We are at a crossroads in healthcare
construction where the speed of
medical innovation has outpaced
the capability of conventional
construction. Structures constructed
using conventional methods cannot
economically, easily or quickly be
adapted to accommodate the latest
therapeutic technology.
Imagine working on a structure for 134 years and still
having another 10 years of scheduled construction! If
your building’s function is rooted in religion, its value
may never be diminished or lost; and perhaps the
journey itself may be a spiritual one.
The Sagrada Família is expected to be finished for the
centennial of Architect Antoni Gaudi’s death in 2026.
This Barcelona Cathedral started construction in 1882
and was consecrated in 2010 giving it a head start
on providing services to its parishioners – if one can
imagine calling 128 years after groundbreaking a “head
start.” History has recorded Gaudi’s response to the
exceptionally long schedule as: “My client is not in a
hurry.”
By contrast, imagine that your cancer facility took
only several years to fund, design and construct and,
when completed, was only the third medical proton
facility of its kind in the USA. One would think it was
pretty special, but the facility closed in 2014, just 10
years after opening due to several factors leading to
obsolescence.
How fast are you building opportunity?
We are at a crossroads in healthcare construction
where the speed of medical innovation has outpaced
the capability of conventional construction. Structures
constructed using conventional methods cannot
economically, easily or quickly be adapted to
accommodate the latest therapeutic technology.
The Indiana proton facility closed during a boom in
the market largely because it was unable to remain
competitive with the newer proton devices. Moreover,
the building was a slave to obsolete technology. The
radiation activation from the cyclotron means that
multiple isotopes in the concrete will remain above
legal clearance levels for radioactively contaminated
materials for decades. What value is this structure now?
And could they have seen this coming?
The traditional 50 year useful lifecycle of a building has
been turned on its head. Medical science is moving
at the speed of Moore’s law doubling every few years
while central planners imagine structures will continue
to function for at least half the life of a cathedral.
Along with technology are changing demographics,
populations and markets which can likewise lead to
facility’s obsolescence
If you are part of the radiotherapy or nuclear industry,
you understand the role of physics in both equipment
and structures. Many will recognize the name Edward
Teller, a theoretical physicist who worked on the
Manhattan Project and later became known as the
father of the hydrogen bomb. He was one of the titans
of nuclear physics along with Oppenheimer, Lawrence
and Ulam.
“If accelerating technology has already passed our ability to adapt, Le us
argues, then surley it has outgrown the facilities that inhibit them. The Teller
graph shows why new methods must be used to adopt faster”.
Today we have “Google X”, also known as the
Moonshot Factory, which is the research and
development subsidiary of Google focused on
large scale changes and advancements rather than
incremental, gradual changes. Their leader, “Captain
of Moonshots,” is Astro Teller, the grandson of Edward
Teller. He is a Stanford undergrad with a PhD in Artifi cial
Intelligence from Carnegie Mellon University.
Astro Teller was interviewed by Thomas Friedman while
writing his book, Thank You for Being Late, an optimist’s
guide to thriving in the Age of Accelerations. The
book, along with the Teller discussion, is an illustration
of how accelerating advancements have outstripped
man’s ability to absorb and adapt. If you were born in
the Middle Ages, 100 to 200 years had little impact
on how you lived. At the turn of the last century, the
time in which lives were impacted by technological
advancement may have been reduced to a generation
or two, roughly 30 years or more. Today, Teller claims,
new technology emerges every 5 to 7 years that makes
that world feel “uncomfortably changed.”
And if it takes society 15 years to adapt, govern and
feel comfortable around new technology, there is a
gap between changing technology and our rate of
accommodation. These shorter innovation cycles
demand we take a new approach to challenges once
solved by traditional methods.
“The time of static stability has passed us by,” Teller
is quoted. “That does not mean we can’t have a new
kind of stability, but the new kind of stability has to be
dynamic stability. There are some ways of being, like
riding a bicycle, where you cannot stand still, but once
you are moving it is actually easier. It is not our natural
state. But humanity has to learn to exist in this state.”
So how does one apply “dynamic stability” to the
construction of medical facilities? And perhaps, why
should you?
