about ’em. And the reality is that inspector may not just have spent very much time on it, or it may not have been one of their things that they focused in on, or they might not have popped the right ceiling tiles or whatever it may be.
Speaker 2 (09:47):
Or your program slipped because you did well. And human nature is to focus on where you need to improve. Once you get a report card that says, Hey, your penetrations are great, but your doors aren’t, so now you go put all this energy in your door. That’s another potential. But yeah, good points. Well,
Speaker 3 (10:06):
There’s a component of that too, human nature where if I’m a facilities guy and I get this glowing report about my above ceiling penetrations in the one survey, I might ignore it until the next time because it was great. I
Speaker 1 (10:23):
Got to focus on other areas,
Speaker 3 (10:24):
Didn’t even look at it, but I didn’t, I’m not going to anybody telling him, Hey, he wasn’t spending it or she didn’t spend much time on the above ceiling and that’s why we got such a great score. I know the reality is we just put in a new IT system and they punched all kinds of holes up there putting those wires through, but they didn’t look and didn’t find him. So, and my nature is, well, maybe the next guy or gal won’t look either,
Speaker 4 (10:47):
So
Speaker 3 (10:48):
I just focus on the doors or something else. And then this next person comes through and starts looking above all the ceilings and Oh boy.
Speaker 1 (10:55):
So as we, excuse me, take a step back and start thinking about how to develop a programmatic approach, how to develop, let’s call it a roadmap. Where does that begin with? So I mean, for me, as an independent contractor coming in, the first thing I would always do is ask, Hey, can I see a copy of your life safety plans? And that becomes the basis for how we would look at barriers and doors and dampers and all of these things. So maybe talk about the challenges of life safety plans in the hospital environment if you can, and the importance of having ’em accurate to, if that’s going to be the foundation building blocks, maybe
Speaker 3 (11:36):
Let me jump in first, because both of us have been in multiple facilities for different reasons, really because Mickey, as we talked last time, has actually been a surveyor. So he’s been in facilities doing the surveys. I’ve been in facilities managing say 15, 20 facilities across the nation as a contractor. So I’d have to go into every one of those facilities, meet the director, get to know ’em, get to know the building. The shocking thing, the only reason I’m saying all this, the shocking thing to me was how rare it was to find that life safety drawings were not only not up to date, because that is one challenge and I’ll let you go take the challenges thing next, but the other one is they just didn’t have them or know what they were. And it was like I would sit there with my mouth hanging open going, this is the key and this is the first part. And you start there with your surveyor, it’s going to be a bad day.
Speaker 6 (12:31):
You’re already starting off at a disadvantage with that because you’re already starting off with a slowness in the process.
Speaker 2 (12:39):
Yeah, it’s a really bad place to be if you have to hand the surveyor a bad set of life safety prints or I don’t have
Speaker 6 (12:48):
A
Speaker 2 (12:48):
Set of prints because at that point then the surveyor has no choice but to move forward.
Speaker 2 (12:53):
And so one thing that’s going to happen is there’s going to be a call to Chicago, which is the Joint Commission headquarters, and there’s going to be a discussion. Most joint commission surveyors are not qualified, and by the way, they’re not getting paid to create a pair of set of life safety drones when they’re surveying. So your survey is going to be rough. To your point, art, I experienced the same thing on the operation side when I was in facilities and go into a bunch of different places. Number one, have a set of life safety drawings. And if you have the skillset, and most people don’t then review them. If you don’t bring somebody in and get it right, it’s easy to keep ’em right. Once you get a good set, it’s much less expensive, much less invasive. There’s a whole nother reason to have it as well. One, you can eliminate a lot of things that you might have to do if you have things designated as suites, that should be suites. You can eliminate doors, you can eliminate fire barriers and firewalls, different things like that that lessens the work you have to do. But it was commonplace, I don’t remember, probably 40, 50% of the time I was assigning findings because of life safety drawings, either being inaccurate or not having them.
Speaker 1 (14:13):
And it is a challenge. I mean, when you look at the hospital environment and they’re constantly changing usage of areas, they’re changing, Hey, look, renovation projects, tis tenant improvements, all of these things, and it’s in the micro of, oh, we’re only changing this little area over here, or we’re swapping these rooms. But I mean, changing the usage of a room can change. The rating that’s required for a room can change again, the fire and life safety requirements around it. And it’s just this downstream effect. And when you take in, you look at a hospital as a ever evolving, ever changing organism. Organism, and I mean trying to keep up, it is a challenge for ’em, especially if you don’t have someone that you’re tasking to be responsible for making sure that they’re up to date. Because one piece lies in facilities. Another piece lies in, again, the operational elements of the hospital. Another piece is with the construction department and so on, so forth.
