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Climate-adapted hospitals require collaboration

Climate-adapted hospitals require collaboration

Danish hospitals must be equipped for climate change. This requires better collaboration between architects and engineers, as well as forward-looking developers.

Over the coming years, a double-digit billion figure will be invested in building and modernising Danish hospitals. Danish regions have a singular opportunity to refurbish and construct brand new super hospitals in projects that embrace both energy efficiency and climate change adaptation.

"Climate-adapted buildings in Denmark should primarily take two things into account: higher temperatures and rises in water-level. While water levels are an important factor in low-lying areas near the coast, adapting to a warmer climate is something that should be incorporated into all building projects in future," says Olaf Bruun Jørgensen, head of department at Esbensen Consulting Engineers.

This applies not least to hospital buildings, where the indoor climate is particularly important. A fine example is the refurbishing of the southern Jutland regional hospital in Aabenraa. In 2003-2004 the hospital had its three courtyards roofed over to provide more space for both employees and patients. The courtyards were glazed over, solar panels and solar shading were installed, along with natural ventilation (hybrid ventilation) and double facades (double-skin facades). In addition to substantial cuts in energy consumption, these changes have provided natural light conditions and a good and healthy indoor climate.

"The project was primarily about creating better indoor climate and low energy consumption, but climate adaptation also came into the equation.  The large area of glass to ensure natural light conditions means that it may become quite hot during the day, and since there will be more heat waves and generally higher temperatures in future, it was important to incorporate natural ventilation and solar shading in the building," says Olaf Bruun Jørgensen. 

Wind cowls as primary driver for hybrid ventilation (exhaust) from the roofed-over courtyard area. (Photo: the EU project, HOSPITALS)

Patients get well sooner
"In the Region of Southern Denmark we are doing much to create the best possible conditions for the people who daily have to stay and work in the rather closed-in environments of hospitals, but we are also including energy-saving measures," explains architect Liane Timm Schwarz from the building division of the Region of Southern Denmark.

"We know that indoor climate and lighting conditions are of great importance for people's well-being on the wards. The project in Aabenraa also shows us that this also means that patients can be sent home sooner," she says.

The energy measures increased the building budget by DKK 5 million, however this figure was quickly cancelled out by savings in the operating budget for ventilation, space heating and utility water heating.

"And we haven't even calculated the savings gained from patients getting well sooner," Ms Schwarz concludes.

Climate must be incorporated from the start
The refurbishing of Aabenraa hospital was a part of the EU-HOSPITALS project, in which five European hospitals took part. The project's technical coordinator, Esbensen Consulting Engineers, applied Integrated Energy Design (IED), a process in which you make sure there is correlation between form, function, architecture and minimised demand for energy.  In traditional building processes the architect carries out his or her part of the assignment first and then the engineers take over. In an IED process, the parties involved work with a common objective and all have ownership of the process.  A prerequisite is that all parties get involved in the process early on.

"The IED process is basically about common sense, about thinking carefully, however in practice architects, engineers and developers alike need new ways of thinking. For the engineer and the architect it is about being proactive and having the courage to ask each other critical questions early on in the process. It is about working together on the drawings, so that the necessary technical installations and the architectural design all come together. For the developer it is about realising that the end result will be satisfactory, even though the process requires greater involvement than usual. On the other hand, there will be fewer things to redo at a later stage," explains Olaf Bruun Jørgensen.

Automatic exterior solar shading of roofed courtyard area. (Photo: the EU project, HOSPITALS)

All talk and no action
Mr Jørgensen believes that this type of working process also provides greater likelihood that the consequences of climate change are incorporated into the final proposal. He is therefore saddened to see that visions for building sustainable hospitals are far too often left behind as mere good intentions.

"Unfortunately, there is a tendency to discard all the good intentions when priorities are set in the building budget. You therefore end up with hospitals which keep to budget, but which end up being far more expensive to operate than was otherwise necessary. This is critical, because hospital buildings are very energy-intensive to operate," says Mr Jørgensen.

Ventilation, lighting and cooling are some of the energy-intensive items in the energy accounts, not least because equipment and treatment methods in hospitals are becoming more high-tech. Although hospitals have very strict air quality requirements, in many places it will be advantageous to use natural ventilation. For example in administration offices, on ordinary wards and in common rooms, where hygiene and cleanliness requirements are not as strict as e.g. in operating theatres, laboratories, etc.

"We know that a good indoor climate gets patients well sooner and reduces staff absenteeism. Therefore, we must invest in effective solar shading instead of choosing the easiest and cheapest solution of installing interior curtains. A solution which most often has none of the desired effect.

Optimal use of natural lighting and natural ventilation must be ensured early on in the design phase and not in a subsequent installation process after the building has been erected. Professionals specialising in energy optimisation, indoor climate and similar should therefore be involved in the project at an early stage, when outlining the main functions and layout of the building. Many of the solutions that we are talking about here cost almost nothing once they are in operation, so it's ridiculous not to include them from the outset," says Mr Jørgensen.

Spreading the word
Another consulting engineer firm, Grontmij | Carl Bro, is also familiar with the problem.

"If we as engineers are not involved in the process until after the developer has accepted the proposal from the architect, our hands will be tied, making it hard to incorporate climate change adaption solutions. It is therefore essential that we in the engineering sector become better at spreading the word to both developers and architects that changing the way we work together will pay in the end," says Sigurd Bunk Lauritsen, a senior consultant who lectures throughout Denmark about climate-adapted hospitals.

"Last year I held a lecture for a crowd of hospital chief technicians. I asked them whether they had considered what will happen if the groundwater starts to rise. No one said a word. So I don't think that climate change and its consequences for hospital buildings are something they ponder over on a daily basis. But there is much money to be saved in the hospital's operating and maintenance budget, if climate change adaptation and energy-efficient solutions are incorporated in the early design phase of building and refurbishment projects," says Mr Lauritsen.