Jason: Welcome to the latest episode of the Construction Insiders podcast, where our host, Jessica Busch, talks with industry experts about new trends, best practices, and how to successfully deliver construction projects in today’s market. Whatever your role on a project, we think you’ll find these discussions interesting and worth your time.
Jessica: Alright, well thank you Jason. Today we are back to talk about what is going on in the healthcare industry. As everyone can imagine there is a lot from the project management side to the MEP side that we’re going to dive into today, cost management. Everyone wants to know what is going on with healthcare, the buildings and how we can move them forward for our needs as this world tries to move forward.
Today we brought in two guests. Our first guest is Zair Sheema. He is one of Cumming’s highly skilled leaders from our MEP division. He also specializes in everything related to HVAC, plumbing, fire protection, energy systems, all of that that falls under the MEP umbrella. He is also an accomplished project management and cost management professional. So we couldn’t think of someone better from our own team to bring into this discussion on healthcare and its systems. In addition today, we have Gary Hamilton, the Senior Vice President and healthcare leader with WSP USA. He is not only a published author, but obviously a well-known thought leader throughout the healthcare industry. And with more than two decades of experience, he is someone that we couldn’t pass up for this conversation and couldn’t think of two better professionals to discuss building systems and all the needs for changes in the healthcare facilities today as we go forward. Without wasting too much more of anyone’s time, Zair I would love to hand it over to you. I know you have thoughts and questions for Gary lined up and go for it.
Zair: Thank you Jessica. And thank you Gary for taking time out of your schedule, for being with us today. I know you were recently named fellow member for Marketing Society of Healthcare Engineers. Congratulations on that.
Gary: Thank you. Thank you. Appreciate it.
Zair: Before we jump into our topic, I would like to talk about your background a little bit. How you got into mechanical engineering and what influenced you later on to specialize in healthcare.
Gary: It’s funny you say that. Sometimes they say the start should be the end. My guide into healthcare started with a bike accident that I had when I was 18 years old. Having that experience, being in the hospital for 3 months, and doing a surgery, which during that surgery my foot got infected based on the air flow condition within the space. So I experienced the bad side of the healthcare system. That was my first exposure to healthcare. During that time, I actually was accepted to do civil engineering in Trinidad. In the hospital I had a lot of thought processes and thinking about how civil engineering can affect the healthcare space because that’s something I need to address. I still wanted to do civil engineering after completing my degree at the University of the West Indies at Trinidad. I decided I was going to move to London. When I moved to London, I was intrigued by the environmental aspect of civil engineering. I applied for a position to be an environmental engineer with a company. They hired me as an environmental engineer, and then they came in and said, “Well, we have some HVAC work for you to do.” I didn’t have a clue what that means. I had never been exposed to those type of systems, but that’s how my career in mechanical engineering started. I worked for a firm who hired me to be an environmental engineer and told me to design HVAC systems. That’s how I started and that’s how it went. I went on to get a masters in mechanical engineering, and that’s how I cemented my position and my career in mechanical engineering. In healthcare now, the situation is, as I said I was intrigued with the environment of care and we were figuring out how I could play my role in reducing infection so that is something I will always try to figure out. The company that I work for did some healthcare projects so I asked them to be involved with some of their clinics renovations in London with NHS system. I got the introduction to look into those spaces and really got interested in that environment and really the technical aspect of it and how we could minimize and use air flow to minimize infection within the healthcare space which affected me in my early years. That’s how I got into it. Fast forward, twenty-three years later here at WSP, I’m a healthcare leader on the east coast and I’m doing a whole lot of projects both locally and globally.
Zair: I hope all is good with you right now. Sometimes life has a plan for us. But we’re lucky to have you in healthcare. I’ve worked with you on projects, multiple healthcare projects. I know you’re one of the best persons in the industry who really cares about the healthcare industry. Let’s dive into COVID. What are prime COVID mitigation engineering applications that can be considered for existing facilities? It’s a concern for everybody these days.
