All hospitals are located in either previously owned buildings/hospitals or purchased land through willing buyer-willing seller transactions. Therefore, no expropriation of land or physical or economic displacement is expected to be caused by the company’s activities; consequently, IFC PS 5 (Land Acquisition and Involuntary Resettlement) is not applicable.

The company’s hospitals are and will typically be located in urban or sub-urban areas in central and north-central Thailand, therefore, the type of risks and impacts envisaged in PS6 (Biodiversity Conservation and Sustainable Natural Resource Management), PS7 (Indigenous Peoples) and PS8 (Cultural Heritage) are not applicable.

 This is a Category B project according to IFC’s Policy on Environmental and Social Sustainability because a limited number of specific environmental and social impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria. 

Key E&S (Environment and Social) risks and issues associated with this project include: (a) adequate social and environmental assessment of the impacts for acquisitions and greenfield hospitals; (b) company’s staffing, capacity and systems to manage social, environmental, health and safety aspects of its existing and proposed operations in compliance with legal requirements as well as PSs and applicable World Bank Group (WBG) Environment, Health and Safety (EHS) Guidelines (General and Health Care Facilities); (c) assurance of fair, safe and healthy working conditions during both construction and operation; (d) management of wastes (particularly hazardous and biomedical waste) and effluents; (e) LFS management for all buildings in accordance with WBG General EHS Guidelines and National Building Act; and (f) resource efficiency (water and energy efficiency).

 Identification of E&S Risks and Impacts:

The company identifies and manages E&S risks and impacts associated with its operations through compliance with applicable national standards and E&S regulatory permits and requirements. Basic E&S permits like fire no-objection certificate, consent to operate for wastewater, and bio-medical waste authorization were noted to be available for the visited hospitals. 

The greenfield hospitals are typically smaller than the regulatory threshold level of 60 in-patients beds beyond which the company is required to undertake an Environmental and Social Impact Assessment (ESIA) study and seek environmental permit. If a new greenfield hospital or renovation of existing hospital will have in-patients beds above this threshold, the Company will complete the required ESIA study considering as well IFC’s Performance Standards’ (PS) requirements and obtain the required permit for the building.

E&S policy and management programs:

PRINC is finalizing a set of EHS policies and an ESMS (Environmental and Social Management System) at the corporate level. EHS polices, objectives and procedures will be incorporated at the hospital level for operations accordingly. As for hospital level, the EHS systems and policies are fully functional and adequately staffed with experienced professionals in quality control, occupational and health safety, life and fire safety and security management. As per ESAP 1, the company will finalize the corporate EHS policy and ESMS; in particular to include provisions for E&S due diligence for acquisitions and the full identification of impacts for greenfield projects; the ESMS, will be completed in accordance with good international practices and IFC’s Performance Standards.

The Pitsanuvej hospital has a quality management systems (QMS) certified as per Joint Commission International (JCI) accreditation since 2012. Although other hospitals are not certified yet, they have implemented similar quality control and management systems under the corporate level QMS.

The management systems include the following manuals, policies and procedures;

1) Safety for buildings, construction areas, and equipment, access and use, with relevant policies and procedures;

2) Hazardous material Standard Operating Procedures including handling, storage, control and dispose;

3) Emergency management, including epidemics with infection control, and other emergencies;

4) Fire safety, fire safety assessment, program including procedures and measures for fire prevention, detection, abatement, fire-fighting and emergency measures, fire drills;

5) Medical equipment, selection, maintenance and infection control;

6) Utility systems, electricity, water and other systems.

Its quality management system, the environmental management system and the occupational health and safety management system have been developed consistent with the current scope of outpatient healthcare services and are regularly monitored by PRINC’s Environmental, Health and Safety Committee on a quarterly basis at each hospital. All policies and procedures are available on company’s cloud-based hospital information system and are accessible to all employees. Regular training programs and induction trainings are conducted at all hospitals on these procedures.

Organizational capacity and competency:

The company has appointed a full time Risk Management and Quality Director, with EHS responsibilities at the corporate level. Its role includes to assess and ensure that the new hospitals and acquired healthcare facilities develop and implement their site specific ESMS in line with corporate policy requirements and impacts of its operations including construction related activities performed by contractor. The corporate level project management team is responsible for design and development of new/existing hospitals with support from internal teams (e.g. IT shared services, quality control and management) and external agencies (architects, consultants and project management companies).

At the hospitals, quality management lays with the operating department including nursing and clinical services, who implements continual quality improvement programs and monitors quality performance of the hospitals. Quality control meetings are organized every month, and the performance is reviewed every quarter by the executive committee consisting of hospital director and head of each department.

