Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary (2007) / Chapter Skim
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Pages 59-100
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From page 59... ...
The primary themes of the sustainability vision are a healthy ecosystem context; healthy university function in the built environment; healthy university structures, leadership, and participation; healthy living, learning, and working communities; and education and research. Emory has initiated a plan for realizing a "sustainable architecture for health." There are currently 11 Leadership in Energy and Environmental Design (LEED)
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From page 60... ...
In the late 1990s, sustainable design and green building concepts were being tested on several new projects. In 2000, sustainable design elements were incorporated into the UF master plan and construction program documents.
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From page 61... ...
The unique and challenging aspect of the green buildings on our campus is that every building is different in size and function. Also, the university's FP&C has taken the lead to work with Shands Hospital on their new hospital construction to bring the hospital component into sustainable design.
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From page 62... ...
Natural materials were utilized as far as possible according to the LEED-NC version 2.2 registeredproject checklist, as such Rikshospitalet would probably achieve certification. Building Green Regardless of the scope of the definition of green building, it is imperative to seek the most important indicators in terms of individual, environmental, and community health.
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From page 63... ...
Rikshospitalet University Hospital Rikshospitalet -- built on a virgin site just outside the city center -- is a tertiary teaching and referral hospital, and covers all clinical specialties, except for geriatrics and psychiatry.
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From page 64... ...
Stress-Reducing Qualities The circulation artery, with its dense pedestrian traffic, integrated art, frequent art exhibitions and concerts, and access to a grand piano -- also for patients, obviously fills one important requirement for stress-reducing factors in hospital environments (Ulrich, 1991) : • A place for positive distractions in physical surroundings • Access to social support • A sense of control with respect to physical and social surroundings The low, nonfrightening appearance of the building volumes and frequent access to nature and daylight may contribute to a sense of control in patients and visitors.
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From page 65... ...
In terms of green building, there are still goals to be achieved.
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From page 66... ...
LEED green building rating system (USGB, 2006)
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From page 67... ...
Our experiences with that project and numerous others since then have confirmed that healthier buildings result from the adherence to four basic principles: • Source control (reducing the indoor chemical concentrations by reducing or eliminating the pollutant source) • Ventilation control (providing adequate ventilation to dissipate and purge the indoor air pollutants)
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From page 68... ...
We were concerned about the building's health impact on the library staff and patrons and incorporated IAQ into the project design criteria. We developed specifications limiting the emission of a few volatile organic compounds that were known to be odorous and have some health impacts, and we selected the building materials based on a careful analysis of technical data provided to us by the materials' manufacturers.
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From page 69... ...
We were requested by the state to give particular attention to delivering a building through the design-build process with good IAQ. We built on the previously prepared furniture procurement specifications and subsequently adapted their methodology for the building materials (Bernheim et al., 2002)
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From page 70... ...
The guidelines have been incorporated into the California Collaborative for HighPerformance Schools program, and they are referenced in the Green Guidelines for Health Care and the USGBC LEED green building rating system for new construction, version 2.2. Numerous building products, including ceiling tiles and floor materials, have been reformulated by their manufacturers to reduce chemical emissions based on these specifications, and more recently, many industry trade groups have developed or are in the process of developing certifications to indicate some level of compliance.
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From page 71... ...
With the unfolding of the 21st century, sustainable design and green buildings will become the norm rather than the exception as their design requirements and efficacy are better understood. When this happens, both global ecological health and individual health will have taken an enormous leap forward.
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From page 72... ...
The arena of positive psychology is highly relevant to patients, staff, and visitors in healthcare settings. As noted before, the links between health and sustainable design currently focus on improved physical health through improved indoor air quality and reduced exposure to airborne biological or chemical substances.
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From page 73... ...