Speaker 3 (15:11):
Well, one of the, since we’re talking about preparation for joint commission or processes, Mickey said have one have ’em done right to begin with. But the process after that is key because if you’re the facilities leader, you better know about all the construction, all the changes in occupancies. You ought to know your plans. I mean, ought to ought sometimes. We’ve talked about the scope of a facility. Person’s responsibilities are so large, you get pulled in so many directions, you might neglect some part of that. And if the life safety plans are one of them, you don’t have a process. That process is straightforward, not simple, straightforward. So you talk about construction or changes in as soon as someone touches one of your spaces, it should automatically be written into a contract with whoever’s doing the work that they do. They update the life safety plan so that you have this thing, like you said, living organism. That is a living document and it keeps changing every time if you have this opinion, if you will, we’ve seen a lot of that where somebody’s going to say, once a year, I’m going to have my architect come in and fix the life safety plans for the whole building. Oh my gosh, what an unmanageable task
Speaker 3 (16:29):
And cost.
Speaker 1 (16:31):
So as we look, okay, so we use the life safety plans as a roadmap, and then the next component is the joint commission or life safety inspector is going to come in and do a document review. That be the first thing that they would start doing during a survey.
Speaker 2 (16:46):
Well, the first thing they start doing is they’ll come in and they take off early and they’ll do a route based walk where they go to your main fire panel, your boilers, chillers, generators, bulk storage for your oxygen, what am I missing?
Speaker 3 (17:07):
Surgery suites
Speaker 2 (17:09):
For the
Speaker 3 (17:10):
Pressure relationships.
Speaker 2 (17:12):
So you’ll do that walk, and that’s key to understand the path because they find easy findings. When you’re in a basement, normally a lot of places they don’t have ceilings. So yeah, you’re taking me to your fire pump, but I’m looking up and I’m finding penetrations.
Speaker 1 (17:31):
So that’s how you’re just diving right in and starting to walk. Yeah,
Speaker 2 (17:34):
Immediately
Speaker 1 (17:35):
I’m
Speaker 2 (17:35):
Going to your generator. Is it in hand? Is it being maintained? I’m going to your critical error. Do you have redundancy? Is it being maintained?
Speaker 3 (17:44):
The labeled breaker,
Speaker 2 (17:46):
The label? Yeah, that’s a good one. That’s a
Speaker 3 (17:48):
Simple point. That’s what they do first, we’re using generalizations. Of course, that’s what they’re supposed to do first. Now, every surveyor might have a different, there’s no rule that says, Hey, must do this first, but
Speaker 2 (18:02):
Well, I mean they don’t know that the issue is the rule’s, not publicized. Rule is the wrong word. They are trained because you talked about the variation in survey. They’re trying to eliminate that. It creates good luck with that havoc, right? It does. It creates havoc. So it’s not really a rule, but it’s how they’re trained. But
Speaker 3 (18:23):
How they’re trained, and we hear that, I mean, and we talked last time about ashy and all the ashy literature and all that. They give you all this information that we’re discussing right now, if you care to look it up or get somebody that knows it and you get that stuff, but it doesn’t mean it’s going to happen that way because these people are human beings too, because it’s not a written rule that they have to do it that way. They may modify it because they want to do it differently because they’re more comfortable with something else. So
Speaker 4 (18:51):
You
Speaker 3 (18:51):
Just got to be careful with that. But as a general rule, the first thing they’re going to do is that path that Mickey was talking about.
Speaker 2 (18:59):
So right after that, you go to the executive introductions right after that, this is where it’ll vary a little bit. The surveyor will say, Hey, do you have ORs? Now, the surveyor knows this, right? I’ve got 16 ORs. Okay, do you have a behavioral health? And if you have a behavioral health wing department, the surveyor is going to go to those two places first, because anything to do with pressurization temperature or humidity will result in an automatic, what’s it called when they come back? A shit,
Speaker 3 (19:41):
Revisit it.
Speaker 2 (19:42):
Yeah, automatic revisit. There’s a technical term. I’ve lost it. And so they want to give you an opportunity to get on that, right? So if you’ve had a clean survey everywhere else and you have an OR room out of whack, and you fix that before they surveyor leads, you got a shot
Speaker 1 (20:00):
At them, not coming back
Speaker 2 (20:01):
At them, not coming back, then they’re going to go into the document review. Now I’m going to tie the document review back to an important process. You’ve got all these things they’re going to look for in the document review, fire alarm, fire suppression, all the components, doors, dampers.
