Healthcare and sustainable design are two exceptionally paired industries because they focus on the same goal: promoting and protecting the health and wellbeing of the community.

However, the perceived and actual first costs associated with sustainable design strategies discourage many small or rural healthcare organizations from pursuing LEED or Green Guide for Health Care (GGHC) certification. These organizations are often challenged to cover high operational and equipment expenses with tight budgets. The costs of building green may be minimal in the context of the big picture, but even a 1 percent increase of construction costs can have a resounding impact on the budget.

So what are environmentally-conscientious healthcare organizations to do? They can follow the lead of Stillwater Medical Group.

Charged with meeting the growing needs of its community, Stillwater Medical Group launched a 92,000-square-foot expansion of its Curve Crest clinic in Stillwater, Minn. The group wanted to incorporate energy optimization measures and sustainable site design principles.

Through its integrated design-build process, Marshall Erdman & Associates assembled an internal team with the knowledge and expertise to identify and support the group’s goals while remaining sensitive to the special requirements of healthcare facility design. The company also introduced the local utility company’s incentive program into the mix, culminating in a significant energy cost savings of approximately $36,000.

Energy Optimization Measures

Café-style seating in the cafeteria provides staff and patients with a comfortable, retail-themed place to relax, unwind and enjoy the view at any time of the year. Photo by Paula McDermid/Marshall Erdman & Associates.

Energy optimization measures often top the list of strategies that most interest facility stakeholders. Energy optimization has a more tangible return on investment than many other strategies, and decision-makers are often more comfortable and familiar with the concepts related to energy conservation.

However, it is essential to select technologies that make the most sense in terms of first costs, payback, benefit and the facility’s intended purpose.

After evaluating Stillwater Medical Group’s goals and intentions, Marshall Erdman coordinated with its strategic partners in a modeling exercise that generated several “bundles” of strategies. Each bundle detailed the base energy cost of the building as designed to code, the first costs of more efficient equipment, the energy savings of the alternatives, and the anticipated pay-back of those initial costs.

Throughout the selection process, the project team remained cognizant that the project was first and foremost a healthcare facility with an urgent care component. System reliability was never sacrificed for unproven equipment.

Considerable Payback

Stillwater Medical Group took advantage of a 90,000-square-foot expansion of its Curve Crest Clinic to incorporate energy optimization measures and sustainable site design principles.

When Xcel Energy toured the completed facility to confirm results, the utility found that Stillwater Medical Group was achieving higher-than-anticipated energy savings. Had the building been built to code, annual energy costs would have amounted to $103,935 (with code defined by ASHRAE Std. 90.1-1989). With the strategies that Stillwater Medical Group put into place, however, the group experienced $67,659 of annual energy costs in 2006.

The bundle included using motion-sensor lighting in low-circulation areas and combining natural lighting with stepped lighting in public spaces. Research indicates that natural light and access to natural landscapes (even viewed through a window) reduce stress and anxiety, leading to better performance and improved wellbeing.

Other, more innovative strategies supported the behind-the-scenes delivery of the thermal environment. Load-responsive equipment was chosen for the mechanical systems so that control motors do not run continuously. The facility also includes CO₂ control of outside air, so that outside air is only introduced as needed.

Sustainable Site Design

The project introduced outdoor environmental stewardship — and lower costs — with natural stormwater management and xeriscaping. Vegetative swales were designed to clean metals and inorganic materials from stormwater runoff. A pond area handles large volumes of rainwater to increase water infiltration and decrease pressure on the nearby natural stream systems.

Native grasses and plants were chosen for large swaths of turf to reduce the costs of, and effects related to, heavy irrigation, fertilization and maintenance.

Integrated Approach

Energy conservation measures, like combining stepped lighting with daylighting in public spaces, has delivered an energy cost savings of approximately $36,000. Photos by George Heinrich Photography.

Sustainable design requires a close-knit team of stakeholders and project team members who thoroughly evaluate how individual design decisions affect the facility’s overall performance. While this naturally applies to every building project, it is amplified on ventures that aim to reduce the building’s impact on the environment. For this reason, integrated design-build is naturally suited for the whole-systems approach of sustainable design.

This was particularly true for Stillwater Medical Group because the group was not relying on a prescribed list of strategies and points, like those outlined by the LEED and GGHC tools. By complementing in-house expertise with strategic partners for energy modeling support, the Marshall Erdman project team was able to identify the client’s goals and pull in the right resources at the project’s outset.

Built-in communication lines and an inherent culture of collaboration enabled the project team to quickly devise cost-effective strategies that stayed within budget and supported healthcare facility codes and requirements. When combined, these solutions have delivered lower energy demand, protected regional water quality and improved wellbeing of occupants — results that influence a healthier bottom line.