While some markets have embraced green design, the healthcare industry, as a whole, has taken relatively small steps toward sustainability. But that’s changing. Clients not only are more comfortable going green, they also are seeking to reduce energy costs and water usage. Design teams are combining creativity with experience to find sustainable features that best suit each project, as illustrated in the five projects shown here.

Cathedral Hill Hospital

At more than 1.2 million square feet, the 13-story, 555-bed California Pacific Medical Center’s Cathedral Hill Hospital in San Francisco (part of the private nonprofit Sutter Health system) is one of the largest healthcare projects currently targeting LEED Gold certification. This is no easy feat when you consider that hospital administrators are typically risk-averse. “Healthcare clients aren’t exactly barrier-breakers,” says Russell Perry, co-director of sustainable design at SmithGroup and managing director of the firm’s Washington, D.C., office. “They’re building some of the most expensive projects out there, and, because these projects represent such a huge financial investment, they have to be very conservative.” However, more clientsincluding Sutter Healthare motivated to lower energy costs, reduce water use, and simply build better.

Strategies used in the design for the $1.7 billion hospitalsuch as variable air volume, displacement ventilation (which Perry expects will soon become a dominant air-delivery system for healthcare projects), and heat recovery (a no-brainer since the hospital is utilizing 100 percent outside air)are expected to reduce annual energy use by 35 percent and carbon emissions by 26 percent. Additional energy savings will come from multilevel switching and dimming lights in patient rooms and staff areas (specifically task lighting), as well as the installation of occupancy sensors to control lighting in corridors, offices, nursing areas, and support spaces. The team is also sourcing energy-efficient medical equipment, which could reduce loads by more than a third. (The search for this equipment is proving difficult because manufacturers don’t yet see energy efficiency as a priority.) SmithGroup also looked into using photovoltaics, but the system couldn’t be justified because energy production would contribute only a token amount to the overall power demand.

The hospital’s water strategies focus on high-efficiency, low-flow fixtures that are expected to reduce domestic water use by 3.3 million gallons per year. Additionally, a pulse-powered, nonchemical water treatment system will be used in place of traditional chemicals to provide corrosion, microbiological, and scale protection in the condenser water system. The process, which reduces bleed off and produces clean water (unlike water treated by traditional chemical processes), is expected to save 20 million gallons per year. Water needed to irrigate the hospital’s green roofs, green walls, and street plantings will come mainly from cooling tower blow-down and captured stormwater. Expected water savings: 180,000 gallons per year.

Torrance Memorial Medical Center

When administrators at Torrance Memorial Medical Center in Southern California talked to HMC Architects about designing a new patient tower, they wanted to go green. “They asked for LEED Silver or better,” recalls Jerry Eich, healthcare practice leader at the Ontario, Calif.based design firm. To reach that goal, Eich and his project team targeted everything from equipment to materials to lighting in the 390,000-square-foot, 256-bed hospital. They even set up on-site construction waste recycling to take the onus off the city. However, it’s unlikely that the $500 million project will ever be certified at LEED Silver. “Socially they’re doing the right thing,” says Eich of administrators at Torrance, “but mentally they haven’t gotten past having to pay for the certification at the end.” For many, it’s enough to comply with LEED without having to spend extra money proving it. Eich tries to get his clients to see the value in both sustainability and certification, stressing that it helps the hospital’s public image, shows the community its commitment to sustainability, and proves that the building really is operating as intended one year later. However, he also expects to see fiscal tightening convince more hospitals to become LEED equivalent, but not necessarily LEED certified.

Ann and Robert H. Lurie Children’s Hospital of Chicago

“Sustainability was a huge concern in the project brief, but the client made it very clear they weren’t going to contribute additional resources to make the sustainable mission happen. So we worked on getting LEED with no premium to the budget,” says Stuart Baur, principal at ZGF Architects, of the firm’s work on the Ann and Robert H. Lurie Children’s Hospital of Chicago. The 23-story, 1.25-million-square-foot facility on Northwestern University’s Feinberg School of Medicine campus is now targeting LEED Silver.

