While other AEC sectors have made environmental design a primary focus, the mission statements of healthcare-focused designers cannot always fit the requirements of both medical and environmental performance. Torn between the two, their choice to date has been clear: reducing infection trumps reducing waste, functional efficiency trumps energy efficiency, and patient outcomes trump LEED aspirations.
This fundamental difference has set healthcare professionals apart.
“When we talk about sustainability, it’s really about changing behaviors and creating an interior environment that we can reuse,” says Kristin Moore, LEED AP, director of healthcare at DIRTT Environmental Solutions. “Yes, recycling is important, but that means that we haven’t maintained sustainability in the solution if we end up in a situation where we’re recycling product.”
To leaders in healthcare design, sustainability is becoming synonymous with flexibility and adaptability, with a number of factors driving the movement—the biggest among them an insurmountable rate of change in technology and medical practice that renders healthcare spaces obsolete faster than facility owners can redesign them.
“We were constantly daunted by this notion that we’re trying to solve problems that we don’t even know exist yet,” explains Joel VanWyck, director of product management for healthcare at Herman Miller. “Not being able to predict what’s going to happen five years down the road when you’re creating a product that will last for 20 years was always at the forefront of our minds.”
Now add a new factor: limited down time. While designers in other sectors may pause to incorporate quantifiable environmental plans into their blueprints, healthcare teams are often redesigning spaces that operate 24/7. In many cases, there simply is no room in the construction timeline for LEED applications—or renovation at all.
“One of the things we see is that healthcare workers are amazing at adapting to less than optimal spaces,” VanWyck says. “Sometimes they know they should make the change, but they live with solutions that are less than optimal until they do, in fact, have to rip things out and start over. The hospital itself will have to decide what’s the cost of a room being available versus closed down.”
The current economic climate is not making these decisions easier. According to a survey conducted by the American Hospital Association in 2010, “hospitals are struggling to update their facilities and equipment to meet the needs of their communities and keep pace with advances in medicine.”
The funding hospitals do get is not determined by organizations like the USGBC, but by the Affordable Care Act—more specifically, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP), a 27-question patient survey introduced in 2012.
“The facility’s reimbursements for treatment are hinging on the HCAHP scores,” Moore notes. “A patient isn’t going to know if that wall has recycled content in it, so that’s not where the facility’s focus is going to be.”
Even if design teams had the time and budget to LEED certify, the endless cycle of progress and changing demands would call for reconstruction time and time again—and lead to unacceptable amounts of material waste. Facility operators know this, and have focused on minimizing the need for change altogether. They are doing it, with the help of companies like DIRTT and Herman Miller, by building functional versatility from within.