RSS Feeds Healthcare

Industry Expert Shares Advice on Energy Savings and Smart Hospital Operation

admin — Mon, 04 May 2009 13:52:19 +0000

Mike Hatten is an internationally known engineer, recognized for his expertise in building energy efficiency and is a principal of SOLARC Architecture and Engineering, Inc. He combines a design, analysis and training background in his roles as project manager, educator and project engineer. He has conducted analysis efforts on more than 20 million square feet of residential, commercial and industrial space.

Mike works as a technical advisor for both BetterBricks' building operations and its design and construction efforts. This interview focuses on his work with building operations in healthcare facilities. Mike provides on-site support to customers and their service contractors to help them achieve energy cost savings from tuning-up and improving the operations and maintenance of equipment and systems. Mike has provided support on 20 hospitals for BetterBricks. He has a deep understanding and appreciation for the type, magnitude and low cost of these tune-up and O&M savings opportunities.

BetterBricks:How many and what types of hospitals have you worked with?

Hatten:Through the BetterBricks program, I've worked with nearly 20 hospitals in the Northwest - half of which are large facilities. Primarily, I review the facility and meet with staff to provide the 50,000-foot-level energy assessment of their energy savings potential and suggest a logical starting point. Of the 20 hospitals I've worked with, three or four have progressed to levels where implementation of opportunities has begun. I've also worked with the Integrated Design Labs (IDL) on the design and construction of about 10 new facilities.

BetterBricks:Is there an example of one project that exemplifies energy efficient practices?

Hatten: St. Luke's Regional Medical Center in Boise is an ideal model for what tune-ups and recommissioning can do for existing hospitals. The energy savings is tremendous. For the first phase of diagnostics, we looked at the 10 largest air handlers and found electric and gas savings potential of well over $250,000 per year. This represents an energy cost reduction of about 5% of the annual energy cost of the facility. We're now in the thick of implementing operational changes to capture those savings.

BetterBricks: What's the typical range of possible energy cost reductions from a tune-up and improved O&M practices that you are seeing in hospitals?

Hatten: We typically see potential for a 10-20 percent cost reduction, especially when strategic energy management (SEM) initiatives have been championed at the executive management levels. A key piece of information to look for is some kind of realistic performance goal and it seems that 20 percent is a very realistic goal.

However, the potential energy savings is much greater in large facilities such as an integrated medical campus with a substantial amount of equipment that operates continuously serving spaces that have variations on occupancy patterns. There are opportunities to cut energy use in half within certain portions of the facility if it's being operated like a hospital. I look at a clinic space to determine whether it's operating in a way that matches typical acute care occupancy patterns or in a manner that actually syncs up to the clinic occupancy patterns. These two instances always have very discreet occupied and unoccupied periods.

It's not about finding more operating or capital dollars. Rather, it's simply about reallocating the operating budgets already approved.

BetterBricks: What's the range if you add in retrofits and capital projects?

Hatten: We typically see total savings potential in the range of 20-40 percent when we add in retrofits and capital projects. That said, it's important to note there's a general lack of knowledge with respect to what's possible with tune-ups and retro-commissioning.

Once these first few hospitals complete a comprehensive tune-up throughout their facility, we'll be able to analyze the data to determine if energy savings were underestimated. I will not be surprised if we find that our initial estimates of savings were conservative. As these efforts are completed and the savings are documented, it will be important for this information to flow back into the conversation within the hospital community - both through professional organizations as well as incentives that the utilities offer.

BetterBricks: What needs to happen to achieve a higher level of energy savings?

Hatten: We need some model efforts, testimonials and real results. We are all striving to get to a point where facility managers can call on one another as resources and ask the right questions. By the end of 2009, we'll have several of those case studies. This will begin to change the whole conversation internally within the hospital. As more success stories find their way to the ASHE conferences and the state engineering conferences, there's going to be momentum building up among other facility managers to achieve what these model projects have accomplished. They'll think, "if they can do it, why am I not looking at that?" It is going to start a market initiative that can't really kick off until we have a few of those model efforts in place with results documented and verified so that information can start being exchanged.

BetterBricks: What are the top energy cost savings opportunities from tune-up and improved O&M?

Hatten: Every time I walk into a facility, the first place I focus on is occupancy patterns. I want to know how the systems are zoned and scheduled, and if they are operating consistently when people are in the facility - this is true for both HVAC and lighting.

A big opportunity is to address lighting needs for the visual tasks being performed in a given space and understand lighting maintenance practices. Almost every facility has done a lighting retrofit project, so it's not about upgrading your lamp and ballast. Rather, it's about changing the way light levels are tuned and relamping is done. Lighting technology keeps marching on, which allows for group relamping to bump light levels up or down depending on the needs. In general, we're seeing a large potential to reduce lighting energy use.
The other big opportunity areas are on the HVAC side. There are three big categories, which are all different manifestations of set point optimization. The first category is to look at the kinds of pressure conditions the facility is trying to maintain in the air distribution system. Usually, the general report is a shortage of pressure from day one. On the surface, this interpretation of operating conditions seems accurate. However, once you look under the hood, the area turns out to be rife with savings opportunities. In response to a "I'm too hot" complaint, a common response might be to increase the pressure set point to force more air through rather than truly understand what's making that zone hot in the first place. Over time, we end up with a bunch of systems with pressure set point cranked to the max - occasionally at set points higher than what the system can deliver.
The second HVAC set point opportunity is on the temperature side. There're big potential savings here because there's a whole cascading series of interdependent temperature set points. Assess the set points starting at the space level then move to the group of set points that work internally to an air system. Know the temperature of the air being delivered and the temperature of the air as it enters into the air handling system. Finally, take a look at the set points that go back to the central plant - primarily the chiller plant. This also indirectly translates into questioning how much hospitals are running their chiller plants in cold weather conditions. It's not unusual for hospitals to run air conditioning when it's quite cold out. I tend to put this into a big opportunity category for temperature set points changes and optimization.
The last of the big three are the air flow set points. These set points happen at two places - at the outside air intake and at the zone level. At the outside air intake, it's important to know the minimum outside air set point in really cold or hot weather. What people think the set points are and how much is actually being brought in are usually two very different numbers. We aim to restore original design intent to the air flow system. At the zone level, it is important to know the minimum airflow set point on these variable load volume terminal units. Knowing if it is set to the appropriate range can inform the operator if it could it be set lower to save heating and cooling energy.

