“Green”—over the years, this now-ubiquitous word has been woven into the fabric of both our professional and home lives. And when the goal of sustainability enters the healthcare landscape, a key metric to achieving it is found not only in the actions of patients, staff, and visitors, but in the building that surrounds them. The actual structure and design of a facility plays a significant role in that facility’s ability to be green.

On Tuesday of the HEALTHCARE DESIGN.11 conference, experts on the topic will discuss what solutions are available to gain ground.

Breeze Glazer, M.Arch, LEED AP BD+C, research knowledge manager, healthcare sustainability at Perkins+Will, joins Janet Brown, director of sustainable operations at Practice Greenhealth, for “Building for Sustainable Operations—Design Strategies that Support High-Performance Green Buildings.” The educational session will be held from 2:15 to 3:15 p.m. on Tuesday, November 15, 2011, in Canal D of the Gaylord Opryland Resort and Convention Center.

HEALTHCARE DESIGN Managing Editor Jennifer Kovacs Silvis spoke with Glazer and Brown about what the green landscape looks like today and what they have in store for their session at HCD.11.


Every day, the topic of green/sustainable design in healthcare seems to gain more and more ground. Do you think “green” is here to stay in healthcare design?

Janet Brown: The word “green” may go away as the associated activities fully integrate into the culture of the organization. Over time, healthcare leaders are discovering that green is quality, safety, and efficiency; is fiscally responsible; and is in line with mission and core values. Someday it won’t be called an initiative, a campaign, or a color, because it will be fully integrated into strategy, planning, and day-to-day operations.

Healthcare sustainability offers numerous positive outcomes, many of which aren’t fully anticipated. Some may embark on greener activities to reduce costs and then benefit from positive press, worker morale, or improved regulatory compliance. When leadership realizes the benefits—from their own experience and their own perspectives—and incorporates a methodology for data collection, reporting, and continuous improvement, it becomes part of the day-to-day operations of the organization.

Breeze Glazer: Without a doubt, green is here to stay in healthcare design. However, I anticipate the definition, and related expectations of green, will change over time, with the bar of performance raised continuously. Today, the term is used to describe buildings that simply seek to do less harm—for example, a building designed to use 20% less energy than the baseline. That will soon be raised to buildings that really seek to do harm with a near-zero resource impact, 100% less energy than the baseline. In the future, that will be raised again—to buildings that heal, particularly true for healthcare buildings that seek to repair their environments and actually produce more clean water and carbon neutral energy for their communities than they consume.


Your session will put together a sustainable operations expert, a designer, and a hospital executive to discuss win-win solutions for sustainable facility design. What are some of the pains all parties feel along the way of discovering those solutions?

Brown: All too often, programs like recycling are not considered during the design phase so that sustainability teams have to figure out a way to “make it work” with the existing limited storage space, soiled utility room size, and dock size. 

We are also still learning about opportunities to avoid waste and toxic material in the purchasing process—both during construction and operationally. There seems to be a notion that greener products cost more. This can be the case if we look quickly, but often a deeper dig identifies additional costs like spill response, air quality testing, and waste removal, which may not be calculated at the point of purchase.

Doing anything a new way takes time and a willingness to try something new. When supply chain is onboard and sees the connection between the materials and the waste, between health of the planet and human health, then the discussion can really get underway and the team can ask manufacturers to disclose the ingredients in their products. And when these healthier choices reduce costs? That’s the icing.

Glazer: Some of the pains are a result of a somewhat linear typical design process, where the project management team the hospital has put forward can be disconnected from the operations team that will be occupying and running the hospital. That operations team may only be engaged toward the end of the project as construction nears, which could be several full years after initial programming that sized and located material management components.

This session will imagine a more optimum process, where all parties are engaged at an earlier stage of design where the operations team can better help to influence the buildings they will be operating. Additionally, an acute care hospital can take 10 years from initial design through occupancy, and in the emerging field of sustainable healthcare operations, it is critical to building the flexibility in our designs to account for new technologies and systems over time.


Why does the actual design of a building play such a critical role in making healthcare facilities sustainable?

Brown: Sustainability is about efficiency, so material movement, storage, and removal play a big role in the cleanliness, safety, and potential for improvements at the facility level. A laboratory can’t distill solvents on site and reduce purchasing and disposal fees by $100,000 per year if there is no space to site the solvent distillation unit, for example.  

Little things can make or break a program, like placement of recycling storage bins. The design of the space can engage individuals and make it as easy to participate as to not participate. The design can help create the culture of environmental excellence and connect the workers to the bigger picture—a true healing environment. It doesn’t make sense to build a LEED-certified hospital with safer materials and connection to nature and then bring in mercury-containing devices or not recycle. Designing for sustainable operations is about the bigger picture—a safer building and safer operations.

Glazer: User behavior is one of the most critical factors in a successful green operations program; and as Janet notes, the physical environment can either encourage or discourage green operations; however, it is rarely a neutral participant. It is the responsibility of architects and interior designers to create environments that support both the green operation strategies of today while looking at the future, acknowledging that hospitals are 50-year buildings and things are certain to change over time.

LEED represents a snapshot in time that actually ends the day the project opens — actual building operations can have a far greater environmental impact than the initial construction.


What kinds of real-life examples will you share with HCD.11 attendees?

Brown: This session is focusing on materials and wastes in healthcare.  For example, we’ll be discussing the perfect soiled utility room—there are so many more waste streams than ever before, and we have the data to predict the types and amounts that will be generated based on number of beds or FTEs, so this data can help designers create the space that will facilitate a strong segregation program.

We’ll also discuss the kitchen, and the materials
and waste handling at the back door. We’ll be sharing some before and after shots of some common current practices versus design for future spaces. We need the designers and their teams to truly understand the day-to-day challenges of waste segregation and the types of spaces needed to make it work.

Glazer: Attendees will also learn of pioneering healthcare networks that are truly pushing the envelope in pursuing strategies for waste reduction across the board in a hospital. While these more innovative strategies may not be viable for everyone today, we hope they will inspire attendees by seeing what may be possible to implement in the near future.

 It is our hope that these examples will begin to recalibrate our understanding of waste today from a deficit, to a latent asset that can actually provide benefit for the hospital and its community.


What conversations do you hope to spur during the session (and beyond)?

Brown: We are looking for varying perspectives, stories and successes that individuals have to share with the group.  We will bring a draft check list with us to help designers identify the waste needs of a given space, and we seek feedback from the group so we can integrate ideas and give back. We have a long way to go to reach a zero-waste facility. We’re just getting started.

Glazer: In my experience, hospitals rarely want to be the very first organization to undertake a specific sustainable strategy or program; however, everyone wants to be the second. As long as someone else went first and took that initial leap of faith (and potential risk), it is that much easier for the next to follow suit. For that reason, we also hope to get a better pulse on the pioneering healthcare organizations, designers, and consultants that are really pushing the envelope on waste reduction strategies today, and share those success stories with other interested organizations.

Breeze Glazer, M.Arch, LEED AP BD+C, is Research Knowledge Manger, Healthcare Sustainability at Perkins + Will. He can be reached at breeze.glazer@perkinswill.com. Janet Brown is Director of Sustainable Operations at Practice Greenhealth. She can be reached at jbrown@practicegreenhealth.org.