Why would a hospital want to pursue a Green design?

In addition to the benefits of being a good steward of natural resources, green design has a positive effect on the bottom line. Hospitals are the fourth highest consumers of energy, so they have to be concerned about energy costs. Design and construction choices that can improve energy efficiency pay off in the long run. Lower utility costs, less staff turnover, and reduced operating expenses mean more funds are available for the hospital’s ultimate mission.

The development of the Green building concept

The idea started on a small scale 30 years ago. During the energy crisis of the late 1970s, the building industry began developing standards for energy performance in buildings. Today, those performance standards have been refined and are common practice in the construction industry.

While the energy performance standards have helped this country save substantial amounts of energy resources, they cover only part of the environmental impact of a building. The construction industry generates more than 100 million tons of debris each year, and by some accounts, the construction and use of buildings consumes more than 40% of all raw materials globally. More than a decade ago, in an effort to reduce the overall impact, a diverse group from across the building industry formed the U.S. Green Building Council (called the “USGBC”). The mission of the USGBC is to promote the design and construction of buildings that are environmentally responsible, profitable, and healthy places to live and work. In short, their mission is to encourage the construction of “green buildings.”

To bring these concepts to the marketplace, USGBC created the Leadership in Energy & Environmental Design® program.

The LEED® program

The LEED® program is a system for designing, constructing, operating, and certifying green buildings. Projects receive points on a wide range of criteria, based on a series of checklists. LEED® certification is available at four different levels: Certified, Silver, Gold and Platinum. The level at which the project is certified depends upon the total number of points obtained.

Participation in the LEED® program requires a three-step process. First the owner must register the project with the USGBC. After registration, the owner can utilize the technical support available from USGBC during the design process. Finally, upon document submittal to and approval by USGBC, the building is certified.

As of early 2006, only about 345 buildings nationwide had obtained certification, but some 2900 projects were registered and pursuing that goal. Two hospitals had met the “gold standard,” according to published reports.

Spreading the Green concept to hospitals

As the green concept started to take in the construction industry, other organizations built upon the work accomplished by the USGBC and created specific programs for specific types of facilities. One such program is the Green Guide for Health Care.

The Green Guide for Health Care, developed by a diverse group of organizations involved with health care facilities, addresses specific health care facility issues such as 24/7 operations. According to its introduction, it “is intended to be a best practices guide, not a basis for industry code or regulatory standard.”

While the basic format follows the LEED® program, the Green Guide for Health Care is a self-evaluating program. In other words, no third party certifies the hospitals that make the grade. Hospitals who desire that certification are not precluded from pursuing it through LEED®. But if they want to follow a guide designed especially for health care and are less concerned about certification, the Green Guide is the way to go.

Why would an owner want to pursue green design, even without the LEED® certification? We asked Tom Snearey, AIA, vice president of Karlsberger Companies, one of the founding partners that worked on developing the Green Guide. As the project manager for the construction of a large children’s hospital in Texas seeking Platinum certification under the LEED® program, Snearey has significant first-hand experience with the process.

“We cannot continue to do business the way we have for the past 70 years.” Snearey said. He points to several reasons why a hospital would want to pursue green design:

• Reduced operating costs from reduced energy consumption. Unlike most office buildings, hospitals operate 24 hours a day. Traditional energy conservation techniques such as night setbacks cannot be utilized. Green design can lower energy consumption and have a positive impact on the bottom line.

• Green design results in a healthier indoor environment. While difficult to quantify, a healthier indoor environment has a positive influence on staff productivity and retention. In the health care setting, green design can result in healthy outcomes for the patients.

• Sustainable design is not more expensive than traditional construction. The rate of return on investment will typically justify the possible premium for green design. After the initial payback period, the savings fall to the bottom line.

Hospitals are large energy consumers. Mechanical systems account for a large portion of that consumption. Green design concepts allow for a number of energy efficiency techniques such as providing separate systems for areas that do not require constant airflow to allow for the use of night setback and designing high efficiency central chiller plants that utilize techniques such as primary only variable flow to maximize full and part load efficiencies. Along with other Green design techniques such as daylighting and building envelope design, increased energy efficiency will reduce overall utility costs.

How does a healthier indoor environment affect hospital care? A study by research teams from Texas A&M and Georgia Tech linked the physical environment and patient and staff outcomes:

• Reduced staff stress and fatigue – work areas designed to meet the needs of the staff, better ventilation in the work area, and lower noise level among other green design concepts all increase staff satisfaction and result in lower turnover. With an estimated cost to replace and train a single nurse ranging from $50,000 to $70,000, retaining even one staff member can be the equivalent of increasing revenue by over $1 million.

• Improved patient outcomes – patients exposed to an increased intensity of sunlight experienced less perceived stress, less pain, took 22% less analgesic medication per hour, and had 20% less pain medication costs.

There is concern that a Green design is more expensive than traditional construction. While it is true that the first costs for some items are higher—approximately 10%, by some estimates—the key to Green design is in evaluating the life cycle cost performance of the overall design. Some of the techniques that have increased first cost have payback periods of less than one year. For hospitals looking to the next 40 years, that means 39 years of savings.

For additional information, see the US Green Building Council website, the Green Guide for Health Care website , and the American Society for Heating, Air Conditioning and Refrigerating Engineers website.