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Building a Better Healthcare Facility

Going Green by Bill Janhonen LEED AP, NAHB – CGP

For those of us in the sustainable building world, hospitals and laboratories have been the “third rail” of green building. Put simply, these facilities don’t easily fit into a standard model or prescriptive path design because they run 24/7/365. I know this personally, as my sister is the Director of Nursing for OB/GYN and Pediatrics at Cayuga Medical Center in Ithaca, New York. People don’t have babies according to a set schedule, and people need medical attention all day, every day. Hospitals run labs, tests, lights and food services, laundry and life-saving equipment all day, every day – and that takes a lot of energy, and I mean energy from the dedicated staff, as well as the grid.

Into this enormous challenge have emerged several groups and builders that have taken on the daunting aspect of building “green” hospitals and improving healthcare companies. In San Francisco, the city-owned Laguna Honda Hospital opened in June with a silver certification from the U.S. Green Building Council’s (USGBC) Leadership in Energy and Environmental Design (LEED) program. The new 780-bed facility is the first hospital to receive such a certification in California. The LEED program itself is in the process of establishing a specific Healthcare certification. Emerging emphasis on sustainable building in healthcare is becoming more common with integrated and holistic views that affect the patients, workers and visitors, but the community at large. In Arizona, Phoenix-based Ascent Healthcare Solutions has been awarded the Champion of Change Award by Practice Greenhealth. The Champion for Change Award recognizes businesses and organizations that demonstrate successful accomplishments in “greening” their own organization, and have assisted their associated healthcare facility, clients, members and customers in improving their environmental performance. Ascent Stryker Sustainability Solution identifies that reprocessing and remanufacturing medical devices are the most impactful sustainability initiatives that hospitals can do to divert thousands of pounds of medical waste from landfills and redirect savings to patient care initiatives.
Chandler Regional Medical Center, another Arizona company that has been recognized by Practice Greenhealth, has been awarded the Partner for Change Recognition Award. This award is for healthcare facilities that have begun to work on environmental improvements, achieved some progress, and have less than 10 percent recycling rate for their total waste stream. In 2009, in conjunction with Ascent Healthcare Solutions, Chandler Regional was able to divert over 14,900 pounds of medical waste from landfills and save over $580,000 in device supply costs.

“Chandler Regional Medical Center, with the support of its leadership, has engaged its employees to identify and prioritize projects that they believe are feasible and will have a real impact on our environmental ‘footprint,’” said John Walters, Director of Environment of Care at Chandler Regional. “Our future plans include identifying opportunities for the use of solar energy and donating food preparation waste to the local farming community.”

In an article by Natalie Engler titled “Green Hospitals,” Bill Ravanesi, Boston’s Regional Director at Health Care Without Harm (HCWH), indicated if every healthcare facility were to embrace green building design, the effects would be felt around the globe. HCWH is a global coalition of almost 500 organizations working to protect health by reducing pollution and promoting high-performance healing environments in the healthcare sector. The healthcare sector comprises about a seventh of the U.S. economy and is the nation’s second-largest consumer of energy per square foot. Annually, the sector constructs 100 million square feet of medical building space and spends $5.3 billion on energy. “That makes it imperative that healthcare become a better steward, not only of health, but of the environment and the planet,” says Ravanesi. “Of all the industry sectors, it is the only one that has taken an oath: first do no harm. It is in its mission to do the right thing.”
Brigham and Women’s Hospital’s new comprehensive cardiovascular care facility was designed according to green design principles. The Carl J. and Ruth Shapiro Cardiovascular Center is a place that promotes healing, reduces stress, improves patient and employee safety, and is sensitive to the community it’s built in, while reducing the carbon footprint. When it came to constructing the 440,000 square-foot, 10-story center, “We pursued green design holistically,” says Arthur Mombourquette, Vice President of Support Services at the Brigham. “We installed state-of-the-art ventilation and cooling systems and energy-efficient lighting, but we also thought about the people who would work in the building, the patients who would stay there, and the residents of the neighborhood surrounding it.”

Some 70 percent of interior spaces receive natural light during the day. “Not the first thing that comes to mind when you think of sustainability,” Mombourquette says. Other green features include low-energy fixtures, an Energy Star-compliant roofing system, high-efficiency air handlers and conveyance systems that improve air flow, low-flow plumbing fixtures, water-efficient landscaping, a wastewater recycling system, and environmentally friendly and recyclable carpets and floor coverings. Non-toxic recycled rubber floors require no waxing or stripping with toxic chemicals and are softer underfoot, potentially reducing slips, falls and stress fractures. In addition, during construction, contractors recycled more than 90 percent of construction waste and used recyclable building materials.

In 2007, Partners HealthCare and seven other major health systems banded together with Health Care Without Harm, Practice Greenhealth, and the Center for Health Design to create the Global Health and Safety Initiative. The hurdles facing hospitals in generating sustainability include creating environmental compatibility, energy efficiency and quality. The basics of green building are as applicable to the healthcare environment as any other. Features such as lower-energy fixtures, Energy Star-compliant roofing systems, low-flow fixtures, occupancy sensors, water-efficient landscaping, and building orientation to allow passive solar heating and cooling and wastewater recycling are all available to hospitals. Those among us who have compromised immune systems, along with children, the elderly and those with illness, also need an environment free of toxic pollutants found in indoor air and from the release of volatile organic compounds (VOCs) found in carpets, furniture and cleaning products. All of these programs and more have been adopted and put into practice by hospitals across the nation.

The USGBC, through LEED and the Green Guide for Health Care (GGHC), have teamed up to provide direction and assistance to facilities pursuing sustainability. The LEED for Healthcare rating system represents a culmination of seven years of close collaboration between the GGHC and USGBC. The Green Guide for Health Care is a best practices guide for healthy and sustainable building design, construction, and operations for the healthcare industry. In today’s world, hospitals are facing the same economic hardships we all are facing, but the reality is that we can no longer assume that the methods and technologies of the past should or will be the direction for the future. Best practices in building seen as a premium, or something extra, are rapidly becoming the standard practice, and before too long may become the mandated method of building. But the initiative shown by hundreds of healthcare facilities around the nation have proven that sustainable building can be performed in a cost-effective manner that takes into account lifecycle concerns and the holistic view of how hospitals affect the patient as well as the workers, visitors and surrounding community.

For more information about sustainable healthcare:
Health Care Without Harm
Green Guide for Health Care
U.S. Green Building Council

Bill Janhonen LEED AP, NAHB – CGP lectures and teaches Green Building methods and technology. His company WSJ Enterprises provides corporations with green staff training and consultation for sustainable policy programs.

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