Green From the Ground Up
When it comes to building, the future is here, and it’s green all the way. UCSF Mission Bay and Dell Children’s Medical Center are just two examples of hospitals that are leading the charge.
There’s a movement afoot that sustainable health care design expert Robin Guenther once only dreamed of, and it’s the idea that building green means building a healthy future.
“There’s a move [now] to set really aggressive goals in new projects and hold the design team accountable to them,” said Guenther, principal with global health care design firm Perkins+Will and senior advisor to Health Care Without Harm. “This isn’t something we saw a few years ago. I think we have bridged the chasm. … [After all] these hospitals are not completely different. [Facility engineers] can walk in the mechanical rooms and know what they are looking at, and there is also a wealth of people to call on to help them through the process.”
In a major shift from the past, Guenther says it’s now the exception when a hospital has not done at least some significant energy conservation in existing plants, where just swapping out fluorescent lighting for LED can mean substantial savings.
“Most hospitals save 25 to 30 percent of their energy just if they do the quick payback energy conservation measures,” she said. And once they see the difference it can make on a small scale, they are eager to apply the same building principles to larger projects.
While it’s “a slam dunk” to make some investments that more than pay for themselves in energy savings, the great news is the overall cost of building greener is also nowhere near what hospital executives and engineers may anticipate.
“People can tour these hospitals and kick the tires and see they are comfortable and they use less than half the energy,” said Guenther, co-author of Sustainable Healthcare Architecture, now in its second edition. “Then they say, ‘I want to save that money too.’”
IN GREEN BUILDING, “DO NO HARM”
Two of Practice Greenhealth’s Top 25 Environmental Excellence Award winners this year are prime examples of hospital administrations that set out to build green and refused to compromise their goals throughout the design and construction process. UCSF Medical Center and Dell Children’s Medical Center of Central Texas also won several Circles of Excellence Awards.
“We are ranked in the top 10 in seven different [medical] specialties in the nation; our medical experience and clinical training are top-notch. To provide a healthy building is an extension of that world-class care,” said Gail Lee, sustainability manager at UCSF Campus and Medical Center, which focused on green building when it began planning the UCSF Medical Center at Mission Bay more than 10 years ago.
“We’re proud that this is a sustainable facility, and we will work toward maintaining it together. I’m a big cheerleader for this in the health care industry now. I tell everybody, ‘You can do this!’ There’s enough data out there that shows it can be done, and it’s positive financially as well.”—Michele Van Hyfte, manager of environmental stewardship for Seton Healthcare family
The Mission Bay campus, which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital and UCSF Ron Conway Family Gateway Medical Building, offers 4.3 acres of green space, including a one-acre rooftop garden.
It also has a smart irrigation system that automatically adjusts water output as the weather fluctuates, dual-flush toilets and low-flow, high-efficiency showers and basins that altogether are expected to save four million gallons of potable water a year.
Lee listed Mission Bay’s other green-building priorities, including: flooring, walls, paint, ceilings and trim free from chemicals associated with cancer, endocrine interference, birth defects and reduced fertility; smolder-resistant fabrics that do not need to be chemically treated; and rubber flooring instead of vinyl floors that require periodic stripping and waxing with harsh chemicals.
All told, the LEED Gold-certified medical center will be 50 percent more energy-efficient than a conventional hospital, Lee said.
“This started back in 2006, so at that time, we were way ahead in the ‘do no harm’ ideal, which was the motto from the start,” said Mission Bay Project Architect Herb Moussa of the consulting firm Stantec, who remembers the project was definitely not “run of the mill” for any of those working on it.
“Normally you would just grab your specs and everything was provided for you, but not here. Each thing that was listed had to be checked by the material and chemical engineers to see if it met our goals,” Moussa said. “When you walk through the hospital, everything you look at—every kind of flooring, ceiling, carpet, wall protection, countertop—was studied. It was pretty vast.”
Hundreds of miles away in central Texas, the word “sustainability” was also on the lips of everyone involved in first discussions of a dedicated children’s hospital, according to Alan Bell, regional director for planning, design and construction at Ascension, parent company of the Seton Healthcare Family, which operates Dell Children’s Medical Center in Austin.
“Every decision had a sustainable overlay to it. [Dell] was the first green project for Seton, for the architect, the contractor, and it was one of the first green hospitals submitted to LEED,” Bell said.
In fact, noted Guenther, Dell earned the very first LEED Platinum health care certification. But obtaining the certification is more than just a plaque on the wall, she said. “It’s a whole process of checks and balances that ensures the products and processes agreed upon at the onset actually show up in your building; they’re not substituted out along the way. For LEED to work as a market transformational tool, it takes a level of rigor that only that level of certification provides.”
As vast a process as the design and building of a green project seems, that’s the easy part, according to Michele Van Hyfte, manager of environmental stewardship for Seton.
