Rethinking Buildings to Heal Patients: The Shift Toward Energy Efficiency in Hospital Facilities



by Isabel Figueredo, Researcher/ Analyst


How do we maintain satisfaction among a growing patient population while decreasing the immense amounts of energy consumption in hospital facilities? The answer is complicated.

Energy consumption is one of the most prevalent problems facing U.S. healthcare delivery. U.S. healthcare facilities spend 8.8 billion dollars on energy annually. Individually, they use almost three times the amount of energy a typical office building requires (Bendewald and Tupper 2013). As a result, there has been a dramatic shift towards energy efficiency initiatives that can decrease operational expenses while allowing the facility to retain maximum operational efficiency and patient satisfaction.

Retrieved from:

Retrieved from:

Managing energy costs in hospital facilities is never straightforward. Almost all hospital facilities are open 24 hours and require cooling and heating systems that vary significantly by climate (Bendewald and Tupper 2013).

“In a typical hospital, lighting, heating, and hot water represent between 61 and 79 percent of total energy use depending on climate”.(National Grid 2014)

Although there are basic fixes and practices that can be conducted in order to decrease overall energy use, the tools for understanding space occupancy, activity, and energy requirements have yet to be effectively constructed or deployed. In other words, there could be an air-handling unit that is serving an unoccupied area at night, but how do we know it is unoccupied (National Grid 2014)?

By being more energy efficient, hospitals could assist in preventing greenhouse gas emissions, improve the air quality in their local communities, and serve as a lead example in their dedication to public health ( An even larger selling factor is that by being more energy efficient, hospitals would save a significant amount of money. As an example, the New York Presbyterian Hospital (NYPH) has developed diligent energy saving initiatives since 2003, and as a result saves $1.77 million in annual savings. Providence Health and Services, a Seattle-based healthcare system has made similar advances and has increased their energy savings from $700,000 in 2003 to $3.4 million in 2006 ( Even so, the majority of hospital facilities have made very little progress towards addressing these challenges and opportunities.

In order to holistically rethink systems that generate inefficiency, it is also important to consider other issues the healthcare system needs to address. For example, new policies and regulations have made health care more accessible to a much larger population (Anderson 2014). Because of this increase in access, healthcare organizations’ energy demand costs are dramatically spiking to meet patient needs. With volume increases, hospitals simultaneously struggle to maintain overall patient satisfaction, the basis for their Medicaid reimbursement revenues.

Hospitals view patient satisfaction as a key priority for various reasons. It has a heavy influence on revenue, cost, and government reimbursements. Hence there has been an abundant push towards studying what factors within the hospital environment can affect a patient’s overall experience. The majority of this research has focused on social environmental factors, such as the staff’s attitude and its effect on patients’ experience.

Even though there has been less focus on environmental and architectural design, there is still a significant amount of existing empirical research to suggest that properly designed hospital facilities can improve patient safety, satisfaction, and overall experience (Reiling et al. 2008; Joseph et al. 2011). Evidenced-based research has also found that properly designed hospital facilities can decrease the facilities’ energy consumption and energy costs (Bendewald and Tupper 2013). Regardless of the multiple studies conducted on each subject, there has been little to no research that suggests looking at the relationship between them.

Understanding the relationship between energy consumption and patient satisfaction and their influences on hospital productivity and cost can lead to essential information the healthcare system could use to decrease energy consumption while maintaining or increasing overall work functionality.

Fig 2. Energy consumption and its relationship to patient satisfaction. Graphic by Annie Liu

Fig 2. Energy consumption and its relationship to patient satisfaction. Graphic by Annie Liu

It is evident that further research is required to explore how physical structures and environments interact and shape cultural outcomes within hospital facilities. Understanding how the environment, culture, and facility structure may influence the overall experience of the patient is essential to helping hospitals meet their primary objective of customer satisfaction.

Architecture, Culture, and Assets all intersect to create a holistic understanding of how patient health is contingent on multiple factors.

