Sustainability Tips

Tip #26

4 Ways Digitization Helps Healthcare Facilities Become More Efficient

Warren Rosebraugh, Solution Architects Director, Schneider Electric

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The healthcare infrastructure is also a key candidate for digital transformation. Before the pandemic, there was already a growing industry shift toward holistically managing these disparate systems under a single IoT-enabled umbrella. Now, industry adoption of this centralized “system of systems” will likely accelerate, due to four core benefits:

Benefit #1: Proactive Digital Maintenance for Better Business Continuity

Even during business as usual, unexpected maintenance issues can keep hospital managers stuck putting out fires instead of preventing them. When you’re facing a surge in patients, the last thing you want is downtime, especially when it’s caused by routine issues.

The best way to avoid this situation is to gain the ability to anticipate the future. Software analytics, paired with our engineers, crunch building management system (BMS) and power distribution system data to notify you of issues like leaky valves or failing circuit breakers — before they cause downtime. With newfound visibility and control over your facility’s infrastructure, your team can focus on high-value work and strengthen business continuity.

Another key to proactive maintenance is remote monitoring. Your staff can monitor from home, paying virtual “doctor’s visits” to check on the health of your infrastructure. It’s like telehealth, but for your facility’s infrastructure.

Benefit #2: Boost Patient Satisfaction With More Digital Control

Another key benefit of digitization is that it enhances patient satisfaction. With digital BMSs, you can give patients control over room temperature, lighting, and nurse calls. They can adjust their settings from a tablet or phone, without needing to rely on your staff. That frees up providers to focus on care while empowering your patients to feel more at home.

Benefit #3: Find Previously Invisible Operational Inefficiencies

Many hospitals are striving to reduce costs. Energy use is a sensible target. According to the ENERGY STAR® program, a non-profit hospital saving $1 on energy costs is equivalent to $20 of new revenue — i.e., saving energy has a multiplier effect.

Digitization is a key efficiency enabler. By monitoring your facility’s systems down to the device level, and running that data through cloud analytics, you’ll spot previously invisible inefficiencies like IT hotspots or expiring batteries. These software tools generate recommendations ranked by how much you’ll save, so you and your team can decide where to spend your time.

Benefit #4: Leverage Unique Funding Opportunities to Modernize

As the saying goes, “Necessity is the mother of invention.” In challenging times, it’s worth considering creative funding approaches that drive digitization.

One strategy is to harness energy performance contracting, which provides capital funds to critical access hospitals. These funds can be used for energy efficiency projects such as equipment modernization and digital tools for energy monitoring. The cost savings can partially offset the investment, while you reap the rewards for years to come.

Another strategy is the energy-as-a-service funding model for microgrids. Microgrids are an increasingly popular back-up power solution for hospitals and other critical sites, and they also accelerate renewable energy adoption. With energy-as-a-service, you lease a microgrid for zero upfront cost while leaving installation and maintenance to the experts, allowing you to focus on your core mission. With digital management tools, microgrids have the added benefit of allowing you to keep your energy prices stable.

About the Author

Warren Rosebraugh HeadshotWarren Rosebraugh, Solution Architects Director, Schneider Electric
Warren is a solution Architects Director at Schneider Electric with more than 25 years of experience. Warren’s passion is to design and implement the Integrated Healthcare Facilities Infrastructure while improving financial performance, patient and staff safety, simplifying regulatory practices, and increasing patient satisfaction, as well as staff productivity and retention.

Tip #25

The Best of Both Worlds: Optimizing Energy Spend While Reducing Infection Risk in Healthcare Environments

Robbie Davis, Senior Product Manager, Digital Solutions at Johnson Controls

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As a result of the COVID-19 pandemic, healthcare leaders are tasked with providing the gold standard of sanitary environments and clean air while delivering on their energy savings targets. The emergence of the Delta variant, limited resources, aging systems, deferred maintenance and data overload have challenged hospital operations teams as they strive to achieve competing business goals.

Digital Transformation and Sustainability

Fortunately, sustainability initiatives and digitalization programs go hand-in-hand. Healthcare organizations cannot implement zero-carbon goals for their facilities without discussing the digital technology that is essential to achieving building and operational efficiencies. The intended goals of sustainability and digitalization might differ upfront, but the means and actual outcomes are often the same.

Investing in emerging digital technologies can help provide guidance on day-to-day operational activities. Analytics and simulation solutions can help healthcare facilities operators weigh multiple scenarios to solve for a wide range of outcomes. These tools provide recommendations to operators to quickly decide to improve indoor air quality (IAQ), lower energy use, or find an equilibrium operating point. These solutions can also be packaged with existing building management systems (BMS) with minimal to no hardware upgrades by leveraging a blend of hardware and cloud packages.

Clean Air and Sustainability

Healthcare organizations are also expected to provide clean indoor air, as a key element of a healthy care environment. In order to best understand next steps and industry guidelines for IAQ, leaders should refer to recommendations from the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). Specifically, two of its guidelines, “Ventilation for Acceptable Indoor Air Quality” and “Energy Standard for Buildings Except Low-Rise Residential Buildings,” provide context to the challenges of bolstering IAQ while reducing energy consumption.

These ASHRAE standards set expectations for IAQ, including outdoor air circulation, filtration and disinfection, but stipulate that the processes that generate the healthiest air are often also processes that consume the most energy. ASHRAE also highlights the benefits of IAQ for occupant health, comfort, and productivity, and in some cases even building usability, all of which can have significant economic impacts for building owners and occupants. In tandem, these standards, supported by the U.S. Department of Energy (DOE), help organizations better understand the most effective indoor air treatment processes to minimize energy use. This includes best practices for equipment efficiency levels, shutdown scenarios, reset strategies, and more.

As hospital operations teams build plans to enhance operations to meet ASHRAE Standards, consider these steps:
1.    Determine IAQ and energy efficiency goals
2.    Involve the correct stakeholders
3.    Determine what data to capture
4.    Decide how progress will be measured
5.    Outline and execute an action plan
6.     Assess progress and make changes as needed

To achieve building sustainability and meet energy management standards while creating healthy spaces for occupants, healthcare facilities will rely on cutting-edge technology to generate efficiency insights from real-time data. Integrating sustainability with digitalization will allow organizations to reach both sets of targets faster, while also creating healthier and more comfortable buildings.


About the Author

Robbie Davis HeadshotRobbie Davis, Senior Product Manager, Digital Solutions at Johnson Controls
Robbie Davis is responsible for creating Energy and Sustainability software solutions for Johnson Controls. In his role, primary responsibilities include customer success, prioritizing strategic roadmaps, and empowering the user experience through the OpenBlue Ecosystem. Robbie has more than 8 years of experience in the building industry and in energy management technologies.


Tip #24

The Sustainable Route: How Choosing Motorized over Solenoid Hardware Can ‘LEED’ to a More Sustainable Hospital

Tim Weller

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Door closers here, door frames there. All of the products you put into your health care facility accumulate points toward LEED-certification. But not all products are created equal. As you select healthy, environmentally friendly solutions for your next project, take a closer look at solenoid-driven hardware. 

Why motorized over solenoid?

Motor-driven solutions consume less power and require fewer power supplies when compared to their solenoid counterparts, which can make them more efficient, cost effective and flexible. Ultimately, specifying motorized over solenoid can earn you more LEED points and result in a more sustainable building if the motorized products have the correct optimization documentation.

Solenoid hardware requires high in-rush amperage, whereas motorized hardware lowers the power draw. For example, in exit device latch retraction applications, motorized solutions use as little as 1/16 the amperage as solenoid. Additionally, motorized solutions are quieter than the solenoid-driven alternatives. As you likely know, less noise has been proven to advance healing in medical facilities. 

Another incentive making these solutions more efficient is power supply requirements. With older technology like solenoids, you typically need one power supply to run each door. With a low-power, efficient motorized solution, you can have one smaller, less costly power supply. Or if you have multiple doors with that same solution, you can choose a bigger power supply and gang together multiple doors. Now it’s one power supply per four doors, or even six doors, depending on the application. You can purchase and use less products in the building. 

There’s more flexibility at installation when you eliminate the need for a power supply at each door. You can design a single access control room for everything, making it simple for installers and the end users. There’s the opportunity for longer wire runs and thinner gauge options since the current required to power motorized solutions is lower.

Less power consumption translates to lower costs. Because you’re choosing a smaller, less expensive power supply, acquisition costs are lower. And, as mentioned above, if there are multiple doors with the same solution, you can group them together as opposed to having individual power supplies for each.

Moving away from high-amperage electrified options to less power-hungry motorized solutions saves long-term costs as well. Total cost of ownership declines because there is less ongoing power draw. With solenoid-driven solutions, there’s a need for continuous charge in certain applications, increasing power usage. 

Acquisition costs are lowered, ongoing costs are lowered and the power consumption is lowered. Not only are you saving money but you’re saving power. And of course, using less materials in the project, like electronics, is better for the overall health of the buildings. Ultimately, opting for motor-driven products can positively impact LEED scores so you can hand over a more sustainable building. Allegion solutions can help get you there.

Allegion commits to conducting business in an environmentally responsible manner, and we help you do the same. To learn more about our sustainability efforts, visit Information on Allegion’s EPDs, HPDs, Declare labels and LEED efforts are easy to find. For questions or other sustainability information contact


About the Author

Tim WellerTim Weller, AHC/CDC, FDAI, Manager of Codes, Standards and Sustainability, Allegion
With over forty years of industry experience, Tim has held a wide variety of roles ranging from distribution to sales management to sustainability and industry relations. Tim is currently responsible for the development of the product sustainability strategy and meeting market demands. Tim holds a B.A. in Business from Regis University and has attained his AHC, CDC and FDAI credentials from the Door and Hardware Institute.


Tip #23

How to Overcome Barriers to Transformative Energy Management in Health Care

Jennifer Black, Craig Walter and Ian Larson

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Health care—which must reliably operate 24 hours a day, 365 days a year—has unique operational needs. Energy is a critical, high-use resource that accounts for more than 2% of operating costs. This makes sustainable energy management especially important in this field to reduce costs, improve reliability of facilities, enhance care and meet the greater good of patients and employees.

During a recent ASHE Lunch & Learn focused on energy management strategies, the audience was polled to find out, “Where is your organization with its energy management program?” The responses ranged from, “we haven’t started (24%)” to “we’re leveraging data to build a business case (24%).” While another 24% have a well-integrated program that they are looking to expand even further.

Whether your organization is just starting in the tactical phase of data collection and planning, or already moving toward a more transformative strategy of monetizing on-campus energy systems, we examine practical solutions to overcome three main barriers to transformative energy management.

Barrier: Lack of data or ability to analyze

ENGIE Impact’s energy management experts have found that 52% of health care facilities implement five or more energy efficiency projects per year, and the foundation of this work is cost and consumption data. This can be collected from utility bills, interval meters or on-site energy management systems (EMS). Once you’ve gathered this data, use it! Apply digital energy management tools like advanced analytics or site level data capture to create baselines and reveal anomalies or outliers. Then prioritize the locations and projects that have the greatest potential for reduced energy consumption and costs.

