Paulo Nunes-Ueno straps on his bike helmet, secures his backpack, and lifts his daughter Twyla Jo into her safety seat as he prepares for the commute to work from his home in Seattle's Bryant neighborhood. He pedals about 2 miles to his job as director of transportation at Seattle Children's Hospital in Seattle, dropping off Twyla Jo at daycare on his way. It's all in a good day's work for Nunes-Ueno, who oversees Seattle Children's award-winning comprehensive transportation plan, which has set lofty goals for reducing single vehicle car use and promoting healthy commuting.

Transportation is often overlooked when identifying pollution sources and opportunities for improved environmental performance in healthcare, yet cars contribute to smog, poor visibility, and poor air quality, especially in congested areas. While one can't smell carbon monoxide, it is emitted from cars and impacts people through reducing the amount of oxygen that is transferred to muscles and organs. At the greatest risk are those with heart or respiratory disease. According to the Environmental Protection Agency (EPA), in 2008, 27% of greenhouse gases came from transportation sources, and those emissions are forecasted to dramatically increase.

The January/February 2011 issue of Sierra Club magazine reports in the article “Beyond Oil in 20 Years” that the United States spends $180 billion per year on fuel imports and that cars alone use 8.6 million barrels per day. With the acknowledgement of transportation's role in pollution, public health, climate change, traffic, and oil dependence, healthcare is in the position to raise awareness of the environmental, social, and health implications of car use and to take a leadership role in transportation planning to reduce health burdens. Healthcare employers can offer incentives for carpools, public transportation, biking and walking, and connecting how we get to work with health outcomes, also known as “conscious commuting.”

Screenshot from Goose Networks, measuring the environmental impact and cost savings due to single vehicle use reduction at Seattle Children's Hospital.


Nestled by mountains, lakes, and Puget Sound, Seattle's landscape intensifies a serious traffic congestion problem. The city created an ordinance that requires large employers to reduce their drive-alone rate as one measure to alleviate the impact of transportation on the roads and the environment. Seattle Children's goal was to expand its campus in Northeast Seattle, but also to reduce the rate of single occupancy vehicle use and to avoid the need to construct 500 new parking stalls at an estimated cost of $20 million. The hospital believed the space needed for the additional parking could be put to better use for clinical areas.

This, in combination with Seattle Children's commitment to the health of its workers and community, led to the development of a comprehensive transportation plan developed in tandem with the facility's strategic plan, looking ahead 20 years and starting in 2013. Seattle Children's goal is to reduce single vehicle car use from its current rate of 40% to 30% by 2028, the completion date for its master plan. The transportation plan has already received notice and garnered the governor's Commute Smart Award, the EPA's Commuter Choice Leadership Award, Commuter Challenge's Diamond Award, and Zipcar's 2010 Wheel of Change Award. It also is recognized as a model for healthy commuting strategies, safety, and prevention. Seattle Children's also has won Practice Greenhealth's Partner for Change Award.

Seattle Children's teamed up with transportation consultants Nelson Nygaard and Transportation Management Systems, and came up with a comprehensive transportation plan comprised of the following tiers:
  1. Reduce single vehicle car use by commuting employees;
  2. Invest in a transportation network, facilitating traffic flow;
  3. Invest in infrastructure for cyclists and pedestrians; and
  4. Develop the new campus so that bicycling, walking, and transit are the preferred way to arrive at work.

Engagement incentives

The hard truth, though, is that people like their cars. They like their music, their comfort, and the heated seat. Some even are quite attached to the pine tree dangling from the rearview mirror. Plus, many have used this mode of transportation for a number of years. The resulting “always done it this way” attitude can be a huge obstacle for anyone looking to modify parking plans. But as mounting evidence points to humans' negative impact on planetary health and the imperative for action, hospitals are increasingly demonstrating their mission through tangible improvement activities and realizing that transportation plans should be part of any strategic plan. By identifying the true cost of parking, facilities can incentivize reduced car use through parking fee avoidance, for example.

Seattle Children's came up with several creative solutions to gently entice employees to change their single car transport habits. Offering free transit passes was costly but provided the tangible return on investment for leaving cars at home and changing employees' engrained methods of getting to work. The financial incentives didn't stop there-for each day that an employee avoids the parking lot, that person receives payment of $3.25. This strategy gives staff an incentive to commute a healthier way while addressing the obstacle of trying something new and unfamiliar. In the assessment of transportation needs for staff, it was found that transit connections were a challenge to using public transportation. Seattle Children's developed its own transit program with the use of 22 minivans (all with bike racks), seating 14 people each and taking passengers from transit hubs to their workplaces. The small vehicles offer flexibility to meet the changing demands of the staff and move more than 350,000 people each year.

