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By Nancy B. Solomon, AIA

Cost is also critical. In health care, very few building projects are adequately funded from the start, so there is always fierce competition for scarce capital dollars. There is a perception, although not always true, that sustainable strategies cost more up front. The fact that they may save money over the life of the building doesn’t always sway decision makers: “If it’s a trade-off between keeping the surgeon or the building-operations staff happy, the surgeon is going to win. Green initiatives can be vulnerable,” explains Guenther.

Medical facilities are also highly regulated, so some hospital administrators and designers fear that environmental goals will become another layer of bureaucracy in a complex industry that is already burdened by many requirements.

 

Children’s Hospital of Pittsburgh, designed locally by the architecture firm Astorino, includes a vast garden (above). Image: Courtesy Astorino

In addition, the first version of the most popular rating system for sustainable design, the U.S. Green Building Council’s (USGBC) Leadership in Energy & Environmental Design (LEED), was tailored to commercial construction, not health-care facilities. But hospitals, in particular, differ greatly from standard office buildings: They run day and night, seven days a week. They require multiple adjacencies, which traditionally necessitates compact floor plates. They require habitable spaces for procedures that would be adversely affected by natural light. They have to accommodate large equipment in significant quantities. And they need more frequent air changes and more rigorous cleaning procedures to prevent the spread of infection. In one way or another, these and many other health-care-specific conditions affect how well the facility can achieve typical sustainable goals.

There are signs, however, that all this is beginning to change. Despite the admitted incongruity, 29 projects have now registered with LEED in the health-care category (including the Patrick H. Dollard Discovery Health Center, in Harris, New York, and Washington State Veterans Home Skilled Nursing Facility, in Retsil, Washington, described on these pages), as compared to none in 2000 when the rating system was introduced, and one hospital (Boulder Community Foothills Hospital, page 184) has already been certified at the silver level. “Overall, there is an enormous interest in sustainability within the health-care industry. And the interest is growing exponentially,” observes Guenther.