This article is part of “Rising Up,” a special report first published in the October 2019 issue of Healthcare Design, where sustainability leaders shed light on the top environmental design challenges affecting the industry, their input, and solutions necessary to solve them.

Here, Robin Guenther, principal, Perkins and Will (New York), shares her ideas on redefining the scope of sustainability to increase its relevance to the evolving needs of health systems.

Sustainable design challenge: Defining a living design framework: Healthcare organizations are changing their approach to sustainable design initiatives as they shift focus beyond “sick care” to “health optimization,” adding occupant well-being and climate resilience to longstanding sustainable goals such as energy and water conservation. Likewise, as leading health systems are recognizing the link between fossil fuel use and human health, they’re adopting significant system-wide carbon reduction goals not specifically linked to individual new building programs.

At the same time, a risk-averse healthcare industry has resisted fundamental energy system transformation in energy-intensive hospital buildings, instead focusing on harvesting the low-hanging fruit of basic conservation strategies. For example, LED lighting systems have become more common, but advanced daylighting and circadian systems have not. Additionally, the resiliency discussion is often confined to emergency management, as organizations struggle to meet the community need to remain operational during and following extreme weather events, and viewed as separate and distinct from sustainable design despite tremendous overlap in strategies. For design teams, it’s increasingly challenging to find the sustainability tools and resources that support each unique project and take full advantage of the synergies between high-performance buildings and to advance innovation. In short, the challenge is to redefine the scope of sustainability to increase its relevance to the evolving needs of health systems and the challenge of climate change and to stimulate true innovation.

Why it’s an issue: As healthcare organizations shift to “total health management,” focusing on sustainability (reducing fossil fuel and water use), resilience (climate adaptation), inclusion (health equity), and well-being (employee well-being, indoor air quality, material health, and occupant health), there’s a growing need for a more inclusive approach. The mainstream sustainable design certification system, LEED, has failed to effectively evolve to meet these evolving interests. Instead, a plethora of tools, resources, and unique certification systems have been introduced to address these areas, such as the Living Building Challenge for sustainable design, RELi for new building resilience, and WELL and Fitwel for well-being and occupant health. It’s confusing and difficult for health systems and their design partners to navigate among the rating systems, which can lead them to narrow their focus to a single rating system or create their own unique design standard. Inevitably, this leads to missed opportunities at the intersection between them and reduced opportunities for design innovation.

As social and ecological determinants of health gain traction, health systems will engage in partnerships with large employers and community organizations to move beyond their four walls to address health equity and deep-seated health disparities in the communities they serve. In turn, they’ll increasingly look to local design firms with deep community engagement and interdisciplinary reach.

The solution: Perkins and Will is a leader in the promotion of sustainable design and has actively supported the development of many rating system tools. But we’re also redefining our approach to sustainability by introducing a more inclusive Living Design framework that focuses on defining bespoke, place-based design solutions that respond to a broader social context and community need. The goal is to define the goals and values of the project—to define each “project story” holistically—and then use appropriate rating systems to support this storytelling.

Our Living Design framework also encompasses regenerative design thinking where buildings are net resource generators rather than resource depleting. The possibilities are exciting and will drive the next generation of design innovation: Buildings can produce more power than they use, have a positive impact on the natural and social systems they sit within, and support broader environmental and community health goals. This aligns with health systems’ fundamental mission to improve health.

Looking to the broader industry, project teams can drive change by reducing fragmentation and looking for synergies between systems and design solutions. For example, a white roof may reduce heat island impacts but it has no impact on stormwater or habitat restoration, while a green roof system with native plantings solves for all three issues. Next, we need to support transparency in the building materials marketplace so that we can fully understand the impacts of our design decisions on health and well-being. Finally, we need to move from vulnerable to resilient built environments by embedding features that solve for both sustainability and resilience. A building that uses less energy or water can operate longer on a fixed supply of both. It’s time for design approaches that integrate disparate ideas and strategies to create a whole that is greater than the sum of individual rating systems—truly living buildings.

For more on sustainable design, read “Rising Up” here or in Healthcare Design‘s October issue.