By Karen Aho

With sustainability and community in mind, Gundersen Health System strives for zero energy this year.

 

When designers talk about healthy buildings, they often focus on interior considerations: air circulation, light, temperature, and maybe energy efficiency as it translates to lower customer costs. Gundersen Health System takes a broader view. The physician-led nonprofit, which includes a leading teaching hospital, trauma center, and dozens of community clinics in Wisconsin, Iowa, and Minnesota, didn’t think it was right to go green without considering the more far-reaching effects beyond its buildings’ walls.

Whether powering boilers or running chillers, Gundersen wanted to develop efficient operations with the health of everyone in mind, and that meant tapping into alternative energy sources. Ideally, those sources would also create local jobs and improve air quality, even for those living hundreds of miles downwind. “We really take to heart our organization’s mission and purpose, to say that we are about the health and well-being of our patients and communities,” says Dr. Jeffrey Thompson, Gundersen’s CEO. For Thompson, setting a goal of eliminating his health system’s dependence on fossil fuels represents a vital step toward improving public health: The byproducts of fossil fuels are known to cause cancer, liver, and kidney diseases; reproductive and respiratory issues; cardiovascular death; and stroke. Although no small task for any building, reducing energy use is particularly daunting for a medical facility. Hospitals, which continually heat and chill air, burn an average of 2.5 times more energy than other commercial buildings, according to the U.S. Department of Energy. Medical buildings alone are responsible for 8 percent of this country’s greenhouse gas emissions. “That’s one of the lessons I’ve learned: how consumptive we are,” says Jeff Rich, executive director of Gundersen’s energy-efficiency program, Envision. Rich headed the Gundersen energy audit in 2008 after energy bills were projected to increase by as much as $500,000 every year. In response, the organization decided to reduce consumption and slashed its energy use by 10 percent within six months and by 25 percent within two years. “One day a few of us got to talking and we asked ourselves, What would it take to get the entire hospital to net zero? Would that even be possible? Or economical?” he says At the time, Gundersen Health System used an average of some 250,000 BTUs per square foot a year—a typical output for a hospital. By 2013, just five years later, Gundersen was averaging 150,000 BTUs per square foot and its new hospital, the LEED-certified Legacy Building began performing this past January at a remarkable 115,000 BTUs per square foot, a level many didn’t think possible. “I remember the conversation with the Legacy project manager and design team, and they kept asking whether 115,000 BTUs per square foot was a goal or more of a target,” recalls Kari Houser, Gundersen’s director of construction and engineering. ”But we set the goal and we achieved it.”

Renewable Sources

In an effort to break free from fossil fuels, Gundersen Health System has partnered with counties and farms in Wisconsin to create local, renewable energy. Gundersen says it is on track to achieve energy independence this winter. Projects include:

The health network slashed $2 million from what began as a $5 million annual energy bill and partnered with farms and counties to produce renewable energy projects, create jobs, and lower patient costs. By 2013 Gundersen had reduced its carbon dioxide, sulfur dioxide, and mercury emissions by more than half—even while adding facilities.

“We see reducing emissions as part of our mission: to treat and prevent disease,” Rich says. “We’ve really had to have a consistency of purpose to get here.” Gundersen is hardly alone in its desire to incorporate healthy energy use—across the country, hundreds of hospitals have joined the Healthier Hospitals Initiative. But Gundersen has set a high bar, prompting other healthcare facilities to consider and address the public health implications of its operations. Envision received so many requests for information from health systems around the world that it set up a for-profit consulting service.

Setting new standards for energy efficiency was not easy, however. Gundersen boldly set out to achieve net-zero energy use in Wisconsin, a state where winters are long and coal is cheap, making it tough to justify scrapping the fossil fuel for a potentially risky unknown. “We’re not rich in ocean currents or geothermal springs; other areas of the country are blessed with better sunlight,” says Rich. At times, engineers, already understandably conservative when navigating the highly regulated and complex requirements of hospital design, were skeptical. Some projects fell through due to changes in regulatory incentives or when initial savings projections turned out to be wildly optimistic.

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“We see reducing emissions as part of our mission: to treat and prevent disease.”– Jeff Rich

 

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A heavily promoted and highly anticipated brewery biogas project, expected to generate 3 million kWh of electricity a year, ended up with unanticipated impurities in the gas stream and had to be scrapped. “When you’re working with a technology that’s new to you, you have to prepare for the unknown and the unexpected,” says Rich. “Not everything goes as planned, but some things go better than planned,” he adds. By harnessing the biogas from a single landfill project, Gundersen powers its entire Onalaska campus, making it the only energy-independent multi-building healthcare complex in the country. A geothermal heat pump at the Legacy Building is alone expected to save 70 to 80 kBTUs per square foot annually. Thompson, a pediatric intensivist and neonatologist, hopes that Gundersen’s lead will encourage organizations to take more responsibility for the long-range health implications of their energy policies, too often pushed downstream as somebody else’s problem. “A lot of things in human health aren’t directly measurable,” he says. “It’s hard to draw a direct line between the coal burned in Ohio and the child affected by the particulates raining down later in Pennsylvania. But we believe it’s our responsibility as a healthcare organization to take that issue on and to think as broadly as possible.”

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A discussion with HOK’s Henry Chao on what makes a healthy building.