BetterBricks: In this economy, we imagine that low-cost and no-cost opportunities are of particular interest to customers. Do the opportunities you've described fall in this category and what is a typical return on investment for the hospitals of these activities?

Hatten: Cost dynamics are quite a bit different than what we've historical thought about in respect to energy projects. Typically, it costs more to do the diagnostics and investigation phase than it does to implement the findings. In that respect, these are no-and-low cost opportunities. Paybacks might be as quick as a couple of months or more typically in the 4-8 month range. When we talk about internal rate of return, it becomes ridiculous because it usually is 300-400 percent.

BetterBricks: How do you convince people?

Hatten: Well, a four month payback is usually pretty compelling. The obstacle is rarely the payback, but rather the upfront costs to get started on the diagnostics phase and where that money comes from. Once a facility gets started, the economics for a sustained effort should fall into place. It's kind of like pushing a sled down a hill - once you get started, it is self perpetuating.

We're really not talking about trying to justify an investment in a conventional way. We are talking about what I call "boot-strapping" your way to energy efficiency. The first step is to take a percentage of a hospital's operating budget and invest it in the organization and facility to start getting energy savings. These savings can be thought of as a revenue stream, and that revenue can be used to fund more savings and so on. Each time a subsequent step is completed, the revenue stream becomes bigger.

We are fundamentally changing the way large hospitals maintain their facilities and it's very appropriate to talk about this boot-strapping model.

Often times, a tune-up will uncover long standing problems with HVAC that have an adverse impact on indoor air quality, which is especially important in a hospital.

Ultimately, what they are doing is diverting some of the money they pay utilities to continue to reinvest and upgrade. It's quite a compelling vision, but it does imply some hesitation. Right now, it is still a little disconcerting to many folks who are accustomed to thinking of an energy project as a discreet thing just like building a new patient tower. What we are driving for is a new process, layered into the maintenance culture, that allows more dollars harvested from the existing operations budget to be reinvested in enhanced operations to improve energy efficiency over time.

It's a lifetime proposition, not a discreet project and "we're-done-with-it" kind of proposition. That's probably the biggest cultural shock I've observed in the conversation and the activities that we've had. We are changing a mindset.

BetterBricks: What does this mean for ongoing costs and new positions?

Hatten: Most advanced hospitals are starting to create resource conservation manager positions (RCM). This person is initially responsible for running the tune-up efforts and making sure implementation happens. It's incorrect to perceive this position as a cost at first. After the initial investment of the RCM's first-year salary while he or she establishes tune-up and improved O&M practices, this person then becomes a cost reduction because of the year after year savings. If the RCM leaves their position, the hospital will have to increase their operating budgets within a year because the persistence will be gone and they will be back consuming more energy.
It's more of a challenging concept to understand from the economic side. It is not about finding more operating or capital dollars. Rather, it's simply about reallocating the operating budgets already approved. Once a hospital starts this process, they are on a permanent reduced cost mode. Achieve the initial savings and keep those savings in place. It's that simple.

BetterBricks: How much does it cost for a large hospital to get started?

Hatten: Large hospitals typically need between $40,000 and $60,000 to get started with an acceptable scope of work. In the context of hospitals budget, that number isn't huge, but it has been an issue for some hospitals in the last couple of years. However, they must complete the first diagnostic and investigation phase and invest that money in order to reap the financial rewards down the line.

BetterBricks: What are the steps that need to be taken for the hospital to achieve these savings?

Hatten: This is really the BetterBricks model for energy savings. First, get commitment from the top of the organization down to communicate the organization's motivation to reduce the overall energy bill. This commitment creates a general line of accountability.

Second, assess what role tune-ups and retro-commissioning can play in achieving larger energy performance goals. Do the quick 50,000-foot-level energy assessment and determine how energy use compares to other hospitals. Collect information from facilities staff that has an operating history with the facility. Do a visual inspection and gather all relevant information to determine the opportunity areas.

The third step and most important, is moving from the assessment and scoping level to the first diagnostics effort, finding the funds to complete it and creating the action plan. By the time the action plan is fully implemented, it almost becomes a self-perpetuating program. There is some scope and planning discussion that needs to happen - defining who the team will be, what does the tune-up team look like, who is internal and external to the hospital, etc. The ideal situation is for the same team to work together on multiple efforts throughout the hospital.

Finally, close the loop on the first diagnostics and implementation with tracking and follow up. At the same time as implementation, have tracking, verification and persistence strategies in place. Some of that is education and training. Some of it is direct metering, sub-metering and monitoring. When the director of facilities is asked, "What have you done and how much energy has been saved," that director can very specifically provide data to illustrate the energy savings in each system. This step also sets the stage for the larger sharing of information with other institutions and professional organizations.

From there, simply repeat.

BetterBricks: Are there some aspects of this process that need to be accomplished by an outside service provider rather than internal operations staff?

Hatten: In my experience, I have not seen any tune-up effort that can be done completely internally - both large and small. It doesn't seem practical in the context of the hospital building operations staff time constraits who are maintaining the facilities. Conversely, I cannot conceive of a tune-up taking place without their involvement. The one exception is if the hospital has appointed or is considering hiring an internal resource conservation manager (RCM). That position can take on a larger position in tune-ups.

