'Green is an investment, not a cost'

Green is good for people. In fact, there is no longer any debate about that. But in order to build green healthcare buildings, the proverbial fences between different disciplines must first be taken down. In a conversation with a construction company and a green contractor, it turns out that greenery is still seen primarily as an expense rather than as a high-return investment. "Nobody has a garden, trees or a green facade on their balance sheet. But that's where we should be heading."

Long ago, hospitals and healthcare facilities were built in leafy settings. "But somewhere we missed a turn and started building gray behemoths of lots of floors in cities," states Math Luijten, Commercial Manager Healthcare Cure at Heijmans. "But I think anyone you ask would prefer to look out on a beautiful green landscape when that person is in a hospital." 

Luijten, together with his Heijmans colleague Jan-Willem Burgmans and Buddy Wijnands of the Dolmans Landscaping Group, sat down with Greenpro at the invitation of De Bloeimeesters to talk about greening healthcare, especially hospitals. Because although more and more stakeholders recognize the usefulness and necessity of greenery in healthcare, the examples are still scarce. Despite the fact that both Heijmans and Dolmans are now involved in several projects. "As a construction company, we can tell you everything about construction and technology," says Luijten. "But actually at Heijmans we want technology to support sustainability and increase the health of users. And that greening is included in construction plans in healthcare at a much earlier stage. Because right now that doesn't happen integrally."

"True," says Burgmans, who is Biodiversity program manager at Heijmans. "An integral call for tenders is rarely issued by healthcare administrators. We are usually called in very traditionally for construction and engineering. Take, for example, the European Medicines Agency (EMA) in Amsterdam, where the architect admittedly thought about the well-being of the employees from the beginning and gave greenery a prominent place in the design. Not just to look at, but as experienceable and accessible greenery. Yet this was not looked at integrally enough, so also with a green contractor and a landscape architect. As a result, the atrium, with all its planting, had to be given extra lighting, which in turn resulted in a higher energy bill. What we, Heijmans, learned from that project is that you have to get around the table with all fields of knowledge at a much earlier stage. Because ultimately you want to move towards natural solutions, where at the moment we still often opt for a technical solution. And no, that's really not more expensive." 

"Greenery is not more expensive in any construction project. Because to my knowledge, paving is always more expensive than a lawn," says Wijnands. "The real question is: Are you willing to invest in an environment that is healthier anyway. Both for patients and healthcare workers?" Wijnands garners support from Burgmans. "Right! After all, you don't spend money, you invest in green because there are benefits associated with it. Those benefits are now rarely taken into account. Besides, where do you compare those costs with? With the costs of maintaining technical installations? Well, then I am very curious as to what costs more." Wijnands nods in agreement. "And the fact that we don't know the value is because green is nowhere on the balance sheet. Take public space: sewage is a balance sheet item and is depreciated over a number of years. But nobody has their tree stock or green facade on the balance sheet. Whereas, once you start valuing something, you are also willing to invest in it. And as long as something is just a cost item, that doesn't happen."   

On the question of whether green contractors might be too modest to be at the table at an earlier stage of (healthcare) construction projects, Wijnands does not have to think long. "I think so indeed. Because most green contractors are also quite capable - with or without a civil contractor - of laying a parking lot or doing street work. But we are rarely asked to tender for such assignments. Perhaps we should become more active in that regard. Anyway: you shouldn't ask us for the construction of an entire hospital or healthcare facility, for that we are dependent on the major contractors and whether they call us in on time."

Luijten fortunately sees a turnaround there. "Instead of clients and subcontractors, at Heijmans we are increasingly talking about partners in a construction team. And partners have each other's best interests at heart; they help each other and involve each other. So if you guarantee integrality as early as the selection phase of a construction project, we will look for suitable partners with whom we can fill in that integrality. Much more than in the past, we will have to contribute and showcase each other's knowledge and expertise. That directive is out of date." 

Burgmans also believes that the old-fashioned way of tendering and soliciting does not produce the right results. "I believe much more in partnerships and challenging each other. So not drawing something out to three decimal places, but just asking for more biodiversity. A partner like Dolmans itself really knows how to achieve that." 

