by David S. Merker, SSMBB, LEED Green Associate, Account Manager

The green design movement is picking up momentum all around us – so much so that it is no longer a movement, but rather a common practice. From hospitals to educational institutions, green building design principles have become the standard, with almost every new construction or renovation project building sustainably. This is partly due to the fact that as a society we are more aware of the impact our decisions have on the environment, and partly because of the financial and health benefits green building design principles deliver. The ability to link green building design to improved health (and a reduction in workers’ compensation claims) was the recent topic of the Delaware Valley Green Building Council’s annual Best of Green Building event held in Philadelphia. Baltimore Medical Systems (BMS), a community-based non-profit providing basic health services, shared clear evidence of how green building design improved employee health conditions and increased employee and patient satisfaction across the board.

Problem: A Sick Building

BMS has six healthcare center locations that cater to the underserved residents in the Baltimore area. The health centers accept all patients regardless of insurance status and offer special services to reduce barriers to healthcare.

“Out of our six health center locations, Highlandtown Healthy Living Center was the unhealthiest and most cramped,” said Katie Callan, vice president for Human Resources at BMS. “The center was located in the grayest neighborhood in the city and was our busiest facility and in the worst condition.” Located in East Baltimore, the center experiences the highest health disparities in Maryland. Alarmingly, a John Hopkins University study showed that life expectancy was 20 years less than in an affluent neighborhood just five miles away.

Residents are exposed to housing stock consisting of row homes more than 100 years old, limited food access, pesticides, poor air quality and lack of greenery. The health center wasn’t a reprieve from the surroundings either. A converted old furniture warehouse, the health center was half the recommended size and would best be described as sick. The building was laden with water and fire damage and had poor air quality. “Dozens of employees filed complaints of allergy symptoms and difficulty breathing while at work,” said Callan. “An air sampling test determined the center had high mold levels, and we knew something had to be done. We couldn’t allow our employees to come to work every day and put their health at risk. Not to mention, have visitors coming to an unhealthy facility where the core mission is to promote healthy lifestyles,” added Callan.

Solution: A Green Building

On a mission to build the healthiest building possible in the unhealthiest part of the city, BMS enlisted the help of a design team that included Emma Jones, now Director of Strategic Operations at BMS. “We wanted to send the message that the built environment is where health starts,” said Jones. In doing so, the team decided to apply principles of the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) program. Originally aiming for LEED Silver certification, the team switched into high gear mid-renovation and elected to attain the program’s highest rating – LEED Platinum. Though no LEED guidelines existed at the time for health centers, the design team looked to guidelines set by hospitals for guidance. In addition to fundraising, federal stimulus funds from the American Reinvestment and Recovery Act helped BMS build the new center.

“The whole process of constructing a LEED-rated building required every step to be examined with a critical eye towards conserving resources,” said Jones. A minimum of 87.7 percent of unused construction debris was recycled instead of disposing of it in a landfill. Additionally, more than 20 percent of building materials came from sources within 500 miles, reducing the environmental impact of transporting materials.

In the new facility, extensive natural sunlight exposure minimizes the need for electrical lighting, with at least 75 percent of classrooms and offices lit with natural sunlight. Amidst the design process, the team had to decipher how to maximize natural light exposure while adhering to HIPAA and other patient privacy guidelines. “One of the biggest complaints about the old center was that it was dark and dreary. The increased lighting has resulted in a more positive and productive work environment,” said Callan. Motion detectors that turn lighting on and off help reduce energy usage where natural lighting does not exist. Additionally, a white membrane roof protects the building against the heat of direct sunlight and cools the building with lower energy usage and costs.

To address the lack of greenery, a terrace healing garden and a front entrance rain garden bring plants and green into the environment. “Gardens have been shown to provide a calming effect to many people,” said Jones. “The gardens have pleasantly become a real focal point of the community.”

Various choices were made to minimize the environmental impact of the building’s interior and furnishings. For example, small squares of cork flooring made of recycled content not only reduce noise, but also can be easily replaced in single squares, resulting in reduced landfill waste. Wooden ceiling beams and trim were reclaimed from a local barn that was torn down. Whenever possible, furniture was also reclaimed or refurbished, and all new furniture was made of recycled materials. Formaldehyde-free furniture was consciously chosen because of the well-documented dangers formaldehyde poses to people’s health. Furthermore, to ensure the highest air quality, low VOC (volatile organic compound) materials, including paint, adhesives, sealants and carpets, were used throughout the building.

When BMS committed to building the healthiest building, the organization didn’t stop at the design. Changes to the everyday operations of the building were made too. The building is smoke-free, and no smoking areas are located within 25 feet of all doors, exterior ventilation intakes and windows that open. A highly efficient HVAC system, which includes an energy wheel, was installed to help bring fresh air in and adjust the building temperature based on the outside temperature. The building is cleaned with environmentally safe disinfectant products by a maintenance company that specializes in green cleaning. Recycling became a priority, and bins for paper, glass, cans and plastic are conveniently located to encourage recycling by employees and are collected to significantly minimize landfill waste generated at the building.

Impact of Green Building Design

The new health center now standing at 3700 Fleet Street replaces the sites at 3509 and 3701 Eastern Avenue. The Healthy Living Center has capacity to serve 22,000 people and handle 84,000 medical visits per year – an annual increase of 7,000 patients. The larger and greener center is consistent with the health center’s mission, stressing the importance of healthy living and demonstrating to the community that the environment is the root of a healthy lifestyle. The center has education rooms, community meeting space and informative displays about health and the environment.

“The proof that green building design was the answer to the problems BMS faced is in the data,” said Callan. BMS saw a sizeable decrease in workers’ compensation insurance claims, staff satisfaction increased by 125 percent and the turnover rate decreased by 18 percent. Further, patient satisfaction increased by 26 percent.”

Medical Assistant Teresita Nixon has worked at BMS for eight years and has seen a dramatic improvement in her health since the new center has opened. “In the old building, I would always get sick. I still have asthma and use an inhaler occasionally, but it’s not nearly as often. Now, I breathe easier at work than I do at home!”

Benefits of green construction extend beyond workers’ compensation insurance into additional lines of Property and Casualty insurance. Due to the additional design scrutiny and detailed inspection process associated with LEED, many insurance companies will apply a discounted rate on a Builders Risk policy for a building that upon completion will apply to become LEED certified. For existing buildings, insurance carriers also offer “Green Amendment” endorsements on a Property policy, which fund unique LEED-related reconstruction costs such as building recommissioning expenses, indoor air quality restoration (flush out/new filtration) and the additional costs to divert to recycling centers in lieu of landfills.

In closing, outlined below are a few best practices for consideration:

1. Ensure that the scope of work is clearly defined
2. Review the requirements for untested or novel design/construction elements
3. Review your insurance – are there any gaps?
4. Know the LEED rating system
5. Include a LEED checklist
6. Select knowledgeable architects/engineers/contractors of all tiers with Green experience; obtain (and call) references
7. Review contractor/subcontractor insurance certificates for correctness
8. Be aware of timelines (deadlines for tax credits, incentives, etc.)
9. Assign commissioning and certification responsibilities by name – confirm they are LEED certified