Building Design and Construction

Sustainable building design and construction is the practice of creating structures and using
processes that are environmentally responsible and resource efficient throughout the life cycle of
a building– from selecting the site to design, construction, operation, maintenance, renovation,
and finally, deconstruction.

Sustainable building expands on and complements the classical building design considerations of
economy, utility, durability, and comfort. Other terms for sustainable building include green
building, high performance building, or sustainable or green construction.

The Impact of Buildings on the Environment

According to the U.S. Environmental Protection Agency and the U.S. Green Building Council,
construction and operation of all buildings in the United States result in the
following consumption of resources:

 72 percent of electricity resources

 39 percent of total energy used
 3 billion tons of raw materials annually (40 percent of raw stone, gravel, sand, and steel;
25 percent of virgin wood)
 17 percent of freshwater flows

As well, construction and operation of all buildings in the United States result in the following
generation of waste materials:

 25-40 percent of municipal solid waste

 50 percent of CFCs
 30 percent of CO2 production
 Other air emissions and water discharges

Given the extent to which buildings affect the environment, the opportunities for improvement
through sustainable planning, design, construction, and operations and maintenance practices are
significant.

Although an organization may choose to prioritize energy reduction, water conservation, waste
minimization, or any number of individual initiatives, the practice of sustainable building is
really about an integrated approach to planning, design, construction, operations, and
maintenance. It is an overarching philosophy or commitment that influences decision-making in
every phase of a project. Sustainable building goes beyond simple return-on-investment (ROI)
analysis of the first costs of specific improvements; rather, it evaluates an improvement over its
entire life cycle, including first costs and subsequent operations, maintenance, and disposal costs.
The health care industry seeks to protect, restore, and enhance health. As a result, it is important
for health care organizations to adopt an approach to design, construction, and operations and
maintenance that supports a healthy environment, both in their facilities and in their
communities.

How Buildings Affect Health

Building design, construction, and operation practices affect public health on three levels
(adapted from the Green Health Care Construction Guidance Statement of the ASHE Green
Building Committee):

The immediate health of building occupants. The health of patients, staff, and visitors is
affected by the quality of indoor air, which in turn is dependent on a building’s physical and
mechanical design (e.g., ventilation, airflow and pressure, location of wastes and toxins), choice
of building materials, management of construction emissions, and building operations and
maintenance. In addition, access to daylight has been found to favorably affect staff productivity
and patient outcomes.

The health of the surrounding community. Local air and water quality is affected by building
design choices for both new construction and renovation projects). Off-gassing (release of
chemicals into the air through evaporation, sometimes over a number of years) of building
materials and finishes, fumes from construction equipment, and exhaust from HVAC systems
can emit VOCs (volatile organic compounds), particulates, and other materials into the air of the
surrounding community that can contribute to formation of ground-level ozone (smog) and
induce allergic attacks, respiratory problems, and other illnesses. Thoughtful land use and
transportation planning, landscape and water management on the grounds, and responsible air
filtration, waste disposal, and energy and water conservation efforts within the building all
influence the amount of toxic emissions released to the water and air throughout the life of the
building.

The health of the larger global community and natural resources. The health impact of a
building stretches far beyond its immediate community. The production of building materials can
release persistent bio-accumulative toxic compounds, carcinogens, endocrine disruptors, and
other toxic substances. The compounds in these materials threaten not just the communities
where they are manufactured; in fact, many of them potentially threaten the health of
communities and ecosystems far from their place of manufacture and use because of their long
life and disposal hazards.

Energy use and associated greenhouse gas emissions contribute to climate change. Climate
change resulting from the burning of fossil fuels is expected to increase the spread of disease
vectors far beyond their current regions, destabilize ecosystems, and ultimately, to threaten
worldwide food supply and quality. Rainforest depletion from unsustainable forestry practices
may result in the loss of medicines and important genetic information that could help fight
diseases. Moreover, the release of chlorofluorocarbons (CFCs) and hydrochlorofluorocarbons
(HCFCs) damages the stratospheric ozone layer, allowing increased levels of ultraviolet rays to
reach Earth’s surface, where they cause heightened potential for skin cancer.

For more information about climate change, read Climate Change Law 101. To learn more about
climate change mitigation strategies, refer to the Roadmap Strategies sections on energy and
water conservation measures, waste reduction measures, and chemicals policy.

The other topic areas in this section explore specific aspects of sustainable buildings in greater
detail. Click the links on the left to learn more.

