Energy Savings for Today’s Healthcare Environment by Nan Schramm, LEED GA, EDAC, Fitwel Ambassador, Senior Associate

Hospitals require a large amount of energy to support daily operations on a 24/7 basis. Daily operations include critical systems and medical equipment, as well as supporting the patient experience. Previously, when a hospital attempted to reduce energy consumption, they would focus on back of house spaces. For example, changing out T12 Fluorescent fixtures to T8’s and adding motion sensors to less frequently used spaces. At the time, these small changes were at the forefront of achieving energy savings. Facility managers and designers have been collaborating on new, innovative strategies and tactics to help reduce consumption. Fortunately for the industry, technology has provided several tools.

Energy Saving Tools
In today’s market, facilities can adopt programs such as EnergyStar Portfolio Manager which provides healthcare facilities tools with which to benchmark their energy score against that of their peers. Energy Star Portfolio Manager considers a facility’s climate, weather, and the business activities at the facility. Building activities, such as MRI use, can be significant drivers of energy consumption. General, critical access, and children’s hospitals are eligible to participate. A hospital’s EnergyStar score (a 1 to 100 percentile ranking) is a framework by which a facility can compare its energy use intensity (EUI) to the national averages and that of their peers. By benchmarking energy use, and even greenhouse gas emissions, hospitals are given a tool to understand inefficiencies and a viable set of strategies to address those inefficiencies.

Another great resource is, Practice Greenhealth, an organization whose mission is “to transform healthcare worldwide so that its environmental footprint, becomes a community anchor for sustainability and a leader in the global movement for environmental health and justice”. It is the nation’s leading membership and networking organization for healthcare organizations who have pledged a commitment to sustainability and environmentally preferable practices. Practice Greenhealth provides tools for healthcare facilities to eliminate inefficient energy use while enhancing patient outcomes and minimizing costs. They believe that new initiatives such as The Department of Energy’s, Better Buildings Solutions Center, can help hospitals to identify viable, cost-effective strategies to reduce energy use.

Retrofitting Lighting
Retrofitting with LED lighting can contribute to a reduction in hospital energy costs. According to the Department of Energy (D.O.E.), lighting accounts for 10% of a typical hospital’s electrical energy consumption. Now, with LED lighting retrofits or redesigns, the Department of Energy estimates that a 100-bed facility can realize $20,000 per year for operating expenses. In addition to cost savings, a facility’s carbon footprint is reduced, and less load is placed on generating facilities and backup power generating facilities.

Further savings can be achieved by substantially cutting back on lighting usage in special purpose rooms (under-used class rooms, lounges, and cafeterias). Facility operators can curtail lighting and plug loads without interrupting routine operations.

Architects and Engineers can also contribute to energy savings for our clients through retro-commissioning. A process for recalibrating older building systems to help energy costs and improve operations, retro-commissioning often includes upgrading lighting to more energy efficient lamps and controls, and right sizing heating and cooling systems with upgrades or retrofits. Making these retrofits often comes with added benefits of noise reduction and lower maintenance costs.

While not common, some hospitals are going off grid and producing their own energy for self- sufficiency. Sharp Grossmont Hospital in San Diego, CA is now officially off the grid having built their own central energy plant using cogeneration. Cogeneration utilizes combustion turbine generator (CTG). The CTG is powered by natural gas and has the ability to produce more energy than the hospital can use allowing for future growth. The new system also reduces the hospitals greenhouse emissions by 90%.

E4H utilizes an “Eco-Charrette” process at the beginning of a project, which builds consensus among the project team (designers, contractors, building users, owners, etc.) to focus on both the big picture as well as the details, thus arriving at an agreement on specific goals, strategies and project priorities relative to energy efficiency and sustainable design. This continual process of verifying quality systems and strategies provides for ready integration into a high-performance building project.

Neighborhood Design Challenge and HCD – By Ayesha Wahid

Team Ayesha and Merielle

When E4H’s internal design competition was first announced, I was incredibly excited. Having recently finished my thesis, it was exciting to be in an environment where experimental thinking was encouraged. While my teammate Merielle and I, had little knowledge of neighborhood hospitals, the prospect of researching and furthering my industry knowledge was a welcome challenge. All teams were provided with past examples of E4H’s recent neighborhood hospitals, a valuable resource.


