Children's hospital to tap sustainable water practices

Architects, designers and planners for the expansion of Lucile Packard Children’s Hospital Stanford are working to significantly reduce water consumption.

- By Ruth Schechter

Now under construction, the Discovery Garden will incorporate underground cisterns for all its watering needs. 
SkyHawk Photography

Hospitals by their very nature require massive amounts of water to maintain complex medical systems and equipment critical to patient care. Heating and cooling systems, and specialty services such as laundry, sterilization, sanitation, food service and integrated computer systems, call for an ongoing source of water. And lots of it.

In fact, hospitals today are the third most water-intensive public buildings, behind senior care facilities and hotels, using an average of 570 gallons of water per staffed bed per day, according to Healthcare Design magazine. In comparison, the U.S. Environmental Protection Agency estimates that an average person uses about 80 to 100 gallons of water per day. 

In this era of water conservation, architects, designers and planners for the Lucile Packard Children’s Hospital Stanford expansion are working to significantly reduce water consumption. The facility, scheduled to open in the summer of 2017, will add 521,000 square feet to the approximately 300,000-square-foot existing hospital, streamlining care for children, expectant mothers and their families.

Landscaping priorities

An inherent sense of environmental responsibility is a driving force behind the children’s hospital expansion, which makes sustainability and “green” systems a top priority. The building integrates nature seamlessly into its layout, with almost four acres of gardens and green space for patients, families, visitors and staff to enjoy. The landscapes also will provide natural habitats for local birds and insects.

A water-sensitive approach to the expansion was factored in long before California’s current drought made low-water landscaping and reduced water usage a major concern. “Seven years ago, when we started planning, we knew there was not enough rainfall to sustain even the most efficient hospital’s needs,” said Robin Guenther, principal at Perkins+Will and the lead designer of the hospital expansion. “That presented the option of finding ways to reuse water as much as possible.”

Seven years ago, when we started planning, we knew there was not enough rainfall to sustain even the most efficient hospital’s needs.

The landscaping will feature native and hardy adapted plants that require minimal water, such as drought-tolerant varieties of yarrow, flax lily, mountain lilac, lavender and sage. A specially designed blend of grasses that require little or no water will be planted instead of a traditional lawn. Expanses of greenery and permeable paving allow rain to be absorbed into the region’s groundwater rather than run off into the bay.

“Nature is an important part of the hospital’s identity, and landscape has been embraced as a central design concept,” Guenther said. “Everything from selection of plant material and retention of trees to the form and functionality of the gardens is customized to the ecological setting of the site, the climate and the users.”

Designed with attention to the demands of security, comfort and safety unique to a hospital setting, each outdoor area will incorporate plants and amenities for different needs —places where kids can play, parents can relax and staff can mingle and unwind.

The centerpiece will be the Discovery Garden, which will feature private meditation niches and nooks framed by hedges for privacy and quiet. The Emerald Garden will feature an open lawn, a children’s play area, stone retaining walls and shaded walkways. The Rainbow Garden, a respite for physicians and staff, will be linked to the campus shuttle system. Courtyards and roof gardens will be easily accessible and allow natural light to filter into the corridors.

Underground storage

These water-efficient landscapes will be irrigated with rainwater and condensate water —water that is extracted from dehumidifying indoor air — that will be collected in two 55,000-gallon underground cisterns. The distilled water that is used continuously in dialysis equipment also will be routed to the cisterns, ensuring that water will be available even when there is no rainfall. Constructed of steel-reinforced polyethylene, each cistern is 70 feet long and 40 feet wide — about half as big as an Olympic-size swimming pool — and 10 feet deep.

“Because we are using water from multiple, constant sources, we do not need to rely on storm-water runoff, which is inconsistent, especially during an extended drought,” said Henry Phillips, project manager at Sandis, a civil engineering firm that specializes in sustainable design. “Water is routed to the cisterns through a pumping system and can be diverted to an integrated bypass system if the tanks are full.”

These sources for irrigation will save as much as 800,000 gallons of water per year, said Michele Charles, project engineer for the expansion, adding that the system can be adapted to add more cisterns in the future. Hospital designers did an extensive analysis before construction to determine how much water the gardens would require so they could set the baseline for the expected supply of condensate water, Phillips said.

Conserving resources

The existing hospital facility also maintains its grounds in a water-wise manner. Designed during a drought in the late 1980s and opened in 1991, the gardens consist primarily of drought-tolerant plants. An ongoing program to monitor and maintain broken sprinkler heads limits runoff, while use of mulch to protect plantings helps retain moisture, said Patrick Connor, administrative director of support services. “No-mow” turf with an efficient irrigation system, which looks and feels like traditional lawn, invites families and visitors to lounge and play, he said.

Using water wisely makes an impact on the whole community and saves money in the long term.

The new building incorporates an extensive external shading system, and windows are positioned to avoid direct sunlight throughout the year. Limiting direct sunlight helps to reduce solar gain — the increase in temperature caused by the sun — while reducing the need for air conditioning, which has energy and water needs of its own. The hospital also has located its data center on the roof rather than in the basement, so that it can be cooled by ambient air rather than air conditioning. That move alone has reduced energy needs by 60 percent compared with other Northern California hospitals, Guenther said.

The hospital also plans to install water-conserving dishwashers and sterilizers, which are projected to use about 80 percent less water than their standard counterparts. Water-cooled pumps and air compressors will be replaced, and on-demand sinks and low-flow bathroom fixtures, both of which also are being phased into the existing hospital, are expected to save 2.5 million gallons of water a year. Together, these systems in the new building are expected to use 38 percent less water than in a comparable standard hospital, according to Guenther. An electronic dashboard in the main lobby will display the building’s ongoing water and energy usage.

“Throughout the design process, we looked at sustainability as a key feature,” said Jill Sullivan, RN, MSN, vice president of hospital transformation and space planning. “Using water wisely makes an impact on the whole community and saves money in the long term. Plus, it’s simply the right thing to do.”

The expansion is part of the Stanford University Medical Center Renewal Project.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit

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