Founded by six major hospital systems (Advocate Health Care; Catholic Healthcare West; Hospital Corporation of America; Kaiser Permanente; MedStar Health, and Partners Healthcare System), the Healthier Hospitals Initiative (HHI) is anchored on the belief that hospitals have a responsibility to minimize adverse environmental impacts of their operations on patients, staff, and the natural environment, and that sustainability can be achieved through a coordinated national approach. In May, HHI released the Healthier Hospitals Agenda, which outlines specific strategies participating HHI organizations should take into consideration in designing, building, and operating their hospitals. Three nongovernmental organizations—Health Care Without Harm (, Practice Greenhealth (, and the Center for Health Design ( —have partnered with HHI to provide expertise and technical assistance in developing programs to address and implement HHI Agenda recommendations. Among the recommendations that directly address healthcare facility design and construction are:

Core goal: Improve environmental health and patient safety.
General recommendation: Design and operate healthier and safer facilities for patients and employees.
Specific initiatives for participating organizations:
1. Utilize the Green Guide for Health Care ( for design, construction, and operations.
2. Select building materials based on the Pharos Project database.
3. Build all new construction and major renovations to USGBC LEED Silver standard or equivalent.
4. Utilize an evidence-based design process for planning, design, and construction (e.g., Evidence-based Design Accreditation and Certification,, and the Ripple database,

Core goal: Reduce healthcare’s use of natural resources and generation of water.
General recommendation: Reduce the consumption of energy; support the transition to renewable energy sources.
Specific initiatives for participating organizations:
1. Investigate the purchase of clean energy, and if available, plan to purchase at least 5 percent clean energy at the next available opportunity.
2. Investigate production of renewable energy on-site and include generation of renewable energy on all new building plans.
3. Encourage use of public transportation by all staff and/or visitors.
4. Implement EPA Energy Star recommendations on reducing energy consumption by 25 percent.

General recommendation: Conserve water.
Specific initiatives for participating organizations:
1. Eliminate seal and cooling water on medical air compression and vacuum pumps, replace flush valves on toilets and urinals, retrofit water faucets and refrigeration systems.
2. Eliminate the purchase of bottled water except where absolutely necessary.
3. Switch from radiological imaging equipment to digital imaging.

General recommendation: Minimize waste and emissions; decrease or eliminate incineration. Specific initiatives for participating organizations:
1. Implement a comprehensive waste reduction program.
2. Target a 30 percent waste reduction goal or more through reduce, reuse, recycle programs.
3. Implement a regulated medical waste reduction (RMW) plan using proper EMW segregation techniques with the goal of RMW comprising no more than 15 percent of the facility’s total waste.
4. Implement a program to use reprocessed medical equipment.

Core goal: Institutionalize sustainability and safety.
General recommendation: Make sustainability and safety a strategic imperative.
Specific initiatives for participating organizations:
1. Develop and commit to a system-wide sustainability policy.
2. Dedicate staff resources at the executive and corporate and facility levels to address safety and sustainability issues organization-wide.
3. Reflect sustainability in strategic and operating plans and budgets.
4. Develop a task force consisting of representatives of various departments and professions within the organization to help guide and implement safety and sustainability efforts.
5. Have staff members in the facility department be trained in LEED and evidence-based design accreditation and certification.

To access the full Healthier Hospitals Agenda and more information on the Healthier Hospitals Initiative, visit