Sustainable Healthcare Buildings - Assoc. Prof. Dr. Müjde Altın

Sustainable architecture is one of today's most discussed topics. The sustainability of a building is measured in part through certification systems known as "Green Building Rating Systems (GBRS)", and buildings worldwide are classified according to how sustainable they are using these systems. The energy crisis experienced globally in the 1970s and the fact that greenhouse gases cause global warming made the search for new energy sources—different from fossil fuels, with unlimited reserves and environmentally harmless—mandatory. On the other hand, the search for solutions to minimize energy needs and energy efficiency have become today's most important and pressing issues. Healthcare facilities, according to research conducted in the United States (Ilıcalı, 2014), are the commercial building type with the highest energy consumption after the food sector. For this reason, obtaining GBRS certification is a good solution to reduce the high energy consumption of healthcare facilities that operate continuously 24 hours a day. In Turkey, through a circular issued by the Ministry of Health in 2012, obtaining LEED certification, which is one of the Green Building Rating Systems, became mandatory for new hospitals with 200 or more beds (Ilıcalı, 2014). For this reason, in this study, healthcare facilities certified with LEED, one of the GBRS that evaluate the sustainability of buildings worldwide, were examined and analyzed. As a result, it will be demonstrated that the use of GBRS such as LEED will be beneficial for designing and constructing more sustainable hospital buildings by reducing energy consumption in hospital structures.

Introduction

Sustainable architecture is one of today's most discussed topics. The sustainability of a building is measured in part through certification systems known as "Green Building Rating Systems (GBRS)", and buildings worldwide are classified according to how sustainable they are using these systems. The energy crisis experienced globally in the 1970s and the fact that greenhouse gases cause global warming made the search for new energy sources—different from fossil fuels, with unlimited reserves and environmentally harmless—mandatory. On the other hand, the search for solutions to minimize energy needs and energy efficiency have become today's most important and pressing issues. Healthcare facilities, according to research conducted in the United States (Ilıcalı, 2014), are the commercial building type with the highest energy consumption after the food sector. It is a building type that must operate 24 hours a day and can cause significant environmental damage with its considerable water, material, and energy consumption and hazardous waste. For this reason, great care must be taken in their design, with many inputs requiring consideration, and obtaining GBRS certification is a good solution to reduce the high energy consumption of healthcare facilities. Following similar logic, a separate category for hospital buildings was created in the LEED certification system. There are numerous hospital buildings certified with LEED or other GBRS worldwide. In Turkey, through a circular issued by the Ministry of Health in 2012, obtaining LEED certification, which is one of the Green Building Rating Systems, became mandatory for new hospitals with 200 or more beds (Ilıcalı, 2014). For this reason, this study examined and analyzed how healthcare facilities are addressed and certified with LEED, one of the GBRS worldwide, through examples of certified hospital buildings. As a result, it will be demonstrated that the use of GBRS such as LEED will be beneficial for designing and constructing more sustainable hospital buildings by reducing energy consumption in hospital structures.

