Hospitals and health systems are extending their efforts to embrace environmental sustainability, especially when it comes to energy consumption, according to the 2015 Health Facilities Management Sustainable Operations Survey conducted with the American Society for Healthcare Engineering and the Association for the Healthcare Environment. They’re making progress in such methods as installing light-emitting diode (LED) exit signs, commissioning or retrocommissioning buildings, upgrading building control and automation systems, and recycling everything from cardboard to electronic waste. “Once [hospitals] have implemented the basic components of energy conservation — the low-hanging fruit — then they are in a position to move to the next level,” says Robin Guenther, a principal in the architecture firm Perkins+Will. That might include purchasing big-ticket items, securing adequate staffing and developing comprehensive sustainability programs.