HOS.T by Shuyi Zhao

MULTIDISCIPLINARY PROJECT - FINAL REPORT

OPEN ROOM A MODULAR VISION FOR FUTURE HEALTHCARE CHALLENGE

Team

HOS.T

Open Room: A Modular Vision for Future Healthcare Challenge

MULTIDISCIPLINARY PROJECT - FINAL REPORT

OPEN ROOM A MODULAR VISION FOR FUTURE HEALTHCARE CHALLENGE Team HOS.T

ALTA SCUOLA POLITECNICA - XIII CYCLE

Principal Academic Tutor: Prof. Stefano Capolongo, Dept. ABC, Politecnico di Milano Other Academic Tutors: Claudia De Giorgi, Dept. DAD, Politecnico di Torino Cesare Maria Joppolo, Dept. DENERG, Politecnico di Milano Cristina Masella, Dept. DIG, Politecnico di Milano Giulio Mondini, Dept. DIST, Politecnico di Torino Gabriella PEretti, Dept. DAD, Politecnico di Torino Riccardo Pollo, Dept. DAD, Politecnico di Torino Francesco Scullica, Dept. DESIGN, Politecnico di Milano Virginio Quaglini, Dept. ABC, Politecnico di Milano External Tutors: Lino Ladini, Architect, CADOLTO Thomas Fritsch, HT Group Andrea Zamperetti, Architect, Salini Impregilo Alberto Beretta, Engineer, Oppent Antonio Cianci, Engineer, Airlite Franco Mola, ECSD Christine Nickl-Weller, ENAH Maurizio Mauri, Doctor, CNETO & Fondazione CERBA Fausto Francia, SItI – Società Italiana di Igiene Daniela Pedrini, Engineer, SIAIS Gaetano Settimo, Istituto Superiore di Sanità

Open Room: A Modular Vision for Future Healthcare Challenge

TEAM MEMBERS

Francesca Bullo Industrial Production Engineering Politecnico di Torino

Emmananda De Martino Civil Engineering Politecnico di Milano

Natasha De Santis Architecture Politecnico di Milano

Chiara Fignon Architecture Politecnico di Milano

Zhao Shuyi Systemic Design Politecnico di Torino

Wan Chih-Wei Interior Design Politecnico di Milano

Devin Tan Civil Engineering Politecnico di Milano

INDEX 1. EXECUTIVE SUMMARY 2. INTRODUCTION 2.1 Hospitl Complexity 2.2 Sustainability and Flexibility in Healthcare System 2.3 Open Building 2.4 Prefab modules and how it develops into the open room concept according to ASP XI cycle 2.5 Aims and scope of the research project 2.6 Method of work 3. STAKEHOLDERS’ NEEDS EVALUATION 4. STATE OF ART 4.1 Evolution of hospital needs over the time 4.2 Evolution of hospital design and layout 4.3 Application of ﬂexibility in healthcare system constructions 5. SOLUTION 5.1 Enviromental unit analysis and choice of rooms

Open Room: A Modular Vision for Future Healthcare Challenge

9 13 13 13 14

16 20 21 25 29 29 30 32 37 37

5.2 Primary system 5.3 Secondary system 5.4 Tertiary system 6. FEASIBILITY ANALYSIS 6.1 Production of the module 6.2 Trasportation of the module 6.3 Installation/construction procedure of the module 6.4 Cost and timeestimation 7. CONCLUSION 7.1 Critical issues 7.2 A plan for the continuation of the work 8. ACKNOWLEDGMENT 9. BIBLIOGRAPHY

39 41 53 65 65 70 71 76 83 83 84 87 89

INdex

Open Room: A Modular Vision for Future Healthcare Challenge

EXECUTIVE SUMMARY Quick obsolescence of facilities, given to the rapid

and sometimes conﬂicting needs. In addition, efﬁciency

and technological evolution, is one of the main issues

and rapidity should be constantly granted to patients and

that hospitals have to face today. It has been demonstrat-

other users, therefore, the need for ﬂexibility should not,

ed that hospitals’ lifespan has reduced from almost 500

in any way, stop or disrupt the daily activities performed

years to no more than 100 years. Therefore, hospital de-

inside the hospital.

signers are challenged to ﬁnd solutions to adapt to this rapidly evolving environment (Capolongo, 2012).

Starting from these considerations, this project represents the second step of a research started two years ago by OPEN BUILDING group belonging to the ASP XI Cycle and has the objective of reinforcing the concept by

Since XXI century many researchers, scholars and designers have tackled the subject of buildings’ ﬂexibility, trying to develop a concept that could respond to these fast-evolving needs, not only in the medical ﬁelds (Habraken, Astley, Kendall, etc..) However, when dealing

demonstrating its technical feasibility and practical implementation as well as expanding it to several functions inside healthcare facilities. In fact, the concept was developed only for single and double inpatient room by the previous team.

with healthcare facilities, an additional element should be considered: complexity. In fact, ﬁrst of all, the dif-

Starting from the Open Building concept (Kendall,

ferent requirements of several stakeholders have to be

2000), the previous project team was able to scale it

considered and satisﬁed. On the one hand, patients that

down by providing a rough design of the Open Room,

should be hosted inside an environment where safety,

ensuring ﬂexibility inside inpatient wards. According to

decorum, comfort and hygiene are granted. On the other

their approach, the whole building, as well as the room

hand, medical, administrative staff as well as workers, vol-

are divided into three different parts depending on their

unteers and service providers should also be taken into

durability: Primary, Secondary and Tertiary structure,

consideration, since they have to spend a large amount

which are closely interconnected.

of time inside the building and have completely different

EXECUTIVE SUMMARY

Obsolescence + Flexibility + Complexity + Conﬂicting Needs & Requirements + Several Stakeholders give birth to

OPEN BUILDING with modular technology

OPEN ROOM

Business Model

Production

Primary: - Structure

Secondary: - Structure - Plant System

Tertiary: - Lighting - Furniture - Material - Implants

Construction

Cost&Be

Figure 1.1 - Project Structure

The aim of HOS.T research project is, therefore, to

module size and weight, many existing installation solu-

deepen the analysis, precisely deﬁning structural re-

tions were explored, to come up with the design of a cus-

quirements, production, installation and transportation

tomized platform and a speciﬁc mechanism used to easi-

constraints and to try to adapt the previous Open Room

ly push the module inside the “partially hollow” concrete

concept to several different spaces inside an healthcare

structure. Since the concrete structure plays an important

facility, such as for example staff break room, doctors’ of-

role in hosting the modules, it has been designed and

ﬁces, ICU room and several others. The result is a modu-

equipped with innovative technologies, such as hydraulic

lar prefabricated, innovative and highly ﬂexible room of

jack and PTFE bearing pad, making it a very unconven-

9.6x2.5x3.5m, which is able to host several different func-

tional structure compared to the common building.

tions, and that could easily be plugged in and out from a fixed structure. The room is divided into three separate and independent parts that perfectly fits with transportation maximum allowed sizes and that is able to grant adaptability both on the short and the long term. Once the three modules are manufactured inside the factory they are moved on the healthcare facility site to be “pluggedin” inside the Primary concrete structure, realized in parallel with the operations performed inside the manufacturing plant. Finally, internal spaces are defined by a series of removable panels, equipped with adaptable furniture that can respond to specific function needed. Given the

Open Room: A Modular Vision for Future Healthcare Challenge

Due to the complexity of the subject, multidisciplinary approach was fundamental to address and ﬁnd a balance between the several existing requirements and constraints. Several case studies and previous researches were analysed, and experts’ points of view consulted during meeting and technical visits in healthcare facilities, in order to come up with a solution that could practically and technically be implemented. The advantages generated by this new approach cover multiple aspects, such as time saving, high ﬂexibility and long-term cost reduction. The time required to complete the building which is

almost halved if compared to the one needed for a traditional construction. Off-site and on-site operations can be performed at the same time, reducing the project schedule, as well as the project budget. It can be argued that the prefabricated techniques are not excessively innovative solutions since they have been used for centuries. However, over the years, it has always been considered as low-quality technique, often used for temporary solutions. Today, opinions are changing, since new materials are being used which are characterised by a very high quality and long duration and several architects and designers are finally seeing the benefits brought by prefabrication. In addition, the more innovative element of this project is not really connected to the modules’ construction technique, but rather to the concept that is hidden behind the Open Room: a flexible space that is able to keep up with changing demand, that can be easily moved and perform several functions, realized with high quality and hygienic materials. On the other hand, the Open Room solution is able to create economic benefits, hidden behind a quite high initial investment. As a matter of fact, the cost estimation that was made referring to materials and standard operations prices revealed that the initial cost is much higher than the one generated and that the solution will be unlikely adopted by public institutions. Nevertheless, the time, money and interventions that are saved thanks to the implementation of this solution should also be considered as part of the cost estimation and analysis.

EXECUTIVE SUMMARY

Open Room: A Modular Vision for Future Healthcare Challenge

INTRODUCTION 2.1 HOSPITAL COMPLEXITY

for all the changes due to the progress of medical and technological acknowledges.

Healthcare infrastructure planning, design and its project (and asset) management involve a complex in-

In addition to the ﬂexibility concept, it is without a

teraction of factors that determines the distributions of

doubt that sustainability has become one of the most

its resources. In the planning process, these factors are

widely recognized issue around the world. Healthcare

interrelated and an interdependent multi-disciplinary

facilities, being one of the most integral, social and eco-

approach is required in order to organize the hospital in

nomic infrastructure to support the lifeline of a city, are

an efﬁcient way over the time. It must be remembered

also a subject of this matter.

that there cannot be a strict division of works inside the team of designers (engineers, architects, etc.), producers and customers; the solution that can be functional from an engineering point of view, may be inapplicable for architectural needs or vice versa, as well as the needs of

2.2 SUSTAINABILITY AND FLEXIBILITY IN HEALTHCARE SYSTEM

producers and customers must be taken into consideration for the evaluation of the feasibility of the healthcare

Several researches have shown that sustainability

facility. As a consequence, the designers must have in

in hospital design is often reﬂected by its capability to

mind that their work would give some constraints to the

adapt to spatial requirements and functional units over

choices of their colleagues: ﬁnding some “shearable con-

the time, or in short: ﬂexibility. Consequently, hospital ob-

straints” would be the key in solving all the operations for

solescence has experienced a fast decrease over the past

the project of a healthcare infrastructure.

decades, which ultimately will lead to a major sustainability issue (Capolongo et al., 2012).

What is currently happening is that hospital designs are incapable of adapting with the needs of its own organiza-

In several developed countries, this notion has been

tional complexity and keeping up with the ever-growing

made aware by the political parties (governments) by

capacity of hospital technologies (Astley et al., 2015). As

incorporating this concept into their local regulations

a consequence, the ﬂexibility has become a key element

(standards). As a result, new facilities nowadays are re-

INTRODUCTION

quired to consider sustainability as an input in their de-

To be more precise, there are 4 levels of ﬂexibility in-

sign, while all the old facilities are to be assessed of its

side a hospital building: functional, structural, technolog-

sustainability performances (Capolongo et al., 2014).

ical and plant. Within the functional ﬂexibility there must be a layout-distribution which comes from a process of:

The most common misconception about sustainability is that it is often related only with environmental aspects: recycling wastes, reducing energy consumption, and so on. While this kind of interpretation is not entirely wrong, sustainability is also related to two important elements, namely: social and economy. The social aspects, as its name implies, are strongly controlled by the degree of comfort experienced by the patient whilst staying inside the hospital. This is often portrayed from the light quality inside the hospital, the presence of hospital (recreational) services and the level of ﬂexibility. The economic aspects, on the other hand, are correlated to the professionality of

meta-project (schemes and functional configurations), integrated design (also considering plants and facilities), aggregated strategies (functional and organizational criteria plant), technology integration. For what concerns the structural flexibility, anti-seismic systems must be ensured as well as the use of materials which can allow different configurations. After it, the technological flexibility: separable and modular materials and systems are considered such that variations are allowed in time. At last, a deep study of electrical and sanitary components, easily replaceable, as well as different configurations of the same plant have to be done for the plant flexibility.

the hospital personnel in managing wastes and pursuing medical/technological innovations. Combining all these criterions altogether, one will be able to properly measure the global sustainability level of a hospital.

2.3 OPEN BUILDING

Flexibility is not a recently recognized issue, in fact it

Although ﬂexibility may seem to be an expensive op-

has been widely acknowledge from the past decades. In

tion at the early phase, it turns out to have a signiﬁcant im-

Italy, for example, this concept was ﬁrst introduced in Pi-

pact in reducing the overall building cost over its service

ano-Veronesi meta-project (DM 12/12/2000), where ﬂexi-

life; ﬂexibility prevents the hospital from losing its value

bility is considered as “the basic requirement in the imple-

since it allows the hospital to adjust itself to the current

mentation of health facilities to meet the contemporary

(or even future) demand from the society and technology.

progressive new requirements”, as explained in the PhD course “Complex Construction” (dept. ABC, PoliMI). The

Nevertheless, a recent study by Kendall, Kurmel,

most common strategy adopted by most stakeholders to

Dekker, & Becker (2014) pointed out that the aforemen-

answer this issue is by having a conservative assumption

tioned conventional method is no longer sufﬁcient to

during the design phase which allows a certain degree of

guarantee the ﬂexibility of a hospital. In fact, it may even

indeterminacy in the hospital.

have an opposite effect towards the performance of the hospital if not properly employed. In order to overcome

For instance, designers will consider the possibility of

this predicament, Kendall starting from Habraken’ stud-

changing the functionality of speciﬁc rooms without dis-

ies, proposed a new concept for the design of hospital

rupting the overall performance of the hospital. Due to

system, namely the Open Building concept, whose idea

this assumption alone, the consequences are multi-fold:

is to separate the structure into three main categories,

higher ﬂoor to ﬂoor height, more heavy pipes surround-

namely the Primary, Secondary and Tertiary System.

ing the areas of the building, and stiffer structural system. In Open Building approach, new product interfaces

Open Room: A Modular Vision for Future Healthcare Challenge

and processes are made with the aim of simplifying con-

years, namely the structure, the building’s enve-

structions, reducing conﬂicts, affording individual choic-

lope, the main distribution and the building plant

es and promoting overall environmental coherence. This

system;

concept is evolving throughout the world, and it is not only consumer-friendly but also governments, housing

•

Secondary system: the components which have a life of 20 years, namely the secondary plant sys-

and ﬁnance corporations and manufacturers are sustain-

tem, space plan conﬁguration, ﬂoorings, ceilings

ing this procedure.

and inner walls; An important aspect is that the responsibility for decision-making (regarding technical, aesthetic, financial and social ones) is distributed on various levels: urban, support (base building) and infill (fit-out) one. Urban level decisions concern the establishment of urban patterns of buildings, streets, parking and utility networks, setback and “street furniture” as well as the character of building facades, the location of public buildings and the distribution of activities. The second level, the support or base building one, includes the parts of the buildings which are common to all participants and which are supposed to last for a century or more. The last level, on the oppo-

•

Tertiary system: the elements of the equipment that can be used maximum for 5/10 years due to the intense use or to the necessity to be upgraded.

OPEN BUILDING (Kendall) TERTIARY SYSTEM 5-10 years FFE (Furniture, Fixture, Equipment) and plants system terminals SECONDARY SYSTEM 20 years Inner walls, ﬂoorings, ceilings, secondary plant system and space plant system and space plan PRIMARY SYSTEM 100 years Structure, building envelope, main distribution and building plants system

site, is composed by systems and parts which can change at cycles of 10-20 years. The possible transformations are Figure 2.1 - Open Building System

due to the occupants’ changing requirements or preferences (social/cultural paradigm shift), to the cyclical need for technical upgrade. The inﬁll level is generally referred to partitioned elements: kitchen and bathroom equipment and cabinets, unit heating, ventilating and air conditioning systems, outlets for power, communications and security. In open architecture, these inﬁll parts may be independently installed or upgraded for each occupant in turn; in order to make it possible, the base building must be kept as physically distinct as possible from its

One of the most important case studies, which shows a high attention in the design phase so as to be a changeready hospital, is the INO Hospital in Bern, Switzerland. The ﬁrst aspect that the designers considered was to rethink the paradigm of facility procurement and design management, instead of inventing new technical systems. The consequence was primarily an organizational innovation, which led to different architectural and strategic choices than usual ones.

less permanent inﬁll and it must be subject to the lowest level of change.

In the INO Hospital, the System Separation approach is both spatial and technical as it can be seen from the fol-

For the application of the Open Building approach to healthcare facilities, the inﬁll level must be divided into two separate components so that the resulting systems

lowing Figure 2.2, extracted from the paper “Open Building: a systematic approach to designing change-ready hospitals” by S.Kendall, 2007 ”.

are now three, as it can be seen in Figure 2.1: The primary system’s base building was designed to •

Primary system: the parts which can last up to 100

INTRODUCTION

last 100 years and expected to accommodate changing departmental sizes and layouts of emergency, imaging, surgery, and pharmacy departments, zoned for specific floors. The secondary system is intended to be useful for 20-plus years and the tertiary system, including equipment, finishes and furnishings, is expected to have a useful life of 5 to 10 years. Moreover, the aforementioned decisional organization for the design process has been followed by the Canton Bern Office of Properties and Buildings (OPB). In fact, a hierarchical structure of decision levels was developed as a management model: higher level decisions provide “capacity” for a range of lower-level functional scenarios partitioning the whole with “systems separation”.

Figure 2.2 - Levels for design organization for INO Hospital (Kendall, 2007)

Open Room: A Modular Vision for Future Healthcare Challenge

2.4 PREFAB MODULES AND HOW IT DEVELOPS INTO THE OPEN ROOM CONCEPT ACCORDING TO ASP XI CYCLE Inspired from the Open Building concept by Stephan Kendall, the previous ASP group of XI Cycle came up with the concept of the Open Room approach, starting from the experiences of CitizenM hotel facilities, whose differences are highlighted in Figure 2.3. The model was designed by taking into account both technical and non-technical aspects such as social, logistics, economics, and environment; making the design a ﬁtting solution to answer not only ﬂexibility but also the overall sustaina-

OPEN BUILDING (Kendall) TERTIARY SYSTEM 5-10 years FFE (Furniture, Fixture, Equipment) and plants system terminals

OPEN ROOM (ASP XI Cycle) TERTIARY SYSTEM 5-10 years FFE (Furniture, Fixture, Equipment) and plants system terminals, wall panels, ﬂoorings and ceilings

SECONDARY SYSTEM 20 years Inner walls, ﬂoorings, ceilings, secondary plant system and space plant system and space plan

SECONDARY SYSTEM 20 years Secondary structure, secondary plant system and space plan

PRIMARY SYSTEM 100 years Structure, building envelope, main distribution and building plants system

PRIMARY SYSTEM 100 years Primary structure, building envelope, main distribution and building plants system

*Decoupling method is not speciﬁed and left for designer to choose

*Decoupling through modular approach

Figure 2.3 - Open Building versus Open Room Approach

bility issue. Students belonging to the previous ASP Cycle

can be the assembled and installed on site (see Figure

were, in fact, able to design a ready to be installed inpa-

2.4). This technique is used to build facilities that are

tient room composed of three modules, entirely manu-

meant to last in time and modularization is used as a solu-

factured inside the factory and transported on site to be

tion in order to reduce building time or reduce the im-

installed inside its Primary Structure.

pact of building construction process on the entire site. As a matter of fact, PMC can be used whether as a part of

Before going any further with the description of the

a more complex project or as a stand-alone one.

Open Room concept according to ASP XI Cycle, a general overview and presentation of what Modular construc-

On the other hand, you have, instead, Relocatable

tion is and its advantages is necessary. Modular construc-

Buildings which are facilities that are completely man-

tion is, in fact, a term used to describe a process in which

ufactured inside the factories and are supposed to be

the different parts of a building are completely realized

used as temporary solutions (see Figure 2.5). They can be

in factory and then moved on site to be assembled and

rearranged, reconﬁgured and transported to other sites

installed to create the ﬁnal structure. Buildings realized

offering a higher level of ﬂexibility.

with this technique are able to respect the highest quality and design requirements of a complex traditional facility, allowing substantial time and material saving. All these features make building constructors, architects and researchers think that prefabrication and modular building is an efﬁcient and ﬂexible solution for their future projects.

The Open Room project, as it was developed in the previous cycle and deepened this year, is thought to be a mixture of the two previous solutions described. As a matter of fact, the modules will be installed inside a permanent structure, known as the Primary Structure, used for the building of a brand-new hospital or to expand an

We can distinguish two different possible solutions.

already existing facility which will continue to carry out its

On the one hand, you have PMC - Permanent Modular

daily activity. However, modules will also have the possi-

Construction, which consists in realizing parts or a whole

bility to be moved from one structure to another one or

building with independent and separate modules that

to another part of the building, providing hospital staff,

INTRODUCTION

Figure 2.4 - 4-sided and open-side modular systems (Ivan Moiseenko, 2017)

management and patients the possibility to adapt the

The reason behind that is that modularization is consid-

building to their needs. Even if they are often described

ered as a solution to increase productivity and respond

as innovative solutions, modular building process cannot

to the increasing demand for mass customized products,

be considered as a completely new activity. As a matter of

solutions that can be easily adapted to clients’ needs but

fact, is has been used for almost 100 years in the commer-

with a production cost and consequently a price that can

cial building sector to realize hospitals houses, schools,

be compared to mass manufactured products.

dormitories and hotels. Over the centuries, however, prefabrication has always been considered as a technique characterized by the use of cheap and poor-quality materials. That is the reason why it was often used as a temporary solution, in case of emergency. However, today, thanks to the technological evolution and the deep analysis of the beneﬁts produced, professionals’ opinions about modular construction processes has changed. According to a survey conducted in 2011, 85% of industry players are using this technique to build their projects and healthcare facilities seem to be the sector that sees the fastest development (McGraw Hill Construction, 2011).

The main advantage of modularization that has a direct impact on higher efficiency and productivity is time saving. As you can easily understand by looking at the time schedule below, modular construction gives the possibility to carry on two activities in parallel, in order to reduce project schedule by 30% or 50%. As a matter of fact, traditional site-built construction requires that the site foundation work is finished before start working on the building construction. With prefabrication the two activities can be done together since the building construction is done in modules inside the factory. (Figure 2.6) Off-site construction is able to engender many other benefits that could have an important impact on project budget and that can perfectly fit the lean manufacturing logic that is invading almost every industry sector and becoming the leading business principle. The general idea behind lean manufacturing and lean management is that wastes should be eliminated in order to reduce economic and environmental impact of a project. When analyzing construction industry under this point of view and com-

Figure 2.5 - Relocatable Home (Kasita Inc)

Open Room: A Modular Vision for Future Healthcare Challenge

paring traditional techniques with modularization pro-

Figure 2.6 - Construction Schedule: Conventional and Modular Approach (Modular Building Institute)

cesses the differences and beneﬁts of the last one are

should not be excessively small, in order to reduce time

evident.

wastes during the production and the assembly phases and to respect minimum sizes required by hospital de-

As explained before, modules are completely manufactured inside the factory which allows a better quality of the ﬁnal output. Throughout the entire process and the production line quality inspection control are made on the product, making it easier and consequently cheaper

sign standards. On the other hand, the module could not be too big either since it had to ﬁt with the maximum sizes allowed by transportation regulation, in order to avoid exceptional transportation, more expensive and more difﬁcult to schedule.

to detect non-conformities and ﬁx it. Moreover, raw materials can be stocked inside a warehouse and the production process is done in a controlled environment which

Therefore, several existing concepts were analysed and two of them hold and further analysed:

prevents materials’ deterioration and project’s delays due to bad weather condition. The result is a long-lasting module that can be directly installed on site.

•

IFD – Industrial Flexible and Demountable Building approach. It consists in the deﬁnition and planning of the internal layout of the rooms so

Beyond time saving and quality management mod-

that the panels could be manufactured inside the

ularization is a process that helps reducing the environ-

production site. The panels are then moved on

mental impact of a building project. As a matter of fact,

site and assembled according to speciﬁc instruc-

since modules are produced in factory wastes can be

tions. This approach helps to overcome the sev-

reused in the manufacturing process, reducing the need

eral limits and drawbacks generated by the con-

for raw material and consequently the amount of energy

tainer method which gives greater possibilities

needed.

of expansion but is preferred in emergency situations, since sizes are not always suitable, and a lot

One of the main issue previous students had to deal with was the difficulty to find a balance between flexibility and the standardization needed by prefabrication and industrial production. Consequently, the definition of the design module required a deep analysis to respond to the numerous existing constraints. On the one hand, it

of energy is required to join the element together and remove hazardous materials. IFD technique, indeed, ensures safer on-site workers conditions, lower construction time since panel production and on-site operations can be done at the same time, as well as a very high ﬂexibility, given that

INTRODUCTION

panels can be relocated or removed when neces-

and Secondary Structure should not be neglected when

sary. is a worldwide approach and it guarantees a

designing the structural grid. Three modules were then

higher ﬂexibility in spite of longer installation time

designed with a size of 2.40 x 8.10 x 3.30 m, which rep-

and on-site assembly.

resent the secondary structure where predisposition of all different supplying implants are installed. Two main

•

Plug-in approach. It consists in the design and fabrication of a complete room inside a container which will then be carried to the site and stacked on top of each other to form a structure/building. Furthermore, it can provide a considerable decrease in construction time, but it lacks in ﬂexibility and it implies bigger dimensions.

