Amy Marks, Head of Industrialized Construction, Autodesk
The outbreak of Covid-19 has underlined the importance of our healthcare system to life in the UK. But it has also put a spotlight on our healthcare infrastructure like never before. That’s because managing the pandemic depends on the availability of hospital beds for those in need.
Normally the delivery of hospital infrastructure takes months or years to complete. But the capacity of the NHS has been increased rapidly, with the creation of temporary healthcare facilities to anticipate spikes in demand for beds.
There have been incredible efforts across the healthcare and construction sectors, together with the armed forces, to delivery temporary Nightingale Hospitals at speed in cities including London, Manchester and Birmingham. Although not every bed has been needed, it was a vital step to avoid the NHS being overwhelmed – and an achievement to be proud of.
Looking to the future, there is a novel methodology that can help construction firms to not only rapidly accelerate the delivery of healthcare infrastructure when needed, but also improve safety and productivity. Prefabrication can benefit everyone across the construction ecosystem: public sector procurement teams, designers, general contractors and subs. But its adoption will require changes in the way that healthcare construction is delivered.
Prefabrication in extreme circumstances
Prefabrication already supports the delivery of medical services in some of the world’s most difficult circumstances. Doctors of the World provides care in areas that other health workers can’t reach, whether that’s disaster zones or extreme environments. But delivering these services requires temporary structures that can function in a whole range of settings, with greater privacy than tents and easier transportation than containers.
An international architectural practice developed a solution based on prefabrication. The Global Clinic is a structure created from plywood sheets that can be easily transported and then assembled in even the most inhospitable climates. Crucially, the shape and size of each clinic can be adjusted to meet medics’ needs, adding waterproofing, ventilation or insulation according to the location.
The Global Clinic showcases some of the advantages of using prefabrication in a healthcare build. Designs can be adapted according to the needs of the setting, ranging from basic modules like stairwells or patient bedrooms to more complex constructions. Because off-site manufacturing takes place in a controlled environment, it is more efficient and safer than on-site construction, so can be completed more quickly.
The work on-site focuses on assembly, rather than building from the ground up; as a result, prefabrication makes it easier respond to sudden spikes in demand, with less disruption to other healthcare activities. However, for prefabrication to function in the more complex ecosystem of the NHS, adjustments will be needed by stakeholders throughout the construction lifecycle.
A change in the procurement mindset
Prefabrication challenges many of the principles at the heart of public sector procurement, potentially presenting complications for healthcare owners. The methodology doesn’t represent a straightforward means of cutting costs. The overall advantages, however, are significant, with greater certainty over the schedule, budget and outcome of the build which can be just as financially beneficially. Equally, the construction site becomes cleaner, safer and more predictable, enabling healthcare foundations to protect the patient experience, while expanding capacity at the rate needed.
The methodology requires owners and general contractors to take a more collaborative approach to each project, shaping the build together, setting realistic expectations of outcomes and even sharing risk. But the change in mindset can deliver extremely positive results. Individual trusts gain consistent, highly functional results that benefit healthcare staff and patients alike. Equally, at a regional level, the UK could consider a stock of “healthcare infrastructure on demand”, to respond to challenges like that of today.
Design that focuses on the elements
Prefabrication also requires a significant change in approach by designers and architects, at the very outset of the project. From the beginning, the team conceptualises each building through element-centric design, rather than traditional stick design. From bathroom pods to operating room ceilings, the designer determines which elements will be prefabricated – and important which won’t. There’s even the option to go further and adopt an entirely modular design.
As a result, even at this early stage, the design team benefits from partnering with general contractors and subcontractors to finalise the approach. Adopting Design for Manufacturing and Assembly principles means looking ahead to how each element will be created and pieced together on-site. Consulting delivery partners can create a better result for the client, while using cloud-based platforms to collaborate on drawings in real-time increases the speed and simplicity of the process.
Incorporating prefabrication does represent a significant change for the design team, but it can be very positive. The configuration of standard elements like stairwells and stud walls can be handled by the fabricators. Instead, architects and designers have the time and space to focus on the signature parts of the design, to create a distinctive finished build which provides a standout experience for patients and healthcare staff.
From general contractor to integrator
Prefabrication alters many of the processes on a project, so has a significant impact on the role of the general contractor. Companies shift to become the integrator throughout the build, altering estimating, procurement and project management – and requiring a slightly different skillset.
A new approach is needed for many of the “traditional” construction processes. At the outset of the project, if estimates are conducted by trade, it can be challenging to compare prefabricated elements later – potentially precluding them from the process.
Likewise, from a procurement perspective, there might only be a limited number of firms able to produce the elements needed, challenging standard requirements for a certain number of bids. Bringing subcontractors into the project early to understand their capabilities and value offers a more productive approach.
Collaboration and relationship building become even more important for general contractors using prefabrication. Contractors might need to find new supply chain partners, which is an area where digital procurement and networking tools can help. Equally, GCs might champion their current suppliers to move into manufacturing. Although changes will be needed, prefabrication presents the opportunity to deliver more productive consistent builds. With safer sites, more predictable schedules and clearer costs, general contractors stand to gain from this new role.
Embracing manufacturing as a subcontractor
Shifting from traditional subcontracting to prefabrication can deliver significant benefits. On top of the improved safety and consistency of off-site manufacturing, firms can adapt efficiency-boosting techniques from the manufacturing sector, with technologies like robotics and automation. Sophisticated quality assurance methods can be used to build right first time. And the controlled environment eliminates some of the unknowns that can impact schedules and budgets, building more predictability – and trust – into relationships with GCs.
Many elements in the healthcare setting can be prefabricated, from headwalls to lifts and even whole patient rooms, so it’s a space that’s ripe for innovation. Subcontractors have the opportunity for specialisation, whether that’s creating sophisticated, adaptable designs or focusing on more sustainable products. Technology like 3D Building Information Modelling can help firms develop advanced designs and share them with partners and clients. By drawing on their existing relationships and existing craft skills, prefabricators can deliver benefits in all kinds of healthcare settings.
A bright future for healthcare
Prefabrication can not only help healthcare providers to meet peaks in demand, but deliver infrastructure in a way that’s reliable, consistent and productive. The methodology can deliver benefits for everyone, from healthcare owners and construction companies right through to the staff and patients using sites on a day to day basis.
The Covid-19 crisis has really driven home the importance of the healthcare infrastructure to life in the UK. Moving forward, being able to take advantage of new methodologies like prefabrication will help us to create an infrastructure that’s fit for the future.