Understanding and Improving Healthcare Using Environmental Life Cycle Assessment and Evidence-Based Design

This dissertation quantifies and analyzes the environmental and human health impacts associated with healthcare through assessment of the physical built environment of a hospital as well as the processes and procedures conducted within the building. Healthcare, especially in the United States, seeks to reduce cost and improve human health in part by reducing waste and improving building design and operational practices. This work shows that sustainability engineering tools help assess the effects of green design considerations in whole hospital performance and can identify areas of high environmental loading in the operating room (OR). A comparative longitudinal assessment showed the hospital performance impacts of green, holistic hospital design. Following the move into the new, green facility, the Children’s Hospital of Pittsburgh of UPMC significantly improved their productivity, quality of care, and staff satisfaction. The utility use per square foot dropped over 50% for electricity, heating energy, water, and sewer, while hospital expenses per patient in bed remained stable. This and other contributions to the field of Evidence-Based Design inform future design decisions which optimize hospital energy use and maximize positive patient outcomes and staff satisfaction. This research established process and hybrid life cycle assessment (LCA) frameworks to assess hospital operating room procedures. Case studies of infant birth procedures and hysterectomies at Magee-Womens Hospital of UPMC show that production and disposal of single-use materials and devices as well as heating, ventilation, and air conditioning systems have the highest environmental loading within the OR. The hysterectomy study, in particular, pointed to upstream material manufacturing as an area for large environmental improvements in healthcare facilities. For example, single-use cotton materials such as towels and gauze make up only 9% of vaginal and 11% of abdominal hysterectomy municipal solid waste by weight, but the production of these cotton materials accounts for 55-90% of the total environmental impacts of vaginal and abdominal hysterectomies in nearly all categories analyzed. A Monte Carlo assessment of the hysterectomy LCA showed ranges of environmental impacts based on variability of OR procedures and uncertainty in impact assessment methods