After a deep analysis of the two solutions advantages and drawbacks, the decision was taken to mix them together and come up with a concept which could grant ﬂexibility both on the long and short term. Therefore, modules have been designed with an IFD approach in order to have the most ﬂexible solution, without having to renounce to the advantages of a rapid construction and installation procedure. In fact, a prefabricated modular room, divided into three parts (modules) for easy transportation, have been designed. The modules are then put in a primary structural frame with a plug-in mechanism and assembled once positioned inside to form the differ-

requirements were taken into consideration when defining substructure building technique. First of all, modules should be lightweight in order to be easily moved and installed inside the primary structure. In addition, they should give workers the possibility to be effortlessly disassembled in order to increase the flexibility level. Therefore, two different solutions have been investigated before coming up with the most suitable one: steel frame technologies and containers. Nevertheless, the maximum height of a container does not fit with the minimum authorized one for inpatients rooms. Therefore, the first solution was chosen. Internal spaces were designed with a series of customizable wall panels that can be adapted to the room function needed. The final result of the previous ASP project is, therefore, a prefabricated and transported inpatient room composed of three modules, able to accommodate several different fit out changes. This grant, therefore, flexibility of the healthcare facility, both in the short and long term.

ent rooms. As a consequence, the ﬂexibility would be ensured both in short terms (5-10 years with IFD approach) and in long terms (20-40 years with Plug-in concept). National and international case studies have been an-

2.5 AIMS AND SCOPE OF THE RESEARCH PROJECT

alysed in order to deﬁne the most suitable structural grid for the primary system, which is between 6.00 and 9.00

While it is true that the concept of Open Room is ca-

meters. In addition, the study of hospital standards and

pable to solve the current ﬂexibility issue, the concept still

spaces required to host furniture and technical equip-

needs to be reﬁned and explore even further. The main

ment, ﬁnally led to the deﬁnition of a rectangular struc-

reason is because the previous study was performed

tural grid of 6.90 x 8.40 m which could host two single

under one limitation: it was developed only for an inpa-

inpatients room.

tient room. However, hospital is not only about inpatient

Given that the Open Room concept has its roots in the Open Building theory that was presented in the previous chapter, the link existing between the Primary

Open Room: A Modular Vision for Future Healthcare Challenge

rooms; there are other rooms whose functions can be considered essential so that the hospital can work as a whole. Moreover, different rooms have different needs

and requirements, which means that some minor or even

Beyond increasing room ﬂexibility, HOS.T research

major adjustments might be required. In addition, ﬂex-

group was also required to provide a “stronger” solution,

ibility is not restricted to a single room; it also concerns

especially from a structural point of view. The three struc-

the interaction between each room and the possibility

tural layers – Primary, Secondary and Tertiary structure –

of changing the room layout every day due to different

should be thought and designed as a whole. Every part

needs.

should be studied separately from the other ones, with its own characteristics and requirements but then, they

The aim of current HOS.T team is, therefore, mainly linked to the deepening and extension of the concept developed by the previous ASP Cycle. As a matter of fact, one of the main weaknesses of the previous Open Room project was the fact that just one room had been designed and studied, without considering the possibility

should be joined together to be sure that no conﬂicts exists between the different elements. The ﬁnal output of the project, indeed, was supposed to be a ready to be installed room for which all the possible issues connected to construction, module manufacturing, transportation and installation had been addressed and solved.

of using the same concept to integrate other functions inside the same space. It is true, indeed, that single inpa-

That is the reason why, compared to the previous pro-

tients rooms are probably the most common and used

ject, the construction and installation phases were more

environmental units inside an healthcare facilities, given

deeply analysed and customised solutions were provid-

to the increasing number of chronic diseases and the de-

ed, in order to present a complete and functioning con-

crease of the average duration of hospitalization. More-

cept, under several points of view.

over, due to the previously explained trends, studies are showing that single rooms are preferred with respect to double or multiple rooms. However, several users should

2.6 METHOD OF WORK

be considered inside hospital scenarios and several needs should be addressed too, to be able to offer the most complete, ﬂexible and efﬁcient solution. Keeping all these elements in mind, a preliminary selection of environmental units was made, on the base of the function performed and the frequency with which these rooms could be found inside a healthcare facility. Since inside the research group none of the member had the expertise and competencies connected to implants and supply system design and installation, low implant

The method of work used during the whole year in which the ASP project was developed, followed an iterative process, characterised by design phases, meeting with experts and tutors, in order to increase knowledge on the topic, as well as hospital visits to directly experience new existing solutions. In addition, regular revisions with principal tutors were organised so that to monitor project progress and look for additional inputs to deepen the analysis.

redundancy has also been selected as a criterion to de-

The very ﬁrst thing that the ASP team did at the begin-

ﬁne the rooms and functions that the Open Room could

ning of the project was a preliminary and deep analysis

address. More redundant and simple rooms were there-

of the State of the Art in hospital planning. The main aim

fore selected, and several possible layouts proposed be-

of academic literature review and the reading of books

fore coming up with the ﬁnal one. Compared to the XI

and article on the topic was to understand the current

Cycle, HOS.T project provides a wider solution, gathering

hospital issues, which are sustainability and ﬂexibility, and

seven different functions inside one single room.

to look for the current trends and technologies in hospi-

INTRODUCTION

tal design that could be useful for the project. This ﬁrst

redundancy and functions’ similarities. This is way seven

research step was fundamental to precisely deﬁne pro-

different rooms were selected and further studied.

ject’s objective and start developing a concept that could respond to the issues emerged during this preliminary project phase. Needless to be said that a deep study of the previous ASP Cycle work had also been required to understand the previous design and the reasons behind

Moreover, all over the year several seminars and conferences were attended, which proved to be extremely helpful in expanding our knowledge of hospital design. •

certain decisions. As a matter of fact, the Open Room was

turo: Ripensare il rapporto territorio/ospedale”

supposed to become the foundation for this year project.

in Camogli (organized by CNETO association)

In this phase strengths and weaknesses of the previous

was extremely important not only for the topics

project were listed, in order to point out the elements

addressed but especially because it gave the op-

on which the new project should work harder and the

portunity to meet with different experts of differ-

ones that could be, instead, considered as a solid starting

ent ﬁelds, providing various “food” for thought

point. For instance, a too strict separation between the

and ideas that were then used inside the project.

three structures – Primary, Secondary and Tertiary – has

In particular, several suggestions were collected

been observed, which contributed to give the project a

on the way different layouts could be combined

lower technical soundness. On the contrary, the expertise

together in order to grant building ﬂexibility. In

and work done by the previous research group on sup-

addition, this was the occasion to think about the

plying implants was exploited and used as a solid base

most suitable situations for which this new design

for subsequent analysis.

proposition could be applied. The decision was taken to come up with a concept that could be ap-

Since none of our group member had an energetic

plied to brand new hospital and to extend already

or mechanical background that could help deepen the

existing healthcare structures, minimising the dis-

analysis on power supply implants, a collaboration with

turbance to the hospital daily activities;

a M.Sc. student, Federica Franze, was created. As a part of her M.Sc thesis, she helped the research group developing all the mechanical calculations for the designed rooms, estimating the size of equipment and electrical lines. In addition, the meeting with Andrea Brambilla, a member of the previous ASP project, that developed his master thesis around hospital ﬂexibility and the Open Room concept, helped us to better understand the complexity of a healthcare facility planning and the importance of users’ requirements satisfaction in the solution the group was proposing. This confrontation gave the research group the possibility to deﬁne the criteria that would have been used further to choose the more suitable environmental units: major occupancy, low implant

Open Room: A Modular Vision for Future Healthcare Challenge

6th Summit for Health “Affrontare le sﬁde del fu-

•

NYA Karolinska hospital visit in Stockholm, instead, gave the chance to understand and sees what the latest available technologies in hospitals are, as well as the more common trends. Questions could be addressed to the main architects, designers and contractors that worked on the project, in order to understand the main difﬁculties and problems they had to deal with. Therefore, this hospital visit, gave the research group the possibility to increase its knowledge on the activities performed inside a construction site as well as on the process that goes from the deﬁnition of the main stakeholders’ requirements inside a hospital to its real construction;

•

BESTA Hospital visit in Milan, with a particular at-

and know-how in order to develop a speciﬁc part of the

tention to the surgery block. With the guidance of

design project, still focusing on the single main objective:

tutors, the group was able to grasp the complexity

the design of a ﬂexible healthcare facility. That is the rea-

of surgery block design whether in terms of lay-

son why, the project was always reviewed with tutors and

out, technology and organization. Furthermore,

all the group members: primary, secondary and tertiary

this opportunity has allowed the group to observe

structure are interconnected and should be designed fo-

a real application of a prefabricated hospital struc-

cusing on the fact that they constitute an integral part of

ture;

a broader project.

The PhD course “Complex Constructions: Ar-

While the previous ASP Cycle had successfully pro-

chitectures for Health”, coordinated by prof. Ca-

posed a comprehensive study of the Open Room, our

polongo, in October-December 2017;

group tried to reassess every aspect of the room from a different perspective. As a result, several features of the

•

Several meetings with Lino Ladini, representative of Cadolto Italia, one of the leading company in the pre-fabrication industry. He gave the group the possibility to take a closer look to the activities performed by an international company,

room such as structural member, grid and module size, have been modiﬁed accordingly. Nevertheless, some parts of the Open Room (for instance, the material and layout) were thoroughly studied and therefore will be kept.

which can boast several years of experience in prefabricated building. The information collected

The ﬁnal design and structural grid approved, the

during this lecture permitted to have a better un-

analysis moved to the cost and time evaluation, in order

derstanding of the construction techniques used

to make a comparison between traditional construction

and all the elements that should be taken into ac-

methods and the Open Room one. To tackle this topic

count for factory production. Ladini’s experience

a systematic review has been carried out and the results

and suggestions were also very helpful to analyse

shared with some ﬁelds experts to approve them and test

concept feasibility and have feedbacks and sug-

their accuracy. A ﬁnal presentation and review has been

gestions on how the room design and the whole

made, in front of tutors and experts belonging to differ-

building structure could be improved.

ent ﬁelds, in order to collect last suggestions and close the project. During this meeting the overall feasibility of

•

Meetings with Prof. Marta Conconi, who has kindly provided some inputs and recommendation

the ﬁnal result of the project was positively evaluated and new elements emerged for further researches.

about the latest material technology for hospital buildings. Starting from the know-how accumulated during the research phase and the analysis of several case studies, a preliminary design was proposed, trying to apply Kendall’s Open Building approach, drawing inspiration from the Open Room project. Every group member tried to bring its own experience

INTRODUCTION

Open Room: A Modular Vision for Future Healthcare Challenge

STAKEHOLDERS’ NEEDS EVALUATION One of the ﬁrst steps of a research project is, the un-

ject requirements. In addition, the point of view of all the

derstanding of the problem as well as the deﬁnition of

identiﬁed stakeholders - public administration, hospital

main stakeholders’ needs and requirements. This same

management, patient, medical and administrative staff,

approach has of course been applied to the HOS.T pro-

architects, designers and building contractors – had to be

ject in order to ﬁgure out the reasons behind hospitals

considered separately. As a matter of fact, it is important

obsolescence and to deﬁne what are the most important

to point out that not all of them have the same inﬂuence

elements to be considered according to stakeholders’

and importance in the decision making-process, or, to

function. Hospital visits, meeting with experts and the at-

be more precise, their bargaining power is different ac-

tendance to conferences, seminars and lectures, gave the

cording to the project phase which is being considered.

group the possibility to fully understand and have a glob-

Public administration and hospital management are, in-

al picture of a healthcare facility functioning and main

deed, the two actors which can be deﬁned as the more

issues. As explained in the previous chapter, seven out

inﬂuential, since they are responsible for the ﬁnal deci-

of the several available rooms were selected, according

sion and can give the authorization to build the hospital.

to widely discussed criteria and main stakeholders were

Therefore, the main anti-seismic, hygienic and ﬁre-resist-

then identiﬁed. For each one of them the principal needs

ant regulations should be respected, as well as disabled

were listed and transformed into project requirements to

people accessibility should be granted. Moreover, the

look for solutions that would have helped to match with

proposed room should assure a high level of ﬂexibility,

them.

in term of time and space as well as the reduction of construction and operation costs. In facts, even if the initial

It is evident that, depending on the room which is being analysed and its function, needs can be very different. Therefore, needs investigation has been done for all the different rooms selected and then mixed together in order to come up with a single and consistent list of pro-

investment is higher, the main interest of hospital management and government, is that in the long term, the price of the designed room results lower than the current ones. Their expectation is, therefore, that the possibility to move modules from one structure to the other and the

STAKEHOLDERS’ NEEDS EVALUATION

shift of furniture panels, will make the whole building to

When considering this last category of stakehold-

last longer and require lower maintenance and general

ers and their deﬁnition of ﬂexibility, a clear difference

intervention in the future.

stands out, linked to the activities performed by nurses and doctors inside the hospital, compared to people

Concerning contractors and architects, on the other hand, the main requirements are linked to the simplicity in which the structure can be designed, installed and then re-used for several other healthcare facilities. As a matter of fact, to propose an appealing and cost-effective solution, the same design should be capable of adapting to several different layouts with minor adjustments, in order to reduce the time needed to rapidly come up with a product that fit with customer’s expectations and whose development cost could be shared over several different projects. In addition, the three elements making up the final building should be easy, practical and rapid to be realized, possibly exploiting the already existing machineries and equipment that are already available on current construction sites. Finally, as for any other product which is sold on a market, the expectations and needs of final users are fundamental and probably more important than the ones of stakeholders that are then responsible for the final decision. As a matter of fact, if hospital management and governments have the power to block a hospital construction project when some of the previously listed regulations are not respected, patients, visitors and hospital staff are the people that spend most of the time inside the facility and that should feel safe and comfortable inside it. Patients and visitors need demand a high quality of stay. This means that their main expectation is to live in a room which is safe and that gives the impression of being at home. Therefore, privacy should be granted, even in double inpatients and outpatients rooms, and they should be given the possibility to have a connection with the outdoor environment. Finally, they want to feel protected in case of emergencies and looked after, so the designed room should provide call systems to alert medical staff if necessary.

Open Room: A Modular Vision for Future Healthcare Challenge

that manage the facility. Medical staff, indeed, needs a room which allows an easy movement of wheelchairs and beds, equipped of devices that can help monitoring patients’ conditions and inform them about their situation. They want a room which has lighting conditions allowing to perform visits and medical activities throughout the whole day. In addition, rooms have to be easy to clean and the conversion from one room to the other should be performed in the simplest and fastest way possible, in order to minimize disturbance of daily activities and of patients. Therefore, differently from government and hospital management, simplicity and user-friendliness of the solution are two needs that should be balanced with the need for cost reduction required by hospital management. After deep analysis of different stakeholders’ needs, project requirements were extrapolated, taking into consideration the Australian hospital and healthcare facility regulation (as shown in the Appendix). Starting from recommended and minimum sizes imposed by regulators, passing through several case studies illustrating already implemented solutions a standard room was designed for which further details will be given in the following chapters of this report.

STAKEHOLDERS’ NEEDS EVALUATION

Open Room: A Modular Vision for Future Healthcare Challenge

STATE OF THE ART 4.1 EVOLUTION OF HOSPITAL NEEDS OVER THE TIME Until the late 19th century, hospitals were places where people went to die. Florence Nightingale reported how, as late as the 1860s, hospitals in London were recording mortality rates in excess of 90%. The modern hospital has its origins around the be-

Figure 4.1 Reduction of Hospital Capacity Over the Decades (WHO Regional Ofﬁce for Europe, 2008)

ginning of the 20th century, following developments in anaesthesia, infection control, medical science and technology. Until the 1950s, however, hospitals were mainly places for bed rest and convalescence and the range of true medical interventions was limited. This changed in the years thereafter and, in the 1950s and 1960s, the capital investments have increased enormously, with a boom in hospital building in western Europe and the United

hospitals and the restructuring of acute care, with more ambulatory treatment and rehabilitation outside hospital. These changes resulted in a decrease in the number of acute hospital beds and a decreasing average length of stay since the management of patients, the technologies and ﬁnancial incentives lead to a shorter period of care needed (Figure 4.2).

States. Since the 1980s many countries in western Europe have tried to reduce their hospital capacity and to shift care to alternative settings, as it can be shown from the following ﬁgure 4.1. In particular, the decrease in the number of patients were due to the spread of long-stay psychiatric communities, the provision of nursing care for the elderly outside

Figure 4.2 - Improvement of Healthcare Services Over the Decades (WHO Regional Ofﬁce for Europe 2008)

STATE OF the ART

As a consequence, the remaining inpatient tend to

scribed before, the hospital design and layout have

be more seriously ill, requiring more intensive care and

changed over the centuries. A particular attention must

high-dependency beds.

be placed on the hospital dimensions and the time of usage of the structures. In fact, it is foreseen that the spaces

Current hospitals in Europe face particular challenges. They have to adapt to many shifting factors: aging populations, changing patterns of disease, a mobile health care workforce, the introduction of new medical technologies, increasing public and political expectations and new ﬁnancing mechanisms. While it is possible to predict with some degree of certainty future trends in population and disease, it is much more difﬁcult to predict technological changes or changes in the health system (McKee & Healy, 2002). According to M. Mauri, it can be foreseen that in the next 10 years, more than 80% of the knowledge and diagnosis, therapy and prevention methods will change. An additional criticism is the fact that the pace of change

dedicated to prevention and promotion activities, as well as the predictive medicine areas will grow a lot compared to 20 years ago so that in 2060 the space for diagnosis and care (traditional medicine) will occupy less than a half of the total hospital area. The second aspect is related to the obsolescence of structures and the time of usage of them; the old hospitals were built in order to last for more than 4 centuries, the XX century’s ones were used for maximum a hundred of years while now the period has decreased to less than 50 years. (Figure 4.3, taken from Capolongo’s presentation “The evolution of signs of healthcare design”, PhD course “Complex constructions”, 2017).

in the 21st century will be faster than ever. These two aspects have strongly inﬂuenced the way in which new hospital layouts are designed.

4.2 EVOLUTION OF HOSPITAL DESIGN AND LAYOUT

From the architectural point of view, the main layout typology is the “slab” but new trends are introducing the “vertical monobloc” to shape the hospital. The functions

According to the evolution of the hospital needs de-

hosted by the former layouts are mainly diagnosis and cure, administration and reception with an intrinsic ﬂexibility in the spatial organization. For what concerns the second possibility, there can be 3 common different organizations of layout, that can be easily seen in the table below: •

Double fold body: it has a linear development and its internal distribution is characterized by inpatient rooms and a corridor;

•

Triple fold body: it is characterized, instead, by a corridor that links the services on one side and the inpatient room on the other. It displays some issues as far as the ﬂux differentiation between medical and visitors is concerned. Nevertheless, it

Figure 4.3 - Hospital Trends Over the Centuries (Capolongo, 2012)

Open Room: A Modular Vision for Future Healthcare Challenge

allows proper orientation of the inpatient rooms

in order to obtain the best sunlight exposure possible; •

Fivefold body: it, well-known as “double corridor”, has a central area devoted to services and connected by means of two corridors to the inpatient rooms. In this case, the patient beneﬁts from direct or indirect sunlight through the entire day whereas the other environmental units, such as medical ofﬁces, nurse stations, kitchens, storages, etc. constitute the central core.

The research on hospital layouts and conﬁgurations is an ongoing process. It is of big interest the Piano-Veronesi (2001) made by the arch. Renzo Piano and the Italian Ministry of Health, dr. Umberto Veronesi, of that time. This research aimed at studying the functional organization and spatial distribution for the contemporary hospital, both considering the technical and social point of views. Four levels of intensity of care are considered: intensive care, high care, day care, day surgery, low care. The Piano-Veronesi project did not give structural design rules

Figure 4.4 - BESTA Hospital (Image courtesy of BESTA Hospital) and BESTA Hospital Layout (Gola, 2017)

but offered functional and typological plans and sections

According to the trend in the recent years, several

with several proposals of spatial organization even at the

studies have been made to test and evaluate the actual

inpatient room scale.

beneﬁts and disadvantages of SBRs. A ﬁrst argument in favour of SBR is that it reduces the risk of spreading in-

The evolution of the hospital layouts is going towards the application of the structural ﬂexibility concepts; this leads to the use of primary structures which must be as much regular as possible in order to be easily divided into modules of dimensions 7 to 9 meters ensuring the passage of the wheeled beds in the inpatient rooms. Considering the microscale design, an aspect which is subject of debates is the use of single (SBR) or double (DBR) bed room. In the United States, for example, the choice of single-bed inpatient wards has become a standard. The typical average area-per-bed of a single bed-room is about 25 m2 while for a double room is about 15 m2.

fection between patients; moreover, it reduces patients’ stress and minimizes the sense of overcrowding that contributes to high blood pressure levels. For what concerns the privacy aspect, single rooms obviously guarantee opportunities to rest and discuss the needs with family members to have visitors without disturbing other patients. One point against the SBRs is that the need of the patient for social interactions cannot be satisﬁed, and the feelings of the patient pass from safety to unsafety. For example, the BESTA Hospital in Milan is a relevant case study. The construction of the present hospital building in Via Celoria started in 1932 but it was enlarged between 1960s and 1992 in order to enable the hospital to cope with its expanding role and technological and

STATE OF the ART

organizational needs. However, the building is unable to

4.3 APPLICATION OF FLEXIBILITY IN HEALTHCARE SYSTEM CONSTRUCTIONS

meet the needs of a modern centre of excellence since it is inconvenient for patients and staff, also due to the lack of space, and since plant and equipment do not conform to current health and safety legislation. As a conse-

The ﬁrst attempt of merging ﬂexibility and prefabri-

quence, a new site for Besta hospital was designed and in

cation was in the 30s when Buckminster Fuller designed

particular the “New health and research city” was thought

and produced prototypes of residential units easy to as-

to be the new big health area in the North of Milan which

semble with a two-piece prefabricated bathroom. After

will include the Besta Hospital and the Istituto dei Tumori

the Second World War, many studies were conducted

in Milan . The whole area would occupy 220 000 m2 for

on prefabrication so as to satisfy the rapid demographic

research, care, services and hospitality and 70 000 m2

growth; in the Sixties, ﬂexibility became a dominant as-

for parking, technological plants and other services. The

pect in the building constructions.

number of total beds would be 1405 (250 at Besta, and It was not only a matter of housing, but also for health-

the rest belonging to two other institutes).

care facilities the concepts of ﬂexibility were made in The layout is made in such a way that the ﬂuxes of vis-

practice in the last decades. The ﬁrst and most famous

itors, inpatients and workers do not mix: ﬁrst the visitors

solution is the use of containers: it allows future expan-

entrance, then the inpatient bed-rooms, after the sanitary

sions but it does not allow changes in the so-called “pri-

paths, and in the end the departments and research labs

mary” system since containers are also part of the struc-

(see Figure 4.4, taken from the presentation “Hospital Lay-

tural element. However, their dimensions are small so that

outs” by M.Gola, PhD course “Complex constructions”).

the comfort of the inpatients inside is reduced. Cadolto

Another important aspect is the way in which the bedrooms are designed. These can be single or double but

group is promoting this way of modular construction, as shown in the Figure 4.5.

all of them have a sort of living room with a view outside;

A second approach to solve the ﬂexibility need is the

a big attention has been put on the necessity of having

use of some prefabricated panels which constitutes the

easy interactions between inpatients and visitors, the

internal walls of the hospital: the Industrial Flexible and

privacy respected and the non-isolation of the patients

Demountable (IFD) Building. This technique implies that

through the realization of green areas where they can

there must be a complete planning and design of the in-

pass their time.

ternal layout of the room in advance so as to let the com-

Figure 4.5 - Plug-In Modular Construction (Image courtesy of Cadolto GmbH & Co)

Open Room: A Modular Vision for Future Healthcare Challenge

pany produce all the panels. Some instructions must be

The rooms, in fact, have identical features so that they

given in order to mount on site the panels.

are interchangeable but in case of different rooms, other technical solutions are needed. At the tertiary level, mov-

The advantages of this approach are multifold: the workers are exposed to less risks on site since the complete production of panels is done in a safe and controlled environment, the construction time is reduced since the production of panels starts even before the ac-

able partition walls are adopted. Panels of 120cm have been built to host the main functions of the hospital, like medical gas piping, electric wiring, while smaller modular sections of 30cm usually host sockets or hooks for furniture. Moreover, a ﬂexible implants system has been

tual building phase and the time spent for the assembly is much lower than the one required for ordinary wet technologies, very high flexibility of the internal spaces since panels can be removed, changed or even upgraded. A studied case is the Martini Hospital, Groeningen (NL) (Figure 4.6) in which new buildings were built using this flexible logic, so that the project is a good compromise between the industrial aspects and prefabrication, and those referred to the specific requirements of the struc-

Figure 4.6 - Martini Hospital (Image courtesy of Dutch Hospital Design)

ture. The Martini Hospital was founded in 1991 but between 2003 and 2007 a reconstruction and expansion was planned by SEED architects with the spirit of micro and macro scale ﬂexibility: the IFD program which has a high degree of standardization and prefabrication. The nominal life for the structural design was approximately 40 years, so the ﬁrst building will last up to 2025 and the new one in 2048. (Figure 4.7 and 4.8, taken from the presentation “Hospital Layouts” by M.Gola, PhD course “Complex constructions”) Figure 4.7 - Martini Hospital General Block Layout (Gola, 2017)

The four flexibility levels are all present: hospital system, building, functional unit, environmental unit. The peculiar characteristic is the complete possibility of disassembly. The structure is prefabricated, and it consist of a frame of reinforced concrete with a distance of 7.2m, which allows a future enlargement, and consequently a possible extension, up to 6 floors. The technologies are able to transform completely some elements and to adapt the hospital complexity to the hospital needs. With the system adopted, it is possible to change one or more rooms, a whole department or expanding the surface through a specific component hooked on the façade.

