By Mike Cavanaugh, AIA, LEED AP, WELL AP and Brett Farbstein, LEED AP, CEM, CBCP, EBCP
When major weather events like last year’s Hurricane Florence and Tropical Storm Gordon make landfall, they create chaos for the people, cities and infrastructure in their path. While many can flee these storms in advance to ensure safety, healthcare institutions must stay operational to serve those in need of care. Decisions to close or evacuate hospitals can lead to life or death for critical patients along with tens of millions in damage.
Given the potential consequences, it’s imperative healthcare leaders invest in hospitals and care facilities designed for maximum resiliency. Selecting materials that can withstand 150+ mph winds, having plans for sustained power loss, and other resiliency measures should be on the table at the outset of every new building project. Failing to design for resiliency can lead to serious challenges and even tragedy. Consider the following:
- Hurricane Florence has led
to the closure of numerous care facilities across the Carolinas and forced
government and healthcare agencies to establish mobile, telehealth and
temporary care options. The City of Wilmington was even completely cut off from
outside access for days due to flooding.
- 12 residents of a Florida nursing home died
during Hurricane Irma in Fall 2017 when the
building’s central air conditioner failed and led to extreme overheating.
- When Hurricane Harvey brought more than 60 inches of rain and strong wind to the Houston area last fall, 20 of the roughly 120 hospitals in the area had to close or evacuate. Per the Texas Hospital Association, the estimated disaster-related costs for reporting hospitals totaled $460 million spanning capital, operating, emergency work, uncompensated care and other costs.
These examples and data begin to reveal the serious threats Mother Nature can pose for healthcare facilities. Fortunately, there are actions health systems can take to ensure stronger resiliency today, next year, and long in to the future.
Resiliency Isn’t Just
About Hurricanes and Superstorms
While major storms elevate resilient design solutions to mainstream attention, resiliency is about much more than being prepared for hurricanes. Per the Per the Resilient Design Institute, “resilience is the capacity to adapt to changing conditions and to maintain or regain functionality and vitality in the face of stress or disturbance. It is the capacity to bounce back after a disturbance or interruption.”
There are scores of disturbances or interruptions that can challenge hospitals. In our work, we most commonly see design responses that focus on resiliency challenges from the list below:
• Sea Level Rise: With evidence that climate change will continue to contribute to rising sea levels, how can hospitals be prepared for new realities 25, 50 and event 75 years into the future?
• Inland flooding: Numerous causes can lead to damaging inland floods. Hospitals need plans and protective design measures ready in advance.
• Wildfires: Both strategic natural landscape design and material selection can prove invaluable in the face of widespread fires.
• Extreme Temperatures: Our evolving climate promises more extreme weather patterns resulting in hotter and colder days than we’re used to (and more of them). Resilient design can ensure building envelopes are optimized for these extreme realities.
• Drought: In the absence of water, how can design strategies and systems ensure hospitals stay hydrated to serve their patients, staff and operations?
• Extended Power Loss: High winds and ice storms can cause the power to go out. Hospitals need a plan to ensure they can remain operable for business continuity without access to an outside power infrastructure. Current building code requires hospitals to have back-up power multiple days, but the utility service can be out for longer and it’s important for health systems to have fuel storage and a plan.
Again, these are just some of the most common and daunting threats to operations. Other weather events (heavy lake-effect snowstorms, for example) or weakened technology networks can all threaten a hospital’s operations, too.
defines a resilient hospital?
Just as there are numerous threats to resiliency, there isalso a multitude of responses. Every healthcare system and hospital requiresits own strategic solution, but there are common themes thatwill permeate the best responses regardless of geography,climate or specific threats.
Anticipate Future Environmental Conditions
Numerous tools, like the U.S. Climate Resilient Toolkit, help designers, city planners, and health systems alike model how climate change will lead to new environmental conditions for any region in the world. These tools can predict future temperatures, sea levels, humidity, and rainfall among other factors. Consider, for example, that the prime development land of today could be the flood plain of tomorrow. How should this effect the placement of critical infrastructure or building entries?
Embrace Redundant Measures
Loss of power is always a threat to healthcare facilities; failing to design redundancies into power systems can leave health facilities without power for extended time periods or during severe weather events. Critical to any resilient design solution is the incorporation of multiple redundancies into a building’s power infrastructure via generators and on-site reserve fuel for these challenging moments.
