Stepping outside the hospital, a blast of hot air fills your lungs. The blacktop radiates below as you walk through the parking lot. Rows of cars glitter in the sunlight and you shield your eyes from the intensity. Reaching your vehicle offers no refuge — climbing into the car feels more like climbing into an oven and you hesitate to breathe until the air conditioner whirls to life.
This is far from an isolated experience, as a massive heat wave this summer induced record-setting temperatures from California to Texas to Maine. Triple-digit temps are mainstays in the forecast, and there’s expected to be little relief in the years ahead. Statistically speaking, this is likely the coolest summer we will experience in the foreseeable future.
Such scorching conditions are especially dangerous for those who live in heat islands, urbanized areas that experience higher temperatures than outlying rural areas. Buildings, roads and other infrastructure absorb and re-emit the sun's heat more than natural landscapes, with urban areas — including our community centers and health systems — experiencing temperatures up to 10 degrees Fahrenheit warmer than rural environments. Hotter cities lead to higher electrical demands, which put communities at greater risk of blackouts and brownouts during hot summer days, and by extension, increased risk for heat-related illnesses especially among older adults, young children, low-income communities, and people with chronic cardiovascular and/or respiratory diseases.
While climate change is an undeniably complex problem, health systems can be part of the solution with some relatively simple design considerations that can help reduce the effects of a warming planet, including lessening the heat island effect and reducing carbon emissions.
Passive heating and cooling reduce heat load
When designing a new facility, passive heating and cooling is the most cost-effective strategy for reducing energy consumption. Simply put, passive solar design techniques take advantage of the construction site’s natural landscape. Orienting the building and windows with the sun provides shade in the summer, warmth in the winter and daylight all year. The concepts are easy to implement but require a targeted approach during the early design phase for a new facility.
For existing buildings, an energy audit provides insights into current building performance and areas to improve energy efficiency. The overall energy savings varies depending on the site layout and strategies implemented — passive solar design is often used in combination with other heat-reduction strategies. An experiment conducted by Birla Institute of Technology and Science, India, found that the most aggressive passive solar designs reduced heat load 53.31% in the month of June compared to a building with no applied strategies. Implementing passive solar design keeps buildings cool and reduces overall energy demand, and cooler buildings lead to cooler communities with a reduction of blackouts on even the hottest days.
Green roofs let sustainability take root
Green Roofs decrease temperatures, reduce stormwater runoff and lessen electrical demand and consumption. Green roof temperatures can range 30 to 40 degrees Fahrenheit lower than traditional roofs and can reduce urban air temperatures by 5 degrees Fahrenheit.
There are two categories of green roofs: intensive green roofs and extensive green roofs. Extensive green roofs are simpler, require less maintenance and are more affordable to install. Extensive green roofs are not publicly accessible, but they provide energy benefits to a building and habitat extension for native plant species, bees and migratory birds. Extensive green roofs can be designed to look like a park or natural landscape. The view of a green roof naturally aids in healing, and research shows that patient outcomes improve when their room overlooks a green space in comparison to patients with an industrial view similar to a traditional roof. Intensive green roofs, which typically resemble a conventional park or garden, tend to be more complex and require more structural support. They are accessible to patients, providers, and all visitors. Intensive green roofs offer a sanctuary and shade on hot days. St. Louis Children’s Hospital installed a green roof, which allowed their young patients to have limited access to experiences like going to a park. This example of green roofing gives kids an accessible, safe place to play between receiving care.
Landscape architecture and design are complements to green roofing
Native trees and vegetation provide shade and cooling through evapotranspiration, the process through which plants exhale water and fresh oxygen. Shaded surfaces range from 20 to 45 degrees Fahrenheit cooler than unshaded materials. Mercy Hospital developed a cohesive campus artwork master plan and built vibrant spaces full of life. Mercy designed their healing garden around a reflection pool and sculpture that mirrors the life and work of patients and providers. Water features are the most effective method of reducing high temperatures.
Similarly, Cedars-Sinai Hospital in Los Angeles developed its exterior common areas to generate emotional wellbeing for staff, patients and visitors. The mixed-use spaces include native plant species, water wise landscaping and pedestrian friendly pathways.
An investment worth making
With thoughtful planning, hospitals can contribute to heat-reduction strategies that positively impact the communities they serve. The concepts are simple, but project teams must prioritize and coordinate site-specific solutions. The upfront costs of smart design principles are an investment in building a healthier continuum of care for patients, staff and visitors. After all, the difference between green spaces and the concrete jungle is palpable. Cooler spaces transform healthcare delivery into safer places for the elderly, youth and at-risk populations. As society adjusts to more extreme weather, integrating green spaces will reduce the negative impacts of excessive heat and precipitation. Climate-conscious design principles are central concepts in improving health equity and community health outcomes.
About the author: Annmarie Stauffer brings over 12 years of experience in the healthcare industry to her role as a senior consultant at Vizient. Her areas of expertise include change management, supply chain management, and performance improvement through value analysis and lean process design. She was raised in Utah, and growing up in the high-elevation desert inspired her passion for living in conjunction with and respecting the natural environment. The original Pueblo people of the Southwest design communities to withstand the extreme heat in the summers and the bitter winters. Stauffer remembers visiting Mesa Verde National Park in Colorado and marveling at the ingenious design of the cliff dwellings, one of the greatest examples of passive heating and cooling.