Gary: Yeah, and to be honest COVID has thrown us a lot of curveballs for us engineering wise. We’re able to pivot really quick and really help many healthcare systems to address how they could quickly adapt and do some simple engineering renovation to meet the requirements of the COVID challenges. We went into many facilities. We facilitate instances where we can convert air system to 100% outside air and where you don’t have the mix of air. During the time, during the initial surge, we called those the shoulder months. We were able to do that because the air flow outside was the right conditions to have 100% outside air so we were lucky during the first surge to do that. For many healthcare systems we’ve gone in to figure out how we can modify their air handling unit to be 100% outside air. Some, they couldn’t. For some, it was a real challenge. And we’ll have to, in some cases, introduce hepa filtration maybe in the duct work because it’s a challenge often to get it into the air handling unit itself. We were quick on our feet to jump in and apply solutions that helped the air in the air flow system at the time. There’s a lot of stuff that we did, creating isolation rooms, in normal patient rooms we’d add exhaust fans connected to the windows or we could add it and connect it to the return air flow system as well to create negative pressure or to create isolation room to treat COVID patients. There are many solutions for interim. And those are interim solutions. Those are not end-all. To create a true isolation room, you have to have negative pressure with all the pressure measurement and all the requirements to seal a room in order to have true negative pressure. We’re able to have those systems quickly installed to help our system in treating those patients in those type of treatment rooms.
Zair: You mentioned renovation, we talked about it just in building. It brings us to a very good point. There are some old buildings out there that have flexible systems. What control settings or system upgrades would you recommend are necessary to prevent COVID transmission? Virus transmission?
Gary: That’s one of the main challenges. When you have some of those vintage systems that aren’t flexible or nimble enough to really adapt to 100% outside air, there’s not much you can do. With respect to duct work, you might have go to the duct work to add hepa filtration and that’s possible in some cases. Or you could go to the unitary level, to the room level in which you’re treating, and add hepa filtration. But you have to be careful also because you have to make sure that the fan can handle that static pressure that you’re adding to the system. There has to be a key collaboration between facility engineer, a balance or tested, advanced engineer, even a commissioned engineer which we have in our office that helps us really figure out these systems. Controls is such an important part because modifying controls is extremely important if you’re going to transform to 100% outside air system as well. And you’re actually changing the normal mode of operation for your building. So the controls is going to be a very important part of ensuring that you have good temperature control within your space. Your control is going to ensure that you have proper negative pressure in the rooms when it needs to be because that’s how you control the space. You cannot underestimate the importance of controls system during COVID because it truly plays an important role. One thing I want to mention about controls as well, going forward, control is going to be an important solution to make a building pandemic ready. Because it has to be a situation in which you’re flexible enough to flip a control switch to talk to the other side of the situation. That’s something we’ll definitely be looking at, how we can do that to be a resource and expand and meet challenges we’re having or are going to have in the future.
Zair: Yeah, you’re exactly right. At the end of the day the end user, they don’t know how that equipment works, they don’t have much knowledge of them. All they want is to control the air, they want to control the temperature and make the space comfortable. Are there different COVID mitigation applications for new construction? Or are they similar to what we’re seeing in existing buildings?