Ultimately, a diverse skill set is needed to address these operational issues. Usually, the team consists of someone who knows the control systems inside and out and someone who knows energy efficiency and energy engineering. The second person is able to take these observed deficiencies and translate them into energy cost savings. These two skills rarely land in the same organization. Some knowledge and experience on both the design side and the major construction side about general HVAC is also helpful.

BetterBricks: What additional benefits do you think hospitals gain from this kind of approach besides energy cost savings?

Hatten: Often times, a tune-up will uncover long standing problems with HVAC that have an adverse impact on indoor air quality, which is especially important in a hospital. Through this process, the facilities staff may discover that an air intake has been clogged or is bringing in pollutants. A major benefit to hospitals is to address these system problems. In large hospitals, certain systems are neglected and are not operating as they should. A tune-up sleuths out these failures, repairs them and ultimately puts the system back in balance.

Finally, the education and ongoing knowledge the internal maintenance staff gains from this process is profound. It's a safe bet that any maintenance person involved in a retro-commissioning effort will emerge with much more detailed knowledge of the systems than they had going into it. That's because of both the direct hands on experience, but also the supplemental training and educational opportunities that would be part of the BetterBricks model for tune-ups and enhanced O&M.

BetterBricks: Are any of these ideas being taught in engineering school?

Hatten: Good question! I recently met with Joel Loveland and Kevin Van Den Wymelenberg, both BetterBricks Integrated Design Lab directors, to discuss the current higher education infrastructure. Joel mentioned that 20 years ago there were four professors teaching building energy systems within the four major schools of engineering in the Northwest. Today, there's only one professor left and he's close to retirement. Unfortunately, there are no new professors to fill these empty spaces. Higher education has not developed the capability to teach this even in a limited way. In fact, the capability has declined over the last 20 years in the Northwest.

This will be a hot subject in higher education over the next ten years. It starts with funding, but it certainly doesn't end there. Conventional education will be insufficient to meet the growing demand. The first 5-10 years on the job is when people learn the significant skills and knowledge. I tend to look at the entire education process as that whole window, which has historically taken the best and brightest about 10 year and rest of us about 15-20 years. We have to figure out how to take a beginning student entering a program all the way to a practicing professional on the job in half the time. Really, it should be an exciting challenge for energy educators and absolutely paramount to driving market change.

Additional Tools & Resources:

BetterBricks Building Operations
BetterBricks Hospital
SOLARC Architecture & Engineering, Inc
Kaiser Permanente Case Study

File Attachment:

Interview with Mike Hatten

Fred Hutchinson Cancer Research Center

admin — Tue, 20 Jan 2009 12:24:21 +0000

By Katherine Morgan and Kathleen O'Brien, O'Brien & Company for NEEA's BetterBricks

As equipment and systems have developed more sophisticated controls and automation, a simple installation or programming error can have drastic implications on energy performance. The Building Commissioning Association defines the basic purpose of commissioning as "documented confirmation that building systems function in compliance with criteria set forth in the Project Documents to satisfy the owner's operational needs.Commissioning requires rigorous testing and measurement to ensure that building systems are working as intended

Since 1988, the Fred Hutchinson Cancer Research Center has embraced sustainable building and facilitymanagement strategies with $6 million investment. A lot to spend? Not when it's bringing over $1 million in annual electricity savings and another half-million in annual water and natural gas savings. Figure in incentives from Seattle City Light and Puget Sound Energy and payback has been less than three years. For the Hutchinson Center, that means more money for cutting edge cancer research.

Healthy, high-performance physical environments are a vital part of the Hutchinson Center's mission to cure cancer. As Winston Churchill said, "We shape our buildings, and our buildings shape us." So why not a hospital facility that joins in the pro-health mission? High performance buildings also help attract and retain world-class research scientists, such as the three Nobel prize winners the Center now boasts. With 3,000 researchers, staff and patients spread across 13 buildings with a combined 1.3 million square feet of space, and more to come, Hutchinson's operations staff knew there was plenty of energy to be saved through a host of systems upgrades, electronic controls that allow room-by-room tuning of temperature and air changes to maximize efficiency, and investments in renewable energy.

Fred Hutchinson has undertaken 43 individual efficiency measures as part of new construction and 80 retrofit measures.

With its existing buildings, the Center utilized an innovative approach to using less energy by tying the heating and air conditioning systems as well as the lighting circuit to occupancy sensors that shut off when no one is in the room. It's reaped $42,000 dollars in annual energy savings.

The Center also has upheld its new buildings to a high energy-efficiency standard. The recently completed Public Health Science Building, designed by Portland's Zimmer Gunsul Frasca Partnership, achieved LEED certification from the US Green Building Council despite the client deciding to pursue the accreditation halfway through construction. The Center has also embraced the "Laboratories for the 21st Century" program, a joint initiative of the US Environmental Protection Agency US Department of Energy to save energy in this heavily energy-dependent building type.

While it is very important in a high tech laboratory setting to manage risk when implementing new measures, the Center's success demonstrates the possibilities available through meticulous management of resource consumption. All new building projects are designed with an eye towards conserving resources, integrating experienced facilities staff in the design process-particularly through the commissioning process. The Center also uses building occupant feedback to guide continuous improvements.

Efficient use of resources and minimizing negative environmental impacts are core components of the Center's overall mission. This gives the facilities team a mandate to regularly pursue conservation opportunities as part of their general operations. Facilities staff members receive intensive training when a new building is being brought on-line and continuing during regular operations. New ideas are brought forward, tested and evaluated, and then implemented incrementally to allow field-testing.

"It's critical to keep current with the technology and vigilant of the utility rate," says Bob Cowan, Facilities Engineering manager for the Fred Hutchinson Cancer Research Center. "It pays to do the math every four to five years to identify opportunities. Tools, technologies and costs all change and the cost of not doing something increases as rates go up. Suddenly the payback might justify the project."

