Net Zero Hospitals: A prescription for a carbon-free tomorrow

As we shift our design focus to address pressing climate challenges, consider this startling fact: healthcare alone accounts for 5% of global carbon emissions. The urgency to reduce healthcare’s environmental impact and align with net-zero emission targets has never been greater.

In this episode of our Anticipate Podcast, Alejandro Falcón, Technical Director and Healthcare Lead at WSP Middle East, is joined by Mike Barns, Programme Director – Architecture, at WSP in New Zealand. Together, they explore the transformation required to future-proof existing healthcare assets and propose a holistic approach to reducing the carbon footprint of healthcare design and construction.

Unable to listen to the full episode? Fast-forward to the key discussion points via the players above or read the key takeaways:

Discussion Points

00:00 - Introduction to Net Zero in Healthcare

04:20 - Challenges of Carbon Emissions in Healthcare

11:31 - Strategies for Achieving Net Zero

18:06 - Retrofitting Existing Healthcare Facilities

24:48 - The Role of Digital Transformation

30:31 - Innovative Solutions for Sustainable Healthcare

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Transcript

Welcome to WSP Anticipate podcast. The topic we're going to be discussing today is net zero in healthcare, transitioning the ways we design, build and educate for healthcare facilities of the future. As we shift our design focus to address the pressing climate challenges, consider the following struts to in fact, healthcare settings alone account for 5 % of global carbon emissions. The urgency to reduce healthcare's environmental impact and align with net zero emission targets has never been greater.

I'm Alejandro Falcon, Technical Director and Healthcare Lead at WSP Middle East. And in this episode, we'll delve into how we can influence the design and construction of new healthcare facilities. We will also explore the transformation required to feed the proof existing healthcare assets. I'm honored to be joined today by Mike Barnes. He's a Program Director, Architectures from WSP New Zealand. He brings a world of knowledge in the healthcare field. Mike, thank you for joining me today. Welcome to the Anticipate Podcast. So...

Why are net zero undercarriage sessions so critical in health care settings in your region? What's the issue that we actually need to address? Thank you, Elia and Zoha for having me on your podcast. It's really humbling to be here. I really appreciate the time that you've made available. It's a really important topic, carbon offset and carbon neutral in healthcare, primarily because it's one of those facilities. Hospitals are a bit like airports in that they're operating 24-7, so seven days a week.

24 hours a day we must operate the hospital, right, because we have patients in there who are often in critical condition and they need to be supported. In order to do that, of course, we need to have energy going into that facility full time and we need to control a lot of things inside the building such as how we manage air around the hospital because you'll remember and realize of course that some of that air is contaminated from some diseases that some of the patients will have brought to the hospital.

So we need to really look at our air conditioning capability, our supply of energy to that. It needs to be full time because if any of this equipment fails, of course we have an emergency and a catastrophe in the hospital. So very pressing. Every hospital in the world faces these issues. Some of the key ones that you have in the Middle East have addressed some of these issues in New Zealand. We're also on that path. Yeah, thank you.

Mike, will also add in the region, Middle East, one of the characteristics is severe climate, like climate condition. It's hot and humid and also water scarcity is common. As we know, in order to address clinical and infection control needs, there is always a requirement for very high outdoor air ventilation, air changes per hour. So this is obviously an amount of air that needs to be pre-treated, to be cool, needs to be dehumidified. And then obviously,

since the heat gains are high within the building, then the cooling capacity that is required from this equipment is relevant and high. Same for the water, what has been required in, for example, central sterilization departments, dialysis, even if some of the equipment is using cooling towers. Obviously, all of this requires a high consumption of energy, water, leading to a higher carbon consumption, which is concerning. I wanted to point out also that

This is in mostly these oil nations that continue to rely quite a lot on low electricity rates coming from fossil fuels still. And still the use of fossil fuel equipment is attractive. So that also leads to a higher rate of carbon consumption and doesn't really help the case. In terms of supplies, most of the components required for the hospital are still imported. This means that the scope of the mission related to transportation and logistics is still high. And only now we know that

This figure is around 72 % of the actual total carbon consumed in hospital, which is a big number to really take it seriously. In recent data analysis we've done in the market, in the region, we have identified that in terms of planning, design, and construction, there is an approximate of 60 live hospitals in the UAE ongoing, another 30 in KSA, and another 25 in Qatar.

