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Commissioning of New and Extended facilities

"Commissioning is a systematic process of assuring by verification and documentation, from the design phase to a minimum of one year after construction, that all building facility systems perform interactively in accordance with the design documentation and intent, and in accordance with the hospital’s operational needs, including preparation of operation personnel" (Ellis, 2003, p. 1).

This definition of commissioning addresses the traditional concept of commissioning a new hospital facility or extension to an existing facility, but as health care has developed, the need for standards and high quality has increased. Vivalon Global Health's processes address all concepts required to make a facility operational. A properly commissioned building still does not incorporate the high-tech equipment typically found in hospitals, the expertise required to manage, maintain and provide health care services, or the policies, procedures and other documentation odf the organisation required to make it functional. Commissioning, from our perspective, should include all aspects required before the first patient enters the system.

A commissioning process should start as early as the design process of the facility, and extend into admission of the first patient. The following tasks are part of the commissioning consultancy:

  • Assist in the development and defining the hospital design criteria
  • Evaluate the design for conformance to criteria
  • Develop verification tests, if not available, and perform and document these tests
  • Prepare system documentation
  • Prepare a final report
  • Prepare preventative maintenance programs
  • Implement operator training programs.

It is typical for organisations to build basic operator training into contracts with vendors of equipment, but it is essential to ensure that training is documented, verified, and that staff can actually operate the equipment proficiently. The same principle applies to the engineering and biomedical engineering departments, where staff need to understand the composition, working and basic maintenance systems and equipment.

In many cases, vendors may be asked to have verification tests performed by a third party or objective specialist in the specific area, and provide the organisation with the required certification. When a hospital has been operational beyond the first year and the original vendors cannot be contacted, verification must be undertaken by the manager of the facility through a qualified specialist. Ideally, a commissioning consultant will provide vendors and contractors with the specifications and list of required certifications during the design phase, so that the necessary documentation can be done concurrently with the construction phase.

Documentation related to commissioning forms the core, or backbone for the organisation. These documents will always be required by accreditation organisations or by new vendors when upgrades or changes to existing systems are necessary. Policies and procedures, systems and processes that are referred to in this document, are often available from the internet, or through well-established accredited organisations. Most important to remember, is that no policy or procedure written for one organisation, can be used unchanged in another facility. Every document that an organisation presents as its own, has to be customised to fit the particular situation.

Commissioning has various benefits, of which the following are a few:

  • The process of commissioning eases the transition from construction to occupancy. Construction contractors and providers of building systems such as electricity, plumbing, Heating Ventilation and Air Conditioning (HVAC), etc. will always allow a 1 or 2 year period (break-in period) to facilitate hiccups which may occur in their systems. Hospitals cannot afford this break-in period, and need the facility to function optimally when the first patient is admitted.
  • Commissioned buildings have the assurance that systems work as intended. When training is part of the package, there is the assurance that systems can be managed optimally by its own staff from day one.
  • The operator training programme of commissioning helps to ensure good environmental conditions, well-functioning equipment and familiarity with providing care to patients.
  • The commissioning phase also allows for staff to do dry-runs in the facility for specific procedures, so that actual patients are treated seamlessly, and without hiccups.
  • Documents can be fine-tuned to fit actual workable processes. This will prevent revising new documents when opening.
  • Commissioning provides the foundation for future operations in the hospital, as it guides the staff through the various processes required, and ensures that regular updates, reviews, maintenance plans, audits, etcetera will take place.