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So Healthy Together

The Lake Erie College of Osteopathic Medicine demonstrates that sustainability and evidence-based design are no longer mutually exclusive.

By Jeff Gatzow

The Lake Erie College of Osteopathic Medicine demonstrates that sustainability and evidence-based design are no longer mutually exclusive.

Custom-manufactured LED luminaires provide sustainable illumination for the soothing artwork found in the atrium of the LECOM John M. and Silvia Ferretti Medical Fitness and Wellness Center. View larger

Health care costs are in the news daily. They are discussed at the lunch counter in small town cafes and on the subway platforms in big cities. Whether one is a patient, caregiver or a health care facility employee, the topic of care and cost is top of mind. And while the political drama wages on in state capitals and the floors of Congress, health care
systems have opportunities to make dramatic impacts both on the bottom line and the environment.

"As cost pressures increase, health care facilities find themselves in increasing competition for both patients and staff," writes Robert Carr in the Whole Building Design Guide. "Architecture is often recognized as an important tool in attracting and retaining the best doctors and nurses, the most successful HMOs and insurance plans, and the most patients."1

Typically, projects with stated sustainability and evidence-based design (EBD) goals were often replete with decisions requiring one goal to be prioritized over the other. However, these no longer need to be mutually exclusive. In fact, working in tandem will bring out the best in both. Additionally, hospitals that are more attractive, better-equipped and more user-friendly gain a competitive edge.

sustainability and greening in health care
In 1998, the American Hospital Association and the U.S. Environmental Protection Agency signed a landmark agreement to advance pollution prevention efforts in our nation's health care facilities. The result was a Memorandum of Understanding, which called for virtual elimination of mercury waste, a reduction of the health care sector's total waste volume, chemical waste minimization, and a variety of educational and information sharing activities focused on pollution prevention and toxics minimization.2

But moving beyond this is the industry's commitment to integrating sustainable design, building techniques and products with environmentally sound operational practices to create true healing environments.

A report from the Deloitte Center for Health Solutions, part of Deloitte LLP, "Greening and Sustainability in Health Care and Life Sciences: Implementing a Strategic Response," reveals that greening has the potential to have an impact on virtually every aspect of the U.S. health care system. It is clearly a trend, not a fad.3

"We shape our buildings and afterwards our buildings shape us." —Winston Churchill

Increasing interest in sustainable design and construction, including LEED certification, is also affecting health care facilities, particularly with respect to energy sourcing, mechanical/electrical/plumbing design, lighting, outdoor and indoor air quality, and selection of environmentally responsible materials. The goal of green building is consistent with the mission of hospitals—to create a healthy, safe and productive environment.

It is critical to understand how health care buildings impact the environments designed for patients and staff. For example, balancing windows, access to daylight and views of nature with thermal comfort and energy efficiency are important steps in the design process. Additionally, increased scrutiny of infection cases drives a need to ensure building systems do not contribute to moisture or indoor air quality problems.

Typically, health care systems include "the best healing experiences for patients" as part of their mission. It only makes sense, therefore, that using a sustainable framework would enable healthcare facilities to not only provide "the best healing experiences" but also help them reduce operating costs and respect the environment.

ebd and better buildings
Evidence-based design for health care is not a new architectural concept. Hospitals and outpatient clinics, whether new construction or renovation, know from research how a building's design affects clinical, environmental, operational and financial outcomes for patients, caregivers and health care executives.

This scientific research has shown that communing with nature helps distract patients from the challenges of their treatment, enhances their sense of well-being, and alleviates stress for family members, friends and caregivers. Additionally, changes in the physical facility provide real opportunities for improving safety and quality for both patients and employees, while also reducing operational costs.

So, with mounting pressure to improve quality and safety, and growing evidence that design can contribute to both, why haven't all hospitals and health care facilities rushed out and implemented EBD? Many have. For those that haven't, the barriers are often perceived to be economic.4 Therefore, it's critical to balance the one-time construction or renovation costs against ongoing operating savings and revenue enhancements. However, as health care costs continue to escalate, sustainable designs and products that have a dramatic impact on both the bottom line and patient and staff outcomes must be considered.