Strategically Invest in Materials
It’s always important to focus on material selection for healthcare projects. Certain materials can inherently promote health in the building, reduce slips and falls and address other safety measures. In resilient healthcare facilities, designers must accommodate all these considerations while also ensuring they select materials that can withstand extremes – 150+ MPH winds, surging water, consistently strong heat waves, etc. Selecting materials for resilient health facilities requires careful consideration and planning to get it right and ensure safety when disaster strikes.
Ensure Maximum Adaptability
As indicated earlier in this document, it’s not just storms that threaten the endurance of buildings, but also time itself. The design community often talks of creating buildings that can thrive for 50-100 years, but that’s only achievable if we design them to accommodate the changes in technology and practice that will occur during their lifetimes.
Using a standardized structural grid provides one solution to the elusive goal of “future proofing” our facilities. A “universal grid” consisting of the optimum set of vertical and horizontal dimensions for a building’s structure can empower almost infinite adaptability – allowing hospital spaces to evolve over time and take on new programmatic purposes. A universal grid also enables these spaces to evolve from one programmatic purpose to another over time, while also enabling efficient configuration of structure, casework, lab equipment, lighting, power and HVAC.
Buildings’ Strengths and Weaknesses
Given thousands of healthcare facilities across the country were built years before we understood climate change and resiliency as we do now, numerous existing facilities are ill prepared to face serious weather events. Still, numerous building renovation or modification efforts can bring hospitals up to code or strengthen their resiliency. Here’s a look at key tools health systems can leverage to understand their real estate’s current strengths and weaknesses:
Survivability Models are computer simulations that reveal how existing
buildings will perform during loss of power or water utilities. These
simulations also reveal the interior environment conditions staff and patients
Building Resiliency Assessments consider the resiliency of every material,
component and system that comprise a building. They inform extensive reports
that indicate building failures, weaknesses and strengths and then outline a
prioritized list of mitigation strategies with associated costs and timelines
for investment. While these assessments should be executed years before storms
arrive, they can also help inform recovery efforts for buildings recently impacted
by weather events.
- Emergency Power Tests verify critical backup and emergency power systems will be reliable if storms damage a facility and/or force it to run without access to larger power grids.
Equip New Buildings
with Customized Resiliency Plans
While resilient design plans for hospitals are usually rooted in common focuses around power redundancy, material selection, adaptability, building insulation and more, each hospital requires its own unique solution that responds to its exact environmental conditions.
For example, Nantucket Cottage Hospital on Nantucket Island faces remarkably different threats than a hospital located on the country’s west coast mainland. Set to open later this year and located on an island, the Nantucket Hospital may need to face hurricane-level winds in the future, but it also needs to be prepared to endure if weather cuts off access to the east coast mainland.
The hospital’s unique location leads to extreme focus on power reliability, access to water and flexible space. Beyond maintaining care for patients, Nantucket Cottage Hospital may also act as shelter for residents of the island who can’t fly, boat or jet back to the mainland. From day one of the project, Nantucket and its parent system Partners Healthcare made resiliency a critical focus.
Given every hospital faces its own weather challenges – hurricanes, drought, fire, earthquakes, tornadoes, etc. – it’s important they don’t just rely on common practices and develop customized resilient design plans.
New healthcare facilities cost hundreds of millions of dollars and should be designed to drive value for 50-100 years. This means buildings can’t just be responsive to current environmental conditions, but also must consider future climates. The prime development land of today may actually be on track to become a flood plain over the next half century.
There are numerous tools, like the U.S. Climate Resilient Toolkit, that health leaders and designers alike model how climate change will lead to new environmental conditions for any region in the world. These tools can predict future temperatures, sea levels, humidity and rainfall among other factors. This predictive information can ensure design teams site buildings to withstand higher temperatures that will develop decades ahead, or that buildings currently not susceptible to inland flooding are equipped to endure it down the line.
Research indicates that major climate change and weather-related events are coming stronger and more frequently than ever before in human history. This means it’s never been more critical to proactively design for future resiliency. Taking action today can ensure our hospitals are able to deliver health and safety for patients, staff and communities even in the worst of times.
Mike Cavanaugh and
Brett Farbstein lead CannonDesign’s sustainable and resilient design divisions,
respectively. They focus on helping companies and communities achieve more