A small but growing number of hospitals is embracing ecologically friendly design and practices as a way to combat skyrocketing health-care costs and improve the health of patients, employees and communities. While the number of hospitals that are going "green" remains low, these facilities paint a picture of a future in which patient stays are shorter, more pleasant and maybe even less expensive, experts say.

Thanks to six courtyard-style healing gardens seeded with native plants, sunlight streams into 80% of the nearly 500,000 million-square-foot Dell Children's Medical Center of Central Texas in Austin. Most interior spaces are within 32 feet of a window, and even the dining room, which is 30 feet underground and features a waterfall, has natural lighting thanks to shafts. " It's been intuitive for a long time, but now we have [studies] that indicate that patients who have a room with a view and plenty of sunlight require less analgesia and a lower length of stay in the hospital," said Robert Bonar, the facility's president and CEO.

Located in a 722-acre new urbanist mixed-use community built atop the former site of Austin's Mueller Airport, the building completed in 2007 is the world's first hospital to qualify for a platinum level certification, the highest level in the United States Green Building Council's Leadership in Energy and Environmental Design (LEED) program. More environmentally friendly attributes include nontoxic building materials, water conservation strategies, motion detectors that turn off unneeded lights, paints and flooring with low levels of volatile organic compounds, and an onsite natural-gas power plant that provides 100% of the facility's electricity.

When going green, hospitals face some of the biggest challenges of any building type, said Robin Guenther, one of three co-coordinators for the Green Guide for Health Care, a self-certifying toolkit which helps health providers develop and implement sustainable practices. Hospitals generate 5 million tons of solid waste annually, require huge quantities of water, have to pump in fresh air rather than recirculate to reduce infection, and operate 24 hours a day, seven days a week, making them the nation's second most energy-intensive industry after food services.

Add to that a concern by many providers that ecofriendly strategies might make it harder to meet stringent regulatory requirements for infection control and building standards, and perhaps it's not surprising that only 36 health-care facilities of all types have qualified for any level of LEED certification. Another 350 have registered to pursue LEED certification, just 2% of total projects in the LEED pipeline. However, many advocates for green health care believe that enough hospitals have taken the plunge to trigger a sea change which eventually will make green hospitals the norm not the exception, Guenther said.

Healthier attitudes

What has changed is a growing belief by many health practitioners that sustainable practices go hand in hand with a mission to both cure the sick and keep patients, employees and their communities well, she added. Kaiser Permanente formalized a companywide ecofriendly program as early as 1997 not because "it's the right thing to do, although it is, but because it's central to health," said Kathy Gerwig, the health provider's vice president and environmental stewardship officer. In other words, global warming from energy-related emissions causes a wide range of health issues, strong chemicals used to cleanse a room for infection may also trigger asthma, and fat-laden hospital cafeterias contribute to chronic obesity, she added.

The insurer/health provider has won many awards for its green practices, including this month the EPA's Environmental Achievement Award for the Pacific Southwest region. Some of its biggest accomplishments include purging 630,000 grams of mercury from its facilities, making its operations 95% mercury free, and establishing a conservation program for its California hospitals that results in 40% less water usage than the national average for hospitals. Kaiser Permanente also was a partner in the creation of the Green Guide for Health Care and has developed a sustainable design template for all new facilities. It plans to install solar energy capacity in all the hospitals it owns in California, Hawaii and Portland, Ore., and it has established onsite farmers markets at its facilities to encourage workers and patients to purchase local produce. A Kaiser study that correlated patients' ability to communicate with doctors via email with a 25% reduction of doctor office visits in Hawaii further suggests how in the future technology may not only reduce waste caused by paper medical records but also benefit both patient satisfaction and the environment.
" Members felt like they were getting quality care, and [the community] is not having the carbon footprint of office visits," Gerwig said.

Thinking energy

Still green strategies in health care most often start with energy efficiency because it provides the clearest link to cost savings that go to the bottom line as facilities struggle to hold down health costs, said Clark Reed, director of the Healthcare Facilities Division of Environmental Protection Agency's EnergyStar program. In contrast to the low LEED numbers, approximately 65% of the nation's nearly 5,000 acute-care hospitals have used an EnergyStar rating tool to benchmark their energy performance against peer facilities, Reed said.

In less than one year, La Crosse, Wis.-based Gundersen Lutheran Health System reduced its energy consumption by 10% through retrofitting heating and air conditioner systems, boiler systems, exhaust fans and light fixtures in the hospital and its 19-clinic satellite system. The health provider plans to increase that savings to 20% by the end of 2009, as well as become 100% energy independent by 2014, said Jerry Arndt, its senior vice president of business services.

The latter goal already has produced an unexpected collaboration between the hospital in La Crosse, its Onalaska, Wis., clinic and City Brewing Company, best known for beer production. In January, the two started construction on a renewable energy facility which will convert methane gas generated by the brewery's waste treatment process into 3 million kilowatt hours per year of electricity, enough to power 280 homes and offset 10% of the two health facilities' total energy usage. " When it comes to renewable energy sources, we are approaching that with a pretty big open mind," Arndt said. "We're looking at biogas, solar, hydro, wind and biomass -- all of which are viable technologies and achievable within the time frame we're talking about."

A trend in the making

Several factors may increase the numbers of hospitals embracing environmental stewardship in the future.

First, a LEED certification specifically for health facilities is about to enter its second public comment phase and will be released by the U.S. Green Building Council soon.

Second, some hospitals may have no choice as more and more local governments require new buildings, especially in urban settings, to meet sustainable standards. For Dell Children's Hospital, LEED certification was a city-mandated prerequisite for building in the new development.

But successful examples may make the strongest case to hospital decision-makers that sustainability is worth the extra expense and will benefit the long-term bottom line, Bonar said.
Dell Children's Medical Center expects to see a return on its energy-efficiency investments within six years, a drop in the hat for a facility that is expected to operate for 40 to 50 years, he added.

Other cost benefits may be harder to quantify, but Bonar said that he is convinced that the more pleasant work atmosphere generated by green practices such as natural lighting has increased employee retention. Replacing a registered nurse is estimated to cost up to $80,000 in recruiting, hiring and training thanks to the current global nursing shortage, he added. " Our turnover is about 2.5% and the national average is 12% to 15%," Bonar said.Happier, healthier, less-stressed nurses may also lead to fewer medical errors, another boon to patient health and pocketbooks, Guenther said.

What about your hospital?

To find out how your local hospital participates in environmental practices, start by checking if it is a member of any organizations promoting sustainability such as the USGBC, the Green Guide to Healthcare, EPA's EnergyStar program, Practice GreenHealth or Health Care Without Harm. Then look to see if it takes a community leadership role in putting on green-related health education events and or has taken actions to improve environmental performance, said Janet Brown, director of sustainable operations for Practice GreenHealth, a nonprofit coalition of heath-care providers committed to ecofriendly practices. And maybe sneak a peek into the nurses' lounge. At Dell Children's Medical Center, all of them have garden views, and as one nurse recently remarked, "it's the best place in the building," Bonar said.

News courtesy of Wall Street Journal: MarketWatch, Anya Martin, freelance writer based in Decatur, Ga., 4/23/2009