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Healthcare’s Green Initiative: The Healthy Hospital Movement

Today, leading-edge health care organizations are striving to create environments that are more conducive to healing, while also working to eliminate barriers to patient safety and environmental risks. The goal is to ensure that inpatient and outpatient settings have a positive, rather than a negative impact on patients’ health.

When the Institute for Medicine came out with its report in 2001 identifying the U.S. health system as unsafe, inefficient and lacking patient-centered focus, it set off a quiet revolution in patient safety and quality that would lead to the transformation of health care environments across the country. Now known as the “healthy hospital movement,” this global effort includes regional, national and international innovators such as the Cleveland Clinic, Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Lexington Medical Center and the East Carolina Heart Institute at Pitt County Memorial Hospital. These leading-edge health care organizations are striving to create environments that are more conducive to healing, while also working to eliminate barriers to patient safety and environmental risks. The goal is to ensure that inpatient and outpatient settings have a positive, rather than a negative impact on patients’ health.

According to a study by the National Association of Children’s Hospitals and Related Institutions (NACHRI) and The Center for Health Design, “A growing body of research shows that the physical design of health care settings unintentionally contributes to negative outcomes. On the other hand, thoughtful evidence-based facility design can help bring the patient, staff and families into the center of the health care experience, increase patient safety and enhance overall quality of care provided.” ("Evidence for Innovation," NACHRI and The Center for Health Design, 2008)  Simple improvements to the interior environment of a health care setting, such as the introduction of natural light or the strategic placement of sinks and hand hygiene dispensers, have been shown to have a positive impact on patient outcomes.

Healthy food programs are another way that hospitals are working to create healthier environments for patients, visitors and staff. By introducing healthy food initiatives, hospitals are modeling good nutrition while working to directly impact the health of their constituents. They are also helping to reduce health care costs by reducing obesity-related conditions such as hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease and stroke among their workforce. ("Healthy Food Environments: Food, Obesity, and Cost," NC Prevention Partners)

Of course when people think of healthy environments, they automatically think of environmentally friendly or green buildings; however, the healthy hospital movement extends far beyond sustainable building practices. Leading-edge health care organizations are striving to create environments that are more conducive to healing while working to eliminate environmental contaminants to ensure inpatient and outpatient settings do not have a negative effect on patients’ health. Some of the steps health care providers are taking include eliminating the use of mercury-based thermometers, eliminating PVCs in hospital equipment, phasing out incinerators that emit toxic dioxin and introducing more healthy and organic options in hospital food, along with using green building practices to save energy and resources while eliminating pollutants. Hospitals are also working to avoid toxic volatile organic chemicals (VOCs) that are given off by many common paints and adhesives used in new construction. Low-VOC products improve conditions for employees and patients by giving them cleaner air to breathe.

Two hospitals in the southeastern United States, the East Carolina Heart Institute at Pitt County Memorial Hospital (Greenville, NC) and Lexington Medical Center (West Columbia, SC), are at the forefront of the global “healthy hospital movement”  – and have committed their organizations to creating healthy hospital environments for their patients, family members and staff. The underlying premise is that healthy, thoughtfully designed, non-toxic environments enhance the patient and family experience, speed the healing process, improve patient safety and contribute to health and well-being of those involved. This effort leads to better clinical outcomes, improved psychosocial outcomes, increased patient and staff satisfaction, enhancements in staff effectiveness in providing care, improvements in staff health and eventually, lower health care costs.

Case in Point: East Carolina Heart Institute at Pitt County Memorial Hospital

The East Carolina Heart Institute, in Greenville, North Carolina, was designed to provide a healthy environment for patients, family members, visitors and staff. The staff and leadership at the Heart Institute recognize the vital role that family members play on the patient care team and seek to include them in a very intentional and thoughtful manner. Some of the “healthy hospital” features built into the new facility include private rooms for patients; accommodations within patient rooms for visiting family members; a paging system to update family members; a design that features abundant natural light; the use of sound-absorbing tiles; patient control of the environment within his or her room; environments designed with the use of  soothing colors and natural tones to promote healing; and elements that provide positive distractions, such as artwork on the walls in patient care units and patient rooms.

Many of the healthy hospital initiatives at the new East Carolina Heart Institute go beyond affecting patients. They extend to family members, visitors and employees of the hospital. These include healthy food options in the café, quiet rooms where family members, visitors and staff can retreat for moments of reflection, data ports and wireless Internet access for visitors; and, of course, a smoke-free campus.

A few of the green/eco-friendly features built into the $160 million, 375,000-square-foot East Carolina Heart Institute:
  • Carpeting in administrative, education and conference spaces is made of 96% to 100% post-consumer recycled content.
  • Porcelain tile used in bathroom walls and floor contains an average of 43% post-industrial recycled content.
  • Recycled material comprises approximately 79% of ceiling tile throughout the Heart Institute.
  • The use of light-colored roofing material to avoid the heat island effect.
  •  Products such as paints, carpets and sealants were selected to minimize harmful chemicals (VOCs) emitted.
  • The use of natural light to reduce the dependence on artificial lighting.
  • Utility plant powering the Heart Institute features energy-efficient air conditioning chillers, high-efficiency electric motors, and variable-speed pumping and air flow systems.

