Canadian Healthcare Facilties - Fall 2011

HealthcareFacilitiesJournal of Canadian Healthcare Engineering Society

InSIdE

Canadian

Volume 32 Issue 1 Fall /l'automne 2011

Abbotsford Regional Hospital and Cancer CentreThe Chester Network's Energy Challenge Personal Emergency Response Systems

PM#

4006

3056

Canadian

HealthcareFacilities

2011 CHES Awards2011 CHES Awards

ASCO: your partner in power.

ASCO Power Technologies Canada • Airport Road PO Box 1238, Brantford, Ontario N3T 5T3Tel: (519) 758-8450 • Fax: (519) 758-0876 • www.asco.com • Division of Emerson Electric Canada Limited Network Power

Call ASCO today foy foy f r morerer infofof rmation on making the switch to smarter powowo ewew r.r.r 519.758.84848 50.

®

At ASCO, we have the products and the expertise to meet all your power challenges: issues like high summer demand for electricity and risks to the environment. By using high-technology power transfer switches to “parallel” your power source, you can manage electricity costs more effectively than ever.

ASCO recently put a solution like this to work for Toronto Hydro, to meet consumers’ needs during summer afternoons when electricity demand and costs are at their peak. By fuel-ing an ASCO power switch with used cooking oil, Toronto Hydro has cut consumption of expensive diesel fuel and significantly reduced emissions. It’s a solution that makes sense...and a switch that could work for you, too.

LO

WER EMISSIONS

EN

ERGY EFFICIENT

UN

M

ATCHED EXPERTISE

LO

WER EMISSIONS

Y EFF

EN

ERGY EFFICIENT

HED E

UN

M

ATATACHED EXPERTIS

E

HED E

ASCOPower-CHES-Summer_Solisco.pdPage 1 5/22/07 11:51:52 AM

contents

departments

6 message from the publisher By steve mcLinden

8 message from the president By John J. Knott

10 Chapter reports

artiCLes

13 Call for nominations: CHes annual awards

14 Wayne mcLellan award of excellence Chatham-Kent Health alliance

18 Hans Burgers award for Outstanding Contribution to Healthcare engineering

roland mcintosh

20 the Chester network's energy Challenge

24 personal emergency response systems (pers) By Zachary Bujnoch

28 abbotsford regional Hospital and Cancer Centre a Case study in design

Canadian HealtHCare faCilities is publisHed bY under tHe patronage of tHe

Canadian HealtHCare engineering soCietY

Publisher steve Mclinden e-mail: [email protected]

editor Matthew bradford e-mail: [email protected]

Advertising sAles sean foley Mediaedge Communications 416-512-8186 e-mail: [email protected]

senior designer annette Carlucci

Junior designer Jennifer Carter

Production rachel selbieMAnAger

sCiss Journal triMestriel publié par Mediaedge CoMMuniCations inC. sous le patron-age de la soCiété Canadienne d’ingénierie des serViCes de santé

Éditeur steve Mclinden e-mail: [email protected]

rÉdAtric intÉriMAire Matthew bradford e-mail: [email protected]

PublicitAire sean foley Mediaedge Communications 416-512-8186 e-mail: [email protected]

PubicitÉ annette Carlucci

coordinAteur de rachel selbieProduction

President John J. Knott

vice-President peter Whiteman

PAst President Michael Hickey

treAsurer ron durocher

secretAry richard lacoursière

eXecutive director donna dennison

chAPter chAirMen Maritime: bill goobie alberta: Ken Herbert b.C.: Mitch Weimer ontario: allan Kelly Manitoba: reynold peters newfoundland & labrador: randy s. Cull

Founding MeMbers H. Callan, g.s. Corbeil, J. Cyr, s.t. Morawski ches 4 Cataraqui street, suite 310 Kingston, ontario K7K 1Z7 telephone (613) 531-2661 fax (613) 531-0626 e-mail: [email protected] CHes Home page: www.ches.org Canada post sales product agreement no. 40063056 issn # 1486-2530

canadian healthcare FacilitiesVolume 32 number 1

Environmental responsibility can be easy without costing more. With Tork one-at-a-time dispensers and 100% recycled refi lls, you can measurably reduce waste, cost and labor. Small steps, big impact.

You don’t need to take big steps to leave a small footprint.

© 2011 SCA Tissue North America LLC. All rights reserved. ®Tork is a registered trademark of SCA Tissue North America LLC, or its affi liates.

To see how Tork products can help cut cost and reduce waste in your facility,

visit talktork.com and enter promo code CHCF for a free trial.

* It’s better business. Hands down.

6 Canadian Healthcare Facilities

I have been working with the group at CHES for over 12 years now, many of which have been spent working with great people like Wayne McLellan. Wayne always brought fresh ideas forward concerning how we could better communicate with members. And even though he wasn’t in the publishing business, Wayne's insight always contributed to the growth of the journal.

With that in mind, it was great see the Chatham-Kent Health Alliance take home this year’s Wayne McLellan Award of Excellence for its Environmental Stewardship Program. Beth Hall, Director of Support Services for CKHA, expressed during her acceptance speech how Wayne’s inspiration and vision are still an influence and a key motivator for their ongoing excellence. Sincere congratulations go to Beth and her team on winning this prestigious award.

Accolades also go out to Roland McIntosh, winner of the 2011 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering. Rolly has played an instrumental role in CHES, and it was great to see his contributions recognized with such an esteemed honour.

From all accounts, the Winnipeg conference was a huge success. This was the first time the National Conference was held in Manitoba, and I know all CHES members are excited about it being in the National Conference rotation.

Of course, we bid a fond farewell to Mike Hickey as outgoing president and a warm hello to J.J. Knott as the incoming president of CHES.

Please enjoy this issue of the journal. As always, suggestions, comments and even criticisms are always welcome.

Steve McLinden

Publisher

[email protected]

Message from the Publisher

Congratulations Award Winners

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor.Canadian Healthcare Facilities Magazine RateExtra Copies (members only) $25 per issueCanadian Healthcare Facilities (non members) $30 per issueCanadian Healthcare Facilities (non members) $80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.

La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice.Prix d’achat du Journal trimestrielExemplaires additionnels (membres seulement) 25 $ par numéroJournal trimestriel (non-membres) 30 $ par numéroJournal trimestriel (non-membres) 80 $ pour quatre numérosL’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS.


