Healthcare Development Magazine

Published on : January 13, 2011

Holistic Sustainable Design for the Healthcare Building Sector Begins with the Site

Holistic Sustainable Design for the Healthcare Building Sector Begins with the Site

The healthcare industry may not have initially been on the “cutting edge” of sustainable design. Considering medical facilities must adhere to complicated procedures to ensure proper waste disposal and other health and safety protocol and are intensive consumers of energy (twice that of commercial buildings in the U.S.), the healthcare industry has taken longer than some other building sectors to institute green or sustainable-design strategies.

Recently, however, the healthcare sector has made clear connections between the built environment and health, and thus tremendous strides in the design of more sustainable facilities. In 2002, the American Society of Healthcare Engineering (ASHE) set out sustainable-design initiatives for this building sector, focusing on ensuring health at three different levels: the health of staff, patients and visitors who occupy a building; the health of the community at large of which the facility is a part; and the health of a world in which the facility needs to conserve natural resources.

The Green Guide for Healthcare (which released a new version in July 2010) has further defined sustainable strategies for this building sector. As the U.S. Green Building Council’s LEED for Healthcare is still in the public-review stage, LEED for New Construction has remained a guide for green building until LEED for Healthcare is officially online. As a result of these initiatives and guidelines, healthcare administrators and facility managers are increasingly recognizing the value of sustainable design to staff, patients and visitors, as well as the facility’s “bottom line.”

In addition, they’re adopting a holistic approach to the design of new and the renovation of existing healthcare facilities with an emphasis on preservation and prevention. Many green design initiatives address the reduction of energy and water consumption through high-efficiency mechanical and low-flow plumbing systems. Others designate sustainable materials for interiors and exteriors that will support and enhance occupant and community health. Sustainable design strategies also focus on bringing outdoor natural amenities (such as flower gardens, water features, walking paths, and native landscaping) inside to staff, visitors, and patients via windows that also draw sunlight to interior spaces.

However, for a healthcare facility to be designed and constructed in a truly holistic manner, architects, builders, and facility managers must also address site or location, which can determine decisions on cost-effective sustainable strategies in a variety of ways. Understanding the specific challenges and opportunities for sustainability that exist at either end of the site spectrum (rural versus urban sites), can save considerable time and expense in deciding on a holistic approach to designing sustainability.

Rural Settings: Challenges and Opportunities

Healthcare facilities located in rural or greater-suburban areas must often contend with such un-sustainable realities as contributing to “sprawl.” The availability and lower cost of land in these areas encourages horizontal development, which can result in a less energy-efficient footprint than that of urban facilities. On the other hand, rural sites are more likely than urban locations to have the land necessary for such green initiatives as storm water retention ponds or geothermal energy fields. Facilities on rural sites can also be designed to forge strong connections with the larger community.

When administrators relocated Jefferson County Health Center to a rural site in southeast Iowa, they collaborated with their architects to incorporate such initiatives into the site planning. The new 120,000-square-foot hospital with attached clinic occupies a 35-acre site near a highway exit for accessibility to the community. The facility also shares an entry drive with a nearby historical amenity: Three restored barns that provide a variety of cultural and recreational activities to the community.

The barns are connected to regional biking and walking trails that link with new trails on the health center site. The health center’s trails wind around an inexpensive and picturesque retention pond, which serves as a community amenity while helping to minimize soil erosion and contamination. Rain gardens near the health center also help control rain runoff. On sites where land is available, retention ponds and rain gardens are ideal solutions to storm water management.

The design of Jefferson County Health Center also maximizes space on its rural site with a high ratio of open area compared to the facility’s developed footprint. The facility’s compact design features “arms” that extend toward a native-prairie landscape planted with vegetation that provides wildlife habitat and promotes biodiversity. In addition, hardy low-maintenance, native vegetation eliminates the need for an irrigation system.

The building’s extensions also embrace courtyards with healing gardens and rain gardens, which are easily viewed from inside the facility through large picture windows. Such strong connections between interior spaces and exterior landscaping provide healing views that enhance patient health and support staff well-being. The gardens were designed as places of relaxation and contemplation for staff, patients, and visitors, whether enjoyed from inside the building or from a sitting area outdoors.

Lower land costs and space availability in rural areas provide great opportunities for using native plantings, restoring natural habitats for wildlife, and providing relatively simple and inexpensive storm water control systems. Land availability in rural locations can also provide the area required for such green technologies as a geothermal energy field.

