Hospitals Go Green

Trustee
Sandrick, Karen

June 01, 2009

Originally Published: 2009-05-01.

When Children’s Hospital of Austin, TX, first began planning to build an environmentally sustainable replacement facility 6 years ago, the board of trustees felt it was in the best position to explore some key strategic issues. So the hospital wouldn’t sink big dollars into capital improvements that might not serve the community into the future, board members concentrated on:

* How healthy it would be to occupy the building over the long term. Because of the desire to make use of durable materials, the number and amount of toxins traditionally used in hospital construction have been considerable. “But, people have to work in the hospital 24/7, so how do we make sure their health isn’t compromised because builders don’t automatically put in nontoxic materials?” says Donna Carter, who chaired the board committee that oversaw the design and construction of the new hospital.
* How a new building project would meet the needs of the local environment. “We are a community that takes energy conservation and sustainability issues seriously. These concepts are written into the community’s goals and objectives toward long-term development. It was the board’s role to reflect those community objectives at a focused and strategic level for the hospital,” Carter says.
* How a sustainable hospital would foster the mission of the organization and still keep costs in line. Children’s Hospital is part of the Seton family of faith-based healthcare facilities whose stewardship responsibilities involve not only financial, but environmental, health. “We, as board members, can outline how conservation and sustainability meet our hospital mission,” Carter says. “We can look at the bottom line and operating costs, and make sure everyone understands that sustainability isn’t just about the first dollar cost of equipment or materials, or even energy operating costs. It has a much broader definition. We, as members of the board, can ask about the advantages of having more control over our energy source and how we consume water.” A

The replacement facility, which was named Dell Children’s Medical Center of Central Texas, opened its doors inI2007, and will most likely become the first children’s healthcare building project to achieve the Platinum designation from U.S. Green Building Council’s LEED program.

Hospital trustees were critical for keeping the focus of the new building on sustainability, says Carter. “Senior management is charged with making sure a building project gets done, that all the programming aspects are met, and that it’s on time and on budget. The hospital executives are the direct line of communication with the architects and construction managers as a project goes forward. If they’re taking on the strategic questions as well, they’re not going to get their basic work done,” she says.

“It’s not that senior management wasn’t involved in strategic decisions. But, our oversight committee allowed for a point/counterpoint discussion that did not affect the progress of the project. It allowed us to help create a pleasant and uplifting space that goes a long way toward getting a better outcome for everyone; bottom line, we are after better outcomes,” Carter says.

The Growing Sustainability Movement
Ironically, hospitals built more than 100 years ago were more in tune with their environment than many of their modern counterparts. Hospitals that once relied on fresh air and water for healing have, over the decades, morphed into high rises with mechanical air-conditioning and closed-in, dimly lit spaces. When Bellevue Hospital in New York City was first built, it epitomized hospital design principles at one time, which emphasized natural light, natural ventilation, and access to fresh water. After many years of expansion, the hospital now occupies 60,000 square feet of floor space onI1.5 acres of land and less than 10 percent of it has windows, according to Robin Guenther, who spoke at the Health, Environment, and Economics Workshop, sponsored by Green Healthcare Institutions inA2007. Guenther is with Perkins+Will, an architecture firm with offices worldwide.

Hospitals consume large amounts of resources to artificially heat up, cool down, and keep the lights burning, and use far more environmental resources than other commercial buildings. A majority of healthcare facilities eat up nearly twice the annual energy total fan average commercial building, says Joe Kuspan, director of design for the Karlsberger architecture firm, Columbus, OH, and lead architect on the Dell Children’s Hospital project. Hospitals account for roughlyI4 percent of the footprint of all commercial buildings in the United States, but they use 8 percent of the energy, he says. Hospitals are resource-intensive buildings because of medical necessity. “You completely knock out someone’s immune system to treat them for cancer. You really have to take some strong steps to keep them alive that aren’t necessarily energy friendly,” Kuspan says.

Unlike office buildings, for example, hospitals cannot save on energy use by recirculating air or drastically reducing lighting, heating, and cooling at night. Nor can they take advantage of energy-saving, raised-floor mechanical systems that keep mechanically ventilated air from stratifying in open-office environments. "The last thing you want to do is blow air up off the floor into someone’s open wound,” says Kuspan.

