Kaiser seeks San Diego edge with super-green hospital

In 2011, Kaiser Permanente held a design competition for architects, engineers and students to submit their vision for the hospital of the future. The Small Hospital, Big Idea Competition resulted in over 100 proposals describing eco-conscious facilities that could leverage technology and sustainability in new ways to deliver high-quality healthcare.

Five years later, a hospital inspired by the competition's innovative designs is becoming a reality. On April 25, Kaiser will open its new 321-bed San Diego Medical Center, which has already achieved Leadership in Energy and Environmental Design platinum certification and raises the bar for green hospitals in California.

The 617,215-square-foot SDMC has a number of sustainability features such as photovoltaic panels, all-LED lighting, and a highly efficient on-site power plant. SDMC marks only the fourth healthcare facility in the world to be certified LEED platinum, the highest possible rating ahead of gold and silver.

The new center will likely make waves in the competitive San Diego healthcare market, where Kaiser has been trying to grow its footprint. The new facility will add over 100 beds to its total in the San Diego area, and they're expected to fill quickly as membership grows.

“The medical population has grown dramatically in San Diego under Obamacare, so the beds are getting filled,” said John Nackel, CEO of Three-Sixty Advisory Group in Pasadena, Calif. “Kaiser's plan has grown dramatically in the last 10 years, so it has actually fallen behind on hospital beds relative to membership.”

But the new hospital also raises questions for health systems aiming for the same high bar in sustainability: What are the added costs to build to LEED standards, and will Kaiser's investment in green technology pay off? Could a smaller, less well-off health system do the same?

“In terms of benefits, our whole purpose of building to LEED platinum is not so much to have bragging rights,” said Jodie Lesh, senior vice president of national delivery system strategy, planning and design at Kaiser Permanente. “We want to acknowledge that sustainability is an essential strategy of an organization like ours that is focused on improving the health of members, staff, and the entire community.”

At the heart of SDMC is its 60,478-square-foot energy center. The three-story building provides power to the hospital in two ways. Photovoltaic technology will produce 3% of the hospital's annual energy needs from 1,560 solar panels.

A so-called tri-generation power plant covers the rest and works by converting natural gas into electricity. It then repurposes the exhaust for heating and cooling to reduce energy costs and greenhouse gas emissions.

Within patient rooms, active chilled beam systems replace traditional air-based HVAC units to further lower energy requirements. Active chilled beam systems, already commonplace in Europe, use a combination of an air supply and coils filled with water to warm or cool the room.

The Small Hospital, Big Idea Competition also taught Lesh and her colleagues about the importance of designing a care environment that facilitates healing while blending into the surrounding community. For example, the SDMC campus has 4 acres with native plants, trees and stone to reflect the natural landscape of San Diego. All patient rooms have a direct view of the landscaped areas.

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.