The PHS Building, for example, was commissioned by a team of representatives from the engineering contractor (Applied Engineering Inc.), the Center's in-house engineering department, general contractor Turner Construction, and various subcontractors. "It worked well to use a team approach," Cowan says. "It allowed for quick resolution, since adjustments could be made as problems were identified."

Every effort is also made to hire highly experienced, talented engineering staff for the Center. "Bob is great at recognizing employees' efforts to provide excellent service," says Jim Walker, an engineer at Fred Hutchinson. "It fosters a sense of ownership and responsibility, so the team looks beyond their specific duties to identify additional maintenance needs or flag potential problems during the course of their scheduled work." This approach has created internal champions for energy efficiency who contribute significantly to the organization's accomplishments.

In a huge venture such as the Fred Hutchinson Cancer Research Center, these process strategies are vital to the effectiveness of the conservation measures themselves. Certainly they are fundamental to the Center's nearly twenty-year success story.

New Hospital Design & Construction

admin — Tue, 20 Jan 2009 15:31:56 +0000

Targeting 100! Envisioning the High Performance Hospital: Implications for a New, Low Energy, High Performance Prototype
This groundbreaking new research effort reveals how hospitals, which account for four percent of all energy consumed in the U.S., can achieve a 60 percent reduction in energy utility use by redesigning the way they use energy. The most salient outcome of this work is the definition of a process that brings together architectural, mechanical and central plant systems to deliver significant efficiencies. Download materials here:

Targeting 100! Executive Summary
Targeting 100! full report
Energy in Healthcare Fact Sheet
Targeting 100 Infographic
Oregon Health & Science University's (OHSU) Center for Health & Healing
The LEED Platinum Oregon Health & Science University's Center for Health & Healing maintains a significant position in Portland's portfolio of green buildings. Occupied since October 2006, it was developed with goals to provide cutting-edge health and wellness technology in an environmentally responsible building. In late 2008, the facility underwent a post occupancy evaluation, which revealed impressive energy savings.

Additional OHSU Center for Health & Healing Case Studies:

Fred Hutchinson Cancer Research Center
Fred Hutchinson Cancer Research Center's investment in efficiency delivers over a million dollars in annual electricity savings, and another nearly half million dollars in annual water and natural gas savings. This means more money for cancer research.

Othello Community Hospital
Othello Community Hospital in Othello, Washington was faced with a life and death decision in 1998 - die economically or expand its services. The owners elected to expand and constructed a three-story, 54,000 square-foot, state-of-the-art medical facility addition to their current building.

The Top 10 Green Hospitals in the US: 2006
By taking up green practices, whether incrementally or from the ground up, many hospitals are managing to lower energy bills, reduce waste and achieve healthier indoor air.

How Hospital Design Saves Lives
Design changes can cut infection rates, lower physician errors, improve staff performance, and make all the difference in delivering care.

Strategic Energy Management Planning

admin — Tue, 20 Jan 2009 15:30:11 +0000

Healthcare: A Business & Ethical Case for Sustainability
The U.S. healthcare sector is at a crossroads in resource management. Accounting for nearly a tenth of the country's CO2 emissions and facing rising energy costs, the healthcare industry is embracing energy efficiency as a viable and cost effective path to improve margins and reduce the impacts from their own building operations. Leading healthcare systems now recognize that to provide the highest quality of care, they have a moral and ethical responsibility to contribute to health - inside and outside hospital walls.

Legacy Health Identifies $1.3 Million A Year in Energy Savings
Legacy Health in Oregon underwent a three year Strategic Energy Management Plan yielding potential and realized savings of more than $1.3 million per year. Now on track to reduce energy use intensity by 10 percent per square foot, Legacy is a model health system for sustainability and resource management.

The Business Imperative for Sustainability: The Seven Critical Success Factors
Sustainability resource management is no longer an option. It's a business, societal and global imperative. Sustainability is now the touchstone for system-wide innovation. This article identifies seven critical success factors for maximizing sustainable resource management planning, development, implementation and success.

Willamette Falls Hospital
Once the facility director at Oregon City's Willamette Falls Hospital figured out how to present energy management to hospital administrators as solid return on investment, there was no looking back. He's now mapped out a strategic energy management plan that will cut energy use 25% and save the hospital over $95,000 in three years through a combination of tightened-up O&M and needed capital improvements.

Saint Alphonsus Regional Medical Center
An engineering manager at Boise's St. Alphonsus Regional Medical Center learned to use persuasive financial arguments and irresistible utility incentives to convince administrators that energy management could improve the hospital's bottom line. Operational changes and capital investments are expected to reduce energy consumption by 25% and save the hospital up to $2.5 million over five years.

Eastern Washington Providence Health & Services
Five very different Eastern Washington Providence Health & Services hospitals - ranging from small critical-care facilities to the second-largest hospital in the state - came together to develop a single, system-wide strategic energy management plan that will reduce energy use through O&M practice changes and cost-effective capital improvements, saving up to $200,000 a year.

PeaceHealth Commits to Energy Efficiency through SEMP
Seven PeaceHealth hospitals in Oregon,Washington, and Alaska approached energy management on a hospital-by-hospital basis until a CEO asked them to tackle a systemwide strategic energy management plan. The hospitals anticipate that they can reduce energy use 10% and eventually save $800,000 annually, mostly through equipment tune-ups, turndowns, and turn-offs.

PeaceHealth Commits to Energy Efficiency through SEMP

admin — Tue, 20 Jan 2009 11:35:43 +0000

Download a PDF of this story

PeaceHealth's system casts a wide net, serving communities in Oregon, Washington and Alaska through seven hospitals totaling about 1,000 beds. Although joined through their PeaceHealth affiliation, the hospitals have been largely regionally operated, with each individual hospital managing its own facilities. This independence also extended to energy management.

