Rendering Credit: BBH Design
American healthcare's financial trajectory is unsustainable. According to CMS, the nation's spending on healthcare increased from $2.34 trillion to $2.47 trillion from 2008 to 2009, and is predicted to increase another 80% by 2019. Every year we spend $16 billion on new healthcare facilities. If all of these facilities were high performance buildings, the healthcare system would literally save billions of dollars. All that is needed is for the systems to rethink the way their buildings are designed and constructed. From a purely business perspective, it is the single number one way to cut spending as well as the easiest and most readily available.
Graphic Credit: BBH-Design
Nearly 99 percent of all hospitals in the United States are not green. Yet, they could, and frankly, should be. Because they are not, thousands of healthcare facilities have bad indoor air quality, use noxious building materials, over consume energy & water and are not ideal for you to visit. You are more likely to come into contact with toxic metals and chemicals in hospitals than any other building type. The medical profession has only recently started to view green building as a real option.
The Beginning of a Green Hospital
Back in 2008, I began working with a team of designers, architects and engineers on a hospital called UPMC-East in the town of Monroeville, Pennsylvania (pop. 29,430), a suburb of Pittsburgh. Monroeville gained a level of fame for being the location of the 1978 cult classic Dawn of the Dead. The project became proof positive that green is the best way to build healthier, more energy efficient and greener healthcare facilities. Now that the project well into construction, I thought it was time to share some of what we did as well as how we did it by while not increasing the budget.
Photo Credit: BBH-Design
When I came onto the project, the client had committed to making the project a LEED Certified building. Like many people, they had seen all the stories reporting that going green cost more. So the first thing I discussed with the team is how we could make the project greener than their expectations AND not increase the budget. For one, green having a higher cost than conventional construction is a myth today and not a reality. At one time, sustainability did take more cash, but lots has changed from those early days. With UPMC East, it was designed without using high tech, expensive gadgets and gizmos (the things that usually bring with them an up-charge). Instead, it was accomplished with teamwork, experience and dedication to good design - things that don't cost more. Our approach eliminated additional expenses to the point when asked about the payback for the innovative features, the answer was that "there was no additional upfront cost, you start saving money from day one".
Green Design Doesn't Have to Cost More
Honestly, why should anyone paying more when it's not necessary? Energy is one of the largest expenses for healthcare facilities. They use double the amount of energy per square foot than office buildings. The healthcare industry spends $6.5 billion on energy each year which in turn is passed along to the consumer. Through sustainable design, energy reductions of 12 to 20 percent are achievable. As the green product market matures, greater energy savings will be possible for a minimal capital investment. Moreover, if the entire industry redesigned their buildings to save 20 percent on energy that would translate to a billion dollars in savings each year. Not doing so is money down the drain. For UPMC East, we were able to cut their energy usage by nearly 16 percent meaning hundreds of thousands of dollars saved every year.
Graphic Credit: BBH-Design
Water is another critical area needing attention. A study from 2002 shows that water use per bed for small hospitals ranges from 70,000 to 300,000 gallons per bed per year. Through sustainable design, reductions of 20 30% are feasible which also means hundreds of thousands of dollars in savings for facility. Less water usage means less energy used to heat domestic hot water thereby increasing energy savings and further accelerating the financial benefits of green design. Initial calculations for water reduction at UPMC East accomplished a 30 percent reduction within the defined budget of the client. One of the biggest issues with hospitals is that they are often designed to be over-indulgently flexible.
Flexibility isn't Always a Good Thing
Adaptability is a positive with some building types like offices or apartment buildings, but best intentions in healthcare make for larger than necessary patient rooms and treatment spaces adding tens of millions of dollars to construction. For every square foot not built is savings for construction and energy costs. All of the extra square footage has to be maintained, heated, cooled and ventilated which demands both resources and money. Hospitals cost on average $300 to $600 per square foot to build. Right sizing healthcare will reduce development costs by as much as 15 percent. We enacted right sizing for the patient rooms in the Monroeville project to maximize effectiveness of spaces and comfort for staff, visitors and patients. To push the design to actually work the best it could, a full scale mock up of a patient room was built to verify special relationships. The reduction of square footage helped us reduce the size of HVAC systems that had a direct positive effect on operational savings.
Photo Credit: BBH-Design
The US government estimates that 75 percent of our healthcare spending is tied to managing chronic disease. Typical hospitals do not help this situation. Their interior spaces are laden with toxins such as lead, mercury, cadmium and dioxins. Yet, alternatives for nearly all toxic materials that typically go into hospitals are available in every region across the country. It has taken a green revolution for these options to be seen as practical. Greening healthcare allows us to reduce our exposure to elements that cause the sickness that we spend so much to cure. Of all the things we did to improve the indoor air quality of UPMC East, selecting better materials was the easiest for interiors. We also dedicated time to choosing the best materials for the exterior and skin design. By using computational analysis, we orchestrated the many parts that will go into the envelope to be highly efficient and cost effective. The Pittsburgh metropolitan area is blessed with manufacturing. There is a large variety of local materials to pick from in the area - from brick to steel to glass to flooring.
Healthcare is a Big Part of the US GDP
The healthcare industry is 16 percent of the US gross domestic product. It has outpaced every other nation in the world. We are forced to reconsider this trajectory as our nation continues to be plagued by increasing public health issues, ecological crises, and increasing costs to treat our health issues. Green design is not a fix all for the industry but with potential savings measuring in the billions of dollars, it is good medicine. No space age technologies are needed for huge savings. Only a committed healthcare provider and an experienced green design team can help reshape the healthcare sector in the United States. A healthy nation is an asset and the foundation to the country's future.
(This article was co-written by Timothy J. Spence, AIA, LEED AP BD+C, Principal and Healthcare Studio Lead at BBH Design)