Like a thermostat at home, keeping the temperatures too low or too high increases energy bills. For a typical hospital building, that could mean an energy bill running into millions of dollars. According to Targeting 100!, a project launched through the University of Washington that Burpee is involved with, a hospital could spend up to $4 million on energy costs. In absolute terms, it seems like a lot, but that only accounts for two percent of the overall operation costs.

“CEOs of organizations and CFOs look at two percent of the total budget and think, there’s not a lot of value in going after that,” says Alan Eber, the facilities operation manager at Gundersen Health System.

In 2014, the network of healthcare facilities became the first in the country to achieve multiple days of energy independence, meaning its hospitals generated as much energy as they used.

To get there, Eber says, “We didn’t tie it to a financial justification.” He acknowledges, however, that Gundersen saved $1.6 million in the past year from its energy efficiency and renewable energy initiatives.

Like most operational costs, utility bills get passed on to patients at hospitals. “That money has to come from somewhere, and the way hospitals get paid is through patients,” Eber says. He sees the savings that Gundersen has made as a part of the organization’s mission to serve its patients.

As for typical energy-intensive hospitals, Pless says, the cost of those bills ends up being the cost of doing business. “Instead of paying twenty grand to have a baby, you’re paying twenty grand and five hundred dollars,” he says.

The problem of energy-inefficient hospitals doesn’t exist to the same extent in European hospitals. Burpee’s research has shown that Scandinavian hospitals use fractions of the amount of energy that American hospitals do. Swedish hospitals, for example, use a quarter of what a similar American hospital would. Burpee’s study specifically looked at hospitals in the Pacific Northwest, which has a similar climate to that of Northern Europe- meaning that the gap in energy use can’t be chalked up to different climate-related energy needs.

European hospitals have many efficiency design features not found in American hospitals. Some of this seems simple, like windows that open in patient rooms and regulate fresh air while allowing more natural light to enter rooms.

“It’s not that the engineers or architects don’t know what to do, it’s that the pressure has not been to create areally energy efficient hospital,” says Burpee. “It’s not some crazy, silver bullet in the basement. There are things we can do that are just not the practices that we have in place today.”
 

In 2012, Pless led the development of the Advanced Energy Design Guide for Large Hospitals, which outlines various energy-saving solutions. The suggestions in the design guide could help cut energy demand in half. The guide cover topics such as heating, cooling, lighting (both natural and electric), window design and building shape and orientation. They are currently best practices in the industry, but they’re not officially part of building codes.

“A code is legally the worst building you can build without going to jail,” Pless explains. “These strategies can pave the way for code development,” he says, but it takes several years for suggestions to make their way into official building codes. The guide is focused on achieving significant energy consumption reduction, but David Moore, the communications director for Architecture 2030, a non-profit that promotes energy-efficient, sustainable urban design, says that there’s potential to go further.

“The technical challenges have been solved - we know how to build net-zero buildings, and the technology is available to support us in that,” Moore wrote in an email. “If the entire grid were carbon neutral, then all building operations that ran on electricity would be carbon neutral,” he explained.

Fossil fuels still drive most of the electricity generation in the U.S., so Moore emphasizes that building more efficient buildings is a key part of meeting greenhouse gas emission targets laid out in the UN Paris Climate Agreement. Most of the solutions the organization promotes are feasible with existing technology, but an “education gap” might be a reason why design and technical strategies aren’t being implemented in new construction or renovations of older buildings.

David Eldridge, the energy subcommittee chair of the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ Technical Committee for Health Care Facilities, points out that funding is an obstacle to significantly changing the energy and electricity consumption of new hospital buildings. “Buildings get budgeted based on the way things were built before, so even if you have a plan to build a Targeting 100! hospital, that funding has to be requested from somebody,” he says.

As for renovating older hospitals with inefficient systems, there’s also the problem of staying operational while retrofits are being made to the building. “They can’t take the ER out of service to make a retrofit, so it might have to stay in service until there’s some suitable opportunity,” he points out. “If you’re a local or regional hospital, you might not have the opportunity.”

On the other hand, energy efficiency isn’t always a priority, according to Burpee. “Efficiency is probably the exception and not the norm,” she says. Pless points to the fact that the healthcare industry is also “notoriously risk-averse," which slows the pace of adopting new strategies.

“You have to have a huge reason to change how you’ve done things that have worked in the past,” he says of the owners and managers of hospital and healthcare groups. “The biggest challenge is to convince the industry that the strategies work and are feasible, and don’t impact healthcare delivery.”

For Gundersen Health System, the shift started in 2008. Through a combination of solar panels, wood-based biomass

Burpee’s research provides concrete examples of successful strategies that hospitals have employed in different countries. “The solutions that work there can work here,” she says. “The healthcare market is a hard one to change, and it takes time.”
fuels and landfill gas recapture, the hospital system is reducing its dependency on nonrenewable energy sources. However, alternatives such as biomass, can still contribute towards emissions and Gundersen does not advertise its facilities as a carbon neutral.

Yet, the network is still leading the field in terms of reducing energy consumption. All the researchers interviewed for this story immediately brought up Gundersen when they were asked about progress being made in the healthcare industry.

“When we burn fossil fuels as much as hospitals do, which is about two and a half times the rate of a typical office building, that’s not living our mission,” says Eber. He points to the negative environmental impacts of fossil fuel combustion which can translate into direct health consequences, such as asthma and other respiratory problems. Gundersen Health’s management decided to set specific targets for energy reduction, as well as time tables to achieve those reductions.

“People talk about efficiency and they’ll say, ‘Build me an efficient building’ and they’ll leave it at that,” Eber says. “Then what happens, they’ll get some daylight harvesting or some little features that are supposed to be energy efficient but at the end of the day, they weren’t given a real target to shoot for.”