The recent COVID-19 pandemic brought almost all countries, most industries, and the global economic and health systems to their knees. It amplified many of the preexisting cracks in the system, but also spurred creativity and innovation, compassion, empathy, and some of the best traits of humankind to combat this health crisis.
As part of the solution against the COVID-19 threat, the Architecture, Engineering and Construction (AEC) sector has also mobilized its creative forces to help the healthcare professionals in providing the much-needed hospital capacities of clean and sterile spaces where patients can receive life-saving treatments.
AEC Sector’s Rapid Response to COVID-19
Although the impetus to help defeat the pandemic is universal among architects and engineers worldwide, their creative solutions extensively range in permanence, speed, and cost of designing and constructing new hospital capacities.
Given the unanticipated character of the COVID-19 pandemic and ferocity with which it swept throughout the world, rapid creation of additional intensive-care capacities became the primary focus of architects and engineers within the first phase of their response.
Hence, numerous designs proposed deployment and construction of alternative-care facilities (ACFs). ACFs are commonly described by Lam et. al. (2006) as “spaces designed to rapidly provide the surge capacity of hospitals which is central to successful combat of pandemic crises”. They include temporary solutions such as military field hospitals located in tent-like structures, temporary modular structures built from redesigned shipping containers, and existing buildings such as hotels, convention centers, and arenas converted into temporary healthcare facilities (Hercules et. al., 2020). Therefore, due to their temporary and rapid erection, ACFs are suitable for patient triage, preliminary treatment of patients with light symptoms, or residence for healthy people in need for isolation from the infected portion of the population (Lam et. al., 2006).
However, to be functional these structures also require specialized mechanical equipment, emergency electric facilities, educated staff, and highly trained engineering and design professionals who can ensure that ACFs adhere to the highest standards of health and safety (Lam et. al., 2006). Otherwise, if ACFs are not designed and constructed properly, they can become dangerous hotspots for the spread of the disease and do more harm than good. Furthermore, once the pandemic is successfully suppressed and life resumes its regular flow, these temporary facilities become obsolete and are not suitable for long-term use as it is reported by diverse regulatory institutions including the World Health Organization. Hence, the materials and equipment invested in their erection become either irretrievably lost and discarded, or a heavy financial burden to maintain until future demand arises.
However, the widespread use of temporary and prefabricated facilities during the pandemic highlighted the need for more flexible and adaptable hospital design. By making it easier to bring healthcare infrastructure in line with current requirements, sunk costs in the form of both ACFs as well as outdated facilities can be avoided.
Long-Term Perspective on Flexible and Resilient Healthcare Infrastructure
As the world learns to live with COVID-19, architects and engineers have started devising solutions for the long-term flexibility and resiliency of the healthcare infrastructure to prepare for the next pandemic as well as the increasingly complex treatments that go hand in hand with the ever-aging global population.
This concept of flexibility and adaptability of healthcare infrastructure is not new, however. It has been studied and reported since the 1960s, when the architects and engineers started to recognize that the functional demands on hospital infrastructure were changing multiple times within the 50-year life span of a typical hospital building (Carthey et. al., 2010). This change in demands is primarily caused by shifting demographics, innovations in medical technologies, improvements in treatment procedures, and continuous attempts of public and private health providers to rationalize hospital budgets (Olsson et. al., 2010). In the 1970s, hospitals still catered to a significant number of patients with infectious diseases that have since been eradicated by vaccines and hygiene. Conversely, cancer treatment was less prevalent and sophisticated. Regarding space requirements, MRIs were only just invented.
Consequently, with ever more increasing rate of change in technology, demographics, and environment, our hospitals need to be increasingly more flexible, as was vividly exemplified by the COVID-19 pandemic and the related rapid surge in demand for intensive-care facilities worldwide. Therefore, the AEC industry has never been more urged and prepared to take a closer look at the technologies and innovations that are crucial in providing long-term resiliency and flexibility to the healthcare infrastructure.
