The session “VA Hospitals on the Sustainable Road—Green Globes or Bust!” was presented by Jane Rohde, FIIDA, AIA, AAHID, ACHA, LEED AP, at the HEALTHCARE DESIGN.11 Conference in Nashville.

The U.S. Department of Veterans Affairs (VA) hospital system is moving through an amazing transformation period. Not only has the VA committed to creating environments based upon person-centered care models with Planetree (information available at for improvement of patient, resident, and staff outcomes, but the VA is also fully implementing sustainable benchmarking with the Green Building Initiative’s new electronic-based survey tool: Green Globes Continual Improvement for Existing Buildings for Healthcare (CIEB-HC) (information available at

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In 2009, the VA began its sustainability journey with the Green Building Initiative. Twenty-one VA hospitals from across the country were involved in a pilot program as a sustainable investment in benchmarking and continual improvement. These hospitals utilized the Green Globes CIEB online survey for evaluation of current operations and physical plant.

The Green Globes CIEB program helps establish performance baselines, best practices, and certification for operations and maintenance of a building in the environmental assessment areas of energy, water, resource management, and emissions and pollutant controls. The fully interactive, Web-enabled tool allows facility personnel to measure, document, and improve the sustainability of a building over time.

Each hospital upon completion of the survey proceeded to the stage of third-party assessment for certification. I was the third-party assessor that had the true pleasure of working with the hospitals, each including a unique and wonderful group of dedicated staff members who were creatively evaluating the physical plant impacts on the environment. The following are just a few of the creative ideas that were discussed while completing assessments:

  • Recycling programs that evaluated every waste stream possible within the hospital, down to having UPS pick up recycled packaging “peanuts.” (San Diego)
  • Evaluation and feasibility of creating an arboretum on the grounds to engage and honor veterans and their families (through tree donations), while conserving water and reducing heat island effect. (Richmond, Virginia)
  • Creating long-term care resident and patient gardens that support activities, sense of ownership, places of respite, and site enhancement. (Asheville, North Carolina)
  • The plant and facility team, who were always seeking ways to improve energy use, harnessed the energy created from all of the elevators when traveling downward. (Portland, Oregon)
  • In-house activity staff had programs for staff wellness that continued to recognize healthy eating and exercise programs. (Richmond, Virginia)
  • A marketing plan for communicating sustainable initiatives to staff, patients, residents, and family resulted in the creation of a toolkit that included reusable water bottles, recycling information, and ways to save money within individual households. Education and outreach programs on green building initiatives that would not only assist veterans while in the hospital, but also assist them with energy-, water-, and cost-saving ideas in their home and community, were created. (Portland, Oregon, and Seattle)
  • Development and utilization of an alternative way to winterize cooling tower equipment so that damage and decay to the towers was minimized during the winter months. (Ann Arbor, Michigan) 

Through information gleaned from pilot assessments and additional research and benchmarking information available, the Green Globes CIEB-HC electronic survey was created. The VA is in the process of utilizing this new healthcare benchmarking tool for approximately 170 additional VA facilities across the country. The CIEB-HC tool (utilizing the CIEB module as a basis) includes content and criteria added that is based upon specific information related to acute care and long-term care settings for inpatients and/or long-term residents. 

The third-party assessment process for Green Globes CIEB and CIEB-HC is conducted on-site with the team of staff that is operating the buildings, and includes a thorough review of documentation and site walk-through of the buildings being evaluated. The discussions involve staff ranging from plant managers to food service directors to nursing managers to veterans.

There are two dedicated positions, the energy manager and the GEMS (Green Environmental Management System) coordinator, that focus on sustainable initiatives. For any sustainable hospital program, there needs to be an integrated team and support by leadership. Benchmarking is not only an evaluation of reduction of use, but also provides the basis for accountable and distinct operational savings.  

The CIEB and CIEB-HC modules provide the opportunity for facilities to be able to electronically benchmark their performance, resulting in summaries of current status as well as recommendations for further improvement. By completing on-site assessments, hospital staff received specific site recommendations that are often utilized in developing strategic plans for sustainability. These recommendations can be utilized to highlight specific areas of improvement, as well as to establish a road map for prioritizing projects, budget for required funding, and continue benchmarking data as improvements are completed.

General recommendations and best practices that came out of both CIEB and CIEB-HC assessments that could be applicable to both private and public hospitals include the following: 

  • Evaluate spaces that we
    re designed originally for one use and are now being utilized for something else, specifically related to energy use. For example, one VA facility used to include a surgical suite within an ambulatory care setting, but the suite was taken out of service. When space was needed for education and training, the surgical suite was utilized; however, the entire unit was being heated and cooled as though surgery was still being completed. This created a large surge of unnecessary energy use, as there was other classroom and office space available that could be used for education and training.
  • Work with local agencies, community planning departments, and parks and recreation departments to create connections to walkways and bike paths from the hospital to the community at-large, and the development of farmers markets that benefit both veterans and staff.
  • Evaluate all recyclables at point of service. Having recycling containers and a stream that requires the waste is the first step; but education and training as well as having containers at the point of use of products promote a successful process. Some hospitals have completed audits and include the utilization of recycled sharps containers, collection of recyclables within dietary settings (commercial kitchen), and effective composting programs.
  • Create an “energy stamp” for the facilities department for the review of all project contract documents to verify that the documents have been reviewed and comply with sustainability initiatives. 

Assessments utilizing the CIEB-HC module were initiated this year and are well on their way at many VA hospitals across the country. I have completed several assessments using the new tool and continue to see great sustainable progress. 

On the Madison, Wisconsin, VA campus, I found an excellent example of sustainability positively intersecting with person-centered care models. During my walkthrough of the new Community Living Center, which was almost complete, the environment demonstrated the strong interconnections between sustainability and person-centered care modeling with the use of daylighting strategies, gardens, and site enhancements, and energy-saving strategies—all in conjunction with an aesthetic, warm living space, private rooms with separate bathrooms, and evaluation of decentralized food service options. 

So what’s next for the VA hospital systems? They are in progress of completing another set of pilots for a guiding principles assessment, based upon the executive order for meeting the five guiding principles for sustainability. The VA is the first agency to utilize this new assessment tool completed by the Green Building Initiative and is anticipated in the future to be available for all governmental agencies working on complying with the guiding principles. For more information, please go to the Green Building Initiative website at HCD


Jane Rohde, FIIDA, AIA, AAHID, ACHA, LEED AP, is a healthcare and senior living consultant. She can be reached at