How do we inject sustainability into healthcare?

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9 November 2020 | 6 min | Article

Do you think hospitals are pleasant places to be? What could sustainability superstardom look like in hospitals that inspire health and well-being? These are two big questions healthcare operators and owners, engineers and planners, face when hospitals and health facilities are developed and redeveloped.

A healthcare system under pressure

Our healthcare system today is under unprecedented pressure with the COVID-19 pandemic, and this comes on top of already-existing challenges that the sector was grappling with:

Growing national demand for health services
Disproportionate funding
The impact of climate change

These challenges are driving the sector to turn to more sustainable design solutions to reduce operational costs and generate better health and well-being outcomes for patients. A sustainable business is no longer just about meeting regulations – it’s about playing an active role in addressing the climate change challenge, while also creating a healthier future for communities.

Under 1 per cent of the nearly 2000 Green Star accredited buildings around Australia are in the healthcare sector. Most are commercial buildings. If big business can reap the rewards of sustainable, healthy workplaces, then why can’t doctors, nurses and – most importantly of all – sick people?

Sustainable healthcare design shouldn’t be an afterthought

We now have more research, lots of pilot projects and a solid business case for sustainable design in healthcare.

While this is good news, unfortunately some health infrastructure is not achieving its full potential because sustainability is an afterthought, or options are not being considered because of a misconception it may drive up costs, or it’s a ‘tick the box’ exercise to chase green ratings rather than consider what makes sense in the context of the project.

When approached in the right way, sustainable design of health infrastructure can bring a myriad of well-established benefits, such as being cost effective and better places to heal and work. This is on top of reducing carbon emissions and the operating costs of facilities.

If big business can reap the rewards of sustainable, healthy workplaces, then why can’t doctors, nurses and sick people?

A sustainable development should meet the needs of the present generation without compromising the ability of future generations to meet their own needs. To make these benefits a reality, it is critical that a whole-of-life perspective is taken in evaluating sustainable outcomes and asset cost benefit, and that sustainability is at the heart of all decision-making.

Large asset owners, such as healthcare providers, need to consider how climate change, increasing operating costs and other external factors will affect business models, supply chains, infrastructure and investments now and into the future. Only then will we achieve the best sustainability result that is the most cost effective and fit-for-purpose for health infrastructure when measured over its lifespan.

Start here: establish the development objectives

The first step to realising the full benefits from sustainable design is establishing development objectives. Whether it’s a new hospital, a system upgrade or redeveloped health infrastructure, development objectives need to reflect the ‘why’ of the projects.

Sustainable design shouldn’t be introduced to counteract the constraints or parameters of a project, but instead reflect the aim, stakeholder needs and values, and the end user (the patient).

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Establish sustainability objectives, enabling integrated design

Patient outcomes are better, productivity is improved, and ongoing energy costs are reduced in health industry buildings that are Green Star-rated, according to a research report from the Green Building Council of Australia with the New Zealand Green Building Council. Their report validates that patients and workers in Green Star-certified buildings report higher health and productivity.

Sustainability objectives for buildings consider all design disciplines and aspects of the project, as well as their impacts. Where things go wrong is if project teams only consider objectives that are relevant to achieving a green rating or fail to consider options because of the myths around solutions being high cost.

The report from the building councils recognises that higher health and productivity leads to faster patient recovery times, increased employee satisfaction and lower staff turnover, as well as lower ongoing energy costs.

For example, if your sustainability objective is to reduce operational energy consumption and carbon emissions, the design may include:

Enhanced building orientation and optimised façades for natural light and sun shading
Reduced use of artificial lighting and mechanical air conditioning
Increased external planting for shading
Optimised building services operation for better efficiency
The development of predictive maintenance models to reduce operational costs and emissions from existing buildings

If an integrated design process is followed, operational energy consumption does not necessarily cost more in capital expenditure, for example, passive design could reduce mechanical plant peak load which in turn reduces the plant size and footprint required during construction.

Another missing piece: validating outcomes

Another critical and often missing piece of the puzzle is validation, especially when sustainability frameworks are implemented without any independent verification.

Early in a project, after sustainability objectives have been set, a strategy for measuring the outcomes of the project should be developed. This includes a strategy for design inclusion, construction inclusion and the commissioning of integrated design initiatives.

An independent commissioning agent should be appointed, such as a Green Star or NABERS representative, or independent peer reviewer. Independent verification is crucial, and all these methods have their place depending on the development objectives and relevant parameters. There is no one size fits all – it must be unique to the project and its ‘why’.

SUNSHINE COAST UNIVERSITY HOSPITAL

Sustainable design in practice

Dubbed a 'sustainability superstar' by a national property awards judging panel, the Sunshine Coast University Hospital shows us what’s possible when sustainable design is done well. Opened to the public in 2017 with 450 beds, it will grow to a 738-bed facility by 2021, with a design enabling further expansion. The hospital is Australia’s largest public healthcare facility to achieve the industry's highest sustainability honour with 6-Star Green Star Healthcare v1 Design rating and As-Built rating. It carefully balances environmental concerns, like energy efficiency, with user centred design.

The building optimises access to daylight, winter sun, sea breezes and the beautiful local landscape, while managing harsher aspects of the Queensland climate, like the strong summer sun and heavy rainfall. The hospital consumes up to 20 per cent less energy than an equivalent non-Green Star facility. Solar hot water and thermal energy storage systems, energy metering and energy-efficient lighting all play their part as well. Rainwater is harvested from around 80 per cent of the hospital’s 38 000 square metre roof. Tanks can collect a massive 1.5 million litres and 90 per cent of all water harvested is re-used.

Many of the patient rooms look out onto lush greenery, bushland, water or wetlands. Three-quarters of all patients and visitors have easy access to at least one place of respite and just under 50 000 square metres of space, around a quarter of the site, is green space.

Tackling the sustainability challenges together

Today, more than ever, we’re seeing our hospitals and health facilities mobilise to respond to a health crisis. As painful as it might be, these moments lead us to consider how our healthcare facilities can be more cost effective, better places to heal, better places to work, contribute to emissions reduction targets and be future-proofed.

We know that ‘green’ buildings aren’t just healthy for the environment, but also for the people who use them.

Our ageing healthcare facilities, with their around-the-clock operations, extensive air conditioning and specialist medical equipment are notorious energy-guzzlers and water users. Hospitals use at least twice as much energy and around six times as much water per square metre as commercial office buildings.

With a shared vision, collaborative working, effective leadership and authentic engagement, we can all play a part to integrate sustainable design into future healthcare projects and deliver lower environmental impacts and greater social and economic benefits.

Excerpts from this article were first published on LinkedIn.