Additionally, all hospitals have a Facility Management and Safety (FMS) department, headed by deputy hospital director and members from different departments including doctor, technician and nurse. The FMS committee covers building and safety management providing trainings for staffs and contractors, ensuring implementation of safety procedures such as usage of Personal Protective Equipment (PPE) and chemical and hazardous management control.

Emergency Preparedness and Response:

As part of the emergency response manual, PRINC has developed response plans for different emergency scenarios using nine color codes. Four color codes specifically prepared for sudden illnesses, stroke and heart attack, indicating the process of assessment, treatment. Other codes are aligned to emergency situations including flooding, potential exposure to hazardous material, theft or attacks, information system failure and code red especially covers fire.

The fire action plan describes processes on assessment of emergencies, decisions on evacuation, patient categorization (based on their vulnerability and mobility) and evacuation procedures. Roles and responsibilities of various people/teams are described in the action plan.

Monitoring & Reporting:

As part of the quality assurance implementation and continual improvement, all hospitals monitor number of quality indicators including health and safety key performance indicators (KPIs) such as clinic and non-clinic related injuries. The KPIs are reported on monthly basis to the respective teams e.g. quality management, clinical operations, medical service and customer relations in each hospital. All incidents are summarized and discussed in the hospital monthly quality control meeting and the quality management team analyses the root causes and implements corrective action. The performance is also reviewed every quarter by the executive committee and other hospital member is joined as an external auditor.

The same approach will be utilized in other facilities once they become operational. As part of the corporate ESMS, PRINC formalizes the platform level monitoring and reporting through IT system so that they could benchmark performance, including energy efficiency, complaints, service performance, building maintenance and environment monitoring records, and share experience across hospitals.

As set forth in the ESAP 2, the company will develop and implement a specific EHS monitoring procedure, as part of the ESMS, covering construction and operations. Monitoring procedure will include key performance indicators on OHS (e.g., accidents, incidents, lost time injuries), labor compliance (working hours, overtime payment, grievances), energy and water efficiency, solid waste management, and implementation of management programs during construction.

 The company has a workforce of about 1700 employees, about 1400 staffs in hospital management business including nursing and customer care, additional full-time and part-time doctors are involved. The gender split of staff is 40-45% male and 55-60% female as 80% female in nursing. Only small number of employees are outsourced mainly in cafeteria and external security and transportation services.

HR Policies and Procedures, Working Conditions and Terms of Employment:

PRINC is finalizing a set of HR policies at the corporate level. Similarly to corporate EHS policy, HR polices, objectives and procedures will be incorporated at the hospital level for operations. As for hospital level, the HR policies and regulations are fully functional and adequately staffed with experienced personnel under the HR division including employee benefits, separation, personal development, position management, performance review, etc.

No instances of child or forced labor were observed, normally no immigrant worker employed due to the governmental restriction with working permit. All employees are given permanent position after the probation period, with written appointment letters which explain their employment terms and conditions, the turnover rate is quite low compare to the other hospitals. Retrenchment is not expected as part of the acquisition of new hospitals but if that occurs PRINC will follow related requirements as per IFC PS2.

Nursing and customer care work in three shifts and the doctors are in two shifts, no accommodation provided to the employees. All employees have access to the on-line based HR management system through which they can process their HR requests.

As part of the ESAP 3, the company will finalize the corporate HR policy/guideline including documented policies on prevention of sexual harassment, grievance mechanism, non-discrimination/equal opportunity.

Freedom of Association & Grievance Mechanism:

The applicable national laws allow formation and registration of trade unions. Although PRINC does not restrict freedom of association or formation of unions, currently there are no staff unions at any of the PRINC hospitals. However, all the staffs can express their grievance directly via on-line based grievance mechanism.

The company has a documented grievance handling procedure at hospital level, however the set of corporate HR policy including grievance mechanism has not yet available. As per the procedure, all employees are expected to first direct their grievances to their supervisor and can then progressively escalate to HR. All hospitals maintain grievance register and based on the review of the same at the visited hospitals, most of the grievances were related to operational matters (e.g. variety of available food choice) and no other significant grievances were noted.

Occupational, Health and Safety (OHS):

As mentioned under PS1, specific safety, infection control, and emergency response are part of the company procedures. The procedures cover fire safety, spill response, emergency response for various types of emergencies, spill management, safety during construction/renovation, bio-medical waste management, and management of hazardous materials (including a MSDS database) etc. Employees and third-party workers undergo a pre-employment medical check as well as annual health checks.

