Hospitals and health systems continue to make strides toward ‘greener' facility design and construction featuring reduced energy consumption
If the idea is to use what you have to get what you need, a hospital in Kansas is reaping the wind while in California, 15 healthcare facilities will be using the sun to supply a significant portion of their energy needs.
Dell Children's Medical Center of Central Texas, Austin, used its community's independent and progressive spirit to go where no hospital had gone before: the first LEED platinum hospital in the world.
LEED is the U.S. Green Building Council's “Leadership in Energy & Environmental Design” program, which measures a building's energy and water efficiency, use of recycled and “sustainable” construction materials, “regional appropriate landscaping,” and indoor environment quality. Points also are awarded for being close to mass transit and building on a previously developed site rather than a “green field” location. View a LEED certification score card (PDF)
Projects are scored on a 110-point scale. A project receiving 40 points or more is “certified,” while those getting at least 50 points are classified as “silver,” 60-point projects get a “gold” rating, and a score of 80 or above earns the coveted “platinum” designation.
As of this month, there are 49 certified healthcare facilities, 43 silver, 36 gold and only five with a platinum rating. Some 918 projects from around the world have been registered with the U.S. Green Building Council and are in the process of or waiting for a certification review.
The 174-bed Dell Children's, part of the 12-hospital Seton Family of Hospitals, opened in July 2007 and, in March 2009, became the first hospital to achieve LEED platinum status.
Located on 32 acres and anchoring redevelopment of the 700-acre Robert Mueller Municipal Airport, the hospital used 47,000 tons of recycled material from old runways in its construction and—except in surgical areas—patients and staff are never more than 32 feet from a window.
This aspect has made Dell Children's something of an anomaly in a time when designs that seek to take advantage of department adjacencies and to reduce the distances staff has to walk to do their jobs are in vogue.
“Because of the push we made for daylighting and courtyards, it has spread out the building,” says Alan Bell, Seton's director of design and construction. “So there is a tradeoff with travel distance and access to nature.”
That said, in the two years Dell Children's has been open, Bell notes that it has had a nurse turnover rate of 2.4% compared with a national average that generally ranges between 12% and 15%. He adds that it can cost up to $70,000 to recruit and train new nurses.
“We don't have a whole lot of science behind it,” Bell says. “Is it the building? Who knows? But, at the old building, you'd look out the window and see the underside of a highway. Now you see a healing garden. It's helped us with recruiting doctors and specialists who we could never get before. This is where everyone wants to take their kids now.”
Jeff West, sustainable solutions coordinator for DNV, a Norway-based company that is often contracted to conduct the LEED certification process on a building project, says that LEED's focus on indoor air quality makes a difference. “If you walk in a LEED building, you notice that it just feels better than in buildings that were built in the past,” West says.
Other statistics Bell provided include having patients average a 4.13-day length of stay in fiscal 2010, compared with 4.76 days at the old Children's Hospital of Austin in fiscal 2007. He also says Dell Children's uses between 30% and 40% less water than four Central Texas hospitals of similar size; and the onsite 4.5 megawatt natural gas-fired turbine providing all of the hospital's electricity is 75% more energy efficient than a coal-fired power plant.
At a construction conference this past February at the Center of Science and Industry in Columbus, Ohio, Bell gave a presentation in which it was mentioned that a guiding principle was that they wouldn't do “dumb things” (such as installing equipment that had low return on investment) just to get LEED points. Items that were rejected included a rooftop wind turbine, a 500,000-gallon rainwater cistern, cotton-denim wall insulation and waterless urinals.
Bell says Dell Children's cost $206 million to build and equip, with construction costs accounting for $130 million. While other hospitals report a drop in philanthropic gifts, Dell Children's exceeded its $75 million fund-raising goal by $12 million. Bell acknowledges that some of that could be due to the fact that children's hospitals generally attract more donations than other hospitals, but he adds that the fundraising effort included challenge grants where donors said they would provide a certain amount if the new building was LEED-certified and an even higher total if it achieved platinum status.
Bells says students from the University of Texas schools of architecture, engineering and interior design regularly tour the hospital, as do groups from Texas A&M and Texas Tech. In addition to local groups, he says Dell Children's has attracted visitors from all over the world.
“You can name a country and they've been here,” he says. “We have a good story to tell, and it's been an ongoing good story.”
The original Kiowa County Memorial Hospital in Greensburg, Kan., destroyed by a tornado in 2007, has been replaced with an energy-efficient facility, including an adjacent wind turbine that will generate 18% of the hospital’s electrical needs.
The same is true at the new Kiowa County Memorial Hospital in Greensburg, Kan., where officials are waiting to hear from the U.S. Green Building Council if they will become the nation's first LEED-platinum critical-access hospital. Though the designation will make it unique among the nation's rural hospitals, in Greensburg, it will be just one among many LEED-certified buildings.
The Greensburg city hall, a John Deere dealership and a townhouse development have received LEED platinum status, and the U.S. Energy Department says, when the town's development plan is complete, it will have the highest per capita concentration of LEED platinum- and gold-certified buildings in the nation. So, suddenly, Greensburg is now a must-see location for the world's eco-tourists.
“We have so many tourists coming through town now,” says Mary Sweet, the hospital administrator. “We like to show off the hospital, but sometimes we have three tours a day.”
The previous 24-bed facility was destroyed on May 4, 2007, when a tornado swept through Greensburg, killing 13 people and essentially wiping out the town—leaving only “one block on the west and one block on the east,” Sweet says. Of the hospital's 95 full- and part-time employees, 68 lost their homes.
