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Panel of Experts is a forum for industry professionals to share their opinion on a topic relevant to healthcare. In this issue our expert panel weighs in on - Cost and the environment. Are environmentally sustainable practices in healthcare worth it in the long run?

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ELISA KNOWLMAN
Head of Healthcare Design,
Peddle Thorpe
In the delivery of healthcare infrastructure, architects are commonly asked to prioritise environmentally sustainable solutions.
Some passive design measures-like building orientation, use of sustainable materials and efficient space planning-can be implemented at a low cost and contribute to reduced running costs. These measures are good design practice, offer environmental benefits, don鈥檛 break the bank and are therefore worth the design effort.
Once a design starts to develop, decisions about elements such as windows, methods of heating and cooling, and water collection and reticulation, start to impact capital and running costs. They also have a great effect on whole-of-life considerations. These short and long-term impacts need to be quantified, usually expressed as a 鈥榩ayback period鈥�.
We present this information to the project owner, as they are ultimately the ones to decide the worth of these measures. The length of payback period a project owner is comfortable with will depend on factors including: their corporate policies and environmental ethos, planning horizons and project operating budgets.
Great designers often achieve ecological benefits in the pursuit of effective design outcomes. But unless a healthcare entity is committed to incorporating sustainability measures, the survival of tailored environmentally sustainable design solutions through any value management process is tenuous.
FIONA ARMSTRONG
Founder and Executive Director,
Climate and Health Alliance
This question about environmentally sustainable practices in healthcare is a provocative one; it also raises other questions. What does being 鈥渨orth it鈥� mean? And what is 鈥渢he long run鈥�?
Environmentally sustainable healthcare initiatives, by their definition, intend to ensure that any impact on the environment is 鈥榮ustainable鈥� i.e. it uses resources in such a way that they will be available over the longer term. I would argue this means 鈥榠n perpetuity鈥�, defined as 鈥樷�榚ndless duration鈥�.
It鈥檚 unlikely that any of the initiatives we currently refer to as 鈥榚nvironmentally sustainable鈥� meet this criteria 鈥� after all we know from the emerging literature on 鈥榩lanetary boundaries鈥� we are already in breach of several environmental limits 鈥渨ithin which humanity can safely operate鈥�.¹
Fortunately the 20,000 hospitals and healthcare services that are part of the 鈥楪lobal Green and Healthy 黑料吃瓜群网s network鈥�² are answering 鈥測es it鈥檚 worth it鈥� with a resounding commitment towards safe operating spaces and shifting towards environmentally responsible, low carbon operations, while striving to improve public health and community resilience. If there is to be any 鈥渓ong run鈥� for humanity, and the tiny blue planet on which we depend, there isn鈥檛 any other option.
JACK KERLIN
Technical Director and ANZ Health Sector Leader,
AECOM Australia
In short yes, and these should always be done with the patient and staff wellbeing as a focus. I believe that there is a trend towards considering the longer term operation of a health facility as opposed to shorter term savings. Environmental approaches are no different and should always consider the 鈥榳hole of life鈥� cost or the payback.
The ongoing discussion of cap-ex versus op-ex is ever evolving, but these should be considered together to understand the total cost of a facility. There is rarely a comprehensive study done to confirm the extent of cost, operational savings, carbon footprint as well as other tangible and intangible outcomes. Planners, engineers and architects will all approach this in different ways so it鈥檚 important that a holistic approach is taken to the design and development of a health facility to reduce the longer term operational risks.
An evidence-based approach is essential which incorporates all of these issues to enable sustainable facilities while supporting improved health outcomes.
References
1. Sefan W et al. Planetary boundaries: Guiding human development on a changing planet.
2. Global Green and Healthy 黑料吃瓜群网s Network.
Want to join the panel? Get in contact: healthcareeditor@aprs.com.au