Hospital Energy Efficiency: Challenges and Best Practices

The healthcare sector is one of the largest segments of the U.S. economy (17% of U.S.GDP) and the  average hospital uses 2.5 times the amount of energy as other commercial buildings, adding up to 836 trillion BTU’s or $5 billion annually, based on Department of Energy (DOE) data.  And although in recent years the priority has been placed on saving energy in hospitals, the healthcare sector still faces some unique challenges to energy improvements.  According to the ‘Advancing the Building Energy Efficiency Market in the Healthcare Sector’ report , these main challenges include:Image

Low Strategic Priority. Healthcare operates in a very turbulent business environment, where energy management is typically not seen as a strategic activity and upper management is focused on large issues like profitability, clinical care changes and healthcare reform.

Energy A Small Part of Operations.  Energy costs account only for between 2%-3% of total operating costs.

Risk-Adverse Culture. The management culture of the healthcare sector is very conservative. It is difficult to generate a sense of urgency in making changes in operating procedures to reduce energy consumption and emissions. And there is a low tolerance for experimentation with new technologies.

Reduced Facilities Staffing. Hospitals are being subject to intensive cost reduction pressures and in many instances this has resulted in substantial reductions in the facilities management staffing. This makes it more difficult to develop and implement energy efficiency measures.

24/7/365 Operation. The continuous use of facilities makes management reluctant to engage in retrofit activities that could disrupt operations. In addition, renovation projects run the risk of generating dust and other contaminants that create infection control challenges.

Need for Backup Systems. Because hospitals are engaged in activities that involve the life and death of patients, their margins for error or system failure are very low. As a result, hospitals must have back up power generation capabilities and be able to continue operations in the event of commercial power interruptions.

High Variations in Space Use. While in many building types (such as residential or commercial office) the nature of space use is highly consistent from room to room and building to building, healthcare facilities include multiple kinds of highly specialized space uses where the building energy requirements vary from space to space – such as surgery/operating rooms, patient rooms, intensive care, morgues,labs, waiting rooms, and offices. Each space has different air pressure, ventilation,temperature and humidity requirements. In addition, it is not atypical for the use of a space to change substantially over its lifecycle.

Strict Air Quality Regulations. Medical facility ventilation systems are regulated and managed in ways that dramatically increase the energy intensity of these systems compared to traditional commercial buildings. These requirements include:

o High outdoor air delivery rates

o High overall air exchange rates

o Air dehumidification requirements, which results in air cooling and then


o High air filtration requirements

o Higher than normal air temperatures for inpatient rooms

o Intensive lighting requirements that generate excessive heat

Some New Practices Increase Energy Intensity. Several trends in healthcare are tending to increase the energy intensity of its practices, including increased use of energy intensive equipment such as CAT scans and MRIs, and increased data center requirements due to the implementation of Electronic Medical Records and the storage of large medical imaging files.

Complicated physical plants. Many healthcare facility campuses consist of a diverse and complex assemblage of multiple buildings with multiple electrical and heating systems, making coordinated energy management a difficult task.

Sophisticated Skills Required for Building Management. Because of the complicated nature of their mechanical and electrical systems, making effective improvements to these systems requires high levels of technical skills and extensive training and experience in building engineers.

Separation of Capital and Operating Budgets. In many instances, the decision-making structures and processes for capital budgets vs. operating budgets are separated. The cost savings of a capital investment in energy efficiency are difficult to recognize in a way that justifies ongoing investments.

Despite these serious challenges, the efforts the industry has recently taken are very impressive as it becomes more and more obvious that energy efficiency represents a huge opportunity for hospitals and the healthcare industry. In 2010 the National Renewable Energy Lab (NREL) released a report entitled ‘Large Hospital 50% Savings’   that demonstrated the ability for a 527,000 square foot facility to achieve energy savings of between 50% and 60% in all 16 climate zones using a standard set of energy conservation measures.

The suggested  best practices are as follows;

1. Leadership Engagement

• Commitment to specific energy and GHG reduction goals

• Inclusion of energy/emissions targets in the corporate scoreboard

• Funding and support for senior staff for energy and sustainability


2. Strategic Energy Management Planning

• Development of a Strategic Energy Master Plan (SEMP)

• Development of gap assessments and energy audits to identify

opportunities for improvement

• ISO 50001 Certification

• Internal systems to prioritize and track energy investments

• Use of Portfolio Manager and other tools to track energy use

• Use of sub-metering and other energy monitoring technologies

3. Dedicated Financing

• Internal Green Revolving Loan Funds

• Standardized ROI and Lifecycle Costing tools

• Integration into capital outlay budget cycles

• Tracking of project results and ROI

• Participation in utility and other energy efficiency incentive

4. Financing Programs Implementation

a) NewBuildings

• Use of green building standards or design guides such as LEED for

Healthcare, ASHRAE Advanced Design Guide for Small Hospitals,

Targeting 100!, and the Green Guide to Health Care

• Use of integrated design processes

 b) Existing Buildings

• Retro-commissioning of existing buildings on a regular basis

• Development of standardized building operating manuals

• Annual building maintenance upgrades

• High efficiency HVAC systems, including boilers and chillers

• Reduced lighting power densities; day-lighting; occupancy sensors

• Demand controlled ventilation; displacement ventilation

• Separation of thermal conditioning from ventilation

• Building management systems

• High performance windows and glazing

• Tighter and better insulated building envelopes

• High efficiency fan and pump motors

• Occupant behavior change initiatives

• Plugload management

• Data center management

5. Alternative Energy Generation

• On-site and remote renewables, including PPAs

• Combined heat and power

• Clean energy grid procurement

6. Implementation –Procurement

• Implement energy efficiency purchasing specifications

• Implement the Electronics Products Environmental Assessment

Tool (EPEAT)

• Reprocess and re-sue single use medical devices

7. Human Capital Development

• Certification programs for facilities and building management staff

• Continuing education and participation in professional associations

• New employee orientation

8. Reporting and Recognition

• Annual Sustainability and Energy Reports

• Participation in Energy Star for Healthcare

• Employee recognition and reward programs

Learn about the latest products and services in the Healthcare Facilities Management Industry at the 13th Healthcare Facilities Forum in Austin Texas



2 responses to “Hospital Energy Efficiency: Challenges and Best Practices

  1. There are actually (2) separate AEDGs on hospitals and healthcare facilities that you may want to reference: The 30% AEDG for Small Hospitals and Healthcare Facilities and the 50% AEDG for Large Hospitals. You can get more information at


  2. Commissioning of the building enclosure with the use of air barriers to blower door type testing will help reduce air leakage for both new and existing building will help reduce energy use.


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