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I've always thought it strange that countries like the UK with the NHS haven't standardised a modular hospital design where you can slot prefab modules into som

I've always thought it strange that countries like the UK with the NHS haven't standardised a modular hospital design where you can slot prefab modules into some framework. Need a CT suite on floor C? Labs on floor F? Need a new floor on top? And then (assuming the British government isn't feeling charitable, which is a good bet) you can export them at a profit or licence the design to other countries. Instead, every single hospital seems to be a money-pit full-custom design and changing one after the fact is almost entirely impossible without huge effort, which is why my latest medical appointment was done in an old laboratory, complete with lab benches round the walls with a high-school-style desk and two chairs awkwardly plonked in the middle. Obviously it's not a simple thing to design such a thing (not least the plumbing!), but the immense resources that go into full custom hospitals, the pain it causes when they become not what is needed, and the expense of modifying them really makes me think.

bluedino 3y ago
The hospital construction industry is huge and wouldn't want that. And, a lot like college dorms, hospitals have become luxury. Basic hospitals would be a hard sell.
- adhesive_wombat 3y ago
  > The hospital construction industry is huge and wouldn't want that. Sounds very much like a them problem (assuming a government since 1948 could show such intestinal fortitude). > hospitals have become luxury Only if you allow the private sector to completely capture the entire industry from top to bottom including government and regulatory function (in the same way the US automotive industry made light trucks basically illegal where they could). That process of top-to-bottom capture having not yet been fully completed in the UK, I don't think you'll find an NHS hospital, even a new one, especially luxurious. A BUPA one, probably yes (but they also don't have expensive money sinks like grubby un-insured and un-moneyed patients, A&E departments to run or junior staff to train). And there's no reason you can't have luxury modules as an upsell, or even third party compatible models. It's how aircraft are configured. You get an empty fuselage and you choose the modules. But the difference is you could fit the same modules to the medical versions of Airbuses and Boeings.
phone8675309 3y ago
Some of this is already occurring. The company I work for makes mobile imaging solutions (CT, MRI, PET) that fit in the size of a shipping container and are often transported by semi-truck. There are hospital designs that leave bays for these trucks to pull into with a door on the side to get patients in and out on detachable tables. So a small hospital system that only has the money for a single CT or MRI scanner can move it from site to site in rotation to see patients instead of siting it at a single hospital and having to send patients further from home. Doing that on a larger scale would be the next step.
bluGill 3y ago
Everyone wants their city to have.unique hospitals. Plus it is rare to build a new hospital, what they do typically is remodel an existing one so there is less gain. Elementary schools could also use a standard modular design, but every town would prefer to spend just a little extra for a custom design. The cost of a custom design isn't much more anyway, as all the parts are standard off the shelf. What a standard really gives is they don't make the gym too small for a.regulation basketball court and other details that are easy forget when specifying a custom building.
- adhesive_wombat 3y ago
  Admittedly not much gain up front, if anything it might be more expensive than a really efficient custom design (though I think most recent UK hospitals are not cheap, one near me cost something like £200 million and has 500 beds and took quite a while to design and build, would be interesting to what went to the design consultants). You can still put a custom fascia on it. Most recent large buildings fundamentally work that way anyway. Concrete inside, panels or bricks outside. The real gain comes in 20 years when you need to change things (medical technology changes, demographics change, multi-hospital organisations-trusts in the UK, networks in the US-change), and you find that you need to gut the whole place to do anything at all. So you either do that at huge expense, or you make do and do your consultations in a disused lab area with a waiting room in a corridor (because labs don't have waiting rooms, but now the lab work is done elsewhere, so it's what you got). Of course when it's all about "profit this quarter" (US) and "being tough on spending" (UK), having a major problem in 20 years is not your problem.
  - stevekemp 3y ago
    It is a similar story for schools, and other building-types. They could be modular, and benefit from overhauls/extensions/fixups every decade or two. Instead we have historically "quirky" buildings that evolve a little in-place at great cost. This recently came to a head, again, in the UK where it was discovered that some schools were on the verge of failing due to the limited lifespan of the concrete and building technique in use: "Crumbling and potentially dangerous concrete has been found in 174 English schools, 27 more than previously known..."
jakogut 3y ago
Lots of things are this way. School busses and fire engines are mostly all custom built to order. Fire apparatus at least make some sense, as the needs of every district vary, but school busses? I would think a few common models would suffice.
- lotsofpulp 3y ago
  I have been to many (majority?) of the states in the US, and took the school bus in 6 very different and far apart states, and I feel like they are all the same. Maybe there are 2 designs, flat front or truck style front.
vlovich123 3y ago
I don’t know. Are CT or MRI machines ever found on anything but the ground floor because of the weight of them / installation complexity? I agree that you want standardized designs, but modular stuff gets tricky because it’s physical infrastructure not code (eg things can fairly physically in unintended ways if the supports aren’t designed for it and designing supports for arbitrary undefined loads to be added later is tricky). At least that’s my uninformed take.
- repiret 3y ago
  At my local hospital, the MRI and CT are on the upper of two floors. They are heavy machines, but buildings can be built to support heavy machines.
  - vlovich123 3y ago
    Couldn't find anything online except for a reddit thread with random guesses. Alternative explanations are colocating with ER (the places I go to tend to not have an ER so not sure that's the reason), or for CT & Xrays the floors might have to additionally be lead-lined if not on the first floor which adds to the cost (when there's a basement imaging can often be located there apparently). Could also be a convention that's just been established but there's no real reason.
- deleted 3y ago
  [deleted]
- adhesive_wombat 3y ago
  Well I mean, you still have to engage your brain and do some design at some point. PortaKabins are modular yet no one specifies to stack them 100 high, even though in theory you could just keep on stacking (infinite floor area hack, real estate agents hate this one simple trick!). As for CT, the last one I had was actually on a floor C, but it was at the back I think, so now I think about it could have been the ground floor as the building was on a hill. But even then the module catalog can just say "you can only put Type H (heavy) modules at the bottom, and Type R (radiological) ones go at the bottom unless shielded". Maybe it's just an insane and impractical idea, but I can't help thinking billions upon billions in one-off design and refitting work is being reinvented every new project (not that I hear architects and consultancies crying about it).
dwd 3y ago
Especially as the British did it first over 150 years ago. One of Brunel's lesser known innovations and highly successful as well. https://en.m.wikipedia.org/wiki/Renkioi_Hospital https://en.m.wikipedia.org/wiki/Renkioi_Hospital
fastasucan 3y ago
Im not convinced that some of the most advanced buildings we build is the ones most fitting for standarization. Ideally every hospital is constructed to fit the needs of the local community (and budget and building permits).
FerretFred 3y ago
> NHS haven't standardised a modular hospital design where you can slot prefab modules into some framework I think the nearest we got was the so-called Nightingale hospitals hastily erected for the first anticipated Covid-19 influx. They were put up very quickly but never saw much use.

