part 1 context - wiley · 2020-03-03 · promotion of human health. such an expanded view ... lar...

CONTEXTPA RT 1

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What does stewardship mean, and what is the role ofthe design disciplines in furthering and developing thisidea? The stewardship model of responsibility has itsfoundation in theological writings on the relationshipbetween humans and the natural world — hence itsprominent position in many of the mission statementsof religious healthcare organizations. At many such or-ganizations, stewardship of God-given natural resourceshas been reinterpreted in the modern era to includepromotion of human health. Such an expanded viewleaves the design industries a correspondingly broadrole in terms of stewardship.

The concept of resource stewardship is pivotal in sus-tainable, or “green,” design as it is currently defined andpracticed throughout the design disciplines. The designof hospital buildings (as cultural artifacts) can be viewedas an important component of the larger practice of the

design of habitats for humans — in this case, healinghabitats. For the last half century, however, the design ofhospital buildings has been remarkably independent ofthe broader trends in architectural design. As a particu-lar typology, healthcare architecture has evolved in aworld apart, responding, for the most part, to industrytrends in technology and ever-more complex life-safetyregulations. Until recently, healthcare owners, architects,and engineers have been unaware of the impact that sus-tainable design concerns have had on the larger designindustry.

Stewardship of the environment is here taken as adefining principle of sustainable architecture. ArchitectBill Valentine, FAIA, postulates below that “less is better”and challenges design professionals to reconsider scaleand deliver better, healthier buildings using less. De-signer and educator Pliny Fisk III presents an expanded

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INTRODUCTION

Design andStewardship

C H A P T E R

The standard for ecological design is neither efficiencynor productivity but health, beginning with that of the

soil and extending upward through plants, animals, andpeople. It is impossible to impair health at any level

without affecting it at other levels. The etymology ofthe word “health” reveals its connection to other

words such as healing, wholeness, and holy. Ecologicaldesign is an art by which we aim to restore and

maintain the wholeness of the entire fabric of lifeincreasingly fragmented by specialization, scientific

reductionism, and bureaucratic division.— DAVID ORR

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definition of life cycle design, one that postulates a “newecology of mind” and links to architect John Eberhard’swork, which joins together architecture and neuro-science. Finally, architect Bob Berkebile, FAIA, challengesdesign to redefine itself as no less than “restorative” forour buildings, our health, and the planet.

The sustainable design movement, through suchleaders as Paul Hawken, Amory Lovins, and HunterLovins, has given us new lenses for viewing the econ-omy: Natural Capitalism: Creating the Next Industrial Rev-olution (2000) and The Ecology of Commerce (1993). Theparallel ideologies of “clean production” and William

McDonough and Michael Braungart’s “cradle to cradle”are beginning to have a significant impact on buildingmaterials science, from revolutions in the petrochemicalcomponents of our material economy to end-of-lifeideas such as “waste equals food.” Science writer JanineBenyus, in Biomimicry: Innovation Inspired by Nature(1997), points to a future when science will look to na-ture for inspiration and technology. Just outside the silothat defines the current practice of healthcare architec-ture, notions of planetary stewardship linked to healthare fundamentally redefining the design and productionof the built environment.

4 Design and Stewardsh ip

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LIVING PLANET INDEX, 1970–2003

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HUMANITY’S ECOLOGICAL FOOTPRINT, 1961–2003

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Figure 1-1: The Living PlanetIndex shows a rapid and continu-ing loss of biodiversity. It tracksthe populations of 1,313 verte-brate species worldwide. Between1970 and 2003, the index fell byapproximately 30 percent (WorldWildlife Fund International 2006).

Figure 1-2:Humanity’s Ecological FootprintSince the late 1980s, the ecologicalfootprint has exceeded the earth’sbiocapacity — as of 2003, by ap-proximately 25 percent (WorldWildlife Fund International 2006).

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THE CASE FOR STEWARDSHIP

The scientific community is in general agreement thathuman activity now exceeds the global carrying capac-ity of the earth’s ecosystems, and that those ecosystemsare degrading rapidly. The Ecological Footprints of Nationsstudy (Wackernagel et al. 1997) estimates the world’seconomies are overshooting their capacity for naturalresource regeneration by as much as 37 percent; theWorld Wildlife Fund’s Living Planet Report (2006) moreconservatively estimates 25 percent as of 2003. Envi-ronmentalist and writer Bill McKibben (1989) contendsthat there are no longer any ecosystems on earth unin-fluenced by humans. From 10 to 15 percent of theearth’s land surface is dominated by agriculture andurban development. Over 40 percent of the earth’s landmass has been transformed by humans. Twenty yearsago, Science magazine reported that humans consumedmore than 50 percent of all available fresh water and al-most 50 percent of the total terrestrial biological pro-duction (Vitousek et al. 1985).

The United Nations’ Millennium Ecosystem Assess-ment, released in 2005, chronicles the continued degra-dation of the natural environment, amplifying thegrowing awareness that healthy people cannot live on asick planet. Contributing to this global discord is thatmost financial ledgers do not monetize ecosystem “serv-ices” — fertile soil, the water we drink, the air we breathe— conservatively worth approximately $33 trillion (seeTable 1-1).

In 1992, the Union of Concerned Scientists, on be-half of 1,600 scientists (including the majority of livingNobel laureates) issued the World Scientists’ Warning toHumanity. It outlined the case for stewardship as essen-tial to survival:

We, the undersigned senior members of the world’sscientific community, hereby warn humanity ofwhat lies ahead. A great change in our stewardshipof the earth [emphasis added] and the life of it is re-quired, if vast human misery is to be avoided andour global home on this planet is not to be irretriev-ably mutilated (Union of Concerned Scientists1992).

The principle of stewardship is intrinsic to the ideaof sustainable development. This movement, global inscope while locally implemented, has broad implica-tions for both medicine and the environments thatsupport it.

The Case for S tewardsh ip 5

Table 1-1 Value of Various Ecosystem Services

Ecosystem Service Value (in trillions of $)

Soil formation $17.1

Recreation 3.0

Nutrient cycling 2.3

Water regulation and supply 2.3

Climate regulation 2.3

Habitat 1.4

Flood and storm protection 1.1

Genetic resources 0.8

Atmosphere gas balance 0.7

Pollination 0.4

All other services 1.6

TOTAL VALUE $33.3

Source: Costanza et al. 1997

The resilience of the community of life and the well-

being of humanity depend upon preserving a healthy

biosphere with all its ecological systems, a rich variety

of plants and animals, fertile soils, pure waters, and

clean air. The global environment with its finite

resources is a common concern of all peoples. The

protection of the Earth’s vitality, diversity, and beauty

is a sacred trust.

—EARTH CHARTER 2000

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SUSTAINABLE DEVELOPMENT

Sustainable development was defined for the first time inthe United Nations’1987 Brundtland Commission Reportas “development that meets the needs of the presentwithout compromising the ability of future generationsto meet their own needs.” It quickly gained stature in thepublic lexicon. This definition both inserted an explicitvalue proposition into the international development do-main and gave “green building” a broad conceptualfoundation on which to grow.