Welcome CHES members. I hope that this message finds you all in good health.It is hard to believe we are in the latter part of 2011 already and the Winnipeg

Conference is now a fond memory. Congratulations and thanks go to Richard and his team from Manitoba for putting on such a great conference.

During the event, we also looked on as Mike Hickey concluded his role as CHES president and moved into his new role as past president. Mike, you have done a tremendous job and I can only hope that I can carry on the good works that you and the presidents before you carried out with patience, perseverance, and determination. Wear your past president’s medal with pride.

I look forward to working with the new National Executive on the many new challenges that CHES will face in the coming years. Through good strategic planning on the part of the executive, and through the strength of our many committees, I am sure we will find creative ways to meet the challenges ahead and create new benefits and opportunities for our membership. After all, that is what CHES is all about; building our membership and member expertise through our vision of excellence through partnerships, innovation, accountability, and education.

CHES continues to work with partner organizations such as the American Society for Healthcare Engineering (ASHE), the International Federation of Healthcare Engineers (IFHE), the Canadian and American Colleges of Healthcare Leaders and Executives, Canadian Standards Association (CSA), the Canadian Coalition for Green Healthcare (CCGHC), and many more. We do this in order to broaden our influence and to participate in the setting of standards and the development of educational programs and other initiatives that will benefit our membership. CHES committee members, and others, are busy working on your behalf to promote CHES across Canada and to the rest of the world. I thank everyone who has put forth such effort for the benefit of all.

As I travel the country to attend the various provincial and national conferences, I hope to meet with as many of our members as I can to talk with you, discuss your needs, and bring your concerns back to the executive table for discussion. Membership is the backbone of CHES, and working together is what makes us great. So let’s build on what Mike and the president’s and executives before him have achieved, and let’s continue to work hard and grow together.

John J. Knott, CET, HMT, CEM

Message from the President

Changing of the Guard

crit ical th inking

Improve the efficiency and comfort in your health care district? Let the Internet-connected products of Reliable Controls® help you do the analysis. We deliver high performing energy management and control systems for health care districts all across Canada.

Visit our website to request a quote from a Reliable Controls®

Authorized Dealer™ near you and let us help you do some critical thinking.

We are the people and technology you can rely on.

Reliable Controls CorporationHealthare Facilities Magazine - - full page ad dimensions (single page full bleed [8.375” x 11.125”]) - 02.09.09 rev-B

www.reliablecontrols.com

LEED™ 5 year™

w a r r a n t yBACnet® CHES™

m e m b e r

C

M

Y

CM

MY

CY

CMY

K

CHCF mag ad rev-B 2009.pdf 3/25/09 2:55:13 PM

Chapter Reportsthe alberta Chapter would like to congratulate richard Lacoursiere and his conference committee members at the manitoba Chapter for hosting a great 31st annual trade show and education Forum. alberta sent 20 delegates to the event, and i must thank our senior administrators in alberta Health services and Covenant Health for supporting our attendance.

planning is well underway for the annual Clarence White Conference and trade show, which will be held november 14-15, 2011 at the Capri Hotel in red deer, alberta. Watch the CHes website for conference details. On behalf of CHes alberta members, i want to thank our Committee Chair randy Badry, as well as our committee members: Jeff smith, preston Kostura, rod Vestby, and Bernard tong.

Our aGm will be held during this conference. this is not an

election year, as the current alberta CHes executive will be starting year two of their terms of office.

alberta Health services Capital management organizational structure has now been revised into five zones. three well known, long serving CHes members are leading three of these zones; John roflik (south); alan roles (Calgary), and steve rees (edmonton). steve Keevill (Central) and mike Linn (north) have been appointed to lead the other two zones, and i know they will all support CHes alberta in our future endeavours.

Lastly, alberta will be hosting a Canadian Healthcare Construction Certificate Course on april 19-20, 2012 in edmonton.

Ken HerbertAlberta Chapter Chair

it appears summer arrived late and ended early on Canada’s left coast. probably because of that, there are a few exciting happenings from the volunteers at your CHes BC executive.

We are pleased to announce penticton as the site of our next BC Chapter Conference on June 3-5, 2012. after two years in Whistler we’ve received numerous member requests to visit sunny penticton once again. as announced at our last chapter conference, steve mcewan is taking over the reigns as conference chair and he has assembled a very talented team to help guide us towards another successful conference. they are presently working on an online conference registration tool to make your conference registration even easier.

the CHes BC executive has been hard at work this calendar year. We will be convening our first quarterly meeting in Winnipeg, and have been meeting frequently on national issues or subcommittee work over the past eight months.

Coming on the heels of our most successful conference ever, the CHes BC education Committee has been working diligently to develop some exciting new member education programs. CHes BC members are invited to apply for our personal education sponsorship program, which this year has increased to a maximum of ten applicants at $1000 per person, and is open to all CHes BC

members. CHes BC has also increased both the quantity and types of education programs that will be supported for 2011/12. the education Committee has been hard at work developing this program for a fall release. as part of this program, CHes BC has set aside $18,000 of targeted funding for BC’s six Health authorities to secure education related to the operations, maintenance, and construction of healthcare facilities. the education committee is also working on developing an approved set of courses for CHes BC member education. these would provide funding support on pre-approved applications based upon successful completion of the course. We’re hoping for a fall/winter rollout of this program.

Once again, CHes BC is sponsoring educational bursaries at six BC post secondary institutions: BCit, Camosun College, Okanagan College, College of new Caledonia, selkirk College, and thompson rivers University. the CHes BC public relations team has contacted several of the recipients to seek feedback on how these bursaries have helped them, and we hope to publish these in the future on the BC webpage of CHes.org.

Mitch WeimerBC Chapter Chair

this will be a very exciting year for CHes Ontario. the new executive looks forward to the challenges that lie ahead. the province is in an election mode and the early part of October we will see what changes are forthcoming.

We had our meeting at Guelph General Hospital in June. We will be meeting at the national Conference, and again a meeting will be held during the Ontario Hospital association in november. We will also be posting these minutes to the Ontario website for all our members to view. this year, we were able to send two executives that work very hard for the society to the national Conference in Winnipeg.

