The Queensland Children’s Hospital. Image courtesy of Queensland Health and Conrad Gargett Lyons

By Lynne Blundell

25 November 2010 – Better air quality, views, large windows, patient and staff focus – not doctors – and cities within cities…it’s all part of an evolving greener profile for hospitals.

Hospitals have long been major energy munchers – they operate 24/7, their equipment is energy intensive and design has focused on medical priorities, not sustainability. And the worst of it all is that many of these highly institutionalised, inflexible monoliths with unhealthy air and depressing interiors are terrible places for the unwell.

But the latest batch of new hospitals are pushing the boundaries and putting patients at the centre of the design – get that right, say architects and designers, and energy efficiency and other sustainable outcomes will follow.

As we reported earlier this year, hospitals can use up to 10 times as much energy per square metre than commercial offices and six times more water. No doubt this is a key reason why NABERS is developing a ratings tool for the sector and the Green Building Council of Australia has targeted the sector as a key priority over the next three years with plans to engage with governments to encourage them to reference Green Star in healthcare building and accommodation guidelines.

The GBCA is also about to release a paper for “Green Healthcare” to help explain and promote the sustainability of Australia’s healthcare facilities. This follows the release last year of its Green Star Healthcare V1 rating tool. So far no projects have received a star rating with the tool but there are five now registered for accreditation – one in Queensland, two in South Australia (one of these is registered for Design and As Built ratings), one in Victoria and one in NSW.

Robin Mellon, executive director – advocacy and International with the GBCA, told The Fifth Estate this week that while no facility had yet received accreditation new healthcare projects increasingly aimed for higher sustainability, whether or not they were registered for Green Star.

“Most often this aim is because it makes good business sense, in terms of operating costs, staff costs and patient outcomes, but it is also thanks to some real ‘thought leaders’ in the industry and leadership within government,” says Mellon.

The four categories that carry the heaviest weightings in the Green Star – Healthcare v1 rating tool are:

  • indoor environment quality – 20 per cent
  • energy – up to 24 per cent
  • materials – 17 per cent
  • water – up to 15 per cent

“The emphasis on indoor environment quality is particularly important, with a growing body of research suggesting that good indoor environment quality can improve patient recovery times, reduce levels of pain medication prescription and lower staff turnover rates,” says Mellon.

Examples cited by Mellon include a case study at the Mackenzie Health Sciences Centre in Canada, which found that depressed patients in sunny rooms recovered faster than those in darker rooms.  Another study at Bronson Methodist Hospital in Michigan found that applying green design principles such as improved ventilation, private rooms, music, light and nature in its redevelopment project led to a reduction in secondary infections and lower nurse turnover rates.

While Australia is still waiting on Green Star certification in healthcare, projects in other parts of the world have been certified. The first US hospital project to receive LEED certification, The Boulder Community Foothills Hospital, has reduced energy consumption by 30 per cent when compared with traditional buildings, saving around US$95,000 year. Waste was minimised during the building phase of the project with 62 per cent of construction waste diverted from landfill, and recycled content materials were chosen where possible.

“The overall project cost, excluding land costs, was $45.6 million (or $452 per square metre), and the outlay for achieving LEED certification was estimated at two per cent of construction costs.  With an expected life of 50 to 75 years, the hospital’s 12-year payback for green features is well and truly worthwhile,” says Mellon.

Similarly, the Ochsner Health System in New Orleans replaced thousands of pump and suction motors with variable speed motors, reducing the hospital’s energy footprint to the tune of US$350,000 a year.

Other green initiatives included using water directly from the Mississippi River in place of traditional cooling towers for air conditioning – which delivered better environmental outcomes and now saves US$3 million a year in electricity. Replacing 60,000 fluorescent lighting fixtures with newer energy-efficient bulbs reduced energy consumption by 20 per cent, saving a further US$1.2 million a year in electricity.

Green Star needs more flexibility for healthcare

Flinders Medical Centre New South Wing has glass-ended corridors for quiet respite areas

The first of the Australian healthcare projects to formally register for Green Star certification was the Flinders Medical Centre New South Wing in Adelaide, which is going for a 5 Star rating. Architects for the project, Woodhead, told The Fifth Estate last week the accreditation process has been challenging and frustrating but also very instructive.

