FGI Bulletin #11

2022 Guidelines Proposal Period: Going….Going…(Almost) Gone!

Now that spring has arrived, can you picture this? You’re relaxing on a beautiful, crisp Sunday morning sipping a cup of coffee. Birds are chirping, flowers are blooming, and in your hand sits a little light reading: the 2018 FGI Guidelines. Okay, maybe that’s not light reading (or your ideal Sunday morning). Still, your moment of serenity ends abruptly when you notice a section in the Guidelines that doesn’t seem right. Trying to reclaim your zen-like mindset, you grab the nearby pencil that was meant for the crossword and begin scribbling notes in the margins of the Guidelines. Can you see it? We can too—but only for the briefest time.

Midnight on June 30th marks the deadline for turning those carefully crafted notes into proposals for change to the 2018 Guidelines for Design and Construction documents. Once the proposal period ends, no new text suggestions for the 2022 edition will be accepted. When the drafts of the 2022 Guidelines documents are released in 2020, comments are only permitted on text that was suggested during the proposal period. In other words, now is the time.

We assure you the new submission process is quite painless. What will take only a few moments of your time could have a tremendously positive impact on future health care facilities. If you are new to the revision process, we offer detailed instructions as well as helpful tips for writing proposals (available as written text and video tutorials) at www.fgiguidelines.net.

The following edition of the Guidelines won’t be released until 2026, so don’t miss this opportunity. You’ve got exactly five Sundays left to turn your thoughts into action.

FGI Guidelines: A Word to the Wise

“Must all existing facilities comply with the Guidelines once they are adopted?”

“Doesn’t adoption of the Guidelines immediately mean running the risk of having existing facilities out of compliance?”

These are two questions we at FGI are asked time and again. Here, we offer answers to these questions, as well as responses to frequent follow-up concerns. The Guidelines for Design and Construction documents are written for new construction and major renovation or replacement work in an existing facility. They are not meant to be applied retroactively to a project that is complete or was started under a different set of building codes or standards, including previous Guidelines editions.

What constitutes new construction?

Section 1.1-2 (New Construction) of the Guidelines addresses new construction in all three documents (hospital; outpatient facilities; and residential health, care, and support facilities). Projects with any of the following scopes of work are considered to be new construction and must comply with the requirements in the Guidelines once adopted:

1. Site preparation for and construction of entirely new structures and systems
2. Structural additions to existing facilities that result in an increase of occupied floor area
3. Change in function in an existing space

How do the Guidelines apply to renovations?

If renovation or replacement work is done in an existing facility, the Guidelines work in conjunction with local, state, and federal codes. Major renovation projects are defined in the Guidelines as projects with either of the following scopes of work:

1. A series of planned changes and updates to the physical plant of an existing facility
2. A renovation project that includes modification of an entire building or an entire area in a building to accommodate a new use or occupancy.”

In addition, a building that’s being converted from one occupancy type to another also needs to meet the requirements for new construction.

Only part of the building is being renovated. Must we apply the Guidelines to the entire building?

No. In renovation projects and additions to existing facilities, only that portion of the total facility affected by the project needs to comply with applicable sections of the Guidelines. Further, only the altered, renovated, or modernized portion of an existing building system or individual component has to meet the installation and equipment requirements.

What about minor renovations?

Minor renovation or replacement work is allowed to be exempted from the requirements in the Guidelines, provided they don’t reduce the level of health and safety in an existing facility. However, the decision ultimately lies with the authority having jurisdiction (AHJ), so it’s always best to discuss any project with your AHJ early in the design process.

When is a waiver in order?

When parts of an existing facility essential to continued overall facility operation are unable to meet particular standards during a renovation project, a temporary waiver of those standards may be sought from the AHJ as long as patient care and safety will not be jeopardized as a result.

Further, in the section titled “Uses of this Document,” the following statement appears:

Authorities adopting the Guidelines should encourage design innovation and grant exceptions where the intent of the standards is met. These standards assume that appropriate architectural and engineering practice and compliance with applicable codes will be observed as part of normal professional service.

2022 HGRC Kicks Off with In-Person Meeting

The 2022 Health Guidelines Revision Committee (HGRC) held its first in-person meeting April 4-5, 2019, in St. Louis. The HGRC is the collaborative, multidisciplinary body of volunteers responsible for updating the Guidelines for Design and Construction and is subdivided into residential, outpatient, and hospital document groups. While most of the work reviewing requirements in the Guidelines and proposing new and revised text is done via teleconferencing, the full HGRC typically meets once per year during the Guidelines revision cycle to discuss new trends and technologies in health care design, align requirements across the three documents where possible, and educate and mentor members of the committee.

During this meeting of the HGRC, committee members discussed issues as wide ranging as telemedicine, palliative care, behavioral health, acoustics, rural hospitals, kitchens in residential facilities, and acoustic conditions in NICUs. Task groups were formed to complement the standing document groups (hospital, outpatient, and residential) and 2022 topic groups (acoustics, behavioral health; behavioral health in the emergency department; resiliency and business continuity; inclusive environments; infection prevention and control; lighting; medical gas outlets/nurse call/receptacles; palliative care; and rural health).

Cross-pollination of ideas and sharing of experiences is critical to ensuring the Guidelines remain relevant and current. As such, education is an important component of these meetings and presentations on issues of the day are built into the structure. This year’s meeting offered two presentations addressing issues currently faced by health care organizations: facility planning for security and active shooter situations (courtesy Ed Browne and the International Association for Healthcare Security and Safety) and the implications of CMS’s decision to require a window in all patient rooms (presented by Enrique Unanue), thus prohibiting interior placement of patient rooms.

A third presentation was also given by Man Made Music (MMM) on the concept of sonic humanism as a way to improve health and wellness through sound and music. Founded by composer and producer Joel Beckerman, MMM is a global “sonic studio” dedicated to solving human and business challenges through powerful music-driven experiences. Their presentation focused on a growing area of MMM’s practice that is dedicated to developing sound and audio-based solutions to combat the rise of harmful noise and bad sound. Evidence continues to emerge that noise is putting patients (and non-patients) at risk for poor sleep, rising blood pressure levels, and cardiovascular disease. Issues of concern that were covered included alarm fatigue, patient recovery, and motivation soundscape for rehabilitation therapy.

The next in-person meeting will take place March 31-April 2, 2020. At that time, the committee will make final determinations on proposals submitted for change to the 2018 Guidelines documents. The draft of the 2022 Guidelines for hospitals, outpatient facilities, and residential facilities will be released to the public in summer 2020.