Sustainability has been defined as “that which meets the needs of the present without compromising the ability of future generations to meet their own needs” (from a UN World Commission on Environment and Development report, “Our Common Future”, published in 1987). An observation that has been variously attributed to Native American leader Chief Seattle, author Antoine de Saint-Exupéry, and others, is: “We do not inherit the earth from our parents; we borrow it from our children”.

Because of the importance of protecting the environment for future generations—not to mention guarding the health of today's patients—sustainable practices in healthcare environments should be looked upon as the keystone of the mission rather than merely an option. If our medical buildings are to be places for healing patients, shouldn't they also be places that protect the environment?

Sustainable practices not only benefit the immediate built environment, but also society and the economy. For example, hospitals can play an important role in society by setting an example for their communities. Gary Cohen in his article “First, Do No Harm”, one of the Designing the 21st Century Hospital series of six white papers, writes, “Hospitals can lead society toward building schools, homes, and office buildings that also promote occupant health and consider the environmental and public health implications of the building materials and systems themselves”.

The healing environments of hospitals should extend from the micro level of the patient to the macro level of the community to the supermacro level of the earth. Along those lines, Cohen also writes: “To heal their patients and safeguard the health of their employees, hospital leaders recognize they must also do their part to transform their hospitals to promote healing, while using their purchasing power to heal their community and the planet”.

In terms of the economy, although constructing green buildings is often perceived to be more expensive than building conventional structures, the evolving industry is now estimating that green construction represents only a 2% premium over traditional construction. The first cost can be mitigated over the life of the project, as operations of sustainable buildings are proving to be more resource-efficient, as well as more desirable to clients, patients, staff, and lessees—and, therefore, more profitable and healthy for the economy.

The following two case studies—one involving a patient care tower being built at Advocate Lutheran General Hospital (ALGH) in Park Ridge, Illinois, and the other involving Prentice Women's Hospital, due to open later this year on the Northwestern Memorial Hospital campus in Chicago—demonstrate two approaches to advocating for sustainable design and illustrate the benefits of “building green”.

ALGH Patient Care Tower

Deborah Rohde, vice-president of facilities construction at Advocate Health Care, championed a green approach to ALGH's new Patient Care Tower (figure 1), which was designed by OWP/P. The building—an 8-story, 382,000-sq.-ft. addition housing 192 private rooms and scheduled for completion in 2009—is pursuing LEED Gold certification.

The new patient care tower being built at Advocate Lutheran General Hospital in Park Ridge, Illinois, is scheduled for completion in 2009. Rendering courtesy of OWP/P.

After attending a seminar on Boulder Community Foothills Hospital, the first LEED-certified hospital in the country, Rohde raised the idea of pursuing LEED certification for the new bed tower with Bruce C. Campbell, DrPH, president of ALGH. He was very excited and supportive of the initiative and, as Rohde states, “Immediately, we had our champion and sponsor”.

When Dr. Campbell presented the idea of pursuing LEED to the Capital Committee, the committee stated that sustainable design was a good thing to do but questioned their ability to follow through, since “capital [was] so tight”. The project team was then challenged to evaluate the cost and associated return on investment. Currently, this $201 million project is showing a .25% premium for LEED-associated components, with a payback period of up to 14 years. The largest investment and payback are associated with credits in the Green Guide for Health Care's “Energy & Atmosphere” category.

According to Rohde, “The local community just loves the fact that we are being environmentally responsible”. She says that going green has also made the regulatory process smoother. “Because the hospital is incorporating features such as green roofs, zoning went much more smoothly than it did on our last project”.

Through the enthusiastic leadership of Campbell in the pursuit of LEED certification for the patient care tower, the hospital staff also came to embrace the idea of sustainability from an operations perspective. A group of employees formed a committee called the “Green LEEDers” to “reduce the impact of hospital operations on the environment”. The following is a sample of their initiatives: commingled recycling at 18%, adoption of reusable sharps containers, audit of house-wide mercury usage, and assessment of pharmaceutical waste management. These efforts were recently recognized by Hospitals for a Healthy Environment (H2E) with a Partner for Change Award for the hospital.

