The platinum standard: Hospitals shoot for the top score in green construction and design

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 Shore-LIJ 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.