Evaluating ROI For Sustainability In Healthcare Interiors

Even though individuals have been working on sustainability in healthcare for many years, only now has it really begun to go mainstream, says Janet Brown, director of facility engagement with Practice Greenhealth. But the hospitals that are now moving into sustainability are starting off with the low hanging fruit: recycling and energy efficiency. Moving into the fabric, finishes, and furnishings is still in the early stages, she says.

One area where pursuing sustainability in healthcare interiors can be particularly challenging is in the discussion surrounding return on investment.

Some products, like low VOC paints, have come to the point where they don't carry a significant premium. But in areas where there is a premium, there isn't an easily calculable ROI to sway top management. Take case goods, for example. Hospitals install lots and lots of case goods and in their projects, Gresham, Smith and Partners often tries to use FSC-certified wood in its case-goods specs, says Greg Gore, principal. (The firm recently designed Porter Regional Hospital in Valparaiso, Ind., which earned two Green Globes.) But that can get pretty pricey and, most of the time, it gets written out. "The sustainability portion of interiors, for good or bad, doesn't dramatically impact the [owner's] bottom line, so it's one often disregarded," Gore says.

One tool that would help sell sustainable interiors strategies to upper management would be data linking design choices to patient outcomes, but it just isn't readily available, or simply doesn't exist at all. Yet.

"The bigger issue is that no one is validating," says Debra Harris, RAD Consultants president and fellow of the Center for Health Systems and Design, Texas A&M University. "People are not testing their design solutions." Whereas corporate real estate has figured out how to make sustainability profitable, healthcare still has a ways to go to figure that out, she says. To address this, third parties such as her are running long-term life cycle cost analysis on interior design and its impact on healthcare workers, for example. The idea is to understand how these decisions play out in a financial scenario, so when the next hospital in a system is built, they know where to invest money to get the desired outcomes.

Let's say a healthcare system wants a sustainable hospital interior that will reduce lower back injuries in nurses, reduce hospital-acquired infections in patients, and reduce falls. "Those are three financially measurable outcomes that have real impact on individuals," Harris says. "If you can say, 'We're designing for these things and it's costing us this amount of money,' you can figure out the dollar figure of cost avoidance tied to those measures." All it takes is extrapolating that information and building a framework for measuring it, she says. Easier said than done, but not impossible.

We're not to the point in healthcare yet where a hospital can say it's sustainable and expect that fact to attract patients, says Jane Skelton, lead interior designer in the Nashville healthcare studio for Gresham, Smith and Partners. But "evidence-based design is making strides in measuring the impact of what we put in the [interior] environment and how it impacts people's stay in that space," Skelton says. "We're developing a bank of knowledge on that, but it's still in the early stages."

Beyond Dollars

Another layer in the sustainability conversation is that healthcare facility managers are beholden to more than just profitability. "When we talk about cost savings, often that is a foot in the door to engage leadership in doing something differently," says Brown. "That doesn't mean it's the only driver. Of course we're looking at population health and quality and safety and risk as well. When hospitals frame these changes, yes, cost comes into play. But so do these other attributes."

While the explosion on the market of products touting their sustainable attributes makes for a bit of work to separate the hype from the fact, it doesn't mean all sustainable products are simply selling spin.

"There are a lot of good quality products that genuinely try to advance the interest of sustainability," says Gore. "Don't replace in kind just because it's the easy thing to do."

Even when using a framework like LEED, the individual product selection is not prescriptive, so facility managers have to first sit down and think about what would be an ideal match for their facility and then do the research to find it. Odds are, the product is out there.

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