Health care facilities can achieve sustainability goals through various design methods.
Sustainability insights
- Health care owners are raising expectations for sustainability, blending LEED pathways, net zero frameworks and institutional road maps that prioritize long-term carbon reduction over certification alone.
- Design teams are expanding sustainability strategies to include advanced air quality measures, renewable integration and resilient infrastructure that can meet demanding clinical needs while reducing environmental impact.
What level of performance are you being asked to achieve, such as WELL Building Standards, U.S. Green Building Council LEED certification, net zero energy, RESET Standard or other guidelines?
Meagan Gibbs: In North America, we are still seeing LEED requested more often than other sustainability certification pathways, however we are currently in a “LEED registration limbo” phase where projects can register for both LEED v4 and the new LEED v5, until sometime in Q1 of 2026 when LEED v4 registration ends. LEED v5 is much more stringent than LEED v4. There is the potential for LEED v5 to be a challenging fit for a variety of projects and project types moving forward. For projects with Net Zero Energy and/or Net Zero Carbon targets/goals, we are seeing the ILFI Zero Energy/Carbon programs used frequently, especially as this certification is validated with real operational data which can then feed directly back into GHG reporting, portfolio-wide carbon neutrality tracking and other operational time-based planning metrics. Sector specific certifications are also more common pathways now, with many colocation/enterprise data centers obtaining Green Globes certification, while many hyperscale data centers are using LEED as the USGBC offers a LEED Volume program which is a streamlined certification process for organizations that plan to certify more than twenty-five prototype-based construction projects within three years, which many large hyperscale data centers can benefit from this certification workflow efficiency.
Jason Butler: We see many institutions taking a practical approach to sustainability, favoring self-selected performance goals over certifications standards. And we see increasing participation in the HHS pledge and sustainability road mapping to achieve net zero energy and/or carbon in the future.
What types of sustainable features or concerns might you encounter for these buildings that you wouldn’t on other projects?
Caleb Marvin: Due to high air changes per hour (ACH) requirements, together with stringent temperature and humidity ranges that must be maintained 24/7, hospitals are constantly simultaneously cooling and heating air. This lends itself to the implementation of heat recovery and heat pump chillers where chilled water is produced with heat rejected to the heating water system on the condenser side. Simultaneous cooling and heating are not prevalent in most other types of buildings and hence the ROI of these types of systems is not nearly as attractive.
Meagan Gibbs: In health care/hospital projects, clean/fresh indoor air is critical. The phrase “let’s go outside to get some fresh air” gives people a negative connotation relative to indoor air in that if outside air is fresh, then indoor air is unhealthy. Health care project designs should aim to challenge that perception, whether it is with innovative, passive or active air cleaning technology or the use of technology to give feedback on what components of indoor air are good or bad and how to correct those anomalies. The potential to improve indoor air quality in the health care sector is there, more often than not, outside air will always be fresher, yet, it will be a project win when you hear the phrase, “time to go inside, there’s fresh air there too.”
On the passive side, it is recommended to use “data-driven” natural ventilation in comparison to the common practice of building occupants just opening/closing the windows haphazardly. Data driven natural ventilation uses climatic data such as temperature and relative humidity in addition to environmental data, such as air quality index, smoke detection from wildfires, or even acoustics and sound data from nearby highways or airports to determine if opening the windows would truly provide the “Indoor Environmental Quality” benefits, which is different than “Indoor Air Quality” alone, with those benefits consisting of thermal comfort, productivity and overall wellness. During times when natural ventilation is not possible, in that it is too warm, too cold, or too humid to effectively use natural ventilation, there are many active systems being marketed for the health care-built environments being explored and implemented, including higher efficiency filters, activated charcoal filtration, ultraviolet-C disinfection and bi-polar ionization.”
Jason Butler: Primary challenges for health care facilities include redundancy / resiliency needs, essential backup power needs and regulatory requirements. While there are many other industries where uptime is crucial for business continuity, the need to provide life-saving care creates a baseline of reliability that is the first consideration for almost all decisions for building infrastructure systems.
What types of renewable or alternative energy systems have you recently specified to provide power? This may include photovoltaics, wind turbines, etc. Describe the challenges and solutions.
Meagan Gibbs: While Solar Photovoltaics (PV) remains the most widely adopted form of on-site renewable energy, we are seeing increasingly creative and impactful applications that go beyond traditional rooftop installations. Building Integrated Photovoltaics (BIPV) are emerging as a compelling solution, where solar panels are seamlessly integrated into the building facade, potentially even mounted vertically on exterior walls. Although this orientation may result in a slight efficiency drop, it unlocks otherwise unused surface area, significantly boosting on-site generation potential and contributing to overall sustainability goals.
