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Saturday, February 04, 2012
Feature: July 2008
Mind, Body and Solar
Area hospitals make buildings healthier for the environment and patients
Story by Joanna Corman
When Kaiser Permanente was developing national standards for its hospitals 15 years ago, it worked to reduce toxic chemicals, waste and energy use in the way it builds and runs its medical facilities. Today, the healthcare industry is starting to use some of those practices as it begins to embrace environmentally friendly construction. Kaiser will showcase some of its most innovative designs when it opens a hospital in Modesto this October.
Kaiser is one of several healthcare organizations in the Capital Region incorporating green building strategies into the construction and operations of their hospitals. They are building additions, erecting new hospitals and renovating with green design principles to varying degrees. Some made green design part of their mission years ago. Others are adding it on a project-by-project basis.
It can be hard to incorporate sustainable materials and construction techniques into healthcare buildings, says Robin Guenther, a Manhattan-based architect who specializes in hospital design. Hospitals are, by nature, risk-averse. They are heavily regulated and often used to operating in a particular way. Also, the size and cost of construction projects can make change difficult. Mistakes happen daily on the construction site, with conventional materials sometimes showing up instead of their green counterparts. Unless there is strict oversight, Guenther says, there won’t be incentive to fix these errors. Leadership in Energy and Environmental Design, a third-party certification program developed by the nonprofit U.S. Green Building Council, is expected to release guidelines targeting hospitals this year. The construction section of the existing voluntary program, the Green Guide for Health Care, which Guenther helped write, will sunset once LEED for Healthcare debuts. “There is a need, I think, for rigor in order to change things from business as usual,” Guenther says. “It’s hard to beat a third-party certification in achieving that.”
While there is no one definition of a green hospital, most advocacy groups agree that it should protect the health of the planet, the individual and the community by being as toxic-free, resource-efficient and carbon neutral as possible. For the past generation, synthetic products have dominated materials and furnishings in commercial buildings. These products were made with chemicals that weren’t tested for long-term impacts on humans, Guenther says. “Hospitals have not been hurting folks willingly. I don’t think we had that information,” says Laura Brannen, senior environmental project manager of Practice Green Health — formerly Hospitals for a Healthy Environment — a Washington-based nonprofit working to green the healthcare industry.
A nationwide hospital boom is giving healthcare organizations the chance to use sustainable design, and the Capital Region is no exception. Every major hospital operator has some type of green project under way, including eliminating toxic materials, lighting and energy retrofits, planting gardens to encourage healing, installing solar power and locating a new project in an infill area rather than sprawl.
The healthcare industry is the fifth-fastest growing market for green building, according to McGraw-Hill Construction’s 2007 Health Care Green Building SmartMarket Report. Industry experts say green building in the healthcare sector has increased tremendously since it began less than a decade ago. The number of hospital administrators polled who are “very dedicated” to green building is expected to jump from 4 percent in 2006 to 19 percent this year, the report says.
The healthcare industry, whose construction market was worth $23.7 billion last year, according to the report, is beginning to recognize the connection between buildings, the environment and human health. A hospital affects more than patients, staff and visitors. The way building materials are manufactured and the way hospitals are built, operated and later dismantled impacts the environment, which affects human health. This realization has been fundamental to fueling the healthcare industry’s green building movement. “It was only when the healthcare industry began to see a direct and indirect correlation with their mission to provide healing that they really caught on and started thinking about green building as something that was a priority,” says Adele Houghton, project manager for the Green Guide for Health Care, the first national green building and operations program for hospitals, which debuted in 2003.
The healthcare industry has a moral obligation to connect human health to the health of the planet and how buildings are constructed, industry experts say. “Wal-Mart is greening its operations because it saves them money. Kaiser is greening its operations because they’re committed to people’s health; it’s much deeper,” says Gary Cohen, co-executive director of Health Care Without Harm, an international coalition working to make the healthcare sector safer for people and the environment. “It’s about expanding what we mean by the Hippocratic oath. What does the Hippocratic oath mean when kids are being born with 100 chemicals in their bodies? What does the Hippocratic oath mean in a planet where the climate is out of control? It means you move toward toxic-free healthcare.”
In the U.S., the healthcare industry ranks third nationally in the amount of energy its buildings use per square foot, according to the U.S. Environmental Protection Agency. “Energy efficiency is the single largest way for a building to reduce its carbon footprint, and a building’s energy use is the largest environmental impact a building can ever have over its lifetime,” says Clark Reed, director of Energy Star’s healthcare facilities division at the EPA.
