HOSPITAL CONSTRUCTION
the conversation on lifecycle costs to materials and other upfront capital investments is lazy; it is to ignore well over 90% of the story just because detailed data is not (currently) readily available.
Adaptable estate Some areas of the hospital require frequent alteration, others occasional. Just how radical and disruptive depends on how the facility was designed and then built. We all know the pressure for changes throughout the design and construction periods, and then almost from the point that the healthcare facility becomes operational on day one. MMC can be far more flexible and adaptable than traditional build, or vastly less so; 3D modular tends toward the latter. GSTT’s adaptable estate strategy (which ETL helped to develop, alongside our client, and design consultants and architects, NBBJ, and Mott MacDonald)3
is
designed to provide sufficient adaptability to support 30-year cycles between significant alterations. Very importantly, it also addresses the need to allow changes to occur with minimal impact on operational areas of the hospital. At one level, we need to be able shut down a floor or part of a floor, and on the other, to perform routine and planned maintenance or replacement in a room or ceiling void without affecting patients or clinical activity, or compromising infection control. MMC can help with that, but there is an upfront premium.
Risk of premature obsolescence Depending on typology, change may be impractical or impossible. Surprising numbers of hospital facilities are demolished before their thirtieth year, less than their first standard lifecycle of 35-40 years. There is no single failed typology meeting that fate. It appears that the culprit may be an overemphasis on a single goal of design to the detriment of others. For instance, very deep plans helped provide radical flexibility, enabled by then-new technologies such as air- handling systems, interstitial plant, and increasingly efficient electric lighting, but, as it turned out, in many areas of the hospital this provided the wrong sort of flexibility. Hospitals of such diverse design as inflexible towers on the one hand, and low-rise hospitals modelled on the terrifically innovative and expensive Greenwich Hospital4
on the other, are all facing premature obsolescence. Figure 2: Key planning principles: how does MMC fare? 64 Health Estate Journal February 2022
A balancing act Traditionally, the more frequent complaint with regard to modular buildings has been that temporary blocks are retained for decades, with compromises that made sense in the light of urgency potentially becoming a burden. That said, MMC can speed up construction considerably,
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