Published on : August 19, 2010

Doing More with Less ~ Methodist West Hospital

Doing More with Less ~ Methodist West Hospital

“Relaxing” and “approachable” are not usually the first words to describe a hospital, but Methodist West Hospital looks nothing like a hospital. The 95-bed, $83 million facility in West Des Moines, Iowa feels more like an upscale hotel. Patients and families enjoy spacious private rooms along with amenities such as a healing garden, cyber café, fine dining, coffee bar, gift shop, common spaces filled with natural light and views of the lake.

Iowa Health, Des Moines’ new environmentally friendly hospital in West Des Moines includes ambulatory/acute care, emergency department, imaging, surgery, birthing center, medical and surgical, as well as an array of other patient and community services. Sustainability is woven throughout the hospital with tremendous outcomes: creating a healthy environment for delivering health care with energy costs that are reduced by 15% and water use lowered by 20%.

Here lies the real beauty ~ Methodist West Hospital does more with less. Iowa’s newest licensed acute care hospital, along with its neighbors, Lakeview Medical Park, Lakeview Ambulatory Surgery, the Iowa Clinic and the Des Moines Orthopedic Surgeons, will draw more than 1 million people to the area for services by 2012. This will be done with minimal environmental impact because sustainable design features are used throughout the site and facility.

This sustainable project began from the ground up, beginning with site selection continuing throughout the design and construction process, according to Sherrilyn Stewart, Director of Design, Construction and Properties Management for Iowa Health-Des Moines. The site design maximizes the amount of green space, and incorporates a lake which is a people-friendly amenity and provides storm water control.

The 49-acre campus includes a healing garden for patients and exterior seating at a café for staff and visitors. Landscaping in and around parking areas create a park-like setting around the hospital. All paved areas are concrete rather than asphalt to reduce the “heat island effect.”

Light fixtures are strategically placed to provide illumination only where necessary without shining light on adjacent properties, into the patient rooms or into the night sky.  Light levels are automatically reduced during low-use times (late at night and early morning).

The LEED Certification point system was used as a guide to develop and evaluate an overall strategy for achieving an environmentally responsible facility. Every decision involving the design, material selection and construction was judged on the value brought to the project and its impact on the environment. Many key initiatives were incorporated relating to site design, energy and recourse utilization, materials and interior environment.

Throughout the project, patient safety was a top priority. Many steps were taken during construction to reduce the risk of infectious hazards including cleaning and sealing of ductwork, dust control, HEPA-filtering and temporary fan units regulated the humidity level during summer construction which eliminated the potential of mold sources.

Energy Reductions of 15%

After schematic design, the building’s structure was changed from a steel frame to cast-in-place concrete. The structural systems include material reuse and replacement of cement with flyash, ground granulated blast-furnace slag and silica fume in concrete mix. This resulted in a significant cost benefit and a structure that is more energy efficient, has less vibration, reduces noise transmission and eliminates air-polluting fireproofing.

The building’s concrete structure provides a thermal storage mass that helps mitigate temperature swings during the day. This reduces the need to accommodate differences between daytime and nighttime temperatures with the heating and cooling systems – thus reducing energy consumption.

High performance glass was specified to maximize the energy efficiency of doors and windows. The exterior walls and roofs are constructed with superior thermal performance characteristics to reduce energy costs for heating and cooling. The entire roof area was designed to reflect heat from sunlight rather than absorb it to reduce the summer air conditioning loads. Combined with the enhanced exterior wall and roof performance, the hospital is expected to see a 15% reduction in energy use.

Individual control of lighting is provided in 90% of the hospital spaces.  Automated lighting controls in halls, lobbies and other non-clinical spaces reduce electricity demands. The system automatically reduces lighting levels during low-use, nighttime hours. Occupancy (motion) sensors in non-patient treatment areas automatically turn lights off when rooms are not being used. Highly efficient light fixtures and bulbs were incorporated, including newly available LED super efficient lighting at select locations.

The heating and cooling systems are designed to maximize the level of fresh outside air that is conditioned and brought into the building. This promotes enhanced indoor air quality creating a healthy interior environment. Mechanical equipment for cooling systems was selected that use no chlorofluorocarbon refrigerants, which are harmful to the Earth’s atmosphere.

Fifty-percent of the interior spaces, including all patient care areas, were provided individual control for air temperature to promote increased comfort and reduced energy consumption. High efficiency boilers are used to create steam and hot water for the building systems and equipment. Energy economizers are used on the chiller systems to efficiently create cold water for use in air conditioning. Premium efficiency fan and pump motors were provided for the heating and cooling systems to conserve electrical energy and high efficiency hot water heaters generate hot water for patient care, kitchen and public use area functions.

Several unique applications were incorporated including a lower temperature heating water system fueled by high efficiency condensing boilers. Even though the condensing style boilers have been around for years, applying them as the primary heating source for a hospital is very unique. In the air distribution systems, the use of “fan wall technology” replaces large single fans with an array of smaller fans. This reduces electrical consumption by allowing for individual small fans to be turned on or off depending on the amount of airflow required. During and following construction, each building system was monitored by a commissioning agent to ensure that the installation was completed in a manner that will provide the necessary performance for comfort and energy use.

Iowa Health-Des Moines received an energy rebate check from MidAmerican Energy for energy conservation strategies. The $115,500 incentive payment is in addition to the annual projected energy savings of $87,395. The sustainable building design recently won a top award from the American Council of Engineering Companies (ACEC)-Iowa.

