1. From the Ground Up Introducing Green at Partners Healthcare Nexus / Green Roundtable May 6, 2010 Scope Organization Energy Research Design

2. 20 MILE RADIUS Partners Hospitals 47,000 employees 14.5M sf owned and leased

3. PEOPLE Patients and Employees Comfort and Safety PLANET Environmental Performance Community Health PROFIT Economic Performance Improved Efficiency PRESSURE Increasing Regulation PRESSURE Increasing Competition PRESSURE AND OPPORTUNITY CAUSE FOR ACTION THE TRIPLE BOTTOM LINE

4. Current world average 1.3 x sustainability level United States 4.6 x sustainability level 60% of US footprint is CO 2 from fossil fuels THE ECOLOGICAL FOOTPRINT Ref.1 IS A MEASURE OF THE HUMAN DEMAND ON NATURAL RESOURCES VS. THE EARTH’S CAPACITY TO REGENERATE ITSELF Typical US acute care hospital approx. 15-20 x sustainable level Ref.2 Ref 1: The Ecological Footprint Atlas 2008. Oakland: Global Footprint Network. Ref 2: Guenther and Vittori Sustainable Healthcare Architecture pp.368-370 [Costa Rica] 1.0 x sustainability level CAUSE FOR ACTION PLANET and ENVIRONMENT

5. ACTION AREAS SITE / LOCATION TRANSPORTATION BUILT ENVIRONMENT ENERGY WATER WASTE TOXINS / HAZMAT FOOD CLINICAL / RESEARCH EQUPT BWH MGH SRH Faulkner NSMC NWH SKRH RHCI Union MV Nantucket Real Estate & Facilities Facilities Engineering Purchasing / Materials Mgmt Information systems Human Resources Buildings and Grounds Parking / Commuter Services Environmental Services Dietary Services Clinicians / Researchers Nursing Infection Control PHS Organization RESPONSIBLE PARTIES Primary Secondary

6. WHAT PARTNERS IS DOING All medical, research materials governed by state and federal regulation Environmentally Preferable Purchasing (EPP) program Eliminate Mercury Reduce/eliminate toxic cleaning materials, herbicides, pesticides New building materials to eliminate off-gasing e.g. rubber floors, non-toxic glues Construction waste increasingly governed by state regulation and LEED WASTE / TOXINS / HAZARDOUS MATERIALS GOAL Improved enforcement, process design

7. PARTNERS CONSUMES 1.5 MILLION GALLONS OF WATER PER DAY GOAL 30% reduction in water use by 2018 WHAT PARTNERS IS DOING Electronic faucets Low flow toilets and showers Convert to digital imaging (X-rays, MRI’s, etc.) Gray water recycling Cooling tower blow-down water Drought-resistant planting/ drip irrigation WATER If you replace a pre-1980 model that uses 7 GALLONS per flush You’ll save 5.4 GALLONS per flush or 77% If you replace a pre-1980 model that uses 5 GALLONS per flush You’ll save 3.4 GALLONS per flush or 68% If you replace a pre-1980 model that uses 3.5 GALLONS per flush You’ll save 1.9 GALLONS per flush or 54%

8. WHAT PARTNERS IS DOING Healthy Eating programs Healthy Heart/ Diabetes Self-Management Cafeterias menu options/ Local Purchasing Eliminate polystyrene Sustainable flatware/ materials Composting GOAL Energy and Materials reduction; Healthy Menu in every hospital FOOD

9. Home Addresses MGH, BWH, SRH Based on 39,026 employee addresses 10 MILES MIT Dept of Civil Engineering, 2008 TRANSPORTATION Spaulding Rehabilitation Hospital Brigham and Women’s Hospital Massachusetts General Hospital EMPLOYEES SELECTION SETS H H H

10. TRANSPORTATION HOSPITAL MODE SPLIT MASSACHUSETTS GENERAL HOSPITAL BRIGHAM AND WOMEN’S HOSPITAL SPAULDING REHABILITATION HOSPITAL OPTIONS transit subsidies / shuttle / carpool / zipcar / bikes / walking

11. CONNECTED WORK A TELEWORKING PROGRAM Wellesley Gateway 10 MILES

12. RESERVABLE WORKSPACES HUDDLE ROOMS TEMPORARY LOCKERS 15-30 MINUTE TOUCHDOWN SPACES CONNECTED WORK A TELEWORKING PROGRAM Wellesley Gateway

