Many clients have inquired about what they can do to ensure adequate safety precautions are being observed in their medical office buildings. A recent study found that 61% of Americans are not confident or only slightly confident that public spaces have the guidance needed to open safely. Another study found that 44% of respondents have delayed health care appointments in light of COVID-19 and 23% have canceled care altogether. The CDC has been updating guidelines on social distancing and other standards as research on the virus develops, but many are searching for third-party certifications that can reassure patients the building owner is following the highest standards based on current research.
This article addresses sources of standards and certifications regarding wellness in buildings and how they apply to medical office buildings ("MOBs").
WELL Health Certification
WELL Health is a newer certification that is similar to the LEED sustainability certification. The International WELL Building Institute ("IWBI") has spent the last 6 years researching and developing a standard for promoting health and wellness in buildings. It has created a certification for buildings inspected by the organization, as well as the Accredited Professional ("AP") program that denotes expertise in the WELL building standard. WELL APs apply the standard when designing buildings but are not qualified to certify the building once complete - only IWBI may certify the building after construction. A building could be designed by a WELL AP and not be certified.
WELL certification is mostly for offices, stadiums, and apartment buildings designed to promote healthy living. This could include open staircases that encourage residents to avoid the elevator or mental health resources for employees. The standard may be best for owners of MOBs looking for a design that will attract tenants in the "new normal" of social distancing. Perhaps most relevant to the pandemic, the WELL Health air quality standard is outlined here and adopts many of the CDC's recommendations to keep patients safe.
Additionally, IWBI has been researching building design impacts on the spread of COVID-19. The organization issues a weekly newsletter featuring updates and advancements in research. The IWBI newsletter is available here.
Fitwel
Created by a joint commission between the CDC and the General Services Administration, Fitwel is another certification system for buildings that support occupants' health. Fitwel is operated by the Center for Active Design, a nonprofit organization started by the City of New York in 2012. To date, the organization has certified nearly 700 buildings around the globe.
The Fitwel standard includes 7 "impact categories" that promote healthy living. Each category consists of strategies that enhance the wellbeing of occupants. As compared with WELL, Fitwel does not primarily address construction standards for the built environment like WELL does. Where WELL certification includes very specific requirements, such as standards on air quality and natural lighting, Fitwel focuses more on behavioral changes in the use and flow of existing space, such as increasing physical activity of occupants, promotion of occupant safety and promoting access to healthy food within a multitenant building.
In general, WELL tends to be more expensive and detailed than Fitwel, but WELL is also harder to implement. Fitwel can address health issues within a building without the need to completely renovate a space as it focuses more on lifestyle factors and making use of existing amenities within a building.
In light of COVID-19, Fitwel has developed a Viral Response module to certify policies and practices that mitigate the spread of contagious disease. This standard is informed by public health research, industry leaders and academics. Because Fitwel does not generally require extensive renovations, it may be a more helpful and realistic standard for owners or operators of existing medical office space seeking third-party review of their COVID-19 procedures. However, it should be noted that these procedures are generalized for all office buildings and may not account for the additional risks or nuances surrounding health care facilities. The organization's entire list of resources in responding to the pandemic can be found here. For new construction, MOB owners should consider working with a WELL AP in order to assure patients the building has been constructed with the latest viral mitigation technologies and best practices.
Other Solutions
Because a health care-specific certification has yet to be developed, some MOB operators may consider calling upon local hospitals and health systems for formal or informal certification. Health system engineers and architects may offer greater expertise on building design as they have always been attuned to the health of occupants and slowing the spread of communicable disease. Health systems can also lend credibility as a trusted name in the local community, which may encourage patients to return to medical offices sooner.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
