Affinity Health System’s Three-Pronged Approach to Sustainable Construction
Affinity Health System visualizes its commitment as a wheel—with a promise of personalized care for all patients at the center. Everything it does involving construction and operations is achieved with the ultimate objective of bringing value to the patient. The Affinity promise is to provide personalized care by listening, treating people with respect, and putting patients’ needs and interests first.
Affinity’s three-pronged approach uses:
1) Lean principles for improved
2) Evidence-based design and
3) Environmental stewardship.
Previously, when using traditional design methods, Affinity found that once the buildings constructed were occupied, they didn’t function very well. This spurred the creation of its current methodology. Over the past 10 years, Affinity has learned, from practice and continuous improvement, the value of making decisions from the perspective of those occupying the space—the community and the staff—and designing that space after workflow and internal processes are assessed and improved.
This commitment was further demonstrated in 2007, when Gary Kusnierz, then director of development and construction, was named vice president of performance excellence to begin a continuous improvement transformation for the design and construction of all Affinity Health System sites.
Pre-construction efficiency and process
Before embarking on a new construction or renovation process, Kusnierz first develops internal teams, with the addition of external experts like architects and designers, to map out processes and use Lean principles to improve efficiencies. “At the core of Lean principles is respect—respect for the patients, the staff, and the community. With this as the core value, applying Lean principles drives safety and efficiency, and values a team approach to internal processes and the design of healing environments,” Kusnierz says.
Affinity has found that clinical and other staff involvement in the pre-design process provides immeasurable value, contributing to the ultimate functionality of the completed space. Only after their recommendations are made does the design process start, with true understanding of the flow of people, patient preferences, materials, and equipment needed to best support an efficient, patient-focused experience.
As a Pebble Partner with The Center for Health Design, Affinity also benefits from evidence-based design research in areas of concern, like staff comfort and fatigue. Or, for example, when patients identify their own concerns, such as noise, Affinity looks for evidence and research to assist it in documented strategies to effectively meet the goals of noise reduction.
New emergency room
Based on loud and clear input from its community, Affinity is currently working on a “no wait” emergency department at St. Elizabeth Hospital in Appleton, Wisconsin, which is scheduled for completion in September 2011. Through efficient processes and the understanding of patient flows, the preconstruction team identified an opportunity to reduce the facility’s footprint by 3,000 square feet.
It aligned the emergency department with the ambulatory surgery site through the use of shared flex space. The ambulatory site requires morning flow capacity and the ED sees increased activity in later hours, so the flex space allowed for the smaller overall footprint, associated savings, and improved environmental performance through “right sizing.” The emergency room patients can be transitioned into the clinical pod and the next point of care at a faster rate, using the flex space during busy hours, if needed.
Further demonstrating Affinity’s commitment, 2009 marked the hiring of Iqbal Mian as the sustainability team leader. Mian’s charge was to partner with the Wisconsin Department of Natural Resources to implement an environmental management plan at the St. Elizabeth site using ISO 14001 standards and with the goal of system-wide implementation.
The framework and certification helps to maintain regulatory compliance for materials, vapors, and wastes, and to integrate an efficient process for operational practices that ensure a long-term safe and compliant program. Simultaneously, Mian is working on benchmarking sustainability activities across the system. As a longtime member of Practice Greenhealth (and its previous incarnation, Hospitals for a Healthy Environment), St. Elizabeth has been recognized through Practice Greenhealth’s Environmental Excellence Awards and sends representatives to CleanMed for further education on sustainability in healthcare.
Affinity’s commitment to environmental stewardship is applied through the use of LEED (and the recent release of LEED for Healthcare) and the Green Guide for Health Care. Affinity focuses less on which level of LEED is achieved and instead on meeting the needs of patients and staff. Kusnierz avoids falling into a trap of trying to achieve credits, rather than focusing on the needs identified by the community.
A 2009 Affinity project achieved LEED Gold certification (its first Gold and eighth LEED project) because of the addition of a vegetative roof. While the vegetative roof has numerous positive attributes, including storm water management and cooling potential, the reason it was included was not to achieve a credit or to achieve a LEED Gold rating, but rather to improve the view for patients in rooms that overlooked the roof.
The focus on energy conservation at St. Elizabeth led to a new central plant and the investigation of solar panels to be used for both hot water and to take electrical load off grid. With solar technology improving, payback is moving into the single digits, making solar a potential solution for Affinity. Affinity works with ENERGY STAR for energy baseline and ongoing measurement, and St. Elizabeth has achieved ENERGY STAR Partner status.
Other recent accomplishments include replacing disposable isolation gowns with reusable gowns, eliminating all Styrofoam products and containers from the cafeteria, offering a cell phone recycling program through volunteer services, and achieving a recycling rate of 34% and a red bag generation rate of 8%. These rates are consistent with the average recycling and red bag rate for Practice Greenhealth’s award-winning facilities.
Recycled materials and recycling in construction
Affinity sources sustainable carpeting that can be returned to the manufacturer for recycling, and sustainable flooring such as rubber and terrazzo. Other healthy attributes like low-VOC paints and adhesives, and formaldehyde-free materials are standard for all Affinity projects. Affinity recovers and measures construction materials for recycling, including wood, concrete, asphalt, cardboard, paper, aluminum cans, ceiling tiles, carpet tiles, glass, batteries, and more.
The business case has been made at Affinity. Over the past three to five years of this process, Affinity has found its solution through providing the cleanest and safest environment possible and continuously strives for more. Affinity’s LEED-certified clinics on average have higher occupant satisfaction than the average of other clinics in the system. In 2011, the voluntary turnover rate in these clinics was zero, compared to the 4.6% average of its other clinics. HCD
Affinity’s green initiative Web page—http://www.affinityhealth.org/page/about-green
Department of Natural Resources Environmental Management Systems Web page—http://dnr.wi.gov/org/caer/cea/environmental/ems/index.htm