Healthcare facility managers have their hands full, balancing the direct effects that forces such as healthcare reform, mergers and acquisitions, physician alignment, reimbursement changes, and IT infrastructure updates have on the buildings they operate.

And while the nuances of those challenges may differ between the military and private sector, the overarching issues are the same, discussed panelists during a morning session at the American Society for Healthcare Engineering (ASHE) Annual Conference & Exhibition in San Antonio.

The session titled “Meeting the Challenges of Healthcare Facilities Management” included panelists George A. (Skip) Smith, CHFM, SASHE, vice president, facility management, Catholic Health Initiatives; Col. Rex Langston, USAF, MSC, CHFM, chief, health facilities division, U.S. Air Force; and G. Brian Prediger, PE, CHFM, director, engineering division office of the assistant chief of staff for facilities, U.S. Army Medical Command Headquarters.

When it comes to healthcare reform, Smith said he doesn’t anticipate an immediate effect on his system’s building projects because little is actually being planned regarding physical space—instead capital is being spent on IT infrastructure for electronic medical records.

Langston agrees the IT piece is fundamental to reform and on the military side, there is a significant effort being made not only to bring medical records online but to have a connection between branches of the military medical records and those of the U.S. Department of Veterans Affairs.

Also a result of reform, mergers and acquisitions continue to temper the healthcare market as hospitals and physician groups also align. In addition, the overall model of care delivery is shifting, and Smith says healthcare systems remain challenged by the reality that the outpatient model is overtaking inpatient care, whereas bottom lines used to be met by having patients in beds.

“How do you make it up?” he asks.

A piece of that puzzle for the facility manager is to cut costs at the building level by making it run as efficiently as possible, and one focus of that effort lies in energy management and providing solutions to identify potential savings—something that used to be a more of a tough sell to the C-suite.

“I think leadership is much more open to hearing it than they’ve ever been,” Smith says.

At Army facilities, Prediger says retro-commissioning is being used to identify inefficiencies in systems operations, so far shaving $16 million over a 3-4 year cycle. Langston says his team is using energy monitoring to the same end, successfully gaining baseline data on energy usage its facilities didn’t have before.

When discussing guidance for achieving leadership roles in facility management, the panelists again returned to the ability facility managers must have to be creative in assessing not just what an initiative will cost to accomplish but how to reduce expenditures, as well.

With reduced reimbursements restricting already-tight budgets, Smith said there is one clear solution all facility managers should be pursuing: “If you’re not involved with Lean today, you will be very shortly,” he says.

Another key is what Langston quipped is the “often forgotten and seldom practiced art of communication.” Facility managers of today finally have a seat at the leadership table and have the ability to impact the decisions made at their hospital or healthcare system. The only way to do that in a meaningful way, he says, is to communicate with leaders.

While providing patient care is the primary function of facilities, Langston adds that facilities must be operating efficiently to deliver care effectively. And the facility managers will be the ones consulted to make it happen.

“We’re the guys and the gals they come to first … our worth in the enterprise is becoming more apparent,” he says.