Architecture, Culture, and Assets all intersect to create a holistic understanding of how patient health is contingent on multiple factors.

MKThink believes that opportunity for operational and planning improvements can be found through studying the relationships between physical and social structures. We have developed a framework that studies the overlaps of three dimensions: Assets, Environment, and Culture. This logic has been used to help give organizations the ability to increase human performance, use fewer resources through optimized resource use, and develop more effective investments in technology and energy efficiency. The initiative has already been supported through the Office of Naval Research (ONR) and the Asia-Pacific Technology (APTEP), and is in the process of expanding and becoming more accessible, non-technical, and efficient.

Implementing this unique framework could benefit hospital facilities in determining what decisions would be the most effective in order to decrease their energy consumption while retaining or even improving overall patient satisfaction.

With all this in mind, back to the original question: how do we maintain satisfaction among a growing patient population while decreasing the immense amounts of energy consumption in hospital facilities? It is still complicated. However, the first step is to reform the way we think about current issues within the healthcare system. Only then can we can use the rapidly developing technologies and preexisting cultural factors around us to determine what the most efficient, cost-effective decisions for the future would be.



Cited references:
Anderson, Amy. 2014. “The Impact of the Affordable Care Act on the Health Care workforce.” The Heritage Foundation, March 18. Retrieved September 8,2014. (

Bendewald, Michael and Kendra Tupper. 2013. “A positive diagnosis: How hospitals are reducing energy consumption.” Green Biz, November 21. Retrieved August 9,2014 (

Energy Star. Healthcare and Overview of Energy Use and Energy Efficiency Opportunities. Retrieved August 8,2014 (

Joseph, Anjali, Eileen Malone, Debajyotie Pati and Xiaobo Quan. 2011. “Healthcare Environmental Terms and Outcomes Measures: An Evidence-Based Design Glossary.” Tandus Flooring, November 2011. Retrieved September 8,2014 (

Reiling, John, Ronda G. Hughes and Mike R. Murphy. 2008. “The Impact of Facility Design on Patient Safety.” Patient Safety and Quality: An Evidence-Based Handbook for Nurses, edited by R.G. Hughes. Rockville, MD/United States: Agency for Healthcare Research and Quality.

National Grid. Managing Energy Costs in Hospitals. E Source Customer Direct. Retrieved August 9,2014 (

Other references:


Old & New: Can Contemporary and Historical Architecture Exist?

by Yodai Yasunaga, Innovation Studio Intern

In 2007, the Royal Ontario Museum in Toronto, Ontario reopened with The Crystal – Daniel Libeskind’s controversial 100,000 square feet extension to the original structure of the museum. The structure is composed of five interlocking prismatic structures made of glass and aluminum on steel frame, and it functions as the new main entrance to the museum. Although the structure does not touch the original Neo-Romanesque architecture built in 1914 except for the connecting bridge, it greatly alters the aesthetics and experience of the museum. The Crystal has been highly controversial, with some praising it as a contemporary monument, while critics have attacked its aesthetic, function, and purpose. For example, The Crystal makes it hard to display exhibits, because all of the interior walls are slanted. Overall, the design controversy surrounding the addition has taken away much of the attention from the actual contents of the Royal Ontario Museum. [Further discussion on it can be found here:]

Can contemporary and historical architecture coexist?

From Studio Daniel Libeskind

From Studio Daniel Libeskind

As architecture technologies and styles evolve, there has always been tension between cotemporary and historical buildings, and the people that advocate for them. Conservationists believe that it is important to prolong the lives of old buildings through carefully planned preservation practices to preserve history that the buildings represent. On the other hand, contemporary architects and their supporters are in favor of technological and architectural change and progress that become to represent the present. In midst of this over-arching debate exists the topic of “architecture of additions” where contemporary structures are built in conjunction to existing buildings (Byard, 1998). The interplay between the old and the new often sparks controversy. Some cases are seen in a positive light, where the old architecture is given new life without destroying its spirit and history. On the other hand, other cases such as The Crystal, receive criticism for overpowering the original architecture. 

