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Three major San Francisco hospitals showed that collaboration does not require a single construction method or a single green-technology package. California Pacific Medical Center (CPMC) at Cathedral Hill, UCSF Medical Center at Mission Bay, and San Francisco General Hospital and Trauma Center (SFGH) exchanged energy-modeling and sustainability information while using lean construction, integrated project delivery, and design-assist delivery respectively. A 2010 case study reported that all three were tracking LEED-NC Gold, but the schedules, costs, strategies, and performance figures below are historical project descriptions or forecasts—not verified as-built results.
The collaboration matters because the hospitals were being designed at the same time, in the same city, with more than 1,100 planned beds and over 2.2 million square feet combined. Their teams could compare assumptions, identify common problems, and still choose solutions that fit each building’s form, site, financing, and clinical program. The U.S. Department of Energy later cited this information-sharing as an example for other building teams.
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The three projects and their different delivery models
Robert Cassidy’s August 11, 2010 case study in Building Design + Construction describes three large hospital projects then in design or construction. The reported project values are planning figures from that period.
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Outbyte Driver Updater FREEScan for outdated or missing drivers - takes under a minuteDriver Scan →Outbyte PC Repair FREEClear out junk files and repair common Windows errorsFree Scan →| Project | Reported size and cost | Delivery approach | Highlighted sustainability direction |
|---|---|---|---|
| California Pacific Medical Center (CPMC), Cathedral Hill | 555 beds; 914,750 square feet; $1.7 billion | Lean construction | Variable air volume (VAV), heat recovery, displacement ventilation, and investigation of construction-phase fuel cells |
| UCSF Medical Center, Mission Bay | 289 beds; 881,000 square feet; $1.6 billion | Integrated project delivery | Photovoltaic (PV) panels, including a possible parking-garage installation, with third-party funding under discussion |
| San Francisco General Hospital and Trauma Center (SFGH) | 284 beds; 448,000 square feet; $900 million | Design-assist | Solar domestic hot water and a detailed lower-impact materials checklist |
Together, the projects were described as exceeding $4 billion, providing nearly 600,000 patient days of annual capacity, and totaling more than 1,100 beds. Those totals reflect the 2010 article’s announced project scope, not a current inventory or an audited final cost.
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Why delivery method affected sustainability decisions
Lean construction, integrated project delivery (IPD), and design-assist each bring different people into decisions at different times. The teams used those arrangements to coordinate architects, engineers, contractors, owners, and specialists, but they did not treat one delivery model as universally superior. Russell Perry of SmithGroup described the exchange as “an interesting collaboration to get into some depth on energy and begin to look at commonalities, both strategically and in energy modeling.”
Sharing information let the teams compare energy assumptions and product criteria without forcing identical designs. The 2011 U.S. Department of Energy report, Net-Zero Energy: The Next Frontier in Green Building, later identified the hospital collaboration as a model of information-sharing among building teams (DOE report).
How energy modeling changed the conversation
Energy models were used to test systems before construction rather than relying on a generic list of green features. The models exposed how much energy came from ventilation, heat recovery, and equipment loads, and they showed that a strategy that worked for one hospital might not work for another.
CPMC’s modeled mechanical package
For CPMC, the reported package combined VAV air distribution, heat recovery, and displacement ventilation. The 2010 model projected a 35% reduction in energy use and a 26% reduction in carbon emissions compared with the project’s reference case. These are modeled projections attributed to the case study, not measured operating results.
CPMC’s slim 17-story form also constrained renewable-energy choices. The article said limited roof area made a large PV array difficult, so the team investigated fuel cells that could supply power during construction and that the hospital might later buy back. The proposal’s financing, ownership, and final installation status were not established in the article.
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Different plug-load assumptions at UCSF and the other hospitals
The models also treated process and plug loads differently. Process/plug loads were reported as 24% of modeled building energy use at UCSF, compared with 48% at CPMC and 47% at SFGH. The article attributed UCSF’s lower figure to having optimized those loads in its model while the other two projects had not yet done so. The percentages therefore describe modeling assumptions and project stages, not proof that one hospital ultimately consumed half as much equipment energy.
Renewable-energy choices were shaped by each site
Alisdair McGregor of Arup summarized the contrast: “You have three major hospitals in the same city, but all three have gone in different directions for renewable energy.” The differences came from roof area, building height, construction logistics, economics, and available financing.
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CPMC explored construction-phase fuel cells as a way to provide temporary power and potentially become a hospital asset. The concept was unusual because it linked a construction need with a possible long-term energy system. The article does not report a final purchase decision, operating capacity, fuel type, emissions profile, or payback.
UCSF Mission Bay: PV and a possible energy-provider arrangement
UCSF had more roof area than the tower-shaped CPMC scheme, so PV received serious consideration. The teams discussed panels on the hospital and over the parking garage. Perry said, “We’ve been talking to an energy provider company to fund the panels, including over the parking garage.” The financing arrangement was still unsettled in the 2010 account; no installed capacity or final ownership structure was provided.
