For the owners of a specialized healthcare practice, the motive to green their new space sprung from the belief that health and well-being result from both the quality of the expertise and the experience. While conceiving of the medical practice in an existing building in Washington, D.C., the owners became more aware of the impacts of architectural design on their patient's experience within the physical space. “Design directly impacts wellness and prevention,” says Sharon Warner. Sharon Warner, CEO and visionary, and Christopher Warner, MD, FACOG, founders and owners of Washington Wellness Institute (WWI), are passionate about serving women's heath needs.

Green Architecture

Suzanne Zahr Fleming of ZDS Architects in Seattle served as the lead designer and strategic advisor to help define the goals for WWI's new business model. As the working relationship unfolded, the Warners and Zahr Fleming mapped out an integrated plan for expanded medical services, consulting for holistic well-being, and stewardship of the environment. The commitment to the environment is expressed in both a sustainable business practice and the Architecture. Like ZDS Architects, WWI is a carbon neutral company.

The environmentally sustainable, 3,300-square-foot center encompasses a reception and waiting area, office, procedure room with recovery area, four exam rooms, and other back-of-the-house amenities. Initially targeting Leadership in Energy and Environmental Design for Commercial Interiors (LEED-CI), Silver Certification, the institute is located in a dense community near mass transit. Energy is conserved through the use of innovative medical and office equipment, ENERGY STAR Appliances, efficient light fixtures, and daylighting. Air quality is designed to be optimal for clean health. Components include the use of highly recycled content in the carpet and terrazzo flooring, regional and local products, rapidly renewable materials, Forest Stewardship Council (FSC) certified wood, and paints and adhesives that limit VOCs (Volatile Organic Compounds).

“The psychology of space, or how it evokes emotions, and natural light are the two aspects that drove the design process. Our goal was to provide a more spa-like and restful experience to welcome patients and minimize any anxiety as much as possible,” says Zahr Fleming.

The Institute provides clientele with a healthy, calming experience enhanced by filtered light, texture, and color. A clear glass wall and pivot door entry (figure 1) allow views through the open reception and waiting area to the trees lining the street below. An abundance of natural light filters into the corridors through translucent resin panel partitions. Lower levels of artificial light create an intimate and serene space. Modern furniture and lighting fixtures float like sculptures (figure 2). A streamlined palette of materials and finishes, along with the textures and colors, organize the space and aid wayfinding. Visible from the building corridor, a dynamic digital display near the entry draws people into the space.

Green stepping stones

So what are the current choices for healthcare facilities seeking green certification?

ZDS Architects worked within the framework of LEED-CI to design WWI due to the rating system's availability. LEED for Health Care (LEED-HC), currently in the latter stages of development, targets new construction and is expected to launch in 2009. While the United States Green Building Council (USGBC), founders of LEED, do not provide a rating system specifically for healthcare within an existing building, the council offered to work with the architect and the owners to create a more suitable category. Apparently, new categories are born through grass roots efforts and one-on-one discussions. The owner did not pursue this option due to the timing and substantial development period for new categories but may reconsider it in the future.

Working closely together to support green healthcare building, USGBC and the Green Guide for Health Care (GGHC) are developing tools and educational programs. Joint efforts encompass LEED-HC and the Green Guide. LEED-HC bypasses the customary pilot program by using a comment process, called GGHC Public Project Input, from more than 100 participating facilities to fine tune the ranking system. The first round of comments is closed, pending revisions; a second and final round of input precedes finalizing the system.

The sustainable strategies of LEED-CI, according to the USGBC, align with investing in people employed at progressive companies who typically seek certification. LEED-CI offers a straightforward process but it does not address the myriad of issues related to healthcare. Entrepreneurs and sustainable enthusiasts, like the Warners, seem to be the type of people the creators of the Green Guide had in mind.

The Green Guide is a voluntary, educational guide for sustainable pioneers in healthcare for planning, design, construction, operations, and maintenance. As a self-certifying toolkit, the guide uses a point system and suggests that users compile as many credits as possible. While it uses LEED as a foundational document, its chief differences include not ascribing to third-party verification or minimum threshold levels. Also registering a project is free. The rankings are intended to provide a means to gauge achievements and to encourage continuous improvement.

The two components for the Green Guide-one for Construction and one for Operations-serve different functions and are not intended to be used simultaneously. The Construction Guide applies to new construction, renovations, and additions to medical facilities. The Operations Guide is divided into 10 categories; it is customized for ongoing maintenance and operations and serves as a resource for sustainable strategies for existing facilities. Upon determining that WWI fulfilled the prerequisites, ZDS and WWI were interested in registering for both components of the Green Guide.

Taking on the task of ensuring greener operations, Sharon Warner completed the Eco-checklist from Practice Greenhealth that was adopted from the GGHC Operations Guide. The checklist was more appropriate in scale and specifics for her obstetrics, gynecological, and specialized medical services practice. Warner recognizes that environmental best practices, as set forth in the checklist, are an ongoing effort entailing continual learning. As a Charter Member of Practice Greenhealth, Warner can access tools and technology to create and maintain a safe and healthy environment. Fortunately, all of the organizations referenced in this article work collaboratively together-readily sharing networks, information, and resources-and eager to assist.

Ultimately, a healthy and efficient environment benefits everyone who steps through the door, into a space that meets benchmarks for thermal comfort, access to daylight and views, minimizing interior pollutants, and controlling lighting and temperature. Yet for medical professionals accustomed to focusing on highly specialized healthcare, the greening of the space they practice in may not be an obvious or immediate concern. Likewise medical professionals are not in a position to evaluate the components, along with its systematic approach, to achieving green design. And that is where an architect who is Accredited Professional (LEED-AP) comes in.

Green for life

Sharon Warner has become a relentless sustainable advocate inside her living laboratory at WWI. “The staff love being at the downtown office with the natural light. They don't feel like they have worked eight hours. They don't get headaches like they do at our other location. After patients come to the newly remodeled office, they don't want to go to our other one. How can you have a pregnant woman walk into a space where the carpet is off-gassing or the air quality is poor?” says Warner.

So what's next? The Warners have set their sights on greening their other office, located at the United Medical Center. The Warners know that once the other doctors see the new space, they will have to green their offices too. “Build it and they will come,” says Sharon Warner. She is okay with reaching across the country to Fleming and ZDS Architects to design the other space because “she gets it.” Even if they sometimes feel like “misfits” finding their way, taking one step at a time. HD

Project Team

Suzanne Zahr Fleming, AIA, LEED AP, ZDS Architects: Architect

Gary Henderson, Henderson | Kelly: Interior Designer

Hubert Construction: General Contractor

KTA Group Inc.: Mechanical, Electrical, and Plumbing Engineer

Web Links

United States Green Building Council:

Green Guide for Health Care:

Practice Greenhealth:

Dyan Pfitzenmeier, Firefly, is a writer and communication consultant in Seattle. Healthcare Design 2009 July;9(7):24-26