The business environment for sustainability in healthcare is rapidly changing. Facing pressure from the Affordable Care Act and reductions in Medicare reimbursements, hospital CEOs are looking to reduce operating costs and overhead, and turning to green initiatives to ease the burden. As a result, healthcare design professionals are finding the need to adjust their approach to sustainability, too.

Not that long ago, firms offered sustainable design as an additional service. However, green elements aren’t add-ons or luxury items today; instead, design firms need to have extensive sustainability expertise even to be considered for new projects.

In May, Kaiser Permanente announced it will seek LEED Gold certification for new hospitals, large medical offices, and other major projects. But it’s not only large organizations that are adopting this stance; hospitals and medical centers of all sizes are demanding that sustainability be an integral feature in their facilities, as well.

“With rising healthcare costs, sustainability has become a key factor in reducing operating costs while maintaining quality patient care,” says Mick Zdeblick, COO of El Camino Hospital in Mountain View, Calif.

Designers shouldn’t simply acknowledge these changes in the business environment; they need to look for ways to provide even more value to clients through sustainable initiatives that will improve the bottom line, for both the hospital and the design firm.

A driving force

To start, sustainable design offers a number of solutions to operational stumbling blocks.

“Our clients, across the nation, are recognizing the need to hardwire sustainability into their operations. By hardwiring, we mean that once a business case is made, sustainability becomes the strategic elimination of waste in all forms. With this approach, environmental and fiscal metrics are used in tandem to express operational efficiency,” says Rick Ament, president of SOS Partners (DePere, Wis.). The firm specializes in strategic organizational sustainability for healthcare organizations.

Lorraine Auerbach, CEO of Dameron Hospital in Stockton, Calif., agrees: “Sustainability is one of our organizational priorities. When we look for opportunities to improve, we look for opportunities in operations, quality, and sustainability.”

As sustainability becomes an integral component of hospital operations, it becomes a baseline expectation for building projects, as well.

Expanding expectations

When designers are working to bring sustainability initiatives to the table on a new project, the definition of what that might be is expanding beyond energy and water conservation and using recycled materials.

The elimination of toxins in building materials, for example, is a common request.

“Because we have kids here who are extremely sensitive to chemicals, we have to be very cautious about the chemicals in our cleaning products and building products,” says Richard DeCarlo, COO of Oakland Children’s Hospital in Oakland, Calif. “When selecting a design team, we brought in architects with specialized expertise in this area to help us make these decisions.”

Likewise, at Mills-Peninsula Hospital in Burlingame, Calif., elimination of toxic chemicals in its new replacement facility was a key criteria.

COO Dolores Gomez explains: “We were one of the first hospitals to eliminate mercury in our facilities. All our building materials are formaldehyde-free. The new hospital flooring is PVC-free, and every time we approached flooring, wall, and furniture materials, we looked as much as possible for products with safer chemicals.”

Cost savings associated with sustainable building

Outside of addressing the enhanced expectations of healthcare facilities, design professionals can also propose green avenues that add even more value—for example, identifying investments that will significantly reduce operating costs, such as energy-saving modifications to systems.

Also, understanding land use development trends, changes in regulations, and emerging technologies from other industries enable firms to identify opportunities that may not be on a healthcare executive’s radar screen.

“I would love to have the architectural community think through the sustainability innovations people are doing outside of healthcare and how to apply them in a healthcare setting,” Dameron Hospital’s Auerbach says.

Often, facilities engineers don’t have the resources to build a business case for sustainability projects, so identifying the cost savings from these types of overhead-reducing improvements and presenting them to administrators is an opportunity for design professionals to generate new projects.

Recognizing sustainability opportunities during master planning is another way to gain work that wasn’t part of a capital program. Trend analysis and projections of future needs also enable design professionals to identify sustainability projects that facilitate land use entitlements or reduce future overhead costs by saving water, energy, and other resources.

Importance of operational training

Even after construction projects are completed, firms stand to gain additional business by developing programs to share expert knowledge with facilities staffs.

“Work needs to be done marrying the sustainable features of the building with operating the facility, to make sure these systems can be practically utilized for a long period of time,” says Tina Segrove, director of facilities at John Muir Medical Center in Concord, Calif.

Mike Johnson, CEO of Facilities at Regional Medical Center San Jose, in San Jose, Calif., points out that the timing of training is crucial.

“When we complete a new building, the designers and installers are required to explain the systems and controls. However, six months down the line when facility operations staff are wanting to fine-tune the system, the designers and installers have finished their work and moved on to something else.”

Paul Tucker, Director of Facilities at Regional Medical Center San Jose adds, “That’s probably when my team could use a second round of training because by then, they’ve really gotten to know the system and have a lot more questions about how to optimize the performance of the equipment.”

Future of sustainable design in healthcare

While the future of healthcare finances remains uncertain, sustainability will continue to be an essential component of healthcare design. As sustainability’s role in design matures, it’s shifting from a nice-to-have feature to a baseline expectation.

With these changes, opportunities will emerge for design professionals to leverage their expert knowledge to:

  • generate new projects that reduce operating costs
  • integrate sustainable strategies with operational strategies
  • expand the definition of sustainability to also focus on safer materials
  • and return to their healthcare clients after the facility has been built to help optimize the operation of the buildings they designed.

Scott Slotterback is senior environmental performance consultant at SOS Partners in San Francisco. He can be reached at