bluedino 3y ago

The hospital construction industry is huge and wouldn't want that. And, a lot like college dorms, hospitals have become luxury. Basic hospitals would be a hard sell.

adhesive_wombat 3y ago
> The hospital construction industry is huge and wouldn't want that. Sounds very much like a them problem (assuming a government since 1948 could show such intestinal fortitude). > hospitals have become luxury Only if you allow the private sector to completely capture the entire industry from top to bottom including government and regulatory function (in the same way the US automotive industry made light trucks basically illegal where they could). That process of top-to-bottom capture having not yet been fully completed in the UK, I don't think you'll find an NHS hospital, even a new one, especially luxurious. A BUPA one, probably yes (but they also don't have expensive money sinks like grubby un-insured and un-moneyed patients, A&E departments to run or junior staff to train). And there's no reason you can't have luxury modules as an upsell, or even third party compatible models. It's how aircraft are configured. You get an empty fuselage and you choose the modules. But the difference is you could fit the same modules to the medical versions of Airbuses and Boeings.

phone8675309 3y ago

Some of this is already occurring. The company I work for makes mobile imaging solutions (CT, MRI, PET) that fit in the size of a shipping container and are often transported by semi-truck. There are hospital designs that leave bays for these trucks to pull into with a door on the side to get patients in and out on detachable tables. So a small hospital system that only has the money for a single CT or MRI scanner can move it from site to site in rotation to see patients instead of siting it at a single hospital and having to send patients further from home. Doing that on a larger scale would be the next step.

