Medical Industry
Waste Prevention Round Table

MAKING THE CASE
For Building "Green" Health Care Facilities
May 3, 2001
Lease Crutcher Lewis Headquarters

Notes compiled by King County Solid Waste Division staff.

Welcome
Overview of Green Building
Why Sustainable Design?
Indoor Environmental Quality
Syska and Hennessy Presentation
Code Green: Greening of Healthcare
Panel Session

Welcome Joe Neuenschwander - Lease Crutcher Lewis
Very sensitive to issues around health care. Sustainable design helps us to take care of the community in which we live. Lease Crutcher Lewis has several green building projects going on. At break, he took people down to see their remodel.

Overview of Green Building
Kathleen O'Brien - O'Brien & Co.
Click here to view PowerPoint presentation

Sustainability = meeting the needs of the present without compromising the ability of future generations to meet their needs. This is not the same as "green." It includes ecology, economy and equity.

Sustainable Building - includes the there Es

Green building - buildings designed, constructed and operated to be very energy efficient,

Believes you can't have a sustainable building without having a healthy building.

Why do we care?
· Buildings spend a huge amount of our natural capital:
· Timber, Energy, Water, ext.
· Uses virgin materials that also create large environmental impacts - including global climate change
· Landfill problems occur
· Poor indoor air quality leads to productivity losses

Who will pay the price?
For higher energy costs, water rates, raw materials -
the next generations will pay

Environmental Objectives of Sustainability Building:
1. Indoor Environmental Quality
Lighting
Ergonomics
IAQ
BENEFIT: Improved Health and productivity

2. Resource Conservation
Water, Energy, Materials
BENEFIT: Reduced operating costs for energy and water and reduced material waste

3. Ecosystem protection
Site
Beyond site
Where the material came from
BENEFIT: Reduced costs for stormwater protection and reduced water impacts.

Costs:
· Minimize by integrated design, identify trade-offs
· LCA to ID offsets
· Low tech approaches
· Full commissioning/training
· Integrate incentives in planning (see handout about incentives)

Reducing Risk:
· Rely on tested technologies and products
· Eco-labels, reliable directories, standards....
· Focus on big bang items
· Start from where you are
· Work out the bugs
· Rely on professionals with "green" experience - look for commissioners with "green" experience
· Integrate local resources
1. US Green Building Council - LEED, Leadership in Energy and Environmental Design - encourages integrated approach, focuses on 5 environmental disciplines, self assessing system, requires documentation. The disciplines include:
2. Sustainable sites
3. Water Quality
4. Energy and Atmosphere
5. Materials Efficiency
6. Indoor Environmental Quality
7. Innovation Credits (other)

Recommended Strategies or Implementing LEED:
· Develop sustainable design early
· Whole system thinking
· Emphasize a multidisciplinary team design approach
· Consider adding a sustainable design specialist to project team

LEED Certification Process - A handout was distributed

LEED is a way of putting a framework around which to plan your building.

Strategies for using LEED:
· Holistic, interdisciplinary approach
· Inclusive, consensus based leadership
· Innovative solutions
· Long term thinking
· Emphasis on healing environments - Enhances the core mission of Healthcare

Process:
Pre Master Plan
· Hire a dedicated design consultants at master plan level
· Establish clear goals for sustainability within the critical decision making bodies

Master Plan
· Look at Urban Redevelopment
· Where possible, build on Brownfield sites
· Orient new buildings for Solar Exposure/ E/W Axis
· Select a site near transit
· Provide bike parking and options for alternative autos
· Build less parking
· Create Green Space around building
· Create Green Horizontal Space
· Provide shade within 5 years
· Provide Underground Parking

Schematic Design Issues
· Recycle Water
· Limit need for irrigation by choice and layout of plant
· Reduce sewage through many different sewage management options including treatment, choice of fixtures, etc.

Why Sustainable Design?
Dick Lee - NBBJ - Sustainable Design Group
Click here to view a pdf version of the presentation

· Increasing resource depletion
· Oil supplies running out
· China and the Amazon are cutting tremendous amounts of trees
· Large waste by-products
· Pollution
· Social equity

Hospitals in the US are very wasteful. It is estimated that they collectively produce ~6000 tons of waste per day. The waste generated by a hospital will greatly exceed the amount of products used to build it.

"Buildings account for 36% of primary energy consumption", EIA
The US (5% of the population) uses 30% of resources

Things to consider:
· Healthy Building = Healthy Community
· Environment should do no harm:
· Infectious diseases
· IAQ
· Safety and security
· Traffic and neighborhood impacts
· Environment should be a healing place
· Inviting and comfortable
· Appropriate for activities
· Meets needs

Initiatives:
· USGBC - LEED Program
· EPA - Energy Star
· H2E - EPA/AHA - mercury and waste stream goals
· European Energy 2000 Program

EPA Energy Star
· Voluntary
· 5 step process to improve energy efficiency
· Starts with improving lighting efficiency
· Provides for energy use benchmarking

Over 800 hospitals are signed up for the Energy Star Program (e.g., Kaiser Permanente - upgrading lights, 23% reduction in E costs)

Timeline for Decisions - Important to look at long term aspects of the building
· 100+ year decisions- site selection, structure, floor to floor heights
· 30+ year decisions - mechanical infrastructure
· 10-20 year decisions - first occupant
· Look at the interrelationship of the components.
· Plan for phased replacement and growth
· Plan to avoid early obsolescence
· Building size and shape - make it regular
· Structure -conservative - think to future codes

Utilize integrated planning
Plan for ST and LT needs
Loose fit vs. tight fit planning
Use general "plans" to make it more useable
Sustainable planning

"If you're not careful in what you're building you may lose the qualities that make it a healing environment."