The Louvre

Photo courtesy of Wikimedia Commons.

The Louvre Pyramid in Paris by I.M. Pei is an iconic example of controversial “architecture of additions”. According to Susan Stamberg, critics described tampering with the historical building of the Louvre “sacrilegious”, but after over two decades, it has been accepted by the public, with many praising it as a masterpiece that made an old museum more relevant in the contemporary world. One key of this success may be that the contemporary addition does not interfere with the interior exhibits of the historical artworks but provides a new sense of balance to the overall structure. 

Tate Modern

The Tate Modern, on London’s West Bank. Photo courtesy of Wikimedia Commons.

The exploration of “architecture of additions” continues to grow in the 21st century, and when done well, it may be the perfect balance between contemporary and historical architecture. It is crucial to evaluate what separates successful examples from the rest, and explore the potentials of this artwork of balancing the old and the new. Precedent works hint that there must be large considerations for the context of the work, including the building’s history, significance to society, location, and the purpose of the additions. Do the old and the new have to be in visual harmony, conceptual harmony, or both? How does the addition contribute to the value of the original? Is the addition really necessary? In any case, there must be a dialogue between the old and the new that foster their coexistence.


The side of the building facing the street maintains the form of the original building to align with the cityscape of Louisville, KY. The contemporary interventions are introduced on the side facing the George Garvin Brown Garden.

#1 George Garvin Brown Garden, MKThink’s current project in Louisville, Kentucky, is a demonstration of architecture that incorporates the old and the new. Working with the currently vacant, historic building of the Business Women’s Club (1911), the project’s concept is to create a center that will be a catalyst for healthy and thriving urban revitalization. The proposed design seeks to preserve and pay respect to the original building while giving it a new life through contemporary interventions that are visually different yet harmonious to the concept of the whole building. #1 George Garvin Brown Garden is a project that builds on Louisville’s history with the technology of the present, to take a stride towards the future.


Other Links: (“New Exterior Additions to Historic Buildings: Preservation Concerns) (examples) (examples)


Byard, Paul Spencer. The architecture of additions: design and regulation. WW Norton & Company, 1998.

Stamberg, Susan. “Landmark At The Louvre: The Pyramid Turns 20.” NPR. NPR, 7 Dec. 2009. Web. 31 July 2014. <>.

“Studio Daniel Libeskind.” Images. N.p., n.d. Web. 31 July 2014. <>.


Sensors in the City: Finding New Applications for Data Collection

By Will Godfrey, Strategic Analyst

Here’s the scenario: Your city determines to improve or change some aspect of one of its neighborhoods and after months of outreach, planning, and building, Street X has, say, wider sidewalks, speed bumps and some benches and trees. The budget’s been used up, the community is generally pleased with the improvements, and the planning department re-assigns the project team to new tasks. If the project’s goals were to improve walkability and calm traffic, it might be difficult to tell how much of an impact was actually made without an in-depth assessment phase. But even if the goals of the project have clearly been realized to everyone’s satisfaction, there’s still value in taking a closer look – maybe if you studied 20 similar projects you’d learn that one of these improvements actually contributes most to the positive outcome, or that two of these improvements work better in concert than they do individually, or that there’s a set of pre-existing conditions that need to be present for a site to see benefits from one intervention or another.

Nine foot tall listening dishes adorn Market Street at the Living Innovation Zone in partnership with the Exploratorium as part of Innovation Month in San Francisco on Yerba Buena Lane at Market Street between 3rd & 4th Streets

Nine foot tall listening dishes adorn Market Street at the Living Innovation Zone in partnership with the Exploratorium as part of Innovation Month in San Francisco on Yerba Buena Lane at Market Street between 3rd & 4th Streets

The difficulty that planning agencies run into is that a thorough investigation using traditional research methods requires boots on the ground counting pedestrians, taking notes on clipboards, etc. This demands staff that aren’t always available, and the results might be skewed by any number of chance factors in play during the observation periods – If the weather is unusually nice, or if the use profile is very different on weekends than on weekdays (when most of the observations are made), or if the World Cup is on TV and everyone’s inside glued to their couch, then the hours of observations can still really only paint a partial picture of the new space’s performance. To fill in all the gaps and complete the picture would require staffing the site 24/7 so that observations can be made continuously.

