With the subject of sustainable design so prevalent in the news, journals, and magazines, it’s sometimes hard to remember how difficult it once was to talk about sustainability with our healthcare clients. While there has been a dramatic increase in clients’ awareness of the benefits of sustainable design, it is likely that you may still find yourself facing an uphill battle in implementing sustainable design practices within a given healthcare project. The environment in which your project is delivered may be fundamentally resistant to change, fiscally conservative, and driven by the bottom-line. You probably have a minimal amount of time to educate your client about how to approach the sustainable design and operations of their facility. You’re going to need a multifaceted game plan to pull it off. (Click here for a sustainable design process schedule, showing activities per project phase.)

To help navigate your way through these challenges, the following strategies should be pursued:

1) Start talking with your client about sustainability as early as possible in the project timeline. This strategy includes making it a point to discuss sustainability formally and/or informally in every major project meeting. Make it clear that you will be implementing sustainable features wherever possible, and promise to point out when such measures may have a premium cost. Don’t allow a negative attitude at the start, or hesitancy along the way, to stop you from talking about sustainability. Other influences may change the client’s attitude during the course of the project.

At the Arlington Free Clinic in Arlington, Va., executive director Nancy Sanger Pallesen credits the ongoing sustainability dialogue as a key driver of successful retention of sustainable features in the final product. She notes, “When we planned our clinic, we knew we wanted to employ sustainable design strategies. It took real commitment not only from my team, but also from the architects and, finally, the contractor to develop the partnership necessary to maintain the momentum needed to see the sustainable design process all the way through.”

2) Facilitate the client’s education about sustainability. Commit to ongoing exchange of sustainability information with the key decision makers. This strategic habit could include paying the client’s registration fees for a local or regional seminar or conference, alerting the client to webinars, and/or sharing relevant literature.

3) Learn about management concerns and commitment to the reduction of operating costs. For example, your client may already be focused on increasing maintenance efficiency of plant equipment and designing infrastructure that supports waste reduction and management. Highlight for the client administration and facility operators that these efforts share common sustainability goals.

Tom Bartlett, principal and engineer with CCRD partners, reflects that healthcare facilities have been targeting higher performance through lower energy emissions for the last 10 to 15 years. “[Client] championing of utilization of technologies, such as the centralized efficient equipment, heat recovery, ventilation monitoring and control, and lighting controls, among other strategies, have kept their energy and maintenance costs down and made the facilities more profitable. There are other facilities throughout the country that have been doing the same things because their staff realized the long-term benefits. These types of facilities find they achieve the energy performance standards necessary for LEED with their standard design packages.”

4) Study whether facilities personnel have written white papers or periodical articles about building operations. All facility managers take pride in their plant(s). While some may be reluctant to make significant changes to their operations or are unsure of the value of a sustainable approach, their desire and obligation to run an efficient facility can be common ground for opening dialogue.

Mark Baker, director of facilities and construction services for Valley Health Winchester Medical Center recalls, “At Valley Health, the efficient operation of the central plant is our goal. When the architect on our current Campus Expansion project began to discuss the credits that would contribute to LEED certification, I realized that many of these sustainable concepts were already embodied in our standard operations.”

5) Get to know the heads of Environmental Services and Maintenance Departments. They offer unique insight into facilities practices and lessons learned. The Environmental Services and Maintenance leaders can become powerful allies when deciding whether to commit to a more formal implementation of sustainable strategies.

Ron Halleen, director of Environmental Services and Patient Transport at Valley Health Winchester Medical Center, notes, “At Valley Health, we implemented green housekeeping practices due to ongoing concerns about the effect that the cleaning and maintenance chemicals, such as stripping and waxing of the floors, were having on staff. We were also looking for ways to improve our productivity and reduce the amount of floor maintenance through the use of resilient flooring. When the campus expansion project proposed resilient flooring with a non-wax cleaning protocol, I saw how our goals were similar.”

6) Tap into grassroots efforts of the organization. Quite often, employees and staff of an organization get turned onto sustainability long before administrators. Encourage the staff’s existing enthusiasm to “bubble-up” to the higher levels of the organization.

7) Investigate your client’s competition for market share and medical staff. If their competitors are actively pursuing sustainability, your client may not know, and chances are, they will care.

8) Explore and develop common ground with nursing excellence initiatives. For example, sustainable design shares objectives with recognition programs, such as the Thomson Reuters (formerly Solucient) “Top 100” hospital listing. Many of these programs assess the implementation of methods to improve the quality, operational efficiency, financial performance, and flexibility of healthcare delivery.

“Nursing excellence is what we all strive for every day,” says Kathy Tagnesi, vice president of nursing at Valley Health Winchester Medical Center. “The hospital administration chose to pursue a formal sustainable approach to the design of the campus expansion project through LEED certification in part because the strategies that were incorporated into the design were similarly focused on raising the quality of the interior spaces for patients and staff. In this way, the design of the new building will support our ongoing nursing initiatives.”

9) Research sustainable efforts and concerns within the adjacent community. A campaign for sustainability on behalf of the hospital can often gain needed public support and enthusiasm for the project.

10) Track sustainability, whether you are able to be paid for it or not. This approach may be controversial, but if your firm is committed to sustainable design, tracking sustainability is merely a means of evaluating your team’s process. Late in the game, when a client asks for a formal tracking process, such as LEED or the Green Guide for Healthcare, you’ll be ready to give the client a realistic assessment right when “the iron’s hot” (i.e. when it’s on their radar). This happens more often than one might think.

With these strategies underway, you will engage the client on multiple fronts throughout the course of the project. This effort provides the highest likelihood of merging your commitment to sustainability with your client’s investment in the design of their facility—a true win-win prospect.

Jonathan Hoffschneider, LEED AP, is an associate principal in Perkins+Will's Washington, D.C., healthcare studio with 22 years of experience. He can be reached at jon.hoffschneider@perkinswill.com.

Data and content for this article was developed from the following sources:

The USGBC's website for LEED for Healthcare: http://www.usgbc.org/DisplayPage.aspx?CMSPageID=1765

The Green Guide for Health Care: http://www.gghc.org/about.cfm

"Sustainable Healthcare Architecture," by Robin Guenther and Gail Vittori

"Prescription for Chiller Plants," by Mark Baker, Dan Roe, P.E., Member ASHRAE, and Mick Schwedler, P.E., Member ASHRAE. Published in ASHRAE Journal (Vol. 48, June 2006)

For another approach to similar goals, please read the Web article "Allan Chochinov's 10 Steps for Sustainable Design" by Jaymi Heimbuch, San Francisco, California, dated 02.23.09 ( http://www.treehugger.com/files/2009/02/allan-chochinovs-10-steps-for-sustainable-design.php)

Information about the criteria for the ANCC’s (American Nurses Credentialing Center) Magnet Recognition Program® can be found at: http://www.nursecredentialing.org/Magnet.aspx

Information about the criteria for the Thomson Reuters (formerly Solucient) “Top 100” hospital rating can be found at: http://www.100tophospitals.com/

Past installments of "Designing for Health" include (click on title to access the full article):
• The Age Factor--Energizing the Healthcare Workplace
• Medical Teaming Centers
• Integrating Security in Hospital Emergency Departments
• We Eat What We Build
• Evidence-Based Healthcare Design Forum
• Designing the Ideal Space