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Benchmarking is a critical step in energy management.

Photo courtesy of Schneider Electric

Hospital facility professionals looking for ways to reduce operational costs can find savings in sustainability. Facility managers increasingly are turning to sustainability, once viewed primarily as a way to help the environment, as a strategic way to provide value to their organizations.

“In today’s health care climate, it is critical for our profession to provide value back to hospitals through greater efficiencies,” says American Society for Healthcare Engineering (ASHE) President Philip C. Stephens, CHFM, FASHE. “Our organizations are relying on us to help free up resources to support patient care.”

Hospitals pursuing sustainability are seeing the payoffs. Memorial Hermann health system saved $47 million over five years by becoming more energy-efficient. The University of Arkansas for Medical Sciences (UAMS) saved enough money through commissioning efforts that it was able to create 60 new beds, remodel five operating suites, build out a floor of a cancer institute and buy seven acres of land. Even hospitals that choose to make more minor changes can reap the benefits of sustainability.

Sustainability is a broad topic, but one simple definition is the ability of a system to continue doing what it’s doing over time. Many organizations are focused on “green” initiatives aimed at creating a more environmentally friendly hospital. But to be continued over time — to be truly sustainable — initiatives must be fiscally sound while also helping the community and the environment.

In addition to being financially viable, initiatives for health care facilities also must be proven to work in the complex hospital environment. Hospitals operate around the clock, house vulnerable patients and are heavily regulated. They also contain energy-intensive areas, such as food service, laundry and sterilization. Sustainability solutions that work in other types of buildings may not translate well to health care.

So how can hospitals find initiatives that work in the health care environment and also are financially viable? ASHE has created several resources to help facility professionals and others navigate the path toward sustainability.

Getting started

The first step in creating change is making a commitment. Getting hospital executives to support sustainability is easier when facility professionals can show value. One resource that explains the importance of sustainability is a new Hospitals in Pursuit of Excellence (HPOE) guide, “Environmental Sustainability in Hospitals: The Value of Efficiency.” This publication explains to health care leaders the importance of making a commitment to sustainability to reduce operational costs.

Benchmarking is another critical step in becoming more efficient. Benchmarking utility consumption at the beginning of sustainability efforts can help to showcase accomplishments later. Benchmarking may seem like a straightforward step, but sometimes people are reluctant to measure energy performance or see how they rank among their peers.

Michael Hatton, CHFM, SASHE, system executive with Memorial Hermann, observed that utility consumption in terms of units of energy or water should be shared and not be treated as confidential. While hospitals often want to keep the unit costs paid for utilities private, documenting and sharing the quantities of energy used (i.e., million British thermal units, kilowatt-hours and kilo-gallons) can help hospitals home in on areas for improvement. “Benchmarking helps hospitals to focus,” he says.

Several benchmarking tools are available. Portfolio Manager from the Environmental Protection Agency’s Energy Star program is used widely, and it allows hospitals not only to input their utility data, but also to connect with ASHE’s revamped Energy to Care program. Energy to Care, formerly called the Energy Efficiency Commitment (E2C) program, allows hospitals using Portfolio Manager to log in to a free online dashboard to quickly evaluate energy use over time and across facilities. The robust dashboard is a great way for facility managers to visualize trends and to share that information with health care leaders.

The benchmarking process helps hospitals to determine their utility baseline against which they can measure progress.

The right projects

Each hospital needs to determine its own approach to sustainability and the goals it is trying to accomplish. The HPOE guide includes guiding questions that can help executives work through this process. All facilities may want to focus on saving money, while others may focus on improving the patient experience or making facility operations more efficient.

Once the direction is set, facility leaders will identify appropriate projects to help accomplish the hospital’s sustainability goals. There are many sustainability resources available, including the Sustainability Roadmap for Hospitals. This website includes step-by-step instructions on projects proven to work in the unique health care environment. It also includes case studies and talking points that can help facility managers make the case for doing the projects. Some are complex and others require little monetary and time investments.

Hatton suggests starting with a project with a high return on investment (ROI). Completing projects and seeing major value quickly will help to build confidence among executives that sustainability is worth the effort. Hatton also suggests that facilities rank potential tasks and projects by ROI, feasibility and the speed and ease of implementation. This will focus efforts on projects that can go a long way toward reaching facility goals. Demonstrating early success will further the team’s ability to seek financial support from their C-suite to address the next series of tasks or projects; ultimately, these efforts and financial outcomes create momentum to sustain the team’s focus.

