Robin Guenther, FAIA, Sustainable Healthcare Design Expert

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Mark Masselli: This is conversations on H ealthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret it’s been really tough to watch the spread of Ebola across
several West African nations. The CDC is predicting really an epidemic outbreak here
that could quadruple to 20,000 cases within just a few weeks.

Margaret Flinter: Well Mark as providers and public health people we know how vital it
is to get ahead of thes e outbreaks but this one was so insidious at first, so hard to pin
down , and once it was clear that they were dealing with an Ebola epidemic , the wildfire
had spre ad. Just a perfect storm to allow it to spread.

Mark Masselli: And it’s interesting to know Margaret that more countries are stepping to
help. The US is expected to spend a billion dollars on the crisis and is sending 3000
American troops to help provi de support on the ground.

Margaret Flinter: Well the UN, the World Health Organization, the CDC.

Mark Masselli: Still half of the 6000 people infected and died and treatment still to
scarce. We will certainly be keeping our eye on the situation , and w e are reminded that
global health issues are really everyone’s issue.

Margaret Flinter: And at the same time back at home a lot of folks are keeping their eye
on healthcare.gov. The Federal Insurance Exchange has undergone some revisions
and the word is they are not promising it will be perfect but it should be more user
friendly than the first government.

Mark Masselli: And you know the administration is promising to redesign
healthcare.gov, well meeting at 70% of the users across 36 states will have fewer
questions to answer, fewer pages to navigate and would allow insurance sign - ups with
a fewer clicks of the mouse and that’s all good news.

Margaret Flinter: And I know that the leaders also know that the site has to be secured
and our conducting ha cking attempts to see how penetrable the site is. I understand
there were both some good and some cause for worry from those attempts .

Mark Masselli: There was in the so called white hackers found a critical vulnerability at
the site but also the praise s from professional hackers who said that they were still
unable to get pass the f irewalls put in place and that vulnerability has since been
addressed so it seems the backup safeguards have worked quite well.

Margaret Flinter: And the Department of Heal th and Human Resources also ran a test
on some of the state exchanges so not just focusing on the Federal Exchange and we
understand well Kentucky held up admirably. New Mexico’s exchange reveals dozens
of vulnerabilities. Actually we think all of this i s good information is good information as
we gear up for the next round of open enrollment. We want to fix these problems before
th
November 15 that’s vital to the success of the country second open enrollment
experience.

Mark Masselli: Another good idea in healthcare Margaret is just beginning to take hold
and that’s using sustainable architecture practices in the building of healthcare facilities.
Our guest today is world renowned expert on this subject.

Margaret Flinter: Robin Guenther. He has been a leader in thought as well practice.
She is the author of Sustainable Healthcare Architecture. Her experience very much
needed as we better understand the vital importance of sustainability as one approach
to building a healthier community.

Mark Masse lli: Well also we have Lori Robertson Managing Editor of FactCheck.org
stop by examining these statements spoken about health policy in the public domain but
no matter what the topic you can see all of our shows by googling CHCradio.

Margaret Flinter: And as always if you have comments please email us at chcradio.com
or find us on Facebook or Twitter. We would love to hear from you. Now we will get to
our interview with Robin Guenther in just a moment.

Mark Masselli: But first here is our producer , Marianne O’Hare , with this week’s
headline news.

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Marianne O’Hare: I am Marianne O’Hare with these healthcare headlines. The Ebola
epidemic is claiming more victims and the world is moving in to respond with several
thousand infected and dying. There are startling numbers looming. 20,000 could be
infected within weeks and the worst case scenario has the number at 1.4 million within a
few months if gone unchecked. Health officials say many victims are dying at home due

