The facility admits natural light to 75% of interior spaces. Construction included the relocation of six three-story residences within the neighborhood, infilling vacant lots, and increasing density with consistent-type housing stock.

Green business initiatives: Only a few years back, they were the purview of a few business owners with strong environmental leanings. Today, the story has changed. Nearly every business sector is examining its own environmental impact, and being green has gone mainstream.

The healthcare industry has been included in the shift toward green or “sustainable” practices. Hospitals, labs, clinics-nearly all types of healthcare-related facilities-are examining their operations and practices with an eye on reducing environmental impact, affecting positive social change, and saving money-the so-called “triple bottom line.”

Forming a green team

As much as most people deplore committees, the complex operations of any medical center require a group effort to plan, implement, and measure a greening program. The “green team” should consist of representatives from every major group and department within the hospital.

In addition to the obvious participation by physicians, nursing staff, the administration, and the particular service lines of the hospital (i.e. oncology, cardiology, pediatrics, etc.), departments that should be included on the green team should be those connected to support functions, such as housekeeping, central processing, material management, engineering services, lavatory, facility services, and food service support.

The green team, and indeed the greening process as a whole, must have the backing of the hospital's senior administrators. While that's not to say that the initiative for healthcare greening cannot come from grassroots employees-a bottom-up effort-at some point, leadership and commitment must be present at the top of the organization. Members of the green team-some organizations have dubbed them green ambassadors-must be individuals who sincerely desire participation. Assigning disinterested individuals to the green team is counterproductive.

Setting goals

Like any endeavor, realistic, yet challenging goals will need to be set; this is the green team's initial work. Goals need to be defined with respect to time; one-, two-, and five-year goals are feasible timeframes. As with any undertaking, the green goals should dovetail with the mission statement. Likewise, the green goals need to be coordinated with the organization's business plan. Formulating goals that just won't be accommodated by the budget is a recipe for failure and, ultimately, disillusionment.

Case study: Brigham and Women's Hospital, Carl J. and Ruth Shapiro Cardiovascular Center, Boston

Open 24 hours a day and meeting strict interior environmental requirements, hospitals are notorious energy hogs, making LEED certification difficult. Brigham and Women's Hospital, Carl J. and Ruth Shapiro Cardiovascular Center was built in accordance with the Green Guide for Health Care-an accomplishment that earned the facility Silver LEED certification and the distinction of being New England's first LEED-certified hospital. The center is designed to standards established for silver certification in five key areas: sustainable site development, water savings, energy-efficiency, materials selection, and indoor environmental quality.

Fletcher Allen Health Care's radiation oncology department's one exposed façade, featuring an aluminum-and-glass materials palette, maximizes the flow of available daylight to interior spaces and harmonizes with the natural limestone cladding of an adjacent building.

An early commitment to sustainable practices enabled the recycling of more than 90% of construction waste during the three-year construction period, as well as the use of materials with significant recycled content. Conservation measures include high-efficiency air handlers, low-E windows, sunshades, and low-energy light fixtures. Through the use of exterior skin materials admitting natural light to 75% of interior spaces, daylight extends deep into the building. Low-emitting adhesives, carpets, and paints preserve air quality, while low-flow plumbing fixtures reduce water consumption. Potable water consumption for irrigation was reduced by 50% from midsummer baseline through plant species selection, irrigation efficiency, and use of recycled water. An educational outreach program educates the public about sustainable design.

Pre-existing site conditions dictated the relocation of six, three-story residences within the neighborhood, infilling vacant lots, and increasing density with consistent-type housing stock. Because the building includes three levels below the road that serves the existing campus, all utilities along that block were rerouted underground. (Chan Krieger & Associates served as Associate Architect/Urban Planning for Brigham and Women’s Hospital, Carl J. and Ruth Shapiro Cardiovascular Center, Boston.)

Establishing metrics

No goal can be truly achieved without some method to measure it; the green team must establish metrics and collect data to support each goal. Metrics should be tangible, objective data-pounds of waste diverted, kilowatts of energy saved, cost reduction in dollars, gallons of water used, or tons of carbon emissions lowered. Keep the metrics understandable and make the benefits visible to employees, staff, and stakeholders.

Forming partnerships

An educational outreach program at Advocate Lutheran General Hospital/Advocate Lutheran General Children's Hospital in Park Ridge, Illinois, educates the public about sustainable design.

With the green team in place, ambassadors should research local partnerships-area environmental organizations, municipal programs, private businesses-with an eye to coordinating activities and gaining knowledge about efforts already underway in the community. Funding for energy efficiency, recycling, or other environmental activities may be available from local utilities, businesses, municipal programs, or private foundations. The point is to know what is going on in your community and tap into it.