Baur says it’s still common for clients to perceive sustainable construction as costing more. But that’s not the case if, in the earliest stages, the right questions are addressed so that money can be allocated where it’s needed: Where is heat wasted? How can water be reused? What are we spending on energy? “I absolutely believe that, done well, you can achieve at least LEED Silver with no premium to the budget,” Baur says, adding that it’s more important to focus on creating the healthiest, most efficient hospital for the budget than it is to focus on a specific LEED level.

The green effort for this project included a high-efficiency ventilation system; high-efficiency plumbing fixtures (expected to reduce water use by 20 percent); a stormwater management system (designed to treat 90 percent of all runoff water); a salvage and recycling program (targeting a minimum 50 percent of demolition waste); a green roof and healing garden about 13,500 square feet in size; and a light-colored, precast concrete exterior and light-colored paving along the street frontage to reduce the heat island effect. It’s worth noting that it is the project team who decided not to target lighting in its sustainable endeavors. “We stayed away from items we didn’t think contributed meaningfully to the hospital,” Baur says. “We chose not to do lighting control because with a 24/7 building, lights are on all the time. … The reality is that most rooms are in use and we didn’t feel like they [lighting controls] would be a value-add. Sustainability is about saving our clients money by giving them the right things.”

Sherman Hospital

Rather than have a sprinkle of green here and there, the project team working on the $250 million Sherman Hospital in Elgin, Ill., focused on one large sustainable gesture: a 15-acre geothermal lake. “You don’t see a lot of geothermal in healthcare so we had to do some convincing to get the hospital on board,” says Katie Faulkner, associate principal at Shepley Bulfinch in Boston.

What helped the architectural firm’s pitch was the fact the lake wasn’t simply a green indulgence; the hospital’s extensive 154-acre campus required three detention ponds for water runoff, so converting one of them to geothermal use wasn’t a stretch. Additionally, the dredged soil would be reused on site, eliminating the need to truck in top soil. Of course, the financial argument was most compelling to the clients: an approximate $1 million reduction in annual heating and cooling costs (depending on utility rates) and an expected eight-year payback. “Anything under 10 years is considered part of your short-term operational cycle,” Faulkner says. After the system was green-lit, hospital administrators secured a $400,000 grant from the Illinois Clean Energy Community Foundation to help offset initial costs.

The geothermal infrastructure and lake system, engineered by KJWW Engineering Consultants of Rock Island, Ill., involves a total of 175 rafts sitting on the lake bottomthey are weighted down at a minimum of 18 feet below the water surfacewith 150 miles of closed-loop pipe circulating a methyl-alcohol mixture through the system and in and out of the hospital. Most of the 650,000-square-foot hospital is served by the geothermal system, including its 255 patient rooms, but some spaces, such as the intensive care unit and operating rooms, still require roof-mounted air-handling units, albeit far fewer than would be necessary with a conventional system.

The hospital opened in December 2009, and Faulkner reports the geothermal system is performing better than expected: The payback period is now tracking at just six years.

Smilow Cancer Hospital

Shepley Bulfinch incorporated green throughout the 516,000-square-foot Smilow Cancer Hospital at Yale-New Haven Hospital in Connecticut, intending to meet LEED certification—which was still somewhat uncharted territory when the project began. “We started working on this hospital in 2004 and at that point [we think] there was only one other hospital that [had] achieved LEED,” says Angela Watson, principal at Shepley Bulfinch. “Clients usually want someone else to have tried something first. No one wants to be a guinea pig.” In this case, however, the owners were excited about the challenge of going for certification, and the hospital eventually earned enough points to target LEED Silver. The $290 million hospital opened earlier this year and is still in the LEED review process.

The hospital hits a lot of the typical sustainable hot buttons: high-efficiency HVAC system; low-albedo roof to reduce the heat island effect; a small vegetated roof on the seventh floor that doubles as a healing garden; recycled construction waste; daylighting with high-efficiency, low-E glazing on the façade; and a terra-cotta rainscreen system that, because of its light weight, reduced the tonnage of steel required in the building’s construction. The hospital also qualified for LEED points due to its educational program that targeted to various audiences—including nurses, visitors, and those responsible for facilities maintenance. “Green buildings require a commitment after the fact,” Watson says. “What happens after the building is completed is equally important.”

Jay W. Schneider has written about the A/E/C industry for more than 15 years, and most recently was senior editor of Building Design+Construction magazine.