A Systems Approach for High Performance Hospitals

Harvard Extension School April 18, 2007

John F. McCarthy, Sc.D., C.I.H.Environmental Health & Engineering

Newton, MA

Hospitals are:

• Complex

• Mission driven

• Technically sophisticated

• Mechanically intensive

Environmental Impactsof Hospitals

10085

110

245

355

0

50

100

150

200

250

300

350

400

Office

Education

Public Assembly

Healthcare

Laboratories

En

erg

y C

on

sum

pti

on

kBT

U /

ft2

Hospital Mission

• Excellence in clinical practice• Evolving practice• Efficiency• Environment of care

Supported by infrastructure

Implementing Sustainable Principles

• Vision• Process• Commitment• Execution

Multiple Constituencies

Facility

Patients

Local Community

Regulators

Clinical Staff

Operational Staff

Global Communit

y

0

2

4

6

8

10

12

P D CD C O O+

100

80

60

40

20

Distribution of Life Cycle Costs

Rel

ativ

e C

ost

($)

Cu

mu

lati

ve C

ost

(%

)87

78

321

CONSTRUCTIONDESIGNFINANCE

ROUTINE O&MNON ROUTINE O&M

2.7

1.8

0.80.8

1.8

0.9

1.5

1.1

1.5

1.1

8.0

1.0

0.8

Green Strategies

Cost & Schedule

DesignPhase

ConstructionPhase

OperationPhase

Building Phases

Performance

Green Guide for Health Care

(GGHC)

Integrated Design

Integrated Operations

How do we ensure a connection to health mission in the design process?

How do we optimize the design process to consider the facility’s operations?

What protocols are necessary to maintain healthy building operations?

LEED vs. GGHC Project Phases

LEED

Sustainable SitesWater EfficiencyEnergy & AtmosphereMaterials & ResourcesIndoor Environmental QualityInnovation in Design

GGHC - CONSTRUCTION

Integrated DesignSustainable SitesWater EfficiencyEnergy & AtmosphereMaterials & ResourcesIndoor Environmental QualityInnovation in Design

GGHC – OPERATIONS

Integrated OperationsTransportation OperationsEnergy EfficiencyWater ConservationChemical ManagementWaste ManagementEnvironmental ServicesEnvironmental Preferable PurchasingInnovation in Operations

DESIGN CONSTRUCTION OPERATIONS

Alignment

Design / Operations Team

Processes

Stakeholders

Strategy

Systems Thinking

The relationship between parts becomes as important as the parts themselves.

Integrated design is one component –integrated business is key.

Global Community

Local Community

Operations Staff

Clinical Staff

Patients Committed Leadership

Clinical Excellence

Commitment to People

Life Cycle Costing

Process Improvements through Sustainable Design

Community Influence

Drivers for ChangeConstituencies

Why LEED for BWH-70F ?

What Are Your Goals?

• High performance– Standard budget

• Energy savings– % > ASHRAE

• Water use– Reuse water, e.g., reverse osmosis (RO)– 100% capture and reuse of rainwater

falling on building

Tie them into opportunities to solve problems

Global Community

Local Community

Operations Staff

Clinical Staff

Patients

Improved Health Outcomes Level of Care Higher Satisfaction

Greater Productivity Improved Sensory Environment Reduced Lost Work Days

Improved Energy Efficiency Compliance Reduced Service Calls

Harmonious Design/ Operations Good Neighbor Code Compliance

Compliance with ASHE/LEED Programs Exemplary Project Recognition

Targets for ImprovementConstituencies

Global Community

Local Community

Operations Staff

Clinical Staff

Patients

Shorter Stays Level of Infection Satisfaction Surveys

Staff Time with Patients Staff Surveys Lost Work Days

Benchmarks Against Energy Star Energy Utilization Reviews Service Calls

Neighborhood Relations Regulatory Complaints Media Coverage

LEED Certification Public and Industry Award Recognition

Key Performance IndicatorsPrioritized Constituencies

Structured Facilitation

ID participant roles

Specify designrequirements

ID System Dependencies (energy, water, materials,

equipment, air flow)

ID Opportunities (energy efficiency,

heat recovery, load mgmt, controllability, IAQ, synergies

Agree on goals For High Performance

(recognize constraints)

AssessFeasibility

(modeling, merits)

Integrate intoDesign

Examples of System

Interdependencies

PeoplePatients/

Staff

Lighting

Water DemandEnergy

Demand

BuildingEnvelope

HVAC

Materials/Furnishings

Indoor Environmental

Quality

EquipmentNon-HVAC

Site

InteriorSpaces

Programming

PeoplePatient

s/Staff

Lighting

Water DemandEnergy

Demand

BuildingEnvelope

HVAC

Materials/Furnishings

Indoor Environmental

Quality

EquipmentNon-HVAC

Site

InteriorSpaces

Programming

Example 1: Energy Modeling and Simulation

OBJECTIVES:

• Simulate the predicted overall energy use for the building

• Evaluate by category (e.g., lighting, equipment, space heating and cooling, fan operation, etc.)