One of the biggest challenges of this work is finding the right mix of time, skill and technology for data collection and analysis. Many organizations are resource constrained in these areas, but benefit from partnerships like those ENGIE Impact has with our clients. From data collection, to analyzation, to prioritization and strategy recommendation, having a holistic partner that is able to solely focus on your resource optimization can elevate your operations to a new level of excellence.

Barrier: Lack of centralized planning and stakeholder buy-in

Implementing change in a complex field like health care must be planned and championed from the executive level. It also requires engagement and action from leaders throughout the organization: facilities, engineering, finance, health and safety, and your supply chain partners to ensure every team is aligned with long-term energy management and sustainability goals. However, it’s a challenge to bring stakeholders together, especially as departments become very lean and long-term capital planning becomes more complex—often taking a back seat to the priority of patient care.

To overcome this challenge, it’s important to present a business case that resonates with decision makers. Facilities and energy managers/engineers can take the lead on development, including expected outcomes, savings, ROI, carbon reductions and a project plan to achieve a few “quick wins” early on. For instance, tackle low-hanging fruit such as energy efficient lighting, considering changes in energy costs, maintenance costs and system interdependencies (e.g., more efficient, cooler lighting could decrease cooling loads and improve both employee and patient visual and physical comfort). Often digital tools, like those utilized by ENGIE Impact, can help to both identify opportunities as well as track performance against KPIs.

Barrier: Overcoming financing risks

Historically, project financing comes with risk. But in health care, doing nothing also brings operational risks. Aging and outdated equipment increases maintenance and energy costs and reduces positive patient outcomes. But by financing capital projects across a portfolio, companies enable more rapid deployment of energy-saving equipment. By committing to an immediate project roll out, organizations can leverage economies of scale and purchasing power, and once more efficient equipment is in place, maintenance, energy costs and overall risks decrease over time.

To overcome the challenge of financing risks, partners like Redaptive are helping organizations transfer risk by taking on project development costs and guaranteeing savings. Two financing types are emerging for energy management: Energy as a Service (Eaas) and Commercial Property Assessed Clean Energy (cPace). Both offer off-book financing and no upfront costs. EAAS typically works better for good credit companies while cPACE can support moderate to low-rated credit companies. Also, work with local utilities to find out if there are commercial rebates based on kWh, therms and water saved.

Energy is just one area in which the health care field can accelerate their sustainability efforts and benefit from the long-term savings. As resources become more regulated – and more expensive – establishing a strategy now will set you up for sustainability success.

To learn more about steps you can take to move toward a more transformative energy management strategy, download ENGIE Impact’s latest report, The Sustainable Resource Maturity Scale: From Tactical to Transformative.


About the Authors

Jennifer BlackJennifer Black, Strategic Account Manager
As a Strategic Account Manager, Jennifer Black drives the growth of ENGIE Impact’s energy, waste, water and carbon management partnerships with clients. Throughout her career in energy and sustainability, she has worked with many leading companies and built a deep understanding of the energy industry and clients’ challenges. After more than eight years managing a diverse portfolio of clients across sectors at ENGIE Impact, in her current role she helps some of the organization’s largest clients access the tools and services they need to effectively measure, monitor and manage their sustainability programs and meet their goals.

Craig WalterCraig Walter, Director Resource Optimization
As Director Resource Optimization, Craig helps ENGIE Impact’s clients gain insight into opportunities to improve the management of their energy and water resources. Throughout his 30-year career in energy and sustainability, he has held various roles at prominent companies focused on delivering complex sustainability solutions as part of an overall program strategy. Building upon his prior role at ENGIE Impact in which he led our team of sustainability advisors and engineers, he now manages our Resource Optimization partner network to enable a broader sustainability solution set for our clients.

Ian LarsonIan Larson, SVP Strategic Projects and Safety
As Senior Vice President of Strategic Projects and Safety, Ian’s responsibilities include sourcing and delivering complex mechanical projects along with the leadership position of safety for Redaptive. Ian’s background includes mechanical contracting, managing offices for general contractors, managing CMC and capital budgets for big pharma and several innovative start-ups.


Tip #22

Energy-As-A-Service Shifts Focus from Operations Back to Patients

Rob Guthrie

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As COVID-19 continues to change the health care landscape, hospitals and medical centers are forced to reduce higher-margin elective procedures to reposition resources. This loss, coupled with static or rising operating costs and lower non-operating revenue from investments, is leaving health care leaders scrambling for new solutions.

Facilities now face a balancing act of optimizing patient care while trying to recoup financially… all while resources are thinnest.

Creative solutions are available that allow hospitals and medical centers to offload a critical piece of operations that has little to do with direct patient care, and nothing at all to do with doctors and administrators — energy.

Energy-as-a Service (EaaS) is a partnership between energy systems experts and professionals who are saddled with facility operations. Systems engineers evaluate water, electrical, heating and air conditioning systems in order to optimize performance, conserve energy and generate cost savings. EaaS providers create custom improvements so that clients may shift capital back to their core. For hospitals, that core is patients.

Consider the value of EaaS, beginning on Day 1:

  • Infrastructure Renewal: Immediately offload critical systems repairs and renewal while cutting energy expenses. These infrastructure improvements and energy optimization services are geared toward improving reliability and resiliency. 
  • Asset Monetization: Monetize core hospital assets, while also transferring the hospital’s risk over a long period of time. EaaS providers purchase the right to use the hospital's energy infrastructure, offering immediate liquidity through an upfront payment that can be invested back into the facility to address near-term capital renewal, energy efficiency upgrades and investments in patient care.
  • Focus on Core Mission: Provide flexibility in the future and the ability to focus on your core business of providing world-class patient care.

Health care facilities are already seeing the benefit of EaaS in the face of conflict. East Alabama Medical Center in Opelika, Alabama, entered a 30-year energy asset concession agreement during the onset of COVID-19. The agreement provided crucial upfront energy optimization improvements, substantial projected annual energy savings and a significant upfront cash payment to EAMC. The transaction is set to provide $826,000 in annual estimated energy savings and $30 million in improvements to the facility.

“The increasing demands on our facilities led to a daunting backlog of deferred maintenance, which was exacerbated during this time,” said Sam Price, EAMC CFO. “We found a solution that allowed us to get ahead of the virus and keep our community as safe as possible.”

EaaS is the answer for many medical centers across the United States. Shifting focus from operating energy facilities back to their communities can be a life-saving decision in many cases. Now more than ever, the health care field is being called upon to get creative and find solutions that strengthen their core business and keep their focus on what really matters — patients.


About the Author

Rob GuthrieRob Guthrie, Executive Vice President
Rob Guthrie is the Executive Vice President for Bernhard’s Development Division where he is responsible for leading the Bernhard team in the successful development of turnkey Energy-as-a-Service projects for clients in health care, higher education and commercial sectors. With more than 15 years of experience, Rob is a qualified leader in helping clients realize long-term operational savings and is a recognized expert in developing projects including public-private partnerships, power purchase agreements, energy savings performance contracts and energy asset concessions. Rob is a graduate of The University of the South (Sewanee) and a Certified Energy Manager.


Tip #21

In 2020 We Got Ready. Will We Stay Ready?

Angie Stokes, Christy Festch and Jon Lehr

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Some of the best memes are the ones that blame every unfortunate accident on the year 2020. Your holiday tree falls over, chalk it up to 2020. You arrive late to an appointment,it’s2020. No doubt, it's been a strange year, but it has also presented opportunities for reflection and for challenging the status quo.

From the onset of the pandemic in March, our health care teams began fighting a hostile enemy. While many of us quarantined, the people that keep our hospitals running had to continue to beat back the beast with only the tools they’ve had in their belts for years. Until 2020, existing numbers of isolation rooms and air change requirements worked well. A need for negative and positive pressure areas that align with our day-to-daycare environment typically met demand. But today, teams of hospital engineers have had to make continuous and varied changes to systems that previously provided a safe and quality patient and staff environment. Today, we are learning new meanings of the word flexibility.

New strategies of varying capability were implemented across health care systems. Energy consumption was impacted as systems had to rise to this new challenge. The need to be flexible to ensure stewardship of financial resources has been more evident than ever. Because we have seen a year driving so much instability, it’s important to understand that maintenance, infrastructure and operational challenges can be reimagined and financed.

At the dawn of the pandemic, our health care systems were in reactive mode. Changes were made to ensure enough spaces to isolate sick patients beyond the traditional ICU and negative pressure rooms.

And what if a sick patient required a procedure? The following initiatives represent a sample of decisions made by health care systems as they strived to follow the Centers for Disease Control and Prevention (CDC) and American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) guidelines:

  1. Dilute:
    Most of the air-handling units in a health care facility are designed to operate using a minimum amount of outside air, which aligns with Facility Guidelines Institute (FGI)requirements. As such, outside air dampers need to maintain a minimum position. With the risk of indoor contaminant build-up, quick decisions had to be made. Certain air-handling units were identified and converted to 100% outside air operation, which eliminated the use of return air from the hospital spaces. These changes were made possible through a series of building automation system (BAS) modifications and/or physical modifications to infrastructure.
  2. Exhaust:
    In a traditional ICU space, there are dedicated exhaust systems designed to maintain a negative pressure relationship to adjacent spaces. Health care systems quickly realized that the need for isolation rooms would far exceed the spaces available. Converting patient rooms to isolation rooms was a common practice, primarily achieved with negative pressure machines that were rented, purchased or built in-house. By using such equipment, room-side contaminants were continuously exhausted and negative pressure relationships were maintained.
  3. Contain:
    Health care systems quickly reacted by making changes to maintain indoor air quality, but this did not come without recourse. Depending on climatic region, operating in 100% outside mode complicated the existing challenge of maintaining indoor relative humidity levels as it relates to compliance, occupant comfort and risk of microbial growth. Short of major infrastructure upgrades, humidity control relied on modifications to BAS sequencing. Adaptingto100% outside air usage meant that BAS systems commanded higher output of mechanical heating and cooling, exposing systems and infrastructure that were already in a deteriorated state.
  4. Clean:
    Health care engineers employed a variety of strategies to reduce particles in the air stream and to keep surfaces clean. HEPA filtration is by far the best option to reduce particles in the airstream. Unfortunately, most of the hospitals’ air-handling units were not designed to leverage HEPA filtration. In lieu of HEPA filtration, it was best practice to ensure that the highest MERV-rated filters were used. UV lighting was leveraged to clean surfaces, such as the surfaces inside the air-handling unit cabinets and at the coil face. The best practice for reducing contaminants is through bipolar ionization, which reduces coronavirus by 90% and all other viruses up to 98%.