Our next conference will be held in Kingston. this conference will be chaired by Chris rousseau, and i look forward to sharing more information as planning gets under way in the coming days.

the membership Chair Jeff Weir will work toward developing strategies that increase membership and target

more Long term Care members. the membership chair will work with the office to assist in emailing non-returning members.

the education Fund is in a good position and the executive will provide input on how to allocate the funds.

rick anderson is looking at ideas for an education session with a social event. We are planning this event for late October. We will communicate the details to our members once arrangements have been made.

We are working with Canadian Coalition of Green Health Care in all of its endeavours and we also sponsored their strategic session which will coming up shortly. We invite all members to stop by the CCGHC booth at the Ontario Hospital association’s Health achieve Conference.

Allan Kelly Ontario Chapter Chair

alb

erta

Ch

apt

er r

epo

rtbC

Ch

apt

er r

epo

rto

nta

rio

Ch

apt

er r

epo

rt


Union Gas partners with the Chatham-Kent Health Alliance

© Union Gas Limited 2011 10/2011 UG20110192

When the Chatham-Kent Health Alliance (CKHA) started down the path of becoming a

leader in hospital sustainability several years ago, Union Gas was happy to lend a hand.

After all, Union Gas has a long tradition of partnering with hospitals across our service area.

This year alone, the CKHA is eligible for over $125,000 in financial incentives from

Union Gas and our energy experts have been at their side providing valuable technical

support. We congratulate the CKHA for being awarded the Wayne McLellan Award

of Excellence presented by the Canadian Healthcare Engineering Society – a fitting

tribute to both the hospital and the man.

We can assist your hospital too. We’ll help you manage your energy costs, pay financial

incentives and provide the support you’ll need to deliver energy projects of every size.

We help partners turn their vision into reality. Call the energy experts at Union Gas.

uniongas.com/cams

Energy ConservationEnergy ConservationEnergy Conservation

Waste Reduction and Recycling

Building Envelope Improvements

Environmental Stewardship

Optimizing HVAC Systems

Staff Educationand Awareness

Best Practice Programs

Building Automation System Upgrades

Facility Renewal and Energy Management Project

Chatham-Kent Health Alliance –

An EnerSmart Champion Turning vision into reality

Untitled-1 1 11-10-13 11:36 AM


the manitoba Chapter has come along way over the past four years, growing to its current size of 71 members. it is this continued growth that will allow the chapter to grow stronger and be of better service to its members. Our last education day in april 2010 was a great success, building further upon the success of the former years. it is that success that has provided us with the opportunity to host CHes’s national Conference this year. in addition, we are in the process of getting ready for our next education day april 25, 2012, which again will be held at the Victoria inn in Winnipeg.

the chapter executives have been working hard this past year and a half to ensure that this conference is a success. as a chapter, we believe in CHes and that networking is instrumental in our day to day operations both provincially and nationally. CHes allows us to seek help from across the country. if you are encountering a problem, chances are someone else has encountered the same problem and can afford you assistance in finding a viable solution.

Once again we are asking for mB CHes members, if possible, to step forward and assist in the running of the chapter and/or sit on one of the national Committees. it is through your continued support and help that the mB Chapter will continue to grow and be able to better serve the health care community by building member expertise.

We would like to express our gratitude for our outgoing national president mike Hickey, for his leadership and unwavering commitment to CHes, and continued success in his future endeavours. in the same breath, we would also like to welcome J.J. Knott into his new as the national chair and ensure him he will have the full support of this chapter.

i would also like to take this opportunity to thank the chapter executive, in particular the chapter secretary, tom still (director seven Oaks Hospital) and treasurer Craig doerksen (divisional director, Facility management HsC) for their dedication and work. at the this time i would like to thank richard Lacoursiere for his hard work as the former chair of the mB Chapter and i would like to wish him luck and great success as he assumes the role of past Chair of the mB Chapter, as well as his new role as the secretary of the national CHes Board of directors.

thanks again to all who attended the national conference in Winnipeg this year. it was a huge success on all sides. Your presence and participation at the conference is what made it a huge success. and we look forward to seeing you all in montreal next year!

the following national committees require representation from manitoba members:

partnership and advocacy: VacantCommunications: Vacantprofessional development: John adetunjimembership: VacantBoard Governance: reynold J. peters

Reynold J. Peters Manitoba Chapter Chair

Ma

nit

oba

Ch

apt

erChapter Reports

1-877-755-5302 | www.coinamatic.com

Save up to 85% in hot water usage and 35% in total water consumption! Call us today for more information on our fully certified, ULC approved, Advanced Oxidation System designed to drastically reduce your operating costs!

Flexible laundry solutions that reduce operating costs and carbon footprint while achieving high quality results!

We are the exclusive Canadian Distributor for IPSO, Lavatec Laundry Technology Inc., Consolidated Laundry Machinery, SailStar, Brightwell Dispensing Systems and EnvirOmatic Advanced Laundry Oxidation Systems.

Top Quality Commercial & Industrial Laundry Equip.Automated Dosing SystemsPurchase or Full Service LeaseExtensive Parts Inventory

Service ContractsFinancing OptionsISO Certified Service Organization24/7 Multilingual Call Centre

3

Our Innovations Stack Up To Savings

®

11_CCL_CHES_halfpage.pdf 1 2011/02/17 4:20:56 PM

11040_Follette_2011.indd 1 11-03-07 12:42 PM

Award Nominations

call for nominations for ches Annual Awards2012

hans burgers Award For outstanding contribution to healthcare

engineering

deAdline: April 30, 2012

to nominate:• please use the nomination form posted on the CHes website and

refer to the terms of reference.

Purposethe award shall be presented to a resident of Canada as a

mark of recognition of outstanding achievement in the field of healthcare engineering.

2012Wayne Mclellan Award of excellencein healthcare Facilities Management

deAdline: April 30, 2012

to nominate:• please use the nomination form posted on the CHes website and

refer to the terms of reference.

Purpose• to recognize hospitals or long-term care facilities that have

demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship

program, or team building exercise.

award sponsored by

For nomination Forms, terms of reference, criteria, and past winnerswww.ches.org / About ches / Awards

send nominations to; ches national office • [email protected] • Fax: 613-531-0626

Fall/l'automne 2011 13


For the staff and volunteers at Chatham-Kent Health Alliance (CKHA), receiving CHES' Wayne McLellan Award of Excellence has been both an honour and a bittersweet reminder of a dear friend. Truly, since receiving word it had received national recognition for their comprehensive Environmental Stewardship Program, the energy in CKHA's halls has been palpable, but for those who fondly remember sharing those halls with Wayne McLellan himself, it's also been cause for reflection.