to the lack of available clinic beds in these West African nations. The US and other
countries are stepping into intervene with money, supplies and military personnel
offering backup support. More insurers are jumping into the Health Exchange Game.
HHS secretary Sylvia Burwell announcing there would be a 25% increase in the
numbers of insurers competing for business on the exchanges and this year’s open
enrollment. This will give consumers more choices for coverage. Meanwhile, hospitals
and states where Medicaid has expanded a re seeing the benefit in fewer unpaid bills
roughly 6 billion dollars coming into hospital covers now that people have covers with
the healthcare. CVS is continuing to expand. It’s pushing to the healthcare arena
rebranding itself recently as CVS health and discontinuing the sale of cigarettes. In a
push further into the healthcare space CVS Health is partnering with several hospitals
and health systems to be a point of care at the pharmacy chains 900 minute clinics now
in patients get a care those facil ities or information will go into electronic health records
connected to the hospitals. I am Marianne O’Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with architect Robin Guenther fellow of the
American Institute of Architect and principal at Perkins and Will an internationally
recognized leader in sustainable health industry design. Ms. Guenther is senior advisor
to healthcare without harm a global movement dedicated to environmentally responsible
healthcare. She coordinated the green guide for healthcare, served on the US green
lead for healthcare committee and recently released the second edition of sustainable
healthcare architecture. Ms. Guenther has won numerous awards for her work, was
twice named as the mos t influential designer in healthcare by Healthcare Design
Magazine and received the Center for Health Design change maker award for her
leadership and innovation in the design of healing environment. She earned her degree
at the Architectural Association of London. Hi Robin. Welcome to Conversations on
Healthcare.

Robin Guenther: Thank you Mark.

Mark Masselli: And you know it’s great that we are meeting now, happen to be March in
New York City over the weekend there has been a huge sea change over th e years with
more institutions getting engaged in this. I think there are still a disconnect on
healthcare on exactly what sustainable architects really means?

Robin Guenther: Well what I mean by it is that sustainable healthcare architecture
incomes th is built environments that basically do no harm to the environment or the
house of artisans, communities or the planet. If in fact our built environments had been

doing that all along of doing no harm we might not be experiencing either environmental
or t he health crisis of our age that all those people were marching about meaning
around resource depletion, pollution, complexities of chronic disease burden so what we
need to get to are built environments that don’t deplete but truly are able to be sustaine d
for generation on generation.

Margaret Flinter: Robin you were on the US Green Building Council Board that actually
developed the lead certifications standards for new buildings now we came to be pretty
familiar with those standards when we set our two build a lead gold building at our
community health center headquarters here in Connecticut but we have learnt so much
about the complex of construction requirements, building material standards, energy
used standards that yield these lead rating maybe you could describe for our listeners
what are some of the standards and their goals and what does it take to achieve the
highest level of lead certification and since I have designed some of those buildings
maybe you have a favorite example of lead certified healthcare facilities that maybe
transformed both the healthcare experience as well as improving or shrinking that
carbon footprint?

Robin Guenther: Well as you noted the lead certification system is the most common
certification tool in the world and it really covers land development resource used
meaning energy, water and raw materials as well as the archi pel [PH] experience
everything from acoustics to indoor air quality to daylight views to achieve the highest
level of certification which is platinum. Buildings need to both minimize their physical
development impacts less paving, more nature, better storm water m anagement and
use less resources while producing actually a higher quality of archipel experience.
We need to contrast today’s green buildings with the first generation of green buildings
in the 1970s when the energy crisis caused people to tighten up the air circulation in
buildings and that led to a whole host of health issues from sick building syndrome to
building related illness so this time around the Green Building Movement is focused
both on reducing resource use but coupling with improved indoor e nvironment. My
personal favorite building in the healthcare world I will say is these days my own or one
of my firms and that’s the Spalding Rehabilitation Hospital in Boston and I think that
building demonstrates both a real transformative idea about how healthcare occupants
can use a building. It has a operable windows in the rehab gym so that patient’s can
actually exercise in ambient air and hear the sound of the birds and the boats on Boston
Harbor. I think we are getting into sort of what I would c all a second generation of
sustainable building where hospitals and healthcare facilities are actually getting more
innovative. They are not just optimizing the way they have always done things but they
are really crossing into territory that we haven’t s een a long time.

Mark Masselli: So if your earliest efforts were addressing the unhealthy qualities of
building blocks, actually the building materials themselves and you and your colleague
put together a list of 25 precautionary building materials to wa tch out for any in over the
past 50 years there has been an increase in chemically based materials that have been
shown to have a harmful impact on human health so again you could tell our listeners
about your concerns about questionable materials and how they are affecting human
health.

Robin Guenther: Yeah Perkins and Will developed what we call the precautionary list
which is a list of 25 substances that are commonly found in building materials that we
believe the weight of science suggest should be saved out of commerce. These include
things like polyvinyl chloride, Bisphenol A, Phalate, Plasticizers and one that is front
page news these days brominated and halogenated flame retardants. I think what
people don’t realize is that building materials u nlike food and pharmaceuticals are not
tested for health and safety before they enter commerce and all building owners
certainly paid the price associated with earlier generations of building materials that
have been removed because of health and safety is sues. The one that comes to mind
are asbestos, leaden paint to understand the consequences of these materials is
important before we purchase them and install them in our buildings and so that idea of
transparency which is the term for that knowing what’s in a product is emerging as the
key corner stone as the materials, the healthy materials economy.