Indoor Environmental Quality
Chris Dixon - Mithun
No copy of the PowerPoint presentation is available

Recently completed a Planned Parenthood
Air distribution evaluation and cleaning are important. When building from scratch you can use construction filters.
Important to focus on low emitting materials - especially important because increasingly more people have chemical sensitivities.

Use:
· Low emitting materials - you can specify these materials.
· Formaldehyde free acoustical tiles
· Use Green Labeled Carpets and formaldehyde free adhesive
· Indoor pollutant source control
· Printers and copiers emit ozone which is a lung irritant
· Cleansers - if not stored properly they are circulated by HVAC system
· Daylight and views - incorporate for LEED points (maximize)
· Benefits: Patients get better faster, connection to nature, increased productivity
· Drinking Water - filtered under counter

Materials and Resources:
· Local/regional materials - masonry, wood, glass tiles, etc.
· Low VOC paint
· Recycled content materials
· Salvaged and reused materials - carpet, flooring
· Recyclable materials - take back
· Use rapidly renewable materials - e.g., wheat board (also no formaldehyde), linoleum, bamboo, and cork - must meet performance specs.
· Bamboo is harvested every 3-4 years and cork every 9 years. Both sequester CO2 (important when calculating greenhouse gas impact of construction)
· Use Certified Wood Products (it is more expensive, 15-20%)
· Minimizing the use of Materials

Mithun's office is naturally ventilated and had no air conditioning

Syska and Hennessy
No copy of the PowerPoint presentation is available

They are the largest healthcare engineering firm in the U.S..
Hospitals are built primarily for patient care
Hospitals are exempt from Title 24 in California.
Hospitals are one of the largest users of electricity. They use more electricity than any other building type.
The typical office building pays $.02-.05/ft2 in electricity costs and hospitals consume $.10-.15/ft2
It is possible to look at creating a sustainable building and making it people friendly.
Hospitals are remarkably sustainable in terms of HVAC systems, based on the need for infection control
Would like to work with hospitals to develop a hospital specific version of LEED

When trying to sell sustainability to a hospital you need to push why it's good
· it will be a better place for patients
· good for PR
· reduces operational costs

It may be beneficial to a hospital to contract a third party to run their facilities stuff.
Hospitals can use sustainability to create a destination hospital. People are looking for the best place to go for their care. A sustainable hospital also has the potential to better retain nurses and physicians.
Pushing sustainability for a hospital is sometimes difficult as upstart costs are usually greater than normal though the long term costs are less.
When a hospital is downgraded in use you can save a lot of money by remodeling to lower standards as old strict health codes may no longer be applicable.
VAV should be used sparingly in acute care environments
Good to consider natural ventilation for non-critical rooms. In Toronto they have implemented a program for getting natural ventilation into patient rooms. Natural ventilation for lobbies is something they are considering.
Need to look at all aspects of the process and see where you can make your building sustainable.

Code Green: Greening of Healthcare
Paul Anseeuw -Keen Engineering
No copy of the PowerPoint presentation is available

Discussed several myths about building a "green" hospital:
· Maintenance
· Can't have windows
· It will be ugly
· It's risky
· The needed technology is not there yet
· It's fringe

Hospitals provide great opportunities for developing a green facility
Gave several suggestions on how to make Green Happen
Gave a lot of design techniques for sustainable building design
Building structure is important
· Space and void
· Natural ventilation
· Stratification
· High delta T
· Water conservation

Gave a breakdown of energy use in a hospital
The goal of one hospital was to reduce greenhouse gas emissions.
They have been working more with once-through ventilation rather than recirculating air.
Sustainable building concepts to look at:
· On-site cogeneration
· Low energy design analysis
· Designing issues and analysis

Could savings be had by grouping isolation rooms? Something to consider.

Panel Session

Q: Who in a facility is best to be the champion?
A: The CEO is best from a facilities point of view, a facilities person is a good person too. You need more than one champion.

Q: How do you get buy-in from facility to make hospital sustainability an on-going project?
A: Work with the tenants from the beginning. If one person comes to tell me something then I think it's a sell job but when an industry is telling me something I may listen to them. Need to get process (upkeep) into a training manual. The LEED program requires recertification so it will force a hospital to stay on top of things.

A building will not be fully commissioned for at least a year and maybe two years. Hard for a hospital to fund this as original funds are no longer available. Some hospitals are doing on-going commissioning where facility staff train with commissioning crew when they do their original commission so they can do it in the future.

Data showing hospitals as most energy intensive may be dated and data centers (tech hubs) have now probably surpassed them.

We need to connect better with medical staff if we're going to really make sustainable building as good as possible. Best opportunity to catch viruses, etc. in a hospital is during the renovation process.

End of Seminar.