Integrated Approaches to Design for Manufacture and Assembly: A Case Study of
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Huoshenshan Hospital to Combat COVID-19 in Wuhan, China
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Tan Tan
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, Grant Mills
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, Jiqiang Hu
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, Eleni Papadonikolaki
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Ph.D. Candidate, Bartlett School of Sustainable Construction University College London,
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UK, WC1E 7HB, email: tan.tan.17@ucl.ac.uk
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Associate Professor, Bartlett School of Sustainable Construction, University College
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London, UK, WC1E 7HB, email: g.mills@ucl.ac.uk
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Vice General Manager, CITIC Digital Intelligence (Wuhan) Technology Co.Ltd, Wuhan,
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China, 430070, email: hujq@citic.com
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Associate Professor, Bartlett School of Sustainable Construction, University College
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London, UK, WC1E 7HB, email: e.papadonikolaki@ucl.ac.uk
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This is the peer-reviewed, post-print version of the paper:
Tan, T., Mills, G., Hu, J., & Papadonikolaki, E. (2021). Integrated Approaches to
Design for Manufacture and Assembly: A Case Study of Huoshenshan Hospital to
Combat COVID-19 in Wuhan, China. Journal of Management in Engineering, in
press.
This material is shared under the permission of ASCE, and may be downloaded for
personal use only. Any other use requires prior permission of ASCE. The official version
of this paper may be accessed at LINK_TO_INSERT
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Abstract
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Rapid deployment of modular hospital facilities has become an essential action in the COVID-
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19 response. Design for Manufacture and Assembly (DfMA) has played a significant role with
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governments commissioning emergency hospital projects. Due to the conflict between some
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DfMA strategies/guidelines, their integration requires further thorough investigation. This
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study aims to explore the integrated approaches to DfMA. A three-step method, including a
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focus group, eighteen designer interviews, and archival study, formed the basis and validation
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of the case. Finally, the study identified 31 DfMA measures, revealed three organisational
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(concurrence, integration and collaboration) and five design attributes that correspond with
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integration strategies for DfMA. Critical to the integrated approaches to DfMA is breaking the
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"mirroring trap". This study contributes to the theory development of DfMA in terms of systems
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integration. Future practitioners can take the example by the case to adapt the project
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organisational structure to the building production.
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Keywords: design for manufacture and assembly, DfMA, healthcare, prefabrication,
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1. Introduction
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According to the World health statistics 2019, more than half of the world's 7.3 billion
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people cannot access the essential health services they need. In response, a United Nations goal
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aims to improve health-related sustainable development and achieve universal health coverage
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by 2030. Healthcare buildings will play a critical role (Mills et al., 2015), although the shortage
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of healthcare capacity and inefficiency in healthcare building delivery remains a significant
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challenge (Gray et al., 2014; Iskandar et al., 2019; Wright et al., 2019). The outbreak of the
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COVID-19 pandemic has intensified the global consensus on these challenges. Some countries
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are trying to expand the healthcare capacity in a short period and smooth the virus's expansion
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speed through rapid healthcare construction projects (Cai et al., 2020; S. Chen et al., 2020;
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Feng et al., 2020; Zhou et al., 2020). Off-site construction techniques and Design for
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Manufacture and Assembly (DfMA) play a significant role and support the preparedness for
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future pandemics.
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Although different modern construction technologies (e.g. component prefabrication, and
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volumetric solutions) have been applied in current practice, many studies have a technical focus
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on the construction phase rather than design (Ali et al., 2008; Arashpour, 2019; Melhado, 1998).
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This is surprising given the significant impact of design and particularly in the complex
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healthcare setting where DfMA strategies have rarely been explored in academia. DfMA was
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introduced from the manufacturing industry(Arashpour, 2019; Gao et al., 2020), but significant
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adaptation is needed to address complex healthcare construction projects. Although some
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studies have explored DfMA in the construction industry, there is a considerable need to
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understand their use within the context of healthcare hospital manufacture.
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DfMA must integrate stakeholders to achieve integrated design (Arashpour, 2019; Gao et
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al., 2020; Yuan et al., 2018). It should not be seen as a collection of design guidelines alone.
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Many studies have emphasized the importance of a multidisciplinary team in DfMA (Ashley,
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1995; Gao et al., 2020; Omigbodun, 2001). Within the context of complex healthcare
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environments, the design have to involve a broad range of speciality sub-consultants, sub-
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contractors and a large number of owner-representatives in early project phases (Cama, 2009;
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Guenther & Vittori, 2008; Lavy & Fernández-Solis, 2010). These broad and highly integrated
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teams are needed to address improvements in patient outcomes (Codinhoto et al., 2009;
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McCullough, 2010), and overcome or build compromises between functional conflicts
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(Adebayo et al., 2006; Guenther & Vittori, 2008).