Patient Outcomes Linked to Environmental Design Research in hospital settings shows that a number of environmental features identified in Table AB-1 are associated with improved patient health and wellbeing outcomes, including improved mood, improved sleep, reduced stress, lower pain levels, and reduced length of stay in the hospital (see extensive reviews of the literature in Rubin et al., 1998; Ulrich, 1991, 1999 ; Ulrich et al., 2004)
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From page 74... ...
in patient rooms to allow for breezes and connection to outdoor sounds Reduced light intensity or use of personal controls in patient rooms An aesthetically pleasing Reduced look and feel of an institutional setting through environment better use of color, sensory variation, interesting décor, natural materials, elements of surprise or novelty, and patterned complexity of features Opportunities for recreational Access to art materials and recreational spaces; music activities and art therapy; use of headphones to deliver music and reduce unwanted noise; flooring materials that aid movement (e.g., carpeting versus slippery floors) Connection to nature and Views of outdoor nature and sunlight; access to gardens natural processes and gardening; indoor sunlight Privacy Single occupancy rooms; privacy nooks; visually interesting screening or other moveable partitions at bedside Rest and recovery Reduced noise; presence of healing gardens and pleasant outdoor spaces; views of nature from bedside SOURCE: Heerwagen (2006, unpublished)
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From page 75... ...
As such, it suggests a system of design interventions and a rationale for their incorporation into hospital design. Hospitals need to do more than avoid harm.
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From page 76... ...
As Winston Churchill so aptly put it: "We shape our buildings, and then our buildings shape us." Why have our hospitals lost the connection to nature and the vitality that inspires the Rikshospitalet? Does sustainable design have the capacity to transform healthcare architecture?
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From page 77... ...
In this generation of healthcare construction, the technological advances in medicine and surgery drove larger and larger contiguous floor plates to accommodate the rigors and requirements of the machine. "Systems thinking" (note the diagrams alongside the Bellevue plan)
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From page 78... ...
Already, we can begin to see the programmatic impacts of these understandings. In design, evidence-based research into the impact of the built environment on therapeutic outcomes and the sustainable design movement are coalescing into a powerful new vision for healthcare architecture.
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From page 79... ...
The Metropolis magazine cover, in October 2003 proclaimed a truth many of us would rather not be reminded of: "Architects Pollute." The federal government recognizes these linkages when it defines green building as "the practice of increasing the efficiency with which buildings and their sites use energy, water, and materials, and reducing building impacts on human health and the environment through better siting, design, operation, maintenance and removal -- the complete building life cycle." In response to the need for a tool to assist in defining green buildings in the marketplace, the nonprofit U.S. Green Building Council (USGBC)
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From page 80... ...
• Healthcare construction is accomplished by a specialized segment of the architecture and design field that was relatively disconnected from the environmental building movement -- lack of education. The Green Guide for Health Care was developed to address the challenge of moving the green building agenda into health care.
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The Green Guide adopted ASHE green healthcare construction guidance statement of principles. It reaffirmed a principle of precaution, echoed in medicine and international sustainable design policy.
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What We Are Learning from the Green Guide Process First, the healthcare industry is largely uninformed about the explicit linkages between sustainable building strategies and human health. Pilot participants and registrants consistently report that the health issue and resource information contained in the Green Guide is important new information for many of them.
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From page 83... ...
. The initiatives that Kaiser Permanente has shown in using the power of their contract dollars to drive significant environmental improvements for building products is a shining example of the power of our collective voice for healthier, sustainable building materials.
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From page 84... ...
Green school design provides an extraordinarily cost-effective way to enhance student learning, reduce health costs and, ultimately, increase school quality and competitiveness at both the student and state level. The main reason for cities and states to adopt green building requirements is to cut costs, improve services, and address a broad array of challenges, such as • the high and rising cost of energy, • worsening power grid constraints and power quality problems, • increasing cost of waste, water, and waste disposal and associated costs of water pollution, • continuing state and federal pressure to cut air pollution, • rising concern about global warming, • reversing the alarming rise of asthma and allergies in children, and • increasing state competitiveness in quality-of-life indicators such as air and water quality, quality of schools, and the skills of its workforce.
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From page 85... ...
