The challenge of sustainable hospital building.

FEW TOPICS ARE as timely as discussions of our shared sustainable future, and there are few settings more difficult to design for sustainability than hospitals with their critical functions, continuous operation, constant energy consumption, huge demand for water, and enormous generation of waste. It is almost a cartoon caricature to say that the gargantuan volume of dangerous and toxic wastes constantly spewed out of our hospitals is making the communities and environments around them sick, and so to wonder about the irony that to some degree they are probably creating their future clientele. BOULDER COMMUNITY HOSPITAL, BOULDER, COLORADO David Gehant lets us know early in his piece on Boulder Community Hospital that grassroots activity by environmentally conscientious employees spurred the hospital's involvement and commitment to environmental principles. These are folks from a progressive college community in Colorado with an activist history. Management's decision to develop a volunteer "green team" and the actions that followed began to align the goals of the organization with the goals of its employees. The decision to hire a full-time sustainability coordinator to develop and maintain environmental initiatives strikes me as forward thinking and relatively rare in the industry. Following the decision to support the bottom-up initiatives of the staff, board approval of the Statement of Principles of the Environment completed the process of endorsement at every level of the organization and allowed the environmental attitude to permeate the culture. This strikes me as an important lesson for organizations wishing to emulate Boulder Community Hospital's success. Its Statement of Principles of the Environment deals with waste reduction, waste disposal, recycling, nonrenewable resources, toxic emissions, alternative transportation, purchase of recyclable and reusable products, water conservation, and commitment to disclosure of incidents of environmental harm. While the list is impressive and laudable, I wondered why energy consumption didn't appear. By the conclusion of Gehant's paper, it is obvious that attention to energy use became important to the organization and that it received significant results in that area. Gehant's documentation of the system's results is extraordinary. It is recycling 500,000 pounds per year, saving more than $2000,000 per year in surgical instrument wraps and instrument reprocessing, and generating more than 100 kilowatts from solar panels. In 2004 it was able to document saving more than 1.5 million gallons of water, nearly a million kilowatt-hours of energy, 1,779 cubic yards of landfill, and 13,500 pounds of air pollutants for which it won the Eco-cycle Award. Boulder Community Hospital makes a strong business case for enlightened healthcare organizations. The numbers and resulting savings from its decision to "go green" would seem to tickle the fancy of any chief financial officer at any hospital. I would have liked some additional comments from the author about what kind of effort is required to gather this sort of data. While hospitals are awash with more data than any reasonable manager might need, and under regulatory obligation to report practically everything associated with the services they provide, few healthcare organizations have a system in place to capture the kinds of data that Boulder Community Hospital has collected to document its sustainability performance. It is said that one can't manage anything that is not measured; if so, healthcare organizations must learn to measure new indicators of stewardship, such as gallons used in irrigation, amounts of disposables, pounds of red bag waste, or tons of landfill. Boulder Community Hospital is a system of facilities, one of which is the new and well-documented Boulder Community Foothills Hospital, which earned LEED Silver Certification. Another is the older main Boulder Community Hospital in Boulder. …