Environmental Business Council of New England July 27, 2005 Robert Castaldo Director, EH&S Massachusetts General Hospital Boston, 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 external o Fire Safety Management o Life Safety Management o 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