Building new hospitals today, in an era of declining inpatient volume and growing outpatient volume, is not as prominent as it used to be. However, despite the shift from overnight hospital stays, there will always be a need to build a new or update an existing hospital.
For hospital executives planning their strategies around new construction projects, they first might want to see how hospital construction has evolved over the past several years. Neil Chambers and Russ Korcuska have seen the shifts first hand.
Mr. Chambers is the founder and CEO of Chambers Design, a design firm focused on green buildings, green design and modern building infrastructure. His firm led the sustainability effort of the 156-bed UPMC East Hospital in Monroeville, Pa., which just opened this summer and received a LEED Silver certification.
Mr. Korcuska is a project director at Sundt, a construction firm with experience in hospital design. Sundt led the construction of a five-story building addition to the existing Sharp Grossmont Hospital in La Mesa, Calif., and the five-story Carondelet St. Joseph's Women's Center in Tucson, Ariz.
Between the two of them, they have seen the "now" of hospital construction, which has a significant impact on a hospital's balance sheet and long-term debt, and here they share three ways the industry has progressed.
1. Building orientation is the first step. Before the first brick can be laid or the first hammer is wielded, hospital executives have to know a simple yet potentially overlooked fact: Which way will the building face?
When Mr. Chambers and his firm were first introduced to the new UPMC East Hospital, led by architectural firm BBH Design, the original design had the building with a north-to-south orientation. However, with the way the sun rises and sets, he realized that was not the most efficient setup. If a hospital is situated in an east-to-west manner, it will be exposed to the sun's hot periods less than if it were in a north-to-south manner and therefore reduces the amount of energy needed to cool off the entire hospital — a structure that typically needs a lot of cooling.
"We did some building simulations of that [north-to-south orientation] and instead oriented the shape to an east-to-west orientation," Mr. Chambers says. "Just by moving the direction of the building, we saw a 17 percent improvement on solar gains because that had a direct effect on how to keep the interior cool."
He adds that this "cost-neutral" approach has to be the first step in a new construction project. "These climatic decisions are the building pieces, and they don't cost money," Mr. Chambers says. "It's the same building, oriented in the correct manner, and it's the best way to get the greenest hospital without increasing costs of construction."
2. Energy savings are a high priority before, during and after the project. Mr. Chambers says hospitals are structures that need a lot of changes if they want to be energy-efficient. Patient rooms need six air changes an hour, and operating rooms need 25 air changes an hour (compare that to a typical office space that needs two air changes per hour). "It's a huge problem to make hospital buildings more efficient, and you really have to be very strategic in how you approach energy savings," Mr. Chambers says.
So how can hospital executives make sure energy savings are at the top of the list from the start of construction? Mr. Chambers and Mr. Korcuska say executives should work with the facilities team and architectural firm to ensure several checklist items are met, such as:
• Instilling retrocommissioning measures, including having motion sensors for lighting control systems, efficient boilers, heat recovery chillers and installing more efficient lighting from the get-go. "Heat recovery chillers reuse heat from the hospital's chilling process and provide hot water," Mr. Korcuska says. "This saves tons on water waste, and you're creating heat from the byproduct of the cooling process. A big hospital could save $300,000 to $400,000 per year on these types of energy consumption measures."
• Using renewable energy sources when possible, which is cheaper and safer than other fuel sources. This also includes taking advantage of the atmosphere around the hospital site. For example, Mr. Korcuska says hospitals can funnel rainwater and water from air conditioners into a tank, which can be used for irrigation.
• Establishing proper waste deposal areas and tactics, including recycling.
3. A healthy, responsible hospital structure equals a healthy patient population. The physical materials used to construct a hospital building have greatly advanced over the decades, meaning lead and other unsafe chemicals are out of the equation. However, Mr. Korcuska says hospitals could go a step further by ensuring their new hospitals have formaldehyde-free wood products, rubber flooring, PVC-free wall protection and other environmentally friendly products that do not use petroleum or other harmful sources. Hospital executives can't be turned off by higher short-term costs when the long-term costs — better patient health, improved quality rankings and an eventual return on investment — are what really matters.
"Using non-environmentally friendly products in materials creates an unhealthy environment," Mr. Korcuska says. "When you're building this type of facility over two-and-a-half or three years, you have to realize your clients will be operating that facility 24/7 for the next 40 years of its life. That's when product selection is going to have the biggest impact."
