Sustainability Checklist For Healthcare Facilities

Pave the way for a sustainable future while supporting patients and staff.

By Merrill Kaney
From the October 2022 Issue

Today’s healthcare industry strives to integrate sustainable practices into operational planning and objectives to protect health and the bottom line, and decarbonization is now a focus. Decarbonization, or the reduction of carbon, is the conversion to an economic system that sustainably reduces and compensates carbon dioxide (CO₂) emissions. Leading healthcare organizations are developing strategic cost reduction programs with good reason; to improve the environment of care for patients, staff, and team members, and the communities they serve. Using less carbon is right in line with this thinking.

healthcare industry
(Photo: Shutterstock)

The U.S. National Academies provide independent, objective advice to inform policy with evidence, spark progress and innovation, and confront challenging issues for the benefit of society. They also represent some of the best scientific thinking in the country. Recently, academies have called on partners, including the American Hospital Association (AHA) and its professional membership group, the American Society for Health Care Engineering (ASHE), to join its efforts to fight climate change. Businesses should be aware there are countless benefits to driving sustainable initiatives and thus be a part of the solution to climate change. By becoming efficiently responsible, gaining a competitive edge, managing performance, experiencing improved economic status, and at the same time, they can positively impact the environments and their communities.

Goals higher up in the tree—such as purchasing energy technologies, securing adequate technical staffing, and developing comprehensive sustainability programs that address the issues from every angle—may take significantly more time. Still pertinent is the guidance healthcare sustainability expert Robin Guenther, FAIA, LEED Fellow, and Senior Healthcare Advisor for Healthcare without Harm, says, “The first step for hospitals is usually reducing energy consumption. Once they have implemented the basic components of energy conservation—the low-hanging fruit—then they are in a position to move to the next level.”¹

  1. Implement basic energy conservation components to continue driving savings from the next lowest hanging fruit.
  2. Revisit BAS (Building Automation Systems) savings to position your organization to move to the next level.

The U.S. healthcare system contributes 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants, and the industry continues to grow. DOE Better Building Healthcare sector partners represent 700 million sq. ft. of space, collectively saving $340 million, as was reported in 2011. In addition, these leading healthcare organizations are developing strategic cost reduction programs to improve the environment of care for patients, employees, and their communities.²

Encourage Sustainable Initiatives

Facility directors need time to analyze their teams and building’s current performance. On many occasions, they struggle to look at the numbers objectively. Instead, they should compare historically via facility run rates. The following four ways will help your facility team maintain and identify opportunities for your hospital. They will support continued sustainable and cost-effective operations:

  1. The individuals on your team will significantly impact the success of your program to improve energy use and build a sustainable future. Essential team member attributes include:
    • All members must understand the objectives and their role in the process.
    • You need a sustainability champion. Who in the organization executively will be this change agent?
    • Do members embrace the vision and commit to the new protocols and procedures?

2. Establish a baseline anew. Review current facility assets and account for new construction, remodeling, and space expansion or contraction changes. Is the new equipment installed operating correctly? How are the sustainable programs presently running compared to specific objectives established? Were staffing and budgets adjusted?

3. Review changes in the square footage plan and goals. Hospital leadership understands that achieving savings goals requires business, organizational, and behavior change. Embracing these important initiatives require strategy planning, new construction and significant renovations, evaluation of existing facility operations and upgrades, procurement practices alignment, financial analysis, and measurement. In reality, the compliance component needs to be considered as well.

When developing the plan and reviewing the status, evaluate the components initially targeted to determine the goals and objectives achieved. This plan needs to be looked at collectively from an operational performance perspective with the environment of care and financial outcome.

A checklist may look like this:


  • Implement efficient surgical task lighting. Is the task lighting meeting the lumens required and achieving savings with a technological approach or application?
  • Re-evaluate temperature and airflow settings, particularly with Infection Control in mind. Is setback during off-hours determined by occupancy, space type, and capability of controls? What technologies are being utilized to ensure high-quality air is going to the spaces?
  • Manage a retro commission review of your HVAC controls and Building Automation Systems.
  • Evaluate HVAC commissioning. Are risk assessments being completed? For example, an air handler is not just an air handler based on space served.
  • Evaluate steam traps for repair or replacement following the PM plan established at inception.
  • Are insulation of hot water system equipment and piping completed?
  • Replace air handling unit AHU filters regularly by PM system’s initial plan.
  • Were variable frequency drives installed on pumps and motors?
  • Was care taken to determine harmonics would not affect equipment, and if so, were reduction technologies applied?


  • Re-establish a baseline for current water consumption. Is a holistic Water Management Plan in place that will best serve the patients and customers?Re-evaluate steam traps for repair or replacement.
  • Re-evaluate hot water system equipment and piping.
  • Review cooling tower efficiency by improving water quality. Be sure to reference your water management plan and treatment for bacterial prevention.
  • Review fixture repairs and replacements to determine if they meet operational and savings goals. Have high usage areas been put on a rounding schedule with an eye toward operational integrity and identification of required repairs/upgrades?
  • Have low-flow flush fixtures been implemented where practical?
  • Evaluate and optimize faucet water flows to determine if efficiency has been achieved.
  • Is there equipment and piping leaks?


  • Review opportunities for waste minimization and form a committee to evaluate end-user participation.
  • Re-conduct a waste audit.
  • Evaluate electronic waste recycling effectiveness.
  • Do you have a facility-wide battery recycling program implemented?
  • Review the facility’s recycling program for effectiveness and efficiency increases.
  • Review construction and demolition recycling pertinent to daily operations and adjust where needed.
  • Reduce regulated medical waste (RMW) generation. Are the right end-users involved?
  • Reduce paper waste with sustainable printing or printing avoidance.
  • Complete analysis of the PM programs. If adequately implemented, PM programs can save hospitals sizable amounts of capital, not only from an operations perspective but also from energy as well. Such programs should apply to all building systems and components. They must be evaluated on an ongoing basis to ensure they are running correctly.

The Next Generation of Healthcare Facility Managers

As many recruiting authorities predict, maintaining healthcare facility managers and technical maintenance trades will likely become more challenging. Organizations with creative and exclusive recruitment strategies are bound to appear more attractive to candidates in the job market. Locating facility managers with acumen toward energy sustainability and decarbonization strategies coupled with a compliance background to meet technical and monetary moving targets is the aim.

As noted by Practice Greenhealth³, research shows inspired millennials want the opportunity to make a difference. It is desirable to feel like they’re working for a place that leaves the world in better shape. So, an investment to attract the top talent helps obtain employee skillsets and retention as hospital campuses establish reputations by incorporating sustainability to improve the facility environment.

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Kaney is a member of ABM’s Healthcare Management and Technical Support teams. He has more than 40 years of experience in plant management operations and engineering.

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