Achieving a national milestone wasn't part of the plan when the Providence Newberg Medical Center (PNMC) team embarked on the design of a new $60 million hospital in Newberg, Oregon, but creating a facility that promoted the healthcare system's mission and core values were. The tenets of “respect, compassion, justice, excellence, and stewardship,” as well as a deep commitment to the community, dovetailed beautifully with sustainable practices.

Although Providence Health&Services (PH&S) hadn't previously integrated green measures into any of its projects, Director of Energy Management Services Richard Beam saw the health system's first new facility in 30 years as a perfect place to begin. From the outset, however, PNMC faced budget pressure and the construction management team considered green measures financially unfeasible. Beam was determined to find a way, and he rallied together public grants and government incentives to support the effort. PH&S selected the U.S. Green Building Council's Leadership in Energy and Environmental Design (LEED) program as their framework and hired Portland, Oregon-based Green Building Services, Inc., to guide and orchestrate the LEED process. The phenomenal success of the project resulted from a proven approach, buy-in from all parties, and the willingness to challenge assumptions

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This article will trace the development of PNMC and its pursuit of LEED Gold certification, as well as offering insights that can be applied to any LEED healthcare project.

Compass points

When undertaking any healthcare project, it is vital to establish a clear direction by identifying what's important to the organization and use this information to define specific goals. For PH&S, its mission and core values provided a strong platform for the project's sustainable objectives.

“Building green is in keeping with our core value of stewardship,” explains PNMC Chief Executive Larry Bowe. “It's important to us as an organization to be excellent stewards in respect to our environment.” With these goals as the starting point, it was easy to extrapolate which green strategies would serve as an outward expression of these values.

At this point in the process, it is important to bring together all stakeholders in a green kick-off meeting such as an eco-charrette. The group should include key players drawn from all facets of the project: administrators and facilities department, hospital's senior leadership, representatives from the board, medical, and nursing staff and the community, the contractor, and all design team disciplines. Green Building Services facilitated the eco-charrette for PNMC that included about 60 people. Through their participation in this meeting, all members gained an understanding of the green goals and became part of the effort.

It is also important to recognize that challenging traditional approaches can make people uncomfortable. Set a neutral tone for the meeting and create a forum where everyone can share their ideas without judgment. New advocates of green practices often emerge once their concerns are addressed.

The stakeholders in this case—PH&S, Green Building Services, Mahlum Architects, Ward Gibbons Souza, Glumac International, Degenkolb Engineers, Larry Anderson Engineering, Inc., Engineering Economics, Inc., and Mayer/Reed—created a “laundry list” of viable alternatives. The outcome of the eco-charrette and the LEED checklist led PNMC stakeholders to challenge themselves and pursue a LEED Silver rating for PNMC.

Maintain the bearings

Implementation should begin with the simple ideas. Adopting the easiest solutions before tackling more complex ones is especially wise if it's an organization's first green project. Once they see cost-neutral sustainable practices incorporated without major efforts, the stakeholders will be more inclined to go to the next level.

Start with specifying a healthier materials palate and consider mechanical systems that have a beneficial impact on occupants and the bottom line. Use good design practices (e.g., siting, orientation) to optimize daylight and minimize thermal gain while providing a building complex that's easy for patients and visitors to understand. Mahlum Architects designed PNMC with three distinct elements—an administrative wing, a medical office building, and the main hospital—wrapped around an east-facing healing garden.

“The facility is positioned to enjoy morning sunlight and views of Parrett Mountain,” says Mahlum Architects Principal-in-Charge Michael Smith, AIA. “Abundant natural light fills interior spaces through a north-facing gallery and east-facing windows to link the garden with the interiors.”

The LEED scorecard can be used to promote accountability in decision making and implementation, as well as to motivate the team. According to Beam, having a firm dedicated to the LEED process made all the difference in proper planning and execution. “Green Building Services made sure every [LEED] element was planned and built into the project,” says Beam. “This is critical because if you don't do it as you progress, you can't just go back and pick things up later.”

Using the right tools also leads to making informed decisions. More complex green techniques usually require exploration or analysis, so organizing a decision-making process that allows time to evaluate the value of a sustainable strategy is key.

Knowing that hospitals use a tremendous amount of energy, a separate charrette was held that focused primarily on improving the energy performance of the building. Ideas the team explored—such as a premium-efficiency, variable-flow, chilled-water pumping strategy and components, premium-efficiency condensing boilers, heat recovery systems, daylighting, and occupancy sensors—were later run through the DOE 2 energy modeling study, which helped quickly identify systems with a large payback.

It is important to understand the total cost of ownership and review the life-cycle costs of each strategy. The Business Opportunity Assessment Team (BOAT) is the PH&S strategic finance group's business-planning oversight committee that must approve projects over $5 million. Some of the sustainable techniques did not initially pass BOAT's business plan standards for initial costs, so Beam presented a business case based on a life-cycle assessment of the desired premium efficiency HVAC system. With grants and incentives to offset the system's cost, PNMC would realize an 80 percent return on investment with a complete payback in 14 months. After that, the facility will save nearly 26 percent in annual energy costs. With this compelling data, BOAT approved the project.

The “total cost of ownership” perspective also affects value engineering. If a project element has a return on investment that meets the corporate hurdle after a life-cycle cost assessment, it doesn't make sense to value engineer it out. Likewise, sustainable strategies that support the organization's values should be embedded as core elements, making them immune to value engineering. For example, one of the early PNMC goals was to offer patients and staff exceptional indoor air quality so a mechanical system that used 100 percent outside air was considered. As a core element of the building, the high-quality ventilation system was then no longer considered an optional add-on.

Point the way

Green goals should continually be pushed forward. By staying on track, PNMC became poised to exceed its initial goal of LEED Silver-level certification and reach for something more.

“We found ourselves tantalizingly close to obtaining a LEED Gold certification,” says Beam. “The prospect of becoming the first hospital in the nation with that ranking was too good to ignore.”

To achieve LEED Gold certification, the team had to get creative. They retooled their measurement and verification plan into a multilayer system to achieve another LEED point. The system was modified to provide better accountability and to comply with the LEED requirements for the Energy&Atmosphere EAc5 Measurement&Verification credit. Also, Beam sought additional funds to purchase green power and, although the LEED point required only 50 percent, PNMC opted to purchase 100 percent green power for all its electrical needs. The result of these extra moves was LEED Gold-level certification for PNMC, making it the first hospital in the United States to achieve that goal.

As an Energy Star partner, PH&S is committed to efficient operations. All of PH&S' facilities adopt maintenance and operations policies that clearly promote environmental responsibility, such as green cleaning practices or the elimination of pesticides to ensure the continuation of healthy environments. The use of ongoing tracking and monitoring will help to continue accountability.

PNMC is a stellar example of how careful planning, ongoing commitment, and forward thinking can guide a hospital to achieve, and even exceed, its own green expectations.HD

Katrina Shum Miller, NZIA, LEED AP, is a Principal at Green Building Services, Inc., a professional consulting firm that helps clients successfully adopt green building and facility management practices throughout the United States and Canada.