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Sustainable Healthcare by Design

While the amount of energy consumed in other building sectors has been steadily decreasing, healthcare facility energy use has been on the rise

Lacks Cancer Center was designed following USGBC guidelines and the Green Guide for Healthcare

Since the past decade, we have seen reports about high-performance schools that enhance learning, sustainable office buildings that improve worker productivity, green retail spaces that experience increased sales and energy-efficient residential units that sell faster than the competition.

On the converse, relatively few healthcare facilities have made similar headlines. However, the proven benefits in other sectors have many healthcare institutions embracing the sustainable design ideology. Motivated by a concern for public health, a desire to reduce operating expenses and a sense of social accountability, healthcare providers are asking questions about sustainable design.

Several commissioned studies on the costs of Leadership in Energy and Environmental Design (LEED) certified projects, in general, conclude that the cost premium for a LEED Silver-Certified project is, on the high end, about two percent for build-to-suit projects. Assuming a cost of Rs 4,000 per-square-foot for an average healthcare facility, this would equate to a cost premium of approximately Rs 80 per-square-foot.

Considering the potential for energy cost savings, staff retention, better recruitment, increased productivity and a healthier indoor environment, this seems like a small price to pay for a 50-plus year facility. While some of the benefits cannot be measured on a traditional balance sheet, there is a strong case for improved economic success.

The Environmental Challenge

There is surmounting evidence that uncharted levels of global warming and climate change are imminent, predominately due to our built environment's consumption of carbon-based fuels. Statistical evidence indicates that the building industry is the largest contributor to greenhouse gasses — even greater than the transportation or manufacturing industries.

Last December, in a move to reduce the environmental impact of the built environment, the American Institute of Architects (AIA) released a policy statement adopting aggressive targets in the fossil fuel consumption of buildings. The resolution, known as the Architecture 2030 Challenge, is a global campaign initiated by New Mexico architect Edward Mazria, AIA. Aimed at reversing the continued escalation of carbon dioxide and other greenhouse gasses released into the atmosphere, the 2030 Challenge asks the global architecture and building community to target the following: "All new buildings and developments should be designed to use 50 per cent of their current fossil fuel energy consumption — half the national average for that building type as benchmarked by the US Department of Energy.

• At a minimum, an equal amount of existing building area is to be renovated annually to use 50 per cent of the amount of fossil fuel energy it is currently consuming.
• The fossil fuel reduction standard for all new buildings be increased to 60 percent in 2010, 70 per cent in 2015, 80 per cent in 2020, 90 per cent in 2025, and, finally, 100 per cent in 2030.

While the amount of energy consumed in other building sectors has been steadily decreasing, healthcare facility energy use has been on the rise, according to the Energy Information Agency. Considering that healthcare facilities consume over twice the amount of energy of other building types and emit commensurate amounts of carbon dioxide, it is time to aggressively consider a new design process.

Tools for the Task

"Numerous surveys document that patients with views to nature have measurably accelerated post-surgical recovery times, required fewer medications and experienced less depression" - Gaurav Chopra

In 2001, the US Green Building Council (USGBC) launched the LEED Green Building Rating System. It was quickly adopted by many commercial and Governmental projects, but was initially considered incongruent, or unsuitable, for healthcare facilities. In 2007, the LEED Application Guide for Healthcare Projects introduced — for review —the LEED rating system for healthcare projects.

Another valuable tool is the Green Guide for Health Care (GGHC). The GGHC is the first quantifiable, sustainable design toolkit specifically tailored for the healthcare sector. It is a voluntary educational guide designed to inspire health-based design principles and to encourage self-certification of high-performance healing environments. According to the GGHC website, more than 100 healthcare systems — representing 27 million square feet in new construction — are using the GGHC to build and operate hospitals that are healthier for people and the environment.

The GGHC is unique in a manner that it identifies specific health concerns for each of its 42 different credits requirements, which integrate solutions or improvements to these health concerns. Another unique aspect of the GGHC is its operational and maintenance protocols. Centered on environmental health, these protocols offer recommended practices imperative to maintaining the health and environmental profile of the facility operations. Such protocols are critical components of a healthcare system and are most successful when considered during the programming and design phases.

The popularity of both of these relatively new tools in India is encouraging and already proving to be highly influential in transforming the design, construction, operations and maintenance of healthcare facilities. There are many synergies between the two products, and healthcare systems are encouraged to use both —gaining the third-party certification offered by LEED and the health benefits afforded by the GGHC.

Healthier Healing Environments

In India, we have only begun to understand the qualitative and quantitative health benefits that can be realised when healthcare projects implement sustainable strategies. Day-lit environments speed the healing process and pacify the anxiety and stress of patients, caregivers and families. Numerous surveys document that patients with views to nature have measurably accelerated post-surgical recovery times, required fewer medications and experienced less depression.

Material selection is also a factor in improving the healing environment. By selecting building materials that are free of toxins, healthcare institutions can improve indoor air quality and protect the health of patients and staff. Current transformations in the building materials market are allowing designers to develop cancer treatment centres free of carcinogens, paediatrician clinics free of airborne chemicals that trigger asthma and landscapes maintained without toxic herbicides, pesticides or chemical fertilisers.