Speaker 3 (20:21):
And by the way, none of this is secret,
Speaker 2 (20:22):
Right? It’s all wide open.
Speaker 3 (20:24):
It’s published in documents all over the place, what things you need to have in what order, how to document all that stuff. It’s not like a secret.
Speaker 4 (20:35):
And
Speaker 3 (20:35):
It’s not even hard to find. It’s just that’s exactly the way they go through it too. It’s not a joke.
Speaker 2 (20:42):
So from a programmatic standpoint though, you’re going to want to get all of that into your computerized maintenance management system, CMMS. And the reason why you’re doing that is so that every month things come out that says, Hey Danielle, you got to do 1, 2, 3, 4, 5, right? To make sure that you get the test done.
Speaker 3 (21:05):
And the beauty is you design and program that CMMS to match the NFPA requirements, or if it’s not an NFPA, if it’s some other regulation you’re following, you can design your system to have the work order come up at the right time, the right place, and then what you do, how do you document it? And all those things can be done. Now you don’t have to put it in a cms. CMMS is a right.
Speaker 2 (21:30):
That’s true.
Speaker 3 (21:31):
It’s again, back to the finances, back to time, back to how much time you can spend doing things. Now, I think we would agree, we don’t agree on much, but I think we would agree that would be a absolute necessity to have a very well designed and programmed CMMS. It’s just not required. Don’t get me
Speaker 2 (21:51):
Wrong. You could do it on a whiteboard, you could do it on a chalkboard, you could do it on an Excel spreadsheet. The issue is you got to upkeep that. So you got to upkeep A-C-M-M-S too. But it just makes things so much easier.
Speaker 6 (22:03):
I love a good list. Checking off list
Speaker 2 (22:06):
Doesn’t make you feel good. It’s
Speaker 6 (22:08):
One of my favorite things in the whole world. That’s right.
Speaker 2 (22:11):
Mine too. Alright, so if you do that, then the next thing you need to do is you get all this work done. Now you need to have a system to organize the work. So are you going to put it in binders? Are you going to try to do it electronically? More people are trying to do it electronically. I had two or three survey, not two surveys where I had people that did their document review completely electronic. One of them was the coolest thing I’ve ever seen. And one of them, it was a train rack. And my advice there is, if you’re going to do your document review electronic, make sure you’re only showing the surveyor what you’re supposed to show the surveyor. Don’t open up a system where the surveyor can read all this stuff and start asking a bunch of other questions. Remember, most people that are surveyors now have experience in facilities. Most of them know what they’re doing. So if you show ’em things you’re not supposed to show ’em or you don’t need to show ’em, and there are issues that are obvious, you’re going to get findings and they’re going to start pulling on the strings. So I did a lot of coaching with the individual that showed me the electronic CMMS and document review. He didn’t necessarily get a lot of findings. It was just sloppy. It was like, look, you don’t need to show me this. Just generate your report with this.
Speaker 1 (23:35):
Yeah. Just out of curiosity, what would you two guys both prefer the wall of binders or the digital given today if you were in there doing it right now, just out of curiosity.
Speaker 6 (23:47):
That’s a great question.
Speaker 3 (23:48):
Yeah. Well, being the age I am, we won’t tell you. We won’t tell you. I would tend towards the wall of binders providing it’s done right and up to date, because that can be just as much of a disaster if not a total train wreck like you were talking about. Because if they’re not up to date or if you think you’re going to play the game of being like, oh, moving this stuff around, see how long we can take to make this surveyor sit here and not get into the building tour and just take up all this time, it doesn’t work anymore. I mean, I want to say, because I’ve been doing this a couple years back in the day, that was a great strategy because you keep ’em busy for two hours looking at documents because you were just going to shuffling around and moving, oh, this book, oh, it’s in here and you’re flipping pages and all this stuff. What really impresses them is if it’s the book, the wall of binders and you flip through it and you’re golden and you can show ’em what they’re looking for. But it’s hard because somebody, it’s almost like a trade off. You’ve got the person that’s going to have to manage this whole book of binders or wall of binders or a person that’s going to have to manage the CMMS.
Speaker 3 (25:06):
It might be less if it’s the CMMS as far as people time, maybe not. We could argue about that I guess all day. But the book of binders seems, it’s like you can touch, you can touch and hold onto, and you’re not sitting there waiting for the computer to blow up on you and you’re searching for something and the surveyor’s sitting there and that is really uncomfortable. Oh, the system’s down. Or Oh, you click the wrong button and you’re back and forth and that kind of stuff. So that’s why it’s kind of more comfortable for the binders. But I would really like to move to the, if myself, if I was in charge of this thing in some place, I would be pushing everybody to move to the electronic.