As facilities professionals learn to adapt their building operations to CDC and ASHRAE recommendations, their focus lies on increasing indoor environment quality(IEQ). Simply put, creating healthy indoor environments is mandatory. Energy usage and utility spend are casualties of these necessary operational changes. In 2020, many health care systems experienced lost revenue and extreme budget pressures, which may become exaggerated if the resulting increased energy usage is overlooked, especially in the demand-heavy summer and winter months. Changing space usages and installing temporary HEPA negative air machines are additional examples of unaccounted-for energy increases. To combat the unpredicted energy expenditures, proactive measures should be taken. Consider areas where support staff once worked in person: Is this staff working remotely? Is the area able to be scheduled to reduce the HVAC strain?

Budgets, space usages and PPE innovations need to be considered more than ever. In the spirit of adapting, facilities are focusing efforts on facility spaces that may not have had 100% outside air or exhaust, which are now required to operate with that functionality. Limits to existing systems must be investigated and creative solutions must be examined.

Now is a great time to consider creative financing. Most health care facilities have other concerns to address beyond the changes needed to be ready and stay ready for COVID-19 or similar challenges. This may not feel like good news, but there are benefits: the marketplace is flush with investors and lenders that are looking to support sustainable efforts. Infrastructure problems in hospital scan be solved with sustainable solutions that reduce the environmental impact and have financial upsides that can be used in Energy as a Service contracts, Commercial PACE lending and other non-capital sources of money.

It is time to get ready and stay ready. It is time to be ready for now and resilient for tomorrow. How will you adapt and respond?


About the Authors

Angie StokesAngie Stokes, Healthcare Market Team Leader
As the health care vertical market team leader for Trane Kentucky and Southern Indiana, Angie Stokes is responsible for energy and infrastructure project sales that align with health care clients’ needs. Angie’s career began in 1997, during her tenure at Purdue University while seeking her BS in building construction management. Her expertise stems from fundamental construction and project management principles and is topped with a unique understanding of the health care marketplace. Angie builds trust with her clients and provides innovative solutions to solve complex issues, improve their compliance metrics and deliver valuable financial impacts.

Christy FetschChristy Fetsch, Energy Consultant
Christy Fetsch is a Certified Energy Manager and LEED Accredited Professional who has helped commercial and industrial facilities increase efficiency and profitability for the last decade. Christy received a Bachelor of Science in mechanical engineering and a minor in mathematics from the University of Kentucky. She uses her talents as a member of Trane Technologies to provide strategic energy management and enhanced physical environments over the last 14 years to help organizations realize savings, manage risk and support their missions. She uses her passion for sustainable environments and technology serving the Kentucky Society of Healthcare Engineers as Co-Sustainability Liaison as well as assisting with their social media.

Jon LehrJon Lehr, Healthcare Consultant
Jon Lehr has been involved in mechanical services for health care since his career began in 2004. He excels at understanding the needs of a health care facility and identifying the appropriate solutions that support his clients in reaching their business goals.

Jon graduated from the University of Kentucky with a Bachelors in finance and marketing. He enjoys watching and playing a variety of sports, coaching his two sons in baseball and spending time with family and friends.


Tip #20

What Is the ANSI/ASHRAE/ASHE 189.3 Standard?

Doug Fick, PE, PMP, LEED BD+C

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I distinctly remember how excited I was when I walked into a specific ASHRAE meeting in Salt Lake City, summer of 2008. The meeting's purpose was to see if there was any interest in creating a new standard to define sustainable health care. After observing the assembly of health care leaders sitting around the conference table, I was optimistic this document would make an impact. The new, comprehensive standard would provide minimum documentation so desired by the engineering community to address site, water, energy, material and operations.

A lot has changed since that summer meeting, from the standard number changing to 189.3 and first issuance in 2017 to the parent document 189.1 integrating into the International Green Construction Code® (IgCC). The committee is working hard toward its next publication of the document in the spring of 2021.

The document has a proven track record of beneficially defining the minimum sustainability level of a health care facility. Written in code language, and simple to adopt in whole or in part, the form assists governments with this minimum definition. It also lends itself to be adopted by a health care system or facility. The committee has been pleased to know that Indiana University Health located in Indianapolis uses the document as the minimum for its design and construction activities. The consultants and contractors working on the project are familiar with code language understand the requirements. Committee members are working with the consultant and health care system who provide input and actionable data and insight on the standard and its adoption issues. Thanks to the upcoming publication of the document's latest addition, the committee will have some time to contemplate the future of sustainable health care.

Some may ask what features or policies a building should include to reflect the improvements in technology or knowledge. An excellent example of such a feature is the application of renewables in a health care facility. 

Due to space limitations in 2012, it was widely agreed that helistops, roof exhaust fans, elevator towers, a host of other issues, and the high energy usage made the required installation of a sustainable energy source prohibitive. In a recent addendum, that same exemption was removed from the document, as it does not reflect the current situation.

In preparation for the 2017 document, the committee added a chapter to address emission effluent and pollution control. The chapter addressed minimum yet key operating issues generally unique to hospitals, such as areas like radiology, pharmacy and hazardous waste. 

In the next three years, what should be added to the document to reflect progress in a sustainable facility? Health care facilities have vehicles, food service and numerous other areas where sustainable measures can be easily implemented.


About the Author

Doug FickDoug Fick, PE, PMP, LEED BD+C
A senior mechanical engineer at CMTA’s Indianapolis office, Doug Fick’s 27 years’ worth of expertise lies in health care and higher education design. He has had the privilege of designing several health care projects of varying sizes, scope and complexity throughout his professional career, including chilled water facilities, surgery expansions and patient tower renovations.

Mr. Fick’s proven dependability and wisdom continues to be instrumental, involving the successes of projects including the Johnson Memorial Emergency Department and numerous Indiana University Health projects.

Mr. Fick’s professional and societal involvement as current chair of ASHRAE 189.3 and member of ASHRAE Region V ARC keeps him ahead of the curve in technology and facility advancements and assists him leading the engineering team to sustainable and high-performing projects.


Tip #19

ASHE Proudly Announces the Release of Its Revamped Energy to Care Dashboard!
New features offer a clean, user-friendly interface for quick interpretation relevant to sophisticated and novice users alike.

by Josh and Lindsey Brackett, Faculty for ASHE Energy to Care Educational Programs

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ASHE recently launched its new Energy to Care Dashboard, which offers an at-a-glance view of health care facilities’ energy performance. ASHE designed this tool to be highly visual and actionable to support users who have limited time and resources. The dashboard is easy to interpret – it makes monitoring energy as simple as monitoring steps with a fitness tracker. Plus, it’s free to all Energy to Care participants as a member value resource!

A successful energy management program optimizes energy performance through benchmarking, establishing reasonable goals, developing action plans, tracking program results and communicating those results with senior management. It will only take 15 minutes a day to use the tool and find energy savings that can influence around half of each health care facility’s budget and add value to the organization.

Like the previous version, the new Energy to Care Dashboard supports bi-directional communication with ENERGY STAR® Portfolio Manager. Users have the option to push data from the dashboard to Portfolio Manager or vice versa, and their current ENERGY STAR score is available right on the homepage along with other key views, or widgets.

The revamped dashboard offers new elements for users in addition to its classic features. Along with ENERGY STAR certification, health care facilities may now participate in the Energy to Care Awards Program. The Awards Progress view on the homepage tracks a building’s year-to-date eligibility toward an Energy to Care Award, which honors facilities that reduce energy consumption by 10% in a single year or 15% over 2 years. The program also recognizes previous award winners that reduce energy consumption by 5%. This feedback ideally will inspire participants to monitor their building’s energy performance on a monthly basis and achieve higher year-over-year energy savings.

The key take-away from Mercy Willard’s journey is to not take a high efficiency design for granted. A building must also operate as designed to ensure that its high efficiency intent can be realized. Scott and his team realized that it was the people behind the operations who made the difference. He credits Mercy Willard’s efficiency improvements to the staff’s involvement and educating them on key aspects of the design intent.

Health care facilities also have the option to participate in the Energy to Care Chapter Challenge. This friendly competition encourages ASHE affiliated chapters to reduce their energy consumption. Chapters that enroll five or more health care facilities in the challenge are eligible to compete. The new dashboard allows users to monitor their chapter’s standing throughout the year.

Homepage views are designed to clearly communicate key energy metrics. There are widgets to monitor a facility’s energy cost index (energy cost per square foot) and its site and source energy use intensity (kBtu per square foot), commonly referred to as EUI. Energy performance graphs provide monthly cost and consumption trend data for electricity, natural gas and total energy. These graphs offer enhanced features like weather data overlays and trigger points (i.e., notes on critical events like equipment failures, energy projects and operational changes).

Users’ energy savings are displayed on the year-to-date Energy Cost Savings widget, which quantifies and captures the effects of improved performance in addition to the trend data displayed on the energy performance graphs. Facility managers now have financial performance data at their fingertips when justifying a business case for energy-related projects to their C-suite. All energy cost and consumption widgets offer users the ability to adjust the view’s timeline with a click of a button. With the proper data, users can scroll through time and identify when significant changes took place and compare current performance against performance from the past month, several months or year.

The Energy to Care Dashboard also offers detailed views and related resources via the homepage’s drop-down menu bar. For example, the Utility Portfolio feature displays graphical views of the selected building’s utility bills and accounts and the Utility Gap Analysis feature provides interactive graphs and a table to identify utility bill data integrity issues. Consider it a checks and balances tool to ensure utility bills are entered into the system correctly and completely. This analysis is especially beneficial for users seeking to verify Energy to Care Award eligibility. The drop-down menu bar also houses complementary resources to support users in engaging with the Energy to Care Program and new dashboard.

If you’d like to learn more about the new Energy to Care Dashboard, visit the Energy to Care website at, or contact ASHE staff directly at

About the Authors

Joshua BrackettJoshua Brackett offers numerous perspectives into health care facilities management due to his diverse background. Starting his career in fire protection design at a national engineering firm, Josh gained a strong foundation in codes and standards. He leveraged this technical expertise to build relationships across the nation and through the ASHE Sustainability Committee and Regulatory Affairs Committee. Later transitioning to a fire protection contracting company, Josh leads Joint Commission compliance and energy management at Arkansas’ largest health care organization, Baptist Health. In 2018, Josh also co-founded Legacy FM and works with hospitals and organizations to empower the men and women that keep our hospitals running by developing training programs for facilities management leaders and their teams.

Lindsey BrackettLindsey Brackett has over eight years of experience in the health care engineering and construction field after earning a bachelor's degree at Oklahoma State University. She has been responsible for the development and management of over $370 million in specialized energy solutions and infrastructure projects. Since starting her career in health care engineering consulting, Lindsey has served as director of facility management services and education. During this time, she has provided health care facilities management teams with the tools and resources they need to make data-driven, well-informed decisions that improve their energy efficiency and facility operations. The most recent of these solutions is a health care facilities operation and maintenance training program, the first of its kind in the field.