Outside of the City Planning sector, the need for more efficient monitoring and data-collection has led to a greater dependence on sensor technologies. Smart meters that communicate directly with energy providers are supplanting human meter readers; the Golden Gate Bridge no longer staffs its tollbooths now that everyone has a FasTrak device. These and other more-efficient systems streamline what used to be resource- and time-intensive processes, and can also establish a constant stream of data for those organizations to learn from and respond to. In the context of planning or evaluating a public-domain project, I don’t think that sensors could ever fully replace the role of an experienced researcher who can notice subtle behaviors and reactions to the city-scape, but what sensors are really good at, and what they could help with are all of the necessarily time-consuming and repetitive (but in the end very valuable!) tasks like counting and taking measurements. Your one researcher standing on a corner can log this type of data for a few hours at that location and maybe come back and do the same thing a few more times over the following weeks. A sensor can monitor the same factors continuously over months, freeing up the staffed researcher to move through the space, ask questions, take notes, photo-document their time on-site, etc. That’s what humans are really good at, so using people and technology together seems like a perfect match for the evaluation process of public projects. The test is whether a sensor (or sensors) can accurately capture the key performance data points that tell the story of how a space is being used when a researcher isn’t present.

Narratives running through the Living Innovation Zone on a given day.

Narratives running through the Living Innovation Zone on a given day.

To explore that question and get involved with a very neat local project, MKThink partnered with the Exploratorium and the SF Planning Department on the former’s first ‘Living Innovation Zone’ (LIZ) at Yerba Buena Lane. If you’ve walked down Market Street lately you’ve probably seen it – it’s a circle of benches backed with slatted windbreaks, and there are interactive exhibits to try out as you sit and eat/talk/relax. People speed-walking down the sidewalk can weave through or around it, but the idea is to slow them down or tempt them to pause and “spend time observing their urban environment —and each other— more closely.” (

MKThink’s role in the partnership was to monitor the installation and consider ways to share that information back to pedestrians as an exhibit in a future LIZ. We conducted some of that old-fashioned in-person observation, but we were most interested in testing out a network of sensors that counts up how many wi-fi devices (as a proxy for foot traffic) pass through the study area and measures how long they tend to stay in the space.

Sample data collection of WIFI devices passing through the site.

Sample data collection of WIFI devices passing through the site.

This was conceived as a test of the technology, and there were some challenges with getting access to power and network (but thanks to nearby building owners we were eventually able to!), so we didn’t establish a baseline of data from before the LIZ was constructed. This limited our findings somewhat, but our monitoring system was in-place for 4 months and we have readings that describe the fluctuations in foot traffic and length of stay – our performance criteria – over that entire time. We can tell that the LIZ experienced its heaviest use on Monday, November 18th, and that visitors on Sundays stay significantly longer in the adjacent plaza than those on Saturdays, and a dozen other anomalies and patterns that lend context to the observations we were making throughout the study. The challenge at this point is that even with our mountain of data, it’s difficult to tell which among all of the factors that make up a complex system like Market Street contribute to the spikes and trends in our data. To understand what happens in and around the LIZ on that level we’d need to take into account a whole range of other factors that influence public space, and probably rely more heavily on human-led research than sensors.

So what is a focused application for sensors in city planning and urban design today? Fitting them into a routine evaluation process for public projects is one possibility. The Exploratorium’s idea to make data visible and interactive to get people engaging with their surroundings is a completely different angle. A counterpoint? The city of Chicago has a new program they call the Array of Things, which just started collecting a whole bunch of city data, and at the moment is simply storing it all for ongoing study. (

What’s next?


