Contract - Designing for Health: Adaptive Reuse, Renovation and Sustainability

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Designing for Health: Adaptive Reuse, Renovation and Sustainability

27 August, 2013

-By Julie Frazier and Mary Dickinson


Approximately 170,000 commercial buildings are constructed annually in the United States, and nearly 44,000 commercial buildings are demolished. According to the United States Environment Protection Agency, sources of building-related construction and demolition debris account for approximately 48 percent of the waste stream every year.  As a response to this, and other environmental hurdles, sustainability is becoming not only a priority, but a standard for healthcare design, with adaptive reuse becoming an increasingly viable solution that shines a light on environmental harm, project constraints, and social issues.  As opposed to a team limiting themselves to a location to meet a specific project type, adaptive reuse is the process of reusing an old site or building for a purpose other than which it was originally built or designed.  By employing this strategy, healthcare organizations practice restraint in more responsible land use, and campus planning and adaptive reuse may be considered a more sustainable solution than a new construction project.

Beyond the great amount of waste generated in construction and demolition, one has to consider the advantages of contributing to the redevelopment of inner-city areas, where adaptive reuse has the greatest demand, and which helps to reduce urban sprawl.  One would think that a dense urban setting would equal poorer air quality, but as noted in the book “Sustainable Healthcare Architecture,” Australian transportation scholar Peter Newman and Jeff Kenworthy have revealed that on a global scale, decreased urban density increases vehicle miles traveled.  More vehicle miles generate more vehicle exhaust, which in turn results in reduced air quality. “The implications to human health are substantial,” public health and green building expert Adele Houghton explains.  "Air pollution caused by elevated traffic levels can impair lung development in children and leads to hundreds of thousands of premature deaths of all ages every year.  However, as demonstrated during the Atlanta Olympic Games in 1996, even a temporary reduction in traffic congestion can reduce the incidence of respiratory-related morbidity and mortality.”

As with any set of existing conditions there are challenges faced and benefits received, which we will demonstrate using three case studies.  Kingwood Medical Center, originally built as a shopping mall, was converted to an acute care hospital and medical office space.  The Wellington Outpatient Centre was an existing corporate office building that was renovated into an ambulatory surgery center.  Lastly, the relocation of Columbia University Medical Center’s flagship practice was completed by adapting a highly-desirable high-rise office space for medical use.

A pressing reason for adaptive reuse is land availability and/or preservation. The Wellington Outpatient Centre, located in London, and Columbia University Medical Center in New York City, are located where green field sites are scarcely an option.  An advantage can occur when project constraints include a limited budget. Kingwood Medical Center, by purchasing an abandoned mall and repurposing it as a hospital and medical office building, was able to create a true “medical mall” concept while avoiding the expense of additional structure and skin construction.  Additional savings included locating non-clinical hospital departments in the B-occupancy portion of the building, such as administration, education, and dietary. While the strategic decision to renovate the abandoned mall was made in order to preserve the mature natural pines and the surrounding woods, the project additionally benefited from the avoidance of site work expenses.

Practical solutions through adaptive reuse have been found to solve many historical or neighborhood restrictions when altering existing properties. Wellington could not be altered by any visible site lines, which led to a glass greenhouse on the roof remaining as circulation and storage space for surgery.  Columbia University Medical Center’s relocation was based on convenience and appropriateness for the professional clientele,  thus giving them an increased access to healthcare during their busy day.  Such implanted amenities aid in the viability of inner cities as resources of economic support and growth.  Ultimately, the project achieved 70 points to obtain LEED CI Gold certification.

Although the numerous benefits make adaptive reuse projects a feasible option, they often present construction challenges.  The Wellington Outpatient Centre has 10-foot floor-to-floor heights, which equated to 8.3-foot floor-to-ceiling heights with four operating rooms in the program. The operating rooms were placed on the top floor, with holes cut out in the roof to extend the ceiling height to more than 11 feet above each operating room for equipment clearance. Kingwood Medical Center’s existing Central Plant was located on the opposite side of the newly defined I-occupancy portion, requiring a lengthy utility trench of over 1,000 feet around the building to service the patient tower.  This still proved to be a more affordable option than running the utilities through the building with horizontal separations. Lastly, Columbia University Medical Center was challenged in delivering additional plumbing to the many revenue-generating exam and procedure spaces. With an inability to penetrate the slab, as it was being used by the tenant on the floor below as their raw concrete ceiling, the issue was conquered by utilizing a raised floor. In addition, the team avoided the loss of natural light, due to the large floor plates, by conducting test fits to maximize exam room yield.  

