There's one important question we ask each of our healthcare clients before we start working with them: Since a sustainable, eco-friendly healthcare facility is superior to a traditional building, why not opt for a green building?

Many folks ask if it must cost more to go green. Absolutely not. While some green buildings we hear about do have increased costs, our experience in providing green buildings is that they need not cost more. We've developed an integrated project-delivery process—Total Project Management: Vision Taken to the Power of Green (TPMg)—that ensures that the benefits of green can be achieved at parity or at a lower cost compared to traditional building costs.

Others ask us to reiterate the benefits of going green. For the record, the benefits of sustainable design for healthcare facilities include:

  • Better patient outcomes. A growing base of research concludes that patients heal and recover faster in sustainable buildings. In fact, The Center for Health Design published a study in August of 2006 that shows increased access to natural lighting results in decreased length of stay in hospitals (Beauchemin & Hays, 1996). With superior patient care being the driving mission of every healthcare organization, it's no wonder that green development is taking off in the healthcare industry.

  • Improved staff productivity. Research shows that employees are more productive in a green environment. Higher access to daylight (figure 1) is linked with increased satisfaction in the work environment (Boyce, Hunter, & Howlett, 2003; Edwards & Torcellini, 2002). Morale is higher in sustainable buildings because staff feel better, both through their own sense of wellness and how they are contributing to the wellness of the environment. Finally, studies show that staff turnover rates are greatly reduced in green buildings (Mroczek, Mikitarian, Vieira, & Rotarius, 2005), indicating a higher satisfaction with the facilities in which they are working.

    Daylighting and views in the reception area of the Affinity Health System's Deerwood Avenue Children's Health Center and OB/GYN Clinic in Neenah, Wisconsin.

  • Lower costs and better overall economics. Green buildings can be built at the same or lower cost than traditional buildings. Furthermore, energy, water, and other operating costs in green buildings are substantially lower year after year. Given the current healthcare environment—with declining reimbursements and shrinking margins—healthcare organizations can leverage sustainable design to improve their bottom-line margins without adding new services. That's a compelling message healthcare executives love.

How Is It Done?

Sustainable design and construction is an art form like any other discipline. Green can be done well or it can be done poorly. For the purposes of this article, we'll discuss our own lessons learned from green projects developed in partnerships with Affinity Health System, Baxter International, and other healthcare service providers.

In all of our work, we leverage our TPMg process, which integrates efficient and cost-effective solutions; provides a single source of responsibility for client planning, architecture, and construction needs; and adheres to a strong commitment to sustainable design and construction delivery.

One often-used approach is the concept of cost trading, a process of funding certain value- or performance-enhancing building choices by reducing or eliminating other elements to stay within budget. Chillers—the equipment that cools and dehumidifies space—are a good example. Our sustainable designs typically employ smaller chillers, and we often use part of those savings to purchase high-efficiency models. Similarly, we use high-efficiency lighting fixtures and lamps, and we provide only the lighting the client wants. The result is fewer but higher-quality lighting fixtures, a reduced construction cost, and a lower electric bill.

Certain building features will, in some cases, increase first cost. For example, some clients opt for on-site renewable energy generation, such as photovoltaic (PV) systems. If these systems are large enough, it is unlikely that there are enough other features—such as unneeded windows or chiller capacity—that can be cost-traded for the PV system. When these exceptional cases occur, we provide building owners with the information they need to decide whether the added value of the project feature is worth the increased cost.

What these examples show is that, in essence, we've elevated total project management to a higher level—to the power of green. We look at everything we do through a green “lens” of sustainability that demonstrates our commitment to our environment.

The following approaches are essential to ensuring sustainability of any project:

  • Sustainable design (whether you like it or not). We are so convinced that sustainable design is the right thing to do that we design all projects to the LEED Silver standard or higher. Most clients don't go through the formal certification process—that's their choice, though we are more than willing to provide certification services. But clients can rest assured that their buildings are eco-friendly and will be constructed at the same costs incurred by traditional approaches.

  • Healthcare-sensitive green design. LEED standards are not specific to the healthcare industry, but the benefits to a healthcare setting are obvious. As part of TPMg, we've combined LEED recommendations with guidance being developed by the Green Guide for Health Care Version 2.1 Pilot—particularly elements related to operations.

  • Starting early with green and staying green to the end. Some of the biggest errors that dramatically affect the level of sustainability of a new healthcare facility can occur during the construction process if proper oversight is not maintained. For example, the architect specifies a green sheet-vinyl product, but the flooring contractor uses a high-VOC mastic. Or perhaps a painting contractor primes the structural steel with a high-VOC paint. These mistakes erode the power of green. It is important to integrate sustainable concepts very early in the process and monitor compliance all the way through the completion of the project and into building operation.

  • Eco-friendliness. Every aspect of design and development within our process emphasizes sustainability. Key considerations include: implementing energy and water efficiency; eliminating the use of toxic building materials; recycling construction waste; providing glare-controlled daylighting and views; providing high indoor air quality; managing storm water to recharge ground water and protect the habitat; ensuring environmentally responsible purchasing; selecting reusable, durable, and low emitting products; emphasizing green cleaning products; and providing building operator tools and training for sustainable operation.

  • Feedback to monitor and test results. Our process isn't to build and leave. Rather, we work closely with our clients to measure outcomes of sustainable design against stated objectives. At the first Affinity clinics we built, we tested the air quality before occupancy to make sure it met LEED requirements; Affinity was pleased to find that the air quality was far superior (figure 2).

Affinity's Deerwood Avenue Clinic provides a playful environment with exceptional indoor air quality.


Incorporating sustainable design and construction practices helps healthcare clients create a healthy environment that improves patient outcomes and increases staff productivity while positively affecting the bottom line. At the same time, it makes a positive contribution to our responsibility to steward the environment. HD

Mark Hanson, PhD, LEED AP, is Director of Sustainable Services at Hoffman, LLC, where he guides Hoffman's activities in sustainable development. Hoffman is a professional planning, design, and construction management services firm headquartered in Appleton, Wisconsin. Before joining Hoffman, he served as the Executive Director of the Energy Center of Wisconsin.