Nevertheless, many new hospitals are adopting energy-efficient principles. Northwestern University’s $509 million Prentice Women’s Hospital in Chicago, which opened in fall 2007, has aA9,500-square-foot green roof and a low-emissivity glass curtainwall system that lets in ample amounts of daylight and controls the amount of energy consumed. And Patrick H. Dollard Health Center, a facility that cares for neurologically and developmentally impaired individuals in Harris, NY, incorporated ground source heat pumps. This reduced its energy consumption by 48 percent, according to the U.S. Green Building Council.

Hospitals are also removing pollutants from their interiors and their grounds. Over the last 5Iyears, Kaiser Permanente, Oakland, CA, stopped purchasing and disposing ofA40 tons of hazardous materials annually. And Dollard Health Center eliminated polyvinyl chloride finishes and plumbing supplies. I

Botsford Hospital in Farmington, MI, which is scheduled to open in 2009, is green in construction and operation. The hospital’s construction firm, Madison, WI-based Marshall Erdman & Associates, is recycling drywall construction waste into fertilizer. Drywall accounts for more thanI25 percent of the waste from major construction projects that is routinely carted away to landfills, whereat principal ingredient – gypsum – releases sulfur and calcium as it decays. Design elements that captured a LEED Silver certification will allow Botsford Hospital to use 30-percentIless water and 17.5-percentIless energy. I

An 80-bed, $221 million replacement hospital for two hospitals in the Mountain Estates Health Alliance, Johnson City, TN, is being designed around energy efficiency, conservation, and environmental responsibility. The building will lie naturally within the existing terrain and capture sunlight, which ties=in not only with energy efficiency, but also with a patient-centered care environment of peace, comfort, and support, says CEO Dennis Vonderfecht. Even the parking lot and roof will have green spaces with grass and trees that will remove pollutants, such as asphalt and oil, from rainwater. In turn, the rainwater from the roof will be channeled into falling cascades that run over natural rock along the sides of the building, adds Vonderfecht.

Hospitals are going green not only to protect the environment, but also the health of their patients and staff. Increasing numbers of studies show the health benefits of high levels of natural sunlight. In one study, published in Psychosomatic Medicine in 2005, patients whose rooms were located on the sunny side of the hospital were perceived to be less stressed and neededU22-percent fewer analgesics while recuperating from elective neck or lower spine surgery than those located on the other side of the hospital.

Green buildings foster health by opting for less toxic materials in adhesives and sealants, carpets, composite woods, and paints, and by controlling indoor chemicals and pollutants at their source. Green buildings also allow more daylight and greater control of light levels and glare, and they regularly monitor the release of carbon dioxide in the operation of heating and air-conditioning systems. By giving occupants more control over ventilation, temperature, and lighting, employee productivity increases by anywhere from 0.5 percent to 34 percent in green buildings, reported Gregory Kats in a 2003 report from Capital E Analysis, a Washington, D.C.-based firm that specializes in the clean energy industry.

The cost of building an environmentally sustainable building is higher than it is for a standard structure. The cost premium is about 2-percentUgreater, averaging betweenI$3 and $5 a square foot; however, the savings in energy, emissions, water use, operations, and maintenance, plus the gains in productivity and health, have a net return of $50 to $65 a square foot, Kats concluded.

Green buildings commonly consumeI30-percent less energy by decreasing their use of electricity, particularly during high-energy demand periods, and generating their own power on-site, according to Kats. Additionally, hospitals cited for environmental excellence by Hospitals for a Healthy Environment in 2007, which is now part of Practice Greenhealth, reported significant savings from recycling alone. The University of Michigan Hospitals and Health Centers, Ann Arbor, MI, saved $236,000 in 2006Aby recycling 1,350 kilograms of elasticized arm or leg compression sleeves. Dartmouth-Hitchcock Medical Center, Lebanon, NH, saves approximately $48,000Eper year by recycling xylene and alcohol.

The $200 million Dell Children’s Medical Center of Central Texas is far more spacious than its predecessor, Children’s Hospital of Austin. It has a total ofI475,000 square feet, three times more than the facility it replaced, as well asI32 emergency department bays, 10 clinical imaging suites, six operating rooms,A14 recovery rooms, and additional services, such as conference and education centers, a rehabilitation gym, a theater, and a play area for patients’ siblings.