Tip #18

Closing the Gap Between High Efficiency Design and High Efficiency Operations

Ryan Allsop – Director, Energent Solutions

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Mercy Willard is a 105,000 square foot critical access hospital located in Willard, Ohio. Built in 2012, Mercy Willard was designed from the outset as a modern, energy efficiency hospital. But its team soon discovered that there can be a big gap between design and physical real-world operations. Once they made this discovery, Mercy Willard embarked on a multi-year journey to align its operations with its high efficiency design and achieve ENERGY STAR® certification.

The journey began in 2013, after Mercy Willard’s initial benchmark score from the EPA ENERGY STAR tool came back at a disappointing 26. The team didn’t understand it. Here stood a new hospital, designed with energy efficiency in mind, somehow measuring only as highly as the bottom quarter of similar buildings. Scott McCarthy, the new facility manager in 2014, made it his mission to figure out the disconnect between the design and how the building was actually operating. He determined that the underlying issue was that, although the staff had done a great job maintaining the equipment, they were only utilizing a small portion of the controls capabilities that the design had allowed for.

Utilizing a systematic approach, Scott and his team began to take action to address the issue. Over the next couple of years, they began implementing several controls modifications, using a step-by-step process to ensure they could understand the effect of each change.

Here is a list of many of the changes Mercy Willard implemented:

  • Proper equipment schedules to match actual building operations
  • Duct static pressure reset
  • Discharge air temperature reset
  • Chilled water temperature reset
  • Daily monitoring of key indicators of a properly controlled and operated building

The key take-away from Mercy Willard’s journey is to not take a high efficiency design for granted. A building must also operate as designed to ensure that its high efficiency intent can be realized. Scott and his team realized that it was the people behind the operations who made the difference. He credits Mercy Willard’s efficiency improvements to the staff’s involvement and educating them on key aspects of the design intent.

Did it pay off? In 2017, Mercy Willard was certified as an ENERGY STAR hospital with a score of a 76.


About the Author

Ryan AllsopRyan Allsop is a Director at Energent Solutions with over 10 years of professional experience. Ryan’s background is in mechanical engineering and his experience includes HVAC design, HVAC retrofits, administering utility demand management programs, management consulting and other energy services.

Ryan is a technical lead for the nationally recognized OHA Energy & Sustainability Program which provides support to more than 60% of hospitals in Ohio. Additionally, Ryan helps manage the energy and sustainability program implementation for a Fortune 100 financial services corporation.


Tip #17

Developing a Green Team Is Key to Your Energy to Care Success

David Lockhart, CHFM, CEM, SASHE, Support Services Administrator, Roseville Medical Center, Kaiser Permanente

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Greetings, and thank you for taking the time to read my Tip of the Month, which I believe will be an essential element to your success in obtaining and maintaining an Energy Star certification.

As part of our national celebration of Earth Day on April 22, my Tip of The Month highlights the importance of developing a Green or Sustainability Team at your facility to assist in your quest to obtain the Energy Star certification. Back in 2012, it was not until we assembled our facility Green Team that we made the necessary progress to reach the Energy Star certification the following year.

Assembling and engaging knowledgeable and passionate staff to be a part of your Green Team is truly the key to making a difference when it comes to your energy and sustainability performance. In this tip, I’ll share who those team members should be, what tools and information you can use, and finally, vital activities and programs you can execute to ignite your entire facility on the path to Energy Star certification.

A successful Green Team is made possible by bringing together leaders who can help you remove barriers, communicate your message and assist you with validating your savings. The individuals you select should be people at the forefront who are passionate about doing what is right for our planet. Let’s start at the top: you need to recruit your CEO or COO as your lead sponsor. Choosing a well-recognized leader as your sponsor demonstrates to all staff how important your mission is. These C-suite members can also help you move barriers when challenges present themselves, because believe me – the challenges will come.

The next person you need to play a role on your Green Team is your CFO or one of their direct reports. As your program begins to reveal savings opportunities, you will want finance to validate your savings; but, more importantly, you want your financial leader to see all of the available opportunities firsthand and support reinvesting at least 50 cents of every savings dollar into more savings opportunities. For your Green Team to sustain their success over time, some investments will need to be made.

Next up, your team should include a project or construction manager. This person plays a crucial role in helping you implement small projects that will reap energy savings payback, usually in under one to two years. Also, it is important that this person has an understanding of future projects and the role energy performance plays in each of them, as well as the ability to communicate these future projects to the Green Team. Almost every project should have an energy goal attached.

Another essential person on your Green Team is your communications/public affairs leader. It will be important that everyone – all staff, but also your members and community – knows about your Green Team’s great work and successes. Sustainability performance improvement is just as important as care experience scores for our members to hear about. You will want your expert communications team to help you spread that message and motivate your organization.

Last is one of the most important tips for your Green Team’s success: invite as many passionate frontline staff as you have to participate on your Team. I guarantee you have nurses, doctors, housekeepers, security officers, administrative staff and many others in almost every department at your facility who live and breathe sustainability. They do it in their homes but have never been empowered to do it at work. These folks see the waste every day, on every shift, and they will provide you with the resources you need to make a difference. Yes, some people may come to you with unrealistic ideas and ideas you will not be able to implement, but I promise you – most will bring you amazing ideas along with most or all of the labor and support you will need to make things happen.   

Okay, so what’s your first step? Your first step is to reserve your largest conference room or outside assembly area and invite the facility to a brown bag “Lunch and Learn,” which will be your kickoff Green Team meeting. This first step is crucial, because it commits you to the team and its goals. Your next step is to gather your data and tools and set your agenda for the meeting.

As you build your agenda, it will be important for you to understand where your facility currently stands when it comes to energy and sustainability performance. What is your Energy Star score? Do you have a recycling program? Use both topics as baseline and as drivers for your key performance indicators as you develop your goals. I highly recommend that you focus on your energy performance first, as this provides easy and early wins and can help pay for other programs as the savings begin to stack up. Next, review all the tools, resources and information that is available on the ASHE Energy to Care website. Review the Sustainability Road Map and anything else you can find that will help you communicate your message and engage your new green team. This kickoff meeting should be designed to communicate your intentions of activating a Green Team and empowering staff to make a difference. Your actual Green Team should be a small group that properly represents your leadership as well as your frontline staff, teams and/or departments. I recommend monthly meetings with the smaller green team and semi-annual meetings or other communication methods to share your progress and activities with others.

Your newly formed Green Team will not have to move this program all on their own, though! Reach out to ASHE and invite their assistance with a facility Treasure Hunt: I’ve been on two so far and the results and education are phenomenal. This is the perfect program to start your team off on the right foot. Also available to help is your electric utility provider. Chances are they have programs and rebates that can help you get started, like bringing in experts in retro commissioning or educating your project team on rebates and other savings opportunities. Lastly, read the many success stories ASHE has published to get more ideas on how you can execute similar steps and activities.

In closing, I want you to hear this more than anything that I said above: just do it and have fun. Energy savings and sustainability are not hard work, they are the right work. When you bring together passionate people who want to do what is right, the work is not hard, the work feels good. You do not need to know it all nor have all the right answers, all you need to do is facilitate and provide some tools and guidance. Believe me, we have all the tools and guidance to help you succeed.

Happy Earth Day!

About the Author

David LockhartAfter serving four years in the U.S. Navy as an electrician and eight years in the power generation industry, Dave joined Kaiser Permanente. Over his 27 years with the organization, Dave has worked at every level of facility operations and has been involved with opening, operating, expanding and improving facilities. Dave has a certificate in Industrial Electricity, an associate degree in Mechanical Electrical Technologies, as well as a bachelor’s degree from Sacramento State in Vocational Education. Dave holds certifications in health care facility management from the American Hospital Association, and is a Certified Energy Manger (CEM®). Dave sits on the Board for both the American Society for Health Care Engineering and its state chapter in California. Dave is the Energy to Care Liaison for both associations and has led many teams to Energy Star Certifications. Dave is currently leading a group of health care teams on the education and implementation of Reliability Centered Maintenance in the health care industry.


Tip #16

Reducing Operational Costs Through Energy Efficiency

By Kara Brooks, Sustainability Program Manager, ASHE

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In anticipation of the upcoming ASHE PDC Summit, this month is a great time to review some tips for implementing sustainability concepts in building and construction projects.

For most construction projects, preparing sustainability initiatives before and during the project is ideal. A project designed with sustainability in mind will naturally produce better results than one that requires integrating sustainability elements later on. To ensure that sustainability is considered before and during construction:

  1. Plan for Energy Savings A new structure can be made more energy efficient in countless ways from the outset. A review of the LEED for Healthcare website can provide scores of ideas, including:
  • Consider location. Is the location easily accessible to public transportation? Will sensitive natural areas be disturbed?
  • Consider environmental issues. How will rainwater runoff be managed? Will the building be a heat sink?z
  • Consider energy consumption. Can the building orientation affect the HVAC and lighting requirements? How can the building envelope enhance energy conservation?
  • Consider the interior design. Will the design be flexible enough to accommodate future uses with minimal reconstruction? Is an advanced building automation system included in the plan?
  • Consider energy elements. Is the site appropriate for ground source heating/cooling? Is solar or wind power suitable?
  • These suggestions are just “tips” of the iceberg; a newly built or renovated health care facility offers a wealth of sustainability opportunities.
  1. Have the Whole Team On Board Early
    • A successful building project of any type, but especially one that includes unconventional energy-saving elements, requires a diverse, talented team that includes equal representation from ownership, designers, construction and facility personnel. Engage these individuals early in the design process to create an optimum high-efficiency project.
  2. Show the Big Picture
    • During design and construction, sustainability concepts can add initial cost to a project. Show budget-concerned leaders the return on investment for prioritizing sustainability. This will capture both the design’s energy considerations and its practicality.

Excerpt modified from ASHE published monograph titled “Reducing Operational Costs Through Energy Efficiency".


Tip #15

Sustainability Messaging to Motivate

By Shannon Bunsen, Sustainability Project Manager for Mazzetti+GBA

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As a follow-up to Tip #4, “Sustainability Engagement Benefits & Strategies,” Shannon Bunsen provides the following insights into providing Messaging to Motivate behaviors.

Are you trying to engage your workforce in sustainable behaviors? How you deliver your message is just as important as the message itself.

  1. Explain the why. Make your explanation personal and relevant. People are more likely to change their behavior when they understand how the benefits directly affect their lives. By understanding your audience and aligning your message with their values instead of your own, you increase the chances of earning their buy-in. A study published in 2013 from Stanford and UC Berkeley found that people were more likely to support pro-environmental policy when reframed in terms of their own morals.
  2. Keep it simple. People are more likely to engage in sustainable practices when they are easy to understand. Highlight one thing at a time and do so consistently. And people relate better to stories than abstract concepts, so incorporate (short) storytelling into your engagement strategy.
  3. Keep it positive. People are more likely to act sustainably with encouragement. “Do bike” is more empowering than “don’t drive.” In fact, negative messaging can have the opposite effect and create resistance toward sustainability. Recent research suggests that pride is a better motivator than guilt when it comes to green behaviors.
  4. Set social norms. We are heavily influenced by the behaviors of those around us. Publicly celebrate the success of your sustainability champions and leverage influential leaders displaying sustainable behaviors to help set sustainability as the cultural norm. Building social networks around sustainability will attract others to join in on the fun and build momentum for your efforts.

