Welcome to WSP Anticipate Podcast. The topic we're going to be discussing today is net zero in healthcare. transitioning the ways we design, build and educate for healthcare facilities of the future. As we shift our design focus to address the pressing climate challenges, consider the following startling fact. Healthcare settings alone account for 5% of global carbon emissions. the urgency to reduce healthcare's environmental impact.
and a life with NETSID emission target has never been greater. I'm Alejandro Falcón, Technical Director and Healthcare Lead at WSP Middle East, and in this episode, we'll delve into how we can influence the design and construction of new healthcare facilities. We will also explore the transformation of the world. information required to feed a proof existing healthcare asset.
I'm honored to be joined today by Mike Barnes. He's a program director, architecture from WSP New Zealand. He brings a world of knowledge in the healthcare field. Mike, thank you for joining me today. Welcome to the Anticipate Podcast. So why are net zero and decarbonization so critical in healthcare settings in your region? What's the issue that we actually need to address?
Thank you, Alejandro, for having me on your podcast. It's really humbling to be here. I really appreciate the time that you've made available. It's a really important topic, carbon offset and carbon neutral in healthcare. Primarily because it's one of those facilities, hospitals are a bit like airports in that they're operating 24-7, so seven days a week.
24 hours a day, we must operate the hospital, right? Because we have patients in there who are often in critical condition and they need to be supported. In order to do that, of course, we need to have energy going into that facility full time.
We need to control a lot of the things inside the building, such as how we manage air around the hospital, because you'll remember and realize, of course, that some of that air is contaminated from some diseases that some of the patients will have brought to the hospital. So we need to really look at our air conditioning capability, our supply of energy to that. It needs to be full-time because if any of this equipment fails, of course, we have an emergency.
and a catastrophe in the hospital. So very pressing. Every hospital in the world faces these issues. Some of the key ones that you have in the Middle East have addressed some of these issues in New Zealand where we're also on that path. Yeah, thank you, Mike. I will also add in the region, Middle East, obviously one of the characteristics of severe climate conditions is hot and humid, and also water scarcity is common. As we know, in order to address clinical and infection control needs,
There is always a requirement for very high outdoor air ventilation, air genius per hour. So this is obviously an amount of air that needs to be pre-treated, needs to be cooled, needs to be dehumidified. And then obviously since the heat gains are high within the building, then the cooling capacity that is required from this equipment is relevant and high.
Same for the water. Water has been required in, for example, central sterilization departments, dialysis, even some of the equipment is used in cooling towers. Obviously, all of this requires a high consumption of energy water. leading to higher carbon consumption, which is concerning. I wanted to point out also that this is mostly these oil nations that continue to rely quite a lot on low electricity rates as coming from fossil fuels still.
and still the use of fossil fuel equipment is attractive. So that also leads to a higher rate of carbon consumption, and it doesn't really help the case. Intenso do a Supplies. Most of the components required for the hospital are still imported. This means that the scope to the mission related to transportation and logistics is still high. And all in all, we know that this figure is around 72%. of the actual total carbon consumed in a hospital, which is a big number to really take it seriously.
In recent data analysis we've done in the market, in the region, we have identified that in terms of planning, design and construction. There is an approximate of 60 live hospitals in the UAE ongoing, another 30 in KSA and another 25 in Qatar. It's a high volume, so there is a real need of addressing and providing measures to reduce carbon, embodied carbon, and porational carbon emissions as soon as possible before this continues to grow and we continue to emit carbon to the environment.
Moving on probably forward, I have another question for you, Mike. From a net zero perspective, what do you think are the WSP key focus items that need attention in a healthcare facility? Yeah, great question, Alejandro. I think WSP is actually well positioned to address these matters globally. We have a carbon approach. we implement across the globe and it addresses regionality such as some of the climate controls that the Middle East
faces, and it also addresses some of the climate issues that we face in New Zealand, where I'm talking to you from now. So two extremely different geographies. I am very close to the Antarctic. where I'm speaking from you today, and you're much closer to the equator. So obviously the demand for energy for a hospital in the UAE of those 60 operating hospitals that you talked about. or the 30N KSA
The energy demands there are quite different to what they are in New Zealand. Notwithstanding that, of course, we have a global response. WSP has a global response as to how we deal with carbon neutrality or controlling carbon emissions.