Gary: The limitations for existing….it’s different. It’s the same type of applications, but for new buildings it’s easier to implement. My favorite clutch during COVID is hepa filtration. Hepa filtration filters up to 99.97% of any antibodies, well any bacterial viruses or any other micro-organisms within the environment of care. What the hepa filtration is able to do is to filter as much of these micro-organisms as possible. And to be honest when it says 99.97% it doesn’t mean that .003% is not filtered. It just means that it’s just a standard they want to specify the percentage but it’s mostly 100% that’s filtered. Hepa filtration is really for me one of my clutch and one of the applications I use the most for buildings. And this can be used for existing buildings and also for new buildings. But it easier to implement this in new buildings because you can select your air handling unit to have a big section that you can add hepa filtration to. That’s extremely challenging if you have an existing air handling unit in an existing space when there’s no space for you to expand and to add those filter bands to it. It can be a real challenge for existing buildings. But for new buildings we can quickly, easily talk architects through adding an extra section and getting a room marginally bigger thank they use to give us – that’s something we’re doing much better. Another application is UV lights. And that’s ultraviolet germicidal radiation and those applications are easy when you have new applications because those are actually lights installed with an air handling unit. Sometimes we use it to sanitize the coils. But during the application of COVID, we can double the light intensity and that will help give us a longer used kill in terms of viruses within the system so that’s something we can implement easily into new design. An older system, it’s electrical requirement and really trying to go into an existing air handling unit and to take it down which is serving a whole department that you have to take down to get these systems installed so it’s always very challenging for existing systems and is much easier for the new buildings that we’re designing. And I think for new buildings this is a no-brainer and owners are making quick decisions and are asking us to implement these type of design strategies because they want to make sure buildings are ready for the next pandemic or even ready for the second surge of COVID if it does come.
Zair: Yeah, I agree with you. One of the concerns when I’m working as a consultant on the cost management is the budget. Right? Owner’s sometimes have a tight budget and the question that often is asked is, “What are the non-negotiables that has to be done to mitigate COVID or any air-born disease in the future.” I know you did provide some mitigation applications and how you could do it, but what is a quick list for owners that are non-negotiables?
Gary: If I think about one of the biggest challenges during the first COVID surge, it’s how do we get patients into the hospital? In emergency rooms? How do we get COVID patients into the hospital? One of the things I’ve worked on with other architects is really trying to create a way that we can isolate the entrance so that we have two modes of entrance within the emergency department and what you can do also as a response to the air system is to compartmentalize it. To ensure that at any time you can actually create a compartment for COVID and non-COVID patients. You can say a pandemic and non-pandemic mode of operation of your ED, of your emergency room. That’s something that is extremely important. And you do this by air flow – having a good selection of air system, having zoned control in terms of having an air handling unit per those zones so that you can control that space easily. And also ensuring those units are 100% outside air. You’re able to take that air and throw it back outside and continue to take outside air during those times that you can flip the switch and have 100% outside air for your space. The next non-negotiable I think is hepa filtration. Whether we put the hepa filtration in day one it’s up to us, but we want to make sure we have the racks, design, size, making sure the fans are sized for that as well. And that’s something that if we don’t put in day one we can have normal for day 14 but in the pandemic operation we can quickly and easily modify and change these filtrations to meet any airborne type of condition we experience going forward into the future.
One of the next things I think we have to create is a pandemic mode for hospitals. It’s what I call a purge. You should be able to purge your building, meaning that you should be able to fully exhaust every space within your building and that will give you some means of sanitizing that space and getting that space ready and cleaning up the space with the air system. That’s going to be combined with cleaning the space with cleaning products but having the air in that space, the ability to take all the air out of your hospital, your ambulatory care facility is going to be extremely challenging in this pandemic situation that we’re experiencing.
Zair: Yeah, the healthcare facilities are specialized and designed as you mentioned. They will prepare the owners for the future surges we could have any flu season or for any future airborne viruses. Are the hospitals ready for surges right now if we get the second hit of the virus? What have we learned from the first surge?
