When Rockingham Memorial Hospital (RMH) officials committed to building their new facility in Harrisonburg, Virginia, as a “green” facility, they were largely forging new territory.
At the time, no more than a handful of hospitals around the country had received certification from the nonprofit U.S. Green Building Council as LEED-certified facilities. Even today, fewer than 50 acute care hospitals (or portions thereof) have achieved LEED Gold or Platinum status, and Rockingham is one of the few possessing Gold.
Many of those involved in the RMH construction project, which opened in June 2010, were skeptical about incorporating green attributes. Would building green cost more? Would operating a green building be truly cost-effective? Would green materials and features last? Would green building features enhance patient satisfaction and complement patient safety and staff efficiency?
“Any time you are on the leading edge of a trend or development, you are taking a chance that something may not work as well as you had hoped,” notes Dennis Coffman, director, RMH Facilities Planning and Development. “But we knew this was a calculated risk; our building was constructed using evidence-based design and around the concept of patient-centered care. We knew we were making design decisions for the right reasons—to provide the best possible patient experience and to build the best hospital and health campus for our community for generations to come.”
In the end, the 700,000-square-foot, 238-bed facility, situated on a 254-acre campus and designed by Earl Swensson Associates, Inc. (ESa), became the first LEED-certified hospital of its size in Virginia—and one of only a few LEED Gold healthcare facilities in the nation—while staying within its $290 million budget.
Many of the green building elements have resulted in energy cost savings while others have increased patient and staff satisfaction, along with other aspects of building construction and design. And along the way, hospital officials have learned lessons they can pass on.
Green features reap energy savings
Two years after opening, some green building features have proven themselves to be saving the hospital money in operational costs. Among those features are its white roof that deflects heat; HVAC system; domestic hot water heater systems and associated circulation pumps; and chilled water service connections and chilled water tertiary pumps.
A unique methane gas partnership with Rockingham County, to channel methane gas from the county landfill to the hospital’s tri-fuel boilers for energy, has been successful in meeting the hospital’s heating and cooling needs.
“We expected the methane gas to supply the majority of energy needs, and it has,” Coffman says. “We are meeting 95% to 100% of our fuel needs with methane gas. It has worked well, and we expect it will continue to. The steep drop in natural gas prices and the unusually mild winter we experienced this year meant our savings were not as great as what we had anticipated. However, given that we locked in a set price for the methane gas, at least we can be sure of what we will be paying for fuel for years to come.”
Because of the methane partnership project’s uniqueness, Chevrolet selected it in late 2011 as a carbon-reduction project in the United States in which to invest. Chevrolet featured the project on its website and in its social media.
The facility has turned out to be even more energy-efficient than expected, Coffman adds, noting that the building tends to be more efficient per square foot than the old facility, in terms of water and electricity usage.
“The electrical usage for the facility trends closely to what we modeled during the design phases of the project,” says Eric Sheffer, manager of sustainability consulting, SSRCx, and a consultant on the project. “Gas usage has not trended as accurately as what was modeled for electricity, which can help reveal to RMH some operational efficiencies that might be gained as the hospital is further tuned by RMH plant operations.”
Paul Ketron, director, facilities management, says that overall, RMH has seen a 20% improvement in energy consumption costs per square foot over its old facility. Heat recovery and economizers were installed on the three 600 HP boilers to use the waste heat off the combustion exhaust to reheat water for the central energy plant and the food and nutrition services department. He notes that thermal comfort has been provided with 70% of the building occupants having individual controls.
In addition, he says, an electrical generating system was installed to reduce peak demand on electrical charges. “However, the complexities of the system have created some delays in getting the performance we wanted,” he adds.
Ketron says the “white,” or reflective, roofing has helped RMH manage the heat load on the building and reduce HVAC costs. “Whenever outside temperatures are below 48 degrees Fahrenheit, we are able to manage building temperatures by means of free cooling—using only outside air,” he says. “Our chiller plant is offline for extended periods, reducing our energy costs.”