For your hospitals, I think there are great opportunities. There's a demand, of course, for a huge amount of energy. You talked about 70% of that carbon that's involved for the hospital is being embedded carbon that comes from equipment that's imported into the Middle East, and that's very hard to counter. The Middle East does have opportunities in other ways.
So yes, very high carbon consumption, but the issue here is that's only part of the problem, right, is any facility that uses energy will emit carbon. However, the Middle East has opportunities for generating carbon neutral energy. So through either wind or solar, and I know that there are huge investments going on and that now, are opportunities that... Saudi and the UAE and Qatar have to mitigate the carbon emissions that happen.
We don't have that as much in New Zealand because we don't have the same amount of solar. What we do have though, so let's consider we have a hospital that consumes... kilojoules of energy per day. In the Middle East you can offset that by generating your energy
in a very sustainable way through either solar or through wind or investments in tidal energy. We have some of that in New Zealand, but what we do have to... manage the carbon emissions in our hospitals is that we create 75% of our energy already through hydro dam. So a lot of our energy is already green. 75% of the national production of electricity in New Zealand is through green, sustainable means.
When we come to address the carbon emissions problem, our energy production is not the biggest side of the problem. Our energy consumption is the biggest side of the problem. So despite that... Alejandro, I think the answer to your question is WSP has a global approach to this. So we have solutions for the Middle East geography and we have solutions for the almost sub-Antarctic environment that we're in now.
Thank you, Mike. I think in addition to that, I would say in the Middle East, the net zero concept overall, although we have seen a strong push and trend in the past year, is still probably in an infant stage. It doesn't apply only to healthcare, but probably to all sectors.
So I think one of the key roles that we have as WSP is to spread awareness and be able to educate our healthcare clients on the importance of providing an effective net-seed approach to planning, design, construction, retrofit. and probably in preparation for a potential mandatory regulatory framework that may count. So clients then prepare for when this is coming.
in order to address the requirements. I think another thing that we see, especially now with the Saudi market booming, is very large communities being developed. In these regards, it's very important during the planning phase to select strategically and properly the location of these hospitals. Again, going back to the scope of the emissions, there's a lot of patients, staff, visitors.
the need to commute to the acute hospitals for treatment, but also the supply of the goods, namely pharmaceutical logistics, food supply, catering. I think this is another important factor that WSP can help from the master planning perspective in making sure that we support from the very beginning in planning well where the building is located. Going for volume 1 in specific. I think WSP has unique engineering capabilities, strong tanning in the house.
So exploring and encouraging clients to utilize microgrids and go more for electrification and move away from fossil fuels is key. And also, when it comes to the major energy consumer, which is mechanical systems, as we see across the world, many countries require, in their codes, different air changes per hour. For example, for an operation theater. Why is that?
So obviously it causes draft render requirements on the basis of the empirical tests they've done, but it's important to every time one or more verify and validate, The actual required eight inch per hour in order to dilute effectively the air pollutants and reduce the concentration of viral infectivity by running CFD modeling.
Because again, one of the major consumers that we see is the amount of air that we need to treat when the air is coming into the building. In connection with this, obviously, I think dollarspin is a focus in ensuring. a proper balance in the design of the fascia, whether it is a design or a cytotrophic, making sure there is a good proportion, equilibrium, between cost, between efficiency of the u-value transmissions of the fascia, ratio, glazing and the respondent panel.
or solid and cost probably. I think working also together with clients to understand what's the actual operation they're going to expect. hours of work within the various medical works of the hospital is also crucial. So the engineer can set
what we call setback controls and switch of the system, whatever the utilization is not required. I think all of these are key components that have been put together can create significant improvement in the embodied carbon and operational carbon emitted by healthcare facilities. If we consider Mike that... By 2050, there is a vision to achieve net zero by many countries. But however, around 80% of the buildings that will be operational at that time, so by 2050, are already built.
What actions are WSP proposing to tackle this retrofitting challenge in your opinion? Good question again, Alejandro. It's true that the buildings, particularly hospitals that we build, they last a long time. They're required to last a long time. They're very expensive buildings to put in place. And we generally work on a life cycle of between 45 and 50 years that that building will stay there. We design them, though, in such a way that we can retrofit them, and particularly...
In New Zealand, we're considering a number of quite large hospitals for this region at the moment, and we're approaching them as modular. which means as the building ages, we can remove MEP or building services or air conditioning plant and replace them as the quality of engineering improves in the future. So it is a building with the structure built now. but those parts which consume energy and produce carbon.
We're designing in such a way that they can be removed as technology increases. And that's true right across the hospital. So if you imagine, a hospital facility is made up of a number of departments, right, or departmental plans. So you have your operating theatres, as you talked about, requiring a certain amount of air changes per hour. That's a given because you don't want infected air to go to patient bedrooms where they've already completed their surgery and they now are recuperating.
And you also have radiology departments where you take x-rays of patients before they go into their operation. You have what's called a CSSD. It's a sterilization area where all the medical instruments that are used in surgeries. and that requires a lot of energy. So as you lay out the hospital, as you're planning it, you have consideration for where the high energy demands are.
across your hospital. So you look at the departmental plans, Which are the highest utilization CSSDs tend to be because you need, of course, boiling hot water to sterilise steel medical instruments. And patient bed towers, where patients basically just sleep and recuperate, have a less energy demand. So you have a graph, if you like, from high demand departments to low demand.
And so to a certain extent, you can spend your money in the areas that are high demand, such as the sterilization department, the CSST. in such a way that as engineering improves over the 45-year life cycle. you can replace that older technology in a very efficient way. So you're not having to dismantle the facade, for example, you can access. that plant and equipment in a much more intelligent way. And the bed towers, which don't consume a lot of power, comparatively,
You also design those so that when you need to, you can replace the equipment in there. So all of that comes together in a departmental plan. One thing that we're considering now to improve even that approach is how we depopulate the hospital to the extent that we can. What does that mean? Where we can use robotics that require less people, because people require air, sterilised air. where we don't need to have people operating the hospital, such as in storeroom.
a pack of house rooms, plant rooms, where we can manage those rooms with robotics or AGVs, they're called, in the industry. We want to apply those, and we're considering those in New Zealand. to reduce the amount of people that the hospital, the staffing and the support people the hospital needs to have. So there's a collection of ways to approach reducing the carbon generation or output from the hospital.
all the way from the detailed departmental plans, which uses the most energy, outputs the most carbon. to how we actually invest in the equipment that's managing and running the hospital. And yes, they are there for a long time. These facilities are there for a long time. But there are parts of it, if we approach them as modern means of construction, as either a modular or a prefabricated. series of spaces, we can control how we're generating that carbon a lot more smartly.
I think in the past we did an analysis of what are the contributors to healthcare carbon, funds and components, which were energy, water, food, materials, waste, and transportation. So within those six, we found that materials, when it comes to life cycle procurement, it was 50% of all carbon. So if we are to look into retrofit in a hospital, one of the things also that we should be looking is to try to redesign the area under retrofit, or even somehow try to...
Modifiers convert the current operation of the hospital to be more user-centric and data-driven. just trying to influence also the actual need of using material and obviously the frequency that these materials are unnecessarily thrown or wasted. I think that can really help in improving the performance of that existing building, which is already challenging and plenty of modification limitations. Obviously, another one important factor could be work with a technology partner.
so that with them we can try to do strategic interventions and leverage their embodied carbon and try to improve operational efficiency by applying smart control systems and trying to regulate equipment in a more efficient manner to reduce operational carbon. Obviously, as much as budget allows, sometimes this is one of the main problems when you're trying to retrofit. How much money is available for the renovation?
Symmetra Sposio tried to replace all technologies that probably use constant systems, you know, when this is still probably not required, but a valuable system that you can actually regulate or stop whenever the manager is in need. So, moving away into the next question, in transforming the way we plan and design future hospitals. Are there any challenges we expect to face Mike?
Oh gosh, you have all the great questions today, Alejandro. Yes, but where would we be if we didn't have challenges, right? kind of what we enjoy I think yes yes we will have we will continue to have the energy and embedded carbon issues and certainly in the Middle East where there is not able to the ability to manufacture a lot of
High cost equipment pieces is not as high as in some parts of the world. There will continue to be embedded carbon issues and carbon consumption or generation within the facility. Our future challenges, absolutely. I think it's important that right from the beginning of the project, we produce our plan on... carbon net zero right from the beginning, and we approach as much of those things that we can control and affect at the outside.
with those controls that you're talking about, such as working with technology partners, managing the embedded carbon, much better use of smart controlled equipment. But there are other things that we can consider as well as those technology things. We have a very large hospital underway in New Zealand now that I was the program director on up until quite recently, a year or so ago.
And we set up that project from the beginning to be a champion of a lot of innovative systems in environmental matters and carbon matters. One of the things we chose to do right from the beginning was... look at not only managing our carbon production, but also how we could offset that. What that meant was we created partnership.
with community groups and we looked to plant one million trees during the construction cycle of the hospital. It's quite a long build. It's a five-year build and the relationships were put in place for the community groups and the contractor, the subcontractors and all the design consultants to take responsibility for planting trees. as a way of addressing carbon reduction for the carbon that we couldn't mitigate through technology. So that may be a little more difficult.
in the Middle East, Alejandro, but I don't know that you're limited to planting trees just in the Middle East. I mean, there could be partnerships. between the UAE government and other governments, and these already will be in place. these replanting programs, which may include food, for example, in some communities.
used to help calculate that offset program. So how we are approaching it in New Zealand is very broad. We're not limiting ourselves just to the technology solutions. We're looking at some social solutions and cultural solutions as well. One of the things I've seen in the Middle East is that institutions, clients, developers and users are still not totally aware of the importance of natural practices and the benefits that they bring into the hospital.
And there is a tendency to actually offer some assistance to this practice because they feel all this sophistication comes at a premium. And there is a tendency to always prioritize course-bound engineering exercises. So this is one of the challenges we've seen. I think education and training and providing and the information to our stakeholders is crucial in order to resolve this issue. Another problem I have seen is limited funding.
So the region, most of the governments are relying now on public-private partnership arrangements in order to diversify economies. so that they can actually take care of the healthcare sectors. And obviously, these contacts are very stringent in terms of payment mechanisms. So investors don't really see an incentive in investing in new technologies. So funding is important in order to push the net zero agenda. Obviously, originally there is no mandatory regulation.
The day we see this coming, it will be a game changer. But as of now, it's quite difficult when we propose these measures to a client and they say, well, but is this required by calls? But because the answer is no, then they say, well, I'll give a pass and probably next time. One thing also we need to consider is GCC healthcare sector is trying to come across to the world as a tourism hub, healthcare tourism hub. So on this, there is a expectation of significant population growth.
not only local, but also expats that come here to live, for vacation, but also to work. So this is something that WSP needs to account for when it comes to designing flexibility and adaptability. Now, we have highlighted great challenges in transforming the way we plan and design. But just in short summary, what needs to happen to overcome these challenges, Mike? The challenge is significant, Alejandro. I think... The difficulty that we have, especially in the private healthcare market, is...
There's an expectation from our clients that it costs so many dollars or dirhams per square meter to build the hospital. And they think that if they build a net zero hospital, it's going to be significantly more. But in fact, it's not really the case if the costs of building and operating that hospital across its life cycle, that is, how much it costs per year, if you take the construction cost, the planning cost, and the operational cost.
the impact of net zero on that hospital is actually very little. And I think that's got to do with education. I don't think there's a lot of knowledge. amongst our clients, as you say. So I think that comes down to us as engineers and architects to help provide that education and knowledge that it actually doesn't cost much more. to produce a net zero approach to hospitals. In fact, over the life cycle, you're saving money towards the last 50% of the life of that facility.
because your place is much more efficient. You're using technology now that will become standard place. If those same clients build a hospital in 10 years' time, I guess that technology may be better then, but the technology that's available now. does us for those 10 years, right? And we win in that carbon calculation. So I think to answer your question, what do we need to do or what needs to happen to overcome these challenges? There needs to be a joint approach.
by the government, if it's a government hospital, and the consultants and the contractor who's building it. If it's a private developer that's involved in healthcare tourism, I think the demands there should be made. clear by the leadership of the country that we are happy for you to come and set up here if you're an American or a European operator or an operator from outside the region.
