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Towards a quantitative sustainability assessment of hospital buildings in

Belgium

Conference Paper · November 2018

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Towards a quantitative sustainability assessment of
hospital buildings in Belgium
Milena Stevanovic, Rense Vandewalle, Stephane Vermeulen and Karen Allacker | 16 Nov 2018

This paper focuses on a new quantitative sustainability assessment method for hospital buildings in Belgium.

That hospitals are highly dependent on natural resources is not a new fact. The idea, however, that buildings focused on healing
the ill are simultaneously causing important environmental and health burdens is rather paradoxical. Concerns about the
sustainability of healthcare facilities have emerged over the past decennia, which led to an increasing interest in the way these
buildings are designed and operated.1

Today, these facilities are challenged in reconciling the decrease of their environmental impacts, while providing affordable and
quality medical care for everyone. Consequently, efforts to ease the sustainability evaluation of hospitals has been reflected in the
proliferation of certification tools developed specially to address healthcare buildings. The eminent ones include BREEAM,
DGNB, LEED and Green Star. Most of these tools use a qualitative approach, ie, they consist of a list of measures that are
assumed to be sustainable and work on the principle “the more measures taken, the more sustainable the building”.1 Although
their ease of use from the first design concept has gained them popularity among building practitioners, the subjectivity in their
assessment approach to sustainability has raised doubts as to whether using these schemes leads towards truly sustainable
buildings.2 This awakening served as a turning point in realising that a quantitative approach based on a lifecycle-thinking
perspective seems more appropriate when tackling the sustainability of hospital buildings. Until now, however, a method relying
on such an approach hadn’t been developed.

Scope of the study

The objective of this paper is twofold. The first is to develop a new sustainability assessment tool for hospital buildings in the
Flemish region using the lifecycle assessment (LCA) to track the environmental performance, and lifecycle cost (LCC) for
financial implications. Secondly, to integrate from an early-design phase to a more precise energy consumption calculation, the
use of the parametric design is explored. The following describes the applied methodology, tool description and results. Finally,
the conclusions discuss the major outcomes of the paper and provide steps for further research.

Method

Lifecycle assessment

Under the proposed method, the environmental impacts of a hospital building are assessed over its entire lifecycle, using the
internationally standardised methodology called lifecycle assessment (LCA).3 The approach to analysing the environmental
implications of the hospitals is based on the Belgian MMG (Milieugerelateerde Materiaalprestatie van Gebouwelementen) LCA
method, developed for assessing building components and buildings.4 The MMG method was converted into an Excel-based tool
at the architectural engineering research division of KU Leuven, referred henceforth as the MMG+_KULeuven tool.

Under this method, the considered environmental impacts are in line with the impact categories defined by the CEN TC350
standards5 and are referred to as CEN indicators. These include: global warming potential; depletion of the stratospheric ozone
layer; acidification of land and water sources; eutrophication freshwater and marine; photochemical oxidant formation; and abiotic
depletion of non-fossil resources. Furthermore, the MMG method covers an additional list of other impacts based on the
International Reference Life Cycle Data System (ILCD) Handbook6 and decided in consultation with the Flemish-Belgian
policymakers. These additional impacts are referred to as CEN+ indicators and include human toxicity (cancer and non-cancer
effects), particulate matter formation, ionising radiation (human health), ecotoxicity (terrestrial, freshwater and marine), land use:
land occupation (agricultural/forest and urban), and land use: land transformation (tropical rainforest) (see Table 1).

The covered lifecycle stages

of the hospital include the
initial, the use and the end-of-
life (EOL) stages. The
production stage takes into
account the extraction of the
raw materials and their
 transport to the production site,
transfer to the construction
site, and construction
activities. The use stage
includes processes related to
cleaning, maintenance,
replacement of components,
and operational energy use.
Lastly, the EOL stage includes
the demolition activities, waste
transport and waste treatment
(see figure 1).

