In the past, owners have been successful using LEED-NC for health care facilities — 230 certified and 1,100 registered health care facilities under LEED-NC — but when it comes to certifying green operations and maintenance in health care facilities, LEED has not been not a good fit. To date, there are very few hospitals (The Christ Hospital in Cincinnati is one example) certified with the LEED for Existing Buildings: Operations and Maintenance (LEED-EBOM) rating system. So, does LEED-HC address how to bridge the gap between construction and facility management? Truthfully, the answer is no — LEED-HC, like it's predecessor really is a new construction rating system. But LEED-HC does a better job than LEED-NC at laying the groundwork for sustainable operations, say experts.
"Everything done in construction should have an impact on operations," says Gallagher-Rogers. "That's especially true through the lens of patient and staff health."
One new LEED-HC prerequisite requires that project teams use the integrated design project delivery method, and as part of that, the owner must be involved during initial planning stages. Those requirements are important because of the complexity of health care projects — the relationship between mechanical systems and the building envelope, for example — and the importance of getting all those elements right. "Integrated design is an absolute necessity," says Vittori. "Having the owner involved really elevates the knowledge at the table and is a very important bridge between construction and operations."
In addition to the prerequisite, there's also a new credit that awards an extra point for "excelling at the integrated design process."
The new measurement and verification credit for water use is another example of an operations-focused credit, as is a new addendum to the enhanced commissioning credit that awards a point for commissioning the building envelope.
To truly focus on sustainable operations in health care facilities, however, it's best to use a combination of the strategies laid out in LEED-EBOM and the Green Guide for Health Care – Operations, says Baum.
While there are no immediate plans for a LEED-EBOM for Healthcare, Gallagher-Rogers says she feels strongly that eventually USGBC will move in that direction.
Guttmann says he'd like to see that happen: "USGBC understands that there's a continuum between construction and operations, so I'm hopeful they'll come with an operations guide."
Will LEED-HC certification give owners a competitive advantage in terms of patients choosing that facility to come to heal, or doctors and nurses choosing to work there? That has long been the million-dollar question for the green building industry. For health care facilities, the question of whether LEED certification offers a competitive advantage may be even trickier to answer.
"I'd contend that the green hospitals today do have a competitive advantage," says Vittori. She cites a nurse-turnover study at Dell Children's Medical Center in Austin, Texas, a LEED-NC Platinum certified facility. The study found that during the first year of operation, the nurse turnover rate was only 2 percent, compared with the industry average of 13 percent.
"I think the competitive advantage with LEED-HC certification will depend on the credits achieved," says Baum. "If hospitals fulfill all the daylighting, connections to nature, and acoustics credits, that hospital will really make a mark in the community."
Numerous evidence-based design studies show correlations between individual strategies such as daylighting and views and reduction of patient healing time. But a lot of external factors — insurance networks, proximity to multiple hospitals, lack of comparative data on hospitals — play a role in the notion of patient choice. As more and more high-performance hospitals come online, however, patients may be willing to go out of their way to choose the hospital in which they feel more comfortable.
"We've been very tolerant of a dysfunctional reality, but as the public gets word of the experiences of patients in the next generation of hospital, excusing the status quo will begin to wane," says Vittori.
Guttmann agrees: "That day is coming quickly. In the future, patients will choose where to recover based on the health care organization's ability to make them healthy." Facilities with LEED-HC certification may very well be best-positioned to fit that bill.
2002: Green Guide for Health Care established, as a partnership between the Center for Maximum Potential Building Systems and Health Care Without Harm. The organization petitions U.S. Green Building Council (USGBC) to use LEED format for development of its own document.
2004: First Green Guide for Health Care document published.
Jan. 2007: Green Guide for Health Care, v2.2 published.
Sept. 2007: After about four years of unofficial collaboration, USGBC and GGHC sign a formal memorandum of understanding to work together to develop "tools, educational programs, and other activities to support green health care building."
Nov. 2007: First draft of LEED for Healthcare rating system, based heavily on GGHC, v2.2., released for public comment. More than 2,000 public comments are received.
Dec. 2008: Green Guide for Health Care – Operations pilot published.
Spring/Summer 2010: Two additional drafts of LEED for Healthcare released for public comment.
April 8, 2011: LEED for Healthcare officially released.
— Greg Zimmerman
Introducing LEED for Healthcare
LEED for Healthcare: Construction is Focus, Not Operations