According to the U.S. Department of Energy, healthcare is one of the top five energy-consuming building categories and accounts for nine percent of energy use in commercial buildings. With utility bills making up an average of 1.4 percent of a hospital’s operating revenue, hospitals in the U.S spend about $8.3 billion total on energy costs each year. The impact of these energy costs on an individual hospital is huge. For example, a 200,000 square foot, 50-bed facility spends about $13,600 per bed on energy costs, equaling about $680,000 each year.

Electricity is the major energy cost for all commercial buildings and lighting is the largest single use of electricity. With this amount of money being spent on energy costs in general, and electricity specifically, it’s no surprise that hospital owners and managers target lighting when looking to improve energy efficiency and reduce costs. Healthcare is a unique business model, as the amount providers can charge patients is controlled by government regulations and insurance company reimbursement rates. They cannot simply raise their rates as expenses increase, meaning that rising or unchecked energy costs can threaten the financial health of hospitals or even create a situation where patient care is compromised by budgetary constraints.

In addition to the direct financial savings, improving existing lighting benefits the overall hospital environment – such as improving the mood of patients and creating a more comfortable and safer environment for staff. The money that is directly saved from reduced energy costs is a resource that can be diverted back into the institution for investments in improving patient care or updating other areas of the campus or facilities.

Understanding Hospital Energy Use

In addition to the cost of energy, many healthcare facilities simply do not operate as efficiently as possible because of the different systems in use. Because many hospitals and healthcare campuses are the result of buildings and additions made over the span of many years, quite often systems and resources are outdated and inefficient and not integrated with each other. As some areas are updated, with a new HVAC system or new and more energy-efficient lighting, for example, others remain outdated and use energy inefficiently. Facilities managers then must navigate multiple types of equipment and multiple building management systems to optimize operations.

To overcome this challenge and mitigate the financial risk, hospitals are looking to outside consultants to help them navigate all their options. The initial step for any project designed to increase energy efficiency is an energy audit. This gives the hospital a clear picture of existing systems, how they are used, how they do or don’t work together, and how the always-on nature of the facilities impacts energy use. Once there is a baseline understanding of systems and a picture of energy use, hospitals can then look to solutions like replacing outdated equipment, integrating systems like HVAC, and upgrading the building management and control systems.

While the path forward may be clear after an energy audit and there are great benefits to upgrading energy systems and retrofitting lighting fixtures, making these updates is not a simple fix for hospitals and other healthcare facilities. They present unique challenges to anyone wanting to accomplish a campus- or system-wide update – the buildings are continuously occupied, security of facilities and patient confidentiality is a critical concern, and there are sterilization and cleanliness protocols that must be adhered to.

Challenges Working with Hospital Facilities

It can be difficult for owners and managers to get approval for this kind of project, due to the fear of disrupting operations. Hospitals are a unique environment for anyone, internal staff or outside consultants, to make large-scale system changes or energy efficiency upgrades. In addition, hospitals are bound by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which ensures the privacy and confidentiality of patient information. Any contractors working in a hospital environment, especially in patient areas, must comply with this law. So any energy efficiency updates must be done with the utmost attention to protecting patients and their privacy and without compromising care. There are three major challenges that hospitals face for projects like these:

• 24/7 environment: Because hospitals cannot shut down, any hospital-wide projects must minimize the impact on patients and staff and ensure constant uptime for electricity and all hospital systems.
   
• Health and contamination concerns: Anyone working on hospital-wide projects, especially those that require they work in patient rooms or sensitive areas like operating rooms, must be healthy and workers must take special precautions to protect sensitive spaces.
   
• Non-integrated facilities: Many hospitals are built over time and with multiple buildings and systems that are not integrated, creating a mishmash of fixtures, equipment, management systems, and documentation.

Best Practices for Hospital Energy Upgrades

With the proper attention to details, it is possible for energy efficiency projects, like a lighting retrofit, to be conducted without threatening the power supply or compromising patient care. When energy consultants follow best practices for the industry, they can achieve success.

Scheduling and managing the site.

• To address the issue of around the clock operations, anyone working on an energy efficiency project in a hospital or healthcare facility must create a detailed schedule. This includes working on upgrades only in areas when it will not disrupt daily activities. For example, no one is allowed to do this type of infrastructure work in occupied patient rooms, and any work in unoccupied rooms must be coordinated with the nursing staff and the hospital’s facilities team.
   
• Contractors must schedule time to do the work in operating rooms and other sensitive areas, like laboratories, which will need to be cleaned and sterilized after the work is complete.
   
• In addition to scheduling, managing the worksite is more critical due to cleanliness and infection control requirements in healthcare facilities. This requires being creative about finding staging areas and space to store materials and coordinating with staff to ensure that the materials and work do not compromise patient health and care.

Health and contamination practices.

• Working in hospitals and other healthcare facilities requires protections and practices outside the norm for most energy efficiency projects. To make sure that the project is as safe as possible, energy efficiency contractors must work closely with the facility’s infection control department and follow their recommendations about how to ensure that the workers and materials do not contaminate sensitive areas or put patients at risk. This includes one simple step—ensuring that workers have received their flu shots, so they do no infect patients.
   
• These protections also include extra precautions such as using containment carts to collect dust while working. This can be time-consuming and costly, but it is the only way to ensure that dust from the project does not spread to patient rooms or contaminate other sensitive areas in the facility.

Integrating systems.

At almost every hospital, large-scale projects across the campus will encounter systems, equipment, and fixtures that are dissimilar and not integrated with each other. Any project that touches on these systems is an opportunity to install a more uniform and compatible set of equipment and fixtures, integrate the existing and new systems and develop common controls to increase energy efficiency and make it easier for the facilities team to operate more effectively.

Expert energy efficiency consultants know how to address these unique challenges in healthcare environments. They also know how to choose the project equipment and lighting fixtures for a lighting upgrade job – such as ensuring proper lumen output, controls, and color temperature for each location and type of room – as well as knowing how to identify other opportunities to improve energy efficiency, such as upgrading HVAC systems and cooling and refrigeration equipment.

As non-profit institutions, most hospitals cannot take advantage of tax incentives for energy efficiency projects. However, they are often eligible for rebates or special incentives from their local utility provider or their state or local government. Energy efficiency consultants know how to find these incentives and will work to ensure that healthcare facilities optimize their energy use and costs in every way possible. The results of a well-implemented energy efficiency project are financial savings for institutions, improved and safer building environments, and more comfortable facilities for patients and staff.