In 1992, the first United Nations’ Conference on En-vironment and Development (commonly referred to asthe Earth Summit), convened in Rio de Janeiro, and re-sulted in Agenda 21, a blueprint for achieving global sus-tainability, and the Rio Declaration on Environment andDevelopment. The Earth Summit produced some of theearliest statements on climate change and biodiversity.Adopted by more than 178 participating governments(including the United States) (UN 2004), its visionarydeclarations and action plans recognized the intercon-nections among all living systems on earth.

Two of these declarations would prove to be pivotalfor sustainable building in healthcare. Principle 1 of theRio Declaration states: “Human beings are at the centreof concerns for sustainable development. They are enti-tled to a healthy and productive life in harmony with na-ture.” Principle 15 advances the principle of precaution,an important construct in medicine:

In order to protect the environment, the precau-tionary approach shall be widely applied by Statesaccording to their capabilities. Where there arethreats of serious or irreversible damage, lack offull scientific certainty shall not be used as a rea-son for postponing cost-effective measures to pre-vent environmental degradation.

THE PROFESSION OF ARCHITECTURE

Early environmental design initiatives were disparate,focusing primarily on the reduction of energy demands.In response to the energy crisis of the early 1970s, the

American Institute of Architects (AIA) established theCommittee on Energy to develop tools and policies toaddress mounting public concern about the building in-dustry’s reliance on fossil fuels. Parallel federal initia-tives included the creation of the Solar Energy ResearchInstitute (now the National Renewable Energy Labora-tory) and the cabinet-level Department of Energy. Ab-sent a larger framework for sustainable design, thesedepartments focused on energy technologies and con-servation.

In 1989, the AIA Committee on Energy transformeditself into the Committee on the Environment (AIA/COTE), reflecting a broader view of sustainability. In1998, AIA/COTE announced the Top Ten Green Projectsannual award program to recognize design excellence insustainable architecture.

Inspired by the Earth Summit, the UIA/AIA WorldCongress of Architects (UIA stands for “InternationalUnion of Architects” in French) issued its Declaration ofInterdependence for a Sustainable Future in 1993. Signedby more than three thousand participants, it states:“Buildings and the built environment play a major rolein the human impact on the natural environment andon the quality of life” — a bold challenge to the profes-sion at large to put a broader sustainability agenda intopractice.

In 2000, the AIA unanimously approved Sustain-able Design Resolution 00-3, a clear directive to incor-porate sustainable design strategies as basic andfundamental to standard practice. Five years later, theAIA issued a more aggressive position statement on theresponsibility of design professionals (AIA 2005):

The AIA recognizes a growing body of evidencethat demonstrates current planning, design, con-struction and real estate practices contribute topatterns of resource consumption that seriouslyjeopardize the future of the Earth’s population. Ar-chitects need to accept responsibility for their rolein creating the built environment and, conse-quently, believe we must alter our profession’s ac-tions and join our clients and the entire design andconstruction industry to change the course of theplanet’s future.


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The statement continues with a commitment toachieve a 50 percent reduction in fossil fuel consump-tion for new and renovated buildings by 2010 and tar-get continuing reduction thereafter, a commitment tointegrate sustainable design education into the curric-ula of architecture schools (and ultimately into the li-censing process), and a commitment to promoteresearch into life cycle assessment methodologies. In2006, architect Edward Mazria issued the 2030° Chal-lenge, calling on architects to transform the design ofbuildings in order to achieve “carbon neutrality” by2030 (see Chapter 12).

THE ETHICAL CHALLENGE FOR DESIGNERS

Ultimately, the built environment is the product of in-tentional design decisions, and waste signifies failure.Metropolis magazine editor Susan Szenasy (2004) sumsup the challenge this way: “Designers today stand onthe brink of being seen by society as essential contribu-tors to its health, safety, and welfare. If you — togetherwith the other design professions — decide to examinethe materials and processes endemic to your work, aswell as demand that these materials and processes be-come environmentally safe, you will be the heroes of thetwenty-first century.” Or, as David Orr (2004) sees it,“The larger challenge is to transform a wasteful societyinto one that meets human needs with elegant simplic-ity.” As this change occurs, labels like biomimicry or sus-tainable design attempt to describe the efforts. The ethicalchallenge is, however, broad in scope. It is not simplyabout designing environmentally benign hospital build-

ings for an ever-expanding industrial-medical complex,but about formulating a system of healthcare that sup-ports vital communities that nurture health and wholepeople “who do not confuse what they have with whothey are” (Orr 2004). This broader vision of design canbest be termed ecological design.

ECOLOGICAL DESIGN

Ecological design, Orr continues, “requires a revolutionin our thinking.” He suggests changing the kinds ofquestions we ask about a design, from, “How can we dothe same old things more efficiently?” to ones such as:

• Do we need it?• Is it ethical?• What impact does it have on the economy?• Is it safe to make and use?• Is it fair?• Can it be repaired or reused?• What is the full cost over its expected lifetime?• Is there a better way to do it?

By formulating the axiom “less is better” for the essayincluded here, Bill Valentine challenges all of us to con-sider these deeper questions. Orr conceives of ecologicaldesign not so much as an individual art practiced by in-dividual designers as an ongoing negotiation between acommunity and the ecology of particular places. Ecolog-ically designed buildings “grow” from the long-termknowledge that derives from intimate experience of aplace over time; they “live” within a biotic framework es-tablished by an understanding of natural principles andman-made policies standing together.

Ecolog ica l Des ign 7

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Figure 1-3: University of Wisconsin Cancer Center. Credit: James Steinkamp

Owner: Joint venture: UW Health, Watertown Memorial Hospital, and FortHealthCare

Design team:ARCHITECTS: OWP/PMECHANICAL, ELECTRICAL, AND PLUMBING ENGINEERS: Affiliated Engineers, Inc.CIVIL AND STRUCTURAL ENGINEERS: Graef, Anhalt, Schloemer & AssociatesGENERAL CONTRACTORS: CG Schmidt, Inc.SURVEY/SOILS/ENVIRONMENTAL CONSULTANTS: River Valley Testing Corp.

Building type: New constructionSize: 14,300 sq ft (1,330 sq m)Program description: Medical and radiation oncology services, chemotherapy

treatments, and clinical trialsCompletion date: 2005

“By acknowledging the landscape, the building becomes a part of it. It’s an inside-outkind of building. People actually take their treatments outside—the building allowsfor that,” says Randy Guillot, OWP/P project manager. The building is located to dis-turb as little as possible of the surrounding site, and designed to follow the natural em-bankment of the land. Water runoff follows its natural patterns, draining around thebuilding. “By pulling the building’s components apart to allow light in, the sky andlandscape become as much a part of the palette as the carpet or brick,” Guillot adds.

