It's easy being green

Responding to the call, the healthcare design community has embraced the Green Guide for Health Care (GGHC) with 150 certified projects and counting. And LEED for Healthcare (LEED HC), which recently went through its second public comment period, has garnered considerable interest and feedback from the industry as the U.S. Green Building Council continues developing the template.

“The LEED HC implementation timeline has been extremely long and frustrating for the design community, but the amount of public comment to date is a true indicator of the level of interest in the system and how important it is,” says Befu's colleague Tyler Krehlik, sustainability firm leader at Anshen+Allen.

LEED HC has already seen some significant changes from its original draft based upon feedback from the first round of public comment in 2007 and from an effort to align it with the LEED 2009 template's reformed credit-weighting system. In addition, LEED has closely connected itself with the Green Guide, using it as an original launching point for LEED HC and, more recently, adopting a number of Green Guide credits to LEED's newly developed Pilot Library.

“In many ways, the GGHC is actually out in front of LEED in that they are more research-focused and are able to consider new concepts and study their effectiveness,” notes Roy Gunsolus, AIA, LEED AP, and principal/director of healthcare sustainability at HKS in Dallas. “GGHC seems to be the research arm, and LEED benefits by implementing new initiatives based on this research.”

That being said, some significant developments are in the works, both with GGHC and LEED, in their combined quest to provide well-researched, expert guidelines to the healthcare design community.

A LEEDing role

Taking a step back, the general concensus is that LEED has contributed much to the healthcare sector by popularizing green design across the board. “LEED has been a boon to architects and designers by opening a pathway to discussions about sustainability and the health of a community at-large in the context of energy efficiency,” Befu says.

In addition, the LEED certification process has pushed project teams to not stop at simply addressing green issues, but to follow through and fulfill the requirements.

On the other hand, many also will agree that LEED for New Construction and LEED for Existing Buildings have been helpful, but the fact they are not targeted to the unique nature of healthcare facilities has been rather limiting. “To date, we have been forced to shoehorn a technically complicated and diverse building type into a rating system designed around a fairly homogeneous office building,” Krehlik says.

Consequently, LEED HC is taking shape with an undercurrent of excitement and anticipation. “LEED for Healthcare will ultimately play a most significant role in greening healthcare facilities,” predicts Vlad Toskiy, vice president of HOK's healthcare group in Chicago. “It will challenge the healthcare industry to bring its performance associated with sustainability to the next level of quality, and it will outline the road for a future LEED system adaptation or integration into a building code.”

On a more practical level, Krehlik says, “LEED HC will allow for more accurate goal setting and easier implementation of LEED into healthcare projects.”

Specifically targeting energy-intensive healthcare facilities, LEED HC is created to give special emphasis to reducing both energy and water use.

Another noted departure from general LEED guidelines is a greater focus on indoor air quality (IAQ), according to Robin Guenther, FAIA, LEED AP, and principal at Perkins+Will in New York. “LEED for Healthcare deviates from other LEED products by placing slightly less emphasis on transportation energy impacts-given that hospital siting is often not discretionary-and more on IAQ, recognizing that continuously occupied buildings and immunocompromised patients require greater attention to these issues,” she says.

In addition, some of LEED 2009′s credits, such as daylighting, will be relaxed to make them more attainable by healthcare facilities, while other more healthcare-specific credits are being added.

“Some of the important content from the Green Guide that appears in the second draft of the LEED for Healthcare tool,” explains Guenther, “are those unique healthcare credits that are rooted in evidence-based design: two points for acoustics, two points for places of respite, and five points related to daylight and views.”

Also, as mentioned, some Green Guide credits have been incorporated into LEED's new Pilot Library. Guenther says they include an innovative ventilation credit, which rewards projects for achieving natural ventilation in hospital settings; a medical equipment energy efficiency credit, which is aimed at curbing energy consumption and associated heat gain through more efficient medical equipment choices; and a PBT elimination credit, which rewards hospitals for moving away from building materials associated with dioxin production in their life cycle.

By registering for the Pilot Library, current projects tracking LEED for Healthcare will be eligible to capitalize on these points in the innovation category.

LEED for Healthcare: At a glance

As the new LEED for Healthcare certification system continues to be tweaked and developed, the following modifications to LEED 2009 were presented during the second public comment period:

• Connection to the natural world-places of respite, direct exterior access for patients;

• Water use reduction-building equipment, cooling towers, food waste systems;

• Community contaminant prevention-airborne releases;

• Furniture and medical furnishings/materials;

• Resource use-design for flexibility;

• Acoustic environment/noise reduction-sound isolation, acoustical finishes;

• Low-emitting materials-wall and ceiling finishes, batt insulation products, exterior applied products;

• Daylight and views-non-inpatient buildings and areas; and

• Integrative project planning and design.

