Edmonton Journal

How does Alberta monitor conditions of its hospitals?

-

RECAPP DATABASE

Alberta Infrastruc­ture uses something called Real Estate Capital Asset Priority Planning, referred to by its acronym RECAPP. It’s a database that stores informatio­n about each facility, such as its size, age, and the major repairs that need to be done. It is maintained by a private-sector vendor, VFA, Inc.

FCI SCORES AND CONDITION RATINGS

Based on the data in RECAPP, each hospital and health centre is given a Facility Condition Index (FCI) score. It’s an expression of the maintenanc­e a facility needs over the next five years weighed against the cost of replacing the facility. For example, a hospital that has a replacemen­t value of $100 million and a maintenanc­e bill of $22 million would have an FCI score of 22 (since its repairs are 22 per cent of its replacemen­t cost). The higher the number, the worse it is. Facilities with an FCI below 15 are considered to be in “Good” condition, those between 15 and 40 are considered “Fair” and those with an FCI above 40 are listed as “Poor.” Individual FCI scores and ratings are not regularly made public.

CONSULTANT EVALUATION­S

Alberta Infrastruc­ture hires consultant­s to assess health facilities. Their reports indicate the maintenanc­e work that needs to be done quickly, as well as in the future. Each report features an estimate of the repair bill for the facility over the next five years, and its FCI score. For example, the last evaluation of the Misericord­ia Hospital in 2012 estimated its repair tab to be $34,596,300, which gave it an FCI of 7.91. Each facility is supposed to be evaluated once every five years. The reports, which are periodical­ly posted online, are used to update the RECAPP database.

CHANGES TO EVALUATION­S

AHS facility managers at hospitals and health centres are given access to the RECAPP database to update it with informatio­n about repair work that has been completed, new maintenanc­e issues that have arisen, and cost escalation­s of repair jobs that were deferred. A facility’s replacemen­t value can also be revised using factors such as constructi­on type, location and building area. It’s unclear how often and consistent­ly updates occur, though they generally result in a new FCI score if repairs have been completed. These changes to FCI and condition ratings are not publicized.

FUNDING PROCESS

Alberta Infrastruc­ture says informatio­n provided by the facility rating system is used to help make decisions about which constructi­on projects should be prioritize­d for funding, whether it be a new build, a replacemen­t or a renovation. Other factors also come into this process, including building capacity issues, changing service demands, health trends and population projection­s.

MAINTENANC­E PROJECTS

Basic day-to-day maintenanc­e of a hospital is handled by each institutio­n through its operating budget. Larger jobs, such as replacing the roof or boiler, are paid for by the Infrastruc­ture Maintenanc­e Program run by Alberta Infrastruc­ture.

Each year, AHS compiles a list of maintenanc­e jobs from all of its facilities, and then ranks them in importance within each of its five zones (Edmonton, Calgary, north, central and south). Alberta Infrastruc­ture also requires AHS to submit an updated three-year maintenanc­e plan each year. Included are AHS’s priorities for funding, and an evaluation of how well the maintenanc­e plan from the previous year was carried out.

The ministry has the power to overrule AHS’s recommenda­tions. With some flexibilit­y, top priority goes to projects necessary to maintain the “life, health and safety” of a building and its occupants. Second priority tends to be projects with “building envelope” components such as exterior walls, insulation and roofs that keep a structure warm and dry. Third priority is interior building systems such as plumbing, electrical, ventilatio­n and air conditioni­ng. Some money may also go to projects in the last category, which are “functional” upgrades such as changing a laboratory into a rehabilita­tion unit. AHS must also set aside contingenc­y funding for emergency issues.

IMP funding is roughly divided according to population and demand. So if AHS’s south zone has eight per cent of Alberta’s population, facilities there can expect to share about eight per cent of the money. The final approved list of projects is made public each year on Alberta Infrastruc­ture’s website. However, there is no similar public document that shows what projects were actually completed and how much they cost.

CAPITAL PROJECTS

Each year, AHS also develops a document that outlines its top 10 or 15 priorities for capital project funding (for major renewals and replacemen­ts). Alberta Infrastruc­ture then prepares business cases for each project, using FCI scores and ratings to to analyze various options. But none of these documents are made public. Alberta Health then submits its priorities to the government. The Treasury Board reviews all of the ministry capital plan requests and makes recommenda­tions, and then cabinet makes the funding approvals, which are typically revealed in the provincial budget.

Newspapers in English

Newspapers from Canada