The future of healthcare: lean, green and digital

Humber River Hospital, designed by HDR

In 2008 the Ministry of Health and Long Term Care (MOHLTC) approved funding for Humber River Hospital (HRH), to begin the planning and design of a 167,300 sm (1.8 million sft) acute care facility on a dense urban site in the middle of Toronto’s North York region. The objective was to combine on one site the services and patient care currently being delivered at three different sites. With this goal in mind Infrastructure Ontario (IO) and HRH partnered to achieve the largest hospital in Ontario and second largest in Canada.

As a major capital project IO and HRH began the process of procurement through the Public, Private, Partnership (PPP) delivery model. HRH envisioned creating a hospital founded upon a “New Model of Care”; while remaining firmly rooted in the diverse community the Hospital serves. For HRH it was important that the new facility’s design not compromise the health of building occupants, the surrounding community and natural resources.

Humber River Hospital, designed by HDR

HOK Architects Corporation (HOK) was entrusted with realising HRH’s vision as the Planning, Design and Compliance (PDC) Architects. HOK is an industry leader in both Healthcare and Sustainable design; bringing to the project leadership in planning and systems development, and a focus on developing a holistic sustainable vision for the overall site. HOK led HRH’s staff and physicians through a comprehensive planning process to develop the specifications, and create a test design establishing innovations and strategic direction for the new Facility; characterized by Lean, Green and Digital principles. Although these principles address different aspects of the hospital’s operations and development they are intertwined; enabling the hospital to provide best quality service to the community while being a thoughtful local neighbour, supportive employer and responsible health and wellness citizen.

The new site is located on the former parking lot of a government services campus; with residential neighbourhoods to the north and major arterial expressway to the south. The planning team met the challenge of providing within a 26 acre site a 167,300 sm (1.8 million sft) new home for a broad range of health care services; while creating efficient, ready access for patients and staff. HRH 656 bed Facility anticipates receiving 136,000 ER visits, 5,300 births, 192,700 ambulatory visits and 40,700 surgeries each year. To accommodate such large volumes of visits to HRH’s services within the site’s size confines HOK proposed to leverage cutting edge technologies and planning concepts.

Humber River Hospital, designed by HDR

Business cases for automated supply delivery systems utilizing robots, complex pneumatic transport of soiled laundry and linen to external haulage units, and the use of a pneumatic tube delivery network are just some of the features implemented to achieve efficient healthcare operations. As a result of these initiatives Barb Collins, HRH’s Chief Operating Officer, believes that the hospital is “on track to save 164 kilometres per day of walking time, with a potential savings of $2,000,000 per year in operating costs.”

Another key strategy is the HOK-developed “Portals of Care”. Similar to an airport drop off this concept allows visitors to access HRH’s services effectively and intuitively at specific drop off points; channeling traffic flow according to desired destination. Compared to a traditional hospital the separation of access to different types of services (like ER, dialysis, ambulatory and inpatients) enhances accessibility for the community, boosts efficiency and gives HRH the ability to manage pandemic incidences without shutting down all services. The cumulative result of HOK’s strategic approach to planning and internal supply delivery is the optimum use of site conditions to achieve a large, complex, state of the art hospital on a tight urban site.

Some of the most advantageous impact HOK’s contribution has had on the realization of the hospital are the sustainable strategies focused on Facility energy consumption. Recognizing that a healthy environment is intrinsically linked with wellbeing, HOK and HRH set forth to minimize the new hospital’s energy footprint and reduce its yearly operational costs. Hospitals are one of the most challenging building types; with “24-7-365” activity, strict indoor environment requirements and occupant safety demands that result in power intensive systems and equipment.

With this in mind the HOK team designed hospital systems with focus on the implementation of energy recovery measures, leading-edge systems design and efficient operational protocols; using typical industry means and methods. At the same time the goal was to maintain 100% fresh air delivery to all areas of the hospital, optimizing indoor air quality.

