About the Green Guide for Health Care™

The Green Guide for Health Care is a superb resource. It helps the leaders and managers of health care institutions "walk the talk," promoting the health of patients, visitors, employees, community members, and the global community, while operating economically and efficiently. I hope that every medical center, hospital, and clinic in the nation gets a copy of the Green Guide, takes its lessons to heart, and joins the growing movement toward healthier, more environmentally friendly environments in the health care sector.

Howard Frumkin, M.D., Dr.P.H., FACP, FACOEM
Director
National Center for Environmental Health/
Agency for Toxic Substances and Disease Registry
United States Department of Health and
Human Services Centers for Disease Control and Prevention
Objectives

Welcome to Green Guide for Health Care™, the healthcare sector’s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. This Guide provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments. Health care facilities present both a challenge and opportunity in the development and implementation of sustainable design, construction and operations practices. Issues such as 24/7 operations, energy and water use intensity, chemical use, infection control requirements and formidable regulatory requirements can pose significant obstacles to the implementation of currently accepted sustainability protocols. Furthermore, it is appropriate that guidelines customized for the health care sector reflect the collective fundamental mission to protect and enhance individual and community health, and that those guidelines acknowledge the intrinsic relationship between the built environment and ecological health. As health care institutions evolve a design language for high performance healing environments, they have the opportunity to highlight the associated health-based benefits. This in turn can inspire the broader adoption of health-based design principles in other building sectors. This document is neither intended to establish regulatory requirements, nor to be viewed as a minimum standard for design, construction or operations. Rather it is designed to serve as a voluntary educational guide for early adopters of sustainable design, construction, and operations practices, to encourage continuous improvement in the health care sector, and to provide market signals to catalyze a richer palette of strategies for those who follow the early adopters. As the general level of green building practice rises, it is anticipated that the Green Guide will be updated to encourage continued leadership and higher levels of rigor associated with creating high performance healing environments.

Updates and Information

This document is available for download at www.gghc.org.

This is an evolving document that has been updated in response to new information and guidance gleaned from the Pilot program and from other evolving green building best practices. If you did not download this document from the Green Guide website, it is important that you register at www.gghc.org to ensure that you will be notified of updates as this document progresses.
Please contact info@gghc.org for further information about document use and opportunities to support it.

Using this Guide

Applicable Building Types

While an array of building types are represented in the health care sector, the Green Guide for Health Care is specifically customized for buildings that are predominately institutional occupancies as defined by the local building code, such as acute care hospitals, where regulatory requirements have created particular needs. Medical office buildings, clinics and other buildings where health care concerns are dominant can also use the Green Guide. Recognizing the full-range of construction, operations and maintenance activities associated with the health care sector, the Green Guide applies to new freestanding facilities, additions to existing facilities coupled with renovation, extensive rehabilitation/adaptive reuse projects, and existing facilities for which the Operations section can be used as a stand-alone best practices guide.

Credit Structure

The Green Guide for Health Care borrows the credit numbering scheme and credit outline structure of the U.S. Green Building Council (USGBC) LEED® family of products, by agreement, with some modifications. Each credit has the following elements:

  • Intent – Summarizes the goal of the credit.
  • Health Issues – (new to the Green Guide) identifies specific health concerns addressed by the credit. Reviewed by Dr. Ted Schettler, M.D., MPH
  • Credit Goals – itemizes the specific steps to achieve the credit including threshold goals.
  • Suggested Documentation – suggests documentation to monitor and baseline performance and to benchmark achievement of the Credit Goals. The Green Guide is a voluntary self-certifying document that does not offer third party certification. Users of the Green Guide are encouraged to establish internal record keeping and tracking systems to support ongoing monitoring and continuous improvement. Note that while the suggested documentation requirements in Green Guide for Health Care: Construction can be completed by the end of construction, some of the strategies in the Operations section require collection of up to a year’s data to determine credit achievement. Furthermore, while these operational data requirements are especially geared for existing facilities, they are also intended to serve as useful references for new construction projects as they establish operations policies and ongoing operational protocols. In addition, the Suggested Documentation will help those teams interested in pursuing eventual LEED certification, as being an approximation what might be documents required by the LEED document.
  • Reference Standards – Identify the standards and documents that establish the basis of the credit requirements.
  • Potential Technologies & Strategies – Suggest helpful information to support the credit Intent and Credit Goals. Regional considerations and project specific performance needs, goals and other constraints are important factors to consider. Products and materials referenced in the Potential Technologies & Strategies section do not represent an endorsement but are suggestions for consideration in some applications.
  • Resources – Cites selected information sources associated with the credit Intent, Credit Goals, and Potential Technologies & Strategies.
Points & Achievement Levels

The Green Guide for Health Care is a self-certifying, best practices toolkit; as such, it does not provide achievement level threshold rankings. The point system provides design and construction teams a way to baseline and benchmark their achievement and to support continuous improvement.

