Social Sustainability: Burera District is one of the most impovershed districts of Rwanda, with extremely poor health indicators to reflect this. The construction of this hospital brought the community of 340,00 people together to build a healthier place to live. They now congregate at Butaro Hospital as a place of great social wealth as well as a place of healing.

Equity: Prior to the construction of Butaro Hospital, the town had only a single community physician, but now that number has grown to 12 ministry of Health doctors, 5 visiting Parners in Health (PIH) doctors, and a visiting PIH doctor in residency. The community has grown around this healthcare center and the two sustain eachother.

Economic Sustainability: Using locally available materials and economically conscience design strategies, the Butaro hospital represents a feasible model of healhthcare design for resource-contrained settings.

Sustainable Design: A Systemic Approach to Healthcare

Timothy Lalowski, MPH and Deborah Wingler, MSD-HHE

Social Sustainability: the capacity of a social system to support its own development through positive reinforcement.

Individual Tier: the holistic well-being of a single patient, including his or her physical, psychological, and social health.

Community Tier: the collective health of a group of people sharing similar location and/or traits.

World Tier: the wellness of humanity as a whole. Equity: The mitigation of socioeconomic disparities in order to alleviate social and economic tensions which threaten the stability of the healthcare system

Literacy Tier: understanding and acknowledging the diversity of needs and assets within the population.

Efficacy Tier: the ability of a healthcare system to promote holistic health within the given resources and context.

Prosperity Tier: the ultimate state of an equity driven system which promotes the success of patient and provider alike, and therefore, society as a whole. Economic Sustainability: the capacity of an economic system to support its own development through compounding growth.

Capital Tier: the initial value of a healthcare system.

Investment Tier: A healthcare system whose services result in economic growth.

Longevity Tier: the quality of a healthcare system that is powered by the economic growth it initiates. Viability: the feasibility of a healthcare system to meet our medical needs without straining the economy or the environment.

Calibration Tier: the process of adjusting a healthcare system to meet the needs of the local economy and environment.

Endurance Tier: the ability of a calibrated healthcare system to withstand use and maintain its worth without depleting the environmental or economic resources from which it draws.

Perpetuity Tier: the ability of a perfectly calibrated healthcare system to indefinitely withstand use and changes in context, through the appropriate allocation and use of resources. Environmental Sustainability: The capacity of an environment to flourish while supporting both itself and the communities built in it.

Resources Tier: the availability of all elements of the natural environment which support life and offer opportunity for healthcare development.

Footprint Tier: the ultimate impact of the healthcare system on the environment’s capacity to support life and development.

Vitality Tier: the capacity of the environment and healthcare system to thrive alongside each other indefinitely.

Stewardship: humanity’s social responsibility to the planet and all the life it supports.

Conservation Tier: a careful preservation and protection of the natural environment through design decisions and material selection.

Synergy Tier: a synergistic relationship is one where healthcare and the natural environment are both improved separately with the common goal of improved health.

Symbiosis Tier: a symbiotic relationship is one where the enhancement of healthcare or the natural environment also enhances the other, resulting in a compounded improvement in human health.

Sustainable Healthcare

Design

Butaro HospitalBurera District, Rwanda

Adelante MesaMesa, Arizona

First People’s HospitalGuangdong Province, China

Peace Island Medical CenterFriday Harbor, Washington

Project Team: Mass Design Group, ICON, Partners in Health, EcoProtection, Sierra

Bainbridge, and Maura Rockcastle

Butaro hospital is a 140 bed acute-care hospital with men’s and women’s wards, pediatrics, post-partem, isolation, operating rooms, imaging, obstetrics, neo-natal ICU, and an ED with trauma bay.

Viability: Because designers have made design decisions that are both harmonious with the environment and reduce the long term energy and maintenance costs, the Peace Island center is a progressively viable solution for healthcare delivery. Reducing the strain on both the environment, which supports human health, and the stakeholder finances, is the goal of sustainable design.

Peace Island Medical Center is an acute-care hospital with 10 inpatient beds, an emergency department, diagnostic imaging, surgical suite, primary and specialty care clinic, medical oncology, and ancillary services.

Environmental Sustainability: First People’s Hospital reduces its impact on the environment through several ingenious design choices, including natural ventilation and dehumidification utilizing stack effect and chilled beams, as well as specially designed operable windows in the atrium. Designers also implemented a photovoltaic system integrated into the facade shading screen, skylight, and roofing system while focusing on low embodied energy materials.

Project Team: HMC Architects, Shunde Architectural Design Institute, SDADI, and ZheJiang ZhongYuan Constructio Design Co.

Project Team: Cascade Design Collaborative, CDi, Hargis, 2020 Engineering, and Howard S. Wright

Social Sustainability: First People’s Hospital has a unique dedication to social structure, offering a dormitory for its staff to foster stronger relationships between employees and to support their social needs. The hospital also serves a civic function through the incorporation of on-site retail functions and a public transit system.

Stewardship: The designers of First People’s Hospital demonstrate their determination to be stewards of the planet by developing innovative stormwater management through bioswales and water catchments, alongwith their on-site wastewater treatment and reclaimed water reuse, which supports 25% of their total water use.

Viability: Adelante Mesa is a one-stop shop for primary and preventive care, allowing patients to schedule all of their needed services consecutively without the economic and resource burden of having to commute around the metropolitan area. As the first LEED platinum community health center in the country, Adelante demonstrates their dedication to sustainability by maximizing services while reducing costs and resources.

Environmental Sustainability: Peace Island Medical Center focuses primarily on energy conservation and habitat restoration through an energy responsive facade, reclaimed water reuse, geothermal heat pumps, natural ventilation, low embodied energy materials, and the conscious decision only to build on previously developed land.

Stewardship: The center is the first carbon-neutral hospital in the U.S., but as stewards for the environment, designers and other stakeholders plan to continue their progress by adding solar thermal and photovoltaic panels, making the entire project net-zero energy.

Project Team: Crawley Architects, Jain Malkin Inc., LGE Design Build, and One Word Development

Adelante Healthcare Mesa is a federally qualified patient-centered medical home focusing on clinic family practice, internal medicine, OB-GYN, pediatrics, and dentistry. Mesa also includes integrated behavioral health and an urgent care clinic.

Equity: As a Federally Qualified Health Center (FQHC), Adelante Healthcare Mesa serves a large population of low-income and medically complex patients, to whom they have pledged their dedication. Design decisions were centered around reducing costs while maintaining a high level of care quality and producing a welcoming environment for patient activation and health promotion.

Economic Sustainability: Reducing the long term and broad scale costs of healthcare is central to Adelante Mesa’s design. The design works to promote efficacy of care delivery, improve patient activation and strength the patient-provider relationship. These movements transform incident-reaction healthcare into preventive, holistic, and lifelong care, reducing healthcare costs while improving population health.

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