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We return to the points made in our paper published in the inaugural edition of this journal to expand upon recommendations to healthcare industry leadership regarding electrical power security. (M. Anthony, Healthcare Management Standards Journal, 2021). Construction spend rate in the United States runs about $60 billion annually in this industry - not including the life-cycle cost of utilities, operation and maintenance. (United States Department of Commerce, June 2023). Among the 5400 hospitals tracked in 2021 by HospitalView average operations and maintenance cost runs about $209.4 million per hospital. (Operations and Maintenance Report, Definitive Healthcare). Those are representative numbers for a “typical” hospital; and likely would be below the operations and maintenance cost of a university-affiliated hospital which receives the most critically ill and is located in regionally expensive neighborhoods. Overall, the US healthcare industry occupies upwards of 20 percent of United States gross domestic product. (IBISWorld Industry Reports).
The foregoing numbers are enough to steer by as we revisit our claim that healthcare facilities can be made safer, simpler, lower-costing and longer-lasting if leadership grants access to operational information to those of us who study power security for all industries.
As the lead author from the Sapienza University of Rome infers, the paucity of data needed for standards setting is not unique to the United States.(Parise, et. al, 2021, IEEE Industry Transactions) Much of the reluctance originates in the following:
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Higher priorities that need immediate attention with scarce resources remaining for lower tier priorities; no matter how well meaning.
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Fears that exposing power system failures will result in lawsuits, penalties by enforcement agencies or both (Parise, et. al, 2921 IEEE Industry Transactions).
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Reluctance to cede competitive advantage. Standardization and innovation are nearly reciprocals of one another. Conforming to a standard means “everyone knows what everyone else is doing” and in many domains trade secrets are protected.
The slow-walking of operational data beyond requisite accreditation reporting minimums is commonplace.
Consider a project now underway by the NFPA, IEEE and Mazzetti Associates to rationalize plug load; the 120V receptacles found in walls or patient bed headwall units (Fire Protection Research Foundation, February 2022). There are thousands of them in a typical hospital and, in many cases, too many of them. While they supply power to the special patient care systems required in a hospital (direct current supply for vital sign monitors, infusion pumps, pulse oximeters, ventilators, point of care testing devices, ultrasound, etc.) the cumulative effect of so many of them at 120 VAC is that they result in oversized building interior power chains (branch circuit wiring, feeders and transformers), (Anthony, et. al 2010 IEEE Industry Transactions). Oversized building power chains result in oversized on-site backup generators. Oversized generators present risk that “rightsized” generators do not. Oversized generators also emit more pollution during testing and operation.
What information would engineers like more access to?
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Generator starting failures. Diesel generators start faster but require ninety-six hours of on-site diesel fuel storage. Natural gas generators start slower but require natural gas from a merchant utility pipeline at specific pressure. Batteries for starting motors present common mode failures.
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Automatic transfer switch performance. Hospitals have a large network of transfer switches for life safety, critical, equipment and three types of essential systems that need testing under full load.
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System operating data for water pumps, backflow pressure, communication, elevators, signaling and internet access.
The foregoing very short list applies to large in-patient hospitals. There are many smaller, outlying auxiliary (satellite facilities) that support the “mothership” hospital with hardened defend-in-place systems with relevant operations and maintenance data.