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The case for sustainable healthcare
About the Established in 2002, the Green Building Council of
" Sunshine Coast University Hospital
Australia (GBCA) is the nation’s authority on sustainable
Green buildings, communities and cities. Our vision is to create
healthy, resilient and positive places for people. Our Contents
Building purpose is to lead the sustainable transformation of
Council of Australia’s built environment. To do this, we:
Green Building Council of Australia Foreword 01
• Rate the sustainability of buildings and communities
Australia through Australia’s only national, voluntary, holistic New Zealand Green Building Council Foreword 02
rating system – Green Star. What benefits will sustainable healthcare facilities deliver? 03
• Educate industry and government practitioners and Green healthcare facilities are more cost effective 04
decision-makers, and promote green building programs,
Case Study: Lyell McEwen Hospital Redevelopment, Stage C, South Australia 07
technologies, design practices and operations.
Case Study: Kay Jewelers Pavilion, Akron Children’s Hospital, Ohio, USA 08
• Advocate policies and programs that support our vision
and purpose. Saving money on development costs 08
The GBCA represents over 600 individual companies with Green healthcare facilities are better places to heal 10
an annual turnover of more than $40 billion. Members Case Study: Flinders Medical Centre – New South Wing, South Australia 11
include major developers, professional services firms,
Case Study: Olivia Newton-John Cancer & Wellness Centre, Victoria, Australia 14
banks, superannuation funds, product manufacturers,
retailers and suppliers from small-to-medium enterprises Green hospitals can contribute to wider health benefits for the community 14
to ASX 200-listed companies. We also have 40 local Green healthcare facilities are better places to work 17
government, 26 state government departments and land
The impact of improved productivity for your organisation 18
organisations, and 18 university members.
Case Study: Sunshine Coast University Hospital, Queensland, Australia 19
Case Study: Forte Health Building, Christchurch, New Zealand 21
Green hospitals can contribute to our national emissions reduction targets 23
About the All New Zealanders deserve to be safe, healthy and happy
in our beautiful country – at home, at school, at work. Green healthcare facilities are future-proofed and more attractive to investors 25
New Zealand Everywhere.
New standards for investment 25
Green At the New Zealand Green Building Council (NZGBC),
we’re a team of people who are passionate advocates for
Leading sustainable investment 26
Building better buildings, because we know that better buildings Unlocking the potential of Climate Bonds 26
mean healthier, happier Kiwis. Green Star-certified healthcare facilities deliver accountability and credibility 27
Council We do this by working alongside politicians, industry and Opportunities to deliver greener, more sustainable healthcare facilities 28
other businesses to bring change.
Improving existing healthcare facilities 29
We run trusted, robust authentication schemes, such
as Green Star and Homestar, that highlight the many
Case Study: Sydney Opera House, NSW, Australia 31
buildings that have proven their healthy, safe credentials. Designing and building new healthcare facilities 32
And we provide education for hundreds of New Innovation in Green Star projects 32
Zealanders every year keen to learn about the technical
GBCA and NZGBC can help you achieve a Green Star rating 35
aspects behind better buildings.
Hundreds of Kiwi businesses are making their buildings
better, thanks to independent and expert technical
standards provided by the NZGBC.
Green buildings in Aotearoa are building momentum.
Thousands of better buildings are being constructed,
backed by billions of dollars. And those businesses
involved, and the Kiwis living and working in these
buildings, are healthier and happier.
New Zealanders want all of our buildings to be happy,
healthy places. For our children. For our businesses. For
our environment, and for our whānau.
The business case for sustainable healthcare 01
Forewords
There is a growing awareness across industry, government and the Like most countries, New Zealand faces growing challenges with the
community that we need to improve the way we design, build and health and ageing of our population, the health of our environment
operate the buildings in which we live, work, learn, play and heal. We and a budget under pressure from all sides. What if we could take a
now have more than two decades of research and thousands of projects holistic approach to human and environmental health that will also
around the world that demonstrate the benefits of green buildings, not save serious money?
just for the health of the environment, but for the health of those who use We know we need healthier homes and buildings. We know we need to reduce energy
them. In Australia, there are almost 2000 Green Star-certified projects. and water use and reduce the waste we generate. We know we need to reduce
A dozen of these are healthcare facilities, but the majority are office greenhouse gas (GHG) emissions and other pollutants. Green buildings can deliver all
Romilly Madew Andrew Eagles
buildings. If banks and law firms are reaping the benefits of healthy, these benefits, while improving our health, wellbeing and our ability to learn, work and
Chief Executive Officer Chief Executive Officer
sustainable workplaces for their staff, then we should be providing the live more productively.
Green Building Council New Zealand Green
of Australia same for the doctors and nurses who help us heal and for patients who Building Council Health is the second largest area of government spending in NZ (behind social security
these facilities are built for. & welfare) and for the 2016-17 financial year spending was $16.2 billion NZD. This is
forecast to increase to $17.2 billion in 2018 and $18.1 billion in 2019.2 Improving the
Australian healthcare spending was $170 billion AUD in 2015-16 – or 10% of Australia’s
indoor environments of our healthcare and aged-care facilities will be beneficial for the
gross domestic product (GDP) – up from $107 billion, or 8.7% of GDP in 2005-06.1 Our
wellbeing of staff, patients, and our elderly. Reducing energy and water use in some of
population is ageing. As the prevalence of serious health issues such as heart disease
our most resource-hungry facilities will also have a significant ongoing benefit as costs
and diabetes increases and our tax-payer base declines, we must become smarter
continue to rise.
about stretching our healthcare spend further. Not only will building more sustainable
healthcare facilities save money on energy and water costs, but they will boost We have a positive start to build from with the number of Green Star-certified projects
employee satisfaction and productivity, reduce staff turnover and improve recovery in NZ growing all the time, including government-owned assets. Certifying that
times for patients. buildings have a reduced environmental impact and improved health impacts aligns
with the Living Standards Framework that the NZ Treasury is now using and recently,
Gail Vittori, Co-Director of the not-for-profit Center for Maximum Potential Building
New Zealand’s Minister of Health, Hon. David Clark, MP, wrote to all District Health
Systems in the US, and a leading voice internationally on sustainable building
Boards (DHBs) outlining the Government’s expectations for 2018-2019. This included a
planning, design and construction, recently visited Australia to share her knowledge
directive for all DHBs to work together with other agencies and across government, to
and insights. Gail encourages governments and healthcare leaders around the world
implement a strong response to climate change. “Plans to address climate change and
to invest in ‘high-performance healing environments’. She advocates for creating a
health, need to incorporate both mitigation and adaptation strategies, underpinned by
portfolio of low-carbon hospitals but notes, “It must be high-performing in reducing
cost benefit analysis of co-benefits and financial savings.”3
energy, but must also have access to natural light, for example. There has to be an
integrated approach where all of these elements are essential.” The evidence is in. The co-benefits and financial savings of designing, building and
operating greener hospitals are significant and we have an industry ready to work with
There are so many positive stories to tell about how buildings and communities are
the healthcare and aged-care sectors to deliver better facilities.
already delivering lower environmental impacts and greater social and economic
benefits. This must also be the story of the healthcare sector and our whole built It is time to build on the achievements of industry and the commitment of the
environment. I hope that The case for sustainable healthcare will be a catalyst for more government. It is time for the healthcare and aged-care sector, industry and the
sustainability stories in Australia and New Zealand. community to ask for – and to commit to – better. When people experience a
sustainable building, perhaps through a hospital visit, at school, or at work, it becomes
something they look for in a home, or demand in a work or education environment.
The more opportunities people have to experience the difference that a healthy,
sustainable building makes for them and their families, the greater that demand will
grow. And the benefits for all of us will grow, too.
The case for sustainable healthcare 01 The case for sustainable healthcare 02
Green healthcare facilities are more
cost effective
Due to the nature of their round-the-clock ward’ consistently demonstrated the
operations, extensive air-conditioning, highest energy consumption of all the
" Northern Beaches Hospital
specialist medical equipment building types and some of the biggest
What benefits will requirements – and because much of our
healthcare infrastructure is ageing and
poorly designed for energy efficiency
potential for improvement.5
In 2013, the GBCA’s The Value of Green
sustainable healthcare
Star: A Decade of Environmental Benefits6
– most of our hospitals and healthcare
analysed the data from 428 Green
facilities are notorious energy-guzzlers
Star-certified buildings and compared
facilities deliver?
and water users. They use at least twice
it to ‘average’ Australian buildings and
as much energy and around six times
minimum practice benchmarks for water,
as much water per square metre than
energy, emissions and waste. The study
commercial office buildings.4
Sustainable healthcare facilities: found that Green Star-rated buildings
Built to Perform, the Australian are slashing greenhouse gas emissions,
• Are more cost effective Sustainable Built Environment Council’s generating significant savings on energy
• Are better places to heal (ASBEC) final report in their Building Code and water-use and have prevented
Energy Performance Trajectory Project, thousands of truckloads of waste going to
• Can contribute to wider health benefits for the community
analysed eight building types across four landfill.
• Are better places to work climate zones. The ‘archetypal hospital
• Can contribute to national emissions reductions targets
• Are future-proofed and more attractive to investors
• Deliver accountability and credibility These results showed on average that Green Star-
certified buildings:
Green Star certification is available for new buildings (Green Star
- Design and As Built), fitouts (Green Star - Interiors) or for the
operational management of buildings (Green Star - Performance). use 66% less electricity than average
%
Australian buildings.
Green Star certification provides a internationally-recognised,
trusted mark of quality for the design, construction and operation of
sustainable buildings, providing government, owners, staff, patients produce 62% fewer greenhouse gas
and the community with the assurance that they are gaining a emissions than average Australian
%
quality building.
buildings.
Healthcare facilities that have achieved certification and made
improvements to their operations all report a range of benefits.
Improved staff and patient satisfaction and wellbeing, and
use 51% less potable water than if they
had been built to meet minimum industry
%
reductions in water, waste and emissions are resulting in cost
savings too significant to ignore. requirements.
The case for sustainable healthcare 03 The case for sustainable healthcare 04
Green More recently an analysis of Green Star-
certified healthcare facilities showed that
generation, the opportunity to reduce
energy use across the healthcare sector is
Achieving a Green Star rating does not
need to add significant cost to the project
healthcare hospitals and healthcare facilities certified
in 2017 and 2018 produce 57% fewer
something that neither country can afford
to ignore. A study conducted
and sustainability features have proven
that they will pay for themselves over
facilities are
greenhouse gas emissions than average
healthcare buildings. Overall, Green Star
In both Australia and New Zealand, in the US in 2008 and over again throughout the life of the
asset. The World Green Building Council’s
energy costs have risen sharply in recent
more cost
rated healthcare facilities are saving
over 35,000 tonnes of greenhouse gas
years and indications are that prices will (and updated in Business Case for Green Building showed
that a minimal 2% upfront cost to support
2013) showed that
continue to rise. In Australia, while there
emissions every year. green design can result, on average, in life
effective are differences from state to state, prices
cycle savings of 20% of total construction
The NZ Productivity Commission report for households increased on average by
the costs for LEED costs.10 Research by Davis Langdon
(cont.) on how NZ can transition to a low carbon
economy was released in 2018. There
72% for electricity and 54% for gas in the
10 years to June 2013. Real electricity
certification8 was
showed that for healthcare projects price
indications were in the order of 0% to
was a clear focus on reducing embodied prices for businesses have seen similar
carbon in buildings, something which increases. around 0.05% to 3% for a 4 Star rating, 3% to 6% for a 5
Star rating and 10%+ for a 6 Star rating).11
is captured by Green Star. The report
also noted the importance of improving
The cost of both energy and water will
continue to rise. The cost of disposing
0.1% of a hospital’s While this research can provide a useful
indication, project costs may come in
construction
existing buildings as buildings consume
of waste will also continue to increase well under these premiums depending on
more than half of New Zealand’s
as landfill space dwindles and higher what features have been included in the
operational electricity. Improving the
energy efficiency of buildings provides a
penalties are placed on waste to landfill. budget.9 design from the outset.
The cost of emissions generated will
valuable avenue for tempering electricity Other studies have shown that capital
become a consideration as emissions
demand, particularly as transport and cost premiums for green buildings are
trading schemes begin to play a bigger
other sectors electrify.7 And given the largely overstated, especially as green
role in achieving emissions reduction
nature of Australia’s high-emission energy building practices become more common
targets. The Productivity Commission also
and industry expertise increases.
noted that the carbon price per tonne is
likely to rise ten-fold to $200-250 NZD to
achieve zero-carbon targets which will
affect the prices of goods and services
with carbon impacts. We would very much like to work in healthy, well
Green Star Green Star
Green Star encourages and rewards
lit, energy efficient hospital buildings. I think most
healthcare healthcare
reducing energy and water use through
facilities produce
implementing greater efficiencies and
introducing renewable energy and healthcare professionals would. All NZ healthcare
facilities produce
57% fewer GHG
features such as rainwater and grey water
harvesting. Green Star also rewards buildings should be rated to Green 57%Star to help
fewer GHG
emissions than
diverting demolition and construction
waste from landfill as well as putting improve the value we get from buildings
emissions asthan
long-
average healthcare
processes in place within buildings to
encourage and facilitate recycling and term investments and to create futureaverage environments
healthcare
buildings. waste reduction. Measures to reduce
energy and water use and waste have in which our patients, families andbuildings.
staff thrive.
a proven positive benefit on operating
budgets. – David Galler, Intensive Care Consultant, Counties Manakau District Health Board
The case for sustainable healthcare 05 The case for sustainable healthcare 06
Lyell McEwen Kay Jewelers The Kay Jewelers Pavilion at the Akron
Children’s Hospital in Akron, Ohio, is
Hospital Pavilion, Akron
Redevelopment Children’s
a LEED Gold certified building, which Saving money on
is designed to support the health and
Stage C, Hospital, Ohio, wellbeing of patients and staff. There was development costs
South Australia USA a strong focus on Indoor Environment
In NZ, a Green Star-certified childcare
Quality through the use of low-VOC
facility successfully applied for
materials and furniture and maximised
a reduction in the development
daylighting, as well as extensive use of
contribution charges it was required to
indoor plants and views to the outside.
pay to the local council by demonstrating
The project team used a lean Integrated
that it would have significantly reduced
Project Delivery (Lean-IPD) approach to
impact on infrastructure compared to
improve planning and decision making
average new buildings. The project could
throughout all stages of building design
prove that:
CASE STUDY
and construction.
• Vehicles per day (vpd) would be 156,
Not only does this project deliver 48.5%
compared with the council’s projected
fewer GHG emissions than the US national
357 vpd – a reduction in traffic intensity
CASE STUDY
average for healthcare facilities, improved
of 56%.
occupant satisfaction and $900,000 in
annual energy cost savings, the project • Potable water demand would be 9.06
& Lyell McEwen Hospital Redevelopment Stage C
was completed $44 million USD under litres per person per day (lpppd),
budget and 54 days ahead of schedule – compared with the council’s projected
proving that green building, with a focus 45 lpppd – a reduction of almost 80%.
on health and wellbeing can be achieved • Water discharge would be 11.5 lpppd,
on a cost effective basis.12 compared with the council’s projected
40 lpppd – a reduction of 71%.
This resulted in a reduction in the
% Lyell McEwen Hospital Redevelopment Stage C
development contribution charges of
67%, or $57,373 NZD, which doesn’t
include the waived charges for
stormwater runoff due to the project’s
green roof and catchment tanks.
SA Health’s Inpatient Building, Lyell Passive design techniques such as high-
McEwin Hospital Redevelopment Stage performance glazing, insulation and
C, achieved a 5 Star Green Star rating external solar shading, combined with
for its design. The project features high high technology mechanical solutions,
levels of natural daylight and outside are predicted to cut energy consumption
fresh air ventilation, solar thermal panels and greenhouse gas emissions by 30%,
to provide onsite generation of renewable when compared the Building Code of
heating energy and rainwater storage Australia’s benchmarks.
tanks to collect water from rooftops.
The case for sustainable healthcare 07 The case for sustainable healthcare 08
Green healthcare facilities are better
" Northern Beaches Hospital
places to heal
Healthier hospitals mean healthier ventilation, private rooms, music, light
patients. The evidence shows that and nature in its redevelopment project
healthcare facilities designed to led to an 11% reduction in secondary
maximise daylight, views of nature, infections.15 The seminal study on the
fresh air, thermal comfort and feelings impacts of heathy hospitals in 1984
of connectedness get better patient showed hospital stays reduced by 8.5%
outcomes. and supporting studies showed that
patients with views of nature experienced
The Mackenzie Health Sciences Centre
faster recovery rates and patients in
in Canada, for example, found that
rooms with bright sunlight needed less
depressed patients in sunny rooms
pain medication.16
recovered 15% faster than those in darker
rooms.13 Similarly, the Inha University People’s perception is also very important.
Hospital in Korea found a 41% reduction Facilities that are designed to be
in average length of stay for patients in sustainable and healthy – and that have
sunlit rooms over those in dull rooms.14 the certification to prove it – are going to
gain more trust and popularity within the
Medical errors fell 30% at The Barbara
community. Where people have a choice
Ann Karmanos Cancer Institute in
in healthcare and aged care facilities, they
Detroit that allocated more space for
are most likely to choose the one that is
their medication rooms, and installed
designed to put their wellbeing, and that
acoustical panels to decrease noise
of the planet, first.
levels. And the Bronson Methodist
Hospital in Michigan found that applying
green design principles such as improved
On the high-performance side,
we consider energy, water use
and waste management and on
the healing environments side, it’s
all about creating a place where
people want to be; that really
gives us a sense of connection.
%Gail Vittori, Co-Director, Center for Maximum Potential Building Systems
The case for sustainable healthcare 09 The case for sustainable healthcare 10
Flinders Medical
Centre – New
South Wing,
South Australia
“Many of the initiatives you see in New
South Wing are good practice and
should be incorporated into healthcare
projects as a matter of course,” Symon
argues.
Did Green Star have a cost impact?
& Flinders Medical Centre New South Wing
CASE STUDY
According to Frank Zotti, the cost
of Green Star is difficult to quantify.
“Financial consideration is difficult
because many of the benefits, such
as increased staff retention, staff
productivity and improved patient
recovery rates, are intangible,” he
explains, “We chose Green Star
because it provides official recognition
and allowed our achievements to
be independently assessed and
benchmarked”.
The New South Wing of Flinders air-conditioning system that allows
Medical Centre (FMC) in South Australia individual temperature control in For other teams considering Green Star,
achieved a 5 Star Green Star certification patients’ rooms, and specified low Zotti offers some straightforward advice:
representing Australian Excellence. volatile organic compound (VOC) paints, “The rewards are worth the effort.”
adhesives and floor coverings for the To achieve its 5 Star Green Star rating,
The Green Star-rated extension houses
entire project. Together with access Flinders Medical Centre’s New South
FMC’s women’s health services and
to external views and a design which Wing was awarded a range of points
has been designed to deliver high
provides good levels of natural light, the under each of the nine Green Star
quality patient care with a minimal
New South Wing’s designers
extension offers a light filled, airy and categories, including:
environmental footprint.
stress-reducing hospital environment for
According to Frank Zotti, Redevelopment A Sustainable Procurement Guide was
have risen to the challenge
patients and staff alike.
Project Manager for FMC, the community developed by the project team to help
Kriston Symon, project team leader for Flinders Medical Centre make smart and
has given the new facility its full support.
“We’ve delivered 271 more babies in the
AECOM, says it just seemed common
sense for the project to focus on both
and built a terrific facility sustainable purchasing decisions, and
new unit without needing to increase the also earned the project a credit under
number of beds. That’s a 10% increase
health and environmental outcomes.
which places patients and the the Management category. SA Health
on previous years - all thanks to this “There is a large amount of evidence has since used the guide on other health
fantastic green facility”. showing that patient recovery rates environment front and centre. projects, ensuring that the sustainability
improve when you provide high levels of lessons learnt at New South Wing are
The extension features a 286-panel
Indoor Environmental Quality (IEQ) such –South Australian Health Minister John Hill spread across the state.
solar hot water system, a displacement
as access to natural light,” she says.
The case for sustainable healthcare 11 The case for sustainable healthcare 12
New South Wing was awarded IEQ This increase in deliveries has occurred
credits for a range of features, including without the need to increase the
low VOC paints, adhesives and number of beds and indicates the strong & Olivia Newton-John Cancer & Wellness Centre
sealants, external views and access to community support for the new facilities.
natural light, as well as independent
A 286-panel solar hot water system, the Olivia Newton-
temperature control of patient rooms.
largest in South Australia, was installed John Cancer &
The attention to clean air has clearly paid to provide hot water across the entire Wellness Centre,
off. Since the new wing opened, births at FMC campus. This earned the New South
FMC have risen from 2,761 in 2008-2009 Wing credits under the Energy category
Victoria, Australia
to 3,012 in 2010-2011, an increase of and has helped reduce energy costs by
almost 10%. $400,000 per year.
Other energy saving measures include
a zoned air-conditioning system that
delivers cooling and heating directly
to where it is needed using the energy
efficient Shaw Method. Developed
CASE STUDY
Kriston Symon explains
in Australia, the system decouples
Our philosophy was humidity and temperature loads to
prevent overcooling and subsequent
to minimise the reheating which occurs in conventional
air-conditioning systems, halving energy
environmental footprint consumption.
A separate upgrade also saw the
of the project and create installation of a new, energy efficient
central cooling plant, which resulted in
a healthy environment no net increase in carbon emissions from
the construction of the new building.
for patients, visitors and Overall, CO2 emissions have been
staff. With this in mind,
reduced by approximately 380 tonnes,
The Olivia Newton-John Cancer & have access to natural light, ventilation
equivalent to taking 74 cars off the road
Wellness Centre at the Austin Hospital and views, recover faster than those who
the extensive evidence
for a whole year.
is a holistic response to the many facets do not.
South Australia’s susceptibility to and needs of cancer care. Named after
The Olivia Newton-John Cancer &
connecting good IEQ drought made minimising water use
a priority. By installing an extensive
Australian entertainer and hospital patron,
Olivia Newton-John – herself a breast
Wellness Centre embodies this approach
to faster recovery rates
to care, striving to create a health
rainwater harvesting system that cancer survivor – the centre provides
sanctuary rather than a typical hospital
provides water for urinals and toilets, as world-class medical treatment and
and improved staff and
setting. Key to this design is the central
well as a water efficient heat rejection supportive care for patients and their
courtyard that provides patients, staff
system, FMC has reduced water families, with an emphasis on wellness
patient health made IEQ
and visitors with access to natural
consumption by an estimated 20% in the and patient wellbeing. The eight-storey,
light, fresh air and views of nature. The
new wing. $189 million centre was the first certified
credits a natural focus
therapy rooms are positioned to look
Green Star – Healthcare Design project in
over the gardens for massage and other
Victoria.
for the project.
treatments and in total 50% of the centre
International research has found that has a direct line of site to the outdoors.
patients who have some influence over Building systems were also selected to
their immediate environment, and who maximise comfort levels, such as the
The case for sustainable healthcare 13 The case for sustainable healthcare 14
The Olivia Newton- Designed to be a tranquil retreat for
patients, carers and staff, the Wellness
John building has Centre is set within landscaped gardens. Green hospitals can contribute
To manage these gardens and other
an extremely high water usage with the Wellness Centre to wider health benefits for the
sustainably, the project placed a strong
environmental focus on water management. community
The design incorporated a 120,000 litre
focus, particularly rainwater storage facility which resulted
in a 100% reduction in the use of potable
The health implications of green buildings go beyond the impacts
on building occupants. Research published in 2017 calculated the
in terms of how water for landscape irrigation. Uniquely link between green buildings and public health benefits for the first
time. The study calculated the avoided GHG emissions of certified
this storage facility draws on rainwater
choice of passive chilled beams over air it can facilitate and the waste water from the reverse green buildings in five countries and used Harvard University’s ‘Co-
Be Calculator’ to determine the health impacts of this. The Co-Be
conditioning. The end result is a truly osmosis treatment undertaken in the
restorative and comfortable environment. better journeys and centre’s laboratories. Water from the calculator applies the social cost of carbon and the social cost of
atmospheric release to translate these emissions reductions into
rainwater storage is also reticulated to all
“If you have a patient who has a very
positive journey, in an environment where
experiences for toilets throughout the development. health benefits. In the US alone (between 2000-2016), the emissions
avoided by certified green buildings was determined to have
they feel comfortable, and their needs
are met not just on a clinical level but are
patients and their “Environmental considerations influenced
every aspect of Olivia Newton-John from
resulted in avoiding an estimated:
also supported at a social and spiritual
level, their care journey will be optimised.”
carers. Not clinically materials selection to creating structures
that would produce low emissions.
172-405
premature
deaths
-Project Director, Megan Gray.
cold as many health This all had to be incorporated within a
demanding healthcare environment and
The Olivia Newton-John Cancer &
spaces are but hospital
171
comply with relevant cleaning and quality
Wellness Centre set a clear brief for the
selection of products and materials – they
standards.” -Project Director, Megan Gray.
admissions
needed to meet the unique demands something that was
asthma
11,000
of a healthcare environment, support
the centre’s wellness philosophy and be warmer and inviting exacerbations
sustainable, with low toxicity and low
embodied energy. and more homely respiratory
Clever materials selection has created
the desired relaxed and non-institutional
in terms of the feel 54,000 symptoms
atmosphere for the centre. Natural
and quality of the lost days
finishes, colours and textures, were
chosen to create a sense of bringing the
space
21,000 of work
outdoors inside. While low VOC and low
-Project Director, Megan Gray
lost days of
16,000
formaldehyde products were chosen for
their low environmental impact. External
materials also meet strict environmental school17
criteria, including the use of structural
Avoiding emissions-intensive energy production is particularly
steel and cement made with recycled
important in NZ and Australia where some providers are using
content.
coal and gas which can have impacts for local air quality.
The case for sustainable healthcare 15 The case for sustainable healthcare 16Green A growing body of research is
demonstrating again and again that
of conventional office buildings, green
buildings and green buildings with
The implications are dizzying. High
indoor environment quality improves
healthcare sustainable, healthy buildings are better
places to work.
enhanced ventilation. At the end of
each day, participants undertook a test
productivity, improves decision-making,
improves staff satisfaction, reduces sick
Design features
facilities are The WorldGBC’s report, Doing Right
of their cognitive function (a key driver
in productivity) and the impacts were
days and absenteeism, and reduces
staff turnover. The cost savings potential
such as connectivity,
By Planet and People,18 showcased 11
better places certified projects from around the world.
significant. On average, cognitive scores
were:
of these impacts, not to mention the
benefits for staff wellbeing and patient
natural light and
Every case study featured pre- and
to work post-occupancy studies that showed • 61% higher in green building conditions
safety, are enormous. Cost savings
attributed to improved energy and water
biophilia are all
employees were happier in their new
green space. Results included:
• 1 01% higher in enhanced green building
conditions.19
efficiency may be easier to quantify and
can be significant, but they are likely to
elements that can
• A
reduction of four sick days per
employee per year and a 27% reduction
Further research also showed that
workers in green buildings also slept
be a small proportion of the total benefits
that can be realised through delivering a
reduce turnover of
in staff turnover at the new Cundall
office in the UK.
better, with 6% higher sleep scores than certified green healthcare facility.
medical professionals
those working in conventional buildings.
• A
64% reduction in reported allergy Another factor that demonstrates that
– Gail Vittori, Co-Director, Center for Maximum Potential
problems and a 68% reduction in where we work, or spend most of our Building Systems
reported respiratory problems at the day, continues to impact our health and
Sherwin-Williams office refurbishment in wellbeing after we have left the building.
El Savador.
Because this study was designed to The impact
• A
t the new Floth office in Brisbane,
Australia, 94.5% of employees are
reflect indoor environments encountered
by large numbers of people every
of improved & Sunshine Coast University Hospital
satisfied with the overall performance, day, these findings have far-ranging productivity for
health and productivity of the new implications for worker productivity,
building. decision-making and safety. In another your organisation
study conducted by educational
• A
SID’s employees at their new Harvard University research found
researchers, it was discovered that the
HQ in Washington DC, USA, were that green rated buildings improved
quality of facilities had a “substantively
overwhelmingly satisfied with their new productivity over 26%. Even a
important effect on teacher retention,”
office and a study conducted showed conservative estimate of improved
even when statistically controlling for
a 19% reduction in absenteeism and a productivity of 10% in a green
other potential factors like pay, parent
16% reduction in presenteeism (where building will lead to huge savings in
and community involvement, age of the
staff are present, but not working large organisations such as hospitals.
teacher, etc. In fact, researchers found
productively). For example, in an organisation where
that facility quality showed a greater
the average employee costs $90,000
Harvard’s T.H. Chan School of Public predictive ability on teacher retention
per year, gaining a 10% uplift in
Health’s Center for Health and the Global than teacher pay for this group of study
productivity is worth $9m per year for
Environment undertook research to test participants.20 Bronson Methodist Hospital
every 1000 employees.22
the impacts of indoor environment quality in Michigan found that applying green
on the cognitive function of building design principles to improve IEQ led to a
occupants. The study participants were decrease in nursing turnover rates.21
exposed to conditions representative
The case for sustainable healthcare 17 The case for sustainable healthcare 18& Sunshine Coast University Hospital
assist the project team to coordinate the respite, views, fresh air and daylight,
thousands of inputs and outputs that are they contribute to reducing the urban
needed for such a large and complex heat island effect of the hospital.
project.
The project team have delivered
While painstaking planning and project excellent outcomes on a range of
Sunshine Coast management was a critical factor in environmental measures including
University Hospital, the project’s delivery, the project team energy, water and a reduced impact on
Queensland, have created a hospital environment the environment.
unlike anything most people will have
Australia experienced before. The result is a
Upon full occupancy of the hospital in
2021, the predicted reduction in energy
facility that contributes not just to the
consumption is estimated to be at
health and wellbeing of staff, patients
least 20%, with a peak energy demand
and visitors, but one that reduces its
reduction of 40% compared to an
impact on the environment as well.
equivalent facility. This will be achieved
Gardens, courtyards and outdoor spaces through a range of measures such as
are an integral part of the hospital’s solar hot water and thermal energy
CASE STUDY
design. They reflect the climate and storage systems, energy metering and
People flock to the Sunshine Coast to landscape – while managing harsher landscape of the Sunshine Coast, while energy efficient lighting, and represents
take advantage of its beautiful beaches, aspects of the climate, such as strong providing staff, patients and their families significant operational savings for a
serene hinterland and wonderful climate. summer sun and heavy rainfall events. with a connection to nature and places tertiary hospital operating round the
Huge population growth in the region led of respite. clock.
Queensland Health had a number of
to the need for a large, state-of-the art
sustainability goals which included: At the heart of the hospital is a central, Given that Queensland is no stranger
hospital and the latest healthcare facility
landscaped courtyard which creates to droughts and flooding rains, water
to achieve Green Star certification shows • Providing a renewable and energy
an outdoor room for patients, staff and was a big focus of the project. A
that size and complexity should pose efficient infrastructure
visitors to use. Many of the rooms look significant volume of rainwater is
no barriers to achieving world-leading • Preventing pollution, reducing waste out on the courtyard and benefit from collected, along with setting high water
sustainability. and consumption and committing to the daylight and views of lush greenery, efficiency targets. Rainwater is harvested
The $1.8 billion Sunshine Coast recycling and recovery over disposal while rooms and areas on the external from approximately 80% of SCUH’s
University Hospital (SCUH) has achieved • Maximising user wellbeing – including sides of the hospital have views over the 38,000m2 roof. There is a tank capacity
6 Star Green Star Design and As Built health, comfort and happiness surrounding neighbourhood, bush, water of 1.5 million litres and 90% of all water
certifications. SCUH was delivered by or wetlands. There are other smaller harvested is reused.
• Producing low emissions and
the Queensland Government in a Public courtyards and planted areas throughout
minimising ecological impact
Private Partnership with Exemplar Health the hospital campus which provide
– a consortium comprising Lendlease, • A high-performance building fabric that green sanctuaries for staff, patients and
Siemens and Capella Capital, with is maintainable and durable visitors and which soften the urban scale
partners Spotless Facilities Services and of the facility.
• Minimising recurrent operation costs
Aurecon.
Three-quarters of all patients and visitors
• Minimising potable water use.
One of the biggest challenges for have easy access to at least one place
the project team was to design and Queensland Health also set a minimum of respite, while all staff have access
construct a facility of 152,000m2 requirement for the project to achieve to a place of respite which is set aside
that meets all necessary clinical 4 Star Green Star Design and As Built exclusively for staff use. All places of
requirements, but is not overwhelming certifications. Lendlease and Aurecon respite are at least 25 metres away from
for staff, patients and visitors. The worked with the GBCA for over a year any major road, car park, loading dock or
building also had to capture the to tailor the Green Star – Healthcare waste collection facility to avoid noise,
elements of the environment that will rating tool to respond to the size and odour and air pollution. In total, there
contribute to patient and occupant complexity of the project. This resulted is around 49,000m2 of green space –
wellbeing – daylight, winter sun, in a 417-page technical manual and the approximately a quarter of the ground
sea breezes and the beautiful local creation of project-specific tools to plane site area. In addition to providing
The case for sustainable healthcare 19 The case for sustainable healthcare 20to be a leading private hospital not just building performance. He encourages
through providing excellent medical good-natured inter-floor and inter-
care, but also through delivering a high departmental competitiveness for
performing building that contributes actions such as turning off lights,
to the health and wellbeing of clients proactively managing air-conditioning
and patients. They believe it would be a and reporting on waste sorting practices
contradiction to have a building in which – reducing energy use and waste to
Forte Health people were treated for their ailments, landfill. Through this commitment to
Building, but where the building environment itself operating efficiently, energy and waste
Christchurch, made them sick. costs have come in well below original
projections.
New Zealand • Commercial and economic benefits –
the owners know that investing in good Tenants report high satisfaction with the
whole-of-life building performance will building using words like ‘comfortable’,
result in lower operational costs. The ‘modern’, ‘secure’, ‘safe’ and ‘warm’. All
Forte Health building. Stephen Goodenough
aim was to realise long-term financial, tenancy fitouts use low-VOC and certified
brand and reputational benefits by materials and products, and these
going the extra mile in high quality principles will continue to be stipulated
design, construction and specifications in future tenancy agreements. Patients
from the outset of the project. also regularly make positive comments
and many measures have been taken
Technology plays an important part in
to make them feel comfortable and
the performance of this building which
at ease, such as high levels of natural
has reduced energy demand (and
light, a concierge to provide greetings,
corresponding GHG emissions) by more
directions and exit care, controllable air
than 40% compared with like buildings.
conditioning in each hospital room and
State-of-the-art operating theatre
&
practices such as allowing patients to
ventilation and ‘scavenging’ devices take
walk to theatre where possible. At Forte,
potentially infected air out of operating
patient welfare, security and comfort – as
theatres to improve patient and surgical
New Zealand’s first Green Star healthcare well as sustainability – have been taken
staff health. Occupancy-sensing DALI
facility delivers efficiency, comfort and to new levels.
lighting was used throughout the entire
sustainability beyond expectations. base build and fitouts, and sub-metering
Tenants report Forte Health, located in the centre of has been implemented to not only
Christchurch, is a multi-disciplinary
high satisfaction medical practice and private hospital
understand the building’s consumption
habits, but also those of each tenant. A
CASE STUDY
with the building which achieved 4 Star Green Star
certification in 2014.
solar hot water system also contributes
to the building’s energy efficiency and We had three key
using words like Peter Davidson, co-owner and tenant high-efficiency water fittings reduce drivers for delivering
water use.
‘comfortable’,
of the building said that not only were
the owners committed to sustainability
a green building -
Perhaps even more critical than the
‘modern’, ‘secure’, throughout the build, but also to technology installed, is the behaviour social conscience,
involving their colleagues on the journey. of the building occupants. The owners brand and marketing,
‘safe’, and ‘warm’. The owners had three key drivers for
delivering a green building:
of Forte are also tenants of the building
and commercial and
which helped drive their determination
• Social conscience – to do the right to create a healthy work environment, economic benefits.
thing for the environment and for but also continues to propel their
Christchurch. commitment to the efficient day-to- –Peter Davidson, Co-Owner & Tenant,
day running of the facility. The building Forte Health building
• Brand and marketing – to establish a
manager is supported by the owners to
point of difference and make a statement
help staff to understand how they can
in their sector. The owners want Forte
take control of workplace comfort and
The case for sustainable healthcare 21 The case for sustainable healthcare 22Green Australia and New Zealand are both
signatories to the Paris Agreement.
the healthcare and aged-care sectors
offer huge opportunities for reducing
Climate change will have a significant impact on public health over
the coming decades. It’s important that the health sector does what
hospitals can The purpose of the Paris Agreement is to:
• keep the global average temperature
emissions and contributing to NDCs.
This is especially true in Australia where
it can, not just to avoid adding to the problem, but to lead the fight
contribute to less than 2° C above pre-industrial electricity is predominantly generated by
levels, while pursuing efforts to limit the burning coal. against climate change. Central to that fight is the need for resilient,
our national temperature increase to 1.5° C To support the national emissions low carbon, healthy buildings. The buildings in this useful guide
• strengthen the ability of countries to reduction target in Australia, states are
are the types of buildings NZ deserves. Good for patients, good
emissions deal with the impacts of climate change setting their own targets and making
plans for reducing emissions. These economically, good for Aotearoa.
• make sure that financial flows support
reduction the development of low-carbon and
include:
• The NSW Government’s Climate Change
– Hon James Shaw. NZ Minister for Climate Change, Associate Minister of Finance, Acting Associate Minister of Health
climate-resilient economies.
targets The Paris Agreement entered into force
Policy Framework27 has set a target
of net zero emissions by 2050 and is
on 4 November 2016 and will take effect
supported by the Government Resource
from 2020. It commits all signatory
Efficiency Policy28 which sets various
countries to take action on climate
targets for energy, water and waste in
change through a Nationally Determined
government operations.
Contribution (NDC) which will apply from
2021. New Zealand’s NDC is to reduce • The ACT Government aims for net-zero
greenhouse gas emissions by 30 per cent emissions in the territory by 2050 at the
below 2005 levels by 2030.23 Australia’s latest in its Sustainable Energy Policy29
NDC is to reduce emissions by 26-28 per and also has a target of achieving
cent below 2005 levels by 2030.24 carbon neutrality in its own operations
by 2020.
In Europe, the building sector is
• The SA Government aims to achieve
recognised as an area of significant
net-zero emissions by 2050 and
potential for emission reductions and
improve energy efficiency of
targets have already been in place for
government buildings by 30% by 2020.
several years. The EU Performance
The SA Government and the Adelaide
Building Directive 2010 states that all new
City Council also aim to establish
buildings must be nearly zero-energy
Adelaide as the world’s first carbon
buildings by 2020 and public buildings
neutral city.
must achieve this by the end of 2018.25
In the UK, since 2008 health authorities The New Zealand Government aims to
require that approvals for new healthcare reduce NZ’s emissions to net zero by
facilities and refurbishments must include 2050. It plans to introduce the Zero
a commitment to achieving a BREEAM Carbon Bill that will set the new emissions
rating.26 Around the world, certification is reduction target for 2050. NZ’s Emissions
widely sought and globally there are 600 Trading Scheme is the key policy tool for
BREEAM-certified health facilities. reducing emissions and meeting targets.