We dove into research on neighborhood hospitals, current trends in inpatient healthcare, patient experience, etc.. At this stage, we were trying to understand what we wanted this project to be, what our big idea or concept was which would eventually drive the design. We started to outline certain problems that we felt were not being addressed. One that stood out to us was the isolation that people within a hospital can feel, be it the staff, the family, or the patients themselves. The hospital can seem removed from the rest of society. Thus, the question arose – how to decrease this feeling of ‘otherness’?

We brainstormed about different social spaces – Central Park, farmers markets, the High Line, and what made them successful. We soon found that certain key words were common in all of these spaces – interaction, nature, daylight, being outside, etc. From here, our concept began to form. We realized that what made those spaces successful were the way they enabled the senses, and that they were all outside. We imagined a hospital which wrapped around a public space, offering access to everyone in the neighborhood. This space would be visible to everyone within the hospital, making them feel connected to the community instead of removed. Then came the problem of how to avoid making people in the hospital feel like they were on one side of the glass looking in. This is where the senses came in, we thought of incorporating the same elements you would experience on the other side of the glass within the hospital.


In the early stages, it was difficult learning how to balance our daytime workload and the excitement of the design competition. In the end, it was a great lesson in time management. Being so new in the industry, we struggled with navigating medical planning and program requirements. Since the neighborhood hospital concept is still a relatively new topic in the field of healthcare design, there was only so much we could find online in terms of planning. Luckily, we were able to refer to the database of previous neighborhood hospitals that E4H has designed. This was critical in our understanding of flow and important adjacencies.

As designers, even with a conceptual project like this, we wanted to make sure that the materials we pulled were free of toxic substances. This required some extra attention to detail and further research. Design Seeds proved to be a helpful site for quickly putting together our color scheme for a graphic presentation. The platform posts beautiful pictures of nature, architecture, food, etc., and creates color palettes pulled from these images. When deciding on what graphic style we wanted to pursue for our renderings and presentation, we looked at Visualizing Architecture. This website has a diverse gallery of architectural illustrations like drawings and renderings, which serves as a good starting point for graphic inspiration and offers tutorials. Since our concept was rooted in stimulating the senses, we used a collage type of rendering style to highlight the colors, textures, etc. of the space.


On the day of the competition, each team was given 30 minutes to present their design for the neighborhood hospital challenge with additional time for questions and critique at the end. The presentations were carried out over an online Go-To-Meeting held in the conference rooms of all offices. Everyone was invited companywide to view the presentations and ask questions either via the chat tool or by calling in. We were all given the exact same program, and yet each team approached and tackled it in their own way. It was amazing to see the skill of our colleagues in their planning, renderings, and design. We were the third team to present and it was incredibly encouraging to have several people from the New York office in the conference room with us while we did so. We received many questions, fantastic feedback, and great suggestions. The various judges were given a grading matrix which was used to place the different teams. Merielle and I were honored when we found out we had placed second.


The prize was an all-expense paid trip to the Healthcare Design Conference in Phoenix where we would get the opportunity to present our concept at the Cocktails and Critique Event. This event was organized for the two teams to present their design during a cocktail hour networking event. Clients were invited to view and critique the finalist’s projects. Each team had two concise boards with which to present when the guests came over. It was very educational to hear the assessments and recommendations from the client side of hospital design.

Taking part in the internal design competition was an amazing, challenging experience. We were able to explore new skills, make new connections and gain access to a wealth of knowledge. It is exciting to work at a firm that supports and fosters creative thinking and design and we highly recommend taking part in such competitions to anyone who is interested.



Our final design included the following elements.

A neighborhood hospital which wraps around a large public green space. This courtyard houses a gallery space with rotating exhibits of art and sculptures by local artists. It is also home to a sculptural playground of sorts, which can be used by children but may also attract the attention of adults. The courtyard has paths for evening walks and views into public spaces of the hospital.

The entry waiting area is large and open, with a variety of seating options including intimate booth seating, hospitality like lounge chairs, as well as a couple of experiential pieces. These movable sculptures house surfaces at seating and bar heights, encouraging users to move them around. It is meant to serve as a form of positive distraction. The waiting area has unobstructed views into the courtyard and a hospitality-like cafe area serving healthy foods and beverages. Ceiling height changes identify various seating areas with a beautiful green soffit. When the client walks in, they are greeted by a receptionist and then directed to check in stations which are semi-private, each numbered in a bold, graphic style.