The design goals included the development of a relationship with the surround-ing community: “The nearby rural environment—older buildings, rustic architecture,and open spaces—inspired the design,” Guillot continues. The project focuses on el-


C A S E S T U D Y

University of Wisconsin

Cancer Center

Johnson Creek, Wisconsin

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egant exposure of natural materials and building structure.Remarking on the views from the interior, a staff member atthe Cancer Center said, “We don’t need to hang art in thebuilding. Just look out the window. The changing of the sea-sons is the artwork.”

Source: OWP/P

Americans consume too much of everything, includingenergy, land and natural resources, and consumer

products. This mega-consumption is threatening to ruinour planet.

Consumer entitlement is close to being a nationalreligion. Even Americans with modest incomes are able to buy more stuff than they ever dreamed about.Everywhere we turn we’re barraged by messagestelling us we don’t have enough, we don’t have whatwe need to live “the good life.” So we work more,purchase more, and go further into debt. Yet the oh-so-elusive good life remains just out of reach.

Though we are fortunate to live in such an affluentsociety, we must be aware of the effect our material-

ism has on the rest of the world: our conspicuous con-sumption and quest for the good life, emulated bypeople in many other countries, is actually degradingeveryone’s quality of life.

The earth’s resources are being consumed 20percent faster than its ability to support renewal,and the average North American is by far the worstoffender. We’re facing a global crisis in terms offood, water, energy, climate change, biodiversity,and pollution.

OPPORTUNITIES IN THE CRISISIn this crisis I see opportunities. The Chinese word for cri-sis, wei ji, is divided into two characters. One characterrepresents danger, and the other signifies opportunity.

Architects have wonderful opportunities to makethings better by enthusiastically promoting “less” in

Less Is BetterBill Valentine, FAIA

Figure 1-4: Simple materials, honestly and elegantly ex-pressed, reinforce the interdependence of the built envi-ronment and nature. Credit: James Steinkamp

Figure 1-5: Natural daylight serves as the primary lightsource during the day. Throughout the building, cancerpatients continually experience the intersection betweenthe clinical care environment and the natural world.Credit: James Steinkamp

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the buildings we design. This doesn’t mean strippingaway the elements that make our buildings beautiful.But we can design structures in simpler, more thought-ful ways that work with, instead of against, nature.And by doing so we can prove to people that less canbe better in many aspects of their lives.

I believe in America. Efficient use of our re-sources helped us become a world power. UntilWorld War II, our waste-not-want-not culture usedresources intelligently and efficiently. Today, neces-sity is creating an environment in which we mustreembrace that philosophy.

Built into the basic American consciousness arefantastic values such as innovation, freedom, opportu-nity, self-reliance, hard work, and competition. Thesevalues have profoundly impacted the world in the past— and they can continue to do so.

AT THE TIPPING POINT?Though we can’t legislate less in our culture, we’re at apotential tipping point—that dramatic time popularizedby Malcolm Gladwell’s Tipping Point (2000) when some-thing that had once been unique becomes common.Using less can become the norm.

US budget and trade deficits are growing. An en-ergy crisis is mounting. In 2005 President George W.Bush signed the first national energy plan in more thana decade. The term peak oil has entered the lexicon ofthe average American. People are wary of rising gasprices and questioning our reliance on Middle Easternenergy sources.

To keep gasoline in their cars and heat their homes,people are cutting back on consumption. They’re mov-ing back downtown from the suburbs. More and moreAmericans believe that natural disasters such as Hurri-cane Katrina result from global warming, that humanactivity is the cause of global warming, and that globalwarming threatens our entire civilization. Hollywoodcelebrities are talking about their hybrid cars. Leadingcompanies like General Electric and Wal-Mart are im-plementing policies related to sustainability. Greenthinking is hitting the mainstream.

This is a perfect time for the “power of less” mes-sage to not only penetrate the psyche of our people,but even to garner a certain cachet. We need to buildon the momentum.

ARCHITECTS FOR THE REAL WORLDAs architects for the real world, isn’t it our job to askclients if they really have to build new? Instead of addingto the clutter by making bigger buildings, let’s be stew-ards and improve lives by using fewer resources to makebetter, healthier buildings.

The idea of building less resonates with all thelarge sustainable design ideas: less space, materials,waste, toxicity, energy, water — and less cost. Con-struction costs are rising. Tight budgets can go hand-in-glove with sustainability. Budget consciousnessis a catalyst that forces us to think carefully aboutusing less.

Do hospitals need loftlike atria? Do airports needgigantic ticketing halls? Do corporate office facilitiesneed to be monuments? Developing smaller buildingswithout all the unnecessary “statement” spaces is thefirst step toward saving land. Only what is trulyneeded should be built.

Less encompasses smaller and simpler, but it’smore than that. It means achieving clarity in design,flexibility over time, and reduced reliance on mechani-cal systems. Less is the elegance of simple, clear solu-tions that also happen to be smaller.

MORE EFFICIENT HOSPITALSDesigners should always be thinking about how to lever-age technology to do more with less infrastructure. Manyconventional architectural solutions provide opportuni-ties for designers of all building types to use resourcesmore efficiently. But perhaps our biggest current oppor-tunity to use less in healthcare design involves usingemerging technologies and breakthroughs in medicaltreatment to create more efficient hospitals.

The US arguably has the world’s best healthcaresystem. Yet millions of people can’t afford access toquality care or even to pursue healthy lifestyles.

A developing field carries the amazing potentialto save more lives with fewer resources. Genetic (orpersonalized) medicine will allow physicians to treatpatients for a specific disease subtype at a molecularlevel. Coupled with molecular imaging, which showslive images of the molecules of a disease insteadof just the gross anatomical characterization, physi-cians will be able to create more effective coursesof treatment.


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Currently being led by our academic medical cen-ters, this revolution in genetic medicine and molecularimaging on our doorstep will transform how hospitalsare programmed and configured. Because the poten-tial is for fewer surgeries, faster procedures, and fewerinpatient stays, hospitals should be able to delivercare in less intensive settings. The number of hospitalbeds per capita in the US (unadjusted for populationgrowth or aging) should go down as treatments be-come less invasive and more effective. As populationsgrow and age, and as new treatments become possiblefor more disease types, the overall numbers of bedsmay still rise. Yet the increase will be smaller thanwhat we would have experienced without these newtechnologies.

At broad societal levels, giving more people accessto this type of pioneering treatment could have a pro-foundly positive impact on the overall health of ourpopulation. It would represent an incredible seachange that gives us double-pronged benefits: the en-vironmental positives of using less along with healthierpeople.

This idea of using new technologies and reassess-ing our approaches to problem solving applies to allbuilding types. Healthcare architects wanting to domore with less should use new technologies to re-duce the size of buildings, their environmental im-pact, and their energy consumption. But technologyalways should inform, not drive, truly elegant designsolutions.

HELP ME BE AN EVANGELISTCan we work together to design smaller, more efficientbuildings? If so, I believe we’ll all be happier andhealthier.

My message actually goes far beyond buildingsand, I hope, straight to the heart of our culture. I’d liketo trigger a move toward less in the building industrythat also spreads across our society and catalyzes aprofound cultural shift toward simplicity. Let’s showpeople that all this stuff isn’t required to live “thegood life.” Let’s change our habits and reclaim our cul-ture by making less a virtue. If we can make the ideaof using less fashionable and chic in the US, our suc-cess could send ripples all over the world.