"If a project came up, we'd price it out, gather information on utility rebates and present it for funding, all at the local hospital level," explains Gary Hall, vice president of facility services for PeaceHealth's Lower Columbia Region, headquartered at St. John Medical Center, Longview, Washington. "There was no system-wide strategic plan behind it. Even with utility incentives, funding by the individual hospitals was usually hit-or-miss," says Hall. "There were limited capital resources for these projects and hospital clinical equipment always had first priority."

A few years ago, PeaceHealth decided that its hospitals could operate more efficiently if procurement and other facilities policies were standardized and it organized a system-wide Facilities Counterpart Group (FCG) to ensure consistency. The FCG, which includes facility managers from each of the PeaceHealth hospitals as well as PeaceHealth's regional vice presidents of facilities, quickly shouldered a number of projects, ranging from standardization of nurse-call systems to development of a master list of pre-approved building services contractors.

But energy management was not yet on the team's agenda until Medrice Coluccio, FCG sponsor and Lower Columbia Region PeaceHealth CEO, heard about BetterBricks' Strategic Energy Management Plan (SEMP) and recognized that it was a perfect fit for PeaceHealth.

"An energy management strategy is an opportunity for terrific hospital savings and a system-wide plan provides a strong focus, synergy and a way to parlay the knowledge of our facilities people across our entire hospital system," said Coluccio.

She asked the FCG to consider the benefits of BetterBricks' strategic approach and the value was seen immediately. The team signed a letter of intent to develop a SEMP and spent the next year carefully crafting its plan. As part of the process, all PeaceHealth hospitals were benchmarked and two representative facilities - a hospital and a medical office building - were surveyed for energy-saving opportunities.

Based on the results, the FCG determined that a cumulative 10 percent reduction in energy use could be attained by incremental efforts over three years. After three years this could lead to a savings for PeaceHealth of up to $800,000 a year system-wide.

"These are dollars saved directly to the bottom line," says Hall, adding, "It's like we're generating brand new revenue."

PeaceHealth is now in the second year of implementing their system-wide SEMP and in the first year, they achieved a three percent reduction in energy consumption, representing $240, 000 in energy savings.

The individual hospitals are now plotting precisely how they'll implement the plan at their facilities, assisted by detailed building engineering analyses, as well as technical support from their regional utility providers: the Bonneville Power Administration, Cowlitz Public Utility District, Eugene Water & Electric Board, and Puget Sound Energy.

As part of SEMP implementation of new construction projects, PeaceHealth created a master template for Request for Proposals (RFP) that includes energy and resource efficiency selection criteria. The RFP's are required in all regions for projects above $1 million. The anticipated outcome of this addition to the PeaceHealth RFP process is competitive bids from design and construction teams with energy efficiency expertise.

This new RFP process helped identify an architecture firm for the new PeaceHealth medical office building, Lakefront Medical Office Park, located in Longview, Washington, which will be constructed in 2009 and will achieve a LEED silver certification.

"The SEMP adds the dimension of being able to see savings over the life of the building," said Scott Tang, system project manager for PeaceHealth. "In the past, we would have designed and constructed a building based on cost alone, but now with SEMP it allows us to design an energy efficient building from the ground up that will be easier to benchmark and monitor over the years."

SEMP strategies have also been implemented in existing buildings' operations and maintenance practices.

"Mostly, facilities maintenance staff just run equipment, they don't fine tune it," explains Hall, "but our analyses show that hospital recommissioning will give us the biggest bang for the buck. We anticipate annual savings of $450,000 - over half our goal - just from tuning up the equipment we already have."

At St. Joseph's Hospital in Bellingham, Washington, building diagnostics and tune up work has already been completed on the North Tower of the facility. R. Scott Dorough, resource conservation manager for St. Joseph, has already noticed a dramatic improvement in operations..

"We started out with the most cost-effective changes first; things like replacing outdated light fixtures, changing filters, cleaning coils, replacing gaskets," said Dorough. "The small changes really add up, especially if you do them system-wide."

Hall notes that PeaceHealth's SEMP calls for review of O&M practices, sharing of best practices and retraining staff to adopt new behaviors. As for new capital investments, lifecycle costing and financial hurdle rates will be used to vet all energy-related projects.

The hospital facility managers have their work cut out for them, but Hall is confident that with the new strategic plan, they'll reach their goal.

"A written, agreed-upon strategic plan is something you can follow, month after month, year after year. Every hospital faces the fires of the day, but you always come back to the plan. It's the relentless 'how are we doing, how are we coming along?' discussion that helps us all stay on track."

CEO Coluccio agrees: "A strategic plan like this can't be shelved. It has to be executed." And PeaceHealth is already seeing benefits from a cohesive, focused SEMP.

Eastern Washington Providence Health & Services

admin — Tue, 20 Jan 2009 11:37:51 +0000

Download a PDF of this story

Five very different Eastern Washington Providence Health & Services hospitals - ranging from small critical-care facilities to the second largest hospital in the state - came together to develop a single, systemwide strategic energy management plan that will reduce energy use through O&M practice changes and cost-effective capital improvements, saving up to $200,000 a year.

A monthly conference call to discuss mutual issues is a long-standing routine for facilities managers at Providence Health & Services' five Eastern Washington hospitals. The hospitals range from Spokane's 623-bed, 2 million-sq-ft Sacred Heart Medical Center - second largest in the state - and 272-bed Holy Family Hospital, to three critical-care hospitals with 25 beds each: Mount Carmel Hospital in Colville, St. Joseph's Hospital in Chewelah, and Deer Park Hospital in Deer Park. Decidedly different hospitals, yet they share a common goal: stewardship of resources, including energy.

"Hospitals are among the most energy-intensive buildings, but we want to be role models to our communities, to be the best neighbors that we can possibly be. We certainly don't want to be the energy hog on the hill," says Phil Kercher, manager of facilities at Sacred Heart.

