Beyond Energy Efficiency: Transforming Hospitals Through An Integrated Approach

By embracing energy-efficient practices, hospitals can enhance patient experiences and improve employee well-being, all while contributing to a healthier planet.

By Robert Fleming, AIA, LEED AP, NOMA

As a facility executive, it is essential to manage a multitude of responsibilities every day. Among them are two critical tasks: increasing energy efficiency and advocating for sustainability. Balancing these objectives while keeping operational costs down and having other long-term strategies in mind can be challenging, often made increasingly complicated due to specific needs and uses of particular space typologies. We see this prominently displayed in the management and maintenance of healthcare facilities. This is why it is essential to include energy efficiency and sustainability as part of an overall holistic approach to facility management.

Energy Efficiency, Hospitals, healthcare facilities
(Photo: Adobe Stock / wladimir1804)

Despite the undeniable importance of energy efficiency, especially given healthcare facilities’ unique needs, it is often treated separately from other key considerations like patient experience and employee well-being.

Healthcare facilities consume a significant amount of energy due to their round-the-clock operations, energy-intensive equipment, and intense lighting demands. This is a direct result of their vital mission of saving lives and healing patients. Despite the undeniable importance of energy efficiency, especially given these facilities’ unique needs, it is often treated separately from other key considerations like patient experience and employee well-being.

Given that energy costs can account for up to twice the initial investment in a building over its lifespan, it is crucial to recognize energy efficiency’s impact on long-term financial sustainability. With significant rising energy costs along with growing employee salaries and benefits, the need for an integrative approach becomes glaring.

Creating a Framework: The Pyramid Approach

Energy Efficiency, Hospitals, healthcare facilities
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Many decision-makers are interested in making their facilities more sustainable, but it can be challenging to know where to start. Energy efficiency strategies all come with an initial cost. To navigate the complexities of energy efficiency in hospitals, a framework should be created and referenced to provide clarity and guide decision-making. This pyramid model offers an intuitive hierarchy of steps, with each level building upon the previous one for maximum effectiveness:

  • Level 1: Education: Hospital facilities’ teams face time constraints that hinder their access to professional development and continuing educational opportunities. Providing access to energy and sustainability education empowers these teams to make informed decisions, creating departmental buy-in and driving energy-saving initiatives. Collaborating with design and planning firms that offer educational sessions on both energy and sustainability provides facility managers and their staff with a stepping stone on the path towards energy efficiency.
  • Level 2: Strategic Planning: Climate action plans in hospitals often rely heavily on carbon offsets, which can be overly ambitious and may not deliver the desired results. Taking a human-centered, inclusive approach during the early stages allows for the creation of a larger holistic strategy with complete team involvement utilizing design charrettes, collaborative goal setting, and planning sessions. This ensures that sustainability initiatives are not just pursued as one-off tactics, or seen as individual projects, but integrate naturally into the considerations of teams and leadership at the facility itself. Employee participation in design decision-making can help to foster a greater sense of agency and buy-in, leading to greater worker happiness and less burnout.
  • Level 3: Passive Systems Design: Worker comfort and energy efficiency are heightened by examining a number of passive strategies, including the building envelope, and emphasizing the importance of well-insulated walls and (more importantly) roofs. Implementing courtyards with native plantings and thoughtful incorporation of daylight must be balanced with energy trade-offs, such as heat loss, glare, and heat gain, which become critical in determining overall facility efficiency. Considering the embodied energy of a design project as it relates to material choices and subsequent function further enhances sustainability efforts.
  • Level 4: Active Systems and Equipment: Once all passive strategies have been maximized, implementing energy-efficient systems and equipment is crucial to optimize energy consumption in hospitals. This large step involves upgrading facilities to high-efficiency HVAC systems, while adding technology like enhanced lighting controls and smart building technologies. These in tandem can significantly reduce energy demand and operational costs, but require increased buy-in and funding to come to fruition. Having the design team work with mechanical engineering partners and the facility operations team early in the process helps create the most buy-in for systems contemplating an active approach.
  • Level 5: Renewable Energy: The top of the pyramid is worth considering once internal energy and efficiency has been sufficiently addressed. Harnessing renewable energy, such as solar or wind power, offers long-term benefits to hospitals as the price of conventional methods continues to rise. Investing in on-site renewable energy generation helps reduce reliance on coal, oil and gas fueled power sources while contributing to a more sustainable and resilient future.

Next Steps And Other Key Considerations

When transitioning a hospital or medical center to an energy efficient space, it’s important to start with education about the basics. The second level, dedicated to strategic planning efforts, remains the most important—not only as the first in a series of concrete steps, but also as the phase in which informs the planning for all the other levels. Levels three through five require more intense, concrete changes that require significant leadership buy-in and financial backing. As a result, it’s important to allocate teams and leadership ample time to incorporate and internalize broader operational changes that could affect the way they work day-to-day.

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It is essential to plan around the core operation of the hospital itself when executing any sustainability plan. Dedicated foremost to the care and service of the surrounding area, all steps towards energy efficiency must be made and contextualized in the broader scope of the hospital’s services to its community. This means that facility planners, designers, and other collaborators must use caution as it relates to closing or renovating specific points so as not to disrupt vital hospital functions. At FCA, this involves the careful phasing of each step of a potential renovation to ensure disruptions are kept to a minimum.

The relationships between energy efficiency, patient comfort, employee productivity, and the prosperity of a hospital are more interconnected than we often realize. By embracing energy-efficient practices, hospitals can enhance patient experiences and improve employee well-being, all while contributing to a healthier planet. It’s time for major hospital networks and their leaders to embrace sustainable practices and lead the way towards a greener and more efficient healthcare sector.

Robert Fleming, AIA, LEED AP, NOMARobert Fleming, AIA, LEED AP, NOMA is Director of Sustainability at architecture, interior design, and planning firm FCA.


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