Featured in mainstream national magazines, TV news broadcasts and wide-release film documentaries, the threat of global warming and other environmental dangers has made its way to the forefront of our national consciousness. As many forecasts for these threats become more immediate and alarming, the public outcry for action grows more determined. A greater number of people are demanding environmentally responsible behavior from both the public and private sectors. For organizations seeking to stay ahead of the curve, the advantages in thinking and acting “green” have never been more apparent.

Environmentalism is nothing new to the building design and construction community. Sustainable design has been a growing trend in the industry for more than two decades and promises to continue expanding in both prevalence and scope. This movement seeks to limit resource consumption while improving building performance and promoting occupant health and productivity. Sustainable projects take all aspects of the building process into consideration, from initial strategic planning and site work to selecting building materials to incorporating efficiencies into the building's operation.

Sustainability In Health Care Design

Of all market sectors, the health care professions appear to offer the greatest opportunity for widespread integration of sustainable building solutions. Sustainable design is a natural extension of the mission of a hospital, clinic or nursing facility: to promote healing, comfort and wellness. In recent years, architects and engineers have made significant progress in the design of high-performance health care projects. Looking ahead, the opportunities for innovative designers and enlightened facility owners to incorporate sustainability as a guiding principle are almost limitless. With continued breakthroughs in medical treatments and technology, the need for new and innovative health care designs will only increase.

In applying sustainable design initiatives, however, health care facilities present a range of unique challenges:

Hospitals must operate at high performance levels 24-hours-per-day, seven-days-per-week.
Clinical demands may require both heating and cooling year-round, often in adjacent functional spaces.
Energy demands include not only emergency and uninterrupted power requirements, but also the guarantee of “clean” electricity for diagnostic and therapeutic equipment.
Finish materials must perform to high levels in terms of both safety and maintenance.
Health care projects generate high individual unit construction costs and complex program requirements.

Of all building types, hospitals consume the fourth-highest amount of energy, accounting for 10 percent to 15 percent of all commercial consumption at a cost of more than $3 billion per year. The health care industry also contributes 5 million tons of solid waste annually to the nation's landfills.

Despite the many challenges, architects and engineers have made major strides in developing sustainable health care facilities. Green principles such as the redevelopment of brownfield sites, the availability of transit systems, the use of high-performance and recycled building materials, the implementation of water and energy efficiencies, and the promotion of environmentally responsible building operations have become common considerations in health care projects. As the short-term and long-term benefits of such measures gain greater awareness, the trend toward sustainable medical buildings will only accelerate.

Cases In Point

Evansville State Hospital is one of five psychiatric hospitals in Indiana. The hospital is a 168-bed replacement psychiatric facility of 140,000 square feet, which was designed to promote a healing environment for a wide variety of patients and to provide an efficient configuration for staff.

The new psychiatric facility seeks to conserve resources and improve the patient experience. The building's exterior is composed of autoclaved aerated concrete (AAC), a product that is manufactured using fly ash residue from the burning of coal in power plants. This concrete product provides outstanding sound proofing and fireproofing protection in addition to its excellent insulating capabilities. The Evansville project represents the largest, most extensive use of this recycled product within an institutional facility in United States.

Other sustainable highlights include:

Careful site development to avoid removing existing trees and vegetation.
An engineered wetlands made up of a series of retention ponds on the site to control storm water and help with runoff problems in the adjacent residential neighborhood.
A majority of rooms with views to the exterior and windows in all patient rooms with individual vents that patients can open and close.
Additional natural daylighting provided through monitors at all of the nurse stations and an elongated skylight over the therapeutic “treatment mall.”

Also located in Indiana is the new Southeast Regional Treatment Center in Madison. It is a psychiatric hospital that serves 18 counties in the southeast region of Indiana and has a 650-acre campus overlooking the Ohio River. The facility supports state-of-the-art treatment and therapy for inpatients with serious mental illnesses and/or developmental disabilities. A primary goal of the project was to create an operationally efficient, functionally flexible facility that will serve the needs of the state during a 50-year period.

The state of Indiana was committed to obtaining LEED (Leadership in Energy and Environmental Design) certification throughout the design and construction process. Established by the U.S. Green Building Council, the LEED Green Building Rating System is a national standard for developing high-performance, sustainable buildings. It provides a complete framework for assessing building performance and meeting sustainability goals. Certification of the project is currently pending approval from the USGBC.

The most innovative sustainable element of the Madison project involves recycling training. Recycling concepts have been incorporated into the patient therapy program in order to prepare patients for re-entry into mainstream society with a solid foundation in the principles of sustainability.

Other key sustainable design elements include:

A construction waste management program diverting 50 percent of construction waste from the landfill.

·        Low-VOC materials to protect indoor air quality.

New efficient windows and optimal insulation in the walls, improving the thermal envelope of the 100-year-old buildings.
Optimized HVAC system for patient comfort and overall efficiency.
A computer energy model to fine tune the mechanical systems and building management systems to monitor performance.
Maximized daylighting and views to the outside.
Bicycle racks and shower facilities for those who bike to the site.

Looking Ahead: Less Is More

Although the accomplishments to date in sustainable health care design are certainly noteworthy and have laid the groundwork for continued progress, the future holds the promise of vastly more efficient health care facilities. The central basis for this optimism comes not from any new concepts in the design industry, but rather stems from groundbreaking advances in the medical field itself — specifically the advent of genetic medicine and molecular imaging.

Genetic (or personalized) medicine will allow the medical community to treat illnesses more effectively and less invasively, at a molecular rather than a gross anatomical level. Meanwhile, molecular imagery offers the possibility of more accurate diagnosis and instantaneous monitoring of the success of treatment. Currently being developed by our academic medical centers, this giant step forward in medicine will transform the way hospitals are designed and constructed.

The potential for fewer surgeries, faster procedures and fewer inpatient stays may dramatically influence the number of hospital beds needed per capita. At the very least, it should help offset the added demands for care expected from our growing, aging population or brought about by new treatments for more disease types.

The challenge for architects and engineers is to begin to understand the implications for hospitals. The successful health care designer must learn to leverage advances in technology and treatments to do more with less infrastructure. A movement toward more efficient, perhaps smaller facilities seems not only likely but imperative. Health care administrators are realizing that through sustainable, less-is-more thinking, they can improve the health of their environment, their patients and their bottom line.

Cost savings for sustainable structures can be significant, and the challenge for owners and their design consultants is to think long term, especially in the health care field where tenants will likely occupy their facilities for 30 years or more. Most recognize the value of reducing operating costs, material usage and energy consumption. Many also see the potential advantages of a proactive approach to pending environmental regulations. With more sustainable health care facilities now in operation and with the continued evolution of evidence-based research, we should soon be able to quantify the value of any construction-related health benefits and the affect that sustainable environments have on staff attraction and retention.

The world is waking up to the consequences of unchecked resource consumption. The health care industry could be the catalyst for creating a more sustainable built environment.

Paul E. Strohm, AIA, ACHA, is the senior vice president for HOK. He can be reached by calling (314) 754-4196, or by e-mailing paul.strohm@hok.com. Visit HOK at www.hok.com.

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