Built to move: covid-19 & modular walls

Principal, Salus Architecture, can be reached at dale.anderson@salus.archi

Surge capacity for healthcare facilities have become imperative in light of the current COVID-19 pandemic. Modular construction is well suited for speedy fabrication and assembly to provide such capacity. We thought you would find the following article by our principal Dale Anderson informative about our own experience with such construction systems.

Healthcare projects today, inpatient or outpatient, are fueled by client goals of achieving flexibility and reduced cost. In the design and construction world, the latest trend to answer those combined needs isn’t new at all—rather, it’s a new application of an old solution: prefabricated wall systems.

Also described as “modular” or “manufactured,” these wall systems comprise standardized components fabricated in a factory and shipped to a project site for assembly into desired room and space configurations. Flexibility and interchangeability were key characteristics that made them popular for decades in office settings and a worthwhile alternative to hard construction installations. It wasn’t until recently that manufacturers adapted the products in a way that made them suitable for healthcare environments. Improvements to acoustic performance, ability to support medical devices, receptivity to technology changes, and standardized sizes corresponding to medical facilities were accommodated to make the products more desirable for use.

Two recent healthcare projects where modular systems were introduced serve as examples of the applicability of this solution in various settings:

  • The Polyclinic Northgate Plaza—In 2016, The Polyclinic began developing clinic space in an existing five-story, 60,000-square-foot building with a 12,000 SF second floor initial build-out. The intent was to establish provider space one floor at a time and expand over multiple years. The Clinic didn’t own all the floors yet and decided to use a modular approach that could be adapted to each floor as it became available. The challenge was creating flexible exam room modules that could be modified at any given time, without disturbing tenants above or below through floor changes.

Image: Polyclinic Team Station
The Polyclinic’s new Northgate Plaza Clinic in Seattle used modular walls in the exam rooms and team stations to help the facility adapt to changing care needs.

EvergreenHealth Silver Tower—Evergreen Hospital’s Silver tower was designed and constructed in the mid-2000s and included multiple vacant floors for future development. In 2015, the Hospital was ready to finish two floors of progressive care units totaling 62 beds, recognizing there would be complications any time technology or utility services had to be upgraded, likely resulting in patient rooms temporarily being shut down and impacting hospital revenue. The Hospital decided an innovative approach was required and requested the use of prefabricated walls for any location that didn’t require fire- or smoke-rated assemblies, including headwalls and footwalls.

Image: Evergreen PCU Patient Headwall
For the new Progressive Care Units at EvergreenHealth Silver Tower in Kirkland, Washington, designers installed a manufactured wall system with integrated utilities, casework and doors that can easily accommodate future technology upgrades.


Both buildings were toured with facilities and staff members, interviewing the users about key decisions that helped them select the use of prefabricated walls. Seeing more demands for these types of applications in healthcare facilities, the driving forces behind the decisions to use these systems needed to be found.

Among the top reasons was establishing standardized care spaces and layouts to simplify assigning practices to any portion of the building and making future changes easier. Facilities teams often have ideals of establishing standardized room sizes throughout a building. Reality often dictates the use of many rooms that don’t meet that standard, resulting from column spacing and placement of stairs, elevators, and mechanical/electrical rooms. The case study facilities actually helped establish standardized care spaces working within manufacturers’ modular systems forcing them to achieve the goal of taking the first step to define functional uses in allocated spaces. For example, an exam room planned for 10 feet by 12 feet requires the wall system modules support the dimensional needs of this configuration. This offers the future ability of changing the configuration of the modules into smaller or larger rooms using standardized panel widths. Neither facility achieved 100 percent modularity, but both were in the 90th percentile.

Another driving factor was adaptability. This month a physician’s suite may be dedicated to primary care and next month it may be for pediatric care. A medical/surgical patient room may become an ICU patient room next year as service demands change. Facilities that are flexible and modular have the greatest advantage of allowing these adjustments. Keeping the walls where they exist and removing the face panel from the wall to access the framing system allows for low-voltage wiring, power outlet configurations, nurse call devices, and even plumbing to be installed, modified, or removed without tearing down walls. The facility directors surveyed noted this has huge cost-savings potential in reducing the days a room is inoperative to only 10-20 percent of the normal remodel schedule. Then the rooms can be restored to use and continue the revenue stream moving forward.


Both facilities have now been operational for a few years, and valuable feedback was offered from staff concerning challenges in implementation, cost impact, and overall satisfaction. Most agreed completing the projects was difficult in ways not expected. Working with a project team who hadn’t previously applied modular systems to projects was more challenging than anticipated. The design efforts required more intensive and interactive processes between the various design/construction disciplines and the product technical representatives understanding capacities and connections. Even rethinking the sequence of activities from design through construction was required as it related to which project components needed to be installed prior to others.

While overall project schedules didn’t change, the timing of activities had to be rearranged earlier or later than traditional construction to make the interface happen correctly. Although there were no expectations for a shorter project schedule, if the same owners were to engage in a similar project in the future, they expect that the process could be streamlined due to team members who are better educated and more familiar in the design and construction of these systems.

Project delivery also was complex as more components had to be delivered simultaneously competing for on-site storage space. The project team didn’t realize using component systems could mean the entire wall assembly shows up at the project site at one time and needs to be stored until installed. With these projects being build-outs of shell spaces or remodels of existing spaces, empty available space for this purpose is at a premium or nearly non-existent. Those interviewed said project teams would be well-advised to consider designers and constructors who have completed similar projects and understand these intricacies of communication and coordination.

Neither of the owners expected to save time or money with their first use of modular systems, but they do anticipate long-term benefits in reduced costs when spaces need to be reconfigured. First costs for these projects may need to increase to accommodate the modular components (they are more expensive than traditional construction), but long-term costs are reduced when considering future changes and remodeling that may occur.

Both facilities’ staffs said they would use the modular system again, and, in fact, are already using the systems as they continue to build additional floors in their facilities.

Designing for flexibility in healthcare is a necessity. Design and building professionals must understand how facility costs impact everyone’s bottom line and work together to implement solutions like modular systems that support streamlined and ongoing facilities projects.