It is no coincidence that virtually every description of Titusville, Fla.-based Parrish Medical Center’s facilities marries the words healing and environment. Long before researchers presented evidence that the physical environment could play a palliative role in the healing process, PMC’s leaders intuitively understood the importance of providing a safe and comfortable environment for patients, visitors and staff.

In 2002, after experiencing tremendous growth and projecting a continued increase in demand for its services, PMC pioneered the use of evidence-based design by opening one of the first hospitals in the U.S. to apply empirical-research results to the creation of a healing environment. For example, PMC eliminated overhead pages and did away with the traditional nurse’s station to provide quiet, more homelike patient areas that are conducive to healing and more efficient for staff. A decentralized nursing model places medical staff closer to patients than the elongated or mazelike circulation systems of many medical institutions. The hospital’s wayfinding system also is designed to “reduce stress, not create it.” A prominent entrance draws visitors to the hospital’s front door where they are welcomed by an atrium/lobby.

Photo Courtesy of Parrish Medical Center

Later, when PMC’s leaders decided to construct an outpatient facility, they realized using a sustainable framework would enable them to expand their mission to provide “the best healing experiences for patients” while reducing operating costs and respecting the environment. “We had to educate some board members about sustainability,” says Chris Male, medical center developer for Parrish Medical Center. “None of them needed much convincing, though, because the potential for energy-cost savings and improved efficiency made sense right away.”

The health-care industry, which is highly regulated, has been slower than other sectors of the building industry to integrate sustainability into the development of its facilities. According to the Washington, D.C.-based U.S. Green Building Council, less than 1 percent of LEED-certified projects in the United States are health-care buildings. Fortunately, Male and others at PMC recognized the goals they’d set for their buildings and surrounding area had parallels to sustainable principles and practices.

For example, scientific research has shown that communing with nature helps distract patients from the challenges of their treatment; enhances their sense of well-being; and alleviates stress for family members, friends and caregivers. The 33-acre (13-hectare) site for PMC’s new outpatient facility, formally known as Parrish Healthcare Center at Port St. John, includes a nature preserve with walking paths that is a protected habitat for a number of endangered species, including the scrub jay. Indigenous plantings enhance comfort through familiarity and require 50 percent less water than non-native alternatives. Four ponds hold storm water that PMC uses for irrigation.

Photo Courtesy of Parrish Medical Center

Large windows provide views of these natural environs while bringing an abundance of daylight into the interiors. Photo sensors automatically adjust interior illumination levels based on the amount of natural light detected. These transitions subtly connect occupants with circadian cycles while reducing the amount of electricity needed for artificial lighting. High-efficiency light sources and motion detectors further reduce energy consumption. To protect IAQ, Miami-based RTKL Associates Inc., which was the designer on the project, chose low-VOC adhesives, sealants, paints, carpeting and composite woods for the facility. PMC enacted a no-smoking policy and its green-maintenance program uses pH-neutral cleaners. The building and systems also were flushed out prior to occupancy. Sensors located throughout PMC’s outpatient facility monitor carbon dioxide, humidity, and temperature levels to maintain ideal interior climatic conditions and good IAQ.

“If the building needs to breathe, sensors trigger the buildingautomation system, which adjusts the dampers to introduce more outside air. This smart system also balances humidity and temperature levels,” explains Scott Avirett, account manager for Milwaukee-based Johnson Controls Inc., which acted as the LEED consultant; design assistant; prime mechanical, electrical, plumbing and technology systems contractor; and facility life-cycle performance partner for the building.

“We were the low-voltage technology subcontractor for PMC’s hospital,” Avirett says. “When we heard PMC was interested in sustainability for its outpatient facility, we proposed a fully collaborative, life-cycle approach. This allowed us to harness and apply what we’ve learned from many years of retrofitting systems of existing buildings to optimizing the performance of a new facility. We are the only project partner that’s been on board from planning through ongoing operations and maintenance.”

PMC’s focus on optimizing patient flow also enabled the project team to minimize the outpatient building’s footprint. Related departments, such as emergency, radiology, intensive care and surgery, are within feet of each other.

In addition, the interiors achieve the owner’s goal for being “culturally responsive” while meeting LEED’s distancefrom- site requirements. The PMC Outpatient Facility features colors, fabric textures and artwork from the Space Coast region of Florida. Sixty percent of materials manufactured for construction were obtained within 500 miles (805 km) of the site.

Photo Courtesy of Parrish Medical Center

As LEED consultant for the PMC Outpatient Facility, Johnson Controls used USGBC’s Web-based program, LEED-Online, and its own software to manage the LEED certification process. LEED Accredited Professionals from Johnson Controls attended project team meetings, reviewed what credits were being pursued, secured proper documentation, input information into LEED-Online and monitored progress toward achieving certification. They also used Johnson Control’s software to establish performance benchmarks; develop accurate scopes of work; and calculate life-cycle costs and the return-on-investment for design alternatives, equipment and materials. In addition to installing low-voltage technology, lighting and building-automation systems, Johnson Controls worked closely with TLC Engineering for Architecture, Orlando, Fla.

“It made sense for us to review TLC Engineering’s designs and energy models because we’d agreed to guarantee energy-consumption levels,” Avirett says. “While we focused on life-cycle costs, we helped reduce first costs whenever possible.” For example, Johnson Controls recommended an air-cooled chiller that had lower installation and operations costs than a packaged rooftop unit considered earlier in the design process.

Johnson Controls also has a three-year service agreement for maintaining the building controls, security system and HVAC equipment, so these continue to perform as intended.

The Parrish Healthcare Center at Port St. John opened in May 2007. In March 2008, it became the first outpatient facility in Florida to achieve CIRCLE NO. 54 or Silver LEED for New Construction, Version 2.1, certification. It is expected to perform 25 percent more efficiently than similar facilities designed to meet ASHRAE 90.1 requirements.

By masterfully blending evidence-based design strategies and sustainable principles and practices, PMC and its project team have further strengthened this institution’s reputation as one of America’s finest healing environments. Male says, “We feel we have created a superior facility that will positively affect everyone who comes into contact with it.”

Building Footprint: 72,234 square feet (6,711 m2)
Building Construction Cost: $19.5 million
Site Development Cost: $2 million

Heather Beal writes about architecture and sustainability from Edina, Minn.


  • OWNER / North Brevard County Hospital District, Titusville, Fla.,
  • LANDSCAPE ARCHITECTURE / Brad Smith and Associates Inc., Melbourne, Fla.,
  • MECHANICAL AND ELECTRICAL ENGINEERS / TLC Engineering for Architecture, Cocoa, Fla.,
  • LIGHTING DESIGNER / TLC Engineering for Architecture, Orlando, Fla.
  • CIVIL ENGINEERS / Honeycutt and Associates Inc., Titusville,
  • COMMISSIONING AGENT / GRG/Xnth, Maitland, Fla.,