How Kaiser Permanente keeps 70M square feet of flooring free of toxic chemicals

Build good relationships with vendors, and there is nothing you can’t accomplish.

Health Care Without Harm
8 min readJul 16, 2019

“Our first consideration when selecting new products is to align with Kaiser Permanente’s environmentally preferable purchasing program which addresses chemicals of concern and includes recently adopted Health Care Without Harm’s flooring criteria. It is very important to have this third-party criteria to create a broad influence for positive change.”

— Jennifer MacDaniel, Kaiser Permanente principal interior designer, facilities strategy, planning + design

Kaiser Permanente is one of the nation’s largest nonprofit health systems. With 39 hospitals and 697 medical facilities across eight states and the District of Columbia, its large portfolio includes more than 70,000,000 square feet of flooring. And according to Jennifer MacDaniel, Kaiser Permanente principal interior designer, all approved flooring has been vetted for chemicals of concern and exemplifies the system’s environmental standards.

Jennifer MacDaniel, Kaiser Permanente principal interior designer, facilities strategy, planning + design

“I feel fortunate to be overseeing this work for Kaiser Permanente for the past eight years. Each day brings the reward of new challenges and opportunities to add value for employees and members alike. The work includes the continual pursuit of new products and innovation, interface with a broad array of interior designers and architects, focus on the importance of ease of maintenance in our facilities, with the end goal of creating a positive experience for our members. I feel such gratitude for these aspects of my design work; this brings me back every day.”

“Kaiser Permanente is concerned that flooring in all medical spaces — both clinical and non-clinical — align with purchasing choices that positively impact the environment and, in the end, support Kaiser Permanente’s overall mission to ‘do no harm’.”

Every day, patients and workers are exposed to a wide array of chemicals in hospitals and health care facilities. Many of these chemicals have been shown to have a lasting negative impact on individual health, public health, and the environment. Since flooring is used in all health care spaces, this heavily impacts the indoor environment, and the overall employee and patient experience.

Choosing healthier flooring can:

  • Decrease patient, staff, and visitor exposures to harmful chemicals that have links to asthma, cancer, and developmental impacts, among other health effects.
  • Eliminate the need for toxic floor strippers and finishes.
  • Reduce maintenance costs and time.
  • Decrease the total cost of ownership.
  • Drive greater transparency in the flooring materials market.

Practice Greenhealth’s new healthy flooring goal is intended to assist hospitals in purchasing and provide a framework to benchmark their progress.

Working closely with Practice Greenhealth, Health Care Without Harm seeks to transform health care worldwide so it reduces its environmental footprint and becomes a leader in the global movement for environmental health and justice.

Since Health Care Without Harm released its healthy flooring criteria, some of the largest manufacturers selling to the health care market have developed lists of approved products.

Health systems like Kaiser Permanente are using these tools to achieve their environmental purchasing goals.

Integrating mission into policy

Kaiser Permanente, as a Practice Greenhealth member, has prioritized healthy flooring for more than 15 years. MacDaniel summarizes the five components in the master performance specification document that started this broad industry change:

“Products made from rapidly renewable resources are preferred, and products containing recycled content are preferred, although we also want to know exactly what the recycled content is prior to approving it. We also value products that do not contain polyvinyl chloride, PFAS, phthalate plasticizers; products that do not have added antimicrobials or mold or mildew inhibitors; and lastly, products that meet our environmental health parameters.”

These standards have since been integrated into the Kaiser Permanente national design and purchasing criteria holistically.

Kaiser Permanente continues to research and modify their standards when new chemicals of concern are identified and communicate them to all industry partners via a nationwide bulletin when needed. This critical must-read document is circulated broadly to all who specify or purchase products, architects, interior designers, architectural consultants, scientific consultants, and all other consultants the health system works with who build and furnish Kaiser Permanente facilities.

Kaiser Permanente maintains a national sourcing list, comprised of 13 resilient floor manufacturers that have worked diligently from a “chemicals of concern” perspective. All Kaiser Permanente consultant design partners charged with purchasing products and designing spaces have access to an online support portal. They can easily find out which products have been approved and determine what type of product, finishes, and specialty items are appropriate for the space they are designing.