Fortunately, due to the green building industry's ability to transform the industry, there are a growing number of safe alternatives to these products that are equal or superior in performance. This is acutely important in areas housing patients with impaired immune, respiratory and neurological systems.

LEED(ing) at St Mary's

St Mary's in the US embraces a healing healthcare setting inside and out

The new St Mary's/ Duluth Clinic in the US, embraces a healing healthcare setting inside and out. The design of the new outpatient clinic building promotes a healthy environment for patients, staff and the community by following sustainable design principles. The four-story, 2,25,000-square-foot clinic was named one of the nation's first Gold Certified LEED healthcare facilities in 2006.

The building, located on an urban, formerly brownfield site overlooking Lake Superior, incorporates many green design concepts that promote the use of environmentally responsible and healthy building materials and practices —ranging from indoor air quality to recycling construction waste.

The team's mission precluded using materials and products that are known to be harmful to human health or to have a negative environmental impact. For example, designers used paints, adhesives, stains and finishes that are free of, or very low in, volatile organic compounds, which have been linked to a variety of health problems.

All interior furnishings were required to meet 'Greenguard' certification. The mission of Greenguard Environmental Institute is to improve public health and quality of life through programmes that improve indoor air. The project team evaluated the life cycle impacts of green materials and systems including its initial cost and long-term durability with the goal of achieving a balance of operational, financial and environmental concerns. The result has been water reduction of 52 per cent through the use of low-flow fixtures and an energy demand that has been reduced by 22 per cent. In addition, the hospital is operated using partial green power.

St Mary's/ Duluth Clinic management estimates the premium to achieve LEED Gold certification at $500,000 — above and beyond its current protocols. The overall construction cost of the project was $63 million. This translates to a premium of approximately eight-tenths of one percent of the construction cost.

Sustainable 'Lacks Cancer Center'

The 1,72,000-square-foot Lacks Cancer Center in Grand Rapids, Michigan is the only comprehensive cancer centre in western Michigan and houses a broad range of primary and ancillary services under-one-roof. St Mary's Health Care made a commitment to become a leader in environmentally conscious design. To achieve this, the center was designed following USGBC guidelines and the Green Guide for Healthcare. In 2006, the Center received LEED certification.

It is the second hospital and the third healthcare facility in the nation to receive this distinction. Striking a balance between the Center's three main goals in a facility that operates 24X7, 365 days a year during design. Many design features that contribute to a green building are also important for improving patient health: reducing VOC emissions, bringing daylight into the hospital, patient-controlled temperature controls and reducing energy use with more efficient HVAC equipment.

The design considered what impact the building's envelope had on occupants and the surrounding community as well as the overall lifecycle impacts of the materials involved. Exterior brick manufactured within a 500-mile radius of the facility was used to tie the facility with the surrounding historic neighborhood. The Centre uses self-cleaning, operable windows that eliminate additional structure for cleaning lifts and reduces detergent runoff. Waste condensate steam, purchased for hospital use by Kent County municipal incinerators, heats domestic water and provides a non-polluting, energy-efficient driveway snow-melting system.

The Centre reduced potable water consumption by 50 per cent by using drought-tolerant xeriscaping, high efficiency irrigation technology and eliminating sodden lawn. It also achieved a 20 per cent reduction in water by using waterless urinals, sensor-operated faucets, low-consumption device-sensing toilets and low-flow showerheads. All told, the Center has achieved a 538,137 gallon-per-year water savings.

To assist in their healing mission, the Centre uses durable, attractive and environmentally responsible building materials that meet LEED-specific criteria. The design incorporates locally manufactured products to reduce transportation and energy costs and more than 20 per cent of the materials specified were manufactured within a 500-mile radius. West Michigan manufacturers provided most interior furnishings. Major materials included Forest Stewardship Council-certified wood; ceiling tiles with 72 per cent recycled content; carpeting that complies with the Carpet and Rug Institute's IAQ programme; low VOC-emitting sealants, adhesives and paints; and PVC substitutes including linoleum and non-vinyl wall coverings.

Construction waste, a leading source of landfill volumes, was sorted and sent to recycling facilities resulting in 98 per cent of the demolition and construction waste being recycled. Most of the recycled concrete was crushed to be reused as roadbed fill for highways.

Overall, the project costs to go green were less than one per cent of the project's $44 million budget.

Sustained Success

The phrase 'first, do no harm' has for many years been a hallowed pledge for physicians — one that recognises human acts with good intentions may have unwanted consequences. It is one of the principle precepts all students are taught in medical school.

Sustainable development teams can apply the same basic premise to the facilities on which they work. This entails design, procurement, construction and operational methodologies that look beyond the cheapest first cost solutions to a more holistic approach that targets the institution's long-term economic goals without compromising the health of the community it serves.

The writer is LEED AP, Practice Leader - South Asia Region HKS, Inc.
gchopra@hksinc.com