Sustainable Architecture

The definition of sustainability was first presented as a result of the 1983 United Nations General Assembly meeting, explained by Gro Harlem Brundtland, Chair of the World Commission on Environment and Development, and published in 1987 in the report "Our Common Future". In this report, also known as the Brundtland Report, sustainable development was defined as "development that meets the needs of the present without compromising the ability of future generations to meet their own needs" (WCED, 1987). Sustainable development has three dimensions. These are "environment, society, and economy". "Sustainable development" refers to the need to ensure that good design that does not harm the environment works for the benefit of society and is economical. Since the concept was first used in 1983, the concept of sustainability has been used in many fields, one of which is "architecture". In this field, the concept appears as "sustainable architecture", and in recent years it has begun to emerge as a movement to achieve sustainable environment and sustainable development. As an extension of sustainable architecture, Green Building Rating Systems emerged for evaluating sustainable buildings and determining how sustainable they are. These numerous systems worldwide have been developed by different organizations in different countries, and upon examination, all of them aim to reduce environmental damage and increase human comfort in spaces. (Altın & Orhon, 2015). GBRS have become more preferred today and more frequently heard in the media because they evaluate buildings comprehensively as a whole, have criteria, are easy to use because of this, and their results are easily understandable (Sev & Canbay, 2009). Among these, the most accepted by countries that are members of the World Green Building Council (WGBC) and the most widely accepted and applied internationally are BREEAM (United Kingdom), LEED (USA), CASBEE (Japan), Green Star (Australia), and SB-Tool (International). However, it is known that BREEAM, as the first of the criteria-based evaluation and certification methods, is the origin of many subsequent methods (Odaman Kaya, 2012)(Altın & Odaman Kaya, 2012). The LEED (Leadership in Energy and Environmental Design) certification system was created in 1998 by the Green Building Council (USGBC) established in America. This was LEED's Version 1.0. Version 2.0 was released in March 2000, Version 2.1 in 2002, Version 2.2 in 2005, Version 3 in 2009, and Version 4 in 2016. (LEED, 2009) (LEED, 2016) However, since Version 4 was only released this year (2016) and the number of buildings evaluated and certified with this version is very small, this study examined hospital buildings that were evaluated and certified with earlier versions. LEED has schemes that evaluate the building at different stages; building design and construction, operations and maintenance, recycling, etc. Its criteria are examined under five sub-headings: Sustainable Sites (SS), Water Efficiency (WE), Energy and Atmosphere (EA), Materials and Resources (MR), and Indoor Environmental Quality (IEQ). A building can earn a total of 100 points from these criteria. In addition to these, there are 10 bonus criteria. These are called Innovation in Design (ID) and Regional Priority (RP). A total of 110 points can be obtained from all these criteria. (Altın, 2016) The distribution of these points is shown in Table 1: There are different evaluation schemes in the LEED system: Core and Shell, Hotels, Schools, Commercial Interiors, Healthcare, Homes, and others. Each scheme has its own scoring system, and the points for criteria differ.

Examples of Sustainable Healthcare Facilities

Through a circular titled "Circular on Minimum Technical Standards to be Complied with in Existing and Newly Constructed Healthcare Facilities" released by the Ministry of Health toward the end of 2012, LEED certification became mandatory for all hospitals in our country with a capacity of 200 or more beds. According to an explanation by Berkay Somalı (Green Building Magazine, n.d.), hospital buildings consume two times more energy and resources when compared to an office building of the same size, and three times more when compared to residential buildings. "In an effort to meet universal health, comfort, and performance standards, the Ministry of Health took a concrete step with a circular it issued regarding state hospitals being built as Green Buildings. According to 2011 Turkish Statistical Institute data, there are 840 state hospitals with a total bed capacity of 121,000 affiliated with the Ministry of Health." (Green Building Magazine, n.d.) For this reason, healthcare facilities that have obtained LEED certification were examined and analyzed in this study to serve as positive examples in terms of sustainability for healthcare facilities to be built in the future in Turkey.

OHSU (Oregon Health and Science University) Center for Health and Healing

The OHSU Center for Health and Healing opened in 2006 and received LEED Platinum certification in February 2007. The building was designed by GBD Architects and has a total area of 37,000 m². The estimated annual carbon footprint reduction rate is 109 kg CO₂/m². The building opened in 2006 and received LEED Platinum certification twice: first in 2007 in the LEED New Construction category, and second in the LEED Existing Building Operations and Maintenance category. (OHSU Center, 2008) (Gragg, n.d.) (OHSU Center, n.d.) The stairwells on the west and east sides of the building provide air circulation while also helping to reduce the building's solar heat gains. Green roofs reduce the building's cooling load. The rainwater harvesting system provides 68% water savings. (OHSU Center, 2008) (Gragg, n.d.) (OHSU Center, n.d.)

