In October 2000, healthcare industry leaders, representing healthcare systems, public and non-profit policy advisors, and professional associations, gathered in San Francisco to assess healthcare’s unique environmental opportunities and challenges. The timing of the conference coincided with the eve of the nation’s most ambitious hospital rebuilding program since the Hill-Burton period. The landmark conference, Setting Healthcare’s Environmental Agenda(SHEA), began with a challenge issued by environmental health advocate Michael Lerner, Ph.D.: “The question is whether healthcare professionals can begin to recognize the environmental consequences of our operations and put our own house in order. This is no trivial question.” SHEA participants endorsed a health based framework to guide the healthcare design and construction sector, as captured by Gail Vittori: “Guidelines and regulations overseeing hospital design and construction should be evaluated based on their impacts on environmental quality and human health and revised so that they reflect these as priority considerations.”
In late 2001, the American Society of Healthcare Engineering (ASHE) convened a Green Building Task Force to draft a guidance statement for the ASHE Vista Awards Committee to use in assessing award applicants. Released in January 2002 as the ASHE Green Healthcare Construction Guidance Statement, the introductory Statement of Principles asserts the importance of protecting health at three scales:
As interest in green building grew, it quickly became apparent that performance metrics specific to healthcare were missing from the marketplace. The US Green Building Council’s LEED for New Construction Version 2.0, released in late 2000, rated commercial buildings based on a numerical achievement of LEED points, but posed challenges for hospital and related healthcare buildings. Development of a LEED tool customized for healthcare was not forecast to begin development until 2005. An astonishing surge of healthcare construction activity throughout the U.S added a sense of urgency. In California, Kaiser Permanente produced an Eco-Toolkit, comparing LEED strategies to the ASHE Guidance Statement approach in an effort to define a system-wide green building tool to guide $20 billion of healthcare construction over 15 years. In response to the demand from both healthcare providers and industry architects and engineers, the time had come to develop a sector-specific green building tool.
Initial Green Guide Development
With initial funding provided by the Merck Family Fund in 2002, the development of the Green Guide for Health Care (Green Guide) began. A professionally and geographically diverse group of healthcare experts was convened to create “the healthcare sector’s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities.”
The Green Guide adopted the ASHE Green Healthcare Construction Guidance Statement of Principles. It reaffirmed a principle of precaution, echoed in medicine and international sustainable design policy. From LEED for New Construction Version 2.0, with permission, it gained credit structure, content and organization. Building upon the work of Hospitals for a Healthy Environment (H2E, now Practice Greenhealth), it reinforced the commitment to the 1998 U.S. EPA/AHA Memorandum of Understanding and defined a comprehensive approach to healthcare operations. From the early healthcare green building adopters, it evolved rigorous materials evaluation requirements, particularly with regard to emissions and persistent bioaccumulative toxic chemical (PBT) avoidance. It reinforced principles of evidence-based design (the Center for Health Design), through emphasis on day lighting, acoustics, and places of respite.
Recognizing that the healthcare industry was in the early stages of sustainability development, the Green Guide did not establish or include minimum achievement thresholds. Instead, it developed as a “self-certification” tool — promoting best practices within the industry by instilling a culture of internal assessment, evaluation, and continuous improvement.
Version 2.0 Pilot
In late 2004, following two rounds of extensive public comment, the Green Guide released Version 2.0 Pilot with the goal of engaging design teams and healthcare systems in using the document. In the two years following its release, Green Guide registrants climbed to more than 10,500, representing every state in the US, with 500 from Canada and 900 from 83 other countries. In addition, more than 100 projects registered as Pilot participants, representing over 30 million square feet and including projects in the US, Canada, China, Malaysia, Guatemala, and Eastern Europe. With an estimated 100 million square feet of healthcare related construction in the US annually, these “early adopter” Pilot Projects constitute a significant percentage of construction volume.
With the Pilot program underway, development attention focused on the Operations section of the document. Version 2.1, released in September 2005, included a substantial update to the Operations section and minor revisions to the Construction section, covering copy and editorial changes.
The Pilot provided an opportunity to test the Green Guide in the marketplace, and to glean insight as to its market relevance, appropriateness of credit thresholds, and effectiveness. In late 2006, the Pilot process closed.
Offering resources and peer-to-peer support, the Pilot generated content that informed the Green Guide Version 2.2 Construction release in early 2007. This document includes substantial content revision based both on Pilot experience as well as revisions to LEED for New Construction between Version 2.0 and 2.2. The Green Guide Version 2.2 became the foundation document for LEED for Healthcare (see Relationship to LEED Products).
In late 2007, the Green Guide and Practice Greenhealth launched a process to once again expand and revise the Green Guide Operations section. The revised Green Guide Version 2.2 Operations was released in early 2009 with the intent of launching a formal Operations Pilot program in 2010. For more information on the Operations Pilot, click here.