Healthcare facilities today face significant challenges when it comes to implementing environmentally sustainable building design. Because hospitals are 24/7 operations, it's often difficult to operate an energy-efficient hospital, while adhering to strict code requirements. Miller Children's Hospital Long Beach, one of four hospitals that make up the Southern California MemorialCare Health System, is one example of a hospital that has found innovative ways to become “greener” in the design and construction of their new inpatient pavilion.

Throughout this process, Miller Children's Hospital Long Beach took a number of steps to mitigate the negative impact traditional hospitals may have on the environment. Yet what many hospitals and healthcare organizations fail to realize is that they, too, can take steps to become greener. This case study serves as an example of how other hospitals can follow in Miller Children's Hospital Long Beach's footsteps as they strive to minimize their carbon footprint and achieve best practices in their quest to become greener organizations.

The process of going green

The decision to implement green practices at Miller Children's Hospital Long Beach first began with a vision and commitment to improving the health of pediatric patients, while reducing the negative impact of the hospital on the environment. When the executive team began planning the construction of the new four-story, 124,000-square-foot inpatient pavilion, one of the initial goals was to achieve Leadership in Energy and Environmental Design (LEED) certification. The criteria for obtaining LEED certification was thoroughly studied, and it was realized during the investigation that this goal would be difficult to attain, as no other hospital in California had achieved this certification. This is largely the result of the state's stringent requirements for hospital construction projects, which are largely driven by seismic and emergency preparedness codes.

As the initial groundbreaking of the new pavilion approached in November 2005, executives at Miller Children's Hospital Long Beach committed to ensuring that every material used was as environmentally friendly as possible. To assist in meeting this objective the hospital partnered with local Architecture firm TAYLOR, who shared the vision of designing a green building-something that is often unique in healthcare.

Despite developing a solid plan for implementing green infrastructure, a few challenges were encountered along the way. The biggest challenge was that the new pavilion was to be constructed over what was once an active oil field during Long Beach's oil production heyday of the 1920s and 30s. To make room for the new pavilion, an existing parking structure was demolished which had been built over abandoned oil wells. It had to be re-abandoned due to today's stringent environmental standards. To guide us through this process the hospital worked closely with the California Department of Toxic Substance Control (DTSC), a department of the State's Environmental Protection Agency (EPA). Working together, a cleanup plan to help remediate and remove contaminants from the soil was developed and implemented. Nearly 45,000 tons of soil was removed from the site and thermally treated to remove any petroleum remnants.

Throughout the project, construction equipment was powered with low-sulfur, low-emission fuel in an effort to minimize the harmful impact the equipment could have on the environment. Clean-burning propane fueled vehicles were also used whenever possible. Efforts made in recycling construction waste, including the concrete and steel from the old parking structure, were recognized. Seventy-five percent of the construction waste-more than 2.5 million pounds-has been recycled throughout the course of the project.

The EPA recognized our efforts to create an environmentally friendly hospital for the patients and the surrounding community and awarded us with three different Brownsfield grants totaling $600,000 to help with soil remediation, removal of the parking structure, and construction of the new building. This makes Miller Children's Hospital Long Beach the first and only nonprofit children's hospital to receive such grants. Many local Los Angeles- and Orange County-based vendors were selected for building materials, as the use of locally manufactured building supplies helped to decrease pollution associated with packaging and long-distance shipping.

Specific green elements that make Miller Children's Hospital unique

The new pavilion's interior finishes were selected with the intent to minimize harmful impacts on the environment and protect the health of patients. For instance, a decision was made to install linoleum floors and use carpet containing recycled content throughout the new pavilion, as opposed to vinyl flooring. Unlike vinyl, which is present in many hospitals today, linoleum is made from organic materials such as solidified linseed oil and wood flour or cork dust. In addition, low volatile organic compound (VOC) paints were used on the walls and in the adhesives for flooring.

The cabinetry in the expanded Neonatal Intensive Care Unit (NICU) is also free of formaldehyde and other chemicals that could be harmful to these most vulnerable patients. Formaldehyde is often used in the adhesives to make particle board and other engineered wood products. A proactive approach was engaged to eliminate the use of medical equipment devices containing Di (2-ethylhexyl) phthalate (DEHP). This is the result of emerging research indicating that exposure to phthalates, which makes plastic tubing flexible, may be harmful to children's healthy development.

In addition, high-efficiency lighting systems were used and daylighting was a key design feature throughout the pavilion. The abundant natural light will reduce our electric lighting requirements during the day and will allow more natural sunlight in, which studies have shown to help patients heal faster. The roof also includes two specially designed gardens which will help to provide solar insulation and connect patients and visitors with the outdoors. In the warmer months light-colored sidewalks and plazas, paired with the white roof, will help to reduce the heat island effect of the site, while reducing the demand on the air-conditioning system.

The benefits of going green

At Miller Children's Hospital Long Beach we believe the health of the patients and the health of the environment are interconnected, and we are proud to lead by example within the Long Beach community. As a result we were adamant about designing the greenest hospital possible, while creating an environment that promotes patient health and well-being. Moving forward we will continue to apply these practices to our existing hospital and to the hospitals throughout the MemorialCare Health System.

As a leader in our community, Miller Children's Hospital Long Beach has proven that even large, traditionally energy-intensive facilities can be modified into eco-friendly institutions. Though we have only recently finished the construction phase, Miller Children's Hospital Long Beach has already seen the benefits of going green. Our pavilion's design, as well as the environmentally friendly practices implemented throughout its construction have demonstrated that even small modifications have the potential to make a difference. Miller Children's Hospital Long Beach is proud to serve as a model for healthcare organizations that are taking positive steps in conserving resources and contributing to a healthier environment while making every decision with our tiniest patients in mind. HD

Richard DeCarlo is Chi
ef Operating Officer at Miller Children's Hospital Long Beach in California.

Healthcare Design 2010 March;10(3):16-18