Designing For Sustainable Healthcare Facility Maintenance
The terms “sustainability” and “green” naturally bring to mind thoughts of the products and features designed and built into a new or renovated facility and the practices followed during construction. But sustainability and sound environmental practices don’t end when the final item is crossed off the contractor’s punch list. The third—and equally important—element of the equation is how the building is maintained and operated throughout its years of use.
While this point may seem obvious, it’s only recently become a significant topic of discussion, and the theory frequently isn’t put into actual practice. In order for green buildings to realize their promise of enhanced environmental and economic performance, operational considerations need to be integrated into the design, construction, commissioning, and occupancy phases of building projects. There must be clear communication and hand-off of information as a project moves from one phase to the next. And facilities must be monitored over their lifespans to ensure that the designed performance is consistently realized.
The impact of operations on building performance
Failure to address post-occupancy operations and maintenance during the design process can lead a facility to fall short of performance expectations. For example, meticulous care can be taken during design and construction to ensure healthy indoor air quality, but those efforts are wasted if the cleaning crew then uses products containing volatile organic compounds (VOCs) or vacuum cleaners that have inadequate filters. Native landscapes installed to filter storm water, increase biodiversity, and create a beautiful healing environment are sometimes replaced with conventional turf grass by building operators who don’t like their appearance, aren’t patient enough to let them mature, or simply don’t know how to properly cultivate and maintain them.
When data on the actual energy use of some New York City buildings was recently released, some newer buildings—particularly some LEED-certified buildings that had undergone pre-occupancy commissioning to test their performance—didn’t score as well as some older buildings. Possible contributing factors include a lack of ongoing building monitoring, ineffective building operations and maintenance, inadequate training for facility staff, lack of operational planning during the commissioning process, actual occupancy and building usage that has varied from initial design assumptions, and design strategies that didn’t adequately address how the building would be operated. And while this data was drawn from large commercial buildings, the lessons learned certainly apply to healthcare facilities.
The solution to these problems is better communication between members of the project team during design and an effective translation of the design assumptions into workable post-occupancy operational plans.
Understanding and education
Before green building strategies are implemented in a project, facility managers must have a thorough understanding of how these systems and products operate and the maintenance that will be required.
The team at Martha Jefferson Hospital in Charlottesville, Va., for example, understood that low-consumption plumbing fixtures can be noisier than their conventional counterparts. So when selecting fixtures for a new replacement hospital, a variety of showerheads, toilets, faucets, and urinals were tested to evaluate performance, assess the noise level, and choose products that would not be disruptive to patients.
Designers must also recognize and account for a client’s maintenance capabilities. The site design for the now-under-construction replacement hospital for Sauk Prairie Memorial Hospital & Clinics in Prairie du Sac, Wis., incorporates native plants to help the campus blend in with the surrounding rural landscape, reduce landscape maintenance costs, and improve storm water quality. Since the hospital will be moving from a small campus to a much larger one and the in-house team has little experience in caring for native landscapes, maintenance specifications were drafted as part of the design process.
Landscape contractors bidding on the project were also asked to bid on maintaining the landscape for the first two years. This will give the hospital’s team needed support while the landscape requires more cultivation and maintenance, and will enable the team to gradually transition to caring for it themselves. It also will ensure that during the early cultivation period, the native plants are not mistaken for weeds and dug up.
A written plan
A written operations and maintenance plan gives facility managers a clear roadmap for maximizing building performance and can earn the facility “innovation” credits toward LEED certification—without affecting the construction budget.
Martha Jefferson Hospital was LEED certified in 2011. As part of the process, the hospital team developed a green cleaning plan that would help maintain healthy indoor air quality. It includes a careful zoning of the building based on cleaning needs so that disinfectants are used only in clinically intensive areas. It also specifies the use of low-VOC cleaning products and vacuum cleaners equipped with high-efficiency particulate air (HEPA) filters. The plan earned the hospital an innovation credit toward its LEED certification. And since it didn’t involve any changes to the building’s construction, there were no additional construction costs.
Since 2009, the University of Wisconsin Medical Foundation has built all of its new facilities to LEED standards. Its UW Health Yahara Clinic in Monona, Wis., recently received LEED certification and its UW Health Stoughton Clinic in Stoughton, Wis., was the first healthcare facility in the state to receive LEED Silver certification. Documentation developed as part of the certification process, and carefully followed by its cleaning service now, includes detailed instructions for cleaning each area of the clinic—from the front entrance to the reception area, offices, restrooms, exam and treatment rooms, and the lab—on a daily, weekly, and monthly basis; instructions for floor and carpet care; the “LEED 2009 Policy Guidelines for Green Cleaning” document; a checklist for use in training new cleaning crew members; and checklists for cleaning service management to use in quality control, equipment inspection and maintenance, and monitoring of chemical use.
Ongoing monitoring is also essential to ensuring optimal long-term building performance. UW Health, parent organization of the University of Wisconsin Medical Foundation, is an Energy Star partner and, as part of that commitment, tracks its energy use in Energy Star’s Portfolio Manager benchmarking tool. Any spike in energy or water use is investigated, and necessary maintenance is performed. Maintenance technicians are assigned to each clinic and are on-site frequently, helping to ensure that any issues are quickly identified and addressed.
Ongoing evolution of standards and practices
Green building rating programs and energy use benchmarking systems are continuing to evolve, placing greater emphasis on operations and maintenance and giving facility
managers better real-time information about building performance. For example, the soon-to-be-released LEED v4 will require the installation of building-level water and energy metering that will provide facility managers with real-time data about water and energy consumption, enabling them to optimize the actual performance of their buildings.
Effective practices are beginning to develop that will help facility owners and managers more fully realize all of the environmental and economic benefits that green building strategies can deliver over a building’s lifespan. Advancement of these practices will require design professionals to better understand and respond to operational considerations. It will require that, before a new or renovated building is occupied, plans be developed for how it will be operated and how its performance will be documented. Finally, it will require better tools and benchmarking standards to monitor ongoing building performance and a commitment by facility managers to use this information to improve building operations.
Matthew D. Tendler, AIA, LEED AP BD+C, is a principal at architecture and experience design firm Kahler Slater (Milwaukee). In 1997, he cofounded the Wisconsin Green Building Alliance, a nonprofit organization that promotes sustainable design in the built environment. He helped write daylighting standards for the state of Wisconsin and has served as an instructor and consultant with the Energy Center of Wisconsin’s Daylighting Collaborative. In 2001, he became the first person in Wisconsin to be certified by the U.S. Green Building Council as a LEED Accredited Professional. He can be reached at firstname.lastname@example.org.