In all my reading, research, and discussions on how buildings are executed and how to improve the speed with which buildings are constructed, I cannot find more than two solutions to speed things up: prefabrication and automation.

I have discussed prefabrication before. The idea is fertile and flexible, with a lot of work being done and major progress being made. From assembling off-site to using a standard kit-of-parts, prefabrication takes many forms and offers a lot of promise for increasing quality and decreasing time—both of which save money.

To me, automation is the last viable chance to make the construction process shorter. It could be argued automation started with computer assisted drawing (CAD). No doubt computers will become a more integral part of the design and construction processes.

In fact, automation may force a design and construction union where design is translated real time into the parts required for construction and analyzed from a manufacturing standpoint. In the future, the best design might be defined as the most feasible and efficient from a construction standpoint. Sure, this might have designers up in arms, but I think this is where things are headed: Things are all merging and overlapping and influencing one another, not diverging—even as people try to carve out careers as being super-specialized (healthcare acoustic designer or facade specialist, anyone?).

Automation is an intuitive choice because it reduces the fallibility of humans (much of the risk and expense) from the construction equation. If a contractor could count on even 95% accuracy in the work done, along with perfect attendance, choir boy behavior, and a perfect safety record, would he not institute such a system? Automation may offer this.

Building production can be very similar to automobile production—a lot of systematic, repetitive work. This work can be broken down into repetitive parts, assembly line fashion; no wonder Lean design grew out of the Toyota Production System. Although Lean is not applied to healthcare design, Lean processes would likely make sense in an automated healthcare construction system.

Robots and mechanized assembly might first creep into production when erecting steel. Instead of men tied off on lifts or contorted in space and blown around, trying to seat trusses, weld, or bolt massive and heavy elements, this might be done via automation. Instead of hand-tying rebar cages, vibrating and manually leveling concrete, a machine or robot could do this. Masonry, fastening of metal stud track and studs, painting large walls—anything repetitive could be automated either on-site or off-site and brought to the site for assembly in large parts for quick erection, or fast execution.

With anything automated, the initial backlash is loss of jobs. The labor might be reduced, but there will likewise be a need for individuals to run, service, and oversee the machines and robots that do the work. More questions than answers exist; yet at a time when construction time adds so much to project cost because of human resources, the long-term ways to save money appear to involve controlling time through labor. I think automation has a valuable future in healthcare construction.

Lee writes on healthcare design, project, and strategy topics in his blog, “Owner’s Toolbox” at