Gary: To be honest, we’re not. I don’t think we are. The existing systems are still going to be struggling. We have created some temporary isolation rooms. We have a facility in which we actually built a complete wing. Meritus Healthcare in Maryland, we built a complete wing and that’s a patient wing that has negative isolation rooms and can have purge modes and everything that is needed for the second surge, but the situation is that not all healthcare systems, we built that hospital wing in 3.5 months. And normal construction durations for those projects is a couple years so we were able to escalate and really push that process and give them a wing that’s needed if there’s a second surge but other hospital systems are still struggling. One of the biggest challenges that we had is that most of the hospitals can’t do elective surgeries during the first surge and take out most of those patients and really bring in and try to treat COVID patients only in the facility so that’s where most of the challenge is. Now, I don’t think the hospital system is really going to back track and do that again because of the billions of dollars they lost during the first surge. I think they’ll have to find a way to treat COVID and non-COVID patients within the same environment. And that’s where the major challenge is. Really there’s no separation in the emergency room for a patient that’s coming in. There’s not enough isolation room to intubate an extubate COVID patients so these are the challenges that we’re going to have. There aren’t enough ICU beds for ventilators if that were to occur so these are continuous challenges. That’s the reason why they wanted to flatten the curve, to reduce the number of patients due to COVID because the healthcare system isn’t built that way to handle any type of surge.
Zair: So when you’re talking to owners and healthcare facility managers, the applications you’re recommending, you’re just seeing them as an interim? Or you’re recommending them to stop the spread of airborne viruses that we could see in the future?
Gary: There’s always a debate because you know the CDC didn’t release any documentation on COVID-19 being airborne until recently and this is something as an engineer and as somebody who is involved in air filtration and OR design and those surgical type of spaces understand the full affect of viruses within the built environment. Based on the transmission we knew they always, they had to be some form of airborne, maybe in the right humidity or other environmental condition, but it truly is. But what we wanted to do and what we’re doing now is really talking to any airborne challenges that we might have in the future. That’s what we’re addressing now. To be honest, if we get a true air borne pandemic, that’s where we’re going to have more challenges than what we have now. So we’re really designing for this future big air borne pandemic that we haven’t seen yet like the measles. Those are the things we’re making sure our system can handle it if we need to handle it in the future.
Zair: That transitions right into my next question. Will the pandemic have dramatic changes when it comes to designing new buildings changes or do you see minimal tweaks and we’ll forget about it?
Gary: When you look at history and what history says about these challenges. We look at instances like 911 that changed airport security for the better. You would think that after, when things die down it’s going to be different, but it didn’t. It really intensified security and terrorism and everything has to be protected against that. I think it is going to be the same type of response to this COVID pandemic. We’re calling it at WSP is the new normal. It’s not going to be back to normal. It’s really creating that new normal and addressing the intrinsic challenges we have in our healthcare system so we can be ready, be truly ready for the next pandemic if it does occur.
Zair: Good. We’ve been focusing on the past and now we’re going to learn from the history.
Zair: I know you sit on various committees for AIA do you anticipate any standards coming out that’s going to be a new norm for building to have to follow? Similar to designing a LEED building? Do you anticipate a certification program for infectious diseases in the industry?
Gary: That’s a good question. I want to look at it in two ways. 1) I think it should go beyond a certification program. I think it’s health and safety and really the protection of – it’s “do no harm” that’s what healthcare is about. We should go beyond creating a LEED or well type of standard. We need to address the code and it’s being addressed now. I should tell you that Ashley with American Society of Healthcare Engineers is working with ASHRAE and they are going into specific details and how they’re going to address and really pivot to help healthcare systems deal with these type of challenges in the future. They’re going in, they’re looking at the code, they’re looking at the right filtration systems and the right type of sanitizing systems whether its air ionization, whether its UV lights and other technology which could really kill viruses and inactivate viruses so they don’t affect our built environment. They’re looking into it. There’s going to be some change coming that will affect how we do things and how we design. It’s absolutely necessary. We have to make sure we don’t see this as we do with LEED. LEED is something now people just view as you can do it or not. Ya know – it’s up to you. We want to make sure when we have those standards or those guidelines, we want them to be more standards and guidelines because we want them to be implemented because health and safety is always at risk if we have a system that isn’t ready for something similar or is worse than what we’ve experienced in this COVID 19 pandemic.
