For years, Chicago hospitals have implemented various projects to conserve energy, including retrofitting countless lamps and exit signs, adding variable frequency drives to pumps and fans, installing occupancy sensors, tuning up boilers, installing pipe insulation, and developing LEED-certified buildings.

The energy savings associated with these activities, as tracked by utility energy efficiency programs, resulted in the ballpark of 241,000,000 kBtus conserved, $3 million in incentives from utility programs received, and $3 million in energy costs saved.

However, to accelerate the pace of energy-efficiency improvements and achieve greater reductions in energy use and greenhouse gas emissions, more comprehensive approaches are needed—approaches that allow hospitals to identify the full range of opportunities available and take action on them.

Many of the Chicago hospitals that have undertaken these initiatives have recently been sharing their experiences and successes as participants in the Chicago Green Healthcare Initiative (CGHI). CGHI was formed in 2012 with support from a U.S. Environmental Protection Agency (EPA) grant to help accelerate the implementation of energy efficiency activities in the healthcare sector, and it continues with support from the Joyce Foundation.

CGHI provides technical support as needed, and it organizes peer exchange meetings among facility managers who are implementing or considering energy efficiency improvements.

Among the solutions being explored by these Chicago facilities, there are five major initiatives that hospitals across the country could benefit from pursuing.

Benchmarking the energy performance of a building tracks the building’s energy use over time. It sets a starting point from which to measure changes, and allows building managers to compare the energy consumption of their buildings to that of similar buildings in the same community or across the U.S. It’s a key tool in energy management, because building managers can’t effectively manage what they don’t measure.

In addition, more and more cities like Chicago are passing benchmarking and disclosure laws, making benchmarking mandatory for buildings of certain classes, while underscoring the importance of benchmarking to facilitate a reduction in energy use.

From a broader perspective, benchmarking is used because it allows facility managers to gauge the magnitude of an opportunity available to them and to help determine how much energy savings is reasonably possible. As managers chart improvements, benchmarking can also help them justify spending for energy efficiency projects or capital improvements.

Chicago hospitals have two benchmarking tools available to them: the EPA’s Portfolio Manager and a local benchmarking survey from consulting firm Grumman & Butkus Associates (G/BA; Evanston, Ill.). Using Portfolio Manager, facility managers can enter data about a building’s characteristics, operational use, energy expense, and energy consumption, and the algorithms in the tool rank the building against others in its class on a scale from 1 to 100.

Buildings scoring, for example, a 35 could have many opportunities left to improve energy efficiency. Those scoring 75 or above qualify for Energy Star certification. Advocate Illinois Masonic Medical Center has achieved an Energy Star certification for the past five years and currently has a score of 98.

The G/BA survey enables hospitals to compare their metrics with those of other participants, including cost/sq. ft./year, Btus/sq. ft./year, kWh/sq. ft./year, cost/kWh, cost/therm, and gallons/sq. ft./year.

These comparisons provide facility managers and hospital executives with a range of insights. For example, G/BA’s 2013 study (for calendar year 2012 data) determined that the average Chicago area hospital spends $3.30/sq. ft./year in utility costs, with the median value of hospitals for the whole survey at $2.81.

From this region-specific data, a hospital that scores in the average range will know that it can reasonably improve its efficiency to at least $2.81/sq. ft./year, which, when scaled to a 400,000-square-foot facility, amounts to a difference of about $196,000 annually.

Facility energy assessments
Energy assessments, or audits, quantify how and where energy is being used at a facility, primarily by looking at the efficiency of individual pieces of equipment. Assessment results identify specific, potential energy conservation measures (ECMs), and provide a financial analysis of these potential ECMs to help set goals and priorities, create action plans, and implement deeper retrofits.

Without an audit, it’s very difficult to know which energy-saving measures can be performed and what the expected benefits are.

Audits can be simple, walk-through assessments that take a few hours to perform, or highly detailed investigations, done over days, that get down to the make and model and expected efficiency of boilers and chillers.