Margaret Flinter: Well Robin you have co - authored what many call the definitive book
on Green Construction in healthcare you know receiving is Mark said th is rapid
transformation how healthcare is delivered but we also have this triple A in front of those
better quality, better safety and lower cost and care and all of these forces sort of have
to be thought of almost simultaneously what’s the conversation t hat happens in the field
today between individuals, the experts like yourself and the people within the healthcare
institutions that are struggling with issues of safety and cost what’s the form for that
conversation in that exchange?

Robin Guenther: I t hink that healthcare without harm through the organizations practice
green health in the healthier hospitals initiative have really begun to engage the
healthcare organizations at a kind of booths on the ground level from the inside of the
healthcare deliv er settings all the way up to CEO’s in the healthier hospitals initiative
working top down in order to really transform practice not just in building design but in
operation and all that is proving to actually come with pretty interesting reduction of
wast e as well as saving money , so it’s showing that there is a lot of ways in healthcare
that can be ferried it out through thinking about sustainable process and what moving
healthcare upstream does and how that relates to sustainability which I think has an

interesting over lapse around the transportation. The idea of getting healthcare where
it’s convenient to consumers is an idea that for example in the UK National Health
System they are doing that to reduce their carbon footprint so if you can place the
h ealthcare in a more convenient location you can reduce your carbon footprint.

Mark Masselli: We are speaking today with architect Robin Guenther fellow of the AIA,
principal at Perkins and Will an internationally recognized leader in sustainable health
i ndustry design. She is also a senior advisor. Robin I was thinking as you were talking I
want to talk a little bit about your featured speaker this year’s TEDMED conferencing yet
the topic you spoke about was I was thinking too small and tell us what do you think
people were thinking too small when it comes to healthcare and healthy design? Tell us
about your thoughts of the underlined speech as well as the TEDMED experience?

Robin Guenther: So the theme of that closing session was thinking too small , and I
realized that if we just think about doing less harm like saving 10% of our energy
instead of transforming our practice to really do no harm or to actually use our buildings
to heal some of the harm we maybe already done w e are thinking too small that
basically every day healthcare contributes to the environmental and health problems it
exist to solve and we need to change that paradigm. We need to create building an
operational solutions that start making us sick.

Margaret Flinter: Well Robin y ou spent much of your career promoting policies that
support more sustainable architecture not just in healthcare , but in general , and you
said that to make that happen healthcare professionals need to understand the
importance of sustainable design but th at’s not enough you have also got to engage the
moms in the equation and when moms learn that the BPA in Plastic Baby Bottles was
harmful to the health of their infants there was an outcry and I am going to add nurses
to that group because certainly in our home state of Connecticut nurses really led that
charge very successfully. How do you see the strategy of getting more people,
everyday people not healthcare people, not architecture people but every day people
interested in demanding healthier products in buildings?

Robin Guenther: I think that healthcare professionals are trust holders and messengers
of health in society and when they join the general public and their communities to do
what you described and do things like opposing cold fire power pla nts it makes a huge
difference. It is getting healthcare professionals to exercise their citizenry and join with
their moms in their communities to push public discordance forward. I also think we live
in an era where acting locally has proven to be very effective, getting municipal level
and state level bans on things like flame retardants or antibiotics in food these days
those local and state bans really send market signals to manufacturers and produce

real market change so I say to healthcare professi onals work in your communities, join
together as nurses and doctors with the moms and the kids and change your
communities.

Mark Masselli: That is a great message and as I mentioned earlier that I took my
daughter down to the climate marched joined a cou ple of hundred thousand people.
You are senior advisor to healthcare provider without harm and I know you are pleased
to see how many healthcare professionals are participating in that event and tell us
about the work of healthcare without harm and your h ope for gauging more
professionals in its mission.

Robin Guenther: Well as Margaret pointed out that healthcare without harm has really
done pretty remarkable work in helping the healthcare community connected to
practices and transform those practices. They really focus on three basic ideas.
Helping hospitals and healthcare organizations reduce the impact of buildings and
operations on the environment and gathering healthcare leaders to advocate for policy
changes that support population health that’s the one we just talked about so again I
really encourage healthcare organizations to look at practice greenhouse, healthier
hospital clinician of HHI and engage in the programs that healthcare without harm offers
out and I see both in my own clients and I thought so clearly at the climate march that
younger medical professionals really care about all these issues. And whether it’s
because they are graduating from universities with progressive environmental policies
and practices I also think they are comin g of age in what someone at TED called the
second industrial revolution, the age of information and with that transparency , so they
are expecting to know what’s in their building products. They are expecting to
understand the components of the things they surround themselves with , and they will
act on that information in the interest of health.