“We are very proud and very honoured to receive this award,” says Beth Hall, Director of Support Services for the CKHA, an alliance which encompasses Public General Hospital, St. Joseph's Hospital, and Sydenham Hospital; and serves residents of Chatham-Kent, South Lambton and Walpole Island First nations. “This award has significant meaning for us given it is named after our dear friend and colleague, Wayne McLellan. We worked with Wayne for many years at CKHA , and it was his vision and leadership that started our Green Team.”

CKHA's Environmental Stewardship Program, for which it won CHES's award, is based on Mr. McLellan's initial vision for a program that would drastically reduce CKHA's

of Excellence Chatham-Kent Health Alliance

WaynE McLELLan aWard


WaynE McLELLan aWard

environmental footprint and improve its overall energy efficiency, green awareness and – perhaps most importantly – the health of its patients, 1,300 staff, 100 physicians, and 600 volunteers.

According to Hall, the program began with smaller initiatives concerning waste and waste reduction, but quickly grew in size and scope, recalling, “The program continues to evolve. It started off small, but each year we just kept adding more and more pieces to the program. We continually get more people who are more aware, more interested and really involved; people who want to be champions and leaders in green health care.”

Among the largest components of CKHA's Environmental Stewardship Program is its waste reduction and recycling program, led by the organization's Housekeeping Division and its internal Green Team group. Through a number of initiatives, the program has successfully diverted large quantities of supplies and harmful chemicals away from landfills, as well as reduced the facility's overall waste output. Working with Turtle Island Recycling, CKHA also became one of the first healthcare facilities in Canada to implement a tray wrapping recycling program wherein blue wrap used on operating room products was recycled rather than sent to landfill. Further, CKHA was the first in Canada to implement a reusable pharmaceutical waste container.

Its Facility Renewal and Energy Management Project is another key part of its award winning program. A joint project with Honeywell, the $5.7


million project included upgrades to lighting, electrical systems, building envelope improvements, and HVAC systems; as well as the installation of a roof top 100,000 KW solar panel project which has granted CKHA access to an renewable source.

“Our Honeywell project we've been embarking on for the last 18 months is a comprehensive facility renewal and conservation program that will upgrade our facilities while reducing energy costs and carbon emissions.,” notes Hall, adding, “And with the changes that we've put in place, we'll save that money in energy cost, close to half a million dollars a year, so the program basically pays for the capitol investments in ten years. That's a big initiative.”

Complimenting CKHA's environmental initiatives is an annual Environmental Expo wherein CKHA's staff and volunteers are invited to interact with key industry partners and suppliers to discuss the many ways by which they can all reach greener goals. The expo is part and parcel of the CKHA's overall plan to encourage its staff and volunteers to take ownership of the Environmental Stewardship Program, and continue to find new ways to be motivated by it.

“Everyone who is involved in these programs has their own jobs, so they're doing this on top of their regular positions,” explains Hall. “[The program] takes a lot of initiative and a lot of manpower to get everybody on board, and to ensure that everybody recognizes and appreciates the importance of [the program] because there's many competing priorities. It's important to make the administration and front line staff aware so they understand why we're doing it, why it's important, and then the benefits of it to keep the momentum going.”

The motivation appears to be working. Since submitting for the Wayne McLellan award, CKHA has furthered its environmental efforts with the creation of a program called Operation Green, which diverts clean unused surgical supplies from landfill and donates them through a charity to 3rd world countries. In addition, Hall notes, “We've implemented recycling equipment within the lab that recycles some of their chemicals so that they can reused and we don't have to pay significant dollars to have them disposed of which was very costly and not environmental friendly.”

Overall, winning the award has cemented CKHA's dedication to a program which has already seen great environmental, financial and morale benefits. Supported by its staff and volunteers, the Environmental Stewardship Program continues to evolve daily, and remains a testament to the strength of Mr. McLellan's vision. Reflecting on the award, Hall says, “We're very excited, but it also certainly a bit emotional for us too in terms of just remembering our friend Wayne and how he was key and instrumental to getting this going. We figured he'd be looking down on us and be quite proud of us for winning this award and being recognized for carrying out his vision.”

“We continually get more people who are more aware, more interested and really involved; people who want to be

champions and leaders in green health care.”

CKHA's Sydenham Hospital Campus

From left to right: Luis Rodrigues (Honeywell), Beth Hall (CKHA), Harrie Bos (CKHA), Carrie Sophonow (CKHA), Mike Hickey (CHES), and Lori Hunter (Honeywell)

greener healthcare

To put our solutions to work for you, call 289-333-1377 or visit honeywell.com/buildingsolutions.

© 2011 Honeywell International Inc. All rights reserved.

Congratulations to Chatham-Kent Health Alliance on winning the 2011 Wayne McLellan Award of Excellence in Healthcare Facilities Management. Honeywell is proud to sponsor the award.

Honeywell technologies help healthcare organizations reduce their carbon footprint, replace aging equipment and improve comfort — all at little or no upfront cost. We engineer a wide range of improvements that help reduce energy consumption and carbon emissions, including renewable energy solutions. Based on completing more than 5,000 energy efficiency projects across the globe, Honeywell helps customers generate real energy savings.

HONE50_3737_(Hunter) Chatham-Kent Health Alliance Congratulatory Ad_1027_01.indd 1 10/27/11 3:08 PMUntitled-2 1 11-10-28 4:33 PM11121_CHF_Fall_11.indd 17 11-10-31 11:10 AM


Roland McIntosh was never aware he was up for CHES' illustrious Hans Burgers Award, but one look into his impressive 27-year resume within the healthcare industry and the organization itself is enough to know he makes the perfect candidate.

“I was surprised,” recalls Roland. “I didn't know my name had even been submitted. I think there's lots of other people who are deserving [of this award], and I would also accept this on behalf of the chapter, since I had a lot of help doing what I did.”

