Mark Chrisman (Headshot credit: Henderson Engineers)
Recognizing that healthcare facilities are among the most energy-intensive buildings—with significant greenhouse gas emissions due to large heating and cooling loads, as well as large medical equipment power requirements—project teams are increasingly exploring electrification paired with renewable energy as a viable path to reduce carbon emissions, improve energy efficiency, and align with local and national climate targets.
The first installment in this article series on all-electric hospitals examined the energy savings, operational considerations, and infrastructure challenges associated with this transition. In Part 2 this article dives into the economic, operational, and design considerations for healthcare projects looking to shift to all-electric models while also offering practical insights into how healthcare facilities can lead the charge toward a more resilient, low-carbon future.
Energy savings opportunities in healthcare design
Electrification often results in improved system efficiency, thus lowering the cost of operating a building. For example, electric heat pumps can offer up to three to five times the efficiency of conventional natural gas boilers, according to global management consulting firm McKinsey & Co
Hospitals can also benefit from integrated energy management systems that optimize performance and reduce waste. Specifically, these systems can track and control HVAC, lighting, and equipment use in real-time, providing visibility into energy consumption patterns and identifying opportunities for further savings.
All-electric hospitals are well-positioned to integrate on-site solar or wind energy as well. These systems can be paired with battery storage to reduce peak demand charges and provide backup during outages. This synergy can lead to significant operational cost reductions by discharging stored renewable energy when time of use electricity rates are at their highest and increase energy autonomy by reducing reliance on the external grid.
Moreover, participation in community solar programs or virtual power purchase agreements, which allow multiple customers to band together to buy energy in bulk, can further enhance financial and environmental outcomes for hospitals and the communities they serve by lowering and stabilizing electricity costs through renewable energy subscription programs and contracts that yield positive net present values and positive cash flows for subscribers.
Optimizing the building envelope and systems to reduce energy demand can also support efforts to reduce energy demand. Enhancing insulation, upgrading to LED lighting, and implementing automated building controls are some of the essential strategies for reducing overall energy consumption. Hospitals can also pursue envelope upgrades such as high-performance glazing and continuous insulation to reduce heating and cooling loads, enabling smaller and more efficient HVAC systems.
Operational considerations for electric hospitals
All-electric hospitals often face heightened scrutiny under ASHRAE 170 (Ventilation of Health Care Facilities) and Joint Commission standards for power reliability. With no fossil-fuel-based backup systems, facilities must design redundant electrical pathways and incorporate uninterrupted power supply (UPS) systems, microgrids, or battery energy storage to meet required uptime thresholds.
Backup power systems, traditionally delivered via diesel generators, are being supplemented or replaced by battery storage and microgrids that offer cleaner, quieter, and more resilient solutions. These systems can provide seamless power during grid interruptions or disasters and can be configured to prioritize critical loads, such as operating rooms and life support systems.
Electrification can increase electrical load of the facility, necessitating robust load management strategies. Demand response programs and advanced control systems allow hospitals to shift non-critical loads and participate in utility incentive programs. Demand response is a grid-interactive mechanism where a facility adjusts its electricity usage based on signals from the utility provider, typically during peak demand periods or when electricity prices are high.
In return, the facility may receive financial incentives or reduced rates. For hospitals, this can involve temporarily reducing or shifting non-critical loads, such as HVAC pre-cooling, lighting dimming in administrative areas, or delaying certain non-urgent operations, all without compromising safety for patient care and staff. For example, pre-cooling or pre-heating buildings during off-peak hours can reduce demand charges and enhance grid stability.
Maintenance and staffing training are also key considerations. Electric systems generally require less maintenance, but facilities teams will need to build up expertise in electric heating systems, smart grid technologies, and energy storage solutions.
Tapping into training programs and workforce development will be critical to ensure smooth operation and rapid response to issues. Partnering with technical schools and labor unions also can help build a skilled talent pipeline that benefits staff and hospital operations over the long-term.
Design considerations for all-electric hospitals
Retrofitting a hospital for all-electric operation requires significant electrical upgrades, including transformers, panels, and internal wiring. These upgrades must support higher peak loads and ensure safety and code compliance. Hospitals also need to consider fire protection, electromagnetic compatibility, and redundancies in electrical pathways to meet health and safety standards.
For example, the additional battery storage on-site may require modifications to the fire protection and life safety approach that exceed what may exist within the facility. Similarly, the new location of the on-site battery storage may require additional electrical pathways to other portions of the facility.
Collaboration with utilities is vital to ensure adequate grid support and interconnection capacity. In some regions, the local grid may need reinforcement to handle the increased demand from electrified hospitals. Engaging utility partners early in the design phase helps secure capacity commitments and may reveal opportunities for grid services revenue through demand-side participation or ancillary services.
On average, hospitals transitioning to all-electric infrastructure may need 20-30 percent more mechanical and electrical equipment space compared to traditional fossil-fuel-based systems. This increase accounts for the inclusion of battery energy storage systems (BESS), larger electrical switchgear, inverters that convert direct current to alternating current, and expanded electrical rooms to support higher peak loads.
Additionally, thermal energy storage, rooftop solar systems, and EV charging infrastructure can place further demands on building footprint and site planning. Retrofitting existing facilities may involve spatial constraints, whereas new construction offers greater flexibility to integrate these systems from the outset. Hospitals must also consider the placement of rooftop solar panels, and the orientation of buildings for passive solar gain.
Pathway to electrification in healthcare design
Hospitals looking to go all electric can adopt a phased electrification strategy, starting with demand-reduction measures such as lighting efficiency and envelope improvements, followed by HVAC systems electrification, before transitioning to electrifying more complex systems such as sterilization and cooking.
Early planning, stakeholder collaboration, and continuous monitoring are key to successful implementation. A comprehensive energy master plan, aligned with capital planning cycles, can help identify synergies and maximize return on investment.
Establishing cross-functional teams involving facilities, finance, clinical leadership, and sustainability officers ensures that electrification efforts are integrated into the hospital’s broader mission and operations.
All-electric hospitals represent a bold and necessary step toward a sustainable healthcare future. While the journey involves technical, operational, and financial challenges, the long-term benefits in energy savings, resiliency, environmental impact, and well-being make it a worthwhile investment.
Mark Chrisman is the health sector executive at Henderson Engineers (Lenexa, Kan.), and can be reached at [email protected].
