This fact sheet has been developed by the U.S. Department of Energy’s Hospital Energy 

Alliance to help owners and operators employ the IBD process to lower energy consumption 

and resultant costs while maximizing patient comfort and environmental sustainability. 

Although some of the strategies considered can be undertaken using a traditional approach, 

IBD often produces results that otherwise would not have been attainable. 

While traditional design and construction involves a series of hand-offs from one expert to 

the next, IBD is a collaborative approach that draws upon the needs, expertise, and insights 

of a multidisciplinary team (see box at left) throughout a project. 

Kicking off a Project

The team can save time and money by identifying incompatible design elements and 

solving problems before actual design and construction begin. Typically, the team kicks off 

a project by holding a “charrette,” an intensive workshop in which the key stakeholders 

generate and discuss ideas for combining low-energy-use and other greening strategies. A 

charrette helps cut across boundaries of a large collaborative project, allowing the team to 

address organizational differences, reduce difficulties, verify decisions, and expedite the 

design process.

Integrated Building 

Design Critical to 

High-Performance 

Hospitals

New construction and major 

renovations offer hospitals their 

best prospects for achieving 

optimal energy efficiency. 

Integrated building design (IBD) 

is a nontraditional approach 

that has been particularly 

effective in creating highperforming, environmentally 

friendly buildings. Such facilities 

often cost less to operate and 

sometimes cost less to build.

BUILDING TECHNOLOGIES PROGRAM

A facility built through the ongoing collaboration of all stakeholders is more likely to achieve 

optimal energy efficiency than one based on a succession of hand-offs. Integrated building 

design increases opportunities to create hospitals that have a favorable effect on patient 

healing, employee health, and environmental sustainability.

Integrated Building 

Design Team

•	 Architects and designers

•	 Construction managers

•	 Contractors

•	 Energy modelers, cost estimators

•	 Engineers

•	 Facilities managers and operators

•	 Integrated design facilitator/

consultant

•	 Medical staff representatives

•	 Owners and senior management

•	 Specialty consultants
2 INTEGRATED BUILDING DESIGN FACT SHEET

• Assess and confirm project feasibility 

and construction requirements.

• Formulate high-performance 

project goals, including measurable 

energy performance goals, such as 

the following:

– Use less than a certain number of 

Btu/square foot/year.

– Achieve 30 percent energy savings 

over code.

• Determine financial evaluation criteria.

• Commit as an organization to the 

IBD process for the project. Discuss 

questions and concerns.

Whole-Building 

Approach is Key

IBD’s “whole-building” approach views 

a facility as an interdependent system 

rather than as separate components. This 

viewpoint helps to ensure that systems 

work harmoniously rather than against 

one another. Whole-building design takes 

into consideration such elements as site, 

energy, materials, indoor air quality, 

acoustics, operations, economics, and 

natural resources. Employing the wholebuilding approach during the initial 

design phase is the most important step in 

achieving high-performance buildings.

The 509,000-square-foot Dell Children’s

Medical Center of Central Texas is the

world’s first inpatient hospital to achieve

Leadership in Energy and Environmental

Design, or LEED®, certification at the

platinum level—the highest offered through 

the U.S. Green Building Council. The

176-bed hospital, built on 32 acres of the 

“brownfield” site of a former municipal 

airport, serves 46 counties. This highperformance facility is the result of a 

collaborative effort among a broad group 

of internal and external stakeholders.

Financial Investments and Benefits

• Capital budget was $200 million.

• Construction cost was $130 million.

• Gross capital savings were $6.8 million

(eliminated the need to build a central 

plant when the local utility and the 

hospital’s parent company collaborated

to build an onsite district energy plant).

• Invested $5.8 million of these savings into

energy conservation measures.

Notable Features 

• “Right-sized” distributed air handling

units with dedicated outdoor air units 

with heat recovery.

• Under-floor air distribution in

administration area.

• High-efficiency lighting fixtures with

daylight-harvesting system and 

occupancy sensors.

• Exterior stairwells that don’t require

climate control.

• Daylighting that reaches 90 percent of

the perimeter rooms and 35 percent of 

treatment and diagnostic areas.