David Gilbert, Woodhead’s principal in charge of Health, says the GBCA has made a good start on addressing key sustainability issues for patients and hospital staff with the tool but there are still areas that need adjustment.

“It is really a question of what the Green Building Council’s philosophy is regarding sustainability – is it about energy saving primarily or does it incorporate wellness? I think the current [Healthcare] tool does try to incorporate wellness but there is room for tweaking and more flexibility with the way some aspects of design are addressed under the tool.

“If you look at the commercial office sector there have been two major shifts in the past 10 to 15 years – one is about energy saving and the other is about the quality of the workplace. It is now well recognised that the quality of the workplace affects performance and wellbeing of occupants. In terms of workplace quality the healthcare sector is still light years away from these developments,” says Gilbert.

Couple this with a new emphasis on patient-focused design – backed by scientific research that shows the impact indoor air quality, natural air and light and views have on patient wellbeing – and we will see a revolution in healthcare design over the next decade.

“We are seeing a new wave of healthcare facilities emerging in Australia and overseas and there is enough evidence of the importance of design to healing and wellbeing to help us as designers,” says Gilbert.

Woodhead senior associate and health facility planner on the Flinders Medical Centre project, Robin Muir, has been closely involved in the Green Star accreditation process. She says the project’s timing made it particularly challenging with the ratings process as the healthcare tool had not been released when the project began. While a healthcare pilot tool had been released it was already full so Woodhead initially used criteria from the Office Version 2 tool to develop its own sustainability matrix, a difficult process given it didn’t include health-specific aspects.

During this process the Green Star Office Version 3 was released with different criteria and shortly after that the Healthcare Version 1 tool was released. Woodhead immediately submitted for a 5 Star rating under this tool and has done its best to adapt to the criteria. It has been a time consuming, expensive and frustrating process but the team has also learnt a great deal, says Muir. ESD consultants, Synergy Green, helped with the process.

“The timing of our project made it particularly difficult – Green Star is very prescriptive with its criteria and this is important for consistency but there could be some tweaking of the tool so that it gets better outcomes,” says Muir.

Areas for tweaking in Green Star
One of the areas for tweaking is the way respite spaces are accredited. Currently respite areas where patients and family can have time away from the main patient rooms are awarded points if they are over 25 metres in size. But in the Flinders Medical Centre Woodhead created smaller spaces at the end of corridors where glass walls allow restful views of trees and gardens. Another area which needed more flexibility is views  – points are currently given for views but not the quality of the view.

“Aspects that align patient care and sustainability could be changed in the tool so that it is more applicable to health facilities. A view of a building wall is not as beneficial as a view of gardens,” says Muir.

Other ESD factors such as air displacement systems, which have been found to be beneficial in hospitals because they provide gentler air movement and allow more natural room temperature with incorporation of fresh air, are not directly awarded points under Green Star but can be accredited under the section for innovation. Internal atriums are recognised – something that is a key feature in the Flinders project.

Flinders Medical Centre, New South Wing

According to David Gilbert, the Flinders Medical Centre has been a major opportunity for Woodhead to use all of its ESD expertise. On an earlier project, the Royal Women’s Hospital in Melbourne, the firm won the award for the best public building in 2010 Property Council Awards for Excellence and Innovation. The project also won the premier award from the International Academy for Design and Health.

The 30-year-old centre required a complete overhaul of its engineering infrastructure and clinical areas. The addition of the new south wing allowed South Australian Health and Woodhead to do “something significantly different” by utilising the latest in sustainability design. As SA Health was also a sponsor of the new Green Star healthcare tool, ESD was always going to be a key priority.

The design process was highly consultative and collaborative, something that is essential for healthcare facilities, says Woodhead. Key sustainability features of the project include:

  • displacement ventilation system to patient rooms (can operate with 100 per cent fresh air – improved patient environment)
  • improved indoor environment quality considerations for a healing environment (such as external views, daylight and glare control, low VOC materials selections)
  • energy efficient plant and light fittings
  • water efficient hydraulic fixtures
  • rainwater storage tanks
  • secure bicycle parking together with shower and change facilities for staff
  • low water locally indigenous landscaping species

The Queensland Children’s Hospital
Another of the healthcare projects currently underway around the country is the Queensland Children’s Hospital. Melbourne architectural firm Lyons is designing thefacility in conjunction with Conrad Gargett in Brisbane.