Inspiring Entrepreneurism in The Built Environment at RoundhouseOne

RoundhouseOne and MKThink are delighted to welcome Kayla, Marley and Sam, three talented interns who are joining us this summer in participation with Haverford College’s prestigious Whitehead Internship Program.

Haverford College

Haverford College in Pennsylvania. Image courtesy of Wikipedia (

The Whitehead Internship Program, sponsored by Haverford alumni and honoring John C. Whitehead ’43, fosters hands-on education and experience that supports students’ interests in entrepreneurism. Haverford alum and MKThink founder Mark Miller inspires and lives the entrepreneurial spirit. Having founded three companies, he brings innovation and entrepreneurism into the traditional practice of architecture. Mark says, “The undergraduates at Haverford College are well known for their ability to successfully participate with and achieve results as researchers at a level commensurate with graduate students.  We are grateful that the Whitehead program provides the opportunity for these talented students to extend their efforts to the professional domain – in our case, to explore practical applications through hands on experience with applied technologies in the built environment that will reduce energy and other natural resource demands while improving health.”

Marley Using a Rangefinder

Using a range finder, Marley verifies classroom measurements for the classroom inventory dataset.

Sam, Kayla and Marley will be living the startup life as part of RoundhouseOne’s data analytics team this summer. The interns are spearheading an Integrated Assessment Study for the Haverford campus. The Integrated Assessment is an evaluation of data from an organization’s architectural, environmental, and cultural dimensions to identify efficiency and performance improvement opportunities. The team will be conducting a utilization and occupancy study with a focus on instructional spaces, a Cultural Cartography evaluation, and environmental data collection.

Splitting time between doing field collection in Haverford and data analytics in our San Francisco office, the interns will gain valuable hands-on professional experience as well insights into how data can improve campus life for students and faculty in their own school.

RH1's Haverford Interns 2014

From left to right: Sam, Marley, and Kayla, the 2014 Haverford College Whitehead Interns.

Meet the Interns:

A spark of interest was ignited in History major Sam Callon during a class called Cultural Landscapes of American Empire. It was during that class that Sam became interested in space and architecture and decided that he would like to work for a company focused on the built environment. Sam has been busy collecting data for the asset inventory database and says, “I have liked working with AutoCAD, going around campus with the rangefinder to get room measurements, and meeting with staff about the project.”

Marley Randazzo, a Growth and Structure of Cities major, is interested in the design of place and ways in which space can be more efficient and effective for users. “So far my favorite part of the project has been speaking with members of the Haverford College community concerning what changes they would make or like to see on Haverford’s campus.  For some, a change as simple as the incorporation of natural light into their workspace would be a huge improvement.” Marley is stimulated by the idea that the built environment can be designed to enhance our daily lives.

Fiction writer and English major Kayla Franceschi has always been interested in the intersection between building design and use and the environment surrounding it. “I grew up in East Harlem and am currently seeing a lot of the buildings near me being repurposed in an effort to attract a different crowd. The neighborhood will certainly undergo changes to match its surroundings, but that has only further cemented the idea that what we build molds a community.” Kayla has found the data collection process interesting and believes it has been a great way to begin interdepartmental conversation about the campus moving forward.

For more information, contact Rachel Posman at

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RoundhouseOne’s Ashley Camps Invited to Speak on Panel at Agrion Disrupt 100

AGRION Disrupt 100 Panel: Using Data Transparency to Optimize Opportunity and ROI

 By Ashley Camps, Lead Marketing Strategist at RoundhouseOne 

 Agrion Disrupt 100

Last week I was selected to participate on a panel titled, “Evaluating Energy Efficiency Investments: Connecting Energy Performance to Valuation in Commercial and High End Residential Buildings- Using Data Transparency to Optimize Opportunity and ROI.” I made my way to the Metropolitan Pavilion at 125 W 18th Street to soak in the expertise provided by my peers and share my own insights from the West Coast.

