The Plat­inum Stan­dard

Hos­pi­tals shoot for the top score in green con­struc­tion and de­sign

Modern Healthcare - - NEWS - By An­dis Robeznieks

Air qual­ity is one of the first things peo­ple no­tice when they en­ter Dell Chil­dren’s Med­i­cal Cen­ter of Cen­tral Texas in Austin.

“There’s al­ways a mo­ment when peo­ple look up and there’s an ‘Ooh, this doesn’t look like a hos­pi­tal,’ ” said Michele Van Hyfte, en­vi­ron­men­tal stew­ard­ship man­ager for the Se­ton Healthcare Fam­ily, a di­vi­sion of As­cen­sion Health. “Then we say, ‘Take a deep breath,’ and they say, ‘It doesn’t smell like a hos­pi­tal ei­ther.’ ”

Dell Chil­dren’s was de­signed to an­chor a sus­tain­able re­de­vel­op­ment on the site of Austin’s old Mueller Air­port. The hos­pi­tal was cer­ti­fied plat­inum un­der gen­eral stan­dards that ap­plied to hos­pi­tals, schools, and re­tail and of­fice de­vel­op­ments. But the hos­pi­tal’s W.H. and Elaine McCarty South Tower, which opened in May 2013, was the first pro­ject to be cer­ti­fied plat­inum un­der LEED stan­dards de­vel­oped in 2009 specif­i­cally for healthcare.

“There was high-level in­ter­est in mak­ing it the health­i­est hos­pi­tal—and, in par­tic­u­lar, the health­i­est chil­dren’s med­i­cal cen­ter—in the world,” Van Hyfte said.

Prac­tice Green­health, a Re­ston, Va.-based ad­vo­cate for en­vi­ron­men­tal stew­ard­ship in healthcare, rec­og­nized Dell Chil­dren’s in May as one of the top 25 en­vi­ron­men­tally re­spon­si­ble healthcare fa­cil­i­ties in the coun­try. It also won hon­ors for be­ing in Prac­tice Green­health’s top 10 for wa­ter con­ser­va­tion, energy con­ser­va­tion and green build­ing prac­tices.

A study pub­lished last Septem­ber in the Jour­nal of Hos­pi­tal Ad­min­is­tra­tion found that Dell Chil­dren’s had higher lev­els of staff en­gage­ment than two Se­ton hos­pi­tals that were not LEED-cer­ti­fied and also had lower turnover rates than the hos­pi­tal it re­placed. “This study demon­strates that the qual­ity of the hos­pi­tal en­vi­ron­ment has so­cial, en­vi­ron­men­tal and cost im­pli­ca­tions that aligns with the in­ten­tion of sus­tain­able de­sign,” ac­cord­ing to the study.

Dell Chil­dren’s was the first hos­pi­tal in the coun­try cer­ti­fied plat­inum un­der the U.S. Green Build­ing Coun­cil’s Lead­er­ship in Energy and En­vi­ron­men­tal De­sign (LEED) pro­gram, which rec­og­nizes projects with en­vi­ron­men­tally sus­tain­able con­struc­tion and op­er­a­tion. Out of the al­most 5,700 hos­pi­tals in the U.S., only three have re­ceived plat­inum cer­ti­fi­ca­tion. The oth­ers are the Kiowa County Me­mo­rial Hos­pi­tal in Greens­burg, Kan., cer­ti­fied in 2011, and Katz Women’s Hos­pi­tal, Man­has­set, N.Y., cer­ti­fied in 2012 and 2013.

Al­most 2,200 healthcare con­struc­tion projects have re­ceived some level of LEED cer­ti­fi­ca­tion or are seek­ing cer­ti­fi­ca­tion. Hos­pi­tal lead­ers cite lower op­er­at­ing costs and in­creased pa­tient and staff sat­is­fac­tion as solid busi­ness rea­sons to pur­sue cer­ti­fi­ca­tion. They also say re­ceiv­ing recog­ni­tion for green con­struc­tion and de­sign is viewed by the public as ev­i­dence of their or­ga­ni­za­tion’s com­mit­ment to work­ing for the so­cial good.

The U.S. Green Build­ing Coun­cil cites stud­ies show­ing that client and mar­ket de­mand and pos­i­tive re­turn on in­vest­ment are driv­ing the trend to­ward green build­ing. It re­ported that build­ing own­ers and man­agers are ex­pected to spend $960 bil­lion be­tween now and 2023 on energy and wa­ter ef­fi­ciency up­grades at ex­ist­ing fa­cil­i­ties. In­cor­po­rat­ing these fea­tures has a 19.2% av­er­age re­turn on in­vest­ment in an ex­ist­ing build­ing and 9.9% in a new fa­cil­ity, ac­cord­ing to the Green Build­ing Coun­cil.

