The healthcare industry is buzzing with talk about greening, built environments, and sustainability, but many find it difficult to get started or, excuse the pun, sustain their efforts. Going green takes more than a few process changes or another recycling program; it requires changing the way you think about your hospital and your patients. Asante Health System in Medford, Oregon, has made that commitment and will incorporate sustainable design standards in all future growth and development. To accomplish this goal, Asante has enlisted master planning and greening experts TVA Architects, Gerding Edlen Development, and The Estimé Group.

“As the largest employer in southern Oregon, we have a leadership role and a responsibility,” says Justin Hurley, Asante director of real estate and sustainability.

Asante was over capacity for most of its inpatient programs and services. The population of its nine-county service area was expected to blossom by more than 100,000 by the year 2020. A complex group of facilities, office buildings, and properties, including Three Rivers Community Hospital in Grants Pass, and Rogue Valley Medical Center (RVMC) in Medford, Asante posed a daunting task for even the most experienced master planners.

Hurley attended a seminar on workforce housing in Portland, Oregon, where he met Mark Edlen of Gerding Edlen, one of the most innovative green developers in the country. They talked about the link between green design, health, and recruitment.
Built in 2005, the new tower at Rogue Valley Medical Center in Medford is the latest addition to a hospital that has grown several times since it was first built in 1958. The new master plan will guide future additions by improving efficiency of the existing structure and the design of new construction. The foreground shows a park-like area that the new master plan will improve to create a more natural, healing, and sustainable surrounding.

Photo by Lanphier Associates, Inc.

Built in 2005, the new tower at Rogue Valley Medical Center in Medford is the latest addition to a hospital that has grown several times since it was first built in 1958. The new master plan will guide future additions by improving efficiency of the existing structure and the design of new construction. The foreground shows a park-like area that the new master plan will improve to create a more natural, healing, and sustainable surrounding.

Impressed, he spent three days with Edlen and his staff, while learning the Gerding Edlen philosophy to, “create vibrant, sustainable, and inspiring places where people can work, learn, and live.” That translated into places that offer fresh air, foster creativity, and incorporate art and culture in combination with superior building performance beyond just energy efficiency to include optimizing water performance and waste reduction measures-as covered in Gerding Edlen's Principles of Place guidelines (http://www.healthcaredesignmagazine.com/PrinciplesOfPlace).

Hurley brought business leaders and Asante CEO Roy Vinyard and Scott Kelly, chief strategy and business-development officer, to Portland for what he now calls the “Gerding Edlen Experience.” “It didn't take long for them to understand why we needed to include LEED as part of our master planning project,” Hurley says. “It is the future, and we have to embrace it.”

Hurley selected Portland, Oregon-based TVA Architects to realize Asante's vision to become one of the most sustainable medical complexes in the country. TVA had a portfolio of award-winning corporate campus projects utilizing sustainable design years prior to the creation of the LEED rating system and extensive experience in innovative workspace design that enhanced the recruitment, retention, and productivity of its clients, including the development of the Nike corporate campus.

“One of Nike's top executives, Howard Slusher, praised their work highly and told me how much he felt like they really understood Nike's brand and incorporated it into the campus design, and how this helped them recruit and retain the best employees,” Hurley says.
The 10-year-old Three Rivers Community Hospital in Grants Pass is among the existing buildings that Gerding Edlen's Sustainable Solutions will evaluate for efficiency and sustainability.

Photo by Lanphier Associates, Inc.

The 10-year-old Three Rivers Community Hospital in Grants Pass is among the existing buildings that Gerding Edlen's Sustainable Solutions will evaluate for efficiency and sustainability.

TVA Architects' principal-in-charge, Montgomery Hill, AIA, IIDA, turned to a newly created subsidiary of Gerding Edlen Development-Gerding Edlen Sustainable Solutions-which specializes in the built environment, renewable energy, and infrastructure. Sustainability expert Renee Loveland, head of the building division, would help address the need of establishing a carbon footprint as a benchmark. Hill also recruited nationally recognized medical-facility planners The Estimé Group, led by renowned laboratory planner Roznec Estimé.

Working closely with Asante leaders, key stakeholders, and user groups, the design team adopted a holistic approach that spills over from the campus to embrace the community and surrounding neighborhood. Rather than a traditional “top-down” process, the team engaged a wide user base-doctors and nurses, lab staff, administrative personnel, and those supplying materials and providing hospital clean-up-to help define a dynamic center with the power to attract and retain a growing population and intellectual talent from around the country.