Director of Lyons, Corbett Lyon, told TFE there are far too many hospitals and healthcare centre still being designed around a highly institutionalised, medico-centric model with no thought of sustainability. Architects have an important role to play in achieving more patient-friendly outcomes by designing with a more humanist approach where families and patients are at the centre.

“Art and cultural ideas are key to this success,” says Lyons.

The Queensland Children’s Hospital design is developed around the concept of a living tree with vertical and horizontal spaces that represent the tree trunk and its branches. Colours of the Queensland landscape and a narrative of local stories, local vegetation and history are used throughout the building.

“We’ve tapped into the idea of a sustainable building through the concepts of landscape and social history. Wherever possible, within the limits of the Queensland climate, we’ve used natural ventilation as well as low rise.

“We have roof gardens with sloping green walls which are very exciting – these will be used for rehabilitation programs for the children. On top of all that we have an arts program where local schools get involved – this means the hospital is more connected to the community, local and statewide,” says Lyons.

Finishes throughout reflect the colours and textures of the Queensland environment, including sustainable timber veneers printed with texts about the environment written by children.

In the internal atrium artworks will be suspended and at the reception glass covered counters will contain specimens of Queensland butterflies and shells. There will definitely be no Walt Disney cartoon characters adorning the walls.

A curatorial panel with visual arts, performing arts and education experts are working with the architects and Queensland Health to collaborate on the installation of fixed artworks, sculpture, video and performing arts programs at the hospital.

The hospital, which is due for completion in 2014, was last week awarded the Arts & Health Australia Award for Excellence in Architecture and Environmental Design.

“It has been a totally inclusive process which has engaged children and families as well as the wider stakeholder base in the design process. We ran a series of workshops to get ideas and feedback,” says Lyons.

Australian designers are also making their mark in healthcare facilities overseas. Melbourne-based architects Silver Thomas Hanley, played a pivotal role in delivering Canada’s first public-private partnership hospital and the first to achieve Gold LEED – the equivalent of a 5 Star Green Star rating.

Designed by STH in a joint venture with Musson Cattell Mackey Partnership in Vancouver the 300-bed Abbotsford Regional Hospital and Cancer Centre features a 24 metre high central atrium and a layout that minimises physical exertion for staff, and takes into consideration the latest infection-control strategies. Large windows, vibrant colours are featured throughout as are facades on walls and ceilings that depict natural scenes.

Energy savings of  about $480,000 annually, were achieved through solar orientation, high efficiency gas-fired hot water boilers, a flue gas-heat recovery system (with recovered energy used for heating and domestic hot water) and a high efficiency chilled water generation system.

According to STH director, Aija Thomas, the project required very close dialogue between hospital staff and the design team. The building was designed as a series of interrelated pods reflecting the firm’s belief that hospitals are like “cities within cities”. Rather than a medico-centric model, patients and staff were very much the focus.

“Patients, staff and visitors are recognised as both short and long-term occupants of the healthcare environment, and we respond to their different requirements,” says Thomas.

Future challenge is financial constraint

While the progress by healthcare designers, particularly in new facilities, is heartening, there is still a long way to go before hospitals are sustainable environments in a comprehensive way. Existing buildings with their outdated infrastructure and inflexible, massive floor plates are difficult to work with. Many government healthcare departments are also reluctant to go through the hoops for Green Star accreditation. It is just too expensive, difficult and time consuming say architects working in the sector.

But the real challenge is financial constraint, says the GBCA’s Robin Mellon. Since healthcare and education projects seldom see the rewards represented by increased sale or rental values, the “green benefits” can often take longer to be felt.

“While the premium on building green may only be a few per cent higher than the cost of building a standard building, when this extra cost is translated to fewer beds, less equipment or fewer staff, governments may be wary of signing off on the project,” says Mellon.

“Operating efficiencies, reduced bills, better maintainability and improved staff and patient outcomes can take longer to add up, although their combined benefit is doubtless significantly higher than any potential cost increase. Right now governments have a rare opportunity to demonstrate that investing in better design and efficient systems will lead to considerable financial and non-financial gains in the long-term.”

lblundell@thefifthestate.com.au