Is Regenerative Design The Future In Healthcare?

What is regenerative design?

The term “regenerative” describes a process that mimics nature by restoring or renewing any sources of energy and materials that process uses. Applied to the built environment, regenerative design moves us beyond basic high-performance design and toward renewal-focused impacts. This includes net-positive energy and water, human and community health, and site systems that become part of a functioning ecosystem.

For healthcare facilities, this means doing more than simply balancing the benefits their care provides to patients with the negative impacts their development can have on communities.

Instead, the industry must drive healthcare facilities toward a future where they give more than they take and realize positive impacts for both people and the planet. This socio-ecological relationship realigns us as part of the natural world and breaks the current development patterns that separate us from it.

Regenerative design in healthcare

What does this look like? Some of the ways healthcare designers can apply regenerative practices to their design process include:

  • Removing fossil fuel combustion and replacing these systems with alternative energy sources that produce more energy than the project uses.
  • Responsibly managing and reusing water for building systems and landscaping.
  • Avoiding harmful chemicals in building materials.

HDR developed and implemented a Regenerative Design Framework to guide the future of the built environment and its place within and impact on socio-ecological systems.

The framework considers seven categories—air, carbon, water, nutrients, biodiversity, human health, and community. It identifies 30 total Key Performance Indicators (KPIs), such as managing water use and runoff patterns for a healthy watershed, applying building massing and landscape systems that support biodiversity, and using materials that not only influence our health but also enhance the communities that create them.

The tool utilizes data analytics and human creativity to see the actual impact of a building on the capital, operational, environmental, and social sides of the balance.

This framework is not a quick fix or plug-and-play process; it is a fundamental shift in the way project teams approach the planning and design of healthcare facilities of all scales.

Here are examples of how any organization can consider these categories and KPIs when approaching healthcare projects.

Steps to move toward a regenerative future

Large hospitals are now expected to last half a century or longer and many are not going to open until up to a decade after conception. Therefore, they must be prepared for the unforeseeable.

This means that these facilities should be designed to flex and adapt not only for advances in care delivery and technology, but also for the needs of our communities and the environment. Like nature, our hospitals need to be able to evolve over their lifecycle to help us realize a regenerative future.

So how do we do this? There are strategies that project teams and healthcare organizations can consider now to work toward a regenerative future.

Establishing carbon neutrality targets

If we have any hope of meeting the Intergovernmental Panel on Climate Change’s target of limiting planetary warming to 1.5 °C above pre-industrial levels, then we must immediately shift away from fossil fuels.

Many health systems are leading in this by establishing targets to achieve carbon neutrality by 2025 through efficiency, electrification, carbon offsets, and other non-fossil fuel-based energy sources such as fuel cells and biogas (renewable energy produced from the breakdown of organic matter).

Project teams can help clients toward these targets using carbon-balancing, a strategy that aims to cut carbon through building techniques and approaches that negate carbon emissions.

They can also design projects that result in zero carbon emissions for both building operations and the embodied carbon emissions associated with construction.

The first big step in this process is removing operational carbon through building and campus electrification. HDR is currently designing several all-electric hospitals at every scale—from large, urban medical centers to small, rural community hospitals.

Design for future electrification

Some organizations may not be ready to go all electric now. However, the industry can prepare these facilities to change in the near future by planning and utilizing systems that are more easily convertible to electricity.

For example, some preparatory measures can include structural and electrical infrastructure for future rooftop solar photovoltaic systems and mechanical space for electric heat recovery chillers to offset forms of mechanical heating.

Outside the building structure, project teams can prepare for future electrification. This involves planning space for on-site green hydrogen storage to replace diesel backup power. Air-cooled electric heat pumps to replace combustion-based indoor boilers is another strategy. Finally, geo-exchange systems that retrieve and store heat from the earth can support this effort.

Additionally, assessments and studies on future energy storage potential and electrical load demands are vital to understand what’s needed to make electrification possible.