With a thoughtful approach to sustainability messaging and some key insights from behavior science, you can better engage your workforce in sustainability and make your program more successful in the long run.

About the Author

Shannon BunsenIn 2017, Shannon Bunsen joined Mazzetti+GBA, global provider of health care engineering and technology consulting, as sustainability project manager. She also leads The Sextant Foundation, a sustainable development non-profit that works in health care settings in the developing world. She offers more than five years of experience in sustainability program management. She was the University of Wisconsin Health’s first sustainability leader, a position she created. Bunsen holds a B.S. from the University of Wisconsin-Madison, with continuing education certificates in process improvement and change management.


Tip #14

Energy to Care Award Myths Busted
Savings are easier, cheaper, and not where you’re looking!

By Kevin Gombotz, PE, Vice President, Envinity, Inc.

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Over the last few years we’ve helped more than a dozen hospital engineers receive Energy to Care awards for achieving a 10 percent reduction in energy consumption. It is fun work, challenging at times, and much easier than most realize. What’s the secret?

This year I’ve been busting the Energy to Care myths at state and district ASHE chapter meetings and greasing the skids for those who haven’t yet trimmed the award-winning 10 percent. Let’s look at some highlights from one of our recent quizzes; I encourage you to write down your answers before you proceed to the myth-busting answers.
Spoiler alert… don’t scroll down until you are ready for the answers…

Energy Myths Quiz
How many survey questions need to be answered to get an accurate Energy Star score?    
(A) 52 (B) 13 (C) 4 (D) 24

A shocking 97 percent of the audience members got this wrong, believing that signing up for Energy Star and Energy to Care is more complicated than in reality. Signing up really is that easy--only four survey questions plus your utility bills are required to receive an Energy Star score and enroll in Energy to Care. What are you waiting for? 

How many total Energy to Care awards have been achieved since 2008,  ASHE wide?    
(A) 37 (B) 105 (C) 299 (D) 791   

This question was answered incorrectly by 69 percent of respondents, who thought fewer peers had received Energy to Care awards. Every health facility should receive recognition for their efforts. In addition to bragging rights, award winners are finding that recognition gets noticed by leadership, resulting in further financial support for their energy efforts and capital infrastructure needs.

The majority of Energy to Care awards have been achieved through:    
(A)    Lighting retrofits (B) Major equipment replacement (C) Low-cost changes (D) Cogeneration

On this question, 69 percent of respondents were wrong, assuming serious capital projects are required to achieve the Energy to Care 10 percent reduction award. The common starting point in the Energy to Care case studies and the ASHE Energy Efficiency Monograph has been with low-cost, high-return fixes such as retrocommissioning and deploying unoccupied HVAC setbacks . Heavier lift projects with deeper savings typically get support after receiving recognition for achieving what is possible with little investment.

It is EASIEST to earn an Energy to Care award at this type of facility:    
(A) Hospital (B) Medical office building (C) Surgery center (D) Administrative building

This question was answered incorrectly by 83 percent of respondents; most thought the in-patient facility would be the best starting point. In-patient buildings are the biggest piece of the overall utility budget and might be the biggest dollar savings; however, to achieve a 10 percent line-item reduction that the CFO will notice (and that will earn an Energy to Care award), a medical office building (MOB) may be your best bet. Why? Since MOBs have fewer compliance requirements, barriers to change are generally lower. Also, HVAC and lighting (over which facility managers have the most influence) are a larger percentage of the energy pie in an MOB. Last and most importantly, most medical office buildings are only occupied 60 hours a week, but have no unoccupied setbacks in place until an Energy to Care team gets involved.

It is EASIEST to earn an Energy to Care award at this age of hospital:    
(A) New hospital, Energy Star score of 50 (B) 1980s hospital, Energy Star score 40

This one is counter-intuitive, but has a good explanation. While a higher Energy Star score does mean the newer hospital has less overall reduction opportunity, success lies in the effort required. New hospitalshave the advantage of up-to-date drawings and full DDC controls. In addition, because newer facilities have a common design standard,  energy opportunities are generally “rinse and repeat” endeavors to scale up facility wide.

About the Author

Kevin GombotzKevin Gombotz, PE, leads an interdisciplinary team of engineers and consultants to help health care buildings work better. By applying retrocommissioning, fault detection analytics, and commissioning-informed design, he works to sustain energy performance without compromising clinical operating requirements. Gombotz’s team has provided coaching and advisory services for energy efficiency work in more than 40 hospitals. He is passionate about the business case for sustainability, noting that his work has had the impact of taking 3,000 homes off the grid and has achieved 12 ASHE Energy to Care awards to date.


Tip #13

Yes, Your ENERGY STAR® Score Probably Changed in August

By Clark Reed, National Program Manager, ENERGY STAR, U.S. Environmental Protection Agency

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On August 26, EPA released updated models that enable commercial building owners across many U.S. building sectors to calculate revised 1–100 ENERGY STAR® scores based on the latest available market data. These revised models did not include hospitals, medical offices, or senior care communities; hospitals and medical office buildings will likely be updated in late 2019. However, hospital engineers may still have seen minor adjustments to their score. Model updates provide EPA an opportunity to update other factors that go into the calculation of ENERGY STAR scores. Since the electrical grid has become more efficient, Portfolio Manager’s Site-to-Source conversion factor for electricity was updated from 3.1 to 2.8. This affects all property types, and EPA calculations show that hospitals will see a small 1- to 3-point increase, on average, in their scores as a result of this change.

EPA also made more significant changes to the score models for offices and warehouses. If your portfolio of buildings includes either of these, then you likely saw the ENERGY STAR scores for these buildings drop sharply. Office scores nationally declined an average of 12 points, while warehouses fell an average of 7 points.

Why the Large Drop?

ENERGY STAR scores compare a building’s performance to others in the nation. Because the national building stock has become more efficient over the past decade, on average, ENERGY STAR scores for most building types decreased after these updates. Moreover, it has been 9 years since the last updates to the score models (something EPA normally plans to do every 4 to 5 years). This gap was the result of 2007 survey data not being published for public use as we had been expecting.

Industry Engagement and Review Period for Updated 1–100 ENERGY STAR Scores

EPA has implemented a review period for the new score models that will help ensure that the models are working as intended to deliver energy performance metrics that empower you to make the business case for operating energy-efficient buildings. EPA will work in conjunction with stakeholders and technical experts to conduct this analysis and adjust the scoring models, if needed. This will include further evaluation of score changes for U.S. buildings of different sizes, locations, and fuel mixes, as well as additional types of analysis that are possible now that stakeholders are able to update their data and calculate their revised scores in the ENERGY STAR Portfolio Manager software tool.

During this period, EPA will temporarily suspend awarding certifications for all U.S. property types with new score models. (This excludes hospital, senior care community, multifamily, and data centers, as well as facilities located in Canada, which will continue to be processed normally.) EPA will work to resume certification as soon as possible, and will begin accepting certification applications by property type as each model is evaluated and finalized.

Why Are My Scores Different from the Average?

The two most common questions we’ve received since the update are:

  1. My score changed more than the average published by EPA. Why?
    The averages published by EPA in advance of the updates were based on typical buildings of each type. Your building’s score change will vary from the average we published depending on its energy use, fuel mix, business activity, property type, and other variables. Furthermore, by definition, roughly half of buildings of any type should have larger decreases than average, and half should have smaller decreases than average.

  2. I’m seeing wide ranges of changes across my portfolio. Why? 
    Each building’s score is dependent on its particular energy use, fuel mix, business activity, and other variables, so wide ranges are to be expected. To read more about the data analysis and model development behind the ENERGY STAR score, read our technical reference documents.

Tips on How to Increase Your ENERGY STAR score

    • Replace default values: We added a number of new required property use details for several property types, and populated these with conservative default values. Replace them with actual values to improve accuracy, and possibly your score. Learn more.
    • Benchmark data center space: If you have data center space within your building, but it isn’t metered as required for benchmarking, you have a new option to use “estimated” data to account for the high energy intensity of data center spaces, and possibly increase your score. Learn more.
    • Check data for accuracy: Confirm that all your other benchmarking data is accurate. Small errors can sometimes have a big impact.
    • Identify potential projects in your building: Find low-cost opportunities for improvements within your properties using our new Treasure Hunt resources, which many organizations have used to reduce their energy use by up to 15 percent.

If you have more questions, check out our Frequently Asked Questions, or submit your question to the experts at our Help Desk.

About the Author

Clark ReedClark Reed serves as a national program manager for ENERGY STAR at the U.S. Environmental Protection Agency where he works with hospitals to identify energy opportunities, promote energy efficiency best practices, and recognize top performing buildings.



Tip #12

Finding Energy Savings in Places You Didn’t Think to Look

By Justin Carron, Global Healthcare Segment Manager, Eaton

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For most health care facility managers, just keeping the lights on is a big enough job. Ensuring smooth day-to-day operation is priority number one, and the challenges that come with the job include plenty to keep managers up at night. It feels like there simply aren’t enough hours in the day to begin to find ways to lower energy costs.

What many managers don’t realize, however, is that finding energy savings is easy if you know where to look—and where to start. Make no mistake: identifying opportunities to lower energy costs in even the simplest of places can add up to big savings.

Recently, Eaton sponsored an Energy Treasure Hunt at Northwest Hospital & Medical Center in Seattle on the heels of the ASHE 2018 Annual Conference. During the Treasure Hunt, four teams of engineers and facility managers worked to identify hidden energy savings in the facility’s energy infrastructure. The opportunities they found can be translated into opportunities for any facility. Here are some places to look.

Review HVAC Systems and Processes

For many health care facilities, checking with hospital staff and clinicians about their needs regarding HVAC processes and requirements is a worthwhile investment of time. For example, asking whether every room requires air conditioning—particularly when the room is not in use—can be a good way to limit or cut off service to areas that don’t need 24/7 air conditioning, which can lower associated energy costs.

Additionally, savings can be identified by conducting a review of disparate systems—for instance, HVAC and air ventilation systems that may not be connected—to make sure they are properly synced. An air vent that pushes air outside and opens just as the air conditioning system turns on wastes energy.

Upgrade Lighting Infrastructure

Many facilities continue to run on older, less efficient lighting systems that use a considerable amount of energy. In recent years, LED lighting has emerged as an affordable and highly efficient way to produce the same amount of light with significantly less energy. Better yet, many utilities offer rebates for customers who change to more efficient lighting.

