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Why We Need to Redesign Hospitals for Resilience

Hurricane Katrina struck just as I had begun my last year in architectural school at Tulane in New Orleans. Charity Hospital had served impoverished New Orleans residents for more than 80 years. It was first built in the 1920s with fully operable windows, but when the hospital underwent mechanical system retrofitting years ago, the windows were sealed shut. A mechanical ventilation system was substituted for fresh air. The system failed during the storm, internal temperatures rose to over 100 degrees, and the building was subsequently evacuated. Taking more than 1,000 lives and forever changing the city, the hurricane profoundly demonstrated how fragile our healthcare buildings are.


In October 2012, power failures and loss of water during Hurricane Sandy caused many New York City hospitals to shut down. With the ability to produce power and harvest water on-site, both of these instances could have been prevented. Recent history has illustrated the extreme vulnerability of healthcare facilities during times of catastrophe—the very moments when we need them most.

My firm, Perkins+Will, recently completed the Spaulding Rehabilitation Hospital located on Boston Harbor. The design team incorporated various resiliency measures, including plantings and retaining walls to lessen flood waters, mechanical services located on the building’s roof, and operable windows for passive ventilation. When it comes to disaster planning and building resiliency, the hope is that these changes will allow hospitals to continue operating amid extreme weather conditions.

Modern hospitals tread a paradoxical line, focusing on restoring patients’ health in the short term while also emitting harmful chemicals that degrade health over time. In addition to resiliency, architects and designers must reinforce the fact that our built environment has a profound impact on human and ecological health and currently, that impact is negative. These two problems are not mutually exclusive, but rather closely related, supporting a synergistic solution that can enable healthcare institutions to move beyond crisis response and proactively foster global wellness. In this model, they can support the most primary principle of medicine: “First, Do No Harm.”

The average 200-bed hospital can use as much energy in a year as 3,500 households and is primarily supplied with fossil fuel through the municipal grid. The same hospital might use up to 51 million gallons of water per year, consuming our most precious resource while burdening water treatment facilities. Besides having the obvious detrimental environmental impacts, this singular reliance on the municipal infrastructure grid inherently causes vulnerability, which we have personally observed in recent history.

An energy-effective hospital can drastically reduce energy consumption through a focused demand reduction process that utilizes alternative energy systems, which can continue functioning despite damages to public infrastructure. The overarching goal is to first reduce demand as much as possible and develop on-site sources, such as rainfall harvest or condensate capture. How can the effluent of one process become the feedstock for another?

This mindset allows buildings to become self-reliant and produce the necessary resources to operate during inclement weather. Not only is this improvement safer, it is also cost effective. I recently led a research project that identified the capital cost premium of large hospitals that achieve LEED certification to be .67 percent of construction costs—significantly less than what is commonly believed within the industry.

Both scientific and financial data stands firmly behind the importance of creating healthy, resilient and energy-efficient healthcare buildings. In order to provide the best possible care, we must ensure that built environments actively reduce negative environmental impacts and instead provide healthy, stable conditions for all.

Image courtesy of Perkins+Will

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