Designing a 21st Century Hospital: Environmental Leadership for Healthier Patients and Famillies

A collection of papers presented by The Center for Health Design and Health Care Without Harm at a conference sponsored by the Robert Wood Johnson Foundation.

The American healthcare industry is in the midst of an impressive construction boom, the result of diminished capital investment in new and replacement hospitals in the 1990s, the aging population, and the increasing number of hospitals experiencing bed shortages and capacity bottlenecks in their emergency rooms, surgical suites, and critical-care units. The forecast of annual capital spending on health facilities rising from $18 billion today to $35 billion in the year 2010 makes a discussion of better building important and timely.

This healthcare construction boom presents a rare opportunity to use the emerging sciences of evidence-based design, materials assessment methodologies, and green building tools to build healthier healthcare facilities that benefit occupants, communities, and the global environment.

Because they are responsible to the communities they serve and their environmental impacts span both operations and construction, healthcare organizations are in a unique position when it comes to being green. Since the mid-990s, the industry has made considerable progress in reducing operational impacts and now stands poised to begin transforming design and construction practices. Moreover, as an industry that employs 1 out of 8 Americans, directly or indirectly, and drives upwards of 15 percent of the gross domestic product, the decisions that healthcare purchasers make can have a dramatic impact on the marketplace.

In the area of operations, the healthcare industry is cleaning up its own house, which serves to make healthcare organizations better community-health advocates. The industry has dramatically reduced reliance on medical waste incineration, which the Environmental Protection Agency (EPA) identified as the largest source of dioxin contamination in the atmosphere in 1996. Since that time, the number of medical-waste incinerators in North America has fallen from close to 5,000 to less than 100. The American Hospital Association signed a memorandum of understanding with the EPA with a commitment to phase out the use of mercury altogether. Many hospitals are beginning to advocate for chemicals policies and reduced use of antibiotics in food sources, as they respond to the growing evidence around linkages between the health of the environment and the health of the communities they serve.

With regard to sustainable building practice, the healthcare industry is slowly taking up the challenge and opportunities that green building presents. According to the U.S. Green Buildings Council, the number of LEED (Leadership in Energy and Environmental Design) registered healthcare buildings in the United States has risen from twenty, just two years ago, to more than eighty today. Moreover, there are more than one hundred healthcare organizations participating in the Green Guide for Healthcare’s pilot program. This means that almost two hundred healthcare organizations in the United States are advancing green design, construction, and operational strategies for their facilities.

It is in the context of furthering this important dialogue that The Center for Health Design (CHD) and Health Care Without Harm commissioned the writing of these papers. Individually, these papers tackle very different aspects of this complex, intricate, and compelling subject. But together, they represent an incredible opportunity to move healthcare from the status quo to becoming more responsible stewards of the environment.