U.S. buildings consume about 40% of energy, of which about 18% are commercial structures. Since healthcare facilities have such intensive energy needs, especially hospitals which are 24-hour facilities, is getting a LEED certification worth the added expense and effort?

The Leadership in Energy and Environmental Design (LEED) Green Building Rating System is a voluntary, consensus-based national rating system for developing high-performance, sustainable buildings. LEED certification is the best known green rating system and is awarded by the non-profit U.S. Green Building Council (USGBC). LEED is a rating system for all building types and the system attempts to address five areas: sustainable site development, water savings, energy efficiency, materials and resources selection, and indoor environmental quality.

According to Marie E. Coleman, Communications Coordinator for the USGBC, "As of April 2, 2009, there were 853 healthcare facilities registered and 64 healthcare facilities which have been certified." Almost half (29) of the 64 healthcare facilities certified were certified in 2008 so this trend is accelerting. The best sales pitch for getting a LEED rating are the studies that the USGBC has sponsored which indicate that LEED buildings "decrease operating costs by 8-9%, consume 26% less energy, and return on investment improves by 6.6%."

When I asked specifically about healthcare facilities, the USGBC responded that they are not aware of any specific follow-up studies regarding how LEED healthcare buildings perform versus non-LEED buildings. So if USGBC is not conducting any studies and are not aware of how these facilities are performing, then it's difficult to ascertain how successful these facilities are once they are built or renovated. According to Ms. Coleman "USGBC has partnered with the Green Guide for Healthcare, http://www.gghc.org/, to devise succinct guidelines to ensure a LEED certified healthcare facility is among the highest performing in its sector."

One of the issues recently raised for going for the LEED rating is the veracity of the energy-efficiency claim by the USGBC. An independent study published in 2008 by Henry Gifford on his site contends that LEED buildings consume 29% more energy than non-LEED buildings. His findings are summarized in the video below:

Gifford's findings were based on a methodological dispute with the USGBC regarding the way their study used median LEED building energy usage versus mean national building energy usage. In doing so, the impact of a few high energy use LEED buildings was ignored. Gifford made some additional interesting points in the video, including a photo of high-rise LEED office building that had all of its lights on in Manhattan at 2am. Could the problem be similar to eating five 100 low-calorie cookies when you would typically only eat two 200 calorie regular cookies? In addition, he speculated that poor building construction techniques (ie, poorly fitted windows, etc.) may also contribute to the issue. The argument goes that if I am a construction worker at a LEED building, it doesn't matter how well I fit the windows because nothing I can do will affect how "green" this building is in the end.

Gifford argues that the LEED system should include construction site monitoring and monitoring actual energy usage (since LEED is a predictive system) in the certification process. After Gifford's study was publicized, the USGBC sent out an email to its chapter members refuting Gifford's findings and Gifford's responses are on his website as well.

It's important to understand that LEED addresses several different factors in sustainable building design (such as renewable materials and indoor air quality), therefore, there are other qualitative factors for following the LEED rating system. For those hospitals and other healthcare facilities that are undertaking the LEED system because of long-term energy savings, however, the results of getting a LEED rating are unknown. Because the healthcare industry is a large and growing segment of our economy, it is critical that the USGBC, the American Society for Healthcare Engineering (ASHE) as well as various stakeholders get together and have an honest dialogue about the actual return on investment and without further study, it will remain an unknown quantity.