Table 1: Environmental impact categories of the MMG method, distinguishing CEN and Under the MMG method, in
CEN+ categories (ref. 4) addition to the characterised
scores for each impact
category, an aggregated single score indicator, expressed in a monetary value (Euro), is calculated. This indicator is referred to
as external environmental cost.7 These costs are calculated by multiplying the characterised environmental impact with their
specific monetary value; by adding these sums up, the overall environmental cost (single score) is obtained.4

Lifecycle costing

The financial implications of a hospital

building are considered in the lifecycle
costing (LCC) approach, a well-known
economic calculation method to estimate
the costs related to different life stages of a
building.9 As discussed in Trigaux et al,9
the costs taken into account cover the
investment cost (ie, material, labour, and
indirect costs for initial construction),
cleaning, maintenance, replacement, and
energy costs during the use phase, and
the costs for demolition and waste
treatment during the EOL stage. The
financial data of the building elements are
mostly based on the Belgian cost
database ASPEN.10,11

To calculate the financial cost over the Figure 1: Lifecycle phases of a hospital building (adapted from Trigaux D,
building’s lifecycle, the sum of the present Wijnants L, De Troyer F, and Allacker K) (ref. 7)
values of all costs throughout
different lifecycle stages is
taken into account. The
economic parameters are
based on the Belgian
statistical data summarised in
Table 2.

The considered building

elements include: cellar floor;
floor on ground; cellar wall;
external wall; loadbearing
internal wall; non-loadbearing
internal wall; storey floor;
stairs; column (free-standing);
flat roof; windows; doors; Table 2: Economic parameters used for the financial and environmental costs (real rates
heating; cooling; ventilation above the inflation), based on Allacker at el. (ref. 4)
installations; pipes; high-rise elevator; low-rise elevator; lighting installations; and electricity cables.

The databases containing the predefined technical solutions – ie, compositions of each of the aforementioned building elements
– were extracted from the previous study by Stevanovic et al,1 where the existing MMG+KULeuven tool was applied to the
general hospital Sint-Maarten in Mechelen. Databases for floors, external walls and roofs were extended with new solutions
based on different materials used for various hospital projects that VK Architects & Engineers has been working on.

Parametric design for operational energy consumption

The early-design stage represents a crucial decision-making phase, where all the design requirements and factors, such as
building geometry, space organisation, facade and other parameters, will be defined.12 With hospitals requiring high amounts of
energy and electricity to operate, and targets to meet the 2010 European Directive on the Energy Performance of Buildings
(EPBD),13 taking into account energy efficiency at the early-design stage is of utmost importance. Given the complexity of hospital
buildings emanating from the fact they house different building typologies in the same facility, using the parametric design to
optimise the hospital energy performance seems to be a fitting solution. This is reflected in studies of Shikder et al 14 and Sherif et
al,15 where parametric optimisation is used for daylight-window configuration in patient rooms.

Early-design stage and parameters for hospital building geometry

The reduction of patient beds and acute care in Flanders led to hospitals in the same network merging into one new building.1
This movement resulted in a vast majority of calls for competitions to design new hospitals around the Flemish region. Most of the
time, the early-design phase of a hospital facility project will occur at the competition level. At this stage, the building practitioners
have to comply with the well-established parameters that serve to define the building geometry, the energy necessary for spatial
heating, the electricity for cooling, ventilation, lighting and medical technical equipment, as well as the water consumption of a
hospital. These include inputs, such as the types of departments required, square metres per department, and the number of
accredited beds.i

VIPAii has defined the number of square metres per hospital bed, based on which the hospital can ask for governmental
subsides.16,17 This number and the predefined square metres per hospital department, serve to calculate the total gross floor area
of a building.

Another important parameter that will influence the

geometry of a hospital building is the construction
grid. Typically, in practice, grids of either 7.2 or 7.8
metres are used. The first one is a well-known
structural grid based on the minimum dimensions
for a single patient room of 3.6 (width) x 3.7 (depth)
metres, within which, it has been established, most
activities can be carried out at the bedside.18 In
case of a double patient room, when circulating with
beds in and out, these dimensions do not suffice.
The grid of 7.8 metres was introduced based on the
experience in practice, owing to technological
advancement and the changing bed size (see
Figure 2).