After graduating from the University of New Brunswick with a degree in Civil Engineering, Roland began his career as a healthcare engineer in 1984 as commissioning coordinator for The Moncton Hospital Redevelopment Project. In this freshman role, he was tasked with overseeing a 383,000 sq. ft. expansion to the facility – the

largest in its history. In 1991, The Moncton Hospital appointed him to director of plant operations and facilities planning, and in 1993 he assumed his current role as director of physical resources.

Roland encountered CHES early in his career when he attended the association's National Conference in Halifax shortly after joining the Moncton Hospital in 1984. Recalling those early days, he notes, “I had only started working in healthcare four months ago. I can remember the founding fathers were there: Steve Morawski, John Cyr George Corbeil, and Harry Callan.”

Eight years later, Roland was approached by George Seely, a former Hans Burgers Award winner, to join CHES and accepted the job as treasurer for the 1992 National Conference in Fredericton. From that day forward, Roland became instrumental in the formation of CHES' Atlantic

Hans Burgers award for outstanding ContriBution to HealtHCare engineering

roland MCintosH

“I think there's lots of other people who are deserving [of this award], and I would also accept this on behalf of the chapter,

since I had a lot of help doing what I did.”

Chapter, which later became the Maritime Chapter. His roles within the chapter have included 6 years as chair, 6 as past chair and multiple years as NB vice-chair. In those years, Roland has contributed greatly to development of CHES, its committees, membership and initiatives.

“I just did what I thought needed to be done,” he recalls, noting, “I know a lot of people helped me along, so I put my ef for ts into helping the chapter along.”

Reflecting on his achievements with CHES, Roland says he's proud to have helped the Maritimes chapter evolve into the entity is today, and to have aided in placing it on sound financial footing. He is particularly proud of the gains the chapter has made in creating successful industry education sessions, popular chapter conferences , and increas ing the organization's membership. At every step along the way, Roland says he was driven by a desire to always find

the better alternative, noting, “The key was about always trying to find a better way. Whatever we come up against, it's just trying to find a better way to do it.”

Asked who he thanks for his award, he adds: “Certainly I'd like to thank the people who nominated me. I wouldn't have gotten this award if there hadn't been good people within the chapter for support. CHES is in good hands.”


P E

[email protected] or

visit www.rikos.com

Re-piping is no longer the best solution!

Understand your options.Save time, save the mess and save the money!

Are Pinhole Leaks Draining You?

Pipe lining is the most effective solution to prevent pinhole leaks and RIKOS is the most experienced high-rise pipe lining company in North America.

RIKOS is the ONLY pipe lining company that specializes in delivering a complete, well engineered solution to pinhole leaks in high-rise domestic hot water recirculation systems.

Revitalize Your Pipes with RIKOS.


Energy challengeCompeting for greener health care

ThE chEsTEr nETWork's

Employees celebrate the win at Clinton Public Hospital alongside CHESTER, The Chester Network mascot and Andrew Williams, Chief Executive Officer for Huron Perth Healthcare Alliance

ThE chEsTEr nETWork's The Chester Network is a growing not-for-profit system of hospitals cooperatively addressing energy management t h ro u g h a n em p l oye e en g a gem en t pro g r a m . By incorporating necessary behaviour change strategies and activities with information that is meaningful and of value to staff, the program generates additional energy savings while creating an energy efficient culture within the facilities. Most hospitals now recognize the value and importance of engaging employees, however the underlying question that lingers in peoples' minds is: how much will it save and are these savings measurable?

To answer this question, the Chester Program began running fun and informative ‘Energy Challenges’ a few times each year with willing departments in the original two network hospitals: London Health Sciences Centre (LHSC), and St. Joseph’s Healthcare in London (SJHC). In these engagement activities, the department’s baseline energy use is measured using a portable meter and the employees are then challenged to reduce their consumption by a customary 10 percent over the next several weeks. The monitoring continues during the challenge and the impact of their behaviour change is measured and made visible to the staff as they climb toward their goal. The challenge's success is celebrated upon completion, and the employees are educated as to the environmental and economic benefits of their effort.

This activity has proven to be a great team building exercise and provides immediate gratification and reward for improved efficiency. In terms of measured savings, the results have varied between a 10 percent and 30 percent reduction depending on the type of space. Like many hospitals, LHSC and SJHC have been in a constant state of flux with respect to other major energy influences. Therefore, to maintain a controlled environment in which to verify the savings from behaviour change, the measuring has been done at the department level only. That is, until now.

Five Hospital-Wide EventIn June 2011, Alexandra Marine and General Hospital, St. Marys Memorial Hospital, Seaforth Community Hospital, Clinton Public Hospital and Stratford General Hospital did something very unique and special; they each monitored their hospital’s electricity consumption as a whole and together turned Chester’s department Energy Challenge into a five hospital event.

Following a promotional campaign designed to gear up employees, the hospitals battled valiantly to achieve the greatest reduction compared to a multiyear baseline for June. Local utility companies were brought on board to take meter readings and monitor the electricity use over the



four weeks while Chester and the h o s p i t a l e n e r g y c h a m p i o n s communicated to employees in a fun and friendly fashion. The challenge was marketed using a boxing theme and employees were encouraged to join this 'Energy Royal Rumble' through a series of posters, computer start-up messages, on-site display booths, and a website. Many employees took the challenge to heart; so much so that in some cases the effort became visibly noticeable throughout the hospital.

Acco rd i n g to Jo a n n e Hay te r,

accounting clerk for Clinton Public Hospital, the biggest impact came from turning off lights that weren’t being used. Washrooms, some hallways, cafeteria and photocopy rooms were among the targeted locations. Those who were keen on participating were also encouraging others to shut down their computers, monitors and photocopiers at the end of the day. Says Joanne, as time passed and results were posted, more people were finding their competitive stripe and getting involved to help catch the leader, noting, “I believe if we had just made June ‘Energy Conservation

Month’, it wouldn't have been as successful as it was.”

