Construction Industrialization and Use of Prefabricated Elements Applied in Hospital Buildings Production: Case Study in The Technology Center of The Sarah

Network of Rehabilitation Hospitals (Ctrs), Brazil

Lukiantchuki, M.A. Postgraduate Researcher at São Carlos School of Engineering, University of São Paulo, Brazil

(email:marieli@sc.usp.br) Caixeta, M.C.B.F.

Postgraduate Researcher at São Carlos School of Engineering, University of São Paulo, Brazil (eamil:michele@sc.usp.br)

Fabricio, M.M. São Carlos School of Engineering, University of São Paulo, Brazil

(email: marcio@sc.usp.br)

Abstract

The construction industrialization based on the use of prefabricated elements has been widely applied in civil construction, seen as a great improvement in the progress of construction. This system rationalizes the material use and optimizes “human labor”, nevertheless it demands a great technical knowledge and improvement and brings the need for control and guarantee of construction quality. Moreover, the use of industrial constructive systems is more rational and economical, reducing losses, raising productivity and providing less environmental impact. The Technology Center of The Sarah Network of Rehabilitation Hospitals (CTRS) - stands out as a Brazilian reference case of design and production of industrial hospital buildings. From the manufacturing facility in Salvador, state of Bahia, managed by the architect João Filgueiras Lima (Lelé), the CTRS developed and built hospitals in eight Brazilian capitals and other cities, from industrial parts and components fabricated in its factory. This production is remarkable for its architectural quality, for the use of “closed industrial construction system” and for innovative design solutions, focusing on hot climate buildings’ thermal comfort, with extensive use of natural ventilation. This work aims to study the production in CTRS, as a Brazilian reference on closed industrialization of hospital buildings. The analysis will be performed by a descriptive case study of product development process of design and production, focusing on the construction system developed. The results are the contextualization of the CTRS production, highlighting the importance of the design and the use of prefabricated elements for the quality of constructive, spatial and thermal comfort solutions and for the building flexibility to the fast advances, new technologies and new medical procedures, thus facilitating the maintenance and expansion stages. This work shows that production of the ferrocement elements in the factory mentioned provides less waste, greater technological control, greater efficiency and rationalization of working sites, together with formal innovations and high architectural quality. Moreover, the construction systems used by the architect allow the hospital structure to be more flexible in both

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aspects: the maintenance and future extensions, resulting in better functioning and suitability for new technologies.

Keywords: construction industrialization, prefabrication, healthcare architecture, lelé

1. Introduction

This article aims to analyze production process at the Technology Center of The Sarah Network of Rehabilitation Hospitals (CTRS), because this has a full course of civil construction, since at CTRS, the teams design the building, produce the prefabricated elements, perform the building assembly and carry out the maintenance of hospitals. Because of this, this work will analyze both production at CTRS and the performance of these systems in these hospitals, through collected data in specialized texts, site visits and interviews with professionals related with this issue.

The CTRS is located in Salvador, state of Bahia in Brazil, and is responsible for the industrialized construction of The Sarah Kubitschek Network of Rehabilitation Hospitals, that constitutes a non-governmental organization dedicated to health promotion, working in the rehabilitation of locomotor system diseases. The Sarah Network is constituted by ten hospitals, the first being in 1980, in Brasília, and later others were built in the cities of São Luís, Salvador, Belo Horizonte, Fortaleza, Rio de Janeiro (Children’s Center), Brasília (North Lake), Macapá, Belém, and again in Rio de Janeiro (hospital) opened in the year 2009, as shown in Figure 1.

Designed by the architect João Filgueiras Lima (Lelé), these hospitals, with ferrocement and steel industrialized construction systems, are the major contemporary Brazilian example in this area.

The architect João Filgueiras Lima, known as Lelé in the Brazilian architectural community, graduated in 1956 and since the beginning of his professional career was in contact with streamlined methods of construction, highlighting its work in construction of the new capital of Brazil, Brasilia, and also the period when he was in Eastern Europe, studying prefabricated building systems.

