Hospital Design

The future of hospitals is modular


Middle East Health speaks to KEF Infra’s Sumesh Sachar on why offsite construction can bring transformative solutions to meet regional healthcare infrastructure needs.

It is hard to imagine that one day hospitals, with their juggernaut of complex structural elements, piping and electricals, will simply be picked from a catalogue, built in half the time it usually takes, and at considerably less cost. Sumesh Sachar, CEO at KEF Infra, the infrastructure arm of UAE-based KEF Holdings, begs to differ. “This reality is here already and ready to take over,” Sachar says, referring to the company’s initiative developed by its healthcare arm, KEF Health in association with Australian hospital design consultants, TAHPI, called ‘Catalogue Hospitals’.

Of the five model hospitals developed within this catalogue, KEF Infra is already nearing the completion of its first project, MEITRA Hospital, which will be India’s first fully offsite-constructed 205-bed tertiary facility that can be scaled to 500 beds. With a total build-cost of just US$5.8 million, the concept hospital spanning 27,870 sq. m. will be delivered in a record 18 months, making a very strong case for its potential.

Understanding the process towards plug-and-play
The process of constructing a hospital off-site starts like every other structure, at the drawing board. “We set out to create a set of ideal form factors for Catalogue Hospitals, but really, the objective is to show that from simple to complex hospital buildings, modular construction can be applied effectively,” Sachar points out.

The design phase
In modular design, while aesthetics play a crucial role, the bigger pursuit is form and functionality. “We typically work handin- hand with the healthcare provider and our partner during the design phase. The patient experience is really the starting point for us,” says Sachar, adding that based on the estimated patient flow the hospital can be designed to combine functional design, efficiencies in energy usage and an overall positive healthcare experience.

At the core of offsite construction is building information modelling or BIM software Revit. “The technology on which hospital design is built is fascinating. We look at the equipment requirements of the facility and apply it to the Revit model to determine everything from the geometry, shape, the ceiling-floor height of the building. We also factor in details such as how many operating rooms are required, or where should the patients wait at this stage,” adds Sachar.

Other technology software such as ETABS and SAFe are applied to the design to check structural quality and stability. KEF Infra also applies Sofistik, an advanced software primarily used in Europe to gauge the building’s behaviour in seismic conditions. From an energy efficient standpoint, the use of insulated wall panels, radiant cooling, and high U-value aluminium cladding, all contribute to a reduction in operating costs for the facility.

Sachar notes that in the Middle East context, the precast concrete facades used in offsite build drastically reduces the work required to fire-proof buildings, adding another advantage to the mix.

Once the structural model is finalized, the MEP (Mechanical, Electrical, and Plumbing) design, which forms the most complex part of hospital structures, is layered on to the structure design and tested for clashes. Clash detection is a critical part of the process that is applied early on in the design phase and continues to be applied at every stage while building the model.

Sachar explains: “Clash detection delivers huge cost savings compared to conventional design, because we are able to identify right at the start where the gaps and cut-outs need to accommodate the MEP matrix.”

The construction and delivery phase
Up to 85% of a catalogue hospital is built at an offsite construction manufacturing plant. “The quality we can deliver from offsite construction is far superior to traditional methods, because we are able to test every pore. There is complete transparency in the process,” says Sachar.

For example, in cement, the design mixcan be tested and checked for consistency. On the other hand, the curing period of concrete is controlled, rather than leaving it to the environment, which can yield imperfect results. Processes such as steam curing lends to the cement strength and structural durability of the building. Adding to this the precision offered by highly automated manufacturing processes further increases the quality of offsite-built structures.

Modular pods and precision installation
Using modular MEP, the more complex structures are put together in the form of sixmetre frames of all the different elements – electrical, mechanical, plumbing, medical gases, etc. which have been manufactured and tested offsite. These are then brought to the site in the form of modular pods and installed in precise sequences.

“In this format, you know exactly where each piece must go, which floor or grid, much like a jigsaw puzzle. The frames are then connected using a ‘clicking’ technology that is very simple,” Sachar notes. “By developing the MEP structure using BIM, we are able to handover to the customer a complete mapping of the hospital, as well as an operating manual on how to best utilize and manage the facility.” In the case of Catalogue Hospitals, the installation and commissioning team additionally offers back-to-back warranties on the equipment sourced from KEF Health partners, GE Healthcare, thereby laying out a total turnkey solution for customers.

