The use of refurbishment, flexibility, standardisation and BIM to support the design of a change-ready healthcare facility

Healthcare in the UK is a very important sector; it provides state of the art accommodation that meets the need of patients, visitors, medical professionals and other staff. The UK Government is currently cutting costs within the different sectors of the economy, while there are raising figures in UK National Health Service (NHS) spending. These are due to a growing and ageing population, advancement in modern healthcare delivery and special needs for different facility users. There is a UK Government proposal set out that requires the delivery of £15-20 billion in efficiency savings over the three year period from 2011 (Department of Health, 2010-2015). This study has understood that cost savings can be achieved by adopting and implementing a framework that supports refurbishment, flexibility, standardisation and Building Information Modelling (BIM). These cost savings can be achieved through Mechanical Engineering and Plumbing (MEP) clash detections using (BIM). 65% of hospital designs are centred on MEP services (interviews). The NHS needs to save cost when responding to possible future changes without compromising the quality of standard provided to the public. A change-ready healthcare facility is proposed to address the issue of change and the design of quality spaces that can enhance effectiveness and efficiency in the delivery of health and social care. A change-ready healthcare facility can be described as a facility that accommodates known or proposed future changes creating novel pathways to increase the quality and life span of facilities. There is also a large chunk of NHS estates that is underutilised EC Harris, (2013). Therefore, healthcare facilities need to respond to future changes in order to optimise their spaces. To achieve quality and cost efficiency in healthcare buildings, key considerations are refurbishment and reconfiguration, optimisation of flexibility, maximising standardisation and implementation of BIM. This research explores opportunities to save costs, time and improve quality of healthcare facilities by making emphasis on the design delivery process. Therefore, the new RIBA Plan of Work 2013 was used as a mechanism to help translate ideas into physical form and yet has been hindered by lack of development and ability to keep up with technological development such as BIM. This is the rationale for developing a framework. The RIBA Plan of Work is accepted nationally. Due to the UK BIM mandate by 2016, this research is focused on the use of BIM to support both space standardisation and space flexibility within a refurbished or new building. Space is a vital component competent in every healthcare facility. It provides the environment for healthcare services to be performed, and links one functional space to another, it can be designed for multifunctional usage. Healthcare spaces are complex entities due to the range of services and technology they support and the number, variety and quality of requirement combined with a rapidly changing environment. Flexibility enables a facility to easily respond to changes, while the introduction of standardisation supports staff performance by reducing the reliance on memory which will reduce human error. But the main question that emerges from current literature is how healthcare designers and planners manage healthcare spaces that cannot easily be standardised due to the constraints of existing structures, diversity in patient and staff needs? With analysis of different flexibility frameworks in the Architecture, Engineering and Construction (AEC) industry, there is a need to improve the existing frameworks. Therefore, a framework for designing a change-ready healthcare facility was developed through a sequence of data analysis starting with literature, preliminary data, questionnaire survey and interviews. Three frameworks for designing a change-ready facility were revised, organised and merged to produce a state of the art framework. Three frameworks were revised as different research methods were required. The successful framework can guide the design process of embedding different flexible design options for a defined project brief to save costs and improve design efficiency. The framework was validated with some of the top 100 architectural practices in the UK, NHS Estates, facility managers and the RIBA through an interview process. Further research and development arising from this research focuses on the process of applying BIM to record or identify key decisions taken for each of the different design options generated from a single brief to inform the designers, clients or other stakeholders involved while collaborating. Findings of this research are described in five peer-reviewed papers. The only certainty in healthcare is change Gressel and Hilands, (2008).