For example, the Massachusetts Energy Efficiency Partnership (MAEPP) supports deployment of energy-efficient technology and tools to the industrial, commercial, and institutional sectors. The MAEEP program delivers its value through a combination of stakeholder input, technology transfer, education and outreach, and research. It leverages resources from the U.S. Department of Energy, the University of Massachusetts and Massachusetts Electric Utilities, NSTAR, Massachusetts Electric Company, and Western Massachusetts Electric Company, in partnership. All partners work together to identify opportunities to improve the efficient use of electricity and other fu
els, improve productivity, and minimize waste in manufacturing and facility operation.

A landscaped green roof and strategically placed skylights draw daylight into circulation spaces at Fletcher Allen Health Care in Burlington, Vermont.

Communication is essential in the hospital's green program. Internally, employees need to be aware of the green goals and specific activities to achieve them. The community at-large-patients, families, even the general public-should understand the hospital's commitment to a sustainable, green future.

Case Study: Advocate Lutheran General Hospital/Advocate Lutheran General Children's Hospital Patient Care Tower, Park Ridge, Illinois

Because the new patient tower at Advocate Lutheran General Hospital/Advocate Lutheran General Children's Hospital replaced central plant equipment, the greatest reductions were made by selecting highly efficient components. Most of the additional cost was offset by pre-purchasing major equipment such as boilers, chillers, and air-handling units. A life-cycle cost analysis allowed the owner to make decisions on how to balance first cost and energy savings. The owner then pre-purchased the equipment directly, locking in the savings and reducing mark-up costs. Reductions were also realized with daylighting controls and a thermally upgraded envelope. The design reduced energy usage to nearly half that of existing peer facilities.

The greatest success story of the new patient tower is its impact on operations. Even before the bed tower project began, a small but ambitious group called the “Recycling Task Force” had started a recycling program on campus. The bed tower design and construction processes provided a strong focus for these efforts, becoming a catalyst that greatly expanded recycling volumes, and other initiatives that improved purchasing, food service, and transportation. The group morphed into the “Green LEEDers” and membership swelled. Soon, food and medical waste was reduced by 10% campus-wide. Leadership's emphasis on sustainable design for the tower accelerated and motivated positive change across the campus, where an environmentally minded approach was just taking root.

In addition to meeting site and water management requirements, which led to being awarded LEED Gold certification, the design team took advantage of these requirements as amenities. An example is the integration of the green roof, storm water design, heat island, and site development into a celebration of water. By effectively connecting all the elements, the design brought multiple water elements that include rain hitting the roof and the pervious paving, and diverting this to rain gardens with native drought-resistant plants. The result is the water remains on site cleaner than when it arrived. In a major rain event, the rainwater will impact the community less than a typical storm system. At project initiation, recycling at the hospital consisted solely of paper. When the team began programming with LEED Gold in mind, the goal was expanded to include cardboard and plastics.

Implement new green projects that are small and achievable, yet fit in with your facility's overall goals.

Advocate Lutheran elected to start the program before construction began and due to its success, has incorporated recycling across the system-practicing good green design throughout all initiatives.

The project received a Citation of Merit award in HEALTHCARE DESIGN's 2010 Architectural Showcase and was recognized at the HEALTHCARE DESIGN.10 conference in November 2010.

It also was awarded the User-Centered Award in the Healthcare Facilities Symposium and Expo's Symposium Distinction Awards program.

Thinking big, starting small

Implement new green projects that are small and achievable, yet fit in with your facility's overall goals. Measure the progress of these smaller projects and then communicate frequently about them.

Case Study: Fletcher Allen Health Care, Radiation Oncology Replacement Project, Burlington, Vermont

This replacement project is an example of how a small oncology project is becoming the epicenter of a shift toward a higher level of sustainability for the hospital.

Designed for LEED certification, the new home of Fletcher Allen Health Care's radiation oncology department is a 22,400-square-foot building recessed into grade on three sides, with a landscaped green roof and strategically placed skylights that draw daylight into circulation spaces. The building houses three linear accelerator vaults, a CT simulator, a procedure room for high-dose brachytherapy, inpatient holding bays, exam and consultation rooms, private changing and gowned waiting rooms, and ancillary support spaces including administrative and clinical offices. A new lower level mechanical room services the needs of the department.

The building's one exposed façade, featuring an aluminum-and-glass materials palette, maximizes the flow of available daylight to interior spaces and harmonizes with the natural limestone cladding of an adjacent building. Garden areas enhance the healing environment providing a visual connection to nature. Arriving patients enjoy convenient access from an adjacent subterranean garage.

The key to a successful hospital greening program is persistence. By establishing a green team that has management commitment, defining goals that can be measured, implementing small projects to start with, and communicating regularly about success, any healthcare facility can add to the triple bottom line-saving money, creating social benefit, and preserving the environment. HCD

John M. Swift Jr., PE, CEM, LEED, is a principal at Cannon Design. With more than 20 years of experience, he specializes in mechanical systems design and construction projects both in the United States and abroad. He can be reached at 617-742-5440 or Healthcare Design 2011 April;11(4):24-31