It's high volume, there is a real need of addressing and providing measures to reduce carbon, embodied carbon, and volatilize carbon emissions as soon as possible before this continues to grow and we continue to emit carbon to the environment. Moving on probably forward, I have another question for you, Mike. From an EZERO perspective, what do you think are the WSP key focus items that need attention in a health care facility?

Yeah, great question, Aljandro. I think WSP is actually well positioned to address these matters globally. We have a carbon approach, which we implement across the globe, and it addresses regionality, such as some of the climate controls that the Middle East faces. And it also addresses some of the climate issues that we face in New Zealand, where I'm talking to you from now. So two extremely different geographies. I'm very close to the Antarctic.

where I'm speaking from you today and you are much closer to the equator. So obviously the demand for energy for a hospital in the UAE of those 60 operating hospitals that you talked about, or the 30 in KSA, or the 25 in Qatar, the energy demands there are quite different to what they are in New Zealand. Notwithstanding that, course, we have a global response, WSP is a global response as to how we deal with.

carbon neutrality or controlling carbon emissions. For your hospitals, I think there are great opportunities. There's a demand, of course, for a huge amount of energy. You talked about 70 % of that carbon that's involved for the hospital has been embedded carbon that comes from equipment that's imported into the Middle East. And that's very hard to counter. But the Middle East does have opportunities in other ways.

So yes, very high carbon consumption, but the issue here is that's only part of the problem, right, is any facility that uses energy will emit carbon. However, the Middle East has opportunities for generating carbon neutral energy. So through either wind or solar, and I know that there are huge investments going on in that now, are opportunities that Saudi and

the UAE at Qatar have to mitigate the carbon emissions that happen. We don't have that as much in New Zealand because we don't have the same amount of solar. What we do have though, so let's consider we have a hospital that consumes, let's say, X kilojoules of energy per day. In the Middle East, you can offset that by generating your energy in a very sustainable way through either solar or...

through wind or investments in tidal energy. We have some of that in New Zealand, but what we do have to manage the carbon emissions in our hospitals is that we create 75 % of our energy already through hydro dams. So a lot of our energy is already green. 75 % of the national production of electricity in New Zealand is through green, sustainable means. So when we come to address the

carbon emissions problem, our energy production is not the biggest side of the problem. Our energy consumption is the biggest side of the problem. So despite that, Alianzo, I think the answer to your question is WSP has a global approach to this. So we have solutions for the Middle East geography and we have solutions for the almost sub Antarctic environment that we're in now. Thank you, Mike. I think in addition to that, I would say

In the Middle East, the net zero concept overall, although we have seen a strong push and trend in the past year, is still probably in an infant stage. This doesn't apply only to healthcare, but probably to all sectors. So I think one of the key roles that we have as WSP is to spread awareness and be able to educate our healthcare clients on the importance of providing an effective net zero approach to planning, design, construction, retrofit, and probably in preparation for a potential mandatory...

regulatory framework that may count so clients then prepare for when this is coming in order to address the requirements. think another thing that we see, especially now with the Saudi market booming, is very large communities being developed. In this regards, it's very important during the planning phase to select strategically and properly the location of these hospitals, again going back to the scope of the emissions. There's a lot of patients, staff, visitors.

the need to commute to the acute hospitals for treatment, but also the supply of the goods, namely pharmaceutical logistics, food supply, catering. I think this is another important factor that WSP can help from the master planning perspective by making sure that we support from the very beginning in planning well where the building is located. Going for the morning specific, think WSP has unique engineering capabilities, strong planning in the house.

So exploring and encouraging clients to utilize micro grids and go more for electrification and move away from fossil fuels is key. And also when it comes to the major energy consumer, which is mechanical systems, as far as we see across the world, many countries require in their codes different energy use per hour. For example, for an operation theater, why is that? So obviously, it costs draft requirements on

on the basis of empirical tests they've done, but it's important to, every time, more and more, verify and validate the actual required 18 hours per hour in order to dilute effectively the air pollutants and reduce the concentration of viral infectivity by running severe demodeling. Because again, one of the major consumers that we see is the amount of air that we need to treat when the air is coming into the building. In connection with this, think, that our spin is a focus in ensuring

a proper balance in the design of the fascia, whether it is a design or it's a catastrophic, making sure that it's a good proportion equilibrium between cost, efficiency of the u-value transmissions of the fascia, ratio, glacing and the respondent panel, or solid, and cost probably. think working also together with clients to understand what's actual operation. They are going to expect double duties.

