If Walls Could Talk

Flexible prefabrication construction streamlines healthcare interior design.

Prefabricated headwall allows flexible changes to an inpatient room.

Whether it’s driven by an ar­chitect, a designer or a client, flexible and adaptable design is taking hold in healthcare. There are a variety of reasons to consider this as a viable interior design solution. It can save a client time—time to go from construction to occupan­cy. It drives efficiencies—opera­tional efficiencies with staff, efficiencies in space planning and utilization, and efficiencies in the patient experience.

Ultimately, the return on investing in this process is lower risk—risks associated with the supply chain and acquiring materials, risks in delayed construction, and risks in budget overruns. These are the risks health systems are constantly working to avoid. But this new way of design­ing and constructing means professionals need to think differently about the process and the desired outcomes for both the client and a practice.

Prefab Systems Changing The Process

Standardized design can take many forms, from means and methods, to the prefabricated design of panels, pods and even whole building modules. Wall systems and furniture, typically used in corporate en­vironments, are being adapted for applications in health­care design. Based on these advances in manufacturing and construction, clients are starting to request prefabri­cated solutions from designers and architects. While this is exciting, it also adds a layer of complexity to an already complex process.

In theory, the prefabricated design process removes several steps traditionally required to transition from design into construction. It also presents the opportunity to follow a non-linear path, using modeling and mock­ups to analyze and revise the design in real time. This works when the entire team is highly integrated. If executed properly, it can be less complicated and ultimately reduce the construction schedule, eliminate rework and impact the bottom line, realizing savings in labor and costs. It is our responsibility to anticipate, manage and mitigate design issues in a whole new way.

Prefabrication removes several steps in the design-construction process for greater efficiency.

Take, for example, team dynamics. This process adds new partners to the table who work and consume information differently. Communication and coordination are critical to developing a successful partnership and, ultimately, a successful project. First, obtain a high understanding of the prefab system being considered and anticipate the potential limitations or challenges the system might pose. Knowledge sharing must occur on every level, including the contractor and subcontractors who will ultimately build the system. Therefore, it is critical to start design with every team member at the table. Only by working through the logistics before the model is complete will the process be successful.

Mock-ups are an integral component to the process to better understand how the design will be translated once built. Will all the codes for the use case be met? Will the finishes and materiality work with the design? Will it provide the flexibility and ease of use both today and down the road? The opportunity to test ideas within the system before it is built with staff, operations and the facilities team, along with the various trades that will implement the design, is priceless. Critical details where transitions occur and materials meet can more readily be resolved and detailed before anything is built. But this takes planning, coordination, and communication.

Flexibility, both in the construction and application of prefabricated systems, is part of the very reason these systems have gained popularity. From the designer’s perspective, the modular nature of the system provides an opportunity to develop a new language of design that integrates a variety of elements seamlessly. To maintain that flexibility for the future takes strategy and forethought. It is important to consider how the kit of parts will create a more aesthetically pleasing environment that feels cohesive.

Experienced From The Inside Out
Prefabricated panels in a nursing unit.

Ultimately, much of the pre­fabricated systems are experi­enced from the interior spaces they create. Take materiality, for example: prefabrication offers the ability to integrate many new wall materials in the healthcare environment (such as solid surface, wood, plexiglass, even full-scale artwork) that were previously difficult and expensive options without a system in place. It is important to know what the options and limitations are, especially when it comes to selecting finishes and art.

Another important design consideration with a prefab­ricated system is the frame­work that holds the assembly together and the reveals it creates. Reveals need to coor­dinate with mechanical and electrical equipment, as well as the technology behind the systems. Panels need to be op­timized and even customized to meet the desired effect.

The most exciting ad­vancement is the integration of lighting and technology into prefabricated systems. A variety of functional compo­nents can be fully incorpo­rated through the use of touch screens. The scale of these screens is impactful and pro­vides opportunities for staff, patients and their families to engage in research, accessing patient data and entertain­ment.

Variable lighting options with dimming ability, color­-changing technology and vari­ation throughout the day can integrate into the walls and ceilings, promoting patient choice and control, as well as enhanced recovery, supporting better sleep patterns. These spaces might look and feel futuristic, but they are the reality of design today.

Prefab In The Real World
Prefabricated footwall includes a touch-screen monitor for patients and family members to access medical data.

The Richard M. Schulze Center Family Foundation for Excellence in Neurological Care project is a 44,000-square-foot, 55-bed shell fit-up under construction in Minneapolis, Minnesota. Once complete, the project will consolidate Abbott Northwestern’s broad spectrum of neurological services, providing their clinicians with 12 ICU rooms, 43 medical-surgery beds, a sta­bilization room and in-unit CT scanner. From the inception, hospital leaders knew they wanted to push innovative, flexible healthcare infrastruc­ture in a neurological setting to the next level.

“We have been paying close attention to manufac­tured wall systems for the last few years,” said Tony LaCroix-Dalluhn, R.N., MSN, NE-BC, Vice President of Operations at Abbott Northwestern Hospital. “There are a lot of appealing elements for us. With our Richard M. Schulze Family Foundation Center for Excellence in Neurological Care project, we made a decision early on to push ourselves to explore innova­tive solutions and stay nimble. Manufactured wall systems fit this project perfectly. What turned out to be one of the best opportunities was being able to involve our front-line care teams in the detailed design process. Having staff design the exact location of outlets and equipment helped streamline the process and better ensure a unit that works as well as it looks.”

Once completed, the center will be the first project in Minnesota to utilize prefabri­cated wall systems in inpatient rooms.

For this project, HGA incorporated a prefabrication modular wall system in the foot and headwalls of all 55 in­patient rooms. Flexible panels in the headwall allow changes to the outlet configuration, re­moving the need to shut down the room for use and reducing the dust and debris associated with traditional construction causing issues with infection control.

Additionally, each patient room is manufactured to be adaptable. Intentional details like casework, art, lighting and patient care boards are inte­grated into the wall system, allowing for relatively easy and quick replacement due to changes in nursing require­ments or accidental damage. Not only does this solve long­-term facility requirements, it also provides opportunities over time to flex the design of each room, changing finishes, artwork, etc., refreshing the space with far less down time and cost.

Prefab Is Here to Stay

Prefabrication in all its forms is here to stay. This process should be understood holistically, anticipating the challenges and opportunities in order to develop a modular and prefabricated healthcare solution.

Ultimately, we have a responsibility to clients to both mitigate their risk and drive improvements to their bottom line, but we do not have to sacrifice the design
to achieve that. Instead, we simply have to commit to thinking, working, and building differently.

Read the full article in Medical Construction & Design.