The Patient Protection and Affordable Care Act states a very strong directive to reduce the overall costs of health care in the United States. Accordingly, medical facility managers and designers are searching for ways to reduce costs without compromising the quality of patient care. Hospital managers have been looking to measures that help tame the energy use of facilities required to be operational 24/7/365, and it has had a profound impact on hospital operations.
The Chicago-area Advocate Health Care system, a 250-site health-care organization based in Oak Brook, Illinois, has embarked on a building program costing hundreds of millions of dollars that happens to coincide with the implementation of the USGBC’s new LEED for Healthcare rating system. This arguably places more exacting standards on what sustainability means in health care and adds a layer of complexity in an already complicated scenario.
Advocate’s several hospitals look to improve patient outcomes through smart design. Each will bring daylight indoors, provide views to nature, and maintain essential indoor climate controls with minimal energy use. These factors promote quicker recoveries, shorter stays, and reduced medication use, and staff health is likely to benefit along the way. “We certainly follow a philosophy of designing and building healthy spaces that will have a positive impact on patient and staff health and be efficient to operate,” says Mary Larsen, system leader of environmental stewardship for Advocate. “It’s clear that patient experiences and possibly health outcomes are improved when they can see outside, be exposed to sunshine, and have places of quiet respite.”
Deconstructing LEED for Healthcare
Published in April 2013, LEED for Healthcare addresses specific demands of healing environments, an important distinction given the special demands of hospitals, clinics, and skilled nursing facilities. These needs include 24/7/365 operations, a highly regulated environment, water- and energy-intensive operations, and climate control. Add to that evidence-based design’s prioritization of human-centered facilities with visual or physical access to nature, and the modern hospital system has innumerable demands. LEED for Healthcare, with new points for “Connection to the Natural World” and “PBT Source Reduction,” acknowledges those demands while incentivizing vegetated roofs and other conscious landscape elements and maximal daylighting with larger and more extensive windows. For all the credits, visit the USGBC website.
The hospital’s roots as a faith-based organization (Evangelical Lutheran Church in America and United Church of Christ) drive a culture of stewardship and conservation, which naturally includes efficiency and ties it all together: less energy used, environments that promote healing, and staff that engage in sustainability. But creating all of this begins in the planning phase.
New building projects at the Advocate Christ Medical Center in Oak Lawn, Illinois, exemplify its approach. To accommodate growth in need and a desire to cut energy costs, two buildings are under construction: one that serves outpatients only and another that includes patient beds, surgical suites, higher-level imaging systems, and the mechanical systems to support it.
The outpatient pavilion can close at nights and on weekends, reducing the need for lighting, heating, and cooling, but the inpatient tower is set up for continuous occupation and operation. “By consolidating the outpatient services, we can take advantage of energy savings,” says Grace Gonzaga, an architect and project manager who oversees design and bidding at Advocate. “We know we can extend the life span of the HVAC system as one means to manage health-care operational costs.”
The inpatient tower is an eight-level, 308,000-square-foot structure due for completion in 2015. Combined with an existing building that had 40,000 square feet of renovated space, the complete facility will cost $189 million. Energy modeling of the project, which is a requirement in LEED for Healthcare, demonstrated that 30 percent glass on the exterior is the sweet spot for balancing energy and daylighting. Architect Gregory Heiser from Cannon Design says this finding was balanced with other objectives: to minimize heat loss and gain and to establish operationally efficient floor plans.
“This facility decentralizes nursing stations, bringing that care closer to patients,” Heiser says, adding that maximized windows for staff are beneficial to their sense of well-being. The design has same-handed room layouts (meaning all caregiving follows the same floor pattern), monitoring of air volumes, submetering of water end-uses, water-efficient fixtures and systems, low-VOC products and finishes, and food-waste reduction. Plus, nearly 90 percent of construction waste will be recycled.
In Barrington, Illinois, another Chicago suburb, a plan to build a new addition to Advocate Good Shepherd Hospital includes substantial site work. An existing storm-water retention pond is slated to be transformed to look and feel more like a natural body of water with native plantings to mitigate parking area runoff. The landscape design blends with the building architecture to create a seamless transition from the landscape to the lobby.
Peter Messina, who is working with HOK on the design of the Good Shepherd renovation and addition, notes how staff and community input on this design prioritized patient care and sustainability—less so aesthetics. “People here are very grounded,” he says. “There is no strong push to grandiosity.” This hospital will strive for LEED for Healthcare Gold, but at this stage plans are fluid because the completion date is expected for 2017. Smart roofs (white and possibly vegetated), enhanced glazing systems, and recycling construction debris are all currently planned.
As both projects are in the design stage, Larsen, Gonzaga, Heiser, and Messina are grappling with the new requirements of LEED for Healthcare. All say they feel that points in the energy use categories are oddly tied to costs, not BTU reductions, a criticism the USGBC might reconsider in the future. Heiser says, “It’s a great direction, but it’s a first edition.”
Health-care facilities are demandingly complicated, after all, and within Advocate’s stewardship of patient health, employee health, resource conservation, and cost-containment, the solutions must be commensurately complex.