Energy management has always been an item on the hospitals' conference-call agenda, and each hospital has pursued it in its own way, doing its best with available budgets and staff. Several of the hospitals have improved lighting, HVAC systems, and building controls; three have benchmarked their energy use; and three have earned EPA ENERGY STAR® ratings.

But the five hospitals' diverse approaches converged when they learned about BetterBricks' Strategic Energy Management Plan (SEMP). "Before the strategic plan, each individual hospital relied on an individual within that hospital to get its energy management practices off the ground," explains Kercher, who heard of SEMP at a Washington State Society of Healthcare Engineers conference, and helped spread the word among his fellow facilities managers.

"We all recognized that BetterBricks' strategic approach could formalize our commitment to energy management and provide our five hospitals with a ready-made structure for making this a systemwide goal rather than a single-hospital goal," says Kercher, adding, "Structure is our friend: with SEMP, we can set common goals, get funding commitment, and have an agreed-upon standard for measuring our energy performance." Tom Nance, facilities manager at St. Joseph's Hospital, points out, "A strategic plan helps educate hospital decisionmakers." And Kercher notes, "A formal strategic plan brings everybody on board, from the top down. It gives energy management increased credibility with hospital administrators. It builds credibility with other departments: doctors and nurses can see that energy efficiency and comfort can coexist, that you're not trying to make them work in the dark or in the cold. A structured plan guarantees the cooperation and commitment of the facilities department staff. It sends a message to our patients that we want them to be comfortable, and it sends a message to our community that we care about the environment."

Using BetterBricks SEMP tools plus assistance from local utility Avista, the facilities managers developed a single strategic plan for energy management at all five hospitals. The plan's goal is a 5% reduction in yearly energy use, a modest goal that takes the hospitals' previous energy management efforts into account. The reduction will save about $200,000 annually among the five hospitals, and at 6% net operating income, the reduction would equal some $3.3 million in new gross revenues every year. "That's how we're using the language of financial administrators to make the business case for energy management," says Kercher.

The plan, now awaiting final approval, allows the individual hospitals latitude in how to reach this goal, but all will begin by tracking, monitoring, and troubleshooting energy use with an energy accounting system. The five hospitals are also surveying their day-to-day operation and maintenance practices to identify low-cost/no-cost energy savings opportunities.

"All the hospital buildings were built at different times, with different operating systems, and each of those systems has a different sweet spot. We have to figure out how to get the best possible performance from each of our hospitals," explains Tom Nance.

Surveys at two hospitals are already completed, and prime opportunities include fan shutdown schedules for such areas as outpatient clinics and offices; maintenance programs for keeping heating and cooling coils dust free; and steam-trap maintenance programs. The surveys are also identifying cost-effective capital projects, including exchanging inefficient lamps and ballasts for high-efficiency replacements.

There's a long road ahead, but as Kercher advises fellow facilities managers, "A strategic plan is your roadmap to energy management success."

Saint Alphonsus Regional Medical Center

admin — Tue, 20 Jan 2009 11:32:03 +0000

Download a PDF of this story

An engineering manager at Boise's Saint Alphonsus Regional Medical Center learned to use persuasive financial arguments and irresistible utility incentives to convince administrators that energy management could improve the hospital's bottom line. Operational changes and capital investments are expected to reduce energy consumption by 25% and save the hospital up to $2.5 million over five years.

Bill Morgan, engineering manager at Saint Alphonsus Regional Medical Center, Boise, Idaho, and past president of the American Society for Healthcare Engineering, knows that managing energy use is a dependable way for hospitals to save money. Yet it takes money to save money, and he's aware that most hospitals have little funding available to invest in energy management.

"It costs a lot to run a hospital, and there's not much left over," acknowledges Morgan: "Any extra usually goes to new MRI machines and CT scanners. You're competing against a never-ending stream of new clinical technology."

When Morgan arrived at Saint Alphonsus, the 358-bed hospital was building a new patient tower, so there was even less chance of funding energy management efforts from the hospital's capital pool: "Too many feeding at the trough," explains Morgan.

The situation began to change when natural gas prices climbed the winter after Hurricane Katrina, just as St. Alphonsus was using large amounts of natural gas to cure fire-stop materials during tower construction. "Gas prices doubled right when our consumption doubled," recalls Morgan, who recognized new possibilities for persuasion.

But the engineering manager's breakthrough came when he found out about BetterBricks' strategic approach to energy management, and the tools available to help develop a strategic plan and enlist needed top-level support. "For me, that was the turning point," says Morgan. "I learned how to make a well-planned financial case for energy management, one that clearly demonstrates how it can directly contribute to the hospital's bottom line. Engineers may hate me for saying this, but engineers are not money people. Yet when you talk with financial people, you need to show up with financial arguments to get your idea across. If you don't understand finance - learn it."

Morgan also learned to tap into any and all additional sources of project funding, including support from his local electric utility, Idaho Power. "Utility support means a hospital doesn't have to foot the entire bill," says Morgan.

Using these strategies, Morgan floated a proposal to install energy-efficient variable-frequency drives on two large central air-handling units that would help support the new tower. "We presented a quick two-year payback, with annual electricity savings of $75,000," says Morgan, and the proposal included a commitment from Idaho Power to pay fully half the capital cost.

"Idaho Power's $81,000 check made the project irresistable," says Morgan. Hospital administrators were beginning to see energy management the way Morgan saw it - a source of revenue - and they gave the okay.

This project paved the way for a more ambitious strategic proposal: an engineering analysis of Saint Alphonsus' 1970s-vintage South Tower to identify energy management opportunities. The hospital had planned to renovate this older tower once the new tower was built, and now energy-saving improvements might help pay for renovation, suggested Morgan.