California hospitals will feel a regulatory push toward green building when the state releases its green building code for all building types, with adoption as early as this month. The guidelines for hospitals will be voluntary when they go into effect in 2009. No decision has been made on whether the hospital rules will become mandatory, says Duane F. Borba, a supervisor at the Office of Statewide Health Planning and Development, which oversees hospital construction.
Industry experts and local administrators say a green building can promote patient healing, provide a healthier place to work and visit, and save money on energy and water. Architect Guenther co-wrote “Sustainable Healthcare Architecture,” and found that of the first dozen healthcare projects pursuing LEED certification, two-thirds saved 20 percent on energy compared to a conventional building and one-third saved 30 percent. “Every dollar you don’t spend on energy is a dollar that you can spend delivering healthcare,” says Guenther.
Energy savings, says the EPA’s Reed, means “instant bottom-line profit.” The agency figured that if a hospital is at a 2 percent net operating margin, then for every $50 in revenue, it is making $1 in profit. A $50,000 annual energy savings, for example, is the equivalent of not having to raise $2.5 million in revenue to create that profit.
Industry experts point to Oakland-based Kaiser Permanente as a leader in healthcare’s nationwide green building movement. Kaiser, which has hospitals and medical offices throughout the Capital Region and is building hospitals in Vacaville and Roseville, designs with the safety of the workplace, the environment and patients in mind. In 2002, it pushed a carpet manufacturer to eliminate polyvinyl chloride, or PVC, from its products at no added cost. The plastic, pervasive in medical devices and hospital building products, creates the carcinogen dioxin in the manufacturing and incineration processes. “There’s been a real conscious understanding of the connection between our mission to provide quality healthcare and how that’s impacted by environmental issues either we create or others create,” says Tom Cooper, who oversees Kaiser’s green building program.
The $430 million Modesto campus is Kaiser’s first to be registered with the Green Guide. Kaiser piloted several green design strategies in Modesto that it will use nationally. They include 7.1 acres of pervious paving, which allows rain water to filter through a parking lot and into the aquifer rather than through a storm water management system of sewer lines and treatment facilities. The porous paving prevents flooding and naturally removes impurities that would otherwise mix with the city’s water supply. This cost about $1 million more than conventional asphalt, but overall saved $290,000 because the hospital didn’t have to build a quarter-mile of pipes or connect to the city’s storm water drainage system. Kaiser saved more than $500,000 on this project with building innovations that are better for the environment, Cooper says. Other innovations include swapping cosmetic screens for solar panels on an adjacent medical office; a roof planted with vegetation, which will insulate and absorb rain; and paint and fabrics low in volatile organic compounds, which are emitted gases that can pose health risks. The hospital served as a test site to eliminate PVC from its building materials.
Catholic Healthcare West, a San Francisco-based system of 41 hospitals — including several in the Capital Region — also has been a leader in the industry’s green building movement. In 2000, the nonprofit started a green building program because it is “the right thing to do,” says Roger Conley, director of design and construction in Northern California and Northern Nevada. He is overseeing $1.2 billion in construction, including projects in the Capital Region. The organization was embarking on $4.5 billion in new construction and wanted to act as environmental and financial stewards. The healthcare industry traditionally has been concerned with upfront cost, rather than the cost of technology over its lifetime. But Catholic Healthcare West looks at a technology’s lifecycle, says Conley, and considers installation when it can recoup the initial cost in three years of savings.
Sutter Health, a nonprofit hospital network in Northern California, is “increasing [its] commitment to sustainability very dramatically this year,” says David Chambers, Sutter Health’s director of planning, architecture and design. Administrators are examining the Green Guide for Healthcare and considering whether to adopt measures for construction and operation that are even more stringent. Sutter has been committed to using sustainable design principles for years, its administrators say. “Philosophically, why would a healthcare organization not be committed to community health, which is part of what sustainability is all about?” Chambers says. “We’re all citizens of one earth. It’s about time we all did what we could to be focused on this.”
How green a Sutter hospital is depends on choices made at the local level. Sutter Medical Center in Sacramento is undergoing a $660 million remodel and expansion. From the start, hospital officials stressed to the architect and contractor that sustainable design was paramount. At Sutter Surgical Hospital-North Valley, now under construction in Yuba City, the physicians, who are also co-owners, said last year they wished the hospital could be built in a greener way, says CEO Toni Morris. The hospital will have some green elements, such as a white roof to reflect heat, but design began eight years ago before the green building movement had taken hold in the healthcare industry.
The perception of green building is that it costs more than conventional construction. Not surprisingly, experts say resistance to building green often comes down to cost. But does it cost more? “There are a lot of claims that people make about cost versus ability to be green, and I think many of them are misleading because it all depends on how you frame the question,” says Walt Vernon, principal with Mazzetti & Associates, a San Francisco-based engineering firm that specializes in hospital design, and co-coordinator of the Green Guide. When it can cost $1,000 per square foot to build a hospital in California — and hospitals typically operate on 2 to 4 percent margins — adding any cost can be difficult.