Figure 4.8 - Transformation Scheme of Martini Hospital (Gola, 2017)

STATE OF the ART

developed.

olinska has stated a thematic organisation based on the patient’s health care journey. As already mentioned, the

A hospital which was studied and also visited by us is the Karolinska Hospital in Stockholm which has started an operation of renewing some years ago (Figure 4.9). A new hospital building was built with the intention of placing highly specialized cancer and cardiac care, acute trauma care and paediatric care. All patient rooms are single ones with an extra bed for family members so as to reduce the spread of disease and hospital-acquired infections. The design and size of the rooms enable the hos-

focal point of the development work at Karolinska is the “Patient ﬁrst”. The care should create value for the patient, in close collaboration with the patients themselves. The care provided at Karolinska University Hospital is organized based on medical themes and a number of functions. In fact, wards, departments and outpatient care units are organized by theme, with care teams working thematically. Each theme will be divided into a number of patient areas.

pital staff to work directly with the patient in teams; the main idea inﬂuencing all the decisions is to have “patient

The themes are: children’s and women’s health, heart

ﬁrst”. Moreover, the new hospital building is designed

and vascular, cancer, neuro, inﬂammation and infection,

to promote even better collaboration between medical

trauma and reparative medicine, aging. A function is an

care, research and education. For example, outpatient

area of expertise that cuts across the themes. A function

clinic and patient rooms are adapted to allow both ex-

consists of skills and resources that are used in many dif-

aminations and patient-oriented research to be conduct-

ferent patient groups and thereby multiple themes. The

ed. In the proximity of the hospital, a new research facility

functions are: emergency medicine, perioperative medi-

has been built directly adjacent to the hospital so as to

cine and intensive care, radiology and imaging, Karolins-

increase the opportunities for patient-oriented research.

ka University Laboratory, allied health professionals. (Fig-

The overall objective was to create an environment that

ure 4.10, taken from Karolinska Hospital website)

is safe for patients, as well as functional and pleasant. Scandinavian materials were used for interior furnishings, while for exterior parts glass facades, atriums and green areas provide light and greenery. The Karolinska hospital is one of the most environmentally friendly and sustainable in the world, since it was designed to easily renovate to meet future operational and clinical needs. For what concerns the Hospital operating model, Kar-

The new operating model makes it clear who has the overall responsibility for a patient at Karolinska, regardless of where the patient is in the chain of care. To create a strong organization for the university health care and for integration of care, research and education, the organisational model is developed in collaboration with Karolinska Institute. The model will also promote collaboration by gathering different professional groups and specialists around a patient group. It will also be easier to follow up on the results of a treatment or how the patient experienced their care. The new organization took shape in stages. The operating model was introduced in phases. The ﬁrst phase involved the units that moved into the new hospital building in Solna in the end of 2016. The complete transition to the new organization was in 2017. This is an emergent

Figure 4.9 - Karolinska Hospital (Image Courtesy of Karolinska Institutet)

Open Room: A Modular Vision for Future Healthcare Challenge

Figure 4.10 - Operating Model of Karolinska Hospital

process and ﬁne tuning are still on-going.

to easily adjust the function of a given environmental unit according to recent technological upgrade. This idea, as

Unlike the previous two hospitals, the Humanitas Clinical Institute in Milan adopts a different approach (Figure 4.11). To incorporate ﬂexibility, the layout of the hospital

simple as it may sound, proves to be very effective and has been successfully implemented for over twenty years (Astley et al., 2015).

has been made uniform and modular, allowing the user

Figure 4.11 - Humanitas Clinical Institute (Image Courtesy of Humanitas Clinical Institute) and Humanitas Clinical Institute Modular Layout for 3 Different Blocks (Astley et al., 2015)

STATE OF the ART

Open Room: A Modular Vision for Future Healthcare Challenge

SOLUTION Having understood the complexity of a hospital, which

process of applicable rooms for the module. Note that

are the needs of the community, the state of the art and

higher room diversity (irregularity) means that the Open

the trends for the future, it has been possible to design

Room module will become more conservative and more

a solution that would take into consideration all the con-

expensive. Therefore, it is essential to select rooms that

cepts aforementioned, especially considering the ﬂexibil-

are commonly used in hospital and share similar typology

ity.

either in terms of structure, layout or implants.

The intention was to apply the Stephan Kendall’s Open

The hospital layout can be studied by disarticulating

Building approach and the Open Room concept to de-

the different facilities and identifying speciﬁc depart-

velop a design procedure obtaining smart, contemporary

ments grouped in homogeneous Functional Areas (FA).

and prefabricated rooms inside modular prefabricated

The following analysis refers to thesis work of Andrea

elements deliverable on site. The aim of this innovative

Brambilla, belonging to the XI ASP cycle.

system is realizing multiple room layouts and conﬁgurations, within the same dimensions, in order to have a variety of solutions according to several different needs.

In particular, 32 Functional Areas can be individuated and divided into 6 classes according to the classiﬁcation provided in the framework of the Finalised Research Project (ex art. 12, Dlgs 502/92) “Technical, organizational

5.1 ENVIRONMENTAL UNITS ANALYSIS AND CHOICE OF ROOMS

and managerial guidelines for the design and planning of high tech and high assistance hospitals” by M.Mauri and L.La Pietra. The Functional Areas are linked one to the others both

Prior to the application of Open Room to hospital struc-

from a functional and from a spatial point of view, namely

ture, the ﬁrst step is to list all of the rooms and layouts

considering the virtual connections between those are-

inside the hospital itself. This phase is paramount since

as as well as the physical distance among them. At the

it helps the research group in understanding the diversi-

interior space of a Functional Area, it is possible to distin-

ty of hospital rooms, which is mandatory in the selection

guish four sectors called Classes of Environmental Units:

SOLUTION

the smallest spaces clearly identiﬁable inside an hospital

•

able to host a single speciﬁc activity or group of similar

EU 2.32 – Nurse Working Room (Dirty) (63%; 20/32)

activities. The four classes of Environmental Units are: •

EU 2.47 – Results Service (25%; 8/32)

•

EU 2.48 – Staff Resting Area (63%; 20/32)

•

EU 2.50 – Meeting Room (50%; 16/32)

•

EU 2.51 – Secretary/Administration (28%; 9/32)

•

EU 2.53 – Staff Toilet (81%; 26/32)

•

EU 2.60 – Medical Ofﬁces (56%; 18/32)

•

EU 2.62 – Break Area (53%; 17/32)

•

EU 2.63 – Nurse Head Ofﬁce (25%; 8/32)

•

For the Support Class:

•

EU 4.04 – Tools Storage (78%; 25/32)

•

EU 4.07 – Drug Storage (47%; 15/32)

•

EU 4.08 – Clean Material Storage (75%; 24/32)

•

EU 4.09 – Dirty Material Storage (84%; 27/32)

•

EU 4.17 – Cleaning Room (94%; 30/32)

EU 1 – Entrance, where all the reception services among the entrance/exit ones are provided

•

EU 2 – Preparation, where the staff working areas and all the services patient oriented are hosted, but without the patient direct presence

•

EU 3 – Operation, in which the patient is the core of the activities such as operating and diagnostic rooms as well as exam and treatment areas

•

EU 4 – Support, which includes all the additional services.

Within each class, a selection of Environmental Units has been made according to the frequency of their presence in the functional areas; the total number of EU is 88. All the following listed units are present in more than one fourth of the 32 total Functional Areas. For the Entrance Class: • •

EU 1.02 – Welcome Area (56%;18/32) EU 1.05 – Patient Waiting Area (50%;16/32) For the Operation Class, the selected rooms are pres-

•

EU 1.23 – Waiting Room (25%;8/32)

•

EU 1.28 – Living Room (25%;8/32)

•

EU 3.01 – Ambulatory (13%; 4/32)

•

EU 1.25 – Toilet for Patients (44%;14/32)

•

EU 3.06 – Inpatient Area (9%; 3/32)

•

EU 1.30 – Administrative Ofﬁce (44%; 14/32)

•

EU 3.09 – Patient Waiting Room (9%; 3/32)

•

For the Preparation Class:

•

EU 3.18 – Double Inpatient Room (9%; 3/32)

•

EU 2.03 – Staff Cloakroom (41%;13/32)

•

EU 3.19 – Pediatric Inpatient Room (9%; 3/32)

•

EU 2.31 – Nurse Working Room (Clean) (63%;

•

EU 3.20 – Single Inpatient Room (9%; 3/32)

•

EU 3.28 – Laboratory (9%; 3/32)

ent in more than 2 Functional Areas:

20/32)

Open Room: A Modular Vision for Future Healthcare Challenge

•

EU 3.47 – General Surgery Room (9%; 3/32)

ICU rooms

•

EU 3.53 – Preparation Room (9%; 3/32)

Meeting rooms

•

EU 3.59 – Visit Room (22%; 7/32)

Staff break rooms

•

EU 3.61 – Specialistic Visit Room (9%; 3/32)

Offices (administration office, nurse head office,

•

EU 3.66 – Toilet (44%; 14/32)

•

EU 3.68 – Patient Cloakroom (25%; 8/32)

etc) Once the desired rooms have been deﬁned, the Open

A further aspect to be considered is the technological one; when it comes to implants is the redundancy that

Room design can be carried out, starting from the deﬁnition of Primary, Secondary, and ultimately the Tertiary system. (Figure 5.1)

they have among different Functional Areas in Hospitals.

5.2 PRIMARY SYSTEM

In general, it is possible to have some parts of a hospital where electricity is fundamental for the functioning of the

The primary system is the “base building” or “core and

area and some other parts where the level of technolo-

shell” which represents the elements with the longest last.

gy is relatively low. In this case, in order to guarantee a

It is made up of the bearing structure, the main distribu-

certain level of ﬂexibility a low-medium level of techno-

tion and the building plant system. It is designed so as

logical redundancy is preferred. As a consequence, some

to exist for more than 100 years and its cost incidence is

classes of separation between high, medium and low

between 10 and 15 % of the total investment. The Primary

implants have been obtained from the 32 Hospital Func-

System should host a certain number of different plans

tional Areas:

and equipment layouts over time, according to Kendall’s

•

High redundancy: more than 32 (76%)

•

Medium-high redundancy: between 26 and 31 (60-75%)

studies. For the primary system, the ﬁrst operation in the design process was identifying a structural grid, which could have had a dimension between 6 m and 9 m for ﬂexibil-

•

Medium-low redundancy: between 20 and 26 (46-

ity reasons. Some case studies have been considered to

59%) •

Low redundancy: less than 19 (45 %)

In conclusion, taking into consideration all these aspects, a selection of Environmental Units that could ﬁt in our Open Room has been made, considering a low implant redundancy and similar functionalities: 1.

Inpatient and/or pediatric rooms (single and double)

Outpatient rooms Figure 5.1 - Open Room Final Result

SOLUTION

order to keep the overall cost of the building within the acceptable range. Although the primary system consists of 3 main elements: primary structure, building envelope, and main building plant system, for this project the discussion of the primary system is limited to the primary structure. Moreover, the nature of this project has limited the study of primary structure to a single structural grid. (Figure 5.2) Figure 5.2 - The Primary Structure

PRIMARY STRUCTURE The primary structure is made of concrete as to provide stiffness required to host the secondary structure. The design of primary system is classiﬁed further into two main systems: gravity and stability. 1.

Primary Element – Gravity System: Just like most conventional building, the primary elements are made of concrete beam and concrete column. Concrete slab may be utilized but leaving the ﬂoor void would be better since more material means higher seismic mass and higher cost. Fur-

Figure 5.3 - Primary Structure Layout

thermore, the concrete slab is not providing any

support the choice, in particular the INO Hospital in Bern,

function during the service life of the building be-

Switzerland (8.4m x 8.40m), Martini Hospital in Gronin-

cause its purpose has been replaced by the ﬂoor

gen, The Netherlands (7.5m x 6m) and Humanitas Clinical

tiles attached on the secondary structure. Howev-

Institute in Milan, Italy (7.2m x 7.2m).

er, the presence of slab is still essential to allow easier workmanship during the construction pro-

Although the previous ASP Cycle has proposed a structural grid of 6.9m x 8.4m, our study has concluded that these sizes are simply too narrow to accommodate other environmental units. Our own analysis of space referring to the Australian Standard has led to the choice of a 9.6m x 7.5m structural grid with clear story height of 4.00 m. In this way, in each space it has been possible to combine an inﬁnite variety of furniture and functions keeping a compact and non-fragmented feeling of the space. Furthermore, our interview with one of the design experts, Lino Ladini, has concluded that it is essential to keep the clear story height to be no more than 4 meter in

Open Room: A Modular Vision for Future Healthcare Challenge

cess. Hence, a temporary slab made of steel grating can be adopted instead (detailed explanation on the temporary slab will be explained at chapter “Installation/Construction Procedure of the Modules”). One peculiarity of the solution designed is that, in the primary structure, the beams are not directly lying on the columns, but they are connected to the ones in the opposite directions. The reason of this uncommon way of construction is the fact that the shortest steel beams of the modules, in order to be installed, must be exactly over the concrete primary beams; as a consequence,

the columns must be external with respect to the

5.3 SECONDARY SYSTEM

beams of the modules. A plan of a grid portion is sketched below, and further details about the in-

The Secondary System is also called “Tenant work”

stallation procedure will be given in the next para-

or “Fit-out” and it mainly covers the space plan and sec-

graphs. (Figure 5.3)

ondary plant system which are supposed to last about 20 years; it is in fact called the Component Level. In this case

Primary Element – Stability System: Given the scope of the study that is limited to a single structural grid, it is difﬁcult to assess and provide a detailed explanation of the global building stability. Depending on the scale of the structure, different

the modules skeleton is representing the secondary system, since the “boxes” are complete of ﬂoors, roofs, walls and the predisposition of all the possible implants (such as water, air, electricity and gases) and are not supposed to change if internal furniture is needed to be modiﬁed.

types of stability system with different costs and effectiveness ranging from moment frame, brac-

The module is a single complex component complete-

ing, shear wall or even dual-frame system may be

ly built in factory and delivered on site in a very short time.

utilized. For this project, our team has assumed

The size of the module is determined based on the Aus-

that the building will adopt the moment frame

tralian regulation which provide the minimum require-

system since it is the simplest, cheapest and most

ments for space, and also the size of primary structural

commonly used for low-rise building to medi-

grid. In addition, the module must neither be too small

um-rise building. However, special attention must

for production and assemblage time waste, nor too big

be given to the beam; a dilatation or expansion

for logistic issues. Taking all of the parameters into ac-

joint must be placed between the neighbouring

count, our team has decided to divide the 9.6m x 7.5m

beams as to avoid the connection between the

structural grid into 3 modules of 9.6m x 2.5m. A total

beams which may induce excessive torsion onto

module height of 3.5 m is required to accommodate the

the moment frame. Furthermore, combining those beams may induce other stability problem which is why some codes such as EN 1998-1-1 requires that the width of beam must not exceed the size of column. (Figure 5.4 and 5.5) Nevertheless, this is one plausible option that the owner/designer may choose to adopt. There are, undoubtedly, other solutions for the stability system in which the dilatation joint may not be needed. Again, the available data have constrained us from giving a more accurate depiction of the primary system and therefore we will not

Figure 5.4 - Primary Building - Stability System (Moment Frame Indicated in Blue Colour)

consider stability as part of our analysis.

Figure 5.5 - Section A-A

SOLUTION

Figure 5.6 - Room Elevation Organization

2.7 m clearance for patient room, ﬂoor tiles, structural ele-

secondary structure, the structural scheme chang-

ments, and some lighting/mechanical equipment that are

es according to the installation stage of the room.

attached together with the secondary structure in the fac-

During the fabrication and transportation phase,

tory. Since the clear story height of the primary structure

a steel column is provided at the middle of the

is 4 m, this means there is a 0.5 meter clearance between

room to improve the stability and to reduce the

the module and the primary structure, which will be used

bending length of the primary beam. Further-

to host the secondary plant systems and to allow workers

more, horizontal bracing are provided at the roof

to assemble the modules or maintenance. (Figure 5.6)

and at the ground ﬂoor to ensure that the room won’t experience excessive torsional rotation

SECONDARY STRUCTURE Unlike the primary structure that is made of concrete, the secondary structure is composed of steel elements whose purpose is to reduce the weight of the modules. It is essential to keep the module (secondary element) as light as possible since there is a limit on the transportation capacity for the truck and also limited lifting capacity for the tower crane. In overall, the design of the secondary structure can be classiﬁed into two systems: gravity and stability.

(differential lateral deformation) when it is transported from the factory to the site or during the lifting process by the tower crane. (Figure 5.7) Analysing the structure, each frame is sustained by 6 columns and made up of 5 principal beams and 6 secondary beams both at top and bottom floor of the module. Increasing the level of detail, an HEB 140 profile have been chosen for the principal longest beams and for the columns, while a lighter and smaller profile IPE 120 was decided for the secondary beams. In order to ensure the max-

Secondary Structure – Gravity System: For the

Open Room: A Modular Vision for Future Healthcare Challenge

imum ﬂexibility in the future design of the ceiling

and the ﬂoor system, the beams have been placed

phase of the construction, disconnecting all brac-

with an axial distance of 1.2m, except for the cen-

ings will signiﬁcantly increase the construction

tral part of the substructure. In addition to the pre-

time which is in contrast with the selling point of

vious elements, some transversal IPE 80 are intro-

the modular construction: fast-erection speed.

duced to allow the possibility of having horizontal

During the fabrication and transportation phase,

bracing on the ﬂoor. Once the room has arrived

2 moment frames and 3 moment frames are avail-

on-site and integrated into the primary structure,

able for the strong axis and weak axis, respective-

the middle column is removed to provide the spa-

ly. Having 3 moment frames on the weak axis are

tial ﬂexibility that the users will need in the future;

extremely important at this phase since the room

in exchange, two steel hangers of IPE 120 are in-

will be exposed to wind load and the 3 moment

troduced. (Figure 5.8) To ensure easier construc-

frames play an important role in making sure that

tion and fabrication, all steel elements have been

the room will retains it rectangular shape in a rigid

assigned with the same material quality: S275.

manner. (Figure 5.9). Once the module has been installed and integrated into the primary building,

Secondary Structure – Stability System: The lateral stiffness is made of moment frame in both direction (strong and weak axis). For the weak axis, the designer may opt for bracing system which in fact will signiﬁcantly improve the lateral stiffness of the module. However, the presence of bracing

the middle column will be removed, and thus the number of moment frame in the weak axis will decrease from 3 to 2. (Figure 5.10) The calculation, load deﬁnition and scope of analysis for each structural member at each phase will be provided in the appendix.

will provide a big restriction for the other discipline because it prevents them from installing

SPACE PLAN (LAYOUT)

walls, pipes, and electrical cables. Although the bracings may be removed on-site during the ﬁnal

Figure 5.7 - Secondary Structure Layout (Fabrication and Transportation Phase)

The rooms layout has been developed considering

Figure 5.8 - Secondary Structure Layout (Service Life)

SOLUTION

the wall. The panels behind the bed are hosting functions related to the patients’ wellness, meanwhile the ones in front of the bed are dedicated to the entertainment and storage, so television and wardrobe. (Figure 5.11) The patient room can also be a double room, inserting the second patient’s bed instead of the desk and the folding bed. As a matter of fact, the wall behind the second Figure 5.9 - Secondary Structure Stability System (Fabrication and Transportation Phase)

patient bed, thanks to the implants predispositions, is ready to host one other headwall panel with connections for gases and electricity. The panels in front of the bed will be replace by a wardrobe. The two beds will be separated by a light curtain in order to guarantee the privacy needed. (Figure 5.12) In order to create an outpatient room, or ambulatory,

Figure 5.10 - Secondary Structure Stability System (Service Life)

the little chamber become a waiting area facing the corridor, the open space will be divided by a light curtain

both the user requirements and the design parameters, from the conceptual phase to the detail scale. Considering that the main goal is to create a room that is able to accommodate different environments, the outcome is

hosting on one side the doctor’s desk and, on the more private side, the ambulatory bed with the headwall panel above. A wardrobe and a sink for the doctor will be provide. (Figure 5.13)

very ﬂexible. The room ﬁnal layout appears as divided in two main areas: a big space and a small chamber. Taking

The ICU room is made by the big open space only. This

into account the three modular boxes of the secondary

area is large enough to host the big machinery needed

system, the chamber is hosted in the ﬁrst one facing the

for the ICU practice. The chamber, therefore, overlooks

corridor, meanwhile the big space is made by the second

the corridor and becomes a storage. (Figure 5.14)

and the third fronting the window. Same as the ICU room, the meeting room does not This layout allows to host different kind of room ac-

need the chamber, so it becomes a storage, while the

cording to necessities. As a matter of fact, the chamber

large room suppresses the large table for meetings. (Fig-

can change its function and conﬁgured in different way

ure 5.15)

according on the needs, thanks to the modularity of the furniture and wall panels in the room (will be explained in depth at chapter “Tertiary System”).

The break room, the space where nurses and doctor chill and have snacks, is made from a little kitchen recreated inside the chamber and a cosy space with sofas and

In the case of the inpatient room, the chamber be-

tables where they can eat. (Figure 5.16)

comes a bathroom, it is designed according to disable accessibility regulations and it is a 240 x 220 cm2. While the large open space houses the patient’s bed, a small desk and a folding bed for a family member is embedded in

The ofﬁce room is the only layout that does not use the chamber. To accommodate the largest number of desks, the three modules are joined together to create a single large space. (Figure 5.17)

Open Room: A Modular Vision for Future Healthcare Challenge

SECONDARY PLANT SYSTEM Although the secondary engineering plants belong to the secondary system, all of the mechanical and electrical equipment (such as water pipes, air ducts and cable lines) are not fabricated in the factory and attached with the module. Instead, they are installed on-site together with the primary system (the main building) for several rea-

Figure 5.13 - Outpatient Room

sons. For starter, having the engineering plants attached with the module will increase the mass and the height of the module; consequently, some structural, transportation and construction issue will arise. Furthermore, connecting the secondary implants during the installation of the room is not trivial and therefore it will increase the construction time, which is a big disadvantage for a modFigure 5.14 - ICU Room

ular construction. Nevertheless, the secondary implants must easily be reached from the module (room) because at the end of the construction phase, the secondary implants have to be connected with the engineering system terminals in-

Figure 5.15 - Meeting Room

Figure 5.11 - Single Inpatient Room

Figure 5.16 - Break Room

Figure 5.12 - Double Inpatient Room

Figure 5.17 - Ofﬁce

SOLUTION

Open Room: A Modular Vision for Future Healthcare Challenge

SOLUTION

Open Room: A Modular Vision for Future Healthcare Challenge

SOLUTION

Open Room: A Modular Vision for Future Healthcare Challenge

SOLUTION

Open Room: A Modular Vision for Future Healthcare Challenge

side each module (please refer to chapter “Tertiary Sys-

rives on site with all the necessary elements of ﬁnishing,

tem”). As a result, 0.5 meter height clearance between the

including the internal panels which host the ﬁxed furni-

secondary and primary structure is allocated to host the

ture of the rooms and the predisposition for all the plants.

secondary implants. A preliminary calculation by Federi-

(Figure 5.18)

ca Franze, which is attached together with this report as PLANT SYSTEM TERMINALS AND WALL PANELS

an appendix, has demonstrated that the 0.5 meter clearance is deemed enough.