Speaker 4 (25:43):
Even
Speaker 3 (25:43):
Though personally, the side story is I told my daughter I’m doing a podcast. And she went like, what? I said, your dad’s not that old god sake. She got all embarrassed and blushed and everything. It’s like, oh my God.
Speaker 2 (25:58):
Yeah, she made fun of me too. What about you? Well, I’ve been a part of a lot of software development, and what I’ve found is unless you can really tell someone how to build exactly what you want, you end up getting a mess. So I would start with books, get it right, and then I would move to trying to, and here’s the other thing. I wouldn’t use the CMS CMMS. I would go to a different software platform so I could control the information.
Speaker 1 (26:34):
Well, that’ll be an interesting, we’ll have to revisit this in our next podcast where we talk about insourcing versus outsourcing,
Speaker 2 (26:41):
Because
Speaker 1 (26:41):
I think that’s a huge component of it. What capabilities do you have to be able to do it
Speaker 3 (26:47):
Versus
Speaker 1 (26:48):
If you’re insourcing it or outsourcing it? Exactly.
Speaker 3 (26:52):
I totally forgot what Mickey just was, I think alluding to, he didn’t say, what I would’ve said is you have these off the shelf software programs. CMMS is that the sales person will tell you is going to do everything for you, and it works seamlessly and all that and not one. And that’s what I think you were referring to. We’ve used every brand, every model through my career into every thing I can think of. And not one was really that way.
Speaker 5 (27:20):
And
Speaker 3 (27:20):
It took a monumental effort to get it into the right shape to meet that. Yeah.
Speaker 2 (27:25):
Yeah, there’s that. And now we will talk about hacks later on, just how to make things better. One of the things that I would do immediately upon arriving at a facility is I would either identify someone or hire someone who had an interest in life safety, and I would immediately start teaching them the codes and the requirements for all the joint commission elements of performance, whether are DMV or the state or whatever it is. And there’s little unique differences that are important. And you may have the joint commission, you may have state, you may have county, you may have city, right? You don’t know. It depends on the area. But I would begin teaching them this because what you want to do is to create a system where it doesn’t consume all of your time as the facility leader, that you have to handle all of this documentation that you have to make sure that everything gets done. It’s your ultimate responsibility, but you need to create a system.
Speaker 3 (28:24):
And I think one of the best systems that we ever put together in our careers was in one of our facilities. We got to the point where Mickey was the director of facilities, and then we had people that had that responsibility and were at that point, highly trained into the code. Of course, we had all the code books handy, all that stuff was there. And Mickey’s role at that point was review
Speaker 2 (28:48):
On
Speaker 3 (28:48):
A monthly basis.
Speaker 2 (28:49):
Exactly.
Speaker 3 (28:49):
Just to look at it, kind of like doing a survey, although he wasn’t a surveyor yet, but doing a survey of your stuff once a month, that was his responsibility. It was put together by somebody else and they sat there in front of him shaking, here it is for the month. They get it. All right.
Speaker 2 (29:06):
But
Speaker 3 (29:06):
They cared.
Speaker 2 (29:07):
Yeah. And part of that was you wanted to make sure the test got done or inspection, there’s failures. Did they get repaired? Did you do an ILSM? Did you fix retest? Right. Just that circle and getting them to understand the components of that, and I LSMs are complicated, but they’re necessary just because you do an IL, just because you do the assessment doesn’t mean you have an activity you have to do, but you’ve got to show that you did that evaluation and it’s better. It’s so much better. And I’ve learned this throughout my career, passing knowledge on and building people up, and I’ll try not to cover it twice, but in the hacks, one of the things that surveyors love to do is walk with people that are learning. So the best thing you can do, so you’re going to have a cart and you’re going to have a set of plans and you’re going to have a ladder. You’re going to have somebody pushing that cart, have the person that you’re training there one, so they can get used to what the survey experience is, but two, have them talk to that joint commission surveyor and tell them their story. It’s amazing how they make that connection. And then the surveyor becomes a teacher in the middle of the survey.
Speaker 1 (30:22):
So as art said, Hey, once they get ready to go out and start doing the walk. So I got two questions for you guys. Number one, how much does the document review affect what they’re going to walk and look for? And then number two, what are those things when that surveyor me, when that surveyor goes out, man, they’re looking for this, right? So you get ready and they’re taken off and they leave your wall of binder room and again, so the first part of the question is relative to what they saw during the document review. And then the second is just high level man as they’re going through, what’s going through the surveyor’s head, do you think?