When installing in parking lots in the form of canopies, or even ground-mount systems with highly reflective surfaces below, the use of bifacial panels has become the standard to capture both direct and reflective sunlight.
Looking ahead, we are closely monitoring the development of project-scale deep geothermal systems for power generation, which promise consistent, low carbon energy output. Additionally, modular motionless wind turbine technologies are gaining traction. These systems offer substantial output-to-cost efficiency, while also being easier to incorporate into the architectural designs.”
Jason Butler: Since a majority of health care organizations have non-profit designations, we’re seeing 3rd party PPA (Power Purchase Agreement) being the primary mechanisms to include alternative energy systems such as photovoltaics. But we are seeing a need to either design for incorporation of these energy systems into the building infrastructure on day 1, or provisions for them to be added later.
What are some of the challenges or issues when designing for water use in such facilities, particularly buildings with high water needs?
Caleb Marvin: Design engineers must account for the city water pressure when designing the distribution of domestic water systems. Many new hospitals are constructed in rapidly growing areas where the population growth rate far exceeds the current city infrastructure. Booster pumps may not be necessary at first for a facility but can be required when the urban or commercial development around them increases. The city infrastructure can change in these situations and the facility may no longer have enough pressure requiring a booster pump until the city infrastructure catches up. Flexibility is important in these types of designs since water pressures can fluctuate up and down over several years before stabilizing.
Darren Harvey: Product development has led to many more options in water use for toilets, urinals and lavatories. While we’re not seeing as much interest in ultra-low flow or waterless fixtures, we are finding new fixtures allow reductions from historic flow rates and still function properly with no additional maintenance needs. We’re also seeing issues with cast iron piping systems due to lower flow fixtures and reduced flow rates through piping systems. The building codes have not caught up to lower flow rates and the reduction of ‘clean’ water through fixtures has a negative impact on the piped systems because the piping isn’t washed as well and the chemical concentration of the wastewater and vented gases is higher than ever. It’s particularly important to make sure the water piping materials and manufacturing process comply with standard manufacturing guidelines.
How has the demand for energy recovery technology influenced the design for these kinds of projects?
Meagan Gibbs: The multi-step process for designing high performance and zero-energy buildings aims to minimize the amount of energy used and one specific workflow that we integrate into our planning and design practices is identifying opportunities for using “waste”, specifically thermal energy waste from building heat gains.
It is crucial for this thermal energy waste to be the Stage 1 of thermal energy in lieu of creating or generating new thermal energy from electricity or fossil fuels. The thermal energy waste streams consist of thermal energy from exhaust/relief air, envelope losses, equipment heat gain, data center equipment heat gain, health care facility heat gain, industrial/process heat gain and wastewater embodied heat. While priority No. 1 is to use this thermal energy waste in the building it originated from, via air-side or water-side energy recovery devices, when the source building cannot take advantage of this energy recovery, looking beyond the building property lines is advantageous to optimize energy reduction on a campus/portfolio level. To transfer thermal energy from a “source” to a “sink”, we have extensively researched the use of Thermal Energy Networks (TENs) and how to optimize the network/loop design for temperature balance, land allocation and energy efficiency/decarbonization potential.
Jason Butler: In general, we’re seeing the health care industry evaluate the payback of these systems intelligently, but the energy code trend has removed many of the previous blanket exceptions for health care applications of energy recovery. These systems certainly add capital cost, which had often been a deterrent in the past, but can result in operational savings over the long term and that factor has become more of a determining factor. Health care institutions are more interested in determining ROI up front and evaluating the types of energy recovery technology to ensure they are making an educated decision and choosing the best option for their given application. By nature, this is introducing new technologies to institutions that they may not already be familiar with or have in their facilities.
How do you address the unique energy demands of 24/7 health care facilities, such as hospitals and what backup or alternative power systems do you recommend to ensure uninterrupted patient care?