GGHC revamped

As for the Green Guide, not only is it distinguished as the first green design tool customized for the unique needs of the healthcare industry, but it is the first to provide explicit links between green building strategies and human and ecological health, Guenther says.

Along those lines, some noted industry accomplishments include encouraging the market shift away from PVC plastics in building products and use of brominated flame retardants in furnishings and textiles, and developing the EnergyStar initiative to bring major healthcare diagnostic equipment to the energy conservation table, the Perkins+Will designer says.

Furthermore, the GGHC Web site, www.gghc.org, was recently expanded and relaunched, now offering free access to an array of healthcare sustainable design resources, such as a case study library, articles, Webinars, and links on healthcare design, construction, and operations.

Looking forward, the organization aims to create a roadmap for institutions to leapfrog efforts to do less harm and sooner achieve a built environment that does no harm, and even heals the environment, Guenther says.

“The Green Guide
is promoting a vision of carbon-neutral, zero-waste, water-balanced, aspirational healthcare building that is likely to influence the future development of LEED tools for this sector and beyond,” she says.

Currently spearheading the healthcare system's announced goal of becoming carbon neutral by 2015, the Green Guide also is promoting a vision of regenerative, restorative, and resilient healthcare, which will be measured on a global scale, community scale, and from a building-occupant perspective scale, Torskiy says.

General sustainable healthcare trends

While the Green Guide and LEED are certainly playing a significant role in the sustainable healthcare revolution, there is now an unprecedented awareness of its benefits, particularly on the business side. For example, an average hospital spends an estimated 15% of its profits annually on energy consumption, according to the U.S. Department of Energy. So, it goes without saying that the bottom line is driving sustainable decisions.

“It's one of the easiest ways for a struggling healthcare provider to reduce overhead because it is under their control, unlike most of their other expenditures. For this reason, interest level in energy conservation is accelerating,” says Troy Hoggard, AIA, LEED AP, OWP/P, of Chicago.

Other overall healthcare green design trends include specifying low-flow fixtures, better daylighting and acoustics, and improving IAQ via strategies like air filtration during construction and selection of low-emitting materials.

Case in point: Hoggard's team recently completed the LEED Gold Advocate Lutheran General Hospital General Patient Care Tower renovation in Park Ridge, Illinois. By replacing most of the main plant equipment, specifying a rainwater collection system and paying close attention to R values, for example, the design team ultimately captured 21% energy savings.

Along the way, energy modeling also played an important role with this particular project. “Design teams have to focus on where the waste is, and such a model will target those areas early enough to make good decisions,” Hoggard says.

Also key, adds Hoggard, is designers' ability to measure those decisions, which, fortunately, is becoming easier as more and more industry data is available to enable important project comparisons.

Overall, it's certainly an exciting time for the healthcare industry with such sustainable initiatives in the works. But considering that an average LEED-certified project yields savings in the range of 20% and that this designation is now required for all baseline green buildings, there's nowhere to go but up.

Energy-efficient design primer

When embarking upon a sustainable healthcare project, Vlad Toskiy, vice president of HOK's healthcare group in Chicago, offers the following parameters for measuring energy efficiency:

• First cost;

• Life-cycle cost;

• Energy systems adaptability and flexibility;

• Energy systems maintenance and time testing; and

• Creation of the healing and healthy environment.

These parameters directly translate to:

• Site orientation/placement;

• Climate-responsive architecture: Sun energy and light, air and wind, precipitation and humidity, and seasons and temperatures; and

• Building efficiency: Heating, ventilation, and electrical systems.

The next step is to consider some the following sustainable design techniques, such as:

• Passive solar heating;

• Thermal mass effect;

• Natural ventilation;

• Direct and indirect evaporative cooling; and

• Exposed mass plus night-purge ventilation in conjunction with passive and active shading.

Homing in on energy-efficient lighting, the following guidelines can help reap valuable savings:

• Carefully selecting the exterior lighting with reduced energy fixtures and light trespassing;

• Interior lighting design that utilizes less than 1 W/SF of space;

• Daylight harvesting, reduction in number of incandescent light fixtures, occupancy sensors, and individual controls.

For the HVAC system, Torskiy recommends the following:

• A single- or dual-path 100% outside air system that includes heat recovery with runaround coils to prevent cross contamination with optimal dehumidification;

• A dual path separating ventilation from temperature control with an independent system that handles thermal loads; and

• In nonclinical areas or freestanding medical office buildings, chilled beams to enable significant energy savings.

Barbara Horwitz-Bennett ( www.bhbennett.com) is a frequent contributor to publications and organizations dealing with building and construction. She can be reached at [email protected]. Healthcare Design 2010 November;10(11):24-31