13. ENV. BEN. EMPLOYEE BENEFITS PARTNERS BENEFITS CONNECTED WORK A TELEWORKING PROGRAM Wellesley Gateway # Pilot Participants 114 ConnectedWork Stations 12 + 3 Permanent Work Stations Released 40 Net Work Spaces Released 25 Net Person Days Worked 570 Days Worked from Home 193 Days Worked in CW Suite 377 Average Daily Commute (total both ways) 40 miles Commuting Miles Avoided/Week 7,720 Gallons of Gas Saved/Week (25 miles/gal.) 309 Commuting Miles Avoided/Year 402,984 Equivalent Pounds of CO2 Emissions 312,876

14. Partners overall energy reduction target 2008 – 2018 , in line with State and Federal targets Partners consumes 364,761,721 kWh of electricity per year, equivalent to electrical consumption for 47,000 single family homes* ENERGY TARGETS SYSTEM WIDE * http://www.eia.doe.gov/cneaf/electricity/esr/table5.xls -25%

15. Health Care second most energy intensive use in commercial sector approx. 250 kBtu/sf/year ENERGY

16. ENERGY TARGETS SYSTEM WIDE

17. ENERGY Capital Investment to achieve 28.2% Energy Reduction Total Energy Conservation Measures $61M Boilers/Condensate Heat Recovery 5.1%, $3.3M New Chiller System 1%, $.7M Unoccupied Lighting Control 3.5%, $4.6M Water Source Heat Pumps 9.4%, $5.5 Fume Hoods 16.7%, $14.2M AHU Modifications and OA Control 57.7%, $28.2M Retro-Commissioning HVAC 6.6%, $4.5M

18. 80 180 INPUT 100 Conventional Grid 180 input / 100 output 45% energy loss SINGLE PURPOSE BOILER PLANT On site, decentralized CENTRAL ELECTRICAL PLANT Offsite ENERGY STRATEGY Supply Efficiency Conventional Systems 30 60 40 20 60 60 40 60 40 Total Output 100

19. INPUT 130 70% of conventional Conventional Grid 180 input / 100 output 45% energy loss COMBINED HEAT and POWER On-site, decentralized Distributed Power 130 input / 100 output 23% energy loss ENERGY STRATEGY Supply Efficiency Combined Heat and Power 30 60 40 20 60 60 40 60 40 Total Output 100

20. Target 146 kBtus/sf/year ENERGY STRATEGY NEW BUILDINGS CBECS/HC 250 kBtus/sf/year ?? Existing Buildings ?? -42%

22. ENERGY MATERIAL LIFE-CYCLE WATER ECOSYSTEM RESTORATION DAYLIGHTING + CIRCADIAN RHYTHM NATURE / BIOPHILIA MATERIAL HEALTH HEALTH + WELL-BEING ENVIRONMENTAL QUALITY RESILIENCE BEAUTY + INSPIRATION COMMUNITY CONNECTIVITY RESOURCES HEALTH & WELL-BEING COMMUNITY NATURE REGENERATIVE DESIGN PERKINS + WILL CRITERIA FOR SUSTAINABLE HEALTHCARE FRAMEWORK

29. P1 Head P2 feet V2 Head and feet V1 Head and feet Typical Patient Room Boundary Conditions Interior surfaces – 70 deg F Exterior walls – 68 deg F Glass – Night time – no solar radiation No additional internal thermal loads have been accounted for. Infiltration modeled at 0.12 ACH supply condition (at 5 deg F) spread across window frame. BUILDING ENVELOPE - PATIENT ROOM COMFORT STUDY

30. BUILDING ENVELOPE - PATIENT ROOM COMFORT STUDY The Patient Room Comfort Study showed that eliminating the fin tube radiation and installing quad glazing would allow for the same thermal comfort with an initial capital cost savings of $300,000 and operating savings throughout the life of the building.

31. V1 feet P1 V2 head P2 feet BUILDING ENVELOPE - PATIENT ROOM COMFORT STUDY

34. VIEW FROM 1 ST AVENUE PERKINS + WILL SPAULDING REHABILITATION HOSPITAL CHARLESTOWN NAVY YARD, BOSTON