Just Read: The WELL Building Standard – promoting health for the people inside

These are the things that doctors with Total Health in their job title keep up to date on 🙂 .

Given that humans spend 90% of their time in buildings, it’s easy to recognize that building designers and developers may have a lot more influence on our health than doctors do, and so why shouldn’t we leverage each other?

WELL is a performance-based system for measuring, certifying, and monitoring features of the built environment that impact human health and well-being, through air, water, nourishment, light, fitness, comfort and mind.

The standard is a 238 page, well referenced, multidisciplinary-developed and reviewed (including physicians) document that describes 7 concepts composed of 102 features that impact the “health, comfort, knowledge” of building occupants. You can see as you review it how each feature if thought through can make a difference in a building occupant’s lives (and buildings can be thought of generically, from hotels to health care).

From ventilation, to food choices, to mental health, I found myself contemplating all the decisions that can possibly made about the environments we inhabit that can have a huge impact on us. Great to see them enumerated and explained here.

This includes things like thermal comfort, not just in accurate temperature control, but with temperature variability and “free address” for workers to find their right zone. For me, this would handle the, “It’s so cold in here I can’t even think” syndrome. Same goes for acoustics, both in noise dampening, but also sound masking – to allow for privacy.

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A building feature that shouldn’t exist in a healthy built environment. Gendered Bathrooms – still allowed in New Hampshire (View on Flickr.com)

From my read, there’s also room for innovation and incremental improvement. One thing that I’m aware of that’s an impediment to health is gender segregated restrooms (aka “Men’s” and “Women’s” rooms). These shouldn’t exist anymore, and it was a jolting reminder that they still exist on my recent trip to New Hampshire, since these kinds of bathrooms are no longer legal in Washington, DC (see: Why doctors should care about gender neutral restrooms : health, safety, and equality, in Washington, DC)

WELL is pretty new, and it connects to LEED, which, on my last poll of pretty innovative doctors, doesn’t have a lot of name recognition (see: MakerDocsDC: Introducing doctors to green building and LEED at USGBC World Headquarters). But both should. Which is why I’m writing a blog post about it, since I do live in the future.

At Kaiser Permanente, and actually in a lot of leading edge health systems, there’s pretty good recognition of the importance of the built environment for health, both in the buildings we build, and the buildings built where our patients live, work, learn, and play.

For us, it really is in our DNA. Our founder, Sidney Garfield, MD, wanted to be an architect before he became a doctor, and was passionate about design and the facilities in which he cared for patients. See: Why a health system cares about the buildings it doesn’t build: Moderating AIA-DC Panel 10/8/14.

Check out this newsreel from 1953, when his way-ahead-of-his-time hospital in Walnut Creek opened. You’re going to see some things that are most definitely not allowed in the WELL standard today (hint, the waiting room), and also some things that the rest of health care has yet to embrace – the connection to nature.

I have not yet worked in a WELL certified environment, but I hope to … very soon. Watch this space.

Credit to Whitney Austin Gray, PhD for lighting the fire (or should I say, igniting the LED) – she’s a doctor in design that’s improving health. Leveraging each other….

Whitney Austin Gray at Center for Total Health 03020
Whitney Austin Gray at Center for Total Health 03020 (View on Flickr.com)

#ActOnClimate : First White House Summit on Climate Change and Health

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White House Summit on Climate Change and Health – Representatives of the Health Care Climate Council (View on Flickr.com)

Kaiser Permanente (@KPShare) is a member of the Health Care Climate Council and one of the greenest health systems in the world.

It was a great honor to share several rooms at the White House (@WhiteHouse) yesterday with other committed health leaders, at the first Summit on Climate Change and Health.

I was present to give a 4 minute overview of Kaiser Permanente’s renewable energy projects. The text of that overview is below. You can see the infographic version on this post. Additional photos also below. Enjoy, comments welcome.

I’m Ted Eytan,
Here on behalf of Kaiser Permanente, nation’s largest non-profit health system, a member of the Health Care Climate Council

I’m a Kaiser Permanente family physician , I work for our medical groups at the Kaiser Permanente Center for Total Health, which is KP’s social innovation center, based here in Washington, DC

I’d like to tell you what we’re doing and then I’d like to tell you why we’re doing it

We’re supplementing our use of green power with three large renewable energy projects that will come online in 2016

110 Megawatts of Solar Power capacity Blythe solar plant in Riverside, CA
43 Megawatts of Wind power from turbines at Golden Hills wind farm in Altamont Pass, California, where Kaiser Permanente will support the replacement of less-efficient turbines on the wind farm with new, more efficient equipment

Solar arrays that will be added to 170 hospitals and facilities in California, for another 70 MegaWatts of capacity

This is in addition to the 17 Megawatts we’ve been generating in California, and green energy projects across the 8 States and District of Columbia

Here in DC, Wind power purchases match 100% of our electricity use in our DC and Maryland based Medical office buildings and our east coast data center

Similar projects are operational now in Oregon, Washington, and Hawaii

In human terms,
Enough power to supply 82,000 homes, and avoidance of carbon emissions equivalent from 45,274 cars

Will supply half the electricity needs for Kaiser Permanente in California.

