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Healthcare Development & Architecture

Sustainability Infusion as Architectural Life Force

Healthcare Development & Architecture

Last month, the two themes of sustainability and hospital development intertwined as a key track, making an impact in Los Angeles, California at the Sustainable Healthcare & Hospital Development Conference. Held on September 22nd-24th, a gathering of global medical travel, hospital executives, and health & wellness leaders shared their knowledge and experience on state of the art development in this arena.

The Sustainable Healthcare & Hospital Development Conference was developed to enhance awareness of the essential parts that make up a sustainable healthcare system. Most people think of sustainability in healthcare as “going green” in the industry but there’s more to it than that. In addition to developing eco-friendly hospitals, there are integral organizational and management operations that need to be planned out accordingly to sustain any business, but healthcare in particular. Many of the guest speakers at the Sustainable Healthcare & Hospital Development Conference addressed these issues, providing business plans and/or methods to effectively implement a sustainable healthcare system.

Jacques Mulder, principal of R&D Practice at Deloitte Consulting LLP, enthusiastically spoke about greening and sustainability in healthcare and life sciences at the Sustainable Healthcare & Hospital Development Conference. He started his presentation by explaining the difference of “greening” and “sustainability”. These two terms are sometimes used as alternatives to the same definition. Mr. Mulder informed his audience that, although similar, they reference two different factors that we should take into consideration when understanding the concept of sustainability in healthcare and hospital development. He explained that the term “greening” focuses on the physical environment, whereas “sustainability” refers to the significant business, including governance, workplace, workforce, technology, supply chain, products, and services.

Eric Wenke, assistant vice president of Baptist Health South Florida, proposed ideas to remedy inefficient healthcare systems. By adjusting PC monitor settings to automatically shut down when not in use can have a savings effect in many aspects of the environment and industry. In just one year, a healthcare business can save $150,000 in energy expenses. It could reduce carbon emissions by 1300 tons, direct medical by $9,500, and save 2.5 days of work. He also showed statistics of using fluorescent light bulbs, a healthcare business could save $125,000 in energy expenses, reduce 540 tons of carbon emission, decrease direct medical costs by $3,200, and save a day of work.

In addition, Cagri Kanver, senior associate of HOK Advance Strategies, held a session on an environmental business plan in the healthcare industry and Clift Montague, senior vice president and chief strategic officer of Albert Kahn Associates Inc., touched upon sustainable design considerations for patient well-being within a constrained budget. Cagri’s presentation took a look at the structure of a business plan, what challenges will be faced, and what approaches to take in order to follow through with the business plan. Clift Montague elaborated on principles of sustaining a healthcare system. His focus pertained to the importance of establishing a strong team within a facility. He examined the value of creating a committed staff base that will then enable a healthcare facility to achieve sustainability.

Once staff has fulfilled their mission, the workplace and workforce will look better and feel better providing efficient care to patients which will allow them to have a comfortable and safe stay. Clift defined employees as the number one asset of a company. He proclaimed that green buildings reduce absenteeism and increase productivity. The staff’s ability to provide care will improve with technology, logistics, and attitude.

Hospital development is also an essential building block to sustainable healthcare. Erik Hokanson, senior project manager at Burt Hill, presented a case study of Al Mafraq Hospital, a hospital that promotes sustainability and wellness as an integral part of the healing environment. Al Mafraq Hospital was designed around the occurrence of wind patterns. By researching and recording the predominant wind current, the design team could develop a hospital that would use the wind as an advantage to create a cooling effect. For an opposite effect, they added solar panels for heat. Wood based material and recycled content was constructed into the design where it was suitable. Reusable water, such as grey water, storm water, and condensation, is captured for irrigation and cooling systems.

Stanley Chiu, vice president of RTKL, Gregory Stackel, LEED AP Principal of RTKL, and Michael Sheerin, principal and director of healthcare engineering, displayed case studies of three different hospital development projects in three different cities: Santiago, Chile; Jeddah, Saudi Arabia; and Shanghai, China. Designed with the lotus flower in mind because of its purity and ability to regulate it’s temperature, these projects are crafted to go beyond patient expectations of quality care and to also respect the environment and its natural surroundings within a set budget.

The integration of sustainable healthcare and hospital development is a lot to digest, especially in three days, but, nonetheless, the dual topics are significant as they correlate to produce evolving healthcare systems into sustainable ones. Moreover, the rise of sustainable healthcare and hospital development is spreading further than just inside the borders of North America. As you have seen in the case studies that were conducted, several countries are jumping on this opportunity to develop better quality of care, while being considerate of the environment. This provides us with a better understanding of the rationale behind integrating the Sustainable Healthcare & Hospital Development Conference with the Medical Tourism & Global Healthcare Conference.

As medical tourism continues to expand, healthcare facilities around the world are more determined to renovate and build hospitals to meet the expectations of good quality care. They are combining design and new initiatives in management to create a greater experience for patients. The awareness of sustainability and “going green” is flourishing and it only makes sense for healthcare facilities to implement this trend. The key: Healthy environment, healthy people, happy world.

The approach of sustainability is different in every country; however, the same challenge remains, decreasing the use of resources available on the planet by controlling their utilization. One step at a time, changing habits and taking new directions are trends medical players are taking in here in the US and in the UK. Instead of enforcing competition, hospitals from around the world can integrate their efforts in maintaining sustainable healthcare facilities for medical tourism patients abroad.