“Chemicals of concern is a very deep subject, one that is exacerbated by the additional project factors of schedule and budget,” MacDaniel reiterates, “It’s so important to adhere to our environmental standards as a means of pushing the health care industry in the right direction. These are learning opportunities to help promote an understanding of the ‘why’ behind the environmental practices. It’s an ongoing process.”

Valued vendor relationships

“That’s the message we are trying to send to the market. Kaiser Permanente, as large as we are, is only buying from these specific manufactures because they meet our chemicals of concern criteria.” — Jennifer MacDaniel, Kaiser Permanente principal interior designer, facilities strategy, planning and design

From the very first industry outreach in 2004 in which Kaiser Permanente requested carpet without PVC to today’s robust innovations around resilient flooring with good acoustics, MacDaniel credits Kaiser Permanente’s strong partnership with flooring manufacturers as the key to their success.

Kaiser Permanente not only purchases the products that are created to meet their specifications, but they also work with the manufactures on storytelling and branding to help promote the new products and hopefully inspire other customers and contribute to a healthy market.

For new manufacturers and new products that come across her desk, MacDaniel starts with Kaiser Permanente’s standards and goes from there.

“The first thing I do is hand them our chemicals of concern list and say, ‘OK this is what we believe in. Take a look at this for you products. If you meet these guidelines, let’s talk further about brand alignment, and other necessary business drivers.’’’

MacDaniel’s perspective and insight into the importance of strong collaboration between manufacturers and health care purchasers was echoed by suppliers at CleanMed, the premier national conference for leaders in health care sustainability, this year:

“Your ask speaks volumes to manufacturers. The only way to see this industry continue to move in this direction is to keep this dialog open, and express your needs.” — Jean Hansen, HDR sustainable principal

“It’s highly likely that we already do business together, or you’ve interacted with our products. Practice Greenhealth has challenged our company to change the way we make products so that we can make positive impacts for people and the planet.” — Tim Conway, Shaw Contract vice president of sustainability

The power of maintenance

According to MacDaniel, even given the absence of chemicals of concern, the flooring in Kaiser Permanente facilities continues to perform well with a minimum number of issues. When these rare issues do occur, in about 95% of the time they can be traced back to an installation or maintenance issue. The health system’s evaluation protocol, and continuing collaboration with their flooring manufacturers, typically helps them overcome these challenges.

Kaiser Permanente has a post-occupancy evaluation process. This involves site evaluations of what’s working, and what’s not, and MacDaniel says that they learn many valuable lessons (including on flooring) through that process.

“Our facilities partners often indicate ‘the product is not performing- we can’t keep this floor clean’. However, with investigation, we are typically able to resolve these issues quickly 99% of the time.”

MacDaniel encourages designers and architects to keep the lines of communication open with manufacturers.

“When specifying a product, I tell designers to work with the manufacturers and determine whether the product is appropriate for the particular space type. Often, manufacturers will share best practices and may want to be involved in the installation process to ensure the correct adhesives are used, and maintenance protocols are in place.”

MacDaniel is noticing a trend toward more resilient flooring and less soft surface flooring.

“More resilient products are coming to the market that have additional acoustic properties and can be a suitable alternative to carpet. From a maintenance standpoint, it’s a dream. Environmental services are happy to use the same cleaning protocol in large areas rather than having to switch from a wet-mop to a vacuum. We are doing more and more resilient flooring, which is probably music to the ears of the resilient flooring manufacturers.

I was concerned that we would lose the design aesthetic and warmth that carpet brings to our waiting rooms. It is my experience that most designers are innovative in using design and pattern to create a classic solution that stands the test of time, regardless of these product constraints. I am proud of our designers who use these materials to create an inviting environment.”

50% by 2025

“All the materials we use to build our hospitals have an impact on human health. Safer products and materials are a key part of our environmental stewardship program.” — Joel Sigler, Kaiser Permanente national environmental program leader

By 2025 Kaiser Permanente intends to increase the percentage of purchases to 50%. MacDaniel is proud that the products she manages — flooring, fabric, and furniture already meet this aggressive industry criteria.

“Kaiser Permanente’s mission is to improve the health of our members and the communities we serve. We care about our communities, our members, our staff, and the environment. Members who sign up for our health care are expecting the best care of course, but I hope that they are also proud that they are receiving this care in a thoughtfully designed building.”

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Photo credits: Kaiser Permanente



Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.