Van Hyfte said many green con­struc­tion and de­sign costs are off­set else­where. When ev­ery­thing is added up, she said ex­penses re­lated to seek­ing LEED plat­inum cer­ti­fi­ca­tion added 2.3% to the cost of the new $48 mil­lion tower at Dell Chil­dren’s.

Michael Cluff, di­rec­tor of fa­cil­ity plan­ning and in-house ar­chi­tect for the Jack­sonville, Fla.-based Ne­mours hos­pi­tal sys­tem, es­ti­mated that LEED-re­lated el­e­ments added about $100,000 to the $397 mil­lion Ne­mours Chil­dren’s Hos­pi­tal in Or­lando, which opened in 2012. He said the pos­i­tive pub­lic­ity as­so­ci­ated with the hos­pi­tal’s LEED gold cer­ti­fi­ca­tion far out­weighed the mod­est ex­tra cost.

Un­der the LEED Healthcare scor­ing sys­tem, there are 27 pos­si­ble site-re­lated points for build­ing on a sus­tain­able site, which in­clude ac­cess to public transit, reusing a pre­vi­ously de­vel­oped site or pro­tect­ing or restor­ing nat­u­ral ar­eas; 11 pos­si­ble points for wa­ter ef­fi­ciency; 35 pos­si­ble points in the energy and at­mos­phere cat­e­gory; 19 pos­si­ble points in the ma­te­ri­als and re­sources cat­e­gory; 16 pos­si­ble points for in­door en­vi­ron­ment qual­ity; six pos­si­ble points for in­no­va­tion in de­sign; and four pos­si­ble “re­gional pri­or­ity” points that ad­dress ge­o­graph­i­cally spe­cific en­vi­ron­men­tal is­sues.

Ba­sic LEED Healthcare cer­ti­fi­ca­tion re­quires that projects earn be­tween 40 and 49 points; sil­ver cer­ti­fi­ca­tion re­quires be­tween 50 and 59 points; gold re­quires 60-79; and plat­inum re­quires at least 80.

Sev­eral hos­pi­tals re­cently have earned LEED gold cer­ti­fi­ca­tion. These in­clude the $1.27 bil­lion Park­land Me­mo­rial Hos­pi­tal set to open this Au­gust in Dal­las and the $284 mil­lion Sut­ter Santa Rosa (Calif.) Re­gional Hos­pi­tal, which opened last Oc­to­ber.

Plan­ners for the Weed Army Com­mu­nity Hos­pi­tal have an­nounced their in­ten­tion to seek plat­inum cer­ti­fi­ca­tion when the new U.S. De­fense Depart­ment fa­cil­ity opens in 2017 at the Fort Ir­win U.S. Army Base in Cal­i­for­nia’s Mo­jave Desert.

Each of the cur­rent plat­inum-cer­ti­fied hos­pi­tals has its own unique story.

The 57-year-old Kiowa County Me­mo­rial Hos­pi­tal was de­stroyed by a tor­nado on May 4, 2007, along with most of the town of Greens­burg. A 15-bed crit­i­cal-ac­cess hos­pi­tal was built and it opened in March 2010. Its sus­tain­able con­struc­tion and op­er­a­tion were part of a cam­paign to “re­build Greens­burg green.”

The new hos­pi­tal has two wind tur­bines. The Na­tional Re­new­able Energy Lab­o­ra­tory de­ter­mined that the hos­pi­tal uses 30% to 40% less energy than other build­ings of its size, said hos­pi­tal Ad­min­is­tra­tor Mary Sweet. The tur­bines have knocked $161,000 off the hos­pi­tal’s elec­tric­ity bill since it re­opened. “That’s fairly sig­nif­i­cant sav­ings,” she said.

In New York state, lead­ers of the 12-hos­pi­tal North Shore-Long Is­land Jewish Health Sys­tem pledged in 2010 to re­duce their sys­tem’s car­bon foot­print. A key strat­egy is green build­ings. The two LEED plat­inum-cer­ti­fied floors at Katz Women’s are the show­pieces in a port­fo­lio that in­cludes 19 LEED-cer­ti­fied projects. Katz Women’s is part of 764-bed North Shore Univer­sity Hos­pi­tal.

Ar­chi­tect Neil Rosen, North Shore-LIJ’s di­rec­tor of sus­tain­abil­ity, said the LEED el­e­ments added only about 1% to 2% to to­tal costs of the $52 mil­lion in ren­o­va­tions com­pleted at Katz Women’s. Low­er­ing wa­ter use by 50% was ac­com­plished at no ad­di­tional cost by low­er­ing flow rates. He said in­stalling more and bet­ter in­su­la­tion un­der the build­ing’s fa­cade cost about 30% more than us­ing stan­dard ma­te­rial. En­hanced win­dow glaz­ing added 15% to the cost of the build­ing fa­cade. So­lar shades added another 10%.

