Designing For Sustainable Healthcare Facility Maintenance

August 13, 2013
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The University of Wisconsin Medical Foundation continuously monitors energy and water use at its facilities, such as the UW Health Stoughton Clinic. This clinic was the first healthcare facility in Wisconsin to receive LEED Silver certification. Photo: © Dana Wheelock 2012. Restrooms in Martha Jefferson Hospital’s prep and recovery rooms feature fixtures that balance low-consumption requirements with low-noise considerations to create a patient-friendly experience. Photo: © Dana Wheelock 2012. As part of the LEED certification process for its UW Health Yahara (pictured here) and UW Health Stoughton clinics, the UW Medical Foundation developed detailed instructions for cleaning each part of the facilities, and those instructions are now carefully followed by the cleaning service. Photo: © Dana Wheelock 2012.
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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.

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