Texas Architect

Sustainable Healthcare Design

Gail Vittori is co-author of Sustainable Healthcare Architecture (Wiley Press, 2008) with Robin Guenther, FAIA. As co-director of the Center for Maximum Potential Building Systems, Vittori also helped develop the Green Guide for Health Care (www.gghc.org) and chairs the U.S. Green Building Council's LEED for Healthcare Committee. TA Editor Stephen Sharpe recently interviewed Vittori about her book and her purpose in writing it.

Healthcare holds a pivotal role in the civic realm. The U.S. healthcare sector represents about 17 percent of the gross national product; in 2007, there was more than 100 million square feet of healthcare-related construction activity representing about $23.7 billion. However, as green building has taken a front seat within the commercial office and residential sectors, healthcare has been a slower adopter. Our book is an effort to reconnect the healthcare sector with the intrinsic links between sustainable architecture and healthcare's mission of health and healing, and to profile the burgeoning activity in the U.S. and internationally that represents a template for 21st-century healthcare design.

For our earlier work on the Green Guide for Health Care, we developed the phrase "high performance healing environments" as a way to convey the breadth and depth of sustainability in the context of healthcare facilities. While "high performance" speaks to building operations, addressing quantified performance metrics such as energy and water use, "healing environments" introduces the significant attribute of healthcare facilities as places for healing-for the patients to heal, for staff to deliver healing services, for the building to contribute to ecological healing on the site, community, and global scales. So the framing of health and healing extends from the facility and what happens inside the walls to the much broader scope. When one thinks of healthcare facilities, it is often as places to take care of sick people. Think, instead, how healthcare facilities could evolve to serve the more pivotal civic role of promoting health and healing. There is an intrinsic humanism in healthcare facilities and we want to honor and celebrate that.

One reason why healthcare has lagged behind other sectors in terms of integrating sustainable design materials and methods is that it is highly regulated-some say over-regulated. There are legitimate concerns about infection control and protection of immunocompromised patients. Healthcare is also distinguished from other sectors in terms of energy intensity-it is the second most intensive building type, with more than two times the energy use per square foot than commercial office buildings, so it has a major role to play in addressing climate change. In terms of healing environments, it is clear that the health benefits that have been linked to access to views and daylight are enormously beneficial to patients and staff. In a way, it is hard to justify, based on what we understand today, how our society can allow healthcare facilities to be designed without ensuring that views of nature and daylight are accessible to patients and staff.

When I started work in the healthcare sector in 2000, I literally was unable to find a single reference to green or sustainable healthcare in the U.S. using Internet search engines. A lot has happened in a short period of time. For example, beginning in 2002, the Green Guide for Health Care, a project of Center for Maximum Potential Building Systems and Practice Greenhealth, developed a voluntary, self-certifying best practices toolkit to introduce green building design, construction, and operational strategies to the healthcare sector, based on the US Green Building Council's LEED framework, with the USGBC's permission. Today, the Green Guide has more than 17,000 Web site registrants, representing every state in the U.S., every Canadian province, and more than 80 countries internationally. In addition, there are more than 130 Green Guide-registered projects, representing more than 35 million square feet, and more than 20 LEEDcertified healthcare facilities – including Providence Newberg Medical Center in Newberg, Ore., which achieved LEED Gold – and more than 130 LEED-registered healthcare facilities. As the stakeholders of healthcare facilities better understand the relationship between green building, health and healing, and the corresponding economic benefits, sustainable healthcare architecture is destined to be embraced and adopted as standard practice. No one will be able not to go down that road.

LEED for Healthcare is in development now. As with other LEED rating systems, LEED for Healthcare will provide a template for strategies that together address the opportunities to elevate the environmental and health performance of the built environment. LEED provides a common language for building designers, users, and the community to create a shared vision of what is possible and then to collectively gauge progress through design, construction, and operations. We have already seen widespread adoption of LEED in other building sectors. The Green Guide for Health Care has been a point of entry for healthcare specialits interested in learning more about green building practices as they apply specifically to this complex environment, and especially as they relate to healthier indoor environments and reduced cost and environmental footprints associated with energy use and water efficiency. Imagine the next generation of healthcare facilities that are connected to nature, offer abundant views and natural daylight, are built with non-toxic materials, and make people feel good.

Dell Children’s Medical Center in Austin is featured on pages 34-37. (left and below) RMJM Hillier’s design for Alexandra Hospital at Yishun in Singapore, scheduled to open in 2009, reduces energy costs significantly through use of shading devices, green roofs and walls, cross ventilation, and a high-performance exterior envelope. (far right) Providence Newberg Medical Center near Portland, Ore., designed by Mahlum Architects, achieved LEED gold certification following its 2006 completion.