Sustainable Healthcare Architecture Second Edition Sustainable Healthcare Architecture Second Edition Robin Guenther, FAIA, LEED AP and Gail Vittori, LEED Fellow Cover image: HMC Architects Cover design: Michael Rutkowski This book is printed on acid-free paper. Copyright © 2013 by John Wiley & Sons, Inc. All rights reserved Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Sec- tion 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Pub- lisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright. com. 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Hospital architecture—Environmental aspects. 2. Health facilities—Design and construction— Environmental aspects. 3. Sustainable architecture. I. Vittori, Gail. II. Title. RA967.G827 2013 725’.51—dc23 2013004583 Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 “Our lives are touched by those who lived centuries ago, and we hope that our lives will mean something to those who will live centuries from now. It’s a great ‘chain of being,’ someone once told me, and I think our job is to hope, to dream and to do the best we can to hold up our small segment of that chain.” Dorothy Day For Perry Gunther and Pliny Fisk III CONTENTS Foreword xiii Acknowledgments xv Key Sustainability Indicators and Infographic xvii PART 1 CONTEXT 1 CHAPTER 1 DESIGN AND STEWARDSHIP 3 INTRODUCTION 3 THE CASE FOR STEWARDSHIP 4 SUSTAINABLE DEVELOPMENT 7 THE PROFESSION OF ARCHITECTURE 7 THE ETHICAL CHALLENGE FOR DESIGNERS 10 ECOLOGICAL DESIGN 10 CLEANER PRODUCTION 11 THE PATRICK H. DOLLARD DISCOVERY HEALTH CENTER 12 LIFE CYCLE THINKING 14 CRADLE-TO-CRADLE DESIGN 16 LIVING BUILDINGS 17 ESSAY LIVING BUILDINGS AND A RESTORATIVE FUTURE by Jason F. McLennan 18 CONCLUSION—THE NEXT GENERATION 21 CHAPTER 2 THE BUILT ENVIRONMENT AND HUMAN HEALTH 23 INTRODUCTION 23 THE GLOBAL IMPACTS OF THE BUILT ENVIRONMENT 24 CLIMATE CHANGE AND PUBLIC HEALTH 25 ESSAY WHERE WE HEAL: THE IMPORTANCE OF HEALTHCARE BUILDINGS TO OUR HEALTH AND THE PLANET’S by Aaron Bernstein, MD, MPH 27 URBAN PLANNING AND PUBLIC HEALTH 28 SPRAWL AND AIR QUALITY 31 SMART GROWTH AND HEALTHY CITIES 32 vii viii Contents ACTIVE DESIGN 33 ESSAY ACTIVE DESIGN: CONVERGING DESIGN EFFORTS TO PROMOTE ENVIRONMENTAL SUSTAINABILITY AND ADDRESS TODAY’S LEADING CAUSES OF DEATH by Karen K. Lee, MD and Joyce S. Lee, FAIA 34 AIR POLLUTION 36 WATER POLLUTION AND SCARCITY 38 GAVIOTAS HOSPITAL 40 INDOOR AIR QUALITY 41 CONCLUSION—THE FUTURE 41 CHAPTER 3 ENVIRONMENT AND MEDICINE 45 INTRODUCTION 45 THE STATE OF HEALTH IN THE WORLD 46 ENVIRONMENTAL HEALTH 47 ECOLOGICAL MEDICINE 49 PROTEA HEALTH 52 HEALTHCARE AND THE ENVIRONMENT 54 ESSAY TRANSFORMING HEALTHCARE by Gary Cohen 55 THE PRECAUTIONARY PRINCIPLE 59 MEDICINE’S ROLE IN ENVIRONMENTAL IMPROVEMENT 59 CONCLUSION 60 CHAPTER 4 NATURE AND HEALING 65 INTRODUCTION 65 THE TRADITION OF NATURE AND HEALING 66 THE THERAPEUTIC SPA MOVEMENT 66 NATURE RECONSIDERED 67 BIOPHILIA 68 BIOPHILIC DESIGN PRINCIPLES 69 URBANIZATION AND NATURE 70 LANDSCAPE PERCEPTION 70 HEALING LANDSCAPE 70 SIDNEY AND LOIS ESKENAZI HOSPITAL AND HEALTH CAMPUS 72 SUSTAINABLE LANDSCAPE 78 CONCLUSION 79 Contents ix PART 2 ACTUALIZING THE VISION 81 CHAPTER 5 IMPROVING PERFORMANCE 83 INTRODUCTION 83 TOOLS AND METRICS 84 LESSONS LEARNED FROM PIONEERS 95 POST OCCUPANCY EVALUATION—PROVIDENCE NEWBERG MEDICAL CENTER 96 POST OCCUPANCY EVALUATION—DELL CHILDREN’S MEDICAL CENTER OF CENTRAL TEXAS 97 RESOURCE EFFICIENCY 98 ESSAY ENERGY STAR®: IT’S NOT JUST A SCORE; IT’S A GOAL AND A STRATEGY by Clark Reed 101 LEGACY SALMON CREEK 104 ENERGY END USE MONITORING 105 ESSAY TARGETING 100! by Heather Burpee and Joel Loveland 105 THE TOXIC-FREE