In the first part of my interview with Mara Baum, AIA, LEED AP BD+C, we delved into the details of her role as Sustainable Design Leader for HOK’s Healthcare practice and the ever-evolving nature of the green and sustainable movement in the healthcare community as a whole. In this second and final part, Baum and I discuss green rating systems, including LEED for Healthcare, as well as how her status as an architect affects her role in the sustainable design world (and vice versa), and what we can look forward to in the future.

To read part 1 of the interview, please click here.


Hutlock: Speaking of LEED, the green rating systems have also changed a lot over the last decade. How has that landscape changed, especially with the advent of LEED for Healthcare?

Baum: That landscape has changed so much. Second possibly to the economy and utility rates, LEED is the one thing most responsible for this increased awareness of  sustainability within the building sector. There’s been so much publicity around LEED that it has now become part of the larger dialogue. When I first started doing this work, HOK was completing a LEED version 1 pilot project, so I’ve been working with LEED for most of my career.  

There had previously been an attitude that it was harder to be green and to pursue LEED in the healthcare environment because there are so many specialized challenges like infection control challenges, code issues, and so on. Healthcare had initially been slower to adopt LEED than other market sectors, but then other tools like the Green Guide for Health Care began pushing the industry forward by introducing healthcare-specific approaches to sustainability. The point began to be raised that green issues are, in fact, health issues and are even more important to healthcare projects. That notion started to raise consciousness.

Now, with the advent of LEED for Healthcare and the dissolution of the Green Guide organization, healthcare rating systems have become even more formalized. In January 2012, it became a requirement that an inpatient or outpatient facility interested in pursuing LEED must use LEED for Healthcare. Prior to January, we had the choice to register for either LEED for New Construction or LEED for Healthcare, but now there one a single, dedicated system in place for new construction, healthcare rating systems have really matured. We also see a number of other rating systems in place around the globe in our international markets. These rating systems are definitely a very important part of the way we practice, but they are just one piece of the sustainability puzzle. Rating systems are never the be-all, end-all of sustainable design. They are one metric, but they aren’t the only thing that matters.

Hutlock: I heard you speak at the 2011 Greenbuild conference, and I wrote a blog piece about your presentation, during which you and fellow panelist Steven Guttmann disagreed on some of the points of LEED for Healthcare.

Baum: : In general, Steve and I agree, and I feel that LEED for Healthcare is moving in the right direction. There is typically a pilot version of each new LEED rating system type. However, because many of the Green Guide for Health Care credits were so similar, LEED for Healthcare considered the Green Guide for Health Care to be the equivalent of a pilot program. There are still a handful of credits, however, that are either completely different or substantially changed from the Green Guide, and so some of these credits are effectively in that pilot process right now.

The views credit—which was relatively straightforward but still challenging under LEED for New Construction—now practically requires a PhD to figure out. I have several LEED for Healthcare projects in schematic design, and it is generally very difficult to evaluate how well or how poorly a project is meeting these requirements without extremely detailed calculations early in the project. Offering views to the outdoors is a relatively intuitive concept that has been made very complicated by this credit. Ihad hoped for additional improvements, but what I’ve seen of LEED 2012 isn’t much better. I don’t think that they’ve received enough real world feedback yet.

In contrast, the LEED for Healthcare project in Germany that I showed at the Greenbuild presentation must meet German view requirements. The German code is pretty hardcore, but its approach is a much better way of doing buildings than we typically use in the United States. The German code says that any space occupied by a worker for more than a few hours must have a view to the outside, and that the view must be enough for the person to tell whether it is night or day. As you can imagine, if any space in a hospital where someone is spending at least a few hours needs a view to the outside, this requires a very different type of layout than we would conventionally see in the United States. That really helped to shape the building form, and by the end of schematic design we had a very successful approach to meeting that goal.

When I looked through the LEED for Healthcare credit, however, it wasn’t apparent that we would definitely get even one of the views points because the LEED and German approaches to details are very different. I find that ironic, but it also shows me that LEED credit is very formulaic and not necessarily in tune with the way we work. In this project, there are many spaces with wonderful views, but they won’t qualify for LEED points because they don’t quite match the specific LEED criteria.

This one credit, however, should not overshadow LEED for Healthcare’s successes. There are other small things in LEED for Healthcare that I might not personally agree with, but for the most part, it has provided us with good metrics, and lots of good ideas can be gleaned from it whether a facility is pursuing certification or not. I tend to be more frustrated with other references as opposed to LEED itself, as LEED tends to reference other standards as much as possible.

Hutlock: Aside from the many hats you wear as Sustainable Design Leader, you are also a trained and licensed architect. How do you contextualize your work in the green and sustainable sector with your architectural training?

Baum: I think that I bring a different perspective to the architecture world from the average architect, and a different perspective to the sustainability world from someone in another field such as engineering or environmental planning. While my primary training was in architecture, I also studied building science and so I bring a more technical approach to energy and environmental issues than the average architect. The ability to translate between architects and engineers has been very important to my work here. It’s very important to have an integrated architectural and mechanical engineering team as early as pre-design to effectively incorporate sustainability and energy efficiency issues.

Hutlock: So where do you see things heading in the sustainability world in 2012 and beyond?

Baum: I think we can look forward to a significant increase in our knowledge
base, especially in the understanding how hospitals use energy and what we can do to significantly reduce that consumption without compromising any of our code or infection control issues. Projecting out over the next decade or so, I think we are also going to see a higher level of research into issues like air change rates, toxicity of materials, and water use. Based on those results, I predict that we will see changes to building codes and industry standards that will really lift some of the barriers that currently exist to dramatically improve energy and other materials usage in healthcare environments. Some of these issues are being studied now, but I expect them to snowball in the coming years to the point at which we have momentum to make some true and lasting changes.