While other AEC sectors have made environmental design a primary focus, the mission statements of healthcare-focused designers cannot always fit the requirements of both medical and environmental performance. Torn between the two, their choice to date has been clear: reducing infection trumps reducing waste, functional efficiency trumps energy efficiency, and patient outcomes trump LEED aspirations.
This fundamental difference has set healthcare professionals apart.
“When we talk about sustainability, it’s really about changing behaviors and creating an interior environment that we can reuse,” says Kristin Moore, LEED AP, director of healthcare at DIRTT Environmental Solutions. “Yes, recycling is important, but that means that we haven’t maintained sustainability in the solution if we end up in a situation where we’re recycling product.”
To leaders in healthcare design, sustainability is becoming synonymous with flexibility and adaptability, with a number of factors driving the movement—the biggest among them an insurmountable rate of change in technology and medical practice that renders healthcare spaces obsolete faster than facility owners can redesign them.
“We were constantly daunted by this notion that we’re trying to solve problems that we don’t even know exist yet,” explains Joel VanWyck, director of product management for healthcare at Herman Miller. “Not being able to predict what’s going to happen five years down the road when you’re creating a product that will last for 20 years was always at the forefront of our minds.”
Now add a new factor: limited down time. While designers in other sectors may pause to incorporate quantifiable environmental plans into their blueprints, healthcare teams are often redesigning spaces that operate 24/7. In many cases, there simply is no room in the construction timeline for LEED applications—or renovation at all.
“One of the things we see is that healthcare workers are amazing at adapting to less than optimal spaces,” VanWyck says. “Sometimes they know they should make the change, but they live with solutions that are less than optimal until they do, in fact, have to rip things out and start over. The hospital itself will have to decide what’s the cost of a room being available versus closed down.”
The current economic climate is not making these decisions easier. According to a survey conducted by the American Hospital Association in 2010, “hospitals are struggling to update their facilities and equipment to meet the needs of their communities and keep pace with advances in medicine.”
The funding hospitals do get is not determined by organizations like the USGBC, but by the Affordable Care Act—more specifically, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP), a 27-question patient survey introduced in 2012.
“The facility’s reimbursements for treatment are hinging on the HCAHP scores,” Moore notes. “A patient isn’t going to know if that wall has recycled content in it, so that’s not where the facility’s focus is going to be.”
Even if design teams had the time and budget to LEED certify, the endless cycle of progress and changing demands would call for reconstruction time and time again—and lead to unacceptable amounts of material waste. Facility operators know this, and have focused on minimizing the need for change altogether. They are doing it, with the help of companies like DIRTT and Herman Miller, by building functional versatility from within. PageBreak
going modular
We are seeing ever-better modular systems rise to the unique challenges facing the healthcare industry. Architects and designers can use these systems to create fluid spaces that mold with the changing needs of healthcare providers, patients and their families—and leave the bulk of the facility untouched.
For example, DIRTT wall systems are being used to replace conventional drywall construction. They are created with four functional layers that can be altered independently, greatly reducing construction requirements for renovations or repairs.
“If something gets badly damaged, they’re not having to do work right there or actually penetrate into the wall, because they can literally just swap out a tile,” says Moore. “It’s clean construction up front, but also during the life-cycle of that building. That’s impacting the operational side of things quite substantially.”
Herman Miller just announced a new-and-improved version of its Compass System, which won a Best of NeoCon Gold Award in Healthcare Furniture in 2010. Since then, incorporating and managing technology has been a critical factor driving the company’s design work.
“As Technology A is replaced with Technology B it can be unplugged from our product and the new technologies plugged in without the product itself becoming obsolete,” VanWyck explains. “Although we may not understand the drivers for what would cause a product solution to change, we know that it probably will, and try to set the product up to be as flexible as possible.”
Compass’s adaptive design and rail system makes it easy to swap out modules and change spaces without room demolition, allowing healthcare designers to make workflow and efficiency improvements without disrupting care.
leed issues
These kinds of innovations lead to real reductions in waste by avoiding renovation, but do little to help secure LEED ratings.
“The people making decisions on construction in these places have different priorities than what’s being outlined in the healthcare portion of LEED,” Moore says.
The difference, according to her, is focusing on changing behavior rather than the USGBC’s current focus on changing material composition.
“It’s hard to talk to a hospital about buying a vinyl-free product when the majority of the floors going in are vinyl-based,” VanWyck says. “They’re more focused on the function than the sustainability aspects—‘Can I make sure that bacteria is not going to live on it?’”
To address some of these concerns, the USGBC created a separate LEED framework for healthcare facilities, first introduced in 2009. They are currently working on a new version of LEED, version 4, which should streamline the process. Some proposals under review include revamping the system to incorporate Environmental Product Declarations (EPDs) and Health Product Declarations (HPDs) that would allow products—not just projects—more impact in LEED.
“For building product manufacturers, the possible adoption of EPDs into the LEED system would require verified environmental life-cycle impact statements,” explains Jason Warnock, senior partner at Post+Beam and member of the USGBC Education and Events Committee. “EPDs are creating the opportunity for behavioral impact.”
If all goes according to plan, we may see a LEED system with a more long-term perspective that rewards the waste reduction benefits of products like modular systems, rather than focusing solely on present construction and recycled waste. The new system is also expected to be simpler, with a streamlined online application process to reduce the time and cost of certification.
That’s good news for designers with tight timelines and a step in the right direction for recognizing sustainability in healthcare, but the industry will have to wait until LEED v4 is released before judging for certain.