The Green Light

Spotlight on Kaiser Modesto Medical Center

May | June 2008

By Diane Laux, ABC

“We’re caretakers of people and of the environment.” So says Tom Cooper, Principal, Environmental Design and Research for Kaiser Permanente’s National Facilities Group. That evangelism is part of the culture of Kaiser Permanente, and it fed the creation of the health system’s flagship green hospital, Modesto Medical Center, opening in October 2008 to serve California’s Central Valley.

Encompassing the Sacramento Valley to the north and the San Joaquin Valley to the south, the Central Valley is a nearly 400-mile stretch of flat, green land, surrounded by the foothills of the Sierra Nevada Mountains and the coastal hills. One of the richest agricultural regions in the world, the Central Valley supplies one-quarter of the country’s food supply. It’s the fastest growing region of California and its population is not without concerns about pollutants, agricultural pesticide use, and how air and water quality could affect their health.

“The entire Kaiser Permanente organization focuses on prevention,” said Cooper. “Keeping people healthy and workplace safety have always been central to what we do. Our physicians know how to connect the dots and have been focused on environmental issues for decades. Modesto Medical Center allowed us to put down green roots and showcase our green systems, and even develop some new ones along the way.”

Saving Green

Kaiser Permanente opened a 385,000-square-foot medical office building and outpatient facility on its 50-acre Modesto campus just over a year ago. Some hospital systems find a commitment to environmentally- friendly building can result in higher building costs, but that doesn’t apply in Kaiser’s case.

Cooper emphasized, “We are not adopting standards that drive costs up. We go cost neutral or lower cost, or we don’t go at all. There is no other alternative. As a not-for-profit, we’re spending our members’ money, so we are mindful about the choices we make. Honestly, there are some things we just can’t afford to do.”

Modesto Medical Center is not a LEED Platinum facility. But it is a green facility. Kaiser has a relatively low cost per square foot, and the system learned they can move markets by leveraging purchasing power.

Fifteen years ago, Cooper said, hospitals tackled HVAC systems the way most other companies did, by looking at “first” or purchase cost. You selected an air handler that met minimum performance requirements and you awarded the contract to the lowest bid. So you’d wind up with a system in the building that had lower first cost but not necessarily lower total cost of ownership.

“When you look at lifecycle costs, you get the best value out of building systems when you strike a balance between first cost and long-term payback,” said Cooper. “When you are identifying green alternatives, you need to look at things like workplace safety, performance, lower energy costs and less maintenance. Research has resulted in us doing a better job operationally, environmentally, and standardizing on better products.”

Creating the greenest hospital in the Kaiser Permanente system required a project director motivated to bring changes and innovation to the project. Mike Hrast fulfilled that role with gusto. For example, Kaiser Modesto was first in a group of template hospitals. In California, the Office of Statewide Health Planning and Development regulates healthcare construction, so Kaiser designed three healthcare facilities at the same time with the same template to get through the review process quicker.

Hrast piloted many things at the Modesto site that have since become standard procedures within the Kaiser system, such as working with a local project team to test new ideas, processes and materials. Case in point: building code requires screen walls on rooftops to shield HVAC systems from view. Hrast installed solar panel screens, which generate 55,000 kilowatts of electricity per year. These photovoltaic screens cost $84,000 more than mechanical screens, but with California offering up to $125,000 in renewable energy rebates, the project is money ahead.

While proof of concept may be driving the design agenda at Kaiser Modesto, it is the human aspect that is at the heart of the matter. Cooper says some employees cried when they toured the site of the new hospital and learned about the sustainable attributes of their workspace.

“What we’re doing in Modesto and other cities is part of Kaiser’s brand. We want our employees and our patients to thrive. If we keep people healthy, they won’t be coming in through the Emergency Department. If we can design healthcare environments to be free of toxic building materials, the patients we serve will benefit, our employees will be healthier and happier, and we give back to the communities we serve.

Cooper stopped to take a breath, then proclaimed, “Wow! I love my job.”

