Transcript: Series 2, Episode 4 - AHDC - Clean and Green Health Design with Gary Coff

Friday, November 25, 2022 11:32 | Anonymous
David Cummins: 0:13

G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host David Cummins, and today we are speaking to Gary Coff, who has been involved with health design almost as long as I have been alive. Gary has helped improve the way health services are delivered to the community from Adelaide around Australia and across the globe. Gary's experience covers all aspects of the healthcare. Ranges from design for remote Aboriginal community facilities to master planning for the rural Brisbane and women's hospital covering emergency medicine, mental health, and age care, service, delivery, planning, and design. Today we welcome Gary to discuss the importance of sustainability in healthcare. Welcome Gary. Thank you for your time to be here.

Garry Coff: 1:00

Thanks David. Good to see you.

David Cummins: 1:01

For those that dunno how old I am and how long you have been in the, I'm just gonna give a warning that it's decades and decades and decades of experience that you have.

Garry Coff: 1:12

Sure. If you like . David Cummins: So what actually Are you an architect or are you a, a, a clinician. What, what actually is your background? Architectural technician. I did a drafting course years ago and then added into that interior design. Based in, in Sydney. I did that in Sydney. and it was a very fortunate point in time where, where the architectural and interior design industry in commercial terms was very alive because of the the main line constructions crash and the empty, the number of empty buildings that were scattered around Sydney looking for tenants. So that was in what the. To late seventies, eighties? It was, Yeah. Early, early to mid seventies. Yeah. And I, I stayed on there until about 1980 and then moved to South Australia.

David Cummins: 2:00

Yeah, right. And so in that time, basically from my understanding of hospitals, it was very simple construction, very simple design, very, very cookie cutter. Simple rectangular rooms to get the job done with minimal interaction with the patients and their needs been very much based around the clinical needs of the patient to get the job done. Is that a good summary of the seventies of construction or?

Garry Coff: 2:24

The the hospital system back in that period of time was pretty much limited particularly in South Australia, I found to taking people off the street who were potentially down and out, giving them some good food and a, and a safe place to sleep and putting 'em back to work. And the hospital planning was very much off a standard plan. They were all pretty much the same.

David Cummins: 2:45

So back then, keeping in mind sustainability, was this word? Sustainability, even around then, Like how, how was it even considered?

Garry Coff: 2:53

No, no, definitely not. We've, we've got in, in South Australia, we've got a number of hospitals that were, that were all built about the same period in time. They were all designed as 400 bed hospitals. None of them got above 200 beds. Some of them ended up as 50 beds, like at Port Lincoln. But they actually built the lift shaft for a four-story building and then only ended up building the first floor. So that was typical. That was typical, the kitchen big enough to to feed a, a war ship and a laundry big enough to cover the whole community and the, and surrounding townships. But very basic,

David Cummins: 3:28

But that sounds like bad planning, more than bad sustainability practices. Was that, was that just the way it was done then? Someone came up with an idea, People did it, and minimal. Minimal thought was given to the future proofing of the area, and also minimal impact to the patient care?

Garry Coff: 3:46

Absolutely. the issue was never energy consumption or or, or indeed any sort of consideration of the long term planning other than the fact that they were all gonna end up as 400 bed hospitals. They were very They were very optimistic about the the populations that were gonna grow in all these regional areas. And so they just put 'em together. Like they did big ships, they had big boiler rooms, They had huge air conditioning equipment that was pretty awful. But, but basically it was it was extravagant and a lot of the, a lot of the facilities the big issue has been to kind of wind all that back and trim them all back to something reasonable. Specifically designed,

David Cummins: 4:24

So when did the word sustainability and sort of evolve in your career? Was it the eighties, nineties, later?

