with green principles, offer a positive vision of sustainable, health-promoting healthcare settings.

In fact, in creating a vision that resonates with health professionals and leaders, “framing” the concept of healthcare facility design for public and environmental well-being is critical. Characteristics of such framing include:

  • Aspirational: Green healthcare facilities aim not only to avoid harm, but also to enhance well-being and to restore the environment.

  • Economical: Green healthcare facilities provide value and save money.

  • Prudent: Green health care reduces future risks, such as those related to energy price shocks, building-related health problems, and building obsolescence.

  • Long-term: Some benefits of green buildings emerge over years, or even over the entire life span of a building.

  • Contextual: Green buildings yield benefits not only within their own walls, but also in the context of the community or even the national or global arena.

A constant theme of the workshop was complexity. Designing, constructing, and operating buildings require careful balancing of a vast array of variables. Careful analysis using systems thinking is essential. Craig Zimring of the Georgia Institute of Technology, during his presentation, warned of the “fallacy of generalized goodness”; not all green decisions are all good. For example, although wide hallways, large rooms, and oversize windows that provide natural daylighting may create pleasant environments for staff and patients, they may also increase energy demand and costs. The presence of plants may pose challenges for infection control. Thoughtful analysis, supported by empirical data and a culture of continuous improvement, is necessary.

Green healthcare principles can be implemented on many scales, from physicians’ offices, clinics, and community hospitals to vast medical centers that occupy several city blocks. At the workshop, most discussion focused on large hospitals and academic medical centers, not only because these are the venues in which many Institute of Medicine (IOM) members work, but also because data are most plentiful from such settings. Moreover, large institutions offer strategic advantages: health science students are trained there, so effective green healthcare principles can be modeled and disseminated. Also, many large institutions are currently undertaking building programs, offering opportunities for far-reaching impact. Even so, participants noted that there is an important role for environmentally friendly practices at every level of the healthcare system.

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