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Prefab is changing health care design, construction

Prefabrication was used by The Beck Group in construction of the Harris Methodist Alliance Hospital patient tower in Fort Worth, Texas.

Mark D. Johnson, AIA
Health care director, The Beck Group

There have been recent studies and articles comparing productivity changes in the architecture, engineering and construction industry versus other fields. The general conclusions are that every industry has seen an increase in efficiency and productivity except for AEC. Many experts agree the silos that exist between architects, contractors and subcontractors are the primary cause.

Exacerbating the situation is the shortage of skilled labor and craftsmen. Between 2008 and 2012, an estimated 2 million jobs were eliminated from the construction industry during the Great Recession. At least 50 percent of that workforce did not return, resulting in a shortage of labor and creating an environment of uncertainty and unpredictability.

Industry experts believe the health care sector suffered most because health care facilities are more complex than other building types and require a higher level of skill in those positions.

To overcome these obstacles, health care architects, contractors and owners are shifting their paradigm and increasingly moving toward modular design and prefabrication. The industry’s willingness to do this is changing how buildings are delivered in seven specific ways.

•Early team selection. To efficiently deliver prefabrication, input from architects, contractors and subcontractors is needed earlier in the process. For this to happen, the traditional method of hiring an architect first, then a contractor and finally subcontractors does not work. The entire team needs to be at the table when concepts are in development. Collaboration like this is a foreign concept to many owners, and not all will be comfortable with this approach.

•The elimination of silos. For prefabrication to be successful, architects, contractors, subcontractors and owners must collaborate and engage more frequently with each other than they have in the past. The need for early information forces teams and owners to work together to solve problems that were traditionally “thrown over the fence” from one group to the other. You must have co-location of the consultants and the use of a “big room” to help with team communication and alignment.

•Early decision making. Prefabrication expedites the decision-making process. Compared to traditionally built processes, prefabricated elements like patient room configurations, materials and finishes are designed and determined earlier in the process to ensure installation is on schedule. Early decision making causes an increase in the use of digital virtual reality and physical mockups, allowing owners and architects to have more confidence in their decisions and helps contractors establish budgets sooner and with enhanced accuracy.

•Better building information models. Prefabrication requires architects and consultants to maintain better building information models because subcontractor trades need a model to fabricate components. As a result, teams must become invested in the creation of integrated models. Additionally, the increased complexity of modeling mandates the use of faster computers and high bandwidth communication platforms.

•Modular designs and standardization. Prefabrication is most efficient when components are standardized around modular configurations. Pragmatic departmental plans focused on operational efficiency will become the standard, helping lessen the complexity of the building information model and eliminating costly customization. Other advantages of standardization are quality control, reductions in waste and cost control.

•Industry integration. Because consultants and trades collaborate early to deliver prefabricated projects, we will see more consolidation in the form of mergers and acquisitions of industry partners. This is already happening with design and construction firms, but soon more firms will have MEP consultants, equipment planners and major trade partners. This integration will allow the industry to have a better appreciation of what it takes to successfully deliver a health care project, and allow architects to become “new age” master builders, similar to what they once were.

•A new construction workforce. As the industry moves toward prefabrication, new companies like BLOX, Pivotek and Factory Blue are being hired to fabricate modular components for health care projects. These companies are changing the construction landscape and perceptions of the typical construction worker. For example, they are bringing in new pools of talent who had no prior interest in construction. Unlike traditional construction, prefabrication occurs in the same place every day during traditional office hours. Additionally, these new companies can help re-establish vocational training and create a new workforce of craftsmen that hasn’t been seen for over 100 years.

Prefabrication improves efficiency because it helps accelerate schedules and wastes less material. Repetitive processes lead to consistency and fewer mistakes, resulting in better, more consistent quality. If you are a decision maker in a hospital or leading a health care construction project, consider how the benefits of prefabrication can improve your next project.

Featured in the January 2019 issue of Health Care Properties Quarterly

Edited by the Colorado Real Estate Journal staff.