Together with doctor Aloysio Campos da Paz and with the economist and engineer Eduardo Kertész, Lelé created the Sarah Network from a document prepared in 1976 under the name of the Health Subsystem in Locomotor System Area. Lelé and Aloysio discussed the possibility of the hospital to have a different perspective, and from this they have matured the proposal over at least 13 years (Menezes, 2004).

Lelé’s architecture is characterized, therefore, by the quest for rationalization and industrialization of architecture. The use of prefabricated ferrocement technology gave the best technical conditions for shipping and parts have great resistance with a few centimetres in thickness, making them more lightweight and flexible.

Lelé suits the Sarah Network designs to technological and environmental needs of the hospital program, establishing principles that guide all buildings of the network, such as building elements

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standardization, green spaces, natural lighting and ventilation, among other aspects that help in the patients healing process. In Brazil, as a tropical country, and by the fact that most of these network hospitals is located in hot and humid weather regions, the use of natural ventilation as a strategy for achieving thermal comfort is essential. Not only it provides more pleasant and wholesome environments, but also avoids the air conditioning and therefore the excessive energy consumption.

Figure 1: Hospitals of Sarah Network. Source: (CTRS Collection, 2008).

The CTRS production is based on prefabrication of structure, walls, facilities, among other things. It can be characterized as a closed loop industrialized building system, in which a single company or organization is responsible for the production of constructive subsystems and determines the compatibility rules between components and, therefore, dominates the product technology and development process (Camargo, 1975 and Serrano, 1980).

The prefabrication systems are applied to all stages of the building, from the superstructure to hospital objects, such as bed-stretcher. Later, these same prefabrication systems of components, natural lighting and ventilation are applied in other projects of the architect, as the administrative centers in different Brazilian cities.

Prefabrication has been widely applied in large buildings. Despite of a little higher cost compared to traditional construction methods, its use is justified by the reduction of work stages, allowing the faster completion and better organization of the work. This streamlining enables the construction by optimizing the work on site, due to part of the production process being moved from site to factories. It is also important to consider its use since the design conception so that a satisfactory outcome can be achieved (Oliveira et al, 2002).

Lelé was usually engaged with construction techniques and pre-fabrication enabled the creation of elements with his own shapes, and in hospital architecture he improved the industrialization of these elements, creating more functional and lightweight compositions.

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2. Research method

This work was based on a case study in the CTRS and uses multiple evidence sources: field research through interviews with professionals related to the theme and site visits. The work began with an extensive literature review - that is not fully presented here – in order to get theoretical tools necessary to understand the features involved in Lelé’s production. After that, we visited the CTRS in Salvador to collect data and to know how Lelé’s entire staff works and the production process at the CTRS. During this visit, it was possible to see the collection of projects developed by the architect, which is composed of explanatory documents, designs, images and models.

Later, there was made an interview with the architect Lelé, in order to understand the design conception process and the CTRS operation. Next, the structural engineer Roberto Vitorino, who is responsible for the structural design of the Sarah Network Hospitals and who plays an important role in the industrialization process was interviewed.

Some hospitals of the Sarah Network were also visited. There were two trips to Rio de Janeiro, one during the construction and another when the building was almost complete. In these trips, it was possible to speak with the architect Adriana Filgueiras Lima, which is responsible for coordinating the hospital construction in Rio de Janeiro. Later, the hospital in Salvador was visited, when the architect Neuton Bacelar was interviewed. He attended the hospital construction in Salvador and is currently a member of Lelé’s staff, responsible for the maintenance of this hospital. And finally, the hospital in Brasilia was visited, where it was possible to analyze the building process of the network first hospital. The data collected on site in the hospitals were carried through photographs, design analysis and building systems.

