Executive Insight | A Culture of Green

A Culture of Green

Lissa Bryan-Smith and Aran McCarthy, November 2010 Download PDF

How one healthcare system’s leadership style made the process of going green so successful.

Cited by President Obama as a model for high-quality medical care at affordable costs, administrators at the physician-led not-for-profit Geisinger Health System, Danville, PA, have made a system-wide commitment to environmental responsibility. #e initiative has helped the company become a leader in a field that has been slow to go green.

In this respect, Geisinger staff work to develop leadership in sustainability that relies on cultural commitment instead of mandates. The effort is most apparent in its facilities. Since 2005, Geisinger, which serves more than 2.6 million people in more than 42 counties across central and northeastern Pennsylvania, has worked with architecture firms such as Francis Cauffman, which has offices in New York, Philadelphia, and Baltimore, to ensure that all new buildings are Leadership in Energy & Environmental Design (LEED)-certified, an internationally recognized green building certification system developed by the U.S. Green Building Council (USGBC).


Interestingly, Geisinger’s commitment to environmental stewardship has been adopted throughout the healthcare system without written policy, said William J. Gladish, director of construction. “Green is so much a part of our culture,” he explained. “For all of us at Geisinger, it just seems like being sustainable is the right thing to do – and we have all pledged to collaborate on doing it. Having LEED-certified buildings is now the convention for us.”

Following LEED guidelines is meshed within the healthcare network’s mission, said Al Neuner, associate vice president, facilities operations. “There’s no question that environmentally friendly buildings are better for people’s health,” he said. “As a healthcare system, we are striving to improve the health of the people in our communities, and green buildings can reduce some of the same problems that we’re trying to solve.”


Attaining LEED-certification is a voluntary process that measures how well a building or community implements energy and resource saving programs and improves indoor and outdoor environmental quality. It includes a thorough review of the building’s design features, construction plans and records. Beyond basic certification, buildings may be recognized at three additional levels representing increasingly strenuous sustainability protocols: silver, gold, and platinum.

To this end, Francis Cauffman has a long history of partnering with Geisinger as a trusted adviser on sustainable development. Each new facility that Francis Cauffman has designed for Geisinger follows a green credo: they are energy efficient buildings full of features that stress the natural over the chemical, the recycled over the new, and the renewable over the wasteful.  They rely heavily on recycled materials and include energy-reducing features such as high-efficiency lighting, heating, and cooling systems.


While going green can come with an up-front cost premium for a hospital, Geisinger administrators have found that the long-term benefits balance out the additional costs.

For example, while commissioning – the process of designing and tuning a building’s systems properly – increases the cost of a project, it also ensures that buildings remain energy efficient over the long term. Research has demonstrated that environmentally friendly buildings do provide a return on the initial investment – and Geisinger’s experience confirms the company’s first facility to go green was its Henry Hood Center for Health Research in Danville. The center received LEED Silver certification in 2007.

“The impetus for us to go green started with a concern over water quality when we were planning the center in 2005,” explained Robert Davies, vice president of system services. “This inquiry ultimately resulted in our first LEED building, and after that, we decided that we would build all green buildings going forward.” One “a-ha” moment in the process was the realization that the impact of using green technology and construction materials for this project was minimal: it added no more than 1-2 percent to the total costs – a figure that has easily been recaptured in energy savings. In fact, the Center for Health Research is outperforming expectations: using 13 percent less energy than originally anticipated.


The success of the research building project gave Geisinger admistrators the experience base to move forward into green clinical facilities, which are significantly more complicated to execute. Francis Cauffman staff helped Geisinger make this transition in creating a master plan for the Wyoming Valley campus. The architects designed two green facilities on this campus, including a critical care building (CCB), which received LEED Silver certification in 2009.

“Creating a sustainable 24/7 acute care facility of this magnitude was extremely difficult because emergency departments typically use an exorbitant amount of energy,” Gladish noted. “Operating room environments are stereotypically ‘energy hogs’ to support around-theclock, high-tech robotic and minimally invasive equipment.”

To achieve a silver rating for the CCB, Francis Cauffman staff used a number of energy-saving techniques, including installing a white roof which helps reflect sunlight to keep the building cooler and last longer than a traditional roof. Inside the building, efficient systems such as a high-performance variable air volume system and energy-efficient lighting were incorporated and created an immediate 19 percent reduction in energy costs over a comparable, non-LEED facility.

The savings on energy costs at the CCB are quickly offsetting any additions to the budget from going green. “This structure reduced Geisinger’s environmental impact immediately and saves about $100,000 per year in energy consumption,” said Denise Thompson, AIA, LEED AP BD+C, who served as LEED captain for Francis Cauffman.


To date, nine Geisinger buildings are currently LEED-registered: five are certified, three are pending, and one is under construction. All told, Geisinger has more LEED projects registered in Pennsylvania than any other health system.

In 2008, Geisinger-Gray’s Woods became the first healthcare facility in the state, and seventh nationwide, to earn the LEED Gold designation. USGBC statistics show that 39 percent of all healthcare- related projects currently registered or certified for LEED in Pennsylvania are Geisinger-owned.

Geisinger’s commitment to green extends beyond new facilities. At the Danville campus, Geisinger is building a cogeneration plant that will generate five megawatts of power, increase efficiency from 30 percent to 80 percent, and reduce carbon dioxide emissions by 16,000 tons annually. The organization is also exploring solar and wind power, conserving water, cutting back on disposable medical items, and using recyclable sharps containers for biological waste. “At every level of our organization, Geisinger is working to minimize our carbon footprint and to save resources,” explained Davies. “We believe it’s the right thing to do for our communities and our employees.”


Healthcare has been one of the slowest industries to adopt environmentally friendly building practices. The unique needs of medical facilities, such as around-the-clock operations, heavy energy and water use, chemical use, and infection control, can pose significant obstacles to sustainability.

There are implications on the construction side as well, noted Francis Cauffman’s Denise Thompson, AIA, LEED AP BD+C: “The commitment to LEED must come early in a project and be championed by all team members, because it can be difficult to integrate sustainable features when a project is already underway.” For these reasons, just 15 percent of hospitals nationwide currently mandate that their construction projects be carried out with environmentally responsible building materials – and a significant

23 percent of hospitals are not using green construction practices for any of their projects, according to a 2008 survey by Health Facilities Mangement. Further, just three percent of current LEED-certified projects are healthcare-related.

Despite the challenges, the benefits to such a commitment are great. Research increasingly shows that the physical design of healthcare environments directly contributes to patient outcomes, with improvements such as the introduction of natural light having a significant positive impact, according to a report by the National Association of Children's Hospitals and Related Institutions and the Center for Health Design. Green buildings can lead to faster patient turnaround and greater patient satisfaction, as well as improved clinical outcomes and employee health, greater patient and staff satisfaction, and increased staff effectiveness.

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