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ca 2012, 2, 187-195

Hospitals Adaption to Principles of Sustainable Architecture

(Case study in 10 hospitals)
Niousha Behmanesh Rad1, Behnam Ghasemzadeh*2, S. Majid Mofidi 3, Kasra Rahbaripour 4, and Masoumeh
Yavari Kolour 5
1
Master Student, Department of Art and Architecture, Tabriz Branch, Islamic Azad University, Tabriz, Iran
2&4&5
Master Student, Young Researchers Club, Tabriz Branch, Islamic Azad University, Tabriz, Iran
3
Assistant Professor, Department of Architecture & Urban Studies, University of Science and Technology, Tehran,
Iran
*Corresponding Author: [email protected]

doi:10.5618/arch.2012.v1.n2.9 || Received: 18-09-2012, Accepted: 23-10-2012, Available online: 06-11-2012

Abstract 1. Introduction
Architectural designs in hospitals have evolved over A hospital is an institution where both in and out
time and this is in relation to innovation in medicine. patients receive medical care at all levels and are even
The study sought to understand the issues admitted when the need to do so arises. They are a very
surrounding sustainability and the architecture important part of the health care provision in any
chosen. Hospitals have been associated with country. The evolution of hospitals, medicine and the
tremendous consumption of the natural resources. services they provide has led to the need of better
Production of waste is also as high though planned structures. This has also been aggravated by the
management of the waste may not be up to par from increased demand for health care services. More people
an environmentalist’s perspective. The architecture’s have realized that the hospitals should not only be
concern for the environment‘s sustainability is also attended at the terminal stages of diseases but right from
probed in the study. This raises the worries the diagnosis [1].
regarding what hospitals can do while choosing the The hospital’s architectural designs have been
designs so as to reduce the consumption to developing over time as more innovations are being
reasonable levels and at the same time conserve the made in the medical section. As the medics discovered
environment. The study also set out to establish the more about diagnosis of diseases, anaesthesia and
attitudes of hospitals towards sustainability and the controlling the spread of information, surgery
efforts being made to achieve this. It was conducted procedures and equipments as well as facilities were
in 10 hospitals in Hawaii and California states. The also going through an enormous transformation. Issues
study used interviews and qualitative design to regarding the environment began to be of more
analyse the results specifically constant comparison. importance as hospitals chose their architectural designs
It has come to a conclusion that the architecture by the end of the 19th century. Environmental issues
affects the sustainability of the environment as the such as use of natural instead of artificial lighting in the
findings suggest. It also found out that hospitals are surgery rooms became more important thus considerable.
embracing some of the new architectural aspects that The hospital’s floors that admitted inpatients were also
consume fewer resources and maximize the designed in a way that would prevent cross
utilization of the other unlimited resources such as contamination. Response to the various medical needs
air and light in carrying out the daily activities. This of patients was also put into great consideration. This
is clear as more hospitals are ready to go green meant choosing a design that would readily provide
especially under the guidance of LEED. The access at all times to the various departments [2].
hospitals’ attitudes towards sustainability are
positive as it benefits them. Most have taken this up By the 20th century, the healthcare section had
to save on costs of running the hospitals. experienced more medical innovations. This meant they
had to do away with some of those used in the past.
Natural ventilation is one of those aspects that had to be
Keywords: sustainable architecture, Hospitals, Hawaii dismissed. Hospitals needed to expand their facilities
state, California state, environment
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more so as to accommodate out patients. The It includes buildings and other man made facilities and
introduction of elevators also caused a major change in infrastructure. Often, man relies heavily upon the natural
the architectural designs of hospitals especially in the environment and the same environment relies on man to
cities. This was back in the year 1889. Hospitals could preserve and maintain it. The environment is at times
now take up a vertical dimension since space was negatively affected by external elements known as
limited in the cities to expand facilities from the ground. pollutants. The negative effect is referred to as pollution
Technology was the most influential factor in hospital [5].
architectural designs. The rate at with more innovations Most architects have not been able to design such
were being made was challenging to match up in terms buildings especially hospital buildings despite their
of infrastructural development [2]. Flexibility should be great knowledge. This poses a great risk to the
considered when designing hospital buildings. Adopting environment as a whole as adverse effects can be felt. To
loose fit designs that can easily adapt to activity change be able to do so, understanding the main principles of
is a good idea [3]. The shift from tight fit architectural sustainability is first and foremost step. This
designs to the loose fit designs is meant to increase the understanding should be followed by analyzing the
hospital’s buildings to change while ensuring main present designs and identify one that exhibits more of
hospital services are not being interrupted. the principles. From there, improving such a design
