Harnessing the Power of Sustainability in the Healthcare Environment

by Jeff Yirak, P.E., CPMP, LEED AP BD+C, O+M and Stephen Chapel, P.E., PMP

This article is part of Wood harbinger’s newsletter series.

This article adapted from a presentation given at the 2015 WSSHE Annual Conference, held October 6-9 in Vancouver, WA.

“Sustainability” is often thrown around as just a buzz word and brings to mind many different things for different people. Is sustainability a LEED certification? Is it bike racks and green spaces? Is it ultra-efficient HVAC systems and LED lighting? I bet we could get as many definitions as there are readers of this article. Maybe more!

Sustainability is the awareness that the choices we make to achieve our needs today affect our ability to achieve them tomorrow. Sustainable design is about more that energy efficiency and earth-friendly materials. It’s about creating resilient and healthy conditions for people, communities, and the environment.

Sustainability and Healthcare

The need for sustainability in this sense is crucial in the healthcare environment. At the facility level, buildings and systems must be reliable, adaptable, and operate efficiently, from grand opening to end of life, through remodels and emergencies. That means facilities personnel need project teams that really listen to their needs and expectations, understand the technically demanding, operationally sensitive, and dynamic conditions of an active facility, and seek economical solutions that deliver real benefits.

It’s all about User Experience

Achieving this “real” sustainability requires a life-cycle approach with up-front considerations and ongoing commitments to assure a positive user experience. From building system upgrades for energy conservation to new and upgraded facilities for better aesthetics and workflow, it all affects user experience. In order to achieve a positive user experience, you need to know who your users are; for whom is the building being designed and built?

Positive user experience is the end goal.

Positive user experience is the end goal.

In the healthcare environment, the end users are the patients, care providers, and facilities staff. Their needs and concerns must be taken into account and addressed, otherwise any project runs the risk of proving unsuccessful in the long term. When speaking of patients as users, it’s important to understand that as the population changes, so does the landscape of need, which affects the planning effort for individual facilities as well as the community or state as a whole. The goal is to enable master planning vs. reactionary planning. Certificates of Need, defined by population geography, inform what medical services are needed to support that population. For example, baby boomers are aging; are you ready?

These are your project stakeholders. Bring them into the planning conversations, then circle back to them as the design develops, testing your understanding of what you heard from them in the early stages.

When Does Sustainable Design Start?

Sustainability is not an add-on; it is a core concept that informs the project, from planning to design to operations. Resilience comes heavily into play requiring systems reliability to maintain continuous operations. both consultants and owners need to be on the lookout for project plans that support these critical parameters from the very start.

For those of you who are healthcare providers or healthcare facility personnel, you likely already know you need to be involved and face challenges in getting your voices heard. Your project consultants can help you. They can advocate for end-user involvement in early conceptual planning and design, emphasizing the direct influence of facility personnel in the success of a project. They can help empower you with knowledge through their understanding existing conditions, by training you, and helping you recognize and confirm that you really are the crucial player in successfully achieving sustainability.

Arm Yourselves…with Pertinent Questions

Every successful project begins with up-front discussions about needs and expectations. Consultants will have their questions, of course, but there are some good questions the capital projects and facilities folks can ask consultants to make sure they have the right knowledge, information, and approach to design a successful project and assure that sustainability considerations are included from the start. Efficient systems that don’t meet the needs for maintenance, operation, reliability, continuous operations, and ease of replacement don’t really increase the overall “sustainability” of the facility.

Here are some suggested topics of discussion with consultants:

  • What do they know about other facilities in the region and how does what they’re proposing change this building in comparison to peer facilities?
  • Ask for previous experience and references of successful examples of proposed systems.
  • Have they designed, for example, displacement ventilation in a hospital setting? If yes, get references/proof points.
  • Ask to talk with facilities personnel from a past project the consultant designed, who are operating a system such as what’s being proposed for the current facility. Ask them what it is like to live with these new systems. What are the system’s limitations? Its strengths? How does it compare to the existing system, or with other proposed systems? This peer-to-peer communication will yield deeper insight.
  • Is there a redundancy or single point of failure?
  • What happens when [insert equipment/system] breaks and/or needs to be replaced? How quickly can it be back up and running? Can operations be maintained or will it require shutdowns?