• 47,000 tons of airport runway material

reused on the site.

• 92 percent of construction waste recycled,

diverting 32,000 tons from landfills.

• Fly ash substituted for Portland cement.

• Water-efficient autoclaves and low-flow

and dual-flush plumbing fixtures save an

estimated 4.1 million gallons of water per 

year.

• Onsite 4.3 MW natural gas-fired CHP

plant that supplies 100 percent of the 

hospital’s electricity, heating, and cooling

and is 75 percent more efficient than 

coal-fired plants.

t

 Case Study

Dell Children’s Medical Center of Central Texas

Austin, Texas • Opened in July 2007

The Path to High 

Performance

There are many steps the IBD team takes 

in the creation and successful operation 

of a high-performance facility. Key phases 

are indicated below, with important 

considerations highlighted within each.

Pre-Design

During this phase, hospital management 

organizes its IBD team and makes broad 

decisions that determine the direction of 

the entire project. Among them:

• Establish key needs and project priorities.

Photos: © John Durant Photography/Karlsberger
INTEGRATED BUILDING DESIGN FACT SHEET 3

• Assemble IBD team. Among the 

important considerations:

– Select an IBD “champion” to drive 

the process.

– Identify roles and responsibilities 

for members.

– Hire design professionals 

experienced with IBD. 

– Hold a design charrette with 

the IBD team.

Design

The IBD process puts all design options 

on the table rather than prescribe the 

use of specific strategies. Many design 

possibilities—each with its unique set of 

technologies based on the team’s chosen 

criteria—are evaluated. Whole-building 

energy simulations are a part of this 

process. For information on energymodeling software, see http://www1.eere.

energy.gov/buildings/commercial_

initiative/modeling_software.html. The 

team selects the best design approach 

only after multiple potential designs—

including new iterations based on 

information or ideas that have come to 

light through this process—have been 

thoroughly investigated and compared.

The most effective, least expensive 

method of reducing a new facility’s 

energy consumption is to properly plan 

its orientation and building envelope. 

It’s easy to see why in this example: 

• Siting a building to maximize 

daylighting reduces the need for 

electric lighting. 

• Reducing electric lighting reduces 

the cooling load. 

• A reduced cooling load requires a 

smaller cooling system. 

Further, designing the most appropriate 

building envelope for a particular project 

often can reduce both heating and cooling 

requirements. Decisions of this nature, 

made early in the design process, are 

likely to have a dramatic effect on a 

building’s lifetime energy consumption. 

Additionally, any upfront savings 

resulting from well-thought-out design 

strategies can be invested in higherquality windows or controls, which will 

result in even more energy savings.

The following concerns and activities 

are important to achieving an optimal 

building design:

• Employ natural light advantageously. 

– Choose window layouts and designs 

that use natural light as much as 

possible, particularly in patient 

rooms and corridors.

– Combine natural light exposure with 

lighting control technologies 

(dimming or stepping).

– Maximize shade provided by exterior 

landscaping to minimize heat gain in 

warm climates.

– Perform preliminary modeling of 

building performance to determine 

how various natural lighting strategies 

would affect the HVAC load.

• Design an energy-efficient building 

envelope.

– Consider using green roofs to 

provide insulation and lower intake 

Providence Newberg Medical Center’s

180,000-square-foot hospital, medical

office, and administrative facility used 

an integrated design process, energy 

modeling, and life-cycle cost analysis of 

design alternatives to become the first 

hospital to achieve a LEED® Gold rating.

Energy-efficient technology and practices

helped Providence achieve a 26 percent

energy savings annually. 

Financial Investments and Benefits

• Construction budget was $63.5 million.

• Incremental project cost was $357,000,

financed partly through incentives from 

local utilities and Energy Trust of Oregon.

• Annual energy cost savings are $178,000,

or about 975,000 kWh of electricity.

Providence Newberg Medical Center

Newberg, Oregon • Opened in 2006

Notable Features

• Condensing boilers operating at 95 percent

efficiency, 15 percentage points over code.

• High-efficiency lighting system that uses

T5 lamps and emphasizes daylighting.

Programmable lighting system monitors

daylighting and dims or turns off lights 

when not needed.