CLEANER PRODUCTION

The concept of stewardship requires a reexamination ofmaterials, the units of production from which the builtenvironment is created. Materials extraction and produc-tion processes as they evolved during the Industrial Rev-olution have come to be categorized as “beat, heat, andtreat” methodologies. Industry thrived in an era of inex-pensive energy, using industrial process to replacehuman labor in an ever-expanding era of raw materialusage. Waste was seen as an inconvenience rather thana measure of inefficient production. In the early 1990s,in response to growing recognition of environmentaldegradation and resource depletion, the United NationsEnvironment Programme (UNEP 1989) defined “cleanerproduction”:

Cleaner Production is the continuous applicationof an integrated preventive environmental strat-egy to processes, products and services to increaseoverall efficiency, and reduce risks to humans andthe environment. . . .

For production processes, Cleaner Productionresults from . . . conserving raw materials, waterand energy; eliminating toxic and dangerous rawmaterials; and reducing the quantity and toxicityof all emissions and wastes at source during theproduction process.

For products, Cleaner Production aims to re-duce environmental, health and safety impactsover their entire life cycles, from raw materials ex-traction, through manufacturing and use, to the“ultimate” disposal of the product.

Advocates of cleaner production have developed“tool kits” for reducing pollution by substituting safer,more benign materials for hazardous materials; by opti-mizing production technologies; and by closing loops inmanufacturing processes to recycle and reuse what hadbeen waste materials. Pollution prevention programs, asdefined by the healthcare industry, are examples ofcleaner production initiatives in action. In some states,“toxic use reduction plans” are manifestations of cleanerproduction initiatives. Cleaner production demonstra-tion programs have been launched all over the world andare now common not only in industrialized nations, but

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also in developing nations. Generally speaking, cleanerproduction “design” activities achieve both environ-mental benefits and economic returns — and demon-strate improved stewardship of both resources throughthe life cycle.

LIFE CYCLE THINKING

Healthcare building design and construction processeshave usually been cradle to grave, with ever-shorteruse life spans. While many late-nineteenth-centuryhealthcare buildings remain in use, they have often

been downgraded from acute care to ancillary facili-ties as the technology and the associated space re-quirements of acute-care buildings have escalated.After sixty years in service, the post–World War IIHill-Burton buildings throughout the US are presentlythe target of replacement. At the same time, mid-to late-1970s facilities are being downgraded afterbarely thirty years in service. Because the vast re-source base that supported the expansion of the builtenvironment in the nineteenth and twentieth cen-turies is diminished, the processes associated withbuildings at every stage of their life cycle is being fun-damentally reconsidered.


Figure 1-6: Each building life cycle phase results in a range of environmental and health consequences — some of these are con-stants and some more variable based on building type, location, and programmatic focus. Using these indicators as evaluative cri-teria to compare material choices and design features leads to robust material specification and design decisions. Credit: Centerfor Maximum Potential Building Systems

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Broadly termed life cycle thinking, the productioncycle for building design and construction will now beexamined, beginning with the multiple processes fromwhich building materials are derived — the extraction,production, and transportation consequences to ecosys-tems and human health that often, collectively, exceedthe use-phase impacts of a building material.

Life Cycle Design:Toward an Ecology of MindPliny Fisk III, MArch, MLArch

LIFE CYCLE DESIGN FUNDAMENTALSLife cycle design (LCD) encourages design professionalsto consider the use phase of a building (the energy ex-penditures and material interactions that occur while abuilding is occupied and operated) as a basis for design,specification, and procurement decisions—as well as anyupstream and downstream human health and ecologicalramifications. These might include processes related tosupporting a region’s resource base; tracking emissions,energy uses, and waste streams — both regionally andglobally — caused by material sources, manufacturing,transportation, installation, and the function of buildingsystems; and the consequences of a building’s final de-construction and disposal. LCD also addresses how abuilding responds to its site’s and climate’s specific cy-cles at a micro scale. LCD relies on the related frame-works of life cycle analysis and life cycle costing tocompare options with the goal of designing a buildingwith a long view toward economic, social, and environ-mental sustainability.

The aim of LCD is to reduce the harm caused by abuilding by expanding its system boundaries from thebuilding outward, accounting for other natural andman-made life cycles that border and intersect it. Likethe concepts of regenerative architecture or livingbuildings put forward elsewhere in this chapter, LCDcan go beyond reducing the harm caused by the builtenvironment and make buildings an active force forthe common good. This essay provides a brief intro-duction to concepts that extend the reach of LCD intoa behavioral realm and suggests that LCD has the po-

tential to engage our perceptions and alter our behav-iors related to the resources we use, reconnecting hu-mans to nature and its processes. (Life cycle designprinciples are outlined below.)

Life Cycle Design Principles

• Recognize the resource flows on which a buildingdepends, and identify them and their multipleboundaries, from the building scale through toneighborhood, city, regional, and global scales.

• Evaluate and apply the source, transport, process,use, and re-source life cycle sequence in all resource-flow areas when considering the scales above, in-cluding energy, materials, water, and air. (Inhealthcare projects, food and medical waste are ex-amples of operational resource flows that might beconsidered as well.)

• Increase resource-flow efficiency by basing decisionsfirst on the scale of the building and site, progressingupward to tap into larger life cycle scales only as nec-essary.

• Support regionalized economic loops by respectingtight-knit regional integration. Each stage of thebuilding life cycle supply chain should become apart of a regional economy.

• Plan for the extended use of a building through theseparation of utilities, structure, and shell. Designingfor flexibility extends the use phase of the building’slife cycle.

• Create regionally relevant benchmarks throughoutthe world through comparisons with similar industrialbases, climates, and material conditions, as well assimilar flora and fauna, using patterns supplied bythe internationally accepted biome system.

• Reduce the size and complexity of the life cycle toenable it to relate more directly to people, involvingthe user with the resources associated with theireveryday activities.

• If possible, incorporate both an input-output lifecycle assessment and a process life cycle assess-ment, one supplying the perspective using nationaldata, the other homing in on the low-hanging fruitidentified.

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Within the discipline of sustainable design, the ad-vantages of LCD have thus far been evaluated on aneasily recognizable, tangible level. For example, reduc-ing the distance a material must be transported to abuilding site creates quantifiable reductions in fuel,emissions, and economic cost. Incrementally more so-phisticated effects of LCD might include the develop-ment of regionalized economic loops incorporatingvirgin and by-product materials, local producers, andlocally appropriate resources, or the advancement of abuilding vernacular based on such a regional network.