1.1 Background statement. Hospitals are great energy would be the next step to meet a larger percentage of the
consumers since some of the facilities have to be kept principles effectively and practically [3].
running for 24 hours. These include air conditioning, 1.2 Problem statement & importance of research.
lighting, life support machines among others. The Architectural designs adopted by most hospitals tend to
amount of toxins and waste released into the have adverse effects on the environment due to natural
environment daily are enormous in quantity. The amount resource consumption and waste production as well as
of natural resources injected into the construction of its management. This is because sustainability has not
these hospitals is also very great [4]. When choosing a been addressed by most architects despite the fact that it
hospital design, the environmental effect is one of the has got its principles well laid out. The waste in form of
many factors put to consideration. Other factors include water and solid produced by the hospitals all over the
the economical value, flexibility to adapt to change, world daily is of great concern with regards to the
effect on the community and its ability to function as environment. The energy consumed in the hospitals as
expected [1]. they carry out even the most basic functions is also a lot.
According to Rassia & Pardalos [3], for a hospital’s The natural resources that are used when constructing
architectural design to be sustainable or rather meet the hospitals are a lot too. This consumption of these natural
sustainability standards; it has to be able to meet the resources may not be as much compared to the amount
present needs without jeopardizing its ability to meet the of waste released and the harm this could have on the
future needs. There are various ways in which environment if not well managed.
architectural buildings can be sustainable. These include The importance of this study is to explore the effects
efficient use of the water resource, proper waste that architectural designs have on the environment. This
management, ensuring the health of occupants is taken will lead to development of knowledge regarding
care of, employing energy saving strategies, avoiding sustainability in architectural designs chosen by
environmentally degrading activities and reducing hospitals. The knowledge developed shall add onto what
incidences of pollution of the environment. It is is already present. The knowledge shall then be used by
important to note that environs of the sustainability kind academicians and other researchers. It shall also be used
improve the healing process in the context of hospitals. by the hospitals especially those that shall be featured in
De [5] has defined the environment as all the the research to improve their sustainability efforts. The
conditions that have an affect the development of any knowledge shall also enlighten all readers and most
living organisms. The major components of the especially the architects on sustainability issues with
environment are the biological and non-biological regards to architectural designs.
aspects. The biological aspect includes flora and fauna. 1.3 Task statement. This is a study of the hospitals
Non biological aspect of the environment includes the adaptability to sustainable architecture. In other words,
atmosphere, lithosphere and hydrosphere. The the study will focus on the efforts made by hospitals to
environment can also be categorized into two types; sustain the environment through the architectural
natural and built environment. The natural environment designs they choose. The study shall be presented in
is made up of the biological and non biological elements written form totalling to ten pages. The study will
of the environment. The built environment is manmade. majorly depend on books for sources as well as credible
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ISI papers within 2005-2012. It shall include a architecture in relation to sustainability in hospitals. The
description of the topic, a statement of the questions to study shall also highlight the various challenges faced
be answered and a detailed discussion of the findings in by the hospitals trying to incorporate sustainability in
regards to the topic of study. their designs. The attitudes towards this topic shall also
1.4 Forecasting statement. The findings of this study be discussed.
are expected to bring about a better understanding of
sustainability in relation to architecture. This includes 3. Research Questions.
the importance as well as the process of achieving 1. Which of these architectural aspects are sensitive to
sustainability. The knowledge shall be used to improve the environment in terms of sustaining it?
the already established hospitals in sustaining their
environment and also the upcoming hospitals in 2. What are hospitals doing to better preserve their
adopting the new propositions of sustainable environment?
architecture. 3. What are some of the challenges in trying to use
environmentally sustainable architecture?
2. Research objectives. Most researchers have not done a lot of research with
1. Establish the hospitals’ attitudes towards regards to this study. From the studies reviewed the
sustainability of the environment. impact of the architectural designs on the sustainability
efforts has not been discussed in detail. This means that
2. Investigate the efforts made to achieve the building designs have not been focused on in the
environmental sustainability. studies. Other architectural aspects such as landscaping,
3. Examine the challenges faced in achieving building materials, spacing, and ventilation have been
sustainability in architectural aspects. considered. The efforts being made by hospitals to
2.1 Focus issues. The focus issues of the study shall be achieve sustainability have been delved into.

