Exceeding one's own expectations has its rewards. In this case, a 238-bed, full-service hospital in northwestern Virginia learned that its reward for over-achievement is Gold.

When Rockingham Memorial Hospital (RMH) established the goal for its new replacement facility to be LEED certified, its sights were set on the Silver level. From the earliest stages of the project, RMH administrators and facility planning staff made an environmentally friendly hospital their objective for the chosen site's health campus. In pursuing this, the owner, designers, engineers, and contractor began planning and instituting sustainable practices and initiatives, many of which were innovative.

The greenfield facility was to be constructed on a 254-acre, picturesque plot of rolling farmland in Rockingham County, Virginia. Its predecessor, the nearly century-old existing hospital, was landlocked on 15 acres in the heart of Harrisonburg, Virginia.

“The site for the new RMH hospital and health campus inspired our vision to create a campus in harmony with the surrounding area, with facilities designed to bring the best of 21st-century health, wellness, and medical care to our community,” explains Dennis Coffman, director of facilities planning, and development at RMH. “It simply made sense to do the right thing for the environment and the community in the way we approached our mission of healing.”

Doing the right thing in a big way dealt Rockingham a nice surprise. In September 2010, the 630,000-square-foot healthcare facility, which opened to patients in June 2010, celebrated two distinctions. Not only was it the first inpatient healthcare facility in Virginia to achieve LEED certification, but it also became only the seventh hospital of its size in the country to achieve LEED Gold, according to information from the U.S. Green Building Council's (USGBC) website.

This certification also marks “firsts” for some of the project's team members. RMH is the first replacement hospital designed by Nashville-based architect Earl Swensson Associates Inc. (ESa) to achieve LEED Gold certification, and the first LEED Gold-certified greenfield hospital constructed by the general contractor, Bovis Lend Lease.

“This recognition now places Rockingham Memorial Hospital within a unique, small group of hospitals in the U.S.,” says Harold Petty, AIA, ESa director of medical design and principal. “The success of this project is a way to promote the value and benefits of green design to other hospitals. We share Rockingham's excitement about this significant achievement.”

RMH was committed to doing what made sense financially while pursuing its goal of sustainability. HEALTHCARE DESIGN highlighted RMH's efforts to build a sustainable, LEED-certified healthcare facility without incurring additional cost in the May 2009 article “Can Hospitals Go Green Without Spending Too Much Green?”

Achieving LEED certification without tacking on a hefty green price tag remained somewhat uncharted territory at that time, and this challenge set the stage for an amazing journey.

Building blocks contribute to the journey

In addition to its extensive pre-planning, throughout the project, the team looked at the efficiencies and long-term benefits of making the hospital more sustainable while also holding down the cost. When all the initiatives were tallied, USGBC awarded RMH 40 points-one more than the number required to achieve Gold certification.

According to data currently available from the USGBC, there are approximately two dozen LEED-certified stand-alone acute care hospitals-four certified, eight Silver, eight Gold, and one Platinum-in the nation. Of these certified hospitals, RMH is the only LEED-certified hospital in the state of Virginia.

RMH won points for meeting LEED criteria in the following areas:

Healthy indoor air quality. Paints, flooring adhesives, furnishings, and cleaning supplies were selected that produced few, if any, toxic fumes.

Energy efficiency. The advanced energy systems are designed to maximize energy efficiency and reduce costs. Part of this initiative is the innovative use of methane gas, a byproduct of the county landfill, as one energy source for its boilers. The new hospital has enough power generation capabilities to go off the electric grid during peak hours, earning savings of about $400,000 annually.

Water efficiency. Reduced water flow toilets and low-flow public restroom faucets were installed, reducing by 20% the amount of water needed for these services. By planting native and drought-tolerant plants, the amount of water needed to maintain the landscape is minimized.

Wetland preservation. Storm water runoff ponds and enhancement of the existing wetland area to slow excess water and sediment runoff, both pre- and post-construction, reduced negative impacts to downstream watersheds. This thoughtful planning for storm water runoff helps preserve the wetland on the site (the headwaters of the Pleasant Run watershed that feed into the Chesapeake Bay).

Careful waste management. During construction, the general contractor put a recycling program in place that recycled or diverted 76% of construction waste from the local landfill. Ongoing recycling programs within RMH will continue responsible waste management principles of “reduce, reuse, and recycle.”

Site selection. The new hospital was built to take advantage of the natural beauty of the site and natural light, as evidenced in the lobby and in the patient rooms, with large windows. During the winter months, the site placement allows the sun to assist in melting snow and ice in the visitor parking areas and walkways, thus reducing the need for melting agents and snow removal.

Partnering sets the stage for success

A key factor in a successful green building project is securing the right partnerships from the very beginning, Coffman notes.

“Those who are considering LEED certification need to talk about sustainability during the selection of an architectural firm,” he says. “They have to be a believer and be a part of the conceptual stage.”

Goals, defined early in the design phase, were established together by RMH's project architect, ESa, and systems engineers, Smith Seckman Reid (SSR).

“The certification stands as evidence that a close working relationship between the owner and the architectural and engineering design team will be rewarded by opening up new opportunities,” Petty says.

RMH's LEED journey was facilitated by SSRCx, a subsidiary of Smith Seckman Reid. This partnership was a significant factor in RMH's success, Coffman notes.

“Working with a consultant did represent a cost to us,” he says. “But it was worth it to have someone guide the documentation process. SSRCx kept subcontractors conscious of what had to happen, like researching where a product came from. They backed it up with awareness and helped us make the right choices early in the decision-making process.”

