When it comes to the environmental impact of buildings, the healthcare industry needs help, stat. Consider these statistics on energy, waste, and water use in healthcare facilities, compiled by the Healthier Hospitals Initiative, a new coalition of healthcare providers who believe hospitals have a responsibility to minimize their adverse environmental impacts. As noted in this issue’s Perspective column (“Healthy Choices”), hospitals are the second most energy-intensive type of buildings in the United States, using 836 trillion Btu of energy each year. Financially, this equates to about $6.5 billion in spending. It’s estimated that healthcare facilities generate 6,600 square tons of waste per day and, calculating disposal costs at $68 per ton, this totals more than $15 billion spent annually on waste disposal. And when it comes to water, it has been estimated that between 68,750 gallons and 298,013 gallons are used per year per bed in hospitals ranging in size from 133 beds to 510 beds.

While it’s hardly an ideal diagnosis, there is plenty of opportunity for recovery and improvement. Getting there, however, will require a change in how we design, construct, and operate our facilities, as well as how we deliver care. The prescription: a range of innovative solutions, as showcased in this issue of .

In our story “Code Green," we look at the sustainable design elements of five large-scale hospitals around the country. As you’ll see, in many facilities environmental performance is addressed through a combination of tactics, from installing high-efficiency HVAC systems, lighting control systems, and occupancy sensors, to incorporating green roofs and healing gardens, and specifying energy-efficient medical equipment.

In some cases, however, the sustainable efforts are concentrated on one showpiece, as illustrated at Sherman Hospital in Elgin, Ill., where a 15-acre geothermal lake serves as a large green element. It’s a showpiece that pays: The lake not only helps manage water runoff on site, but the geothermal system is expected to reduce the hospital’s annual heating and cooling costs by $1 million. And while initial estimates predicted an eight-year payback period, after just seven months of operation that estimated payback period has already dropped to six years.

Looking at how a kit of parts can contribute to a more sustainable whole is “Targeting 100! Envisioning the High Performance Hospital: Implications for A New, Low Energy, High Performance Prototype,” a study from two researchers at the University of Washington. Published in June, the study was produced in collaboration with a number of architecture firms in the Pacific Northwest and funded by the Northwest Energy Efficiency Alliance’s BetterBricks Initiative. Its main hypothesis is that a new 225-bed acute care hospital in the Pacific Northwest can reduce its energy use by 60 percent by utilizing a combination of energy-efficient strategies. While the complete study is available online, our story (“Road to Recovery”) takes a quick peek at some of the technologies it recommends using to meet that reduction target—which, by the way, would also meet targets set by the 2030 Challenge.

This study’s release is good timing: According to the 2010 Energy Efficiency Indicator survey conducted by Johnson Controls in association with the American Society for Healthcare Engineering and the International Facility Management Association, healthcare organizations are more likely to invest in energy efficiency than other industry sectors. The survey found that 58 percent of healthcare building decision-makers reported energy management as very or extremely important to their organization, and 67 percent of the responding healthcare organizations planned to make capital investments in energy efficiency over the next 12 months. In comparison, 52 percent of survey respondents as a whole reported energy management as very or extremely important and 52 percent planned to make capital investments in energy efficiency over the coming year.

Of course, care is not just delivered in large-scale hospitals. It also takes place in specialized outpatient facilities, long-term care and assisted living communities, spas, and, as showcased in “Health Reform," student health centers. It also can be administered in unexpected venues, such as repurposed shipping containers (see our Ecocentric story, “Ship-Shape Care”).

Speaking of size, consider this question raised by Kathy Gerwig, vice president of workplace safety and officer of environmental stewardship for Kaiser Permanente, when we chatted for this issue’s Perspective column: How will changing the delivery of care impact our facility design? As a example, she spoke of Kaiser Permanente’s work to encourage e-visits, where patients e-mail their doctors before making a physical trip to the medical office or hospital. Last year, patients in Kaiser Permanente’s health system sent 8.6 million e-mails to their doctors, reducing the need for car trips to a facility for an in-person visit. The larger query is this: Is there medical care that doesn’t require the enviromental footprint of a physical facility?

Whether they are designing a gigantic research hospital or retrofitting a small community clinic, building professionals working in this sector must create design solutions that address a number of elements that are non-negotiable. Among them: infection control and sanitation issues, flexibility in space planning and technology, security. Will sustainability eventually become one of these non-negotiable elements?