Transforming operational discipline into energy savings

St. Joseph Medical Center’s sustainability goals are part of a larger directive set by Prime Healthcare called the Sustainable Resource Initiative.

Image courtesy of Prime Healthcare

Hospitals are among the most energy-intensive building types in the country. They must operate continuously; support critical care functions; maintain strict temperature and ventilation requirements; and balance energy efficiency with patient safety, clinical reliability and staff comfort. For Prime Healthcare’s St. Joseph Medical Center in Kansas City, Mo., that balance has been the focus of a practical approach to reducing energy use without compromising the hospital’s mission.

The work at St. Joseph Medical Center reflects a broader strategy across Prime Healthcare: energy management as a daily operating discipline, not a one-time project. Since 2015, Prime has developed and implemented a corporate energy strategy, dubbed the Sustainable Resource Initiative, across its national portfolio in partnership with ecom-energy Inc., an energy and sustainability management company headquartered in Orange County, Calif. The strategy is built around a corporate commitment to sustainability, carbon reduction, energy efficiency, renewables and grid independence, and strategic commodity procurement.  

Knowing it can’t manage what it can’t measure, Prime benchmarks all facility data in a single system for increased visibility and tracking. Emissions data for select key regions also are measured following the Greenhouse Gas Protocol. This provides meter level visibility for feasibility evaluations and post-install performance tracking using the International Performance Measurement and Verification Protocol guidance. This structure gives the facilities team a clearer way to connect operational decisions — boiler tuning, scheduling, insulation repair and controls adjustments — to measurable building performance. 

For St. Joseph Medical Center, a 571,600-square-foot hospital, the results have been notable. The facility showed significant long-term improvements, including: 

• 36% usage reduction in Therms
• 13% lower energy costs
• 14% lower natural gas costs
• 11% lower site energy use intensity 
• 22% reduction in greenhouse gas emissions. 

These results did not come from a single, silver-bullet approach. Instead, they were derived from a combination of equipment tuning, operational scheduling, distribution system improvements and a culture of proactive facilities management.

Four key energy-saving focuses 

Heating system. One of the areas of focus was the boiler and heating system. Rather than approaching the boilers as equipment that needed to remain available, the team analyzed how the system was operating, examining air-to-fuel ratios, burner performance, temperature requirements and how much reheat was being created across the building. This approach led to the facility performing boiler burner diagnostics and tuning to improve combustion efficiency, leading to stabilized operations and reduced excess fuel use.

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Where clinical and comfort requirements permitted, the team also reduced hot deck temperatures by approximately 15 to 20 degrees. In a hospital, this type of adjustment requires care, accounting for space conditions, patient care areas or infection control requirements. But when applied thoughtfully, reducing hot deck temperatures can reduce overheating, decrease reheating demand and limit unnecessary natural gas consumption. In practice, this meant the team was not just conserving fuel at the boiler plant; it also was reducing waste across the air distribution system.

Cooling system. The second major improvement areas involved the facility’s central plant and cooling strategies. Historically, both the main hospital and medical building chiller plants operated continuously, 24 hours a day, 365 days a year. The facilities team reassessed that practice and identified opportunities to better align plant operation with weather conditions and building load.

One key change was curtailing the medical building chiller plant during late fall through mid-spring when outdoor temperatures remained below approximately 45 F. The team also leveraged outside air strategies at air-handling units during favorable weather conditions to reduce the need for mechanical cooling. These measures helped reduce plant runtime, minimize system overlap and avoid unnecessary energy use tied to simultaneous heating and cooling.

That type of operational change can be especially valuable in hospitals because central plants often run conservatively to protect reliability. A “leave it running” approach may feel safer, but over time it can normalize unnecessary energy consumption. St. Joseph Medical Center demonstrated that reliability and efficiency can work together when facilities teams actively evaluate operating conditions and adjust systems based on real-time needs.