Ketron adds that the hospital also has achieved reduced water usage due to chillers/cooling towers being offline when outside temperatures allow for free cooling. He says low-flow toilets and lavatory fixtures have reduced water use, but they also have introduced issues with flushing disposable disinfection wipes used in patient rooms. “The low water flow created blockages that were hard to resolve,” he explains. “We used this condition to backtrack to the design team to be sure the drain pipe slope was being matched to the low flow water toilets.”
Overall, Ketron notes, “It’s been a refreshing experience to be able to operate in a new facility with all new equipment of the same vintage. Facilities management operations staff were involved from the first site development through final commissioning to achieve a high level of performance and operational efficiency—by tapping into the resident experts. Many good ideas look great on paper, but it takes the design team and the operations staff to work through the actual challenges in making a new building as efficient as possible.
"The first day I walked into the chiller plant in the fall of 2010 and it was all quiet, I knew this was different. In my 27 years of facility operations in four hospitals, at least one chiller was always on to provide cooling for at least the surgical suites. When we could maintain the temps they required without running the plant, it was a red letter day.”
Green elements complement safety and efficiency
Green building features were integrated into the building and campus alongside evidence-based patient safety and staff efficiency features. Every patient room is private and has a stunning view of the surrounding mountain vista.
“RMH’s decisions on green building were directly related to the patient experience, especially with indoor environmental quality. Research suggests that patients having a view to the outdoors can have a positive effect on their recovery,” Sheffer says.
Each patient room also features a badge-entry medication cabinet, a handrail by the bed leading to the bathroom, a lipless bathroom and shower threshold, and a bedside computer for staff charting and barcode scanning.
Nurses’ stations centrally located halfway down the hall of each patient unit enhance efficiency for staff and a quieter environment for patients.
The interior color pa
lette and design are designed to “bring the outdoors in” and create a soothing environment for patients. Low-emission paints and other interior materials reduce noxious fumes, improving indoor air quality for patients as well as staff.
“One of the greatest compliments we’ve received is that the hospital doesn’t have that ‘new car smell,’” Coffman says. Another compliment came from a woman attending a conference at the hospital recently.
“I was especially impressed by LEED certification because in a relatively new building—or even one that was recently painted or has new carpet—I end up with a splitting headache because of the fumes from resins and other materials,” she says. “That didn’t happen, and my sinus congestion actually eased.”
Impervious flooring—terrazzo in public areas and vinyl wood in patient rooms—is “green cleaner friendly” and also improves infection control.
“These flooring surfaces result in a bit more noise, but they clean better and easier, which the environmental services staff loves,” Coffman says. Solid-surface countertops also contribute to an environment that is easier to get and keep clean, which is vital in a healthcare environment.
He adds that the smooth surface of the terrazzo floors in the front lobby area is safer for people walking, using walkers, or in wheelchairs.
Logical adjacencies of departments—for example, having Imaging next door to the Emergency Department, and the Operating Rooms one floor directly above the ED—have made patient care more efficient and timely as well.
“RMH leaders, clinical leaders, and staff wanted major clinical departments adjacent to one another, whether horizontally or vertically, for quicker patient evaluations and treatment,” says Kevin Harney, ESa senior designer/project manager. “Based upon recent post-occupancy evaluations, these critical departmental adjacencies have shown to be successful for both patients and staff.”
Perhaps the most telling fact is that RMH’s overall inpatient customer satisfaction score increased more than 20% from calendar year 2010 to calendar year 2011. While there is no scientific correlation between facility design and the increase in inpatient satisfaction, this score would appear to reflect satisfaction with the inpatient environment as well as the efficiencies the facility design provides that allow staff to be more responsive to patient needs.
Outdoor green features enhance the environment
What patients and visitors see when they approach and circle the health campus clearly affects their impression of the hospital. And what they see is a warm and welcoming environment, complete with forestland, ponds inhabited by geese and ducks, and a 1-mile walking loop that attracts walkers and joggers of all ages throughout the day and evening.
“We have achieved a beautiful open campus with great views from all sides,” Ketron notes. “We have a campus we can develop as opportunities and needs present themselves.”
The site, which had been a working farm, was disturbed as little as possible with a relatively tight development footprint. Preserved areas include the preservation of the wetlands and woodlands. Retention ponds for storm water runoff have performed well, according to Ketron, and many birds and other wildlife have made their homes in the wetlands. “We are exploring how we can use the retention ponds for irrigation in upcoming projects,” he adds.
