A boiler room containing natural gas-fired hot water boilers (left) and combined heat and power generators (right) on a roof at Memorial Sloan Kettering Cancer Center’s New York City campus.

Image courtesy of World Energy Innovations, which owns the original

Health care facilities consume the second most energy of all other building categories in the United States and, as a result, are among the biggest sources of carbon and greenhouse gas (GHG) emissions, which can have potentially catastrophic consequences for the health of local communities, the planet and all its inhabitants.

New York City’s Memorial Sloan Kettering Cancer Center (MSK), the world’s oldest and largest private cancer center (having devoted more than 130 years to exceptional patient care, innovative research and outstanding educational programs), has faced the challenges to decarbonize its facilities and operations head on.

As a result, it has reduced the carbon footprint of its owned and leased spaces by 58% per square foot since 2007 as part of the NYC Carbon Challenge for universities and hospitals program.

Valuable insights

MSK’s experiences, the challenges faced along the way, the solutions settled upon and the results thus far can provide valuable insights to similar institutions as they face their own decarbonization challenges.

Two factors that proved crucial to the ongoing success of MSK’s initiative were fostering a relationship between the hospital and vendors in projects that venture into uncharted territory, and the way that the project team addressed funding issues, including an offer by energy solutions partner World Energy Innovations (WEI), Fremont, Ohio, to guarantee the entire project.

These challenges can appear daunting for health care institutions that are ready to explore or embark on their own sustainability and decarbonization journey. However, there are some excellent resources that map out the steps, including the American Society for Health Care Engineering’s (ASHE’s) Sustainability Roadmap for Health Care, which not only outlines the main path but also provides links to numerous other resources to help kickstart the process.

The rewards are multifold. In the words of Chad Beebe, AIA, CHFM, CFPS, CBO, FASHE, deputy executive director at ASHE, “There are large health care systems seeing huge benefits, not only in the bottom line, but also in attracting staff and talent, by embracing decarbonization.”

Decarbonization without disruption. Health care facilities, especially juggernauts like MSK, face distinct operational and energy imperatives. Above all, they must guarantee uninterrupted, reliable care for their often critically ill patients, which makes any infrastructure upgrade or change much more challenging than in other built environments.

Underscoring and amplifying the imperative is that patient care is non-negotiable: catastrophic weather events (e.g., Hurricane Sandy), major pandemics and terrorist attacks have all happened already in this century in New York City. Predicting the unpredictable is part of the equation, and the maintenance of rock-solid reliable and sustainable operations is of paramount importance, eclipsing even decarbonization as the number one imperative. However, the two frequently go hand in hand.

While new facilities can be designed from the ground up to implement and optimize the latest-generation sustainable technologies and techniques, older institutions like MSK have for many decades been reliant on traditional, fossil fuel-based energy sources, and their technical infrastructure reflects this. Underscoring the imperative to make significant changes is a shift in awareness of climate issues and evolving cultural attitudes that are frequently reflected in new, more stringent regulatory regimes.

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New York City’s local laws, which require large buildings in the city to perform energy audits and retrofits to reduce energy use, provided a strong starting point to guide MSK’s efforts. The project team took the “starting point” aspect of New York City’s requirements seriously and used them as the basis to chart a road map for energy and efficiency projects in the future that exceed the current guidelines.

“Voluntarily addressing decarbonization is crucial to help avoid potentially more extreme regulations,” Beebe says.

One of the first areas of opportunity that MSK identified was the potential to switch from local utility Con Edison’s steam to more efficient and controllable heat sources in a “Super campus steam to hot water” project. The Con Edison infrastructure is old (some of it over 100 years old), with periodic steam line and transformer issues impacting reliability. In some cases, the only realistic option was to augment existing services or even become completely independent of external services in case of a loss. Another major area of opportunity the team is exploring but has not acted upon thus far is the potential of using heat pump chillers. All of this is to be implemented smoothly, without disrupting operations.

Finally, cost and financing were a huge consideration; the challenges being faced carried hefty price tags, in the vicinity of $100 million. This was the biggest single energy project from an expenditure perspective that MSK had ever contemplated. To hospital administrators, the primary drivers were, of course, reliability and resiliency, but dollars are a reality, and they factored heavily as well. 

As a result, climate was hardly mentioned as an explicit consideration, although, of course, it was already baked into the city’s laws.

Questioning assumptions and innovating. MSK partnered with WEI early in the process and, over a period of a few years, the two organizations formed a strong integrated team. A key characteristic of this team was a single-minded, relentless commitment to full empirical analysis and understanding of existing infrastructure and needs.

The team created an exhaustively detailed thermal model that examined all assumptions and validated them through deep scrutiny and relentless questioning — the team insisted on nth-level detail in order to arrive at the most thorough analysis possible.

The integrated team was responsible for implementation as well as requiring participants to buy in and own the responsibility — there was little to no hand-off or outsourcing to third parties — even to the level of being willing to provide performance guarantees. At MSK, with thousands of individual rooms and environments, the energy audit had to be comprehensive enough to generate a granular set of requirements without disrupting operations.

The New York City skyline viewed from a Memorial Sloan Kettering building illustrates the premium placed on street and rooftop space in the urban environment.

Image courtesy of World Energy Innovations, which owns the original

With the audit complete, the team leveraged the valuable insights gleaned and developed a set of recommendations on the best ways to achieve energy reductions, notably by running 90 F water instead of the 160-180 F that had been the norm, by replacing steam with hot water for many functions in which it had long been assumed that steam was required, and by employing dual-fuel services.

Significantly, the “Super campus steam to hot water” project team oversaw the installation and implementation of 21 natural gas-fired hot water boilers and six 550-kilowatt combined heat and power (CHP) reciprocating engines designed with black-start capability to provide cooling in the event of a power outage.

Emissions calculations and analysis were the primary focus of work for many months, and it took multiple iterations of design changes to ultimately arrive at an approved system. Environmental Protection Agency and New York City regulations and guidelines were an important factor and presented some formidable hurdles, which the team worked to overcome in collaboration with the New York City Department of Environmental Protection and the New York State Department of Environmental Conservation.

During the time frame of the project, natural gas-fired hot water boilers and CHP were considered the most environmentally sound options. Because the steam load was converted to the lowest temperature hot water possible, gas boiler efficiency was optimized, setting up MSK to potentially make a transition from boilers to even more efficient, non-fossil-fuel-based, low-temperature heat pumps in the future.

The physical implementation of this new energy infrastructure presented huge challenges, which were tackled with great ingenuity and, sometimes, combined with enticing incentives to potentially recalcitrant stakeholders. For example, in exchange for taking crucial rooms out of service briefly for energy upgrades, those rooms would get full makeovers, including repainting and relighting, as part of the project budget. Idle roofs and unused shaft spaces also were pressed into service. In fact, the interior of an abandoned incinerator shaft in the hospital tower was demolished and repurposed for new hot water piping.

A key to cracking the various puzzles that confronted the project team was a spirit of play and experimentation. A small building became a dedicated “playhouse” to pilot various approaches and verify that they worked — anything that didn’t defy the laws of physics was fair game for consideration.

The results are visible throughout the implementation. The David H. Koch Center for Cancer Care building, for example, was designed with resiliency measures like floodgates and microturbines that use natural gas for heat and electricity. These features help to ensure the continuity of services during power outages or other adverse conditions.

Another area with potential that came into focus as the project got underway was LED lighting, the key insight being that LEDs use direct current (DC). This means that they’re amenable to receiving power directly from sources like solar panels. In fact, although initially MSK’s sole focus was on steam and energy cogeneration, it quickly became apparent that another channel for savings, efficiency and huge improvements in reliability was in reworking MSK’s entire lighting operation.

Although solar isn’t really feasible given the scarcity and value of real estate — even rooftop real estate — in New York City, the huge efficiencies afforded by LEDs made it worthwhile to pursue as an enterprisewide option for MSK. The team deployed a customized solution throughout MSK, consisting of LED modules that are fed DC power by robust panels that deploy a DC infrastructure.

The project called for installation of high-efficiency condensing boilers (top) and more than 30,000 feet of new hot water piping (bottom).

Images courtesy of World Energy Innovations, which owns the originals.

These autonomous units, which are highly adaptable and customizable per environment, carry the added advantage of not requiring electrical conduits to transport their power (they are low voltage). And, importantly, the fact that they reduce electrical consumption by approximately 60% means that all of that now freed-up electrical capacity can be pointed at other crucial functions within the hospital environment, like magnetic resonance imaging equipment and other high-energy technology that is vital to front-line patient care.

The dedicated project team also worked closely with third-party vendors to optimize systems for MSK. For example, one of the building management system vendors opened the code on one of its platforms so that the team could weigh in and bring that code up to speed with a new heating coil.