Drawing on neuropsychological research, this think-ing may be extended to suggest that LCD could haveeven deeper and more remarkable ramifications. Thehypothesis is based on an understanding of how hu-mans engage with their environments through life cycleevents — when we directly encounter the life cycles ofwater, energy, food, air, and materials often remotefrom our everyday experience. This reflects our lack ofknowingly playing a role with life cycle “events,” suchas how oxygen is produced or carbon is absorbed by acertain quantity of vegetation and soil systems. The factis that approximately 5000 sq ft (465 sq m) of temper-ate forest is needed to support an individual’s oxygenneeded for breathing, and 7500 sq ft (697 sq m) isneeded for carbon sequestering — these essential life-giving threads have not been part of our ‘event’ vocabu-lary, but should be. In the model outlined here,buildings are designed to mimic and illuminate the lifecycle events around us, causing humans to experienceresource flows and cycles, understand resource depend-encies, and adapt their behavior accordingly.

This is a new LCD framework not driven solely bythe physical and engineering manipulation of resourcesand analyses of building phases, but instead by theidea that our relationship with life cycle events mightbe related to behaviors based on the evolution of thebrain itself. In this new conception of LCD, miniaturiz-ing the life cycle — for example, bringing the cycle ofwater (from capture to use to waste treatment) withinthe site boundary so that the processes are no longerremoved and abstracted— is recognized to trigger brainfunctions that may better connect us to these signifi-cant environmental sequences. Buildings, then, extendour perceptions and connect us to the resources we useon a deeper level than previously imagined.

A NEUROLOGICAL BASIS FOR LIFE CYCLE DESIGNEarly humans, like other animals, organized around whatmight be referred to as resource events, existing in rela-tion to what was directly visible around them in time andspace: they saw food, sourced and transported it, thendiscarded the remains. Their ability to predict conditionsof change from the patterns around them was limited. Asresource events eventually became connected to concep-tions of time past and time future—evidenced in prehis-toric paintings — human brains evolved to perceivesequence, seasons, and mistakes engendering an increas-ingly sophisticated trial-and-error adaptive strategy.These perceptions evolved into the uniquely human traitof critical thinking, located in the neocortex, which makesup the majority of the human brain.

The neocortex is responsible for our senses, partsof our motor function, spatial reasoning, and consciousthought and language. According to neuroscientists,the neocortex is also responsible for interval patternrecognition (Wright 2002). This part of the brain re-sponds to activity sequences and controls our ability toadapt when confronted with new patterns, in contrastto the part associated with the circadian clock — thosedaily and seasonal rhythms focused on in biophilic design. The neocortex can quickly develop feedbackloops that reinforce or discard past conditions, but alsopropose entirely new ones. There is also evidence thatthis part of the brain tends to seek new stimuli to feeditself: its food for evolutionary growth is the new, thedifferent, the challenge of solving, of patternizing inrapid-response sequences (Biederman and Vessel2006). Recent discoveries have shown that when prop-erly and sufficiently stimulated, this part of the brainactually grows new neurons (Gould et al. 1998).

Currently, our neocortex’s information hunger is sa-tiated at least partially by the creation of and interac-tion in a resource-unconscious world of electronicinformation technology that takes us into make-believerealms disconnected from much of the actual physicalworld around us. Some analysts who have studiedglobal population in conjunction with the trend of in-terhuman communication propose the possibility of apoint at which arises a truly omnipresent awareness ofeach other and each other’s actions — the point atwhich we function as an entire adaptive organism, or atruly compassionate society (Teilhard de Chardin 1955;


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von Foerster 2003). That population appears to be be-tween 16 to 18 billion (Kursweil 2005), disturbinglyfar above what resource analysts refer to as the earth’sholding capacity: optimistically between 10 to 12billion people (Durning 1989; Durham 1992).

Today we face not the simplistic resource events ofprehistory, but life cycle events of mammoth propor-tions and grave concern due to their transformative ef-fects on humans and planetary life in general —climate change, for instance, or the long-term toxic ef-fects of industrial and technological processes. Thanksto our advanced neocortex’s ability to record and pro-pose alternative action strategies, science is able toproject potential ecological catastrophes. But in manycases, what our brains are willing to see and predictsurpasses nature’s ability to respond to. Even if we takeaction, success or failure may not be evident fordecades or centuries. This discrepancy between na-ture’s time and the human neocortex’s time may in-deed be at the core of our increasing disconnect fromnature and its processes.

Understanding these relationships may provide aplatform for designers of all building types (healthcarefacilities among them) to begin to redirect the neo-cortex to conceptualize the resource problems of theeveryday world before the advent of planetary devas-tation. Life cycle design has the potential to serve asa link between human brain capacity and the key life-support capabilities of the natural processes aroundus. But to properly address the future through design,humans must first become engaged with life cycleevents in the built environment in a time frame closeto what the neocortex craves — so that the gap be-tween natural processes and human consciousness be-gins to close.

Another step toward closing the gap between na-ture time and neocortex time might be a massivehuman response on the order of what evolutionary bi-ologists refer to as “connected behavior,” based ontheir studies of swarming animal populations. Furtherevidence of whether such behavior occurs in significantways in human populations is needed. Recent workshows evidence of this type of mass-population re-sponse as convincing as that pointing to individualneocortical responses; text messaging using cellulartelephones is one recent example of this, demonstrat-

ing the redirection of public opinion resulting in massaction (Rheingold 2003).

Environmental psychologists De Long and Lubar(1979) have identified conditions (not yet attributedto a specific physical area of the brain) that suggesthumans perceive a strong relationship betweenspace, size, and time, with larger spaces slowingdown perceived time and smaller spaces speedingup perceived time. The relationship between timeperception and space has been shown to reduce pro-portionally: humans dealing with one-sixth scalemodels perceive time at one-sixth its regular rate. Weexhibit an increasing tendency to accelerate timewhen faced with two-dimensional images — when in-formation is viewed on a smaller screen, time per-ception during the period of engagement decreases,and information retention increases (Brickey 1994).Following this theory, designers would focus on scaleand size — of, for instance, an event sequence in re-lation to the place where it occurs — in seeking toalter our ability and speed in perceiving and respond-ing to patterns.

A space and the events within that space, then, canbe designed so that occupants witness more thor-oughly their interaction with a resource and the lifecycle that creates it; turning on a faucet, for example,triggers a recognition of the rainwater cistern the watercomes from and, further, an understanding of the lifecycle of water we rely on. Synchronizing with the brainon this level, then, may become a primary design goal,increasing designers’ abilities to alter perception andultimately, behavior. Such an idea might be used intandem with biophilic design, which utilizes the moreprimitive brain function of circadian rhythm to influ-ence our synchronization with natural processes in theworld around us.

Further, this space-time correlation may form acritical link to the time-interval element of the neocor-tex, accelerating or decelerating how we perceive se-quenced events (De Long et al. 1994) and potentiallysatisfying our evolutionary need to stimulate braingrowth. The design principles outlined below representa distillation of the above hypothesis, the launch of an“ecology of mind” (Bateson 1972) that introduces adimension to enrich life cycle design not addressed by biophilia.

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Sustainable design, in this eventuality, bridges thewidening gap between human brain capacity and keylife-support capabilities of the natural processes aroundus. The neocortex fulfills its evolutionary potential as anadvanced, internal consequence-mapping tool, its drivefor information sated by engagement with life cycleevents made explicit in the design that surrounds us, itsdominance directed to resource-related reasoning thatcontributes to continuing life on earth.

