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Hospitals discover energy efficiency good for ailing budgets
Hospitals face so many challenges—Medicare reimbursements, staff shortages, treating the uninsured, replacing aging equipment—that energy efficiency may not be a top priority. Rising energy costs are beginning to change that, however. In a 2005 Health Facilities Management magazine survey, 90 percent of the responding hospitals reported that their energy bills increased over the previous year. For 15 percent of the respondents, that increase was 25 percent or higher. As budgetary pressures mount, hospital administrators are discovering that energy efficiency offers a cost savings opportunity they cannot ignore. According to the Environmental Protection Agency's Energy Star program, every dollar a nonprofit healthcare organization saves on energy is equivalent to generating $20 in new revenues for hospitals or $10 for medical offices. Those figures may partly have inspired the American Society for Healthcare Engineering's Energy Efficiency Commitment initiative to educate members about the environmental and economic benefits of improving energy efficiency in healthcare facilities. ASHE joined the Energy Star Challenge this summer to help their members improve energy efficiency in hospitals by 10 percent. Montana's first Energy Star hospital More than 1,100 hospitals—30 percent of the acute care market—have received energy performance ratings from Energy Star. Burke Helmer, deputy director of the Indian Health Service Billings Area Office, made a decision to benchmark his region's facilities when he joined IHS. "We wanted to get an idea of where we were and where we wanted to go with energy use," he recalled. A few things jumped out of the benchmarking process, Helmer said. "The older Blackfeet Hospital was more efficient than some newer buildings. We wanted to recognize that in a formal way, so that led to the Energy Star rating." To gain that rating, the hospital underwent several upgrades, including the commissioning of its HVAC system in December 2001. Like many hospitals, the Blackfeet Hospital was built in phases with the first building completed in 1937. Additions followed in 1960, 1986 and 2001. That kind of expansion typically leads to mix-and-match mechanical systems that haven't been commissioned, separately or together, said Western Energy Services Specialist Ron Horstman. "Commissioning is critical to make sure a system works the way it is supposed to." Horstman participated in an energy efficiency upgrade at Sioux Center [Iowa] Community Hospital and Health Center in the early '90s. Other improvements that helped the hospital achieve its rating included Johnson automated building controls, T-8 lamps with electronic ballasts, upgraded roof insulation, fans with variable frequency drives and high-efficiency chillers. "All just good engineering decisions," said Helmer. Issues unique to healthcare "The standard used to require a complete air exchange 12 times an hour," confirmed IHS Facilities Engineer Rob Smith. "Now it's 18 times. The standards keep getting more rigorous." Smith, the supervisory facility manager for the Blackfeet Hospital maintenance team, noted, "In isolation wards and surgeries, temperature, humidity and lighting requirements are pretty set." Business areas offer more flexibility to make the most efficiency gains, he continued. Administrative staff can more easily adapt to a small thermostat adjustment. They can also contribute to conservation efforts by turning off lights and office equipment that is not being used. Patient care equipment is another story, said Energy Star National Healthcare Manager Clark Reed. Most of the engineering probably goes into performance rather than efficiency, but nobody really knows at this point. That may change soon, with a study Energy Star plans to evaluate and possibly rate hospital equipment. "We're working in partnership with professional associations like ASHRAE to see if certain types of medical equipment could meet efficiency criteria set by the EPA," said Reed. People make the difference It's not just the equipment, Smith emphasized, it's the maintenance. "A lot can be done to keep older equipment working efficiently," he asserted. Not surprising from the facilities engineer who developed the comprehensive maintenance program that helped Blackfeet Hospital earn its Energy Star, but results bear him out. Helmer pointed out that one critical difference between the Blackfeet Hospital and the other regional IHS facilities was the highly experienced team. "They were well versed in the control system," he said. "At the other buildings, the maintenance crews weren't as familiar with the systems' capabilities. They just fixed them when they weren't working." A rigorous cleaning schedule is also part of the hospital's success. "We tear down our boilers and descale them annually, and we regularly clean coils, heat exchangers and equipment cabinets," said Smith. "You have to remember that buildings don't run themselves." Horstman recommends commissioning building systems every other year. "It helps with the continuity of maintenance techniques, since hospitals often have high staff turnover," he said. Echoing facilities managers in every industry, Smith pointed out the importance of educating all employees about wise energy use and how they can help the company control those costs. Training is another area that can improve a facility's energy performance no matter how old the building is. A well-trained maintenance staff is one of the most effective tools for controlling energy costs, declared Smith. "Invest money in your people and they will save you money down the road," he said. 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