Other LEED features include 100% LED lighting, reclaimed water for landscaping and cooling towers, and over 2 miles of walking paths surrounding the building.
SDMC overall has 30% lower energy consumption than the system's other hospitals, according to Joe Stasney, Kaiser's national director for hospital design and construction. The biggest surprise? The $850 million hospital didn't cost any more to build than a facility without the green features.
“If you start thinking about building to LEED platinum at the very beginning-and you utilize efficiency, goals and teamwork-it doesn't cost any more money,” Stasney said. “Our project here is tracking underneath a hospital we built three years ago, on a cost per square foot basis. Costwise, we are spending less than some of the buildings we've built in the past that hadn't even attained gold.”
However, this may be more of an exception rather than the rule. Hessam Sadatsafavi, a postdoctoral associate at Cornell University's department of design and environmental analysis and the Cornell Institute for Health Futures, said the capital cost premium for a LEED platinum hospital can be up to 5%. The premium can vary depending on its size, location of the facility and LEED experience of the team.
“From a purely financial perspective, and only looking at facility operation and maintenance costs, pursuing LEED certification is a high-risk investment,” Sadatsafavi said. “Financially well-off systems are probably in a better position to accept/manage the risk of such investments.”
His recent analysis of 32 LEED-certified U.S. hospitals found that the annual operation and maintenance costs of most were not any lower than those of non-LEED facilities of comparable type, ownership and location. While previous studies of other facility types such as hotels and office buildings have shown a positive return-on-investment over time, his study of healthcare facilities failed to prove that LEED certification will result in a financial return.
But the potential benefits of LEED credits can go beyond the bottom line. Improvements in patient and staff satisfaction, tax credits and incentives, and branding advantages have been cited as indirect benefits for a green hospital.
“Research shows that employees like working in green buildings,” Nackel said. “They tend to have more features that are employee-friendly, so you get a residual impact of having happy employees, and anytime you have happier employees, you have lower turnover.”
The motivation to build SDMC came from increased demand coupled with not enough beds. Under the Affordable Care Act, Kaiser's care population had grown beyond its existing hospital in San Diego County.
“We have an older hospital that has been in place for 40 years-Zion Medical Center, which is about 5 miles away from the new hospital-but our membership outgrew it,” said Dr. Michael Lalich, area medical director and chief of staff for Kaiser Permanente San Diego.
The 406-bed Zion Medical Center is currently under renovation as it transitions to 266 private rooms, so the opening of SDMC also prevents any shortage of care.
Nackel believes the new facility makes good business sense, beyond the LEED aspects. San Diego is a competitive, but consolidated, market dominated by Sharp HealthCare, Scripps Health and Kaiser. With SDMC, Kaiser will continue to gain market share in San Diego County, and he foresees all the new beds will quickly fill.
“They have strong market share, with one advantage that Scripps and Sharp don't have,” Nackel said. “The vast majority of their population is employed and healthier compared to a Sharp or Scripps, who might have larger Medicaid and unemployed populations.”
Given the successful rollout, Kaiser plans to use SDMC as a template for future hospitals, including one in Sacramento that it also plans to build to LEED platinum.