With the objective of providing short term ﬂexibility, the perimeter wall of the room have been designed as a collection of modular panels that can be easily attached/

5.4 TERTIARY SYSTEM

detached from the secondary structure. Each panels are equipped with acoustic insulation layer to provide priva-

The Tertiary system is generally called Equipment and

cy and comfort for the user. In addition, special attention

it includes all the internal elements: FF&E (Fixtures, Fur-

must be given to the ﬁnishing material of the panels; an-

nishing and Equipment), IO&T (Initial Outﬁtting and Tran-

timicrobial layer must be provided as the external ﬁnish-

sition), wall panels, ﬂoorings and ceilings. The life of these

ing to prevent bacteria and molds from growing inside

items is between 5 and 10 years due to the intensive use

the room. As such, BioClad PVC wall has been chosen to

and the rapid technological upgrade.

guarantee that important rooms such as inpatient, outpatient and ICU, will remain sterile without having the need

The theme of ﬂexibility is considered as well also in this part of the design by incorporating the panel approach, as described in the State of the Art section, into every items that belongs to the tertiary system. The module ar-

to continuously clean and maintain the wall surface. Furthermore, plants system terminals, such as electric sockets, cables, oxygen tubes, and equipment screen, are integrated together into some of the panels. By having all

LIST OF TERTIARY ELEMENT Rooms Teriary Elements

Removable Panels

Removable Partition Wall

Fixed Furniture

Removable Furniture

Removable Ceiling Flooring

Single Patient

Double Inpatient

ICU

Ambulatory

Break Room

Meeting Room

Basic(Plain)*

Low Voltage Equipment Screen

—

Medical Gas

—

Light

Internal

External

Wardrobe/Bookcase

—

Foldable Bed

—

Sofa

—

Ofﬁce/Meeting table

—

Cabinet

—

Module Type 01

Module Type 02

—

Sink

Ofﬁce ¥ — — ¥ ¥ ¥ ¥ — — — ¥ ¥ ¥ — ¥

*: There are 2 kinds of basic panels with different size that function in the same way.

Figure 5.18 - List of Tertiary Elements

SOLUTION

of the complementary elements incorporated altogether,

performed a thorough analysis of each material, ranking

the end user can easily adjust the functionality of a room

each of them according to the advantages and weakness

in a swift and straightforward manner, simply by switching

that they provide. Eventually, Linoleum was considered as

the wall. In overall, there are ﬁve basic panels that help to

the most optimum solution with since it is able to provide

serve this purpose, as shown from the ﬁgure 5.19. Apart

the best service despite of its high initial cost and difﬁcul-

from the modular (removable) wall panels, some panels

ty to be repaired.

mainly serve as a partition wall (for instance, the walls that are facing the corridor); they do not have any implants attached together with them, but they require an additional layer of thermal insulation, as shown from the ﬁgure 5.20. In addition, some partition walls might be exposed to the external environment, in which case single layer partition wall is no longer deemed enough to protect the room. Consequently, two partition walls (internal and external)

Apart from the finishing, there are other elements which constitute the floors inside the hospital. The other layers mostly serve as a structural element and insulation to protect and provide comfort to the users along the service life of the room. The detail description of each layer can be found from the figure 5.21. FURNITURES

are combined together with an extra waterprooﬁng layer to prevent water from seeping into the room. While the

All furnitures inside the modules must provide a certain

internal panel is ﬂexible and demountable, the external

level of ﬂexibility while being fully functional and modular

panel is left entirely without functions in order to allow the

as to allow the user to adjust the room’s functionality in

maximum freedom for the facade composition and glass

a straightforward manner. After that all the stakeholders’

surface. Furthermore, since the external panel will be re-

needs and requirements have been identiﬁed, a total of

quired to carry glasses, special detail must be addressed.

eight different typologies of furniture are designed into the rooms, which include: wardrobe, bookcase, sink, sin-

FLOORINGS Just as how ﬁnishing layer plays an important role for the wall panels, it is also considered as one of the most in-

gle bed, side table, ofﬁce table, meeting table and cabinet. (Figure 5.22) A thorough analysis and understanding of all the fur-

tegral part of the floor element since it is in direct contact with the user. The floor’s finishing layer must fulfill several requirements: easy maintenance (cleanability), low (or even zero) odor, soundproof, comfortable, visually attractive, resistant to stain marks, easy to install, high durability, sustainable, reasonable cost and high hygiene standard. There are indeed several materials in the market nowadays that is able to offer all of the aforementioned services, such as PVC, Synthetic Rubber, Polyolefin and Linoleum. However, each of them has its own drawback and strength, and hence, the choice of suitable material becomes sophisticated since it involves a complex decision making process. As an answer to this challenge, the previous ASP Cycle

Open Room: A Modular Vision for Future Healthcare Challenge

Figure 5.22 - Furniture Concept Diagram

Figure 5.19 - Abacus of the panels and panels materials detail

SOLUTION

Figure 5.20 - Vertical partition detail

Open Room: A Modular Vision for Future Healthcare Challenge

Figure 5.21 - Horizontal partition detail

SOLUTION

divided into the unit by the structure of the room to make it modular. (Figure 5.24) The one coloured in grey is the fixed part, which is composed of a sink and it is used in the majority of rooms except the office and the meeting room. The green sections are the flexible parts that can be changed according to the type of room needed; they work in opposite directions to provide services for the Figure 5.23 - Furniture Classification (Fixed and Removable)

rooms on the two sides. Two possible components have been designed: one of them has an internal structure that can be modiﬁed, becoming a wardrobe or a bookcase, the other one is a unit with single bed often used to host a second person. Moreover, the backside of each unit adds the function of an easy side table and the television to accomplish the function of room. In this way, the panels can be used both in patient rooms and ofﬁce rooms. (Fig-

Figure 5.24 - Fixed Furniture Concept

ure 5.25) Users can choose the suitable functional units to customize their own middle wall. Here follow some examples of using scenarios. (Figure 5.26, 5.27, 5.28) As for removable furnitures, their functionality must not be limited to a single room. Instead, each furniture must be adaptable so that they are capable of serving at least 2 rooms to fulﬁl the ﬂexibility requirement. The picture 5.29 describes the applicability of each removable furniture for different rooms. (Figure 5.30, 5.31, 5.32)

Figure 5.25 - Wardrobe/Bookcase Inside structure and 3D model

nitures has led to two general categories: fixed furniture and removable furniture. Basically, each furniture is classified according to its corresponding functionality and mobility; the fixed furnitures are those which are located in the middle of the modules whose purpose are double: to provide the functions for the users and to serve as a wall, dividing the modules equally into two rooms. The other category, the removable furniture, includes multifunctional furnitures that can be used into different rooms for various needs (Figure 5.23). For the fixed furniture, it is Figure 5.29 - Removable furniture system

Open Room: A Modular Vision for Future Healthcare Challenge

Figure 5.26 - Fixed Furniture inside Double patient room

Figure 5.27 - Fixed Furniture inside Single patient room

Figure 5.31 - Ofﬁce Table Meeting Table

Figure 5.28 - Fixed Furniture inside Ofﬁce room

CEILINGS/LIGHTINGS In order to fulﬁl the ﬂexibility requirement, the lighting design for the rooms should follow three main targets: requirements, module and maintenance. (Figure 5.33) “Requirement” represents the rule, restriction and human

Figure 5.30 - Sofa

Figure 5.32 - Cabinet

SOLUTION

ing requirements, four different options of module type 02 with different number of lighting arrangements and products are prepared (as shown from the ﬁgure below). In common situation, only one square lighting product with the size of 60 x 60 cm might be utilized. For some speciﬁc cases, the square lighting product can be combined to provide higher illuminance and create a better atmosphere for the room. (Figure 5.35) Figure 5.33 - Lighting Concept Diagram

In addition, module type 02 can be integrated other needs that governs the design and choice of lighting product. To this end, EN 12464-1:2011 is used as the main reference to deﬁne the degree of comfort for the user.

equipment such as air diffuser, surgical lighting, surgical equipment and even other lighting products, etc.. (Figure 5.36)

According to the code, the lux level for general lighting should be at least 100 Em to provide good illuminance.

Finally, the third target is “Maintenance”. The light-

Furthermore, Philips lighting product has been chosen

ing design has been integrated into the REVIT model in

because the company offers several options speciﬁcal-

which all the relevant information of lighting products

ly for hospital rooms which are aligned with our needs

such as brand, size and properties have been identiﬁed.

(requirements). The lighting design has been carried out

In case if the bulb or lighting products are broken and

with DIALux and the result are attached together with this

need to be changed with a new one, the user can get

report as an appendix.

the product information quickly by referring to the REVIT model. (Figure 5.37)

The second target, “Module”, implies that the design for the ceiling must be separated into panels with specific size, just as how the room itself is divided into several modules comprise of multiple wall panels. By doing so,

5.4. VIRTUAL REALITY ROOM

the user may easily change the function of the room by replacing the ceiling panel with another panel equipped with the appropriate lighting product.

Regardless of all the technical beneﬁts that the Open Room may offer, by the end of the day what matters are the end user’s experience about the room itself. Asking

The ﬁrst ceiling panel or module type 01 has the size of

feedbacks from users such as staffs, doctors and patients

140 x 55 cm, which follow the size of architectural panels

with surveys or interviews are not very effective due to

module. This panel occupies the majority of the ceiling

human limitations. However, if we can allow the end users

and it is ﬁtted with small lighting product. (Figure 5.34)

to ﬁrst-handedly observe and experience the rooms, naturally they will be able to elaborate and give feedbacks

The second ceiling panel or module type 02 has the

in a more speciﬁc manner. Thus, our group has decided

size of 222 x 140 cm, which is bigger to afford more light-

to build a Virtual Reality version of all the rooms that have

ing products. In contrast to the ﬁrst panel type, module

been designed in this project with the hope that we can

type 02 only occupies the center of the room where the

encourage a Bottom-Up decision-making approach to

user’s main activities will take place. Due to different room

improve the quality of the project in the future. The link to

functions, which implies different user activities and light-

each Virtual Reality Room are provided below:

Open Room: A Modular Vision for Future Healthcare Challenge

Figure 5.34 - Module Type 01 (Yellow Panels)

Figure 5.35 - Module Type 02 (Green Panels)

5.36 - Module Type 02 (Alternative Options)

SOLUTION

Figure 5.37 - Lighting Information in REVIT Model

Double Inpatient Room: http://panorama.enscape3d.com/view/uqqqqgh2

Staff Break Room: http://panorama.enscape3d. com/view/35tif78q

Meeting

Room:

http://panorama.enscape3d.

com/view/djho8bqj 4.

Single

Inpatient

Room:

http://panorama.en-

scape3d.com/view/khjynrzm 5.

ICU

Room:

http://panorama.enscape3d.com/

view/jcrphm10 6.

Outpatient Room: http://panorama.enscape3d. com/view/z8xrttpy

Ofﬁces:

http://panorama.enscape3d.com/view/

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Open Room: A Modular Vision for Future Healthcare Challenge

SOLUTION

Open Room: A Modular Vision for Future Healthcare Challenge

FEASIBILITY ANALYSIS After the design for all rooms/modules have been de-

Several case studies have been analyzed and consid-

termined, what follows is the feasibility analysis. In this

ered in order to deﬁne the most common steps in a mod-

part, the Open Room approach is assessed of its appli-

ule production process. However, the main issue to deal

cability and practicality from ﬁve different aspects, name-

with is the fact that the majority of them illustrates the

ly: production, transportation, construction process, cost

production phase of prefabricated homes or ofﬁces, rath-

and time. As a matter of fact, some important design pa-

er than healthcare facilities. In addition, materials used

rameters are controlled by those factors. For example, the

are different, which can require slight adjustments to the

width of the module has been adjusted according to the

general process. However, some standard manufacturing

maximum allowable size for transportation in European

steps have been identiﬁed and listed below:

countries, which is 2.5 meter. •

Processing proﬁles: where the external structure of the module is deﬁned and different surfaces such as walls, inferior and superior slab are real-

6.1. PRODUCTION OF THE MODULE

ized •

As explained in the previous chapters, one of the main

Manual preassembly of the module in order to deﬁne its 3D structure

advantages of prefabrication is the fact that modules are manufactured inside the factory, where the secondary

•

prevent corrosion

substructure of is realized. Here the production process starts, as for every other Engineering to Order or Make

Robotic welding and ﬁnishing of the structure to

•

Completion of the module structure by operators

•

Finishing and equipping the unit structure with

to Order product, with procurement. Raw materials and components should be bought from different suppliers or from one general contractor that is able to provide the

ﬁnishing components such as doors and windows,

factory with all the parts needed. Once materials have

water and sanitary system, air conditioning system

been shipped and are available for production the whole process can start.

•

Inspection of the ﬁnal module and mounting of

FEASIBILITY ANALYSIS

allow the factory to increase productivity and quality of the modules produced since machine have higher level of performances and work faster than a traditional operator. (Figure 6.1) On the other side, the more automated a production line is, the less ﬂexible it becomes. Modules are manufactured on the base of standard elements, batch size are bigger and fewer variants can be produced, whereas when operations are performed by operators, ﬂexibility Figure 6.1 - Design and Production Flexibility Versus Automatization Level (Bock, T., Linner, T., Robotic Industrialization, 2015)

the structure that will protect the module during transportation

increases to the detriment of process speed. This allows to produce several variants of the same product, giving the end user more possibilities to customize the good. However, the output rate will be reduced, and prices will

When speaking about ﬂexibility and product customi-

increase accordingly. The graph above explains the rela-

zation, the ability that a production process has to adapt

tion existing between automatization level and the pro-

to demand variation is important. Therefore, a general

duction ﬂexibility that can be achieved throughout the

overview of the internal manufacturing plant organization

entire process.

should be provided, in order to understand the link existing between factory layout and module variety.

Finally, when analysing the automatization level of a manufacturing company we should take into considera-

Generally speaking, building factories use different

tion the global output. As a matter of fact, automatization

layouts to realise the entire manufacturing process, ac-

requires very high investment in terms of machines and

cording to factories level of automatization, that can be

maintenance needed to make lines working. This high-

calculated as the sum between the number of operators

er cost can be justiﬁed, from an economic point of view,

working on a single workstation plus the ones that con-

only if the production output is very high, since the cost

trol the entire line, divided by the total number of work-

for a fully automated line can be then spread on a bigger

stations. When the ratio is close to zero it means that the

volume.

production line is highly automated and that the majority of the work is done by machines; operators have the task to control the whole process and intervene in case of problems. As in every other sector, automation will

Figure 6.2 - Linear Production Layout

Open Room: A Modular Vision for Future Healthcare Challenge

The ﬁrst possible layout and the most automated one is the linear one. The production line is composed of different workstation that are organised around a conveyor.

Each time a step in the production process is ﬁnished the

ey by producing standard parts that can then be custom-

module is automatically moved to the following work-

ised in the ﬁnal steps. As you can easily understand when

station where another task is performed. Operators are

different parts of the same products are produced on dif-

generally in charge of monitoring the whole process and

ferent manufacturing lines the synchronisation of produc-

intervene in case a problem is recorded, both on the

tion ﬂow is extremely important. That is the reason why

quality of the ﬁnal output or on automatic machines ac-

intermediary inventory should be considered all along

tivities. The layout that allows the highest productivity is

the production line, both to decouple production steps

shown in ﬁgure 6.2.

and grant workstations’ independency.

Another possible solution is the static layout, which

In order to deﬁne the best line layout and to evaluate

can be deﬁned as product-oriented layout. As a matter

a production line performance, the process leading from

of fact, the module does not move during the assembly

raw materials to the ﬁnal delivery of a ready to be used

process, but operators move around it accomplishing

and installed module should be analysed in further de-

the different tasks that result in the assembled module.

tails.

This line layout is characterized by the lowest level of automatization and is often use for all the products that are designed in collaboration with the end user and that are generally highly customized.

To do that the PBS (Production Breakdown Structure) is considered as one of the best tool to divide the issue into simpler steps and analyse a manufacturing line into details. It can be compared to the WBS (Work Breakdown

The third possible solution is a semi-automated line

Structure) which is the most used solutions for project

which is characterised by a process known as delayed dif-

management in order to follow tasks completion and

ferentiation. This solution gives the possibility to produce

monitor costs. As a matter of fact, the whole project is

standard elements like walls, ceiling and panels on sep-

divided into actions to which a duration, a manager and

arate highly automated lines and then to assemble the

some resources can be assigned. Once the structure and

ﬁnal module thanks to manual operations at the end of

the work packages are well deﬁned a cost estimation

the manufacturing process. (Figure 6.4)

could be done as well as the deﬁnition of a delivery date.

This solution allows companies to save time and mon-

The PBS technique consists in dividing the whole man-

Production line (Level 1)

ufacturing process into ﬁve different stages, each one of

Fabrication Area (Level 2)

them will give the opportunity to better understand the tasks needed and to ﬁnd the most suitable solution. In the case of our speciﬁc project the production process could be divided as follows, starting from the more gen-

Assembly Area (Level 2) Module roughing and ﬁnishing (Level 2)

eral steps and going deeper into details in order to arrive till the workstations’ level. The most general level of analysis is the level one, where the overall production line is studied. That is the step in which the entire structure composed of several modules is decomposed into standing alone units, having a similar conﬁguration. At this stage, different produc-

Figure 6.3 - PBS Structure level 1 and 2

FEASIBILITY ANALYSIS

Figure 6.4 - Semi-Automated Production Layout

tion areas are considered as one. The idea is not yet to

is linked to the balancing of users’ ﬂexibility and custo-

deﬁne a speciﬁc layout, or the number of workstations

misation with the need of manufacture the product on

needed, but just to generally deﬁne lead time and line

an existing production line to an industrial level. When

parameters – such as cycle time, line capacity – in order to

producing an ETO or an MTO product, volumes are very

satisfy market requirements

low and design costs cannot be divided on a wide base, making the purchasing cost higher and consequently the

The following step in the analysis, instead, deals with the line functional areas. The production line is, therefore, divided into different areas, according to the tasks performed and their function. (Figure 6.3) In the specific case of a module construction a standard production line could be split into three different zones. The first one would be the area in which raw materials are available in order to pre-manufacture the different parts needed to deliver the final product. Once these components are ready they will move to the assembly zone. Here the prefabricated panels will be put together in order to manufacture the final product. The module can then move ahead on the production line to undergo the roughing and finishing process. The third level of the analysis aims at dividing the different functional zones according to the construction element on which the process is focused. Even if modules are designed in different ways according to customer’s requirements, some standard parts were defined in order to practically manufacture the final output. As a matter of fact, the main problem related to the HOS.T project

Open Room: A Modular Vision for Future Healthcare Challenge

product less appealing. Considering this project specific case and the segment of clients selected, private but more frequently public healthcare facilities, the decision of maintaining the highest level of flexibility possible but matching it all the limits and requirements of the industrial field was taken. That is the reason why, starting from a case study done in a modular house manufacturing company in Canada, three standard components were identified which will fit with every possible design solution. An attempt to match and assign them to the functional areas, defined at the highest level, was, therefore, done. Consequently, seven different work centres were listed, according to the standard element produced or the production process step. The fabrication zone could be then divided into wall, floor and ceiling fabrication, three activities that can be done in parallel in order to reduce the overall time needed to implement the entire structure. As explained before, the following area will be dedicated to pre-fabricated parts assembly. Once the ceiling and the walls are mounted together and then assembled with the floor to

create the three-dimensional structure of the module.

be added to the standard structure in order to

The module is now ready to pass to the roughing and

customize it.

the ﬁnishing process. This last phase could be the one in which, according to client requirements, the module could be customised and adapted to its needs. The strat-

Wall Fabrication •

egy is called late differentiation and it consists in produc-

Wall framing : starting from the components that are available for production, this workstation

ing standard elements that are then assembled and cus-

would be dedicated to the creation of the panel

tomised according to customer preferences. It allows, on

frame for wall component

the one hand to reduce the manufacturing costs by producing a bigger volume of standard element, permitting

•

Wall panel building

to realise economy of scale and gaining from “learning effect” and, on the other hand to provide customer with a personalised product which is adapted to his needs.

Ceiling Fabrication •

that are available for production, this workstation

The fourth stage of the PBS analysis is concerned with

would be dedicated to the creation of the panel

the deﬁnition of the different workstations needed inside

frame for wall component

every area previously found. Therefore, every standard component is divided into subcomponents. This allows

Ceiling framing : starting from the components

•

Ceiling interior

•

Ceiling ﬁnishing: that’s the workstation in which

to further split the activities into easier tasks in order to assign them to single workstations. Starting always from the study and experience presented by the case study

roof is then painted and ﬁnished

mentioned before the different steps that could fit in every one of the previous components manufacturing process were identified and are listed below for the first three work centres.

Once the different components are produced the module can move to the following functional are which is dedicated to assembly. At this stage the prefabricated components are available on buffers and can be mount-

Floor Fabrication :

ed together in order to create the three-dimensional structure of the module. Walls are installed on the ﬂoor

•

Floor framing : starting from the components that are available for production, this workstation

panels and then the ceiling in mounted on the box that result from the previous assembly phase.

would be dedicated to the creation of the panel frame and the starting of the plumbing

The module is then ready to pass to the roughing phase. As a matter of fact, once the different panels

•

Floor sheathing : that’s the workstation in which wiring of the ﬂoor and HVAC is started and the ﬂoor is sheathed.

•

Value added : plumbing, wiring and hvac are ﬁnished

are put together they should be connected to one another. Workers will then perform electrical wiring connection between wall and ceiling, the insulation and sheathing of the walls, the wall plumbing, the installation of windows and doors components and ﬁnally the ceiling insulation.

•

Floor ﬁnishing : the workstation work according to customer’s requirements, speciﬁc elements could

Finally, the ﬁnishing process is dedicated to the electri-

FEASIBILITY ANALYSIS

cal and plumbing installation ﬁnishing and to all those

During the design phase, therefore, problems raised

activities that would transform and adapt the module

due to transportation limits and need for ﬂexibility. As a

to client’s requirements. That is, indeed, the phase in

matter of fact, increasing the size of the single module

which interior and exterior parts of the modules are

would have helped to design a more ﬂexible space with

treated and the unit is cleaned in order to be ready to

less modules but that would have caused problems dur-

be transported on site and installed.

ing the transportation phase.

The last step of the analysis is known as the motion

Two solutions different solutions were studied, to un-

level, and, at this stage, the analysis is focused on the

derstand their compatibility with the research project re-

motion of different workers between the workstations,

quirements. On the one hand, there would be the possi-

in order to define line efficiency and find out solutions

bility to use the road truck that can transport a module of

to improve the overall production line ﬂow.

maximum 7.82m x2.5m.

For the purpose of this research project, this level of

However, the module designed is 9.6 x 2.5 m, there-

analysis is too speciﬁc and goes beyond its initial aim:

fore a second solution had to be found to match with

deﬁning the main steps included in the modules’ pro-

the length of the designed module. Articulated vehicle

duction process and identify already existing solutions

is, therefore, the existing transportation solution that was

to practically manufacture hospital rooms.

chosen. As a matter of fact, with its maximum transportable size of 12.5m x 2.5 m, it will allow a safe transportation of the prefabricated module on site. Even this solution,

6.2. TRANSPORTATION OF THE MODULE Transportation can represent an important issue in modular construction processes. As a matter of facts, if on the one hand the fact that the module is produced inside a factory engenders many advantages as budget and schedule reduction, on the other hand it requires additional transportation costs and analysis.

however, used without any further adjustment could not perfectly ﬁt with the module’s requirements. The height of the prefabricated room is, indeed, 3.5 meters, and the maximum height allowed for transportation is 4.2-4.5 meters on almost every country, due to the presence of bridges and other obstacles. Nevertheless, if we take into consideration the height of the truck’s wheels as well as the thickness of the loading platform, no more than 2.5m are available for the module.

Concerning road transportation, for instance, every country has its own limits and rules, but, according to the European Transportation Regulation, the maximum width allowed without special measures is 2,5 meters for a maximum length of 12 meters and height of 4 meters. When cargos exceed these limits, special measures and authorisations are required and transportation cost is higher. Limits are also imposed on the total load of each cargo; according to the country it can vary from 40 to 42 tons maximum. Figure 6.5 - Low Loader Platform (http://schwarzmueller.com)

Open Room: A Modular Vision for Future Healthcare Challenge

Therefore, a low loader platform will be necessary in

Modules could then be shipped on a bolster plat-

order to easily transport and unload the module on site.

form which size is – for the 40’ – 12,19 x 2,44 x 0,65 with a

(Figure 6.5)

gooseneck tunnel at each end in order to make it easier to unload the modules once they arrive to the port.

According to the structural calculations that you could ﬁnd annexed to this report, each module has a total weight of almost 18.5 tons in total, therefore it perfectly ﬁts with the maximum load limitation imposed by the law. The possibility to ship modules by boat was also ex-

6.3. INSTALLATION/CONSTRUCTION PROCEDURE OF THE MODULE

plored. The idea is, in facts, to assure shipments in various countries, starting from a speciﬁc manufacturing site. This

Once the design of the room has been ﬁnalized by

would give the chance to propose the solution on several

the engineer and approved by the owner, the construc-

markets and, consequently, increase project competitive-

tion process will take place. Unlike conventional modular

ness.

structure where the fabrication of the room and site development may be carried out in parallel, our modules

According to ISO (International Organisation for Standardization), when goods are transferred by boat they are put inside containers in order to be protected during transportation, to simplify the nature of goods’ identification and to facilitate intermodal transportation. There are two different container that differs according to their size: 20 TEU (Twenty Foot Equivalent Unit, that is to say 5 x 2,3 x 2,3m) or 40 TEU (Twenty Foot Equivalent Unit, that is to say 12 x 2,3 x 2,3m). The problem is that the size of the designed module does not fit inside the standard dimension of the container. That is the reason why other possible solutions were studied, in order to assure a more flexible solution even from a geographical point of view.

will be fabricated only if the construction for the skeleton (primary structure) has started. Therefore, the project will begin with the preparation of the site: deﬁning benchmark, setting the grids (layout), building the perimeter fence and temporary site ofﬁces. Depending on the typology of the primary structure, for instance hospital building with basement, site excavation supported with temporary earth retaining wall might be required. Furthermore, if the hospital is designed as a medium-rise or high-rise structure, conventional footing system is no longer viable and a more advanced solution such as bored pile or driven pile must be utilized. In such scenario, the earthworks and foundation will require a substantial amount of time and should be performed prior to the

Figure 6.6 - Modular Construction With Tower Crane in Singapore (Carlisle, 2017)

FEASIBILITY ANALYSIS

fabrication of the modules in the factory.

Apart from the tower crane, a mobile crane is another plausible solution for this challenge. (Figure 6.7) The

Afterwards, the main skeleton of the hospital, including slab, beam, column and wall will be realized, followed by the M&E installation which will be attached directly to the primary structure. In parallel to the site construction process, the modules are to be built in the factory. Consequently, time management becomes quintessential to

construction of Hawthorne Dual-Brand Marriott hotel in California, for instance, have been using mobile crane to transport the prefabricated module around the site. As a matter of fact, Marriott has started to build 4 new hotels around the Northern America region with the same construction procedure and heavy equipment (Moore, 2017).

ensure that the module will be installed directly into the main building once it arrives on site to avoid excessive stacking of the modules.

In addition to the two aforementioned solutions, there is another technology that can be used, namely the scissors-lift; it has the capability to hoist materials and it is

The main challenge for the modular room construction arises right after the modules has arrived on site. To begin with, lifting the module from the ground to the desired elevation or position requires speciﬁc heavy-duty machine with a considerable lifting capacity and ﬂexible reach.

able to provide the mobility that the module will need during the construction. However, generally scissors-lift has a very limited lifting capacity and given the enormous scale (weight) of a single modular room, scissors-lift is no longer considered a feasible solution. (Figure 6.8)

Several projects from different parts of the world have demonstrated that there are indeed several machineries

For our project in which the estimated weight for each

that can be utilized to serve this purpose. For example,

module is 18.5 ton in total, tower crane is the most suita-

the construction of the highest prefab structure (up to 40

ble technology out of the three plausible options.

stories high) in Singapore is performed with the help of tower crane as the media to carry the 8.5x3.2x3.15 meter module from the ground to the desired position. The tower crane has a lifting capacity up to 40 ton with working radius of 35 meter and along the whole construction process, the tower crane had been actively working to lift modules ranging from 17 – 29 ton with in weight (Carlisle, 2017). (Figure 6.6)

The second problem is related to the construction method; the conventional approach for modular structure revolves around the so-called plug-in procedure with stacking method. In such case, the modules are stacked on top of each other just like “LEGO” to form the shape of a building. While this method has been proven valid and widely accepted around the world, it is deemed unsuitable for the modular room that our project is aiming for. Instead of putting the modules together from the top, the modules for this project must be laterally pushed and stacked sideways. However, pushing the room is not a trivial task; a signiﬁcant energy is required to move the 18.5 ton module into the primary structure. Furthermore, the right tools are required to facilitate and ensure the stable lateral movement of the module. The most common answer for this problem is by using heavy equipment such as gantry

Figure 6.7 - Modular Construction With Mobile Crane (Source www. guerdonmodularbuildings.com)

Open Room: A Modular Vision for Future Healthcare Challenge

crane or overhead crane. (Figure 6.9 and 6.10)

Technology

Advantanges - Hight Load Capacity

Tower Crane

- Require space for crane foundation

Useful for high rise structure

- Has Long Arm Reach - Commonly used for hight rise

-Moderate Mobility

- Slower Erection Speed - Limited Height Reach - Require space to move around the site

Mobile Crane - Faster Erection Speed

Predalles

Conclusion

Disadvantages

- Moderate Load Capacity

- High Mobility

- Extremely Limited Height Reach

- Faster Erection Speed

- Extremely Low Load Capacity

1. Good fire protection

- Require space to move around the site

2. Good fire protection

- Unstable

Bubble Deck

Useful for low rise structure with smaller room (weight)

Not applicable

Figure 6.8 - Lifting Technology Comparison

Gantry crane is typically used in warehouse or at load-

hydraulic jack inside the primary structure is extremely

ing port to transport heavy materials like containers, while

limited. As a result, the size of hydraulic jack is constrained

overhead crane is popular in bridge construction since it

and its capacity is restricted. To compensate its small pro-

is capable of carrying massive precast bridge deck. De-

pelling capacity, a smooth sliding material (PTFE bearing

spite all of the advantages that the two machines can of-

pad) is provided as an intermediary interface between

fer, they are only suitable at the initial construction phase

the steel module and the concrete beam. It serves as a

where the primary building is still hollow since the mod-

tool to reduce the friction between the module and the

ules have yet to be installed inside. Once the building is

primary building during the construction process. Conse-

fully functional and the owner would like to remove the rooms, having a heavy machine inside the primary structure is out of the question due to the limited space. After careful consideration and thorough studies, our group decided to adopt a smaller technology, namely the hydraulic jack. The idea is inspired by the Movable Scaffolding System that uses hydraulic jack to move precast bridge deck from its casting point to the desired position.

Figure 6.9 - Gantry Crane

In fact, this technology has been used to construct the Mersey Gateway Bridge located in Liverpool, UK where the hydraulic jack is expected to move 1700 ton of mass (Morby, 2015). Compared to our module which is only 18.5 ton, the hydraulic jack is considered more than capable. (Figure 6.11) Nevertheless, the space available for integrating the Figure 6.10 - Overhead Crane

FEASIBILITY ANALYSIS

Figure 6.11 - MSS Technology with Hydraulic Jack (Gateway, 2016)

Figure 6.15 - Customized Loading Platform

quently, a smaller amount of lateral force is required and smaller hydraulic jack might be used. (Figure 6.12) Although the problem of pushing the room has been addressed, there is still one more problem to be discussed: the loading platform. Since the modules are to be moved laterally, the action required to push the room will become a reaction that will move the platform on the opposite direction. Therefore, the loading platform has to be connected to a rigid structure as to support the module during the pushing process. Modular structure with stacking methodology normally neglects this issue Figure 6.12 - Hydraulic Jack and PTFE Bearing Pad Installation on Primary Structure

because the modules (containers) are hanged directly onto the crane without having the need to be supported by loading platform. Although for some cases, loading platform might be used, but its structural typology is designed only for gravity load and therefore is not suitable for this project. To be frank, there is one type of loading platform in the

Figure 6.13 - PTFE Bearing Pad (Left) and Hydraulic Jack (Right)

market nowadays that are able to move sideways, namely SuperDeck. However, its size and weight capacity is far from being capable of supporting the module. (Figure 6.13) Since there are no platforms in the market which may fulﬁll the aforementioned requirements, our group has decided to provide a conceptual design for a customized loading platform. Taking the SuperDeck concept as an example, the sketch of the loading platform can be seen from the ﬁgure 6.14.

Figure 6.14 - SuperDeck (Source www.prestonhire.com.au)

Open Room: A Modular Vision for Future Healthcare Challenge

The module will be placed inside the loading platform

GreenSpec reported that cement production (one of the

and connected to steel columns around the platform to

main elements for concrete structure) contributes up to

prevent the module from sliding (falling) from the plat-

4% of the world’s CO2 gas emissions. It is also heavier

form. Afterwards, the loading platform will be carried by

compared to other options such as Predalles or Steel

tower crane and placed on top of a temporary support

Grating slab which in fact may provide not only lighter

made of steel materials before the “pushing” operation

weight but also faster construction time. Nevertheless,

commence.

other solutions also have their own strength and weaknesses, as shown by the table 6.15.

Along the construction process, the workers will have to move inside the primary building. Since the primary

Taking all the points into account, the steel grating

building is void of slab, having the worker working inside

slab is chosen for this project because most of its advan-

will lead to undesirable accident. Using conventional

tages are aligned with the concept of universal modular

concrete slab to avoid this issue is welcomed since it also

room that offers fast and temporary solution. Besides, its

provides several advantages, such as noise insulation and

disadvantages are compensable by introducing more

ﬁre protection. However, after the construction has been

modiﬁcation into the secondary structure, for example by

concluded, the main purpose of having a concrete slab

adding insulation layer for acoustic, protecting the sec-

is now lost since its capability to host live loads has been

ondary structure with anti-ﬁre coating, etc.

replaced by the ﬂoor tiles. Furthermore, concrete slab has several disadvantages over the other slab technologies that are available in the market nowadays. For starters,

Choice of Slabs

Conventional Concrete Slab

Last but not least, to make sure that the modules and the primary system will not experience “pounding” phe-

Advantanges 1. Provide Noise Insulation

1. Not sustainable

2. Good fire protection

2. Heavy

3. Universal

3. Long construction time

1. Fast erection speed 2. Lightweight

Steel Grating

Predalles

Disadvantages

3. Removable

1. Prone to fire 2. Difficult to connect with concrete

4. Universal

3. Not providing noise insulation

1. Moderate erection speed

1. Moderate weight

2. Good fire protection

2. Not universal

1. Good fire protection

1. Mostly used for long span slab

2. Good fire protection

2. Long construction time

Bubble Deck

Figure 6.16 - Slab Technology Comparison

FEASIBILITY ANALYSIS

ules, moment connections with steel plates are provided at the top of the secondary structure. They can be realized at the same time when the workers are trying to install the steel hangers. (Figure 6.17)

6.4. COSTS AND TIME Figure 6.17 - Connection Between Steel Module and Concrete Structure

ESTIMATION Once the new Open Room designed and the different problems connected to production, transportation and installation solved, the analysis moved to the evaluation of the time and costs needed to apply this solution. The main aim of this phase was to prove that the proposed

Figure 6.18 - Connection Between Steel Modules

project output is more convenient than the traditional

nomenon during earthquake event, the rooms have to

building methods that are used today. The main prob-

be rigidly connected to each other such that they are

lem the research group had to deal with in this last phase,

behaving like a rigid box. When the ﬁrst module arrives

however, was due to the fact that, given the innovative-

inside the primary structure, the module is attached into

ness of the solution, it was difﬁcult to collect relevant data.

the concrete column to prevent it from sliding out of the building. This is realized by providing anchor bolts connecting the steel column and the concrete column, as shown in the picture 6.16.

Therefore, after several researches, the decision to proceed with a systematic review was taken, in order to look for information in the existing literature concerning time estimation. Starting from the search string: “TIME*

In order to avoid pounding between adjacent mod-

OR TIME SCHEDULING OR TIMING AND PREFABRICA-

Figure 6.19 - Conventional construction schedule

Figure 6.20 - Open Room construction schedule

Open Room: A Modular Vision for Future Healthcare Challenge

TION OR MODULAR OR MODULE* AND SITE CON-

considered to complete the whole building. About four

STRUCTION “, on the database Scopus, and after having

months are required to build the concrete structure on

selected the research ﬁelds that could be connected to

site, approximately two weeks and a half per ﬂoor, con-

HOS.T topic, a list of twenty-one open access papers were

sidering both the time to lay the concrete and the one

found. This list has further been reduced to four articles

needed by the material to solidify. When the primary

that were considered useful and in keeping with the topic

structure is completed, almost nine additional months are

studied.

needed to build the 96 rooms the hospital is composed of. (Figure 6.18)

To make the estimation as coherent as possible, the group decided to base its analysis on a brand-new hos-

On the other hand, the new construction method pro-

pital that is hypothetically composed of 96 rooms, 16 per

posed by this research project is far less time consuming

ﬂoor and developed on 6 ﬂoors.

than the traditional one. The main advantage, indeed, is the fact that on-site work is done in parallel with the

If we take into consideration the traditional construc-

module construction in factory. Therefore, once the pri-

tion method, thirteen months on average should be

Material

Unit cost

Total cost per module

S275

2,70 €

3.341,15 €

HEB140

S275

2,70 €

1.288,42 €

IPE120

S275

2,70 €

795,3 €

IPE 80

S275

2,70 €

311,04 €

L30x30x4

S275

2,70 €

1.056,80 €

column HEB140

S275

2,70 €

1.965,38 €

Element HEB140

Secondary structure

Figure 6.21 - Structural Cost for Each Module

Code E.06.30.15.A

slabs [thickness 10mm]

Unit cost

Total cost per module

53,52 €

3.853,44 €

39,69 €

2.857,68 €

26,00 €

1.872,00 €

E.08.20.40.A_X

Supply and installation of wainscot [thickness 20mm] Insulating boulder consisting of concrete dough R 32,5

E.09.70.10.A

Linoleum floor

41,00 €

2.952,00 €

E.05.100.10.A

Supply and installation of internal partition wall with a single metal frame

51,47 €

4.632,30 €

E.10.30.20.A

PVC coating [thickness 3mm]

32,84 €

2.955,60 €

E.17.10.20.B

Plasterboard false ceiling in

33,57 €

2.417,04 €

E.19.120.20.A

Doors for ICU

15.144,16 €

E.19.20.70.B

Doors

488,19 €

1.952,76 €

E.19.120.20.A

Monoblock in wood and aluminum fixed or with opening parts [tilting]

388,67 €

5.951,32 €

E.04.65.90.A Tertiary structure

Element

Figure 6.22 - Material Cost for Each Room

FEASIBILITY ANALYSIS

Material

Unit cost

Total cost per module

S275

2,70 €

3.144,69 €

beam IPE 120

S275

2,70 €

82,08 €

beam 300x600

concrete

130,00 €

163,80 €

beam rc 350x450

concrete

130,00 €

839,48 €

L 100x100

S275

2,70 €

1.483,45 €

slab

concrete

130,00 €

682,50 €

10,00 €

160,00 €

Element column HEB 200

Platform

hydraulic jacks

Figure 6.23 - Structural Cost for Loading Platform

Unit cost

Total cost per module

beams to support

3,39 €

1.180,57 €

steel grating

4,82 €

2.544,96 €

Code Steel grating

Element

1.872,00 €

SUBTOTAL

Figure 6.24 - Structural Cost for Primary Structure

mary structure is completed and parts of the modules

out and ﬁeld experts were consulted in order to come up

are completed the installation process can start, while

with a rough estimation that could be used as a basis for

missing “box” continue to be produced inside the manu-

comparison with traditional construction methods. The

facturing plant. Therefore, considering a production rate

calculation was performed separately for secondary and

of almost 5 hours per module and 6 weeks to build the

tertiary structure, without taking into consideration both

whole primary structure, the installation process could be

primary structure and implants since they can be consid-

started at the beginning of the third month, when the ﬁrst

ered similar for both construction techniques.

rooms have been completed and shipped on site. Installation has been estimated to last approximately 3 months. To sum up the overall time needed to build this 96 rooms facility would be of almost 6 months, which is far away from the entire year needed to build the same facility using the traditional construction method. However, it is important to point out that since supplying systems were not deeply studied and designed, due to the group lack of skills on this topic, the installation time on both structure has not been considered but supposed equivalent in both solutions and therefore not particularly inﬂuential. (Figure 6.19) Regarding cost estimation, a deep analysis was carried

Open Room: A Modular Vision for Future Healthcare Challenge

Concerning the secondary structure, the cost and number of beams to build the module was considered and the table 6.20 sums up the average cost per module. Concerning the tertiary structure, instead, several types of materials were considered, according to their characteristics and prices. In the table below, calculations for the construction of the tertiary structure for the whole room are detailed, with a distinction between an Open Room including the possibility to change into an ICU or not. Prices include not only the cost of materials but also the one of labour and they are taken from the ofﬁcial Italian price-list of 2018. (Figure 6.21)

Once secondary and tertiary structure of the module

evaluate the Open Room rough cost, implants installation

are completed, it should be moved on site to be installed

and furniture and machineries needed inside the facili-

in the already built primary structure. As explained in the

ty were not taken into consideration, which will increase

previous chapter the size of the module has been stud-

the total cost of the Open Room solution. Nevertheless,

ied in order to avoid extraordinary transportation. The

when making a comparison between the traditional and

assumption made, to make the calculation and the case

Open Room approaches, the advantages are evident. As

study more realistic is that there are 340km from the man-

a matter of fact, even if the initial total cost of an hospital

ufacturing plant to the site where the module need to be

built with traditional construction process would result

installed. Therefore, the rough cost for the transportation

lower than the one of a new hospital built using Open

of one single module will be 555,22€, to which the price

Room approach, duration, construction time and ﬂexibil-

of a driver and truck rent should be added. Considering

ity of the latter solution should be taken into consider-

a cost of 70€ per hour of service and that the 340 km are

ation when making such an evaluation. As explained in

travelled by an articulated vehicle in 4 hours and a half,

the previous chapters of this thesis, indeed, construction

the total transportation cost will reach 870€ per module.

times are almost reduced by half when adopting prefabrication techniques, which means that this kind of solution

Finally, the cost of the platform and of the steel grating which is used as a temporary solution to grant worker safety should also been taken into consideration in the cost estimation. You can ﬁnd in the tables below the details of the calculations. It is important to precise, however, that in the platform cost, the price of the Hydraulic jacks, the mechanism used to push the module inside the primary structure is considered too. (Figure 6.22) In addition, since a single platform is used to install all the rooms inside the hospital, its total cost should be divided by the number of room the hospital is composed

should be preferred any time there is a certain urgency and the healthcare facility should be up and running in a short amount of time. Furthermore, it has been estimated that a traditional hospital today is not capable of lasting more than 50 years. Important and invasive interventions should then be made on the structure to adapt to new requirements. Therefore, the initial lower investment, institutions and hospital management have to sustain, will be distributed on a reduced number of years and intervention and maintenance costs will increase the facility price in the end. Thanks to the Open Room approach, instead, the higher initial cost can be amortised on a longer

of.

period since the global duration shifts from 50 to almost Taking all these partials into consideration and consid-

80-100 years. In addition, every intervention and room

ering a hospital composed of 100 rooms, the total cost is

reconﬁguration could rapidly be performed, without ex-

€ 82.762,40 for an Open Room which has the possibility

cessively disrupt the daily hospital activities: panels re-

to transform into an ICU, and € 69.571,00 for a tradition-

placement, furniture change would permit to complete-

al Open Room. If considering the total area of the de-

ly change the conﬁguration of the room, in a quick and

signed Open Room the cost per square meter will result

safe way. Moreover, once the healthcare facility arrives at

in € 1.149,48 for a room with 7 possible conﬁgurations

the end of its life cycle, still operating modules could be

and € 966,26 for a room with 6 available conﬁgurations.

moved to another similar structure. As a matter of fact,

According to researches and studies made on tradition-

the standard production process and the standardisation

al rooms that are built today inside hospitals the general

of both primary and secondary structure, would allow to

price per square meter is around 700€/m^2. However, it

reuse the same module or entire room into another facili-

is important to note that during the calculations made to

ty. For the same reason, even the expansion of an already

FEASIBILITY ANALYSIS

operating facility would be easier thanks to the Open Room approach: the existing structure would continue to perform its daily tasks while new modules and rooms are installed nearby. For all these reasons, even if from a purely economical point of view the solution proposed by this thesis could result as more expensive and probably less easy to implement than a traditional method, all the variables and parameters going from the facility building to its end of life show that the designed solution would provide users with advantages and beneﬁts that cover and balance the initial higher investment.

Open Room: A Modular Vision for Future Healthcare Challenge

FEASIBILITY ANALYSIS

Open Room: A Modular Vision for Future Healthcare Challenge

CONCLUSION 7.1 CRITICAL ISSUES

from the outside of the primary structure, only perimetral rooms can be constructed following this procedure. As a

The provided research work is very articulated and

consequence, it can be applied in two cases: if the whole

hides a lot of high specialized knowledge about the us-

Hospital layout is a three-fold body such that there is only

er’s requirements, the healthcare issues, the state of the

a corridor in the middle and the rooms are at its side, or

art and the technological possibilities. It has been the end

if there is a need of enlargement of the previous Hospital

of a multidisciplinary effort, in order to put together the

such that new rooms can be constructed at the sides of

needs and constraints of each professional ﬁgure, to cre-

the original one.

ate a cooperation between the primary structure’s shape and technology and the secondary/tertiary systems re-

Secondly, in order to install the room, a big amount

quirements. It has not been an easy task, and it has in-

of space in the surroundings of the hospital is needed

volved a lot of “doing and redoing” since each solution

to be occupied due to the platform and the crane and it

had to be approved by all the sub-systems. Flexibility has

must be veriﬁed whether if it is available or not. Moreo-

been the key word in the whole project which has led to

ver, it has to be considered that the operation of pushing

a product which is easy to realize in the factory, fast to

the module and ﬁxing them is not an easy task since it

assemble on site and well integrated in the hospital life-

requires an extreme level of working precision, and the

cycle.

workers should be prepared to manage a limited space next to the modules.

The Open Rooms designed in this way are promoters of sustainability, because of the possibility to make

A further critical aspect to be remembered is that the

changes in space and functions both in the short, thanks

primary structure is no longer shaped as the tradition-

to the Tertiary System, and in the long term, by substitut-

al frame, but, as it was previously explained, the beams

ing modules of the Secondary System. However, some

directly end either into the columns or into the orthog-

applicability constraints must be deﬁned since it is not

onal beams such that the columns result to be external

such a universal method of construction.

with respect to the grid of beams. As a consequence, this would require a certain level of difﬁculty in the construc-

First, considering that the modules have to be installed

tion phase; it is then important to know it in advance and

CONCLUSION

design the proper concrete primary structure. Always

sponse of the market to this innovation.

speaking about the structures, it has to be highlighted that the real interaction between the primary and the secondary structure is hard to be foreseen in advance, especially during an earthquake event.

In order to provide different stakeholders (companies) with a better explanation of the Open Room Concept and to show them how the idea could be practically implemented, the draft of a possible Business Model Canvas

Last, but not least, this solution is feasible for the environmental units selected but it is hard to extend it to

was developed and can be consulted in the Appendix of this thesis.

the ones which would have to satisfy heavier M&E needs since the interstorey height is quite limited.

Thanks to this strategic management tool, a list of possible customers and partners is given, as well as all the

In conclusion, after having put in evidence the criti-

main activities and beneﬁts that the project would bring

cisms and limitations of this approach, it can be consid-

to potential end users. A rough estimation of costs to im-

ered as an innovative solution in order to increase the

plement the solution and revenues’ streams is provided

nominal life of a hospital and facilitate its continuous ne-

to evaluate the project feasibility.

cessity of updating. It is also important to consider that it is a very efﬁcient way in order to build a hospital in a situation of urgency, spending half of the time that would have been required for a standard method of construction. As a last application, it must be mentioned that in case of enlarging of a hospital, this solution would allow a fast perimetral expansion without interrupting the usual activities of the building and increasing the value of provided services.

As explained in the previous sections of this thesis, three are the main stakeholders and end users of the new healthcare facility. First of all, there are all the hospital patients that will beneﬁt from the medical treatment provided inside the structure and that are looking for a healthy, safe and homelike environment. Hospital staff, such as doctors and nurses ae the second customer segment which should be considered since, as patients, they are the ones that spend the largest amount of time inside the hospital. Finally, the third group of clients is the hospital

7.2 A PLAN FOR THE CONTINUATION OF THE WORK

management and hospital administrative staff which are the customers that have the biggest bargaining power since they can decide whether or not to implement the project.

This project can be considered as a strong base for a future development; the criticisms above presented

Once the main customer segments are identiﬁed,

could be a starting point in order to enhance the features

their main requirements are highlighted in order to un-

of this method and expand its applicability ﬁeld so that

derstand how the project could respond to them. In this

future research groups can focus on those aspects and

case, the Open Room project will provide the principal

improve them.

users with a ﬂexible solution, able to adapt to the new society fast-evolving needs in terms of both time and space.

Moreover, it would be interesting to propose this solution to some companies and listen to the comments they would make about this work; in fact, the real applicability of this method could be “measured” basing on the re-

Open Room: A Modular Vision for Future Healthcare Challenge

As a matter of fact, the client will have the possibility to customise its own room and see its maintenance and future interventions’ costs reduced thanks a complete prefabricated, demountable and easily transportable plug-in

module. Therefore, to provide the client with such a ser-

the Architects for Health association and the consulting

vice, the main activities proposed by the team composed

ﬁrm Salus Global Knowledge Exchange. Second, we will

by architects, engineers and designers are, besides the

submit our paper for the “Global Perspectives and Local

module design, an after-sale service which will give the

Identities in Healthcare. Salutogenic Hospital Design and

customers the possibility to be assisted and helped with

Urban Health” symposium that will take place on 28-31

every issue that appearing after the installation and the

March 2019. As last, a collaboration with the internation-

putting into service of the facility. In addition, to grant the

al research group of Open Building approach would be

maximum ﬂexibility level possible, a Reverse Logistics

carried out.

service is proposed, in order to move the module from one facility to another one or to the plant where it was firstly manufactured and where materials could be reused on new structures. Several partners are of course necessary to implement the solution in addition to the designing team. On the one side, there are all the suppliers from which raw material for the module construction and medical equipment to be installed inside the rooms will be bought. On the other, instead, you could find all the subcontractors that will participate to the module building, transportation and installation, such as modular and prefab companies, logistics provider and installation contractors. The externalisation choice is principally linked to the fact that, despite partnership costs, it is more beneficial to entrust these activities to organisations that have several years of expertise in that specific field. The project team could, in this way, focus on its core business. The main costs that should be considered to implement the project are linked to the creation of partnership contracts with the different organisations as well as the ones connected with module manufacturing, transportation and installation. On the contrary, the project main revenues streams are linked to the selling of the Open Room and its on site installation as well as the payment of all the services the customers can benefit from and that are provided to them after sale. Last but not least, it would be desirable to participate to two main events. The first is an international competition “European Healthcare Design Awards” organised by

CONCLUSION

Open Room: A Modular Vision for Future Healthcare Challenge

ACKNOWLEDGMENT The whole HOS.T team would like to express its spe-

tare le sﬁde del futuro: Ripensare il rapporto territorio/

cial thanks of gratitude to our academic supervisor Prof.

ospedale”, which was a great opportunity for the team to

Stefano Capolongo who assist us throughout the entire

meet experts and share ideas. The team of Tengbom Ar-

duration of the project, ﬁxing its main objectives and giv-

chitects, for giving the team the chance to take a closer

ing us many useful feedbacks that helped us to deepen

look to hospitals’ new construction trends and visit the

our researches. The group is also grateful to all the tutors

innovative Karolinska Hospital near Stockholm. Prof. Mar-

of the research project for their help and support during

ta Conconi for the awareness raised in the material and

this year and a half of researches and work.

interior design ﬁeld.