Detailed questionnaires and workshops involving managers and staff were designed to explore not only what makes a workspace functional, but what comprises an exceptional active campus-one that contributes to a livable community. The goal was to elevate the medical complex as the intellectual hub of a vibrant community where high-density occupancy synergistically spawns a diversity of services and economic opportunities, and where dynamic public spaces promote health and wellness. The project would encompass a larger branding message, expressing in built form, Asante's desire to be recognized as a center of healing, both for the body and the environment.
As shown in this aerial photo looking to the west, RVMC is a complex campus blended into the surrounding community, which provides the opportunity for changes through the master plan to have a significant, positive effect on the community.

Courtesy of Eye in the Sky, Inc.

As shown in this aerial photo looking to the west, RVMC is a complex campus blended into the surrounding community, which provides the opportunity for changes through the master plan to have a significant, positive effect on the community.

“One of TVA's strengths is branding,” Hurley recalled. “It forced us to ask ourselves how we are conveying our message in the built environment.”

A major task was to define and develop sustainable narrative standards as steadfast rules for the master plan. The LEED for Neighborhood Development (LEED-ND) guidelines, as well as best practices for creating high-performance healing environments as outlined by LEED for Healthcare, informed the process. Key concepts included integrated design, the selection and development of sustainable sites, water efficiency, energy and atmosphere, materials and resources, environmental quality, and innovation in design. The vision took shape into a sustainable campus community and neighborhood that supports density and diversity; provides highly walkable, tree-lined streets; promotes bicycle, alternate, and public transportation; and reduces the parking footprint. It also fosters community outreach, encourages the production and use of local materials, and promotes a district-wide heating and cooling system, as well as energy efficiency with the use of renewable energy and green power.
This preliminary map shows where buildings will be added on the RVMC campus, including a main water and power building, new vertical parking to make better use of available space, and new traffic ways

This preliminary map shows where buildings will be added on the RVMC campus, including a main water and power building, new vertical parking to make better use of available space, and new traffic ways

It was mandated that every new building in the Asante master plan would achieve LEED certification, while allowing opportunities to upgrade existing structures to LEED-EB (existing buildings). Construction would focus on the use of sustainable building materials and construction waste management, the use of low-VOC materials, indoor air monitoring with outdoor air delivery, abundant daylight views, and innovation in design wherever possible. Emphasis was placed on community connectivity and zoning around the campus to provide vibrant outdoor spaces that would promote a localized, synergistic “live/work/play” culture.

To understand where Asante's current facilities stood relative to other healthcare institutions, Gerding Edlen's Sustainable Solutions evaluated the existing buildings and established a baseline carbon footprint against which all new projects built within the system could be measured. This also gave Asante a road map for improving the energy efficiency of existing facilities.

Another critical component was developing a symbiotic relationship between Asante, the cities where its facilities are located, and other local resources. This included working with the cities on zoning issues and integrating adjacent uses into the urban fabric. Often this afforded opportunities to engage in educational sessions and inspire local jurisdictions with the benefits of sustainability measures. Challenges included overcoming a natural reluctance on the part of the cities to engage in new and unfamiliar practices. For example, storm-water and waste-water maintenance traditionally would be handled through an underground cistern or vault system that would accommodate buildable land above it. However, sustainable practices recommend the use of bioswales landscaped with drought-resistant, native plants, allowing for the natural infiltration of storm water-a more efficient way to filter water and allow its return to the water table, albeit without the added benefit of buildable real estate.

Finally, branding-an expression of Asante's culture in built form-provided another teaching opportunity and learning tool for understanding the far-reaching green measures Asante desired to incorporate. This larger branding message would be expressed through the LEED standards integrated in the campus facilities, as well as in the environmentally sensitive public outdoor spaces, defining friendly, welcoming, healing places for people.

“This is the first time in Asante's history that the way we develop, build, renovate, and plan has been examined under such scrutiny,” Hurley summarized. “It's a great responsibility, but we have an incredible opportunity to create social change. We will not only be affecting the lives of our employees, physicians, and patients, but everyone in the communities we serve. To heal people has always been one of the greatest joys of working in healthcare, and now, through this plan, we will help heal the environment as well, while positively addressing the issue of recruitment and retention experienced by all healthcare institutions.” HD

Grant Walker is a public relations specialist at Asante Health System, a nonprofit organization providing comprehensive medical care at facilities in Medford, Grants Pass, and Central Point, Oregon.

For more information, visit http://www.asante.org. Melissa Mitchell is the marketing director for TVA Architects. For more information, visit http://www.tvaarchitects.com. For more information on Gerding Edlen Development, visit http://www.gerdingedlen.com. For more information on The Estimé Group, visit http://www.estime group.com.

Healthcare Design 2009 April;9(4):22-26