hours of work within the various medical wards of the hospital is also crucial. So the engineer can set what we call setback controls and switch of the systems, the utilization is not required. think all of these are key components that have been put together can create significant improvement in the embodied carbon and operational carbon emitted by healthcare facilities. If we consider, Mike, that by 2050 there is a vision to achieve net zero by

many countries. But however, around 80 % of the buildings that will be operational at that time, so by 2050, are already built. What actions are WSP proposing to tackle this retrofitting challenge in your opinion? Good question again, Alejandro. It's true that the buildings, particularly hospitals that we build, they last a long time. They're required to last a long time. They're very expensive buildings to put in place. And we...

generally work on a life cycle of between 45 and 50 years that that building will stay there. We design them though in such a way that we can retrofit them and particularly in New Zealand we're considering a number of quite large hospitals for this region at the moment and we're approaching them as modular facilities which means as the building ages we can remove MEP or

building services or work conditioning plant and replace them as the quality of engineering improves in the future. So it's as a building with the structure built now, but those parts which consume energy and produce carbon, we're designing in such a way that they can be removed as technology increases. And that's true right across the hospital. So if you imagine,

Our hospital facility is made up of a number of departments, right, or departmental plans. So you have your operating theaters, as you talked about, requiring a certain amount of air changes per hour. That's a given because you don't want infected air to go to patient bedrooms where they've already been completed their surgery and they're now recuperating. And you also have radiology departments where you take x-rays of patients before they go into their operation.

You have what's called a CSSD, it's a sterilization area where all the medical instruments that are used in surgeries sterilized and that requires a lot of energy. So as you lay out the hospital, as you're planning it, you have consideration for where the high energy demands are across your hospital. So you look at the departmental plans, which are the highest utilization CSSDs tend to be because you need, of course,

boiling hot water to sterilize steel medical instruments. And patient bed towers where patients basically just sleep and recuperate have a less energy demand. So you have a growth, if you like, from high demand departments to low demand. And so to a certain extent, you can put, spend your money in the areas that are high demand, such as the sterilization department, the CSSD.

in such a way that as engineering improves over the 45 year life cycle, you can replace that older technology in a very efficient way. So you're not having to dismantle the facade, for example, you can access that plant and equipment in a much more intelligent way. And the bed towers, which don't consume a lot of power, comparatively, you also design those so that when you need to, you can replace the equipment in there. So all of that,

comes together in a departmental plan, one thing that we're considering now to improve even that approach is how we depopulate the hospital to the extent that we can. What does that mean? Where we can use robotics that require less people, because people require air, sterilized air, where we don't need to have people operating the hospital, such as in storerooms, back of house rooms.

plant rooms where we can manage those rooms with robotics or AGVs, they're called, in the industry. We want to apply those, and we're considering those in New Zealand, to reduce the amount of people that the hospital, the staffing and the support people the hospital needs to have. there's a collection of ways to approach reducing the carbon generation or output from the hospital, all the way from the detailed departmental plans.

which uses the most energy, outputs the most carbon, to how we actually invest in the equipment that's managing and running the hospital. And yes, they are there for a long time. These facilities are there for a long time, but there are parts of it, if we approach them as modern means of construction, as either a modular or a prefabricated series of spaces, we can control how we're generating that carbon a lot more smartly.

So interesting Mike, thanks for that. think in the past we did an analysis of what are the contributors to healthcare carbon. We found said components which were energy, water, food, materials, waste and transportation. So within those six we found that materials when it comes to life cycle procurement, it was 50 % of all carbon. So if we are to look into retrofitting a hospital, one of the things also that we should be looking is to try to redesign the area and the retrofit.

or even somehow try to modify or convert the current operation of the hospital to be more user-centric and data-driven. Just trying to influence also the actual need of using material and also the frequency that these materials are unnecessarily thrown or wasted. I think that can really help in improving the performance of an existing building, is already challenging and plenty of modification limitations.

Obviously another one important factor could be work with the technology partners so that with them we can try to do strategic interventions and leverage their embodied carbon and try to improve operational efficiency by applying smart control systems and trying to regulate equipment in a more efficient manner to reduce operational carbon. Obviously as much as budget allows, sometimes this is one of the main problems when you're trying to retrofit. How much money is available for the renovation?

As much as POSIO tries to replace all technologies that probably use constant systems, when this is still probably not required, by a valuable system that you can actually regulate or stop whenever the money is actually needed. So moving a bit into the next question, in transforming the way we plan and design future hospitals, are there any challenges we expect to face, Mike? gosh, you have all the great questions today.

