Standardized, Prefabricated Hospitals

Dymaxion Car introduced by Buckminster Fuller in 1933

Why aren't hospitals built using standardized plans with prefabricated components?
I'm sure there is a good answer to the question, so please help me out; I'm not an Architect or an Interior Designer.

If Designers used evidence-based design to create standardized (but customizable) plans and components, there would be tremendous savings. How many variations on a patient room or operating room do we need? Does it have to be reinvented for each and every hospital? Hospitals typically cost many millions of dollars.  There could be tremendous savings in reducing unneccesary design and construction costs.

Art however could not be standardized. The surface details like art and wall color would need to have greater variation to allow each facility have a unique identity.

This question was triggered while I was reading an article in the New Yorker: "Dymaxion Man: The visions of Buckminster Fuller". Elizabeth Kolbert writes:

Imagine, Fuller says, what would happen if a person, seeking to purchase an automobile, had to hire a designer, then send the plans out for bid, then show them to the bank, and then have them approved by the town council, all before work on the vehicle could begin. “Few would have the temerity to go through with it,” he notes, and those who did would have to pay something like fifty thousand dollars—half a million in today’s money—per car. Such a system, so obviously absurd for autos, persisted for [hospitals] Fuller argued, because of retrograde thinking... What was needed was a “New Era [Hospital] which would be “erectable in one day, complete in every detail,” and, on top of that, “drudgery-proof,” with “every [medical device] known to mankind, built-in.”

This was a quote, except to substitute "hospital" for "house" and "medical device" for "appliance"

To read the full text of the article in the New Yorker click here
To learn more about the exhibit on Buckminster Fuller at the Whitney Museum click here

Comments

[Nick Peckham, AIA, LEED® AP]

I was in the PhD program with Bucky as my mentor for the last nine years of his life. (Without RBF I did not complete the dissertation)

He was a great proponent of using the industrial process for construction. Again, he was way ahead of his time. The handcraft of building is slowly changing. For example, the Eco Schoolhouse (which Peckham & Wright Architects designed and worked with about 50 builders, engineers and suppliers to donate at no cost to the Columbia Public Schools) is made of structural insulated panels that were manufactured in a plant south of Jefferson City.

Bucky recognized the need, the growing need, for healthcare. He know of the great expense in this building type and made the comment you quoted. In execution today, I believe parts of a hospital will always be unique,
and parts could be standardized. Hospitals grow. They are often in
crowded locations.

A more timely comment Bucky often made, beginning in the 1970's and until he died in 1983, is, "The 21st century is when we will find out if the human race is a failed experiment."

Best always,

Nick Peckham, AIA, LEED® AP
Principal/CEO
Peckham & Wright Architects, Inc.

[Jeffrey Charles Raasch AIA]

I cannot think of any hospital that operates similarly to another. Hospitals may be one of the most complicated building types to design with each having a unique set of programmatic elements. There are many factors that influence the design and layout of a hospital from the site and budget to the types of services that are provided, and more importantly how those services are provided.

There is no one right way to lay out a hospital plan. There are however may wrong ways. An appropriate solution relies on an architect to work with the provider to find which organizational arrangement will best serve their patients and staff to provide the best care possible. This can be as simple as whether patient rooms use inboard toilet rooms or outboard toilet rooms, or if each unit consist of 24 beds or 32.

There are also specialty hospitals that differ from a general hospital, so to use a standardized plan for a hospital would be to assume that one size fits all, and we all know that that is never the case.

There are however some health care systems that are moving into more standardized hospital plans that are being duplicated within their own system which may be a more reasonable approach to standardizing and prefabricating a hospital.

Jeffrey Charles Raasch AIA
Principal / Architect
Flad Architects

[Greg Mare, AIA]

There are many things that could be standardized in a hospital. There are also many factors that prevent this from happening.

One of the reasons standardization doesn't happen is that there are many operational approaches to how healthcare providers work, and this leads to the customization of their environments.

Another aspect is the varying cultures that exist in different organizations. This leads to operational and physical differences between hospitals.

A third aspect is related to budgets and how money is spent for facilities. Different hospitals have different priorities. Some hospitals want the most square footage they can buy for their money, others want higher quality finishes for durability and appearances.

Lastly, architects are creative by training. The idea of designing something that looks the same as what someone else has designed is foreign to how we think. We always have a different approach from everything that has gone before it. In many cases we want to improve, learn from the past, leave our own mark. We work hard to please our clients.

As a result, our designs become personalized by the people who are creating them, and customized for the clients we are working for.

Greg Mare, AIA
Principal
Anshen+Allen

[Ann M. McGauran, NCARB]

If McDonalds' isn't doing it yet (and they are not) then the technology isn't there for hospitals to even start looking at it.

Unless you are talking about a series of green field sites, there is just too much variation in hospitals to make this cost effective.

Also the theory is that like "tinker toys" you could break the components down during renovations and just put them back together. This is difficult at best when you consider how tightly everything needs to be sealed for infection control and acoustical privacy.

Ann M. McGauran, NCARB
Vanderbilt Medical Center
Architect|Project Manager, Space and Facilities Planning