Aesthetics are also key to a facility's public image, and are an important marketing tool in today's competitive health care environment. Aesthetic considerations include:

  • Increased use of natural light, natural materials and textures
  • Use of artwork
  • Attention to detail, proportions, color and scale
  • Bright, open, generously scaled public spaces
  • Homelike, with intimate scale in patient rooms and offices5

Studies show that the public's perception of the quality of health care being delivered in a facility is often shaped by the image and appearance presented, not only by the condition of the physical plant, but also the quality of the interior design. Upon entering, patients and visitors begin a subconscious comparison of what they are told, what they see and what their experiences bear out.

ebd and sustainability in action: lecom
In 2009, the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa. took a major step to promote healthy lifestyles with the announced expansion of the campus to a new building adjacent to Millcreek Community Hospital. LECOM recently opened the LECOM John M. and Silvia Ferretti Medical Fitness and Wellness Center.

The LECOM Medical Fitness and Wellness Center believes a peaceful mind and a calm spirit are just as important as a healthy body. In keeping with the osteopathic philosophy of nurturing the mind, body and spirit, LECOM approaches health and fitness from a holistic, medically integrated perspective. The center provides an environment designed to focus on a person's total well-being by offering something for every wellness goal, from day-to-day health and fitness to sports performance training and rehabilitation.

The design and development of the wellness center was the result of intense study and planning by the LECOM team. Their mission was to develop a facility that creates a healthy lifestyle atmosphere, one that welcomes visitors and draws them into the fitness center that occupies the first two floors. Based on direction from the college, Codgell, Spencer ERDMAN (formerly Marshall Erdman and Associates), a well-respected health care architecture firm, integrated the LECOM design team's requirements into working architectural drawings.

The first and second levels house the fitness and conference center. The third level provides suites for Medical Associates of Erie. The expansive two-story atrium with a glass curtain wall allows natural light to fill both levels of the fitness center.

challenges in combining ebd and sustainable design
LECOM wanted to improve the focal feature of the building and worked with Codgell, Spencer ERDMAN to select artwork that would be compelling yet soothing—a symbiotic blending of medicine and relaxation. Similar in planning to a retail environment, wellness facilities are conceived with patient access and convenience in mind. Innovative architectural features enhance the wellness experience.


  1. Carr, Robert F. "Healthcare Facilities," Whole Building Design Guide, revised by the WBDG Health Care Subcommittee, last updated 12-30-2010.
  3. "Greening and Sustainability in Healthcare and Life Sciences," Deloitte Center for Health Solutions.
  4. Sadler, Blair L., JD.; Dubose, Jennifer R., MS.; Malone, Eileen B., RN, MSN.; Zimring, Craig M., PhD. "The Business Case for Building Better Hospitals Through Evidence-Based Design," Healthcare Leadership White Paper Series.
  5. Carr, Robert F., "Outpatient Clinic," Whole Building Design Guide, revised by the WBDG Health Care Subcommittee, last updated 12-30-2010.
Codgell, Spencer ERDMAN researched how to best illuminate the artwork that fills the expansive two-story atrium. Traditional fluorescent lighting was originally specified, but would have required ongoing maintenance, given the technology's short lifespan. It would also have necessitated the opening of unwieldy 4'-6'x 4' back panels to access the fixtures. The architects knew there had to be more efficient technology to get the job done.

They eventually selected graphic panel illuminators, which utilize state-of-the-art LED luminaires and patented technology. The LED manufacturer was able to design, engineer and build custom LED light panels that fit the curvature of the curtain wall, essentially turning the entire curtain wall frame into a series of large light boxes. The new LED lights featured a long life—the originally-specified fluorescent fixtures would have needed replacing six times to equal the lifespan of the LED luminaires—and provided uniform illumination, something very difficult to accomplish with other lights.

Codgell, Spencer ERDMAN also incorporated a number of other sustainability and EBD features into the LECOM Medical Fitness and Wellness Center. Extensive use of natural daylighting in public areas adds to the facility's positive environment, while features like high-efficiency building insulation, Low-E glazing, a reflective cool roofing system, water-saving plumbing fixtures and occupancy lighting sensors lower the college's utility bills. Energy-saving variable transmission drives on HVAC equipment, an interactive building automation system and a HVAC commissioning regimen improve operational efficiency. Utilization of regionally-produced materials, a rapidly renewable and recyclable rubber sports flooring and highly-durable, natural finishes extend the lifecycle of the entire facility.

In conclusion, masterfully blending EBD strategies and sustainable principles and practices takes careful planning, but paves the way for better products for the health care market. This also enables a more integrated design process between health care providers, architects, engineers and manufacturers, and leads to improved patient outcomes.

Jeff Gatzow is Everbrite Lighting's product manager and may be reached at or (414) 529-7178. Based in Milwaukee, Wis., Everbrite Lighting is a division of Everbrite, LLC. Everbrite Lighting designs, engineers and manufactures LED luminaires and a variety of medical specialty lighting products.