Minimizing environmental and health impacts through informed design
Hospitals exist to help heal the sick and create healthier communities, yet many traditional practices in construction and operations can have potential consequences for the environment. To boost the life-saving and life-sustaining potential of healthcare facilities, many hospitals are finding solutions that create healthier, more natural surroundings that positively impact the environment as well as the health and well-being of patients, healthcare workers and the surrounding community.
Designing for Better Outcomes
Over the past two decades, The Center for Health Design, along with environmental research programs at Georgia Tech, Texas A&M and Cornell University, have produced hard evidence linking health outcomes to the design of the healthcare environment, says Julie Kent, manager of facilities planning and sourcing for the Capital Project Management department at Trinity Health, and a member of HealthTrust’s Facility Infrastructure Advisory Board.
Kent cites Saint Alphonsus Medical Center in Nampa, Idaho, as an example of a people-centered hospital that was designed to optimize the user experience from the front door to the point of care. During the earliest phase of the project, a multidisciplinary project team established a set of “ideal state design criteria” that was used to evaluate design options, including: quality (standardized space and ease of use); vitality (efficient processes, operations, facilities and energy use); and growth (flexible, adaptable and expandable facilities).
“The physical environments that surround us have a direct influence on our physiological condition, contributing to our emotional state of mind, stress levels, heart rates and the ability of the body to heal itself,” Kent says. “By focusing on people-centered environmental design, we can influence positive outcomes with fewer patient infections, lower pain levels, shorter lengths of stay and more engaged family members.”
Healthcare facilities across the country are implementing new solutions based on evidence-based design, lean process improvement and energy-saving methodologies, Kent says. With these tools in hand, healthcare providers are working to develop and operate a healthcare environment that is centered on improving outcomes in terms of safety, satisfaction, operational efficiency and energy savings. To support these efforts, many healthcare organizations are participating in national programs such as the Healthier Hospitals Initiative (HHI), Pebble Project, and Leadership in Energy & Environmental Design (LEED). In return, these organizations are collecting and publishing post-occupancy data to further contribute to the knowledge base and highight the importance of environment sustainability.
“We are finally starting to see the roots of informed design taking hold at the corporate level of large, national health systems,” Kent says. “The next 20 years will bring a transformational change in environmental design, creating environments that protect, heal and optimize human and operational outcomes.”
Improving Environmental Stewardship
In the past, leaders in the environmental movement didn’t show how environmental consequences were linked to health outcomes. Workplaces were encouraged to become environmentally conscious “because it’s a good thing to do,” says Robin Guenther, FAIA, principal architect at New York-based Perkins+Will and senior advisor to Health Care Without Harm, an international coalition of hospitals and healthcare systems committed to environmentally responsible healthcare.
Now, publications like The Green Guide to Healthcare, a project established in 2002 by the Center for Maximum Potential Building Systems, and organizations such as Health Care Without Harm and Practice Greenhealth, are helping make the connection between ecological health and human health.
“If you’re not conserving energy; if you’re putting pharmaceuticals down the drain; if you’re buying PVC tubing—those actions have direct impacts,” Guenther says. “We shouldn’t shame ourselves, but we should acknowledge the world is changing and that we are now more capable of understanding the consequences and acting to counter them.”
At this point, many hospital leaders start to see dollar signs—more dollar signs than they care to spend. But that’s looking at the problem all wrong, according to Guenther.
“It’s not money that prevents us; it’s mindset,” she said in a 2014 TEDMED talk on the topic. “Many of these solutions are cost neutral or actually generate financial savings. The reason we don’t do these things is sometimes … it’s difficult to see the harm, or sometimes it’s just more comfortable to continue to design and operate as we always have.”
The level of commitment to environmental stewardship and building a better healthcare environment looks different depending on the hospital, but the progress is widespread and encouraging.
Hospitals in the Midwest and Great Lakes regions are focusing on water conservation and water quality projects because those are the types of topics featured in the local news, Guenther says. For instance, instead of allowing dairy manure to run off into the water supply, Gundersen Health Systems, a regional IDN based in La Crosse, Wisconsin, undertook an energy project to harvest methane from manure. Other facilities are building so-called restorative hospitals to better connect patients to nature and their surroundings, or utilizing healthier materials and cleaning supplies to help improve air quality.
