Green Healing

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Visiting a hospital isn’t usually a walk in the park, but it could practically be mistaken for one at Dell Children’s Medical Center of Central Texas, in Austin. The 473,000-square-foot facility is constructed around six courtyards and a healing garden. Huge windows look out on the open spaces and flood the interiors with natural light.

As charming as these courtyards may be, the space is actually greener on the other side of the glass. While hospitals around the globe could be joining Kermit the Frog in a chorus of “It’s not easy being green,” the 169-bed Dell Center became the first hospital ever to earn a LEED^® Platinum-level certification, the highest designation granted by the U.S. Green Building Council.

The criteria for high-level LEED certifications are based on office buildings that typically aren’t occupied around the clock and don’t share many of the same needs as a healthcare setting; so it’s challenging for medical facilities to meet the requirements. “There are things you can do in an office building at 3 a.m. when there’s no one around that can’t be done in a hospital,” points out Joseph Kuspan, the lead architectural designer on the Dell project, and a senior vice president and director of design with Karlsberger, of Columbus, Ohio. “In office buildings you can recirculate air and not worry about spreading infections. With sick people, children, immunocompromised people—or in the case of an adult hospital, the elderly population—you’re always very challenged there. Also, in a hospital it’s 24/7 occupancy; you can’t flush the building out at 4 a.m. with nighttime air.”

Nevertheless, qualifying for LEED Platinum certification was the goal for the Seton Family of Hospitals-owned facility from the get-go. Environmental concerns are especially important in a healthcare setting, according to Susan Long, Karlsberger’s director of interior design on the Dell project. “It’s not like a home or office, where you’re spending limited time. People could be spending days, weeks, or months there without a break. It’s our duty to provide environments that are not harmful.”

The Karlsberger team never strayed from the green element, even when dealing with issues such as comfort, familiarity, ease of maintenance, and a design theme with cross-generational appeal. “In most cases, people went into it with open mind, open heart,” says Kuspan.

A children’s hospital has to comfortably serve a constituency that includes the preschool set and extends far beyond. Patients range in age from tiny tots through more sophisticated teens, some of whom make repeated visits over a long course of treatment. Adults, including employees and concerned family and friends of patients, spend a lot of time in such facilities as well. With that in mind, the designers strove for timelessness rather than trendy appeal in the interior appointments.

“Kids are very perceptive, very intelligent; we want the design to make them feel like they are respected and that they are in a high-tech environment,” explains Long. “Even though there is some whimsy to the design, there’s also a level of sophistication.”

Local and regional materials are incorporated into the Dell Center, and their distinctive appearance makes them natural wayfinders for navigating the building. Instead of following the yellow brick road, a patient might be guided to his or her destination by an almost 900-foot-long wall constructed of red stone. The stone was a traditional material for construction of civic buildings in the Texas Hill Country: San Antonio’s City Hall is a prime example. The architects had an old quarry reopened to provide the stone.

“In utilizing materials and the color palettes of the region, the familiarity makes it less stressful for the patients and their families,” says Long. “You don’t choose to go to the hospital; you’re there for a reason. We want to try to make it as relaxing as possible.”

Limestone, sandstone and mesquite from the area also make frequent appearances. “They used to pave some of the streets in this part of Texas with mesquite hardwood blocks,” says Kuspan. “Mesquite is so hard it wouldn’t rot. There’s a bridge in the lobby that’s clad in mesquite and also a wood wall.”

A bit of whimsy is evident on the interior concrete columns. They’re ornamented with doodles, silhouettes, handprints, and measuring sticks that practically call out to kids to check their growth. The patterns were devised after the designers decided to leave the concrete columns exposed to take advantage of the material’s durability, ease of maintenance and green potential. Kuspan found himself wondering, “Why put on steel studs and drywall, and vinyl or stainless steel corner guards, when the material you’re protecting is harder than any of those?” The concrete mix for the Dell Center contains 28 percent fly ash, a waste product from coal-burning power plants that would normally go into a landfill. It actually makes stronger concrete than Portland cement, which is very energy intensive to manufacture.

