High-Performing Places

The Evolution of Regenerative Design in Healthcare



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The evolution of regenerative design in healthcare is in response to the growing understanding of the interconnectedness between the built environment, human health, and the broader ecosystem. Healthcare buildings are among the largest consumers of natural resources and contributors to pollution due to their constant operational demands and specialized equipment. Consequently, designing these facilities to surpass conventional green design and sustainability standards becomes crucial.

The term "green architecture" emerged in the 1960s and 1970s alongside the modern environmental movement, driven by concerns about pollution, dwindling resources, and urban sprawl. The energy crisis of the 1970s underscored the importance of energy-efficient design, leading to the rise of passive solar design, an approach using building orientation, solar gain, and natural ventilation to regulate indoor temperatures naturally. The green building movement gained further momentum in the 1980s with the origin of organizations such as the U.S. Green Building Council (USGBC).

The overarching objective of green architecture is to create buildings that have minimal adverse effects on the natural environment. The concept transcends conventional practices by prioritizing the reduction, recycling, and reuse of resources. In response to environmental concerns, healthcare facilities began incorporating energy-efficient systems and green materials to reduce their ecological footprint.

The early 2000s marked the progression to sustainable design with the Leadership in Energy and Environmental Design (LEED) certification system established by the U.S. Green Building Council (USGBC). LEED provided a standardized framework for evaluating and promoting sustainable building practices. These design principles became increasingly integrated into building codes, regulations, and industry standards. Technological advancements in building materials, construction techniques, and renewable energy systems have further propelled the evolution of green architecture. Building Information Modeling (BIM) and advanced simulations have enabled architects to design and analyze the environmental performance of buildings more accurately.

During this era, healthcare design started focusing on patient-centered care, aiming to create healing environments that integrated well-being’s physical, mental, and emotional aspects to improve patient outcomes and experiences. Strategies like natural light, calming colors, water features, and access to nature became integral to design. The importance of outdoor spaces and healing gardens also gained prominence, providing patients, families, and staff opportunities for respite.

With sustainable design, the architecture community has seen a push toward net-zero energy buildings – structures that generate as much energy as they consume. Net-zero energy buildings (NZEBs) significantly reduce environmental impacts by minimizing energy consumption, decreasing greenhouse gas emissions, promoting renewable energy adoption, and serving as sustainable design and construction models.

According to the U.S. Environmental Protection Agency, buildings contribute up to 40% of carbon emissions, and healthcare buildings make up 10% of this, resulting in 539 million tons of greenhouse emissions in the United States. Given this statistic, the trend to design for net positive results, also known as regenerative design, has become increasingly prominent.  

Regenerative design is an approach to design and problem-solving that goes beyond sustainability and aims to create systems that actively improve the environment and enhance ecosystems. The goal of regenerative design is to create built environments and products that contribute positively to the planet's natural systems by restoring, renewing, and replenishing resources, promoting ecological health and resilience, enhancing community well-being, and fostering a harmonious relationship between people and nature.  The current trend also emphasizes community engagement, ensuring healthcare facilities serve as community assets. Designs are resilient, considering future challenges such as climate change and public health crises.

This architectural design concept originates from the Cradle-to-Cradle Certification program, which encourages innovation in product design and manufacturing, aiming to create products that have a net positive impact on the environment and society. It takes a holistic approach by evaluating products based on the five key criteria of material health, material reutilization, renewable energy and carbon management, water stewardship, and social fairness.

It is important to note that sustainable practices integrate into the more holistic regenerative design process. Regenerative design goes further by actively creating positive benefits for society and the environment beyond sustainability.

Case Study – Weed Army Community Hospital

RLF designers have made a concerted effort to create regenerative design in healthcare projects. One example is the 216,399-square-foot Weed Army Community Hospital (WACH) at Fort Irwin, California. The project was designed to be net-zero and carbon-neutral and is the Department of Defenses’ first LEED Platinum hospital, a significant milestone for DoD healthcare. The resilient campus can be self-sufficient for four days.

