BOOK REVIEW
Sustainable Healthcare Architecture, by Robin Guenther, FAIA, LEED-AP, and Gail Vittori, LEED-AP (2008, John Wiley & Sons)

Reviewed by Stephanie Stubbs, Assoc. AIA, LEED-AP
Managing Editor

Summary: Robin Guenther, FAIA, LEED-AP, and Gail Vittori, LEED-AP, a health-care architect and a sustainability specialist respectively, have teamed up to present their professional peers with a thoughtful and engaging presentation of forward thinking health-care design destined to change the way we practice. The authors pooled their advance knowledge and expertise in a tried and true format near and dear to architects’ hearts: the case study. They selected 50 case studies, supplementing wide-ranging essays, to illustrate the best example of green health-care design through the gamut of health-care building types.

That green buildings are healthy environments for their occupants appears a truism that garners more supporting research every day. They embrace fresh air, views to the outdoors, and, implicitly and explicitly, connections to and healthy respect for the natural world. The gap from healthy to healing environments is not great, and authors Robin Guenther, FAIA, LEED-AP, and Gail Vittori, LEED-AP just leapt it and made the case for sustainable health-care architecture as a way of life. Yet health-care architecture, more than most building types, also embraces challenges of intricate and complicated programs as well as seemingly insatiable needs for the latest ever-changing technologies that gobble up usable square feet as well as power. Sustainable Healthcare Architecture shows buildings that balance the dichotomy.

Universe of ideas
Across its 450 pages, the book covers theories and tools for now and into the future. The authors have chosen a lively presentation method to bring forth 13 major concepts in 13 chapters, highlighting ideas ranging from “Design and Stewardship,” to “Nature and Healing,” to “Integrated Operations.” The authors put forth a thesis for each of the ideas with their own introduction and follow up with case studies and related essays by a multidisciplinary array of contributors.

Arguably of most immediate interest to architects are the case studies. Building types presented include hospitals, research centers, a college, a clinic (in Bhopal), treatment centers, outpatient centers, and a health-care village/continuing care center. About half of the buildings presented are in the U.S.; the rest span the globe from Norway to India. Each case study is short and sweet and carries a bullet list of the project’s key building performance characteristics, grouped by the U.S. Green Building Council’s quintet of LEED® credit categories: site, water, energy, materials, and environmental quality. Photos, drawings, charts, and sidebar text keep the presentations lively while decent sized type is easy on the eyes.

As an example, in the chapter on “Toward a New Language of Form,” a case study of the Patrick H. Dollard Discovery Center in rural Harris, N.Y., by Guenther 5 Architects PLLC, showcases the building known as the “barn with an attitude.” The center, which supports a population of 250 wheelchair users, was begun before the institution of LEED. It employs a nature-based program that embraces organic farming, goats and horses pastured in surrounding fields, a therapeutic horseback riding program, and a dairy farm. Its high-touch program partners with a high-tech skin that helps the building achieve an energy reduction of 42 percent below the ASHRAE 90.1-1999 standard. Systems include radiant heat, ground-source heat pumps, and an extensive rainwater harvesting system. The building’s long and narrow footprint fosters daylight’s reach into 90 percent of occupied spaces.

Essays pepper the text with thought-provoking concepts and, like the case studies, traverse the globe of possibilities. In the early part of the book, we have “Good Places—Good Health” by Richard Jackson, MD, MPH, and Marlon Maus, MD, MPH, which explains how urban planning and public health worked together to prevent infectious diseases for the last century. Now, the authors posit, urban planning and architecture must shift their attention to combating public health’s current scourge: chronic disease in its many guises: diabetes, obesity, depression, asthma, osteoporosis, and cancer. Near the end of the book, architect Stephen Kendall, PhD, explains why hospitals of the future can’t be designed anymore as “wholes,” but rather must be considered to be like cities, as open systems.

Out on a green limb
This is a very important book. The authors document a change in the profession that is as remarkable as it is swift-paced, because they present eloquent examples of sustainable architecture thriving in environments where it has the potential to do users the most good. Equally important, the book embodies the integrated, collaborative practice that makes green architecture possible, both in the presentation of the buildings and the book itself. For instance, “AIAs” abound among the essays, but so do RNs, AICPs, PEs, LEED-APs, PhDs, and an MD or two. Are we listening to each other? Are these remarkable buildings the result? Join us on a limb of this green tree as we inch toward the skinny branches (and feel free to take part in this week’s blog if you would like to take part in the dialogue). The authors of this book are women. A large number of its contributors are women. Is the increasing diversity in the profession, especially the presence of more women, increasing the collaborative nature of architecture?

Sustainable Healthcare Architecture is well documented, well written, well indexed, and well edited. It’s also well illustrated, albeit in black and white, and with its 16-page four-color signature as a visual treat, it’s a cut above Wiley and Son’s usual reference book presentation. It comes on 100 percent post-consumer recycled paper, is printed with soy-based ink, and its back-page environmental statement, according to the manufacturer, tells you that it saved 225 trees and 153,000 gallons of water, and 259 million BTUs over standard processes.

The authors build a fascinating case for how green health-care has evolved; perhaps it’s fair to say that it is reaching its tipping point. Building on the good work of earlier pioneers, such as the Green Guide for Health Care the book also is well timed, coming on the cusp of release by the U. S. Green Building Council’s LEED for Health Care, which is due out this year. Do yourself and the planet a favor and read this book. Whether you do health-care architecture or not, it clearly presents an important portrait of our profession.