At the units with radiation materials, a detailed policy is developed and followed in line with requirement of local department of Medical Sciences, under Ministry of Public Health along with tracing of exposure levels / allowance limits and ongoing follow up.

Regular training programs and all induction trainings were noted to be conducted at the visited facilities on various safety related topics.  All employees have access to an internal web-based system for recording incidents/accidents.

Construction Safety and Management:

PRINC typically hires a project management company (PMC) when developing new hospitals in greenfield site or renovated existing buildings. PRINC oversees the projects through the PMC and corporate level quality management team monitors and reports on safety performance. The PMC has also asked to have their safety officer on-site as well as a project manager from PRINC’s corporate engineering team. Safety guidelines for the projects have been documented and covers key areas of OHS at construction sites. The payments and benefits are managed by the PMC and reviewed by the corporate HR and Procurement Management departments.

Workers engaged by third parties:

Apart from the construction workers, a small number of third-party workers are employed at the hospitals mainly for housekeeping, café/food services, security or drivers.

The attendance for these workers is monitored through IT based attendance system installed in their mobile phone. The HR and Procurement Management department reviews compliance of the contractors with respect to labor laws for their workers internally as well as through quarterly compliance audits.

 Energy Supply and Air Emissions:

Electricity is sourced from the public grid for all hospitals. As standard back-up systems for grid failure, diesel generator (DG) sets and Uninterruptible Power Supply battery back-up systems are installed. Each hospital conducts the DG function testing every month.  Based on review of available data and information on use of DG sets, though their use is quite limited as below 50 hours in a year, all visited hospitals were noted to conduct annual air emissions testing and results were noted to be compliant with the national standards.

Resource Efficiency:

The hospitals’ energy consumption is monitored in the centralized IT system and resource efficiency is continuously improved based on the monitoring results. Some of the initiatives implemented at PRINC hospitals for resource efficiency in the past few years include installation of LED lighting, controlling temperature in rooms and use of illumination and electricity during periods of non-occupancy, efficient use of printing and reduction on use of materials such as plastics and paper.  

The company plans to install solar photo-voltaic (PV) panels at Pitsanuvej hospital for lighting power and plans to install the same at few other hospitals. To maximize the air conditioning efficiency, the company closes all the open atrium/terrace spaces at Suvarnabhumi hospital and Uthai Thani hospital.

The usage of electricity during 2018 was 3,314,000 kWh/year for the Suvarnabhumi hospital and 4,687,000 kWh/year for the Pitsanuvej hospital. The existing usage of water is 35,200 m3/year at Suvarnabhumi hospital and 91,200 m3/year for the Pitsanuvej hospital. All hospitals monitor the electricity, diesel and water consumption. Based on the available data, the annual electricity and diesel consumption for the PRINC hospitals (for FY18) was about 10.87 million kWh and 2,320 liters.  Considering these estimates, the expected GHG emissions from the project are expected to be less than 25,000 tons CO2 eq/annum.

Water and Wastewater:

Water for the existing hospitals is sourced from the borewells installed inside the hospitals and is stored in the underground water tanks, the maintenance technical staffs of each hospital inspects the water quality from the wells at least once a month and use it for purposes of sanitation, cleaning and laundry services. Adequate treatment is provided through filtration, softening and disinfection and reverse osmosis. Potable water for patient and staff consumption is sourced from local bottled water supplies.

Each hospital has an on-site waste water treatment plant (WWTP) with   secondary biological treatment, it is linked to a monitoring system, recorded daily from the maintenance staff. Wastewater quality is checked from the contracting company every month. All visited hospitals were noted to conduct monthly testing of the wastewater quality and the results were noted to be in compliance with the national standards and WBG EHS guidelines.

For any new greenfield hospital and any future acquisition of hospitals, PRINC will ensure that the on-site waste water treatment plants (WWTP), when required, are designed to meet the WBG/IFC’s EHS Guidelines or the local regulations, whichever is more stringent. As per ESAP 4, the company will develop and implement specific wastewater management and monitoring plans for new facilities covering: the installation of adequate wastewater treatment plant, or pre-treatment if required. In case these hospitals will have arrangement with the central waste water treatment plants of cities they will be built in, the waste water quality at the entry point to the municipal sewage will respect national requirement for discharge of waste water to public sewers.