The process of commissioning new projects and retrocommissioning existing facilities is another way hospitals can reach sustainability goals. The commissioning process involves examining the complex systems in health care facilities and making sure they function as designed. Commissioning helped UAMS in Little Rock save enough to complete other projects without affecting the bottom line. UAMS continues to improve its efficiency and directs about $400,000 in additional savings to other projects, says Mark Kenneday, CHFM, FASHE, vice chancellor for campus operations at UAMS. “We want to reinvest that money and go after low-hanging fruit in our strategic energy plan,” Kenneday says.

Hospitals that focus on one area of improvement can see results, but creating initiatives across multiple areas can produce even greater efficiencies. The Sustainability Roadmap includes information on energy, water, waste, supply chain and chemicals.

Both Kenneday and Hatton note that improving energy performance at an existing campus does not require large capital expenditures. Both leaders have demonstrated large energy-efficiency and bottom-line financial improvements at their campus locations simply by focusing on tuning, adjusting and balancing existing central plant and HVAC distribution systems, both for older buildings and newer hospitals and buildings.

Hatton further suggests that “simply by focusing a team on a proven ‘Top 10’ list of low- or no-cost energy management tasks and with regular follow-up, it is relatively simple for any health care organization to improve its energy efficiency by 10 to 20 percent in a two-year time period without capital expenditures.” Furthermore, “things such as time-of-day scheduling of HVAC systems, seasonal temperature resets of heating and cooling systems, and closely monitoring building control system point overrides and failures are tasks that largely can be completed with in-house resources at no additional cost to an organization.”

Culture of sustainability

To sustain improvements and continue lowering operational costs, hospitals should foster a culture of sustainability. Culture can start at the top, so getting leadership support is critical.

Hatton suggests creating friendly competitions between buildings to encourage sustainability efforts. “It gets people motivated,” Hatton says. “No one wants to be last and everybody wants to be first.”

The Energy to Care program also taps into the power of competition. Regional challenges through the program allow hospitals to compete with one another to see which facilities can produce the greatest reductions in energy-consumption.

Recognizing and celebrating successes are another way to encourage long-term commitment to sustainability. The Energy to Care program offers several awards to hospitals that have seen energy use decline.

By understanding the strategic importance of environmental sustainability, hospitals can streamline facility operations and reduce operational costs over the long term. Facility professionals can lead the way by showing their organizations the path to sustainability and savings.

“Our organizations rely on us to help free up resources to support patient care,” Stephens says. “I strongly encourage everyone to be part of the movement toward sustainability.” 

is communications manager for the American Society for Healthcare Engineering.

Resources for health care efficiency

The American Society for Healthcare Engineering (ASHE) has developed or helped to coordinate a number of resources to help health facilities professionals tap the benefits of sustainability. They include the following publications, websites and tools.

"Environmental Sustainability in Hospitals: The Value of Efficiency." A publication of Hospitals in Pursuit of Excellence, the American Hospital Association’s strategic platform for accelerating performance improvement in hospitals and health systems, this guide on sustainability urges executives to create a sustainability plan to help save resources and support patient care. The guide includes steps to sustainability, guiding questions, sustainability focus areas, case studies and other resources. It can be accessed at

Energy to Care program. This free program, formerly called the Energy Efficiency Commitment (E2C), can help hospitals to meet their sustainability goals, reduce operational costs and funnel more resources to patient care. It allows participants to benchmark their organizations' energy use data with a new and robust dashboard developed with support from Johnson Controls. The program also allows participants to create energy-saving challenges and provides awards for hospitals that achieve energy savings. It can be accessed at

Sustainability Roadmap for Hospitals. This website features numerous how-to guides for efficiency projects. Whether facilities professionals need to know how to retrocommission their HVAC system, install variable frequency drives on pumps and motors, or research other energy-saving measures, the Sustainability Roadmap can help them to complete projects to improve efficiency. It can be found at

Energy University. This initiative offers free online learning courses for facility professionals. ASHE and its University Program Partner, Schneider Electric, have created three learning paths — one for energy managers, one for facility managers and another for technicians. The courses are a way to hone efficiency skills while earning continuing education units. It can be accessed at

Commissioning publications. Several publications are available on health care commissioning. The Health Facility Commissioning Guidelines explains the commissioning process recommended by ASHE. The process, unlike traditional commissioning processes, is specifically tailored to health care facilities. A companion publication, the Health Facility Commissioning Handbook, is a step-by-step guide to completing projects using the commissioning guidelines. The handbook includes sample commissioning documents. Both books are available at

Commissioning educational programs. ASHE offers a health facility commissioning educational program that helps facility professionals to make the business case for commissioning. The course teaches participants how to develop a business plan that demonstrates the return on investment of commissioning. It also explains how commissioning can be scaled to projects of various sizes. More information can be accessed at