To say that Robin Guenther (FAIA, LEED AP) and Gail Vittori (LEED Fellow) wrote the book on the importance of green building in the healthcare sphere would be, well, completely accurate. The wildly impressive duo released their first addition of Sustainable Healthcare Architecture in 2008 with a second edition that followed in 2013. As Rick Fedrizzi pens in his introduction, the authors “show us how critical our green building mission is to the future of human health and secures a lasting legacy that will continue to challenge and focus the green building movement, the healthcare industry, and the world.”

Guenther_Vittori_SHAv2_cover-1 copyThe two became acquainted in August of 2001 at a meeting arranged by Dr. Al Sunseri, the then executive director of the American Society for Healthcare Engineering (ASHE), to develop sustainable design criteria for their annual Vista Awards. This event led to the publishing of the ASHE Green Healthcare Construction Guidance Statement in 2002, which established many of the core principles and framing concepts of Guenther and Vittori’s collaborative work. It was this event that inspired these women to craft the Green Guide for Health Care (the sector’s first quantifiable sustainable design toolkit); and four years later Wiley and Son publishers approached the duo with hopes of releasing a book on the topic (which of course, they did).

“Rick expresses our intention well; I think we realized from the start of the Green Guide that healthcare leaders would not take on green building unless and until they understood the health connection—and once that was clear, it would be impossible for them to ignore,” Guenther and Vittori say. “We believe that decisions associated with the design, construction, and operation of our built environment is one of the most influential human endeavors relative to human health, and the book provided a great opportunity to make visible what are too often invisible links between buildings and human health.”

Here, we asked the pair to pick their three favorite healthcare facility designs from the past few years.

Throughout the hospital is a 975-piece art collection that showcases local artists. Each piece was hand-selected or commissioned to enhance health and wellness.

Throughout the hospital is a 975-piece art collection that showcases local artists. Each piece was hand-selected or commissioned to enhance health and wellness.


Why they picked it:Kaiser Permanente has been pioneering a methodical, comprehensive health-focused greening approach for their entire building portfolio for more than a decade with careful attention to ensure that their green investments are cost effective. Their first LEED-Gold certified hospital, Westside Medical Center in Hillsboro, opened in August 2013—an outcome of Kaiser Permanente’s announcement earlier that year that all of its new hospitals and major construction projects would meet LEED Gold standards as a minimum. The hospital had less than a 1% capital cost premium; operational savings are projected to pay back five times over the life of the building.”

It’s sustainable because: “Westside Medical Center exemplifies two of Kaiser Permanente’s green strategic priorities that underscore the commitment to protecting public health and promoting environmental stewardship: its healthy materials palette features formaldehyde-free products, PVC-free flooring and carpet, and minimal use of heavy metals including mercury and lead—still a challenge for the healthcare sector. Recognizing the human health consequences of climate change, it integrates a 10kW solar photovoltaic array on the parking structure’s roof that contributes to 70% of the hospital’s power derived from clean energy sources, and a 26% modeled energy reduction compared to code.”

What surprised them about this project: “Before Kaiser Permanente’s public announcement to prohibit furnishings manufactured with chemical flame retardants, they asked the hospital’s contractor to remove products manufactured with PBDE, a halogenated flame retardant banned by the Oregon Legislature effective January 1, 2011, after construction had begun. Although the legislation only applied to products installed after its effective date, Kaiser Permanente’s decision to remove all the PBDE-containing products, resulting in significant expense, highlighted its bold commitment to align its building material procurement practices as integral to its health promoting initiatives. This strategy is not recognized as a credit in LEED BD+C.

We love this quote from Kaiser Permanente’s project director Daniel Green: “Why would we want to build a brand-new building and leave that stuff in? I’m proud of the local doctors and the construction management people, as well as in the headquarters in Oakland for saying we’ll stand tall and pay for this.” Acknowledging that Kaiser Permanente has had its own materials-related standards in place for some time, Green further elaborated: “…Kaiser pushed for the cradle-to-grave history on the products [it] bought—on carpeting, paint, upholstery for furniture. And we said, ‘Get the toxic material out of the products or we won’t buy them from you.’”

