With upcoming changes in store for guidelines documents, Facility Guidelines Institute CEO Douglas Erickson and Managing Editor and Editor-in-Chief Pamela James Blumgart share with MCD their insights on the changes, challenges, revision process and focus on the future of design and construction for hospital, outpatient and residential care facilities.
(Q) The decision was made by FGI to produce consensus-based guidelines. Can you tell us a little more about this?
Doug: Back in 1985 when the federal government decided to get out of the business of writing hospital minimum construction standards, a small group of us formed to save the work of the Public Health Service and make it a publicly held and written document. Our primary mission was to continue to improve upon the fine work of a small, hand-selected committee but to expand the group to include a wide range of expertise from the healthcare community. The strength of the Guidelines is the multidisciplinary committee of experts (at 100 members for the 2018 revision cycle) who take the public input provided through open proposal and comment periods and, using a consensus process, turn those recommendations into a nationally accepted series of Guidelines documents.
Pamela: By submitting ideas for change during the public proposal and comment periods, anyone with an interest in the health and residential care environments can participate in revising the Guidelines.
(Q) Doug, with more than 40 years of experience developing health facility codes and standards, what are some of the biggest challenges you’ve faced throughout your career?
The absolute biggest challenge is getting state and federal agencies to adopt the most up-to-date version of the Guidelines. While some states, such as New Jersey, are very progressive in adopting the new document(s) when issued, others have outdated legislation that makes them very slow to adopt new editions. As a result, some states are using editions that are more than 20 years old to regulate healthcare facility construction. As I have told many people in the past, the lack of adoption of the new requirements means in some states we are designing and building ‘brand new old’ healthcare facilities.
Another challenge is finding that sweet spot of what is considered a baseline requirement versus a best practice or a “beyond fundamental” requirement. Over the past couple of revision cycles, the Facility Guidelines Institute and the Health Guidelines Revision Committee have been publicly challenged by professional organizations concerned that the Guidelines requirements exceed what they consider the “minimum” for providing a safe and effective healthcare facility. The FGI and the HGRC leadership are very concerned about these statements and, beginning in the 2010 cycle, put into place a Cost/Benefit Committee that reviews all proposals with an associated cost to assess how effectively they would benefit the quality of care, patient and staff safety, and the overall efficiency of the physical environment. Through the work of this committee, each proposed change is weighed on its merit as a solid baseline requirement. When you have a group of 100 experts from different healthcare professions debating whether a new requirement is fundamental, too costly or a best practice, it gets very interesting to watch and sometimes to referee.
(Q) Pamela, with your experience being the primary editor of the FGI Guidelines since 2001, what are you most looking forward to in your new role as managing editor?
Although I’ve worked on the Guidelines since the 2001 edition, I’ve always done it as an employee of another organization with other responsibilities. Now that I’m only working for FGI, I’m looking forward to having time to work on some efforts we’ve talked about for years, such as posting many of the advisory opinions we’ve written on the FGI website and using social media messaging and other means to publicize FGI’s activities and the information we have to offer.
(Q) As the 2018 revision cycle approaches for the hospital, outpatient and residential care facility Guidelines for Design and Construction documents, what do you most want to accomplish?
Doug: We always have the Health Guidelines Revision Committee’s mission statement in mind as we develop new editions of the Guidelines, which is “to create documents, using a multidisciplinary consensus process advised by research, that can be used to create an advanced, cost-effective, high-quality built environment for the healthcare community.” This statement keeps us grounded and focused on our task of writing requirements that serve the patients/clients/residents, staff and visitors who use healthcare and residential care facilities in the United States.
If, as chair, there is one thing on my bucket list to accomplish, it is to have the Guidelines documents be viewed as the trusted “consumer reports” for the design and construction of hospitals; outpatient facilities and residential health, care and support facilities. We work very hard to keep “scope creep” out of the documents and even have a research grant issued for a major healthcare institution’s simulation lab to review all the requirements in the 2014 hospital and outpatient document to determine whether they are influenced by evidence and baseline or if they are beyond fundamentals. Those requirements determined to be above a baseline standard will be moved to a second set of publications with a title of beyond fundamentals. These beyond fundamental documents will include best practices, operational elements, new research initiatives and so on.
(Q) What is the timeframe for the revision cycle?
Pamela: The public proposal period for submitting suggestions to change the content of the 2014 Guidelines documents will take place from June to October 2015. The draft 2018 documents will be posted for public comment from September through November 2016. The plan is for the 2018 fundamentals documents to be published in March 2018, followed later that year by beyond fundamentals publications. The format and timing of the latter are still in development, however.
(Q) Anything else you’d like to share?
Doug: We invite those in the healthcare industry to get involved with the Guidelines revision process by submitting public proposals and comments on language that needs to be added, modified or deleted. These documents are written for the specific purpose of providing healthcare workers with quality environments so quality patient/client/resident outcomes can be achieved, and public input is vital to the development process.
Photo source: www.fgiguidelines.org.