Margaret Flinter: Well we had Earth d ay and it’s great to see this generation creating a
whole new environmental push. We had been speaking today with architect Robin
Guenther fellow of the AIA, principal at Perkins and Will and senior advisor to
healthcare without harm a global movement dedicated to environmentally responsible
healthcare. You can learn more about her work by going to
transparency.perkinswill.com or noharm.org or healthierhospitals.org. Robin , thank you
so much for joining us today on Conversations on Healthcare.

Robin Guenther: Well thank you Mark and Margaret for inviting me.

Mark Masselli: Conversations on Healthcare. We want our audience to be truly in the
know when it comes to the facts about healthcare reforms and policy. Lori Robertson is

an award winning journalist and managing editor of FactCheck.org a non partisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori , what have you got for us this week?

Lori Robertson: Well those political parties like to pick certain provisions of the
Affordable Care Act ones that are popular or unpopular and use them to attack
opponents for suppor ting or opposing the law. In West Virginia for example D emocratic
representative Nick Rahall zeroes in on a provision about black one benefits , a popular
subject in the coal mining state. His R epublican opponent Evan Jenkins supports for
re pealing the Af fordable Care Act which included two amendments to the Black Lung
Act to make it easier for miners and surviving spouses independence to claim black
lung benefits. Based on that a Rahall TV ad claims his opponent has pledged to take
away Black Lung benefits from coal miners but Jenkins didn’t make such a pledge and
in fact has said he is opposed to any cut in the Federal Black Lung Benefit Program.
Even if the ACA were repealed Black Lung Benefits wouldn’t be taken away from coal
miners who are now receiving them. The Federal Benefits Program established in 1969
provides compensation from miners disabled by the disease and their survivors upon
their death. The amendments to the ACA made it easier for miners and survivors to
qualify by requiring the mining company to prove that cold dust wasn’t a significant
factor in a miners disease and preventing survivors from having to file a new claim upon
a miners death but the campaign ad doesn’t address these details instead it distorts the
facts and that’s my fact check for this week. I am Lori Robertson managing editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us at
chcradio.com, we will have FactCheck.org's Lori Robertson check it out for you here on
Conversations on Healthcare.

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Margaret Flinter: Each week conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Right now there are about three
and a half million people living in refugee camps around the world whether displaced by
wars or natur al disasters. The plight of these people is often the same living in squalid
conditions intensities that provide little protection from harsh elements and these
conditions pose serious threats to their health and well - being. The IKEA foundation has
taken the parent companies while the successful do it yourself approach to home
furnishings and applied it to the problem of inadequate housing for displaced refugees.

They have created a do it yourself dwelling that can be shipped and assembled
anywhere.

Jon athan Spampinato: So first and foremost there is the very well - known flat tech
approach that IKEA has pioneered. Secondly, the materials and the product itself , so
it’s a shelter it’s not attentive.

Margaret Flinter: Jonathan Spampinato is the head of communications and strategic
planning at the IKEA Foundation. They are working closely with the United Nations
Organizations working on the ground trying to assist refugees in Somalia and other
parts of the world.

Jonathan Spampinato: We extended that t o also include funding for an innovation in
UNHCR so they could think more long - term so providing that funding allowed them to
start the refugee housing shelter looking at how to design a better shelter.

Margaret Flinter: And since on an average a person is likely to spend up to 12 years in
a refugee camp these IKEA structures have some unique properties that can make the
experience more bearable.

Jonathan Spampinato: To the walls and the roof are made out of a new fancy version
of basically a plastic m aterial that is much more durable but very, very light weight and
still is inflated.

Margaret Flinter: The IKEA Foundation currently has prototypes. Being tested in
various refugee camps and will scale up productions once refinements are made and
true t o IKEA the price point is going to commend under $1000 per structure, a
deliverable, affordable do it yourself dwelling that can provide some sense of dignity,
privacy and protection for families who are struggling as refugees now that’s a bright
idea.

Ma rgaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at Wesufm.org an d brought to you by the Community Health
Center.