Caleb Marvin: As the air handling equipment must remain live 24/7, setpoint resets to use the energy only as necessary help reduce the overall energy consumption. Heating water resets to provide only the heating necessary to limit gas consumption. Static pressure resets for air handling units and differential pressure resets on pumping systems enable these systems to limit the power draw while delivering the required flow rates. These resets help limit the energy demand for a 24/7 facility. Chilled water reset and discharge temperature reset can be considered in health care but much care should be taken as raising the chilled water temperature too high will affect the ability to sufficiently dehumidify for the conditions in certain critical spaces such as operating rooms and pharmacy compounding areas. Brad Reuther:
Meagan Gibbs: Two major utility grid challenges are currently affecting the unique energy demands of 24/7 health care facilities:
1. Shifting Peak Demand Patterns: As more buildings transition to electrified heating systems, especially in colder climates, regions that were traditionally summer-peak demand zones are now shifting toward winter-peak or dual-peak demand profiles. This change places additional stress on the grid during colder months, potentially leading to increased risk of grid instability and brownouts, higher electricity prices during peak winter periods and a greater need for on-site energy solutions to ensure reliability.
2. Limitations on Renewable Energy Buyback: Many utilities impose limits on how much renewable energy building owners can sell back to the grid. Once a building exceeds a certain kilowatt (kW) threshold, the buyback rate drops significantly, reducing the financial incentive for on-site solar or other renewable generation.
To overcome these limitations, building owners and designers are increasingly turning to on-site power resiliency solutions, including Battery Energy Storage Systems (BESS) to maintain uptime during grid disruptions and manage price volatility, fuel cells powered by natural gas, on-site hydrogen generation, or truck-delivered hydrogen to provide clean, reliable backup power and reduce fossil fuel combustion and innovative battery technologies, such as sand batteries and thermal storage systems, which are gaining traction in Europe and may soon be adopted in North America. These systems can store excess renewable energy and convert it into heat for winter use, enhancing both energy efficiency and resiliency.
What value-add items are you adding to these kinds of facilities to make the buildings perform at a higher and more efficient level?
Caleb Marvin: Power monitoring of the electrical systems in hospitals is becoming more prevalent to understand the actual electrical demand and consumption. With monitoring segregated by load type, the facility engineers can better understand and consider evaluating measures to reduce consumption in a specific area. Dual fuel heating systems are also being provided. Using propane or diesel as a backup fuel source for natural gas fired boilers provides resiliency for the hospital. Depending on the owner’s natural gas provider, it is likely that, with a sufficient back-up fuel source, an industrial curtailment rate can be obtained. This can potentially result in an attractive ROI for the dual fuel system.
Meagan Gibbs: Resilient design must address more than just fuel source flexibility and grid independence – it must also prepare buildings for climate hazards and rapid recovery. Our approach includes over 100 building engineering strategies with the most effective enabling facilities to return to operation quickly without major capital investment. Key strategies include on-site backup power, back-up water systems (potable, fire, cooling-tower, etc.) and infrastructure designed with integrated hookups for temporary services (power, cooling, water). These connections via valves and transfer switches, allow seamless integration of emergency power, cooling and water – ensuring continuity during and after disruptive events.
Describe a project in a unique or challenging climate. How did the climate impact sustainability goals or performance levels?
Meagan Gibbs: We recently completed a feasibility study for the expansion of a facility in the Northern Alaska interior. The existing site operates entirely off-grid from a utility-perspective, generating electricity via fuel oil generators. To reduce greenhouse emissions from fuel transport and combustion, the facility is exploring diversified energy sources including GeoExchange for thermal energy, on-site solar photovoltaics for renewable generation and potentially biomass as an alternative energy source. These strategies aim to enhance sustainability while maintaining reliable year-round energy supply in a remote and challenging environment.
The ASHRAE 99.6% heating design temperature for this region is in the range of -50 deg F to -60 deg F. Fossil fuel combustion equipment for energy generation and heat generation has a benefit that thermal energy can be created regardless of extreme outside air temperatures, however all-electric air-source heat pumps that extract heat from the ambient air and move that heat via the refrigerant vapor compression cycle to a heat sink have minimum temperature thresholds under which operation is not feasible. This minimum temperature is commonly -20 deg F, well above temperatures possible in this region. To ensure reliable equipment performance in the remote conditions of interior Alaska, the concept design includes multiple stages of power and heating generation. These stages are aligned with varying temperature bands below 0°F, helping protect both short and long-term equipment life. Additionally, tempered enclosures were designed to not only protect critical HVAC equipment from harsh outdoor air conditions yet also protect the storage of biomass materials from snow and minimize moisture content. While the climate proved challenging for the project, the integration and sequencing of multiple power/energy stages will not only result in high-performance targets to be achieved this will allow the facility to be resilient to multiple types of climate related hazards over time, both acute and chronic.
