Incorporating Sustainable Principles into New Hospital Design

  • When Gundersen Health System’s new Hospital opens in January 2014, it is expected to run at approximately 115 kBTU per square foot per year.
  • At current energy costs, achieving 115 kBTU will save Gundersen approximately $660,000.
  • By designing and building the Hospital using sustainable principles, Gundersen will improve the building’s overall impact on the environment.

In 2011, Gundersen Health System broke ground on a 425,000 sq. ft. hospital building that will serve people in a 19-county, 3-state service area. Those involved with the project were challenged with designing and constructing a building that used sustainable principles to limit the building's overall impact on the environment, both during construction and once the building is open. Two main sustainability goals guided Gundersen’s plan:
  • The building will run at 115 kBTU per square foot per year, putting the new hospital in the top 1 percent for the energy efficiency of hospitals in the Midwest.
  • Achieve LEED certification for the building.
In order to achieve the goals set forth for the new Hospital, the environmental plan includes a number of components, including energy efficiency, recycling and building design.  The LEED certification process provides a roadmap for any facility owner in navigating the decisions and choices they face throughout the planning, design and construction of their facilities to incorporate sustainable values. It is a common language and methodology that’s been well vetted. The facility planning process is incredibly complex and the LEED certification process hardwires a management methodology that delivers a more sustainable building that when done right, saves the facility money in the long-term.
Energy efficiency
Gundersen understood that the 115 kBTU target is an aggressive one, but it will pay dividends over time and ultimately help Gundersen lower the cost of healthcare for patients.
One of the most significant pieces of the energy plan is a geothermal heat pump. Gundersen installed a field of wells under a parking lot on their La Crosse Campus. The wells will be used as a heating and cooling source for the new Hospital, and result in a savings of 70 to 80 kBTU per square foot annually. This system will drastically reduce Gundersen’s dependence on fossil fuels and exposure to fuel price volatility. The geothermal heat pump is currently supplying heat for Gundersen’s Inpatient Behavioral Health building, which opened in January 2013.
Other elements include:
  • Efficient lighting design with lower wattage lamps and high-efficiency ballasts, occupancy sensors and fixtures that better disperse light, for an anticipated savings of 5 to 7 kBTU per square foot.
  • A highly insulated building shell (windows, walls, ceilings, etc.), for an expected energy savings of 17 kBTU per square foot.
  • Energy efficient chillers, cooling towers and chilled water pumps that replaced an aging infrastructure and will allow the new Hospital to be cooled more efficiently. This will save 8 to 10 kBTU per square foot.
During construction, Gundersen aims to keep as much construction waste as possible out of area landfills. Gundersen worked closely with their contractors to separate and recycle construction waste. The contractors have set up several dumpsters at the construction site to sort the waste by metal, wood, concrete, cardboard, etc. Since 2010, construction recycling/reuse rates for the new Hospital and Inpatient Behavioral Health building has exceeded 93 percent.
Building design
When the building interior was designed, Gundersen worked with their architects and designers to incorporate a wide array of green elements, such as:
  • Eliminating PVC materials from interior finishing, such as flooring, carpeting, upholstery and wall coverings, as much as possible.
  • Water-efficient landscaping.
  • Using materials with a recycled content when possible, such as counters in public rest rooms made from 50 percent recycled materials, a decorative ceiling in a main concourse, and the ceiling tiles and carpeting throughout the building.
  • Using FSC-certified wood throughout the project. Companies with FSC-certification practice forestry in an environmentally responsible way.
  • Using materials sourced within 500-miles of Gundersen when possible. For example, the decorative cast stone that will be used in the Lobby, Healing Garden and Café will be manufactured in New Ulm, Minn.
Implementation Process
Sustainability was one of the primary guiding principles for all teams involved in the planning, design, construction and operations of the building project. Gundersen believes that by integrating those responsible for the daily operations of the facility, those responsible for furthering the organizational goal of sustainability and those with technical and industry expertise, the organization will achieve stronger outcomes. 
Key stakeholders representing engineering, commissioning, architecture, building owners, planners and designers were at the table from the start. Why? Designers don’t manage the day-to-day operations of a building. Design engineers aren’t typically involved in the post-occupancy evaluation of design goals. Those with day-to-day building management responsibilities aren’t always aware of operator decisions on overall energy consumption in an effort to maintain the basis of design.  Gundersen used a multidisciplinary team who shared the value of long-term sustainability to achieve the desired results.
These groups evaluated barriers that may impact Gundersen’s ability to advance its sustainable goals, prioritized sustainability items and continued to evaluate the impact of decisions on current and future sustainability and financial targets.
Lessons Learned/Recommendations
Gundersen found that careful and continual evaluation of sustainable outcomes is necessary throughout the planning and design process. It is necessary to evaluate each action based on an organization’s location in the country and goals. Following are Gundersen’s top three lessons and recommendations for other organizations.
  1. An action that could result in a sustainable outcome in one area of the country can have little to no impact in another part of the country. For example, vegetated rooftops are touted as energy savers and highly marketed in the “green-washing” of sustainable initiatives. However, they do not have the same outcome on energy savings in the northern part of United States as they do in the south. Prepare to evaluate each decision through the lens of sustainability and to delve into the details as to whether a choice really does have a favorable environmental impact before investing.
  2. Constant compromise is necessary as goals sometimes compete. One of Gundersen’s objectives was to create a healing, homelike environment for their patients. Their sustainability goal for interiors was to reduce products with poor cradle-to-grave scores. Gundersen found they were faced with limited choices for sustainable flooring products within their life-cycle cost range that also provided a homelike finish. A decision had to be made. Gundersen focused on using sustainable flooring options throughout the facility, but chose a vinyl product for inside the patient room to bring a “wood-look” and more natural looking flooring. Gundersen focused cost savings on the energy savings for the project to maximize the long-term reduction of energy consumption and reduce the annual cost burden. Compromises and competing needs were a constant. Continuing to evaluate the short- and long-term impact of each decision in the face of competing needs is critical.
  3. Not all involved will be champions of the sustainable choice. With each decision, there is a cause and effect and the decisions will impact the work of many of the stakeholders. One choice will create a benefit, such as gaining efficiency with low-maintenance, sustainable flooring (i.e., Nora rubber, non-waxed terrazzo, etc.). Another choice will create additional complexity and effort for another group (i.e., a highly complicated, technical sequence of operations for the central plant involving the geothermal well-field).
Demographic information
Headquartered in La Crosse, Wis., Gundersen Health System is a physician-led, not-for-profit healthcare system which includes a 325-bed teaching hospital; community clinics; affiliate hospitals, clinics and nursing homes; behavioral health services; vision centers; pharmacies; and air and ground ambulance services. Gundersen serves 19 counties throughout Wisconsin, Iowa and Minnesota. The hospital is a tertiary referral center and a Level II Trauma Center. The more than 700 medical, dental and associate staff are supported by a staff of more than 5,500.

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