When Rey Tuazon analyzes electricity and gas bills for Adventist Midwest Health, a four-hospital system serving the western suburbs of Chicago, he is just as valuable to the organization as is a busy physician.

"The mission of the hospital, of course, is saving peoples' lives, and I am part of the mission," says Tuazon, the system's regional energy utilities consultant. "My regional budget is around $6 million for the four hospitals and if I can save $1 million or $1.5 million, then I'm doing my job and supporting the mission."

That savings may be used to buy medical equipment, hire clinicians or keep premiums in the community lower. "If you save $1 million, that's equal to at least $25 million of revenue, and that's a lot of patients that you have to see to make that same million dollars," says Cathy Fischer, chair of Envision, an energy management subsidiary of Gundersen Health System, La Crosse, Wis.

Even more important, health systems that reduce energy consumption make their communities healthier.

"One of our major challenges in our community is asthma, and we are addressing that by utilizing less energy and, therefore, putting fewer toxins into the air," says Kay Winokur, vice president of quality and professional services and co-chair of the green committee at Beaumont Health System in the Detroit market.
This year, Gundersen will become the nation's first energy-independent health system, meaning that it will produce more energy than it consumes from fossil fuel sources. In addition to supporting the local economy through its renewable projects, Gundersen serves as a role model for its community.

"We do a lot of tours, a lot of teaching and we are out in the community interfacing with people who are supporting sustainability," Fischer says. "It really provides an opportunity for us to teach the young and old about sustainability and the benefits to them and to our community."

While being energy-independent may be out of reach for most health systems, dramatic energy savings are not. Jeff Rich, executive director of Gundersen's Envision program, says health care facilities, which are about 2.5 times more energy-intensive than commercial office buildings, may be among the highest energy wasters in the land.

"Most health systems can save 20 to 30 percent of their energy costs by becoming more energy-efficient, compared [with that of] their benchmark institutions," he says.

Building Green

The board of directors for PeaceHealth, a nine-hospital system serving Washington, Oregon and Alaska, made sustainability a priority when it adopted a strategic energy management plan, or SEMP, in 2007. Among other things, the plan helps to expedite decisions that support energy conservation, says Gary Hall, system director of facilities and construction for PeaceHealth.

"We typically prioritize the investment for anything that has a 20 percent or higher return on investment," he says. "And if we have something that is a 50 percent or higher return on investment, that falls into the immediate-action category. That is our guiding principle."

PeaceHealth's three-year SEMP was developed in conjunction with the Northwest Energy Efficiency Alliance, a nonprofit alliance of utilities and energy-efficiency organizations working to accelerate energy-efficiency efforts. Cynthia Putnam, the NEEA consultant who worked with PeaceHealth, says all regions of the country have similar alliances.

An energy management plan involves benchmarking a health system's current energy use and practices against other health care facilities, setting annual energy-efficiency goals and identifying projects needed to achieve those goals, Putnam says. Progress is tracked throughout the plan's duration.

"At PeaceHealth, the team met quarterly for three years to monitor how they were doing," she says.

In developing its SEMP, hospital-level and system-level facility managers surveyed buildings to determine that energy use could be reduced by 10 percent via incremental efforts over three years, generating $800,000 in savings annually.

Much of that savings has been achieved through what Hall calls retrocommissioning. "That is basically taking the existing building systems that we have and putting them back into a fine-tuned operating mode," he says. "It is kind of low-hanging fruit. This does not take a lot of investment, but just some focused time to get systems operating efficiently."

For example, reprogramming a building's air handler to run 10 hours a day instead of 24 hours is a no-cost energy saver. In another situation, PeaceHealth combined $300,000 of its own money with a $200,000 matching grant from a utility company to buy computerized building controls.

"I really would urge boards and administrations throughout the country to look for grants, because there is a lot of grant money available for these projects," Hall says. "This particular project had a 1.5-year payback."

PeaceHealth's SEMP also requires that any project that costs at least $1 million must include energy- and resource-efficiency criteria to evaluate proposals from design and construction teams. That process helped its newest hospital — the 10-bed Peace Island Medical Center on San Juan Island — to be built as one of the most energy-efficient hospitals in North America.

"Everything on an island is basically self-contained, so all of the resources are precious," Hall says. "We looked at how we could make that project as efficient as we could, not only to conserve the island's resources, but to have minimal operating costs moving forward."