Improve efficiency and reduce energy consumption

The next step toward zero operational emissions is improving efficiency and driving down energy use as much as possible. Strategies to achieve this include detailed façade analyses to minimize solar loads and glare.

Using more efficient systems like chilled beams and displacement ventilation can better support human comfort. Installing lighting systems with controls and circadian rhythm measures and designing for flexibility to adapt to newer and more efficient technologies in the future can also drive down energy usage.

These systems should also help mitigate the challenges presented by climate change, which may include increased heat events, increased unhealthy air quality days, and risks to water supplies.

Think about embodied carbon

The goal is to eliminate the harmful emissions that drive climate change and influence many community health impacts. As such, the industry needs to carefully look at hospital infrastructure and how the entire campus system can unify to work toward regeneration.

This requires addressing embodied carbon emissions by reusing existing buildings whenever possible. Where new construction is necessary, buildings should be designed to use less materials.

Projects can target those materials that have the highest impacts—notably concrete and steel. Alternatives to consider include mass-timber or by maximizing material carbon sequestration opportunities like carbon dioxide mineralization in concrete.

Additionally, the industry needs to ask manufacturers to limit the carbon associated with their materials and reward those that do by using their products.

Designs to benefit ecosystem, community

Supporting the human-nature relationship means integrating with and improving the ecosystem that surrounds the built environment.

In planning and designing new projects, it’s important to retain or develop biodiverse environments. This can be achieved through a variety of measures such as the re-naturalization of a landscape with native plantings or creating fauna-friendly and bird-safe designs.

Typically, hospital towers are surrounded by parking. Project teams can employ the help of an arborist or an ornithologist to better understand how landscape design can positively impact the future of each unique site. They can also help plan how to reduce or eliminate the negative impact on wildlife that live there.

In many cases, certain native plantings should be retained; however, on other occasions, non-native invasive species must be removed and replaced to restore the natural environment.

Green space is critical, but the correct species for the location and fauna are even more critical for biodiversity. At the Orleans Health Hub in Ontario, the decision was made to reintroduce long grass meadows and native plants to re-naturalize the landscape and surrounding area.

Integrating green facades and green roofs into our buildings can provide a native environment for nature to thrive. They also provide useful and pleasant outdoor spaces for occupants.

However, it’s important to be mindful in how these approaches are achieved to minimize hazards to birds and other wildlife.

Through strategies such as applying glazing treatments, considering lighting impacts, and material selection, bird strikes and other adverse impacts to nature can be avoided. With revegetation in tandem, the entire site can become a healthy part of the environment.

Design to support community health, well-being

When designing a large medical center or campus, socio-ecological systems should be considered in design decisions as project boundaries are not drawn by borders or property lines.

Considering these factors and how they influence one another, we’re able to draw clear connections and links between systems. For example, the amount of water used on a project has a carbon emissions impact related to the treatment and conveyance of that water.

Those carbon emissions in turn impact air quality and human health. Negative human health issues impact social equity, universal access, job security, and more.

For a hospital project in Utah, using the Regenerative Design Framework tool revealed that peak asthma incidences aligned seasonally with harvest seasons and not with the usual contributors (socio-economic factors, urban living, industrial pollutants).

As a result, designers were able to exercise precaution, using natural ventilation via filtered mixed-mode HVAC over operable windows to bring in fresh air.

Each design decision has impacts that resonate at the smallest and largest scales. A focus on human health and community well-being is critical with each design decision.

The healthcare industry has moved beyond building performance for measuring the impact of the built environment toward finding ways to measure the social and ecological impacts.

Regenerative design is the way forward if we are to reverse the impacts of the built environment, and the healthcare design industry is uniquely positioned to change how buildings interact with nature in the future.

Matthew Cunha-Rigby is sustainable leader at HDR (San Francisco). He can be reached at Eric Meub is design director at HDR (Los Angeles). He can be reached at Peter Duckworth-Pilkington is sustainable design leader at HDR (Toronto). He can be reached at

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