Indoor Environmental Quality
As befitting the therapeutic environment, indoor noise levels must be held to reasonable levels in healthcare applications. Recognizing this, LEED for Healthcare awards up to two points under Indoor Environmental Quality (EQ) Credit 2, Acoustic Environment: Exterior Noise, Acoustical Finishes, and Room Noise Levels. Obtaining these points requires rigorous determination of exterior noise levels and an acoustic design of the total building envelope. It involves measurement of ‘as-built’ sound pressure levels.
LEED for Healthcare provides for a thermal comfort survey of building occupants, coupled with a corrective action plan, as an alternative to American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) 55-2004, Thermal Environmental Conditions for Human Occupancy. This may earn the project one point toward certification under EQ Credit 7, Thermal Comfort. When coupled with low air infiltration rates, the use of high-performance glass and thermal barrier aluminum frames in window systems can greatly contribute to occupant comfort in keeping interior surface temperatures close to interior air temperatures.
The aforementioned importance of access to daylight for patients, staff, and visitors in healthcare facilities is acknowledged throughout the design community. Incorporation of natural daylighting strategies without placing undue loads on mechanical systems requires an integrated design approach.
LEED for Healthcare awards a maximum of four points from the six available in EQ Credit 8, Views and Daylight, outside of Innovation in Design (ID) points for exemplary performance. Separate requirements are given for diagnostic and treatment areas versus in-patient units.
Techniques and strategies include increased window head and ceiling heights, glazed partitions, and courtyards and atria.
A question of economics?
In 2011, an “Economics, Efficiency, Energy & Environment” survey was conducted by the Corporate Reality, Design, and Management Institute (CRDMI) in partnership with the Healthcare Council of the International Facilities Management Association (IFMA). Many of the 1251 respondents—architects, designers, engineers, hospital facilities managers, healthcare engineers, project managers, and contractors—underestimated the impact design and operations could have on a hospital’s financial health. The survey summary notes:
Given a 4% total margin, saving $1 in energy equals $25 in revenue, and for the average-sized hospital in the U.S. that translates to an additional $7.2 million in revenue.
Less than 15 percent of the survey respondents said they select products or equipment based on durability and expected lifecycle. By keeping any claims and representations focused on tested, third-party validated, performance parameters, as well as sound engineering judgment, manufacturers can present a more credible case for their products’ support of sustainable design initiatives.
A new hospital in Washington, D.C., Saint Elizabeths provides intensive, in-patient care for individuals with serious and persistent mental illness. (Under the aforementioned survey, only three percent of respondents from D.C. indicated sustainability features took precedence in the final selection of their last building project. Half of these participants also said LEED certification or the U.S. Environmental Protection Agency’s [EPA’s] Energy Star for Buildings program would be the most important next step in pursuing sustainability goals.)
Established in 1852, Saint Elizabeths was the first large-scale, federally run hospital for people with mental illness. Its design incorporates numerous sustainable design elements emphasizing daylighting and external views. Patient safety and security remained a top priority. Windows were furnished with interior polycarbonate glazing for human impact resistance. The move into a new facility completes a transition from the historic, psychiatric institution into a modern, healing environment.
Whether building a new hospital, renovating existing spaces, or leveraging adaptive reuse of areas originally intended for another occupancy, window selection in areas accessible to psychiatric patients can be very challenging. Windows without jail-like bars or heavy security screens help create a more home-like and caring atmosphere with unrestricted views to the outside. At the same time, patient safety must remain the primary consideration.
Through development programs with state agencies and their architectural consulting partners, leading window manufacturers have designed psychiatric-grade fenestration systems answering this need.
Lisa May is an architectural services and healthcare market manager with Wausau Window and Wall Systems, providing technical assistance, sustainable design input, thermal modeling, detailing, and specification review to design professionals nationwide. She successfully completed Six Sigma training and the U.S. Green Building Council’s (USGBC’s) Leadership in Energy and Environmental Design (LEED) Green Associate accreditation. May instructs others in American Institute of Architects/Construction Specifications Institute (AIA/CSI)-approved continuing education programs addressing thermal and acoustical performance, and window and curtain wall selection. She can be contacted via e-mail at email@example.com.