bluGill 3y ago

Everyone wants their city to have.unique hospitals. Plus it is rare to build a new hospital, what they do typically is remodel an existing one so there is less gain. Elementary schools could also use a standard modular design, but every town would prefer to spend just a little extra for a custom design. The cost of a custom design isn't much more anyway, as all the parts are standard off the shelf. What a standard really gives is they don't make the gym too small for a.regulation basketball court and other details that are easy forget when specifying a custom building.

adhesive_wombat 3y ago
Admittedly not much gain up front, if anything it might be more expensive than a really efficient custom design (though I think most recent UK hospitals are not cheap, one near me cost something like £200 million and has 500 beds and took quite a while to design and build, would be interesting to what went to the design consultants). You can still put a custom fascia on it. Most recent large buildings fundamentally work that way anyway. Concrete inside, panels or bricks outside. The real gain comes in 20 years when you need to change things (medical technology changes, demographics change, multi-hospital organisations-trusts in the UK, networks in the US-change), and you find that you need to gut the whole place to do anything at all. So you either do that at huge expense, or you make do and do your consultations in a disused lab area with a waiting room in a corridor (because labs don't have waiting rooms, but now the lab work is done elsewhere, so it's what you got). Of course when it's all about "profit this quarter" (US) and "being tough on spending" (UK), having a major problem in 20 years is not your problem.
- stevekemp 3y ago
  It is a similar story for schools, and other building-types. They could be modular, and benefit from overhauls/extensions/fixups every decade or two. Instead we have historically "quirky" buildings that evolve a little in-place at great cost. This recently came to a head, again, in the UK where it was discovered that some schools were on the verge of failing due to the limited lifespan of the concrete and building technique in use: "Crumbling and potentially dangerous concrete has been found in 174 English schools, 27 more than previously known..."

jakogut 3y ago

Lots of things are this way. School busses and fire engines are mostly all custom built to order. Fire apparatus at least make some sense, as the needs of every district vary, but school busses? I would think a few common models would suffice.

lotsofpulp 3y ago
I have been to many (majority?) of the states in the US, and took the school bus in 6 very different and far apart states, and I feel like they are all the same. Maybe there are 2 designs, flat front or truck style front.

vlovich123 3y ago

I don’t know. Are CT or MRI machines ever found on anything but the ground floor because of the weight of them / installation complexity? I agree that you want standardized designs, but modular stuff gets tricky because it’s physical infrastructure not code (eg things can fairly physically in unintended ways if the supports aren’t designed for it and designing supports for arbitrary undefined loads to be added later is tricky). At least that’s my uninformed take.

repiret 3y ago
At my local hospital, the MRI and CT are on the upper of two floors. They are heavy machines, but buildings can be built to support heavy machines.
- vlovich123 3y ago
  Couldn't find anything online except for a reddit thread with random guesses. Alternative explanations are colocating with ER (the places I go to tend to not have an ER so not sure that's the reason), or for CT & Xrays the floors might have to additionally be lead-lined if not on the first floor which adds to the cost (when there's a basement imaging can often be located there apparently). Could also be a convention that's just been established but there's no real reason.
deleted 3y ago
[deleted]
adhesive_wombat 3y ago
Well I mean, you still have to engage your brain and do some design at some point. PortaKabins are modular yet no one specifies to stack them 100 high, even though in theory you could just keep on stacking (infinite floor area hack, real estate agents hate this one simple trick!). As for CT, the last one I had was actually on a floor C, but it was at the back I think, so now I think about it could have been the ground floor as the building was on a hill. But even then the module catalog can just say "you can only put Type H (heavy) modules at the bottom, and Type R (radiological) ones go at the bottom unless shielded". Maybe it's just an insane and impractical idea, but I can't help thinking billions upon billions in one-off design and refitting work is being reinvented every new project (not that I hear architects and consultancies crying about it).

dwd 3y ago

Especially as the British did it first over 150 years ago. One of Brunel's lesser known innovations and highly successful as well. https://en.m.wikipedia.org/wiki/Renkioi_Hospital https://en.m.wikipedia.org/wiki/Renkioi_Hospital

fastasucan 3y ago

Im not convinced that some of the most advanced buildings we build is the ones most fitting for standarization. Ideally every hospital is constructed to fit the needs of the local community (and budget and building permits).

FerretFred 3y ago

> NHS haven't standardised a modular hospital design where you can slot prefab modules into some framework I think the nearest we got was the so-called Nightingale hospitals hastily erected for the first anticipated Covid-19 influx. They were put up very quickly but never saw much use.