Sustainability programs continue to move forward
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Sustainability is a hot topic among hospital executives. After all, data from the Energy Information Administration shows that health care represents 4% of commercial floor space in the United States but 9% of energy consumption.
The American Society for Health Care Engineering (ASHE) has focused on helping hospitals improve their sustainability with several initiatives over the past few years. These include three ASHE member task forces providing input on key sustainability issues; a project to gather accurate baseline sustainability data; a burgeoning program to provide pro bono assistance to hospitals preparing Environmental Protection Agency (EPA) ENERGY STAR® applications; and an improved process for seeking ASHE Energy to Care® Awards.
“ASHE has been maintaining our key pillars of sustainability,” says Kara Brooks, MS, LEED AP BD+C, senior associate director of sustainability for the American Hospital Association. “Sustainability is a key topic at the International Summit & Exhibition on Health Facility Planning, Design & Construction™ (PDC Summit™) as well as ASHE’s Health Care Facilities Innovation Conference™. We know sustainability is an issue that our members care about and that is important for our society overall.”
Task force topics
One way that ASHE taps the collective sustainability knowledge of its membership is through several volunteer task forces. The Sustainability and Decarbonization Committee chooses the topics that the task forces will tackle each year based on trends and current issues.
“The committee tries to predict which issues are going to be most important, and which the field really needs to focus on,” explains Austin Wallace, MA, SFP, sustainability senior specialist at ASHE.
In 2024, three task forces were formed, focusing, respectively, on sustainability financing; a sustainability project database; and sustainability innovation. Each task force, which exists for just one year, is responsible for writing an article for Health Facilities Management (HFM) magazine about their findings.
Each task force has 10 members, which is up from five members in each task force in 2023.
“I think the reason the task forces have grown is that more members can see their efforts and names attached to actual resources that are being published on our Sustainability Roadmap for Health Care™,” Wallace says. “We have found that the best way to get good engagement and quality results is to let them approach the topics with their own expertise and innovative ideas. The participation we’ve had has been incredible.”
Kathy Henderson, CEM, national business manager — health care for Ameresco Inc.’s Asset Sustainability Group in Framingham, Mass., chairs the ASHE task force on sustainability financing. This group collected information about funding for sustainability projects from the federal and state levels.
Multiple topics were included, such as details around the Inflation Reduction Act, elective pay, grant resources and case studies. Their deliverables were a spreadsheet with links to up-to-date websites and an HFM article on the topic.
Henderson believes the results of the sustainability task forces are valuable, and the members benefit from their participation.
“Sustainability projects are often not at the top of the capital projects list, and finding trusted and accurate information around financing models, such as power purchase agreements, energy savings performance contracts or energy as a service, can be challenging,” she says.
“Our goal was to make the process more efficient and vet the countless websites to determine the most current and trustworthy sources available. We also wanted to include information on funding sources such as grants, tax credits and state incentives to help get those projects to the finish line,” Henderson adds. “Of course, bringing the team’s institutional knowledge to the data and getting to know other ASHE members is just another benefit to joining the task forces.”
Data gathering
Another sustainability initiative in 2024 was a project to gather reliable baseline sustainability data for hospitals. Brooks explains that as more rules and regulations about hospital sustainability are created, the importance of good baseline data will become more essential.
“As these hospitals create these goals and these targets, the data that is used to set those targets needs to be reliable,” Brooks says. “We’ve seen some examples of how these targets have been set by data that is not quite as accurate as it should be, and that can skew the target and make it perhaps too ambitious. We want the targets to be ambitious, but we want them to be achievable. Having accurate baseline data would help them set those targets appropriately.”
ASHE’s Energy to Care program has an enormous database of utility consumption data from hospitals across the country, explains Peter Dahl, Ph.D., LEED AP, CEM, the St. Paul, Minn.-based founder of define sustainability LLC. Dahl spearheaded a project to tap the database for usable information.
To ensure that the information is consistent, only data from hospitals with 24 months of continuous data in the Energy to Care database were included, Dahl says. Ultimately, data from 528 hospitals met the criteria.
In October 2023, Dahl produced an eight-page report for ASHE titled Energy Benchmarking for US Hospitals that detailed energy-usage trends over five years. He is working on a follow-up report to be published later this year that will dive more deeply into the data.
“In the 2023 report, we broke the data down by size of the hospital and climate zone, and now we’re going further into that analysis to see what it looks like in terms of different energy sources on-site,” Dahl says. “For example, we’re looking at the split between electricity and natural gas, which represent 98% of energy consumption at hospital facilities. Then we’re translating it back into carbon and looking at different carbon factors that impact hospitals, depending on where they are in the U.S.”
Dahl explains that the new report considers electricity “cleaner” in some locations than in others, based on how it is generated. Grid electricity in Minnesota, for example, is generally cleaner than electricity in West Virginia, while both are topped by the clean energy of California and the Pacific Northwest. While hospital facilities managers don’t have direct control over the electric utility, hospital organizations need to account for the carbon emissions associated with their electricity consumption.
Dahl’s reports serve a dual audience. One audience is hospital facilities managers, who can use the information to compare their hospital’s energy consumption to that of other hospitals that match their size and climate conditions. The other audience may be policymakers who are setting carbon targets for buildings. Both audiences need accurate data to do their jobs.
