Construction Methods and Building Systems
There has been considerable interest in recent years in green design as a visible demonstration of commitment to sustainability and the health of the planet. It may be a while before it becomes mainstream in private practice medical and dental offices but clinics associated with hospitals and larger organizations such as Kaiser Permanente are making that an imperative. In Chapter 3, Cisco LifeConnections is LEED Gold and in Chapter 4, community health center Adelante Healthcare, is LEED Platinum. San Francisco Surgical Arts, an oral surgery facility presented in Chapter 10, represents total dedication of a solo-practice provider to Leadership in Energy and Environmental Design (LEED), a doctor who became an evangelist for this concept and shares generously and transparently all of his innovation. In July 2013, Kaiser Permanente, Oakland, made a commitment to spend an estimated $30 billion on the building of new health facilities to a minimum LEED Gold certification standard. According to an article in Health Facilities Management magazine (July 2013), they are aiming to achieve energy performance 25 percent better than ASHRAE 90.1–2007 and to use at least 30 percent less water than the baseline established by the U.S. Energy Policy Act of 1992.
All too often, medical office buildings (MOBs) have been built by developers under pressure to build at the lowest cost in order to be competitive. This means taking shortcuts and choosing inexpensive systems that have a bigger environmental impact. There will be a tipping point, however, at which market forces will favor LEED-certified buildings and then, in order to be competitive, the majority of developers and contractors will enthusiastically support stewardship of the environment. This is an evolutionary shift in attitude that has been occurring over the past 15 years, and it has really picked up steam. In the manufacture of building products, interior finish materials, furniture, coatings like paint, and fabrics, it is increasingly uncommon to find products that contain substances that off-gas, or that contain PVC or other unhealthy substances. Years ago, manufacturers saw the handwriting on the wall and have progressively transitioned their product lines to be environmentally safer. If a physician or dentist moves into a building that was not designed to comply with LEED, it becomes very difficult for an individual medical or dental office to become certified because LEED points relevant to the site and building shell as well as mechanical system and utilities will not be available.
At the center of the movement to have healthier buildings is the United States Green Building Council (USGBC), which offers the LEED certification system, which puts projects through a rigorous process of review. In exchange for constructing a more sustainable built environment, projects are rewarded with tiered rankings and coveted plaques that reflect a company’s commitment to a high-quality built environment.
LEED certification is a standard for green building that can be found around the world and comprises an extensively detailed process that includes components of site location, water and energy efficiency, material selections, indoor air quality, and occupant comfort. The USGBC offers a variety of rating systems from which to choose. These include new construction, homes, schools, healthcare, retail, commercial interiors, and so forth. Depending on the type of construction project one of these specialty systems is selected and its various prerequisites and elective points are pursued through the process of design and construction. Within each system, the number of points obtained determines which LEED certification is awarded. The highest level that can be earned is Platinum, followed by Gold, Silver, and Certified. Certain prerequisites must be met in each category. Beyond that, the project team selects which elective credits to pursue depending on various factors of the project, including budget, tenant/owner priorities, and the desired level of certification.
While some criticize this process as costly and time-consuming, the reward of LEED certification is a return on investment in energy savings, employee satisfaction, and a higher premium on leasable space. LEED certification also provides businesses with a competitive advantage and a LEED “badge of honor” that consumers recognize. For the government, LEED is a standard at the federal level for new building projects and quite often the standard at state and local levels. For example, in California all new and renovated state-owned facilities are required to be certified LEED Silver or better. States such as Arizona, Rhode Island, Nevada, New Mexico, Washington, Michigan, and Pennsylvania have similar requirements. More and more businesses are realizing the advantages of getting their projects LEED certified.
A rating system specifically for medical and dental offices does not exist. LEED for Healthcare is targeted toward green hospitals but may be used for larger standalone offices on individual sites. Kaiser, as an example, is using LEED for New Construction Building for its MOBs. For a majority of medical and dental offices that lease or own space in a medical office building, LEED for Commercial Interiors (LEED-CI) is the appropriate choice for certification. Both LEED-CI and LEED for Healthcare are broken down into seven main categories: Sustainable Sites; Water Efficiency; Energy and Atmosphere; Materials and Resources; Indoor Environmental Quality; Innovation in Design; and Regional Priority. A large portion of the credits to be obtained for LEED-CI certification are in the categories of Energy and Atmosphere and Sustainable Sites. LEED for Healthcare also places emphasis on Indoor Environmental Quality.
To begin the process of obtaining LEED certification, a project team, which includes the tenant/owner, the designer/architect, and typically a LEED consultant, will choose which rating system to use. A project administrator, usually the LEED consultant, will register the project on the USGBC website. This begins the official LEED process. A certification application, including all documentation for the prerequisites and credits, as well as required fees must then be submitted. The application will then be reviewed and a certification decision will be made by the USGBC. This decision can be either accepted or appealed. During the appeal process, a project team may add additional credits in an attempt to obtain or increase their level of certification. Once a project is certified, the USGBC provides guidelines for public relations promotion and information on ordering LEED plaques and certificates. Plaques are often displayed in prominent locations at the entry of a suite or building and signify the commitment to green building.
A LEED Accredited Professional (AP) is very often included in a project team as a consultant who tracks targeted points and helps guide the design team in their selections and specifications. Interior designers and architects are often LEED Accredited Professionals as well. By using an independent LEED consultant, the design team can be freed up to focus on their expertise while the LEED consultant maneuvers through the system of certification. LEED and green building consultants have proliferated in recent years to meet the demands of this growing market. In order to become a LEED Accredited Professional, one must pass a detailed examination on green building and relevant LEED rating systems. Continuing education credits are required to maintain the LEED AP with specialty accreditation. The advantages of working with LEED-accredited architects and designers should be emphasized even if one has engaged a LEED consultant to manage the process. These experienced design professionals will know how to select appropriate building systems and materials that will lead to maximum LEED points while providing a high level of design. Even the selection of furniture figures into the equation. Furniture that is manufactured within a 500-mile radius of the site adds to the points. A LEED Accredited interior designer will be familiar with these resources.
For physicians, dentists, or practitioners who wish to create a LEED certified clinic under the LEED for Commercial Interiors rating system, selecting a building or development site is an important first step in the design process. LEED heavily rewards site selections that are in existing LEED certified buildings. If the building is not LEED certified, then points may be earned for buildings developed on brownfields, with stormwater management plans and water efficient landscaping, and with elements that mitigate a heat island effect and light pollution reduction. LEED points may also be earned under Sustainable Sites by selecting an office location in an established, walkable community or close to public transportation. Site amenities such as bicycle storage and changing rooms for employees can also earn points toward certification.
The Water Efficiency