3. The construction of the sarah network hospitals: a differentiated technology by the CTRS

When the management contract was created, at the beginning of Sarah Hospital Network, one of the goals was to extend the network throughout the country. Thus, it was decided to create the Technology Center in Salvador with the main purposes: to design and implement the network buildings based on industrialization, looking for economies and speed in construction, to design and implement hospital facilities if they offer advantages over market and perform buildings and equipment maintenance of all network units (Latorraca, 1999).

3.1 Design conception process

The conception of the Sarah Network hospitals is multidisciplinary. It involves professionals from different areas, such as architects, civil engineers, mechanical engineers, among others. The person responsible for architectural design and technical coordination is the architect Lelé, who manages the

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whole designing process and supervises every detail thoroughly. This greatly facilitates the subsequent stages: assembly and maintenance.

Table 1: Coordinators responsible for the design sectors in the CTRS

Design Sector Number of coordinators Designers on team

Architectural design and technical coordination

01 - João Filgueiras Lima --

Design teams 02 09

Consulting in Thermal Comfort 01 09

Landscape Architecture 02 02 Source: CTRS Collection

Related to hospital equipment, there is a selected engineer responsible for solving the hospitals automation, such as movable frames, training swimming pools, among other things. Furthermore, there is a landscaping architect responsible for the landscaping of the hospitals. Lelé also had the collaboration of the artist Athos Bulcão, who died in 2008. He was responsible for the integration of artworks.

The architectural design conception takes place simultaneously with other projects. First, the architect makes a sketch of the building and meets the structural engineer Roberto Vitorino, so that the architecture and structure design can be developed together. At this stage, they also talk to the mechanical engineer George Raulino, who is responsible for the calculations of the heat load and the air conditioning ducts so that the whole architectural design is scaled according to these requirements. It optimizes time and also provides a full integration among architectural design, structural design, electrical, hydraulic, and others, seeking a better functioning building in practice.

As the offices of Lelé and the majority of his team is in the CTRS, the design process is facilitated because at the same time a prefabricated piece is designed in the offices, it is performed in a workshop beside the offices, analyzed and coordinated by the architect. The excessive caution with the architectural design conception, with the production of prefabricated parts and the assembly of the buildings happens because all steps are performed by Lelé’s team, including the maintenance.

The architectural design developed reaches a high level of detail. In order to assist in the manufacture of parts and later in their assembly in the construction site, the details are made in a 1:1 scale, even the screw fittings. In one hospital design, the details reach 10,000 drawings (verbal information)1. Moreover, we draw a diagram to show how to assemble on site, to make process easier and faster. This procedure is important because the CTRS is located in the city of Salvador, and most of the hospital network is located in other cities, like Rio de Janeiro, Fortaleza, Brasília, among others.

1 Interview realized with the architect João Filgueiras Lima, in November 18th, 2008.

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Another important aspect is the modulation. In complex buildings standardization it is important, such as hospitals, which requires a fast and streamlined constructive method, not only to increase productivity but also to the design compatibility. Thus, in Sarah hospitals, it has established a modulation which enables greater precision in measures, improving the relationship among the various designers. This modulation is used in architectural, structural, electrical and hydraulic designs, and also in the manufacture of prefabricated parts.

Sarah Network Hospitals are a successful example of modulated systems use. Lelé says he has already used modules as 1.10 m and 1.20 m (Carvalho and Tavares, 2002), however, he believes that adopting a measure for module is also a matter of common sense, because it is difficult to define which the best module is. Currently he uses the module of 1.25 m and its multiples, because it is working better and has a lot of advantages, which will be shown forward.

First, the modules adopted previously had problems with flooring materials – pressed melamine and porcelain, basically. In Sarah Hospital Network, they use pressed melamine in pre-cut pieces of 0.625 m, thus following the basic modulation of 1.25 m. The ceramic pieces that they use have 50cm, which is not compatible with the module of 1.20 m. The module of 0.625 m makes the placement of floors easier, rationalizes the use of materials and reduces waste (Carvalho and Tavares, 2002).

The Sarah wards are large halls that allow the patient mobility. However, it is possible to isolate each bed when privacy is necessary. Each bed boxes has a measure of 2.50 m, which is also facilitated by the module of 1.25 m (Carvalho and Tavares, 2002).