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The Precautionary Principle

Prevention is a fundamental principle of providing quality health care and protecting public
health. Indeed, preventing disease is vastly preferable and more effective than treating disease
after it has occurred. In the face of uncertainty, precautionary action is appropriate to prevent
harm. This public health approach makes sense both in the clinical setting and in response to
environmental and public health hazards. Similarly, a precautionary and preventive approach is
an appropriate basis for decisions regarding material selection, design features, mechanical
systems, infrastructure, and operations and maintenance practices.

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Integrating Sustainable Principles into Project Delivery

The ASHE Green Building Committee developed a construction guidance statement to answer
the question of what sustainable design and construction means in the context of a health care
facility. Although this material is intended as a guideline for new construction, many of the
principles can be applied to existing buildings as well. The Roadmap covers most of these
principles in greater detail throughout the site, with an emphasis on improving existing facilities.
Common practices for integrating sustainability into the design process address those aspects of
planning, design, construction, and operations listed below. For descriptions of these practices,
read the ASHE board's guidance statement.

 Integrated design
 Site design
 Water
 Energy
 Indoor environmental quality
 Materials and products
 Construction practices
 Commissioning
 Operations and maintenance
 Innovation
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Compliance and Policy Considerations

Many states and cities have adopted some form of sustainable building standard as part of their
local building codes. For example, the 2010 Oregon Energy Efficiency Code, which applies to
all new building and renovation projects requiring a building permit, is a local adaptation of
the International Energy Conservation Code.California has recently enacted the first statewide
green building code, and Massachusetts requires compliance with LEED requirements or self-
certification through the Green Guide for Health Care in order to obtain a Determination of Need
for a health care facility. This trend is gaining momentum. Your local building code office is a
good place to start to determine what will be required for your project.

In June 2010, the U.S. Conference of Mayors endorsed the International Green Construction
Code (IgCC), which was developed by the International Code Council in collaboration with the
American Institute of Architects, ASTM International, ASHRAE, the U.S. Green Building
Council, and the Illuminating Engineering Society (IES). This code references ASHRAE
Standard 189.1-2009: Design of High-Performance Green Buildings, Except Low-Rise
Residential Buildings and includes requirements in the following categories:

 Site development and land use

 Material resource conservation and efficiency
 Energy conservation, efficiency, and atmospheric quality
 Water resource conservation and efficiency
 Indoor environmental quality and comfort
 Commissioning, operations, and maintenance
 Existing buildings
 Existing building site development

Also, be mindful of related climate change legislation, as this will impact both the types of
projects you may pursue and the way you implement them. For an outline of the breadth of
current and expected climate change legislation, see the material on regulatory
requirements under the Drivers tab on this website.

Opportunities and Benefits

Planning for a construction project offers health care organizations an opportunity to formulate
overall sustainable building goals, if these are not already in place. These goals can include such
actions as using sustainable materials in a renovation project or adding more green space around
the facility. Your organization should agree on goals and then develop and implement strategies
to achieve them. Work with an experienced sustainable building team specializing in health care
facilities to implement advanced sustainable building strategies that will realize additional
gains. The Green Guide for Health Care rating system is a good tool for incorporating
sustainability into hospital design and construction. Many hospitals also refer to the USGBC
LEED certification system for guidance in greener building and construction.
A number of incentives and policies exist to support sustainable building practices. To learn
what may apply to your organization’s project, explore the following areas:

Energy-efficient commercial buildings tax deduction: The federal Energy Policy Act of 2005
established a tax deduction for energy-efficient commercial buildings applicable to qualifying
systems and buildings placed in service from January 1, 2006 through December 31, 2007. This
deduction was subsequently extended through 2013 by Section 303 of the federal Energy
Improvement and Extension Act of 2008 (H.R. 1424, Division B), enacted in October 2008.
A tax deduction of $1.80 per square foot is available to owners of new or existing commercial
buildings that make improvements to (1) interior lighting; (2) building envelope, or (3) heating,
cooling, ventilation, or hot water systems. These improvements must be part of a plan to reduce
the building’s total energy and power cost by 50 percent or more in comparison to a building
meeting minimum requirements set by ASHRAE Standard 90.1: Energy Standard for Buildings
Except Low-Rise Residential Buildings.
For more information, visit www.efficientbuildings.org.

State and local incentives and regulations: Several states, counties and municipalities have
implemented financial incentives, expedited permitting programs, and instituted regulations to
promote sustainable design and construction. For a searchable, up-to-date listing, visit the
Database of State Incentives for Renewables and Efficiency (DSIRE) website
at www.dsireusa.org.