Idaho Power again sweetened the deal by offering to fund nearly half the cost of the study by one of BetterBricks' Integrated Design Labs. Saint Alphonsus gave its assent, and several months later received word that the Boise lab had identified improvements that could save the hospital up to 25% a year in energy consumption, annually adding back as much as $500,000 to the bottom line. Best of all, many of the improvements were no-cost/low-cost operation and maintenance practice changes rather than capital projects.

Thinking big, Morgan is now using BetterBricks tools to develop a Strategic Energy Management Plan (SEMP) to carry out as many of the capital and operational improvements as possible. If all are implemented, Saint Alphonsus could save a total of $2.5 million over five years. Morgan hopes to persuade hospital administrators to fund these efforts by reinvesting energy cost savings: "I want to roll operational savings back into capital projects."

His facilities team has already begun making inexpensive, hospitalwide O&M practice changes: "For example, we're reviewing our HVAC system operational programs, set points, chilled water and reheat temperatures, and outside air percentages," says Morgan. Even newly installed systems such as the chillers that support the latest hospital tower are under scrutiny.

Morgan's final advice to fellow facilities engineers and managers: "Don't think with the narrow focus of 'I've got to upgrade my boiler.' Develop a comprehensive strategic plan, use financials to make a passionate presentation to management, and get them to commit."

SEMP Tools & Resources

admin — Fri, 12 Dec 2008 15:58:54 +0000

Assessment Tools(see SEMP Step 1)

ENERGY STAR® Portfolio Manager
Compares the current energy use of your facility to other similar hospitals. Use it to "score" your hospital's energy performance, and to estimate energy savings and carbon reductions.

Energy Practice Checklist
This tool involves gathering information for your SEMP on current energy management practices and how they could be improved. The information will be used to develop your SEMP.

Planning Tools (see SEMP Step 2,Step 3 and Step 4)

Think Like Your Hospital Executives
Tips and strategies from hospital facility directors on getting executives' attention and asking concisely and convincingly for what you want.

The Business Imperative for Sustainability: The Seven Critical Success Factors
Identifies seven critical success factors for maximizing sustainable resource management planning, development, implementation and success.

SEMP Template and Workplan
Use this tool to develop your organization's Strategic Energy Management Plan.

Sample Executive SEMP Presentation (PowerPoint download)
Use this as a template to develop your own executive presentation to obtain SEMP approval

Financial Tools (see SEMP Step 5)

Life-Cycle Cost Analysis Versus Simple Payback: Why, When, How
This tool includes a discussion of the advantages and disadvantages of LCCA versus SPB. Also provides guidelines on when to use SPB and LCCA.

LCCA Spreadsheet

For simpler Life-Cycle Cost Analysis, use this spreadsheet.

eVALUator
A web-based tool for a more complex life-cycle cost analysis.

Guide to Optimizing Your Hospital Facility Investments
A detailed guide to understanding and applying LCCA plus a range of financing options.

Purchasing Tools (see SEMP Step 5)

Setting Up an Energy Efficient Purchasing (EEP) Process
This tool will help you determine who needs to be involved, how to set priorities, communicating with staff, sample policy language.

Energy Efficient Equipment Purchasing Guidelines
Covers over 20 energy-related types of equipment. Includes "no brainers" for cost-effective purchases, tips and cautions for purchase and application, and recommended specification content.

Air Filter Comparison CalculatorandChiller Total Cost of Ownership Calculator
These tools help you and your vendors work together to choose the equipment that meets your needs at the lowest Total Cost of Ownership.

Operations & Maintenance Tools (see SEMP Step 5)

Top Five No Cost / Low Cost Energy Savings Opportunities
Cost reductions from tune-ups of energy related systems and improved operations and maintenance practices in hospitals typically garner 10-20% energy cost reductions. With a return on investment of 150-300%, these measures can quickly save energy and reduce costs.

What is Enhanced Operations and Maintenance?
This brief overview compares the features of conventional O&M and enhanced O&M.

Better Building Operations
The building operations portion of the BetterBricks web site has information for both building operators and service providers.

Design & Construction Tools (see SEMP Step 5)

Guide to the Design and Construction of High Performance Hospitals
Describes why and how to use "Integrated Design" as a technique and process essential to helping achieve high performance facilities on time, within budget and with less risk.

Sample Request for Qualifications and Proposal for Hospital Facility Development
Download and adapt next time you need to hire architectural / engineering services for new hospital facility development.

High Performance Building Design Charrette and Sample Agenda
How-to-guide on organizing and running a design charrette. Helps define what it is, when it should occur, who should participate, role of the owner, and desired outcomes. Includes a sample charrette agenda.

Taking a Strategic Approach to Capital Upgrades
This tool gives key recommendations to help you optimize overall energy savings, financial returns, and other benefits.

Green Guide to Healthcare (GGHC)
The GGHC's structure is borrowed by agreement from the U.S. Green Building Council's LEED program but is self-certifying and tailored for healthcare.

Staff and Public Awareness Tools (see SEMP Step 5)

Communications Quick Sheet
Tested practices to engage staff in activities that save energy, conserve water, and reduce waste.

Additional Resources to help with Staff and Public Awareness

ENERGY STAR Challenge Toolkit
Natural Resource Canada's Guide to Implementing an Energy Efficiency Awareness Program
Hospitals for a Healthy Environment's Partners Toolbox

Tracking & Recognition Tools (see Step 6)

ENERGY STAR® Portfolio Manager
See Assessment Tools. Use to establish a baseline score and then re-score annually to track progress.

Energy Practice Checklist
See assessment Tools. Track progress change with this tool.

Software Tools
For utility bill tracking, benchmarking, and trend logging at the building operations portion of the BetterBricks site.

The Carrot Principle
Adrian Gostick and Chester Elton. Free Press (Simon + Schuster) 2007. Talks about the importance of recognition and rewards in motivating staff.

