In the LEED

"And a children's hospital shall lead them …”

The first construction projects whose designs were influenced by the healthcare-specific standards under the Leadership in Energy and Environmental Design program—released in 2009—are just now being certified by the U.S. Green Building Council. The facility leading the way is Dell Children's Medical Center of Central Texas in Austin. In June, its new W.H. and Elaine McCarty South Tower was the first project to earn platinum certification—the program's highest honor—under the LEED for Healthcare standards. Back in 2008, the Seton Healthcare Family facility became the first hospital to earn LEED platinum certification under the previous criteria.

LEED recognizes environmentally friendly construction

and operation. Previously, most healthcare projects were certified under the same general LEED New Construction standards used to judge new schools, office buildings and shopping centers. A few were also certified under Commercial Interior or Core and Shell standards.

Prior to LEED for Healthcare, there were 564 LEED-certified healthcare projects. With each level representing a higher level of commitment to environmental sustainability, there were 149 projects achieving basic certification, 215 earning silver status, 180 earning gold certification and 20 making it to platinum. Out of the 20 platinum projects, only two were hospitals: the first being Dell Children's, certified in 2008; followed by Kiowa County Memorial Hospital, Greensburg, Kan., certified in 2011.

Michele Van Hyfte, Seton's network facilities manager of environmental stewardship, says the Seton executive leadership supported the effort to go for the highest level of certification—though she acknowledges that it was just sort of lucky timing that led to Dell Children's being the first to earn it under LEED for Healthcare.

Van Hyfte says the bed tower project was able to build upon the momentum created by the medical center's original platinum certification. She says that led to setting higher goals and adding additional components—such as installing a solar energy-producing array on the tower roof.

“The expectation was, 'You did it once, you're going to do it again,' so the team was completely empowered to do whatever they had to do to match that original level of excellence,” Van Hyfte says. “It was a nice way to continue the story … It was the cherry on top of the ice cream sundae when we were the first LEED platinum all over again.”

Though there are about 110 projects in the pipeline waiting to be scored, the only other facility so far to be certified under LEED for Healthcare is Group Health's Puyallup (Wash.) Medical Center, which earned gold-level certification.

Phil Giuntoli, principal with the Seattle design and architecture firm CollinsWoerman, explains that, for Group Health, being a good environmental steward is something they can market to the community to show they are practicing preventive medicine. “LEED certification is a demonstrable symbol that it is part of their brand,” he says.

Giuntoli says the new LEED for Healthcare, or LEED HC, scoring system takes into account the 24/7 365-days-a-year operation of a hospital and “acknowledged that healthcare has traditionally been an energy hog.”

Melissa Gallagher-Rogers, USGBC director of technical solutions, says LEED points are given for construction projects that are in more densely populated areas where public transit is available, but the trend in healthcare is to build in more open, suburban locations that are mainly accessed by car. So, she says, the new system reduced the focus on location and public-transit access and increased the focus on indoor environment and energy conservation.

There was some controversy—or “healthy discussion,” as Gallagher-Rogers describes it—about the indoor environment scores, as some LEED advocates wanted there to be “sticks,” or score subtractions, for using products with toxic materials. But the USGBC went instead for a “material ingredient optimization” system of “carrots” that rewarded facilities for using materials with low or no toxicity.

“We are always working with tension between what the market is ready for and aspirational goals,” she says.

Under LEED HC, there are 18 possible points for building on a sustainable site, which includes access to public transit, reusing a previously developed site (known as a “brownfield”) or protecting or restoring natural areas; nine possible points for water efficiency; 39 possible points in the energy and atmosphere category; 16 possible points in the materials and resources category; 18 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 HC certification requires between 40 and 49 points; silver-level certification requires between 50 and 59 points; gold, 60-79; and platinum, 80 and above. Puyallup Medical Center earned a score of 60 while the Dell Children's tower had an 86.

For Dell Children's and Puyallup, the timing worked out fine. LEED HC came online as those projects were just being developed. But architects for several other projects, such as the Nemours Children's Hospital in Orlando, Fla., were faced with a decision of whether to switch midstream to designing for the arguably more relevant LEED HC system or stick with designing to the original new construction standards.

The new Nemours Children's Hospital opened last October and was certified LEED gold in July under the original new construction standards. Michael Cluff, staff architect for the Nemours system, says design work began on the project in 2007 and was well underway when the LEED HC standards came out in 2009. He says a side-by-side comparison of the two systems was done and it was determined that there would be no significant difference in the project's LEED score if it changed from the previous criteria to LEED HC. So executives decided that switching at that point would serve only to generate a lot of paperwork.

Cluff remains a supporter of the LEED program in general, explaining that it “set the tone for the design and construction of the project from the beginning.” But, he adds, achieving a certain score under a certain system was not the motivation behind designing an environmentally sustainable facility. “Our goal was that you didn't have to say which credits we received and didn't receive, just that—when you walked in the building—you knew it was different,” he says.

Kaiser Permanente's Westside Medical Center in Hillsboro, Ore., opened Aug. 6 and already earned gold certification under the previous LEED criteria. It's the integrated healthcare mega-system's first LEED gold hospital and now there will be no turning back. Kaiser has committed to seeking a minimum of LEED HC gold certification for all its new hospitals and major construction projects where the criteria would be applicable. And its plans call for building $30 billion worth of new facilities over the next 10 years.

Though it can be difficult to track how much LEED design elements add to a facility's price tag, Kaiser Chief Energy Officer Ramé Hemstreet says, in general, the additional first costs of pursuing LEED certification account for less than 1% of the expense of a construction project, with payback from energy and water utility savings coming within four to five years and a fivefold return on investment being realized over the life of a building.

Hemstreet adds that Kaiser's goal is to reduce its carbon footprint 30% by 2020. This involves reducing the 850,000 metric tons of greenhouse gases its facilities produced in 2008 to 600,000. “That's a fairly ambitious goal if you consider that, in the meantime, we're adding additional facilities,” he says, explaining that strategies to increase both energy efficiency and generating renewable energy will be used.

In Hawaii, for example, Kaiser plans to install solar energy equipment at seven existing facilities and at one under construction. It's expected that solar power will account for 10% of the energy needs for those eight facilities. Ground hasn't been broken for the new 321-bed Kaiser Permanente San Diego Central Hospital Medical Center, but Hemstreet says that—when it's completed in 2017—it will be the site of many environmental innovations such as active chilled beam technology, which provides more-efficient cooling at a facility.

Hemstreet says LEED standards past and present serve as a guide for Kaiser's environmental agenda, but they do so without maintaining a hard line on how to reach sustainability goals.

“The worst thing you can do is be proscriptive in how you're going to achieve it,” he says. “I think LEED gets us to 95% of where we want to be.”

Seton's Van Hyfte agrees, adding that healthcare architecture is being redefined and LEED HC certification is influencing how that's being done.

“We wanted the healthiest environment possible for the healing process,” she says of Dell Children's new platinum-certified tower. “The goals that we set for this project were very much in alignment with LEED for Healthcare.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks