Rob Fleming

Photo Courtesy of Rob Fleming

This article was originally published on September 21, 2023, and is among Healthcare Design’s most-read articles of 2023. To see a full list, click here.

Healthcare facilities are open 24 hours a day, 7 days a week, and contain lifesaving equipment and systems that use large amounts of energy. The energy use intensity of hospitals is one of the highest of all building types, according to Energy Star Portfolio Manager, an energy measurement and tracking tool for commercial buildings.

Many healthcare systems have recognized the environmental impact of their buildings and committed to being better environmental stewards, particularly through improved energy use.

However, it’s important to place the drive toward energy efficiency in perspective. Hospitals exist to save human lives. When a person is on the operating table, their life hanging in the balance, saving energy is not a concern. Furthermore, the primary goal when designing healthcare facilities is to achieve a range of health-related benefits including patient healing, worker well-being, and staff productivity.

To help guide these efforts, FCA (Philadelphia) developed a Sustainable Design Hierarchy, which illustrates a strategic approach to understanding sustainability within the larger set of priorities in the design of medical facilities. This process includes educating the facilities team and prioritizing human health, including saving lives, healing patients, and enhancing well-being. When healthcare planners begin to transition their focus to energy efficiency, environmental responsibility, and resilience, we offer five key steps to create a strategic approach:

Step 1: Invest in low-hanging fruit

Thanks to technological advances in refrigeration, lighting, and HVAC systems, along with the adoption of energy management systems, a typical hospital is already reducing its energy use as compared to a decade ago. Most organizations have shifted to LED lighting, which in turn saves on air-conditioning costs as less heat is emitted from the fixtures.

HVAC systems are increasingly efficient across the board, following improvements in smart technology, refrigerants, and duct sealing. However, the process of purifying air quality for patient healing and comfort actually requires motors with higher horsepower for the fans to push the air through the filters. The additional energy use can be reduced by the use of variable speed motors. During COVID, healthcare settings implemented a wide array of supplemental air purification measures, many of which remain in place today.

Step 2: Measure and set baselines

The best way for hospital facilities to begin understanding their energy footprint is to use the Energy Star Portfolio Manager, a database of U.S. Energy Use Intensity (EUI) by property type. By benchmarking a facility’s energy use against the national averages, organizations can get a sense of how well the facility is performing.

From there, an energy-use baseline can be established to set the standard by which future energy savings will be measured. One of the best available tools is the AIA 2030 Design Data Exchange, which provides a digital platform to collect, report, and compare energy use against widely accepted national standards or against previous energy performance energy levels.

Step 3: Set targets

Once baselines have been identified, yearly energy reduction targets can be established. A common mistake made by enthusiastic sustainability directors is to set overly ambitious targets. When exorbitant costs and time barriers arise while attempting to reach these goals, it can be demoralizing.

A more educated, intentional, and integrative approach is to set modest goals that rise incrementally each year. For example, a 30 percent energy reduction is obtainable over a 10-year period of 3 percent incremental gains.

Step 4: Perform schematic energy modeling early in the planning process

Utilizing schematic energy modeling early in the planning and design process is a key strategy to help determine which energy-efficiency measures will yield the best results.

At this stage in the process, energy modeling should be used to compare strategies and never be used to represent accurate predictions of overall future building performance. Once a building is designed, engineers will provide accurate energy models, which are used to size HVAC systems.

Step 5: Take control of the financial savings

Once energy efficiency measures are in place and the resulting energy reductions are quantified, the financial benefits can now be captured. It is critical to be intentional and strategic about leveraging the resulting financial savings by establishing a “Green Fund,” a budget line that is funded by energy savings.

These funds can be reinvested in more ambitious and more impactful sustainability projects. For example, a Green Fund can be established to support professional development of staff to learn more about subjects like deep energy retrofits, renewable energy installations, or a host of other sustainability initiatives.

Benefits of strategic planning

Overall, these energy and cost savings along with the associated sustainability improvements must be broadly and clearly communicated to the entire hospital community consistently and in easy-to-understand formats.

The process of increasing levels of sustainability in healthcare facilities is far more complex than presented in this article. However, with a more intentional, strategic, and educated approach, healthcare facilities can achieve the goal of healing patients and protecting the environment through increasing levels of energy efficiency.


Rob Fleming is director of sustainability at FCA (Philadelphia) and the 2023 President of the Philadelphia AIA, and can be reached at