How the Middle East can benefit from modular hospitals?
Besides the focus on medical tourism in countries such as the UAE, population growth and a relative rise in health issues are triggering a steady growth in healthcare needs. In the GCC alone, the demand for hospital beds is set to rise at a CAGR of 3.5% touching 162,000 by 2025, according to McKinsey. Another report by Alpen Capital, indicates the GCC’s healthcaremarket is projected to grow at a rate of 12% per annum to $69.4 billion by 2018, with Saudi Arabia expected to be the largest market, followed by Qatar and the UAE.

“In the Gulf countries, there is a measured benchmark against which we can apply the various design, time and cost utilities of modular construction. Across the region, however, there are markets that are still grappling with outdated hospital infrastructure, where quick and effective solutions can play a significant role in saving lives,” says Sachar.

“At KEF Infra, we have started speaking to potential partners in Africa as well, where the demand for modern hospital infrastructure is understandably at a peak.” With the benefits weighing well over any potential disadvantages, it does seem puzzling why the region has not taken a keener interest in the catalogue hospital proposition.

“It comes down to awareness and education, as with any other avant-garde take on concepts that have not changed for centuries. Offsite or modular construction is not really a new concept if you think about it, but the modern treatment to its application in industries such as healthcare is revolutionary. I believe it is only a matter of time before modular design takes root, and evolves in to something even bigger and better,” Sachar says.



KEF Holdings and MEITRA Hospital
A new era social enterprise headquartered in Dubai, KEF Holdings was founded by philanthropist-entrepreneur Faizal E. Kottikollon, and operates across India, the Middle East and Singapore. The company has five business verticals – KEF Infra, KEF Health, KEF Education, KEF Metals and KEF Investments – that correspond to the core sectors it services. KEF’s industrial forte lies in its ability to create integrated business processes and deliver cuttingedge off-site construction technology and solutions, including precast, prefabricated bathrooms, joinery and aluminium glazing. The company applies this expertise to the creation and upgrades for essential infrastructure, such as educational, healthcare, commercial and residential facilities.

Meitra hospital, developed by KEF Infra for KEF Health illustrates the company’s innovative approach to healthcare. Besides highly superior build quality, the hospital will feature advanced patient management services developed with renowned specialist doctors from Cleveland Clinic, and also house state-of-the-art equipment from GE Healthcare. Combining clinical specialties such as Cardiology, Cardiovascular and Thoracic surgery, Neurology, Neurosurgery and Orthopaedics, among others. Meitra hospital is set to open its doors by 1 December 2016.

Delivering new healthcare capacity across the Middle East

By Yasser Khan and David Smith Directors, Arcadis Qatar

Recent data from Alpen Capital estimates that the Middle East’s healthcare market will grow by more than 50% over the next five years. Research from MEED presents a similar outlook, with US$60bn worth of investment planned or already underway to help create new healthcare facilities across the region.

This is in response to a number of important trends that are converging at the same time. Rising populations, higher life expectancy rates, wider adoption of healthcare insurance and the rise of lifestyle diseases such as diabetes, obesity and cardiovascular illnesses, are just some of the factors that are creating a need for much greater healthcare capacity within the GCC.

In response to this growing demand, several countries have already allocated significant budgets as part of their ambitious nationbuilding programs. The challenge now will be to deliver the next wave of hospitals and clinics that enable medical professionals to provide a level of care that responds to their patients’ needs and improves quality of life for the local populations.

Maximizing the impact of investment in new healthcare assets
Falling oil prices are having an impact on public sector budgets with some governments beginning to curtail or defer their expenditure plans. However, there’s also an appreciation that within the GCC region, hospital bed density remains significantly lower than in other high income nations. Furthermore, total healthcare expenditure as a percentage of GDP remains considerably lower than the global average.

Governments remain committed to prioritizing investment in healthcare, however the current economic climate means there is an added pressure to ensure that the budget spent, delivers the best possible outcomes for clinicians, patients and local communities.

Many of the world’s leading healthcare providers are already active in the region, however on a number of existing projects, they’re finding that the full benefits and strategic intent behind their schemes are not yet being realized. This is partly due to the complexity that can arise as a consequence of the number of different stakeholders typically involved in designing and creating a new healthcare facility, however it’s also due to the manner in which new healthcare capacity is currently being delivered.

Think ‘program’ rather than ‘project
If healthcare providers are to achieve productivity gains and ultimately improve the quality of care provided, they need to move away from viewing their project in isolation and embrace a program management approach when it comes to the delivery of new healthcare facilities.