“We have to stop thinking in cathedral time,” states
RAD Technology Medical Systems President John
Le´ us. “Speed to market and our ability to change
have to be accelerated. Before concrete can cure,
the next greatest solution may have already been
introduced.”
Building a Better Way
We can start by looking at advanced therapeutic
medical facilities in terms of 5 to 15-year business
cycles. Longer than that, you are just betting against
technology. Here is where the traditional brick and
mortar approach falls short. The protracted time
to market, the lack of flexibility in adopting new
innovations and 50 year expected economic lifecycle
make pouring concrete yesterday’s technology. The
“lock-in” to an unlikely 50-year lifecycle expectation is
no longer tenable.
nstitutional modular construction solves many of these
challenges. The speed to market is often half the time
or less versus traditional construction and it comes with
key advantages. The modular structures, or parts of
them, can be later removed, replaced or reconfigured
with new modules catering to the latest technology
Perhaps more significant is that instead of using capital
funds to invest in bricks and mortar, clients can simply
rent or lease the solution for whatever period of time
makes sense, often on par with the expected life of
the medical technology. This eliminates balance sheet
impairment and capital challenges while providing
increased revenue and capabilities.
“After 35 years in specialty institutional modular
construction, Lefkus shares, the superior quality of
factory construction remains the industry’s best secret.
Anyone who has spent time in the field knows how
weather and physical conditions can impact quality.
It’s not hard to imagine how a welder in a heated
factory, working at a waste high jig, can perform better
than one bundled in overalls on a 25 degree day
working on a ladder with temporary lighting. With most
adhesives and paints being water based today, the
extreme temperature and humidity conditions in the
field wreak havoc on all types of finish operations. And
no one would dig a foundation by hand today when
we have modern excavators that do a better and faster
job. The same holds true with factory construction
where factory fabrication methods are simply superior
to field solutions.” Modular factory construction, like
many manufacturing technologies, will continue to
see accelerated innovation and improvements over
conventional site techniques. The precision of CNC
and robotic manufacturing will continue to offer greater
accuracy and speed.
A great illustration on just how dynamic a medical
modular structure can be is the installation of a fully
functioning radiotherapy facility over the course of one
year produced by RAD. This structure houses a 10 MV
linear accelerator generating x-rays up to 250 times the
energy of most conventional diagnostic devices. Before
you criticize the one-year time frame of being good,
but not great, you need to know it was installed three
times in three different cities spanning 2,400 miles over
the course of that year. Starting in New Hampshire, and
with a stop in Colorado’s Vail Valley before going on
to Idaho, the TRV was repeatedly erected in about 14
hours and made ready in only 5 days.
Just the installation and commissioning of the average
medical accelerator usually takes over 100 days and
yet RAD provides pre-commissioned equipment and
the entire facility in just over 100 hours. This is stability
while moving and what dynamic innovation looks like.
Without the use of an interim facility and equipment
provided by RAD, cancer treatments for patients could
be stalled for several months while institutions upgrade
their equipment and perform renovations.
“Not content to merely match the old norms, I have
sought out opportunities in my career as a modular
builder where factory construction can outperform and
achieve superior solutions over traditional construction,
states Mr. Lefkus. “Many of our clients, confronted with
a choice between taking a chance on our modular
approach or simply doing nothing, have recognized the
value and witnessed the power and versatility of our
approach.”
Accelerating advancements are served optimally by
factory structures such as those deployed by RAD
Technology. These solutions fit comfortably into the 5
to 7-year innovation cycles and bring new economic
solutions that accompany the new technical ones.
With the dawn of telemedicine, remote learning and
online retailing, the current brick and mortar facilities
that serve the outdated models will find it difficult, if
not impossible, to repurpose themselves in the age of
dynamic stability.
How fast are you building opportunity?
RAD Technology Medical Systems is a design-build
construction company that provides revolutionary
modular building systems for the healthcare industry
complete with equipment and lease options. These
turn-key solutions are factory fabricated eliminating
the need for lengthy on-site construction and can be
temporary, interim or permanent. For more information,
please visit radtechnology.com.
This article originally appeared in the Modular Advantage Magazine - First Quarter 2018 released in February 2018.