Existing facilities are encouraged to track their ongoing performance using the Operations section, while making a commitment to utilize the Construction section on future projects.

Construction projects are encouraged to identify the operations-related credits that they intend to achieve and establish commitments to these O&M goals through policy setting. Note that construction projects are unable to attain all of the points in the Operations section, as some credits require a year’s worth of data to achieve credit goals.

Integrating Operations

Operations and maintenance protocols are critical to maintaining the health and environmental profile of health care facilities. As a result, using better, more health-promoting practices will benefit existing facilities and should also be considered during the design of new projects. Acknowledging this relationship, the Green Guide for Health Care has developed specific credits related to operations and maintenance These represent a critical component of a sustainable design, continuous improvement program. Given the critical relationship between operations, building program and design, design teams are strongly encouraged to collaborate with facility staff early in the design process to establish commitments to sustainable operations policies included in the Operations section, and evaluate the impact of these protocols, during programming and design to ensure their integration.

Relationship to LEED® Products

The Green Guide for Health Care has been informed by a number of important guidance documents that have preceded it. See the Reference Documents section of this website for access to these key documents. The Green Guide’s organizational structure is borrowed by agreement from the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED®) Green Building Rating System. The Green Guide is not a LEED® Rating System and not a product of the U.S. Green Building Council. The LEED structure was adopted because it is a familiar and effective method used by a rapidly growing sector of the building design, construction, operations and maintenance industries. For many credits, the Green Guide directly incorporates the language of a parallel LEED credit, referencing credits in the LEED systems for New Construction, Existing Buildings and Commercial Interiors. In some cases, existing LEED credits have been modified to respond to the unique needs and concerns of health care facilities. In others, new credits have been added beyond those in current LEED products. The Green Guide’s Credit Summary identifies its relationship to LEED® credits. Although the Green Guide is a voluntary, self-certifying best practices guide to support teams in incorporating sustainable elements into their projects, the Green Guide can be used to facilitate teams pursuing LEED certification:

(1) Consider pursuing all the “prerequisites” and as many “credits” as are aligned with the project’s guiding principles and goals.

(2) Consider following the “Suggested Documentation” associated with each prerequisite and credit. For projects using the Green Guide, documentation is not required, but is helpful to baseline and benchmark project performance, and to support continuous improvement. Because the “Suggested Documentation” approximates documentation requirements for LEED certification, it is recommended for projects contemplating eventual certification under LEED for Healthcare, anticipated for release in late 2007.

Development History

The initiation of health care focused sustainable design tools began with the Green Healthcare Construction Guidance Statement published by the American Society for Healthcare Engineering (ASHE) in January 2002, representing the first sustainable design guidance document to emphasize a health-based approach. The Green Guide for Health Care development initiative began in March 2003 with a professionally and geographically diverse group of green health care industry leaders convened as an independent Steering Committee to guide the document development (see the Steering Committee list on the Contributors page). Working Groups for each section of the document drafted credit language that was reviewed and approved by the Steering Committee as a whole. In December 2003, Version 1.0 of the Green Guidelines for Healthcare Construction was released in draft form for public comment. More than 900 registrants downloaded the document during the public comment period from organizations representing a broad range of architectural, engineering, construction, health care, and manufacturing firms and industry associations. Between December 2003 and the close of the comment period on February 29, 2004, more than 1,200 public comments were received. A partial listing of those who submitted comments is included on the Public Comment page. The Steering Committee reviewed all public comments prior to the drafting of Version 2.0. In November 2004, Version 2.0 of the Green Guide for Health Care was released for general use in the Pilot phase. Version 2.1, released in September 2005, included a substantial update to the Operations section of the document and minor revisions to the Construction section, covering copy and editorial changes.

