In 2007, Dell Children’s Medical Center of Central Texas opened what would earn the U.S. Green Building Council’s (USGBC) first LEED Platinum certification under the rating system’s new construction category.

Four years later, when funding was approved to add an 86,000-square-foot bed tower to the 32-acre campus, leadership could have pursued the same green path, using the data and design concepts implemented in the original 503,000-square-foot building.

But the market had evolved since Dell embarked on that first project: There were greater product options and newer technologies, the design community was savvier, and the USGBC had released a new LEED rating system specifically for healthcare.

So rather than mimicking its previous green strategies in the addition, Dell Children’s instead opted for the more challenging task of pursuing LEED for Healthcare (LEED-HC), says Alan Bell, director design and construction, Seton Healthcare Family, Dell’s Central Texas-based not-for-profit healthcare organization.

“We didn’t just do the original building,” he says.

Gathering many of the same partners involved on the first project, including Polkinghorn Group Architects, Obrentz Design Group, The Beck Group Inc., and the Center for Maximum Potential Building Systems, the team gathered for an early design charrette to start discussing new opportunities, lessons learned from the original building design, and where they could push the envelope.

“Not only did we have that expertise, but we also had a very savvy owner that understood how the building was functioning and was able to inform the design team on where we could improve,” says Tanya Berry, project designer, Polkinghorn Group Architects (PGA; Austin, Texas). “They knew what was working and what could work better.”


Digging deeper
During those early discussions, the team started identifying the LEED points it wanted to go after, ideas for the building systems, and the financials as related to payback and value to the owner that would guide each decision. “We weren’t interested in buying points just to gain points for a certification level,” says Nolan Rome, associate principal, CCRD (Austin, Texas), the MEP engineer on the project.

The decision target was anything that had a 12 percent rate of return or a 6-year payback on the system, he says. “Anything that exceeded the payback, we did a lifecycle cost analysis on it, including utility inflation rate and the owner’s cost of future maintenance, and then looked at it on an individual basis,” he says.

For example, one idea for a rooftop cooling tower that would use free evaporative cooling in addition to a heat recovery wheel was shelved because the team was uncertain about maintenance costs of the complicated system and how it would hold up over time.

One proposal that did get the green light was a solar hot water heating system, which operates by running building water through a series of solar collectors on the roof to preheat the water before it goes back to the plant, saving about 303 MMBTUs annually, Rome says. Another was the installation of a 26 kw photovoltaic array on the roof that feeds the normal power distribution for the addition. Both innovations contributed to the bed tower project achieving 23 out of 24 possible LEED points related to energy.

Brian Horras, project manager at The Beck Group (Springfield, Mo.), says the team also decided to push the envelope by using all LED lighting in the bed tower, rather than more traditional high-performance fluorescent fixtures, because of the perceived energy and maintenance cost savings. “We did some tests in some sample panels and decided that it was the way we wanted to go,” he says.

He says the maintenance staff loved the idea because they no longer had to stock bulbs. In addition, many of the fixtures on the Dell project required dimming capabilities and the LED fixtures could be dimmed thru a lighting control system without the use of a dimming ballast that’s necessary on traditional fixtures. 

“This was the most extensive use of LED fixtures in an installation that we have performed,” Horras says.

For maximum efficiency, the LEDs are tied to lighting controls that are integrated with building controls. When a nurse checks out a patient, the room can be placed in an unoccupied mode, allowing the systems to work together to turn off the TV, dim the lights, and bring the HVAC system to a minimum level. “It stays in that mode until a nurse checks a patient into that room through the bed tracking system,” Rome says.

In addition to energy savings, Dell Children’s location in drought-prone Texas meant water conservation was also top of mind. For example, Dell was already using reclaimed water for landscape irrigation and low-flow water fixtures inside patient and staff areas. With the bed tower, the team saw the opportunity to do more with new technologies as well as to explore a new LEED credit that focuses on process water use associated with medical and mechanical equipment.

Since the bed tower relied on the base building for most of its mechanical equipment, the team looked to the tower’s ice machines to save water by installing a more efficient machine that uses 12.6 gallons of water per 100 lbs. of ice compared to the baseline model, which uses 35 gallons per 100 lbs. The result is an aggregate 49 percent savings in process water in addition to a 38 percent savings from low flow and flush fixtures that are installed throughout the building, including in patient rooms and public and staff restrooms.

