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The minefield of different terms means there is a tendency to assume that the landscape is complicated but there really is a simple relationship between all these different elements and it starts with DfMA.. DfMA is a design approach.

Be Lean (passive): minimise the use of energy via passive design measures such as optimised form, orientation and window-to-wall ratio (WWR); design energy efficient facades that incorporate thermal insulation, high airtightness, external shading and solar control glazing; use of natural ventilation and thermal mass and design transitional spaces and low thermal expectation spaces.. Be Lean (active): minimise the use of energy via energy efficient lighting (LED, daylight and presence control sensors) and ventilation systems (demand control ventilation, low SFPs, heat recovery); use technologies such as waste-water heat recovery and specify energy efficient lifts and appliances/equipment.. Be Clean: connect to district heating networks that have plans for decarbonisation; explore plans and feasibility of local hydrogen district networks.. Be Green: use onsite low and zero carbon technologies such as air source heat pumps (ASHP), ground source heat pumps (GSHP), photovoltaic panels, solar collectors for domestic hot water and wind generation among others.. Be Smart: implement innovative technologies such as electric batteries, heat storage, post-occupancy evaluation and develop smart-metering systems..Offset: any remaining carbon should be offset via Power Purchase Agreements (PPA) or recognised carbon offset schemes.

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Offsets used should be publicly disclosed.. An example of specific design strategies that Bryden Wood have adopted follow the proposed operational carbon hierarchy is shown in Figure 5 and is demonstrated with examples below..Step-by-step hierarchy for net zero operational carbon.In order to substantially reduce embodied carbon, our designs will adopt the following hierarchy:.

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Build Nothing: identify opportunities to reuse existing structures, refurbish and reuse demolition materials onsite.Build Less: optimise the building’s form, structure, structural grid, WWR and DfMA components; recommend the use of durable materials, design-out basements and false ceilings (exposed soffit); design spaces which are adaptable and can be easily deconstructed..

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Build Clever: specify low carbon materials with a focus on the recycled content of steel and concrete and the use of timber; maximise the recycled content of finishes, use reclaimed floors and explore system’s rental; where possible use low GWP refrigerants and avoid VRF systems..

Build Efficiently: implement innovative construction strategies such as Modern methods of Construction (MMC) and use a DfMA approach to reduce waste onsite..In addition to these advantages, Maswiken enthuses about how lucky they are at Circle Reading to have their core/prep rooms, as well as the benefit of a layout which enables patients to go out through recovery to the wards, rather than back through the theatres.. Goel also comments on layout efficiency saying, ‘The recovery, the day case ward...is very close by.. Further to this, he and Maswiken have many other positive elements to highlight about the Circle theatres.

The three used predominantly for orthopaedic surgery have laminate floors and special ventilation systems providing ultra clean air, which Goel describes as ‘perfect.’ He also enthuses about how having images of x-rays on the computer system, enables them to be projected onto a television screen on the wall.On a more personal note, he enjoys the ability to put music on.

‘Everywhere else, I have to take my own box because they don’t have sound,’ he says, ‘so that’s quite nice.’.Maswiken also talks about the benefits of the lighting flexibility, with the ability to dim the lights or increase lumination, which he says provides options depending on the type of surgery being conducted.