Veterans Hospitals Utilizing Green Globes® for Continual Improvement

Published on : March 01, 2011

Veterans Hospitals Utilizing Green Globes® for Continual Improvement

Veterans Hospitals Utilizing Green Globes® for Continual Improvement

As an investment into continual sustainability in VA hospitals, 21 facilities utilized the Green Globes® Continual Improvement of Existing Building (CIEB) on-line survey for evaluation of current operations.  The Green Globes CIEB program helps establish performance baselines, best practices and certification for operations and maintenance of a building in the environmental assessment areas of energy, water, resource management and emissions and pollutant controls.  The fully interactive, web-enabled tool allows facility personnel to measure, document, and improve the sustainability of a building over time.  Each hospital upon completion of the survey proceeded to being third party assessed for certification.  Jane Rohde, a third party assessor reviewed documentation and completed site visits for all 21 hospitals.  All of the hospitals were awarded between two to four Green Globes (4 Globes being the highest available certification).

General recommendations and best practices that came out of the different assessments that would be applicable to both private and public hospitals include the following:

  • Evaluate spaces that were designed originally for one use and are now being utilized for something else as related to energy use.  For example, one VA facility used to include a surgical suite within an ambulatory care setting, but was taken out of service.  When space was needed for education and training, the surgical suite was utilized; however the entire unit was being heated and cooled as though surgery was still being completed.  This created a large surge of unnecessary energy use, as there was other classroom and office space available that could be usable for education and training.
  • All VA hospitals have an Energy Manager and a Green Environmental Management Systems Coordinator (GEMS Coordinator).   As a result of having these two positions that usually have a dual role of every day operations, industrial hygiene, and/or facility responsibilities, there is a dedicated focus on sustainable practices that improvement outcomes, as well as creating financial savings.  For example, one Energy Manager, once on board realized that all of the steam traps had not be reviewed since the facility had opened.  Once repairs and/or replacements to the traps were completed, energy use decreased enough that other planned projects were no longer required.
  • Utilizing staff’s creativity for ideas and continual improvement is key to creating an integrated team approach to sustainability.  In one hospital, the plant and facility team, who were always seeking ways to improve energy use, had even harnessed the energy created from all of the elevators when traveling downward.  In another facility, in-house activity staff had programs for staff wellness that continued to recognize healthy eating and exercise program.  A marketing plan for communicating sustainable initiatives to staff, patients, residents, and family resulted in a creation of a toolkit that included reusable water bottles, recycling information, and ways to save money within individual households.
  • Working with local agencies, community planning departments, and department of recreations and parks to create connections to walkways and bike paths from the hospital to the community at-large. 
  • Evaluate all recyclables at point of service.  Having recycling containers and a stream that requires the waste is the first step; but education and training as well as having containers at the point of use of products promote a successful process.  Some hospitals have completed audits and include the utilization of recycles sharps containers, collection of recyclables within dietary settings (commercial kitchen), and effective composting programs.

San Diego Recycling Program was extensive; even including the recycling of Styrofoam peanuts by UPS.

  • Many of the hospitals are embracing culture change initiatives that support patient-centered and resident-centered care models.  In one facility, a Planetree director position has been created to promote person-centered care models.  There were also Eden AlternativeTM and small house concepts being utilized for the Community Living Centers (CLCs), which are long term care settings within VA Hospitals.  Additional information on culture change includes the following resources:

-Access to successful outdoor activity areas and places for respite was predominantly driven by nursing management staff.  Specifically in the CLCs easy access and areas located for ease of staff monitoring of outdoor space were the most utilized by residents and patients. 

Asheville VA CLC Garden: individualized tomatoes with residents’ names on their tomato supporting resident-centered/patient-centered care models.

-Utilization of microfiber cleaning processes; which not only reduce the utilization of chemicals and water, but more importantly improves infection control.  Both using of mop heads and cleaning cloths is recommended.  The microfiber system allows smaller and lighter housekeeping carts to be utilized.  This assists with reducing potential staff injuries as well as having the added benefit of protecting wall surfaces.  The older stainless steel carts that are still used in some facilities are not only heavier, but also do higher levels of damage when coming into contact with corners and wall surfaces.  Within housekeeping closets utilizing premeasured systems for chemicals also assists with indoor air quality by controlling the old premise; “if a little bit of cleaning chemical is good, then a lot of cleaning chemical is better.”

-Completion of staff and patient surveys is important for continual improvement.  However, once these types of surveys are completed, they need to reach those that can impact positive change.  By utilizing an integrated team approach to sustainability, implementation of recommendations is more apt to occur on a regular basis.

From the successful piloting of the Green Globes® CIEB assessments, the Veterans Administration has awarded the Green Building Initiative® (GBI) to provide an on-line, sustainability self-evaluation tool for an additional 173 hospital facilities.  This new tool will be for healthcare; specifically hospitals that include in-patient or long term care beds.  Both energy and water consumption calculations shall be based upon the number of beds within a hospital facility.   The CIEB – Healthcare – Hospitals self-assessment tool has been developed based upon the recommendations and outcomes from the 21 VA third party assessments; utilizing recommendations from VA staff as well as information gleaned from the recommendation reports completed for each pilot hospital.  The 173 buildings to be assessed encompass some of the largest and most complex commercial buildings in the United States.  This project represents the first steps in what could be a broader sustainability assessment/certification initiative spanning entire campuses.  Green Globes is highly compatible with the elements of the High Performance and Sustainable Buildings Guidance utilized by the Federal Government and is an important tool to help federal agencies evaluate compliance with the Executive Order.  

Until now, it has been difficult to have a continual improvement tool that allows facility departments to evaluate systems on a regular basis utilizing in-house knowledge.  The new CIEB – Healthcare – Hospitals tool provides a fresh approach to sustainability that is based in the development of practical and efficient operations. 

For more information on the Green Globes® evaluation tools and Green Building Initiative, see

About the Authors

Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP is the principal and founder of JSR Associates, Inc., a senior living and healthcare consulting firm providing the following services; client focus groups for creative program and care model development, innovative funding strategies, and design and project management services based on evidence based research, sustainable design principles, and resident focused/patient centered programming. Jane sits on the Environmental Standards Council; part of The Center for Health Design.  Jane is the former Vice President of the Board of Regents for the American Academy of Healthcare Interior Designers (AAHID) and sits on the Health Guidelines Revision Committee (HGRC) for the 2010 and 2014 Cycles of the Guidelines for Design and Construction of Health Care Facilities.  Jane services on the committee for the development of ASHRAE 189.2 Design, Construction & Operation of Sustainable High-Performance Health Care Facilities.  Jane speaks nationally and internationally on senior living, aging, healthcare, evidence based design and sustainability.  She may be reached at [email protected].

Sharene Rekow, CAE, is the VP of Marketing/Sales/Membership at the Green Building Initiative. Prior to joining the GBI, Sharene held several director and top management positions at national and local nonprofits which include the Better Business Bureau, the Rotary Club of Downtown Portland and Associated General Contractors of America. As well, she has been the channel director to the nonprofit marketplace in a software-as-a-service company.

Sharene specializes in coalition building between the GBI and national, industry- related leaders and nonprofits. As VP of marketing/membership for the Green Building Initiative, Sharene is responsible for external activities that educate and inform potential members, partners and the public about ways to interact significantly in the green building movement. Her role includes the branding and recognition of the GBI as a green building leader through the development of partnerships, web seminar training, trade shows and public recognition.  She may be reached at [email protected].