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Guides Make It Easier to Green Hospitals

By David Kozlowski   Green

When Boulder Community Hospital in Boulder, Colo., received its certification from the U.S. Green Building Council for a LEED silver rating, the hospital not only joined a select group of LEED buildings, but it also became the first and only hospital so far to get a LEED certification.

There will likely be more LEED-rated hospitals, but not without a struggle. There are 27 health care facilities registered with LEED awaiting word on whether they’ve earned a green rating. While that’s a good start, health care facilities comprise 30 percent of the new construction market. Given that, experts say nearly one-third of the 1,800 projects registered with LEED should be hospitals. Because it so difficult to make those facilities green, however, less than 2 percent are.

There’s a good reason for this. Building green is an uphill battle for any facility, but especially for hospitals with their 24-hour operation and volumes of special regulations. Just moving air around takes more energy in a hospital than it does in most facilities. Lighting levels are higher and elevators operate all day and night. All this makes designing, building and operating a green hospital more difficult and makes getting a LEED certification a daunting, and potentially costly, task.

“The LEED process itself is not yet tailored to this building type,” says Kelly Davis, principal with Zimmer Gunsul Frasca Partnership. Davis, architect of the LEED-registered Legacy Health System hospital in Portland, Ore., was able to use LEED, but it wasn’t easy. He says that the more stringent requirements for hospitals, such as higher fresh air demand, can stymie attempts to reach energy credits.

Darrick Walls, director of construction for JPS Health Network in Fort Worth, Texas, says the cost of trying to make JPS’s new acute care facility LEED-certified was too much. Tarrant County, for which JPS is the public health system, couldn’t afford green. An analysis showed that it would add 4 percent — $2 million — to the total project cost to attempt LEED certification.

“We have a fixed budget of $50 million and that’s it,” Walls says. “When it comes down to spending an additional $2 million for the building or $2 million for medical technology, it is very difficult to argue for the building.” That said, Walls expects to make the new hospital as green as possible, “but I am afraid it will fall short of LEED.”

Jeff Smitley feels the pain of hospital owners trying to build green buildings, but he is intent on pursuing MetroHealth’s plans for a LEED silver campus.

“It’s really not as difficult as it is made out to be,” says Smitley, director of engineering and real estate for MetroHealth in Grand Rapids, Mich. The green aspects of the hospital, which is under construction, will add 1.5 percent to the total project cost. “As LEED becomes more prevalent and experienced teams become more prevalent and products more available, the costs are coming down. Our experienced team has saved us money.”

MetroHealth’s green ambition is buttressed by what the regional health care company sees as the cost of doing business.

“Green hospitals are the future,” he says. “They are better for patients, better for the community and better for the environment. Doctors, nurses and patients will demand them.”


Help on the Horizon

This green future and the problems of getting there have not gone unnoticed by either the American Society for Healthcare Engineering (ASHE) or the U.S. Green Building Council (USGBC), developers of the LEED rating system.

Working with ASHE and USGBC, Gail Vittori, co-director of the Center for Maximum Potential Building Systems and co-chair of committees with each group, says guidelines by these organizations will help owners and designers adapt LEED requirements to make more sense given hospitals’ peculiar characteristics.

The first guideline, which is currently in a pilot phase, is ASHE’s Green Guide for Health Care (GGHC). This self-certifying tool parallels LEED with a few modifications. For instance, Vittori says, the GGHC identifies specific health issues that each credit addresses. It also offers credit for creating areas of respite, something not explicitly required in LEED.

The GGHC is going to help address key hurdles, such as the prerequisite in LEED to meet ASHRAE 90.1 energy requirements. Evidence of the difficulty in meeting this requirement is that in most states, licensed health occupancies have not been held to much, if any, energy code compliance, says Kim Shinn, an engineer with TLC Engineering.

“I’m not aware of any state that does enforce energy code compliance on hospitals,” Shinn says. “I believe the underlying reason for the exemptions is that no one wants to compromise health care delivery on the altar of energy savings.”

Because of this, there is little history among hospitals on how to achieve energy efficiency, says Steven Guttman, principal with Guttman and Blaevoet Consulting Engineers. In part, the problem is with the energy standard.

“ASHRAE 90.1, while not ignoring facilities such as hospitals altogether, does not allow for easy accommodation of the high air change rates and room pressure relationships required in hospitals,” Guttman says.

GGHC has taken the ASHRAE 90.1 document and made accommodations for the unique design parameters for hospitals and similar health care facilities, as well as inserting more detail into the modeling assumptions, he says.

“This will make modeling of hospitals easier and, hopefully, more meaningful when it comes to evaluating improvements in the energy performance of such facilities,” he says.

Certifying Green

Two years in the making, the GGHC also is being used as a prototype for USGBC’s own application guideline for hospitals, the Application Guidelines for Health Care. These guidelines are due out mid to late 2005, after the GGHC pilot phase.

“The GGHC lays the groundwork for the LEED guidelines for health care, and we’ll be paying close attention to the GGHC pilot phase,” Vittori says.