Speaker 3 (31:06):
Yeah. Well one of the things that I was trying to remember, you were trying to remember what the term is that I don’t remember what it was you were trying to remember earlier, but there’s these terms that they use and you forget ’em over time. They get overused and they stop using ’em because it was no fun anymore because everybody understood what they were saying. And basically, I forgot this term and I was trying to remember it today, but it means they go out and look to validate what they see out there with what they read. Basically, does what you see match what you were told? And there was this term they used
Speaker 2 (31:42):
And this isn’t it, but reconciliation comes to
Speaker 3 (31:44):
Mind. Yeah, it’s that. But they had this term where they would say the visual inspection matched the things we saw on paper. So that’s what they’re doing. They’re going out. You said, let’s just pretend you said we have a perfect system to make sure none of our penetrations are ever there. We inspect them all daily and no one ever punch it in and we got the system in. So he’s going to go out and verify that that’s what’s there to see what you said is true. And then they do that constantly looking to verify what you say you’re doing is actually being done, or they go up and look above the wall and you say, oh yeah, we knew about that. We have a work order. You may go back and say, show me the work order, verify that that’s true, that it’s really doing that.
Speaker 2 (32:29):
And my response would be in terms of the document review and my experience matches either being the director being surveyed or the surveyor surveying me personally as a surveyor, if your document review is sloppy, it agitated me and it gave me the impression that you weren’t bought in on what I think is the main focus of your job, keeping your patients safe and visitors and staff. When it was right, the surveyor seemed to relax and it gave the surveyor an impression that you know what you’re doing, you’re organized. You’ve got a programmatic approach. Now I want to see if it matches out in the field. You show ’em a pile of junk when they go out there to Arch point, they’re expecting to see a pile of junk in your building.
Speaker 3 (33:24):
And it’s usually true,
Speaker 2 (33:25):
And it’s usually true. Now to the second part of your question, you’re out. You’re doing the building tour. Well, there’s multiple types of findings, but there’s life safety findings and then there’s environment care findings. Focus on those two. A lot of surveyors fund a lot of environment care findings. The title of your job at the Joint Commission is life Safety code surveyor. And I remember going to training and they talked about this. They said, environment of care findings are great. CMS is looking at life safety code findings. So the joint commission is pushing the surveyors, find penetrations, find door issues, find sprinkler obstruction issues. They’re pushing them. And so I shifted the way that I surveyed based on the training that I went through to say, I’m going to check these boxes for sure. I’m going to find the environment of care stuff. When you find a breaker, if it’s just a mislabeled breaker or a not labeled breaker, that’s environment of care. If it’s the breaker for your main fire alarm panel and it’s not on the life safety branch, then that’s a life safety issue. So there’s different semantics that you need to know, but the life safety code surveyors are supposed to focus on life safety issues, life safety drawings. Are they accurate? Do they have suites listed on ’em? Do they have the barrier walls and all of that.
Speaker 1 (34:55):
So as they go throughout there, and so we’ve sort of talked about the life cycle of what this is going to look like. So I think people would be super interested in would be what you had said before the hacks, right? So as you look at that, maybe if you had someone new coming in that job, what are the two or three things you’re going to recommend to them? We’ll call hacks in terms of, Hey, this is going to lead to the best possible result that you’re going to have for your survey. I think
Speaker 3 (35:26):
We said it already. Go ahead.
Speaker 6 (35:27):
I was just going to say, because a lot of the times they’re walking into a pile of just stuff to get done and they’re not quite sure where to start.
Speaker 3 (35:35):
Right. Well, I mean, it’s not the hack I would say. I mean, I would reiterate the same thing over and over that Mickey stated right at the beginning, see what you got, organize it and make a plan to take care of those major things.
Speaker 2 (35:50):
Get funding.
Speaker 3 (35:51):
That’s not a hack necessarily. That’s the ABCs. You’ve got to do that first, and then you can start looking at the hacks or things that you can do quickly or whatever. But that first part, and set up that process, whether it’s the wall of binders, the CMMS, whatever it is you’re going to do, get that lined up and get it started. Because without that, and Mickey just, I heard him in the background, said funding. I mean, we could hit this all day long and we could talk about it forever, but none of us ever had enough money earlier on. Mickey said, you hire somebody, good luck with that. Unless you’re trading out somebody because your CFO is going to say Uhuh. Unless we’re going to talk about that someday too. But that is the toughest part. We go ahead with the
Speaker 2 (36:43):
No, and I didn’t at the place where art and I was at, I didn’t hire somebody. I found somebody and then I trained him. And you have to, he was actually a general maintenance mechanic, but he showed promise and he showed interest. And so over time I was able to build a business case that we should do this.