Water Usage Reduced by 20%

The use of fresh water for irrigation of landscaping and lawns was reduced by 50% with highly efficient systems that incorporate drip application sensors and controls. Some of the campus was planted with drought-resistant, native vegetation that doesn’t need irrigation.

No fresh water is used to cool medical or food service equipment. Low water plumbing fixtures reduce water used by sinks and toilets by 20%. The cooling tower design and closed loop cooling for compressors reduces the use of potable water in the building system equipment.

Construction Waste Reduced by 75%

A fast-track approach to the design and construction involved sequential bid packages that aligned with the progress of the construction. The team delivered the project four months sooner than originally anticipated and reduced the project cost by $5 million. Construction waste was reduced by 75% by collecting and processing recyclable materials such as concrete, steel, paper, plastics, wood and gypsum board.

New Products and Materials Contribute to Sustainable Outcome

Approximately 10% of new products purchased for the construction were manufactured from recycled material, including wood products, gypsum board, concrete, steel, wall protection, floor tile and carpet.

Twenty percent of materials used in the building construction were procured from sources that are regionally available to reduce the cost and energy consumption caused by long distance transportation. These materials included steel, brick and concrete masonry products, stone, fabricated wood products (such as cabinets and casework), concrete and gypsum board.

In addition to local materials, local labor was engaged. Over $37 million was paid to local labor and local contractors providing hundreds of jobs over a two-year period during a recession. The operations of the hospital will continue to drive economic benefits to the local community for years to come.

Minimizing Contaminants

Construction activities were performed implementing controls to prevent environmental air and water pollution by controlling run-off and erosion, and by limiting the creation of dust. Erosion control measures were rigorously maintained and inspected weekly by an independent agency.

Policies were established to minimize latent contaminants that could be captured inside the building. Hidden spaces such as stud wall cavities were thoroughly cleaned prior to being concealed later. Absorptive materials such as carpet and ceiling tiles were installed after materials that initially emit hazardous vapors and fumes were fully cured. To protect the internal ducts that are part of the heating, cooling and ventilation air system, all ducts were continuously sealed during construction. Heating and cooling systems were not used during construction to eliminate the collection of dust and other contaminates.

Adhesive and sealants inside the building were carefully selected to reduce volatile organic compound emissions. Environmentally-friendly paints, stains, sealers and carpet were used for interior finishes. Cabinets and other manufactured wood products were specified not to contain harmful substances such as formaldehyde. Durable and easily maintained materials were selected throughout to increase the life expectancy of the building, reduce future maintenance and replacement costs, reduce the use of new raw materials and reduce future use of land fills.

Toxic substances such as lead, cadmium and mercury were avoided in materials and products such as thermostats, light fixtures and bulbs and solder for pipe joints. This improved the health and safety of construction workers and building users by reducing the toxins in the environment.

Sustainable Operations Today

Iowa Health-Des Moines continues to develop new and innovative sustainable design initiatives to reduce the impact of their day-to-day operations on our environment. Collection facilities and policies encourage ongoing recycling of cans, bottles, cardboard and paper. Food service has instituted a value waste program for food and nutrition. Eco-friendly plates, cups, utensils are used. No trays are used in the dining areas and eco-friendly food storage containers are used in the kitchen, and cooking/frying oils are recycled.

A salvage committee reviews the reuse of old equipment. Surgical instruments and supplies are reprocessed or remanufactured. Reusable sharps containers are throughout the hospital. Florescent lamps, PCBs, electronics and motors are recycled as well.

A campus wide ban on the use of tobacco products is enforced to promote a clean and healthy environment in and around the building.

Energy and water use is monitored continually to ensure that all mechanical and electrical systems and fixtures continue to operate as designed.

Methodist West Hospital achieves a level of sustainable design that is holistic, dealing with the overall well being of the environment, the community and the building occupants. The outcomes achieved at this new hospital will be carefully measured and compared to the typical results of older facilities with traditional layouts.

Tracking of clinical errors and patient falls are expected to illustrate that the design and operational attributes of this hospital do decrease these occurrences and do create a safer environment. A LEAN study comparing a traditional acute care floor with a central nursing station with the decentralized model used at this hospital is being considered. It is anticipated that staff efficiency and improved medical outcomes will be proven by this study. The outcome of these studies is expected to inform future projects throughout all facilities of this health system.

About Iowa Health Des Moines

Iowa Methodist Medical Center, Blank Children's Hospital and Iowa Lutheran Hospital merged in 1993 to form Iowa Health-Des Moines. Methodist West Hospital proudly joined them in October 2009. The $600 million healthcare organization also includes multiple physician organizations and more than 40 primary care physician clinics throughout central Iowa. Iowa Health-Des Moines is an affiliate of Iowa Health System, the state's first and largest integrated healthcare system. Iowa Health-Des Moines' mission is "to improve the health of our communities through healing, caring and teaching."

About the Author

Gary Van Dyke, LEED AP, is a healthcare designer for Shive-Hattery in West Des Moines, Iowa. He served on the architectural design team for the Methodist West Hospital. Shive-Hattery is an architectural and engineering firm focused on “Creating Healing Environments.” The 275-person firm provides a full range of architectural, engineering and planning services allowing for a single source of solutions. Shive-Hattery is ranked 28th in Building Design & Construction magazine’s list of top design firms and 277 in Engineering News Record. For more information, visit www.shive-hattery.com