Moving from Sustainability to Wellness in Health Care

We know by now that there is a strong business case for sustainability in health care. Our clients are seeing strong results that go far beyond saving money on energy bills.

Since I first spoke about health care sustainability in the 1990s, we’ve seen incredible evolution. Sustainability principles have impacted our designs and the expectations of our clients. Hospital owners and operators are measuring those impacts in new and interesting ways, and they are beginning to look at how designs focused on sustainability and wellness can work together to help deliver better care to patients and increase staff satisfaction and retention.


Dell Seton Medical Center at The University of Texas in Austin was built with patient care and sustainable design in mind.

A Tale of Three Hospitals

Hospitals’ operating budgets are spent primarily on maintenance, energy and staffing, with staffing having the biggest impact. As sustainable thinking has evolved, we’re seeing a new focus from our clients: Can we increase our staffs’ productivity, wellness and fulfillment by designing and operating more sustainable facilities?

The answer is yes, as the Seton Family of Hospitals found out a few years ago. By surveying employees at three of its hospitals – all of which were ground-up facilities built within a two-and-a-half-year period and using the same engineer, WSP – Seton saw real results of the varying design philosophies employed at the three facilities: Dell Children’s Medical Center, Seton Williamson and Seton Hayes.

Dell Children’s, located in Austin, Texas, had an eye towards achieving high sustainability goals from the outset and included a great deal of analysis to reach these targets and provide a model for future health care facilities. Implemented measures included extensive daylighting, heat recovery, steam water generation and natural habitat plantings. A later addition improved sustainability features with solar photovoltaics, water reduction measures saving 1.3 million gallons, CO2 monitoring and lighting controls for 90% of the occupants. Dell Children’s was the U.S. Green Building Council’s first certified LEED Platinum building of its kind.

Seton Williamson and Seton Hayes, while still highly focused on achieving high levels of energy efficiency, had a different focus. Situated in rural areas outside of Austin that sorely needed health care services to accommodate growing populations, both hospitals were designed and built in less than two years. The accelerated time frame limited the ability to conduct some of the advanced sustainable analysis that informs high performance designs like those seen at Dell Children’s.

So, while all three hospitals are models for energy efficiency – each operates with an energy density below 200kbtu (kilo British thermal units), saving Seton around $350 million a year compared to typical hospitals, which operate around 225kbtu – Dell Children’s had more focus on advanced sustainable design than the others.


The W.H. and Elaine McCarty South Tower at Dell Children's Hospital was the third health care facility to achieve LEED Platinum certification.

Measuring Results

After the three hospitals were completed, Seton hired an outside research firm to conduct a study of 1,900 employees at the hospitals over a two-year period. The goal was to measure employee engagement, health and well-being, turnover, injuries and perceived indoor air quality, and compare the results as they related to the investment in sustainability.

Across all areas measured, Dell Children’s outperformed the others. The employee engagement rate was 5 percent higher, and turnover rates were 3.1 percent and 3.6 percent lower than Hayes and Williamson, respectively. In an area like Austin where qualified staff are hard to come by and the market is extremely competitive, these figures caught a lot of attention. Injury and illness rates were also about 3 percent lower at Dell Children’s than at the other two hospitals.

Finally, the perceived indoor air quality at Dell Children’s was 14 percent higher. This jump has been attributed to the indoor courtyards that are located throughout the facility. While they were originally included in the design as a daylighting measure, they have the added benefit of creating a sense of being outside anywhere in the facility.


The efficient MEP systems at Dell Seton Medical Center were designed to convert the humid Austin air into a comfortable climate in patient rooms.

A Future Focused on Wellness

Seton is applying what it learned from the study in its latest project in Austin, a new medical campus at the University of Texas that has an emphasis on health and well-being. In addition to hospitals, the campus will include exercise centers, bike paths, food stores with healthy options, and other elements focused on wellness.

A new teaching hospital at the center of the campus, the Dell Seton Medical Center, was designed and built based on what Seton leadership learned from the employee study. Sustainable measures minimize the facility’s impact on the environment while maximizing its capacity to hold future medical technologies.

The Level 1 trauma center achieved LEED Gold certification, thanks in part to features like 100 percent outside air, heat recovery chillers, LED lighting and the inclusion of pedestrian and bike paths. In addition to 23 percent projected energy savings (equating to $240,000 per year saved versus traditional systems), Seton expects to see similar results in employee satisfaction, engagement and retention as it did at Dell Children’s.

Marking another step on the evolution of designing for sustainability to designing for wellness, it is worth noting that the new medical center comprises the same number of beds as the old facility it is replacing, in a city that is growing at a rate of 10 percent a year. This affirms Seton’s commitment to sustainable and wellness design, and its belief that a focus on wellness will result in fewer people needing to be in the hospital long-term.

Rick Rome spoke on this topic at the recent European Healthcare Design Conference. Watch the presentation.

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