Membership in the Pebble Project is not limited to healthcare providers. Recently, a growing interest of corporate manufacturing companies has added “Corporate Pebbles” to the Pebble Project's research community. This only means heightened research opportunities—by collaborating with Pebble healthcare facilities, Corporate Pebbles can better understand the needs of the healthcare market and how advancing their products can impact evidence-based design (EBD) outcomes. Together with Pebble providers, Corporate Pebbles are helping to elevate this initiative to a whole new level, so that every detail of building design will have a profound impact on the healthcare industry.

Corporate Pebbles focus on specific facets of the healthcare industry as they see fit within their own company's scope of services and products. Armstrong Ceiling systems has collaborated with provider Pebbles including Jersey Shore Medical Center and Palomar Medical Center to study the impact of high-acoustical-grade ceiling tiles on noise levels within existing nursing units. Hill-Rom supported Banner Health's Pebble research project in comparing advantages and disadvantages of decentralized and centralized nurses' stations. Nurture by Steelcase has researched the quality of interaction between the patient and physician with exam room design modifications. Tandus is studying the impact of carpet floor covering on several issues including acoustics, rollability, and the perception of attractiveness. Health Care Projects, LTD, out of the UK is currently developing areas of research interest for consideration in developing its Pebble research study.

By better understanding the role these systems play in healthcare facilities, these companies can apply their findings to identifying the types of functions, new materials, and systems required for healthcare facilities of the future. Even if their products aren't visible to the eye, they still have a fundamental impact on facility performance. In understanding that impact of those behind-the-scenes materials, a look into Johns Manville's expertise on building products is studied in this Pebble Report.

Johns Manville (JM), a manufacturer of building products, including roofing systems, insulation, woven glass textile wallcoverings, filtration media, and reinforcements, became a Corporate Pebble in 2007. Joining the Pebble Project gives JM an opportunity to help create positive change in the way healthcare facilities are designed and operated by demonstrating the importance of passive building systems such as the building envelope and acoustical treatments. “Because of our expertise in building science, research, and testing capabilities, it only made sense to combine efforts with the Pebble Project, and help in the mission of spreading the knowledge of research and design activities with a goal to improve healthcare,” says Tim Swale, vice-president of research and development for Johns Manville.

Through the Pebble Project, JM is furthering its commitment to research and its goal to improve the environments in which we work and live. Areas of focus include: improving the understanding of how interactions among the building, building systems, environment, staff, and patients impact clinical outcomes; patient and staff satisfaction; and healthcare operations.

Understanding building systems

While it is known that building systems such as the roof or the building envelope are critical to by-and-large building performance, there is little understanding of how passive building elements impact building performance, healthcare delivery, and financial operations. It is understood that roofs must not only keep rain out of the building, but they must also provide heat control for energy efficiency, be able to resist enormous wind loads, and occasionally be used as a garden. There is a need to better understand how the installed roof system impacts maintenance costs, energy use, and moisture/infection control. Similarly for wall elements, it is well known that insulation helps to save energy, control condensation, and maintain thermal comfort. Additionally, wallcoverings can impact the ability of a wall to manage moisture. Again, what is needed is to connect system design and material selection to operations and environment of care factors. Quantifying these relationships between the building and healthcare operations can help to move specification of these building systems from the realm of “best practice,” into an integrated element of the EBD process.

Answers to these research questions will promote healthcare facility designs that incorporate the ideal building envelope—one that delivers exceptional thermal control, is airtight, effectively manages water, prevents condensation, dries when wet, and provides good acoustical control. A building that delivers all these needed functions will support any innovations in care delivery the project team wants to implement, rather than becoming an obstacle that must be worked around. This data helps drive new product development for the healthcare market, preventing product combinations that may not be compatible with the mission of a healthcare facility.

The science behind buildings

Building science is the application of physics and engineering principles to the design, construction, and operation of buildings, so that the building effectively manages moisture, air, heat, fire, sound, and light. A key consideration when applying building science principles is that building components must work together as a system. Testing for fire, thermal and moisture properties, as well as acoustical performance and VOC emissions is critical to ensuring optimal building performance. Simulation capabilities can also predict energy use, condensation risks within wall and roof systems, and the acoustical performance of spaces. Within a project, these capabilities can be used to better understand how the building design and specified products impact energy use, acoustic comfort, indoor air quality, and infections in healthcare facilities.

Current projects

At The Children's Hospital (TCH) in Aurora, Colorado, JM supports TCH's Pebble Project research on the impact of a new facility on many satisfaction and operational outcomes. In studying acoustics, JM's role is to help measure and analyze acoustical data and correlate the data to operational factors, design choices, and material selection. Options for providing acoustic comfort through the use a new type of thin acoustical wall treatment are also being explored. Several other collaborative projects with other Pebble Project partners, including Spectrum Health in Grand Rapids, Michigan, and Affinity Health System in Appleton, Wisconsin, are underway to evaluate the effectiveness of this approach.

Future projects

As a next step in understanding how the building envelope and building science principles impact healthcare, JM is working to launch two new research projects. The first is the impact of building products on indoor air quality (IAQ), specifically hidden or enclosed products such as insulation, roofing, and acoustical products. As part of this project, VOC emissions of a variety of building products over a range of in-use conditions would be evaluated. Using current simulation tools and follow-up with air sampling in the facility after construction, VOC concentrations within the building would then be predicted to validate the simulations. The testing results would be compared to satisfaction ratings and any potential complaints would help guide future design decisions.

JM is also looking to better understand the role the building envelope plays in infection control and comfort by comparing nosocomial infection occurrences (dates, type, and root cause if available) to maintenance and repair records and the design of the building. This kind of analysis could help to separate infections that are related to facility operations or other factors versus ones that may be due to the building or environmental factors. The goal would be to apply these findings in a detailed building envelope review for a new facility, and conduct a follow-up study to evaluate the effectiveness of design changes on both infection rates and on facility maintenance costs.

Merging evidence-based design with building science

As the Pebble Project progresses and EBD becomes more sophisticated, it will be more and more critical to understand how healthcare buildings impact the environments designed for patients and staff. Balancing windows, access to daylight, and views of nature with thermal comfort, and energy efficiency will be important steps in the design process. Increased scrutiny of nosocomial infection cases will drive a need to ensure building systems do not contribute to moisture or indoor air quality problems. Acuity adaptable rooms and good IAQ demand not only effective HVAC controls, but effective passive systems, such as air sealing of interior spaces to prevent unintentional airflow through building partitions into other hospital areas. “Furthering these EBD developments will only pave the way for better products for the healthcare market and a more integrated design process between healthcare providers, architects, engineers, and manufacturers,” asserts John Smith, leader of JM's building science group. HD

Francis (JR) Babineau is Acoustics and Indoor Environmental Quality Leader, Building Science Platform, at Johns Manville.

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The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at

Healthcare Design 2008 December;8(12):20-22