To anticipate your success when contemplating if adaptive reuse is right for you, consider the following questions and approach in an attempt to weigh benefits against challenges during site selection.  The team should assess if the prospective property has physical damage, decay, or disrepair that remove the benefits of reuse.  What is the ecological condition of the site? For example, is extensive abatement necessary?  Is there government funding available for abatement?  One cost impact that can quickly diminish the advantages of reuse is the need to update the space to meet current healthcare occupancy codes.  However, benefits need to be weighed in a parallel with the negatives.  These could include assessing the historical importance of the site for the community, who would garnish support.  The team should consider if surrounding conditions support a need for revitalization, by which the project could be a catalyst for further urban redevelopment, and thus economic development.  What are other marketing benefits for the client? Does the project fit within the corporation’s strategic plan? 

 By applying this best practice methodology to an existing property, adaptive reuse has the capability to solve project constraints, while contributing to great sustainable and social benefits.  


References:
The United States Environmental Protection Agency’s “Building and the Environment: A Statistical Summary,” 22 April 2009.  www.epa.gov/greenbuilding/pubs/gbstats.pdf

Robin Guenther and Gail Vittori, Sustainable Healthcare Architecture, 2008, pg 33.

Adele Houghton, Biositu, LLC   http://www.biositu.com




Bios:
Julie Frazier, AIA, LEED AP BD+C, Associate;   Medical Planner / Sustainable Leader; Dallas, TX; julie.frazier@perkinswill.com
Julie is a licensed architect and LEED accredited with BD+C specialty. Creating Development Packages on over 40 hospitals to determine feasibility, she has gained insight into incorporating sustainable practices while maintaining budgets with a set program. She is also a co-leader of the Sustainable Design Initiative at Perkins+Will helping the company reach their commitment to the 2030 challenge.

Mary Dickinson, Associate AIA, RID, LEED AP BD+C, Associate; Interior Designer / Sustainable Leader; Dallas, TX; mary.dickinson@perkinswill.com
Mary is a registered Interior Designer at Perkins+Will with a primary focus in Healthcare Design, one of the firm’s Sustainable Design Leaders, member of the Perkins+Will Precautionary List taskforce, and Chair of the AIA Dallas Chapter’s Committee on the Environment (COTE).  




Designing for Health: Adaptive Reuse, Renovation and Sustainability

27 August, 2013


Approximately 170,000 commercial buildings are constructed annually in the United States, and nearly 44,000 commercial buildings are demolished. According to the United States Environment Protection Agency, sources of building-related construction and demolition debris account for approximately 48 percent of the waste stream every year.  As a response to this, and other environmental hurdles, sustainability is becoming not only a priority, but a standard for healthcare design, with adaptive reuse becoming an increasingly viable solution that shines a light on environmental harm, project constraints, and social issues.  As opposed to a team limiting themselves to a location to meet a specific project type, adaptive reuse is the process of reusing an old site or building for a purpose other than which it was originally built or designed.  By employing this strategy, healthcare organizations practice restraint in more responsible land use, and campus planning and adaptive reuse may be considered a more sustainable solution than a new construction project.

Beyond the great amount of waste generated in construction and demolition, one has to consider the advantages of contributing to the redevelopment of inner-city areas, where adaptive reuse has the greatest demand, and which helps to reduce urban sprawl.  One would think that a dense urban setting would equal poorer air quality, but as noted in the book “Sustainable Healthcare Architecture,” Australian transportation scholar Peter Newman and Jeff Kenworthy have revealed that on a global scale, decreased urban density increases vehicle miles traveled.  More vehicle miles generate more vehicle exhaust, which in turn results in reduced air quality. “The implications to human health are substantial,” public health and green building expert Adele Houghton explains.  "Air pollution caused by elevated traffic levels can impair lung development in children and leads to hundreds of thousands of premature deaths of all ages every year.  However, as demonstrated during the Atlanta Olympic Games in 1996, even a temporary reduction in traffic congestion can reduce the incidence of respiratory-related morbidity and mortality.”

As with any set of existing conditions there are challenges faced and benefits received, which we will demonstrate using three case studies.  Kingwood Medical Center, originally built as a shopping mall, was converted to an acute care hospital and medical office space.  The Wellington Outpatient Centre was an existing corporate office building that was renovated into an ambulatory surgery center.  Lastly, the relocation of Columbia University Medical Center’s flagship practice was completed by adapting a highly-desirable high-rise office space for medical use.