A special thanks to all the tutors of the project, in par-

A special thanks to PhD candidate Marco Gola, for the

ticular Prof. Franco Mola and Prof. Virginio Quaglini for

patience and time that he has dedicated to periodic revi-

their guidance and assistance in developing the structur-

sions and all the opportunities he had given us to deepen

al concept. We would like to extend our heartfelt grati-

our knowledge concerning the hospital topic. The previ-

tude to prof. Scullica, prof. Gabriella Peretti, Prof. Riccardo

ous ASP Cycle group for the accurate and thorough work

Pollo, Prof. Marta Bottero, Prof. Maddalena Buffoli, Prof.

they did, and especially Andrea Brambilla for all the sug-

Claudia De Giorgi, Prof. Cristina Masella.

gestions on how to deal with such a difﬁcult and complex topic. In addition, thanks to Maria Rosanna Fossati and

We really appreciate the time, the energies, the suggestions and useful reviews of the project, spent by arch.

Alessandra Sironi for their reviews, suggestions and ideas for improving the technological solution.

Lino Ladini, representative of Cadolto Italia, and the knowledge related to Cadolto construction system and technologies.

Federica Franze, for the help provided concerning the technical calculations of the implants. The ABC Department, especially PhD Andrea Rebecchi and Marta

All the members of the CNETO association and, espe-

Dell’Ovo for their kindness and hospitality.

cially to the president Dr. Maurizio Mauri, for the possibility of participating to the 6th Summit for Health “Affron-

ACKNOWLEDGMENT

Open Room: A Modular Vision for Future Healthcare Challenge

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Open Room: A Modular Vision for Future Healthcare Challenge

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Open Room: A Modular Vision for Future Healthcare Challenge

Appendix A: Structural Calculation

The Modular Room: Primary Structure (Blue) and Secondary Structure (Green)

Scope of the Structural Calculation: The structural calculation of this project is constrained to the design of hospital rooms; the global performance of the primary building (either in terms of gravity or stability) will not be discussed due to limited amount of data. As such, a conceptual design for gravity load will be proposed for the primary element, while for the secondary structure, the analysis will cover up to the preliminary phase. The full description of each member and choice have been discussed in the main report and therefore will not be discussed further. Furthermore, given the nature of the room, a detailed design of the room poses to be a challenging subject; there are multiple details which require further study and cannot be solved at this phase.

Gravity Load Definition: 1. For Secondary/Steel Structure (Superimposed Dead Load): On the roof, the superimposed dead load comes from the weight of the false ceiling with plasterboard and its corresponding support made of aluminum. The total superimposed dead load is expected to be 124 N/m2. As for the ground floor, the superimposed dead load is controlled by the total weight of floor tiles with linoleum finishing material equipped with acoustic insulation. In addition, the weight of medical equipments that will be provided inside the room have to be taken into account. The total dead weight of the whole architectural and mechanical element is estimated

to be 1.8 kN/m2. Furthermore, a considerably thick wall panel of 1.6 kN/m load is positioned right on top of the perimeter beam. 2. Secondary Structure (Roof Live Load): Following EN 1991-1-1 clause 6.3.4.1, an accessible roof belongs to H category that share a live load value equivalent to 0.4 kN/m2.

However, during the fabrication process in the factory or installation of the room on-site, some workers might need to walk on the roof. As a result, EN 1991-1-6 dictates that a minimum distributed live load equivalent to 1 kN/m2 must be used instead.

3. Secondary Structure (Ground Floor Live Load): According to EN 1991-1-1 clause 6.3.1.1, hospital rooms such as inpatient, outpatient and ICU room falls under C3 category with live load ranging from 3-5 kN/m2. Other general-purpose rooms, such as offices, staff break area, doctor on-call and meeting rooms belongs to C1 or C2 category where the live load varies from 2-4 kN/m2. Ultimately, a mean value of 3 kN/m2 is adopted for the ground floor of the module.

During the service life of the building, the user might decide to install partition walls in the middle of the room in order to change the room’s functionality. Consequently, EN 1991-1-1 clause 6.3.1.2 requires an additional live load to be introduced onto the ground floor. In this project, the partition wall is assumed to have a maximum self-weight of 2 kN/m, which is equivalent to an additional live load of 0.8 kN/m2. Apart from gravity loading, the structure will also sustain wind load during the lifting process; the detail calculation for the wind load will be given on the next page. In conclusion, the total load for the secondary structure can be summarized below: Roof Phase Installation Transportation Service Life

SDL (kN/m2) 0.124 0.124 0.124

LL (kN/m2) 1 0.4 0.4

Ground Floor SDL LL (kN/m2) (kN/m2) 1.8 3 1.8 3 1.8 3.8

Room Perimeter SDL (kN/m) 1.6 1.6 1.6

Wind No Yes No

4. Primary Structure (Dead Load and Live Load): For the primary structure, the mechanical and electrical equipments attached directly to the primary beam are responsible for producing the superimposed dead load, whose value has yet to be determined. Apart from the dead load, there is also live load acting on the temporary slab made of steel grating due to the worker moving around the building during the construction. Once the

module has been integrated into the primary building, the primary structure is no longer exposed to a live load, except from those originating from the secondary structure.

Wind Load Definition: When the room is transported (or lifted from the ground), the structure will be exposed to wind. Since it is impossible to have the room completely open and let the wind blow freely, consequently the wind will act as a pressure load on each side of the module. Thus, the stability of the room needs to be assessed to make sure that the wind will not induce excessive lateral deflection or even structural failure. The calculation of the wind load will be determined based on the procedure proposed in EN 1991-1-4: 1. Basic wind velocity (𝑣𝑏 ): 𝑣𝑏 = 𝐶𝑑𝑖𝑟 ∙ 𝐶𝑠𝑒𝑎𝑠𝑜𝑛 ∙ 𝑣𝑏,0 = 20 m/s where: 𝑣𝑏 = basic wind velocity (m/s) 𝐶𝑑𝑖𝑟 = directional factor, taken as 1 𝐶𝑠𝑒𝑎𝑠𝑜𝑛 = seasonal factor, taken as 1 𝑣𝑏,0 = fundamental value of basic wind velocity (m/s) According to EN 1991-1-6 regarding loads on structure during execution process, the return period for 𝑣𝑏,0 is determined based on the total duration of the construction:

Once the return period is known, the fundamental wind velocity can be obtained by referring to the National Annex. However, given the circumstance of the project in which no exact location is given and by assuming that each single module will take 3 months maximum for the installation, EN 1991-1-6 clause 3.1.5 recommends 𝑣𝑏,0 = 20 m/s

2. Mean wind velocity (𝑣𝑚 ): 𝑣𝑚 (𝑧) = 𝐶𝑟 (𝑧) ∙ 𝐶𝑜 (𝑧) ∙ 𝑣𝑏 = 21.6 m/s

where: 𝐶𝑟 (𝑧) = the roughness factor 𝐶𝑜 (𝑧) = the orography factor, taken as 1 for flat terrain (assumed) Calculation for the roughness factor follow the following steps:

Assuming that the hospital is located in the middle of the city surrounded with buildings, the corresponding parameters are: 𝑧0 = 1 m and 𝑧𝑚𝑖𝑛 = 10 m. Furthermore, the maximum elevation must be identified, in which is assumed to be 𝑧 = 100 m (equivalent to a medium rise building with approximately 20 story in total). Once all the parameters have been gathered, the roughness factor can be computed: 𝑘𝑟 = 0.19 (

𝑧𝑜 ) 𝑧𝑜,𝐼𝐼

0.77

= 0.234

where: 𝑘𝑟 = terrain factor 𝑧𝑜 = roughness length, taken as 1 m 𝑧𝑜,𝐼𝐼 = reference roughness length, taken as 1 m 𝑧

𝐶𝑟 = 𝑘𝑟 ln (𝑧 ) = 1.08 𝑜

3. Turbulence Intensity: 𝐼𝑣 (𝑧) =

𝑘1

𝑧 = 0.22 𝐶0 (𝑧) ln (𝑧 ) 𝑜

where: 𝑘1 = turbulence factor, taken as 1

4. Peak Velocity Pressure: 1

2 𝑞𝑝 (𝑧) = [1 + 7𝐼𝑣 ] ∙ 2 𝜌𝑣𝑚 = 740.66 N/m2

where: 𝜌 = wind density, taken as 1.25 kg/m3 Once the wind pressure is known, the same wind pressure will be applied on both direction of the module:

Wind Blowing on the Weak Direction (Wy)

Wind Blowing on the Strong Direction (Wx)

The total wind load acting on each direction is computed by means of EN 199-1-4 clause 7.6. The procedure is as follow: 1. Force coefficient for rectangular section: 𝐶𝑓 = 𝐶𝑓,0 ∙ 𝜓𝑟 ∙ 𝜓𝜆 = 1.283 (for Wy) and 0.75 (for Wx) where: 𝐶𝑓,0 = force coefficient for rectangular section with sharp corners and without free-end flow 𝜓𝑟 = reduction factor for square section with round corner. 𝜓𝜆 = end-effect factor for elements with free-end flow. The value of 𝜓𝑟 is determined based on the next figure:

𝑟 𝑏

In this project remains as 0, regardless of the direction of the wind. In parallel, the value of 𝐶𝑓,0 can be obtained from the figure below:

Thus, the value of 𝐶𝑓,0 varies according to the direction of wind load. If the wind is blowing on the strong direction (𝑊𝑥 ), 𝐶𝑓,0 = 2.053. On the other hand, if the wind is blowing on the weak direction (𝑊𝑦 ), 𝐶𝑓,0 = 1.25. The value of 𝜓𝜆 is determined based on the next graph:

where: 𝜓 = the solidity ratio, taken as 1 𝜆 = the effective slenderness

The computation for effective slenderness is controlled by the table below:

In this case, the room falls under the 𝑙 < 15 meter category, and therefore: 𝑙 𝜆 = min (2, , 70) 𝑏 Again, the value of 𝜆 changes depending on the direction of the wind load. In case of wind blowing in the y-direction (𝑊𝑦 ), 𝜆 = 2 and consequently 𝜓𝜆 = 0.625, while in case of wind blowing in the strong direction (𝑊𝑥 ), 𝜆 = 0.758 and consequently 𝜓𝜆 = 0.6 2. Total wind force: 𝐹𝑤 = 𝐶𝑠 𝐶𝑑 𝐶𝑓 𝑞𝑝 (𝑧𝑒 ) 𝐴𝑟𝑒𝑓 = 30.1 kN (for 𝑊𝑦 ) and 4.6 kN (for 𝑊𝑥 ) where: 𝐶𝑠 𝐶𝑑 = the structural factor, assumed as 1 𝑞𝑝 (𝑧𝑒 ) = peak velocity pressure (N/m2) 𝐴𝑟𝑒𝑓 = reference pressure area (m2)

Calculation for the reference area depends on the direction of the wind. For wind blowing in the weak direction (𝑊𝑦 ), the reference area is 9.6×3.3 = 31.68 m2. On the other hand, the reference area for wind blowing in the strong direction is 2.5×3.3 = 8.25 m2

Loading Combination: Ultimate State: 1. 2. 3. 4. 5.

1.35(DL+SDL) + 1.5LL 1.35(DL+SDL) + 1.5LL + 0.9Wx 1.35(DL+SDL) + 1.5LL + 0.9Wy 1.35(DL+SDL) + 1.05LL +1.5Wx 1.35(DL+SDL) + 1.05LL +1.5Wy

Serviceability State: 1. DL+SDL+LL 2. Wx 3. Wy

Limitation: Ultimate State: 1. Shear Check: 𝑉𝑟𝑑 > 𝑉𝑒𝑑 2. Axial Check With or Without Single Axis Bending: 𝑁𝑟𝑑 > 𝑁𝑒𝑑 3. Single Axis Bending With or Without Axial Load: 𝑀𝑟𝑑 > 𝑀𝑒𝑑 4. Biaxial Bending With Axial Load:

𝑁𝑒𝑑 𝑁 𝜒𝑦 𝑟𝑑

+ 𝑘𝑦𝑦

𝛾𝑚1

𝑁𝑒𝑑 𝑁 𝜒𝑧 𝑟𝑑 𝛾𝑚1

+ 𝑘𝑧𝑦

𝑀𝑦,𝑒𝑑 𝜒𝐿𝑇

𝑀𝑦,𝑟𝑑

𝑀𝑦,𝑟𝑑 𝛾𝑚1

Serviceability State: 𝐿

1. Gravity Deflection due to DL+SDL+LL: 𝛿𝑚𝑎𝑥 < 240 ℎ

2. Lateral Deflection due to Wx: 𝛿𝑚𝑎𝑥 < 300 ℎ

3. Lateral Deflection due to Wy: 𝛿𝑚𝑎𝑥 < 300

𝑀𝑧,𝑒𝑑 𝑀𝑧,𝑟𝑑

𝛾𝑚1

𝑀𝑦,𝑒𝑑 𝜒𝐿𝑇

+ 𝑘𝑦𝑧 + 𝑘𝑧𝑧

𝑀𝑧,𝑒𝑑 𝑀𝑧,𝑟𝑑 𝛾𝑚1

Calculation: 1. For Installation Phase -

Check Secondary Beam – IPE 80:

Parameters: • 𝑞𝑆𝐷𝐿 = 2.25 kN/m • 𝑞𝐿𝐿 = 3.75 kN/m • 𝐿 = 1.2 m

Calculation:

•

Ultimate Moment: 𝑀𝑒𝑑 = 8 𝑞𝑒𝑑 𝐿2 = 1.56 kNm

•

Ultimate Shear: 𝑉𝑒𝑑 = 2 𝑞𝑒𝑑 𝐿 = 5.2 kN

•

Deflection: 𝛿𝑚𝑎𝑥 =

•

Allowable deflection: 𝛿𝑙𝑖𝑚 = 240 = 4.8 mm

5 (𝑞𝑠 𝐿4 ) 384 𝐸𝐼

= 0.96 mm 𝐿

Check Secondary Beam – IPE 120: Parameters: • 𝑃𝑆𝐷𝐿 = 2.7 kN • 𝑃𝐿𝐿 = 4.5 kN • 𝐿 = 2.5 m

Calculation:

•

Ultimate Moment: 𝑀𝑒𝑑 = 4 𝑃𝑒𝑑 𝐿 = 6.5 kNm

•

Ultimate Shear: 𝑉𝑒𝑑 = 𝑃𝑒𝑑 = 5.2 kN

•

Deflection: 𝛿𝑚𝑎𝑥 =

•

Allowable deflection: 𝛿𝑙𝑖𝑚 = 240 = 10 mm

1 2

1 (𝑃𝑠 𝐿3 ) 48 𝐸𝐼

Check Strong Axis Frame:

= 3.5 mm 𝐿

Parameters: • 𝑞𝑟,𝑆𝐷𝐿 = 0.16 kN/m; 𝑞𝑟,𝐿𝐿 = 1.25 kN/m • 𝑞𝑔,𝑆𝐷𝐿 = 3.85 kN/m; 𝑞𝑔,𝐿𝐿 = 3.75 kN/m • Beam and Column Size = HEB 140 • 𝐿 = 4.8 m; 𝐻 = 3.3 m • 𝑊𝑥 = 0 kN Results:

Check Weak Axis Frame:

Parameters: • 𝑞𝑟,𝑆𝐷𝐿 = 0.08 kN/m; 𝑞𝑟,𝐿𝐿 = 0.6 kN/m • 𝑞𝑔,𝑆𝐷𝐿 = 2.7 kN/m; 𝑞𝑔,𝐿𝐿 = 1.8 kN/m • Beam and Column Size = HEB 140 • 𝐿 = 2.5 m; 𝐻 = 3.3 m • 𝑊𝑦 = 0 kN

Results:

2. For Transportation Phase As it has been pointed out earlier in the report, wind load will act as a lateral load on the structure. The wind load calculation has shown that the resultant wind force is 30.1 kN for wind blowing on the weak axis of the building, and 4.6 kN for wind blowing on the strong axis. Half of the wind load will be distributed into the roof and the other half will go to the ground floor where the

horizontal bracings are located. For the calculation of the wind bracing, it is assumed that only the tension diagonal chord is activated. It is also assumed that the wind load will act as a concentrated force directly at each intersecting node, as shown by the figure below:

Furthermore, since it is a statically indeterminate structure with singly symmetric scheme, changing the direction of wind load will indubitably produce different results. Therefore, it is essential to change the wind direction and structural shape in order to capture the most conservative result:

As for the wind blowing on the strong direction, the structural scheme is shown from the figure below:

Note: Although the structure is non-symmetrical in the horizontal plane, the structural scheme is statically determinate. Hence, changing the direction of wind load is pointless since it will give an almost identical result. The concentrated wind force assumption normally stands valid as long as the perimeter panel enveloping the structure is properly detailed. Once the model has been defined, the internal forces is computed with MATLAB software: -

Wind blowing on the weak axis of the building (Positive Direction):

Note: The deformation is expressed in millimeter and scaled up by 1000 units. In other words, although the figure shows that the maximum deformation is 280 mm, in fact the maximum deformation is only 0.28 mm.

Note: Red line with negative value means compression while the blue line with positive value means tension. All the forces shown in the figure are expressed in Newton. Ultimately, the vertical support reaction is 3,83 kN for edge support and 7.6 kN for middle support. These support reactions will become the lateral force acting pushing the moment frame.

Wind blowing on the weak axis of the building (Negative Direction):

Note: The deformation is expressed in millimeter and scaled up by 1000 units. In other words, although the figure shows that the maximum deformation is 260 mm, in fact the maximum deformation is only 0.26 mm.

Note: Red line with negative value means compression while the blue line with positive value means tension. All the forces shown in the figure are expressed in Newton.

Ultimately, the vertical support reaction is 3.83 kN for edge support and 7.6 kN for middle support. These support reactions will become the lateral force acting pushing the moment frame. -

Wind blowing on the strong axis of the building:

Note: The deformation is expressed in millimeter and scaled up by 1000 units. In other words, although the figure shows that the maximum deformation is 40 mm, in fact the maximum deformation is only 0.04 mm

Check Diagonal Bracing – L30x30x4: The diagonal braces will only experience tensile load due to the wind load: 𝑁𝐸𝐷 = 1.5(4) = 6 kN

On the other hand, the tensile capacity of the diagonal chord according to the Eurocode requirement is: 𝑁𝑅𝐷 = 𝐴.

𝑓𝑦 𝛾𝑀0

= 62.2 kN

Therefore, the diagonal bracing is okay. -

Check Secondary Beam – IPE 80: Parameters: • 𝑞𝑆𝐷𝐿 = 2.25 kN/m • 𝑞𝐿𝐿 = 3.75 kN/m • 𝐿 = 1.2 m

Unlike the previous phase, the secondary beam now undergoes axial and bending moment simultaneously due to the wind load. The calculation for the bending moment and shear still follows the same formula; however, the ultimate shear and moment now differs according to the type of load combination under consideration. Hence, a general computation for the bending moment and shear is provided:

•

Dead Load – Moment: 𝑀𝐷𝐿 = 8 𝑞𝐷𝐿 𝐿2 = 0.41 kNm

•

Live Load – Moment: 𝑀𝐿𝐿 = 8 𝑞𝐿𝐿 𝐿2 = 0.68 kNm

•

Dead Load – Shear: 𝑉𝐷𝐿 = 2 𝑞𝐷𝐿 𝐿 = 1.35 kN

•

Live Load – Shear: 𝑉𝐿𝐿 = 2 𝑞𝐿𝐿 𝐿 = 2.25 kN

•

Wind Load (Wx) – Axial: 𝑁𝑊𝑥 = ±2.5 kN

•

Wind Load (Wy) – Axial: 𝑁𝑊𝑦 = ±0.77 kN

•

Deflection: 𝛿𝑚𝑎𝑥 = 384

•

Allowable deflection: 𝛿𝑙𝑖𝑚 =

5 (𝑞𝑠 𝐿4 ) 𝐸𝐼

= 0.96 mm

𝐿 240

= 4.8 mm

Check Secondary Beam – IPE 120: Parameters: • 𝑃𝑆𝐷𝐿 = 2.7 kN • 𝑃𝐿𝐿 = 4.5 kN • 𝐿 = 2.5 m

Following the same explanation as that of the IPE 80, the result of the general computation is as follow:

1 4

•

Dead Load – Moment: 𝑀𝐷𝐿 = 𝑃𝐷𝐿 𝐿 = 1.7 kNm

•

Live Load – Moment: 𝑀𝐿𝐿 = 4 𝑃𝐿𝐿 𝐿 = 2.8 kNm

•

Dead Load – Shear: 𝑉𝐷𝐿 = 2 𝑃𝑒𝑑 = 1.35 kN

•

Live Load – Shear: 𝑉𝐷𝐿 = 2 𝑃𝑒𝑑 = 2.25 kN

•

Wind Load (Wx) – Axial: 𝑁𝑊𝑥 = ±3 kN

•

Wind Load (Wy) – Axial: 𝑁𝑊𝑦 = ±0.43 kN

•

Deflection: 𝛿𝑚𝑎𝑥 = 48

•

Allowable deflection: 𝛿𝑙𝑖𝑚 = 240 = 10 mm

1 (𝑃𝑠 𝐿3 ) 𝐸𝐼

= 3.5 mm 𝐿

Check Strong Axis Frame: Prior to the analysis of the structure, Eurocode demands a preliminary check on the P-delta behavior of the structure. To that end, EN 1993-1-1 clause 5.2.1. requires analysis with second order effect taken into account if the structure is prone to excessive lateral deformation (sway frame). The structure can be considered as non-sway and second order analysis may be ignored if: 𝛼𝑐𝑟 =

𝐹𝑐𝑟 ≥ 10 𝐹𝐸𝐷

The computation of the critical load (𝐹𝑐𝑟 ) typically is carried out with Finite Element software. However, Horne (1980) proposed an alternative solution to compute the critical load, as such: 𝐹𝑐𝑟 =

ℎ ∙ 𝐻𝐸𝐷 𝛿𝐸𝐷

where: ℎ = floor to floor height 𝐻𝐸𝐷 = the ultimate story shear 𝛿𝐸𝐷 = the ultimate lateral deformation due to lateral load In conclusion, the structure is considered as non-sway if: ℎ ∙ 𝐻𝐸𝐷 ≥ 10 𝛿𝐸𝐷 ∙ 𝐹𝐸𝐷 where: 𝐹𝐸𝐷 = the total ultimate vertical load on the frame. During the transportation and lifting of the module, there are two scenarios which must be considered:

1. Case 1 – During transportation by truck, the structural scheme is:

Parameters: •

𝑞𝑟,𝑆𝐷𝐿 = 0.16 kN/m; 𝑞𝑟,𝐿𝐿 = 0.5 kN/m

•

𝑞𝑔,𝑆𝐷𝐿 = 3.85 kN/m; 𝑞𝑔,𝐿𝐿 = 3.75 kN/m

•

Beam and Column Size = HEB 140

•

𝐿 = 4.8 m; 𝐻 = 3.3 m

•

𝑊𝑥 = 1.16 kN

In this case, the second-order effect must be checked:

As it can be seen from the figure, the lateral deformation of the structure due to wind (𝛿)

ℎ

is 0.55 mm, which is much lower than the allowable (𝛿lim = 300 = 11 mm). Eventually, the second-order check can be carried out:

Load Combination 1.35DL+1.5LL+0.9Wx 1.35DL+1.5Wx+1.05LL

𝐹𝐸𝐷 (kN)

𝐻𝐸𝐷 (kN)

𝛿𝐸𝐷 (mm)

ℎ ∙ 𝐻𝐸𝐷 𝛿𝐸𝐷 ∙ 𝐹𝐸𝐷

Second Order

9.3 7.1

1.04 1.74

0.5 0.83

740.9 974.4

No No

In conclusion, first order analysis is enough to compute the internal forces. 2. Case 2 – During the lifting process with crane, the structural scheme is:

Parameters: •

𝑞𝑟,𝑆𝐷𝐿 = 0.16 kN/m; 𝑞𝑟,𝐿𝐿 = 0.5 kN/m

•

𝑞𝑔,𝑆𝐷𝐿 = 3.85 kN/m; 𝑞𝑔,𝐿𝐿 = 3.75 kN/m

•

Beam and Column Size = HEB 140

•

𝐿 = 4.8 m; 𝐻 = 3.3 m

•

𝑊𝑥 = 1.16 kN

For this case, the second-order analysis can be neglected because the columns are under tensile load and second-order effect will give a positive effect in reducing the internal forces. Finally, both case 1 and case 2 show that the second order analysis can be neglected. Proceeding with the internal forces computation, the second case will give the most conservative result, and thus the analysis will be limited only to the second case:

Load Combination – 1.35DL+1.05LL+1.5W:

Load Combination – 1.35DL+1.5LL+0.9W:

Check Weak Axis Frame: Following the same principle as that of the strong axis frame, there are two scenarios which must be considered:

1. Case 1 – During transportation by truck:

Parameters: • •

𝑞𝑟,𝑆𝐷𝐿 = 0.15 kN/m; 𝑞𝑟,𝐿𝐿 = 0.5 kN/m 𝑞𝑔,𝑆𝐷𝐿 = 3.8 kN/m; 𝑞𝑔,𝐿𝐿 = 3.6 kN/m

• • •

Beam and Column Size = HEB 140 𝐿 = 2.5 m; 𝐻 = 3.3 m 𝑊𝑦 = 7.6 kN

In this case, the second-order category check must be performed:

As it can be seen from the figure, the lateral deformation of the structure due to wind (𝛿)

ℎ

is 11.2 mm, which is considerably close to the allowable value (𝛿lim = 300 = 11 mm). Eventually, the second-order check can be carried out:

Load Combination 1.35DL+1.5LL+0.9Wx 1.35DL+1.5Wx+1.05LL

𝐹𝐸𝐷 (kN)

𝐻𝐸𝐷 (kN)

𝛿𝐸𝐷 (mm)

ℎ ∙ 𝐻𝐸𝐷 𝛿𝐸𝐷 ∙ 𝐹𝐸𝐷

Second Order

4.65 3.56

6.84 11.4

9.9 16.5

490.33 640.45

No No

In conclusion, first order analysis is enough to compute the internal forces. 2. Case 2 – During the lifting process with crane, the structural scheme is:

Parameters: • •

𝑞𝑟,𝑆𝐷𝐿 = 0.15 kN/m; 𝑞𝑟,𝐿𝐿 = 0.5 kN/m 𝑞𝑔,𝑆𝐷𝐿 = 3.8 kN/m; 𝑞𝑔,𝐿𝐿 = 3.6 kN/m

• • •

Beam and Column Size = HEB 140 𝐿 = 2.5 m; 𝐻 = 3.3 m 𝑊𝑦 = 7.6 kN

For this case, the second-order analysis can be neglected because the columns are under tensile load and second-order effect will give a positive effect in reducing the internal forces.