Zair: So you see the industry focusing more on healthy living going forward versus getting a sustainability or certification program. The focus would be for people and healthy living. Overall, the construction industry, do you think it will emerge stronger after this pandemic? Or will it take some time to rebalance?
Gary: It’s going to take some time to rebalance, but as professionals, our industry is always resilient. I think we’re going to bounce back and bounce back quickly. I think for engineers and for innovations, we’ve seen how quickly we were thinking on our feet and getting stuff done and using simple innovations to create solutions that were truly mind boggling. We did it and we were less prepared. I think now we have the tools. It’s been about 8 months, 9 months going on, we have global solutions that other countries have used also that we’re learning from as well. We’re going to come back pretty quick. It’s going to take a little time based on economics and financial challenges we’re going to have. I think we’ll be back soon in respect to where we were in buildings.
One of the things I wanted to add in respect to what we’re doing in healthcare, we’ve actually been advising a lot of commercial buildings and schools, offices about what they can do to minimize COVID transmission. It’s taking what we’ve used in healthcare for many years, and now other industries want to know what we do and how we do it. I’ve been talking to a lot of developers, even Amazon gave a whole presentation to the Amazon design team about how they can design their space to minimize transmission of COVID or other airborne types of viruses. Other industries really learn from us, from the healthcare industry as well. That’s something that is going to continue. A lot of schools are doing hepa filtrations now and that’s something they’re installing in all their schools. And restaurants are doing it with both hepa and UV lights so other industries are really catching on and are really trying to protect themselves for any future challenges that might occur.
Zair: Healthcare facilities were always ahead in design and thinking forward. Patient safety was their first priority. But now I think these design systems or design applications that you have been recommending would transition to any work place environment and restaurants where people can go and be happy and not worry about the transmission or the air flow. Looking back a few months, have the events of 2020 affected your daily work more? Less? About as much as you expected?
Gary: I’m talking more on Zoom and Microsoft, all video communication protocols I’ve used I’ve become much more savvy in that platform. We’ve transitioned to virtual working since March. I think I’ve been in the office twice since this pandemic. But to be honest I haven’t skipped a beat in terms of serving my clients on a whole. I’ve been more involved on the thought leadership and as well as writing articles and speaking about COVID and how we can combat this massive challenge that we’re encountering now. For me, it really stimulates my part of the brain that wants to find a solution and help the industry find a solution and something that is truly lasting that we can truly turn the corner and say we’ve been part of that response and really helped to shape this new normal that we’re about to create for children, and their children afterwards.
Zair: You talk about children and technology, this brings up a good question. What words of advice do you have for young engineers coming out of school starting their professional lives? What would you recommend to them?
Gary: I just spoke to – there’s a school for gifted kids. There were 14 or 15 of them and they were so smart. It blew me away completely. I thought, “What are we teaching this generation?” They’re on the right step. They’re making the right decision in respect to learning. Looking back, my view of science was always how I viewed solutions. It’s looking at the physics of things and really trying to figure out how do we put together stuff and if it’s a chemical reaction to try to solve problems, they’re doing that in labs now to try to find a vaccine for COVID. It’s really concentrating on the sciences and really be – have innovation as an important part of how you think. That’s a thought process I continue to challenge younger engineers is to be open minded. Be ready to be flexible and nimble. Be ready to pivot because that’s important. It’s not only learning technical aspects that’s important but it’s also the aspect of engineering that’s important is relationships and working with clients and working with people as a whole. So that’s something you have to be a part of. You can’t just be in your book and think that’s the solution. There’s really a combination of multiple facets.
Zair: I absolutely agree with you. I tell youngsters, “We’re engineers but our goal is to solve problems. We need to understand the problem first and we need to understand what are we solving for and who are we solving for.” If you can’t understand that, just the books won’t help you. Sometimes you have to think about innovation. Every building we work on, owners and developers want it different and the end-users want it different. You have to picture it all together to make it work. If you can’t do that then you won’t be a good engineer. I totally agree with you and I like your advice. I know you’ve authored some books. You’re a published author. Can you share some insights from the book you recently published?
