Healthy Buildings and Healthcare

1
Healthy BuildingsandHealthcare

• Arthur Mombourquette
• Brigham Womens Hospital

EPA Workshop Compliance Updates Green Tools
for Healthcare January 25, 2007
2
Why arent there more LEED hospitals right now?
Lack of knowledge, fear of unknown, costs,
regulations, etc

• When I think of LEED compliance, I think of
  making compromises around air handlers or in
  electrical distribution. The fear for me is
  cost, both initial and ongoingIf you would have
  asked me two years ago to consider sustainable
  building design, I would have said no because I
  equated it to spending money unnecessarily. The
  Green Guide provides a wonderful incentive to
  pick up the green challenge.
• Arthur Mombourquette, vice president of support
  services at Brigham and Womens Hospital in Boston

3
(No Transcript)
4
Challenges

• Tight urban building site
• Building dimensions/configuration
• Limits natural light/viewscape
• External appearance/conformity requirements
• Impact on neighbors
• Balancing first-costs with life cycle cost
  savings
• 24/7 operations
• Infection-control issues
• Medical waste
• Building code requirements
• Intensive water, chemical and energy needs

5
Why Bother?

• Good design can reduce energy costs
• Day lighting can improve productivity
• Good indoor air quality can reduce recovery time
• Good indoor air quality can increase productivity
  and decrease absenteeism
• Choice of appropriate interior finishes can cut
  cleaning and maintenance costs

6
Results of a Recent Survey Conducted by Turner
Construction Company

• Turner solicited the views of gt 700 U.S.
  executives involved with buildings either as an
  owner of rental buildings, owner-occupant,
  developer, designer, consultant or builder
• 75 said their green buildings had lower
  operating costs
• 91 reported greater health and well-being among
  occupants
• 84 believe that building green yields higher
  building values
• 75 said they generated a higher ROI then
  traditional buildings
• 51 expected the number of green buildings in
  their organization to increase substantially over
  the next three years

7
Getting Started

• Find (or preferably Be) a champion
• Make your goal clear
• Engage and energize your team (or tell them,
  tough, were doing this, so get over it)
• Get senior management on your side
• Choose (or design) an approach
• Choose a facilitator

8
Big Picture Expectations

• Outside facility (community, residents,
  neighbors)
• Minimize site disturbance during construction,
  operations, etc.
• Reduce traffic-related impacts congestion,
  contaminants
• Manage other pollutants, e.g., light noise,
  chemicals, etc.
• Provide best use of site for access, views, etc.
• Be a good neighbor
• Inside facility (staff, patients, practitioners)
• Focus on patient safety and healing environment
• Maximize access to natural light
• Evaluate shift work impacts risk , error,
  ergonomics
• Optimize nursing unit design for workflow and
  productivity
• Maximize building efficiency

9
Goal Setting
Targets for Improvement
Constituencies

• Improved Health Outcomes
• Level of Care
• Higher Satisfaction
• Greater Productivity
• Improved Sensory Environment
• Reduced Lost Work Days
• Improved Energy Efficiency
• Compliance
• Reduced Service Calls
• Harmonious Design/ Operations
• Good Neighbor
• Code Compliance
• Compliance with ASHE/LEED Programs
• Exemplary Project Recognition

Patients
Clinical Staff
Operations Staff
Local Community
Global Community
10
Goal Setting
Prioritized Constituencies
Key Performance Indicators

• Shorter Stays
• Level of Infection
• Satisfaction Surveys
• Staff Time with Patients
• Staff Surveys
• Lost Work Days
• Benchmarks Against Energy Star
• Energy Utilization Reviews
• Service Calls
• Neighborhood Relations
• Regulatory Complaints
• Media Coverage
• LEED Certification
• Public and Industry Award Recognition

Patients
Clinical Staff
Operations Staff
Local Community
Global Community
11
Structured Facilitation
Specify design requirements
Agree on goals For High Performance (recognize
constraints)
ID participant roles
ID Opportunities (energy efficiency, heat
recovery, load mgmt, controllability, IAQ,
synergies
ID System Dependencies (energy, water,
materials, equipment, air flow)
Assess Feasibility (modeling, merits)
Integrate into Design
12
Integrated Design Process

• Begins with defining the big picture
• Requirements
• Priorities
• Value
• Return on investment

13
What does Integrated Design accomplish at BWH?

• Aligns with BWH goals and objectives
• Defines the elements of a successful
  high-performance hospital program
• Establishes a roadmap towards sustainable design
• Identifies technical opportunities that can be
  integrated into design
• Links design decisions to critical path of
  deliverables
• Highlights process and system interdependencies

14
Putting Concept into Action

• Make your team aware of specific LEED and GGHC
  credit descriptions
• Establish your baseline
• Existing practices around management of the
  environment
• Existing construction practices
• Baseline assumptions about building design and
  operations
• Rank the probability of achieving each credit
• Do financial analysis for each
• Initial cost
• Life-cycle cost
• ROI
• Decide which points give the best bang for the
  buck
• Set certification goal

15
Managing Green During the Life of the Project

• Schematic Design
• Integrate the architectural design with the
  buildings performance requirements and energy
  design
• Evaluate building materials for sustainability
  (health, performance, environmental
  preferability, cost)
• Design Development
• Evaluate all suggested design decisions using
  computer models and simulations to ensure they
  will not compromise building effectiveness
• Perform a design review
• Construction Documents
• Ensure that specifications are clearly written
  and detailed
• Clearly show high-performance design strategies
  in construction drawing details to minimize
  on-site interpretation

16
Managing Green During the Life of the Project

• Construction
• Implement programs to minimize site/community
  impacts
• Provide on-site quality control/oversight
  inspections
• Establish and enforce clean construction
  practices
• Initiate commissioning program
• Provide flush-out prior to occupancy
• If design changes are proposed during
  construction, evaluate potential impact on
  building performance
• Occupancy
• Ensure that all punch list items are completed
• Complete training of operational personnel
• Establish a measurement and verification program
  (for LEED)

17
Where do we Stand with LEED?

• BWH is registered for and actively pursuing LEED
  Silver Certification
• BWH-70F LEEDTM point summary
• Design credits 16 points
• Construction credits 14 points
• Innovation in Design 5 points
• Total 35 (SILVER 33 38)