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Building Operating Management

Moving Forward


The Green Guide for Health Care highlights best practices for both facility operations and design

By Brandon Lorenz, Senior Editor    Green   Article Use Policy

Facility executives who want to build a green health care facility need not feel like they are heading into uncharted territory. Modeled after the U.S. Green Building Council’s (USGBC) Leadership in Energy and Environmental Design (LEED) program, the Green Guide for Health Care offers a framework for implementing green design in new construction, and for greening existing operations.

The Green Guide is both a rating system and a best practices tool to help health care organizations become leaders in the green building movement. Borrowing the format of LEED, the Green Guide adds a health-related perspective to each of its credits. The Green Guide also expands the credits available to a building based on some unique challenges that health care facilities present. It is a free, voluntary, self-certifying rating system: Health care organizations that choose to use it need not submit to a third party for certification.

Version 2.2 of the Green Guide was released in February and marks the end of the pilot program. Meanwhile, the USGBC’s LEED application guide for health care is expected later this year. The application guide is meant to provide specific guidance for achieving LEED certification in specialized facilities. The Green Guide is also developing technical briefs aimed at helping those who are trying to pursue greener building strategies in their health care organizations.

The Green Guide’s operations section offers a roadmap for facility executives who want to start by tackling their existing operations. Such an approach has a number of benefits, experts say. First, it helps introduce facility executives and other stakeholders to the process without the pressure of a multimillion dollar new construction project.

“Focusing on operations first really serves as a learning experience for all the people involved,” says Alan Scott, principal with consulting firm Green Building Services. “It becomes an incremental approach as opposed to trying to do things right in one shot on a new construction project.”

Building a Track Record

Facility executives may also be able to target low-hanging fruit on the operations side and roll some of the savings into projects with less attractive paybacks, which can help build a track record, Scott says.

Focusing on operations first also helps eliminate the possibility of sending mixed messages to the public, which is becoming increasingly savvy about what is green. “I think hospitals have been unwilling to undertake green building when they still have foam cups in their cafeteria,” says Robin Guenther, who is a co-coordinator for the Green Guide and principal for Guenther 5 Architects. “Hospitals are answerable to their communities. They can’t try to take credit for green building when they have underlying waste disposal issues or no recycling programs.”

Some hospitals have taken the first step by looking at their waste. More aggressive sorting of medical waste and better recycling can save tipping fees that would allow a hospital to hire a staff member to oversee more green initiatives, says Guenther, who also is a member of the team developing the LEED application guide for health care.

When it comes to new construction, energy efficiency and indoor air quality remain two major obstacles for facility executives, partly because of the unique needs of hospitals, but also because the perception in health care is that it is difficult to improve one without compromising the other.

Even by implementing best practices such as using Energy Star equipment and variable frequency drives, hospitals with traditional mechanical systems seem to be hitting a ceiling of 20 percent better than ASHRAE 90.1-1999, says Guenther. LEED for new construction, by contrast, offers points for energy reduction up to 42 percent over ASHRAE 90.1-2004.

One danger some project teams fall into is to automatically rule out any green measure the teams feel may fall short of earning a LEED point, a situation that sometimes happens to health care facilities pursuing LEED certification, says Scott. A better approach is to find a meaningful way to address the intent of the credit, he says.

Taking responsible energy measures in health care facilities isn’t impossible. Built on the site of a former airport, the $110 million, 455,000-square-foot Dell Children’s Medical Center in Austin, Texas, includes a 4.5MW natural-gas-fired turbine cogeneration system, an option recommended by the Green Guide. Health care facilities make a good match for cogeneration systems because they are constantly occupied, which leads to a relatively even power load, says Joe Kuspan, architectural designer on the Dell project for Karlsberger Associates.

In the case of Dell Children’s Center, waste heat from the plant is converted to steam and used for heat, or sent to absorption chillers through a district loop. An 880,000-gallon thermal storage tank stores chilled water overnight for peak cooling times. The cogeneration plant was paid for by the community electric utility, Kuspan says. This freed up $6.8 million for other green measures in the hospital, which is aiming for LEED platinum certification, the highest level.

Improving indoor air quality was a priority for the Dell project. The old approach to air quality problems was simply to increase ventilation rates, a strategy that is becoming cost prohibitive, says Guenther. What’s more, increasing ventilation alone isn’t enough, as indicated by high adult-onset asthma rates, she says. One approach is to use low- or no-VOC paints and carpets. Dell has linoleum floors instead of vinyl, which eliminates the need for harsh stripping and waxing chemicals, Kuspan says.

“In a hospital, people think being able to see your reflection in the floor implies clean,” Kuspan says. “It really isn’t. It just gives you the look of clean.”

One major challenge facing facility executives who want to go green is trying to keep a lid on energy use while at the same time meeting stringent ventilation needs. “You need to make a certain number of air changes and after a while there is just no way you can be efficient,” Kuspan says. “It gets to be tough.”

One approach facility executives can consider is using heat recovery units, which is also recommended by the Green Guide. Unlike older technology, heat recovery units on the market today are able to keep the incoming and outgoing air streams separate, Guenther says. At Dell, air handlers are decentralized and matched with heat recovery units. Air intakes are sited to bring in fresh air from open-air courtyards that surround the building instead of a hot roof or loading dock. Decentralizing the air handlers and sizing them for specific zones in the hospital minimizes the need for fans and ducting, according to Kuspan.

Convincing Top Management

Regardless of how sophisticated their plans are, when making the case for sustainability with the C-suite, facility executives may want to consider a two-pronged approach.

Highlighting the potential for operational savings is one key. Some CFOs might be open to longer paybacks with health care facilities because they are owner occupied. In the case of the Dell Children’s Center, for example, green elements were allowed to have a 6-year payback.

Combining attractive paybacks with the notion that going green helps contribute to a hospital’s healing mission makes for a compelling argument. “It helps the CEO deal with broader public trends and tie into other initiatives in reducing climate change impacts,” says Guenther. “Together they make a win-win. It gives benefits on the community side and, for facility executives, benefits on the money side.”


posted on 3/1/2007



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