Seattle Children's ensured that its other programs were in line with the transportation plan. The hospital does not offer monthly pricing for parking, so there is an opportunity to make a healthier choice every day. Staff found value in both carpooling and public transportation. These choices were deliberate and careful in the multi-pronged approach toward the value of car use reduction.

In addition to financial incentives, Seattle Children's wanted to promote exercise and health, and develop a plan for increased walking and biking to work. The current rate of employee biking is 6% and the target is 10%. The hospital is situated near an existing 50-mile bike trail, which could connect to the facility campus through improvements at various access points and for handicapped users and strollers. This led to the development of the Seattle Children's “Livable Streets Initiative.” The creation of bike boulevards and other improvements were completed to make biking and walking more hospitable and to reduce car use by those who would otherwise consider biking or walking unsafe. With a tremendous number of staff within walking distance of the hospital, addressing safety and aesthetics promotes walking.

Lessons learned in healthcare regarding design and its role in culture change, safety, and healing environments can be applied to the value of design in terms of the facility and its integration into a neighboring community. Integrating bike paths, safe routes, signage, bike ramps, bike lanes, and easier access to bike racks, lockers, showers, and building entryways, helps communicate to employees the benefits and fun associated with healthier modes of transportation. Special focus has been given to travel time, placement of transit hubs, and the attractiveness of car alternatives, whether transit, carpooling, biking, or walking.
Those who choose a slower method of transport (not driving) can save some time through easier access to buildings. Transit hubs are being designed to be more attractive so the overall waiting experience is more pleasurable. This is addressed through additional landscaping, shops, and other commercial activity. Long-time car users may experience outcomes they didn't expect when transitioning to biking or walking, such as weight loss, stress reduction, and realizing that a commute can actually turn into a fun event in itself-a time to cherish for reflection, singing, contemplation, or the simple enjoyment of propelling oneself to work.

Company bike program

Seattle Children's developed a bike loan program for any staff that committed to biking at least two days a week. The interested person received a free bike, helmet, training, and a lock. The individual also is educated on the safest route to work. This resulted in 150 bikes on loan to workers. The program has been very well received. Subsidized repairs and maintenance is offered on campus two days each month.


As with any other sustainability initiative, education is critical. To provide transportation news, educational facts, and a calendar of events, and to track the impact of the transportation program, Seattle Children's worked with local company Goose Networks to track employee transportation choices, measure environmental impact, and appropriately charge/pay employees for their transportation and parking choices. Workers report on their mode of transportation and earn a daily alternative commute bonus. The software measures environmental impact as well as gas and maintenance savings. The commute calendar is connected to the parking lot and shuttles, which also serve off-site parking lots, intra-facility transit, and transit from public transit hubs.

The software tracks the cumulative result of all of the choices made. The reduction in single car use adds up to measurable results, like declines in greenhouse gases and gas use as well as cost savings, maintenance savings, and fewer vehicles on the roads.

Measurement and results

Seattle Children's cyclists ranked #2 in the region's bike-to-work challenge, #2 in team, and #3 in bike travel miles, and this was compared to some very large employers also located in the area.

All told, Seattle Children's alternative commuting efforts have taken 630,000 car trips off the roads and freeways, reduced vehicle miles travelled by 6.5 million miles (the equivalent of 13 round trips to the moon), and saved 235,000 gallons of gas.

We can learn from Seattle Children's and make a big impact by tackling the “car in the room” and recognize transportation's role in health, wellness, and prevention. HCD

Learn more and get involved

Goose Networks-Seattle Children's technology partner for innovative solutions to the challenges of everyday transportation-

Seattle Children's Livable Streets Web page-

Seattle's Office of Sustainability and the Environment-including a link to the city of Seattle's Climate Action Plan-

Commute behavior survey tool from Washington State Department of Transportation-

The Green Guide for Health Care Version 2.2 transportation operation section can help a facility take a step-by-step approach to improving health through the reduction of single vehicle car

U.S. Department of Energy Clean Cities program- to advance the nation's economic, environmental, and energy security by supporting local decisions to adopt practices that contribute to the reduction of petroleum consumption.

EPA Transportation and Air Quality page-

Get involved and sign a letter to President Obama, asking to make 60 miles per gallon the standard for cars by 2026-

Janet Brown is the director of sustainable operations and green building at Practice Greenhealth. She can be reached at Healthcare Design 2011 March;11(3):14-22