The National Health Service (NHS), United-Kingdom, publicly-funded health system, created in 1948, runs the majority of the healthcare services provided in its country including hospitals, clinics, and employment of doctors and nurses.

The NHS is truly colossal in its impact on the environment and on the economy, employing around 1.4 million people with a $185 billion budget, according to NHS sustainable unit operational director, Sonia Roschnik.

“The NHS is the fourth largest organization in the World, behind the Chinese Red Army, the Indian State Railway Company and Walmart,” Roschnik stated. “The NHS pumps out 21 million tons of greenhouse gases a year –that is more than some medium sized countries– and produces more than 3 percent of our countries total carbon emissions.”

Indeed, according to Roschnik, 59 percent of the carbon dioxide that the NHS is responsible for comes from procurement of pharmaceutical products, medical instruments, business services, and paper products.

Time has come for the NHS to react and try to decrease its carbon footprint, for its own interest and that of the planet. Thus, NHS sustainable development unit developed the “Saving Carbon, Improving Health Program.”


To decrease its carbon emission and become more sustainable, the NHS is trying to improve the staff and patients travel loads. To do so, medical staff personnel are more likely to visit the homes of patients, according to Roschnik, avoiding patients driving to the hospital or the medical center for general treatment.

“Moreover, British Telecom developed an ultra fast broadband service which is inter-connecting hospitals. Called N3 it is a dedicated line that is being used to send to London angiogram images, which are moving X-ray pictures of the heart arteries,” Roschnik stated. “That means consultants have real time discussions while patients are on the table and they can discuss the best treatments quickly and safely.”

Within a year, nearly 400 angioplasties took place in the region of Kent. Prior to that, all of them had to be done in London. N3 broadband has saved nearly 30,000 miles of patient travel and 5,500 hours of cancer consultants’ time in London, according to Roschnik.

At a higher level, the NHS goal for the future is reducing carbon footprints significantly from 21MtCO2e a year to less than five. To meet these expectations, the NHS wants to develop telemedicine and make patients more responsible for their healthcare.

“What we know we need to do is focus on promoting health than treating sickness,” Roschnik said.
The NHS also encourages patients and staff to get started on an individual level using other forms of travel other than their car.


The United States approach to sustainable health and medicine is working very differently from the United-Kingdom. Indeed, most of the hospitals being private, the government is not able to impact and support a sustainable change as in the U.K. However, a couple of organizations appear as guides in terms of sustainable hospitals.

First, for ten years now, the U.S Green Building Council has encouraged the construction of green hospital building by instating guidelines and standards of how to become a sustainable hospital through the Leadership in Energy and Environmental Design’s certification system.

The Environmental Protection Agency (EPA) is also working with hospitals. Medical waste incinerators contribute 13 percent of mercury emissions making them the fourth largest source of mercury emissions. Moreover, hospitals contribute four to five percent of the total waste water mercury load in some communities according to the EPA. In that way, healthy hospital initiatives have been initiated to reduce mercury.

However, contrary to the U.K, the sustainable programs are largely supported by the states. In that way, hospitals in some states can handle their chemical emissions efficiently while others struggle. California, for example, is initiating a green chemistry program.

One of the problems the EPA and other sustainable organizations have is the Toxic Substance Control Act. The TSCA has been enacted more than 30 years ago and has never been reviewed.

According to EPA assistant administrator for the Chemical Safety and Pollution Prevention office, Steve Owens, nobody reviews the safety of chemicals in the U.S. Over 20,000 chemicals have been added up at the TSCA without evaluation since 1976.

“That’s the big issue about what’s called confidential business,” Owens said.

According to him, business confidentiality protects formulas but also hinders the identification of some chemicals. Thus, it becomes harder to watch the different chemicals emitted in the environment. EPA has taken action to limit or ban chemicals only five times since 1976, according to Owens.

For the upcoming year, EPA’s goal is to create a “chemicals of concern list”, requiring industries to submit more information to understand chemical risks and make public access on chemicals easier.

Sustainability is moving quickly as medical tourism exerts itself worldwide. A strong correlation that’s growing is to enforce a healthier lifestyle and better quality care for patients. This endeavor excites healthcare leaders around the globe and ensures patients of the safety and satisfaction from healthcare services that they can expect. The healthcare disposition is impressively impacting society, making healthcare systems revamp extraordinary amenities into providing elegant and safety precautions to strengthen the future of healthcare services.

About the Author

Anne-Line Crochet is Communications Intern for Medical Tourism Association. With a Masters degree in political science, a Minor in journalism, Anne-Line provides professional expertise to our public relations and editorial functions. Previously a staff writer for French publications Fragil and Ouest-France, she is fluent in English and French; and conversant in Spanish and Russian languages. Anne- Line writes for MTA’s Medical Tourism Magazine and Health Tourism Magazine. She can be reach at

Amanda Shaw is currently an intern at MTA, focused on Sustainable Healthcare & Hospital Development. Ms. Shaw holds a Bachelors of Arts degree in Journalism from Columbia College in Chicago. She was a member of the National Society of Collegiate Scholars at Columbia, and a journalism intern at Chicago Splash Magazine. Her interests in medical tourism include global healthcare development, healthcare reform, healthcare quality and international marketing.

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