4. Literature Review (Table 1)

Time Writer Title of the research work Resource Research Results

model

2012 Janet B. Leading Communities To a Health care Design General Going green is one of the strategies
Healthier Future hospitals are using to cut costs.

2011 Andersson J. E. 'Touching up' Communal Space Journal of Housing General A well planned interior décor and
of a Residential Home Setting: for the Elderly environmentally friendly floorings
A Comparative Study of Tools and paints too can reduce the
for Assessing Changes in the maintenance needs such as waxing
Interior Architectural Space. of floors and so on.

2010 Hill B. International Architectural Healthcare Design General The financial challenges and lack of
Showcase enough reimbursements may cause
them to reduce their green activities.

2010 Damon Barda Breaking Ground Environmental General It is clear that sustainability efforts
Design and may begin in the planning stage. The
Construction main objective was to create a
naturally friendly environment to
promote healing among the children.

To be continued

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Time Writer Title of the research work Resource Research Results

model

2010 Damon Barda Breaking Ground Environmental General During construction, the hospital
Design and recycled most of the materials
Construction whenever possible. It opted for
white roofing to reduce the heat
emanating from the building, the
internal temperatures thus reducing
the need for round the clock air
conditioning. The hospital has
numerous windows which make
good use of the daylight thus using
electricity minimally and efficiently.
The plants within the compound do
not need a lot of watering so as to
conserve water.

2010 Damon Barda Breaking Ground Environmental General The sustainability objective
Design and safeguards the environment and also
Construction enhances healing process of patients
and places the community who are
stakeholders at an advantage too.

2010 Ferenc J. Going Greener Health Facilities General Hospitals produce a great amount of
Management waste. Waste reduction has become
of great importance as recycling of
the waste produced. The motivation
towards this is the economical
benefit associated with waste
reduction

2006 Bruce G. New Ore. hospital powered by Waste News Report In a bid to conserve energy, more
wind hospitals are beginning to construct
their buildings guided by the
Leadership in Energy and
Environmental Design Standards
(LEED) principles. The Providence
Newberg Medical Centre, in the
United States shall be the first in the
country to operate under wind
generated power. The wind power
plant is expected to shoot up the
construction cost hugely. The value
of environmental conservation and
sustainability by the Providence
hospital cannot be valued in
monetary terms as it is great.

5. Theoretical framework architectural aspects for research. It will also highlight

This study will seek to explore some of the challenges some of the efforts towards sustainability in the
that the hospitals face while trying to incorporate hospitals under study.
sustainability in their facilities. It shall consider the Conceptual and operational definition for variables.
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The two main variables in this study are architecture and analysis will involve going through the data carefully
the environment. The conceptual definitions of these and identifying all the solid issues that are there. After
variables are as follows. Architecture is the style chosen this the issues or themes will be coded and categorized.
for a building and expressed into a tangible and visual From this, conclusions shall be made based on constant
form [6]. The environment is defined as the observations.
surroundings by [5]. The operational definitions of these The study shall be conducted among hospitals as they
variables are types of architecture and environment. are the main topic of study. In general, 10 hospitals will
be involved. Interviews shall be conducted with staff
6. Methodology members from each of these hospitals. The study shall
This study will use the qualitative research design. This be conducted within the United States’ hospitals. The
is a design that will concentrate more on descriptions study shall consider hospitals within California and
and explanations of various phenomena in the study. It Hawaii. These are states of the United States. From each
shall enable creation of comprehensive results of the state, 5 hospitals shall be picked randomly. The data
study. The study will explain to the audience the collected shall be presented in diagrams and then later
occurrences and their reasons. In order to accomplish on discussed.
this, the feelings, comments, experiences and responses 1. What are some of the considerations while
as well as opinions of the respondents regarding the constructing the hospital?
topic under scrutiny must be well comprehended.
Qualitative design shall compel the researcher to collect Diagram 1. Considerations and Evaluation Process.
data from various correspondents who have varying
opinions. This design will not end up in aggregating all Considerations Hospitals
the findings but shall retain individuality of the findings.
It shall therefore enable the understanding of all Purpose of the hospital 4
responses that will occur under different circumstances.
The sampling method that will be used in this study is Budget of construction 3
simple random sampling. While using this method, the
researcher randomly picks the respondents in the Location of the hospital 1
targeted population. The subjects in the study are
hospitals in California and Hawaii states in United Future prospects 2
States. From each of these states, five hospitals shall be
selected totalling to ten. 10

