The Group Health Puyallup Medical Center, a new 53,000-square-foot, two-story facility in Puyallup, Wash., is the first project in the country to achieve certification under the new LEED for Healthcare rating system (LEED-HC). Recognizing that healthcare facilities tend to use the most materials and create the most waste in terms of everyday building processes, client Group Health Cooperative of Seattle set out to achieve LEED Gold for its new outpatient clinic.

As the design team began reviewing LEED credits to see what areas could be tackled, the U.S. Green Building Council released LEED-HC, so the team opted to go for the healthcare-specific rating and to potentially be the first to achieve it. And while credits under the Healthcare rating are at times more difficult to meet than the typical New Construction, Core and Shell, or Interiors rating systems, they also applied directly to this particular facility in relation to areas of respite for patients and staff, HVAC systems that support healthcare equipment, finish materials that support indoor environmental quality for patients, and a number of daylighting and site access protocols.

Digging in
Because there were no previous projects to reference, working toward LEED-HC required a deep understanding of what the rating was asking for, and how to best approach it and then document it. The healthcare rating is fairly similar to LEED for New Construction (LEED-NC), but it includes a few more prerequisites and a handful of new credits. Being a general outpatient clinic certainly made it easier to address some credits than if the project were a full inpatient emergency hospital, because the project team didn’t have to address the intensive commercial equipment that typically runs in an emergency hospital or the 24-hour building cycles that directly impact energy calculations. But even so, when the project fell short on some credits, the team had to work to make sure it could cover a number of credits in other areas to reach Gold.

For example, one large difference between LEED-HC and LEED-NC is in the area of water conservation: The credit for LEED-HC for water is much more rigorous in terms of the documentation, measurement, and verification required. For the Puyallup project, there was large section of the water conservation piece that couldn’t be addressed in regards to conservation involving cooling towers or food waste. Because the project didn’t have kitchens or food preparation areas, calculations for process water used for food steamers, ovens, ice machines, and dishwashers were disregarded. Also, due to the lack of intensive medical equipment typically found in inpatient hospitals, the project was not able to attain points for minimizing potable water use for medical equipment cooling.


LEED-HC also has areas that focus on connection to nature by using areas of respite. The team was able to utilize a number of areas on the Puyallup site as well as create access to a green roof to meet these requirements. However, access, safety, and need have to be addressed alongside budget, making the incorporation of green spaces at times difficult to achieve. Because safety concerns exist in allowing patients to access the roof, a respite area there is only available to staff. This meant that sufficient spaces had to be provided elsewhere on the site, at ground level, for the patients.  It was difficult to naturally incorporate these respite areas, which require certain levels of shade and accessibility, without exceeding the site budget. In addition to the main plaza working as a shaded connection to nature, the project incorporated a number of small areas scattered around the site and pedestrian pathways with breakout points to meet the requirements of this credit.

Another area that was a challenge was daylighting in terms of both access to natural light and views, especially in relation to the programming of the facility. The project focused on creating spaces that are more efficient for patients and staff and utilize a design that was modular in nature. The systematic layout used what the team referred to as pods, which hosted the staff in an interior area, with circulation and patients outboard of the staff. The modularity of the pods allows the departments to be flexible; using separate patient corridors and staff areas that could be reconfigured to fit needs, from standard exam rooms to a physical therapy gym to a pharmacy. Because of these layouts, the design was successful in allowing a large amount of natural light for the perimeter hallways and staff spaces, but it was difficult to get a lot of natural light into the exam rooms. While daylighting is achieved through the use of skylights and solar tubes, the project wasn’t able to meet either of these credits due to the care rooms not having direct light or views. In weighing whether to pursue this credit, it’s important to consider the facility type. For example, it makes a lot of sense for inpatient facilities to pursue daylighting in patient rooms, as studies have shown that views of nature or natural lighting can help recovery. Whereas in an outpatient clinic, patients are often only in an exam room for 30 minutes, so the expectations and priorities for having natural lighting and views aren’t as critical.

Scoring big
A large number of points were earned from optimizing energy performance, which uses an energy analysis to show the performance rating of all energy costs associated with the building. By bringing in natural light through large windows and curtain walls, skylights, and solar tubes, the team was able to minimize the use of artificial lighting—and the lighting that was used incorporated LEDs, motion sensors, and individual task lighting. The energy performance credit also addresses the energy used to heat and cool the building. To address this, the building was oriented with the main canopy and entry into the grand lobby facing north, with outboard staff areas on the east and west. The layout lends itself to utilize different sun levels throughout the day and throughout changing seasons, while minimizing required window protection in public spaces, and an efficient exterior wall system helps to reduce energy required for heating and cooling.

The IEQ Credit 4 for low-emitting materials and MR Credit 3 for sustainably sourced materials and products were also earned on this project. A lot of coordination went into the selection of furniture, casework, equipment, and finishes that would enhance the environment, minimize impact caused by production and transportation, and provide high indoor air quality. Local materials and materials with a high recycle content were selected, as well as items with low-volatile organic compound (VOC) content, low urea formaldehyde content and low levels of perfluorinatred chemicals (PCFs) and perfluorooctanoic acid (PFOAs).The team also refurbished and used wood from the site to create furniture and interior finishes. Other woods selected were Forest Stewardship Council (FSC)-certified and in general were salvaged, recycled, and local.

Natasha Epstein, LEED AP BD+C, EIT, is an architect with CollinsWoerman (Seattle). She can be reached at



The green roof at Group Health Puyallup Medical Center helped the project achieve four different credits:

  • SS Credit 6—Reduces storm water discharge
  • SS Credit 7.2—Insulates the building, keeps the roof temperature low, and reduces energy needed to heat and cool the building
  • EA Credit 1—Heat absorption from the roof reduces demand and increases efficiency on the cooling systems.
  • SS Credit 9.1—Created a connection to the natural world, helping to support the doctor area of respite accessible on the roof.

For more information about Group Health Cooperative’s Puyallup Medical Center, visit PHOTO TOUR: Puyallup Medical Center.