The best way to undertake an LED upgrade is to have a complete lighting and controls strategy going into the project, rather than seeking to simply replace bulbs and fixtures ad hoc. Having a comprehensive strategy will help the manager gain a full understanding of the cost benefits and although replacing these systems may require a more extensive investment and disruption of hospital service, the potential return on that investment is significant.

Audit Equipment

Facility managers who have a strong understanding of all the equipment in use at their facilities are in a good position to grasp which equipment gets the most frequent use. For these managers, conducting a review of which equipment is used and how frequently it is used could unearth opportunities to remove excess equipment that consume a significant amount of energy but don’t provide any value to the facility.

Review Electrical Infrastructure

Many health care facilities were constructed with power management technology that is 10, 20, and even 50 years old, and electrical infrastructure has come a long way in the intervening years in terms of efficiency. Forming a closer relationship with the vendors of your electrical products and leveraging the services they offer can be an excellent way to rightsize your facility’s power infrastructure to ensure equipment is both up to code and running at optimal efficiency.

Additionally, Internet-of-Things (IoT)-enabled devices have emerged as an attractive way to modernize facility infrastructure, whether that means upgrading what is in place or replacing older technologies with newer, IoT-ready ones. These solutions can be integrated into the building management system or can be used to create a modernized power management system, allowing for greater control over energy infrastructure and, ultimately, greater energy savings.


How can health care facility managers apply some of the principles used in the recent Energy Treasure Hunt to their own facilities?

The first way is by gaining a better understanding of the systems in place, which means looking for opportunities to educate and become trained on the technologies and tools used within the facilities. And while facility managers focused on the day-to-day operation may find such an undertaking daunting, ASHE has several resources available to help facility managers better understand their infrastructure and how to get the most out of their systems.

With the right approach and a little bit of foresight, health care facility managers can identify opportunities to lower energy costs and usage within their own facilities, all of which can add up to big savings and better opportunities to reinvest money saved into improving patient care.

About the Author

Justin CarronJustin Carron, Global Healthcare Segment Manager, Eaton works with health care facility managers and executives to design power management strategies for hospitals, health networks, and other organizations across the health care landscape.



Tip #11

Maximizing Your Environment with Optimum Chiller Performance

By Fawn Staerkel, Director, Healthcare and Performance InfrastructureTM, Johnson Controls Building Solutions North America

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When operating at maximum efficiency, chillers can create a healthier health care environment, cut energy costs, and be tailored to fit almost any need. Ensure that your chillers are working for you instead of against you by considering the following three tips.

1. Troubleshoot to identify energy waste
To mitigate potential energy-wasting issues with your chillers, regularly review their operating data and ensure they are properly maintained. Look out for undercharged machines or slight changes in approach temperature, which can be indicators of dirty or obstructed condenser or evaporator tubes. In addition, low pressure machines that operate in a vacuum are susceptible to leaks, which reduce efficiency by displacing refrigerant vapor and increasing condenser pressure and temperature.

Keep up with scheduled maintenance, and also observe how the chillers are operating – for example, are they running with the lowest possible cooling tower temperature or are they being sequenced efficiently?

2. Improve and update preventive maintenance for chillers
Traditionally, chiller operators “log” the chiller daily so they have a record of operating data and can monitor changes over time. A study of operators shows that 50 percent log their chillers on at least a daily basis. Most operators use a paper and pencil method and keep the logs in a binder near the chiller. However, the ability to access and analyze this operating data is key to being able to troubleshoot energy-wasting chiller issues; therefore having the data in a paper log in a binder next to the chiller is not the most efficient or effective practice.

With the advent of the Internet of Things (IoT), data from chillers can now be collected automatically and stored in a cloud-based analytics platform. Connecting the chiller to the cloud allows you to:

    • Send an alert to a monitoring center if a critical issue arises. The center can quickly notify the right people to take care of the problem.
    • Access the data remotely so a technician can begin troubleshooting the problem instantaneously, even if he or she is not on-site. The tech can arrive on-site prepared with the correct tools and parts.
    • Analyze the data using advanced fault detection and diagnostics algorithms, which can help identify deteriorating conditions like refrigerant leaks or fouled tubes before they cause a critical emergency.
    • Collect operating information like the average load over a 7-day period and condenser water temperature to analyze whether low-cost control strategy changes could be employed around sequencing or reducing entering condenser water temperature.

Non-destructive testing including vibration, oil and refrigerant analysis, infrared scanning, and eddy current testing are also ways to improve maintenance. The key is to perform integrated testing so that all the test results go back to a single center of excellence that analyzes each test and provides a combined report and recommendations based on the overall picture of the machine health provided by all the employed technologies.

3. Employ new-generation chillers
New generation chillers often eliminate some common maintenance issues, which helps to reduce the overall cost of ownership. For example, our YORK® YZ magnetic bearing chiller is oil-free, which eliminates oil changes and oil analysis. In addition, smarter panels feed more quality information into IoT systems, which improves predictive capabilities.

The latest generation of chillers provides efficiencies below 0.1 kW/ton and has proven performance maps that cover almost every HVAC application and operating condition. Technology developments continue to improve and optimize chiller components, but maintenance requirements remain a key factor in efficient and reliable performance throughout the life of the equipment. Tubes must be cleaned to reduce the negative effect of fouling on chiller performance, and water quality must be monitored and maintained to guarantee the integrity of chiller and variable speed drive heat exchangers.

About the Author

Fawn StaerkelFawn Staerkel, Director, Healthcare and Performance Infrastructure™ Johnson Controls Building Solutions North America, is responsible for directing the overarching strategy for health care across Johnson Controls, Inc. As “master translator,” Fawn listens to health care customers, understands JCI’s field teams, and monitors the trends and challenges in the marketplace. Fawn has more than 25 years of experience in the building industry and in supporting health care facilities and their building technologies.



Tip #10

The First Step in the “Long Push" – How to Get Started with a Self-Funded Energy Sustainability Program

By Lindsey Brackett, Health Care Facilities Operational Efficiency and Solutions Expert

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The self-funded approach to an energy sustainability program is often referred to as the “Long Push” because it is a multi-year, multi-phase program carefully constructed to achieve long-term outcomes. Although various financing mechanisms can be incorporated throughout the duration of the program, projects are largely funded with accepted and accumulated energy cost savings. The idea is to start with low-cost and no-cost energy projects, begin generating energy savings early on, and then use those savings to fund projects with a longer payback or higher cost. This approach enables hospitals to reduce capital renewal and deferred maintenance backlogs without siphoning funds away from other critical projects. However, it does require discipline because mid-course changes could be counter-productive and result in catastrophic effects on the desired goals.

The self-funded energy sustainability program has two primary components: (1) a multi-year, multi-phase, long-range strategic energy and infrastructure plan, and (2) a business case to make it happen.

To get started, gather all the relevant informaation and make sense of it. Become informed by digging into whatever documentation you can get your hands on; the primary target should be utility bills. Two common metrics to become familiar with are EUI (energy use intensity) and ECI (energy cost index). A third metric to understand is FCI (facility condition index), although FCI is not as commonly used when discussing energy projects.

Energy Use Intensity (kBTU/SF/year): calculated by dividing the total energy consumed in one year by the total gross floor area of the building

Energy Cost Index ($/SF/year): calculated by dividing the total annual energy cost by the total gross floor area of the building

Facility Condition Index ($/$): calculated by dividing a building’s total maintenance, repair, and replacement deficiencies by the current replacement value of the building

Identify your current rate structure, taxes, date of last rate increase, and date of next expected rate increase. Look for billing errors, inappropriate sales tax collection, improper utility rate selection, and other no-cost or low-cost opportunities to cut expenditures.

To answer the question, “How bad is it?,” enter 12 months of utility data into the EPA ENERGY STAR® Portfolio Manager®. This platform will process your hospital’s information and calculate an ENERGY STAR rating so you can see how you stack up against your peers. Take this opportunity to use the ASHE Energy to Care platform, which is user friendly and beneficial in determining your energy performance.

Next, perform a comprehensive operation and maintenance benchmarking analysis. ASHE offers an excellent benchmarking tool at The benchmarking process ensures that energy efficiency and sustainability objectives are aligned with hospital staffing levels and expertise. Remember, the objective is to cut BTUs and not FTEs.

Obtain as much information as you can on your existing infrastructure and planned projects. Relevant documentation includes as-built drawings and master plans. Pull information from your CMMS like work order history, recurring issues and alarms, and any unusual override patterns. Make sure you have a detailed equipment inventory and related testing reports and maintenance logs because you will need this information to develop your long-range plan.

Once you have gathered facility information, define the magnitude of the problem and identify the root cause. Establish the key performance indicators by which you will measure the organization and calculate them for your hospital. Some questions to answer include:

    • Is the root cause on the supply side, demand side, or both?
    • Is the problem isolated or global?
    • Is your energy consumption unusually high because of a design issue, or because of deferred maintenance and failing equipment?
    • Does the issue stem from obsolete programming and rampant overrides?

Determine the primary drivers so you can fix the problem.

The final question to answer is, “What does success look like?” Common objectives include increased energy efficiency, reduced greenhouse gas emissions, reduced annual energy costs, and improved patient outcomes, occupant safety, thermal comfort, and indoor air quality. Discuss program objectives with other departments, including clinical staff and leadership, before finalizing your goals.

At this point, you have identified the problem areas, established key metrics to measure improvement, and determined the objectives that you will accomplish by implementing a self-funded energy sustainability program. You are finally ready to put all the pieces together and develop a plan.

Solutions to overcome the evident problem areas should be prioritized and phased into a long-range plan that considers budget restraints, available resources, and future infrastructure needs. Typically, the plan time frame ranges between 5 and 15 years. Start with items that require little or no cost to implement but yield a high economic benefit in their return. After your plan is developed, you can begin next step in the process: creating the business case.

About the Author

Lindsey BrackettLindsey Brackett, Health Care Facilities Operational Efficiency and Solutions Expert, has been responsible for the development and management of more than $370 million in specialized energy solutions and infrastructure projects. Since starting her career in health care engineering consulting, she has provided health care facility managers with the tools and resources they need to make data-driven, well-informed decisions that improve their energy efficiency, building performance, and facility operations. The most recent of these solutions is a health care facility operation and maintenance training program, the first of its kind in the industry.


Tip #9

Applying Advanced Analytics to Improve Health Care Facility Operations

By James Dice, PE, CEM, CMVP, Vice President of Strategic Solutions, Sitton Energy Solutions

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Energy to Care participants know the value of using utility bill data to benchmark hospital energy performance. This first step on the energy efficiency journey is viewing the hospital portfolio as from a mountaintop. Such a big-picture view helps answer questions like, “How does each hospital compare to its peers?,” and “Are there opportunities for energy savings?,” and “How much are those savings opportunities?” 

To figure out exactly how to improve performance, hike down the mountain into each building. At these lower altitudes, the many hidden opportunities for savings can be uncovered. A closer view helps answer questions like, “Is the building automation system doing the right things?,” and “Have the control sequences been interfered with or overridden?,” and “Have individual components (sensors, actuators, dampers) degraded or failed?” 