Informed by ecological design approaches, industrialdesigners are beginning to use an alternative frameworkfor reengineering both products and processes as a re-sponse to the limits of “cradle-to-grave” ideology. Archi-tect Bill McDonough and chemist Michael Braungart(2002) developed the “cradle-to-cradle” (C2C) designparadigm based on three key principles (see sidebar).

Benyus (1997) suggests nine principles that definenatural systems (see below). These design axioms pro-vide a roadmap for how we might further broaden andre-vision an approach to life cycle design, an idea that isexplored in Fisk’s essay. As industry redesigns materialproduction in accordance with C2C and biomimicryprinciples, it remains the task of designers to reimaginebuildings based on similar tenets.


Elements of an Ecology of Mind

• Consider life cycle events in a building — direct in-teractions with the natural life cycles of water, air,energy, and materials — as microcosms of the lifecycle events around us, and treat them with thesame awe and respect as natural life cycle events,eliciting engagement with and response to these cy-cles through design.

• Identify the full range of ecosystem life cycles andlife cycle events in and around our buildings, andconsciously cover all environmental life cycle phases(or in behavioral terms, “events”) from source (e.g.,rain) to re-source (e.g., drinking water).

• Conceive of the life cycle as successions of resourceevents that can be balanced and the user part ofthe balancing act, so that people understand boththe parts (i.e., the individual events) and the whole.

• When designing, differentiate between building ele-ments that stimulate human brain activity at the cir-cadian and interval scales, so that life cycleinvolvement can occur at both levels.

• Go beyond circadian brain rhythms by engaging the interval time function of the brain’s neocortexthrough the miniaturization of the life cycle.

• Synchronize the scale of everyday life cycle eventswith the interval time of the neocortex through two-and three-dimensional means and miniaturization.

• Project from past to future and from locus to regionthe effects of our actions, not just at the individualscale but also at the community, regional, andglobal scales. Consider simulation and gaming envi-ronments so the neocortex is enticed to participatewith the life cycles that support us.

• Waste equals food. In nature, one organism’s waste isfood for another.

• Use current solar income. Plants use sunlight to manu-facture food. In fact, fossil fuels are “ancient sunlight”—past solar income. Both energy and material inputsare renewable rather than depleting.

• Celebrate diversity. Nature’s diversity provides manymodels to imitate in the design of systems andprocesses: biomimicry.

CRADLE-TO-CRADLE DESIGN

Nature runs on sunlight.Nature uses only the energy it needs.Nature fits form to function.Nature recycles everything.Nature rewards cooperation.Nature banks on diversity.Nature demands local expertise.Nature curbs excesses from within.

Nature taps the power of limits.

NATURAL SYSTEMS

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Liv ing Bu i ld ings 17

LIVING BUILDINGS

What would ecological design mean for the typology ofhealthcare buildings? “In the century ahead we mustchart a course that leads to restoration, healing, andwholeness” (Orr 2004). Bob Berkebile’s essay intro-duces the concept of living buildings — buildings thatactually restore the ecosystems within which they aresituated.

Architect Bob Berkebile and designer Jason McLen-nan (1999) define the future of architecture as a futureof living buildings, operating on these six principles. Liv-ing buildings will:

1. Harvest water and energy needs on site2. Be adapted specifically to site and climate and

evolve as conditions change3. Operate pollution free and generate no wastes that

aren’t useful for some other process in the build-ing or immediate environment

4. Promote the health and well-being of all the in-habitants, as a healthy ecosystem does

5. Comprise integrated systems that maximize effi-ciency and comfort

6. Be beautiful and inspire us to dream

This is not a future predicated on less, but ratherone inspired by doing more — and doing better — withless. To move building design toward this vision,McLennan and the Cascadia Region Green BuildingCouncil (2006) developed the Living Building Chal-lenge. Initiatives such as this will have a dramatic im-pact on the design of the built environment in the nextdecade.

Restoring Our Buildings,RestoringOur Health, Restoring the EarthBob Berkebile, FAIA

“The future belongs to those who give the next generation reasonto hope.” —PIERRE TEILHARD DE CHARDIN

The vital connection between human health and thebuilt environment, between our human behavior

and the health of the planet, has been studied anddocumented for decades. While still an architecturestudent more than forty years ago, I took on a re-search project at the famous Menninger Clinic, thenlocated in Topeka, Kansas. During that semester, Istudied how varying a patient’s physical environmentcan affect his or her mental, emotional, and physicalwell-being. The variables we used were simple—color, temperature, daylight, humidity, and acousticlevels. Nor were our measurements particularly sophis-ticated. Yet we were able to observe how patients re-sponded to changes in color (red made them moreagitated and “eye-ease” green, more calm) as well asthe effects of light and temperature on their appetites.It was obvious to me even then that the environmentwe create for people can dramatically affect theirhealth, heart rate—even their ability to feel goodabout themselves.

Thirty years later, I began to understand this con-nection differently and on a much broader scale. I wasprivileged to visit the South Pole in 1993 as part of aNational Science Foundation team there to exploreways to make US facilities in Antarctica more sustain-able. Scientists understand that our individual actions,our community patterns, what we design, build, andoperate — all dramatically affect the planet’s well-being, which in turn affects our own well-being. Inthat amazing place, where scientists collect data on theocean’s thermohaline circulation and other global phe-nomena, I gained a new awareness of hard science: itwas no longer general, no longer merely theory.

WHAT’S THE ISSUE— AND THE OPPORTUNITY—BEFORE US?In the last few decades, we’ve acquired a tremendousbody of knowledge concerning the direct links betweenbuildings and human health and productivity. In schools,better environments result in greater learning potential,a fact documented in studies from Alberta to Massa-chusetts to North Carolina to Brazil.

The Rocky Mountain Institute (RMI) reported onthe power of daylighting to improve standardized testscores in California, Colorado, and Washington (Burnsand Eubank 2002). In two school districts studied,

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students in classrooms with the most daylightingshowed scores 7 to 18 percent higher than those withthe least. Strategic consulting firm Capital E has alsocited benefits based on data compiled from thirtygreen schools nationwide (Kats 2005). Not only arethese schools saving energy and water while reducingcosts associated with waste and emissions, but studiesdemonstrate positive health or productivity impactsfrom improvements in air quality and related building-comfort conditions as well.

This connection between human health and thebuilt environment goes even deeper. The Academy ofNeuroscience for Architecture (ANFA) is now mappingthe brain; recent research has identified a cortical re-gion containing voxels, described by John Eberhard,former director of research for AIA, as collections ofneurons that have the function of recognizing build-ings. This part of the brain doesn’t appear to exist forany other reason: researchers never find it active unlessthe body is reacting to its environment. Over time, wewill be able to use this information to inform our de-signs and their impact on many variables of well-beingthat up until now have been deemed anecdotal or dif-ficult to measure.