In addition to a ground-source heat pump, the hospital has low-flow sinks and toilets, an orientation to the sun that allows for passive heating and cooling, and natural ventilation through operable windows. The result: annual energy use that is an estimated 63 percent less than the average hospital of a similar size in the Pacific Northwest.

Rethinking Energy Use

In the Detroit area, many of Beaumont's energy-efficiency initiatives have come from a culture change that makes sustainability a systemwide value [see Beaumont Employees Lead Green Brigade, Page 13]. But the system's board also has supported major investments designed to reduce energy use.

"The green and sustainability actions of Beaumont Health System are tied directly to the health outcomes of our community, the patients we serve, and the staff we employ," Stephen Howard, chair of the Beaumont board of directors, said in an email interview. "We understand both the immediate and long-term benefits that affect all our stakeholders."

Winokur's system-level green committee recommended replacing the lights in Beaumont's parking lots and garages with fixtures that use low-energy, light-emitting diode lights.

"By retrofitting all our parking decks and lots, we are seeing huge energy savings," she says. "That was probably one of our biggest successes."

Beaumont spent about $900,000 to replace 1,413 fixtures on its three hospital campuses. In some cases, the new LED lights are up to 90 percent more efficient than the fixtures they replaced. Because the energy savings were so significant, the project qualified for $60,000 in rebates from the local utility company.

The result: The new lights save nearly $300,000 a year in power and maintenance costs and will pay for their capital outlay within three years.

Investing in Renewables

Gundersen has gone beyond conservation to become a power producer through renewable technologies.

It is a joint venture partner in two wind turbine projects, and it pipes landfill gas to run an engine that meets all power needs on a 350,000-square-foot outpatient campus.

Gundersen's biomass boiler uses organic wood fuel sources, such as milling or forest byproducts, to heat water that creates steam, accounting for 38 percent of the system's energy-independence goal.

A geothermal heat pump and 156 wells buried beneath a parking lot work together to provide efficient heating and cooling at the health system's newest facilities. And its dairy digester system turns manure produced by 2,000 cows at three local farms into electricity.

"This does strengthen our local economy," Fischer says. "For example, for our biomass boiler, we buy wood byproducts from some local businesses. And we partnered with La Crosse County Solid Waste Department in our biogas project."

Indeed, Gundersen generates more electricity than it needs. The for-profit Envision limited liability company was created as a vehicle to sell surplus electricity to local utilities and to receive tax benefits and incentive grants for renewable projects.

Gundersen made the move into clean renewable energy sources in 2008 when the system set a goal of becoming energy-independent in 2014. At that time, Rich expected to focus only on biogas and wind projects, but as other opportunities surfaced, Gundersen pursued the ones with the best payback.

"There is a maze of variables that you have to work through to try and understand which one's going to work best for you," he says.

For example, because of its wood industries, Wisconsin particularly lends itself to biomass initiatives while solar projects generally have a better return on investment in the Southwest, and wind is most advantageous in the Midwest.

Despite his enthusiasm for renewable energy, Rich says health systems should first focus on conservation. Before pursuing renewable projects, Gundersen spent $2 million over two years to implement a conservation plan that generates about $1 million a year in energy savings. That represents a 25 to 30 percent improvement in energy efficiency from the system's 2008 baseline.

"Conservation is the best investment in your energy program because the paybacks are better than renewables, in most cases, and it is the best thing for the environment and health," Rich says. "Then if you are going to do renewables and try to become energy-independent, it reduces the amount of renewable energy you have to put in place."

Partnering for Success

Adventist Hinsdale (Ill.) Hospital opened a new patient pavilion in 2012, but other parts of the building are more than 60 years old.

"We added 20 percent square footage on the main building, and we are still using about 10 percent less energy than before we built the patient pavilion," says Tuazon.

Since 2007, Adventist Hinsdale has spent $1 million on 21 projects — including lighting, heating and cooling, kitchen ventilation and others — that received financial incentives from ComEd, the local utility.

Through its Smart Ideas for Your Business program, ComEd provided $259,000 to offset the hospital's expenditures on the projects. Together, the improvements are generating $253,000 a year in savings, making the payback period on the hospital's investment less than three years.

Adventist Hinsdale started using the incentive program in 2007 when it received $5,777 from ComEd for retrofitting light fixtures in a parking garage with more efficient lamps and $61,000 from Nicor Gas' Business Custom Incentive Program for installation of a high-efficiency burner on its dual fuel boiler.