The electrical installations are inserted into rails that run horizontally by steel beams or in vertical ducts. These rails and ducts are also useful for fire and hydraulic plumbing and air conditioning facilities. Thus, the solutions are standardized and it decreases the variety of materials (Carvalho and Tavares, 2002). The ferrocement walls follow the modulation, which has a width of 0.625 m. The structural design also follows this modulation, which can be seen in the roof trusses and frames. Unlike the horizontal dimensions, there is no modulation in the vertical direction, which is determined according to the need of the project.

3.2 Production: technology center of sarah network of rehabilitation hospitals - CTRS

In 1992, the CTRS began operating in temporary premises, and the permanent premises appeared only in 1993. The Center was established at the same site of Sarah Kubitschek Hospital, in Salvador, with about 20.000m2 of built area (Latorraca, 1999). The Center is configured by connected one-floor buildings, with 6 meters high, where the workshops – shown in the table 2 – function.

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Table 2: Workshops and Sectors of Technology Center of Sarah Network of Rehabilitation Hospitals - CTRS

Workshops / Sectors Managers Workers on team Functions

Administrative Superintendence

01 14

Facilities 03 Data not available

Structures 03 Data not available

Light Metallurgy 01 28 To execute small structures, such as furniture and hospital equipment

Heavy Metallurgy 01 31 To execute steel components , such as frames.

Ferrocement 01 16 To make wall pannels, retaining wall, among others.

Joinery 01 25 To make wood components, such as doors and furniture..

Plastic 01 12 To make components with injected plastic and fiberglass to construction and equipments.

Painting Data not available 08 To paint metal,wood and plastic pieces with

electrostatic-based epoxy and polyurethane

Maintenance/cleaning/

security Data not available 37

Automation 03 13

Visual Communication 01 04

Assembly on site 01 ~ 03

(depending on hospital size)

Data not available

Source: CTRS Collection

It is important to remember that within each sector described above, there are many other professionals, such as workshops workers of the CTRS.

The building system of Sarah Network Hospitals is composed by prefabricated components produced in the CTRS in Salvador. The system is basically constituted by a metallic structure and ferrocement wall panels. This allows great flexibility and makes the stages of construction assembly and especially the maintenance and future expansions of the building easier. In Health Care buildings it is very important because the flexibility allows adaptation to the new techniques of care, treatment and new equipments. According to Pressler (2006), although that requires a higher initial investment, the flexibility can result in increased operational efficiency and staffs, as well as potential economics in

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futures projects. In the case of Sarah Network Hospitals, as the production is industrialized, this initial cost is reduced, allowing flexible enterprises.

Upstairs in the workshops, there are mezzanines from where it is possible to overlook the workshops where they develop the technical, management sectors and cloakroom. In this same place Lelé’s office is located, who supervises the whole production. The interconnection of workshops happens through corridors superposed on two levels. The upstairs corridor serves the offices and cloakroom and the downstairs corridor serves supply and intercommunication of the production sectors (Latorraca, 1999). This integration between building and production is fundamental, according to the architect.

Figures 2 and 3: Heavy and light metallurgy workshops (Lukiantchuki, 2008)

Figures 4 and 5: Ferrocement and Painting workshops (Lukiantchuki, 2008)

The heavy metallurgy workshop produces heavier elements and structures, using the technology of steel beams which guarantees a specific design of the pieces (verbal information)2.

In the ferrocement workshop are produced all of the divisions of the hospitals. The reinforcements are made in industrialized steel tissue and special steel to counteract mechanical and specifics efforts. The ferrocement is mixed in cement machines and distributed mechanically to the posts of melt, which is injected by gravity in metallic molds using a funnel. This process is aided by vibrators attached to the

2 Visit in the CTRS, on November 19, 2008, guided by architect André Borém

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molds which guarantee a homogeneous distribution of the material, avoiding possible bubbles. After the molds filled, they are lifted by cranes and immersed in the tanks with water at 60°C – that accelerates the cure process with protection against contraction – which takes about 4 hours. After curing, these molds are transferred in a translation mechanic system where they go through unmolding. Subsequent to defacing, the pieces are transferred to the quality control (verbal information)3.

After unmolding, it’s necessary to finish the parts to remove burrs, sanding, and others aspects that require refinement. After this process, the walls are ready and they are put in storage, and later on taken to the building sites. The CTRS has a production capacity equivalent to 3 or 4 cycles per day.

After the components are ready, they are taken to the painting workshop, where the pieces receive the final touches, and when the paint is dry, the pieces are packed. The materials are stored in marked and specified boxes to facilitate the work on site.

The making of the covers is a rigorous process, because Lelé’s architecture is marked by curved roofs through the use of sheds. The radius of sheds established in the Project is designed on the ground as basis for the workers. The tiles go through a calender several times until they reach the desired radius.

Figure 6: Roof with curved sheds (Lukiantchuki, 2008)

In the light metallurgist workshop, based on the use of steel, elements that require a more rigorous finishing are produced, such as frames, furniture and hospital equipments.

In the first Sarah Network Hospitals, all frames were opened manually and now they are motorized. These mechanical and automation parts have a high technical rigor and all of theses parts are manufactured in the CTRS, at the mechatronics and electronics sector, in the Light Metallurgy.

As examples, there are the frames of the hospital in Rio de Janeiro, which are all motorized: the pool developed by the architect for the patients’ training, the bed-stretcher, which has movable height, is designed to facilitate the transfer of patients from stretcher to chair, and Sarah hospital trolley in

3 Ibidem

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Salvador, which transports patients from the lowest to the highest point of land. In addition, the cars that transport the patients are also developed in the CTRS.

The joinery is a smaller workshop and is responsible for manufacturing finishing elements - doors, partitions, among others – and furniture, such as cabinets and shelves. In the plastic workshop they make plastic chairs for the reception, fans, among others. Furthermore, the CTRS produces all visual communication elements to the hospital, such as warning and alert signs.

The average potential of production in the CTRS is one equipped hospital with 200 beds, worth 35 million dollars per year. But its potential may reach double: 70 million dollars per year, with no loss of quality or increase of production costs. The minimum production to keep it economically viable can not be less than 11 million per year (Antunes, 2008, p.63)

3.3 Transport

The easiness of transport of the pieces is very important for the Sarah Network Hospitals because all the components are produced at CTRS in Salvador and later taken to the hospital building site throughout the country. Thus it was necessary to consider the transport in the production process. Although the factory is located near a maritime port, the means of transportation chosen was trucks because of just one load-unload at the factory-site, and because there are Sarah Network Hospitals in several Brazilian states and many hospitals are distant from coastlines – two loading-unloading process would be necessary, thus putting pieces at risk of damage. Plus, it makes it simpler and more affordable (verbal information)4. The pieces were designed keeping the size of the trucks in mind to make the loading and the transportation of the components as regular and as fast as possible. According to structural engineer, must be avoid the use of larger trucks, especially those that exceed the length established by law and require auxiliary traffic vehicle.

3.4 Assembly

In the case of industrialized construction, the architecture and structure of the hospitals are designed considering the stages of assembly. This includes in the detailed projects, how the pieces will be mounted, what type of crane will be used, among other factors.

All the assembly of the parts produced at the factory is done at the construction site through joints and welds. The data colleted in the case study shows concern with the easiness of assembly through meticulous instructions in order to avoid mistakes. Besides, there is great attention paid to the structuring of these “plug-ins” to guarantee the efficiency and quality of work.

4 Interview with structural engineer Roberto Vitorino, November 19, 2008

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During the production, purposeful slacks are left. The parts are made with smaller sizes than the module. These slacks are proportional to the size of the pieces. Thus, problems during the construction are avoided and that diminishes the waste of parts. According to interviews, these errors are due to cut or fold of the sheets for example, but don’t admit mistakes because of inattention. If there are errors that compromise the construction quality, the pieces will be returned to the factory to be repaired or replaced.