For hospital executives planning their strategies around new construction projects, they first might want to see how hospital construction has evolved over the past several years. Neil Chambers and Russ Korcuska have seen the shifts first hand.
Mr. Chambers is the founder and CEO of Chambers Design, a design firm focused on green buildings, green design and modern building infrastructure. His firm led the sustainability effort of the 156-bed UPMC East Hospital in Monroeville, Pa., which just opened this summer and received a LEED Silver certification.
Mr. Korcuska is a project director at Sundt, a construction firm with experience in hospital design. Sundt led the construction of a five-story building addition to the existing Sharp Grossmont Hospital in La Mesa, Calif., and the five-story Carondelet St. Joseph's Women's Center in Tucson, Ariz.
Between the two of them, they have seen the "now" of hospital construction, which has a significant impact on a hospital's balance sheet and long-term debt, and here they share three ways the industry has progressed.
1. Building orientation is the first step. Before the first brick can be laid or the first hammer is wielded, hospital executives have to know a simple yet potentially overlooked fact: Which way will the building face?
When Mr. Chambers and his firm were first introduced to the new UPMC East Hospital, led by architectural firm BBH Design, the original design had the building with a north-to-south orientation. However, with the way the sun rises and sets, he realized that was not the most efficient setup. If a hospital is situated in an east-to-west manner, it will be exposed to the sun's hot periods less than if it were in a north-to-south manner and therefore reduces the amount of energy needed to cool off the entire hospital — a structure that typically needs a lot of cooling.
"We did some building simulations of that [north-to-south orientation] and instead oriented the shape to an east-to-west orientation," Mr. Chambers says. "Just by moving the direction of the building, we saw a 17 percent improvement on solar gains because that had a direct effect on how to keep the interior cool."
He adds that this "cost-neutral" approach has to be the first step in a new construction project. "These climatic decisions are the building pieces, and they don't cost money," Mr. Chambers says. "It's the same building, oriented in the correct manner, and it's the best way to get the greenest hospital without increasing costs of construction."
2. Energy savings are a high priority before, during and after the project. Mr. Chambers says hospitals are structures that need a lot of changes if they want to be energy-efficient. Patient rooms need six air changes an hour, and operating rooms need 25 air changes an hour (compare that to a typical office space that needs two air changes per hour). "It's a huge problem to make hospital buildings more efficient, and you really have to be very strategic in how you approach energy savings," Mr. Chambers says.
So how can hospital executives make sure energy savings are at the top of the list from the start of construction? Mr. Chambers and Mr. Korcuska say executives should work with the facilities team and architectural firm to ensure several checklist items are met, such as:
• Instilling retrocommissioning measures, including having motion sensors for lighting control systems, efficient boilers, heat recovery chillers and installing more efficient lighting from the get-go. "Heat recovery chillers reuse heat from the hospital's chilling process and provide hot water," Mr. Korcuska says. "This saves tons on water waste, and you're creating heat from the byproduct of the cooling process. A big hospital could save $300,000 to $400,000 per year on these types of energy consumption measures."
• Using renewable energy sources when possible, which is cheaper and safer than other fuel sources. This also includes taking advantage of the atmosphere around the hospital site. For example, Mr. Korcuska says hospitals can funnel rainwater and water from air conditioners into a tank, which can be used for irrigation.
• Establishing proper waste deposal areas and tactics, including recycling.
3. A healthy, responsible hospital structure equals a healthy patient population. The physical materials used to construct a hospital building have greatly advanced over the decades, meaning lead and other unsafe chemicals are out of the equation. However, Mr. Korcuska says hospitals could go a step further by ensuring their new hospitals have formaldehyde-free wood products, rubber flooring, PVC-free wall protection and other environmentally friendly products that do not use petroleum or other harmful sources. Hospital executives can't be turned off by higher short-term costs when the long-term costs — better patient health, improved quality rankings and an eventual return on investment — are what really matters.
"Using non-environmentally friendly products in materials creates an unhealthy environment," Mr. Korcuska says. "When you're building this type of facility over two-and-a-half or three years, you have to realize your clients will be operating that facility 24/7 for the next 40 years of its life. That's when product selection is going to have the biggest impact."
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