Similarly, the macroscopic view of earth from spaceand humanity’s ongoing imprint on the planet is re-vealing our interdependence. Through sophisticatedsatellite imaging, infrared photography, and computermodeling, scientists are discerning changes on a globalscale never previously imagined. This “large-patternscience” is showing us pollution levels, temperatureswings, the fragility of the ozone layer, even the toxic-ity of the soil in extreme detail — all from miles andmiles overhead. As a result, we are now receivingalarming reports about climate change and globalwarming as scientists precisely measure the amount ofice melt on the polar caps, the decline of thermohalinecirculation, and the further degradation of our life-sup-port systems.

RESTORING THE EARTH: WHAT’S POSSIBLE?

“The significant problems we face today cannot be solved bythe same level of consciousness that created them.”

—ALBERT EINSTEIN

We have come to a place where there is nolonger any doubt that our actions as a society or as acollection of societies influence global economics,culture, and climate. A seemingly endless list of jour-nal articles, television broadcasts, news stories,books, reports, environmental initiatives, and founda-tion programs bear witness to this obvious and in-evitable trajectory. It appears that our ability tomeasure and track our own environmental demisehas far outpaced our ability or will to understand it,let alone do anything about it. Despite this, weshould remain encouraged by recent signs of in-creased interest among institutions, business, andgovernment in understanding our impact on thehealth of the environment.

If we are to trust Einstein’s maxim, our solutionsmust involve an opposing doctrine of connectivity, in-tegration, and interdependence. It is a matter of chang-ing not just the way we live, but the way we think andthe way we work. It is not sufficient to use fewer rawmaterials and minimize emissions. A culture of changeand a spirit of teamwork and interconnectedness thatis far different from our current state of isolation andadversarial tendencies is required. This enlivened con-sciousness and understanding accelerates the potentialfor change.

Compelling new ideas, new technologies, andnew models of integration are emerging that providea glimpse into a more hopeful future. We knowenough today; there is no reason to wait for the restof the evidence, to wait until it’s all absolutely scien-tifically proven. The pattern is strong enough toallow us to take these next steps and employ thesenew capabilities. Significant advances are alreadyunder way, with the rise of the US Green BuildingCouncil, AIA’s Committee on the Environment, andthe Healthy Building Network, as well as evolvingbenchmark tools such as Leadership in Energy andEnvironmental Design (LEED) and the Green Guidefor Health Care.

In her revolutionary book Biomimicry, JanineBenyus explores the seemingly infinite realm of naturalsystems — evolving, adaptive, and sustainable — andhow a growing number of innovators are capitalizingon this wisdom. The movement toward biomimetic ar-chitecture and high-performance design holds tremen-


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The Next Genera t ion 19

dous promise for new products and methods of con-struction that emulate life’s genius. Incredible newtools that offer better design efficiency, resourcing, andintegration are also emerging. Building informationmodeling (BIM), for example, has the potential to re-veal relationships between complex systems and accel-erate toward a language and practice of sustainability.It’s now a matter of using these tools to create inte-grated design options and evaluate material selection,system selection, and building performance, includingenvironmental and health impacts.

WHAT’S NEXT, AND HOW CAN WE PROCEED?

“The best way to predict the future is to design it.”BUCKMINSTER FULLER

The promise of BIM and our willingness to learn fromnature will help us move more quickly to healthybuildings. These are, in fact, integrated issues: on onelevel, it is about human health and our local environ-ment, which includes buildings, neighborhoods, andcommunities; beyond that, it is about the larger envi-ronment: the planet. And each element can and shouldbe part of the design definition.

For me, Fuller’s early lessons resonate today morethan ever — particularly his advice to young architec-ture students to practice “anticipatory design” for thefuture: “Architects, if they are really to be comprehen-sive, must assume the enormous task of thinking interms always disciplined to the scale of the total worldpattern of needs, its resource flows, its recirculatoryand regenerative processes” (Fuller and Marks 1963).This moment in time represents the largest window ofopportunity for a major shift in thinking in my life-time. The immensity of these issues, of these neededchanges, is manifest to most people.

But what will it take to make that shift? In part, itrequires a convincing — and consistent — sense of ur-gency. In addition, we must offer up approaches thatare clear, comprehensible, and attractive, so peoplewill want to reach out for them.

It is critical that we begin to move beyond greenbuildings, even beyond the current generation of greenbuilding tools, and embrace the concept of livingbuildings or even restorative buildings. In BNIM’s workfor the David and Lucille Packard Foundation (Packard2002), we defined the living building as having no netimpact on people or the environment: it harvests all itsown water and energy needs, is adapted specifically tosite and climate, is built primarily of local materials,and generates zero wastes. The restorative buildinggoes even further: it produces more energy than it con-sumes, purifies more water and air than it pollutes, andcan actually restore a degraded environment throughits very existence. We have the ability to design andbuild restorative buildings now — to create environ-ments that are inspiring and uplifting and where peo-ple can gain, or regain, their health just by virtue ofbeing in them.

We also have much more to learn. But we do knowenough about sustainable architecture to move towarda regenerative future in our communities. Addressingthis ultimate design challenge will require us to suc-cessfully realign human nature with Mother Nature,the built environment with natural environments.More than that, it will require of us a new way ofthinking, of imagining something unimaginable not solong ago, of looking through new eyes to a world ofbuildings that restore.

THE NEXT GENERATION

Physical manifestations of this expanded vision of de-sign are already being realized. While we have not yetseen the first generation of climate-neutral healthcarebuildings, the projects in this book suggest new ap-proaches to bioregionalism and specific adaptations tolocation and site context. They embrace the goals of pro-moting the health and well-being of all inhabitants. Theyare integrating systems in innovative ways. Many, in fact,are beautiful and inspire us to dream.

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Owner: BC Cancer FoundationDesign team:

ARCHITECTS: IBI Group/Henriquez Partners Architects in joint ventureSTRUCTURAL ENGINEERS: Glotman SimpsonMECHANICAL ENGINEERS: Stantec Consulting Ltd.ELECTRICAL ENGINEERS: R. A. Duff and Associates Inc.LAB CONSULTANTS: Earl Walls AssociatesPROGRAM AND PROJECT MANAGERS: Stantec Consulting Ltd.GENERAL CONTRACTORS: Ledcor Construction Ltd.LANDSCAPE CONSULTANTS: Durante Kreuk Ltd.

Building type: New medical research laboratory facilitySize: 233,000 sq ft (21,650 sq m)Program description: Cancer research center, genomics facility, laboratories,

offices, interstitial service floorsCompletion date: 2004Awards/recognition: Canada Green Building Council LEED: gold certified


C A S E S T U D Y

BC CancerAgency

Research Center

Vancouver, British Columbia

Figure 1-7: BC Cancer Agency Research Center. Credit: Nic Lehoux, Nic Lehoux Photography

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This fully integrated cancer research center includes fa-cilities for advanced therapeutics, cancer control re-search, cancer endocrinology, cancer genetics anddevelopmental biology, cancer imaging, molecular on-cology and breast cancer program, and medical bio-physics; a genome sciences center; and the Terry FoxLaboratory, a multidisciplinary research unit dedicatedto improve cancer diagnosis and treatment.

