Prefab-ulous flexibility

Prefabricated construction could provide healthcare facilities with many opportunities for efficiency, quality and cost savings compared to constructing on-site. So why is this technique not more widespread in hospital construction than it already is?

Currently in Australian hospitals, the factory technique of production is only striking acceptance in remote locations where minimising construction disruption is a major driver, or situations where there are significant repeated elements (such as dropping finished bathrooms into an otherwise traditional construction site). There are signs of the premanufacture industry breaking out of these limitations and being more widespread in acceptance.

Developing hospital flexibility

An often-cited constraint of a premanufactured module system is its tendency to be delivered with non-flexible, load-bearing walls, or at least with added bracing inside the partitions to face the harshness of transit. Any such hindrance for future change to walls is certainly not flexible and does not allow the hospital to keep up with the health service. A health service nowadays is fast-developing and the building which accommodates it needs to be responsive to the accelerating need for change. In some projects, this first barrier to flexibility has been overcome by providing an independent structural frame, rather than load-bearing walls. The need for the additional bracing has also been overcome by making these elements redundant (or at least relocatable), once the building modules are assembled on-site. Designers must, of course, remember to clearly identify the expendability of the bracing so that it is clear to ongoing trades who open up walls in the future.

However, hospital flexibility is more than the ability to move the internal walls. Once the changeability of partitions has been tackled, there are many further adaptability opportunities in modular construction. These include:

• Uniform presentation: It is an advantage for hospital users to utilise repeated building elements. An example may be a uniform consulting room. The uniform presentation ensures familiarity and a universal procedure¹, reducing a risk of errors (in health care, a small lapse of attention can be significant). Prefabricated building units have a greater chance of keeping their elements similar because of their regular set-out and the factory technique embedded into the nature of production.
• Universal rooms²: These are generic rooms which suit multiple functions. For instance, a bedroom may be structured to suit a regular patient, mother, child or obese patient. Each function can swing with little alteration. With the room being suited for multiple purposes at the outset, it is likely to be rounded to a size which suits the multipurpose function and this again coincides with modular construction where the regular manufactured component is also expediently rounded. The result of the premanufactured module technique is a planning layout which is more likely to serve multi-use universality.
• Modular planning: This technique allows zones to capture a number of varying suites or rooms. Examples may include a series of operating suites or imaging modalities. Unlike universal rooms, this technique is more an allocated floor allowance, requiring a level of construction to move from one state to another. The technique is significant because it allows evolving change to clinical needs. Again, premanufactured construction is more modulated by its nature and has a greater predisposition towards modulated planning allowances.

There are various degrees of change to a room function: from just walking in to undertake your new intended purpose to shuffling change onto the whole floor to accommodate the new room function. Designing with flexible methods optimises changeability to the degrees illustrated. Image credit: Harm Hollander. For a larger version, click here.

Conclusion

The flexibility offered by prefabricated modular building systems represents an opportunity.

Naturally, these advantages do not just fall into place automatically. Designers will need to develop planning priorities and awareness in order to gain these advantages. Each new design should strive to improve the last. This process will incrementally increase value, quality, clinical effectiveness and satisfaction, as well as the ability for hospitals to better face the future.

Footnotes

1. There is ongoing opinion on whether reverse handing or mirroring layouts present enhancements or hindrances.
2. Some variances on this theme are loose-fit rooms, the ‘duffle coat’ approach (reference to a limited range of incremental sizes of a coat in a few select sizes, to fit all) and multipurpose rooms.

*Harm Hollander is a Principal Architect with Conrad Gargett architecture firm.

Image caption: Broken Hill Hospital Community Health Centre, Far West Local Health District, delivered by Health Infrastructure NSW (architect Conrad Gargett, builder Hutchinson Builders). This premanufactured module technique was made viable by the remoteness of the site and utilised uniform presentation, modulation, reverse engineering (commencing with the building in the simplest regulatory framework to inform its capacity for the services accommodated), a regular structural grid in lieu of load-bearing walls, expendable transit bracing and a conscious minimum factory appearance. Image credit: Conrad Gargett.