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A Prescription for Healthier Health Care
Friendly to both the environment and patients, green health care initiatives are also saving green.
By Lynn Murray

It’s a funny thing about change: no matter how good the idea, and no matter how widespread the anticipated benefits, it usually takes a major catalyst to make it happen.

Green practices in the medical field are not new, but until the past decade, heavily regulated health care was hesitant to embrace additional guidelines – especially those not easily integrated with regulations set by the Joint Commission, OSHA or other governing organizations.

One of the first organizations to create awareness of environmental sustainability and green building was Hospitals for a Healthy Environment (H2E), an independent not-for-profit organization that promotes environmental sustainability in the health care industry. 

H2E is a joint effort of the American Hospital Association, U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

While hospitals and health care professionals agreed in concept with the H2E mantra, putting green initiatives into practice was far from simple. The industry standard – the U.S. Green Building Council’s LEED® (Leadership in Energy & Environmental Design) Green Building Rating System – presented challenges. Hospitals are complex organizations. By their very nature, they use large quantities of natural resources: energy, air and water. And they are traditionally governed by conservative boards and leaders that are cautious about embracing activities that might involve risk or require an investment without knowing tangible results. 

In 2003, a new set of guidelines was developed – the Green Guide for Health Care™ (Green Guide). Modeled with permission after the LEED rating system because of its familiar format, the Green Guide is unique in that it is tailored to the particular structure and regulatory challenges of health care buildings. It also incorporates design elements that enhance patient healing and staff well-being. One of the most unique features of the Green Guide is the “why” for green practices, linking specific health issues to each credit, a vital reminder of the primary purpose behind each undertaking. Unlike LEED, the Green Guide requires integrated design practices and is self-certifying rather than certified by a third-party. 

In a nutshell, the Green Guide is an alternative treatment for green building that seems to be working. More than 80 health care organizations are currently part of the Green Guide Pilot Program. Many – who have now been with the program for several years – are starting to see the tangible results. Undeniably, reducing toxic materials, curbing waste, recycling and adopting other environmentally friendly construction and operational procedures are healthy steps. But it’s a healthier bottom line that has ultimately inspired hospitals to make the change.

The time has come
Cost is the driving factor in the greening of health care. But public health issues, market competitiveness and social responsibility also are reasons that factor heavily in the decisions of hospitals and other medical organizations to embrace green.

Operationally, health care profit margins are declining as hospitals struggle to find new ways to maximize efficiencies and minimize expenses. Investing in green design can cut energy costs, reduce cleaning and maintenance expenses, improve employee productivity and reduce absenteeism, and improve patient outcomes and recovery times. 

Long-term, these investments can help a health care organization gain market share for running an efficient ship that provides a healthier healing (and working) environment than its competitors. 

Eliminating harmful chemicals in the hospital environment, as well as construction materials that contain or release them, improves air quality and overall health of building occupants. 

As a flagship of the community, a hospital sets an example for responsibility and accountability. It’s a safe haven, a paragon of both business practices and compassion. If a hospital doesn’t lead by example as an environmental steward, it loses both the trust of its patients and staff and its position as the community conscience.

The Green Guide for Health Care™ (Green Guide)
As the premiere green building guide for the health care industry, the Green Guide for Health Care is a transformational tool kit for building healthier hospitals. The self-administered rating system is broken down into 96 design and construction points and 72 operations points which address key areas. The Green Guide has gone through several revisions reflecting comments and suggestions initiated by more than 114 organizations that sponsored Green Guide projects. In 2007, Green Guide Version 2.2 was released, reflecting significant changes to the design and construction points, and transitioning the Green Guide from a pilot program into a full-fledged registration and self-certification program. 

Design and construction credits can be given for the following key areas:
Integrated design
– Ensures that the building is viewed as a set of interrelated and interdependent systems, which is instrumental to successfully development and implementation of cost-effective green and healthy building strategies. Integrated design also ensures that design, construction and operational decisions and strategies are fundamentally driven by the principles of health and prevention. 

Sustainable sites – Includes pollution prevention during construction; site selection with consideration to environmental impact, development density, community connectivity and transportation; storm water design features and heat island effect consideration; light pollution reduction; and connections to the natural world.

Water efficiency – Minimizes or eliminates the use of potable water for non-life sustaining purposes, including cooling of equipment and landscaping irrigation.

Energy & atmosphere – Encourages optimal energy performance, development and use of onsite energy renewal sources and green power sources, reduction of ozone, and commissioning, measurement and verification of building energy systems. 

Materials & resources – Includes storage and collection of recyclables, management of construction wastes, sustainable sourcing of materials, elimination of mercury and other toxic chemicals, and flexible and durable resource design. 

Environmental quality – Addresses minimum indoor air quality performance, environmental tobacco smoke control, outdoor air delivery and natural ventilation, wall and ceiling finishes, flooring, furniture, lighting, thermal comfort, daylight for occupied space, indoor places of respite and acoustics and noise. 

Innovation & design process – Additional credits can be gained for innovative achievements beyond those articulated in the Green Guide or research initiatives.

Each credit or prerequisite corresponds to a distinct aspect of health care facilities’ design and construction. Within each credit, one or more points define a range of opportunities and strategies to reduce the facility’s ecological footprint. While the Green Guide is not directly linked to LEED certification, the tool kit prerequisites will assist project teams interested in pursuing eventual LEED certification.