Alejandro, yes, but where would we be if we didn't have challenges, right? It's kind of what we enjoy. I think, yes, yes, we will have, we will continue to have the energy and embedded carbon issues. And certainly in the Middle East where there is not able to, the ability to manufacture a lot of high cost equipment pieces is not as high as in some parts of the world. There will continue to be embedded carbon.

issues in carbon consumption or generation within the facility. Our future challenges, absolutely. I think it's important that from right from the beginning of the project, we produce our plan on carbon net zero right from the beginning and we approach as much of those things that we can control and affect at the outside with those controls that you're talking about, such as working with technology partners, managing the embedded carbon.

much better use of smart controlled equipment, but there are other things that we can consider as well as those technology things. We have a very large hospital underway in New Zealand now that I was the program director on up until quite recently, a year or so ago. And we set up that project from the beginning to be a champion of a lot of innovative systems in environmental matters and carbon matters. One of the things we chose to do right from the beginning was

look at not only managing our carbon production, but also how we could offset that. What that meant was we created partnerships with community groups and we looked to plant one million trees during the construction cycle of the hospital. It's quite a long build, it's a five-year build, and the relationships were put in place for the community groups.

and the contractor, the subcontractors and all the design consultants to take responsibility for planting trees as a way of addressing carbon reduction for the carbon that we couldn't mitigate through technology. So that may be a little more difficult in the Middle East, Alejandro, but I don't know that you're limited to planting trees just in the Middle East. mean, there could be partnerships between the UAE government and other

governments and these may already be in place where these replanting programs which may include food for example in some communities are used to help calculate that offset program. So how we're approaching it in New Zealand is very broad. We're not limiting ourselves just to the technology solutions, we're looking at some social solutions and cultural solutions as well.

One of the things I've also seen in the Middle East is that institutions, clients, developers and users are still not totally aware of the importance of net-share practices and the benefits that they bring into the hospital. And there is a tendency to actually offer some assistance to this practice because they feel all this sophistication counts at a premium. And there is a tendency to always prioritize cost-value engineering exercises to reduce initial cost.

So this is one of the challenges we've seen. think education and training and providing and the information to our stakeholders is crucial in order to resolve this issue. Another problem I have seen is limited funding. So the region, most of the governments are relying now in public-private partnership arrangements in order to diversify economies so that they can actually take care of the healthcare sectors. And obviously these contours are very stringent.

in terms of payment mechanism. So investors don't really see an incentive in investing in new technologies. So funding is important in order to push the net zero agenda. Obviously, originally there is no mandatory regulation. So the day we see this coming, it will be a game changer. But as of now, it's quite difficult when we propose these measures to a client and they say, but is this required by the cause? But because the answer is no, then they say, well, I'll give up fast and prove it next time.

One thing also we need to consider is GCC healthcare sector is trying to come across to the world as a tourism hub, healthcare tourism hub. So on this, there is an expectation of a significant population growth, not only local, but also experts that come here to live for vacation, but also to work. So this is something that WSP needs to account for when it comes to designing, community and adaptability. Now,

We have highlighted great challenges in transforming the way we plan and design, but just in short summary, what needs to happen to overcome these challenges, The challenges are significant, Alianzo. I think the difficulty that we have, especially in the private healthcare market, is there's an expectation from our clients that it costs so many dollars or dooms per square meter to build the hospital. And they think that...

If they build a net zero hospital, it's going to be significantly more. But in fact, it's not really the case if the costs of building and operating that hospital across its life cycle, that is how much it costs per year. If you take the construction cost, the planning cost and the operational cost, the impact of net zero on that hospital is actually very little.

And I think that's got to do with education. I don't think there's a lot of knowledge amongst our clients, as you say. So I think that comes down to us as engineers and architects to help provide that education and knowledge that it actually doesn't cost much more to produce a net zero approach to hospitals. In fact, over the life cycle, you're saving money towards the last 50 % of the life of that facility.

because your place is much more efficient. You're using technology now that will become standard place. If those same clients build a hospital in 10 years time, yes, that technology may be better then, but the technology that's available now does us for those 10 years, right? And we win in that carbon calculation. So I think to answer your question, what do we need to do or what needs to happen to overcome these challenges? There needs to be a joint approach by the government.

if it's a government hospital and the consultants and the contractor who's building it. If it's a private developer that's involved in healthcare tourism, I think the demands there should be made clear by the leadership of the country that we are happy for you to come and sit up here if you're an American or a European operator or an operator from outside the region. However, we would like you to be responsible with our environment as well.

