How Prefabrication is Changing Healthcare Construction and Design

By Mark D. Johnson

There have been recent studies and articles comparing productivity changes in the architecture-engineering-construction (AEC) industry versus other fields. The general conclusions are that every industry has seen an increase in efficiency and productivity except for AEC.  Many experts agree the silos that exist between architects, contractors and subcontractors are the primary cause.

Exacerbating the situation is the shortage of skilled labor and craftsmen. Between 2008 and 2012, an estimated two million jobs were eliminated from the construction industry.  At least 50 percent of that workforce did not return, resulting in a shortage of labor and creating an environment of uncertainty and unpredictability.

Industry experts believe the healthcare sector suffered most because healthcare facilities are more complex than other building types and require a higher level of skill in those positions.

To overcome these obstacles, healthcare architects, contractors and owners are shifting their paradigm and increasingly moving towards prefabricated modular buildings. The industry’s willingness to do this is changing how buildings are delivered in seven specific ways.


To efficiently deliver prefabrication, input from architects, contractors and subcontractors is needed earlier in the process. For this to happen, the traditional method of hiring an architect first, then a contractor, and finally subcontractors does not work. The entire team needs to be at the table when concepts are in development. Collaboration like this is a foreign concept to many owners, and not all will be comfortable with this approach.


For prefabrication to be successful, architects, contractors, subcontractors and owners must collaborate and engage more frequently with each other than they have in the past.  The need for early information forces teams and owners to work together to solve problems that were traditionally “thrown over the fence” from one group to the other. You must have co-location of the consultants and the use of a “Big Room” to help with team communication and alignment.


Prefabrication expedites the decision-making process. Compared to traditionally built process, prefabricated elements like patient room configurations, materials and finishes are designed and determined earlier in the process to ensure installation is on schedule. Early decision making causes an increase in the use of virtual reality and physical mockups, allowing owners and architects to have more confidence in their decisions and helps contractors establish budgets sooner.


Prefabrication requires architects and consultants to maintain better Building Information Models (BIM) because subcontractor trades need a model to fabricate components.  As a result, teams must become invested in the creation of models. Additionally, the increased complexity of modeling mandates the use of faster computers and high bandwidth communication platforms.


Prefabrication is most efficient when components are standardized around modular configurations.  Pragmatic departmental plans focused on operational efficiency will become the standard, helping lessen the complexity of the Building Information Model and eliminating costly customization.  Other advantages of standardization are quality control, reductions in waste and cost control.


Because consultants and trades collaborate early to deliver prefabricated projects, we will see more consolidation in the form of mergers and acquisitions of industry partners.  This is already happening with design and construction firms, but soon more firms will have MEP consultants, equipment planners and major trade partners. This integration will allow the industry to have a better appreciation of what it takes to successfully deliver a healthcare project, and help architects to become the master builders they once were.


As the industry moves toward prefabrication, new companies like BLOX, Pivotek, and Factory Blue, are being hired to fabricate components for healthcare projects. These companies are changing the construction landscape and perceptions of the typical worker. For example, they are bringing in new pools of talent who had no prior interest in construction. Unlike traditional construction, prefabrication occurs in the same place every day during traditional office hours. Additionally, these new companies can help reestablish vocational training and create a new workforce of craftsmen.

Prefabrication improves efficiency because it helps accelerate schedules and wastes less material. Repetitive processes lead to consistency and fewer mistakes, resulting in better, more consistent quality. If you are a decision maker in a hospital or leading a healthcare construction job, consider how the benefits of prefabrication can improve your next project.

Mark D. Johnson serves as director of healthcare at Beck Group.