When Seattle Children's Hospital looked to expand its operations, one thing became immediately clear: It wasn't going to have enough land in the densely populated Northeast Side of town for both new buildings and the parking garages required to support them.

The solution was simple in its conception even if it might prove difficult in the execution: Get at least 500 of its roughly 8,000 employees to walk, bike or bus to work, thus eliminating the need for more parking.

Asking nicely wasn't going to cut it, so the hospital administration built serious incentives into their wellness program: If an employee bikes to work, the hospital adds $3.25 to his or her pay that day. The employee also saves the $6 parking fee for a net of $9.25.

How can the hospital afford to give its employees raises of up to $16.25 a week? "The math is pretty straightforward," says Paulo Nunes-Ueno, director of transportation. "We saved $20 million by not having to build a parking garage. And we don't have to maintain a parking garage, which is expensive. Also, on the land where the parking garage would have been, we will have a building full of patients (56 additional beds) rather than cars."

The hospital's master plan also provides money — nearly $4 million — for a Livable Streets Initiative, which will include improvements to a nearby bike trail and the construction of "green streets" connecting parks and schools to the trail. The money also will pay to make it safer for pedestrians to cross arterial streets in the neighborhood.

The initiative not only makes sense economically, but also means Seattle Children's Hospital will be an even better neighbor.

"Some of the things like the green streets and the arterial pedestrian crossings will be noticeable to our neighbors, and others, like reduced traffic congestion and carbon monoxide, won't be quite as obvious," Nunes-Ueno says.

Janet Brown is the executive director of Practice Greenhealth, an organization that encourages more environmentally responsible practices in health care. She says every health care organization comes to its "a-ha moment" at its own pace and in its own way.

"In health care, you have slim margins, costs are exploding, so performance has to be improved," Brown says. "Leadership has to come to the realization that environmentally sound practices aren't just the right thing to do, they are also sound business practices."

In addition to Seattle Children's Hospital, Brown says several other large systems have begun to embrace green practices, including Bon Secours, Kaiser Permanente, Ascension Health and Partners Healthcare in Boston.

Seattle Children's has launched its transportation plan at the same time it has renewed its efforts to improve employee wellness, notes Kalisha Phoenix, manager of wellness and employee recognition. Biking, walking and even taking the bus are healthier alternatives than driving a car.

"The most important thing is to manage expectations," she says. "That's why we have a three- to five-year plan. Though we're not going to get immediate results, we do expect to see a reduction in claims by the end of the fifth year."

The hospital is using incentives ($30 and $50 gift cards) to entice its employees to participate in its wellness program.

"It's an investment that also has the additional benefit of reminding them we care about them as people," Phoenix adds.