6.1 Research tools. In this study, the research

instruments which will be used are interviews. These Diagram 1 shows the results from all the ten hospitals
interviews shall contain questions that will lead to regarding their construction considerations. Four of
answers of the research questions of the study. This will them believe that the purpose of the hospital is
allow the respondents to provide more information to paramount in construction. 3 of them believe that the
the questions asked. These interviews shall be conducted budget they have allocated the project should guide the
face to face so as to enable collection of all expected construction. 2 of them believe that the future plans of
data. This will also allow the researcher to capture the the hospital should be considered right from the
emotions of the subjects. beginning. I of the hospitals stated that the location of
6.2 Limits and Limitations. The limitations of this the hospital is very important.
study are time factor and finances. The study would 2. Did you have any environmental considerations in
require a lot of time to conduct effectively and your construction plans?
comprehensively. However, much time is not available.
The diagram 2 is a pie chart that represents the
Financial resources required to conduct the study are
proportions of the hospitals regarding the presence of
limited. This requires the researcher to choose the most
environmental concerns during construction. 40%
economical methods of study that will provide the most
responded negatively implying that they did not have
appropriate results.
the environment in mind while constructing the
hospitals. 60% of them responded positively having
7. Results and Findings considered the environment.
After data has been collected, constant comparison shall
be used to analyze the data collected. This method of
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Diagram 2. Environmental consider- 4. What were some of the challenges that you faced while trying to
ation. implement these considerations?
Diagram 4 as shown below represents the responses of the challenges
faced when trying to implement these environmental considerations as in
diagram 3. 3 of the hospitals cited financial strains as a major challenge
while 2 of them cited time factor a major limitation. 1 hospital claimed to
lack good sources of expertise advice regarding environmental issues.

Diagram 3. Environmental concerns.

3. What were some of these

considerations?
Diagram 3 is a graph showing the
responses of the subjects regarding the
environmental concerns that the 60%
who responded positively in diagram 2
had. 1 hospital considered the minimal
consumption of natural resources while
building. 2 of the 6 hospitals
considered having zero pollution of the
environment while the other 3
considered maximising the utilisation
of natural resources.

Diagram 4. Challenges for environmental considerations.

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Table 2. Hospital Factors Analysis.

Factor 1

Construction Purpose of the hospital Budget allocated Location of the Future prospects
determinants hospital

Number of 4 3 1 2
hospitals (10)

Factor 2

Environmental Minimal consumption of Maximised utilisation of Zero environmental

concerns natural resources natural resources pollution

Number of 1 3 2
hospitals (6)

Factor 3

Challenges in Financial strain Time limits Expertise advice

implementation

Number of 3 2 1
hospitals (6)

8. Discussion electricity during the day conserving energy.

According to the results of the study, most of the The hospital practicing minimal consumption of
hospital’s purpose greatly determines its construction. natural resources cited the recycling of materials when
This may affect the style, the time of the project and constructing. This will reduce felling of more trees for
many other factors. The financial resources are also a timber and reduce waste materials as featured in [9]’s
great deal in construction. Most hospitals conduct study.
projects with fixed budgets. Construction that strains the The study suggests that finances tend to be the greyest
budget tends to be dismissed and that within budget hurdle in incorporating the environmental concerns in
considered. The future plans that the hospital has laid construction. Landscaping is one architectural aspect
out are a worthy consideration as well. This enables the that consumes a lot of water which is a natural resource.
hospital to work towards the goals much more Most hospitals have started going green by planting
strategically [7]. drought resistant plants to decorate their compounds and
The study reveals that most hospitals have a caring create a serene environment [10]& [11].some of the
attitude towards the environment. This is because most actions that hospitals are taking up have been identified.
of them take it into consideration when planning Proper waste management dominates the results.
construction projects. The main reason that was noted Hospitals produce a lot of waste in their daily activities.
during the study among those who consider it is that it This waste may be hazardous and infectious [12] & [13].
has great effect on the patient’s healing process [8]. Of Managing to dispose the waste without putting anyone
the most common environmental concerns is the or the environment at risk has become of great
maximization of natural resources utilization. These importance. Some of the hospitals give up waste for
resources include light, fresh air among many others. recycling and others have incineration plants within
The hospitals adapt to these by ensuring that their their facilities [14].
buildings are open in terms of windows so as to let in
the air. This reduces the need of air conditioning that
uses energy. Use of natural light eliminates the need for
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9. Conclusion [10] Dave, C. (2008). Greening Up. Health Facilities