Wijnands: "The key lies in assessing each other on an equal footing and taking responsibility together. I have often said that a client can leave the responsibility for, say, the maintenance of green spaces with me for 10 or 20 years. Because then I will then think very carefully about how best to approach that and come up with a different solution than if I am only allowed to lay out a garden. It's not a bad thing to let the market answer your question." 

Charlot ten Dijke, architect and director at Tangram Architecture and Urban Landscape and Ineke van der Ham, professor of technological innovations in neuropsychology at Leiden University argue how essential greening is for the healthcare sector.

According to Ten Dijke, the healthcare industry needs to rethink how its spaces contribute to healing and well-being. "We need to learn more, because otherwise we can't make good healthcare buildings," she stresses. Her approach integrates green, natural elements that make an "incredibly positive contribution to the whole social community" and help create a relaxing atmosphere for both residents and staff. She explains that integrating natural elements such as water, greenery and light not only enhances the aesthetic value of a building, but also plays a crucial role in promoting the health and well-being of residents. "Our buildings, designed with green spaces and natural light, provide a serene environment that reduces stress and accelerates resident happiness and recovery." She believes that thoughtful architectural design can directly contribute to a better quality of life for residents.

Professor Van der Ham points to the scientific basis for this approach. "Green environments reduce stress and improve working memory," she explains. She also emphasizes the importance of sightlines in the designs of healthcare facilities, making it easier for residents to orient themselves and become familiar with their surroundings. "Studies show that green environments and natural light are essential components for mental and physical health," she adds. Her research supports Tangram Architects' design philosophy that a well-designed care environment promotes overall well-being and may even reduce dependence on medication, although there is no conclusive evidence yet for the latter.

Integrating greenery into healthcare buildings is not just an aesthetic choice, but an essential part of architecture that considers the needs of users. "Our buildings have been made with greenery from the inception of our firm because we put people at the center of our designs," says Ten Dijke.

A recent publication by Tangram Architects takes a closer look at the importance of nature and architecture in the construction of healthcare facilities. The booklet, titled "Designed with Care," highlights the positive impact of natural elements on the well-being of residents and staff in healthcare environments. It also addresses the economic benefits of green healthcare architecture. By using sustainable materials and energy-efficient designs, healthcare facilities can save costs in the long run. "Sustainable practices not only lead to a lower environmental footprint but also contribute to the financial health of healthcare facilities through lower operational costs," Ten Dijke explains. This approach shows that financial and environmental sustainability can go hand in hand in the healthcare sector.

A key question is whether this approach is economically feasible. Van der Ham confirms this, "There is clear evidence that a green environment not only benefits health, but also saves costs in the long term through, for example, reduced healthcare use and increased staff productivity."   

The Zuidoever project, a residential complex with 54 rental apartments for the elderly with a care indication on Amsterdam's Zuidas and designed by Tangram Architects, serves as an exemplary example of how the integration of nature and architecture can create a healing environment for the elderly. This project highlights the vision of creating spaces that are not only aesthetically pleasing, but also contribute to the well-being and health of residents. Charlot ten Dijke describes how South Bank is designed with large windows and natural light that blur the boundaries between inside and outside, making residents feel more connected to the natural environment.

In South Bank, special attention has been paid to the common areas designed to promote social interaction and activities, which is crucial to reducing loneliness among the elderly. These spaces are placed so that they are easily accessible from different parts of the building, providing a natural meeting point for residents. The project has no corridors, only dwelling spaces, also underscoring the importance of flexibility in design so that spaces can be adapted to the changing needs of residents over time.

South Bank illustrates how thoughtful design can contribute to improved quality of life by providing an environment that is not only safe and functional, but also aesthetically enriching and socially stimulating. The project now serves as a beacon of innovation in healthcare architecture, applying the principles of nature integration and human-centered design to create a sustainable and supportive living environment for the elderly. As a neuropsychologist, Ineke van der Ham is closely involved in the evaluation and follow-up research of the project. She praises the green sightlines in the complex: "For the overview and orientation of the elderly, these are very important. And they immediately provide a sense of peace and security."