To keep the challenge as close and competitive as possible, a multiyear b a s e l i n e w a s c h o s e n w i t h t h e understanding it would produce more modest results than a baseline of June 2010. When the first round bell rang, Clinton Public Hospital came out strong and scored a 13.9 percent reduction in the first week, followed closely by St. Marys Hospital at 13.5 p ercent . A lexandr a Mar ine and General Hospital came out to a slower start in the first week but jumped right

• Blowdown Tanks

• Deaerators

• Economizers

• Condensate Systems

6 Scanlon Court, Aurora, Ontario L4G 7B2Tel: 905-727-1901 Fax: 905-727-8656

www.thermogenicsboilers.com

• Coiled Tube Boilers

11040_Thermogenics_2011.indd 1 11-03-23 3:33 PM

HEALTHCARE DESIGN LEADERS

Delivering forward thinking, patient-centred, evidence based healthcare solutions for over 25 years.

www.designdialog.ca

PARTNERS IN WELL-BEINGresearch | innovation | sustainability | delivery

Integrated architects, engineers, interior designers, urban designers and planners.

Untitled-8 1 11-02-28 8:05 PM

“Many employees took the challenge to heart; so much so that in some cases the effort became visibly

noticeable throughout the hospital.”


The Water Spec ia l i s ts

WWW.KLENZOID.COM

265 Watline Avenue, Mississauga, Ontario L4Z 1P3 Tel: (888) 712-40005830 Côte de Liesse, Suite 100, Ville Mont-Royal, Québec H4T 1B1 TÉL : (514) 342-2121

Proven Solutions for Healthcare Facilities through Service-Intense Water Management Programs

Is your

watergettIng the

treatmentIt deserves?

back into contention in week two with a 17.7 percent reduction. By the end of the third week the top three hospitals were within three percent of each other, but when the final round ended, Clinton Public Hospital edged away with the victory at an even 14 percent r e d u c t i o n o ve r a l l . A n ave r a g e electricity reduction of 9.7 percent was achieved by the five hospitals for the month. Afterward, the challenge results were compared to June 2010 consumption and normalized for weather to provide an accurate and relevant report to the hospital leaders

on the impact employees had made. When the dust settled, the staff had achieved an average of 11 percent reduct ion for the f ive hospita ls combined and Clinton had reached a staggering 19 percent. The hospitals had saved as much electricity as would have been used by almost 300 average s i ze h o m e s a n d p o cke te d ove r $20,000.00 for the month of June.

The challenge confirmed that the s av i n g s re corde d w i t h v a r i o u s departments over the years is in fact achievable on a hospital wide scale and this is further testament to importance

and expected results of implementing a successful engagement program as part of an energy management plan. The Network would like to commend Mer ibeth Vlemmix, Direc tor of Support Services at Alexandra Marine and General Hospital and Chuck M e y e r, D i r e c t o r o f F a c i l i t i e s Management Department at Huron Perth Healthcare Alliance for bringing their engagement program to fruition. Additional information about this program and how you can join our growing network can be found at www.chesternetwork.com.

The aging population is at the forefront of many discussions about the future of healthcare. However, discussions are much more limited concerning how to involve and enable the general population to help overcome current healthcare issues such as elderly care. For years, the personal emergency response systems (PERS) market has provided a health monitoring service for the elderly, which have been paid directly by the consumers. Generally, these traditional systems are simplistic in nature and provide little in the form of actual accident prevention and life management. That said, this market continues to be receive attention due its significant market penetration into the elder population. This is resulting in an evolution of traditional simple PERS to more advanced systems that are poised to play a significant role in the future of elderly independent living.

What is a Traditional PERS?The most basic PERS consist of a pendant or other type of button notification device, a base station receiver in the home, and a call center component managing the transmitted events. These systems have been in existence for more than 30 years, and many current products are patterned off this or ig inal idea. Technological progression has occurred throughout the years, but at a slow rate. For example, a recent innovation was the addition of fall detection technologies imbedded inside these systems.

The market is dominated by direct-to-customer service relationships similar to home security systems, with limited direct equipment sales. With the 65-plus demographics growing fast, PERS are emerging as a necessity rather than a luxury in the residential security market. Proliferation of wireless systems and cellular

Personal emergency response systems (Pers)A cornerstone for the future of elderly independent living


ne twor ks increases the ease o f installation, and these systems are very affordable. However, this market has recently been receiving high attention as it is one of the few markets involving healthcare related services that provide direct-to-consumer services. With children commonly moving out of their parents’ region, it becomes necessary to hire a person to take care of the elderly or move them to an assisted care home. And with the a d v a n c e s i n m o n i t o r i n g a n d telecommunication technologies, it has become increasing ly easy to monitor people with PERS.

Current and Next Generation PERS Today's PERS commonly take the form

of an electronic device that lets the person wearing it summon help using a panic button during an emergency. With newer models, it can also consist o f a m o n i t o r i n g s e n s o r t h a t automatically alerts the respective people to send help in case of distress. In the case of new automated PERS, the sensor can be placed on the person being monitored, or it can be placed throughout the house like a motion sensor or a sound sensor. The back-end management of information plays a critical role in current and next generation systems, giving caregivers and loved ones real-time access to useful displayed information that enables them to make a real impact on a person’s life. PERS also work as a

great integrator with other non-hospital care services such as medical dispensing and management systems, remote monitor ing , and general wellness programs.

Future Trends - PERS and TelehealthThe idea behind monitoring behaviour and movement patterns involves the core pr inciple of the te leheal th movement in healthcare; that is , eliminating physical distance through technology. In the past, elderly people used to live with or nearby their family members, but the distance between family members has increased greatly in recent years. Hence, providing c a r e g i v e r s w i t h c u t t i n g - e d g e , affordable solutions to maintain an


F I L T R A T I O N

EVITAVONNIWEN

TCUDORP Ultra-Cell LR

The new Ultra-Cell LR® is 99%+ efficiency on 0.3 micrometer particlescoupled with 0.53 w.g. initial resistance (box construction). Thisoutstanding efficiency and pressure drop is achieved using our

proprietary media and “Embossed pleat” (E-pleat™) technologieswhich maintain pleat spacing and geometry to maximize

the LR’s performance. Ultra-Cell LR® is initially available in asingle-header, high-impact plastic (HIPS) cell side model and a

no-header, box-style configuration constructed with metal cell sides.

UL CERTIFICATE 10001663 QM

www.norspec.com

Warehouse Locations In:Sarnia • Hamilton • Edmonton

800-265-0247

Call For

Pricing

Today!

