The Business Case for Green Healthcare Facility Design                                                                        

“If you wish to sustain your body in good health, take care of the world. Your body is part of the world; so you cannot abuse the world, and still expect your body to remain well.
By treating the world well, you can be at peace with it. By being at peace with the world, you can be calm. By being calm, you can follow the Way.”

 CHUANG TZU

“Well body, well earth” – a phrase originating in the United States – tells us that our health and that of the world around us are one and the same thing. The earth is like family, and that means we are committing incest in our times. There are no taboo’s in today’s’ pursuit of happiness. Studied rapacity can be said to be the battle cry of material progress, bent knowledge.
 

“Food, clothing and shelter – roti, kapda aur makaan.” The production of all three affect the ecological balance, but of the three it is shelter – makaan – that is the worst offender. Healthcare facilities shelter healthcare activities, and surely the buildings that house these activities should take the lead in safeguarding the health of the community it serves and the world it is an integral part of.
 

Health care institutions’ core mission of protecting human health provides the basis for them to speak with their words and actions on the health implications of building construction and operation. The healthcare industry has a leadership opportunity to move the larger building industry to a healthier approach by demonstrating the best in healthy, sustainable design, construction, operations and maintenance practices in its own facilities.
 

I now quote from a report by the World Green Building Council:

“Research clearly shows that there are a large number of compelling benefits from building green, which are received by different stakeholders throughout the building life cycle. Yet, one issue that has remained controversial is whether it is possible to attach a financial value to the benefits of green buildings-crucial information for real estate lenders and the investment community. Do green buildings attract a financial premium in terms of rental and sales value? Are they more attractive to tenants and occupiers? Are employees occupying greener buildings more productive?”
 

 The rest of this excellent report goes on to prove that the answers to these questions are a resounding”yes!”

This report is titled “The Business Case for Green Building – A Review of the Costs and Benefits for Developers, Investors and Occupants” and is available at http://www.worldgbc.org/ for free download.
 

All of us in the healthcare industry know that hospitals are large consumers of energy and are responsible for a lot of the carbon dioxide emissions given off by buildings and the construction industry. There is also the huge amount of different types of waste produced by hospitals, some of it toxic.
 

Dumping all of these unhealthy types of waste into the environment isn’t what the mission of healthcare provision is about, not to mention the financial aspects (energy costs) associated with running facilities 24 x 7. Hippocrates said “First, do no harm.”
 

Energy usage, waste and costs can be reduced by sustainable design (green design) so why is it the healthcare community is not buying into it? The reason is there is a perception by those involved in the decision making process that the initial costs of building green were unacceptable.
 

The Commonwealth Fund says in its report, “Can Sustainable Hospitals Help Bend the Healthcare Cost Curve?”, that it’s been assumed by healthcare providers and healthcare facility design professionals that green design would cost more than any potential savings.
 

Based on the findings in its report, though, the organization says that concern is misplaced.

“Given the small interventional costs and positive return on investment for the interventions studied—as well as their broader environmental and public health benefits—we contend that all hospitals should implement these innovations,” the study states.
 

The traditional view is that green building features are add-ons. This view contends that building green naturally costs more than conventional construction because it uses premium materials, more efficient equipment and complications in the workflow.
 

As of today, healthcare providers and designers are coming to know that a focus on green design at the beginning of the process can facilitate building features that will provide environmental and social benefits without necessarily increasing costs. Take, for instance, this example: by just orienting a building correctly to optimize window openings and passive solar heat gain may result in lower energy usage and increased reliance on natural daylight which increases productivity of employees and accelerates the healing process in patients without adding any increase in the construction cost.
 

A green building approach can help the healthcare provider avoid expenses at the beginning of the project. The selection of air-conditioning equipment provides one example: if the design of the green building minimizes the wastage of heat through better choice of lighting equipment and has an energy efficient façade the hospital may require significantly less cooling capacity. This may mean the building could do with one less chiller and thus reduce the initial project cost substantially.
 

Another meaningful advantage of going green in healthcare facilities and for buildings in general for that matter is improved Indoor Air Quality (IAQ). Many chemicals used in the construction of buildings and in furniture, flooring and paint, to name a few, emit Volatile Organic Chemicals (VOC’s) which are harmful to human beings. This can lead to lower employee productivity and lower patient recovery periods in the case of hospitals. The use of appropriate finishing materials can greatly improve the IAQ.
 

In this area of workplace productivity and health, from a financial perspective there are clear incentives for improving employee health and productivity and patient outcomes. Allowing natural light to enter the building improves employee job satisfaction and patient health, decreasing their Average Length Of Stay (ALOS) and improvements in their healing process.
 

In Europe there is a growing trend to allow natural light into the Operation Theater (OT). This is not only because it has environmental benefits but also because natural light promotes better working environment for OT staff. Research has shown that natural light enhances mood, increases the alertness level of staff, decreases fatigue, reduces stress and improves the staff’s natural body rhythms. For hospital staff, best qualities, quality patient care and more natural light have shown to positively impact job satisfaction.
 

Operating costs too can be greatly reduced by sustainable design. One major area of savings is in their energy costs. Typically, energy savings attained through sustainable design will exceed any cost premiums associated with their design and construction within a reasonable payback period. This is the key test of green buildings, how they operate during the buildings occupancy phase.
 

Thus reduced operation and maintenance costs and productivity and health benefits are the major justification for added capital costs in the construction of green building. A research study found that an increase of 2% in construction costs of a project resulted in over ten times the savings over initial investments, based on a life cycle of 20 years for 33 LEED-rated projects in the United States.
 

Leadership in Energy and Environmental Design (LEED) is the green building certification program created by the United States Green Building Council. The comprehensive rating system(based on prerequisites and points) takes a whole building approach factoring in community resources and public transit, site characteristics, water efficiency, energy efficiency, materials and resources, indoor environmental quality, awareness and education and innovation.
 

A Platinum LEED rated hospital in Mumbai, India, (one of the few in the world), cut its energy costs by about 50% with a 15% increase in construction costs. The site did not provide any scope for cutting energy losses by orientation, like so many urban projects on high-cost real estate. Efficient facade design and efficient mechanical services design would have led to this saving, with an appropriate Building Management System.
 

In conclusion, a short note on the indirect economic benefits of green design to society as a whole:

We have seen that building construction as well as operation and even demolition have a wide range of environmental impacts. Air pollution, greenhouse gas emissions associated with climate change, the generation of solid waste, the reduction of natural resources and habitat disturbance of animals, birds, insects and plants all are caused largely by conventional building activity. Green or sustainable design is aimed at substantially reducing these impacts. The application of green principles will reduce the health effects associated with environmental pollution and will have other less quantifiable economic values to society. In addition to this, reducing energy consumption and the application of sustainable design provisions to the building industry and the generation of waste from buildings (especially hospitals) will in time reduce the infrastructure needed to support human habitats, such as power plants and related power distribution infrastructure and landfills. The economic aspects of these societal benefits make green or sustainable design the need of the day.
 

Healthcare facilities, as custodians of society’s health and well-being, are or should be the natural leaders in this sustainable design and operations effort. It falls to healthcare providers and healthcare facility design professionals to take the lead to make sure that “First, do no harm”.
 

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The author, Hussain Varawalla, is a healthcare facility planning and design professional, and is reachable at hussain@healthcarearchitecture.in