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Triple Bottom-Line Benefits

Given the significant benefit to the environment that can result from instituting sustainable
building practices across the country, the potential contribution of the health care sector is
proportionally large. Sustainable building practices contribute to “triple bottom line” benefits; in
other words, greener buildings result in improved performance in three areas: environmental,
economic, and health and community. For each building project, your organization should
identify, qualify, and quantify the benefits in each bottom line area. Examples in each of the
three areas are listed below:

Environmental Benefits

 Enhancement and protection of ecosystems and biodiversity

 Improved air and water quality
 Reduced solid waste
 Conservation of natural resources

Economic Benefits

 Reduced operating costs

 Enhanced asset value and profits
 Improvements in employee productivity and satisfaction
  Optimized economic performance throughout the building’s life cycle
 Increased resiliency against unstable energy markets

Health and Community Benefits

 Improved air, thermal, and acoustic environments

 Enhanced occupant comfort and health
 Minimized strain on local infrastructure
 Contributions to overall quality of life

How Buildings Work

ASHE is committed to enhancing the professional knowledge of building systems or, simply put,
to adding to the body of knowledge of how stuff works. When considering new technologies and
sustainable systems, understanding how buildings work is important. To that end, we plan to
draw on ASHE’s Maintenance Management for Health Care Facilities. We also want to add
your experiences to the discourse, so if you have materials or stories to share, please contact the
roadmap coordinator.

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Commissioning
The ASHE Health Facility Commissioning Guidelines (HFCx Guidelines) defines
“commissioning” as a process intended to ensure that building systems are installed and perform
in accordance with the design intent, that the design intent is consistent with the owner’s project
requirements, and that operations and maintenance staff are adequately prepared to operate and
maintain the completed facility. The HFCx Guidelines offer a commissioning (Cx) process
structured to meet the specific needs of the health care industry. By providing a standard set of
terms, definitions, and processes, the guidelines bring a consistency to the commissioning of
health care facilities—referred to as HFCx—that helps optimize the return on investment (ROI)
realized from a project.

Many buildings designed for high performance fail to achieve high-performance results. ASHE
is convinced that commissioning is critical to the success of every health care facility project.
The guidelines are intended to help health care organizations achieve the facilities they want.
ASHE has also produced the Health Facility Commissioning Handbook to provide practical
information to help those launching a health facility commissioning or retrocommissioning
effort.

The value derived from commissioning can be shown as a simple relationship in which the
benefit obtained from commissioning is divided by the cost to deliver it: Value = Benefits / Cost.
The greater the benefit derived from a specific cost, the greater the value to leadership. A
properly commissioned project lowers the cost of operating a facility, often as a result of lower
utility demands and costs. Be sure not to confuse contract administration services provided by
the design team during construction with commissioning. The fundamental element that
separates the two is the benchmarking documentation of equipment installation and performance
involved in commissioning.

Similar to the benefit/cost relationship for commissioning, the value of sustainability is measured
by improvements in environmental performance and satisfaction, and reductions in energy and
water consumption and costs, divided by the cost of the improvements. Sustainability is focused
on cost-effectiveness, quality, satisfaction, and environmental performance. Commissioning is
fundamentally in alignment with these objectives. To that end, the Roadmap’s performance
improvement measures (PIMs), where appropriate, link to specific and targeted commissioning
and retrocommissioning topic areas found in the ASHE Health Facility Commissioning
Guidelines.

For more information about commissioning, see the page on commissioning under the Strategies
tab on the Sustainability Roadmap.

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Using the Roadmap to Develop Sustainable Buildings

The Roadmap identifies opportunities for health care organization to improve their facility’s
sustainability performance for energy, water, waste, supply chain, and chemical management
through both facility design and operations. It helps health care organizations develop
customized short- and/or long-term management strategies to achieve sustainability goals. Your
organization can customize its goals and plans based on your facility’s baselines and benchmarks
in sustainability performance and on how aggressively the organization wants to pursue its goals.

Roadmap resources that can be applied to sustainable building design and construction efforts
include the following:

 Consumer Guide—an overview of sustainable building programs to help you manage

your integrated building program
 Strategies for building sustainability teams
 Information on drivers for and barriers to sustainability efforts
 Strategies for gaining leadership support
 Strategies for financing sustainability projects
 A guide to planning for sustainability projects
 Performance improvement measures (PIMs)—projects or activities that will help improve
your facility's sustainability profile
 Green Light projects—easily adopted PIMs that will provide meaningful results at low
cost