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Thinking

The future of health facility design and delivery

Aurecon

Over 200 years ago, Florence Nightingale had to argue for adequate food, fresh air, hygiene and sanitation. Nowadays, healthcare facilities use automation to transport food, linen and waste, while design and delivery have been revolutionised through digital modelling, prefabrication and modularisation.

A case study in innovative design and delivery

In a modern, medical facility like the new Sunshine Coast University Hospital in Queensland, the vast 165,000 square metres of building footprint is serviced with automated robots. Driverless vehicles, guided by infrared sensors running throughout the basement, transport food, linen and waste underground from the facilities management centre to and from the main hospital.

Across the project, Aurecon, in partnership with our client Lendlease, employed digital technologies to drive a lean thinking approach, push project management efficiencies, utilise building information modelling (BIM) and deploy 3D design modelling to allow off-site fabrication of services areas.

The Sunshine Coast University Hospital, set on 20 hectares of greenfield land, uses prefabricated modular risers, ducts and pipework to deliver critical services across the facility footprint.

With overall dimensions of the floor plate for the main building an impressive 200 m by 180 m, courtyards and plenty of windows blend the modern sterile nature of hospitals with greenery, open space and even art.

Queensland’s newest public teaching hospital has an on-site tertiary arm, the Sunshine Coast Health Institute (SCHI). The facility caters for over 1,000 medical, nursing and allied health students from TAFE and the neighbouring University of the Sunshine Coast, all of whom benefit from facilities such as an auditorium where students can watch operations and procedures on a live feed.

Construction benefits of prefabrication and modularisation 

On 18 August 2006, the Queensland Government announced its intention to establish a new tertiary hospital at Kawana on the Sunshine Coast, and purchased a site in 2007. In April 2017, the Sunshine Coast University Hospital project opened for business. Aurecon’s client, Lendlease, set a clear vision at the outset of the project to maximise, wherever practical, off-site prefabrication and modular construction.

Sunshine Coast University Hospital used prefabricated modular risers to deliver critical services across the facility footprint.

The practicalities of continuing to deliver projects within the conventional supply chain, after a structure has cured (post concrete-pours), is both impractical and rooted in the (more recent) past. Aurecon and Lendlease knew something needed to change.

Pre-fabrication off-site enables critical elements of the construction to commence in parallel with main concrete pours, thus advancing construction activities of elements which would typically only commence when safe possession was advised.

Off-site fabrication also provides an opportunity to reduce on-site construction waste (improved sustainability), control construction works in and around the large services risers (improved site safety), and support quality control (allowing pre-installation testing in controlled environments).

To obtain the maximum benefits of pre-fabrication, it is essential to have a degree of repeatability between the modules. Recognising this, the primary focus of the project design team was to promote standardisation wherever possible. This included common room layouts, vertical riser sizes, layout of services routings, etc.

From the outset, a committed joint effort was promoted between the architect, engineering and construction teams.

Hospital and healthcare facilities are complex in departmental planning and are heavily serviced. Given their inherent uniqueness, not all areas would be suitable for prefabrication, so it was important to identify early where standardisation could be practically achieved by repeatability and scale. Typically, this can include:

  • Pre-construction of standard patient bedrooms within inpatient units
  • Off-site fabrication of vertical multi-service risers and some horizontal services modules running along common corridors
  • Off-site assembly to integrate all parts and equipment
  • Testing of other types of major plant components

Digital design and modelling

The project team was faced with a range of issues with respect to speed of construction:

  • Buildability
  • Site logistics
  • Availability of materials (due to the scale of the project)

These requirements shaped a project environment where digital design and modelling became the obvious solution to both underpin and drive the project design, delivery and quality processes going forward.

Using building information modelling (BIM), specifically Autodesk’s Revit, the project team was able to model components and systems in their proposed locations and plan spatial allowances and fixings. Proof of concept testing was conducted using 3D printed rapid prototyping. In doing this, it was recognised that not all areas would be suitable for prefabrication because of their inherent uniqueness and complicated services’ needs.

