By Anne Cosgrove
Published in the January 2006 issue of Today’s Facility Manager
When Kaiser Permanente decided to create a new resilient flooring standard for its facilities, Tom Cooper, manager, strategic sourcing and technology, was at the forefront of the decision making process for the health care organization. With occupant well-being a prime concern, four pilot projects provided key information in researching the options in the marketplace.
How many years have you been in the facilities profession?
I’ve been at Kaiser Permanente for 17 1⁄2 years. I work in the National Facilities Services group, which develops standards for Kaiser Permanente facilities. This affects all new construction and renovation work throughout the 64 million square feet of space we own and operate. Our standards program is mandatory, so the consultants and contractors who work with Kaiser Permanente are required to comply with them.
When and how did you become interested in environmental issues?
I became aware while in high school. I grew up in New York City and was right in the midst of smog and those kinds of pollution issues. I was aware of the environmental movement and understood some of the larger issues involved.
What defines the green philosophy your organization would like to convey?
The concept of Kaiser Permanente and how we deliver health care is based on a preventive model. We don’t just look at healing people who are sick and treating their condition. The company was built on innovation and looks at causes of health issues.
Back in 1963, Kaiser Permanente sponsored an environmental symposium, and the keynote speaker was Rachel Carson [author of Silent Spring]. A lot of what she addressed concerned chemicals and their impact on health.
Why was the decision made to pursue new resilient flooring standards in your facilities?
This is part of a strategy that Kaiser Permanente initiated more than four years ago to eliminate polyvinyl chloride (PVC) from the materials used in our buildings. We studied the science around PVC and found there are many direct links between the particulate and offgassing of PVC-containing products that impact indoor air quality. That led to the conclusion that we needed to reduce or eliminate those kinds of products from our facilities and certainly not introduce any new ones.
In 2002, we conducted a study, which specifically focused on resilient flooring and finding alternatives to resilient flooring containing PVC. The study ran for 2 1⁄2 years and yielded a lot of valuable information.
The issue with vinyl resilient flooring—vinyl composition tile (VCT) and sheet vinyl—is not just the product itself and the PVC contained in it, but also in its maintenance. It requires a wax, which then has to be stripped.
This introduces a lot of harmful chemicals into an environment occupied by people who are immune compromised or whose health may be negatively impacted.
What was the vendor selection process like? Did you feel limited?
There’s a lot of product on the market that is PVC-free. The issue for us was that it have the proper aesthetics and performance characteristics, which narrowed the field. We looked at many products, some of which are in our facilities already. To evaluate others, we went to other hospitals and other types of facilities to study how the product was applied there.
We were looking for alternatives, and each one on the market costs more. But VCT costs the most to maintain, because of the waxing and stripping. We decided that because it was going to be a higher first cost, we needed to find products with a lower life cycle cost.
We eventually zeroed in on four different products—three rubber flooring products and Stratica [an ecopolymeric product from Amtico International]. At that point, we established four pilot projects in two existing hospitals and two brand new medical office buildings. We put Stratica in one of the hospitals, and in the other hospital we installed a floor from one rubber manufacturer. The two medical office buildings got rubber flooring from the other two manufacturers.
What type of information were you looking for with the pilot projects?
We tracked performance for eight months. We conducted our own testing for offgassing. Kaiser Permanente has an in-house National Environmental Health & Safety Group that conducts air sampling. This testing occurred on the day of installation and at subsequent periods after installation.
We also performed in-house stain testing, because the ASTM test doesn’t determine whether you can clean a material—only if it stains. We did stain testing with 11 different chemicals that are used in our laboratories, surgery suites, and other departments. We tested the materials for cleanability of stains after 24 hours, one week, and two weeks. We also compared it to vinyl.
We tracked the cost of maintaining the four different floors and also tracked staff and customer satisfaction in terms of appearance and other factors. We wanted to go further than the normal testing protocols to make sure we had a full understanding of how the materials would perform. At the same time, we requested that each of the manufacturers provide us with a variety of third party testing.
The other issue was workplace safety. We spend millions of dollars a year in claims related to slips, trips, and falls. So one of the things we looked at—as a way to reduce those injuries—was products with a higher coefficient of friction than a waxed vinyl floor.
When comparing the pilot projects in the medical office buildings with two other medical office buildings with VCT, there was a dramatic difference between the number of injuries in the buildings. We’re continuing our study to dig deeper into what’s causing some of the slips, trips, and falls at the other clinics.