Speaker 3 (37:05):
And that’s kind of a hack. I mean if you want to go that way is you repurpose people within your organization, because I’m sure you can’t imagine this, but not everybody’s as productive as they can be at work. Everybody’s always working at the top level. They’ve always can work at, right?
Speaker 6 (37:24):
100% one day in and
Speaker 3 (37:25):
Day out, day in and day out. There’s never any waste. There’s never any off time. So one of those hacks is you determine that you got, however you find that out where the people are that have extra time or aren’t productive, and it’s a motivation factor for some maybe. We’ve always had somebody in our team, and again, I can think of a thousand different examples, but he always had somebody in our team that was a really good person, wanted to be there, liked their job, but they didn’t do much. They had all the excuses or they just didn’t do their job very much because they had a bad attitude about maybe they were there 20 years, maybe they’re 10 years, but they just got soured with the environment or something. And you found out first. That’s the first thing you find out is there comes tattles on ’em, right? There’s guys a waste of time, blah, blah, blah, blah, that kind of stuff. So you go down that road and what do you want to do?
Speaker 4 (38:20):
Fire
Speaker 3 (38:21):
’em, right? You want to get rid, you got a body
Speaker 4 (38:23):
That’s
Speaker 3 (38:24):
Taking up space, is not doing anything. But then you find out this is the person who knows the most about the building and you can motivate them to take on this role. If you can figure those kinds of things out. Now, you might not always find that kind of an individual, but you might find the hole that you can use to fill and get the person and moving people around. So that’s kind of a hack, if you will, in that regard.
Speaker 2 (38:43):
Yeah, we can do a whole podcast on how smart the people that actually work in facilities are and how, I mean, I used to love walking with them and understanding what they know and then having what do you want to be when you grow up and finding a place for ’em. But going back to the surveyors showing up and what do you do? So we used to have advanced teams and we would have trail teams, and so you’re going to have a group walking with a surveyor. I always kept that as small as I could. It was usually me. It was usually the young, not necessarily young, but the hungry person that was learning. And then sometimes you’d have to have an administrator come along.
Speaker 3 (39:25):
Why are you shaking your head like that? Because
Speaker 2 (39:27):
Was I was
Speaker 3 (39:28):
There, it
Speaker 2 (39:29):
Was aggravating as hell. What are
Speaker 3 (39:31):
You shaking your head like that
Speaker 2 (39:31):
For? You’ve got in the way, rolling your eyes in the way in the way, right? Lemme do my work. Alright guys. Alright, back up. But essentially you got a radio and they find a penetration and well, I’m sorry, your advanced team, you know the route, they’re not going into patient rooms, they’re walking the perimeter of the floor, they’re checking the fire doors, the cross corridor doors and the fire doors and the stairwell. Have your advanced team check it when you’re doing your document review, send your guys up to the A floor. Get started, right? Look for obvious findings.
Speaker 3 (40:06):
That’s part of the hack too. Yeah, the hack. Well, part of the hack is knowing the route ahead of time. Top down, right?
Speaker 2 (40:12):
Top down. And then if you do miss something and you get a finding, have your trail team fix it. Take a picture, take it to the surveyor. Surveyors aren’t allowed to use pictures as evidence as something compliant, but I tell you what it does do, it puts that thing in the mind of the surveyor like, damn, these people aren’t playing around.
Speaker 2 (40:32):
So now you’re building that credibility with the surveyor. The other thing people, you said surveyors are people ask ’em questions. The whole idea about the person that’s learning, that’s going with you, talking to the surveyor, they love the idea of that person answering the question. And you know what? Surveyor asks a question and you’re the director and you answer it wrong. That’s not good. But the person that’s, Danielle, you’re walking with me and I introduce you as you’re learning and they ask you a question and you get it wrong, they go, well, let me explain that. That’s a great answer, but let me explain. 1, 2, 3, 4, 5, right? It goes over well.
Speaker 1 (41:08):
Yeah. So to that point, codes and standards are interpretive, right? I mean they are and they disagree with each other in lots of places. And so when you’re walking with that surveyor, how much do you push back? Confrontational.
Speaker 3 (41:25):
Oh, you get into no, you go right into arguing around with them. You jump up and down and start screaming. This is why you
Speaker 1 (41:30):
Didn’t want him with you. Right?
Speaker 3 (41:31):
Exactly.