The courtyards make a green contribution, too—one that is based on a concept far older than LEED or low VOC. “For thousands of years we’ve been designing courtyard buildings, like cloisters and monasteries,” says Kuspan. “It probably wasn’t until the mid-20th century, after World War II, that we started designing buildings that had such a high carbon footprint. Pre-air-conditioning and pre-electrically illuminated buildings all had courtyards, with daylighting and natural ventilation … things like that you’re able to take advantage of.” At the Dell Center, fresh air is “brought in through the courtyards, where it wasn’t super-heated by the roof.”

The hospital serves a 46-county area of Texas that is bigger than some medium-sized states, with terrain and microclimates that include coastal regions, forests, flatlands, wetlands, and hill country. Plants from throughout the service area are used in the gardens in an effort to provide a familiarity and a comforting, homey touch for the patients and their families. Courtyard space is devoted to cultivating lost species of pine and maple that are native to Texas but are now rarely found growing in the wild.

The native plants also served as the inspiration for the palette and motifs used in the interior design. “Bark and other things you see in the native plant material … we brought that into the color scheme. We tried to symbolize a lot of the plant materials, mainly native flowers in Texas, and make simple graphic symbols with colors that correlate back to the flowers that are in each of those ecosystems,” explains Kuspan.

The Dell Center’s round-the-clock operations actually turned out to be an advantage when it came to power. The facility’s consistent need for energy made it an ideal setting for an on-site natural gas-fired combined heating power plant built by Austin Energy.

The plant was key to garnering high enough marks to hit LEED Platinum. “That gave us basically seven of the points that we got for energy or atmosphere—without the cogen [cogeneration] we would have gotten two or three points,” notes Kuspan. The medical center had a total score of 54 points on the LEED checklist. “The overall level of usage is pretty consistent; that’s what you’re seeking when you want a cogen plant, you don’t want loads going up and down,” adds Kuspan. “It also really gives very clean, clear power; you don’t get spikes in it like you get off the grid. That’s really good for the longevity of computers. Also, for a lot of the sophisticated medical equipment, clean uninterrupted power at the proper voltage is really good.”

Other strong green components are related to generating the electricity on-site: No power is lost in transmission, and the steam that runs the power-generating turbines “is not just wasted or thrown up a smokestack; it is actually stored and used to make chilled water and for steam needs,” the architect says.

In many cases throughout the hospital, “It’s not just the product itself that’s sustainable, but the products you use to clean it—you’re not using harmful chemicals to maintain the product,” says Kuspan. Spills can be wiped off solid surface countertops and high-performance fabrics. The linoleum floors don’t require an endless cycle of waxing, stripping and rewaxing, though sometimes staffers find it hard to break the habit. “When they see a dull linoleum floor they think it’s dirty; it’s not, it’s just the way it is.”

Involvement in healthcare facility projects has led Kuspan to ponder the clash between the “do no harm” philosophy of Hippocrates and the hypocrisy of using potentially harmful materials. “A product you specify in a building that has carcinogenic problems in its manufacturing that could be harmful to the people who have to make it, isn’t a good thing.” He cites PVC as an example: “It’s got longevity going for it, but its manufacture produces dioxin. It’s hypocrisy for us to make anything for a children’s hospital that is adding to the world’s pollution and other problems.” With that in mind, Kuspan decided to minimize the use of PVC wall fabrics, corner guards, and the like in the Dell Center. Other choices included the linoleum floors, low-VOC finishes, carpets fabricated entirely from recycled materials, and even attaching signage with mechanical fasteners instead of adhesive.

“It was utterly amazing to walk in the building before it was occupied, and not to smell anything. I’ve never been in a new building that didn’t have that new building aroma,” affirms Kuspan.

Elzy Kolb is a White Plains, New York-based freelancer writer, editor, and copy editor. Her writing has appeared in The New York Times, Westchester magazine, TheStreet.com, and other industry publications. She can be reached at [email protected].

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