By Jeff Harder

Healthcare in the United States is undergoing major changes, with the underpinnings of the system shifting away from simply treating incidents of illness toward promoting overall health and well-being. And for architects like Henry Chao, design principal for the global healthcare practice at the international firm HOK, this shift provides an opportunity to create hospitals and facilities that contribute to this broader purpose. Chao’s most notable projects have included the Ohio State University Wexner Medical Center Expansion in Columbus, Ohio; the Cleveland Clinic Miller Pavilion in Cleveland, Ohio; Kuwait University College of Science in Kuwait; and Ng Teng Feng (Jurong) General Hospital in Singapore. Here, he speaks about subtle design decisions that change perceptions of illness for the better, the parallels between planning hospitals and planning cities, and LEED’s role in fostering a 21st-century sense of what it means to be healthy.

No one would ever make a fuss if someone was going to a city library. No one would make a fuss if someone was just going to the neighborhood park. If you heard that someone went to the hospital, why should that be a big deal? It shouldn’t be. And [we need] to make sure it isn’t.

A hospital by itself can easily have 12 to 16 different individual departments. Each department has five or six different sections. And healthcare architects need to understand what they do, how they do it, how they relate to each other, how they connect with each other. It is an incredibly functional constraint. The beauty of a hospital is that the architect needs to take the essence of medicine, take the essence of healing, and the essence of science, interpret it, adopt it, express it in a way that it can communicate with its surrounding in a reciprocal manner… it is a two-way dialogue. Each hospital needs to speak about health in a manner that the community can accept and understand.

If you think about the inside of a hospital, a floor plan can be [the same size as] one or two football fields. There’s the circulation, the wayfinding—people always talk about hospital wayfinding being bad and I don’t blame them, because it’s such a complex environment. With each block and each department, it’s like a mini-city. I’ve found that a lot of times, between a hospital space planner and a city planner, there’s a lot of similarity in terms of the amount of information that has to be juggled, balanced, and negotiated. Basically, it takes a designer who is not afraid of a lot of data to tackle a building like a hospital.

After I joined HOK, one of my larger projects was at Ohio State [the Ohio State University Wexner Medical Center Expansion], where we’re dealing with a 1.2-million-square-foot cancer center, with the vision not to treat cancer patients as though they have done something wrong or made a mistake, but to treat cancer as just part of a stage of life. And in fact, that’s what it is. That notion coincides with a major shift in the healthcare environment—and I want to take away the word “care”—the health environment in the United States that’s happening right now. We’re trying to switch from a solely episodic disease treatment health system into preventive and health maintenance and a healthy living society. That’s a tremendous thing, and we as architects have a tremendous opportunity to contribute.

When I was a young architect, the first thing I ever learned about cancer center design is that we need a separate doorway in and out for cancer patients. For years, in healthcare architecture for cancer centers, it was always a separate door. Not only a separate door, but separate parking, separate everything—you don’t want to embarrass these people right? But Ohio State thought that when you have a separate door, you’re actually stigmatizing [cancer patients]. As if they’re so different—almost like, “I have cancer—I can’t even go through the front door. I have cancer—I look so bad that I have to be hidden from public view.” So Ohio State said no to that. They actually put very simple, convenient parking access for everyone. They put a waiting lounge for the people to have a little privacy, but it’s the same entry, everybody comes in and goes out in the same place. And that actually inspired me. 

At Ohio State, the chemotherapy center has great views of open spaces. We created a family and conversation area because a lot of times, when one person gets sick, it’s like their entire family gets sick. Having those conversations becomes important. So when the patient and family want to connect with each other, we don’t isolate them. I actually thought that was a tremendous breakthrough. The building will probably be completed by this fall, I think, and I can’t wait.

When I was growing up, I didn’t understand so-called preventive care. I didn’t go see my dentist, didn’t get an annual check-up. But my daughter, growing up in this society, knows she needs to go see her dentist every so often to make sure her teeth are good, go to her annual check-up to make sure her health is good, and she takes the responsibility to do that. I think that’s great. I think this generation is going to fundamentally change how we perceive health and healthcare. And they’ll understand that getting proper healthcare is our civic right, and keeping proper health is our civic obligation. In the so-called care environment, whether it’s a hospital or a clinic, now it’s taking on a fundamental shift in identity: the big white elephants, the big grey buildings that sit in the community now need to be seamlessly linked, connected, weaved into the fabric of community life on a daily basis.

I see LEED as a means to an ultimate objective. LEED is never the objective [itself]. The ultimate objective is a healthy environment. Even saying a healthy environment is very limiting—I’d say LEED’s objective is to be responsive and responsible in an environment—responsible behavior, responsible architecture. Health just happens to be part of it. My feeling is that LEED has been a very effective tool: it’s become a mechanism that is to a great extent measurable, and it’s in the marketplace. If our client wants to have that recognition, that becomes an incentive to push our industry to move toward responsible architecture and responsible design, and I think that’s wonderful.

Healthcare facilities deal with the most traumatic moments of people’s lives: when you’re born, when you’re sick, and when you’re actually leaving the world. It’s an emotion-filled environment. But by doing work for a healthcare facility, when you sit down across the table from the healthcare providers—the doctors and nurses—you are talking to a group of very smart, well-educated, well-read people. When I sit down with them, the conversation is always about how I can make an environment the most conducive to better their practice—which is, in general, saving people’s lives. That is absolutely fascinating to me.

To be a healthy person, you need to be in a healthy environment. And a healthy building is just part of it.

HOK’s $1.1 billion revitalization of the Ohio State Wexner Medical Center campus includes construction of the new 276-bed James Cancer Hospital and Solove Research Institute and Critical Care Center. Aiming for LEED Silver certification, the design integrates space for research and education on each patient floor.

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