{"id":48946,"date":"2021-05-03T08:00:27","date_gmt":"2021-05-03T12:00:27","guid":{"rendered":"https:\/\/healthcaredesignmagazine.com\/?p=48946"},"modified":"2021-05-03T08:19:16","modified_gmt":"2021-05-03T12:19:16","slug":"growing-green","status":"publish","type":"post","link":"https:\/\/healthcaredesignmagazine.com\/trends\/growing-green\/","title":{"rendered":"Growing Green Rating Systems In Healthcare Design"},"content":{"rendered":"

There are a growing number of third-party environmental rating systems in the healthcare design and construction marketplace, fueled by the increasing interest in health and occupant well-being and the early success of the U.S. Green Building Council\u2019s Leadership in Energy and Environmental Design (LEED<\/a>) program. But use of these certification systems is relatively limited\u2014why? What are the barriers and challenges? And what might the future development of environmental tools look like and how might utilization by health systems be improved?<\/p>\n

To explore these topics and more, a deep-dive workshop was held at the 2019 Healthcare Design Expo & Conference in New Orleans, addressing the question of what\u2019s working for healthcare owners (and what\u2019s not) in today\u2019s green building certification systems. The three-hour event included a discussion on the state of rating systems; a panel presentation by health systems including NYU Langone Medical Center, Kaiser Permanente, and Cleveland Clinic; and breakout discussions among 30 participants representing designers, rating system representatives, and health system facility managers.<\/p>\n

Based on the session findings, a survey was developed and distributed to approximately 20 sustainability leaders and engineers at design firms as well as to facility managers. The goal was to develop a snapshot of the current state of healthcare rating and certification systems and identify what the healthcare sector needs from these systems to deliver healthier, restorative, and regenerative buildings that support improving care and reducing operational costs.<\/p>\n

Growing landscape <\/strong><\/p>\n

While a number of green building certification systems exist, LEED is the best known and most widely used tool in the market today. LEED for Healthcare<\/a> (LEED-HC), initially released in 2009 and now in Version 4.1, is specifically tailored to the unique 24\/7\/365 operational needs of hospital buildings and is the most widely used third-party certification system. Ambulatory projects and medical office buildings use other LEED rating system tools, such as LEED-CI (Commercial Interiors) and LEED-BD&C (Commercial Buildings). A resilience consensus standard called RELi<\/a>, which Perkins&Will<\/a> helped to develop in 2012 with the Institute for Market Transformation to Sustainability<\/a>, is available only to projects seeking LEED certification and offers a comprehensive certification rating system for socially and environmentally resilient design and construction.<\/p>\n

The Living Building Challenge<\/a> (LBC), a product of the International Living Future Institute, provides a framework for performance-based rating and certification of regenerative buildings, such as net positive energy, water, and waste. While it isn\u2019t specific to health facilities, the system is actively seeking pilot projects to recommend adaptations for healthcare projects.<\/p>\n

WELL is a performance-based certification promoted by the International WELL Building Institute<\/a> (IWBI) and quantifies a range of health and well-being impacts on occupants, featuring indicators that include both construction and operational strategies. Fitwel<\/a> is a health and wellness rating system, managed by the Center for Active Design<\/a>, with quantifiable indicators that include food, occupant safety, and social equity. Both rating systems are being used by healthcare organization in both new construction and renovation of administrative and ambulatory settings, with Fitwel viewed as an accessible, low-cost option that can be administered directly by building managers. (For more on green building rating and certification systems see sidebar at end of article.)<\/p>\n

Barriers to wider adoption\u00a0 <\/strong><\/p>\n

With a growing number of options available, workshop participants and survey respondents identified several perceived barriers to the wider adoption of third-party green building rating systems by the healthcare market.<\/p>\n

The cost of the certification process is one of the most commonly cited barriers. This includes not only the certification fees paid to the rating system, which range from 5 to 6 cents per square foot, but also the soft costs incurred by the design and construction teams for energy modeling, commissioning, and certification services (often provided by a third-party consultant). These services have been estimated to add $1 to $5 per square foot (with large projects at the low end and small and\/or complex phased projects at the higher).<\/p>\n

The price for certification is often viewed as the cost above and beyond that of a building not seeking certification. However, it\u2019s common to optimize performance of new buildings with energy modeling and commissioning\u2014key elements of the LEED rating system\u2014which means these services shouldn\u2019t be included in the cost of certification. Energy modeling is typically used as a code compliance tool, aside from its function as a tool to optimize energy performance, while commissioning is now virtually an industry standard practice, given the level of quality assurance it provides the owner. In other words, the premium associated with certification is often just the cost of a third-party certification consultant and the fees paid to the rating system.<\/p>\n

Lack of perceived value of certification is another obstacle, responses showed. Owners, in particular, believe that their project teams are following many of the best practices that are defined within the rating systems and incorporating those ideas, such as local material sourcing and construction waste recycling, into their projects, eliminating the need to incur the cost of certification. In fact, an increasing number of systems are developing construction standards that incorporate many LEED and wellness strategies. However, one of the key attributes of a rating system is to encourage market transformation\u2014changing the way buildings are designed and constructed. In addition, third-party certification explicitly demands rigor: Incorrect products must be sent back to distributors, demolition waste must have a legitimate recycling destination, filters must be changed in the field, monitoring must be documented. These processes require management and time.<\/p>\n

The healthcare design and construction industry is heavily regulated, with virtually all aspects of a project subject to at least one code or regulation\u2014everything from room size to ventilation rates to material flame and smoke spread, creating hesitancy to add yet another layer of requirements to projects. However, many health systems now have environmental, social, and governance (ESG) goals, such as energy or carbon emission reductions, which demand documentation that\u2019s inherent in the green building rating systems and certification requirements. In these cases, the rating system becomes an extension of \u201cquality control\u201d and ensures that all projects achieve performance targets that support a system\u2019s ESG goals.<\/p>\n

Features of an ideal rating system <\/strong><\/p>\n

Moving beyond the limitations of current systems, participants in the session and survey were asked to name the important characteristics of an ideal third-party rating and certification system. Participants agreed that rating system developers will need to focus on these ideas to grow use by the healthcare sector, particularly in acute care hospital projects. Here are a few ideas for future tools:<\/p>\n