It is no small irony that the buildings designed to make us well contribute more than their fair share of pollutants that can make people sick and render the environment more toxic. According to a study by the University of Chicago, which was published in the prestigious Journal of the American Medical Association (JAMA), about 8 percent of all carbon emissions in the U.S. come from healthcare facilities, numbering approximately 6,000 nationwide as defined by the study.
That figure doesn’t begin to touch water-management inefficiencies, energy use, resource conservation and the handling of biohazardous materials.
Those numbers are shifting through the efforts of varied consultancies and organizations such as Practice Greenhealth and online healthcare publications, many of which have begun using their PR and editorial to push for greener, smarter healthcare design/build programs. These include Becker’s Hospital Review Top 60 Green Hospitals, which compiled its recent list late last year.
Executives are taking notice, and now healthcare finds itself among many other industries and business sectors trying to catch up, keep ahead or lead when it comes to modernizing their approaches to sustainability.
Key toolkits and information for those heading toward hospital building construction include: the recently updated LEED for Healthcare v4 which includes the reduction of mercury and other harmful materials like lead in building materials, as well as ENERGY STAR for Hospitals.
The Department of Energy's Hospital Alliance estimates that the nation's healthcare facilities spend more than $8 billion on energy costs annually.
Children’s hospitals are one sub-set category leading the way, as was evidenced at the recent awards ceremony of CleanMed, a green healthcare summit that showcases the Top 25 Practice Greenhealth Environmental Excellence Awards, and a recent separate recent ranking of the 30 top green hospitals by the Healthcare Administration Degree Programs website, catering to potential students.
Two top winners from the Healthcare Administration Degree Programs website list included: Children’s Hospital of Pittsburgh in Pennsylvania, and the Dell Children's Medical Center, which is the premier health care provider for children and adolescents in Central Texas, whichcovering a 46-county area.
On the Practice Greenhealth awards list for 2018 revealed in May of this year, the high marks went to Seattle Children’s Hospital, which a 14 percent reduction in irrigation water—nearly a million gallons in 2017, more than triple their initial stretch goal. Recognizing that anesthetic gases comprise 3 to 5 percent of the organization’s greenhouse gas emissions, the anesthesia department decreased its Desflurane usage by 31 percent in 2017.
Children's Health of Dallas is the second-largest healthcare system user of renewable energy in the nation, and it is on track to become the largest renewable electricity user among pediatric healthcare providers.
<<subhead>>Taking the temperature of the sector
About 70 percent of hospitals are measuring energy savings, but are not using performance metrics for budget purposes, according to a 2015 Health Facilities Management (HFM) Sustainable Operations Survey conducted with the American Society for Healthcare Engineering (ASHE) and the Association for the Healthcare Environment (AHE).
Some regional progress has been reported in the last 12 months, including Boston hospitals jumping forward to define greenhouse gas emission reduction goals. Tracking has been done in recent years there from 20 hospitals serving on the Boston Green Ribbon Commission’s Health Care Working Group. Massachusetts has mandated emissions cuts of 25 percent by 2020 but these hospitals want to do more—reducing emissions by 33 percent by 2020, according to reporting in Health Facilities Management magazine.
Becker’s Hospital Review list of green hospitals spotlights the steps into alternative energy:
- Solar power is pushing out into the ranks of hospitals for accolades. Johns Hopkins Hospital in Baltimore installed a solar farm, maintains more than 65,000 square feet of green roofing and hosts a farmer's market six months a year.
- Kaiser Permanente San Jose Medical Center showcases the installation of 10 electric vehicle charging stations on campus.
- The University of Maryland Medical Center has formed the UMMC Green Team to champion sustainability and energy conservation efforts.
In 2010, the Sustainability Roadmap for Hospitals was published and continues to drive hospitals to examine key areas of energy, supply chain, waste and water concerns. One rising area of interest remains LED lighting.
Other steps in construction can be simple as well. Installing low-flow flush fixtures, low flow faucets, and measuring plus benchmarking natural gas usage can be a step in the right direction, according to the Roadmap project, which is still referenced and can be found online.
Kyle Wilson, partner at TEG Architects in Louisville, Ky., recently spoke to the Kentucky Hospital Association about sustainability steps that are recommended, even if LEED is not the direction of the project. For smaller, regional hospitals, looking at long-range energy costs upfront can be important toward construction approaches like using an insulated concrete form (ICFs). Insulating concrete forms combine expanded polystyrene (EPS) with a strong structural building material, steel reinforced concrete. The result is a wall system that is energy efficiency, and offers noise reduction.
“We were able to use this at the Pikeville (Kentucky) Regional Medical Center for their data center. LEED has served its purpose in the industry, eventually pushing the international energy code now to what LEED used to be,” Wilson said. “With hospitals, since they operate 24/7, we often like to make sure they are eligible for Energy Star.”
He suggests the following list to review when looking at sustainability modeling—what his firm does on virtually every project:
- Continuous insulation
- Tighter envelopes
- Pressure testing
- LED lights
- An Evaluation of building orientation and shape
- An Evaluation of glass quality and type
- High recycled content of new materials
Wilson said that the international energy code has been influenced greatly by the LEED process and that states like North Dakota, now require MEP commissioning—a review of mechanical, electrical, and plumbing records and drawings. Such is the case for Wilson’s company project which is the Trinity Health North Dakota, an acute hospital with a six-story office building scheduled to open in November 2020.
Even cancer centers are taking another look at whether environmental concerns should be scrutinized. Practice GreenHealth cited Memorial Sloan Kettering Cancer Center this year for its key efforts in looking at construction materials. The Department of Design + Construction continues successful institution-wide efforts to eliminate PVC from interiors, including fabrics, wall coverings and flooring for all new buildings and renovations. And the center is speaking out to other hospitals about addressing chemicals in flooring, fabric and furniture, as well as the reduction of DEHP and PVC in medical supplies.
The writer is a frequent contributor to ProudGreenBuilding.com and ProudGreenHome.com. She is the CEO and executive director of Technology Association of Louisville Kentucky and the president of ASPectx, an agency specializing in marketing, strategy and competitive analysis.