SFGH: solar hot water after PV and wind screening
SFGH evaluated PV and wind but judged them uneconomic under the conditions described in the case study. The selected direction was a solar domestic-hot-water system using flat-plate solar thermal collectors. The collectors were planned to occupy roughly 8% of roof area.
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Against a Commercial Buildings Energy Consumption Survey (CBECS) baseline for a typical inpatient hospital, the model estimated 61% savings in water-heating costs, more than $11,000 in annual energy-cost savings, and a 14-year payback. McGregor said, “Right now, it’s a 14-year payback, but with some work, we think we can get it down to 10.” Those figures are project-specific estimates from 2010; they should not be used as a universal payback for hospital or residential solar thermal systems. A flat-plate collector is a component of a larger engineered system, not a plug-in household product, and hospital applications require professional sizing, storage, controls, water-quality management, and code review.
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Materials and indoor-environment criteria
SFGH’s checklist approach
SFGH reported a checklist for selecting lower-impact materials. Criteria included:
- Low- or no-VOC products
- No PVC
- Locally sourced materials
- Cradle-to-cradle certification
- Recycled content
A checklist makes requirements visible to the design and procurement teams, but the article does not provide a complete product schedule, weighted scoring system, or verification of how every criterion was applied.
UCSF’s shift from “toxic-free” to “toxic-less”
UCSF screened common patient-room finishes for chemicals of concern. The team initially sought a “toxic-free” environment, then changed the target when few products met that threshold. Tyler Krehlik of Anshen+Allen explained: “We saw that it would be difficult to create a toxic-free environment, so we went to a ‘toxic-less’ environment.”
That change illustrates a practical procurement lesson: define measurable exclusions and safer substitutions, document trade-offs, and avoid claiming absolute elimination when the available product market cannot support it. The case study does not identify brands, concentrations, exposure measurements, or post-occupancy indoor-air results.
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Clinical benefits were not proven by the case study
The 2010 article discussed possible connections between green healthcare design and outcomes such as length of stay, pain, morbidity, and mortality. It also noted that, at publication, little peer-reviewed scientific evidence supported definitive claims for healing gardens, views of nature, daylighting, or green materials improving those outcomes.
Therefore, the projects’ daylight, nature, ventilation, and material strategies should be described as environmental, operational, or occupant-support measures—not as proven treatments. Anyone making a current clinical-outcome claim should consult up-to-date peer-reviewed healthcare research rather than treating this historical case study as evidence.
A practical framework for applying the teams’ lessons
1. Share models before selecting technologies
Set common definitions for floor area, schedules, weather files, ventilation rates, plug loads, and baseline energy use. Exchange model assumptions among project teams so differences are visible before systems are priced.
2. Match the system to building form and site
Check roof area, tower geometry, parking structures, structural capacity, utility interconnection, shading, maintenance access, and construction phasing. CPMC’s limited roof area led toward a fuel-cell discussion, while UCSF’s available roof and garage surfaces supported PV consideration.
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3. Test economics with transparent boundaries
State whether a payback includes incentives, financing, replacement, maintenance, escalation, or avoided demand charges. SFGH’s 14-year solar-hot-water estimate—and its aspirational 10-year target—cannot be transferred to another hospital without a new load and cost model.
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5. Keep forecasts separate from measured performance
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What this collaboration demonstrates—and what it does not
The strongest lesson is organizational: competing or separately delivered hospital teams can share methods, assumptions, and mistakes while retaining project-specific solutions. The DOE’s 2011 account supports that information-sharing lesson and separately notes that 138 architecture firms had signed the AIA 2030 Commitment at that time, with historical targets of a 50% predicted energy-use-intensity reduction and a 25% lighting-power-density reduction. Those AIA figures are contextual commitments; they are not reported achievements for these three hospitals.
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Scan for outdated or missing drivers - takes under a minuteDriver Scan →Clear out junk files and repair common Windows errorsFree Scan →The case study does not establish final certification, completed costs, installed renewable capacity, actual energy or carbon savings, or clinical outcomes. It records a point in the projects’ development and the teams’ intended strategies. Used with those limits, the three-hospital comparison remains a useful example of how delivery structure, modeling discipline, site constraints, and procurement policy can work together in healthcare construction.
Quick Recap
Primary sources
- Robert Cassidy, “3 Hospitals, 3 Building Teams, 1 Mission: Optimum Sustainability,” Building Design + Construction, August 11, 2010: https://www.bdcnetwork.com/products-and-materials/green-building-products/article/55144190/3-hospitals-3-building-teams-1-mission-optimum-sustainability
- U.S. Department of Energy, “Net-Zero Energy: The Next Frontier in Green Building,” March 2011: https://www1.eere.energy.gov/buildings/publications/pdfs/rsf/netzero_energy_buildings_and_homes.pdf
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