An integrated design group (including HRH, HOK, The Mitchell Partnership and Mulvey & Banani International Inc.) set a target of 40% energy cost reduction from the base case in ASHRAE 90.1 2007. Nine months of research (using energy modeling, test design inputs, cost verifications and a concerted focus on enhancing conventional systems to reduce energy use) proved that 40% energy cost reduction could be achieved for this building type and size. Despite doubt from the Proponent Consortiums, HRH and HOK were confident in the research and that their vision could be attained.

To ensure that the sustainable innovations and targets were met once the project was released to the bidders, HOK specified in the bid documents that 15 points were to be achieved for the LEED® Canada-NC 2009 Credit EA – Credit 1: Optimize Energy Performance. Sample test design and energy model data equating to 40% energy cost reduction was included to guide the bidders. In addition the consultant team specified essential requirements based on the research test design; examples being the delivery of reduced air velocities and the utilization of waste heat, while leaving enough opportunity for market and industry value assessments. To ensure success HOK worked with IO to implement the Energy Guarantee Letter; an aspect of the Project Agreement between HRH and the winning Project Company Consortium that stipulates a specific energy usage in the 30 year Facilities Management contract. Where the LEED Credit EA – Credit 1 targets energy costs, the Energy Guarantee Letter targets actual energy use and is not impacted by the fluctuation of energy prices. In HRH’s case this leads to a 50% reduction of energy use from the base case; ensuring that the hospital will continue to achieve energy reductions once in operation, and into the future.

As the Consortium team continues to build the new facility the vision is beginning to be realized. Once HRH opens in the fall of 2015 it will be considered one of North America’s most energy efficient hospitals. The research developed through HRH’s and HOK’s leadership puts the new hospital on track to provide over $3,000,000 per year in operating expense savings. HRH is on target to achieve LEED gold and the predicted energy use will be 1.15GJ/square metres/year versus the North American average of 3GJ/m2/year. These efficiencies will offset 11,371 tonnes of CO2 per year; equivalent to taking either 2,187 cars off the road, saving 409,356 twenty-five year old maple trees or saving 4,373 acres of forest. In addition the site will be planted with 800 new trees to meet the City of Toronto’s Tier 1 planning specification. The Facility’s Energy Use Intensity is on target to be 103 kBTU/square foot/year; putting HRH 15 years ahead of the 2030 challenge of 101 kBTU/square foot/year.

Humber River Hospital, designed by HDR

The vision and innovations of HRH, its stakeholders and the consultant team have made possible the reimagining of a hospital’s mandate and the site’s potential. The result is a highly sustainable health hub for the community and City; setting a new standard of care that balances social, financial and environmental wellbeing.

By Tracy Hanes and Tim Van Seters

When it was constructed at the Kortright Conservation Centre in 2009, the Archetype Sustainable House (ASH) was intended to be a state-of-the-art “green” abode that would demonstrate viable, sustainable housing.

The goal of the ASH, built by the Toronto Region Conservation Authority (TRCA) and the Building Industry and Land Development Association (BILD), was to educate the public, builders, and housing industry professionals about leading-edge building practices and products and how they could be used to create sustainable homes and communities. The house has achieved some of those objectives, as well as providing invaluable research through energy and water monitoring by universities and colleges in partnership with TRCA’s Sustainable Technologies Evaluation Program (STEP).

The ASH, actually two semi-detached units at the Living City Campus at Kortright, is one of the most efficient renewable energy houses in North America. One showcases the best green building practices available, while the other highlights up-and-coming technologies.

Features include solar photovoltaic roof panels, a wind turbine, in-floor radiant heating, heat and energy recovery ventilators, low-VOC finishes, waste-water recycling and drain water heat recovery units.

“Not only were these two semi-detached houses to be a showcase of the best in green building technologies, but we also wanted to learn what works best and how they can be configured to optimize costs and energy performance,” says Larry Brydon, who was on BILD’s board in 2007 when the decision was made to construct the twin houses, and served as BILD’s project manager.