Gary: Yes, I think the best thing I’ve ever done is actually wrote the “Ghetto Youth’s Bible.” It’s an inspirational book. I call it a road map for people from the inner city or what I call the ghetto community to really help them navigate the challenges they might encounter in inner life growing up. I went through it. I actually didn’t have a road map or any document or narrative to tell me how to make decisions or how to navigate poverty to reach where I am in life. This book is really directed to younger folks to really teach them how to overcome challenges, to show them when you lose you aren’t really defeated. That is something I truly believe. You learn from your challenges. I call it, “You fail forward,” so every experience that you go through whether its good or bad, you really learn from that experience. That’s what my book teaches. I have something I call 10 Commandments of Ghetto Youth’s Bible. That’s the name of the book, “The Ghetto Youth’s Bible” because I’m from the ghetto. It’s really looking at mentorship and continuous learning and looking at entrepreneurship. I ended my last commandment on “Thou shalt pay it forward” which means for me – give back. Give back as much as you can. pay If I didn’t have mentors and other people who invested in me, they didn’t have to. That’s an important part of my life. I always try to give back to my community. I have my own non-profit organization called The Chair Foundation where we do mentorship, especially now during this pandemic. I’m doing it by Zoom. I’m mentoring folks here in Maryland and also back in Jamaica, kids, and they’re excited to hear positive messages. And that’s what I’m trying to do with my foundation. I also adopted a hospital in Jamaica called Savanna Public General Hospital and we do project every year up to $10,000 US we try to contribute as part of the foundation. We were really challenged during COVID but we’ve given care packages to nurses and staff that’s been tremendous during this COVID pandemic. It’s an important part of me, to pay it forward. It’s something that’s always going to be an important part of my life for years to come.
Zair: I’m impressed with what you’re giving back to the community. I’m from Brooklyn. I’m from the hood too. I tell people I didn’t get here. I was lucky to have good bosses and mentors that when I asked the question, they guided me to the right place. Gave me the right direction. I think that plays an important role of what you do out of your life. It’s important that we give back to our community and to the youngsters out there and to guide them. I’m impressed. I do need to get your book and read it. Well, thank you. Is there anything else that you would like to touch on for our audience? Or did I get enough questions?
Gary: I think you did. To address the current, it’s not an elephant in the room, it’s bigger than an elephant – the COVID challenges we’re going through. Its really a testament to our resolve that we’re able to really respond in the right way and to flatten the curve and to provide an engineering response to something we’ve never experienced in our lifetime. It’s kudos to the healthcare staff, to the healthcare professionals, the designers and architects and contractors out there who are going beyond their normal daily duties to really provide solutions that will last and serve us in this better normal that we’re trying to create.
Zair: Yes, they are our heroes. Well, wonderful. Thank you so much for your time. I know you’re a busy man. I appreciate you taking the time and talking to me. I learned a lot and hope my audience does too. Looking forward to having you back maybe sometime later and talking more about this. This is a deep topic. Thank you.
Gary: Thank you. I appreciate it Zair.
Jessica: I just wanted to jump back in gentlemen and thank you both for your time today and for taking the time to talk to us. I think we provided a lot of really interesting solutions for owners and developers as we navigate this pandemic and really thinking about the future and how we’re going to come back and future airborne viruses and what that looks like. Thank you both. This conversation will be ongoing I’m sure as the months and who knows years – hopefully not – continue. Thank you both. This took a lot of your time but I think the audience got to learn quite a bit and I got to hear some new perspectives. Thank you.
Jason: If you enjoyed this episode of Construction Insiders, we encourage you to check out our website at www.ccorpusa.com, that’s ccorpusa.com. Where you can find our full knowledge library under the Insights tab. It’s all great stuff, we’re really passionate about it, and we hope you’ll check it out. Thanks for listening.