Prentice Women's Hospital

Alicia Murasaki is the senior project manager for Northwestern Memorial Hospital's (NMH) new Prentice Women's Hospital (figure 2), which was designed by the VOA + OWP/P Design Collaborative. The new 940,000-sq.-ft., 16-story, 328-licensed-bed hospital, which includes an 86-bassinet NICU, will open later this year. NMH is pursuing LEED certification for this new facility.

Prentice Women's Hospital, expected to open later this year, is located on the Northwestern Memorial Hospital campus in Chicago. Rendering courtesy of 3I.

During the initial planning for the new hospital, Murasaki approached her boss regarding the possibility of pursuing LEED certification. He thought it was a great idea and would fully support the endeavor, but he had one question: “Will LEED certification bring any more patients to NMH?” Unfortunately, that question did not have an easy answer. There also was some resistance from the design team regarding cost implications, even though they agreed to the concept that “green design is good design”; and the construction manager identified a potential 20% premium for green design. Therefore, Murasaki's initial approach was to incorporate green design features whenever possible but not officially pursue LEED certification—a “stealth” LEED approach. Instead of referencing LEED or sustainable design, the specifications simply asked contractors to state where specified products were manufactured, so that sustainable products could be identified and used whenever their cost wasn't prohibitive.

Not all the naysayers' predictions about sustainability for this project were correct. For example, the construction manager initially had estimated that recycling construction waste would add a 30% premium to the project. However, the selected construction waste contractor (the lowest bidder) was able to recycle 85% of the waste with no additional cost.

The pursuit of green design was entirely in keeping with the hospital's publicity campaign of “Enjoy Your Health”, so Murasaki learned early on in the project the importance of “speaking the language of her audience”. For instance, when she presented the idea of a green roof to the Patient Care administrators, she spoke in terms of improving views from patient rooms—by designing them to overlook vegetation instead of a typical hard roofscape. As it turned out, the incorporation of a green roof also helped to obtain the necessary approvals when a zoning variance—to extend the building over the property line—was needed.

During construction, Murasaki received an internal phone call asking if it was too late to pursue LEED certification. A donor had just made a significant pledge contingent on the pursuit of LEED certification. Murasaki's stealth approach had paid off in an even bigger way in the end; because sustainable products and methods had been used whenever the cost had been comparable to that of traditional products and methods, it was possible to fulfill the request and accept the donation.

By empowering the team and consultants to “go green” and choose sustainable practices, even contractors were able to be champions. One day while conducting a site inspection, Murasaki questioned a worker at the construction site on the composition of a red substance being scattered to control dust. A few days later, Murasaki noticed that the red material had been replaced with a green type. Again, she questioned the worker. He relayed that after learning that the red pellets were petroleum-based, the contractor had switched to a more environmentally friendly product.

Final Thoughts

The lessons learned from Rohde and Murasaki are that leadership buy-in is critical, that all stakeholders must be engaged, and that all levels of the organizations involved need to be constantly educated about green concepts and processes. Furthermore, they agreed that sustainability ought to be funded by the healthcare mission. Goals must be realistic, and achievements must be celebrated.

In the early days of the environmental movement, there was a public service announcement (PSA) in which an actor portraying an Indian on horseback, Iron Eyes Cody, surveyed the American landscape and saw ecologic misadventures all around him. In the final scene, a tear was seen sliding down the cheek of the “Crying Indian”, as he came to be known. More than 30 years later, that PSA still has a powerful message. As green champions, we should all strive to develop facilities designed to heal both patients and the planet, so that if Iron Eyes Cody were to ride up to your hospital on his horse, he would smile. HD

Kevin Hall, AIA, LEED AP, is an Associate in the Chicago office of OWP/P Architects.

Willy Schlein, AIA, LEED AP, is Senior Associate in the Phoenix office of OWP/P Architects.