Awareness of green design in the healthcare sector has come a long way since sustainable-building advocate Gail Vittori, co-director of the Center for Maximum Potential Buildings, and industry colleagues helped launch the Green Guide for Health Care in 2002. Wary of any new building strategy due to their sensitive patient populations, healthcare organizations were cautious at first about changing their design approach. Regulations and guidelines for facilities in the United States, meanwhile, were slow to keep up with green-building techniques such as natural ventilation or water reuse that had gained acceptance abroad. More recently, however, with the help of a few leadership examples—notably a generation of children’s hospitals that have embraced green design such as Dell Children’s Medical Center in Austin, Texas, which was built in 2007 and was the first LEED Platinum–certified healthcare facility—the healthcare industry has largely begun to understand the environmental, economic, and health benefits of sustainable facilities, Vittori says.

“The healthcare sector is embracing green strategies on a trajectory that [now] matches the residential and commercial-office sectors,” says Vittori, who is also a founding chair of the USGBC’s LEED for Healthcare core committee.

But while it’s rapidly catching up to other commercial market subsectors, healthcare is starting from behind. At press time, the USGBC counted only 315 healthcare facilities with LEED certification and 1,298 registered for certification, out of 11,363 LEED-certified and 32,773 registered commercial projects. Nevertheless, since the development of LEED for Healthcare, the pace of registration for healthcare buildings has increased, Vittori says.

Long-term energy and cost savings are still a driver for many healthcare organizations’ green-building efforts, and for good reason. As Vittori says: “Hospitals tend to be tremendous consumers of energy.” The bright side is that healthcare facilities can have a large environmental effect by reducing their energy usage—and see a clear payback on their investment in utility savings. While energy-saving features are particularly popular in a tight economy, healthcare architects are also now thinking about how green-building features can improve patient or resident care.

The 135,000-square-foot Djavad Mowafaghian Centre for Brain Health in Vancouver, British Columbia, Canada, a joint project of the University of British Columbia and the Vancouver Coastal Health Research Institute, mixes clinical outpatient facilities with academic research in an environment that aims to improve both patient care and brain-disease research through collaboration.

“The whole point was to institute a dynamic where more academic researchers, who typically have little interaction with patients, are put into direct contact with doctors and patients,” says David Martin, AIA, the project designer and a principal and practice leader for the London office of Stantec Architecture. The firm’s San Francisco and Vancouver offices collaborated on the project. “There is a therapeutic gain when there is a sense … [that the patients] are part of something bigger than themselves.”

Inspired by the idea of a brain synapse, the building was designed to create collisions between researchers and clinical workers. The lower two floors contain patient facilities, the upper two floors hold research areas, and the level in between houses offices and meeting and support rooms. The spaces are interlocked with spaces reminiscent of connective tissue: a three-floor atrium in the back and a primary five-floor atrium at the entrance. The visually transparent design allows visitors to glance right to see the patient reception area or left to see scientists conducting advanced research.

With the potential for heat buildup, the large glass atrium also is the focus of energy-saving strategies. Mandated to construct the building to LEED Gold standards, Martin’s team maximizes heat recovery in the atrium, running exhaust air through a manifold and reusing the heat to pre-temper incoming air. While the exhaust requirements of the research areas ruled out a natural-ventilation strategy, the designers created separate zone systems for each area to maximize energy savings. “Some research areas need 10 to 12 air changes an hour, but the patient areas are on a much lower draw, around four air changes an hour,” Martin says. “Only 60 percent of the building needs to be at a higher rate, so the building systems were designed for the populations within them, rather than the lowest common denominator.” Set to be completed in 2013, the building is designed for energy use 60 percent below baseline conditions, Martin says, and half of the savings will be achieved through air-side heat recovery. The facility also has a green roof, with reflective surfaces on both the roof and the landscape; automatic lighting controls; and a graywater-harvesting system.

With many facilities owned and operated by not-for-profit enterprises, healthcare clients are often more receptive to building approaches that have higher upfront costs but yield long-term savings, says Jeffrey W. Anderzhon, FAIA, principal for Crepidoma Consulting, a design consultant serving care providers and architects in Fairfax, Va. “They often own the building for the entire life cycle of the building, so they’re interested in longer-term operating costs and energy costs,” he says.

Saving energy was an explicit goal for NewBridge on the Charles in Dedham, Mass., a 1 million-square-foot senior community designed by Perkins Eastman in Pittsburgh and completed in 2009 that combines a community center; healthcare center; housing for 800 residents, including assisted-living and memory-support apartments; and long-term and subacute care, as well as a K–8 school for 450 students. Operating costs were important—residents pay a monthly service charge that rises with the cost of operation.

The project’s single biggest investment targeted at sustainability was a field of 400 geothermal wells used for the community’s primary heating and cooling. The system is anticipated to generate a 50 percent savings in natural-gas consumption and provide a return on investment in 10 years—a solid investment for the long-term owner.

The campus is also notable for its connection with nature and the surrounding neighborhood. With 2,000 feet of frontage along the Charles River, the site has naturally occurring biodiversity ranging from dense wetlands to open forest. The project reinforced and expanded the existing path network for use by residents and the surrounding neighborhood, and the campus buildings were positioned to feature preserved, mature trees and connect building interiors with the natural surroundings.

For populations requiring specialized care, such connections can be vital in providing safety, security, and fulfillment for residents. Sweetwater Spectrum, a pilot community for adults with autism in Sonoma, Calif., that broke ground in September, was designed to minimize sensory overload and maximize familiarity for residents with a broad spectrum of needs.

“We needed to offer real clarity in design, to allow residents the ability to preview situations and make choices on how to engage with other individuals in the community,” says Marsha Maytum, FAIA, principal of Leddy Maytum Stacy (LMS) Architects in San Francisco, which designed the community.

Uniting universal design with sustainable design was central to that goal. To increase comfort as well as ease wayfinding, Maytum’s team developed a plan that creates clear thresholds at every transition between settings. For instance, a pathway leading to a covered arbor provides a transition between the welcome building that is open to the public and a community zone open to residents and caregivers. Forecourts and porches also indicate transitions to private areas and the homes. The site, meanwhile, is located within walking distance of Sonoma’s town square, and the designers hope to provide safe, comfortable ways for residents to integrate into the larger community.

The architects are planning to make the community, which will be completed at the end of 2012, as energy-efficient and sustainable as possible. Designed to LEED Gold standards, with energy use 30 percent less than Title 24 requirements, the residences will have solar-thermal systems and are designed to accommodate PV arrays, making them net-zero-energy capable.

Many of the community’s sustainability features are natural pairings with universal-design goals. The designers paid particular attention to providing daylight and a connection to the outdoors, which creates a peaceful environment that helps residents become attuned to the cycle of the day. Buildings are heated and cooled by a quiet radiant system, eliminating disruptive mechanical noise. Durable, non-off-gassing materials were another focus.

As LMS finalizes the details for construction bids, more than 90 families have signed up to get information on the community, which will house 16 individuals. With a rapidly growing population of young adults with autism nationally, it may be Sweetwater’s small, specialized community model that is most influential. “The healthcare community has to find new ways of dealing with these issues,” Maytum says, “so everyone has a safe and secure place to live and a meaningful life in the future.”