The Agrion Disrupt 100 Conference was a gathering of over 100 innovators and 600 managers of energy companies from around the world. Following a day of sessions and introductions, Mike Rovito (ERS) gave a captivating presentation on “Net Zero and Positive Energy Buildings: A Cost Effective Framework,” which highlighted the value of implementing operational changes to support the physical and financial investments.

These are some of the questions that I discussed with my fellow panelists:

How does the marketplace view sustainability/efficiency investments?

Energy efficiency and sustainability in buildings today is highly valued. It’s not only trendy and creates the perception of being high value and upscale, it can also result in customer retention and generation. Ultimately, though, the primary reason why an organization will work towards energy efficiency is because it saves money.

If it’s about saving money, it’s about saving energy. How do we measure that?

RoundhouseOne was started and incubated architects, strategists and planners who didn’t want to build just for the sake of building, who knew that the best solution for their client’s needs wasn’t always the addition of a new facility to their portfolio. Often, learning to solve for a client’s asset, energy, or operational inefficiency by considering the relationships between the three legs of the stool that Mike had mentioned is the best approach. For example, an organization might try to save money by closing all of the windows in a room to get the highest efficiency from their cooling units.  As a result, they succeed in using less energy to power the cooling unit, but the lack of ventilation results in lower air quality and staff performance suffers.  Does revenue suffer as a result?  This is why it’s important to use a multidimensional approach to analytics when evaluating energy efficient investments.

RoundhouseOne (RH1) is the data-driven technology company that delivers insight to improve an organization’s performance by relating human factors, environmental conditions and physical structures.  Our technology and technologists collect, qualify, correlate, analyze, and communicate data so that our clients can see the full picture and reduce their TCO, avoid capital expenditures, and optimize revenue.

BK CO2 Analysis

C02 concentration vs. occupancy. The grey portion is the level that is known to cause severe impairment to decision-making.


Investments aren’t always fixed. How can we leverage data to identify commissioning opportunities?

RoundhouseOne uses client data, sensor data, and public indices to correlate key metrics against baselines, benchmarks, and help our clients find their KPIs for their organization’s mission, competitor or industry-driven success goals.

How much energy does your organization require to run at your target performance level? Where are the opportunities to save or generate energy? For example, we can look at plug loads, equipment and thermal comfort systems against occupancy and utilization to evaluate opportunities to save. We can look at solar radiation, wind speeds, weather patterns, air temperature and rainfall to evaluate generation opportunities. This only scratches the surface.

Explain the difference between using data to reduce risk in Statistics vs. Engineering. 

The collection and analysis of data removes emotions and assumptions from decision-making. Our clients use RH1 insights to support planning and capital expenditures: From discovery, assessment and strategy to post occupancy study; from city planning departments to school districts to universities, our clients can use RH1 insights for micro planning to creating building sustainability, air quality and energy efficiency baselines and corporate responsibility standards.

Not only do our clients use RH1 Insights to Optimize Opportunity and ROI and to support business cases, but our proven process and patented technology platform validates, standardizes and hosts cross departmental data and powerful insights to provide Data Transparency.

Explain your Methods and Approach.

It’s important to explain that RH1 does not provide the solutions or strategies to solve for these Energy Efficiency or Environmental Resource problems, but that our technology and insight packages are used to diagnose the key metrics defining these needs. This data then can be used to test scenarios before decision-making and support the business case after implementation.

Agrion Disrupt 100 Main Conference Room Agrion Disrupt 100 Main Conference Room

All in all, it was a unique learning experience. I want to extend a thank you to my fellow panelists for a great discussion:

  • Michael Rovito, ERS
  • Timothy Lezgus, Con Edison
  • Dave Jaros, Noesis Energy
  • Andy Frank, Sealed Homes

I look forward to working with more like-minded individuals and partnerships to create a more sustainable, more energy efficient market for generations to come!


Ashley Camps

For more information, contact Ashley at

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