which means that yes, there are some commercial benefits for you to be based here, but we would like you to achieve these net zero targets for us. If it's a local entrepreneur or client or investor, I think the long-term acknowledgement and embrace of those conditions which the Middle East is facing is quite necessary. And I would be surprised that if that demand was put in place to acknowledge that long-term need.

that the entrepreneurs would not agree, they would struggle to argue that they don't want to invest. It's a long-term issue, it's not something that can be solved overnight. And the more facilities we get in place that drive towards net zero, the more normal it will become and the more standard it will become and then there won't be as much pushback from our clients to do that. It's the same as when we had to do

you know, lot of other things for building controls that it changes over time. Since COVID times, something we've seen in the healthcare sector is an enormous digital transformation in the way we operate hospitals and we approach the actual patient care. How do you think the digital transformation supporting the transition to net zero in hospitals, I think it's critical, to be honest. We know from the

large and beautiful hospitals that have already been produced in the UAE and now which are going into Qatar and into Saudi, that asset management, managing that asset over its 45-year life cycle is the most expensive part of having that facility, right? There's a metric that we used to use when I was in the Middle East that said one, 10, 100, took a dollar to design it, $10 to build it, and $100 to operate it over its life cycle.

So if you can manage that last part, that $100 part, much more intelligently or astutely or with much more consideration, you can reduce that expensive part of the ownership to the owner. A lot of the asset management is dependent on the digital twin model. So we would spend more money on the design part, that $1 part. We might spend $1.50 or $2 comparatively.

we would spend a little bit more than the $10 to construct it because we would be installing equipment, HVAC equipment and security equipment and wayfinding equipment and medical equipment that was digitally compliant and was smart equipment that we could manage it in that last cycle and the facilities management and operation phase all digitally. So we would have a digital twin.

that we could control then which departments weren't needing to have the large amount of energy supplied. So maybe at nighttime, we don't need to have the operating theaters, HVAC and air control happening at night because we're not doing operations at night. So we could reduce that infection controlled air at night to those departments through digital asset management. That's becoming now a big focus on not just supporting the owners to reduce costs.

but also targeting a net zero approach. It's totally reliant on a LOD 700 BIM model, which a lot of contractors are now familiar with, and a lot of consultants. WSP is very fluent in that area, producing a digital twin to manage the hospital over that life cycle, that 45-year life cycle, as a very smart and cheap way to actually drive to carbon net zero. Thank you, Mike. I think...

The digital world is really, really vast. There is just so much we can do. One of the things that consider important is moving from the standard building management systems that operate MVP systems in hospitals to add a component of artificial intelligence, AI. And this is because sometimes the way we design the buildings based on the way we get brief or believe the operation is going to be, is not exactly how the building is going to perform.

but also the performance of the building, the way it operates, change over time. So the beauty of AI is that by providing field sensors, you can retrieve real-time data all the time. So the system can learn to adjust the systems to the actual demands through the year at any time across the years. I think this is one component that will really change the way we control systems, improving the efficiency of the scene. Another one obviously is emphasizing the use of micro-victory technology.

to smartly use on-site renewable technologies when probably it is available and the peak loads are at maximum. This way, obviously, the carbon used from the main grid when it is more intensive, it's not there, will be using our technology in order to switch from the main grid to the smart green renewable technology so that we can use our own systems on-site to the benefit of the end user.

In terms of the patient, think a component we've seen recently adding lot of value is telemedicine. when a patient cannot just move to a hospital simply in order to reduce scope three emissions again, providing telemedicine helps the patient to be attended from their own home. Even some of the suppliers are already shipping diagnostic equipment connected to an application to the patient house so they can actually be monitored and at the best comfort of being really sitting at home.

Use of electric vehicles, also important. But sometimes if you need to move to an acute hospital, which is somehow far from home, there's a stress in terms of not finding a parking where you can charge the car. So developing health care applications where you can book a living charger so you can park the car and you know you have your parking spot reserved can help us encouraging the use of the electric vehicle, which is obviously less carbon consumer than combustion vehicles. All in all, think

collaborating as I earlier with technology partners. It's crucial to understand what is the present and probably expected clinical solutions coming next so that we can, as designers, WSP, try to design to that capability so we can incorporate those new sophistications in the future projects. Thank you very much, Mike, for the insight that you've shared with our listeners today.

and to our audience, thanks for listening all the way through and please leave us a comment if today's episode has been of interest and don't forget to join us on future healthcare episodes. Stay tuned.