Parameters for spatial heating energy

calculation

To calculate consumptions of energy for heating,

the combination of the 3D computer-aided design
application software Rhinoceros 6 and its plug-ins,
Ladybug and Honeybee, is used. In addition, a
visual programming language, Grasshopper3D,
which runs within the Rhinoceros programme, is
used to build generative algorithms to create a 3D
geometry. Ladybug is a recently developed
environmental plug-in for Grasshopper3D. It
benefits the parametric platform of Grasshopper to
allow the designer to explore the direct relationship
between environmental data and the generation of
the design through graphical data outputs that are
integrated with the building geometry.21 Honeybee
is the extension of Ladybug, which enhances users’
ability to work directly with Radiance, Daysim, and
EnergyPlus.21

The parameters necessary to calculate energy

Figure 2: Hospital structural grid and standard patient (single and
consumption include: the type of hospital building
double bed) room showing the problems of circulation when moving a
bed in a 3.6m-wide room against the ease of doing the same when the
bed in a 3.6m-wide room against the ease of doing the same when the
width of a room is 3.9m (ref. 19,20) emanating from the typology defined in Prasad22
(see Figure 3); the climate data for the context in which the building is designed; orientation of the building; spatial organisation of
departments; floor height; and the heat transfer co-efficients (U-values) of the heat-loss surfaces.

Figure 3: Hospital building typology: a) linked pavilion; b) atrium; c) podium with a tower; d) podium with two or more
towers; and e) monoblock (as defined in Prasad, ref. 22)

Tool description

Dashboards for environmental and financial cost calculation

The tool’s interface consists of two simple Excel-based spreadsheets, “Concept” and “one_building_scenario”, and spreadsheets
for each of the building element containing graphs with representations of their environmental impacts. In the first spreadsheet,
building practitioners first define the basic parameters for hospital building geometry, such as the number of beds, the square
metres per bed, and the number of floors (see Figure 4).

Based on these inputs, the tool already calculates the

gross floor area, the area of one floor, the thermal
envelope, and the building volume. Furthermore, the tool
provides estimates of the building element ratios that will
later serve for the calculation of the environmental impacts
of the materials used for hospital construction. Building
practitioners can choose predefined technical solutions for
different building elements and input them for a scenario.
Buttons for each scenario copy and paste the values for the
energy, electricity and water consumption calculation,
while ‘reset materials’ buttons clear the selections under
the ‘Materials for scenarios’ if necessary. All these steps
can be seen in Figure 5. Based on the choice of a
predefined technical solution for floor on ground, external
walls, windows and roofs, the tool will inform building
practitioners whether their choices are in line with the
Flemish Energy Performance of Buildings (EPB)
regulation,23,24 by displaying the cells of U-values in either
red (not in line with the EPB) or green (in line with the
EPB) (see Figure 4). Once the U-values correspond to the
EPB regulation, they help calculate the operational energy
for spatial heating using the parametric design in
Rhinoceros, and the Ladybug and Honeybee plug-ins.

The second dashboard, “one_building_scenario”, allows

for a more detailed report of a specific building scenario, Figure 4: Basic design parameters building practitioners need
including an overview of building element ratios and to input to define the building geometry
choices of construction materials. Building practitioners
can select which lifecycle stage they would like to see the impacts coming from building elements (see Figure 5). There are also
options to select the graph presentations based on the monetary impacts or impact equivalent. The results of these selections
refer to the spreadsheets for building elements, with graphs representing the comparison of their environmental impacts and
financial costs. These last spreadsheets serve as information on the most optimal solution of each building element in terms of
their environmental performance.
Figure 5: Overview of building elements ratios, the choices of predefined technical solutions for each of them, with
buttons serving to input the selection for each building scenario