In areas where power grids are overburdened, hospitals are instead focusing on conserving energy. In 2008, Gundersen approached a nearby brewery about the possibility of harvesting energy from its waste. While the partnership with the brewery wasn’t particularly effective at producing low-cost energy, it was an important first step toward the goal of being the first healthcare system in the nation to achieve energy independence. Last November, Gundersen earned that distinction, thanks to innovative community programs like dairy digesters, wind turbines and a landfill gas-to-energy initiative. S
Creating a Living Workspace for Healthcare
Traditional healthcare workspaces were designed for individual work rather than teamwork, says Ross Westlake, national accounts manager at Herman Miller Healthcare. The emphasis used to be on installing barriers between patients and clinicians and between doctors and nurses. But today’s changing healthcare models are focused on collaboration and communication and teams working together—rendering traditional workspaces less useful or comfortable.
Facilities aiming to create an effective healthcare environment must pay attention to the workspace needs of practitioners. Westlake offers five tips for reconfiguring workspaces that won’t cost a lot of money:
1. Develop workspace principles. Before changing workspaces, develop specific guidelines for your design. For instance, if your goal is to become the most patient-centered hospital—or the safest or most sustainable—that focus will inform your design.
2. Make workspace decisions thoughtfully. For instance, the design of a caregiver station must consider visibility and flow, as well as the activity that takes place there. Use guided simulations, or allow nurses and doctors to practice some of the work they do in a proposed workspace layout before implementing it.
3. Consider recent research. While traditional hospital workstations were designed mostly for seated work, recent research shows that much of the work nurses do is of shorter duration, lasting two minutes or less. For such short tasks, people are unlikely to sit down. “Today’s workstations must find a balance between collaboration and privacy, between digital communication and face-to-face communication options,” he says. Standing desks in private spaces and modular systems with interconnected parts in open, public spaces might be good options.
4. Ask for guided input. It’s important to solicit clinicians’ feedback when redesigning their workspaces, but you may get better results by involving them in a guided rather than an open-ended way. “It’s better to have a framework or structure to begin with, explaining basic needs and options for how they have been addressed in other situations,” Westlake says. “Engage clinicians in a conversation rather than just asking them for a list of what they want.”
5. Create workspace flexibility. To the extent possible, utilize adaptive, reconfigurable workspaces. “If it’s nailed down to the floor, it’s really difficult to change and you probably won’t take the time,” Westlake says. “But if it’s adaptive, workers can adjust the space to particular needs.”
Eco-friendly Product Options for HealthTrust Members
For facilities interested in being more environmentally conscious, HealthTrust offers a number of products that are environmentally friendly to produce, incorporate features abundant in nature and are easy to maintain and recycle, says Jenna Thomas, former senior director of Facility Infrastructure Solutions for HealthTrust. Some of the HealthTrust-negotiated contracts and products include:
Flooring
Teknoflor from Shannon Specialty Flooring is made with up to 71.9 percent post-consumer recycled material and requires no waxing or buffing, so no dust or bacteria are dispersed during cleaning and there are no odors from floor care products.
As a leading innovator of sustainable rubber flooring systems, Nora flooring products are GREENGUARD Gold Certified for low VOC emissions. Nora flooring products are made with natural rubber, a rapidly renewable raw material extracted from the sap of a tropical rubber plant.
In addition to its commitment to include recyclable materials into its vinyl composition tile (VCT), Mannington also has a responsible end-of-life plan for all products it manufactures. Mannington’s LOOP reclamation program takes post-consumer VCT and closed-loop recycles it back into VCT. Regional reclamation partnerships keep the program’s environmental footprint small and new products cost-neutral to members.
Furnishings
In an effort to support a healthy healing environment, furniture manufacturers are using safer chemicals and sustainable materials. Many products are designed and manufactured with recycled content, and free from toxic flame retardant chemicals. HealthTrust is contracted with industry- leading furniture brands such as Steelcase, Knoll and Herman Miller that offer eco-friendly furniture lines to members along with design assistance and end-user education and training.
Construction Materials
Tremco Roofing offers a number of building envelope solutions that include sustainability options to extend roof life. Roof restoration with the AlphaGuard family of fluid-applied roofing systems provides a fully warranted waterproofing system that can cost one-half to one-third that of a replacement roof. AlphaGuard’s standard white surface can help lower energy consumption, and restoration keeps thousands of pounds of roofing waste out of landfills.
Cummins Power Generation products include diesel and alternative-fueled electrical generator sets from 2.5 to 3,500 kW, alternators from 0.6 KVA to 30,000 KVA, transfer switches from 40 amps to 3,000 amps, paralleling switchgear and generator set controls. Cummins can help HealthTrust members design a power generation system that meets the needs of their facility, region and sustainability goals.
To find out more about these options, contact your HealthTrust account director.
Share Email