To give a sense of the energy intensity of health care, Kaiser Permanente uses nearly 1.5 billion kilowatt hours of electricity a year, and emits 806,000 metric tons of harmful greenhouse gases into the atmosphere

These projects make Kaiser Permanente one of the top users of green power in the country and takes us down to 617,000 metric tons, three years earlier than promised, at the same time we are helping more people and communities achieve their life goals through total health – over 10,000,000 members.

By the way, these renewable energy sources don’t require the transportation, pumping, and heating of water, so we will reduce our water consumption by over 100 million gallons, in a part of the United States where there is a serious drought

Clearly, this investment is better for health because we can provide more preventive and other health services with less resources and less impact on the communities we serve.

I’ve been a Permanente physician for 15 years, and what I’ve learned since I came here is how much can be done by health care. That’s why we’re here.

Much of what we are doing today has been happening long before I was born. Kaiser Permanente was built for health.

Our iconic co-founder, American Industrialist Henry J. Kaiser, ordered the first steel mill west of the rockies to be the cleanest ever built. Physician entrepreneur and co-founder Sidney Garfield, MD, who designed futuristic health facilities that provided the most gentle surroundings for healing, with the least impact on the environment.

we’ve known that greenhouse gas emissions are a known contributor to climate change and the rise of pollution and disease,

our focus on health drives a portfolio of environmental stewardship that includes LEED certified green health facilities, diverting recyclables and compostables from landfills, reducing the use of harmful chemicals, and promoting sustainable food choices – to learn more -> kp.org/green.

These actions help doctors, nurses, and all health professionals to provide nationally recognized, high quality, affordable health care.

Being here with more and more health systems demonstrates that we’re not alone in understanding the link between environmental stewardship, health, and the ability to heal.

This past week was Millennial Week in DC, and Kaiser Permanente was one of the sponsors. There, I was reminded of our responsibility to our future patients and their future doctors, nurses, and other health professionals. They expect that institutions including health care protect the communities’ health.

Of the 16 million people in the Health Care workforce today, 200,000 of them work at Kaiser Permanente – I am very excited that our generation has the ability to think of total health AND do something meaningful for the people who come after us.

Infographics: How health care can strengthen the food system

These are great, because as I have previously pointed out, the health system and the food system appear at times (much of the time?) to be at odds with each other (see: Comparing the stats: The US Food System and US Health Care System | Ted Eytan, MD).

There’s a way out. Thanks to Health Care Without Harm (@HCWithoutHarm) and Kaiser Permanente (@KPShare) for producing these. H/T Kaiser Permanente Institute for Health Policy (@KPIHP)

Health Care Food Purchasing Power

Hospitals As Anchor Institutions

Healthier Hospital Food Service

Changing Climate (chart), Washington, DC USA 1871-2014

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Average Annual Temperature Washington DC USA 1871-2014 (View on Flickr.com)

2014’s average temperature in Washington is below predicted trend, compared to the western United States (see my hometown, Phoenix, Arizona’s Haywood plot below).

The likelihood is that cherry blossoms will eventually bloom one month earlier than present, and there will be impacts on health including seasonal allergies, which are extremely costly to the health system and employers.

Interactive version of the chart below

Don’t forget about sustainable Information Technology: ENERGY STAR Low Carbon IT Champions

I posted earlier today about sustainable food. There’s also a thing called sustainable (low carbon) Information Technology, and it matters for health.

Data centers are one of the fastest growing energy uses in the country. Health care has to heal across all dimensions…

EPA ENERGY STAR (@EnergyStar) recognizes Low Carbon IT “Champions” who are cutting costs and saving energy in the one of the fastest growing energy uses in the country – information technology. Please see the case studies and public service announcements (PSAs) recognizing their efforts below.

Kaiser Permanente — the first health care provider to earn ENERGY STAR building certification for their data center — implemented a raised floor optimization (RFO) program, diagnosed their efforts with a unique computer room functional efficiency (CRFE) metric, and optimized cooling during a large expansion

via ENERGY STAR Low Carbon IT Champions : ENERGY STAR.

For more information / why this matters: #greenhealthcare part 4: Health Information Technology helps health care be green | Ted Eytan, MD

Sustainable Food Scorecard Creates a Healthier Supply Chain| Kaiser Permanente Share

Kaiser Permanente Share | Sustainable Food Scorecard Aims to Create a Healthier Supply Chain.

Kaiser Permanente created the industry’s first Sustainable Food Scorecard, which allows the organization to rate suppliers and vendors and select the vendors who can best support the organization’s sustainable food purchasing initiatives. 

Great job, Kathleen Reed and team, in working to create a healthier food system for all.

“Kaiser Permanente spends approximately $52 million on food each year,” explains Reed. “So we want to use our purchasing power to begin shifting the supply chain towards more sustainable food options. And the Sustainable Food Scorecard is critical to that process.”

Sustainable Food Scorecard Infographic

The new, Green Kaiser Permanente Antelope Valley Medical Offices #GreenHC

Kaiser Permanente – Antelope Valley Medical Offices from J&M Concrete Contractors on Vimeo.