The hospital makes ample use of natural sunlight, and it mirrors the local ecology. It has a hub-and-spoke design that channels natural light throughout the facility and seven interior courtyards that mimic the ecosystems in the hospital’s surrounding area. Interior paints and adhesives were used that have no or only small amounts of volatile organic compounds, such as linoleum secured with green-labeled adhesives and carpet and backing made of recycled materials.

During construction, work crews were careful to reuse or recycle waste. Contractors recycledE70 percent of project waste, including 35 ,000 tons of asphalt that were removed from the building site, pulverized, and used as a base for parking areas. Contractors also decreased the use of cement, which releases elevated levels of carbon dioxide.

In cooperation with Austin Energy, Dell Children’s Medical Center operates an energy cogeneration plant to conserve energy use. The cogeneration plant, which supplies energy directly to the hospital, is 2.5 times more efficient and, more important from a healthcare standpoint, provides clean power, Kuspan says.

“The IT department has already taken note of the fact that their equipment is not breaking down. There are Uno power spikes, which shorten the life of high-technology equipment. When you think of a hospital, which has $2 million MRIs and other incredibly sensitive equipment, you want to have reliable power,” Kuspan explains.

The cogeneration plant also saves on energy costs. The plant cost $18 million to build, but it saves the hospital $6 million by redirecting natural gas that otherwise would be sent up the smokestack to make steam to power the hospital as well as other buildings on campus, including a Ronald McDonald House, medical office buildings, and a pediatric research facility, Kuspan says.

Building according to LEED principles did add to the cost of construction, but it wasn’t as expensive as CEO Robert Bonar originally thought. The hospital will recoup its investment in green building strategies in about 5 years largely because of savings on energy usage. For hospitals that may be contemplating green building, but fear the extra costs, Bonar advises caution and careful analysis.

“There’s nothing at all wrong with being concerned about the cost. In fact, a healthy skepticism is good. But, I would tell people to at least take a look at it in more detail because they may be able to make up that extra cost in 4 or 5 years and then some.”

A green building project may also resonate with the local community. The original goal for Dell Children’s Medical Center’s fundraising campaign for capital construction was $50 million. Once the project went green, the campaign raised an additional $36 million. "It became an interesting interaction with the business community in Austin, who thought, by and large, it was a great idea,” Bonar says. “When I showed them charts and graphs [saying] that we could recoup our investment in 5years, they became even more interested. So, the project helped our philanthropy as well.”

By maintaining the link between the project and the community, the board of Dell Children’s Medical Center showed how a healthcare facility fits within the larger healthcare universe. “One of the biggest issues was how to construct a building so patient flow would facilitate and maintain continuity of care,” says Bonar.

As an example, a common problem in pediatrics is the kind of life children return to once they’re discharged from the hospital. “How can we run these kids through our system so there’s a checkpoint before they leave?” Bonar asks. “How can we be sure that, even though we’ve given them a prescription and a 2-day supply of drugs, they will actually get the medication they need so they don’t come back through the emergency room and are readmitted?”

On the surface, that issue would seem to have little to do with a building project. But, Bonar says, it influences the design of the portals of entry and exit within the hospital as well as the community at large. Out of discussions with board members rose the Children’s Optimal Health Initiative, which includes hospital and other healthcare providers, schools, police, and social service agencies in a collaborative effort to improve the health status of area children. The Children’s Health Express, a van that has been converted for use as mobile exam rooms, is now on the road four days a week to provide check-ups, immunizations, and follow-up care.

“It’s funny how things began as a sort of germ and flourished in the discussions of our board building oversight committee,” says Bonar. “This was started by trustees asking questions and advancing ideas and propositions for the building of the children’s hospital.”

It rose from the trustees’ stewardship. “And that doesn’t just mean stewardship of the organization’s financial status,” says Bonar. "It also means stewardship of things that are usable and exhaustible, and part of that is the environment and the health of the children who live in it.”

(C) 2009 Trustee. via ProQuest Information and Learning Company; All Rights Reserved.