CONSTRUCTION
Figure 6: An early sketch of the MEP services strategy for Circle Reading.
Developing your MMC strategy Deciding which form of MMC should be deployed, and where, should be considered as early in the process as possible. The design process and MMC strategy should be considered as integrated activities, and developed in parallel, because: n The benefits of MMC are diluted if they are applied retrospectively to a ‘traditional’ design.
n It is critical that clinical outcomes or operational excellence are never compromised due to the constraints of a particular form of MMC (and so it is important to develop a shared understanding of their benefits and disadvantages).
Factors that should be considered, and will be critical to the optimal use of MMC, include: n Client value drivers and KPIs; n Level of commonality/repeatability (of rooms or spatial ‘clusters’, such as wards) vs. value (cost, but also site effort/productivity);
n Status of current design solutions; n Likely benefits of an MMC solution vs. likely effort to develop it;
n Number of interfaces/site activities that can be removed from site;
n Maturity/capability of supply chain to deliver MMC solution;
n Learning from other Trusts, and particularly the early HIP schemes.
In developing their strategy, Trusts should set success factors to help guide and refine the approach. MMC is new to many people, so it is useful to define key principles or outcomes and decide ‘what good looks like’ as a way of guiding decision making. Success factors may include: n Ensuring maximum integration of design disciplines;
n Reducing duplication of effort; n Driving down total costs; n Engaging with the supply chain in a
Figure 7: An inpatient bedroom at the Circle Reading Hospital.
planned and timely fashion, drawing on expertise and innovation where it adds value;
n Facilitating waste reduction through strategic and collaborative procurement using common components, materials, and construction processes;
n Blending highly standardised, mass customisable, and bespoke elements together, to create solutions that are finely tuned to suit the context;
n Optimising the use of traditional, modular, flat pack, and system build elements where they add the most value, e.g. to maximise offsite labour where appropriate, and improve the efficiency of in-situ construction;
n Facilitating de-construction and flexibility through the creation of standard components that can be readily adapted to future changes in policy or regulations, and eventually disassembled.
Case study: Circle Health, Reading
Circle Health is an independent hospital provider, whose ethos encompasses excellent patient care, staff engagement, best practice management, and a culture of partnership. Circle Reading was the second of the business’s facilities, providing elective surgery through GP referral, both on a private basis, and as part of the expansion of patient choice within the NHS. The 10,000 m2
facility
includes five theatres (plus one endoscopy theatre), an imaging suite, 30 inpatient and 20 day-case beds, 15 consulting rooms, and an extensive rehabilitation department. Circle wanted to use Reading to develop a standardised solution that could be replicated across multiple sites, at scale. It appointed Bryden Wood as its integrated design consultant with a brief to create a new benchmark for efficiency in the delivery of healthcare projects. Results on the project include:
n A 28% like-for-like capital cost saving compared with traditional build; Circle Reading was delivered for less than £2,500/m2
.
n A 20% saving on construction programme from hospital one – with improved content and larger size.
n 78 per cent of components were standardised, repeatable elements.
Stakeholder engagement Stakeholder engagement rationalised the design and optimised clinical flows. In the first instance, the team used a range of digital tools and developed a ‘visual language’ that helped engage stakeholders and map out the optimum schedule of accommodation and adjacencies to deliver the clinical outcomes. This ensured that the brief was robust and highly rationalised, allowing us to develop the MMC strategy with confidence. MMC was, in fact, built into the earliest concepts. Bryden Wood and Circle Health worked closely together to establish a design that separated critical, high-tech high-specification spaces, from non-critical/clinical spaces, to create a clear hierarchy of clinical departments. This improved clinical outcomes, patient safety, and experience, but the clear delineation in functions also helped in developing the MMC strategy. The facility was then conceived as a series of ‘kits of parts’ (See Figure 5; this project used a high degree of componentisation; it predates the Platforms initiative, but is a direct predecessor), including: n Superstructure; n Façade; n MEP (mechanical and electrical services and plumbing) distribution;
n Key fit-out.
The superstructure assembly was very quick and quiet, with no welding or drilling (the site is surrounded by residential properties, so this was an enormous benefit), but resulted in a very accurate ‘carrier frame’, to which the other
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