We also kept in mind the experience of the staff. The staff quarters are placed along the main corridor with views out to the courtyard. Keeping in mind their privacy, the glazing is operated with smartglass technology which allows them to switch on and off the translucency of the glass. Staff are provided with a fully equipped kitchenette, lounge furniture, and touchdown areas. In the adjacent corridor, the wood tile extends into the courtyard to give the sense that the lines between the inside and outside are blurred.

Past the public corridor, we then enter the patient room zone. The family waiting area is centered with a large nurse station with a view into the courtyard. Here too, ceiling height changes differentiate between circulation and seating areas. Here is a spot for clinicians to speak with family members enabled by the intimate, private furniture. The columns are furred out and embedded with plants and herbs that positively impact the air quality.

The patient rooms are numbered in a graphic style similar to the check-in stations at the entrance. Rooms are placed alongside the glazing, allowing for natural light in each patient room. In addition, the doors to each room are accompanied with sidelights which allow for views into the family waiting right outside. Each patient room is framed with a wood headwall that wraps across the ceiling and then comes down in the form of a foot wall. This sculpture is equipped with sound systems which the patient can operate themselves to play their favorite music, listen to the news, listen to the ambient noise from the courtyard, etc. The television is concealed within the footwall to encourage the patient to take advantage of the other amenities. The footwall also features a moss wall which requires little to no maintenance and does not impact the air quality of the room. Diffusers are embedded into the green wall which allows patients and family to operate controls which release calming essential oils.

National Wear Red Day

E4H participated in Wear Red Day on Friday February 1, 2019. This initiative resonates with E4H as it helps further the mission of their clients to raise awareness and education to the topic of Heart Health.

Dallas, TX

Forth Worth, TX

Washington, DC


Boston, MA



Nashville, TN


Burlington, VT


Wentworth-Douglass Hospital Site Visit

E4H aims to expose staff of all phases of architecture including the working construction sites. Every so often, we’ll gather a team to head out to a current project site for a visit. While on site, we’ll review lessons learned, common construction practices, as well as any interesting or unique items specific to that project.

Recently a group from the Boston office visited the Wentworth Douglass Pease MOB sites, in Portsmouth, NH. The group toured two MOB buildings in various stages of construction. Building A is a 2-Storied 25,000 SF building that is roughly 80% complete. Building B is a 3-Storied 60,000 SF building that is roughly 30% complete. Below are the lessons learned from the site visit.

“This site visit enhanced my understanding of the reality of design when implemented during construction. It reminded me of the importance of communication for successful integration of the different building elements and building systems. Having the opportunity to see two buildings in very different phases of construction was eye opening for me. It was like seeing an X-ray of an evolving building because we got to see the “veins” and “guts” that come together to create the exterior walls, the interior walls, and the floors in one building and then we got to see it further along in the other building.

We had the chance to speak to the project superintendent about the coordination it took to construct the space for a linear accelerator. On the design front, we learned that a Physicist was consulted to aid in calculating the thickness and construction of the envelope needed for this space and that there are special lasers that are used with this machine that require an extremely carefully laid out and constructed room for them to work properly. To implement the construction and design required for this space, coordination between the design and construction teams was essential to its success. To me this was not only fascinating but a perfect example of the importance of communication in the healthcare design and construction industry.”

– Kimberly Leonard, LEED GA, project coordinator

“This was a great opportunity to share the day to day activities on a construction site with our younger staff, who would not normally be introduced to a project at this phase until later in their careers.  Observing projects during construction gives a greater appreciation for the effort needed to design, draw, and coordinate thoroughly.  Everything included (or not included) within the drawings and specifications makes its way to the construction site.  It is a good reminder that a project is not finished once the construction documents have been completed.”

– Ray Boudreau, project manager

“It was great to visit the two sites and seeing the projects in their respective stages. I’ve never been to a project site so early in the construction phase as Building A, so it was definitely eye-opening to see how much coordination our projects require from the start, even before the interior walls are even laid out. It was also interesting to learn about the how the future growth of the building was accounted for in the design, as well as how the exterior building finishes were an impact.

Since Building B was much further along, the most beneficial part of this visit was to see the details that we draw in 2D back at the office installed in real life. Other lessons included materials transitions (and how to clarify trouble points on our drawings) and a review of what to check for during punch lists.”