“In a hospital environment, the rule of thumb is about 70 percent of total water is for process uses, like equipment, and only 30 percent is for sinks, showers, toilets, and so on,” says Gail Vittori, co-director, Center for Maximum Potential Building Systems (Austin, Texas). “It’s great to be reducing those fixture requirements for water use, but that’s only doing 30 percent better of 30 percent. If we’re talking 30 percent of 70 percent, obviously you’re making a bigger dent and going beyond code to embrace some of these water-saving opportunities.”

The project team also reviewed user satisfaction responses regarding the original low-flow showerheads and found that patients thought the water pressure was too low. Putting new technology to the test, three fixtures were installed in some of the facility’s locker rooms and input was gathered from staff before a new low-flow model was chosen for the bed tower.


Materials push

In addition to pushing beyond the original hospital’s efficiency features, the expansion project team sought to improve air quality and reduce pollutants in the clinical environment.

The new healthcare-specific rating system introduces several new credits in the materials and resources section that are specifically associated with chemicals of concern and go beyond what other rating systems have done in the past.

“People think that we’re done with lead in the built environment but, in fact, there are many places where lead actually continues to be part of the manufacture of commonly used materials,” Vittori says.

Using a new credit that focuses on persistent bioaccumulative toxins and source reduction for lead, cadmium, and copper, the project specified zero-lead content roofing and flashing products and lead- and cadmium-free interior and exterior paints. In addition, all electric wires and cables have lead content that’s less than 300 ppm, and all solder and flux products used to connect new plumbing pipe on the bed tower comply with the standards.

The team also sought one of the LEED-HC pilot credits that addresses dioxins and halogenated organic compounds (HOCs), including products with chlorine, bromine, or fluorine chemical elements, achieving 81 percent of all exterior components (based on cost) and 93 percent of interior finishes free of added HOCs.

Vittori says the owner and project team’s early commitment to strive for Platinum certification helped everyone stay focused and committed to specifying healthy materials.

“When you’re willing to spend the time to find information that’s not readily available and to stay with it, you’re actually contributing to advancing an interest to promote healthier materials,” she says. “I think the motivation for the team was to create a healing environment within the hospital, but it has broader implications outside of that specific context, as well.”

The project’s interior design team also took time to look at the baseline materials from the first building and identify areas where new, improved products could be switched out without compromising the overall aesthetic of the facility. For example, PGA’s Berry says the original wood doors and millwork were showing wear and tear after a few years. A new solid surface product that looked like wood was found that would be more durable and achieve the same look in the bed tower but was made with recycled material content that would contribute to LEED points.

The original hospital, which is PVC-free, also had to specify certified wood bumper guards because a PVC-free version wasn’t available at the time. The new bed tower was able to choose a non-PVC synthetic product that looks similar. “Had that been available on the first project, we would have used it,” Seton’s Bell says. “Why cut down more trees for wall rails?”


Continuous improvement

Rome says the project’s first eight months of utility trend data were on target and that the building is performing at expected levels. He adds that the commissioning of some of the systems, such as the lighting and HVAC controls, has taken longer than expected and that once the facility gathers a year’s worth of utility data, CCRD plans to work with the staff on further adjusting the control scenarios to make sure the building is functioning at maximum efficiency and in line with the energy modeling.

“There will be some tweaks,” he says. “We haven’t gone through a full spring yet, which in central Texas is a high-humidity time of year.”

Bell says with the bed tower up and running, the owner is going back to the base building floors one by one and refreshing them with new paint, refinished floors, and new LED fixtures in the main corridor.

Looking beyond the walls of Dell Children’s, Vittori says she hopes the bed tower project provides further proof that LEED-certified hospitals are a viable option, pointing out that the bed tower project came in on schedule and budget.

“Hopefully we’re approaching a tipping point with our understanding that you can do all of this and not move outside of your budgetary parameters,” she says. “How is it possible for this not to become the basis of design and operation for our healthcare facilities in the future?”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at

For a source list relating to this project, see “Dell Children’s Third Bed Tower: Project Breakdown.”