Case Studies

admin — Mon, 08 Dec 2008 11:19:34 +0000

Providence Newberg
The new Providence Newberg Medical Center, stands out as an example of how to design, and just as importantly, finance a high performance hospital.

Mercy Medical
Improvements save Mercy Medical Center in Roseburg $71,300 annually in energy costs. Teamwork, cost-conscious, long-term planning and implementation make this hospital a model for a high performance hospital.

New Construction Projects

admin — Fri, 21 Nov 2008 13:16:48 +0000

Oregon Health Sciences University Health and Healing Center (OHSU)
The LEED Platinum Oregon Health & Science University's Center for Health & Healing demonstrates energy-efficient building and environmental sustainability.

Green Revelation: Boulder's 'Environmentally Responsible' Hospital
One factor driving the green building boom is the realization among industry leaders that easy on the environment does not necessarily mean rough on the bank account.

Fred Hutchinson Cancer Research Center
Fred Hutchinson Cancer Research Center's investment in efficiency delivers over a million dollars annual electricity savings, and another nearly half million dollars in annual water and natural gas savings. This means more money for cancer research.

Othello Community Hospital
Othello Community Hospital in Othello, Washington was faced with a life and death decision in 1998 - die economically or expand its services. The owners elected to expand and constructed a three-story, 54,000 square-foot, state-of-the-art medical facility addition to their current building.

The Top 10 Green Hospitals in the US: 2006
By taking up green practices, whether incrementally or from the ground up, many hospitals are managing to lower energy bills, reduce waste and achieve healthier indoor air.

How Hospital Design Saves Lives
Design changes can cut infection rates, lower physician errors, improve staff performance, and make all the difference in delivering care.

Additional Partners & Resources

admin — Tue, 18 Nov 2008 16:24:39 +0000

How to Save Energy (and Money): An Audio Interview
Jennifer Stout, healthcare market mananger for BetterBricks, discusses how to help hospitals save not only energy, but also money. Listen to the full interview on HealthLeadersMedia.com.

Your HVAC Could Save you Millions
As CFO's look for innovative ways to trim expenses from the budget, they should look no further than the HVAC and lighting systems. For the full story, visit HealthLeadersMedia.com.

Center for Health Design and the Pebble Project
Through research, education, advocacy and technical assistance, The Center for Health Design supports healthcare and design professionals all over the world in their quest to improve the quality of healthcare through evidence-based building design.

Green Guide for Healthcare (GGHC)
GGHC is a best practices guide for healthy and sustainable building design, construction, and operations for the healthcare industry.

Health Care Without Harm
A global coalition of 443 organizations in 52 countries working to protect health by reducing pollution in the health care industry.

Hospitals for a Healthy Environment (H2E)
Hospitals for a Health Environment (H2E), the Green Guide for Health Care, and the Health Care Clean Energy Exchange are creating a national movement for environmental sustainability in health care.

Values-Driven Design and Construction: Enriching Community Benefits through Green Hospitals
Paper by Robin Guenther, FAIA, Gail Vittori, and Cynthia Atwood. Presented by The Center for Health Design® and Health Care Without Harm at a conference sponsored by the Robert Wood Johnson Foundation, September 2006.

Leadership in Energy and Environmental Design (LEED)
LEED Green Building Rating System™ encourages and accelerates global adoption of sustainable green building and development practices through the creation and implementation of universally understood and accepted tools and performance criteria.

American Society for Healthcare Engineering
Dedicated to optimizing the healthcare physical environment.

Northwest Hospital Engineering Associations

Northwest Hospitals Associations

Better Building Performance

admin — Wed, 02 Jul 2008 17:36:06 +0000

Kaiser Permanente's East Interstate Medical Office
After implementing Enhanced O&M and Building Tune-up strategies, Kaiser was able to reduce its occupant complaints by nearly 23%. Now with a comfortable building, both staff and patients can relax and focus on the important work of getting well.

Mercy Medical Center
Improvements save Mercy Medical Center in Roseburg $71,300 annually in energy costs. Teamwork, cost-conscious, long-term planning and implementation make this hospital a model for a high performance hospital.

Sacred Heart Receives ENERGY STAR Award
For a second time, Sacred Heart Medical Center has received the Environmental Protection Agency's ENERGY STAR recognition for its low energy use per-square-foot of space.

Charles Lemoyne
The energy efficiency upgrade program is part of the Canadian Council on Health Services Accreditation's overall management approach and is yielding tangible results. Annual energy saving at the Charles LeMoyne Hospital are estimated to be $360,000.

SEMP

admin — Wed, 02 Jul 2008 17:35:43 +0000

Willamette Falls Hospital
Once the facility director at Oregon City's Willamette Falls Hospital figured out how to present energy management to hospital administrators as solid return on investment, there was no looking back. He's now mapped out a strategic energy management plan that will cut energy use 25% and save the hospital over $95,000 in three years through a combination of tightened-up O&M and needed capital improvements.

St. Alphonsus Regional Medical Center
An engineering manager at Boise's St. Alphonsus Regional Medical Center learned to use persuasive financial arguments and irresistable utility incentives to convince administrators that energy management could improve the hospital's bottom line. Operational changes and capital investments are expected to reduce energy consumption by 25% and save the hospital up to $2.5 million over five years.

Providence Health & Services Eastern Washington
Five very different Eastern Washington Providence Health & Services hospitals - ranging from small critical-care facilities to the second-largest hospital in the state - came together to develop a single, systemwide strategic energy management plan that will reduce energy use through O&M practice changes and cost-effective capital improvements, saving up to $200,000 a year.

PeaceHealth
Seven PeaceHealth hospitals in Oregon,Washington, and Alaska approached energy management on a hospitalby-hospital basis until a CEO asked them to tackle a systemwide strategic energy management plan. The hospitals anticipate that they can reduce energy use 10% and eventually save $800,000 annually, mostly through equipment tune-ups, turndowns, and turn-offs.