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    Credit: Michael Kirkham

When an oil slick along Cleveland’s Cuyahoga River caught fire in 1969, it was neither the first nor the worst blaze of its kind. Oil fires have recurred for decades on numerous cities’ rivers, says Christina Vernon, AIA, Cleveland Clinic’s executive sustainability officer.

But the 1969 fire had good timing: Rachel Carson’s novel Silent Spring had spurred the environmental movement in 1962, and seven years later, the public was ready to take the planet’s degradation seriously. By then, the full array of urban-renewal-era pathologies prevailed in Cleveland: sprawl bred abandonment and unemployment bred crime. Corporations treated the city like a sinking ship, while hospitals and universities weathered the rough decades by staying put and, in many cases, expanding. Now, the Cleveland Clinic and other so-called meds and eds have found that institutional expansion and greening are deeply intertwined with their community’s viability, and they are looking for ways to grow while staying green. Clevelanders point to the 1969 fire as a wake-up call and they hail the clinic, university hospitals, and other institutions linked with the Cleveland Foundation’s Greater University Circle Initiative as revitalization catalysts.

The Cleveland Clinic is one of a few urban hospitals that is working to harmonize its expansion with the broader well-being of its community, understanding that sustainability, in a sense, begins, but does not end, with carbon footprints, checklists, and biophilic design.

But this has not always been a prevailing view. Even California’s tough Title 24 energy standards, introduced as recently as 2008, classify hospitals as exempt. Yet with the 2009 development of the U.S. Green Building Council’s LEED for Healthcare (HC) ratings, the growing use of the related Green Guide for Health Care, and the proliferation of like-minded groups such as the Healthier Hospitals Initiative, CleanMed, Practice Greenhealth, and Health Care Without Harm, hospitals and architects are not only raising the bar for energy performance but redefining sustainability as having a positive influence beyond campus borders.

Many hospital campuses rely on central utility plants to provide power. Some, particularly in the Midwest, have an entrenched dependence on coal-fired facilities to generate the necessary energy. Improvements to the physical infrastructure require a long-term approach to integrating municipal or, if it’s a university hospital, institutional power sources. It is a master-plan issue as much as it is an engineering challenge, explains Benjamin Shepherd, associate director at the sustainability consultancy Atelier Ten. “Part of what we do is provide real energy forecasts for hospitals: ‘Here’s your demand now, here’s where you’re going, and here’s what we think you can get down to with innovative environmental approaches to best service your remaining demand while planning for changing utility costs and regulatory environments.’ ”

At the Columbia University Medical Center, greening efforts address a dense mix of newer and aging buildings (some last renovated in the 1970s), deriving large gains from careful attention to central plant systems, says Rachel Futrell, associate director for energy management and sustainability. “A lot of focus is always given to finishes, appearance, and bringing light in,” she says, “and you want to make sure that the HVAC and mechanical-equipment side is not neglected in the process.” Staff and patients may not notice upgrades to air-distribution systems (a vast opportunity for performance gains), chilled-water cooling systems shared between buildings, or replacement of No. 6 diesel with cleaner-burning fuels, but these details are the nuts and bolts of high performance.

Incremental efficiency gains have substantial effects—as Robin Guenther, FAIA, Adele Houghton, AIA, and Gail Vittori argue in Health Environments Research & Design Journal—and the upfront costs of infrastructural improvements should not dissuade hospital executives from exploring green technologies that incorporate more daylight and fresh air. They also point out that, since staffing represents the lion’s share of hospital expenses, environmental improvements are sound improvements, as they reduce sick days, boost productivity, and create recruitment incentives.

As healthcare systems grow their physical plants, taking the long view in terms of energy consumption and sustainability has to happen if they are to be good neighbors. That idea applies to both suburban and urban campuses across the country.

Dallas’s Parkland Memorial Hospital is expanding to a new $1.27 billion, 64-acre, 865-bed, complex designed jointly by HDR Architecture and Corgan Associates. The hospital is targeting at least LEED Silver, “a handful of points away from Gold,” says Walter B. Jones Jr., AIA, Parkland’s senior vice president of facilities planning and development; it is scheduled to open in early 2015. The institution’s “hospital-in-the-park” healing philosophy, Jones says, has been a not-too-literal metaphor for years, as Dallas County has grown around a site that was once considered “out of town.” Directly across the street, the new campus largely replaces demolished or transitioning industrial properties, so displacement problems have been minimal, Jones says.

Parkland, which is a teaching hospital for the University of Texas Southwestern Medical Center, receives about 40 percent of its funding from Dallas County and treats a substantial proportion of uninsured and underinsured patients. As a result, the hospital hosts a Dallas Area Rapid Transit station at the center of its campus, and its landscape includes a number of clearly marked pedestrian–friendly walking paths, dining patios, fountains, and courtyards. “We know the first level of stress that anybody has when they’re coming to a hospital is, first off, [that] they’re coming to a hospital,” Jones says, “and the last thing they need to do is to get lost.”

Another research-driven effort, Parkland’s “art for healing” program, involves studying how the visual environment affects patient outcomes. Consultants from American Art Resources and a patient–family advisory committee are guiding Parkland’s planners in tuning appropriate images for various areas of the campus, since corridors, patient rooms, staff areas, and specialty suites require different elements; abstract art, for example, is unhelpful in a psychiatric ward.

Such design features do not strike Jones as extraneous, but foundational. “I did not want sustainable elements to be split out as a series of separate line items,” he says, “because if you remove it from the hospital’s design, you harm the project.”

Short-term growth attaches a higher premium on space for urban campuses—and the needs of the hospital are weighed against the needs of the surrounding community, often in a very public way. The Cleveland Clinic, whose neighborhood has economic challenges but strong anchor organizations, is expanding along a “green spine” according to a Foster + Partners master plan,which has earned it Energy Star Partner of the Year awards for the past two years. Along with improving energy performance at its main campus and smaller family health centers alike, the clinic has created an employee housing-assistance fund, hosted a farmers market, and increased local purchasing from vendors within 10 miles. It also fosters economic innovation in the form of the Evergreen Cooperatives, or employee-owned shops in sectors where existing businesses weren’t meeting the hospital’s needs, from laundries to solar energy.

“We’re meeting our sustainability objectives,” the Cleveland Clinic’s Vernon says. “We’re keeping it financially viable, but doing it in a way that involves our community.” The clinic is also a prime mover in Sustainable Cleveland 2019, the city’s official drive to become, by the 50th anniversary of its famous fire, “a green city on a blue lake.”

Major hospitals need to communicate with a public that rarely understands the total scope of what they do and how they do it; a public that only associates them, perhaps unavoidably, with major health events. As institutions reshape themselves to handle public health needs that are now less about isolating the sick and more about promoting what keeps people well, it follows that their campuses should—and increasingly do—promote what keeps our environment and communities well.