Finally, both case 1 and case 2 show that the second order analysis can be neglected. Proceeding with the internal forces computation, the second case will give the most conservative result, and thus the analysis will be limited only to the second case: Load Combination – 1.35DL+1.05LL+1.5W:

Load Combination – 1.35DL+1.5LL+0.9W:

3. For Service Life -

Check Secondary Beam – IPE 80:

Parameters: • 𝑞𝑆𝐷𝐿 = 2.25 kN/m • 𝑞𝐿𝐿 = 4.75 kN/m • 𝐿 = 1.2 m

Calculation: 1 • Ultimate Moment: 𝑀𝑒𝑑 = 8 𝑞𝑒𝑑 𝐿2 = 1.84 kNm

1 2

•

Ultimate Shear: 𝑉𝑒𝑑 = 𝑞𝑒𝑑 𝐿 = 6.12 kN

•

Deflection: 𝛿𝑚𝑎𝑥 = 384

•

Allowable deflection: 𝛿𝑙𝑖𝑚 =

5 (𝑞𝑠 𝐿4 ) 𝐸𝐼

= 1.64 mm

𝐿 240

= 4.8 mm

Check Secondary Beam – IPE 120: Parameters: • 𝑃𝑆𝐷𝐿 = 2.7 kN • 𝑃𝐿𝐿 = 5.7 kN • 𝐿 = 2.5 m

Calculation: 1 • Ultimate Moment: 𝑀𝑒𝑑 = 4 𝑃𝑒𝑑 𝐿 = 7.625 kNm 1

•

Ultimate Shear: 𝑉𝑒𝑑 = 2 𝑃𝑒𝑑 = 6.1 kN

•

Deflection: 𝛿𝑚𝑎𝑥 = 48

•

Allowable deflection: 𝛿𝑙𝑖𝑚 = 240 = 10 mm

1 (𝑃𝑠 𝐿3 ) 𝐸𝐼

= 4.1 mm 𝐿

Check Strong Axis Frame:

Parameters: • 𝑞𝑟,𝑆𝐷𝐿 = 0.16 kN/m; 𝑞𝑟,𝐿𝐿 = 0.5 kN/m • 𝑞𝑔,𝑆𝐷𝐿 = 3.85 kN/m; 𝑞𝑔,𝐿𝐿 = 4.75 kN/m • Beam and Column Size = HEB 140 • Hanger = IPE 120 • 𝐿 = 4.8 m; 𝐻 = 3.3 m; h = 0.75 m • 𝑊𝑥 = 0 kN Results:

Check Weak Axis Frame:

Parameters: • 𝑞𝑟,𝑆𝐷𝐿 = 0.08 kN/m; 𝑞𝑟,𝐿𝐿 = 0.24 kN/m • 𝑞𝑔,𝑆𝐷𝐿 = 2.7 kN/m; 𝑞𝑔,𝐿𝐿 = 2.3 kN/m • Beam and Column Size = HEB 140 • 𝐿 = 2.5 m; 𝐻 = 3.3 m • 𝑊𝑦 = 0 kN

Results:

Beam Capacity Check: IPE80_Installation Phase Cross Section: IPE 80 Check Cross Section Slenderness Ned (kN)

Med (kN)

1.56

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 1200 Zg (mm) 40 Za (mm) 40 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 1200 Ly (mm) 1200 Lt (mm) 1200 Stability Curve b α 0.34

Bending Capacity Calculation Buckling Curve a Mcr (kNm) 13.55 λLT 0.69 αLT 0.21 φLT 0.71 χLT 0.77 Mrd (kNm) 4.90

Axial Capacity Calculation Ncr,x (kN) 1152.89 Ncr,y (kN) 122.34 Nct,t (kN) 488.87 Ncr,ft (kN) 488.87 λ 1.31 ϕ 1.55 χ 0.42 Nrd (kN) 88.64

Insert Safety Factor γm0 1 γm1 1 η 1

Shear Capacity Calculation Av (mm2) 357.36 Vrd (kN) 56.74 Web Stockiness OK Conclusion Ned (kN) 0

Ved (kN) Med (kNm) 5.2 1.56

Vrd (kN) 56.74

Nrd (kN) 88.64

Mrd (kNm) Conclusion 4.90 OK

Beam Capacity Check: IPE120_Installation Phase Cross Section:

IPE 120

Check Cross Section Slenderness Ned (kN)

Med (kN)

6.5

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 60 Za (mm) 60 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.348 C2 0.553 C3 0.411 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 1250 Lt (mm) 1250 Stability Curve b α 0.34

Bending Capacity Buckling Curve Mcr (kNm) λLT αLT φLT χLT Mrd (kNm)

a 23.04 0.85 0.21 0.82 0.74 12.42

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness

629.52 99.95 OK

Conclusion Ned (kN) 0

Ved (kN) Med (kNm) 5.2 6.5

Insert Safety Factor γm0 1 γm1 1 η 1

Vrd (kN) 99.95

1054.55 367.43 544.29 544.29 0.99 1.13 0.60 218.12

Nrd (kN) 218.12

Mrd (kNm) Conclusion 12.42 OK

Beam Capacity Check: HEB140_Installation Phase_Strong Axis Cross Section: HEB 140 Check Cross Section Slenderness Ned (kN)

Med (kN)

0 0

20.8 10.4

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 4800 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 4800 Ly (mm) 4800 Lt (mm) 4800 Stability Curve b α 0.34

Bending Capacity Buckling Curve Mcr (kNm) λLT αLT φLT χLT Mrd (kNm)

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

a 158.83 0.65 0.21 0.69 0.77 52.17

Insert Safety Factor γm0 γm1 η

1 1 1

1357.46 494.77 3397.42 1357.46 1.55 1.92 0.33 385.32

Shear Capacity Av (mm2) 1312.00 Vrd (kN) 208.31 Web Stockiness OK Conclusion Ned (kN) 0

Ved (kN) Med (kNm) 26 20.8

Vrd (kN) 208.31

Nrd (kN) 385.32

Mrd (kNm) Conclusion OK 52.17

Beam Capacity Check: HEB140_Installation Phase_Weak Axis Cross Section:

HEB 140

Check Cross Section Slenderness Ned (kN)

Med (kN)

0 0

3.31 1.65

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 2500 Lt (mm) 2500 Stability Curve b α 0.34

Bending Capacity Buckling Curve Mcr (kNm) λLT αLT φLT χLT Mrd (kNm)

a 180.38 0.61 0.21 0.66 0.78 52.62

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness

1312.00 208.31 OK

Conclusion Ned (kN) 0

Ved (kN) Med (kNm) 8 3.31

Insert Safety Factor γm0 1 γm1 1 η 1

Vrd (kN) 208.31

5004.13 1823.90 3408.77 3408.77 0.81 0.93 0.72 852.87

Nrd (kN) 852.87

Mrd (kNm) Conclusion 52.62 OK

Column Capacity Check: HEB140 Cross Section: HEB 140 Check Cross Section Slenderness Med,x Med,y Ned (kN) (kN) (kN) 4.53 2.40 0.63 11.10 0.00 1.26

Strong Axis Classification Web Flange CLASS-1 CLASS-1 CLASS-1 CLASS-1

Weak Axis Classification Web Flange CLASS-1 CLASS-1 CLASS-1 CLASS-1

Cross Section Classification CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 3300 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 3300 Ly (mm) 3300 Lt (mm) 3300 Stability Curve b α 0.34

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λx λy ϕx ϕy χx χy Nrd.x (kN) Nrd.y (kN)

Bending Capacity (Strong Axis) Buckling Curve a Mcr (kNm) 161.20 λLT 0.65 αLT 0.21 φLT 0.68 χLT 0.78 Mrd,x (kNm) 52.22

Shear Capacity (Strong Axis) Av (mm2) 1312 Vrd (kN) 208.31 Web Stockiness OK

Bending Capacity (Weak Axis) Mrd,y (kNm) 33

Shear Capacity (Weak Axis) Av (mm2) 3116 Vrd (kN) 494.73 Web Stockiness OK

2871.97 1046.78 3402.13 2871.97 0.64 1.06 0.78 1.21 0.82 0.56 964.45 659.51

Insert Safety Factor γm0 γm1 η

1 1 1

Conclusion Location Edge Col. Interior Col.

Ned (kN) Ved (kN) 4.53 11.1

1 0

Med,x_top (kNm) 1.1 0.0

Med,x_bot Med,y_top Med,y_bot (kNm) (kNm) (kNm) -2.4 0.31 -0.63 0.0 0.62 -1.26

Ratio

0.029 0.021

0.060 0.033

Beam Capacity Check: IPE80_Transportation Phase Cross Section: IPE 80 Check Cross Section Slenderness Loading Combination

Ned (kN)

Med (kN)

1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

2.25 -2.25 3.75 -3.75

1.57 1.57 1.27 1.27

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 1200 Zg (mm) 40 Za (mm) 40 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 1200 Ly (mm) 1200 Lt (mm) 1200 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 13.55 λLT 0.69 αLT 0.21 φLT 0.71 χLT 0.77 Mrd (kNm) 4.90

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

1152.89 122.34 488.87 488.87 1.31 1.55 0.42 88.64

Ved (kN) 5.20 5.20 4.19 4.19

Med (kNm) 1.57 1.57 1.27 1.27

Insert Safety Factor γm0 1 γm1 1 η 1

Shear Capacity Av (mm2) 357.36 Vrd (kN) 56.74 Web Stockiness OK Conclusion Loading Combination 1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

Ned (kN) 2.25 -2.25 3.75 -3.75

Vrd (kN) 56.74 56.74 56.74 56.74

Nrd (kN) 88.64 88.64 88.64 88.64

Mrd (kNm) Conclusion 4.90 OK 4.90 OK 4.90 OK 4.90 OK

Beam Capacity Check: IPE120_Transportation Phase Cross Section:

IPE 120

Check Cross Section Slenderness Loading Combination

Ned (kN)

Med (kN)

1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

2.70 -2.70 4.50 -4.50

6.50 6.50 5.24 5.24

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 60 Za (mm) 60 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.348 C2 0.553 C3 0.411 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 1250 Lt (mm) 1250 Stability Curve b α 0.34

Bending Capacity Buckling Curve Mcr (kNm) λLT αLT φLT χLT Mrd (kNm)

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

a 23.04 0.85 0.21 0.82 0.74 12.42

Insert Safety Factor γm0 γm1 η

1 1 1

1054.55 367.43 544.29 544.29 0.99 1.13 0.60 218.12

Shear Capacity Av (mm2) 629.52 Vrd (kN) 99.95 Web Stockiness OK Conclusion Loading Combination 1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

Ned (kN) 2.70 -2.70 4.50 -4.50

Ved (kN) 5.20 5.20 4.19 4.19

Med (kNm) Vrd (kN) 6.50 99.95 6.50 99.95 5.24 99.95 5.24 99.95

Nrd (kN) 218.12 218.12 218.12 218.12

Mrd (kNm) Conclusion OK 12.42 OK 12.42 OK 12.42 OK 12.42

Beam Capacity Check: HEB140_Transportation Phase_Strong Axis Cross Section: HEB 140 Check Cross Section Slenderness Loading Combination

Ned (kN)

Med (kN)

1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

5.00 -5.00 4.20 -4.20

24.63 16.94 21.60 13.50

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 4800 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 4800 Ly (mm) 4800 Lt (mm) 4800 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 158.83 λLT 0.65 αLT 0.21 φLT 0.69 χLT 0.77 Mrd (kNm) 52.17

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

Insert Safety Factor γm0 1 γm1 1 η 1

1357.46 494.77 3397.42 1357.46 1.55 1.92 0.33 385.32

Shear Capacity Av (mm2) 1312 Vrd (kN) 208.31 Web Stockiness OK Conclusion Load Combination 1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

Ned (kN) 5 -5 4.2 -4.2

Ved (kN) 28.75 23.2 24.6 19.25

Med (kNm) Vrd (kN) 24.63 208.31 16.94 208.31 21.6 208.31 13.5 208.31

Nrd (kN) 385.32 385.32 385.32 385.32

Mrd (kNm) Conclusion 52.17 OK 52.17 OK 52.17 OK 52.17 OK

Beam Capacity Check: HEB140_Transportation Phase_Weak Axis Cross Section:

HEB 140

Check Cross Section Slenderness Loading Combination

Ned (kN)

Med (kN)

1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

2.53 -2.53 5.00 -5.00

7.34 3.63 10.64 1.40

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 2500 Lt (mm) 2500 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 180.38 λLT 0.61 αLT 0.21 φLT 0.66 χLT 0.78 Mrd (kNm) 52.62

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

5004.13 1823.90 3408.77 3408.77 0.81 0.93 0.72 852.87

Ved (kN) 17.48 8.85 18.3 4

Med (kNm) 7.34 3.63 10.64 1.4

Insert Safety Factor γm0 1 γm1 1 η 1

Shear Capacity Av (mm2) 1312 Vrd (kN) 208.31 Web Stockiness OK

Load Combination 1.35DL+1.5LL+0.9W 1.35DL+1.5LL-0.9W 1.35DL+1.05LL+1.5W 1.35DL+1.05LL-1.5W

Ned (kN) 2.53 -2.53 5 -5

Vrd (kN) 208.31 208.31 208.31 208.31

Nrd (kN) 852.87 852.87 852.87 852.87

Mrd (kNm) Conclusion 52.62 OK 52.62 OK 52.62 OK 52.62 OK

Column Capacity Check: HEB140 Cross Section: HEB 140 Check Cross Section Slenderness Med,x Med,y Ned (kN) (kN) (kN) 9.20 12.74 7.34 13.10 -11.10 -10.70 9.85 -0.75 7.34 12.30 -1.25 -10.70

Strong Axis Classification Web Flange CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Weak Axis Classification Web Flange CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Cross Section Classification CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 3300 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 3300 Ly (mm) 3300 Lt (mm) 3300 Stability Curve b α 0.34

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λx λy ϕx ϕy χx χy Nrd.x (kN) Nrd.y (kN)

Bending Capacity (Strong Axis) Buckling Curve a Mcr (kNm) 161.20 λLT 0.65 αLT 0.21 φLT 0.68 χLT 0.78 Mrd,x (kNm) 52.22

Shear Capacity (Strong Axis) Av (mm2) 1312 Vrd (kN) 208.31 Web Stockiness OK

Bending Capacity (Weak Axis) Mrd,y (kNm) 33

Shear Capacity (Weak Axis) Av (mm2) 3116 Vrd (kN) 494.73 Web Stockiness OK

Insert Safety Factor γm0 1 γm1 1 η 1

2871.97 1046.78 3402.13 2871.97 0.64 1.06 0.78 1.21 0.82 0.56 964.45 659.51

Conclusion Location Edge Column Interior Column

Ned (kN) Ved (kN) 9.2 13.1 9.85 12.3

5.92 5.26 0.42 0.7

Med,x_top (kNm) 12.74 -11.1 -0.75 -1.25

Med,x_bot Med,y_top Med,y_bot (kNm) (kNm) (kNm) -6.8 7.34 -6.9 6.3 10.64 -10.7 0.63 7.34 -6.9 1.1 10.64 -10.7

Ratio

0.16 0.18 0.07 0.10

0.35 0.36 0.12 0.18

Beam Capacity Check: IPE80_Service Life Cross Section:

IPE 80

Check Cross Section Slenderness Ned (kN)

Med (kN)

1.84

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 1200 Zg (mm) 40 Za (mm) 40 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 1200 Ly (mm) 1200 Lt (mm) 1200 Stability Curve b α 0.34

Bending Capacity Buckling Curve Mcr (kNm) λLT αLT φLT χLT Mrd (kNm)

a 13.55 0.69 0.21 0.71 0.77 4.90

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

1152.89 122.34 488.87 488.87 1.31 1.55 0.42 88.64

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness

357.36 56.74 OK

Vrd (kN) 56.74

Nrd (kN) 88.64

Conclusion Ned (kN) 0

Ved (kN) Med (kNm) 6.12 1.84

Insert Safety Factor γm0 1 γm1 1 η 1

Mrd (kNm) Conclusion 4.90 OK

Beam Capacity Check: IPE120_Service Life Cross Section:

IPE 120

Check Cross Section Slenderness Ned (kN)

Med (kN)

6.5

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 60 Za (mm) 60 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.348 C2 0.553 C3 0.411 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 1250 Lt (mm) 1250 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 23.04 λLT 0.85 αLT 0.21 φLT 0.82 χLT 0.74 Mrd (kNm) 12.42

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness Conclusion Ned (kN) 0

Insert Safety Factor γm0 1 γm1 1 η 1

1054.55 367.43 544.29 544.29 0.99 1.13 0.60 218.12

629.52 99.95 OK

Ved (kN) Med (kNm) 6.12 7.625

Vrd (kN) 99.95

Nrd (kN) 218.12

Mrd (kNm) Conclusion 12.42 OK

Beam Capacity Check: HEB140_Service Life_Strong Axis Cross Section:

HEB 140

Check Cross Section Slenderness Ned (kN)

Med (kN)

0 0

23.7 11.83

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 4800 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 4800 Ly (mm) 4800 Lt (mm) 4800 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 158.83 λLT 0.65 αLT 0.21 φLT 0.69 χLT 0.77 Mrd (kNm) 52.17

Axial Capacity Ncr,x (kN) 1357.46 Ncr,y (kN) 494.77 Nct,t (kN) 3397.42 Ncr,ft (kN) 1357.46 λ 1.55 ϕ 1.92 χ 0.33 Nrd (kN) 385.32

Insert Safety Factor γm0 1 γm1 1 η 1

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness

1312 208.308 OK

Conclusion Ned (kN) 0

Ved (kN) Med (kNm) Vrd (kN) 29.6 23.7 208.31

Nrd (kN) 385.32

Mrd (kNm) Conclusion 52.17 OK

Beam Capacity Check: HEB140_Service Life_Weak Axis Cross Section:

HEB 140

Check Cross Section Slenderness Ned (kN)

Med (kN)

0 0

3.7 1.85

Cross Section Classification Web Flange Cross-Section CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1 CLASS-1

Parameters for Bending Check Length (mm) 2500 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 2.576 C2 1.562 C3 -0.859 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 2500 Ly (mm) 2500 Lt (mm) 2500 Stability Curve b α 0.34

Bending Capacity Buckling Curve a Mcr (kNm) 180.38 λLT 0.61 αLT 0.21 φLT 0.66 χLT 0.78 Mrd (kNm) 52.62

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λ ϕ χ Nrd (kN)

Shear Capacity Av (mm2) Vrd (kN) Web Stockiness

Ned (kN) 0

Insert Safety Factor γm0 1 γm1 1 η 1

5004.13 1823.90 3408.77 3408.77 0.81 0.93 0.72 852.87

1312 208.308 OK

Ved (kN) Med (kNm) 8.9 3.7

Vrd (kN) 208.31

Nrd (kN) 852.87

Mrd (kNm) Conclusion 52.62 OK

Column Capacity Check: HEB140 Cross Section: HEB 140 Check Cross Section Slenderness Med,x Med,y Ned (kN) (kN) (kN) 2.16 0.57 -0.14

Strong Axis Classification Web Flange CLASS-1 CLASS-1

Weak Axis Classification Web Flange CLASS-1 CLASS-1

Cross Section Classification CLASS-1

Parameters for Bending Check Length (mm) 3300 Zg (mm) 70 Za (mm) 70 Zs (mm) 0 Zj (mm) 0 Ky 1 Kz 1 Kw 1 C1 1.127 C2 0.459 C3 0.525 λLT,0 0.4 β 0.75

Parameters for Axial Check Lx (mm) 3300 Ly (mm) 3300 Lt (mm) 3300 Stability Curve b α 0.34

Axial Capacity Ncr,x (kN) Ncr,y (kN) Nct,t (kN) Ncr,ft (kN) λx λy ϕx ϕy χx χy Nrd.x (kN) Nrd.y (kN)

Bending Capacity (Strong Axis) Buckling Curve a Mcr (kNm) 161.20 λLT 0.65 αLT 0.21 φLT 0.68 χLT 0.78 Mrd,x (kNm) 52.22

Shear Capacity (Strong Axis) Av (mm2) 1312.00 Vrd (kN) 208.31 Web Stockiness OK

Bending Capacity (Weak Axis) Mrd,y (kNm) 33

Shear Capacity (Strong Axis) Av (mm2) 3116.00 Vrd (kN) 494.73 Web Stockiness OK

Insert Safety Factor γm0 1 γm1 1 η 1

2871.97 1046.78 3402.13 2871.97 0.64 1.06 0.78 1.21 0.82 0.56 964.45 659.51

Conclusion Location Edge Col.

Ned (kN) Ved (kN) 2.16

0.52

Med,x_top (kNm) 0.57

Med,x_bot Med,y_top Med,y_bot (kNm) (kNm) (kNm) -0.114 0.07 -0.144

Ratio

0.008

0.016

Appendix B: Implants Calculation The sub-structural frame of the secondary system will be integrated with all the possible implants necessary for an inpatient room such as water, air, electricity and gases. The secondary system, in order to guarantee the maximum flexibility of space and functions, is designed taking into account not only the implants necessary for the single inpatient room, but also all the other possible functions that the room may host due to future trends and modifications. From this point of view, it was necessary to analyze the needs of the other uses of the secondary system: the double room, the ICU room, the ambulatory, the lounge, the meeting room and the office; these alternatives are taken into account in the positioning of the implants’ terminals.

Sanitary Water and Wastewater System- Pipe sizing calculation 1. Sanitary Water System The model chosen for the pipe sizing calculation regarding the sanitary appliances is the loading unit method. In this way, a-dimensional values are assigned (defined as loading unit) to each sanitary appliance according to their nominal flow rates and their simultaneously use. As consequence, based on these values, the project flow rates are determined through apposite diagrams and tables (UNI 9182). Through the flow rates and the maximum acceptable value of velocity, the final internal diameter of each pipe could be calculated.

UNI 9182- Loading Units for buildings of public or collective use – Single appliances

UNI 9182- Loading Units for buildings of public or collective use – Appliances combinations

The loading unit calculation for the sanitary appliances regarding the Open Room module (considering all its set-ups) are reported in the table below.