Dell Children's Medical Center

Dell Children's Medical Center opened in 2007 and received LEED Platinum certification in the Healthcare category in 2013. It was the first hospital building in the world to receive this certification. The building received certification for its environmentally conscious design, which incorporates water and energy conservation, improved indoor air quality, use of natural daylight, and reduced pollutants. Solar collectors and a 36 kWp photovoltaic (PV) system were used on the building's roof, earning points through the use of renewable energy. (PGA, 2013) (Dell Children's Medical Center of Centre, 2009)

Conventus Building

Located within the Buffalo Niagara Medical Campus in New York, the Conventus building opened in June 2015 and received LEED Platinum certification in the Core and Shell category in 2015. The building was designed by Buffalo-New York-based Ciminelli Real Estate Corporation. The seven-story building has a total area of 32,516 m² (350,000 square feet), with two basement levels for parking. It has 1,115 m² (12,000 square feet) of green roof. Through the use of low-flow plumbing fixtures, more than 1,900,000 liters (500,000 gallons) of water are conserved annually. More than 50% of building materials used are from recycled materials. (DiNardo, 2015) (Conventus, 2015)

Einstein Medical Center, Montgomery (EMCM)

Einstein Medical Center opened in 2012 and received LEED Silver certification in 2013. It has a total area of 360,000 m² and was designed by the Perkins + Will New York office. The design team developed solution strategies in building material selection that would ensure sustainability and reduce long-term lifecycle costs. While high performance was considered in the selection of exterior materials, the selection of building materials used in interiors was made with consideration for their effects on people; for example, materials with low VOC content were selected. For all materials, those produced sustainably were preferred. In addition, the cost of building materials, reduced energy consumption, the maintenance schedule for building materials, and maintenance and repair costs were also considered and planned. All building materials were selected so that at least 10% would be sourced from within 500 miles of the building site. In this building, landscaping was also used for human health and comfort. (Caramanico, n.d.) (Glazer, n.d.) (BaRoss, 2013) The color selection and design of exterior building materials were carefully made in locations where increased solar heat gain was desired. The solid wall sections of the facade were built from durable brick that serves as thermal mass. Areas exposed to high solar radiation were constructed in very light and reflective colors to prevent unwanted heat storage. (Caramanico, n.d.) (Glazer, n.d.) (BaRoss, 2013) In this study, hospital buildings certified with LEED from 2007 to the present were examined and analyzed. Three of these buildings were certified with Platinum, the highest LEED certification, while one was certified with LEED Silver. The facilities examined in the study received certification in different categories. Information about examples on the USGBC's LEED website could be accessed up to 2013; however, information about two facilities that received certification from 2013 onward could not be found. From this, it can be assumed that information about certified buildings is published on the website with some delay. However, the ability to access information about buildings that received certification three years ago from the website is a very important and positive feature in terms of being beneficial to those who want to certify their buildings.

Conclusion

The fact that at least three hospital buildings have received LEED Platinum certification, the highest certification level, from 2007 to the present—in a building type such as healthcare facilities that operates 24 hours a day and has very high energy, resource consumption, and waste generation—proves that hospital buildings can also be constructed at quite high levels of sustainability. Approximately 40% of the energy consumed in a country is consumed in buildings. This rate is even higher for healthcare facilities specifically. For this reason, making healthcare facilities more sustainable is important both in terms of reducing energy demand and reducing resource consumption. At the same time, the creation of healthier environments is an additional benefit. Therefore, certifying healthcare facilities with a Green Building Rating System is important and necessary for creating buildings and living environments that are more economical, less harmful to the environment, and healthier. For this reason, certified healthcare facilities were examined in this study, and it is expected that the features that earned certification for these buildings will assist architects in hospital designs. In conclusion, the use of GBRS such as LEED will produce positive results for designing and constructing more sustainable hospital buildings by reducing energy consumption in hospital structures. Assoc. Prof. Dr. Müjde Altın / Faculty of Architecture - Dokuz Eylül University

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