Green schools provide a range of additional benefits that were not quantified in this report, including reduced teacher sick days, reduced operations and maintenance costs, reduced insured and uninsured risks, improved power quality and reliability, increased state competitiveness, reduced social inequity, and educational enrichment. There is insufficient data to quantify these additional benefits, but they are significant and, if calculated, would substantially increase the recognized financial benefits of greening schools.
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From page 86... ...
Yes, there are hospitals in the country that incorporate significant environmentally sustainable improvements using green materials; optimizing energy performance; and reducing, reusing, and recycling chemicals and supplies. We decided to go well beyond that because our commitment to health care stretches from our hospitals' walls into the community and region in which our patients and families live.
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From page 87... ...
Moreover, we are creating a healthcare model for environmentally sustainable engineering in a city that is recognized as a leader in the worldwide green building movement. Pittsburgh is home to the world's first and largest certified green convention center -- the David L
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From page 88... ...
And, given the work being done at the University of Pittsburgh Cancer Institute and the Graduate School of Public Health, we are moving ahead in building relationships in multiple areas, including an environmentally preferable purchasing policy; reductions in the use of toxic chemicals, the consumption of water and energy, and the volume of all waste streams; improvements in indoor air quality and work atmosphere; and coordination of efforts to reduce all forms of pollution, including vehicle emissions. The measures that Pittsburgh's leaders took almost 60 years ago to clean up our region enables us throughout UPMC to promise a future where hospitals will be models of disease prevention and cure.
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From page 89... ...
This is why a certain amount of study and a team accustomed to rigor will be useful. The challenge to financial assumptions will require careful analysis and cautious budgeting that avoids overreliance on previous budget or cost models.
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From page 90... ...
The Indoor Environment Building-related comfort and health are directly related to indoor environmental quality, which is determined by combinations of temperature, temperature gradients, humidity, light, noise, odors, chemical pollutants, personal health, job or activity requirements in the building, and psychosocial factors. That is, buildings are complex dynamic systems of multiple interacting factors that determine the state of the system at any given time.
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From page 91... ...
. It is, therefore, difficult to draw a distinct line between a building with an unhealthy indoor environment and one in which a subset of building occupants appear to have heightened sensitivity to often poorly defined but ordinary environmental contaminant levels.
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From page 92... ...
Many of these compounds are not easily measured, yet they may be highly relevant in terms of health effects. Indoor Pollutants Associated with Building Operations and Maintenance Building design decisions can also influence which products are used in routine building operations and maintenance, and thus influence indoor environmental quality.
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From page 93... ...
Dampness and Humidity Building dampness can facilitate mold growth, particularly on surfaces with organic material that can serve as a nutrient source. MVOCs can also be emitted from heating, ventilation, and air-conditioning (HVAC)
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From page 94... ...
Building designers have an opportunity to influence worker and public environmental health through informed materials selection and attention to worker and social justice concerns. In addition, it is essential to begin to address explicitly the long-term public and environmental health impacts of healthcare activities themselves.
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From page 95... ...
And we buy the products that meet our grueling criteria. Building on a large scale does have its advantages, and we are using these advantages to facilitate a market transformation in green buildings for health care.
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From page 96... ...
In 2002 we used the ASHE Green Guidance statement as the foundation for our own eco toolkit, a document that links Kaiser Permanente's robust design standards program to the green practices identified in the ASHE statement. Today we are using the Green Guide for Healthcare (GGHC)
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From page 97... ...
NFS has a robust standards program to control quality, facilitate design, ensure operational efficiency, and promote our green buildings program. The national purchasing agreement
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From page 98... ...
We also included two other members of our green buildings committee: an outside architect and a representative from the Healthy Building Network. The team was charged with focusing on three main criteria in evaluating current and potential bidders: sustainability, product performance, and aesthetics.
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From page 99... ...
So the team focused on what companies were doing in their research and development to create an alternative to PVC and how likely they were to partner with Kaiser Permanente in that quest. Based on our analysis of the five companies, Kaiser Permanente did not renew the contract with one of the original two companies and added a new one.
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From page 100... ...
. Consumers, like us, would benefit from additional research on the health impacts of the products we use to build and maintain our facilities.
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