– Marissa Walczak, interior designer

“After the transition from the familiar theoretical realm of learning in school to now seeing firsthand the Wentworth-Douglass Hospital Pease project under construction is certainly an exciting new way to understand the development of design and construction. While walking through the site and hearing from fellow co-workers on how they addressed and reviewed certain challenges was remarkable. It seems that every site will offer a few lessons and to enhance our skills.”

– Shannon McManus, project coordinator


E4H Cares | Holiday Warmth and Gift Giving

E4H Cares recognizes that the holidays can sometimes be a difficult time and hopes to provide assistance to those in need. Our offices selected different causes to contribute gifts, food, and time to, as described below. We would like to extend our wishes for a bright and healthy 2019!

Boston, MA: The Boston office sponsored 20 individuals – 7 women and 13 children. Each individual asked for specific items such as clothing, blankets, or toys. We were happy to provide all requests, in addition to more, totaling 40 gifts. Household items such as laundry baskets, soap, and shampoo were also donated to the Alternative House.

Portland, ME: The Portland office supported the Barbara Bush Children’s Hospital (BBCH), where $140 worth of toys helped stock the Snowflake Station. At the Snowflake Station parents of the BBCH patients were able to pick out gifts for their children. Some of the donations will also provide therapeutic play activities in the Child Life Department.

Nashville, TN: The Tennessee office prepared 20 lunches for The Oasis Center volunteers who are working at the crisis center.

Dallas and Ft. Worth, TX: See our recent blog post regarding The Salvation Army Angel Tree.

Burlington, VT: The Vermont office donated $400 worth of toys and gifts to the Ronald McDonald House, proud to support the children and families who are facing childhood illness.

Washington DC: The DC office delivered $450 worth of gift cards to Fort Belvoir for “Operation Sugar Plum”, a program which assists eligible families assigned to Fort Belvoir by providing gift and food cards during the holiday season.

NeoCon 2018

NeoCon brings together nearly 500 companies and 50,000 design professionals, providing 100 CEUs and showroom tours highlighting new products. We were honored to attend “the commercial design industry’s launch pad for innovation” at the 50th Annual NeoCon.

Similar to a project launch, our trip began with familiarizing ourselves with the site (Chicago) and networking with ten other Boston designers who comprised our team for the week. The icebreaker event at BeSpoke Cuisine divided the group into smaller task forces, each completing one course of the meal. We were excited to work together to make something wonderful, appreciating the unique skills and perspective everyone brought to the table!

The following morning, we headed to the Focal Point factory, which graciously sponsored our trip to Chicago with Boston Light Source. Familiar with the Focal Point, we were excited to delve into their design and development, manufacturing processes, and operational strategies. We were given the opportunity to weigh in on some of their newest product developments like the Skydome Edge Acoustic, an acoustical ceiling solution that compliments their Skydome LED pendant. We are already brainstorming ways we can utilize these innovations in one of our next projects!

Chicago’s architecture has an amazing blend of Neoclassical juxtaposed against the sleek lines of modern design. This contrast of old and new is also apparent in the sculptural art found in the city—for instance Buckingham Fountain with its Rococo-influenced intricacies in comparison to the simplicity of Cloud Gate. And for the record, we Bostonians agree… it’s most certainly a bean, not a cloud.

Over the past few years, we’ve started seeing a shift in healthcare design to take inspiration from other sectors of design, in particular hospitality and residential, and this year’s product introductions at the Merchandise Mart only reinforced this trend. Comfort and flexibility impact the user experience and we’re starting to see waiting spaces evolve. A combination of soft seating, usable work areas (such as a high-top counter), and areas for privacy versus family space are all considerations when designing these healthcare waiting environments. As designers, we are responsible for considering the needs of a wide range of users to make our designs as inclusive and comforting as possible.

The Merchandise Mart also featured a few finish showrooms such as Tarkett, where we saw new releases in both the resilient (Johnsonite) and carpet (Tandus) industries. Bold shapes and tile formats left us brainstorming fresh ways to look at flooring for future projects.

We kept our eye out for unique alternatives for products as our industry continues to look at other markets for inspiration. Carnegie, Buzzispace, and 3form all had great new concepts for combating acoustics, without sacrificing form for function. Incorporating decorative techniques to address acoustics could impact hospitals, specifically regarding HCAHP scores on the “Quietness of Hospital Environment”.