In some specific cases of more complex structures, such as the auditorium’s roof of Rio de Janeiro hospital, the pieces are pre-assembled at the factory, pre-welded at the corners to make sure they fit together. After making sure that the pieces are not defective and the mounting is correct, the structure is dismounted and then transported to the construction site. According to the interviews, this is justifiable because possible mistakes are easier to be found in the factory. That happens due to the complexity of the structures – and it is easier and faster than having to return the pieces to the factory all the way from the construction sites kilometers away.

The case study shows the preoccupation of the coordinator team in accomplishing the more complex activities in the factory, because the labor is more qualified and the work environment better. That takes place because of the comfort, the resources and the proximity between production, workers and technical team of architects and engineer.

4. Final considerations

We can say that the Technology Center of The Sarah Network of Rehabilitation Hospitals (CRTS) isn’t only a factory, but a Research Center too - for improvement and quality of its products and production. The work of the architect at the CTRS does not agree with the view that prefabricated parts provide monotony and cramp the creative process.

Besides, prefabricated construction makes the maintenance of the buildings simpler and faster when parts need to be repaired or replaced. This guarantees building quality throughout its life cycle.

Thus, the closed systems have benefits and a big advantage in large scale production using the mass industrial method over regular construction. This allows costs reduction by production unit, and the expansions of technological quality and constructive system content, guarantying the integration between constructive components. The logic of mass industry also allows a great project investment and detainment of constructive system, because the investments will be diluted in the production series.

The difficulty of their systems is the necessity of higher constructive components production relatively standardized, implying some kind of homogenization of the aesthetic language of buildings from the same construction systems. However, the production of Sarah Network Hospitals shows that this doesn’t mean unimaginative or low quality construction, even though it is standard architecture.

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Nowadays, although the Center can produce in large scale, it has a low production because it is only allowed by the government to produce exclusively to the Sarah Network Hospitals and there is no prevision of new units to be built at the moment. Thus, the CTRS is working basically to guarantee the maintenance of existing units, thus being rather idle. According to the architect,

The Tribunal de Contas says that we are creating competition against the private construction company, so the government has prohibited us to produce anything to other companies other than the government’s – which means we have to work exclusively to Sarah Network. We predicted an expansion of this factory, but had no choice but to stop our projects because the current Sarah Network Hospitals don’t need any expansions, although many other hospitals desperately do. (Lima (Antunes, 2008)). 2004 apud Antunes, 2008, p. 58-59).

Bibliography

Guimarães, A G (2003) João Filgueiras Lima: O ultimo dos modernistas. Dissertação (Mestrado) – Escola de Engenharia de São Carlos, Universidade de São Paulo, São Carlos.

Latorraca, G (1999) João Filgueiras Lima, Lelé. São Paulo, Instituto Lina Bo e P. M. Bardi.

Menezes, C (2004) O que é ser arquiteto: memórias profissionais de Lelé (João Filgueiras Lima), Rio de Janeiro, Record.

Oliveira, L A, Souza, U E L and Sabbatini, F H (2002) “Produtividade da mão-de-obra na execução de fachadas com painéis pré-fabricados arquitetônicos de concreto”, Encontro Nacional de tecnologia do Ambiente Construído, Foz do Iguaçu.

Pressler, G R (2006) “Born to flex: Flexible design as a function of cost and time”, Health Facilities Management, Volume 19, Issue 6, Pages 53-54, 56, 58, June 2006, Chicago.

Carvalho, A P A, Tavares, I (2002) “Modulação no Projeto Arquitetônico de Estabelecimentos Assistenciais de Saúde: o caso dos Hospitais Sarah”, III Fórum de Tecnologia Aplicada à Saúde, Faculdade de Arquitetura da Universidade Federal da Bahia, Salvador.

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