Each credit includes a summary of the intent of the credit goal; identification of specific health concerns addressed by the credit; specific steps to achieve the credit; and suggested documentation to monitor performance and benchmark achievement.

Hospitals using the Green Guide will vary in size and scope, but environmentally smart innovation is widespread: use of recycled building construction materials, landscaping irrigated with captured rainwater; smart lighting that turns off automatically when a room is not occupied; and extensive use of regionally available materials to reduce fuel usage to transport. 

Green health care in practice
Oakland, Calif.-based Kaiser Permanente is a dedicated proponent of environmental sustainability, with six projects enrolled in the Green Guide pilot program. An early adopter of green building practices, the large non-profit health care organization has learned how to build green and save green in the process.

One of Kaiser’s most successful Green Guide projects is the Modesto Medical Center, a 650,000-square-foot project on a 50-acre site in the Central Valley area of north Modesto, Calif., scheduled to open in fall 2008.

The project is “a great collaboration – a great leap forward,” said Tom Cooper, Principal, Strategy, Planning and Design for Kaiser Permanente, who chairs the company’s High-Performance Buildings Committee.

Cooper and his team research new technologies and methodologies of green design and construction, and investigate sustainable strategies for each project that also can serve as models for future projects.

The Modesto Medical Center boasts many unique green building initiatives that either saved money or were cost-neutral. For example, pervious paving – a system that integrates hardscape surfaces with storm water management – was used for the facility’s extensive parking area. Water seeps through voids in the pervious asphalt, and then through a filtration system, which captures chemicals, eliminating storm water run-off and damage to the surrounding environment. Instead of taking a short-sighted approach to the $1 million in added costs, said Cooper, Kaiser viewed the system holistically. A more traditional paving system would have required a sewer system, infrastructure and tap-on fees. By avoiding these expenses, the pervious paving system actually saved the company $290,000.

The local building codes required equipment screens to be placed on the top of buildings to conceal unsightly mechanical system components. Instead, Kaiser chose to use energy-saving solar panels to block the equipment, an increased cost of $84,000. However, by doing so, the company garnered a rebate check from the local utility company, Pacific Gas and Electric Co., for $125,000, through the California Solar Initiative program, resulting in a net savings of more than $40,000, not counting the added savings from solar energy.

In compliance with the nationwide campaign to remove all polyvinyl chloride (PVC) chemicals from building materials because of health risks, Kaiser sought a solution for external pipe applications at the Modesto facility. It replaced the PVC pipe with high density polyethylene, which was similar in cost to PVC but came in 50-foot spools instead of 10-to-20-foot lengths. As a result of easier installation, the company saved $75,000 in labor costs. 

Sometimes, tapping into the resources and expertise of business partners is a smart solution. Hospital carpet is required to have an impermeable backing so fluids cannot penetrate to the substrate. PVC-backed carpet was the industry standard. Kaiser tried to find PVC-free carpet backing of similar performance with no luck. So they signed a two-year contract with two carpet manufacturers with a requirement that they develop a PVC-free backing that met their performance criteria but without added cost. C&A Carpet developed ethos, which uses a film layer made from the by-product of recycled safety glass – polyvinyl butyrol. By creating a product to meet Kaiser’s need, C&A secured future business with the health care giant and was able to introduce a new product that’s now in demand throughout the industry. 

The company had a similar experience with wall and corner protectors, a necessity for most hospitals. Those sold in Europe were made without PVC, but cost 30 percent more than those made in the United States that contained the substance. Kaiser negotiated with the vendor and promised business if the company, Construction Specialties, Inc. could engineer a comparable product at the same cost. The company’s innovation, Acroyvn® 3000, is now a market leader. 

As a not-for-profit hospital system, Kaiser is extremely cost-conscious, so green building had to fit in to its business strategy, said Cooper. Even using the Green Guide initiatives, Kaiser consistently maintains an average of 5 percent below the average construction costs in the marketplace.

“Green design and construction make sense financially and operationally for our company,” said Cooper. “But we must always remember our primary purpose in health care. Performance must be Number One.”

Greening together
In December 2007, the green health care building movement came full circle. The U.S. Green Building Council, which offers the LEED® portfolio, officially joined forces with the Green Guide for Health Care™. The agreement states that the two organizations, which have collaborated for the past four years yet remained separate, have agreed to work together on the development of tools, educational programs and other activities to support green health care building and foster best practices. USGCB will continue to administer the LEED for Health Care certification process and the Green Guide will continue to act as a change agent for hospitals and other health care organizations to take a leadership position in the world of green building and operations.

“The health care industry is by far one of the most important sectors that can benefit from the practice of green building design and construction,” said Rick Fedrizzi, President, CEO and Founding Chair of the U.S. Green Building Council.

“By employing green practices, whether incrementally or from the ground up, many hospitals are managing to lower energy bills, reduce waste and achieve healthier indoor air quality,” said Adele Houghton, Project Manager, Green Guide for Health Care.

For more information visit www.gghc.org. A free download of The Green Guide for Health Care™ is available or a print version of the guide is available for purchase.


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