The Cost of Change

With medical technology change is a constant. The healthcare delivery side is more open to change because new inventions and methods are always in the pipeline. The maintenance and operations side is where the barriers are. According to Cooper, Kaiser is necessarily very risk averse. Because of their size, a small change they make could save—or cost—millions.

But some green changes didn’t cost a thing.

Concerned about off-gassing, the release of chemicals into the air through their continual evaporation, Kaiser uses low Volatile Organic Compound (VOC) paint which emits fewer fumes and is cost neutral. They recently negotiated a contract for fabric that is lower cost and essentially toxin-free. They required PVC-free corner guards and wall protection, though there was no such product, so they pushed their supplier to create it, with no cost impact to the hospital.

“The lesson here is don’t take everything your suppliers say as the final word,” said Cooper. “Maybe the product you desire doesn’t exist yet. Stay on your suppliers, because if you need it, chances are other hospital systems can benefit from it as well, and you’ve just created a market for that supplier.”

In another bold move, Kaiser Modesto used porous paving instead of asphalt for all their parking lots. At the time of install it was the largest porous paving project west of the Mississippi. Asphalt lots would have required sewer infrastructure to be built for runoff, which would then drain into the city’s waste treatment system.

Porous paving allows Mother Nature to handle the rain. Rainwater recharges the aquifer, which is important for the soil. Porous paving was not cost neutral and had its detractors early on. “Sustainability requires you to put your neck out and challenge peoples’ thinking. Tradition isn’t always what it’s cracked up to be,” said Cooper.

“We don’t see sustainability in isolation. It’s a connector to other issues. We’re building a safer workplace for staff, a healthy oasis for patients, and we consider the environment in everything we do. You can’t discount that. It allows us to provide healthcare in a better way than we have in the past.”

Community Impact

According to Moses Elam, MD, Physician-in-Chief for Kaiser Permanente’s Central Valley region, everyone who lives and works in the region benefits from the Medical Center’s sustainability initiatives.

For decades, farmers in the Central Valley were exempt from air and water standards. Smog from the coast settles over this inland region. Today new agricultural regulations are in place, and most cities have environmental initiatives underway.

“When you are building a facility as large as Modesto Medical Center, with so many people employed here and passing through, it makes sense to do all we can toward energy efficiency and reducing pollutants,” said Dr. Elam. “We’re creating an environmentfriendly, healthier place that will have a direct impact on the community.

“It’s a tremendous opportunity, one which Kaiser regards as an obligation, not only as healthcare providers, but as community partners.”

According to Dr. Elam, the physician rate per capita in San Joaquin County is the lowest in the state. Yet he has hired more than 120 physicians in San Joaquin and neighboring Stanislaus Counties.

“A commitment to greening healthcare for our patients, staff and communities is a great enticement and it is aiding physician recruitment. Many of our physicians are coming from the cement cities of the East Coast, so the Valley and the efforts we’re putting into preserving ecology and environment are really a draw.

It drew Dr. Elam, as well. “I’m originally from New Jersey. We measure things in city blocks and use skyscrapers as landmarks. But when you come near our facility, what you see is vineyards and orchards, and the campus naturally rises out of this. It is pleasing and comforting as you drive up and takes the stress out of a doctor or hospital visit.”

Patients who visit the outpatient center recognize the cleanliness of the facility and comment on the broad hallways and rooms, and natural lighting. The color schemes evoke the outdoors and create an inviting environment and one that promotes healing and well being.

“The sustainability initiatives in the Modesto project are a natural fit for our organization that was founded on prevention and wellness,” said Dr. Elam. “But in looking at the industry as a whole, I might say, ‘What took us so long?’ Ecological and environmental sensitivity is a continuation of being leaders in healthcare and what that means as individuals to lead in such a critically important area of health and wellness.

“We need to not only take care of the acute needs of our patients but to heed the global notion of the total health needs of the communities we serve and of the world in which we live.

“There are so many aspects that simply fit together that allow for a successful sustainability venture regardless of where you are based: rural, metropolitan or anywhere in between.

“Come visit us and you’ll see what I mean.”