Maximising prefabrication and modular construction

Throughout the planning and development of the prefabrication schemes, key issues had to be addressed, including:

  1. Limits on safe handling dimensions: where possible the modules would be constructed and then partially dismantled for transport. The delivery of pre-fabricated modules to site would typically be via road, employing standard flatbed trailers. Off-site fabrication facilities would be located in established workshops in and around Brisbane or beyond. The optimum module size was in the order of 3.5m x 3.5m, with lengths between 4.5m to 14m (subject to weight and lifting limitations). Larger modules needed greater strategic coordination with local transport authorities and police escort.
  2. Limits on lifting capacity of site cranes: available site cranage requirements had to be closely coordinated, and in many cases, the total weight influenced the final module size. Individual modules would be in the region of four tonnes to four and a half tonnes, and would include intermediate steelwork such as platforms, hand rails, kick plates etc., which all had to be accounted for in the weight.
  3. Stability during construction of floor slabs: vertical multi-service modules were lifted into place prior to shaft linings being constructed. It was intended that the vertical imposed load would be taken by the base slab and therefore the weight had to be taken into account in the local slab thicknesses. However, it was also realised that, when placed into location, the modules themselves would be exposed to temporary external lateral forces from wind etc. so, for further stability, the modules would need to be tied to slab edges. The final support system incorporated a sliding bracket that allowed for construction tolerances.

The vision to maximise site prefabrication and modular construction, to advance construction activities, did become a reality for many prefabricated components, with the vertical services modules arriving on site and successfully lifted into place. Work on the main plant rooms required the design and subcontracting teams to coordinate all the elements including plant modules, pumping sets, switchboards, busducts, steam boilers, flues and air handling units. To help expedite this, Aurecon provided a dedicated shop drawing project office where the builder, subcontractor and designers could collaborate.

However, the original plan to adopt pre-constructed standard patient bedrooms and horizontal services modules eventually proved impractical in the context of this hospital environment. This was largely due to the complex and unique services requirements around the main clinical floors, coupled with high transport logistics costs. The approach also would have required individual trades to have representatives at a common prefabrication facility to install the respective components. This was not practical for a number of specialist trades associated with the necessary systems, such as security, BMS, medical gases or pneumatic tubes, with it being more practical to install these systems on site. The use of BIM by Lendlease, Aurecon, AE Smith and other subcontractors allowed these systems to be virtually modelled and thus the installation space could be planned and coordinated, to maximise practical savings while maintaining safety on site.

Collaboration and innovation outcomes

Through the close collaboration between Aurecon, AE Smith, Lendlease and architects, Architectus and HDR, the vision to maximise the use of off-site prefabrication and modular construction to advance construction activities was implemented, ushering in a new era of design and construction for this type of building. This was further supported by collaborative information management tools providing simultaneous multi-user input for recording, tracking and design validation.

Historically, hospital construction has been subject to time and labour-intensive construction materials and methods, such as ‘blood and bandage’ brickwork. So much more can be achieved by today’s design, modelling, planning, materials and technology to deliver a superior era of hospital care – where whisper-quiet air-conditioning and ensuites combine patient comfort with the superior technology that saves and prolongs lives. The Sunshine Coast University Hospital has, for instance, two linear accelerator bunkers – special concrete structures, up to 2.4m thick – of sufficient density and limited crack widths to ensure the containment of treatment radiation.

In world-class interventional patient care and pathology, a very high degree of vibration control is needed on many floor areas. Sophisticated computer analysis techniques were used in this case as well, to design floors for the required vibration performance, validated by post-construction vibration measurements.

The successful design and delivery of the Sunshine Coast University Hospital construction is a case study in future hospital and mid-level commercial building construction, where integrating and utilising digital design tools, when matched to an innovative approach to project delivery and supply chain parameters, creates a powerful model for managing construction and design, improving time to market and worker safety.

About the authors

Susie Pearn

Susie is Client Director - Education, and was previously Client Director - Health at Aurecon. She has played lead management roles in the planning and delivery of numerous infrastructure programs and projects, including ones over a USD billion dollars in value, for both public and private health, education and research clients.

Adrian Jenkins

Adrian is a building services engineer, technical director and a multi-disciplinary major projects director. With now over twenty years in the building industry, he has actively contributed to and been fully immersed in the Australian building and infrastructure boom over the last two decades.

 

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