Energy and electricity calculation

To build up the 3D model of a hospital building, Grasshopper needs an Excel table with different hospital departments, the
desired area according to the competition programme, and the correlating zone programme for the energy calculation (see Figure
6). For the purpose of this research paper and to define the zones in a hospital building, we used ASHRAE Standard 55, already
available in the Ladybug plug-in.25 Grasshopper makes Rhinoceros layers for each department based on group name, layout and
grid for each level of the hospital. The building practitioner defines the structural grid of a building and the model of the building
(based on Prasad).22

All areas are extruded with

4.1m to brepsiii and placed on
top of each other, as shown in
Figure 7. This will serve as the
input for the energy
calculation. Ladybug converts
these into zones, relying on
the zone programme defined
in the Excel table. A window
opening percentage is then
defined with the Honeybee
 window creator using the
scripting language (see Figure
8). An EnergyPlus
construction is assigned to the
windows, external walls, walls
to the ground, the ground
floors, and the roofs.

Figure 6: Excel table with a list of hospital department defined in the competition
programme with the surfaces assigned to each of the department

Figure 7: The extruded hospital departments with a 4.1m floor

height and coloured based on their function

Figure 8: Window opening percentage defined with Honeybee

extension

Results

The results of the calculations are presented on the graphs in the “Concept” spreadsheet. Using the monetary values to express
the external lifecycle costs explained above, it’s possible to simultaneously track and control both the environmental and financial
costs of a hospital building. The presentation of the results is split into three sections: results of environmental costs; results of
financial costs; and results of the financial costs per hospital bed, respectively.
Figure 9: Results of each building scenario representing their environmental costs subdivided into graphs for global
impacts, impact indicators and lifecycle stages

In the first section, the results of the environmental costs are subdivided into three graphs representing the six hospital building
scenarios in global environmental cost, results per impact indicators, and results per lifecycle stages (see Figure 9). Similarly, the
results for financial costs are represented with the difference of a graph showing the total cost per building scenario, coupling the
environmental and financial cost together (see Figure 10).

Figure 10: Results of each building scenario representing the financial costs of each building scenario, subdivided into
graphs for global costs, total costs and costs per lifecycle phases

The results for a chosen building scenario on the “one_building_scenario” dashboard are again given per global environmental
impacts, including the impacts from the spatial heating per impact indicators and per lifecycle stage. An additional graph is
provided to visualise the impacts per building element for a chosen lifecycle phase (see Figure 11).
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Figure 11: Environmental impacts per building elements, subdivided in CEN and CEN+ indicators, giving the results for a
chosen lifecycle stage of a building

Conclusions

In this paper, a tool for evaluating the sustainability of hospital buildings during the early-design phase, and based on lifecycle
thinking, is described. The advantage of this tool lies in its ability to provide estimations of the environmental and financial costs
based on the few design parameters necessary to define the building geometry. The tool allows for a comparison of six scenarios
to optimise the hospital building in relation to both the environmental and financial costs, as well as its overall energy
consumption. By combining the tool with the Rhinoceros programme and its plug-ins, Ladybug and Honeybee, the developed
method can be applied in other climatic contexts. Furthermore, the combination of lifecycle assessment (LCA) and lifecycle
costing (LCC) with the energy calculations provides a powerful tool to optimise a hospital building from an early-design stage.
The tool is also applicable to other healthcare facilities of a smaller scale.

The next steps include developing the calculation of the electricity consumption for ventilation, cooling, lighting and medical
apparatus. Moreover, the energy calculation for spatial heating should be refined using the EPB norms for Flanders, integrated in
the tool. The database of HVAC installations will also be expanded to provide a complete insight into the environmental impacts
and financial costs of hospital buildings. Validation of the tool will be conducted throughout its use by VK Architects & Engineers
in future competitions.

Authors

Milena Stevanovic is a project architect at VK Studio Architects, Planners & Designers, as well as a PhD candidate at KU
Leuven. Co-authors Rense Vandewalle and Stéphane Vermeulen also work at VK, while Karen Allacker is an assistant professor
at KU Leuven.

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