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This study aims to explore the strategies and capabilities applied to establish an integrated
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approach to DfMA. It deciphers the efforts and actions to rapidly build the 1000-bed emergency
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Huoshenshan hospital in 10 days. There are three research questions accordingly:
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1. To explore the attributes of DfMA guidelines/strategies;
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2. To describe the interdisciplinary design team integration in DfMA;
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3. To identify the methods applied to integrate DfMA.
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The rest of this article consists of four parts. The first is an overview of healthcare
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construction and the development of DfMA. Secondly, research methods, including data
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collection, data analysis and the selected frontier DfMA case, are described. Next, the thematic
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data analytical processes and research results are presented. Finally, the implications of the
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research are discussed and summarized. This research can help healthcare construction
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practitioners to implement and integrate DfMA better. By introducing Wuhan's experience and
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efforts to cope with COVID-19 through rapid healthcare construction, this research will be an
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important basis for sharing international best practice in DfMA and building a new rapid
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hospital manufacture approach.
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2. Literature review
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The urgent need for healthcare services has accelerated the development of healthcare
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infrastructure worldwide. In 2019, the total value of healthcare construction underway
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worldwide was $ 400 billion (Ellis, 2019). But many industry reports criticized the inefficiency
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or even failure of healthcare-sector projects (Gray et al., 2014; Iskandar et al., 2019; Wright et
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al., 2019). The outbreak of the COVID-19 pandemic has exacerbated capacity shortages and a
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crisis in healthcare facilities. Modern Methods of Construction (MMC) are regarded as an
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advanced pathway to accelerate capabilities and revolutionize traditional healthcare delivery
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(Adebayo et al., 2006). Many governments are expanding their emergency healthcare capacity
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through the use of off-site and modular construction techniques. However, customisation, user-
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centric integrated design and innovation remain challenging (Lahtinen et al., 2020).
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Several studies have detailed the application of DfMA construction policy, strategies and
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practices, although many are adaptations of manufacturing-oriented DfMA (Tan et al., 2020a).
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These strategies and guidelines have not had academic validation in the context of healthcare
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building projects. Others have described the technical implementation of DfMA. Few studies,
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however, focus on the design strategies of the whole building project. Single building
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components/parts relatively have received more attention, although infrequently in complex
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healthcare settings. And there is no research to comprehensively investigate DfMA application
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for modern healthcare building manufacture, nor evaluate the delivery effect (e.g. efficiencies
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and increased quality).
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Systems integration refers to combining multiple individual sub-systems or sub-
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components into one all-encompassing system that allows the sub-systems to function
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together (Brady et al., 2005; Grady, 1994; Whyte et al., 2020). The integration of
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various functional and operationally interconnected components raises challenges. And
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the relationship between DfMA and systems integration has not been fully explored.
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The indiscriminate usage of DfMA guidelines will not contribute to the achievement of
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building systems integration. Besides, current DfMA research has little considered the
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interactions between people, process and technology, namely the management issues around
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design. DfMA should respond to the integration challenges for complex building systems.
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Although many studies have highlighted the importance of integrating modular principles in
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design and the necessity for collaboration, coordination, and early involvement of contractors
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and suppliers, facilitating these advantages for the implementation of DfMA through
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organisational adaption and innovation is rarely discussed. Also, the design management of
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DfMA in different organisation context was ignored.
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The relationship between organisational structure and product structures (i.e. the
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"mirroring" hypothesis) has been discussed for the past decade. It predicts that organisational
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ties within a project, firm, or group of firms (e.g., communication, collocation, employment)
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will correspond to the technical dependencies in work being performed (Colfer & Baldwin,
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2016). Modular organisational forms in which loosely coupled organisational units specialize
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in distinct knowledge domains are more likely to design modular products (Sorkun & Furlan,
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2017). However, the Architectural, Engineering and Construction (AEC) industry has fallen
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into a “mirroring trap” (Colfer & Baldwin, 2016), hindering systems integration and project
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success. “Mirroring trap” means professional knowledge is deeply rooted in the personal
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behaviour of professional companies and their employees (Hall et al., 2020), which traps
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project design and execution into the prevailing standard system architecture and resists
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attempts for system-level innovation (Katila et al., 2018; Taylor & Levitt, 2007). Many recent
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studies have explored the company's strategic actions to achieve systems innovation and how
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integration strategies can make individual projects eliminate the "mirroring trap". To further
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advance the previous construction-oriented DfMA studies (Gao et al., 2020; Gbadamosi et al.,
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2019; Tan et al., 2020a; Tan et al., 2020b; Yuan et al., 2018), this paper goes beyond design
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