Speaker 6 (41:33):
See, I’d have to keep myself in check. I can get a bit sassy sometimes
Speaker 2 (41:37):
It does. You no good to you should state your case, right? You also have to read people. Some surveyors are more confident than others, some surveyors are more engaging. Those are the ones you can have a little bit more conversation with. If you find somebody that’s got it, they’re insecure and they’re quick to take offense, then I would state my case. And then I might say, if we still disagree, and I’d say, listen, no disrespect, but can we ask S for an interpretation? The standards. Standards and
Speaker 3 (42:10):
Interpretation group,
Speaker 2 (42:11):
Thank you. Standards interpretation group. Now, if the person’s insecure, they may be pissy with you. You always have the ability after a survey to challenge a finding. And I’ll tell you now, back when I was surveying all the time, I would survey someplace in Massachusetts, I’d be in Colorado the next week. I’d get a phone call, they would explain to me the challenge, and I remember distinctly going, I don’t know what I was thinking. Get rid of that. And that’s it. They don’t give you a hard time about it. They just release the finding. So there’s no backlash from that. You’ll find administrators because they’re so freaking, and I was an administrator, and so I’m messing with him because I like to mess with him. But they’re so risk averse. Don’t say anything to the surveyor. Don’t push back on the joint commission. No, you’re paying them. If you’re building safe and you believe it’s safe, then you should be able to challenge.
Speaker 3 (43:09):
Yeah, I mean, I can remember maybe one time in my entire career where, I mean I got my panties all in a wad because I knew the surveyor was wrong. I mean, I knew they were wrong. And so I did the whole thing. I mean, I told them why I thought they were wrong at that time. We didn’t have the phone call to sig. You had to send in all this stuff. So I went through all that stuff and in the end, I won my case. I had the finding removed and I thought afterwards, I said, why? Because I had 20 findings. So I got one removed, I won. But why did I go through all that to have this one finding removed? And it was just a technicality and your STO codes and standards interpretation thing, and you read it and it said in the back of the things in the index aren’t codes, they’re just suggestions. Well, the surveyor was enforcing a suggestion, so I won the thing. But why?
Speaker 2 (44:10):
Right now what’s interesting, and I don’t know if you remember the whole deal with the smoke detectors that were three foot with the, was it AMP that was a supplemental in the appendix or something? If you’re dealing with the state, good luck. Good luck. One of the reasons why I like the Joint Commission is they are trying to educate and they want the facility to be safe. They do talk at co in training, in conversations with your leaders. They talk about not over surveying. What’s the intent. So whether all surveyors take that and do it that way, who knows?
Speaker 1 (45:01):
Yeah, no, this is great. Just in the interest of time and not making this thing run on for a couple hours. I think we are sort of at that mark now. So if we think about the key takeaways that you would want to impart upon someone who is new to the job or going through it and just wants to learn from some guys that have got some pretty lengthy experience from what I heard is, Hey, look, it starts with a good set of life safety plans. That’s the beginning roadmap to go out there. Then moving into knowing what that path is going to be and making sure that hey, at least as they’re going to walk that initial path before they come into the document review portion, you’ve got those areas chunked away on, and then you had said temperature, humidity, and pressurization and just making sure that all that critical is online and is where it should be. Right? Then it was the document review being organized, being highly organized, having the wall binders that looks good, knows where things are at or on the computer. And then we’re going to expand upon that with the next topic, which is insourcing and outsourcing that might have some effect on that.
Speaker 1 (46:22):
And then getting down into the building tour.
Speaker 3 (46:27):
I don’t think we spent a lot of time on both critical air and water management. I mean that’s in the document review, but it’s hot topics. I mean it’s really hot. I mean it always has been really, once they started, it became like fire doors. I mean fire doors at one time. It was always in the code, but they never surveyed it. Well, then the joint commission got gigged by CMS center for Medicare Medicaid services that you aren’t looking at fire doors like you’re supposed to because they were doing follow-up surveys and finding these things wrong that the surveyor for joint commission didn’t find. Right. So that became in the hot topic, and that’s where fire doors have become this just most important thing you’re doing in your facilities. So those kind of things you just need to know upfront. And Mickey talked about that first few, the first hour, first 30 minutes. We didn’t quote every place they go directly because I don’t have it in front of me and I don’t remember this story, but look at that and make sure those things are ready. That breakers marked and labeled the generators in auto, the
Speaker 2 (47:33):
Fire
Speaker 1 (47:33):
Pumps
Speaker 3 (47:33):
And auto fire pumps and auto, those kind of things where they go first. And one of those things is wrong, can be, what’s it called? The immediate,
Speaker 2 (47:43):
Immediate threat to life. Yeah,
Speaker 3 (47:44):
Immediate threat to life. And you’re on the entire survey, not just life safety survey in your facility. The entire survey is now a mess. I mean, you just destroyed the whole thing. They’re going to put you in a headlock basically.