There are also infection control benefits, because the products are non-porous, which is why they don’t require waxing. That is obviously a big concern for us.
After eight months, we conducted survey and site visits. After analyzing all the data, we selected Stratica and nora Rubber Flooring. We negotiated contracts with both manufacturers and established a standard with them that was instituted in September 2004.
What type of cleaning is required with the flooring products that were chosen?
The products have a very different cleaning protocol than vinyl flooring. They both require some chemicals but fewer than vinyl and neither needs any type of sealant. We found in our pilot projects that the maintenance cost was about 80% less than vinyl. That was a big driver.
To address changes from the previous flooring products, prior to the installation we host an education session with various staff members from the affected departments. After the installation, we sponsor more education with the staff. The environmental services staff is trained to clean the floor differently. Also, part of the manufacturers’ agreements is that they help in the training of the staff.
When this new resilient flooring reaches its end of life, what are the plans for disposal?
We are working with the manufacturers to take back the material and recycle it when the flooring reaches the end of its useful life. That’s a big piece of all of our national contracts—that manufacturers have to be responsible to keep material out of landfills.
What factors determine which of the two flooring products will be used in a project?
Since the Stratica only comes in tile, it can’t be used in procedure rooms, surgery suites, and any area where there’s an infection control issue due to seams that can’t be sealed properly. In those areas, we would use nora, because they also have a sheet rubber product and the seams can be bonded.
The Stratica gets used virtually anywhere where we’re not going to have to seal the seams.
What was the reaction of upper management to the decision to embrace principles of sustainable design in this project?
Kaiser Permanente has an Environmental Stewardship Council that is made up of senior leaders within the company. They report to our CEO George Halvorson. Decisions like these come from that council and are supported at the highest levels of the organization, because of the direct link these issues have to health care outcomes and workplace safety.
We do have to develop a business case that proves what we’re trying to do is beneficial and what the costs are, but the company is willing to take bold stands because of the vision.
What were some of the non-economic challenges and highlights of this project?
One of the challenges was changing our maintenance practices. That was one of the reasons why we wanted to study it in pilot projects, because it’s a very different way of cleaning in terms of the chemicals and processes that are used. That continues to be a challenge, but we’re very confident that over time, as we install more and more of the new flooring products, that practice will change. It’s a recognized issue.
Have you applied for LEED certification from the USGBC?
No, Kaiser Permanente has never applied for LEED. However, we were very involved in the development of the Green Guide for Health Care and are in the process of adapting it as a guideline for our projects. The primary reason is that LEED doesn’t focus on some issues that are critical in health care. The Green Guide for Health Care is based on a LEED-type formula, but it doesn’t require the third party certification.
Did this project cost more, the same, or less than a standard project?
It definitely has a higher installed cost. There’s no question about it. But that’s only one piece of the equation. At Kaiser Permanente, we consider the overall health and safety benefits and the long-term return on investment.
What is the anticipated return on investment?
We have a simple ROI based on the savings on the maintenance end. However, we’re also trying to develop a more robust analysis that includes some of the other side benefits in terms of the reduction of slips, trips, falls, and disruption. But the straight payback is about five years or so.
What has been the reaction to the project inside your organization?
In the facilities where we’ve installed the new flooring products, and we’ve gotten our environmental services staff to maintain it properly, they love it.
Another aspect of the two products that we ultimately chose is their superior acoustics. In the areas where we’ve installed it, there’s high staff satisfaction, because it’s noticeably quieter. There is also much greater comfort underfoot, because of the resilience of the floor.
What did you learn from this project?
Though we knew this already, we noted that you shouldn’t just take a manufacturer’s word on how its product performs. It was a great value to us to be able to do a lot of testing ourselves.
Why should other facility professionals consider green solutions when the opportunity is present?
They should consider it for all the reasons that Kaiser Permanente does it. It’s the right choice in terms of health care in general, whether you’re managing an office building, or a school, or any other type of building.
What was the most professionally rewarding aspect of this project?
It was the fact that Kaiser Permanente stood behind this decision, because it’s a dramatic change. Considering how many millions of dollars we spend on resilient flooring, for the organization to say it was willing to spend more money in first costs—because it’s the right thing to do for our members, visitors, and staff—is proof that we practice what we preach.
Questions about this project can be sent to Tom Cooper at thomas.cooper@kp.org.
