Classified by the U.S. Green Building Council (USGBC)  as the most significant and comprehensive update since LEED’s inception, the new LEED v4 features more aggressive energy and water efficiency prerequisites and credits, and unprecedented building product reporting and disclosure requirements. Overall, healthcare designers are embracing the update, particularly the notion of product transparency. But some are wondering if the new system’s requirements are a bit too ambitious.

“Through several LEED versions over the past 15 years, the bar has slowly risen. Arguably, the capacity for sustainable design in the design and construction world has risen more quickly, leaving LEED a little bit behind the rest of the industry,” says Russell Perry, co-director, sustainable design, SmithGroupJJR, (Washington, D.C). “The LEED Steering Committee and USGBC leadership have gambled that the industry is ready for a larger leap forward this time. I think they’ve gone too far, too fast, but I’m stimulated by the challenge and am eager to be proven wrong.”

“As much as the design industry likes innovation, it often does not embrace change quickly, especially in healthcare, given the long cycles of design and construction for large projects,” adds Mara Baum, senior associate, sustainable design leader, healthcare, HOK (San Francisco). “Many aspects of v4 are very new to the sustainable design community, so it will take time for the industry to adjust.”

It’s about time
In response to LEED v4’s rigorous revamping of its Materials and Resources category with new product transparency credits, healthcare designers are cheering in the wings. “We’ve been waiting so long to have a coherent material toxicity conversation around building products, so the new credit for transparency and disclosure is very exciting,” Smith GroupJJR’s Perry says.

Perry’s colleague Tyler Krehlik, a healthcare sustainable design specialist based in the firm’s San Francisco office, adds: “Healthcare institutions operate under the Hippocratic Oath of ‘do no harm,’ and yet due to the lack of transparency in the building industry, designers, up until now, have had no way of ensuring their designed buildings were living up to that same challenge.”

And while manufacturers are required to furnish MSDS sheets, HOK’s Baum says that these documents are often incomplete or contain language unfamiliar to architects. In cases where designers choose to go that extra mile to try to uncover unhealthy aspects of a given building product, an enormous amount of research is required. “Multiply this by tens of thousands of products in a typical healthcare construction project and the task becomes overwhelming and untenable,” Krehlik says.

At the same time, the process of developing environmental product declarations (EPD), healthy product declarations (HPD), and lifecycle assessments (LCA) will be a challenging and time-consuming. “The industry is going to have to scramble to catch up to LEED in the materials realm. Very few products have EPDs, fewer have HPDs, and no one really knows how to do a comprehensive LCA,” Perry says.


In response to industry concerns that these provisions are too ambitious, the USGBC is allowing projects to register under LEED 2009 until as late as June 2015. Furthermore, v4 is awarding credits for simply reporting the LCA, as verified by an EPD, regardless of what the LCA reveals—or, alternatively, specifying products that have demonstrated an environmental impact below the industry average for that specific product type.

Although Baum understands the USGBC’s quandary in addressing this issue, she is concerned that environmentally irresponsible products earning LEED points merely by publishing an EPD can be very confusing and might spur greenwashing.

Clarifying the issue, Jacob Kriss, a USGBC media associate, states, “The purpose of this is to accelerate the availability of environmental impact data in the market for consumers to use when selecting products.”

A closer look
As product manufacturers busy themselves with developing EPDs and LCAs, healthcare designers are sure to have their hands full trying to meet LEED v4 energy credit standards.

Although each individual case is dependent on the credits pursued and strategy adopted by a project team, it’s likely that designers will face difficulty achieving energy efficiency with large volume air movement systems as compared to less energy-demanding systems, such as chilled beams and displacement ventilation, the USGBC states.

In addition, Brantley Davis, associate, Hord Coplan Macht, says that hospital additions and renovations, limited by existing central plants, will be hard tasked to exceed baseline requirements, whereas new construction or projects, with new or updated utility plants, will have an easier time.

Also available is a new Demand Response credit related to external energy service providers. All projects have an opportunity to earn points under various options of this credit, which weighs use of programs offered by service providers to customers to reduce demand at peak times of energy usage in an area, USGBC states.

Davis also questions the likelihood of healthcare projects availing themselves of LEED v4’s Green Power and Carbon Offsets credit, which requires a five-year contract for 50 percent of the building’s total energy usage, with carbon offsets also permitted to contribute toward the requirements.

On the other hand, healthcare designers anticipate that newer water conservation credits will be easier to handle. “For water, the path to achieving credits has not changed very much, but we have the opportunity to earn more points,” says Jeff Saad, vice president, healthcare Midwest, HKS (Chicago). In addition, Perkins+Will’s Glazer says that some of the new v4 credits closely align with credits already in LEED for Healthcare v3, such as water metering and process water use reduction—so in some cases, healthcare designers already have a jump start. There are variations on some credits, USGBC notes, including daylight, quality views, and acoustics. There are also credits that are unique to healthcare that were carried over from LEED 2009.

Ready for the challenge
Overall, healthcare designers are saluting LEED v4 as a timely push for sustainable building design, but building teams should expect a learning curve while adjusting to the new system. “Teams can no longer take for granted that they know everything about the system. We’ve been overdue for change for many years. This is a much-needed step even if we face fumbles and challenges along the way,” Baum says.

In particular,
designers can expect extra work in terms of understanding the intent of the credits, deciding whether to pursue them, and documenting compliance. Davis also believes that justifying the anticipated additional costs may a challenge for healthcare providers, but those that do will be rewarded with highly sustainable buildings.

“The raised performance thresholds of LEED v4 will continue to drive the innovation and design/engineering intelligence needed to achieve the energy- and water-neutral hospitals of our future,” says Breeze Glazer, associate, national research knowledge manager, sustainable healthcare, Perkins+Will (New York).

SIDEBAR: How healthcare interfaces with LEED
Despite growing numbers of LEED-certified facilities and the buzz surrounding the release of LEED v4, the healthcare industry continues to lag behind with fewer LEED projects than there are in other building markets.

“We have a lot of great leadership in sustainable design and it’s definitely improved over the years, but this is still not as ubiquitous as it is in many other building types,” says Mara Baum, senior associate, sustainable design leader, healthcare, HOK.

Granted, healthcare is a highly regulated industry, and in many cases, providers simply don’t want to take on the burden of yet another set of requirements. But at the same time, the idea of not fully embracing eco-friendly construction seems inconsistent with hospitals’ core values. “I find this ironic,” Baum says. “The resource use reduction and occupant health improvements that sustainable design can support should theoretically be desirable to organizations that focus on these issues in other aspects of their projects and organizations.”

Why the inconsistency? Russell Perry, co-director, sustainable design, SmithGroupJJR, suggests two reasons. First, he believes that unlike those in universities, K-12 schools, and offices, consumers of healthcare have done an insufficient job of demanding more environmentally friendly facilities from owners and developers. And second, despite efforts in the realm of evidence-based design, Perry says that the green building industry hasn’t done enough to connect green building strategies with human health benefits. At the same time, Perry does salute ongoing research and USGBC efforts to make the case for green healthy buildings more compelling.

In terms of LEED v4’s potential impact on healthcare projects choosing to pursue LEED, designers say the new system’s greater complexities and stringencies may be discouraging for healthcare organizations and result in a drop-off of those pursuing the certification. But with the facilities able to use LEED 2009 until 2015, that allows plenty of time to learn the new requirements and jump on board later.


Barbara Horwitz-Bennett is a contributing editor for Healthcare Design. She can be reached at