Ryan Hullinger

Ryan Hullinger

Healthcare Partner, NBBJ
With a focus on enhanced clinical performance and adaptable hospital design, Ryan works to ensure that research-driven methodologies are at the center of healthcare design. Most recently, he has focused on a performance-based approach that leverages the transformative potential of Building Information Modeling (BIM), Integrated Project Delivery (IPD) and prefabrication. This work is yielding architectural solutions that are collaboratively developed, rapidly constructed and highly adaptable — solutions he has presented at conferences across the United States, Canada, New Zealand and the Middle East.

How Modular Construction Can Supply Beds in the Coronavirus Crisis

Advancements in Rapidly Deployable Inpatient Architecture Are a Key Solution as Hospitals Scale Up

March 24, 2020

Healthcare Partner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them however we can as they courageously care for the sick. So we’re posting design ideas based on work with several clients across the U.S., in the hope that we can to contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

 

The unprecedented challenge of the COVID-19 pandemic puts tremendous strain on healthcare infrastructure in the U.S., with staff and patients at elevated risk. A recent study found that in a moderate outbreak scenario, hospitals in 40% of American markets would not have room for all COVID-19 patients, even if they emptied all beds of other patients. While authorities are responding with strategies to address the national bed shortage, such as New York’s plan to create 8,000 new hospital beds in two weeks, there will be an ongoing need to increase inpatient surge capacity nationwide.

Quick Response with Rapid Inpatient Units

A rapid-response inpatient unit can be set up in a range of converted spaces, including military bases, schools, dormitories, office spaces, and arenas. Additionally, temporary structures such as tents, modified shipping containers and even purpose-built semi-trailers/RVs can be utilized. One such approach, the U.S. military’s Deployable Rapid Assembly Shelter, provides a turnkey system combining portable enclosure and high-output HVAC provisions. These and other mobile approaches are particularly compelling for virus response because they enable a healthcare structure to be delivered precisely to the point of greatest need, and can be moved from one hotspot to another in direct response to viral transmission patterns.

Yet in many ways, the building enclosure around a temporary ICU is the easier part to construct and deploy. The more challenging step is the construction of the life-support medical engineering systems that support patients within that enclosure.

Using Prefabrication for Increased Adaptability, Configurability and Speed

One solution may be an unconventional approach to ICU unit design and construction that maximizes the potential of prefabricated patient room components. These components act as a highly adaptable chassis for an ICU’s most complex engineering subsystems, including the life-support headwalls that deliver data, power and medical gases via a highly adaptable “plug-and-play/motherboard” framework. Rather than building these components conventionally at the job site, the modules can be prefabricated in a dedicated off-site assembly plant and then delivered and installed with significantly improved schedule, precision, cleanliness and efficiency.

Prefabricated building components can be installed up to 50% faster than similar conventional construction methods; the speed afforded by this prefabricated approach has clear applications for rapid crisis response. Our research in this field benefited greatly through a partnership with the Ministry of Health in Christchurch, New Zealand, after the devastating earthquake there in 2011 required the design of a state-of-the art replacement hospital. And the research was pushed further still in response to the Ebola crisis in 2015.

With these global events acting as a catalyst for innovation, headwall components can now be developed for prefabricated delivery, as well as for life-cycle demountability, enabling continuous reconfiguration and redeployment. In a conventional healthcare setting this flexibility allows caregivers to calibrate their work environment more precisely to need, and in a crisis situation — like COVID-19 — it could enable rapid ICU fit-out for a variety of temporary enclosures. These systems achieve their increased flexibility by incorporating features such as quick-connect fittings, flex piping, scalable technology management, adaptive leveling and panelization (rather than relying on conventional wet-joint sheetrock). Overall, the design leverages a great deal of manufacturing logic from the demountable furniture systems incorporated in corporate workplace projects.

The capacity issues that face the healthcare sector in the current crisis are daunting and cannot be addressed by conventional approaches and thinking alone. Modular construction offers one potential path forward, which may help hospitals respond more rapidly and effectively to the challenges ahead.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

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Let’s Make Obsolete Hospitals Obsolete

Prefabrication Can Make Healthcare Resilient and Sustainable. Here's How.

February 5, 2014

Healthcare Partner, NBBJ

Healthcare today is changing like never before — practice models are evolving radically, medical technology is advancing at an unprecedented pace, and healthcare’s financial infrastructure has become extremely volatile, especially due to recent steps toward insurance reform. Each of these issues has the potential to significantly affect how a new healthcare facility will be used in the future, and too often these drastic changes in use have led to premature obsolescence in hospital design.

Today architects invest tremendous effort in designing hospitals that are sustainable in terms of energy performance and near-term environmental impact, but unless we specifically address the threat of premature obsolescence, our hospitals are destined to be inherently wasteful in the long run. Once a healthcare facility becomes obsolete, it will either be overhauled, demolished, or worse yet, left in place for decades as an underperforming workplace that frustrates staff, diminishes patient care and squanders resources. These are not sustainable outcomes. At the societal scale, this wastefulness has afflicted trillions of dollars of healthcare spending.

Ryan-for-nbbX 2-ed

A New Approach 

In order to prevent obsolescence and ensure that a medical facility’s enterprise value will endure, architects are now developing strategies that maximize a hospital’s ability to accommodate unforeseen change. These strategies are based on a new design thinking that moves past the traditional view of a building as a static container, and instead explores opportunities for designing a building as an open-ended framework of prefabricated components. By developing a component logic that is highly standardized, demountable and multifunctional, key areas within the framework can be repurposed, reconfigured or replaced as performance requirements evolve. Eventually this allows for a massive reduction in waste because it significantly increases the probable lifespan of the entire project and ultimately leads to a future where medical facilities are designed to be transformable rather than disposable.

In a new age of clinical sustainability, can we make “Replacement Hospitals” a thing of the past?

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