Sustainability: Healthcare

We are all aware of research which correlates environmental pollution with disease, and environmental quality with patient health. Today the modern healthcare facility has championed sustainable thinking to promote fuller human health. At HOLT we assist healthcare clients reach and surpass their goals by creating innovative facilities that emphasize the conservation of natural resources and the promotion of improved indoor environmental quality through daylighting and interior finishes that directly contribute to patient health.  


What is sustainability?


Sustainability, from the Latin sustinere (to hold up), is, in its broadest sense, the capacity to endure. In 1987 the Brundtland Commission of the United Nations defined sustainable development as "development that meets the needs of the present without compromising the ability of future generations to meet their own needs." Others have challenged this definition, asking how any development can be sustainable. Many see sustainability as a balance of three overlapping and often competing systems: environment, economy, and society.


At HOLT, we recognize that development is needed to support and advance societal goals, and we endeavor to achieve social, economic, and environmental sustainability in all that we do.


In December 2005 the American Institute of Architects issued its Sustainable Architectural Practice Position Statement:

The profession is confronting the fact that buildings are the largest single contributor to production of greenhouse gases and almost half of the total annual production. As architects, we understand the need to exercise leadership in our role in creating the built environment. Consequently, we believe we must alter our profession's actions and encourage our clients and the entire design and construction industry to join with us to change the course of the planet's future.


Accordingly, HOLT has joined the AIA 2030 Commitment toward realizing a goal of net zero carbon emissions in new buildings and renovations by the year 2030.


What is LEED?


The LEED Green Building Rating System is a voluntary, consensus-based national standard for developing high-performance, sustainable buildings. It provides a vehicle for quantifying and comparatively evaluating the degree to which any project achieves sustainability.


In the current version, LEED 3.0, there are a total of 110 possible points divided among seven categories: Sustainable Sites, Water Efficiency, Energy and Atmosphere, Materials and Resources, Indoor Environmental Quality, Innovation in Design, and Regional Priority. Within the categories there are prerequisites, which must be satisfied, as well as optional points from which to choose. There are four levels in the rating system, with the minimum points required for each indicated in brackets: Certified [40], Silver [50], Gold [60], and Platinum [80].


What is a LEED AP?


A LEED Accredited Professional is a trained individual who has passed a test administered by the U.S. Green Building Council. Many of the professional staff at HOLT are LEED APs.


What makes a building "Green"?


As noted above, there is a vast array of possible strategies for making a project sustainable, and many levels of sustainability. In general, we at HOLT strive for maximum attainment in energy conservation, resource management, and indoor environmental quality. Actual strategies depend on the type of project, the owner's priorities, and the particulars of the building and the site.


How much more does it cost to build "Green"?


This is a difficult question to answer, because it depends on the baseline standard against which the sustainable project is measured. In higher education, where the norms of construction are set at a fairly high level, the increment to achieve a moderate measure of sustainability can be quite small. Often the life-cycle costs can be capitalized to completely offset any increase at all, particularly when energy conservation is emphasized.


Besides the construction cost increment, there are additional design costs associated with "Green" buildings. Non-standard energy sources, like geothermal or solar, require specialized engineering in addition to the usual systems design. To optimize building envelope and operating systems, digital energy modeling is a necessary part of the design process. Commissioning is a pre- and post-construction engineering process that helps to insure that operational systems perform to their intended levels of efficiency.


If the project is registered to pursue actual certification, there are additional costs for the substantial amount of documentation required. The actual cost will vary with the size of the project, which points are pursued, and the level of certification sought. As a general rule, a range of 0.5 percent to 2.0 percent of construction cost could be anticipated.


Why should my project be "Green"?


The reasons for sustainable design are as varied as the projects themselves. In the broadest sense, the preponderance of scientific thinking supports the concern that an excess of carbon dioxide in the atmosphere is leading to destructive and accelerating climate change. With nearly half of those emissions coming from buildings, it is important for present and future generations that we strive toward carbon-neutral development.


On a smaller scale, energy costs are increasing at rates in excess of inflation, and designing for reduced energy consumption will pay dividends for the life of the building. In some parts of the country the cost of water is experiencing similar increases, and water conservation measures can have economic as well as environmental benefits.


Improved indoor environmental quality is a feature of sustainable design that everyone can enjoy. When indoor air is free of volatile organic compounds and toxins like formaldehyde, people using the building are happier and healthier. When spaces have windows and daylight, studies have shown that learning and productivity improve. And when spaces have localized control of temperature, humidity, and fresh air, inhabitants are more comfortable. All of these improvements make a project more valuable.


A LEED Certification plaque is not necessary for a building to be "Green," but it is a third-party validation that can itself have market value. As a college or university seeks to attract students from a cohort who increasingly are concerned about a sustainable future, campus projects with LEED Certification help to demonstrate the institution's commitment to sustainability.


What would be an example of a LEED certified building for healthcare?


With Healthcare being a high-tech industry, often operating 24/7, healthcare facilities have a disproportionately high consumption of natural resources compared to other building types. But they also have a similarly high potential savings in resource conservation and operating costs when designed with those objectives in mind, and are therefore among the most appropriate targets for pursuing sustainable design objectives. A successful example is Cayuga Medical Center's (CMC) Southwest Addition that received the first LEED Silver certification for a healthcare project in New York State.

Many within the healthcare and related professions will argue that concern about health, the built environment, and even the natural environment are inextricably linked together. Not only are there numerous empirical studies showing a positive relationship between the quality of the indoor environment and human performance, but there is also considerable evidence linking poor indoor environmental quality with a number of health-related problems. These discoveries correlating environmental pollution with disease, and environmental quality with patient health, result in healthcare facilities being among the most appropriate targets for a design approach that emphasizes indoor environmental quality and for selecting interior finishes that contribute to a healthy indoor environment.


The design intent for CMC's Southwest Addition was to improve heathcare through better building design, and to enhance the existing architectural language. Patients having the ability to control their environment, as well as positive distractions and prominent use of day lighting, all contain the synergy between sustainable design and a healing environment.

Architectural features include building materials, such as carpet, adhesives and paints, made without dangerous solvents such as trichloroethylene (TCE), woods that come from certified sustainable forests, and healing gardens that use local vegetation. Occupants benefit from better indoor air quality and places to spend time outdoors. These design strategies and projects do not substantially affect construction costs, yet have been shown to improve patient health and reduce recovery time.


Among the more notable Green Building strategies implemented, CMC installed a new parking lot with what was believed to be the first porous paving installation in New York State, reducing runoff pollution of the nearby streams and lakes. Other Green Building site strategies included promoting the use of alternative forms of transportation, both bicycle and public transportation.


Energy efficiency was aggressively pursued through design of high-efficiency mechanical systems, detailing of a high-performance building envelope, building commissioning, the use of a "cool roof" to reduce solar heat gain, and installation of sophisticated heat recovery systems. The resulting energy performance is projected to be a 40 percent increase in efficiency above code required performance for the new construction areas, and a 30 percent increase for the renovation areas.