The site, in a transitional neighborhood in down-town Vancouver between commercial and residentialareas, was zoned for less floor area and more parkingthan was required for the program. The decision tobuild a sustainable building accelerated the reviewprocess. The city agreed to double the allowable floorarea and modify height and setback regulations once itbecame clear that the massing of the building, whichseparated the labs and offices into distinct, smaller-scale units to achieve daylight and ventilation objec-tives, would not overwhelm adjacent properties.

The building is broken up into 35 percent office and65 percent laboratory blocks, each with its own archi-tectural expression. In cross-section, two floors of of-fices correspond to one floor of laboratories and itsinterstitial service floor. A total of 68 large, round “petridish” windows (one for each principal investigator),each 15 feet in diameter, reduce the apparent height ofthe laboratory block.

Based on the calculation of staff use of public trans-portation and bicycles, the agency successfully reducedthe on-site parking in favor of research space. Thecommitment to environmental stewardship eased theprocess of removing the land (previously occupied bya for-profit parking concession) from the property taxrolls.

When asked what researchers appreciate mostabout the building, Mary McNeil answers that it is theoperable windows and dual-flush toilets: “Both aremoments when people interact with the building toelicit control over resource use—a way to live their val-ues.” Twelve floors of office space look out on oceanand mountain views through multicolored glass strips.The office block’s vertical, striplike window pattern is an

Because we are a cancer center and there’s a broad pub-

lic awareness of the environmental links between the

causes of cancer and the environment, we opted for envi-

ronmental sustainability early in the design process. Not

only was it the right thing to do, but it’s helping us to re-

cruit researchers as well.

—MARY MCNEIL, PRESIDENT AND CEO, BC CANCER FOUNDATION

Figure 1-8: Organic forms are expressed in the rooftop terrace,a welcome outdoor place of respite for building occupants.Credit: Nic Lehoux, Nic Lehoux Photography

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abstraction of a sequence of chromosome six, a subject ofstudy in cancer research. These windows open to allow for nat-ural airflow.

Another important element is the open stair — a doublehelix that recalls human DNA. “We wanted to encourage theresearchers to use the staircase and not the elevators,” recallsMcNeil, “but that won’t work if you put a dark staircase in themiddle of a building. All of the meeting rooms abut this stair-case, which is located with the best views in the building.Again, the city loved it; it’s a visible extension of activity onthe street.”

KEY BUILDING PERFORMANCE STRATEGIES

Water� Reduction of 43 percent in potable water demand� Dual-flush toilets, waterless urinals, and low-flow faucets

Energy� Energy savings of 42 percent below code using HCFC-free

air conditioning equipment� Heat recovery system for exhaust air and condensing units� Variable air-volume supply and exhaust boxes in the perime-

ter zone to reduce air volumes during nonpeak load times� Radiant heating and cooling in office areas� Natural ventilation in all laboratories and offices� Highly reflective roofing membrane� Operable windows reduce reliance on mechanical cooling

Materials� 24 percent of materials contain recycled content� 98 percent of construction waste recycled� Formaldehyde-free composite wood

Environmental quality� Low-emitting carpets, paints, and sealants� Large, round windows daylight the laboratory space� 90 percent of occupied spaces (including laboratories) have

access to daylight, views, and operable windows

Source: Henriquez Partners Architects


Figure 1-9: The open double helix stair—recalling thestructure of DNA—is a central organizing elementand visual symbol. Clustering conference rooms ateach floor landing promotes walking and interactionamong researchers. Credit: Nic Lehoux, Nic LehouxPhotography

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Owner: Dutch Care Federation (Nederlandse Zorgfederatie)Design team:

ARCHITECTS, ENGINEERS, AND CONTRACTORS: de Jong Gortemaker AlgraLANDSCAPE ARCHITECTS: Buro Poelmans Reesink Landschapsarchitectuur

Building type: New replacement hospitalSize: Main hospital: 592,015 sq ft (55,000 sq m); psychiatric center: 61,354 sq

ft (5,700 sq m); radiation therapy clinic: 55,972 sq ft (5,200 sq m); site: 27acres (11 ha)

Program description: 380-bed acute teaching hospital with specialty clinics forpsychiatry and radiation therapy

Completion date: 2007Awards/recognition: European Union Hospitals Project demonstration facility

Formed in 1985 in a merger of two smaller facilities, Deventer Hospital is a large teach-ing hospital with a staff of 2,000. The hospital’s new facility, under construction on agreenfield site east of the city of Deventer, will serve a population area of 170,000.

The project’s design focuses on energy efficiency, driven primarily by the DutchCare Federation’s pledge to reduce facility energy consumption by 30 percent below1988 levels. Designers anticipate that the energy efficiency measures will result in an-nual emissions reductions of 1.943 tons of carbon dioxide (CO2), 8.71 tons of sulfuroxide (SOx), and 3.35 tons nitrogen oxide (NOx). This is a reduction of 69 percentfrom the average Dutch hospital.

As a European Union Hospitals Project demonstration facility, the hospital designhas benefited from consultations with outside engineers and energy modelers. Design-ers were concerned with patient comfort; locating single-, double-, and triple-patientrooms away from public waiting rooms and high-traffic circulation areas; and improv-ing patient access to daylight and views.

C A S E S T U D Y

DeventerZiekenhuis

Deventer, Netherlands

Figure 1-10: Deventer Ziekenhuis. Credit: Courtesy of Deventer Ziekenhuis

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KEY PERFORMANCE STRATEGIES

Site� About half of the 950 parking spaces located in underground decks� Space for 200 bicycles

Water� High proportion of pervious cover reduces storm water runoff� System of wadis (originally an Arabic word describing a dry riverbed), swales, and

small ditches funnels rainwater and functions as landscaping when dry in summer� During ten-year storm events, ditch system overflows into a large canal nearby� Green roof filters rainwater and reduces storm water runoff

Energy� Annual energy cost savings estimated at €154,545 from a baseline case, with a

simple payback time for the owner of 13.4 years, or 8.7 years after European Unionincentives

� Heating system energy use reduced an estimated 73 percent (to 44 kWh/sq m)and cooling by half compared with a conventional system through the use of ge-othermal heat and cooling storage, a heat pump, ventilation heat recovery, andcombined heat and power (CHP) plant

� Electricity consumption reduced an estimated 16 percent compared with a standardDutch hospital’s

� Increased building envelope insulation� Low-E glazing� Floors and areas with similar use periods grouped to reduce space-conditioning

and lighting energy demands

Environmental quality� Built using Dutch government DuBo (duurzaam bouwen, or “sustainable build-

ing”) principles, which consider project life cycle costs from design to disposal� Planted sedum roof of 139,930 sq ft (13,300 sq m) over outpatient area filters rain-

water and provides views of living vegetation for upper levels� Building wings designed as “fingers” to maximize daylighting� Operable windows in patient rooms

Sources: Deventer Ziekenhuis and EU Hospitals Project

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