The Barbican showroom featured their NeoCon Gold-winning WEV collection and a new concept for ceiling design—a 3D fiberglass printed mesh grid system which could be accented in a variety of colors while allowing lighting, sprinklers, sound, and security systems to live above the tiles. This product lends itself to a particular type of installation where the ceiling plays a more influential role, but if specified in the right application, it could introduce color and pattern in an unexpected way.

A few more product highlights:

  • KI featured their new desking series Tattoo, which won a NeoCon Gold award. This series embodied flexibility with options from sliding privacy screens, height adjustable worksurfaces, and hybrid storage and seating options.


  • Doug Mockett had rows and rows of hardware and accessories. This was interesting to see firsthand as these details sometimes come as an afterthought. We’re always keeping an eye out for innovative design.
  • Sherwin Williams highlighted color trends for the upcoming year. To combat the stereotype of hospitals being white and sterile, it’s important to incorporate fresh and engaging schemes. Paint is an inexpensive way to refresh a space.

Gerflor flooring’s European product designers were the masterminds behind the latest Gerflor launch—a terrazzo inspired sheet product with vibrant color options. This product would be perfect in bright colors for a pediatric environment but could also be used in neutral colors for a lobby space looking for a terrazzo visual for a fraction of the price. We’re seeing a growing interest in resilient flooring (rubber, sheet goods, and luxury vinyl tile) because of cleanability, comfort under foot, and acoustics.

NeoCon offered plenty of inspiration for us. We’re looking forward to applying these innovative products to our projects.

Breakthrough in Autism Research

An exciting breakthrough in autism research was recently published in the highly reputable academic journal, Nature. Scientists have observed brain enlargement in children with autism spectrum disorder (ASD). A retrospective analysis of head circumference and longitudinal brain volume studies in two to four-year-olds indicate increased brain volume may be an early indicator of ASD. These findings suggest an earlier diagnosis may be possible, helping those with ASD and their caregivers better respond to challenges associated with the disorder.

In any given year, 1 in 68 Americans is diagnosed as having autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Jacques Black, AIA, a partner in our New York City office, has completed several projects for the Center for Autism and the Developing Brain in White Plains, NY. Together with Cathy Lord, a clinical psychologist and director of the Center for Autism and the Developing Brain, he has published and presented on the unique dynamics of the built environment and individuals with ASD.  For example, when designing for autistic patients it is important to acknowledge and address their sensitivities to noise, color, and texture.

We are excited about the potential this research has for young families across the world and will continue to seek to better understand how to design spaces which address the unique needs of patients with ASD.

Food in Healthcare


There is a growing trend in healthcare to make hospitals more hospitable. One element of this trend involves hospitals cooking up food that doesn’t taste like ‘hospital food’, but instead restaurant quality fare.

Many restaurants across the country have embraced the ‘localvore’ movement (cooking with locally sourced ingredients). Chefs find that the practice is healthier (requiring fewer preservatives and processing to the foods), more sustainable (necessitating less travel distances and decreased carbon footprint) and more neighborly (purchasing directly from nearby farms and companies).  Hospitals are taking note and have begun to look local for food sourcing.

This trend is not new to The University of Vermont Medical Center (UVM Medical Center). Through our ongoing relationship with the health network, both as architects and as patients (many of our employees utilize the UVM Health Network for care), we have come to appreciate firsthand the benefits of delicious locally sourced food. As part of their sustainability initiative, the University was one of the first to sign the Healthy Food in Health Care Pledge in 2006, dedicating itself to, “providing local, nutritious and sustainable food”. As well as supporting local farmers, it maintains a roof garden which supplies the cafeteria with fresh blueberries, kiwi and assorted vegetables, when in season.

E4H has worked with UVM Medical Center to support multiple sustainability initiatives, during our recent design of the Robert E. and Holly D. Miller Building  at UVM Medical Center, representatives from Nutritional Services were a part of the design team, contributing input on how to best address the nutritional needs of patients in the acute care setting. We have also worked with department leaders to achieve LEED Gold Certification for the  newly renovated Mother Baby Unit and Clinical Research Center.

It is also interesting to note that Hospitals & Health Networks recently reported Connecticut’s New Milford Hospital saw its patient satisfaction scores rise from the 30th percentile to the 95th percentile after implementation of its Plow to Plate local food sourcing movement. Serving tasty local food may also be good business.

We are happy to partner with forward thinking companies like The University of Vermont Medical Center and are excited to see the trend of locally sourcing food to spread across the country.