Since the 1980s, virtually every industry has downsized—except healthcare, which plows ahead like the seemingly invincible Titanic. Now, most industry analysts believe past methods for doing business are crumbling and major changes lie ahead. As past processes and paradigms fall under the critical forces of reform, will sustainable design be thrust aside as a marketing gimmick of the new millennium, or will it play a critical role in healthcare’s renaissance? The design and construction of UPMC East, a 156-bed community hospital outside of Pittsburgh that opened in July 2012, rode the wave of the Great Recession and provides an example of how sustainable design can be part of healthcare’s transformation.

From a national standpoint, the healthcare industry spends $6.5 billion on energy each year that’s eventually passed along to consumers. If healthcare providers were able to save 20 percent on energy consumption, it could save consumers $1 billion a year. The 20 percent goal is completely within reach, given current technologies, and emerging innovations will only sweeten the savings. Jim Rodgers, CEO of Duke Energy, the largest power holding company in the United States, calls energy efficiency the “fifth fuel” behind coal, natural gas, nuclear power, and renewables. According to Rogers, the cheapest kilowatt is the one that does not need to be produced. At the beginning of UPMC East’s design process, a curvilinear building form was considered and favored by the design team and client. In further analysis, computer simulation revealed a 17 percent solar heat gain reduction through proper orientation of the bed tower. Without a single extra dollar in construction, the solar-oriented tower saved the capital costs of increased mechanical systems and annual operational expenses.

The use of computer simulation software further assisted in identifying the highest energy uses within the design. By attacking the top three—heating, plug loads, and lighting—the design achieved an 18 percent reduction in energy use that translates into $164,582 savings per year at the present energy rates. By leveraging current design tools, sustainable design through energy reduction produces tangible bottom-line results that lower the cost of healthcare.

Just as the best way to save energy is to reduce demand, the most sustainable approach to building is to not build. The pre-reform paradigm favored building bigger to provide ultimate flexibility and to allow for myriad amenities. At the current cost of construction and with the ongoing cost of operating, maintaining, and staffing the built environment, every square foot translates into mega-dollars over the life of a building. The charge on UPMC East was to create a patient-centered room incorporating the latest evidence-based design (EBD) criteria in the least amount of square footage possible. Through extensive study of current patient room sizes across the United States, evaluations of EBD metrics, 3-D computer models, and a thorough mockup process with full staff participation, a right-sized room was developed. The patient room saves 80 square feet compared to the industry accepted room size of 300 square feet. At current construction costs, this translates to a $4 million savings in capital costs. In regard to the ongoing operational savings, for every square foot saved, there’s a $700 per-square-foot savings over the building’s life. When the construction and operational costs are totaled for the life of the building, changing the paradigm from super-sized to right-sized is the gift that keeps on giving.

One of the tenants of sustainability is to connect beyond the boundaries of a particular site and close the loops in a cradle-to-cradle manner. The site for UPMC East in its previous condition was developed by artificially flattening a 70-foot-deep ravine into a 100-percent impervious parking lot. The parking lot dumped all rainwater runoff onto the adjacent municipal street. The stormwater was then discarded into the neighboring creek. By looking beyond the site’s boundary, the UPMC East design team discovered that the creek is a feeder to the Mississippi River, one of the largest watersheds on the planet. Instead of burying a stormwater strategy in engineered infrastructure, a natural landscape approach provides places of respite while performing critical stormwater management functions. In solving the hydrological issues, the site’s junk fill is removed and the site is restored close to its original topography. The grade is manipulated to move the stormwater along the longest possible route through a series of rain gardens, bioswales, and a retention pond before a controlled release back into the stream. By simply redirecting the allocation of buried construction dollars, the stormwater solution reduces the stormwater run-off from the site by 36 percent, well above the 20 percent required by the municipality, and provides places of respite with purpose. Using the landscape in both a performance and amenity capacity produces places of respite to enhance healing while playing an important role in stormwater management. It’s this type of synergistic application that allows sustainable design to positively impact the bottom line while enhancing patient care.

Turning the ship
Will our titanic industry plow ahead unscathed or will it run aground with the changing economics? As Joe Flowers states in his book, “Healthcare Beyond Reform: Doing it Right for Half the Cost,” the math paints a rather straightforward picture. The United States spends more than any other country in the world on healthcare and about 50 percent more than our wealth suggests. The healthcare industry will have to course correct. When one considers that for every dollar a healthcare organization saves, it has the equivalent impact on the operating margin as increasing revenue by $20, sustainability plays a vital role in removing waste and reducing spending.

A 2010 Health Care Facilities Sustainable Operations Survey by ASHE indicates that 79 percent of healthcare facilities opt for sustainable features as a way to curb costs. Green design is neither a passing fad nor a marketer’s repackaging and reselling of the same old ways of doing things. As demonstrated by UPMC East, green design is one of the vital components of turning the ship.


Timothy J. Spence, AIA, LEED AP, is principal, healthcare market leader, at BBH Design (Raleigh, N.C.). He can be reached at