In 2005, a national design competition, sponsored by TRCA (which operates Kortright) and run by the Design Exchange, called for a four-bedroom home designed for mass production, that had innovative waste-water treatment and would meet LEED Gold (Leadership in Energy and Environmental Design) and Energy Star standards. The design had to be flexible to allow for intensification.

The winning design, Building Blocks, was created by a Toronto team that included Anne Stevens (FORT Architect Inc.), Clelia Lori (Iori Architects) and Terrell Wong (Stone’s Throw Design). They designed modules that could be combined to create singles, semis or townhouses and to accommodate varying family size. They submitted the idea for two semis, 1,800 and 2,300 square feet.

The design allowed for factory manufacture and site assembly or for conventional on-site framing. In 2010, the house was awarded LEED Platinum status.

Half a decade later, the TRCA and BILD are looking at what has been learned, and how that information can help improve sustainability in the residential construction sector.

This has been facilitated by instrumenting the house as a laboratory with over 300 sensors that feed into a state-of-the-art data acquisition system.  Many technologies have been installed so they can be easily replaced or reconfigured as newer, more advanced options become available.

Data collected for analysis includes: air temperature, relative humidity, and volumetric flow rate; water temperature and flow rate; natural gas consumption; solar radiation; and power consumption of individual components. It is among the most comprehensive residential energy monitoring projects worldwide.

The most important lesson is not so much about the houses, but how the systems integrate, according to David Nixon, monitoring coordinator for STEP.

“Often an electrical or mechanical device will have a performance rating that gives the buyer some sense of how efficient the device is and the savings that can be achieved by using it,” explains Nixon. “But when these are installed as part of a system, the performance can change significantly.”

One example is the heat recovery ventilator, installed to ensure an adequate supply of fresh air in the well-insulated house.  As a stand-alone system, the HRV is meant to minimize heat loss, but when coupled with the air handling unit, the fan was forced to run at higher than optimal speeds, resulting in wasted energy.

“Balancing the system at low fan speed would provide better fresh air distribution at lower energy cost,” says Nixon.  “There is a simple solution, but experimental research is needed to standardize an approach that will work best in a variety of different contexts.”

Dr. Alan Fung from Ryerson University’s Department of Mechanical and Industrial Engineering  worked with two of his students to develop the matrix for selecting technologies to be installed in the house and has supervised more than ten graduate students who conducted research there.

“What really sticks out in my mind is the research we did on the variable capacity air source heat pump,” says Fung. “We didn’t expect to see such high performance during the winter, especially at low temperatures.  The heat pump operated for most of the heating season on part load, at a performance level that was well above the rated capacity.”

Public tours and education programs target homeowners, students and professionals/trades in the building industry.

Alex Waters, senior manager of the Living City Campus, says that over 10,000 students, 2,000 professionals, and 2,500 homeowners have toured the ASH and it has been used for consumer workshops such as eco-home renovations, efficient heating systems and DIY solar.   “The response has been very positive,” says Waters.  “People like that they can see the latest in green building design and get unbiased advice as to what works and doesn’t. Visitors love the open concept and the amount of space these small footprint houses have. The most surprising comments concern the renovation-ready attic and the one switch which turns off all the lights in the house.”

The success of the ASH and other technology demonstrations contributed to the British Research Establishment’s (BRE) decision last year to select the campus to be Canada’s Innovation Park, part of the BRE Innovation Parks Network across the globe. This will result in the construction of up to eight more low rise buildings next to the ASH that showcase innovative construction and low carbon technologies, and demonstrate integrated designs that are practical and affordable.

If you are a fan of sustainable approaches and design, that really will be something to see.

For more information about the ASH and five year anniversary event in June, visit www.livingcitycampus.com

Tracy Hanes is a freelance writer.  Tim Van Seters manages the TRCA’s Sustainable Technologies Evaluation Program