As hospital campuses grow, how can they simultaneously shrink their environmental footprints?


Bill Millard

When an oil slick along Cleveland’s Cuyahoga River caught fire in 1969, it was neither the first nor the worst blaze of its kind. Oil fires have recurred for decades on numerous cities’ rivers, says Christina Vernon, AIA, Cleveland Clinic’s executive sustainability officer.
But the 1969 fire had good timing: Rachel Carson’s novel Silent Spring had spurred the environmental movement in 1962, and seven years later, the public was ready to take the planet’s degradation seriously. By then, the full array of urban-renewal-era pathologies prevailed in Cleveland: sprawl bred abandonment and unemployment bred crime. Corporations treated the city like a sinking ship, while hospitals and universities weathered the rough decades by staying put and, in many cases, expanding. Now, the Cleveland Clinic and other so-called meds and eds have found that institutional expansion and greening are deeply intertwined with their community’s viability, and they are looking for ways to grow while staying green. Clevelanders point to the 1969 fire as a wake-up call and they hail the clinic, university hospitals, and other institutions linked with the Cleveland Foundation’s Greater University Circle Initiative as revitalization catalysts.
The Cleveland Clinic is one of a few urban hospitals that is working to harmonize its expansion with the broader well-being of its community, understanding that sustainability, in a sense, begins, but does not end, with carbon footprints, checklists, and biophilic design.
But this has not always been a prevailing view. Even California’s tough Title 24 energy standards, introduced as recently as 2008, classify hospitals as exempt. Yet with the 2009 development of the U.S. Green Building Council’s LEED for Healthcare (HC) ratings, the growing use of the related Green Guide for Health Care, and the proliferation of like-minded groups such as the Healthier Hospitals Initiative, CleanMed, Practice Greenhealth, and Health Care Without Harm, hospitals and architects are not only raising the bar for energy performance but redefining sustainability as having a positive influence beyond campus borders.
Many hospital campuses rely on central utility plants to provide power. Some, particularly in the Midwest, have an entrenched dependence on coal-fired facilities to generate the necessary energy. Improvements to the physical infrastructure require a long-term approach to integrating municipal or, if it’s a university hospital, institutional power sources. It is a master-plan issue as much as it is an engineering challenge, explains Benjamin Shepherd, associate director at the sustainability consultancy Atelier Ten. “Part of what we do is provide real energy forecasts for hospitals: ‘Here’s your demand now, here’s where you’re going, and here’s what we think you can get down to with innovative environmental approaches to best service your remaining demand while planning for changing utility costs and regulatory environments.’ ”
At the Columbia University Medical Center, greening efforts address a dense mix of newer and aging buildings (some last renovated in the 1970s), deriving large gains from careful attention to central plant systems, says Rachel Futrell, associate director for energy management and sustainability. “A lot of focus is always given to finishes, appearance, and bringing light in,” she says, “and you want to make sure that the HVAC and mechanical-equipment side is not neglected in the process.” Staff and patients may not notice upgrades to air-distribution systems (a vast opportunity for performance gains), chilled-water cooling systems shared between buildings, or replacement of No. 6 diesel with cleaner-burning fuels, but these details are the nuts and bolts of high performance.
Incremental efficiency gains have substantial effects—as Robin Guenther, FAIA, Adele Houghton, AIA, and Gail Vittori argue in Health Environments Research & Design Journal—and the upfront costs of infrastructural improvements should not dissuade hospital executives from exploring green technologies that incorporate more daylight and fresh air. They also point out that, since staffing represents the lion’s share of hospital expenses, environmental improvements are sound improvements, as they reduce sick days, boost productivity, and create recruitment incentives.