Hospitals are facing increasing pressure to cut operational expenses, and facility professionals are often charged with finding ways to improve the bottom line. One key way that facility professionals can provide value to their organizations — while demonstrating their own value — is through the commissioning process.

The commissioning process for buildings ensures that a facility operates as it is designed to operate. The commissioning process helps organizations to achieve results when building a new facility or making changes to an existing facility.

Commissioning can be done during new construction, and existing facilities can be retrocommissioned. It’s important to note that all commissioning processes are not equal. In 2010, ASHE published the Health Facility Commissioning Guidelines — the first commissioning guidelines specifically tailored to health care facilities. In 2012, ASHE published a companion book called the Health Facility Commissioning Handbook. This step-by-step guide provides information on implementing the ASHE commissioning process.

A recent ASHE publication called Commissioning Insider was sent to all members. It explains the ASHE commissioning process and also provides snapshot examples of hospitals that have saved through commissioning.

• Saint Thomas Midtown Hospital in Nashville, Tenn., conducted a retrocommissioning project that examined all major systems, occupied/unoccupied controls in operating rooms, programming, and the building automation systems (BAS). The majority of the project was completed without the need for capital funding, and immediate cost savings were reinvested into new commissioning projects. From 2008 to 2012, the facility’s Energy Star rating increased from 13 to 72. Annual energy cost savings exceed $1.8 million, and cumulative program savings are more than $7 million.

• Texas Children’s Hospital in Houston conducted an energy audit and retrocommissioning project. The commissioning agent wrote the facility’s strategic energy plan and developed standards for HVAC designs and BAS graphics. Actual energy cost savings exceed $1.6 million annually.

Commissioning Insider includes additional case studies, articles and a handy matrix that shows the recommended scope of work for various types of commissioning projects, large and small.

Commissioning Insider is available on the ASHE website at The ASHE guidelines and handbook are available at ASHE also offers an educational course on commissioning and more information about that program is available at

Deanna Martin is the communications manager for ASHE.


Important monographs available from ASHE

Following are two recently released monographs that can be accessed by ASHE members as free PDFs at

Life Safety Code Comparison. The 2012 edition of the National Fire Protection Association’s Life Safety Code offers new design and compliance options for health care facilities that didn’t exist in previous editions. It provides an exhaustive list of the changes in the new edition and a detailed comparison with the 2000 and 2009 editions.

• Managing Hospital Emergency Power Systems: Testing, Operation, Maintenance, Vulnerability Mitigation, and Power Failure Planning. Hospitals must take a holistic approach to emergency power systems, blending utility management with emergency management and infrastructure master planning. This monograph describes a complete EP system management program intended to satisfy these needs.

Design guidelines available to industry through ASHE

The 2014 editions of the Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities and the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities can be purchased at