Assessments of Health Care Facilities, Services and Building Systems

Note: The title & scope for this NOI (originally published on April 4, 2024) was updated by the responsible SDO on February 25, 2025.

1.1 General

This Standard provides a framework for the requirements and guidance for a consistent approach on how to plan and conduct functional suitability and technical performance assessments of existing HCFs/NHFs, to determine their ability the support current and future health care service delivery. 

1.1.1 Categories of assessments 

There are two categories of assessments: Functional Suitability Assessments (see Clauses 4.4.1 and 6) and Technical Performance Assessments (See Clauses 4.4.2 and 7). 

1.1.2 Types of assessments 

In each of the two categories of assessments, there are three types of assessments to create a tiered approach which may be tailored to the purpose of the assessment: Current State, Gap Analysis and Future State Options (See Clauses 3.1, 4.5, 6.2 and 6.3.3).

These types are typically progressive, although not necessarily mutually exclusive:  a Gap Analysis will require that a Current State is completed prior to or as a part of the Gap Analysis. Future State Options will require some elements of Current State and Gap Analysis information to be available. See Figure 1.

1.2 Application 

This Standard applies to HCFs, including existing hospitals, LTCH, outpatient HCFs, and NHF or settings being considered for use in the delivery of health care services. 

It is intended to be used by HCFs providing services regardless of type, level of care, size, or location.

Where applicable by AHJs, the focus of the assessment should be aligned with the objectives of the funding agency or study sponsor to address HCF planning or design issues, to inform capital planning and investment, or to learn from elements of the completed assessments to inform future studies and/or projects. 

Future studies can include planning, design, and construction (PDC) studies and post-occupancy evaluations (POE) and Sustainability or Climate Resilience Plans (See CSA Z8003 for more information on PDC and POE).

1.3  Inclusions, users and interdisciplinary teams (IDT)

This Standard is developed for a broad range of users, including, but not limited to, HCFs, funding agencies, governments, professional design and planning teams, architects, engineers, infection prevention and control professionals (IPC), health care teams, providers and clinical staff, vendors, researchers, and internal and external evaluators.

This Standard supports IDT involvement in the assessments, in order to determine the scope of the assessment and to guide an assessment of the functional suitability and the technical performance of the building systems.

As applicable, input from health care authorities may also be necessary to establish the assessment purpose and scope.

Note: The IDT members of the HCF become the subject matter experts (SME) for the assessments and include administrators, health care program and clinical planners, clinical staff, infection prevention and control professionals, facility operations and maintenance staff, patients and their families, and non-clinical support staff. Other key members of the IDT may include non-HCF individuals (e.g., professional design and planning teams, vendors, funding agencies).

1.4 Objectives

1.4.1 General objectives

The general objectives of this Standard are to:

a)  assess the performance of the existing building’s functional suitability and technical performance and the ability to support the HCF’s health care purposes;

b) apprise the HCF or provider of the apparent condition and capacity of the space and systems, identify gaps in performance and associated issues related to the effectiveness of operation and maintenance, 

c)  highlight priority concerns that require in-depth investigations and more detailed information, based on tests and analyses, such as: 

i)    risks and liabilities, including evaluation of risks; 

ii)  life expectancy and deferral of replacements, repairs, or maintenance;

iii) environmental impact considerations; 

iv)  sustainability such as GHG emissions, water consumption, effluence, waste management, etc.;

d) add to the project’s database for asset management, for project planning, and for recommissioning systems; 

e)  indicate capacity of the facility to accommodate extended service life: and

f)  assess capacity of the facility to accommodate a proposed change in function.

1.4.2 Business continuity 

An understanding of the HCF’s business continuity role in the event of the disruption of health care services should be included in the assessment and may include the following:

a)         number of beds (base plus surge capacity);

b)         role of the facility in local or regional emergency preparedness system;

c)         post-disaster requirements;

d)         timeline of expected continuation of normal or reduced operations following an event;

i)          electrical power failure: capacity (hours) of diesel generator fuel storage;

ii)        Information Technology/Communications failure;

iii)       failure of site central utilities (heat, cooling, ventilation, medical gasses, reverse osmosis, etc.);

iv)        failure of natural gas to HCF: electric provisions or alternate fuel;

v)         interruption of roadways/bridges to HCF;

vi)        failure of incoming water supply: on-site storage capacity; and

vii)      failure of storm/sanitary outflow: on-site storage capacity.

Note: For more information on business continuity/emergency management please see Z8000, Z8002, Z8004, Z1600. For additional details regarding technical system specific references to business continuity/emergency management see Z317.1, Z317.2, Z7396.1, Z32, Z282, Z314.

1.4.3 Climate change and sustainability 

This Standard provides high-level guidance to assess HCFs for sustainability, including operational continuity, environmental impact, energy management, reduction of GHG emissions that contribute to climate change and increased resilience to the impacts of climate change. Assessments for these factors are embedded in the functional and technical assessments and referenced throughout the Standard.  The outcome of assessment of space and systems for climate resilience and sustainability assessment may result in a recommendation for the development of a Climate Resiliency Plan (CRP).  A CRP is different than business continuity plan. 

Note: For more information on business continuity/emergency management please see Z8000 and Z1600.

1.5 Terminology

In this Standard, “shall” is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply with the standard; “should” is used to express a recommendation or that which is advised but not required; and “may” is used to express an option or that which is permissible within the limits of the Standard.

Notes accompanying clauses do not include requirements or alternative requirements; the purpose of a note accompanying a clause is to separate from the text explanatory or informative material.

Notes to tables and figures are considered part of the table or figure and may be written as requirements.

Annexes are designated normative (mandatory) or informative (non-mandatory) to define their application.

1.6 Units of measure

The values given in SI units are the units of record for the purposes of this Standard. The values given in parentheses are for information and comparison only.

Measurement of spaces in HCFs shall follow CSA Z8000 and CSA 317.11