From Kaiser Permanente Share | A New Home for Specialty Care Opens in Antelope Valley


The new Kaiser Permanente Antelope Valley Medical Offices will open with a ribbon-cutting ceremony on Friday Oct. 3. Also at the ceremony, Kaiser Permanente Southern California Community Benefit will present the Antelope Valley Community Clinic with a $250,000 grant to expand its existing space and provide services for an additional 10,000 patients per year. The grant will also support additional Dental Clinic space.

The new Kaiser Permanente Antelope Valley Medical Offices and the expansion of the Antelope Valley Community Clinic are part of Kaiser Permanente’s long-standing commitment to provide high-quality, convenient care for our members and the communities we serve.

I have been learning about Antelope Valley, and now it’s here. I hope to visit some day. Its opening is the perfect compliment to the discussion recently had about designing buildings for health (A bunch of doctors, an architect, and a bridge builder: Designing for Health | Ted Eytan, MD).

Before anyone says this is worshipping bricks and mortar, it isn’t – look at my companion presentation that shows how much of our medical care is shifting out of health care facilities and where our members are (Why a health system cares about the buildings it doesn’t build: Moderating AIA-DC Panel 10/8/14 | Ted Eytan, MD)

Why a health system cares about the buildings it doesn’t build: Moderating AIA-DC Panel 10/8/14

“Growing Screens” – Kaiser Permanente Westside Medical Center

What’s a doctor doing a moderating a distinguished group of panelists tomorrow evening on Improving Health Through Active Design | AIA DC? Well, come and find out 🙂 .

It’s hosted by American Institute of Architects (@WashingtonDCAIA) at the gorgeous District Architecture Center in Washington, DC, USA (of course).

Here’s the why:

  • Our model of care is changing – 50% of our touchpoints with patients are in person, down from almost 100% in 2003
  • In a model of care like ours, where we are reimbursed for health instead of sickness, we seek out health for our members wherever it is
  • Most human beings spend their time in buildings, and mostly not in health care buildings.
  • Our iconic founder, Sidney Garfield, MD, hoped to be an architect before he was a doctor, so as a result we have a robust facilities innovation program (including the groundbreaking “Total Health Environment” program, where we are leading the way in green building in health care at the same time. (see: Through the eyes of interior architects: The new Garfield Innovation Center + future of healthy building | Ted Eytan, MD )

The photograph in the post above is just one visual example of how any facility can be made healthier. John Kouletsis, AIA, EDAC
Vice President, Facilities Planning & Design, Kaiser Permanente:

Designing for health? We do this a lot, but many of the examples would be invisible to the casual observer. Prohibiting the use of PVC, HDPE (high density polyethylene) piping, and fire retardant chemicals in the furniture that is specified for KP projects are all good examples of the “invisibles.” Visible examples would be some of our building lobbies where we make sure that the stairs are the most prominent feature, leading people to take the stairs rather than the elevator. Westside Medical Center in the NW Region did a very unusual thing with the multi-story parking garage–they have “growing screens” to shield the neighbors from the view of parked cars and light spill over from cars in the parking structure at night. The green screens are watered from rainwater that is collected for that purpose. While being an attractive screen, they also clean the air.

I get to call John my colleague. He and his team are partners in producing health with our doctors, nurses, and members. That’s why a doctor wants to moderate a panel on designing for health!

Just Read: What physicians (and patients) need to know about Climate Change – JAMA

The facts:

Similar trends can be seen for snowfall and precipitation, both trending down instead of up, in Washington, DC, with a whole host of livability and health effects that will result.

This post is about a pair of papers in this week’s Journal of the American Medical Association about climate change, that are nicely comprehensive and about what climate change means for health. As I have said previously, I am not an environmentalist, I am a health activist – that’s why I can and do go from thinking about medical care for people who are transgender to designing healthy buildings.

In “Climate Change: Challenges and Opportunities for Global Health” you’ll find exactly what colleagues and I had previously been looking for in the published literature – a good accounting, from all health angles, of what happens when CO2 levels rise. A lot of the impacts I am familiar with, some are new, such as increase risk of depression and other mental illness.

If physicians or other people in health care – including patients – have time to read only one article about why this is important, this is a good one. There’s a lot that health care and people who work in health care can do, and a lot that has already been done (see: Just Read: Greening Health Care: How Hospitals Can Heal the Planet | Ted Eytan, MD).

The second piece, “Code Green,” is written by a physician (and a family physician at that), for physicians. Caroline Wellbery, MD, PhD, discusses the role of health practitioners in being a voice for change. That’s something that comes very unnaturally to me if you read this blog :). As I have written previously, physicians are not yet mobilized in a significant way to think about the role of environment in preserving or more likely in the future, destroying the work they do to keep people healthy (Do physicians tweet about environmental stewardship in health care? | Ted Eytan, MD). I think that’s going to change as the health impacts become part of the curricula for physicians in training, as evidenced by this piece itself.

If we are here to keep people healthy, we can’t do it if we sicken their communities at the same time. Enough said. Well almost enough. It’s as simple as your walk to work in the morning. Try it.