According to this study it is clear that hospitals are Management. , 21 (7), 15-21.
embracing environmental sustainability. However, some [11] Dave, C. (2010). Green + Greener. Health Facilities
are still facing financial challenges and lack of proper Management. , 23 (7), 15-21.
sources for expertise advice which is much needed in [12] Janet, B. (2012). Exit strategy: Designing for waste
the transformation. They are taking into consideration and material flow. Healthcare Design , 12 (1), 12-14.
some of the minor but effective ways to begin the
process of going green. These include use of natural [13] Jane, R. (2012). VA hospitals on the sustainable
lighting and ventilation as well. They have realized that road: Green Globes or bust! Healthcare Design , 12 (1),
the health of their patients is important and can be 16-19.
enhanced by going green. It is therefore clear that the [14] Liz, S. (2006). Health without harm. Earth Island
architecture chosen has a positive or negative effect on Journal, 21 (4), 34-38.
the environment as well as patients’ well being [15] Janet, B. (2012). Leading Communities to A
depending on its nature. Healthier Future. Healthcare Design, 12 (5), 78-80.
[16] A., S. K. (2011). Healthier Hospitals Initiative.
10. Further Research Healthcare Executive. , 26 (4), 60-63.
Studies in the future should concentrate more on the [17] Andersson, J. E. (2011). 'Touching up' Communal
architecture field and the environment. This will need Space of a Residential Home Setting: A Comparative
them to delve more into architecture as a field of study Study of Tools for Assessing Changes in the Interior
in its own right and highlight its major interrelation with Architectural Space. Journal of Housing for the
the environment. This will enhance better understanding Elderly, 175-216.
of the connection between architecture and
sustainability of the environment. [18] Bruce, G. (2006). New Ore. hospital powered by
wind. Waste News, 12 (4), 5.
References [19] Ferenc, J. (2010). Going Greener. Health Facilities
Management, 24-27.
[1] Malhotra, A. K. (2009). Hospital Management: An
Evaluation. New Delhi: Global India Publications Pvt [20] Hill, B. (2010). International Architectural
Ltd. Showcase. Health care Design , 10 (10), 82-83.

[2] Solomon, N. B. (2008). Architecture: Celebrating the

Past, Designing the Future. New York: Visual APPENDICES
Reference Publications Inc. Appendix 1
[3] Rassia, S. T., & Pardalos, P. M. (2012). Sustainable Interview
Environmental Design in Architecture: Impacts on
Health. New York: Springer. What are some of the considerations while constructing
the hospital?
[4] Bodart, M., & Evrard, A. (2011). Architecture &
Sustainable Development - Proceedings- Vol. 1. Did you have any environmental considerations in your
Louvain-la-Neuve: Presses univ. de Louvain. construction plans?

[5] De, A. K. (2007). Environmental Education. New What were some of these considerations?
Delhi: New Age International. What were some of the challenges that you faced while
[6] American Institute of Architects. (2008). The trying to implement these considerations?
Architect's Handbook of Professional Practice. New What kind of materials did you use for construction of
York: Wiley and Sons. the hospital?
[7] James, V., & D., B. R. (2010). Positive performance. Which architectural aspect is your biggest natural
Health Facilities Management , 23 (9), 33-37. resource consumer in the hospital?
[8] Jennifer, W., Robin, P., Patty, L., Jennifer, P., Mary What are some of your efforts towards conserving the
Beth, S., Kelsie, T., et al. (2012). Relationship-Based environment?
Care: Implementing a Caring, Healing Environment.
MEDSURG Nursing, 21 (3), 179-184.
[9] Damon, B. (2010). Breaking Ground. Environmental
Design & Construction, 13 (4), 22-25.
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Appendix 2 Wahiawa General Hospital

List of interviewed hospitals California
Hawaii San Francisco General Hospital
Wilcox Health Sharp Memorial Hospital
Shriner's Hospital Naval Medical Centre
Kaukini Medical Centre Kern Valley Hospital
Hawaii Pacific Health Fresno Surgery Centre

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