The healthcare industry steadily is shifting toward community-based services with more outpatient clinics, micro-clinics, wellness centers, and ambulatory surgery centers. This outmigration of care from a centralized Medical Center reflects a growing emphasis on population health—engaging patients as active partners in their healthcare process through education, wellness, prevention, and convenience.
To meet the growing focus on community-based outpatient services, some forward-thinking healthcare organizations are implementing new approaches to building clinics through modular planning and prefabrication. This cost-effective design-and-construction process increases speed-to-market, enabling providers to target the right service at the right time at the right place.
Yet modular planning and prefabrication require a paradigm shift in traditional healthcare design and construction. The construction industry generally has followed a standard process over the past 100 years, in which buildings are constructed from the ground up on-site, from foundation to framing, MEP systems, enclosure, and interior fit-out.
The automotive and retail industries, however, long since have adopted a modular approach to product planning and development.
Since the first Model T rolled off the assembly line, the automotive industry has been an innovator in modular design, in which standardized parts are combined in almost limitless ways within the parameters of predetermined options. This results in predictable quality, customizable to meet a wide range of needs. Every year the auto industry produces a new car and every three to five years they completely reboot the car based on feedback from the existing model.
Similarly, the retail industry has systematically streamlined the design and construction of Big Box stores through tested standardized, modular planning and prefabricated finishes and systems. The benefit for retailers is cost-effective speed-to-market to meet consumer demands. The advantage for customers is familiarity—they know where to find what they need, no matter what store or city they are in.
With improving technology and materials, the time is right to adopt a similar approach in healthcare design and construction. A typical Medical Office Building can take three to five years to complete, from early concept planning and programming to design development, construction, and finally occupancy. Nearly one-third to one-half of this time is spent in risk management, such as validating program and building stakeholder consensus around customized solutions. The typical process has a series of sequential steps and approval processes, separated by time-consuming and sometimes imperfect hand-offs. Each hand-off poses a potential delay—and unexpected expense or unpredictable outcomes.
But by shifting the design-construction model to modular planning, healthcare organizations can create a competitive advantage by decreasing their reaction time, predicting their costs, and delivering consistent results across their system.
The Rules of Modularity
Designing for modularity and prefabrication requires a shift in thinking by designers as well as by owners. In rethinking the healthcare planning process, follow the Rules of Modularity, in this order:
First, healthcare organizations need to Standardize building components to reduce variation whenever possible and appropriate. In addition to being easier to prefabricate, standard design elements—such as a typical exam room—have the advantage of ensuring quality by eliminating unintentional deviation from best practice. Many healthcare organizations have begun to develop standard room types based on a growing body of evidence-based research. The key for them is to create a “learning” system that promotes innovation through a process of continuous improvement; otherwise, the prototype will simply become outdated over time, or worse yet, will end up as a constraint to quality care.
Once organizations have standardized the parts, they must intentionally plan how individual parts come together in a Modular, systematized way. As with Lego® blocks, modular planning offers consistent, repeatable elements that can be flexibly adapted and reconfigured for different programming needs and sites, in almost unlimited ways.
Finally, standardized modular components should be Prefabricated. This requires collaboration with construction partners and vendors, and should be incorporated in the early design stages. Prefabricated components (such as interior wall partitions or entire rooms) are built off-site at the same time as on-site construction (such as site work and foundations) is progressing and then assembled on-site. This reduces cost by saving time and the associated general conditions of managing a construction site. Many elements are commonly prefabricated, encompassing everything from interior wall panels to entire rooms, MEP racks, exterior envelope, and structural steel.
Prototype Thought Leaders
While most organizations still plan and design facilities as one-offs, a few visionary organizations are developing modular/prefabricated prototypes that streamline the planning process—from entire ambulatory facilities to individual components within larger, more complex acute care hospitals.
For instance, HGA currently is working with a major California healthcare provider to develop a 25,000-square-foot Medical Office Building (MOB) prototype for low-acuity patients that addresses rapid changes in technology, social trends, and population health. The prototype is scalable; flexible for a variety of subspecialties; integrates the right operational, physical and technological features regardless of size; and can be adapted to multiple locations across their system.
Several key principles are guiding the modular prototype, including:
- Build in flexibility
- Leverage technology
- Promote collaboration
- Create a user-friendly environment for wellness and education
- Keep it affordable
The prototype is based on a standardized 26’-8” x 28’-0” structural grid that can accommodate two different options for clinic layouts. The design maximizes flexibility with standard room types and components sized (and re-sizable) for flexibility of use, demountable partitions for easy reconfiguration, minimal built-in casework or non-mobile furniture for flexibility, and standardized structural/MEP systems for plug-and-play adaptation.
The prototype goal is to be 70 to 80 percent prefabricated. Approximately 25 percent of the prototype square footage is in standardized design elements that are the same across all projects, 50 percent is in choices between standardized elements, and 25 percent is in design elements that are customizable within certain prescriptive requirements. Despite the range of operational models and scales, the prototype can be consistently implemented throughout the system, reducing cost and increasing speed-to-market.
As healthcare turns increasingly toward population health, wellness and preventive care, modular/prefabrication increases value exponentially through reduced first cost, faster construction schedules, and quicker iterations of new care models—creating savings that can be directed to patients.
While most organizations are designing facilities as one-offs, advances in prefabrication are changing the way we design and build. Consider the following three steps as you move forward with your next project:
- Recognize complexity, scale and building type matter. Smaller ambulatory centers, with simpler programs, are strong candidates for modular/prefabrication, while acute care centers, with more complex programs, offer opportunities with select prefabricated components.
- Begin to develop project delivery processes to encourage incorporation of modularity and prefabrication opportunities early in the design process.
- Build relationships with vendors, prefabricators, contractors and designers who are experienced in prefabrication.