HOSPITAL 119 ESSAY THE PBT-FREE CHALLENGE by Tom Lent 121 TOOLS FOR DESIGNERS AND SPECIFIERS TO DE-SELECT TOXICANTS 124 VISUALIZING THE PATH AHEAD 125 CONCLUSION 126 CASE STUDIES 01 Dell Children’s Medical Center of Central Texas, Austin, TX 127 02 OHSU Center for Health and Healing, Portland, OR 131 03 Peace Island Medical Center, Friday Harbor, San Juan Island, WA 134 04 Sherman Hospital, Elgin, IL 137 05 Kiowa County Memorial Hospital, Greensburg, KS 139 06 Kohinoor Hospital, Mumbai, India 141 07 The Dyson Centre for Neonatal Care, Royal United Hospital, Bath, England 144 08 St. Mary’s Hospital Sechelt Addition, Sechelt, BC, Canada 146 09 New Karolinska Solna University Hospital, Stockholm County, Sweden 148 10 UCSF Medical Center at Mission Bay, San Francisco, CA 151 11 Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA 154 CHAPTER 6 MEASURING VALUE 161 INTRODUCTION 161 HEALTHCARE AND THE TRIPLE BOTTOM LINE 162 x Contents THE ECONOMICS OF SUSTAINABLE HEALTHCARE 163 ESSAY LEED CERTIFIED HOSPITALS: PERSPECTIVES ON CAPITAL COST PREMIUMS AND OPERATIONAL BENEFITS by Breeze Glazer, Robin Guenther, and Gail Vittori 166 TRADING CAPITAL COST FOR OPERATIONAL SAVINGS 174 CROSSING THE CAPITAL-OPERATIONS CHASM: PROVIDENCE HEALTH & SERVICES 175 CAN SUSTAINABLE HOSPITALS BEND THE HEALTH CARE COST CURVE? 176 THE SOCIAL VALUE OF SUSTAINABLE HEALTHCARE 177 DELL CHILDREN’S MEDICAL CENTER OF CENTRAL TEXAS POST-OCCUPANCY EVALUATION 178 THE LIVING BUILDING FINANCIAL STUDY 180 CONCLUSION 183 CHAPTER 7 LESSONS FROM HEALTH SYSTEMS 185 UNITED KINGDOM’S NATIONAL HEALTH SERVICE 185 GUY’S HOSPITAL TOWER, LONDON 191 CASE STUDIES 12 Mittal Children’s Medical Centre, London, United Kingdom 193 13 The Bluestone Unit, Craigavon Area Hospital, Craigavon, Northern Ireland 196 14 New South West Acute Hospital, Enniskillen, Northern Ireland 199 SYSTEM PROFILE: PARTNERS HEALTHCARE 202 15 The Lunder Building, Massachusetts General Hospital, Boston, MA 209 16 Spaulding Rehabilitation Hospital, Boston, MA 212 SYSTEM PROFILE: PROVIDENCE HEALTH & SERVICES 215 PROVIDENCE NEWBERG: FIVE LESSONS LEARNED 217 17 Providence Newberg Medical Center, Newberg, OR 219 18 Providence St. Peter Hospital, Olympia, WA 221 SYSTEM PROFILE: GUNDERSEN HEALTH SYSTEM 224 19 Gundersen LaCrosse Hospital Addition 228 SYSTEM PROFILE: KAISER PERMANENTE 231 KAISER PERMANENTE’S JOURNEY TO SUSTAINABILITY 234 20 Small Hospital, Big Idea Competition 236 PART 3 SUSTAINABLE HEALTHCARE TODAY 243 CHAPTER 8 GLOBAL SURVEY 245 CASE STUDIES 21 Akershus University Hospital, Loreskøg, Norway 245 22 Butaro Hospital, Burera District, Rwanda 252 Contents xi 23 Deventer Ziekenhuis, Deventer, The Netherlands 257 Trias Energetica 260 24 First People’s Hospital, Shunde District, Foshan City, Guangdong Province, People’s Republic of China 263 25 Hospital Universitario San Vincente de Paul, Rionegro, Colombia 268 26 Khoo Teck Puat Hospital, The Republic of Singapore 272 27 Portadown Health and Care Centre, Portadown, Northern Ireland 278 28 REHAB Centre for Spinal Cord and Brain Injuries, Basel, Switzerland 284 29 Reina Sofia Foundation Alzheimer Centre, Ensanche de Vallecas, Madrid, Spain 291 30 The New Royal Children’s Hospital, Melbourne, Victoria, Australia 297 31 Rush University Medical Center, Chicago, IL 304 32 Salam Centre for Cardiac Surgery, Soba (Khartoum), Sudan 314 33 Santa Lucia University General Hospital, Cartagena, Spain 315 34 St. Bartholomew’s and The Royal London Hospitals, London, England 322 35 Swedish Medical Center, Issaquah, WA 329 Ten Lessons Learned 333 36 Ysbyty Aneurin Bevan (Aneurin Bevan Hospital), Ebbw Vale, Blaenau Gwent, Wales 335 PART 4