Designed to be a "medical oasis within a desert landscape," the facility's architecture draws inspiration from the adjacent cantilevered rock formations. This influence is translated into the design using precast panels and glazing, carefully emulating the visual allure of water reflections.

The facility is a single structure divided into two distinct sections: one for inpatient care and the other for outpatient services. Spanning three floors, it encompasses an array of features, including 15 inpatient beds, a well-equipped emergency department with nine treatment rooms, and a dedicated trauma room. The pharmacy incorporates cutting-edge automation for increased operational efficiency. In addition, the facility houses a laboratory, orthopedics department, primary care services, radiology, women's health, optometry, physical therapy, medical and surgical wards, and behavioral health services. The hospital's strategic positioning to the north provides panoramic vistas of the Mojave Desert Wildlands and the Tiefort Mountains from patient rooms, enhancing the healing environment.

The clinic comprises two wings with a total of 55 exam rooms. The design prioritizes flexibility and adaptability to accommodate evolving healthcare requirements and technological advancements. Notably, the layout allows for a 40% expansion, prolonging the facility's lifespan and minimizing the need for extensive future renovations.

By employing an integrated green charrette, the design team followed a five-step process to identify and incorporate passive conservation strategies and active measures. These strategies align with the principles of regenerative architecture, going beyond mere sustainability, aiming to restore ecosystems, promote energy efficiency, and actively contribute to improving and restoring the environment and the community.

The hospital adopts a holistic strategy for energy efficiency, integrating passive techniques and renewable energy systems to meet its complete energy needs. The lower level of the horseshoe-shaped building is seamlessly merged with the mountainside, utilizing natural insulation. This arrangement guarantees that around 90% of occupied areas benefit from abundant daylight through clerestory windows, translucent wall systems, and skylights. To enhance insulation, the roof, walls, and floors are additionally insulated, and precast overhangs offer shading, aiding in cooling the entire building.

The design separates functions necessitating continuous operation and higher energy consumption from less-intensive functions. This division reduces power demands and permits nighttime shutdowns. A solar water heating system meets 65% of domestic hot water needs, supported by high-efficiency condensing boilers and water heaters. The HVAC systems incorporate variable frequency drives for enhanced efficiency, and occupancy controls are implemented throughout the facility to conserve energy in unoccupied spaces.

Through these conservation strategies, overall energy consumption is reduced by 33.2%, leading to a decrease in total greenhouse gas emissions by 3,925 metric tons annually compared to the baseline. The hospital achieved a remarkable Platinum rating by earning 82 out of 110 possible LEED points, surpassing the Silver threshold without incurring additional costs to the Government. Introducing renewable energy systems is projected to reduce Fort Irwin's overall energy expenses by approximately $700,000.

The design employs active, regenerative measures resulting in a net-positive impact on the project, the environment, and the community. A fixed-panel photovoltaic array field produces an impressive 2.5 gigawatts (GW) of solar power to serve the hospital. This solar array can generate more electricity than the hospital requires, enabling the surplus energy to feed back into the post's electrical grid. This excess energy contribution aids the post in diminishing its overall dependence on the external electrical utility.

The initiative to collect water from the facility's cooling systems and repurpose it for irrigating native plantings across the site highlights the commitment to water conservation. These thoughtfully chosen plantings enhance biodiversity and create therapeutic surroundings that contribute to the healing experience for both patients and staff members.

Furthermore, the newly established WACH serves as a vital emergency shelter for the surrounding community. The design allows full operation independently for up to four days. It has redundant power sources, a substantial 550,000-gallon water reserve storage tank, and an underground sewage storage capacity of 475,000 gallons.

The meticulous integration of regenerative strategies throughout the design and construction of Weed Army Community Hospital showcases a commitment to creating a space beyond sustainability. The holistic integration of regenerative principles, innovative energy-efficient strategies, and community-focused design makes the hospital a beacon of sustainability, resiliency, and healing amid the Mojave Desert. This project not only showcases the potential of architecture to impact the environment and community positively but also sets a remarkable precedent for future healthcare facilities.