Green Guide for Health Care Pilot Program

The Green Guide Pilot program, launched in November 2004 with the release of Version 2.0, provided the opportunity for the Green Guide to collaborate with a cross-section of leading health care institutions in an active development process. The Pilot’s internal list-serve, online project management tools, and personal contact with the Pilot Coordinator generated sustained communications between the Pilot projects and the Green Guide, resulting in several revised credits in the Construction section of Green Guide for Health Care Version 2.1, released in September 2005.

Over the course of two years, the Green Guide Pilot program generated a wide-ranging set of comments and suggestions to improve and enhance Version 2.2. Overall, the program encompassed 115 pilot projects representing 30 million square feet of construction in the U.S. and abroad – an increase of 45% over 2005. Pilot projects range in size, building type, building phase, and region, demonstrating the Green Guide’s versatility as an effective tool for many building types and project phases.

Green Guide for Health Care Version 2.2

The release of the Green Guide Version 2.2 in January 2007 marked a transition from the Pilot program into a full-fledged registration and self-certification program. In this context, the Green Guide continues to work closely with project teams to gather case studies and to promote research into innovative design strategies and technologies.

The third release since its inception in December 2003, Version 2.2 is the most significant revision of the Construction section to date, reflecting substantial feedback from Green Guide pilot projects, market trends including aligning, as appropriate, with LEED® for New Construction Version 2.2, and steering committee input. Green Guide Version 2.2 also incorporates several clarifying changes to the Operations section.

Decision Making Process

The Green Guide for Health Care committee process is structured to include representation from a wide range of stakeholders and interests to ensure consistency and rigor in the document’s development. Steering Committee membership, however, precludes organizations with direct financial interests in the products or certification services addressed by the document. Furthermore, this document is intended to be a best practices guide, not a basis for industry code or regulatory standard. For these reasons, the document is not intended to meet the legal definition of an industry “consensus based” standard.

Levels of Support

The Green Guide for Health Care welcomes support of its continued efforts through several options: Supporters, Partners, and Endorsers. Supporters, Partners and Endorsers affirm the intent and principles of the document (see the ASHE Green Healthcare Construction Guidance Statement – Statement of Principles) while not expressly endorsing every strategy or credit.

Sponsors provide a $10,000 minimum donation for a one-year sponsorship. Sponsors’ logos are displayed on the Green Guide website home page, on the title page of the Green Guide, and in the Supporters section of the document and the Green Guide website. The Supporters section listing includes a brief one sentence description of the Sponsor.

Partners provide a $5,000 minimum donation or equivalent in-kind contribution for a one-year partnership. In-kind contributions include organizational support for an active Steering Committee member or other significant contributor to the Guide. Partners are listed in the Partners section of the document and the website and may, at their option, have their logo displayed on the Partners page of the Green Guide web site.

Sponsor and Partner status is open to the following organization types, subject to Steering Committee approval:

  • Non-Profit Organizations
  • Professional Associations
  • Private Foundations
  • Government Agencies
  • Health Care Organizations/ Hospital Systems
  • Design and Construction Firms
  • All other organizations except manufacturers and their trade associations and product certifiers

    • To avoid potential conflicts of interest, the Green Guide Steering Committee has determined that manufacturers, their trade associations and product certifiers are ineligible for Sponsor or Partner status. All organizations and companies are welcome to support the Green Guide as Endorsers.

    Endorsers agree to support the principles of the Green Guide and indicate their intent to use and promote the Green Guide. No direct financial or in-kind commitment is required to sign on as an Endorser. Endorsers are listed in the Supporters section of the document and on the Green Guide website, which will be periodically updated.

    Donations to support the work of the Green Guide are tax deductible to the fullest extent of the law.
    Contact info@gghc.org for further information about opportunities to support the Green Guide for Health Care.

    Product Endorsement

    The Green Guide for Health Care does not endorse products nor does it recommend for or against the purchase of specific products. In some instances, the Green Guide references product types that may be useful to address credit goals, considering price competitiveness, regulatory requirements, performance standards, and environmental/health impacts.

    Release for Public Use

    The Green Guide for Health Care™ (Green Guide) is released for public use in PDF format. All replication in whole or in part must reference the Green Guide and include the limitations on its use described herein. The Green Guide is an open source document that is provided at no charge for use by the health care design, construction, and facilities management communities. Material contained within the Green Guide may not be used by or as part of a for-profit enterprise (for sale or as a component of an educational program) in which attendees are charged fees without the express permission of the Green Guide for Health Care Steering Committee.

    Contact

    Please contact info@gghc.org for further information about document use or sponsorship opportunities.