In addition to dedicated parking for fuel-efficient vehicles, the parking areas include bike racks to encourage those who prefer alternative, fuel-free transportation. Shower facilities are also available to those who bike to work or who want to take a jog at lunchtime. “These have been welcomed by those who use them and would be considered a success,” Ketron says.
Coffman notes that while overall there is ample parking—about twice what it had at the old facility—the hospital also has more visitors to its site. “We have worked on having better distribution and correlation between where people park and the entrance they need,” he says. The Emergency Department parking lot size, for example, was more than tripled, from 15 spaces to 54. Coffman says 35 more spaces will be added in an adjacent area.
One area of particular success outdoors is the parking lot downlighting, which reduces light pollution while conserving energy, as well. “Both to be good neighbors and to avoid high levels of light wash, the fixtures and light levels were held to low levels to achieve both objectives,” Coffman explains. “We continue to evaluate the lighting for perceived safety concerns from patients, visitors and staff.”
Hospital officials continue to have conversations with residents of adjacent neighborhoods at least once a year. The neighbors appreciate the hospital’s consideration in installing down-lighting in its parking lots, and they make good use of the 1-mile walking trail around the hospital. Some concerns noted, including the noise created by a medical transport helicopter flying low over the neighborhood, have been addressed. The neighbors continue to indicate satisfaction with the “new kids on the block.”
Conclusion: The commitment was worth it
Coffman says that overall, the staff and community have responded positively to the hospital’s green efforts as well as to its patient-centered features.
“We are hearing very positive comments. Patients and families appreciate the beautiful views from patient rooms, the size of the patient rooms themselves, and the size and attractiveness of our dining facility. Everybody thinks the building is spacious, beautiful, and brings the outside in. Most don’t think it’s extravagant, and for people who live in a farming community to not feel that you wasted their money, that’s a good deal,” Coffman says.
He adds that education is an important part of green building because some concepts are so new and unfamiliar. “Even in today’s environment, there are times when the newness of energy-saving devices and innovations means that people don’t understand them, so they are not used properly,” he says.
Coffman notes in particular that education around the use of dual-flush toilets, waste receptacles designated for recycling, and reserved parking for fuel-efficient cars is vital.
“In green healthcare facilities, we often find that those less understood components of a facility also provide the greatest opportunity to help increase the awareness of building users and staff about considerations such as water conservation and alternative transportation,” Sheffer remarks.
As a case in point, Coffman says, “Our fuel-efficient vehicle parking is ample and well-marked, but visitors and patients don’t always use this parking appropriately.” The hospital has a list of fuel-efficient vehicles and criteria that can be given to motorists, he says.
Coffman adds that even when some of the energy-saving green elements are doing what they’re supposed to, they can cause problems. The white roof, for example, deflects heat, but also increases glare into some patient rooms. Coffman says that concern has been addressed by applying coating on the exterior glass that reduces the amount of glare.
As Coffman notes, some things you can learn only from the experience of “living” with a facility for awhile. Thus, two years out, a number of challenges and opportunities for improvement exist and are being addressed.
“When you are starting to discuss a new facility 6 to 7 y
ears ahead, you can’t get everything right,” he reflects. “You try to make yourself flexible enough to be able to correct what you didn’t get right. But if we had it to do over, in concept, I would still do all the things we did. When you are brave enough to pioneer something new and innovative, there are very few others you can learn from. In the end, you become that facility that others learn from.”
“Overall, the effort to achieve LEED has resulted in positive outcomes for our facility. It lays the groundwork for us to manage as we take our lessons learned and apply them to future projects,” Ketron says.
Not only do all parties agree the facility more than met overall expectations, all agree that they learned valuable lessons they can take into future projects.
“The project’s success is a testament to an owner’s vision and the willingness to stay true to that vision throughout the entire process,” Harney says. “The design and construction team can be proud of the product produced, while RMH can build upon the facility’s successes.”
Debra Thompson is Director, Corporate Communications, for RMH Healthcare, a member of Sentara. She can be reached at firstname.lastname@example.org.