However, a building that follows the GGHC closely and scores well isn’t necessarily a shoo-in for a LEED rating, Vittori says, but it will come close. Projects that have used GGHC will have a leg up in being certified by the USGBC because the approaches are so similar, she says.

Vittori says there is room in the market for both guidelines: One set of guidelines for facilities that are interested in a green hospital but not a LEED rating and one for those more interested in attempting a LEED rating.

Joe Howard, director of facilities with Boulder Community Hospital, says he thinks an application guideline that amends the LEED process is all right if it’s needed to spur the market, but adds that hospitals can do it without the help. He says his 153,000-square-foot hospital did.

“Despite the fact you can only get energy use down so far, there are other areas where hospitals can maximize their design to get LEED credits,” he says. “Hospital owners or any building owner should want to achieve the highest level they can, and they shouldn’t need extra help to do so. Otherwise you might be lessening your accomplishment.”

Vittori applauds Boulder Community Hospital’s achievement but says most of the industry may not have a similar level of resolve. For an industry struggling to mesh the demand for energy and the challenges of the regulations with a desire to build green, the guidelines will be a big help, she says. “What the guidelines will do is help hospitals meet their highest potential as high-performance green buildings,” she says.

LEED or not, some think health care facilities are going to go green regardless.

“For hospitals,” says Michael Savone, director of facility services and technology for the Farnsworth Group’s Rocky Mountain region, “I think 20 to 50 percent of the market will adopt green building practices because they realize it’s the right thing to do for patients, recruitment and retention, and productivity.”


Book brings back oldie but goodie What’s old is new again, according to the Northwest Energy Efficiency Alliance. With the publication of “Natural Ventilation in Northwest Buildings,” funded by BetterBricks, an initiative of the Alliance and Seattle City Light, commercial building owners have a resource for a more energy-efficient alternative to mechanical ventilation.

According to the book, natural ventilation can reduce operating costs, construction costs, building energy use and reliance on mechanical cooling systems. The book discusses two main types of natural ventilation: cross ventilation and stack ventilation, and offers several examples of buildings in the Northwest area.

There is a long architectural history of natural ventilation because it has only been in the last 70 years that buildings have been cooled by mechanical air conditioning.

The free book can be ordered online.

Good Indoor Air’s Impact on Schools

Three recent studies point to measurable impacts on energy and student productivity linked to poor indoor air quality.

The first two studies, “Schools Air Monitoring Project for Learning and Energy Efficiency ” or SAMPLE2 and “Continuous Indoor Air Quality Monitoring in Minnesota Schools” found that energy use could be cut by 13 to 20 percent by continuous IAQ monitoring. Improvements often involved simple fixes, such as relocating thermostats to better positions for monitoring room temperature, purchasing thermostats with setbacks and improving maintenance of the ventilation system.

These two studies and a third one, “Associations between Classroom CO2 Concentrations and Student Attendance in Washington and Idaho” published in the journal Indoor Air, found that poor ventilation in schools leads to higher concentrations of CO2 (carbon dioxide) and higher absenteeism.

All three studies found that half of the classrooms studied in Minnesota, Washington and Idaho periodically exceeded 1,000 ppm of CO2 and fell short of the ventilation rate minimum of 15 cubic feet per minute per person. The increase in CO2 was associated with a 10 to 20 percent increase in student absenteeism.

The study in Indoor Air notes that because school funding is linked to absenteeism, higher concentrations of CO2 and increases in absenteeism could lead to a funding decrease of $450 per classroom.

Inside Meets Outside Lighting Requirements

Exterior lighting requirements have been strengthened in the American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) commercial energy conservation standard.

Among addenda recently approved for ASHRAE Standard 90.1-2001, Energy Standard for Buildings Except Low-Rise Residential Buildings, are new requirements that limit lighting power density for exterior lighting applications. The addendum includes a requirement that all exterior applications must have automatic controls capable of turning off exterior lighting when there is sufficient daylight or when the lighting is not required.

Other lighting requirements strengthened in 90.1 are a reduction in the climate zones to 8 from 26 and the addition of an occupancy sensor control requirement for some spaces, such as classrooms, meeting rooms and break rooms.

On-site Power on the Increase

As power reliability becomes more important, the United States is turning to on-site energy systems. Use of these systems is on the increase, says a renewable energy marketing and policy firm. Sales were up by 20 percent overall in 2003. On-site systems include green sources such as photovoltaics, solar thermal and wind, as well as fuel cells, microturbines and engine-driven generators.

There are several reasons for the increase, according to the Stella Group. On-site systems can save money, offsetting some demand charges and peak power rates; help meet regulatory requirements; increase power quality; and increase reliability.

Green is Not a Budget Buster

A new report finds that building green doesn’t mean busting the budget. “Costing Green: A Comprehensive Cost Database and Budgeting Methodology” by Lisa Matthiessen and Peter Morris with Davis, Langdon and Adamson, a construction cost management and planning firm, suggests factors other than green design features — such as program planning and design, local codes and climate — can have even more significant effect on the cost of a building.