The ETS will need to be strengthened
In Australia and New Zealand, buildings
and improved to align with new targets.30
are responsible for around 23% and
Now is the time to take advantage of
20% of total emissions respectively.
opportunities to reduce energy use,
Australia has almost 700 public hospitals
emissions and operational costs to future-
and over 620 private hospitals. New
proof against possible future increases in
Zealand has 87 public hospitals and 80
the carbon price.
private hospitals. If you consider the
growing number of specialist clinics and
aged-care facilities in both countries,
The case for sustainable healthcare 23 The case for sustainable healthcare 24Green Governments and businesses that
" Northern Beaches Hospital
have taken steps to mitigate and adapt
healthcare to the impacts of a changing climate New standards Leading Unlocking the
will reduce their exposure to risk and
for investment sustainable potential of
facilities
rising insurance premiums. Assets with
independent certification such as Green
The Clean Energy Finance
investment Climate Bonds
are future-
Star will become increasingly favoured
Corporation (CEFC) is aiming to kick
by investors and this is an important GRESB is the global benchmark for The Climate Bonds Initiative is an
start new standards in clean energy
consideration for governments looking
proofed to leverage private sector investment for
for healthcare by investing up to $100
million in the new Dexus Healthcare
environmental, social and governance
(ESG) performance of real assets. In
international organisation that works
to mobilise the $100 trillion bond
social infrastructure.
and more Wholesale Property Fund (HWPF). 2018, GRESB assessed 903 real estate market for climate solutions. Certified
Green Star verifies the kind of good companies and funds, representing green buildings provide assurance
HWPF will own Australia’s first
attractive design which will future proof buildings more than 79,000 properties and AUD that a project or asset will meet the
portfolio of hospital and healthcare
against the impacts of a changing climate $4.9 trillion in global assets under objectives and eligibility requirements
assets to focus on environmentally
management. of a bond issued under the Climate
to investors
and the rising costs of energy, water,
sustainable development. HWPF
waste and emissions. Rising temperatures Bonds standard. There have been a
is targeting emissions reductions The Australia/New Zealand regional
can be mitigated with features like number of hospitals around the world
of 45% in both new and existing score was 76, compared with a global
external shading and blinds designed to that have benefited from investment
buildings when compared with the average of 68. The Australia/NZ
protect the building from the strongest from climate bonds, including in
Council of Australian Government region continues to lead the world,
sunshine and solar thermal gains. Water Switzerland, Sweden, France and the
(COAG) Baseline Energy Consumption although the gap with other regions
sensitive landscaping, well-designed US.
in commercial buildings. New HWPF is slowly closing. In 2017, Australia/NZ
stormwater systems and rainwater scored 73, compared with the global There have already been a number of
buildings will target 5 Star Green Star
harvesting can help minimise the impact average of 63. green bonds issued in Australia and
– Design & As Built ratings, as well as
of storm events that are increasing in New Zealand which are intended to
Green Star – Performance ratings.32 A record 73 Australian companies
frequency and intensity. finance a range of projects and assets
with AUD $447 billion in assets
The Royal Institution of Chartered including green buildings, renewable
reported to GRESB in 2018, up from
Surveyors’ report, Green Value: Growing energy generation and low carbon
66 companies and $205 billion the
Buildings, Growing Assets31 found transport.
previous year. According to Ruben
that assets employing green building Langbroek, Head of Asia Pacific
practices that increase energy efficiency at GRESB, industry stakeholder
and reduce greenhouse gas emissions, collaboration and ambitious zero
are more likely to attract grants and carbon goal setting is driving the
subsidies. region’s leadership.
Globally, more and more organisations are
required to report on climate-related risk.
The Taskforce on Climate-related Financial
Disclosure (TCFD) was established to
develop voluntary, consistent climate-
related financial risk disclosures for
companies to use in reporting to
investors, lenders, insurers and other
stakeholders. The TCFD is supported by
over 300 of the world’s leading financial
and insurance organisations.
The case for sustainable healthcare 25 The case for sustainable healthcare 26Green Star-
Opportunities to deliver greener,
Increasingly, leaders in both the public
and private sector have a financial
certified responsibility to deliver assets that are
Ultimately, we
more sustainable healthcare
affordable and represent value for money
healthcare
over the long-term.
chose Green
facilities
As an internationally-recognised,
facilities trusted mark of quality for the design,
construction and operation of sustainable Star because it
deliver buildings, fitouts and communities,
Green Star does just that by ensuring a provides official
Green Star assesses the The Green Star rating tools for
accountability commitment from all project stakeholders
to deliver (and to prove they have recognition, sustainable design, construction buildings assess sustainability
and operation of buildings, across nine impact categories:
and credibility delivered) a building that is designed
and constructed to meet best practice and allowed our fitouts and communities.
benchmarks for sustainability and
efficiency across the board. achievements to Choosing Green Star can help Management
you save money, create a healthy
Green Star provides certainty and
independent verification that benchmarks
be independently place for people, minimise your Indoor Environment Quality (IEQ)
have been met, unlike buildings which
claim to be green, or claim to be ‘designed
assessed and environmental footprint and
build a better future for us all.
Energy
to’ Green Star standards without engaging
in the certification process.
benchmarked. Green Star is an internationally-
A study undertaken in the US to examine -Frank Zotti, Redevelopment Project Manager, recognised, independent, third- Transport
the costs and benefits of achieving LEED Flinders Medical Centre – New South Wing party certification system which
certification for hospitals concluded currently operates in Australia, Water
that considering the objectives of the
healthcare organisations, along with the
New Zealand and South Africa.
due diligence, accountability and third- Materials
party verification of the LEED process,
Green Star certification is
awarded for projects which
certification was a sound investment
Land Use & Ecology
delivering measurable economic, achieve 4 Star (Best Practice),
environmental and human health 5 Star (Australian/New Zealand
benefits.33
Excellence), or 6 Star (World Emissions
Leadership) benchmarks.
Green Star – Performance Innovation
also recognises 0-3 Star
achievements to assist facilities
to benchmark and identify
opportunities for improvement.
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