In Winnebago, Minnesota, the new Adolescent Treatment Center operated by the United Hospital District features geothermal underneath its site. Geothermal uses a simple piping system underground, at a depth where the earth’s temperature remains steady, to heat and cool the building. At 17,000 square feet, the geothermal well field is nearly the same size as the facility itself. Due in part to this sustainable technology, the treatment center enjoys energy performance approximately 30 percent better than that required by code.

Urban Sites: Challenges and Advantages

Many would argue that urban sites are inherently more sustainable than rural settings. Urban locations, for new or renovated healthcare facilities, usually have been previously disturbed or developed, as opposed to “greenfield” sites which are more common in rural areas. In larger metropolitan areas, the site can maximize infrastructure that already exists for the facility, including utilities, public transportation and recycling systems. For example, many cities now have recycling infrastructure that provides opportunities for re-purposing construction waste, sorting trash, and diverting materials from landfills without requiring special procedures.

The need for extensive surface-parking areas may also be less on urban sites. Compared to rural medical centers, city healthcare facilities often require fewer parking stalls per square foot of building due to their proximity to bus lines, light-rail routes or other public transportation. To reduce a facility’s footprint on the site, parking is often contained in multi-story garages or placed underground. Both parking scenarios minimize the extent of on-grade parking surfaces, and thus reduce the heat-island effect (the heat captured and retained by buildings, concrete, and asphalt).

For example, Hennepin County Medical Center’s (HCMC’s) Whittier Clinic, a 60,000-square-foot outpatient facility in Minneapolis, was designed with almost half of its available parking underground to conserve site space and minimize its visual impact. But this strategy also fulfilled a community-based requirement unique to the location. The site’s design needed to be sensitive to special zoning requirements along a primary pedestrian street next to the location. In accommodating the zoning requirements, the architects also included a new bus stop (as the site is near public transportation), racks for bicycle parking, and seating next to planted areas.

The development of HCMC’s Whittier Clinic addressed community needs in other ways. Because the clinic was developed on an abandoned industrial site which had been contaminated through prior uses, considerable effort and funds were dedicated to remediating the “brownfield” site. To complete the site’s transformation from urban blight to community amenity, small parks and gardens, planted with low-maintenance native plants and hardy non-native species, were incorporated into the site design.

As a result of these sustainable strategies, the development is helping to revitalize an urban area that had recently suffered from neglect. Once considered an oddity in an otherwise pedestrian-oriented district dense with mixed retail and housing, the site is now home to a thriving medical clinic used by a multicultural neighborhood that was actively involved in the facility’s planning process.

In addition to providing natural amenities to the neighborhood in the form of plantings, parks, gardens, and restful sitting areas, the medical center includes meeting rooms for neighborhood groups with windows that reinforce the project’s connection to the community at large. In such ways, HCMC’s Whittier Clinic demonstrates how a sustainable urban healthcare development can engage and invigorate a metropolitan community and act as a catalyst for future growth.

Holistic Healthcare Design: Sustainability Begins with Site

As healthcare facilities reinvent themselves as more holistic centers for healing and well-being, the incorporation of sustainable construction methods, materials, and technologies can demonstrate a strong commitment to high-quality patient care, as well as a dedication to preserving and enhancing the health of its surrounding neighborhood and the global community. Healthcare facilities can also contribute significantly to the social and economic well-being of their communities. This aspect of sustainability is arguably as important as high-efficiency heating and cooling systems, low-e glazing and less water-consumptive plumbing. And it begins with the site itself.

For a medical center to be sustainably designed and constructed in a holistic manner, location must be addressed. Increasingly, architects, builders, and facility managers involved in the healthcare building sector are working to better comprehend the advantages and disadvantages, challenges and opportunities offered by specific sites, from the rural to the urban.

Sustainable-design strategies that include initiatives unique to the project’s site also can enhance facility operations and the bottom line. Today, by understanding cost-effective strategies specific to each unique site, healthcare administrators and managers are developing facilities that sustain the health and well-being of clients and staff, as well as the world in which they live.

About the Author and HGA:

Amy Douma is an Associate Vice President in the Minneapolis office of HGA Architects and Engineers. HGA is an integrated architecture, engineering, and planning firm that helps prepare its clients for the future. With offices in Minneapolis and Rochester, Minnesota; Milwaukee, Wisconsin; and Los Angeles, San Francisco and Sacramento, California, the nationally recognized firm has developed expertise in the healthcare, corporate, arts, community, higher education, and science/technology industries since 1953. HGA’s culture for interdisciplinary collaboration, knowledge sharing and design investigation enables its clients to achieve success with responsive, innovative and sustainable design. Visit