By Roslyn McMann

Hospitals provide health care, but at the same time, operations have an impact on the environment. As health care facilities, hospitals have an opportunity to serve as role models for the communities in which they serve. This can be achieved from the initial design and construction phase, through efficient operations and energy awareness.

What makes health care facilities unique?

• 24/7 operation
• Energy/water intensity "rank second only to manufacturing facilities in electricity usage per square foot, in the United States"¹
• Regulations (ie: % humidity in operating rooms)
• Infection control is an important aspect (waste disposal etc)
• Purpose is to promote health –environments should recognize the connection between health and environmental factors.

The following graphic illustrates the inputs and outputs in a hospital.

Source: http://www.bms.com/static/ehs/sideba/data/greenh.pdf

There are many benefits to energy and environmental management including lowered operational costs, reduced impact on the environment and improved occupant productivity. In the case of hospitals, productivity encompasses staff productivity (reduced absenteeism, enhanced recruitment, improved employee morale) and patient productivity (discharge rates). A 2005 California study showed that patients in green buildings were discharged 2.5 days earlier than those in non-green environments².

Green Design in Hospitals

In addition to regular LEED design guidelines, the Green Guide for Health Care™ has been developed. This initiative began in March 2003, with the purpose being to provide "the health care sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments."³ It is largely based on the LEED system as well as ISO 14001, however there are new strategies created specifically for hospitals such as:

• "Incorporate a health mission statement in the project’s design intent document that includes goals to safeguard the health of building occupants, the local community, and the global environment while creating a high performance healing environment for the building’s patients, caregivers, and staff."⁴
• "Provide direct access to an exterior courtyard, terrace or balcony with a minimum area of 5 square feet/patient served for 75% of all inpatients and 75% of qualifying outpatients with clinical length of stay (LOS) greater than 4 hours. Design balcony edges to ensure patient safety."

The Green Guide for Health Care point structure provides rating systems that encourages health care facilities to baseline and benchmark their achievement and to support continuous improvement. Both existing facilities and new buildings are included in the operations and construction credits. The Construction section is mainly based on LEED for New Construction and the Operations section is based on LEED for Existing Buildings, LEED for New Construction, ISO 14001 Certification standards and some strategies that are specific to the Green Guide, as discussed above.

• Construction has 7 categories including: integrated design, sustainable sites, water efficiency, energy & atmosphere, material and resources, environmental quality and innovation and design process.
• Operations has 9 categories including: integrated operations, transportation operations, energy efficiency, water conservation, chemical management, waste management, environmental services, environmentally preferable purchasing, and innovations in operations.

Similar to LEED, facilities earn points in each area, however facilities are not classified into levels (Platinum, Gold, Silver), and it is self-certifying.

On the road to becoming green, health care facilities can use the toolkit of best practices provided in the green guide to help them integrate environmental and health principles into all aspects of their facilities. By implementing an energy and environmental strategy, health care facilities can become role models for the communities they serve by preventing pollution, and addressing the life-cycle costs of building materials, products and services.

Roslyn McMann works in the Energy Advantage Services group and is based in our Calgary office. She combines her interest in the environment and energy management with her customer service skills to ensure delivery of optimal service solutions to our clients.

¹http://www.bms.com/static/ehs/sideba/data/greenh.pdf
²http://www.usgbc.org/ShowFile.aspx?DocumentID=1894
³Green Guide for Health Care Version 2.2 January 2007
⁴Green Guide for Health Care Version 2.2 January 2007, pg. 23.