The 2016 Sustainability Benchmark Report released by GreenHealth showed that sustainability is rapidly becoming a design requirement of most health care organizations. Given health care’s escalating costs, it may appear surprising that the industry was interested in making what others claim is an expensive investment. Despite government policy changes and funding challenges, sustainability continues to gain traction in health care because of its congruence with the mission.

As a champion of health and wellness, it would be hypocritical to exclude from consideration the health of the physical space in which health care services are provided. Why wouldn’t health care providers invest in architectural features that enhance healing? Although there are many avenues where the sustainable design strategies align with the needs of health care, three key considerations include climate change mitigation, super chemicals, and green purchasing.

Climate Change & Ethical Resource Management 

A surprising fact: one of the largest consumers of renewable energy in the U.S. is California-based Kaiser Permanente, which is currently using 1 terawatt per hour annually. Kaiser Permanente has formalized its goal to be carbon neutral by 2020, causing other providers to take note. Others are turning to co-generation or combined heat and power (CHP) to more efficiently heat water and air — two resources health care facilities consume more than many other industries.

> FIGURE 1. Whiteman Air  Force Base exam room. All images courtesy of Hoefer Wysocki

The health care industry has recognized climate change as a major opponent to human health. Pollutants from energy generation are pumped into the atmosphere, adversely affecting asthmatics — those with compromised respiratory systems, children, and the elderly. Erratic weather patterns, often attributed to climate change, injure homeowners and cause mental and emotional trauma or anxiety. Sustainable design offers considerable health and wellness benefits to occupants and improved bottom lines in terms of operations — effective resource management almost always reduces life-cycle costs. Since medical facilities use so much power and water, any reduction to either resource often nets substantial dividends over time. The case for renewable energy and potable water use reduction is both ethical and practical.

Chemical Warfare

The push for safer chemicals in health care began with the phasing out of mercury 25 years ago. Now the same practices are being implemented for formaldehyde, halogenated flame retardants, perfluorinated compounds (PFC), and polyvinyl chloride (PVC). In the case of mercury, the stances taken by health care facilities generated market transformation; however, this time, it isn’t just the health care industry asking for material transparency.

More and more consumers from the individual to enterprise levels are questioning the chemical contents of their purchases. This trend toward consumer awareness began with Declare labels, championed by the Living Building Institute. This demand has now expanded to include transparent information about materials used in the built environment. In 2012, the Health Product Declaration Collaborative was formed to launch its Health Product Declaration (HPD) Open Standard specifications, which guide accurate, reliable, and consistent reporting of product contents and associated health information for products used in the built environment. Today, HPDs integrate with all third-party sustainability certifications. Armed with more knowledge, the health care industry is raising the bar in terms of the safety of materials used in their facilities, and designers are driven to specify materials that meet these higher standards.

> FIGURE 2. Daylighting in the lounge of the Dept. of Veterans Affairs, San Jose Community Outpatient Clinic, extends into the corridor.

Green Buying Power

Green purchasing entails the procurement of products and services that have a reduced impact on human health and the environment when compared with similar products or services. Green purchasing strategies consider the entire supply chain, including manufacturing that is free of harmful chemicals, use of biodegradable raw materials, conservative packaging, and efficient distribution methods. Additionally, using local materials reduces greenhouse gas emissions from transportation, which further aligns with initiatives related to climate change mitigation. Hospitals are often seen as a hub of a community, so by using local materials they are also enhancing their local economy.

Other green buying strategies, like use of products with recycled content and Forest Stewardship Council-certified (FSC) wood, contribute to improved management of natural resources. A connection to the natural environment has shown significant health benefits. It follows that the health care industry would want to protect these natural resources to ensure the health benefits occur. 

Knowledge is Empowerment

Use of these sustainable strategies needs to occur at the outset of facility design. The first step in design is to inform and educate owners and stakeholders about the quantifiable health benefits of green buying, use of safer chemicals, and the subsequent operational and financial impacts of a sustainably-driven design. Once facility owners understand the benefits and impacts, they’re more likely to embrace a design that centers on sustainable principles, which in turn facilitates faster decision-making during the design phase.

> FIGURE 3. Lackland Air Force Base, Reid Clinic, is a LEED Gold certified facility.

As is often said, looks aren’t everything. In sustainable design, aesthetics are no longer the primary consideration in material and equipment selection — performance is. Indeed, aesthetics matter, but performance matters more. Incorporation of any sustainable strategy begins with a clear definition of the client’s goals, such as net-zero, water use reduction, etc. Communication early and often must guide the process. Subject matter experts and stakeholders alike need to be brought to the table early to ensure a unified vision is clearly understood from the outset. Through these early conversations, the client identifies health and wellness impacts that best align with their vision and the design team lends insight and lessons learned to identify options and applicable sustainability strategies. Through this collaborative process, an optimal design emerges that meets all objectives including sustainability, schedule, budget, and operations. For example, a fixture may be beautiful and within budget but uses more water. When design is guided by sustainable principles, an alternative fixture is identified that meets water use standards, is within budget, and complements the aesthetic vision. 

A high-performance health care facility incorporates sustainable strategies from the ground up, from wall to wall, from floor to ceiling, and across the operational enterprise. Health care and sustainability are now intricately woven through a common mission — the sooner this is embraced, the more innovation can occur in both industries. Design professionals must be both champions and facilitators of sustainability in health care facilities.