This program-level approach must be vision-led, aligned to strategic objectives, benefits focused, and able to cut across institutional boundaries that are typical on healthcare schemes. If a single project is about delivering a discrete output like a new hospital building, a program is about the big picture, the delivery of outcomes and the realization of a number of strategic and measurable benefits.

In practice these outcomes may include achieving the capabilities and throughput required across a series of healthcare facilities to reconfigure the way in which services are delivered within a healthcare system. The associated benefit might be an improvement in the quality of care provided, characterised by a lower length of stay for stroke patients or a reduction in readmission rates.

The benefits of a program management approach
By embracing a program managementapproach, there are a number of important benefits that healthcare providers can secure as they seek to design and deliver the next generation of healthcare facilities across the Middle East region.

1. A more effective delivery model
Most major healthcare providers know how to interpret a vision and translate this into a strategy. Where there is often a gap is in creating a delivery unit that is capable of bringing all of this to life. A successful delivery team needs to balance a number of important priorities. It must be fully engaged with the organization’s strategic objectives, clear on how to reflect these in a well-phased program of work, capable of managing multiple departments and end users (each with their own priorities), and able to remove obstacles that impede continuous progress. When designing the delivery model, it’s important to have a clear picture on how the healthcare organisation will work once complete. This includes the organizational structure (people and capability), the processes (operational and clinical service model), capital asset requirements and information strategy. This is only possible by taking a program level perspective rather than focusing on a single project.

2. The opportunity to design a genuinely patient-centred system
If a healthcare provider aspires to move away from a supply-driven healthcare system organized around what physicians do, and instead move to one that is organized around patient needs and outcomes, this must be reflected in the blueprint at the very outset. The design of the system needs to consider the types of benefits that the healthcare provider wants to achieve (lower average length of stay, reduction in readmission rates) and ensure that these objectives are reflected in every part of the design process, with clear practical steps from planning to outcomes.

3. A clearer governance structure
One of the weak links that can make it difficult to translate strategy into delivery is the governance arrangements. Taking a program management approach offers providers a control framework which details the roles required to deliver the program and its associated change, but also ensures that the right people are in the right roles to deliver the best outcome. If the delivery unit is to be effective, it needs to function as an extension of the senior client team and must adopt a forward looking approach that’s focused on unblocking delivery obstacles, rather than looking backwards or assigning blame. In our experience success is only possible by engaging people on a vision and a journey that paints a picture of a better future for the organization, rather than focusing on the destination or project end date.

4. A stronger, multi-disciplinary team
One of the key benefits of a program management function is that it will typically incorporate a wider mix of skills and capability that are needed to help deliver the program of works. As well as program and project managers, a team will also include design managers, people with a clinical background, engineers, healthcare planners and demand and capacity specialists amongst others. Good stakeholder engagement of this group enables everyone to have a voice and input in the direction of the program. These soft skills are key, particularly in finding the right balance between when to allow some users to have greater input (for example, recognising that clinical users need more involvement at the start of the process) and when to challenge proposals using an evidence-based approach.
5. A greater ability to respond to change and manage risk Programs take longer to complete than a project and as such, will normally carry a higher level of risk. Circumstances will inevitably change and a key challenge for program managers is to deal with this uncertainty without deviating from the larger vision. This is particularly relevant for a region like the Middle East which is rapidly changing and increasingly fraught with geopolitical, socioeconomic and technological risk. Healthcare providers need to be flexible and able to re-evaluate priorities in terms of capital allocations. A program management approach doesn’t predict the future, but it does better equip teams to cope with the ambiguities inherent in the delivery of healthcare in the region.

Taking a long-term view of success
Although the benefits and outcomes may take longer to materialise, a program management vision, blueprint and benefits plan will help to prevent a disjointed and piecemeal approach that misses key pieces of the jigsaw. Delivery of ambitious new care models in an acute setting may well be the right approach to the reconfiguration of services, but it will only be part of the picture – and may end up pushing problems further down the line if the necessary infrastructure is not available in primary or community care settings. In a region where there is a need and an appetite (both private and public) to invest in the health sector, the planning and delivery of new facilities has to be underpinned by, and respond to, a series of strategic imperatives. The individuals charged with this need to understand the region, the sector, and the subtleties of what makes an effective program management function, in order to deliver the right types of assets and improve the quality of care that is offered to citizens across the GCC.

Date of upload: 15th Nov 2016

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