The new $24 million, 15-bed hospital was built on the former site of a John Deere dealership and opened March 12. It has fewer beds because it does not include the old facility's geriatric-psychiatric unit. The 50,000-square-foot building features an extensive rainwater collection system that provides water for landscape irrigation and toilet flushing.
According to an energy-modeling analysis, its design will help make the hospital 32% more energy efficient than other buildings of the same size and shape. One of the hospital's most noticeable features, an onsite 50-kilowatt wind turbine, provides about 18% of the facility's electrical needs. All told, it's been calculated that a similar sized and shaped building's annual energy costs would run about $367,500. But Kiowa County Memorial's annual energy tab is expected to be about $248,750.
Sweet says the turbine is expected to pay for itself in eight years and last for 25. Having a wind turbine so close to a hospital might create some concerns about noise, but Sweet says these fears are unfounded.
“Ours is right in front of my office window,” she says. “My flag pole makes more noise than the wind turbine does.”
In addition to energy efficiency and production, Kiowa County Memorial also received many LEED points for its water efficiency and its use of recycled materials in its construction.
At last month's Healthcare Facilities Symposium & Expo, an annual event that attracts more than 2,700 healthcare construction professionals to Chicago to discuss what constitutes a “healing environment,” Wichita, Kan.-based architect Tim Dudte, who worked on the new hospital, said, “We attacked every water point LEED had to offer.”
But Sweet says conserving water and taking care of the soil is ingrained in the regional culture. “Kansans are already known for that,” she says. “We farm on ground our great grandparents farmed and that we hope to have our grandchildren farm.”
Sweet says the hospital was not able to capture any LEED points for the building's use of natural light because of the layout of interior offices and diagnostic imaging facilities, but she adds that the influx of sunlight into patient rooms, corridors and other common areas has made a significant difference.
“I'm disappointed that we didn't get the points,” Sweet says. “But it's very light and very sunny. I think it's more conducive to work. It's a more conducive healing environment.”
One of the nation's largest renewable energy efforts initiated by one of the nation's largest healthcare systems was launched in March when Oakland, Calif.-based Kaiser Permanente announced it was partnering with San Francisco-based Recurrent Energy (which was bought last month by the Sharp Corp. for $305 million in cash) to install 16 solar power systems at 15 Kaiser facilities that will generate a total of 15 megawatts of power when fully implemented.
At the Healthcare Facilities Symposium two years ago, Jeffrey Keyak, senior energy consultant for Kaiser Permanente, and others on a panel announced that the system would be making a significant push toward using solar power. At that time, it was noted that Hawaii would be a particular focus because using more solar power there could help somewhat stabilize the state's volatile and expensive energy picture. Kaiser Permanente has 19 medical facilities in the state, including one hospital.
But Keyak says this has been put on hold because of Hawaii's “feed-in tariff,” which allows utility companies to buy solar-generated power below market price. For example, if the market rate for a kilowatt hour of electricity is 26 cents, the utility company may purchase it from a generator of solar power for 17 cents, Keyak explains, and this makes it “not a very good proposition.”
So, instead, Kaiser focused on California markets where the cost of generating solar power was at or below the cost of electricity. Twelve of the installations are in Southern California, and three are in the north—including the first installation, which took place in August at Kaiser's Livermore Medical Offices east of Oakland.
Keyak says solar-power generators will be producing 35% of the electrical load at Livermore, and the next installation will be either at the 229-bed Kaiser Foundation Hospital in Santa Clara or at its La Mesa Medical Offices facility near San Diego.
A systemwide request for proposals should be issued next year in which third-party experts will tell Kaiser what alternative energy sources would work best and at which Kaiser locations, Keyak says, adding that the intent is for Kaiser facilities to use the power they generate onsite and not to distribute it into a community's electrical power grid. “We're not interested in being a utility,” he says.
Kaiser is apparently not interested in LEED certification either.
“It's not a company directive at this point,” Keyak says. “Yet we certainly challenge our teams to incorporate into our designs that which LEED looks for: like passive solar and day lighting.”
The LEED system itself is a work in progress (May 17, p. 10). Currently, hospitals are judged on the same rating system as office buildings, but the U.S. Green Building Council is entering the final stages of developing a “LEED for Healthcare” rating system. The proposed rating system went through a third public comment period between Aug. 17 and Sept. 5. Council spokeswoman Ashley Katz says a “consensus body” made up of a subset of the organization's members and cutting across all of its user groups will receive ballots later this month. Voting will take place for 30 days or until a quorum is reached.
Jeff West at DNV says surveys have shown that healthcare facilities use twice as much power as office buildings. He notes that—along with the energy-chewing equipment they use—most hospitals also have kitchen and laundry facilities that contribute greatly to a building's energy bill.
According to West, however, simple efforts to decrease the amount of hot water consumed and using better insulation to help retain that heat can make a big difference in energy consumption.
“We should be looking at healthcare facilities a little more intensely,” he says, adding that simple changes in water and lighting fixtures can lead to significant energy savings.
Since Dell Children's opened, Bell says the facility is constantly being tuned, and he's identified several energy-saving measures that would cost a total of about $120,000 to implement but would pay for themselves in less than a year.
“You can always get better,” he says, noting that the hospital's LEED platinum certification was not the end of its journey. “To be the first in the world to do something good is pretty neat, but it's just how we do things now.”
Sweet agrees. “LEED building is just a way to get credit for making a smart building,” she says. “We should all be looking at ways to cut costs. The more we looked into it, the more sense it made.”