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The Sustainable Healthcare Market: Guidelines, Standards & Codes

Apr 2014

PDC Summit
The recent Planning Design and Construction (PDC) Summit in Orlando, Florida, brought together the American Society of Healthcare Engineers (ASHE) and the American Hospital Association (AHA) focusing on the theme of Where Top Industry Perspectives Converge.   Sustainability was one of many topics addressed during the conference, including the session entitled, Meeting the Challenges of Green Building Rating Systems, Standards, and Codes!   This session included all of the updates in the healthcare sustainability arena:

  • Green Globes – New Construction has been vetted and updated by The Green Building Initiative.  This electronic survey tool is informed by the GBI/ANSI Standard 01-2010; while also addressing updates in the arena of materials and resources selections from a life cycle perspective, cross referencing the requirements of the Executive Order for Guiding Principles for government agencies, updating standards, and provides an on-site assessment process for certification.  Note that the GSA approval of Green Globes as an acceptable sustainable building rating system has been an important step toward the success and use of the Green Globes suite of tools. (
  • Green Globes – Continual Improvement for Existing Buildings (CIEB) for Healthcare is available for private and public healthcare facilities from The Green Building Initiative.  This tool was developed by the completion of 21 VA Hospital assessments, utilizing information gleaned from the assessments and completion of additional research to provide the healthcare version of the electronic survey that provides immediate feedback upon submittal of information into the on-line tool.  Third party on-site assessment is part of the certification process for Green Globes – CIEB.  (
  • Green Globes – Sustainable Interiors is under development.  This is a new rating system for The Green Building Initiative that is anticipated to be released soon in 2014 and includes criteria for interior fit-outs of buildings. (
  • LEED v.4, which includes LEED for Healthcare criteria, has been adopted for use by USGBC.  Currently LEED 2009 is available through 2015, but projects can be registered for LEED for Healthcare.  All of the different ratings systems for Building, Design and Construction (BC+D) are included in one rating system.  (
  • 2014 Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities are published and the new Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.  These planning, design and construction guidelines are used for licensing of healthcare facilities throughout the continuum of care.  The Guidelines are used by providers, architects, designers and engineers, and authorities having jurisdiction and adopted by states as code.  Sustainability in the Hospital and Outpatient Facility book is addressed minimally in the main body and appendix text, but references a white paper on sustainability that was completed by a subset of the FGI’s Health Guidelines Revision Committee (HGRC) and ASHE’s Sustainability Committee.  This white paper is available on the FGI website, as well as the Sustainability Roadmap created by ASHE.   The Residential Health, Care, and Support Facility Book addressed sustainability in its Part 2 Common Elements Part that includes a sustainability overlay for all project types included in the new guidelines; nursing homes, hospice facilities, assisted living facilities, independent living settings, adult day care facilities, wellness centers, and outpatient facilities.  The sustainability overlay also includes reference to the Senior Living Sustainability Guide®.  (
  • ASHRAE/ASHE 189.3 Standard for the Design, Construction and Operation of Sustainable High-Performance Health Care Facilities has gone through public comment and references the updated ASHRAE/USGBC/IESNA 189.1 Standard for the Design of High-Performance, Green Buildings Except Low-Rise Residential Buildings.  ASHRAE 189.1 is one of the only standards that is not only used as a reference from other guidelines and voluntary rating systems as a resource, but is also an alternative path of compliance for the International Green Construction Code (IgCC).  ASHRAE 189.3 is intended to provide specific information for healthcare that is not addressed within ASHRAE 189.1.  Currently if a jurisdiction adopts the IgCC and/or ASHRAE 189.1, healthcare facilities would have to comply with one of these paths.  (
  • International Green Construction Code (IgCC) proposals were made in January, 2014 for the next code update.  Proposals that align with ASHRAE 189.1 in regard to Materials and Resources have been completed.  (
  • Guiding Principles Compliance certification supports the Executive Order to meet certain sustainable thresholds.  A compliance tool for existing buildings has been developed and is available from The Green Building Initiative, and a new construction version is under development.

The following chart includes a summary of voluntary sustainable guidelines, standards that are often referenced within guidelines, standards, and codes that are adopted by a jurisdiction and usually enforced through an authority having jurisdiction (AHJ).

voluntary sustainable guidelines

Survey Summary

Prior to the PDC Summit, a survey was sent out the attendees signed up for the session, Meeting the Challenges of Green Building Rating Systems, Standards, and Codes!   The survey was used to create a framework for the presentation, providing a point of discussion around who knows the different guidelines, standards, and codes, and who is using what in the healthcare sustainability marketplace.  There were 15 total questions, and the following charts were developed from some of the questions, providing insights into the status of using healthcare guidelines, standards, and codes:

Green Building Rating Systems, Standards, and Codes Survey 1


Green Building Rating Systems, Standards, and Codes Survey 2


Green Building Rating Systems, Standards, and Codes Survey 3


Green Building Rating Systems, Standards, and Codes Survey 4


Green Building Rating Systems, Standards, and Codes Survey 5


Green Building Rating Systems, Standards, and Codes Survey 6


Green Building Rating Systems, Standards, and Codes Survey 7


Green Building Rating Systems, Standards, and Codes Survey 8


Green Building Rating Systems, Standards, and Codes Survey 9


Green Building Rating Systems, Standards, and Codes Survey 10

Overall, although the survey sampling was small, it was interesting to see where the priority of sustainability lies as a “medium” level of importance for healthcare setting.  Also, there is interest in understanding all the complex changes within both healthcare and sustainability since the 2009 recession and the Affordable Care Act.  The development of these new guidelines, standards, and codes creates some anxiety for both the design professional and the provider, because each one raises the bar.  The future development of updates is a balancing act; for them to be usable, attainable, and affordable (through evaluation of life cycle of buildings as well as sustainable operations).