Case in Point: Lexington Medical Center

Another player in the healthy hospital movement is Lexington Medical Center in West Columbia, South Carolina. For a number of years the state’s Business Recycling Assistance Program has recognized Lexington Medical Center for its industry-leading recycling practices. It was also the first hospital to become a member in the South Carolina Environmental Excellence Program (SCEEP), a voluntary program that promotes environmental leadership among businesses in South Carolina.

In April 2008, Lexington Medical Center received notification from U.S. Green Building Council (USGBC) that its new medical office building had achieved Silver LEED certification. With this announcement, Lexington Medical Center became one of the first health care organizations in South Carolina to develop a facility that meets USGBC’s standards for sustainable site development, energy efficiency, conservation of materials and resources, and indoor environment quality. This put Lexington Medical Center on the leading edge of the healthy hospital movement. Through its actions, the hospital has made a clear commitment to creating healthy environments for patients and health care workers.

How unique are the actions taken by Lexington Medical Center? According to U.S. Green Building Council, of the more than 3,600 LEED-registered projects in the United States, only about 2% are health care buildings. The health care industry is slowly but surely taking up the cause.

Some of the important measures Lexington Medical Center undertook in the development of its new environmentally and people-friendly medical office building included:
  • More than 75% of the construction waste generated by the project was recycled instead of being sent to a landfill.
  • Materials used in the project were selected to have a high recycled content and provided from regional suppliers and manufacturers to reduce emissions caused by transportation of materials. Materials selected that were high in recycled content included fly ash used in the concrete for the parking deck, reinforcing steel for the concrete, structural steel used in the building framing, metal studs to support walls, carpet, etc.
  • An existing retention pond that captures runoff from the new building reduces the  impact of the building’s stormwater runoff .  The retention pond allows suspended solids in the stormwater to settle in the pond, so they were not discharged to rivers or streams.
  • Bicycle storage racks and showers in the building were provided to encourage workers in the building to bicycle to work. A shuttle system operated by Lexington Medical Center also encourages use of public transportation.
  • Water-conserving plumbing fixtures were selected for both central core restrooms and tenant areas.
  • A 30% savings in energy usage was accomplished by using energy-efficient white roofing to reflect the sun, improved building insulation, and energy-efficient windows to reduce the amount of heating and air conditioning needed.
  • The building’s air conditioning equipment was selected to use refrigerants (R-134a, a hydrofluorocarbon) that are less damaging to the earth’s ozone layer.
  • To remove contaminants in the air caused by chemical emissions from new carpet, paint, cabinetry, etc., the building was flushed with fresh air for two weeks between finishing the construction and move-in.  Removing contaminants helped ensure improved indoor air quality for the building’s tenants and patients.
  • Paint, carpet, adhesives and sealants, and composite wood products were selected to minimize the amount of harmful chemicals these products emit into the building.
  • Janitors’ closets were exhausted to the outside to ensure any harmful chemicals that might be emitted to the air by housekeeping products stored in the closets were not recirculated to the building.
As in the case of Lexington Medical Center’s new LEED designated medical office building, most of the green health care facilities going up around the country are smaller free-standing buildings, additions or renovations to existing facilities, rather than full medical centers. Examples of green health care facilities include: Boulder Community Foothills Hospital in Boulder, Colorado; University of Texas Houston, School of Nursing; Mt. Sinai Medical Center, Obstetric Services – Postpartum Unit, New York, New York; and Legacy Good Samaritan Hospital, Portland, Oregon.

Lexington Medical Center has also instituted a comprehensive healthy food program that has garnered a great deal of attention within the industry. The “Healthy Choices” program has been marketed extensively throughout the hospital using banners, table tents, newsletter articles, the hospital blog and Facebook Group, along with the employee Intranet site.


This healthy hospital movement is a trend that is taking hold in hospitals across the country and throughout the world. It is counter-intuitive for hospitals to offer anything other than the most healthful environments. When a tobacco state like North Carolina announces that every hospital in the state has gone smoke-free, as it did in July 2009, you know that this movement is a force to be reckoned with. Some smart hospital marketers are even using their healthy environment initiatives as points of differentiation in their advertising. And, contrary to popular opinion, many of these initiatives can lead to cost savings for the organization.

Sources of information on the Health Hospital Movement:
Much of what I've learned about the healthy hospital movement has come from information accessed from the organizations listed below. They were important resources in the development of this article.

•    Global Health and Safety Initiative – www.globalhealthandsafety.org - An industry-wide collaboration to transform the way that healthcare designs, builds and operates its facilities. It supports evidence-based improvements at the intersection of patient safety, worker safety and environmental sustainability.
•    Health Care Without Harm – www.noharm.org/us - A coalition of 473 organizations in more than 50 countries working to protect health by reducing pollution in the health care sector.
•    Practice Greenhealth – www.practicegreenhealth.org - The nation’s leading membership and networking organization for institutions in the healthcare community that have made a commitment to sustainable, eco-friendly practices.
•    The Center for Health Design – www.healthdesign.org - A catalyst for change in healthcare design, the Center for Health Design supports healthcare and design professionals all over the world in their quest to improve the quality of healthcare through evidence-based building design.

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