Garry Coff: 4:32

I guess it, it, it crept in in the eighties, late eighties because we were starting to look a, a lot more at a lot more different styles of construction and, and it became evident that, that the hospitals for. Low dependency sort of care didn't need to be over, over designed. Whereas prior to that, there were a lot of money spent on facilities where there weren't appropriately trained doctors to actually perform the tasks that were being designed for. So yeah, that, that, that was where it started to, to happen. It's really kicked off in the 2000's. And obviously, we're, we are in a different world now. But sustainability becomes quite the, quite the key issue in both, both the future development and an ability to maintain a, an updating process which wasn't in our minds in those in those days.

David Cummins: 5:26

Yeah, I think the statistics show that Australia's got one of the worst carbon footprints for healthcare as an industry in the world behind America. It's almost double what is in the UK at the moment, and it's certainly above the global average. What do you think are some of the reasons why the Australian healthcare footprint is, is so dramatic?

Garry Coff: 5:46

A lot of our design was, was based around the British model. And the British climate, of course, is incredibly different to, to the Australian climate. So you start from behind the eight ball right at day one, and then, peddling as hard as you can to catch up. Where we are now, at least at a position where we, we have. Economies of, of of scale and operation. And we are designing more appropriately to shut sections of buildings down and to make sure that they're efficient. And in some locations where the climate is fine. You don't need air conditioning. We've actually started to recognise that you can, you can be flexible about that sort of thing.

David Cummins: 6:25

Yeah. And keeping in mind design. I would argue design over the. Probably 30 years, certainly last even 10, 15 years, and even more recently, last four or five years. There's been a stronger emphasis on sustainability in design. What are your thoughts on that?

Garry Coff: 6:43

Well, it's very hard to beat the very basic guidelines of orientation. If you get the sun in the right spot, it's not about moving the sun. It's about putting the building in the right spot and facing at the right directions and, and a little less concern about the view and a bit more concern about energy consumption and the quality of the space.

David Cummins: 7:04

Yeah, I, agree. would, I would say my career, which is only a fraction of yours, I've still never built a hospital with double glaze windows, and for me, that's a concern.

Garry Coff: 7:17

It could be a bit of a worry. The hospital buildings are, typical they require a lot of window there's a lot of external wall and there's a lot of window required. And of course, that pushes you towards the solutions for not just to, to keep the heat out, but the solutions to manage your, your temperature and glare factors and all sorts of things that double glazing can take care of. So, yeah, so it is a bit scary. I know there's a lot of high, performance glass out there in, in multistory buildings, and actually in giving the, best to the external factors that are gonna influence the way the building will work.

David Cummins: 7:52

So what do you think are some of the, resistance and the barriers towards why Australia is so far behind the global average for our healthcare sustainability footprint? what do you think some of the, major challenges have been? And, and how do we overcome those challenges?

Garry Coff: 8:08

Well a lot of it is, about the fact that you can overcome, you can Basically build an igloo in, in, in the middle of the desert if you, if you go about it in the right way. Dubai is a good example of being able to do that. So we Australians in, in general like a challenge and if it becomes an issue of you really want that view, well we'll make it work for you. It's it's, it's, it's really a matter of settling back and recognising the long term impact of the cost of that view and actually recognising. we are using a lot of energy that we don't need to use. It really is, just a natural thing that we seem to try and take over what nature's providing. So it's a futile sort of Argument really to actually go on doing that. However, we still see examples of that. So it's not gonna be easy to to change people's thinking, but really there's a lot happening in that direction right now, which is great.

David Cummins: 9:04

Yeah, I agree. And I also think the turning the tide is, has changed dramatically where it is now a priority for people in development and construction and, and, and their projects to actually have sustainability as a, KPI which probably wasn't really around, well, certainly when I started my career, it wasn't really around to have it as a priority. It was a word that was very quickly squashed and, and not taken serious.

Garry Coff: 9:27

Absolutely. Yeah. Yeah. I, I have a client that has and, and really I need more of these, but I have a particular client who, who really wanted to go with a passive building and, and he, he managed to secure a really good site in the middle of what used to be the old Mitsubishi manufacturing or vehicle manufacturing plant here in Adelaide. And he secured a Prime site. And he wanted to build a four-story, Medical center, right in that spot. And he wanted to be off grid. Totally off grid. And, and it, it, it is, it is a real example of what you can do. But it does, you, I suppose you, you, you look at it and you say, Well, we're making some concessions, but the fact is this building really does run on it. the smell of a I won't call it an oily rag anymore. , let's, let's call it a, a disinfectant cloth . And so, free air, really free air conditioning is, is, is amazing. And we've ended up with a design of a building that could. a lot of people's thinking, but it does need some funding. So we're, he's, he's currently sourcing the funding to go forward with it. So, but the design's been done and we have a magic solution if we can just get the right interest in it.

David Cummins: 10:41

So is that a health project?

Garry Coff: 10:43

Yes, it is. Yeah. It's, it has a it has four operating theaters with a suite of day surgery facilities. It's got it, it, there, there's a a level of General practice consulting, which is effectively specialising in skin cancers and dermatology sort of issues. It has a, medical imaging facility proposed in it with a MRI pet pet CT and PET/CT scanner. It includes a pharmacy, it includes a dentist. it's quite an array of equipment and materials and engineering that you wouldn't expect to find in an off-grid building.

David Cummins: 11:17

So my mind is boggling. Just with that last 30 seconds of conversation, how is that possible to have a passive hospital with such critical, crucial. Clinical care. Do you mind just talking through some of the principles of that, especially like with theaters and MRI, like, that's just mind boggling that that's possible.

Garry Coff: 11:37

we do have some pretty fascinating people involved in the planning. Trust me. it's not it's not an amateur's process. the principle's simple. it's an esky. It's built like a, it's designed to be an esky. It's completely sealed. It's completely insulated by the very nature of the materials. There are, timber and cement block of, of huge proportions, really quite a large setup. It's, it's faced on the outside with solar panels. The roof is fully absorbed with solar panels. It has a car park with solar panels on the roof. And of course the other part of that that makes it all possible is there's 600,000 liters of water storage in the basement. In, in bladders, not, not just running free, but in bladders in the basement of the building. So that becomes the source of being able to manage the air conditioning and the generation of, of heat and power by managing that, combination of panels, storage the qualities are, stored within the water. The water provides the heat exchange. The air that comes into the building is limited to coming in through the plant room where it's all filtered. It's all de humidified. It's then re- humidified and distributed without pressure to all the floors of the building. It comes into each of the rooms of the building at a low level, and the air is expelled through a central atrium that before it is expelled out into the into the atmosphere. It goes through a, an evaporative process where the energies well returned, returned to the water if you like, so that we actually generate heat from the water, from the air as it's expelled. So you have incoming evaporative, air conditioners, bringing the air in. You dehumidify the air, you circulate it through the building and it goes back out and you take the heat back as it goes.

David Cummins: 13:26

Yeah, that, that's phenomenal. Obviously theaters and MRI are, are extremely energy consuming and extremely critical. How do you compensate for the criticality of, those areas when, the elements may not work? Is there, I assume there's generat and backup for, for such things, correct?

Garry Coff: 13:45

there is a backup generator but there is plenty of power on board. And the issue is that you, we do have to have stand, we'd have to meet standards with air conditioning and, and with the medical imaging and the heat resource that comes out of the medical imaging process, there's batteries and, and inverters involved in all of that. But basically we are feeding energy into a system that runs chiller sets and boiler to actually manage the temperature control and quality of air and the number of air changes that are required throughout the the operating theater zones. So it's, it's actually quite. It's, it's just a matter of balancing the power and the demand and being able to run a, a proportion of the building with that as an additional component to what you would call the low tech area, I suppose the low tech area issue is the fact that the air conditioning is not forced. So what we're doing by running. Air and water through, through the floors we're actually calling and warming the building, not the air. And it's not the air that's doing the cooling or the warming, it's actually the water that's in the slabs and the and the fact that the system that provides that temperature stays at 22 degrees basically all the time, 24 hours, seven days a week.

David Cummins: 15:06

I bet that hospital has got arm double glaze windows?

Garry Coff: 15:10

Absolutely. Triple . It does have triple, Yeah. Yeah, you're absolutely right. And the blocks themselves that, that form the walls they, they are they are high, they have a very high R rating. They're, they're, they're actually very very energy efficient. But the big deal is it's sealed. It's completely sealed.

David Cummins: 15:30

So for someone who has worked in health for a long time, both of us, the absolute benefit of a hospital like that, not only does it reduce the carbon footprint, it's self-sufficient. It actually creates less pollutants in the air, which ultimately is what a. Hospital building should do, it should actually be there to provide health and almost as a preventative. So what would be some of the other benefits of a building like this? If, if every hospital in Australia was, was such, was like that?

Garry Coff: 16:01

Well, I guess you're right. This is one of the things that I've always been quite concerned about is the fact that hospitals become incubators for disease. They, if you're gonna, if you, if there's something out there, you'll catch it at the hospital. It's for sure. It's, it's, it's bound to be there and it'll, it'll come and get you. So we go looking for it by going into hospitals and as hospital designers get into a bit of strife with that sometimes, I think, however, you're right, the thinking is clean. The thinking is, this was all started well before Covid, but when you look at it in the context of Covid, it's got a lot to do with the infection control and the separation and the ability to, to keep the quality of the air very high and to get a, a good proportion of of air through the. Through all parts of the building. So, you're trying to keep the whole building at the same temperature all the time.

David Cummins: 16:47

Yeah. Very, very interesting. So why have not we done this earlier?

Garry Coff: 16:52

There's a lot of reasons. our engineer. If you like, our, the engineering processes are very radical in comparison to what is actually out in the marketplace. We would be putting at risk a lot of businesses that manufacture air conditioning equipment and, and support the industries that, that are actually. Driven by all of that. So you've got a lot of other interests involved that, that are not necessarily gonna be very warm at, at taking this sort of approach along with it. Well that's one of the reasons I guess I can't be too critical about that. But ultimately it's, it's different to the, to the way people normally think. It's, it's a new paradigm, it's a different approach and to change the trend of, of what people trust is hard work.

David Cummins: 17:43

Yeah, I think, I think that's really the, I think that's really the point. It hasn't been done before, so why change it?

Garry Coff: 17:51

Yeah. Yeah.

David Cummins: 17:52

We have to change these up.

Garry Coff: 17:53

You're right. You're right. But, but we, we didn't do this without some research and some in depth planning. So there has been a building built which replicates these principles. It's a medical center, but it's, just a medical practice, so it doesn't, go to the extremes of medical imaging and, and operating theaters, but it works in principle, the things that were probably critical about that, that that aren't acceptable. That there wasn't enough windows. Yeah. The building lacked in windows, and the windows were small. And they were, not providing much of an outlook. They were providing some incoming light, but not a lot of out ward view. And that it was re it was, it was actually constructed using styrene type refrigeration wall panels, but on a pretty good scale, three story building. and the the issues that came with that were, it was difficult to lease so as, as a commercial proposition. So we've introduced a, a whole different approach to that by putting the. Health issue on the line to see what it might develop into.

David Cummins: 18:59

So just to dig a little bit deeper before we finish up, how much would this building have cost without all these sustainability initiatives versus how much does it cost? You don't have to give exact figures, maybe just a percentage, and then I assume what would be the payback? My understanding is most sustainability initiatives are about 10 to 15% above the total construction cost with a payback of about, five to 10 years. For a 50 year building, you're making money within, year 10, year 50. Would that be similar to, to your findings for this passive hospital?

Garry Coff: 19:39

No, it's rather surprising actually. Because, because the tone technology is actually quite basic and quite simple. We're using air and water where we, we have to use good quality materials, but we, we are trans, we're using a lot of heat transference. In, in a, in that takes up space that's, that's actually internal. So the leasing capabilities, you, you have a fair proportion of area that is plant that is not able to be leased. Now, that still happens in modern hospital design. We have quite huge plant areas and quite large engineering spaces. And of course they don't generate any sort of positive benefit other than maintaining the standard of the, of the accommodation with the, with the obvious issues of 24/7. So, The cost, the initial cost is, is quite low other than the building materials are, are a bit of a challenge in as much as they, they are new to Australia. The concept of sealed esky style building is, is, is foreign. We have, we have a lot of air leaks and, and We, we accept a, a pretty low standard of, of seal building seal. The issue of the insulation's not a no, no difference really. If we did proper insulation, we'd be doing the, spending the same money. The fact that it's different materials and, and no one wants to be the first to try is, is a challenge. But the technology's very simple and the amount of replacement equipment is, is way lower. You still have the operating theater components. You've still got the equipment, you've still got the air conditioning and the chiller and that sort of, But it's not for the whole building, it's just for a proportion of the building. So you can isolate that element. You can run the operating theaters in, in timelines where you have excess energy, and you can manage the functionality of that to meet what the, what the energy consumption is at the. So really it's a surprise. No, it, it, we're talking, we're talking four stories with the, as I described, the fittings and the, and the type of work. It's a specialist consulting floor in amongst that. But j as a general exercise, it's, it's in the, it, it, it's, it's probably more like $5,000 a square meter than 10,000. And in hospital design these days, that's that, that's. Probably a real challenge for people to believe, but there you go.

David Cummins: 22:13

Yeah. Very, very fascinating. Just before we go, cause we're running out of time, how would you like to see sustainability in healthcare change? You've been in the industry for over 30 years obviously I don't think you'll be around doing it for the next 30 years, although, I'm sure, I'm sure the industry would benefit from your knowledge, but how would you like to see the industry change in reference to sustainability over the next 30?

Garry Coff: 22:35

One of the key elements that, that, that I struggle with is, is that we, we, we've started building hospitals bigger and bigger. They just, they just get bigger and bigger. We, we actually end up with, with things that are quite out of balance with, the cycle that we're trying to be part of. And, and that fits into the categories of saying, well, okay, every time we add more diagnostic and treatment, a more sophisticated diagnostic and treatment. Tend to add more beds. And, and the cost of building the beds and running the beds is where all the money goes. So you'll end up with a, with a high cost inpatient CAPA capacity that doesn't actually need to be there in that form if you, if you decentralise so that your. high cost and high technology areas are grouped and may be smaller, but more accessible to the communities. And then if you looked into the communities and put residential accommodation in a, in a more acceptable way, you could perhaps end up with more of nursing capability rather. Clinical capability in those outlying accommodations. So therein lies. Are millions of saying, Okay, we work the clinical area 24 hours, seven days a week, and we process, but we move people fairly quickly out into lower cost facilities. still driven by lack of nursing staff and skilled qualified people, but nevertheless in a more comfortable and more residential style of accommodation. So that would be a really big change. But it, but it would be, it would. Better perhaps than, than these mul monster buildings that we are focusing on at the moment, which are, which are huge and all areas are expensive to run. And, you end up operating lots of, lots of beds generally accruing a number of them that are long stay, that, that aren't, that don't need to be in a hospital, but they're there because there's nowhere else for them to go. So yeah, there's a few ideas in there that can be unpacked but you can see it's a decentralised model and it's suggesting that we minimise the high end cost of the technical spaces.

David Cummins: 24:41

Yeah. Very interesting. I could listen to you all day. Well, we're running out of time, so something tells you we should have another podcast soon. So thank you very much, Gary. I find you very fascinating and thank you for all your hard work you put into the last 30 years to help improve the Australian healthcare.

Garry Coff: 24:54

Thanks for the invitation, David. it's a pleasure to talk with you.

David Cummins: 24:57

You have been listening to the Australian Health Design Council podcast series, Health Design on the go. If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you.

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