• Quantify dominant energy use areas

• Evaluate dominant areas to identify potential energy-saving opportunities

Contribution to Building Cooling Load by Component

0 5000 10000 15000 20000 25000 30000 35000 40000

Wall Conduction

Roof Conduction

Window Conduction

Window Solar

Ventilation

Occupants

Lighting

Equipment

MBTU/yr

100% Peak Load, 24 Hours Continuous 100% Peak Load Day, Reduced Load Night

 

Energy Modeling and Simulation Key Findings• Dominant use categories: equipment (43%) and

lighting (22%)• Space cooling and fan systems are lower (~15%

each)

• Major contributor to cooling load is equipment, with equal contribution from lighting, occupants, and ventilation

• Cooling load from solar gain through window is <5%

• To save energy costs and reduce space cooling load, optimize lighting and equipment energy use (controls, dimming, etc.)

• Opportunities to reduce fan system energy use and space cooling load: optimize ventilation, reduce airborne heat load

Example 2: Identify OpportunitiesWater Conservation Strategies

• Using Amory RO reject water to flush valves, sterilizers, wall hydrants,cooling tower through a dedicated pumped distribution system in BWH-70F (Goal: Evaluate for LEED innovation credit)

• Electronic faucets in public restrooms (Include)

• Waterless urinals (Include)

• Minimization of filter backwash (Pending)

• Use of make-up water meter included for the cooling tower (Analysis required)

• Low flow and/or waterless medical air and vacuum systems (Analysis required)

• Equipment spec to include flow control devices on sterilizers (Approval required)

Design Elements

• High deck to ceiling clearance• High efficiency glazing• Large window expanse• Significant concrete massing• Large equipment load

Design Elements

• High efficiency (Low E) glazing

• Upwardly deflecting “window blinds”

• High room ceiling heights (~11 feet)

• Clerestory windows

• Reflect daylight deeper into the central core hallways

• Reduce glare inpatient rooms and radiant heat gain on patients

• Reduce artificial light demand (variable)

• Reduce electrical demand

• Reduce needed cooling capacity

Outcomes

Design Elements

• Utilize T5/T8 lights• Automatic dimming

control (to compensate for changing ambient light levels)

• Further reduces cooling capacity and electrical demand

Outcomes

Design Elements

• High ceilings allow for a low wall displacement ventilation system

• Improve IAQ by providing cleaner/fresher air to occupied zone

• Reduced cooling capacity needed (~50% of heat from lights does not reach occupants

• Requires less fan horsepower since less total air is needed

• Provides expanded use of economizer mode

• Less room noise (due to reduced exit velocities)

Outcomes

Outcomes• Provide a more

comfortable and draft free room (supply higher temperature, lower velocity air)

• Individual room VAVs are not needed

Design Elements

• Radiant surfaces

• More comfortable environment for patients and staff

• Permits a generally lower room air temperature (minimizes thermal loss to floor decking)

• Facilitates effectiveness of displacement ventilation under low occupancy

• Reduces operating costs by using water rather than air to thermally condition

Outcomes

Core Principles Guiding Mechanical System Design

• Optimum health

• Reduced energy use

• Liability avoidance

• Risk aversion

Anticipated LEED submittals to U.S. Green Building Council (USGBC):

Design package (Aug 2006) 17 pointsConstruction package (2008) 14 pointsInnovation credits 5 points

Current Goal 36 pointsLEED- Silver range 33 – 38 points

Projected BWH-70F LEED Goals

High Performance Design Features of BWH-70F

• Community/Site:– Exemplary commuter choice program for

alternative transportation and parking

– Exemplary construction waste management by recycling over 90%

– Exemplary neighborhood rebuilding and community development by relocation of six houses

High Performance Design Features of BWH-70F

• Water Conservation:– Landscape irrigation needs met 100% by

reclaimed water from hospital

– Use of high-efficiency drip irrigation technology to minimize water wastage

– Use of waterless medical equipment and CPD sterilizers with water-saving technologies

High Performance Design Features of BWH-70F

• Indoor Environment:– Access to day lighting from over 75% of

interior spaces

– Use of low-emissions paints, adhesives, sealants inside building

– Minimization of indoor and ambient impacts by program control and monitoring

– IAQ pre-occupancy monitoring

High Performance Design Features of BWH-70F

• Energy Conservation:– Energy savings by high-efficiency light

fixtures, variable speed pumps, drives, etc.

LEED Credit Distribution by Category

SS Sustainable sites

WE Water Efficiency

EA Energy and atmosphere

MR Materials and resources

EQ Environmental Quality

ID Innovation & Design

9

2 16

12

5

35

15

1317

5

14

69

0

10

20

30

40

50

60

70

80

SS WE EA MR EQ ID Total

Category

Po

ints # Max Available

# Points

Evidence Based Design

• Relevant HVAC research– Full size mockups

• Regulations and codes• Infection control issues• Curtain wall/HVAC issues• Light shelves• Understand demand

Aids to Success

• Support hospital mission• Centralize costs

– Identify true costs

• Train proactively– Involve directors in training design

• Develop common goals, vocabulary, and key performance indicators

A Systems Approach for High Performance Hospitals

Harvard Extension School April 18, 2007

John F. McCarthy, Sc.D., C.I.H.Environmental Health & Engineering

Newton, MA