If you’ve been following healthcare sustainability, you’ve likely heard about Gundersen Health System. Gundersen Lutheran facilities had been pieced together over the last century and the physical space no longer met the needs or expectations of patients, families, and staff.

The organization’s in-house, multidisciplinary team partnered with its design firm, AECOM, and construction management firm Kraus Anderson Construction to add an additional 500,000 square feet to the existing space.

Gundersen broke ground on the new hospital, which will connect to the existing hospital, in January 2010, and is on track to begin caring for patients in the new space in January 2014.

The 500,000-square-foot expansion will include a new lobby, emergency services department, imaging, operating rooms, cath labs, pre- and post-surgical settings, a neonatal intensive care unit, private rooms for all patients, and much more.

The Lacrosse, Wisconsin-based health system has embraced practices in LEED-certified construction, solar and wind power, methane recovery, locally sourced foods, mercury-free operations, and recycling—all accomplished with lower operational costs.


Primed for energy savings
One goal for the new construction is to improve energy use to 115 kBTU per square foot, up from the current 240-280 kBTU per square foot. Reaching this goal will put the hospital in the top 1% for energy efficiency of hospitals in the region. At current energy costs, achieving 115 kBTU will save Gundersen Lutheran about $660,000 annually.

One of the most significant pieces of the energy plan is a geothermal heat pump system, whichtakes advantage of the moderate temperatures underground to greatly improve efficiencies of HVAC equipment. A 300-ton heat pump will be installed along with 156 wells buried about 400 feet underneath a parking lot. At that depth, Gundersen says, the ground is at a relatively constant temperature of roughly 48 degrees Fahrenheit, providing an efficient heating and cooling source year-round.

It works like this: During the winter months, water from the geothermal wells is sent to the geothermal pump. There, the energy (heat) from that water is used to add heat to the building. The water that had the energy removed is then sent back to the geothermal well to once again have energy transferred to it from the earth.

The opposite happens in the summer months. The cool water from the geothermal wells is sent to the geothermal heat pump, where energy (heat) is transferred from the building to the water. The warmed water is then sent to the geothermal wells to transfer its heat back to the earth.

In addition, all hospitals have continuous heating and cooling requirements that have nothing to do with outdoor temperatures. For example, heat is always needed for the sterilization of medical instruments, dehumidification, or laundry.

On the other side of the coin, medical equipment, electrical equipment, and computer systems are constantly generating heat.

So the geothermal heat pump system at Gundersen includes an ingenious set-up that will capture this heat and send it to areas where it can be used. By taking advantage of the heat, less energy will be needed from the geothermal wells in the winter, further increasing the efficiency of the system.

Work on the geothermal system will be completed in Winter 2012 Gundersen anticipates the geothermal heat pump will result in a savings of 70 to 80 kBTU per square foot annually—by far the largest energy-saving component of the new hospital. Gundersen says the system will drastically reduce its dependence on fossil fuels and exposure to fuel price volatility.

Other elements of the energy plan for the new hospital include: Efficient lighting design with lower wattage lamps and high-efficiency ballasts, occupancy sensors, and fixtures that better disperse light for an anticipated savings of 5 to 7 kBTU per square foot; and a highly insulated building shell (windows, walls, ceilings, etc.), for an expected energy savings of 17 kBTU per square foot.

Energy-efficient chillers, cooling towers, and chilled water pumps that replaced an aging infrastructure and will allow the new hospital to be cooled more efficiently. This will save 8 to 10 kBTU per square foot.Gundersen is seeking LEED certification on the construction. In addition to the energy goal, other green practices include the use of sustainable materials, local and regional sourcing of materials when feasible, and construction waste management.


Interior motives
Gundersen has signed onto the free Healthier Hospital Initiative and all of its six challenges, joining with other hospitals to engage and measure a suite of environmental interventions and use the data to demonstrate environmental and financial value. With an expansion project of this size, the industry gains an excellent opportunity for insight into decisions around healthier interiors and other environmentally preferred purchasing.

When the building interior was designed, Gundersen worked with its architects and designers to incorporate a wide array of green elements, including:

  • Materials with recycled content wherever possible, such as counters in public restrooms made from 50% recycled materials, a decorative ceiling in a main concourse, and the ceiling tiles and carpeting throughout the building.
  • FSC-certified wood throughout the project. Companies with FSC certification practice forestry in an environmentally responsible way.
  • Materials sourced within 500 miles of Gundersen when possible. For example, the decorative cast stone that will be used in the lobby, healing garden, and café will be manufactured in New Ulm, Minnesota.
  • Three rooftop gardens with container plantings, which include a small demonstration area that will be used for kitchen herbs and a sensory garden for patients.

Greening construction and hospital interiors is a difficult business as the number of contractors and vendors touting environmental solutions increases. The team described its effort as “moving through weeds” as they tried to balance the right choice for their patients, the cost of care, and achieving sustainability goals.

Tom Thompson, Gundersen’s sustainability coordinator, says, “It’s up to us to nudge the marketplace and let manufacturers and service providers understand very clearly what we require. We’re deeply engaged with our community and by leveraging the marketplace with our need for safer materials and equipment, we’re sending a message that will have an impact far beyond our walls.”

To date, Gundersen’s project is about 46% complete and crews have handled 20,000 tons of construction waste materials. An astounding 98% of that waste has been recycled. Achieving this recycling rate is a direct result of buy-in from Gundersen’s contractors.

Recycling is more work , requiring the allocation of space and paying for fuel and surcharges. Where they used to negotiate pricing for a container of mixed materials, contractors now negotiate a price per pull for concrete, cardboard, wood, and other segregated commodities.

In the construction yard, there are as many as five different dumpsters capturing various materials at any one time. Some materials, like concrete, are reused in other projects. While there have been challenges along the way with separating and segregating materials, the crews were able to work through the issues in weekly meetings.

The recycling priority won’t end with construction. Once the space is complete,
recycling will be incorporated into all areas of the hospital. Containers will be strategically placed throughout the building to promote recycling for patients, visitors, and staff.


Kari Houser, director of construction and project management (and an accountant by training), offers a financial perspective on the endeavor. “We know that a commitment to sustainability doesn’t mean spending more,” she says. “It does, however, require looking at the lifetime of the product and material, equipment and disposal fees, and the impact to internal labor and operations associated with that product to make informed decisions based on the big picture.”

For example, the team took a deep dive when considering flooring choices and conducted a life-cycle analysis of vinyl composition tile (VCT) versus rubber. It was clear that VCT had a cheaper up-front cost.

But looking at the maintenance difference and supply costs over the lifetime of the flooring, the decision was made to go with rubber. This is a great example of how integrating the environmental services team into the design process achieved even greater operational results.


Flexibility as prevention
A flexible design addresses the uncertain future and preparedness for inevitable change in need and facility design. Gundersen sees flexible design as an act of prevention—it can help avoid renovations and the associated materials, staff-time and management costs.

Gundersen’s regional sourcing and market impact can help others make similar healthier choices, without spending more.

Any hospitals efforts around safer, regional, or recycled materials impact the entire sector as we move towards a more sustainable future for the entire sector.