“Maintaining the operation is the challenge,” she said, noting that she believes a philosophy of sustainability must permeate any health care system that successfully maintains green operations.
“It’s part of our culture. We’re proud that this is a sustainable facility, and we will work toward maintaining it together,” she said. “I’m a big cheerleader for this in the health care industry now. I tell everybody, ‘You can do this!’ There’s enough data out there that shows it can be done, and it’s positive financially as well.”
There’s also plenty of help and advice available on how to do it, she said, suggesting, “Reach out to organizations like Practice Greenhealth and Health Care Without Harm.”
NATURE’S HEALING POWER
Beyond helping the environment, green building also has positives for the health and well-being of staff, patients and visitors, Van Hyfte said.
That idea is fueling a second trend in green building that Guenther says is gaining momentum—something called biophilia, a concept popularized by author Edward O. Wilson, who wrote a book by the same name.
“This is what I would call nature connectivity—the idea that we all have an innate interest and affinity for nature and natural settings that is hardwired in us,” Guenther said. “Integrating nature in a healing environment—when we are vulnerable and sick—is an idea that is really taking off.”
Whether it’s creating gardens for patients and staff to enjoy or building rooms and positioning beds to maximize the view out the window, hospitals are connecting the dots between body and mind that return a holistic picture of healing and health.
“Staff retention rates and patient satisfaction scores are showing that making the hospital a better place to work is working,” Guenther said. “This is a very exciting trend to see.”
She highlighted UCSF Mission Bay as a prime example of recognizing the healing connection of body and mind to natural surroundings.
“A key design feature of our building was natural light. Daylighting has been shown to improve healing, so we made a conscious effort to maximize lighting in areas where patients and staff are,” Lee said. “I think the staff in particular are happy with the natural lighting; it gives them places of respite to relax.”
The focus on direction of the patient rooms stands out to Moussa. “Patient beds are toward the windows and are view-oriented—you see the bay, the boats, the bridge and the hills beyond. [And] the family amenities—the amount of space they have and the furniture that is comfortable for sleeping in—are great,” he said.
Moussa is especially proud of the rooftop gardens, each tailored to the patient population that will use them, such as a play area for the pediatric patients or inviting places to sit and reflect for patients and staff.
“It’s invigorating,” Moussa said. “As much as any building can give hope, this building gives does. Body and mind are very connected; keeping your mind positive, refreshed, relaxed can help you heal.”
BUILDING IN RESILIENCE
Guenther highlighted another buzzword in the vocabulary of green hospital owners and builders: resilience.
The driving force behind the new focus? Extreme weather the likes of which few have seen before, she said.
“The hospital evacuations in New York after Sandy, coming seven years after Katrina—although not as bad—it still was front-page news that hospitals failed and needed to be evacuated. People said, ‘How could this happen? Didn’t we learn from Katrina?’ Sandy taught us that weather is changeable and extreme weather is increasing,” Guenther said.
For hospital owners, the lesson that Katrina and Sandy taught is the need to make some tough decisions now to avoid potential disaster later, she said.
“If you operate in a place that relies on centralized, large-scale infrastructure to control water—like a levee—should you be building as if the infrastructure will hold or as if it will fail? Are you willing to make that investment if it costs more, even if you’re not sure it will ever happen? It’s a tough conversation,” Guenther said. “But I think you have to build as if it will happen. If you’re an East Coast hospital along the ocean, I think you have to build as if sea-level rise will happen. You don’t have to believe in climate change to raise your hospital up.”
At Dell Children’s, a partnership forged early in the hospital planning stages with the city of Austin positioned the hospital to be self-sustaining. Meanwhile, Seton has its own on-site combined heating and cooling plant and generates its own electricity with backup power supplies from the city grid, according to Bell.
Seton is also the relief hospital for hospitals on the coast and operates the only two facilities that have Level 1 trauma center status in the area—Dell Children’s and University Medical Center Brackenridge—so it was already thinking along the lines of resilience, Van Hyfte said.
“We are the end of the hurricane evacuation route for the coast of Texas,” she explained. “Rita was the significant hurricane for Texas, and we had about two million people from the coast of Texas show up in Austin. More recently, the Memorial Day flooding in Austin this year proved the topic of resiliency needs to be at the top of the list when you look at any design project.
“Austin is known as a green center, and it has a comprehensive community climate plan, one of five U.S. cities to have one,” she added. “When you look at green building in the social context—how it affects people and population health issues—planning and design can cause public health problems, or it can provide public health solutions. If anybody should be paying attention to this, it’s the world of health care.”
Indeed, Guenther said, hospitals must look more seriously at their role within a network and community in order to determine a level of resilience to strive for, based on those perimeters, not simply on geography, she said.
“It’s not really a one-size-fits-all answer,” she said.
Carolyn Kimmel is a freelance journalist based in Pennsylvania and has more than 25 years’ experience writing for newspapers and magazines.