Excerpts adapted from the session “Healthy Hospitals: Boston Green Building Initiatives,” presented April 20, 2006, at CleanMed 2006 in Seattle

Health Care Without Harm (HCWH) continues to collaborate with a number of leading Greater Boston healthcare capital projects on high-performance green design and construction. These include Brigham and Women's Hospital, Boston Children's Hospital, Dana-Farber Cancer Institute, Beverly Hospital, Spaulding Rehabilitation Hospital, and Massachusetts General Hospital.

In September 2004, HCWH and Rocky Mountain Institute organized “Design for Health: Summit for Massachusetts Healthcare Decision Makers” at the Massachusetts Medical Society's conference center. Attendees included more than 100 leading hospital decision makers. The primary goal of the Summit was to bring the decision makers together to discuss the arguments for and evidence supporting “healthy green design, construction, operations, and maintenance,” and to brainstorm initiatives and implementation strategies to achieve healthier hospitals. The Green Guide for Health Care, a voluntary, self-certifying system, was highlighted throughout the Summit. The Green Guide is tailored specially for the healthcare sector and modeled with permission after the U.S. Green Building Council's LEED rating system.

Massachusetts General Hospital's Yawkey Center for Outpatient Care in Boston.

After the Summit, the hospitals mentioned above registered for the Green Guide pilot and today see themselves as leaders in creating high-performance healing environments. HCWH believes that the Summit back in 2004 “seeded” the healthcare sector in Massachusetts for accomplishing that.

The Howard Ulfelder Healing Garden at the Yawkey Center for Outpatient Care.

As one of the examples, The Massachusetts General Hospital's Yawkey Center for Outpatient Care (figure 1), which opened in the summer of 2005, was originally designed several years ago, before the release of the Green Guide, so we looked at this project as a transitional building for sustainable design. For one thing, the designers made a strong effort at daylighting, so instead of planning a high, square building, they flattened it out and stretched it so that it pulls the daylight farther into the building. Interestingly, when the Massachusetts General Hospital (Partners Healthcare System) representatives attended the 2004 Boston Summit, the Yawkey Center was two-thirds through construction. When they left the Summit, they decided that they wanted to incorporate additional green features to bring the building another step closer to sustainable design. On the eighth-floor roof, they built a magnificent outdoor healing garden (figure 2) adjacent to the oncology department (there is also an interior garden space for use when the weather is inclement).

The Howard Ulfelder Healing Garden is designed as a place of respite, a meditation space if you will, with teak furniture and many plants (figure 3). There is virtually no noise there, so when people leave the oncology department with serious things to think about—radiation, chemotherapy, etc.—they have a space to visit with their families in relative solitude.

The Howard Ulfelder Healing Garden features teak furniture and abundant plants.

The Howard Ulfelder Healing Garden looks out to the west over the Charles River, with a view of both the Boston and Cambridge skylines.

The healing garden looks out to the west over the Charles River, with a stunning panoramic view of both the Boston and Cambridge skylines (figure 4) and the Longfellow Bridge in the foreground. This westerly view allows patients, visitors, and staff to take in the sunsets. The beautifully landscaped garden also has a small reflecting pool with trees, grassy areas, granite benches, and teak furnishings. Cambridge Seven Associates, Inc., was the architectural firm, and Halvorson Design Partnership, Inc., provided the landscape Architecture. The garden is named after Dr. Howard Ulfelder who practiced for decades at MGH.

In closing, because Boston is such a medical mecca, we aspire to making the metropolitan region a model of high-performance green design. HCWH will be putting a lot of intensive effort into this during the next couple of years.

We clearly think it's important to help incentivize high-performance healing environments, and we believe the Green Guide for Health Care is the transformational tool/road map for building and operating healthy hospitals. CD

Bill Ravanesi, MA, MPH, is Boston Regional Director for Health Care Without Harm.


Common Characteristics of Green Building by Kurt Rockstroh, AIA, ACHA, President and CEO, Steffian Bradley Architects

Among common denominators to building green in New England, I would say number one is an enlightened client. That includes senior management, facility engineers, environmental services, medical professionals and—I would say one of the most important—board members.

How many of you have been chastised at a board meeting because you were pushing something that had more than a 3-to 4-year payback but had environmental advantages? Back in the 1970s and early 1980s this happened on a regular basis. Now we are seeing a very different situation—we're starting to get buy-in from boards, not just from some senior management.

Having a planning design team with knowledge and conducting initiatives involving all of the consultants are also important steps. Having the authorities who have jurisdiction being actively engaged in the concept is yet another important characteristic; in each of our projects we have had something against which the authorities having jurisdiction pushed back, but after we raised sustainable design discussion points, they understood and were cooperative.


Recommendations from the Boston Summit by Alexis Karolides, Principal, Rocky Mountain Institute

The 2004 Boston Design for Health Summit brought together hospital decision makers to address the opportunities and challenges in implementing sustainable design in healthcare. Recommendations of the Summit were that both collective and individual action are needed to advance the goal of healthier hospital buildings. Hospitals can form collaborative networks for group purchasing of healthier products, information exchange, and working with utilities and regulatory agencies to incentivize green building, particularly combined cooling, heating, and power operations.

For individual hospitals, the recommendation made most frequently was to establish senior leadership commitment and hospital culture change. They need to adopt a sustainable-oriented policy framework for operations, purchasing, and construction. This involves, in part, life-cycle costing, with both up-front costs and operational costs over the entire life of the hospital considered. They should commit to integrated, holistic green design that incorporates indoor air quality, high-performance lighting and daylighting, quiet acoustics, views of nature, healthy materials, and continuous commissioning of the building to make sure that the systems are working not only from day one, but continually throughout the life of the system. Also, combining cooling, heating, and power can improve energy efficiency by 56%. Water efficiency is another area with huge potential for savings. For upgraded fixtures, elimination of leaks, and water recovery measures, such as reusing wastewater from cooling towers and condensate, a 40% return on investment is very achievable.

Finally, maintenance is critical. Design should support ease of cleaning, and janitorial staff should be educated about appropriate, nontoxic maintenance and cleaning products; otherwise, they might be waxing floors that don't need to be waxed or releasing toxic fumes into the indoor environment. Education is key for all staff, and a cross-departmental “green team” is essential to achieving all these goals.