Eric Sheffer, senior project manager at SSRCx, notes that sustainable design and construction for healthcare facilities can present unique challenges, but bringing project team members together early is an important step to success.

“By continuing to encourage discussion and cooperation across disciplines throughout the design and construction process, RMH was able to exceed its original goals while keeping added costs to a minimum,” Sheffer says. “The RMH team demonstrated outstanding motivation to excel in sustainability at their new facility. It makes all the difference to have a project owner dedicated to the sustainable design process.”

Having general contractor Bovis Lend Lease on board from the beginning with the green mission was
critical, as the company was an integral part of the LEED certification process, Coffman says. “You've got to have everybody at the upper levels pulling for it,” he says. Daniel Meadows, project executive for the healthcare group, Bovis Lend Lease, echoes that statement.
“There was a true sense of collaboration among the design team and Bovis to leverage as many potential opportunities as possible during the construction process,” Meadows says. “In addition, the subcontractors provided documentation for the materials used and were extremely proactive during the commissioning process to ensure compliance.”

Bovis team members participated in design intent meetings where LEED credits were sought, Meadows says. In addition, Bovis took part in implementation meetings, established procedures for execution, collected and reviewed documentation, and facilitated the commissioning process. In the final phase, Bovis provided a certified package collected during the construction process for review by the USGBC.

Community collaborations produce results

Building green is a team effort, but not just between architect, systems designer, and general contractor. Securing community partnerships and identifying local green champions also move a LEED project forward, Coffman notes.

For example, utilizing methane from the Rockingham County landfill as a fuel source was a community partnership that won LEED points for energy efficiency and innovation.

“There is probably not another hospital in the country using methane from a landfill to run boilers,” Sheffer says. “Methane is a guaranteed revenue source for the county, and the county is charging a lower rate for the methane than the cost of natural gas, so the hospital wins, too.”

Methane tri-fuel boilers include a 20-year warranty and represent overall cost savings of $600,000 to the organization, Coffman notes.

Another unique partnership included the relationship between RMH and James Madison University (JMU). Through the JMU-RMH Collaborative, JMU biology professor Wayne Teel, PhD, and students assessed and enhanced the wetland area on the RMH campus. The group created berms to help with runoff filtration and planted native trees to attract wildlife.

RMH's commitment to green building attracted the attention of the Shenandoah Valley Builders Association (SVBA), which named RMH as the recipient of the SVBA 2009 Arbor Day Community Gift. In conjunction with Fine Earth Landscaping, SVBA donated 33 trees, valued at $13,000. The trees were planted with the help of more than 80 Rockingham County third-graders, along with the Harrisonburg mayor. The gift launched RMH's $1.7-million landscaping campaign, “Going & Growing Green,” to beautify the new campus and complete green projects.
This campaign helped fund a healing garden, including trails and a reflection pond on the campus.

To do it all over?

While successful LEED Gold certification is a tremendous accomplishment, the maturing technology of green means that there may not always be a tried-and-true precedent. Hospitals can expect that to embrace innovation may involve increasing staff education or training mechanics to use new technology, Coffman notes.

One such example is dual flush toilets, on which users pull the handle up for low-flow and down for high-flow. Not everyone is accustomed to this technology.

“You have to educate people on how to use them,” Coffman explains. “A standard toilet flushes 3 gallons of water; a low-flush uses 1.6 gallons. People still throw hand wipes, sanitary napkins, and paper towels in the toilet. With a low-flush toilet, this becomes more of an issue as these items clog the pipes. People have to be trained and reminded not to do that.”

There is also the aesthetic element. While using an energy-efficient white roof represented a cost savings, the color white shows sediment more quickly.

“You have to decide, is that OK or not?” Coffman says. “I might be more cautious about where I would put a white roof to make it more visually appealing. You need to be aware of the people who look out onto the roof.”

Also of note, RMH decided to use harder surface flooring to pair better with green cleaners, but there was a tradeoff. “With harder surface flooring, there's a little more noise and sound reverberation,” he says. “It's just something to be aware of.”

The upside of the emerging technology, Coffman says, is that it's easier now to get environmentally friendly materials than it was even four years ago.

In the community, RMH's hospital planning officials say they're pleasantly surprised by the level of interest and encouragement for the hospital's commitment toward sustainability.

“It's been surprising to me to see the individual support for this,” Coffman says. “The average person seems to care and support what we're doing. There are certain things people expect, like being a safe hospital. People expect you to be safe; they don't necessarily expect you to be green. That's extra. It shows that we care not only about the person, but the environment.”

“We are extremely pleased to be named the first green hospital of this size in Virginia,” he continues. “We made this choice not for recognition, but because it's the right thing to do for our community-now and for future generations. Being green is cost-effective, and it ensures we will continue to be good financial stewards of our community's resources.”

RMH Healthcare CEO and President Jim Krauss says that while he led tours of the facility before its opening, he consistently received positive feedback from community members regarding RMH's commitment to going green.

“Given the stringent criteria for LEED certification, it is difficult for hospitals to achieve this distinction,” Krauss notes. “This is a tremendous honor and a reflection of our commitment to providing a sustainable future for our community.” HCD

RMH's regional services include interventional cardiology, heart surgery, general surgery, women's health, and cancer care. For more information, please visit www.rmhonline.com. Healthcare Design 2011 May;11(5):12-16