Finally, a key to the project’s success was engagement, training and buy-in by MSK’s staff. MSK placed a strong emphasis on inclusion, recognizing that an ignited workforce could only contribute positively to the initiative, especially considering the disruptions to their daily routines that it sometimes entailed.

A collateral effect was the increased attractiveness of MSK as a place to work, especially as younger, more climate-concerned workers enter the marketplace.

Savings, decarbonization and resiliency. MSK’s bold efforts have yielded impressive results. Heating energy (steam purchased versus natural gas purchased) across the MSK super campus has declined by over 86,000 metric million British thermal units, resulting in a 23% reduction in heating energy usage from 2020-2022, saving $7.9 million in utility costs. GHG emissions alone have been reduced by 34%. Additionally, chilled water generation has plunged by 20% during the same period, thanks to the abandoning of miles of hot steam piping throughout the facilities. These numbers do not yet include CHP.

MSK has demonstrated that investing in infrastructure upgrades and innovative technologies can significantly impact both its environmental and financial performance while enhancing the resiliency and reliability of its facilities. This results, of course, in an enhanced ability to live up to its vision, “To be the world’s leading authority on cancer,” and its mission, “Ending cancer for life.”

Aiming high and collaborating 

By questioning assumptions, embracing innovation, forging strong partnerships and engaging and igniting its employees’ enthusiasm, MSK has achieved significant carbon reductions and enhanced the resiliency and island-mode imperatives that its facilities have to meet.

Key takeaways from MSK’s “Super campus steam to hot water” experience include the importance of setting ambitious goals, being open to new technologies and approaches, and fostering a culture of innovation and employee engagement. 

Additionally, strong communication and coordination between all project stakeholders and the willingness to inspect and pivot for changing circumstances, are essential.

Developing the ideal project team

Memorial Sloan Kettering Cancer Center (MSK), New York City, identified World Energy Innovations (WEI), Fremont, Ohio, to be its key technology and energy partner early in the project and, over time, a highly collaborative team with a mind-melded approach emerged.

The unified team shared the enthusiasm to think outside the box, try new ideas even when its members recognized the risk of failure, and engage in open and transparent communication even when that was sometimes uncomfortable. Untried and untested potential solutions were tested in a “playhouse,” allowing for the identification of novel approaches that, in some cases, were integrated into the project.

The team identified a few key elements as being pivotal to and decisive in its success. On MSK’s part, a deep familiarity with, appreciation for and adeptness in engineering principles enabled the team to better understand and execute the technical aspects of the project and, most importantly, emboldened it to dream big and articulate audacious goals. On WEI’s part, the technology partner dove deep in its analysis of MSK’s systems, motivations, culture and pain points, with particular sensitivity to the overriding concerns around patient well-being and the maintenance of seamless operations even during the most potentially disruptive phases of the project.

And rounding out the team, the involvement of city and state agencies was a crucial factor in the ultimate success of the initiative. By treating them as sometimes challenging but nevertheless integral elements of the team instead of as antagonists, a level of acceptance and endorsement was attained, even perhaps setting standards for future initiatives by other institutions. 

Exploring project financing guarantees

A $100 million project is a major undertaking, and financing considerations loom large. Memorial Sloan Kettering Cancer Center (MSK), New York City, explored different financing models for this initiative, including power purchase agreements, cost-shared savings and direct financing.

One of the more innovative and intriguing models considered involved guarantees offered by World Energy Innovations (WEI), the Fremont, Ohio-based technology partner. It committed to specific levels of energy savings over a multiyear schedule — essentially promising that if specified energy savings during a particular year were not met, it would make up the shortfall and pay MSK the difference.

Although this was not the model that MSK decided to pursue, the fact that the guarantees were seriously offered and considered bolstered MSK’s overall confidence in the project and informed its decision to go ahead with it. The project team went so far as to say that the willingness of the external partner to provide guarantees was enough to help tip the scales in favor of moving ahead with the project.

While not pursued in this case, such guarantees nevertheless provide a viable model to consider for mitigating risks inherent in large-scale infrastructure projects and encouraging organizations to pursue innovative decarbonization solutions. 

Robert Berninger is director of plant operations, energy and engineering in the facilities management division at Memorial Sloan Kettering Cancer Center in New York City; and Edward Kiser, PE, is director of engineering and concept design at World Energy Innovations (WEI) in Fremont, Ohio. They can be contacted at berningr@mskcc.org and ed.kiser@wei.energy.