Waste Management:

PRINC has waste management procedures including BMW (Bio-Medical Waste) which follows the system of appropriate sorting, labeling, handling, storage and disposal and is consistent with the applicable legal requirements. Visited hospitals were noted to have a segregated waste storage area where BMW waste is stored in fridges. Medical and hazardous waste generated at medical areas are segregated at source as per the waste management procedures and kept into color coded bags. From the storage area, all the waste collected by authorized external agency (government and private sector) for disposal specialized in each type of the waste. With the quality control mechanism and IT systems, the company can maximize the efficiency of purchase minimizing wasting expired equipment and medicines. Moreover, the company has been reducing the use of plastic bags.

Waste materials with traces of radioactive materials are stored in a secured premise on site, managed by the radiation officer as an in-house staff under the supervision of the Department of Medical Sciences, Government Department.

Community Exposure to Disease:

PRINC implements infection control program and procedures at all its hospitals to prevent infections for the patients and visitors as required by host country legislation. In addition to the engineering and administrative controls and architectural segregation, the company has documented procedures on various aspects related to infection control including prevention, cleaning, disinfection and sterilization, sanitation, accident management, monitoring, etc. Each hospital has an infection control staffs as well as quality control center to monitor implementation of the program and procedures.

Life and Fire Safety Management:

PRINC has a set of fire safety procedures describing actions to be taken in the event of fire, mechanisms for fire detection and prevention, evacuation procedures, roles and responsibilities of the various staff and are reviewed regularly through pro-active measures. PRINC facilities undertakes fire drills over-all hospital premises at least once per year. Each drill is followed by an assessment of observed gaps with corrective actions to be sent to concerned department heads and discussed in facility management and safety department, explained in the PS1.

Visited hospitals were noted to be provided with LFS infrastructure and systems including different types of fire extinguishers, smoke detectors and fire alarms, manual call points, sprinklers in the basement and all floors, fire hydrants, fire hoses/reels at every floor, overhead and underground fire water storage with fire pumps, fire alarm control panel and public address system. Nevertheless, the initial review on LFS elements indicates some deficiencies on LFS provisions, as per ESAP 5  PRINC will engage a suitably qualified L&FS expert acceptable to IFC to conduct a risk-based LFS review at a representative number of existing hospitals, covering the elements of the section 3.3 of the WBG General EHS Guidelines, such as means of egress, detection and alarm systems, compartmentation, fire suppression and control, fire prevention and operation and maintenance. as. Findings of the review will be used to set a time-bound action plan to be implemented and to introduce systematic improvements on L&FS management at the company level.

The projects team of PRINC hires an engineering company to prepare LFS designs for the new hospitals. The designs are reviewed by PRINC’s projects team. Once the hospital is constructed, the implementation of the LFS systems is reviewed by the projects team. The same is also reviewed by local fire safety authorities for their compliance and the company obtained the certificate in advance to the operation. 

PRINC will comply with local regulations and IFC requirements regarding life and fire safety design and installations in the new greenfield hospital and the existing facilities to be acquired. Any new building or those undergoing significant renovation will follow the requirements of the L&FS section of the WBG General EHS Guidelines.

As per ESAP 6, a suitably qualified expert in international LFS standards will  prepare a LFS Master Plan for the new hospitals, providing guidance and/or design criteria on LFS to ensure compliance with the requirements of the L&FS Section of the WBG General EHS Guidelines.

The Master Plan will be applied for all future hospitals, including existing hospitals that will be subject to large renovation projects. The design should meet both local requirements and those of an international L&FS code (such as NFPA 101 of the National Fire Protection Association).  The standard specifications will include operational and maintenance guidance, such as the preparing of schedules for mandatory regular maintenance and testing of life and fire safety systems and regular fire drills.

As per ESAP 7, once the firsts 3 new hospitals are built or remodelled the LFS professional should provide a certification confirming that the hospital has been built as per the master plan and that the project is in compliance with the requirements of the L&FS Section of the WBG General EHS Guidelines.

Security Personnel:

All hospitals are guarded with unarmed security guards from private security agencies and PRINC will review the security policy and provide training and monitor the conduct of security personnel.

The draft ESIA will be circulated for public consultation and each stakeholder including public/local community can raise concerns during the process as part of governmental procedure in Thailand, and PRINC will follow all the required procedure. PRINC publishes Corporate Social Responsibility report every year. The company also provides monetary supports, health check-ups and trainings to local community.

 Contact Person: Miss Ritima Jirasuradate

Company Name: Principal Capital Public Company Limited

Address:  No 29, Bangkok Business Center Building, 23 floor, Soi Sukhumvit 63, Khlong Tan Nuea, Watthana, Bangkok 10110

Email: ritima.ji@principalcapital.co.th

Phone: +662 714 7171-3