In the past, answering these questions has been very labor-intensive, but advances in automation and analytics software mean answers can be just a few clicks away. Today the challenge is to take advantage of the powerful technology at our fingertips to continuously improve hospital operations. Here are a few tips that have helped health care systems rise to this challenge: 

1. Start with Strategy
When it comes to energy efficiency, analytics is simply one tool in the toolbox. Before putting the tool to the task, think through how analytics fits into your health care system’s comprehensive energy strategy. Fitting into the strategy will produce the highest return on investment and answer questions such as:

    • What key performance indicators are important to the organization?
    • How will we modify construction, operations and maintenance, and building automation practices to best take advantage of analytics?
    • How will we fund investments in analytics? Are incentives or rebates available?

2. Select the Right Tool for the Job
Dozens of different types of analytics software are available and new players seem to hit the market each day. The marketplace is diverse, so take time to select the best tool for your needs. As a starting point, look for the following features:

    • Fault detection and diagnostics (FDD) – the ability to automatically find patterns in system data that represent equipment failures, anomalies, or degraded performance
    • Semantic data modeling – the ability to describe the meaning of each data point in the building and use this “metadata” in the analytics itself
    • Measurement and verification (M&V) – the ability to automatically and continuously validate the results of energy savings measures

3. Build a Process and a Team Around It
Analytics software is most effective when it is implemented inside a structured, ongoing monitoring-based commissioning (MBCx) process and team. Get the following team members in place:

  1. Engaged operations and maintenance staff
  2. Responsive implementation vendors and contractors
  3. Analytics and MBCx services provider
About the Author

James DiceJames Dice, PE, CEM, CMVP, is vice president of strategic solutions at Sitton Energy Solutions. James specializes in applying advanced technology to optimize facility performance. His expertise in data analytics software, including fault detection and diagnostics algorithms, helps Sitton provide an industry-leading return-on-investment for clients.

Have a tip you want to share? We’d love to hear from you. Contact Kara Brooks at


Tip #8

You Win with People

By Marty Lanning, CMVP and LEED AP, Founder and CEO, Energent Solutions

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Energy efficiency—or energy productivity, as some are beginning to refer to it—is not a race, but rather a journey for health care organizations. As in other areas of life, it takes a village or team to produce results.

Hospitals that have achieved tremendous success implementing energy or sustainability programs have the following three key attributes.

1. Vision

Leadership takes many styles. Some organizations build a program on cost savings, others use faith or mission to drive results, and some simply try to be good stewards of their communities. There is no right answer; neither is there a wrong answer. However, successful organizations have a stake in the ground, a stretch goal that is 5 to 10 years in the future. Skilled leaders summarize long-term goals into everyday language and rally their organizations around them. 

What will be your “15 in 15” (referring to a 15% reduction in consumption in 15 years)?

2. Structure

Energy productivity is not a task that can be achieved alone. A successful program will take years to deliver on the objective. 

Build a structure that creates accountability but not bureaucracy. An ideal scenario includes a central group that involves senior leadership and is tasked with focusing on the stretch goal. Each member of that central group should also lead or participate in subcommittees that promote activities such as employee engagement, recycling, and energy procurement that drive success of the overall stretch goal. 
Structure graphic
In addition to involving facility management, align contractors, utilities, purchasing, finance, hospital administration, and clinical staff to deliver results. 

3. Persistence

If designed appropriately, energy programs should not create a burden on participants, but simply add focus or reward attention to detail for those involved. Most successful programs are based on incremental change or heightened focus rather than wholesale changes in operations.

About the Author

Marty LanningMarty Lanning is the founder and CEO of Energent Solutions. Under his leadership, the firm helps clients optimize energy usage to create tangible cost savings and a compelling environmental story for their brand. Last year, Energent worked with one out of five Energy Star® certified hospitals in the country, including the 2017 ASHE Energy Champion Award winner. Earlier in his career, Marty worked in the business consulting division of a Big 5 accounting firm and a Fortune 100 financial services corporation  , and led the sales organization for one of the fastest growing electrical services companies in the country. Marty holds a BSBA in finance from The Ohio State University and is in the process of completing his MBA at the University of North Carolina's Kenan-Flagler Business School.

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Tip #7

Energy Procurement

By Ryan W. Ollie, CEM, CMVP, EIT, Manager of Energy Solutions, Facilities, Advocate Health Care

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Demand-side energy management is often prioritized over supply-side energy management by health care facility management professionals, because demand-side management is easier to control. Simply put, the potential savings from installing a variable-frequency drive is easier to understand than the mystery surrounding energy procurement and the deregulated retail energy market. However, to execute a balanced energy management program, you must not neglect the procurement side of the business. Before I cover some important tips, I will review some basic information about the energy market. 

The United States contains both regulated and deregulated markets. In regulated markets, utility companies are vertically integrated. In other words, regulated electric utilities own or control the generation, transmission, and distribution infrastructure of the power grid, while deregulated utility companies only own or control the distribution portion of the business.1 

In deregulated markets, customers can purchase energy from a retail marketplace of suppliers versus only being able to purchase from the incumbent utility company in a regulated market. Since energy is traded as a commodity on an exchange, customers can implement various procurement strategies with their retailers that meet their budgetary constraints. While some customers are less risk averse  and are willing to “float” along with the ever-changing market index prices, others value budget security and choose to lock in future utility delivery prices at a premium so that they can sleep better at night. Many customers use a combination of both extremes (often called a block and index procurement strategy) and lock in a portion of their load while letting the remainder float with the market index prices.2 
The following tips apply to customers that are in deregulated and semi-deregulated states.

The Retail Supplier and Customer Relationship: While securing low energy rates is extremely important, it is also equally important to select a partner that understands the complexity of the health care industry. All major suppliers should be able to provide similar market intelligence, but make sure that you are also informed about the different types of contract structures, billing options, and other value-added services that are available to customers.

Some organizations may want a supplier that offers one summary bill for hundreds of separate accounts to help streamline the payment process for the accounts payable department, while other organizations may want a supplier that creates annual budget forecasts for all of their accounts. Don’t be afraid to ask your supplier to provide an offering that meets the unique needs of your organization. 

The Team: While some organizations set up formal committees of key decision makers (and sometimes external consultants) to handle energy procurement, not all organizations have the ability or resources to organize a group of this nature. At the very least, facility managers should try to develop relationships with key people in the supply chain and finance departments to add additional interdepartmental insight on best practices.  

The Strategy: The level of detail required in a procurement strategy varies from organization to organization. Some may want a formal policy visible to senior leadership, while others allow the facility management team to create their own plan. Either way, document your strategy and periodically update it as the financial circumstances change within your organization.3 

To be clear, I am not an energy procurement expert; however, the above tips have helped my organization and may also be helpful in your endeavors. No one has a crystal ball in regard to energy procurement. Each organization must manage their own risk and create a strategy that works within their budgetary constraints. For more background and details on health care energy procurement, please read ASHE’s monograph Energy Procurement: A Strategic Sourcing How-To Guide.

energy deregulated graphic

1 Robin Deliso Woodcock, Regulated and Deregulated Energy Markets, Explained, (, 2014).
2 Mark Mininberg & Walt Vernon, Energy Procurement: A Strategic Sourcing How-To Guide, (Chicago, ASHE, 2017), 11.
3 Mininberg & Vernon, Energy Procurement: A Strategic Sourcing How-To Guide, 9.

About the Author

Ryan OllieRyan Ollie, CEM, CMVP, EIT currently serves as the Manager of Energy Solutions for Advocate Health Care and has been a part of their Support Services team since September of 2015. In this role, Ryan supports the Facilities, Design and Construction teams on all energy and water related items. Prior to joining Advocate Health Care, Ryan worked in various engineering roles within the MEP design and energy consulting space. In addition to these professional experiences, Ryan has also achieved the Certified Energy Manager (CEM), Certified Measurement & Verification Professional (CMVP) and Professional Engineer in Training (EIT) certifications.

Have a tip you want to share? We’d love to hear from you. Contact Kara Brooks at


Tip #6

Energy Treasure Hunts

By Clark Reed, U.S. EPA ENERGY STAR®

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A building is like a treasure chest. The hidden savings can make you wealthy, but you must find it first. Just ask the facility engineers at OSF  Healthcare and Atrium Health. They created teams of energy treasure hunters who fanned out across three hospital campuses looking for easy energy-saving opportunities. They struck gold, identifying more than $350,000 in savings from operational changes and small capital projects like lighting upgrades. Most of the projects had paybacks of under one year and some even had instant paybacks by reducing airflow in unoccupied areas from an HVAC system that formerly operated 24/7/365.

St Joseph MEdical Center - Treasure Hunt
On the Hunt: An energy treasure hunt team at St. Joseph Medical Center, Bloomington, Illinois.

While the main purpose of an energy treasure hunt is to identify opportunities to use energy efficiently, the longer-term value is the start of a culture change. These events begin a behavioral shift in how the organization thinks about energy use. Team work is essential; all employees (not just those in facility operations) are engaged to identify opportunities to reduce energy use. Employee involvement helps create a sense of responsibility for the solutions and sparks employee ownership of energy-saving strategies.


General Electric, one of the early adopters of treasure hunts pioneered by Toyota, trained more than 3,500 of its employees globally to think about how wasted energy and water directly affect their own jobs. That experience motivated the employees to identify more than 5,000 projects that improve energy efficiency, eliminate 700,000 metric tons of greenhouse gas emissions, and save $111 million in operational cost.

Last year, ASHE introduced the concept of energy treasure hunts to chapters competing in the Energy to Care Chapter Challenge. The Environmental Protection Agency’s ENERGY STAR program conducted a four-part webinar series that explained how to plan a treasure hunt, including preparation, pre-training, the event, and follow-up. Three hospitals have already completed hunts and are in the process of implementing their findings. More hunts are being planned, including a post-conference treasure hunt on July 18 and 19, 2018 that you can join in Seattle following ASHE’s Annual Conference & Technical Exhibition. The deadline to register for the treasure hunt is June 8. For more information on how to plan an energy treasure hunt at your hospital, download a free copy of the EPA’s “Energy Treasure Hunt Guide.”

About the Author

Clark Reed serves as a national program manager for ENERGY STAR at the U.S. Environmental Protection Agency where he works with commercial building partners to identify energy opportunities, promote energy efficiency best practices, and recognize top performing buildings. He manages the EPA’s efforts to establish ENERGY STAR scores for hospitals, medical offices, senior care communities, and most recently, hotels. He is a member of the ASHE Sustainability Committee and a past member of the 2007 ASHE PDC Planning Committee, the LEED Guide for Healthcare, and the Green Guide for Healthcare. Mr. Reed holds a bachelor’s degree from the University of Washington and a master’s degree from Tufts University.

