Sometimes the construction industry gets accused of using the same technologies as it did when the Pyramids were built. This may have been true years ago, but today we are seeing new developments in many aspects of healthcare construction, with prefabrication and safety being two areas where there has been substantial change.
One of the biggest drivers enabling prefabrication in construction is computer modeling (BIM). We have such a high degree of accuracy in the models, we are able to confidently use BIM information for coordination, pre-installation planning, pre-assembly, and actual factory fabrication of critical building components.
You may ask, “Why hasn’t the industry been able to implement prefabrication sooner?” Until recent improvements in computer technologies, I’m not sure there was enough trust that the computer model could be relied upon in the field— If prefabrication needed re-work at the site, not much savings in time, cost or quality would be achieved. Some of the issues with early prefabrication attempts, real or perceived, included:
- Inaccurate documentation for fabrication
- Approval process prior to start of fabrication
- Silo-ed, separate trades claiming responsibility
- Transportation to site – Weather damage/Transport and Storage cost/Dimensional stability/Erection
- Buy-in by all team members and Authorities Having Jurisdiction (AHJ’s)
- Perception of lower quality
Today we are able to use GPS and laser systems to locate BIM information in the field—providing much higher accuracy, assured layout, less rework, and faster schedules. We use this BIM information in logistics planning to assist with replacing large medical equipment, such as MRI’s, to find the best route through the existing hospital.
This minimizes the impact to the building, the public, and ongoing medical operations.
Using laser scans of existing spaces, we are able to create more accurate documents than may have existed with “as-built” information (if it could be found, and if the prior work was accurately located on the as-builts). Using the laser scan information, we can more accurately fit new work to the existing work, producing a higher quality result, in less time, saving money. Commonly prefabricated items in hospital facilities include:
- Bathroom modules
- Mechanical Electrical corridor Racks
- Headwall assemblies
- Exterior wall assemblies
- Preassemblies for standard room ductwork and electrical controls
All of these innovations allow smoother installation, better quality, lower cost, and safer work condition.
Focus on safety is the inspiration for many improvements in healthcare construction. We are challenging our project teams to produce the same (or better) result, eliminating risk to the patient, the worker and adjacent objects, people or buildings. Just because “we have always done it that way” is not a good enough reason to continue unquestioned.
There was a time, when safety was not a priority at all: you’re likely familiar with the 1929 image of workers sitting on a beam during construction of the Empire State building in New York. The photo includes quite a display of what has changed, as a matter of project culture, to what we would see on our healthcare construction sites today.
You can contrast what you see in the photo, to this list of safety items in common practice now:
- Safety harnesses worn above 6 feet
- Safety nets protecting workers below
- No food or smoking (anything) inside of the building
- Personal Protective Equipment – PPE (hard hat, safety glasses, ear protection as required, gloves)
- Proper Clothing (boots, long pants, shirts with 4” sleeves or better, safety vest or bright-colored safety shirt)
- Orientation Safety Class and background check (name badge – RFID or QR tag)
- OSHA/CPR/First Aid Certifications (Hard-hat stickers)
- The first step in working safely is awareness of a risk (or lack of protection from a risk).
One of the reasons many of our best, most innovative changes come through safety activities is because work teams regularly look at Job Hazard Analyses (JHAs), each time they start a new work activity. This is so we can answer the question of, “how can we accomplish this more safely, with less risk?” This often results in better quality and, once adopted, does not impact the schedule.
In the best-selling book, The Checklist Manifesto, author and surgeon Atul Gawade, describes how the World Health Organization was able to dramatically improve safety inside the operating room, and patient outcomes in general, when the whole team utilized procedural checklists. The same practice is true with JHA’s on healthcare project sites.
The safety ethic on a well-run construction project is infectious (in the best sense of the word). Everyone works together to make the project safer for all. Waste (including wasted effort) is minimized, project sites are cleaner, material management allows for better productivity, and less manpower is required to put increased volume of work in place.
Real workforce productivity improvements are measured on a regular basis, starting with the team agreeing on the best way to safely and efficiently accomplish a new task.
Innovations in prefabrication and safety are just two aspects of healthcare construction that leading builders are continuously improving to achieve better production and higher quality finished product, with less risk to workers, patients, staff and families.
Steve Whitcraft is a 28-year construction-industry veteran. In his role as Turner Construction Co.’s director of commercial and healthcare segment groups in the Texas region, he is responsible for client development, project strategy, pre-construction and construction leadership on healthcare, office, multifamily and mixed-use building sectors.