Distribution system. A third area of focus was distribution system efficiency. The team repaired and replaced deteriorated piping insulation throughout mechanical rooms and distribution systems, prioritizing exposed hot water, steam and heating loop piping. These repairs reduced heat loss, supported more stable space temperatures and created ongoing natural gas savings.

While insulation repairs may not carry the same visibility as a major equipment replacement, they are among the simplest efficiency measures available. In many facilities, insulation becomes damaged, is removed during repairs or degrades over time, allowing heat loss to become a source of waste. Repairing that insulation improves system efficiency every hour the system operates.

Team culture. The fourth and perhaps most important part of the story is the shift in team mentality. The facilities staff placed greater emphasis on visual observation and operational cues: overheated spaces, unusual equipment runtimes, failing insulation, control drift and other indicators that systems were no longer performing as intended. Instead of waiting for a complaint or failure, staff were proactive in identifying early inefficiencies, escalating concerns and correcting issues before they became operating issues.

That cultural shift is central to sustaining energy performance. Many hospitals complete efficiency work but gradually lose savings as schedules drift, setpoints change, sensors fall out of calibration or temporary overrides become permanent. St. Joseph Medical Center’s approach recognizes that energy management is not finished when a project is installed. It must be maintained through consistent monitoring, operator engagement and accountability.

Aligned with the sustainability mission

This also is where the facility’s work aligns with Prime’s broader Sustainable Resource Initiative. The strategy emphasizes reducing energy consumption, increasing efficiency, improving operations and lowering costs while increasing renewables and promoting corporate social responsibility. Across the portfolio, Prime has implemented and identified energy-reduction projects involving lighting; heating, ventilating and air-conditioning; central plant upgrades; building controls; and other energy- and water-efficiency measures. These efforts have avoided approximately 44,112 metric tons of carbon dioxide emissions annually. 

The St. Joseph Medical Center story is useful because it shows the value of looking beyond capital projects alone. Lighting upgrades, controls modernization and major plant improvements are important, and Prime continues to evaluate and implement these types of projects. But operational optimization remains one of the most accessible ways for hospitals to begin saving energy. 

For healthcare facilities leaders, the lesson is clear: Strong performance begins with visibility. Benchmarking provides insights and identifies areas for improvement. Operational review helps explain why performance changes. Staff engagement turns observations into action. And measurement and verification help confirm whether savings are being sustained.

The work at St. Joseph Medical Center also underscores the importance of aligning local knowledge with system-level support. Facilities staff understand how the hospital operates day to day, so a systemwide energy management framework gives that local knowledge a place to translate into measurable outcomes, portfolio learning and strategic investment.

In that way, St. Joseph Medical Center is not just an example of natural gas conservation. It is an example of practical energy stewardship in a complex healthcare environment. The facility improved performance through a combination of technical measures and disciplined operations. 

Asking the right questions 

For other hospitals looking for a starting point, the message is encouraging. Energy savings do not always require waiting for major capital dollars. They can begin with asking basic but powerful questions: Are systems running when they do not need to? Are setpoints aligned with clinical and comfort requirements? Is insulation intact? Are boilers tuned? Are staff empowered to report unusual conditions? Are benchmarking results reviewed and used to guide action?

At St. Joseph Medical Center, those questions helped uncover opportunities that reduced fuel use, lowered costs and supported emissions reduction. For Prime, the facility’s progress reflects the broader value of a consistent, data-driven sustainability program. And for the wider healthcare facilities community, it offers a practical reminder: Meaningful energy efficiency is often built one operational decision at a time.

Carlos Lopez II, CEP, CSDP, BEP, REP, is managing principal at ecom-energy, Inc.; Mia Darden is manager of energy and utilities benchmarking at ecom-energy, Inc.; Yasmeen Qursha-Fessy, MSM, CAP, is manager of energy and sustainability at ecom-energy, Inc.; Jennifer Francis is senior associate of energy and sustainability at ecom-energy, Inc.; and Rakesh Seth is vice president of facilities operations and construction at Prime Healthcare.