Tools of the Trade

In addition to project experience and an understanding of the healthcare environment, there are some handy tools that can be used to compare system options, quantify their differences, and calculate energy savings based on real-world data. At Wood Harbinger, a couple of proprietary tools that we use include our Sustainability matrix, which provides an at-a-glance comparison of different systems types with various considerations, and our Energy Conservation Measures Toolkit. While these tools are proprietary, EZSim is an openly available tool and a handy one for energy evaluation.

Wood Harbinger’s ECM Toolkit allows us to do easy, on the fly comparisons.

Wood Harbinger’s ECM Toolkit allows us to do easy, on-the-fly comparisons.

Any comparison tools must have the capacity to evaluate the specific facility type, in this case healthcare, to capture the individual use characteristics of the proposed system. In the example below, a natural gas hot water boiler is estimated to use 14 million kBTU/year:

natural gas water heaterIncidentally, if this were an in-patient facility, the EUI would indicate a demand of about 38 million kBTU/yr. Specificity matters! Energy use comparisons should also break down energy by end use, using actual local utility rates, rather than nationwide averages.

Overcoming Bias

Another important facet to consider when planning for facility sustainability is the perspective of the providers on the team. What are their motivations for recommending certain options over others? Particularly in an existing facility, where often there is an issue prompting the discussion about upgrades and renovation, how can bias be removed from the conversation? The answer is to start from the beginning in order to inform the end decision. The beginning is an objective review of the facility’s current state of operation.

Existing Building Commissioning for Sustainability

An Existing Building Commissioning (EBCx) program is the most comprehensive method for understanding a facility’s current state. More than an energy audit, EBCx encompasses health and safety analysis, operations and maintenance, failure/risk analysis, and energy analysis.

Energy Audit vs. EBCx

EBCx vs. Energy Audit

EBCx is about painting the big picture, and that picture needs to be painted by someone who only seeks to paint, not to sell you a new chiller. EBCx is selling knowledge; the commissioning provider arms an Owner with the information about current state, which then defines the direction toward and seeking better solutions for success in planning, design, training, operation, maintenance, and replacement.

Scalability is one of the most valuable aspects of EBCx. Through this up-front analysis, owners could find out that the capital project they’re about to start may not be needed and that existing facility system tweaks are all that is needed to get the desired results, whether that’s better efficiency, better energy conservation, better user experience, better continuity of services, or greater system longevity. Here are some common things we’ve found during our various EBCx projects:


Probable Cause

Higher than expected utility usage.

Over-ridden set points or schedules, “driving with the foot on the brake”

Frequent comfort or noise complaints

Construction issues not resolved

“It’s never worked right”

Inadequate maintenance documentation and training

EBCx addresses the cause of problems, not just the issue, through a structured and rigorous investigative process. Some of these are energy concerns, some are not, but correcting these issues will improve the sustainability of the facility.

When to Use Existing Building Commissioning

EBCx is most effective as a master planning strategy or in preparation for any size renovation or tenant improvement. Rather than relying on outdated as-builts or assumed capacities, EBCx reduces the unknowns that can make projects problematic. EBCx also provides an opportunity to identify other issues present in a facility that can be solved in tandem with another planned capital project, or can be solved just by ironing out operational issues with a building tune up.

In Pursuit of True Sustainability

Achieving sustainability in the healthcare environment is truly a core initiative that takes a team effort. That means including the right people on the team—informed owners, various end-users with different definitions of success, knowledgeable consultants with the Owner’s best interests in mind, and objective reviewers to reduce bias in the process. An existing building commissioning process can be advantageous in helping develop building tune-up plans as well as informing capital project needs, based on the actually facility condition, usage, and data. Projects approached from this perspective are well poised to achieve sustainability—the energy-centric buzzword kind, as well as the resilient, longevity-focused kind.


Follow Jeff and Stephen on Twitter @JYirak_WH and @SChapel_WH

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