“Where I see these reports providing the highest value is to standards-making organizations and jurisdictions,” Dahl says. “If we can provide some good data on what the average hospital consumes for energy in a typical year, I think that can help to improve programs that promote energy efficiency. For example, ASHE can educate policymakers on energy consumption in existing hospitals so that realistic efficiency goals can be established that will reduce carbon while also ensuring continued operation of reliable facilities that control the cost of care.”
Application assistance
In addition to the successful 2024 programs mentioned above, ASHE has several sustainability initiatives that are emerging or improving, including an effort to help members apply for ENERGY STAR certification and a streamlined application for Energy to Care Awards.
ENERGY STAR certification for a hospital involves a detailed application that must be reviewed by a licensed professional engineer or registered architect before it can be submitted. That is a costly enterprise for a hospital without a licensed professional engineer on staff.
To ease that burden, ASHE is working on a program that will connect hospitals with ASHE members who hold the appropriate certifications and are willing to review the applications on a pro bono basis. ASHE is working with the EPA to ensure that the program would meet its specifications.
“Once we identify the folks who are eager to participate, we invite them to a platform where they go through a quick ENERGY STAR virtual training to ensure they meet EPA expectations for verification,” Wallace says. “Then we can begin connecting them with hospital facilities managers from the eligible facilities.
“Now we are identifying the best approach to partner eligible facilities and licensed professionals,” Wallace adds. “Some reviews can be done remotely. Depending on the amount of participation and locations of the volunteers who want to get involved, being able to do things remotely would make the process go even quicker.”
Likewise, ASHE’s Energy to Care program is an important sustainability initiative, and hundreds of hospitals have been honored with awards from the program.
In 2024, 202 hospitals earned the Energy to Care Award, 136 earned the Sustained Performance Award, 21 received the Sustainability Champions Award and two ASHE Chapters won the Chapter Challenge. That total of 361 awards is nearly triple the number from 2023, when 126 awards were presented.
A significant reason the number has increased is an improvement in the application process, Brooks says.
In March, the Energy to Care dashboard was changed to allow participants to conveniently view all the facilities in their portfolio and determine which awards they are eligible for. If all requirements are met and the data is correct, the participant can check a box, and the application is complete.
If the award requires additional documents — as the Sustained Performance Award and the Sustainability Champions Award typically do — the dashboard now allows the user to easily upload those documents.
“The improved application process has made it easier for our members to be recognized for their sustainability efforts, and that’s reflected in the larger number of winners,” Brooks says. “Helping hospitals become more sustainable is an important part of ASHE’s mission, so it’s always great when we can honor those who succeed at sustainability.”
Environment and finances
ASHE has long focused on sustainability as an issue that affects both the environment and hospitals’ finances. The initiatives that concluded in 2024, and those that continue into 2025, will have an impact well beyond the immediate participants.
“Sustainability is a topic that ASHE members need to be educated about and prepared for,” Wallace says. “Some places are ahead of the curve, and some places have no goals or targets set, but it’s coming down the pike and could potentially be just a matter of time before a federal rule or goal is established. Ultimately, we want to have all these resources available so that folks can hit the ground running.”
Related article // ASHE’s Treasure Hunt evolves into four-tier HealQuest program
The American Society for Health Care Engineering’s (ASHE’s) Energy Treasure Hunt program was an effective way for health care facilities managers to do a deep dive into potential energy savings in their hospitals. But the program was halted during the COVID-19 pandemic because the volunteer treasure-hunting teams could no longer safely enter hospitals to search for energy-saving opportunities.
“The pause in the program gave us a chance to look at what made it really valuable, and what we found was that there was a huge focus on team building and culture shift,” explains Austin Wallace, MA, SFP, sustainability senior specialist at ASHE. “So, we thought, ‘How can we expand that to all of sustainability?’”
The result is a program called HealQuest™. Rather than just focusing on finding ways to save energy, HealQuest helps hospitals save water, reduce waste and improve other sustainability measures.
“We wanted to maintain that format of taking teams throughout these spaces but with multidisciplinary teams,” Wallace explains. “We can have a nurse, a lab technician and a facilities manager walk into the hospital’s central plant.
“This is a space the facilities manager is going to be very, very familiar and comfortable with, but the nurse and the lab tech might not, so it’s a new perspective in those spaces,” he continues. “They might see things the facilities manager doesn’t. For example, they might walk into a storage space and notice that the lights are always on. How much energy is that wasting? It really opens people’s eyes to what our daily operations look like.”
HealQuest comes in four tiers. The first tier is an online course on hospital sustainability; the second tier is on-site team building; the third tier is the team walk-through of the space; and the fourth tier is the goal-setting and action-planning phase, where the ideas are turned into concrete plans.
Wallace reports that ASHE is seeking the first hospital to undertake HealQuest.
“The majority of the professionals I discuss the idea with love it, and they think it would be phenomenal for their hospital,” he says. “But it is a program that requires financial investment on the part of the hospital, so it is a long decision cycle. However, we are confident that once a hospital undertakes the program, the savings will greatly exceed the cost. The investment in your hospital and its staff will pay off.”
Ed Avis is a freelance writer based in Chicago.