This facility features a green roof, a strong connection to the natural world, patient gardens, and more.

This facility features a green roof, a strong connection to the natural world, patient gardens, and more.

Why they picked it: “This is the first building to certify under LEED for Healthcare—a major achievement! LEED for Healthcare is really aimed at 24/7 institutional occupancies, so the fact that the very first project to certify is a community health center demonstrates the enthusiasm and will of an owner and design team to push the boundaries of current practice. The team, including The Benaroya Company (developer), CollinsWoerman (architect), GLY (Contractor), and the broader consultant team agreed to performance targets for the whole project—a clear demonstration of Integrated Project Delivery (one of the defining prerequisites of LEED for Healthcare).”

It’s sustainable because: “There are three credits unique to LEED for Healthcare that this very first certified project achieved, validating their relevance to healthcare users. The first, connection to the natural world, is clearly demonstrated through the inclusion of both patient gardens and dedicated, covered outdoor roof space for staff. Given the programmatic and budget constraints of a community health center, achieving this level of connection is noteworthy. The project also achieved the two PBT source reduction credits, focusing on a less-toxic material palette through a broad range of strategies—from mercury reduction achieved through long-lamp life and lead-free solder to mechanical joints in copper piping. Finally, they used the healthy furniture credit, selecting furnishings with low-volatile organic compound (VOC) content, low urea-formaldehyde content and low levels of perfluorinated chemicals (PFCs) and perfluorooctanoic acid (PFOA) treatments.

What surprised them about this project: “The focus on integrated design delivered particular design strategies that have multiple benefits—for example, the green roof contributed to four credits—reduced stormwater runoff (SS Credit 6), reduced heat island impacts (SS 7.2), provided connection to the natural world and respite (SS Credit 9), and improved energy performance (EA Credit 1). Only integrated teams can really capture those benefits across categories. The building also expresses its sustainable strategies creatively and elegantly; its surprising to see a first-time LEED owner embrace the improved health of the community as a core value in the decision to embrace sustainable building.”

This 50,000-square- foot addition is North America’s first carbon-neutral hospital.

Why they picked it: “When we were researching our book, this project captured our attention because of the audacious sustainable goals expressed through a very modestly scaled and simple community hospital project. The inspiration for the design, eloquently expressed by architect Tye Farrow, was the cedar bent-box, unique to the coastal First Nations. In this concept, the bent-box holds our most precious possession—our health.”

It’s sustainable because: “The design supports this notion of improved health through a range of features, from enhanced daylighting, amazing views, and a truly innovative approach to carbon reduction. The area’s First Nations’ peoples believe a connection to nature is necessary for healing and overall health in all living things—hence the new patient rooms required oversized windows for optimum daylight and views. To achieve the required energy performance, sensor-activated motorized external blinds on south, east, and west elevations reduce unwanted solar gain. The envelope features above code-minimum envelope performance: R-60 roof construction, R-40 exterior walls, and high performance glazing.”

What surprised them about this project: “Given the modest project brief of a 50,000-square-foot addition, the goal of delivering North America’s first carbon-neutral hospital was really surprising. As the project took shape, the team committed to achieving a “net zero carbon footprint” project—i.e., no campus energy increase compared with the current facility following completion of the project. The design team, led by Farrow Partnership in association with Perkins+Will, achieved it through the installation of a new, high efficiency ground source heat pump central plant. A second comparison, based on CO2 emissions, suggests that the expanded campus carbon footprint is actually less than the prior campus carbon emissions, and approximately 50% less than had the addition been completed by expanding the existing systems. We generally don’t believe that such an outcome is possible in a modest project like this.”St Marys Hospital - Perkins+Will Canada / Farrow Partnership Architects Inc