Have a tip you want to share? We’d love to hear from you. Contact Kara Brooks at


Tip #5

Setting Priorities for Efficiency

By Kathleen Stanley, CEM, CLEAResult Consulting

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Kathleen Stanley from CLEAResult Consulting sat down with Sturdy Memorial Hospital’s utility manager Russ Reeves to discuss the success he has had in energy efficiency for the hospital. Russ has experienced great results over the past several years in his efforts for energy efficiency at Sturdy Memorial Hospital. He has seen an electricity usage reduction of 11.67 percent—or 1,489,000 kWh—since 2010, and an overall cost savings of $848,520. These results are quite an accomplishment for Russ’s team. Russ maintains that sticking to the fundamentals will pay off. His priorities are number 1, safety; number 2, reliability; and finally number 3, cost savings. He continues to use this hierarchy to make decisions and it has served him well. His advice for a new engineer coming into a facility is as follows:

Russ Reeves

Russ Reeves
Utility Manager
Sturdy Memorial Hospital

Russ has worked over 35 years in the Power Plant Industry and the last 6 years in Health Care. Russ holds a First Class Stationary Engineers License from the state of Massachusetts. He has taught stationary engineering and maintains a website

  • Understand that maintenance and utility costs are a financial burden on all hospitals. By improving the reliability of equipment and reducing energy costs, a manager can improve the hospital’s bottom line.
  • Learn about your systems. The more you know about the different systems, the better you will understand any weak links. Address redundancy and reliability and tie them into any capital upgrades that you pursue. In one scenario, Russ was able use a controls upgrade to improve reliability for the chiller plant, which allowed him to better use his team and implement energy savings.
  • Choose vendors that align with your goals and priorities. Vendors must share the priorities of the team and help to identify areas that can be improved, build better resiliency into the system, and step up the level of performance.
  • Gather electric and fuel bills, log data usage, and study trends. Understanding where you start is important to identifying the changes your work produces. Russ and his team have implemented many great projects such as LED lighting for outdoor spaces, LED retrofit to the hospital itself, steam trap survey and testing, and pipe and valve insulation. He ties these projects back to improvement of resiliency and redundancy when possible. A substantial amount of utility incentive also improves project financials.
  • Create an environment for your team where they want to contribute. Russ’s team knows that they always have his ear if there is an idea or an observation to share. One of his maintenance team members observed a motor running continuously on an elevator and brought this to his attention. The team corrected this problem and the savings were substantial. The problem would have been difficult to find without this maintenance team member’s awareness.

Russ is passionate about saving energy and improving the performance of his plant. His passion is contagious, and his team is proud of their accomplishments. While it gets harder to keep improving on energy efficiency once you have implemented the easier projects, this team is up to the task of continuous improvement. They are looking at CHP (combined heat and power), solar power, and the overall efficiency of their chilled water plant and improving resiliency as well.

About the Author

Kathleen StanleyKathleen Stanley, CEM, is an energy professional with more than 25 years of experience working in the energy industry. Ms. Stanley has held positions in energy utilities, ESCOs , energy efficiency firms, and energy supply companies and has owned her own energy consulting firm. Ms. Stanley has worked in sales and business development focusing on public entities, industrial users, institutional users, and other large energy users. She is a board member of the Association of Energy Engineers, New England Chapter, the chair of the AEE New England Technical Roundtable Event Series, and a past president. Ms. Stanley holds a bachelor’s degree from the University of Rhode Island and is a Certified Energy Manager.

Have a tip you want to share? We’d love to hear from you. Contact Kara Brooks at


Tip #4

Sustainability Engagement Benefits & Strategies

By Shannon Bunsen, Sustainability Project Manager for Mazzetti+GBA

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In 2013 the European Environment Agency reported that up to 20 percent of energy savings can be achieved by targeting behavior change. Individuals make daily decisions that affect energy consumption; when you engage individuals, you empower them to be part of the solution. 

And engagement matters. Gallup research from 2012 found that organizations that scored in the top half on employee engagement scored nearly double  in customer ratings, profitability, and productivity compared with those in the bottom half. Top-scoring organizations saw lower turnover and absenteeism, and fewer safety incidents and quality defects. 

In 2017 the National Environmental Education Foundation conducted a study that found a positive relationship between sustainability engagement and employee engagement. They also found that sustainability engagement positively affects almost every dimension of traditional engagement, including alignment, pride, discretionary effort, and advocacy. Nearly 90 percent of employees that were engaged in their company’s sustainability efforts said that it enhances their job satisfaction. 

When engaging employees in sustainability, it’s best to use a combination of methods. Passive approaches include designing spaces for sustainable behaviors and incorporating signage or “action triggers” to turn behavior into habits. Active strategies include educating occupants and enlisting them to participate on green teams. Written communications can raise awareness, but interpersonal communication can change behavior and add much more value for the employees involved. 

Implementing a variety of strategies, and doing so thoughtfully, will lead to the wide-ranging benefits that sustainability engagement has to offer.

About the Author

Shannon BunsenIn 2017, Shannon Bunsen joined Mazzetti+GBA, global provider of healthcare engineering and technology consulting, as sustainability project manager. She also leads The Sextant Foundation, a sustainable development non-profit that works in healthcare settings in the developing world. She offers more than 5 years of experience in sustainability program management. She was the University of Wisconsin Health’s first sustainability leader, a position she created. Shannon holds a bachelor of science degree from the University of Wisconsin-Madison, with continuing education certificates in process improvement and change management.

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Tip #3

Kitchen Ventilation

By Brent Morris, West Region Business Development Manager for Intelli-Hood at Melink Corporation

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Kitchen ventilation, for both exhaust and makeup air, represents a significant opportunity for kWh and kBTU reductions in health care facilities. Demand control kitchen ventilation, or DCKV for short, uses both temperature and optic sensors to vary the speed of exhaust and makeup air fans in response to the precise cooking intensity underneath kitchen hoods. Running the fans only as fast as needed provides savings on fan energy (controls produce 40% to 60% average fan speed versus 100% without controls). In addition, heating and cooling savings are gained because the kitchen isn't evacuating all the expensive conditioned air.

These controls can be installed in new construction projects, specified by the engineering firm in the design phase of your project, and should qualify for one LEED point. In addition, DCKV is a path to compliance for commercial building energy codes for states that have adopted ASHRAE 90.1 2010 and later. You can see what your state's requirements are here.

Retrofitting the temperature and optic controls within existing kitchen exhaust hoods is equally effective at generating energy savings. At the outset of a project, confirm that the controls are UL 710 and 2017 listed, which permits them to be installed in any manufacturer's hood in any cooking application. Many utility rebate incentive programs are available for the installation of DCKV.

Ultimately the goal of any DCKV project is to maximize the energy savings within the kitchen. Controls will help in compliance with building energy codes, attain LEED points, and make the kitchen much quieter and more comfortable for staff. The fall 2017 Inside ASHE article The Financial Impact of Variable Speed Ventilation Controls in Hospital Kitchens provides further information on these topics and dives deeper into how controls pay back initial investment.

About the Author

Brent MorrisBrent Morris is the west region business development manager for Intelli-Hood at Melink Corporation. He partners with VPs, directors, and managers of facilities, engineering, and operations to assist them in achieving greater energy savings within their facilities. Some of the facilities he has helped include acute care hospitals, assisted living facilities, VA medical centers, and health care property management companies such as JLL and CBRE.

Brent is a member of the American Society for Healthcare Engineering and holds a bachelor’s degree in business from Hanover College.

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Tip #2

Translating the Cost of Energy Reduction

By Kara Brooks, LEED AP BD & C, ASHE Sustainability Program Manager

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Health care facility professionals are often looking for ways to get the attention and support of the C-Suite for energy reducing strategies. Discussing energy savings on a square foot basis may not always get the attention desired. The EPA’s Energy Star Portfolio Manager has broken down the data for facilities in Energy Star’s Portfolio Manager in a guide, “Energy Use in Hospitals,”which helps establish the results of a facility’s efforts toward energy reduction. This is a great guide for those who want to understand the implications of energy reduction through a variety of metrics—not just those based on square footage.   To illustrate how these other metrics can be used, let’s take a look at a per-bed metric for four sample health care facilities. 

A per-bed metric examines the affect that energy has per bed, not per square foot. In its “Energy Use in Hospitals” guide, the EPA states that the median beds per square foot is around 0.5 beds/1,000 square feet. This number is important as it can be used to determine the cost of energy on a per bed basis.
Similarly, the EPA states that the median number of FTEs per square foot is 2.6 FTEs/1,000 square feet. Again, we can use this number to understand the effect of energy use as it relates to number of FTEs. From there we can further understand how improving a facility’s ENERGY STAR score can help establish a business case for saving energy. The following graph depicts each of these metrics as they are compared to ENERGY STAR scores for four sample healthcare facilities with an estimated median range of staffed beds between 110 and 190:

Energy cost per staffed bed

It’s easy to see that the cost of energy drops dramatically on both a staffed bed and FTE basis as the ENERGY STAR score rises. 

Why is this important to the C-Suite? The data show that even small energy reductions can make a big difference. the hospital with the ENERGY STAR score of 2, the cost per bed is about $11,700 with a cost per FTE of around $3,000. For the hospital with an Energy Star Score of 10—a relatively modest improvement—the cost per bed is $8,050 with a cost per FTE of around $1,550.
By making small changes, facilities can re-allocate their resources, allowing for additional FTEs or projects that improve patient care. Communicating the benefits of energy efficiency in this way makes a complex concept easy to understand for those who manage beds or staffing.


Tip #1

Energy Management? Where Do I Start?

By Kara Brooks, LEED AP BD & C, ASHE Sustainability Program Manager

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While presenting ASHE’s Sustainability programs at the ASHE Region 8 conference, I was questioned about starting an energy management program with limited resources. I would venture to say that it begins with ENGAGEMENT. I’m referring to engagement of key stakeholders in the process. Key stakeholders include those affected by energy use within the health care facility: the energy manager, maintenance staff, hospital administrators and financial managers, local utilities, auditors, and consultants. Stakeholders gain a thorough understanding of the energy that is being used through benchmarking energy use in facilities. This benchmarking information can then be used to engage stakeholders in a commitment to sustainability and the establishment of an energy management program.
One tool for benchmarking health care facilities is Energy Star’s Portfolio Manager. Currently more than 5,000 health care facilities in the United States have benchmarked their facilities in Portfolio Manager, encompassing more than 85 percent of the health care market in terms of square footage. Of these 5,000 facilities, more than 2,500 have enrolled in ASHE’s Energy to Care program (which utilizes the energy data from Energy Star’s Portfolio Manager). Top performers are translating impressive results, however the numbers of facilities eligible for Energy Star Certification represent less than 10 percent of health care facilities across the United States. The numbers are telling of the availability of improvements that are available to the health care profession.
Resources are available to facilities to help with the process of benchmarking, and ASHE and your local chapters are excited to assist you. For more information, please contact AHSE’s Energy to Care help desk at