But those costs were off­set quickly by the energy sav­ings they pro­duced. Fur­ther­more, the lo­cal util­ity, PSEG-Long Is­land, paid the cost of energy mod­el­ing.

Rosen said his or­ga­ni­za­tion has about 40 projects reg­is­tered with the U.S. Green Build­ing Coun­cil in line for cer­ti­fi­ca­tion, though he lamented how slow that process can be. “Some­times the reg­is­tra­tion process takes longer than it took to build the build­ing,” he said.

Prac­tices such as in­stalling energy-ef­fi­cient light­ing, con­serv­ing wa­ter, re­cy­cling con­struc­tion waste and fo­cus­ing on in­door air qual­ity can be re­peated at each pro­ject, he said. “We’re not rein­vent­ing the wheel.”

North Shore-LIJ’s LEED-cer­ti­fied projects in­clude sev­eral ren­o­va­tions, which can be prob­lem­atic in ob­tain­ing LEED points for ac­cess to public trans­porta­tion, Rosen said. “Ob­vi­ously, we’re not go­ing to move our hos­pi­tals if we don’t have a bus stop out front,” he said.

Other hos­pi­tals, he said, are fol­low­ing North Shore-LIJ’s lead in green con­struc­tion and de­sign be­cause it at­tracts pa­tients. Births went up 4.7% in the first year af­ter the ren­o­va­tions to 6,343 in 2012 from 6,056 in 2011. That’s par­tic­u­larly true for ma­ter­nity ser­vices be­cause fam­i­lies typ­i­cally have months to re­search where they want to have their baby. “If they’re los­ing pa­tients to us, they have to try to do what we’re do­ing. There’s ab­so­lutely a keep­ing-up-with-the-Jone­ses at­ti­tude.”

Ex­cept for us­ing geo­ther­mal energy from the ground, North Shore-LIJ doesn’t use much re­new­able energy. “What we’re find­ing is that the re­turn on in­vest­ment is not as great as in­vest­ing in energy ef­fi­ciency,” Rosen said.

Since it gets few re­new­able energy points, North ShoreLIJ has to work harder in other cat­e­gories to boost its LEED scores. “We con­cen­trate a lot on in­door air qual­ity be­cause it’s what af­fects our pa­tients and our staff,” he said.

The 216,000-square-foot Weed Army Com­mu­nity Hos­pi­tal is de­signed to be car­bon-neu­tral while op­er­at­ing in a desert en­vi­ron­ment 150 miles east of Los An­ge­les, where tem­per­a­tures can fall to 8 de­grees in Jan­uary and hit 120 in Au­gust. Its two-megawatt pho­to­voltaic ar­ray is ex­pected to pro­duce al­most 4.5 mil­lion kilo­watt hours of elec­tric­ity an­nu­ally, while a so­lar-ther­mal col­lec­tor sys­tem will pro­vide most of the hos­pi­tal’s hot wa­ter needs.

The hos­pi­tal, which will re­place a 40-year-old clinic, will pro­vide med­i­cal ser­vices for the mil­i­tary base com­mu­nity of about 19,000. Work be­gan in 2014, and Turner Con­struc­tion ex­pects to com­plete the pro­ject by spring of 2017.

Be­sides hos­pi­tals, about a dozen other healthcare build­ings in the U.S. have been cer­ti­fied LEED plat­inum. They in­clude the Wounded War­rior Hope and Care Cen­ter at the Camp Pendle­ton U.S. Marine Corps Base near San Diego, and the Re­cov­ery Cen­ter that’s part of the Men­tal Health Cen­ter of Den­ver.

In ad­di­tion, Kaiser Per­ma­nente has a plat­inum-cer­ti­fied data cen­ter in Napa, Calif. It’s seek­ing plat­inum cer­ti­fi­ca­tion for its An­te­lope Val­ley Med­i­cal Of­fices in Lan­caster, Calif. Kaiser opened the three-story, 136,000-square-foot med­i­cal of­fice last Septem­ber.

At left is the Dell Chil­dren’s Med­i­cal Cen­ter’s gar­den, with the South Tower in the back­ground. Above is Dell Chil­dren’s Hos­pi­tal’s heal­ing gar­den.

Kiowa County Me­mo­rial Hos­pi­tal in Greens­burg, Kan., re­ceived plat­inum cer­ti­fi­ca­tion in 2011. It is one of only three hos­pi­tals in the U.S. to re­ceive the cer­ti­fi­ca­tion.

Katz Women’s Hos­pi­tal, Man­has­set, N.Y., re­ceived LEED plat­inum cer­ti­fi­ca­tion for two floors in 2012 and 2013.

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