Single Appliance WC Basin Shower Clinic Basin Kitchen Basin Shower + Basin + WC Total

Supply Box Mixing group Mixing group Mixing group Mixing group Mixing group

Loading Units Cold Water Hot Water CW HW 5 1.5 1.5 3 3 1.5 1.5 2 2 5 3 18 11

Total HW+CW 5 2 4 2 3 5 21

The next step is to determine the maximum simultaneous flow rate with the method of loading units both for hot and cold water. The values could be extrapolated by charter considering the flow rate as a function of the loading unit: 𝑞 = 𝑓(𝐿𝑈) [𝑙/𝑠]

In the following diagram, in the x axis are reported the loading units and at the intersection with the curve in the y axis are described the correspondent flow rates; curve-1 is considered for this case.

UNI 9182- Curve q=f(LU) flow rates (l/s) in function of loading units.

The flow rates for the sanitary appliances regarding the Open Room module are below reported.

Single Appliance

Rate flow CW [l/s]

WC Basin Shower Clinic Basin Kitchen Basin Shower + Basin + WC Total

0.3 0.3 0.3 0.3 0.3 0.3 0.82

Rate flow HW [l/s] 0.3 0.3 0.3 0.3 0.3 0.55

Now, it is possible to proceed with the pipe sizing calculation through the following formula: 𝑉 ∙ 103 √ =2 ∙ 𝜋 ∙𝑐 2

𝜙𝑖,𝑚𝑖𝑛

where 𝜙𝑖,𝑚𝑖𝑛 [𝑚𝑚] is the minimum diameter of the pipe, V is the flow rate [l/s] previously calculated and c [m/s] is the maximum velocity permissible.

The maximum velocity permissible is equal to 2 m/s considering the part of implant such as header pipes, rising pipes and floor service pipes, so for the calculation the velocity considered is equal to 2,0 m/s. Calculated the minimum internal diameter, the last step is to choose the corresponding external diameter of the pipes considering the PEX/AL/PE-HD material, as it is shown below.

Cold Water Di [mm] De x s [mm]

Single Appliance WC Basin Shower Clinic Basin Kitchen Basin Shower + Basin + WC Total

14 14 14 14 14 14 23

Hot Water Di [mm] De x s [mm]

20 x 2.5 18 x 2 18 x 2 18 x 2 18 x 2 20 x 2.5 32 x 3

14 14 14 14 14 19

18 x 2 18 x 2 18 x 2 18 x 2 18 x 2 26 x 3

A multilayer pipe composed by synthetic materials such as reticular polyethylene and polyethylene with high density offer high resistance to corrosion or chemical agents, and greater hygiene levels: Single Appliance WC Basin Shower Clinic Basin Kitchen Basin Shower + Basin + WC Total

Rate flow CW [l/s]

Rate flow HW [l/s]

0.3 0.3 0.3 0.3 0.3 0.3 0.82

0.3 0.3 0.3 0.3 0.3 0.55

Cold Water D e x s [mm] v [m/s] 20 x 2.5 18 x 2 18 x 2 18 x 2 18 x 2 20 x 2.5 32 x 3

1.70 1.95 1.95 1.95 1.95 1.70 1.55

Hot Water D e x s [mm] v [m/s] 18 x 2 18 x 2 18 x 2 18 x 2 18 x 2 26 x 3

1.95 1.95 1.95 1.95 1.95 1.75

All of the products are taken from Valsir, a company that specializes in producing pipes for sanitary or wastewater system. The detailed description of the pipe can be found from: http://www.valsir.it/pdf/st/ST_MIXAL_T02286002_IT.pdf

2. Wastewater System The rate flows and pipes dimension for the waste water system are reported in the table next page.

rate flows and pipes dimensions for the waste water system Single Appliance Rate flow [l/s] DN [mm] WC 2.5 100 Basin 0.45 32/40 Shower 0.45 40 Clinic basin 0.45 32/40 Kitchen Basin 0.45 32/40

D in 4'' 1" 1/4/1" 1/2 1 1/2" 1" 1/4/1" 1/2 1" 1/4/1" 1/2

The plug-in of the room implants, alongside the ones in the main distribution, is simplified by the predisposition of a technical wall adjacent to the corridor. All the hydraulic implants in the room, in fact, are converging in such a way that only one pipe for each typology should be connected to the ones in the corridor. The pipes providing the water flow for the hypothetical basin in the middle of the room are interrupted by a valve.

All the junctions with the principal distribution system should be done on the construction site, after the positioning and connection of the substructures. The cold and hot water pipes will be directly connected to the main distributions in the corridor while the wastewater pipes will be connected to the disposal columns that should be placed in the technical wall and realized in situ since they have to cross the entire building.

Heating and Ventilation and Air Conditioning (HVAC) Calculation The HVAC system is designed to help maintain good indoor air quality through adequate ventilation and provide internal thermal comfort. In this specific case, the HVAC system used is all air system, where the heat carrier fluid is air - carried to the environments in ducts and could be used to control the IAQ (indoor air quality) in multiple zones.

To determine the quantity of air the influencing factors are: -

Number of people present in the zone and their activities (CO2, which increases with activities and with the reduction of space m2)

Zone latent loads

Pollutants and smoke

Quality of external air

Thermal loads

Heat losses and needs.

The HVAC system design was performed through a 3D performance analysis software (IES-VE environment), which requires precise input data depending on the external climate conditions of the site of application. The external conditions however are highly variable: the calculation will be based on assumptions and hypothesis on the application site in order to define the limits of applicability of the product. Moreover, the thermal loads are strictly dependent on the solar irradiance, the latitude and orientation at which the room is installed. A dynamic simulation was run, considering all the possible orientations of the module as well as different latitudes at each hour of whole year in order to evaluate the more disadvantageous case.

Standards: 1. UNI 11300 – Evaluation of energy need for space heating and cooling 2. UNI 10339 – Air conditioning system for thermal comfort in buildings 3. UNI EN 12831 – Prestazione energetica degli edifici – Metodo per il calcolo del carico termico di progetto .

Thermal Zone Definition: The inpatient room requires precisely thermal comfort conditions during the heating and cooling seasons as is reported in the table below.

Thermo-hygrometric comfort Winter Temp.

RH [%]

[°C] 20 +/- 1

40 +/- 5

Summer Temp.

RH [%]

[°C] 26 +/- 1

50 +/- 5

The internal loads considered are: -

4 people

illumination

machinery.

People Q sens [W] 90

Internal Gains [kWh] Fluorescent Lighting

Qlat [W] 60

Qsens [W/m 15

]

Machinary Q sens [W] 40

Thermal Loads Definition: 1. Winter thermal loads According to the standard UNI EN 12831 – it is possible to calculate the heat losses of a space considering the heat losses by both thermal conduction and air exchanges (ventilation, infiltration). The heat losses due to thermal conduction are relied on the thermal transmittance and thermal bridges of the envelope closure and its exposure to climate conditions. An external window of 7.5 m2 with a U=1.6 W/m2K considering a metal frame with thermal break was considered. On the other hand, the heat losses due to air exchanges are relied on the natural ventilation (portata d’aria minima richiesta per questioni igieniche) and the infiltration (indotta dal vento e dall’effetto camino sull’involucro dell’edificio).

Ventilation Rates Thermal Zone Inpatient Room (2 beds)

Air Exchange l/(s*person)

Schedule

ach

24/7 all year round

Bath

Infiltration

0.1

ON continuously

2. Summer thermal loads The thermal loads during the summer season necessary to calculate are based on the contribution of both sensible and latent heat. Sensible heat is mostly dictated by 4 factors: solar gains, thermal transmittance, infiltration of external air and internal gains due to people, illuminance and electrical machinery. At the same time, the contribution of latent heat is controlled by water vapour due to the presence of people, infiltration of external air (when the humidity contribution has a value higher than the internal humidity), and water vapour due to the presence of electrical machinery. Through a dynamic analysis, it is possible to analyse the heat losses and gains along the whole year. Changing the external climate conditions (latitude) and the orientation of the module, it was possible to determine the worst conditions. After running the energy simulation, it was possible distinguish the sensible heat gain and the latent ones considering the worst hour of the whole year.

Qvent

Q sensible [kW] Q cond Qsol

-32.6

-524

Q sensible [kW]

OPEN ROOM

Qig

1141.7

1313.7

Q latente [kW] Qig

Qig

Qvent

1313.7

240

-3.2

V [mc]

Qhl [W]

Qsens,tot [W]

Qlat,tot [W]

R [-]

250

1.889

1898.8

236.8

0.89

Winter and Summer Thermal loads for HVAC system

To fulfil those needs, FCX product has been chosen. The available sizes and its corresponding capacity can be seen from the table below:

Looking from the table, the most suitable product is FCX22 with dimension of 520x750 mm, whose performance may provide capacity higher than the demand: Qhl,demand 1.889

MODEL FCX22

Qsens,perfomance 2*1055

Qtot,performance 2x1330

Qcooling,performance 2*950

Furthermore, by considering an air velocity equal to 5-6 m/s, the required cross sectional area of the air duct is 320 cm2, which corresponds to the size of 16x20 cm2.

Appendix C: Lighting Analysis

Lighting Analysis of Inpatient Single Room Average illuminance: 249 lx

Lighting Analysis of Inpatient Double Room Average illuminance: 207 lx

Lighting Analysis of ICU Room Average illuminance: 220 lx

Lighting Analysis_ Ambulatory Average illuminance: 159 lx

Lighting Analysis_ Staff Break Room Average illuminance: 141 lx

Lighting Analysis_ Office Average illuminance: 142 lx

Lighting Analysis_ Meeting Room Average illuminance: 137 lx

APPENDIX D: NEEDS AND REQUIREMENTS Rooms

Inpatient

Doctor OnCall Room

Stakeholder

Needs

Requirements Minimum area of 15m2 for single bedroom Minimum area of 25m2 for double bedroom Provide ensuite with minimum area of 5m2 to allow access for both wheelcair patient and assisting nurse Minimum distance of 2.4m between bed centre lines Minimum bedsize is 2.25m x 1.05 m Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Good quality stay Provide a multi-function handsets at the side of the bed whose function can serve as: TV channel selector, volume control, reading light control, reassurance light and patient call button/alarm. TV must serve as a media for the patient to talk with doctors and nurses. Bedrooms must have glazed windows to have external views with minimum area of 10% of floor area Floor finishes inside the bedroom must allow easy movement of objects, easy on the foot; while floor finishes inside ensuite must be non-slip Patient Floor colors must be chosen such that it doesn’t alter the observer's perception of skin colour Grabrails/Handrails must be provided inside ensuite Minimum clear door openings shall be 1.4m x 2.03m Wheelchair access Minimum clear door openings to ensuite is at least 0.9m Provide an electronic call system which may alarm the nurses in a discreet manner. The alarm should be loud enough to notify the nurses but discreet enough not to alarm the other patients Nurse Call System Visual privacy of each Provide window curtain, or smart glass for the window patient Provide blinds/curtains for double bedroom to ensure visual privacy for each patient All windows and doors must be lockable Security The interior and the furniture inside the room should adopt a calming colour rather than stimulating Minimum Standard Transfer Coefficient of 35, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade Acoustic Privacy plasterboard on the other side. Cavity infill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Minimum clearance of 1.2m must be available at the foot of each bed Minimum corridor width of 2.1m Movements for beds and Expansion joint covers must be flush with the floor surface to facilitate the use of wheelchairs wheelchairs Bedroom doors shall not swing into the corridors Doors to ensuite, toilets and showers must open out Floor finishes must allow easy movement of objects and easy on the foot Nurse/Doctors Provide corridor indicator light that shows which patient called for help Indicator Provide medium wall mounted basin with hands-free operation (elbow or wirst) at each room Sanitary Provide 2 oxygen gas outlet, 1 medical air outlet and 2 suction outlet Medical Gas Adequate lighting for clinical observation Lighting Provide a minimum of 16 power outlet Bedside monitoring should be located to permit easy access and viewing, and should not interfere with the visualization of, or access to the patient. Bedside Monitoring Floor finishes must use material which allows easy cleaning and discourage accumulation of dust Easy maintainance and Hospital Staff Wall finishes must be scrubbable with smooth surfaces, and In the immediate vicinity of plumbing fuxtures, the finishing shall be smooth and water resistant cleaning Ceilings shall be finished as to be readily cleanable with equipment routinely used in a daily housekeeping activities Cubicle screens, bed screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Anti-static flooring must be used for anaesthetising areas where flammable anaesthetic agents might be used Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Provide smoke management system Government/ Provide emergency lighting, detection and warning system Regulator Avoid using plastic & material which may release toxic gas Health Vinyl flooring must be used under all handwash basin Carpet must not be used Infection Control Skirtings must be installed at each corner of the floor, tightly sealed against the wall and constructed without voids Gaps are not allowed between: cupboards and floors or walls, or between fixtures attached to floors and walls Floors must be surfaced with smooth, impermeable seamless material (such as vinyl) to avoid accumulation of blood/body fluids To allow efficient circulation Minimum area 10m2 in the room Must be located at a discreet area with ready access to critical area Doors and windows must be lockable Security Doctor Nurses Staffs Minimum Standard Transfer Coefficient of 35, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade Acoustic Privacy plasterboard on the other side. Cavity infill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Provide a telephone in order to ensure that the room is contactable Technical Cubicle screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Government/ Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Regulator Provide smoke management system Avoid using plastic & material which may release toxic gas Health

Rooms

Stakeholder

Needs

Requirements Minimum area of 15m2 for single bedroom Minimum area of 25m2 for double bedroom Provide ensuite with minimum area of 5m2 to allow access for both wheelcair patient and assisting nurse Minimum distance of 2.4m between bed centre lines Minimum bedsize is 2.25m x 1.05 m Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Provide a multi-function handsets at the side of the bed whose function can serve as: TV channel selector, volume control, reading light control, reassurance light and patient call button/alarm. Good quality stay TV must serve as a media for the patient to talk with doctors and nurses. Bedrooms must have glazed windows to have external views with minimum area of 10% of floor area Floor finishes inside the bedroom must allow easy movement of objects, easy on the foot; while floor finishes inside ensuite must be non-slip Floor colors must be chosen such that it doesn’t alter the observer's perception of skin colour Cabinets/Storage for toys, educational and recreational equipment shall be provided Patient Storage for cribs and adult beds shall be provided Two sets of door handles at high and low level must be provided Grabrails/Handrails must be provided inside ensuite Minimum clear door openings shall be 1.4m x 2.03m Wheelchair access Minimum clear door openings to ensuite is at least 0.9m Nurse Call System Provide an electronic call system which may alarm the nurses in a discreet manner. The alarm should be loud enough to notify the nurses but discreet enough not to alarm the other patients Visual privacy of each Provide window curtain, or smart glass for the window patient Provide blinds/curtains for double bedroom to ensure visual privacy for each patient All windows and doors must be lockable Security The interior and the furniture inside the room should adopt a calming colour rather than stimulating Minimum Standard Transfer Coefficient of 35, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade Acoustic Privacy plasterboard on the other side. Cavity infill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Minimum clearance of 1.2m must be available at the foot of each bed Pediatric Minimum corridor width of 2.1m Movements for beds and Expansion joint covers must be flush with the floor surface to facilitate the use of wheelchairs wheelchairs Bedroom doors shall not swing into the corridors Doors to ensuite, toilets and showers must open out Floor finishes must allow easy movement of objects and easy on the foot Nurse/Doctors Indicator Provide corridor indicator light that shows which patient called for help Sanitary Provide medium wall mounted basin with hands-free operation (elbow or wirst) at each room Medical Gas Provide 2 oxygen gas outlet, 1 medical air outlet and 2 suction outlet Adequate lighting for clinical observation Lighting Provide a minimum of 16 power outlet Bedside Monitoring Bedside monitoring should be located to permit easy access and viewing, and should not interfere with the visualization of, or access to the patient. Floor finishes must use material which allows easy cleaning and discourage accumulation of dust Easy maintainance and Hospital Staff Wall finishes must be scrubbable with smooth surfaces, and In the immediate vicinity of plumbing fuxtures, the finishing shall be smooth and water resistant cleaning Ceilings shall be finished as to be readily cleanable with equipment routinely used in a daily housekeeping activities Cubicle screens, bed screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Anti-static flooring must be used for anaesthetising areas where flammable anaesthetic agents might be used Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Provide smoke management system Government/ Provide emergency lighting, detection and warning system Regulator Health Avoid using plastic & material which may release toxic gas Vinyl flooring must be used under all handwash basin Carpet must not be used Infection Control Skirtings must be installed at each corner of the floor, tightly sealed against the wall and constructed without voids Gaps are not allowed between: cupboards and floors or walls, or between fixtures attached to floors and walls Floors must be surfaced with smooth, impermeable seamless material (such as vinyl) to avoid accumulation of blood/body fluids To allow efficient circulation Minimum area of 12m2 - 15m2 (depending on the number of user) in the room Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Minimum Standard Transfer Coefficient of 35, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade Doctor Nurses Staffs Acoustic Privacy plasterboard on the other side. Cavity infill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Provide at least two telephone outlets, depends on the size of the meeting room Technical Office Room Cubicle screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Government/ Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Regulator Provide smoke management system Avoid using plastic & material which may release toxic gas Health

Rooms

Stakeholder

Patient

Nurse/Doctors Intensive Care Unit

Hospital Staff

Government/ Regulator

Patient's Family

Small Meeting Room

Nurse/Doctors

Hospital Staff

Government/ Regulator

Needs

Requirements Minimum area of 22m2 for single bedroom Minimum bedsize is 2.25m x 1.05 m Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Good quality stay Bedrooms must have glazed windows to have external views with minimum area of 10% of floor area Floor finishes inside the bedroom must allow easy movement of objects, easy on the foot Floor colors must be chosen such that it doesn’t alter the observer's perception of skin colour Minimum clear door openings shall be 1.4m x 2.03m Bed access Nurse Call System Provide an electronic call system which may alarm the nurses in a discreet manner. The alarm should be loud enough to notify the nurses but discreet enough not to alarm the other patients All windows and doors must be lockable Security The interior and the furniture inside the room should adopt a calming colour rather than stimulating Minimum Standard Transfer Coefficient of 35, Recommended value is 40, wall type 2. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade Acoustic Privacy pasterboard on the other side; or one layer 13mm thick standard grade plasterboard on each side of 92mm steel stud. Cavity infill of: 60mm polyester, or 50mm glasswool Minimum clearance of 1.2m must be available at the foot of each bed Minimum corridor width of 2.1m Movements for beds and Expansion joint covers must be flush with the floor surface to facilitate the use of wheelchairs wheelchairs Bedroom doors shall not swing into the corridors Doors to ensuite, toilets and showers must open out Floor finishes must allow easy movement of objects and easy on the foot Indicator Provide corridor indicator light to show which patient called for help Sanitary Provide a cliical scrub basin of large 'Medicex' type. It has to be wall mounted, hands-free operation (elbow, foot or electronic) Medical Gas Provide 3 oxygen gas outlet, 2 medical air outlet and 3 suction outlet Adequate lighting for clinical observation Lighting Provide a minimum of 16 power outlet Provide a camera and observation glass to keep in check with the patient's health condition Observation Each patient bedspace shall incude storage and writing provision for staff use Bedside Monitoring Bedside monitoring should be located to permit easy access and viewing, and should not interfere with the visualization of, or access to the patient. Floor finishes must use material which allows easy cleaning and discourage accumulation of dust Easy maintainance and Wall finishes must be scrubbable with smooth surfaces cleaning Ceilings shall be finished as to be readily cleanable with equipment routinely used in a daily housekeeping activities Cubicle screens, bed screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Anti-static flooring must be used for anaesthetising areas where flammable anaesthetic agents might be used Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Provide smoke management system Provide emergency lighting, detection and warning system Health Avoid using plastic & material which may release toxic gas Vinyl flooring must be used under all handwash basin Carpet must not be used Infection Control Skirtings must be installed at each corner of the floor, tightly sealed against the wall and constructed without voids Gaps are not allowed between: cupboards and floors or walls, or between fixtures attached to floors and walls Floors must be surfaced with smooth, impermeable seamless material (such as vinyl) to avoid accumulation of blood/body fluids To allow efficient circulation Minimum area of 12m2 in the room Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Provide beverage bay nearby for distressed relative Stress Relief Minimum clear door openings shall be 1.4m x 2.03m Wheelchair access The interior and the furniture inside the room should adopt a calming colour rather than stimulating Security Minimum Standard Transfer Coefficient of 40, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade pasterboard on the other side. Cavity fill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Acoustic Privacy Expansion joint covers must be flush with the floor surface to facilitate the use of wheelchairs Movements for beds and Doors shall not swing into the corridors wheelchairs Floor finishes must allow easy movement of objects and easy on the foot Floor finishes must use material which allows easy cleaning and discourage accumulation of dust Easy maintainance and Wall finishes must be scrubbable with smooth surfaces cleaning Ceilings shall be finished as to be readily cleanable with equipment routinely used in a daily housekeeping activities Cubicle screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Provide smoke management system Health Avoid using plastic & material which may release toxic gas

Rooms

Outpatient

Meeting Area

Stakeholder

Needs

Requirements Minimum area of 12m2 for single bedroom To allow efficient circulation Minimum bedsize is 2.25m x 1.05 m in the room Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m TV must serve as a media for the patient to talk with doctors and nurses. Patient Minimum clear door openings shall be 1.4m x 2.03m Wheelchair access The interior and the furniture inside the room should adopt a calming colour rather than stimulating Security Minimum Standard Transfer Coefficient of 40, Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade pasterboard on the other side. Cavity fill of: 60mm polyester, or 50mm glasswool, or light/heavy masonry Acoustic Privacy Expansion joint covers must be flush with the floor surface to facilitate the use of wheelchairs Movements for beds and Outpatient room doors shall not swing into the corridors wheelchairs Nurse/Doctors Floor finishes must allow easy movement of objects and easy on the foot Sanitary Provide medium wall mounted basin with hands-free operation (elbow or wirst) at each room Adequate lighting for clinical observation, this can obtained by providing adequate natural light or colour corrected artificial lighting or task lighting Lighting Floor finishes must use material which allows easy cleaning and discourage accumulation of dust Easy maintainance and Hospital Staff Wall finishes must be scrubbable with smooth surfaces, and In the immediate vicinity of plumbing fuxtures, the finishing shall be smooth and water resistant cleaning Ceilings shall be finished as to be readily cleanable with equipment routinely used in a daily housekeeping activities Cubicle screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Fire resistant Anti-static flooring must be used for anaesthetising areas where flammable anaesthetic agents might be used Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Provide smoke management system Government/ Health Avoid using plastic & material which may release toxic gas Regulator Vinyl flooring must be used under all handwash basin Carpet must not be used Infection Control Skirtings must be installed at each corner of the floor, tightly sealed against the wall and constructed without voids Gaps are not allowed between: cupboards and floors or walls, or between fixtures attached to floors and walls Floors must be surfaced with smooth, impermeable seamless material (such as vinyl) to avoid accumulation of blood/body fluids To allow efficient circulation Minimum area of 12m2 in the room Minimum ceiling height is 2.4m, while the optimum ceiling height is 2.7m Provide duress alarm Security Recommended value is 45, wall type 3. In other words, minimum 2 layers of 13 mm thich standard grade plasterboard on one side of 92mm steel studs, one layer of 13mm thich standard grade pasterboard on the other side. Cavity fill of: Doctor Nurses Staffs 60mm polyester, or 50mm glasswool, or light/heavy masonry Acoustic Privacy Provide at least two telephone outlets, depends on the size of the meeting room Technical Provide video and teleconferencing facilities Cubicle screens, curtain/window treatments shall be non-combustible or rendered flame retardant Expansion and seismic joints shall be constructed to resist passage of smoke Government/ Fire resistant Install fire fighting equipment, such as hydrants, hose reels, fire extiguishers, and sprinklers Regulator Provide smoke management system Health Avoid using plastic & material which may release toxic gas

Logistics providers Installation Contractors Medical equipment suppliers

Designing flexible modules Flexibility Reverse Logistics

After sales service

Adaptability to time and needs

Medical Staff

Customer service Customization

Hospital Management

Raw Materials suppliers

Modular/Prefab companies

Hospital Patients

Human Resources: Architects, Designers and Engineers

Reduced maintenance costs

Presentations during conferences on hospital design

Maintenance

Installation

Personnel Modules delivery and installation

Transportation

Partnership

Double Patient Room

Sink × 1

Wardrobe × 2

PANEL Light × 4

PANEL Low/extra low voltage equipment ×2 screen

PANEL Medical gas equipment × 2

PANEL Plain × 4

Single Patient Room

Sink × 1

Wardrobe × 2

Bed × 1

PANEL Light × 2

PANEL Low/extra low voltage equipment ×1 screen

PANEL Plain × 4

PANEL Medical gas equipment × 1

PANEL Plain × 4

ICU

PANEL Light × 2

Wardrobe × 2

Sink × 1

PANEL Low/extra low voltage equipment ×1 screen

PANEL Medical gas equipment × 1

PANEL Plain × 4

Ambulatory

Bookcase × 2

PANEL Light × 2

PANEL Plain × 6

PANEL Plain × 4

Break Room/ Oﬃce/ Meeting Room

Bookcase × 2

PANEL Light

×4

PANEL Plain

×4

Bookcase (low) × 1

PANEL Plain × 4