Over recent years, practices with regard to the design and building of major healthcare facilities throughout Australia have come under considerable levels of scrutiny amid significant cost blowouts on a number of projects and problems experienced during planning and construction.
Indeed, from a cost perspective, on a square metre basis, Sydney and Perth were tied as the third most expensive cities in the world behind Toronto and London on which to build general purpose major hospitals, according to a Turner & Townsend report last year, though these direct cost comparisons were impacted by differences in labour costs and other factors.
Whereas the British built the Queen Elizabeth II Hospital with 1,300 beds and all facilities associated with a teaching hospital for the equivalent of $1.1 billion (or $850 per bed), Arup principal and Queensland leader – buildings Andy Bradley says, Australia built the 800-bed Sunshine Coast University Hospital for a whopping $1.8 billion or $2.25 million per bed. That, Bradley says, is despite the fact that material costs were roughly similar and that differences in gross floor area accounted for only around 20 per cent of the cost differential.
The quality of builds is also coming under question. Refrains about the standards of output being delivered by contractors are growing amongst designers and clients alike, Silver Thomas Hanley managing director Ernest Girardi says.
“I don’t think we are doing it particularly well,” Girardi said, asked about how Australia was performing in terms of delivering high quality output on major healthcare projects at an acceptable cost. “Without naming projects, if you did an audit of some of (Australia’s) developments, one of the biggest issues facing clients and operators is the quality of the product they are receiving from the contractor.
“There are numerous examples in the media at the moment where that is the case.”
With all that in mind, questions arise with regard to the advantages and disadvantages of different approaches to design as well as whether or not Australia is overly reliant upon bespoke design and construction methods as opposed to greater use of standardisation and modular technology.
Before talking about these considerations, Girardi says it is important to appreciate that the type of build undertaken can be influenced by differences in client groups, sites and procurement methods. Whilst the health department in New South Wales, for example, is pushing for greater levels of standardisation across its sites, other client groups may differ in terms of their level of comfort in adopting standardised approaches. When working within brownfield sites, meanwhile, the ability to roll out standardised designs may be curtailed by constraints on a particular site.
Be that as it may, he says standardisation delivers a number of benefits. From a construction point of view, these include greater predictability with regard to costs involved and time taken along with potentially better safety and consistency of quality. On the clinical front, meanwhile, standardisation across a portfolio allows personnel to gain familiarity with critical aspects of design and fitout and thus to transfer more safely and easily between facilities.
On the other hand, in cases where clients are able to articulate specific requirements and the way in which they plan to deploy and deliver services, bespoke designs are able to deliver specific outcomes which align with these requirements.
In terms of challenges, Girardi says contractors are looking at greater use of modular construction, but thus far the prefabrication industry has yet to demonstrate an ability to deliver as good or better outcome on a consistent basis.
Bradley, meanwhile, believes there is a strong role for standardised elements within excellent design. Ideally, he would like to see the industry adopt a national agreement upon a common suite of standard rooms, with a simple range of options for each room type which could all be available from a standard suite of parts.
Take for example, single-bed wards with ensuites. Four different standard solutions could be developed for these, Bradley says, which the design team could talk through with clients whilst explaining the advantages, disadvantages and cost estimates of each option. Under this type of approach, he says, clients would more easily be able to make informed decisions, whilst each of the options could be refined and enhanced over time.
Bradley says builders and designers overseas are increasingly adopting innovative construction methods on major healthcare projects. These include volumetric modular construction for rooms, bathroom pods and operating theatres; prefabrication for riser, plantrooms and corridor service modules; modular wiring; flat packed systems (for operating theatres, for example) and pre-wired and pre-plumbed wall systems. He says all of the above were used on the Queen Elizabeth II project in the UK, for example, with the result being that the project was delivered six months ahead of schedule with virtually zero defects.
Bradley says Australia's design culture is excellent and that we have a unique climate which can require bespoke solutions. Nevertheless, he feels greater standardisation in Australia is being unduly held back by a culture of wanting to do things our way and concerns on the part of building unions with regard to standardisation leading to a de-skilling of the industry and lower wages on site.
“I have tried with several major contractors to implement this approach in Australia,” he said, referring to some of aforementioned construction methods. “Generally, they are very keen to adopt this approach and gain the clear benefits, however they are concerned that the unions will perceive the new approach as a means of de-skilling the workforce and limiting the pay awards for operatives on site.
“In reality, this couldn’t be further from the truth. The experience from overseas is that the operatives would still be paid the same rate as if they were on site, however the contractor would make an overall saving as the productivity of his team would be dramatically increased.”
For now, Australia appears to not have embraced standardisation or modular construction in hospitals and major healthcare facilities to the extent that we could.
Were we to do so, it appears, significant benefits could result.