The new Ultra-Cell LR® is 99%+ efficiency on 0.3 micrometer particlescoupled with 0.53 w.g. initial resistance (box construction). Thisoutstanding efficiency and pressure drop is achieved using our

proprietary media and “Embossed pleat” (E-pleat™) technologieswhich maintain pleat spacing and geometry to maximize

the LR’s performance. Ultra-Cell LR® is initially available in asingle-header, high-impact plastic (HIPS) cell side model and a

no-header, box-style configuration constructed with metal cell sides.

actionable care link with their loved ones is likely to be the key in solving this critical healthcare issue in North America.

Elderly care and aging independently is at the core of the current healthcare crisis, and it is not likely to be solved by doctors and other healthcare professionals alone. Everyone must play a more active role in managing the elderly. The evolving PERS market will need to enable consumers to do that, as this is likely to be highly desired considering the growth of the population aged 65 and above.

Shifting from Reactive to PreventativeLike many innovations, the PERS market was founded upon a cr it ical necessity : the need for effect ive management of elderly independent l iv ing. This requirement and the traditional “I’ve fallen and I can’t get up” monitoring systems created in response to this concern are nothing new. However, the healthcare market now seems ready for systems that fully realize this need more than what is currently being accomplished by the traditional PERS market. Traditional PERS relies heavily on the fear aspect of in-home elderly monitoring, but it does l i tt le to address the true management and preventative opportunities made possible by in-home elderly monitoring systems.

This new preventative aspect in the PERS market is pushing beyond the basic PERS offerings and striving to evolve the traditional PERS market. New systems and technologies such as fa l l detect ion and act iv i ty monitoring have a higher price point than the traditional PERS, but they must remain affordable, with costs under the cr i t ica l $100 per month mark. Prov iding a customizable monitoring experience beyond simple emergency notification to enable caregivers and loved ones to manage and improve patient care and prevent undesired events is likely to be a significant growth opportunity.

Elderly care is one of the direst issues facing healthcare in North America. Whether through an elderly community or in a person’s home, the effective management of elderly care with the minimal involvement of professional services is going to be an absolute necessity as we look to the future of how we conduct healthcare. Despite the daunting nature of this task, it is uplifting to see markets evolve in response to these needs, with the PERS market being a wonderful example of that. Moving away from simplistic, limited value services and shifting toward true health and wellness impactful offerings shows not only stable growth for this market, but promises a real impact to the way the elderly and at-risk patients live.

Zachary bujnoch is a senior industry analyst in patient monitoring and telemedicine for frost & sullivan.


The CHES 2012 National Trade Show & Education Forum will be held in Montréal QC at the Palais des congrès, September 23-25, 2012. The Palais is a veritable hub where the city’s main attractions converge. It connects Montréal’s business centre, international district, arts and entertainment district, Chinatown and Old Montréal.

The theme of the 2012 conference is “Towards World Class Healthcare”. The CHES 2012 Education Program will feature 2 major tracks, one on Regulatory Compliance and one on Health Care Facility Management Best Practices.

We look forward to seeing you in Montréal in 2012!For more info visit our website at

www.ches.org

Social

TourS

opening reception:

city Tour of Montreal:

Keynote Speaker:

The Great cHES Golf Tournament:

Flavors & aromas of little italy:

Plenary Sessions:

cHES Gala Banquet:

Sunday September 23, 2012Come join us for food, friends and fun!

Sunday September 23, 2012This exciting tour will introduce you to various parts of the city that make Montréal what it is today. You will have the chance to see how culturally diverse Montréal is, as well as visit landmarks and new developments that are so very important in making Montréal such a unique city.

Monday September 23, 2012

Senator Larry SmithPast President & CEO Montreal Alouettes Football Club

Sunday September 23, 2012

Quatre Domaines golf club.This golf course features 2 courses that can accommodate all levels of play with demanding fairways and lush greens.

Monday September 24, 2012Come discover Little Italy, one of the most captivating neighbourhoods of Montreal with its colourful past, its quaint streets, its well known restaurants and fine epicurean groceries. Come and visit the Jean Talon Market, the biggest outdoor market in North America.

Begin and end each Education Day exploring world-class healthcare facility construction and maintenance from one of four unique perspectives: Québec, Canada, US, and International. These sessions will feature guest speakers from Montreal’s new SuperHospitals, ASHE (American Society of Healthcare Engineers) and IFHE (International Federation of Healthcare Engineers).

Monday September 24, 2012

Marche Bonsecours Inaugurated in 1847, Marché Bonsecours is acknowledged as one of Canada’s ten finest heritage buildings and has become an essential stop on any visit to Old Montréal.

11220_CHES_Conference_2011.indd 1 11-10-31 10:32 AM11121_CHF_Fall_11.indd 27 11-10-31 11:11 AM


Brit ish Columbia 's Abbotsford Regional Hospital and Cancer Centre (ARHCC) opened its doors in 2008. Greeted by a four-story atrium that is naturally ventilated by temperature sensors and automated windows, the 645,000 ft2, 300-bed acute care facility

features technologically-advanced medical equipment, nine operating rooms, psychiatric care, pediatrics, maternity, inpatient isolation rooms, a radiation cancer treatment centre, support services and more. The facility showcases excellence in HVAC design

A case study in design

Abbotsford Regional Hospital and Cancer Centre

Pho

tos

cour

tesy

of S

tant

ec C

ons

ultin

g a

nd M

cQua

y In

tern

atio

nal

British Columbia's Regional Hospital and Cancer Centre is a 645,000 ft2, 300-bed acute care facility designed with innovative technology and facility management best practices.


and engineering as well as facilities management. From the moment they enter the doors, visitors know they are in a carefully designed building.

Notably, ARHCC marks a number of firsts as it is BC's highest profile public-private partnership (P3), Canada's first P3 hospital, and Canada's first LEED Gold NC (new construction) hospital. ARHCC was planned using a fully integrated design process that involved a high degree of cross-functional collaboration. The owner, architects, engineers and user groups—including 140 physicians and other medical professionals—all provided design input.

Access Health Abbotsford (AHA) is the project company which has the long-term facilities contract with ARHCC. AHA is subsidiary of John Laing Investments and a part of the P3 responsible for the design, construction, financing and maintenance of the facility. According to ARHCC operations director Marcus Akhtar, who works for AHA, operations and maintenance personnel were fully involved in its design and construction process to ensure equipment was selected and installed to allow for safe maintenance and ensure system failure downtime would be minimized, noting, "In this contract, we are incentivized to make sure 100 percent of the facility is available 100 percent of the time. Every room has a value against it and if that room is unavailable, we get a penalty."

