Special Report: Designing Healthcare: A Sustainable Approach

July 1, 2007

By Jane Rohde, LEED AP

As the healthcare market continues to grow, more A&D firms are looking for ways to incorporate environmentally-conscious design philosophies as part of the healing process.

Healthcare designers have to have such a depth of knowledge in so many areas of expertise: regulations and codes, The Joint Commission, care models, culture change, trends, infection control, reimbursement streams, and evidence-based design are all common vocabulary for the healthcare designer. Healthcare is really a generic term for a design segment that includes specialists in acute care (hospitals), ambulatory care, medical office buildings, and senior living. Often a firm will focus in one specific area of expertise, even within these segments. For example, senior living could include anything from adult living communities, with residents who are 55-years-old and above, to skilled nursing facilities to in-home hospice care. 

Healthcare is one of the largest growing segments in the design industry and sustainable practices are becoming part of the vocabulary. In embarking on a sustainable path, it is recommended to start with five basic tenets for a
successful project:

  1. Commitment to sustainable building to ultimately improve outcomes.
  2. Communication to foster better decisions.
  3. Cooperation with team members to integrate green building components. 
  4. Compassion for co-workers, staff, and most importantly patients and residents.  
  5. Community, which is the emotional, spiritual, and physical result of the first four tenets. 

An integrated and interdisciplinary team that utilizes the five C's will result in the creation of healing, patient-centered and resident-focused environments1. In creating sustainable healthcare projects, there is no "one size fits all" approach. In presenting "Greening of Healthcare Materials" to a live audience, the question often comes up, "Can't you just give me the list?" There is no magical list of materials that you use and "Wham!" the project is automatically sustainable. Sustainability is a system that starts with sustainable business models, high-performance systems, materials and products selected for appropriate applications, and owner maintenance manuals that provide guidance on how to care for a sustainable building. In order to create sustainable environments, all design elements have to be reviewed in conjunction with one another. Research and education are important to assist in supporting sustainable environments. Resources that provide evidence-based information include: The Center for Health Design2; the Coalition of Health Environments Research (CHER)3; and Environmental Design Research Association4.

In specifying finishing materials for healthcare, designers need to do their homework. For example, seeking products that are produced from a manufacturing facility that is certified by the International Standards Organization (ISO) is a great place to start. When a manufacturer commits to completing the ISO certification process (ISO 9000 and ISO 14000), a designer knows that they are specifying a product that is made by an organization that has established an Environmental Management System; this includes continual benchmarking and improvements to manufacturing processes, including sustainable practices.

Surfaces in healthcare facilities need to be extremely durable, easy to clean, not produce glare, hold up to roller traffic, and provide ease of ambulation and no visual barriers, in addition to being attractive and aesthetically pleasing. There are several new product offerings on the market that are touted as ‘green' or ‘sustainable' products appropriate for healthcare, but the designer needs to verify the quality of products before specifying them in a healthcare environment. It is recommended to always install a mock-up for ‘abuse' testing to see if an unproven product will indeed hold up to the stringent requirements of a healthcare facility.

Indoor Air Quality (IAQ) is another topic that designers need to keep in the forefront of the design process for healthcare buildings. In terms of new products, offgassing prior to installation is recommended whenever possible. Using low- or no-VOC paints, sealants, and adhesives is quickly becoming the standard in specifications and most manufacturers have stepped up to the plate in meeting these goals.

In specifying materials, the goal is to maximize the use of recycled content in materials, products, and systems as well as maximize the use of reusable and recyclable packaging and products with low embodied energy (production, manufacturing and transportation)5. Most manufacturers already make products with recycled content or are in the process of developing such products. Ideally, using products in the waste stream as feedstocks, helping to avoid landfills, is the most sustainable approach. Healthcare products are constantly changing and the sustainable movement has acted as a catalyst for innovation of not only manufacturing processes, but also global thinking.

There are also guidelines available to assist designers with healthcare projects and their sustainable design journey. The Green Building Initiative (GBI)6 has two products that are useful for healthcare projects: Green Globes and Green Globes for the Continual Improvement of Existing Buildings. Green Globes is an electronic green management tool that includes an assessment protocol, rating system and guide for integrating high-performance environmental design elements into projects.

The United States Green Building Council (USGBC)7 is currently in development of Leadership in Energy and Environmental Design for Healthcare (LEED-HC). The Green Guide for Health Care (GGHC) offers a non-consensus based guideline for predominantly acute care healthcare buildings that is being utilized by the Healthcare Core Committee to develop a LEED-HC project.

Another available resource is the 2006 Guidelines for Design and Construction of Health Care Facilities, which was originally a General Standard in 1947 as part of the implementation of the Hill-Burton program. Over the years, this document has evolved into a guideline that is now being used as code in more than 42 states.

Incorporating upfront planning and an integrated team approach is vital for both operational programming and sustainable building practices for healthcare projects. It is an on-going process from conception through the completion of the building to the daily operations and care provided. Sustainability represents the process, the building, and the on-going philosophy of a healthcare facility or system. The American Academy of Healthcare Interior Designers (AAHID)8 is a qualifying and certifying organization for interior designers working in the healthcare marketplace. The organization's study guide and reference listing provide additional sustainable design, and care model resources for healthcare designers.

In closing, it is important to note that sustainability ‘starts at home.' When your organization wants to create sustainable, healing environments, it is recommended to look at what your firm, and you personally, are doing to support sustainability and health. It is a mindset that starts with simple things like recycling the waste in your office, consciousness of turning off a faucet while you brush your teeth, choosing an organic lunch vendor for a lunch-n-learn, considering selecting an apple instead of the cinnamon bun for a snack, walking instead of driving up the street, and considering a hybrid when purchasing your next corporate or personal vehicle. As I have become more educated and continue to seek balanced, credible information and processes to create sustainable environments, my personal habits have followed suit. Good luck on your journey!

Jane Rohde is a senior living consultant in Ellicott City, MD, who sits on the Coalition of Health Environments Research Council (CHER) and the Environmental Standards Council (ESC), both part of The Center for Health Design. She is also a founding member of the American Academy of Healthcare Interior Designers (AAHID) and provides educational guidance on healthcare, senior living and sustainability.

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