Our Insights

by John F. McCarthy, Sc.D., C.I.H.

Headquartered in Boston, Massachusetts, U.S.A., Brigham and Women’s Hospital (BWH) is a 777-bed, nonprofit, teaching affiliate of Harvard Medical School. Recently, hospital administrators developed a plan to centralize all cardiovascular care in a single location. The plan would also upgrade and modernize their operating room platform while adding 5 net new operating rooms.

The Carl J. and Ruth Shapiro Cardiovascular Center (Shapiro Center) is a 440,000 square-foot, state-of-the-art, tertiary care facility. In its 10 above-ground and 3 underground levels, the complex accommodates 136 private patient rooms (126 of which are acuity adaptable, capable of providing intensive care as well as regular inpatient care) and 16 operating rooms (including robotic surgery and image-guided surgery areas). The design also envisaged added outpatient facilities, clinical and research laboratories, and imaging rooms.

Industry sources estimate that U.S. healthcare facilities spend approximately $5.3 billion annually for energy costs alone. BWH planners realized that any new facility would face considerable escalation of such costs for the foreseeable future. So they sought systematic reductions in energy use, following Leadership in Energy and Environmental Design® (LEED) criteria.

The hospital registered the Shapiro Center project for LEED at the start of 2004, making BWH one of the earlier adopters of LEED in healthcare. They also chose Environmental Health & Engineering, Inc. (EH&E) as the project’s LEED agent.

From the initial design, EH&E and BWH sought to reduce site energy consumption to the maximum extent possible without compromising the highest quality of patient care.

Facing the Challenges

Healthcare facilities present unique difficulties not fully addressed in LEED rating systems. (At publication time, separate LEED healthcare ratings were pending.)

EH&E and BWH administrators overcame challenges including the necessity for 24/7 operation; intensive energy consumption demanded by imaging equipment, medical equipment cooling, and conditioned spaces; issues relating to infection control; the need for redundant energy supplies; internal demands for improved lighting and air quality; and external community concerns such as traffic and construction.

Perhaps the greatest challenge: achieving LEED goals while maintaining an aggressive construction schedule and meeting paramount clinical requirements.

The project team’s holistic approach saw identifying and engaging stakeholders early as a critical initial step. The team consulted with patients (inpatient, ambulatory, visitors), staff (clinical, operations, support personnel), the local community (immediate neighbors plus the city at large), various regulators, and the global community. This early stakeholder involvement allowed the team to illuminate vital opportunities where innovative facility design could positively impact both green requirements and clinical needs.

For example, BWH conducted a study asking nurse managers what factors could improve patient care and related responsibilities. Their responses gave high priorities to indoor air quality (IAQ), acoustical noise, ventilation, and natural lighting. EH&E placed a premium on achieving these elements in the final design.

All members of the BWH/EH&E project team also had to agree on performance metrics, to aid in highlighting opportunities. The team identified areas where green design and building could impact factors such as enhanced patient care, improved health outcomes, higher patient satisfaction, superior infection control, and required emissions — then calculated their life cycle costs. Potential initiatives or products were rated against these factors. Highly rated factors had a better chance of inclusion in the final design.

Coordinating and tracking initiatives required a truly data-intensive process. The EH&E team used a Web-based project management and collaboration platform (constructed using Microsoft SharePoint®) to facilitate communication among the stakeholders and design team, as well as provide a task tracking mechanism to ensure the project remained on schedule. It also provided a constantly updated repository of information that significantly improved the preparation of LEED submittals.

Implementing Green Initiatives

With processes in place, as planning and then construction progressed, the team incorporated initiatives that met its critical design/clinical impact criteria.

For example, BWH had previously implemented a stringent policy to minimize volatile organic compounds (VOCs). Since this is also a key LEED credit, the team standardized the use of low-VOC-emitting products throughout the new complex. During preoccupancy air quality testing, the center’s VOC levels were measured at levels far below those of similar facilities and met LEED requirements.

To further improve air quality, the ventilation system was designed to reduce the buildup of latex allergens in ceiling spaces.

In another example, the nurse manager input already mentioned contributed to the inclusion of large windows wherever possible. These admitted a maximized amount of natural light to interior spaces, including patient rooms — saving the hospital significant lighting costs.

The planners also scored innovative design points in materials and resources. For instance, one program resulted in recycling 95% of construction waste.

In related efforts, six homes on the site were relocated to nearby vacant lots. This protected much-needed housing for low-to-moderate-income families, helped maintain the fabric of the neighborhood, and improved relations with BWH’s neighbors. Also, the team avoided added pollution, congestion, and noise by deciding to forgo new parking for the facility. Instead, the hospital maximized the use of public transportation and shuttle buses, and constructed a pedestrian-safe skybridge over the roadway, connecting to the main complex and its existing parking facility.

Finally, the design alleviated development density by specifying that three stories of the Shapiro Center be constructed underground. This reduced building height and remained more in scale with the surrounding neighborhood.

Appreciating the Results

The Carl J. and Ruth Shapiro Cardiovascular Center opened in July 2008 to good reviews from everyone involved. Important green goals were achieved. Compared to a more conventionally designed facility, the Shapiro Center achieved a 20% reduction in energy usage.

Stakeholder engagement, performance metrics, identification of potential opportunities, and project coordinating and tracking were all key to the success of this project.

John McCarthy, Sc.D., C.I.H., is President and Co-Founder of EH&E. Dr. McCarthy has been extensively involved in helping define the parameters of sustainable design and incorporating them into high performance buildings.