Challenging Sustainability RequirementsPaul Marmion, P. Eng, LEED, AP, senior pr inc ipa l a t S tantec Consul t ing in Vancouver, also had a tal l order in representing the firm hired by the P3 project architects Musson Cattel Mackey/Silver Thomas Haley for mechanical consulting services on the project. Stantec provided design of the HVAC, plumbing and fire protection systems at ARHCC.

“Hundreds of possible energy strategies were analyzed on simulation

software to achieve the best energy savings and cost effectiveness with a

reduced environmental impact.”

"The facility had to meet defined sustainability standards such as to qualify for the LEED Silver green building rating with at least three energy credits and to obtain Natural Resources Canada's commercial building incentive program, all in a cost-effective manner," recalls Marmion.

Among the project requirements, Marmion says energy targets were the most difficult to meet, explaining, "It was necessary to rethink typical hospital design practice and create cost effective, energy-efficient design solutions. Operation, maintenance and reliability of the HVAC equipment was a major consideration."

Overall, hundreds of possible energy strategies were analyzed on simulation software to achieve the best energy savings and cost effectiveness with a reduced environmental impact.

Innovative HVACUltimately, the chosen design of the HVAC greatly contributed to ARHCC's energy-saving strategy. HVAC design includes two high-efficiency gas-fired hot water boilers and a flue gas heat recovery system. A high-efficiency chilled water generation system, comprised of two McQuay 900-ton centrifugal chillers configured in series counterflow, allows for energy recovery on both chillers at peak efficiency throughout various load ranges.

HVAC at ARHCC also incorporates special air handling units (AHUs), which were custom designed and pre-tested prior to delivery to fit stringent indoor air quality requirements, as well provide make-up air in the mechanical room and heat recovery of exhaust air.

While the primary heating and cooling plant is housed in the AHRCC mechanical room in the lower level, other HVAC equipment was placed on the roof to support tight floor-to-ceiling design constraints, the fast-tracked construction schedule and to allow for easy access. This includes AHUs and HVAC piping for heating, natural gas and chilled water lines. "Placement on the roof was very unusual for a hospital, and attributed to the fast-tracked project because of phasing and the cost impact," Marmion says.

30 Canadian Healthcare Facilities30 Canadian Healthcare Facilities

Going for the Gold in Energy SavingsWhile the P3 project aimed for Leadership in Energy and Environmental Design (LEED®) Silver certification from the USGBC, it exceeded that bar to achieve Gold certification. Other sustainable design elements include a high-performance building envelope, the use of an existing pond for storm water control and other "green" building materials.

"The end result of the integrated design process was to produce a hospital which will consume approximately 38 percent less energy as compared to a code-compliant hospital," says Marmion, adding, "All of this translates to 3,120 metric tons of CO2 savings annually and an equivalent energy operating cost savings of $480,000 per year which can be redirected into providing healthcare."

Akhtar at ARHCC validates the savings, noting, "We come in under the upper utility limit that is specified in our project agreement.”

Savings over time are, of course, significant when one considers the 30-year contract.

AHA/Laing Investments oversees ARHCC operations which includes monitoring quality and output relative to key performance indicators and subcontract administration for ARHCC's operations. These operations include subcontractors that provide a gamut of services, including 'help desk' core functions, which is a centralized dispatching and operations center; portering; housekeeping, including linen and laundry; patient and retail foodservice; materials services; plant services; security; and parking management.

Selected contracts at ARHCC such as with Johnson Controls Limited Partnership for plant services are for the long term (30 year) duration while others are "market tested" for shorter durations.

"There is no convenient time to have something not work. What makes a P3 of this complex nature successful is a unified culture that we work hard at. Housekeepers, doctors and mechanics all work together with a mutual respect for each other's role in the facility," Akhtar explains. "It comes down to relationships. The P3 is only as good as the relationship between the public sector and the private partner, in this case John Laing and all its partners."

Facility at a glanceabbotsford regional Hospital and Cancer Centrelocation: abbotsford, b.C.size: 645,000 sq. ft.owner: access Health abbotsford ltd. (aHa)architects: Musson Cattel Mackey partnership, Vancouver, with silver thomas Hanley of australiageneral Contractor: pCl Constructors Westcoast inc.Mechanical engineering: stantec ConsultingMechanical Contractors: lockerbie & Hole Contracting, ltd.facilities Management: John laing investments through aHadistinctions: leed® gold nC, 2010 asHrae region Xi technology award

We are pleased to announce that Ventcare now monitors 50 plus hospitals in the Ontario region.

Labour Canada has fully “acknowledged” the scope of work provided in the semi-annual inspection program. In addition, the written documentation contributes greatly to the hospital accreditation programs.

Further we are always pooling the knowledge resources of Infection Control and Engineering Groups like CHES, the ventilation inspection program is in a constant evolution to meet future healthcare needs for patients and staff.

The location and inspection of the hospital ventilation fire doors may be part of

your building audit this year. Some of you have already taken advantage

of our new software program which in conjunction with our patented robotics, allows us to minimize ceiling access requirements.

To date, of the thousands of fire doors inspected approximately 30% are not humanly accessible from traditional ceiling

access points. Our patented robot overcomes

this obstacle, allowing complete documentation of all

fire doors within the ventilation system. Further, of the total, 7%

have been found defective, blocked with wood, wired up, or simply closed

shutting off airflow.

Ventilation MonitoringBandy II

“Setting the Standard for Commercial Ventilation Care”

Fire Door Inspection

HEALTHCAREVENTILATION SYSTEMS

What’s really in yours?

75

176 Bullock Drive, Unit 14, Markham, ON L3P 7N1 Tel: 905-201-7887 Fax: 905-201-1340www.ventcare.com


















Ventcare CHF.indd 1 27/04/10 2:26 PM


















75

176 Bullock Drive, Unit 14, Markham, ON L3P 7N1 Tel: 905-201-7887 Fax: 905-201-1340www.ventcare.com


















Ventcare CHF.indd 1 27/04/10 2:26 PM

Canadian Healthcare Facilties - Fall 2011

Documents

Transcript of Canadian Healthcare Facilties - Fall 2011