HOSPITAL CONSTRUCTION
and thus time constraints are a key consideration in MMC strategies. In fact, the entire programme is affected, as early decisions are required to truly ensure time savings overall, and late changes may carry high investment costs or risk quality. Our strategies will need to weigh many
criteria and competing interests. Do we prioritise inherent social value of new investments in UK manufacturing, or tried and tested imported systems? Locally produced or lower cost imports? Net zero? Can we objectively assess these and find a balance between such diverse metrics? There is a theory that design automation could help assess options. It may, but poor data or system design will only mask problems the automated design system isn’t built to examine.
Asking (all) the right questions What are the key questions for a successful MMC strategy, and how do we select the right products for a specific project? Here are some of the key questions that need to be answered, in no particular order: n What (range of) types of use will the system need to suit – including both clinical and non-clinical uses?
n How often do we expect to make changes to each element or part of the facility, and what sorts of change may be needed?
n How fast do we expect to adopt new technologies, and how do they impact on space and building system requirements?
n What impacts might ensue from changes in models of care in each department, and what will be deemed an acceptable level of risk?
n How important is expandability – both overall, and for each department. What is the masterplan (or development control plan) strategy governing expansion?
n What’s the obsolescence plan? n What are the requirements and priorities in relation to the flows of healthcare, and how does the masterplan concept address this in the light of MMC strategies?
n If we select a relatively inflexible solution, what is the estimated impact on future staffing costs (in terms of clinical staffing, estates and facilities management staff, and administrative personnel)?
n What surge capacity needs to be accommodated, and how may it be accommodated?
n In what ways may the overall facility and its departments need to be used differently for periods of time? (such as happened due to the COVID-19 pandemic). To what extent do we need the facility to
respond in an agile manner?
n Does the structure need to be demountable? In each area, is this a ‘deal-breaker’ or a ‘nice-to-have’?
n What are the routine maintenance requirements and constraints in the light of the planned type of clinical use? Infection control? Patient groups?
n In what ways should adaptability be accommodated? Why and to what end? What is the cost-benefit?
n Will we require technical support for the service life of the product?
n What service life should we seek? (Cost-benefit analysis needed.)
n What standards must the product comply with?
n How soon will I need to select a type of product, and how soon will we need to select a supplier? RIBA 1, 2, 3…? What is the impact of changing the specification later in the design process?
n What site constraints do we need to plan for? (Footprint, height, access during and after construction, hazards, soil, and underground conditions etc.)
n What programmatic and delivery strategy constraints need to be taken into account?
n In terms of the environments to be designed, what patient groups needs to be addressed in each area, and what staff working conditions need to be
February 2022 Health Estate Journal 65
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