The walk-through audits identify low-cost, quick return opportunities that can be funded out of operating expenses. For example, an audit would show the number of T12 light bulbs in use in 24/7 locations like hallways and stairwells, and would calculate the potential energy savings from replacing those with T8 bulbs.

The in-depth audits, those that are comparable to the national standard, ASHRAE Level II, identify deeper issues and larger projects, and can be a starting point for developing a strategic energy management master plan—an approach that’s been explored by Northwestern Memorial, St. Bernard, and Norwegian American hospitals.

Often, hospitals choose to conduct these assessments because the larger projects identified could require integration into capital planning, and therefore need to be identified well in advance. In Chicago, hospitals can seek financial support for this type of effort from a local energy provider.

Life cycle cost over first cost
There are many ways to determine the cost of a purchase or capital project. “First cost” measures cost by totaling the initial expenditures—capital expense, site preparation, transportation, and installation.

Quite differently, life cycle cost analysis (LCCA) quantifies the total cost of ownership of a piece of equipment, building system, or facility by taking into account not only the initial costs but also the costs of owning, maintaining, and disposing of the item. LCCA is especially useful for comparing options that have different initial and operating costs.

For example, as part of a recent cooling plant upgrade, Advocate Illinois Masonic Medical Center chose to use LCCA to select three new, high-efficiency, 700-ton chillers with variable frequency drives and magnetic bearing compressors.

Using LCCA not only allowed Advocate Illinois Masonic to purchase more efficient chillers, which will save it an additional $29,000 per year (over less efficient options, every year for the 25- to 30-year life of the chillers), but it also allowed the facility to receive a $203,700 incentive from an energy provider’s program, the largest rebate for an energy-saving retrofit ever presented to a Chicago hospital.

Retrocommissioning is one of the most cost-effective approaches to reduce energy use and raise building performance. It recalibrates and optimizes the operating schedules of equipment, identifies malfunctioning equipment, and quantifies no-cost and low-cost energy saving improvements.

For example, the retrocommissioning of one Chicago hospital iden
tified 20 opportunities with an annual electric energy cost savings of $50,501, implementation cost of $145,870, and about a three-year simple payback. Twelve Chicago hospitals, including Mt. Sinai, Swedish Covenant, Norwegian American, Northwestern Memorial, University of Chicago Medicine, and Advocate Trinity, have undergone or are undergoing retrocommissioning.

An enhancement to retrocommissioning that some Chicago hospitals are considering is monitoring-based commissioning, which uses specialized software integrated into a building automation system that continuously, or in near real time, analyzes a building’s system performance for energy-saving improvements. These opportunities, once implemented, are also fine-tuned over time.

Sharing experiences
Facility managers at many Chicago hospitals have begun collaborating with their peers at other hospitals to share their experiences in implementing energy-efficiency retrofits and to learn what’s going on at other institutions.

One way they’ve been doing this is by participating in the CGHI’s peer exchange meetings, where technical presentations are given on topics in energy efficiency and tours of facilities are provided.

The group hopes that more hospitals will adopt this type of big-picture approach to sustainability and that more facilities will join their peers for networking, learning, and sharing of best practices. And it’s hoped that these approaches will only be expanded upon.

For example, Shriners Hospital for Children, Presence Health, Advocate Trinity, and Advocate Illinois Masonic have each set energy and greenhouse gas reduction goals of up to 20 percent over five to seven years.

And what’s being learned in Chicago can be applied in other cities, as well. Each region has its own challenges—weather, ordinances, utility providers, and trade allies—and can benefit from local solutions. In Chicago, the plan is to work to expand the opportunities for collaborations and the number of partners who gain by working together.

There are plenty of opportunities left, too. Energy efficiency is never really done; you can achieve milestones, but it’s a continual improvement process, and there are always new technologies to implement and new approaches to try.

Peter Locke is president of TerraLocke Inc., a Chicago-based sustainability consulting company. He’s been involved in a range of energy-efficiency strategy and implementation efforts in the Chicagoland area, including heading up the Chicago Green Healthcare Initiative. He can be reached at