Since its inception, the idea of flexible hospitals has been closely linked to the development of new construction solutions, which ranged from interstitial floor space construction, prefabrication of elements of the hospital building, through to the 3D volumetric modular construction of entire hospital rooms (Krystallis et. al., 2012). However, many of these technologies and the supporting market ecosystems have not been sufficiently developed until recently. Therefore, the complete market adoption of flexible and modular hospitals has been hindered until recently by the perceived high initial investment costs, insufficiently understood creative design freedom, and the stagnant state of innovation among the architecture, design, and construction industries, coupled with conservative legislative frameworks across the globe (Olsson et. al., 2010). Nonetheless, as McKinsey Global Institute reported in their 2019 assessment of the modular construction sector, the recent developments in digital technologies and planning methods (exemplified by BIM), robotics, and integrative digital manufacturing logistics have instigated a new era of efficient and sustainable modular design and construction. Additionally, the surge in demand for modular solutions has been fueled by an increasing awareness among clients of the long-term economic and environmentally sustainable benefits these systems provide to the built infrastructure. Hence, the COVID-19 pandemic can only serve as a positive catalyst to emphasize the need for the long-term planning, investment and development of resilient and flexible hospital infrastructure with the innovation in modular adaptable design and construction technologies.
Digital Planning of Facilitates for Modular and Adaptable Hospital Design (MAHD)
As with many long-lasting infrastructures, hospital design still relies on a mix of analog and digital planning simply because many existing structures were planned and built long before the advent of digital methods. Experience in other areas has shown that the tools needed to digitize planning in such complex fields requires tools that are either specifically designed or heavily adapted at the very least.
The procedure for introducing a digital planning tool into hospital design can be summed up in four steps:
The first step would include a thorough case-study analysis of a set of most representative hospitals for their suitability with the MAHD Evaluation Framework. The choice of hospitals for analysis should focus on recent examples where adaptability principles were defined as the primary design goal, with special emphasis on projects built with prefabricated and modular technologies. This analysis will provide a detailed outlook on the procedures that are required to redesign the analyzed hospitals and make them compatible with MAHD principles and technologies.
These insights can then be categorized and used to create a list of rules for assessing the compatibility of future hospital designs with the MAHD Methods and Framework. This step translates the Framework and all the underlying laws, codes, guidelines, and user requirements for MAHD design into a list of simple BIM rules.
Following, these BIM rules should be translated into machine-readable rules that can be checked using BIM software and implemented within the Digital Model of future hospital designs for an automated MAHD compliance check. The translation of the rules written in human-level language into machine-readable language should be done based on the principle called codification process, which offers a number of feasible solutions including the commercially available automated rule engines (Alnaggar & Papadonikolaki, 2019).
Finally, as future hospitals are designed and their corresponding Digital Models are created, the BIM Tool can be used for MAHD compliance checks iteratively throughout all the stages of design. Lastly, the results can be assessed with the feedback from D&C professionals (planners, architects, engineers) and future hospital users (owners, staff, patients) to improve design results and the long-term Digital Tool functionality.
Benefits of Modular Adaptable Hospitals
It was anticipated even before the COVID-19 pandemic that the new modular construction technologies would stimulate a wave of innovation in the domain of design of flexible hospitals worldwide, with a potential to yield over $1 billion of annual savings in new hospital construction in the US and Europe by 2030 (McKinsey, 2019). Additionally, the modular adaptable technologies are capable of accelerating project delivery by up to 50% (McKinsey, 2019), which can prove crucial in any future response to pandemics, other natural disasters, but even more importantly during the regular operations of hospitals. Furthermore, the superior quality of spaces built for long-term flexibility and resiliency is proven every time reconstruction is needed for introducing the new digital or robotic technologies into hospitals (Messner et. al., 2017). Facilities built with modular adaptable technologies can be reconfigured for achieving optimal process flows, with minimal disruption of regular hospital operation due to reconstruction-related noise, dust, or vibrations, and with maximal level of health and sterility adhered to during the reconstruction process (Kamali & Kasun, 2016). Finally, modular adaptable technologies allow for design and planning of sustainable life cycles of hospital infrastructure with minimization of on-site construction waste, recycling and reuse of materials within a circular economy ecosystem (Salama et. al., 2017).
Humankind has most certainly shown strength through unity, as we successfully overcame the pandemic crisis, but even more importantly we have been prompted to learn and improve our healthcare systems for future challenges. Hence, exciting times are ahead where new technologies and digital processes will be innovated to maximize the benefits of modular adaptable design and construction in providing a sustainable system with life cycle economic, social, and ecological sustainability of the future healthcare infrastructure. As Albert Einstein said, "In the Middle of Difficulty Lies Opportunity”. Now it is up to all of us to work towards this brighter future.
This article first appeared on the international version of the Renggli blog.
Header image: Daniel McCullough on Unsplash
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