To help control costs, increase quality, and accelerate schedules, healthcare spaces are being improved through the utilization of prefabricated and modular construction. As the schedule and budget directly impact each other, by accelerating the schedule, healthcare systems are able to start
seeing patients and generating revenue earlier than traditional construction methods allow. Additionally, the expediated schedule that prefabricated and modular construction creates lowers construction costs by the reduced time the construction team spends on site.

When considering prefabricated and modular construction, the owner/design team need to consider the impact on the clinical workflows and the design of the patient care environment at the beginning of the process. The “kit-of-parts” format requires the design team to challenge the conventions of traditional project design and rethink a broad range of spaces in outpatient healthcare settings, such as:

• Integration of Clinical Planning Standards – As healthcare systems grow, they are adopting clinical planning standards.
Typical exam rooms, operating rooms, imaging spaces, and staff areas are standardized based on broad user group input. By having a standardized series of spaces, prefabrication and modular construction are a logical extension of this effort that provide a consistent clinical environment.

• Planning for Long-Term Flexibility – As regulatory, clinical, and reimbursement models change, the patient care environment needs to be flexible enough to respond to updates. Integrated additional space for long-term needs is critical when developing modular solutions. Shell space and additional capacity for future growth and renovation must be accounted for in the programming phase of the project.

• Curated Patient Experience – Prefabrication and modular construction allow for consistency in the patient experience.
As clinical care standards are developed, there are opportunities for the creation of standard palettes, from signage and wayfinding to exterior design concepts, that can provide each project an individual character while still providing a consistent aesthetic experience for patients.

With modular construction and prefabrication, there are great opportunities to provide an architectural consistency that prioritizes the patient’s clinical care experience. This consistent experience can help in a myriad of ways, from clinical efficiency to improved wayfinding, while still allowing for long-term flexibility and growth.

Like any design approach, these ideas are not always appropriate for every project. During the beginning of the design process, it is important to analyze if this is a viable approach for the project, taking into account the following variables:

• Scale of the Project – Similar to automotive manufacturing, the biggest gains come from leveraging a large number of repetitive components on the project. That is why scale of the project is the largest determining factor in utilizing modular construction and prefabrication. The more standardized components are part of the project, the greater return on investment. Part of the upfront investment comes from spending the time to test if there is enough repetitive content on the project to pursue prefabrication.

• Method of Delivery – To maximize the impact, prefabrication and modular construction require a series of critical path decisions early in the process. Because of this, it helps to have the construction team involved earlier in the process. Construction Management, Integrated Project Delivery, and Design Assist delivery models all provide opportunities for the builders to provide input on where prefabrication and modular construction provide best value.

• Increased Quality Control –. There are several benefits to having components produced in a controlled environment, including reduced impact from inclement weather, fewer wasted materials, and tighter tolerances in fabrication lines.
Mechanical, electrical and plumbing sub-contractors are already prefabricating runs and components in the shop and then quickly installing on site.

• Integration of System Standards – Prefabrication and modular construction can leverage planning and design standards to a great degree. By utilizing standards, critical decisions are made early in the process and can accelerate the start of mass production. For examples, drywall can be pre-cut by a CNC machine for the repetitive spaces.

There are several factors in healthcare that require extra attention when considering either prefabrication of components or modular construction. Having early strategies in place can help ensure a successful project:

• Transportation of Modules – Transporting modules from the factory floor to the project site is a critical metric when deciding on the what is being fabricated off-site. Bridge clearance, trailer length, and lane widths all influence module size. In Michigan, for example, this limits transport
loads to 13’-6” in height (including trailer). Trailers over 50’ in length are limited to designated highways and widths over 14’-0” are restricted based on season. Weight requirements are also seasonally restricted. The design team should consider these dimensions to ease costs associated with module transportation.

• Structural System Integration – The way that the modules interact with the structural system, depending on what is prefabricated, has to be taken into account. Floor systems, building framing, and lateral systems must be designed to support the modules.

• Floor-to-Floor Heights – With the limits on transport height, the design and fabrication teams need to ensure that patient care spaces have the required height and the walls go to the deck. Typically, outpatient care spaces have at least a 14’ – 15’ floor-to-floor height, higher heights in hospitals, and engineering systems must be successfully routed through the building. Having walls going “to deck” is an important part of designing acoustic privacy into the patient care environment.

• Exterior Design – Prefabricated exterior design is a key way to ensure the envelope enclosure is not slowing down construction. Panelization of façade elements has become an increasingly popular way to speed installation of pre-cast and curtainwall assemblies.

As prefabrication has become progressively used as a method to reduce costs, improve quality, and increase speed to market, fabricators have begun to expand on what is possible to construct off-site.

• Mechanical, Electrical and Plumbing – These subtrades have been involved in prefabrication for some time. Beyond air handlers and chillers, pre-assembled components include pre-wired electrical panels, main duct runs, and medical gas manifolds. Building information modeling technology has allowed for prefabrication, further accelerating the project schedule.

• Structural Systems – Pre-cast concrete is the most common prefabrication in the building structure and can extend from steel framing components to bridge spans.

• Wall Systems – The example above talked about pre-cut drywall, but the range of sophistication goes from pre-cut drywall to fully-assembled rooms with interior finishes. SIP panels, pre-assembled curtainwall, and pre-cast concrete wall panels have become increasingly common on projects.

The benefits associated with prefabrication and modular construction are causing the method to become increasingly common in healthcare facilities. The impact on schedule alone provides enhanced value and can reduce costs for the project. To gather the most benefits, the decision to prefabricate needs to be settled on early in the design process. The project needs to be of a scale that it can benefit from repetitive fabrication.
Most importantly, the design team needs to be an integrated group of architects, engineers, construction managers and fabricators, working alongside the owner.

This allows for a collaborative approach that provides a project that maximizes value for the owner and creates an outstanding care experience for patients. This method is not the right solution for every project. However, if your healthcare system is planning a project of a proper scale, has repetitive programmatic elements, and has the right team in place, it can be a great option. Modular construction and prefabrication have the ability to provide outstanding value by leveraging system standards and lessening construction costs and disruption, while providing a facility with the flexibility to meet.