Robin Guenther is a Principal of Perkins+Will and Senior Advisor to Health Care Without Harm. An expert in sustainable healthcare design, Robin is a long-time advocate for healthier healing environments and spoke on the topic at TEDMED 2014. Notable projects include leading the major expansion of the Lucile Packard Children’s Hospital at Stanford, and ongoing work with preeminent institutions such as Memorial Sloan Kettering Cancer Center. Robin also led one of the two winning teams in the Kaiser Permanente “Small Hospital, Big Idea” Competition. Contributor Julie Potyraj, an MPH candidate at George Washington University and the MPH@GW Community Manager, caught up with Guenther on the latest trends in green healthcare design and on whether resilience is the new sustainability:
Healthcare facilities spend more than $10 billion per year to power their operations, which is the second-highest total for an industry in the United States. These facilities consume two times more energy than office buildings of similar sizes, and hospitals use somewhere between 80 and 150 gallons of water per bed per day. This number is 10 pounds per day per bed for solid waste — which is often incinerated. When you add up all of the waste, it’s easy to make the case that there’s room for improvement in how hospitals and medical centers care for the environment.
“Healthcare is the only sector of our economy with an explicit mission to heal,” said Robin Guenther, sustainable healthcare design lead for the architecture and design firm Perkins+Will. “Our built environments need to improve and restore natural systems, not degrade them, because we won’t have healthy people if we don’t have clean water and air.”
How a healthcare center is managed with regards to environmental factors also contributes to the overall health of its occupants. Vinyl flooring, for instance, releases toxic emissions like dioxins and phthalates, especially when wet. These can exacerbate respiratory diseases and may cause harm to fetal development. Toxin-laden cleaning supplies create similar problems by adding irritants and harsh emissions to the building’s interior.
Guenther explained that since healthcare makes up 18 percent of GDP, these businesses have huge purchasing power and “can drive markets for healthier materials, and move markets from less healthy options.”
Digging down to the bottom line, the costs of maintaining a building impact how much money is available for delivering actual healthcare. The creeping costs of energy and water put at risk the available funding for making people well. Since keeping costs as low as possible means there is more money for improving health, many building designers and managers are looking to green ideas to reduce waste and improve the efficiency of our healthcare system.
We won’t have healthy people if we don’t have clean water and air.
Trends in Sustainable Healthcare Buildings
According to Guenther, the most efficient ways to improve the construction and operation of healthcare facilities are in energy and water conservation.
“There continues to be a belief that hospitals can’t achieve aggressive sustainability goals because it costs more money or is in conflict with codes, but neither of those need to be true,” she said. “We know that energy conservation actually saves money, and there are many creative, code compliant solutions.”
Beyond these solutions, Guenther identified the three biggest trends in green healthcare facility design:
- self-generated (sustainable) energy systems
- connections to nature
- the resilience of structures that are designed to maintain functionality in the face of changing conditions such as natural disasters
Health campuses are setting up independent utility entities, such as district energy microgrids and onsite co-generation systems for providing heat and electricity, which dramatically reduce greenhouse gas emissions and improve resiliency. Healthcare buildings are incorporating more nature into their designs, which can significantly boost the physical and mental well-being of a building’s occupants.
“There is a pivotal shift in building design to incorporate courtyards and green space within deep diagnostic floor plans and outdoor space for families and staff on nursing units,” Guenther said.
Climate change-fueled natural disasters such as superstorms and flooding are also at the top of the priority list for hospital and medical facility architects.
“Is resilience the new sustainability? I am focusing on the intersection between sustainable design and resilience, because so many sustainability strategies actually improve resilience,” Guenther said. “For example, the less energy and water you use, the longer you can operate on a fixed supply. Daylighting reduces the use of electric lighting in stairwells and buildings during daylight hours. Operable windows can prevent building overheating when you need to shelter in place.”
Expected waves of boomers entering these facilities build the business case stronger for greener buildings.
“Baby boomers will demand healthier, less institutional environmentally responsible housing,” Guenther said. “Long-term care facilities need to get ready. And ambulatory facilities should reduce operating costs wherever they can.”
Is resilience the new sustainability? So many sustainability strategies actually improve resilience.
Leading the Way in Sustainability
As someone on the front lines of greener building designs, Guenther is in the perfect position to witness some of the best innovations being seen in the sector.
“Around us, there are really inspiring examples of hospitals doing amazing work on reducing water consumption by 60 percent, moving to renewable energy, and instituting waste reduction and pharmaceutical take-back,” she said. “We see healthcare leaders concerned about healthier materials and encouraging manufacturers to phase out worst-in-class substances.”
Here are just a few examples to illustrate the exciting shifts taking place:
- In Boston, hospitals cut their energy use by 6 percent despite facility growth in the region. In all, their increased efficiencies are estimated to save $11.9 million every year, which is enough to provide care to 1,055 Medicare enrollees.
- Spaulding Rehabilitation Hospital in Boston is built with many resiliency features to help it withstand extreme weather. These include placing critical mechanical, electrical, and communications infrastructure on the roof; installing redundant power systems; and designing the ground floor to be 30 inches above floodplain levels.
- The Evergreen Cooperatives of Cleveland was established to allow locally-owned businesses to leverage the $3 billion in annual purchasing power of anchor institutions such as the Cleveland Clinic and area hospitals. Their services include delivery of organic foods, laundry, and solar installations.
- The Gundersen Health System in La Crosse, Wisconsin, (including four hospitals and 75 medical and specialty clinics), set a goal to become carbon neutral by reducing energy consumption by 30 percent and offsetting the rest with renewable energy. They have instituted conservation measures that deliver $2 million in annual energy savings, and have used solar, wind, and biofuel energy to provide $2.1 million worth of renewable energy. In all, they have reduced their fossil fuel consumption by $5.4 million.
- The Hackensack University Medical Center's pediatric oncology center in New Jersey switched from toxic cleaning chemicals to natural products and reduced their cleaning costs by 15 percent.
There are more opportunities for improving the way we build and operate our healthcare facilities to benefit both the planet and human health. According to Guenther, it’s easy to justify embracing sustainability as a means of going green and reducing operational costs, making green design not just a healthy bonus but a healthcare imperative.