"All the incentives we get from ComEd and Nicor are put back into our program so we can do more projects," Tuazon says. "Because we have an old building, we are constantly needing to upgrade."

Lola Butcher is a freelance writer in Springfield, Mo.

Beaumont Employees Lead Green Brigade

Employees at Beaumont Hospital, Royal Oak campus, the flagship hospital of the Beaumont Health System in the Detroit area, awakened the system's conservation sensitivity when they asked hospital leaders to become more accountable to the environment.

In the three years since, the hospital has implemented 16 initiatives that have saved water and electricity equal to powering 1,883 houses for a year, filling 1,065 swimming pools, removing 3,699 cars from the road and planting 5,057 trees.

Moreover, the Royal Oak campus has created a green culture that has expanded to Beaumont's other two hospitals and empowered staff members to be leaders in low-cost, high-impact energy conservation efforts.

"This was a grassroots effort that bubbled up from our employees; however, it was taken very seriously by leadership," says Kay Winokur, Beaumont's vice president of quality and professional services and a champion of the campus' sustainability efforts.

Today, the system has an infrastructure that keeps sustainability at the forefront:

• In addition to the system-level committee, green committees at each of the hospitals identify and prioritize opportunities to increase energy efficiency and reduce environmental hazards.

• A Green Team is made up of 550 green officers, representing every department at each hospital, as well as medical clinics and other facilities. Any hospital staff member interested in sustainability can complete a two-hour training program, be deputized as a green officer, and affix a Green Team insignia to his or her name badge.

"We ask them to go back into their departments and live by a green officer job description, which means recycling, turning off lights, using the revolving door to save conditioned air, using refillable water mugs instead of water bottles, and those kinds of things," Winokur says. "Our green officers really model the behaviors and teach their fellow co-workers how to be green."

• Kaizen — Japanese for "improvement" — teams meet for two full days each month to observe individual buildings in search of inappropriate energy use. One team included Winokur, Royal Oak's head plumber and head electrician and two facilities staff members.

In one year, they rotated through the hospital's five towers, the imaging center, research center, medical office building and other areas, searching for overlit elevators, spaces that were unnecessarily heated and cooled on weekends, and coffeemakers that wastefully heated water around the clock. "In that first year, we saved $100,000 in just simple things — and that multiplies every year," Winokur says.

Beaumont's multifaceted approach to identifying energy-saving opportunities has led to multiple ways in which conservation is enforced. The Kaizen team developed standards for the use of motion sensors that turn lights on and off. "Everyone thought they wanted one in their office, but we said, ‘No' — this is appropriate for spaces like medication rooms, equipment rooms and public restrooms," Winokur says.

Meanwhile, stickers on each switch remind staffers to turn off the light. Some employees used to leave their lights on all night to signal to their co-workers that they were working long hours, but now the green officers are on patrol. "We changed our culture," Winokur says. "Now, if you're not in your office and your light is on, you're not being very green — and someone is going to remind you." — L.B.

Who Wants to Help?

Several major organizations are eager to help hospitals conserve energy and reduce environmental hazards:

• The American Hospital Association's Sustainability Roadmap is an online set of tools for strategic planning and tracking progress on sustainability goals. The website was developed in conjunction with three AHA personal membership groups: American Society for Healthcare Engineering, the Association for the Healthcare Environment and the Association for Healthcare Resource & Materials Management: www.sustainabilityroadmap.org

Practice Greenhealth is a membership and networking organization for health care organizations that have committed to environmental sustainability: https://practicegreenhealth.org

• The Healthier Hospitals Initiative, created by 11 major U.S. health systems, is a national campaign to encourage environmental health and sustainability in the health care sector. The initiative provides a guide for hospitals to improve sustainability in six areas, including leaner energy use and less waste: http://healthierhospitals.org

• The Department of Energy's Better Buildings Alliance promotes energy efficiency in U.S. commercial buildings. Alliance members commit to energy-savings goals and adopting cost-effective technologies and practices: http://www4.eere.energy.gov/alliance/node/9

• The Database of State Incentives for Renewables and Efficiency is an online resource sponsored by the DOE and the North Carolina Solar Center: www.dsireusa.org

Online Exclusive

Reducing energy use is a laudable goal, but where do you start? To learn how hospitals in this article launched their initiatives, read the Web-only article "Getting Started on Energy Management".