However, we would like you to be responsible with our environment as well, which means that, yes, there are some commercial benefits for you to be based here, but we would like you to achieve these net zero targets for us. If it's a local entrepreneur or client or investor, I think the long-term acknowledgement and embrace of those conditions which the Middle East is facing.
is quite necessary. And I would be surprised that if that demand was put in place to acknowledge that long-term need, that the entrepreneurs would not agree. They would struggle. to argue that they don't want to invest. It's a long-term issue. It's not something that can be solved overnight. And the more facilities we get in place,
that drive towards net zero, the more normal it will become and the more standard it will become. And then there won't be as much pushback from our clients to do that. It's the same as... when we had to do a lot of other things for building controls. It changes over time. Something we've seen in the healthcare sector is an enormous digital transformation in the way we operate hospitals and we approach the actual patient care.
How do you think the digital transformation is supporting the transition to net zero in hospitals, Mike? I think it's critical, to be honest. We know from the large and beautiful hospitals that have already been produced in the UAE and now which are going into Qatar and to Saudi that Asset management, managing that asset over its 45-year lifecycle is the most expensive part.
of having that facility right there's a metric that we used to use when i was in the middle east that said one ten a hundred took a dollar to design it ten dollars to build it and a hundred dollars to operate it over its life cycle So if you can manage that last part, that $100 part, much more intelligently or astutely or with much more consideration. you can reduce that expensive part of the ownership to the owner. A lot of that asset management is dependent on the digital twin model.
So we would spend more money on the design part, that $1 part. We might spend... $1.50 or $2 comparatively. We would spend a little bit more than the $10 to construct it because we would be installing equipment. HVAC equipment and security equipment and wayfinding equipment and medical equipment. That was digitally compliant and was smart equipment.
that we could manage it in that last cycle and the facilities management and operation phase all digitally. So we would have a digital twin that we could control then. which departments weren't needing to have the large amount of energy supplied. So maybe at night time, we don't need to have the operating theatres. happening at night because we're not doing operations at night. So we could reduce that infection controlled air at night to those departments through digital asset management.
That's becoming now a big focus on not just supporting the owners to reduce costs, but also targeting an its hero approach. It's totally reliant on a LOD 700 BIM model, which a lot of contractors are now familiar with. and a lot of consultants. WSP is very fluent in that area, producing a digital twin to manage the hospital over that life cycle, that 45-year life cycle. is a very smart and cheap way to actually drive to carbon net zero.
Thank you, Mike. I think the digital world is really, really vast. There's just so much we can do. One of the things that are considered important is moving from the standard building management systems that operate MEP systems in hospitals. to add a component of artificial intelligence, AI. And this is because sometimes the way we design the buildings based on the way we get brief or believe the operation is going to be, is not exactly how the building is going to perform.
but also the performance of the building, the way operators can change over time. So the beauty of AI is that by providing field sensors, you can retrieve real-time data all the time. So the system can learn to adjust the system. to the actual demands through the year at any time across the years.
I think this is one component that will really change the way we control systems, improving the efficiency of the same. Another one, obviously, is emphasizing the use of microdictive technology to smartly use on-site renewable technology. when probably it is available and the big laws are at maximum. This way, obviously, the carbon used from the main grid, when it is more intensive, it's not there, we'll be using our technology in order to switch.
from the main grid to the smart green renewal technology so that we can use our own systems on site to the benefit of the end user. In terms of the patient, I think a component we've seen recently adding a lot of value is telemedicine. So when a patient cannot just move to a hospital simply in order to reduce...
scope 3 emissions again. Providing telemedicine helps the patient to be attended from their own home. Even some of the supplies are already shipping diagnostic equipment connected to an application. to the patient house so they can actually be monitored and at the best comfort of being really sitting at home. Use of electric vehicles.
also important but sometimes if you need to move to an acute hospital which is somehow far from home there's a stress in in terms of not finding a parking where you can charge the car So developing healthcare applications where you can book an EV charger so you can park the car and you know you have your parking spot reserved can help us encouraging the use of the electric vehicle which is...
housing less carbon consumer than combustion vehicles. All in all, I think collaborating, as I said earlier, with technology partners, it's crucial to understand what is the present and probably expected clinical solution. coming next so that we can, as designers, WSP, try to design to that capability so we can incorporate those new sophistications in the future project. Thank you very much, Mike, for the insight that you've shared with our listeners today.
And to our audience, thanks for listening all the way through. And please leave us a comment if today's episode has been of interest. And don't forget to join us on future healthcare episodes. Stay tuned.