Matthiessen and Morris compared the cost of green buildings with buildings housing comparable programs which did not have sustainable goals. Using the firm’s database of cost data on hundreds of projects, the study looked at each LEED point and analyzed the cost of pursuing that point. While budgets and costs varied, they found that if green features were part of the design program and not add-ons, the construction cost difference between LEED-rated and nongreen buildings isn’t significant. Just as there are high-cost and low-cost conventional buildings, there are high-cost and low-cost green ones, they note.

An examination of the non-LEED and LEED buildings in the study also suggests that for any building, there are usually about 12 points that can be earned without any changes to design, due simply to the building’s location, program, or requirements of the owner or local codes. Up to 18 additional points are then available for a minimum effort and little or no additional cost required. One non-LEED project qualified for 29 points — enough to certify the building under LEED.

In a comparison of building types, the authors also analyzed 45 LEED-seeking and 93 non-LEED-seeking libraries, academic buildings and laboratories. The authors found no significant difference between the cost of LEED facilities and non-LEED facilities.

Renovation Proves History No Obstacle to Green

Baltimore. During the first half of the 20th century, the Stewart’s Department Store Building was a keystone in the historic retail district of Baltimore’s West Side neighborhood. But after World War II, as the city’s middle-class began its exodus toward the suburbs, the neighborhood fell into decline and many businesses closed. The building, constructed in 1899, had stood vacant for more than 20 years until a recent plan to rejuvenate the area included a $24 million renovation of the Stewart’s building as well. The result was a project that blended historical preservation with sustainable design, specifically a LEED certified rating.

The renovated structure includes 250,000 square feet of research, academic, technology and telecommunications space, with 30,000 square feet of ground-level retail space.

Even though renovation projects present different challenges than new construction to obtaining a LEED rating, one of the biggest challenges for the design team was completing the documentation and paper work for LEED certification, says Tom Liebel, project manager and senior associate at Design Collective.

“It’s a fallacy to assume that obtaining a LEED rating for renovation projects is inherently more difficult,” he says. The designers just focus more on materials, indoor air quality and site sustainability credits than on the energy and atmosphere ones, he says.

The building’s urban environment provided an unusual opportunity to take advantage of existing infrastructure, most notably, the building’s use of district chilled water to provide cooling. The district chilled water utility uses remote redundant central chiller plants to produce and store ice during off-peak hours. This will reduce peak-load demand and thus the cost of electricity required for the building’s cooling.

The outside plate-and-frame heat exchangers provide a flexible system that eliminated the need for additional cooling towers and chillers. The flexibility of the system, which can deliver between 400 and 1,600 tons of cooling, allows tenants to change cooling requirements over time, reduces the footprint of the mechanical system as a whole and prolongs its life.

The building was commissioned as well, which Liebel sees as an opportunity to verify what has been designed and ensure that the owners get what they pay for. “Commissioning is not an added cost,” he says. “It’s an added value to the building.”

Liebel says he believes the building’s aesthetics were also enhanced by the design team’s commitment to LEED. To match the regional architecture, and to help achieve the LEED point for local materials, a dense, black slate from Virginia and a sandstone from eastern Ohio were used in the building’s lobby.

Other green features of the renovation include a building automation system that sets back the temperature at night, and lighting that is efficient and easy to maintain, says Liebel.

The building serves as an example of what is possible with a green renovation, he says. “Because, after all, recycling a building is a fundamentally green endeavor.”

Adding to the Skyline of the Big ‘Green’ Apple

New York. Bank of America and The Durst Organization are building what may become the first LEED platinum high-rise in Midtown Manhattan. The Bank of America Tower, a glass-clad, 945-foot, 2.1-million square-foot tower, located at One Bryant Park, is scheduled to open in 2008.

Located on the largest development site in Midtown, the $1-billion Bank of America Tower will house the 1.1 million-square-foot headquarters for the New York office of Bank of America.

Designed by Cook and Fox Architects, the steel, aluminum and glass tower will showcase high-performance green technologies. A double-wall envelope and floor-to-ceiling windows will provide daylight to the interior of the building while eliminating much of the sun’s heat. The underfloor air displacement distribution system will be served by air handling units on each floor, allowing for individual floor control. A gray-water collection system will capture and treat rain water and waste water for reuse. A 4.6-megawatt on-site cogeneration plant will provide the building’s power.

The building is expected to use 50 percent or less energy than a code building, reduce water consumption by 50 percent and reduce sewer discharge of storm water by 95 percent.

U.S. Green Building Council

James E. Hartzfeld
Interface Americas

Vice Chair
Kevin Hydes
Keen Engineering

Vice Chair
Mary Tucker
City of San Jose, Calif.

Alex Wilson
Environmental Building News

Paul von Paumgartten
Johnson Controls, Inc.

David A. Gottfried
WorldBuild Technology Inc.

Michael L. Italiano
Sustainable Products Corp.

President, CEO and Founding Chairman
S. Richard Fedrizzi
U.S. Green Building Council
1015 18th St., NW Ste. 805
Washington, DC 20036

Web site

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  posted on 11/1/2004   Article Use Policy

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