UC Davis Medical Center in Sacramento doesn’t have a green building program. Instead, it focuses on energy conservation. Recent energy-efficient projects, such as lighting retrofits, have saved $226,000 annually, says Patrick Putney, energy conservation manager. The hospital, which is building a 472,000-square-foot addition, is researching solar power.
NorthBay Healthcare, with hospitals in Fairfield and Vacaville, is in the “infant stages” of using green design, says Dave Mathews, director of plant operations and general services. The organization began focusing on sustainability a few years ago in part because administrators think it will help it make Fortune 500’s list of the top companies to work for. Both hospitals are undergoing renovations to expand their medical services, including a $100 million, 60,000-square-foot addition at VacaValley Hospital.
Changing the culture has been a challenge, says Joelyn Gropp, director of facilities development. During a remodel a few years ago, the hospital replaced a vinyl floor with a matte material, which changed a maintenance routine that was harmful to the environment and to human health. Vinyl needs to be stripped and waxed with harsh chemicals, potential triggers for asthma, while the new floor needs only a damp mop. Employees said the new matte surface looked dirty compared to the glossy tiles elsewhere in the hospital.
Hospital administrators and industry experts say the healthcare industry’s green building movement is a permanent shift. It has been helped in part by Kaiser Permanente, which started the Global Health and Safety Initiative in October, a coalition of hospitals and nonprofits working to leverage hospitals’ buying power and promote environmentally friendly construction and operations. Hospitals have the responsibility to reduce their carbon footprints and stop using materials made from toxic chemicals, but they cannot force change alone, says Kaiser’s Cooper.
“We’re changing practices in the construction industry that are very difficult to bring about unless it’s a much broader initiative than what we just do as Kaiser Permanente.”
Air quality in the workplace
by Rebecca Adler
It shouldn’t take admission to a hospital for a pair of lungs to find a healthy environment. Americans spend about 90 percent of their time indoors, according to the U.S. Environmental Protection Agency, including a good portion in the office environment. “It’s no wonder people begin to feel a bit off when they spend so much time in confined spaces,” says Robert Danielson, senior industrial hygienist and president of Indoor Environmental Consultants Inc. in Wheatland.
For the past 15 years, Danielson has helped office managers and homeowners overcome a host of indoor air quality problems — from choosing the best heating, ventilation and air-conditioning system for allergies, to testing for volatile organic compounds. “But sometimes the solution can be as simple as moving an industrial-sized printer to a different area of the office,” Danielson says.
If office workers are complaining of allergy symptoms, constant headaches or nausea, it’s important to take the claims seriously, he says. Before hiring a private consultant, there are a few steps to take. First, have the HVAC system checked out to assure it’s running properly and the vents have been cleaned. Danielson also recommends checking for any outdoor problems with the air-intake system, such as a pollinating tree.
Second, find out when and where employee symptoms are most prevalent. If it’s near the printer, try moving the equipment to an enclosed room specifically for printing and faxing purposes. If problems are below a vent, it could mean a problem with the HVAC. And if complaints increase in the spring, step up janitorial services to include more vacuuming and dusting to keep allergens from accumulating in the office.
“Prevention is always, always the key,” says Danielson, who encourages biannual inspections. “Check for moisture, water damage and dust.”
Not only will this result in happier employees by ensuring good indoor air quality, studies suggest improved productivity and fewer sick days will follow, says Peggy Jenkins of the California Air Resources Board’s indoor air division.
For office managers who have already received air quality complaints, Jenkins recommends checking out self-assessment tools provided on the U.S. Environmental Protection Agency’s website at epa.gov.
If problems persist, she suggests hiring a private consultant, such as Danielson, to survey employees, take air samples and inspect the HVAC system. And don’t let cost be a deciding factor in whether to have indoor air quality inspected, Jenkins says. For a less expensive inspection, she recommends making an appointment with the California Division of Occupational Safety and Health to have an agent come out for an inspection and give advice for improvements. There’s one caveat: An inspection may bring light to other problems with the building — and the owner or occupant will be expected to correct them.
To prevent problems from the beginning, be sure to have a high-quality HVAC system installed, says Andy Persily, vice president of the American Association of Heating, Refrigeration and Air Conditioning Engineers. When thinking about where to spend overhead money, it’s important to remember how much ventilation affects employees, Persily says. “Research shows that poor indoor air quality decreases productivity,” he says. “If you consider that the most expensive thing in an office building is the salaries of the people working there, then spending a little extra on proper ventilation makes sense.”