Speaker 2 (47:58):
Yeah, and I’ll add two things, Kirk. One is we talked about Ashe and understanding the requirements. Grad is a great place to go to get the list of things that you need to do. You just go to the issue website, they’ll give you the, and actually the joint commission website, it’s all, nobody’s trying to hide anything. So you understand what you need to do and then get your plan, whether you use a contractor to do it or you think you have the skills to do it, get a list of what’s wrong, assign funding, communicate to your administration team and agree on how much when’s the funding coming out and how fast you’re going to be able to get it done. And also, here’s a big thing, the discussion around, Hey, what’s the risk if we don’t do this? Okay, I’ve got a compressor on my critical air system is not working. I need $30,000 to fix it. Well, what if we don’t do that? Okay, well let me explain it to you. Right? It’s not good, right? Oh yeah. Now you’re talking about that immediate threat to life thing. It can go that high.
Speaker 3 (49:00):
And we talked a little bit about CMS and we really didn’t go down the corrective part of that. We did the
Speaker 2 (49:07):
Escalations,
Speaker 3 (49:08):
The preventative, if you call it that side. And one of the hacks, if you will, that I’ve always had with the surveyors, you can’t get everything fixed all the time as fast as you want to. You might have a door out of place, you might have a hole in a wall or a ceiling tile out of place. But if you have all that stuff listed in your CMS as a corrective measure and you can show the joint commission surveyor, it’s on the list and it’s going to be done within 30 days, it basically washes it out.
Speaker 4 (49:35):
I
Speaker 3 (49:35):
Mean, that’s something we didn’t talk about, but that’s another key keys, a tool in your tool belt to take care of some of the stuff that you know is there, but you’re never going to get it done before they get there because, and there’s all kinds of other things, like long-term, it’s going to take a year to fix this one corridor that’s a dead end corridor. But we got a plan, we got a budget.
Speaker 2 (49:57):
That’s
Speaker 3 (49:57):
All there and ready. You
Speaker 2 (49:58):
Got an ILS in, how are we doing on time?
Speaker 1 (50:01):
A couple more minutes. And I think just one last point on that, and that is that it’s interesting they publish their top 10 list of findings.
Speaker 5 (50:08):
That’s
Speaker 2 (50:09):
Right,
Speaker 1 (50:09):
Sure. Do they do? So I mean, you know that this is, let’s say for 2023, what people are getting cited on. And when you look at the historical year over year, the list doesn’t change a lot from year to year,
Speaker 2 (50:22):
Right? Doesn’t it?
Speaker 1 (50:23):
No. And I do think it’s momentum in there sort of begets more momentum because when you mentioned doors, right? Well then when the fire doors are getting cited at such a high rate, then every survey is, well, fire doors must be bad in facilities. I need to go really pay more attention to ’em. So it just makes it, it’s like the snowball effect, right?
Speaker 2 (50:41):
See, that’s actually a great point. So go back to setting expectations for administrators. One of the things I used to do, I used to work for Sodexo. I traveled around the country and so I would go into places where they were having trouble with accounts, and the first thing that I would do is I would grab the CEO or COO and I’d walk with them. And the reason why I would do that, it’s one, let ’em bitch at me. But two, it would be like, okay, you see that fire door, it was fixed two hours ago, somebody hit it with a cart. Part of the reason why you’re always going to have fire door findings, you’re always going to have penetration findings and multiple other things is because it’s a living organism. Most hospitals operate 24 7. Most hospitals have people delivering things in the hallway with carts and very heavy things and things. They punch holes in walls by accident. They drive carts in the walls. And so you want to explain, look, all the doors were done, they’re all fixed. You’re going to find some in the building tool.
Speaker 1 (51:46):
Yeah, for sure. Alright, and with that, let’s wrap it up. In next podcast, we’re going to be talking about insourcing versus outsourcing. So it should dovetail along with this, well, as we talked about preparing and then we go looking at the challenges of taking different areas and attacking ’em. I mean, that’s pretty much the two generic approaches as we look to do that. So
Speaker 2 (52:11):
Yeah, very good.
Speaker 1 (52:12):
We’re excited and that’ll be for our next podcast, so fantastic. With that, we thank you all.
Speaker 2 (52:16):
Yeah,
Speaker 1 (52:16):
Thanks. Thank you for hanging out with us on FM After Hours. Make sure you follow us on all of our social media platforms for your regular dose of Facility insights. As always, a big shout out to remediate for their gracious sponsorship. Catch you next time on FM after hours.