By Darwin L. Crawford & Merrill Kaney / Special to Healthcare Facilities Today

Are you doing all you can to enhance your facility’s bottom line? Today’s healthcare industry strives to integrate sustainable practices into their building’s operational planning and objectives. All other industry enterprises have embraced the idea of environmentally friendly operations — and with good reason as to what it can mean to the bottom line.

Since 2011 The U.S. Department of Energy stated that the Healthcare Sector collectively saved $195 Million. (https://betterbuildingsinitiative.energy.gov/alliance/sector/healthcare) Businesses should be aware there are countless benefits to driving sustainable initiatives; they become efficiently responsible, gain a competitive edge, manage performance, experience improved economic status, and at the same time they can positively impact the environments and communities surrounding them. 

However, despite the growing adoption to improving the environmental performance of our buildings, hospitals continue the transition through the practice of reducing energy wastes and carbon emission from their facility. The process of implementing sustainable strategies isn't a "step-one and done" solution, yet an ongoing effort which requires resources.

Financial obstacles

One of the most common remarks heard when discussing sustainability is the lack of funding. Hospitals are cash-strapped for capital. Each department has a laundry list of requests, all requiring a slice of the budget. Getting money set aside is very difficult, and it is a constant challenge for facility directors to find innovative ways to use available capital and operational spending to fund and improve hospital efficiencies.

In addition to budgetary concerns, subpar preventative maintenance (PM) programs can serve as a roadblock.  Several hidden costs occur when a PM program isn't implemented correctly. Traditionally a reliable PM program can save up to 2-3% in added charges if implemented successfully. Also, wasted energy and the lifespan of the equipment are at risk, which results in future increased capital expenses. Additionally, energy-related maintenance requirements can be built into the system on strategic facility assets, providing a launchpad for initiation.

It is possible to turn these obstacles into opportunities by developing an internal plan of increasing the use of programs and tools available from energy providers and services such as Energy Star® and the American Society for Health Care Engineering's (ASHE) Energy To Care Program. A voluntary program of the U.S. Environmental Protection Agency-EPA also has resources to use. Many of these programs and initiatives will produce projects delivering a return on investment; which the administration will surely want to harness. There are financial incentives available to facilities, depending upon the type of investment made, when modifying a building as a sustainable property. The government places a high interest in environmentally sustainable economic development. More and more tax authorities are offering incentives to encourage investments in sustainable projects and technologies, such as grants; tax abatements or deductions; or utility discounts or rebates. 

Encourage sustainable initiatives 

Facility directors need to analyze their teams and building’s current performance. They should compare historically via facility run-rates since the kick-off of a sustainable program. Below are four ways that will help your facility team members maintain and identify opportunities your hospital can address for continued environmentally friendly and cost-effective operations:

1. Reexamine the team members currently on-site to determine if end-user participation is adequate.

The individuals on your team will significantly impact the success of your program to improve energy use and build a sustainable future. Essential team member attributes include: 

• All members must understand the objectives as well as their role in the process.
• You need a sustainability champion. Who in the organization executively will be this change agent?
• Do members embrace the vision and commit to the new protocols and procedures?

2. Re-establish a baseline. The completion of the first initiatives will show the success of the program through data results. Review current facility assets and account for changes due to new construction or remodeling. Is the new equipment installed operating correctly? How are the sustainable programs presently running as compared to specific objectives established on initiation?

3. Review the initial implementation plan and goals. Hospital leadership understands that achieving savings goals requires business, organizational, and behavior change. Embracing these important initiatives require strategy planning, new construction and significant renovations, evaluation of existing facility operations and upgrades, procurement practices alignment, financial analysis, and measurement.

When developing the plan and reviewing status, evaluate the components initially targeted using the following checklist to determine the goals and objectives achieved. This plan needs to be looked at from an operational performance perspective with the environment of care and financial outcome collectively.

Energy 

• Implement efficient surgical task lighting. Is the task lighting meeting the lumens required and achieving savings with a technological approach or application?
• Re-evaluate setback of temperature and airflow settings during off-hours as determined by space type and capability of controls.
• Manage a retro commission review of HVAC controls and Building Automation System.
• Re-evaluate HVAC commissioning.
• Evaluate steam traps for repair or replacement following the PM plan established at inception.
• Are insulation of hot water system equipment and piping completed?
• Replace air handling unit AHU filters regularly by PM system's initial plan.
• Were variable frequency drives installed on pumps and motors?
• Was care taken to determine harmonics would not affect equipment, and if so, were reduction technologies applied?

Water

• Re-establish a baseline for current water consumption.
• Re-evaluate steam traps for repair or replacement. 
• Re-evaluate hot water system equipment and piping.
• Review cooling tower efficiency by improving water quality. Be sure to reference your water management plan and treatment for bacterial prevention.
• Review fixture repairs and fixture replacements to determine if they are meeting operational and savings goals. Have high usage areas been put on a rounding schedule with an eye toward operational integrity and identification of required repairs/upgrades?
• Have low-flow flush fixtures been implemented where practical?
• Evaluate and optimize faucet water flows to determine if efficiency has been achieved.
• Is there equipment and piping leaks?

Waste

• Review opportunities for waste minimization, and form committee to evaluate end-user participation.
• Re-conduct a waste audit.
• Evaluate electronic waste recycling effectiveness.
• Do you have a facility-wide battery recycling program implemented?
• Review the facility's recycling program for effectiveness and efficiency increases.
• Review construction and demolition recycling pertinent to daily operations and adjust where needed.
• Reduce regulated medical waste (RMW) generation. Are the right end-users involved?
• Reduce paper waste with sustainable printing or printing avoidance.

4. Complete analysis of the PM programs. Are they fully implemented? As previously mentioned, if adequately implemented, PM programs can save hospitals sizable amounts of capital, not only from an operations perspective but also from an energy one as well. Such programs should apply to all building systems and components and need to be evaluated on an ongoing basis to ensure that they are running correctly.

Cultivate an energy treasure hunt

Energy Star® recommends implementing an Energy Treasure Hunt. This initiative encourages teams to walk around facilities looking for quick wins to save energy. The Energy Treasure Hunt also has four distinct phases that will guide you to a successful reduction in energy usage:

1. Re-evaluation: 

• Did the facility's leadership give their support?
• Were data and metrics gathered to review against a baseline?

2. Was training provided to the facility members (clinical and non-clinical)? Is more training needed, and if so, identified categorically?

3. Survey your teams' makeup for success. Identify and quantify energy-saving opportunities. During the event, tours of the site are undertaken by several groups to identify and summarize energy reduction opportunities.

4. Follow-up: Re-develop a schedule for pursuing projects to capture energy reduction opportunities.

Lastly, initiate leadership discussions before any team site walkthroughs. Set the stage for adapting energy initiative programs and participation.

Discuss next steps: 

• Plan your site energy walkthrough.
• Meet to identify and study all possible sustainable, energy cost saving projects, and estimated payback.
• Prioritize and identify the high-payback opportunities.
• Meet with leadership to discuss both sustainable and energy identified savings. Agree upon requests for funding to move ahead with approved projects.

Darwin L. Crawford is the Facilities Management Vice President of Operations and Merrill Kaney is the Management & Technical Support for ABM Healthcare.