A pressing reason for adaptive reuse is land availability and/or preservation. The Wellington Outpatient Centre, located in London, and Columbia University Medical Center in New York City, are located where green field sites are scarcely an option.  An advantage can occur when project constraints include a limited budget. Kingwood Medical Center, by purchasing an abandoned mall and repurposing it as a hospital and medical office building, was able to create a true “medical mall” concept while avoiding the expense of additional structure and skin construction.  Additional savings included locating non-clinical hospital departments in the B-occupancy portion of the building, such as administration, education, and dietary. While the strategic decision to renovate the abandoned mall was made in order to preserve the mature natural pines and the surrounding woods, the project additionally benefited from the avoidance of site work expenses.

Practical solutions through adaptive reuse have been found to solve many historical or neighborhood restrictions when altering existing properties. Wellington could not be altered by any visible site lines, which led to a glass greenhouse on the roof remaining as circulation and storage space for surgery.  Columbia University Medical Center’s relocation was based on convenience and appropriateness for the professional clientele,  thus giving them an increased access to healthcare during their busy day.  Such implanted amenities aid in the viability of inner cities as resources of economic support and growth.  Ultimately, the project achieved 70 points to obtain LEED CI Gold certification.

Although the numerous benefits make adaptive reuse projects a feasible option, they often present construction challenges.  The Wellington Outpatient Centre has 10-foot floor-to-floor heights, which equated to 8.3-foot floor-to-ceiling heights with four operating rooms in the program. The operating rooms were placed on the top floor, with holes cut out in the roof to extend the ceiling height to more than 11 feet above each operating room for equipment clearance. Kingwood Medical Center’s existing Central Plant was located on the opposite side of the newly defined I-occupancy portion, requiring a lengthy utility trench of over 1,000 feet around the building to service the patient tower.  This still proved to be a more affordable option than running the utilities through the building with horizontal separations. Lastly, Columbia University Medical Center was challenged in delivering additional plumbing to the many revenue-generating exam and procedure spaces. With an inability to penetrate the slab, as it was being used by the tenant on the floor below as their raw concrete ceiling, the issue was conquered by utilizing a raised floor. In addition, the team avoided the loss of natural light, due to the large floor plates, by conducting test fits to maximize exam room yield.  

To anticipate your success when contemplating if adaptive reuse is right for you, consider the following questions and approach in an attempt to weigh benefits against challenges during site selection.  The team should assess if the prospective property has physical damage, decay, or disrepair that remove the benefits of reuse.  What is the ecological condition of the site? For example, is extensive abatement necessary?  Is there government funding available for abatement?  One cost impact that can quickly diminish the advantages of reuse is the need to update the space to meet current healthcare occupancy codes.  However, benefits need to be weighed in a parallel with the negatives.  These could include assessing the historical importance of the site for the community, who would garnish support.  The team should consider if surrounding conditions support a need for revitalization, by which the project could be a catalyst for further urban redevelopment, and thus economic development.  What are other marketing benefits for the client? Does the project fit within the corporation’s strategic plan? 

 By applying this best practice methodology to an existing property, adaptive reuse has the capability to solve project constraints, while contributing to great sustainable and social benefits.  


References:
The United States Environmental Protection Agency’s “Building and the Environment: A Statistical Summary,” 22 April 2009.  www.epa.gov/greenbuilding/pubs/gbstats.pdf

Robin Guenther and Gail Vittori, Sustainable Healthcare Architecture, 2008, pg 33.

Adele Houghton, Biositu, LLC   http://www.biositu.com




Bios:
Julie Frazier, AIA, LEED AP BD+C, Associate;   Medical Planner / Sustainable Leader; Dallas, TX; julie.frazier@perkinswill.com
Julie is a licensed architect and LEED accredited with BD+C specialty. Creating Development Packages on over 40 hospitals to determine feasibility, she has gained insight into incorporating sustainable practices while maintaining budgets with a set program. She is also a co-leader of the Sustainable Design Initiative at Perkins+Will helping the company reach their commitment to the 2030 challenge.

Mary Dickinson, Associate AIA, RID, LEED AP BD+C, Associate; Interior Designer / Sustainable Leader; Dallas, TX; mary.dickinson@perkinswill.com
Mary is a registered Interior Designer at Perkins+Will with a primary focus in Healthcare Design, one of the firm’s Sustainable Design Leaders, member of the Perkins+Will Precautionary List taskforce, and Chair of the AIA Dallas Chapter’s Committee on the Environment (COTE).  

 


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