• HVAC system providing 100 percent

outside air.

• Variable primary flow chiller system.

• Emergency generators are leased to utility

for maximum of 400 hours per year for

10 years, in exchange for $56,000 in

incentives. 

 Case Study
4 INTEGRATED BUILDING DESIGN FACT SHEET

EERE Information Center

1-877-EERE-INFO (1-877-337-3463)

www.eere.energy.gov/informationcenter

For more information, contact:

Pat LeDonne

Building Technologies Program

Energy Efficiency and Renewable Energy

U.S. Department of Energy

pat.ledonne@ee.doe.gov

November 2010 commercialbuildings.energy.gov/hospital

temperatures. These add value by 

improving patient views as well.

– Contemplate installing revolving 

doors in high-traffic locations to 

minimize loss of conditioned air.

– Work as a team to treat the building 

envelope as a complete system so 

that all aspects perform optimally 

together. 

• Investigate on-site renewable energy 

options, facilitating available 

opportunities through careful site 

selection. Work as a team to consider 

renewable generation impacts when 

making decisions in other disciplines, 

such as architectural decisions.

• Compare multidisciplinary implications 

of centralized vs. decentralized plant 

options. 

• Right-size the boilers and chillers 

based on reduced loads from other 

improvements.

Construction and Commissioning 

During construction, it is important for 

contractors and subcontractors to stay 

involved in the IBD process. Responsible 

parties must review all substitution 

requests carefully to determine their 

impact on the energy efficiency of other 

building systems and the ability of the 

facility to meet energy-performance 

goals. 

Prior to use, the new facility should be 

commissioned by an independent 

provider to verify that it performs 

according to the building owner’s needs, 

its design, and contract documents. 

Commissioning is critical for ensuring 

that the design developed through the 

whole-building design process is 

successfully constructed and operated.

• Systematically evaluate all equipment 

to verify it is working according to 

specifications. Measure temperatures 

and flow rates from all HVAC devices 

and calibrate all sensors to a standard.

• Review the sequence of operations to 

verify that controls are providing the 

correct interaction between equipment. 

Because members of the IBD team have 

firsthand knowledge of the building from 

pre-design through installation, they 

should be involved throughout the 

commissioning process—as well as 

during subsequent recommissioning.

Operations

Once construction is completed and 

occupancy of the new building begins, 

responsibility will shift from the IBD 

team to the energy management program 

team. This group is composed of 

representatives from across the hospital 

spectrum—finance, maintenance and 

facilities, purchasing, quality assurance, 

government relations, clinical operations, 

and medical personnel. The team has 

primary responsibility for the long-term 

success of all energy-efficiency planning 

and operations.

Members develop and implement each 

element of the hospital’s ongoing energy 

management plan. Programs such as 

EPA’s ENERGY STAR® for Healthcare 

are helpful in creating energy 

management guidelines and 

benchmarking tools. The following are 

important aspects of an energy 

management plan:

• Monitor performance, verify that goals 

are being met, and identify 

opportunities for improvements.

• Oversee energy-efficiency operations 

and maintenance training and periodic 

recommissioning. 

• Assess occupant satisfaction and 

fine-tune the integration of every aspect 

of energy efficiency. 

• Identify challenges and solutions. 

Target opportunities for additional 

energy savings and energy cost savings.

For more detailed information on IBD, 

visit http://www1.eere.energy.gov/femp/

pdfs/29267-4.1.pdf.

A Strong Energy Portfolio for a Strong America

Energy efficiency and clean, renewable energy will mean a stronger

economy, a cleaner environment, and greater energy independence for 

America. Working with a wide array of state, community, industry, and

university partners, the U.S. Department of Energy’s Office of Energy

Efficiency and Renewable Energy invests in a diverse portfolio of

energy technologies.

Hospital Energy Alliance 

HEA is a forum in which healthcare

leaders work together with DOE, its

national laboratories, and national building 

organizations to accelerate market

adoption of advanced energy strategies 

and technologies.

“Many high-performance ‘green’ buildings cost no more, 

and even less, than their ‘brown’ equivalents—the key 

is integrated design.”

—Robin Guenther, Perkins+Will