At the peak of the COVID-19 outbreak in Wuhan, China, two modular hospitals—with 2,600 total patient beds—were assembled using simple steel frames in just 10 days. It’s a test case for how factory-built, rapidly deployable emergency buildings can empower communities to respond faster and potentially save thousands of lives in a crisis. It’s also an example of what can be done through technology, hard work, and determination. But not all modular prefabrication is created equal.
While the COVID-19 pandemic is providing a real-world opportunity for prefabrication to help mitigate a crisis (be it a storm or a virus), that doesn’t mean complex, master-planned hospitals with large patient towers will pop up in less than two weeks—at least not any time soon. Certain aspects of prefabrication can help immediately, some can help midterm, and some represent long-term solutions to prepare the world for pandemics of the future.
The Immediate Response
As the demand for hospital beds increased in the past couple of months, emergency-management responders have turned to venues such as hotels and dormitories. These buildings contain rooms, beds, and the basic infrastructure a health-care setting needs, but they lack the ability to be quickly retrofitted.
Because these buildings were constructed in situ, they’re useful only in their existing physical place. You can’t redeploy them to another site. The retrofitting process may be considered wasteful because once the health-care need is over, contractors have to return the building to its original state.
Field hospitals have also popped up in parks and stadiums around the world. Although health-care organizations have the infrastructure to build these temporary structures in just days, the tents lack durability and can succumb to weather.
Fleets of containerized solutions and temporary modular solutions can fulfill these same emergency demands, and they can last longer. Like tents, prefab modular buildings are temporary and rapidly deployable. But they’re also reusable, and they can be built for precise needs, whether that’s caring for COVID-19 patients or treating the injured after a hurricane.
Modular: 6 to 12 Months
Some parts of the world may not be experiencing a COVID-19 outbreak yet, but they could be in the months to come. Local governments need to think about putting midrange emergency solutions in play to prevent area hospitals from becoming overwhelmed if their situation gets worse.
In the 6-to-12-month range, it’s possible to move away from temporary solutions and look to existing factories that are able to pivot or ramp up production. For example, my friends at BLOX are still in full production building health-care facilities throughout the COVID-19 crisis, and they also have the capability to prefabricate mobile isolation care units (MICUs). Other manufacturers and subcontractors with fabrication facilities are able to pivot from building modular hotels and schools or prefabricated MEP (mechanical, electrical, and plumbing) subassemblies and skids to hospitals.
I worry about owners and developers looking to the wrong part of the industry for solutions. Prefabrication can answer emergency needs in short-, mid-, and long-term timelines, but it has to be the right solution for the right time frame. The fleet program is not going to build your patient tower three years from now, and those small factories doing volumetric modular aren’t necessarily a fit for the entire facility when master-planning larger hospitals.
Prefabrication: 3 to 5 Years
Grand hospital towers with multiple floors and thousands of patient rooms often take years to design and build. Given the timeline and planning required, owners and developers should look across the entire continuum when they consider prefabrication.
General contractors (GCs) and designers will have to act more like integrators, using element-centric designs and principles of design for manufacturing and assembly (DfMA) that enable supply-chain partners that build prefabricated elements. GCs will need to procure and integrate lots of prefabricated pieces and parts with in situ elements—things like headwalls, distribution racks, bathroom pods, operating rooms, plant rooms, and even elevators.
These elements can be made in a factory—built concurrently as the ground is being cleared—and delivered to the site of a new hospital or an existing hospital expansion, capitalizing on tight schedules and shaving days, weeks, and maybe even months off construction timelines.
By getting subcontractors to put more energy into their fabrication shops, the industry can develop and mature an ecosystem for DfMA and prefabrication. This approach could push existing companies using prefabrication and other industrialized-construction methodologies, such as automation and digitization, to be more successful or even start up new factories.
Prefabrication for Cleaner, Safer Spaces
Prefabrication makes sense in designing and building critical infrastructure buildings such as hospitals, because it promotes safety, sanitation, and patient experience.
One reason this aspect is particularly important to me is that, several years ago, a coworker friend’s daughter fought and eventually succumbed to a brain tumor. During her illness, she was in a hospital for the better part of eight years. Her caregivers and parents were careful to keep her room wiped down and clean to reduce exposure to bacteria and viruses. I always consider patients like her when a hospital begins construction planning, and I think about the activities that would occur near her room—the dust, debris, noise, and construction workers existing in the space that needs to be pristinely clean for her experience, health, and survival.
Besides gaining concurrency for time and cost savings, DfMA and prefabrication can help hospital systems and contractors build healthier buildings while disrupting patients’ lives less.
The DfMA strategy includes other considerations for designing for new technology, such as decoupling technology-intensive areas like MRI or proton-therapy vaults. These structures can be prefabricated faster than traditional construction and provide crucial care for patients while generating early revenues for health-care companies. Technology can be scaled with capacity needs and swapped out with other technologies as they evolve.
Why Prefabrication for Emergency Buildings?
I know that elements of the old ways of construction—including prioritizing cost and schedule first—will always be considered. DfMA and prefabrication enable more certainty around cost, schedule, and scope. But along with this certainty, I want to see healthier hospitals that are less disruptive to their patients, staff, and surrounding neighborhoods.
Prefabrication promotes a more sustainable industry. Prefabrication facilities are cleaner, safer, and more controlled environments than construction sites. They’re less disruptive and less noisy than a construction site, and they’re more efficient because they can produce structures concurrently with work being done on the permanent site.
In factories, the learning curve is shorter because the same group of workers handles multiple concurrent jobs; crews can learn something on one job and apply it to the next job coming down the production line.
Yes, prefabrication provides better general opportunities for the construction industry. But during this pandemic, it provides a pathway to accelerate responses to emergencies on every scale, whether it’s a small-town hospital that needs a separate wing for anticipated COVID-19 cases down the road or a large inner-city hospital that needs hundreds of beds now. Prefabrication will make architecture, engineering, and construction smarter and stronger, and it will help communities respond with the right solutions in times of great need.