Best Practices in Energy Efficiency


Energy efficiency can enhance human health by reducing greenhouse gas emissions, improving outdoor air quality and decreasing acid rain. The energy needed to run commercial and industrial buildings in the United States produces 19 percent of U.S. carbon dioxide emissions, 12 percent of nitrogen oxides, and 25 percent of sulfur dioxide, at a cost of $110 billion a year.

The health care sector is in need of cost-effective solutions to address the rising cost of energy and the health implications of energy use. Once a facility has developed an energy baseline by tracking and measuring its energy use, it can begin to zero in on areas of inefficiency and review potential energy reduction strategies with an eye for what will work given the financial resources of the organization.

Improving the efficiency of energy end uses reduces both energy cost and greenhouse gas emissions – and is often called "demand-side management." 

A robust energy efficiency program is the foundation for a hospital to take its next step towards a cleaner energy portfolio – and is often called "supply-side management." Displacing the use of conventional energy with clean, renewable energy reduces GHG emissions and contributes to softening price volatility associated with oil, natural gas, coal, and electricity generated from these fuels.

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Demand-side management

"Demand-side management" is a facilities management approach that involves ways to reduce the need for energy.  The key to demand-side management is system-wide energy conservation programs. These types of programs identify cost-effective procedures that reduce energy consumption and develop systematic programs of energy system efficiency improvements. Health care facilities examine and analyze energy use to determine where it could be possible to cut back.

There are several key areas a health care facility can target when looking for energy efficiencies. The following areas are the energy use categories laid out by EnergyStar and provide a useful framework for assessing opportunities for energy reduction:


Commissioning involves ensuring that mechanical systems are designed, installed, functionally tested, and capable of being operated and maintained according to the hospital's operational needs. Commissioning usually takes place when the building goes into service. Retrocommissioning involves the same process of reviewing systems alignment and optimization, but takes place at a later point in the building’s lifecycle — and can recalibrate systems to function more efficiently and effectively — reducing energy and improving operations.


Lighting consumes close to 35 percent of the electricity used in commercial buildings in the United States and affects other building systems through its electrical requirements and the waste heat that it produces. Upgrading lighting systems with efficient light sources, fixtures, and controls can reduce lighting energy use, improve the visual environment, and affect the sizing of HVAC and electrical systems. Looking at the intensity of lighting in different areas — what levels of illuminance are appropriate for a clinical area vs. a supply closet — may also identify opportunities for modifications and greater efficiencies.

Supplemental load reduction

Supplemental load sources are secondary load contributors to energy consumption in buildings — typically people, computers, lights, and the building itself. These loads can adversely affect heating, cooling, and electric loads. However, the effect of supplemental loads can be controlled and reduced through strategic planning and implementing energy-efficient upgrades. With careful analysis of these sources and their interactions with HVAC systems, equipment size and upgrade costs can be reduced. These upgrades can increase HVAC energy savings and reduce wasted energy. The best ways to reduce supplemental loads include:

  • Reducing equipment energy use
  • Upgrading the building envelope by improving insulation, fenestration, and roofing 

Air distribution systems

On average, the fans that move conditioned air through health care institutions account for about 8 percent of the total energy consumed by these buildings, so reductions in fan consumption can result in significant energy savings. An EPA study found that almost 60 percent of building fan systems were oversized by at least 10 percent, with an average oversizing of 60 percent. “Rightsizing” a fan system, or better matching fan capacity to the requirements of the load, is an excellent way to save energy in air distribution systems. There are also opportunities for energy-saving improvements to the air distribution system in four other categories:

  • Adjusting ventilation to conform with code requirements or occupant needs,
  • implementing energy-saving controls,
  • taking advantage of free cooling where possible, and
  • optimizing the efficiency of distribution system components.

Heating and cooling upgrades

Heating and cooling systems account for a significant portion of a building’s energy use — typically about a quarter. However, it is possible to lessen this impact in both central and unitary systems by increasing their efficiency. Cooling systems generally have higher space-conditioning capacities than heating systems because waste heat from people, lighting, and office equipment supplies a large portion of a building’s heating requirement. Although their higher capacities often translate into more opportunities for savings from cooling systems, significant savings can still be had from heating systems. Many existing systems are oversized, to begin with, so it may now be possible to justify replacing the current system with a properly sized one — or retrofitting it to operate more efficiently. When replacing system components, it is extremely important to size the equipment properly to meet current loads. Besides saving energy, proper sizing will likely reduce noise, lower first costs for equipment, and optimize equipment operation, which in turn reduces maintenance costs and extends equipment lifetime.

**The material above comes directly from Energy Star’s Building Upgrade Manual.

A staged approach

Energy Star recommends a staged approach to energy efficiency, meaning that an organization would want to look at the efficiency mechanism categories above in sequential order. Energy Star points to the fact that many of these strategies build upon each other and can increase efficiencies in later strategies if the early strategies are completed first. Practice Greenhealth recognizes that there are a variety of drivers for selecting which energy initiative comes first — including the availability of capital, but generally supports this framework.

EPA stages of integrated lighting upgrade approach
Stages of integrated upgrade approach (ENERGY STAR Building Upgrade Manual Chapter 6: Lighting

Purchase of energy-efficient products and equipment

A key element in a comprehensive energy efficiency program involves specifying products and equipment that meet certain energy efficiency standards. While specifying energy-efficient equipment is clearly integrated into the strategies above, health care organizations can also benefit from putting some clear guidance into place for purchasing staff, so that other departments and units ordering supplies and equipment are informed of the preference for energy-efficiency where possible.


Specifying highly efficient building equipment – boilers, chillers, and air conditioners – can greatly reduce a facility’s energy consumption while maintaining comfort. All HVAC units should be properly sized and selected for high efficiency. A basic requirement for energy efficiency is compliance with any existing Energy Star or Federal Energy Management Program (FEMP) standard for the equipment category (whichever is more stringent), with preference given to those models showing the highest energy efficiency ratings according to Energy Star/FEMP assessment criteria. For HVAC equipment see Energy Star Qualified Products. For information on Green Seal certified chillers, see their Environmental Standards and Product/Service list.

The Department of Energy also provides several fact sheets on buying energy-efficient equipment including:

Case studies:


Practice Greenhealth also provides energy-efficiency specifications for other products found in health care, including:

The Department of Energy also has useful guidance:

And EnergyStar:


Learn more about how strategic transportation operations can improve efficiency and reduce emissions.

Energy efficiency tools and resources

Green Guide for Healthcare Facility Management Credits

The Green Guide for Healthcare is the health care sector’s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations, and maintenance of health care facilities. This self-certifying credit system allows health care organizations to access information on best practices for sustainability and health in a credit-based format. Through its volunteer committees, GGHC develops and distributes health care specific and health-focused tools, technical guidance and educational resources to support, reinforce and accelerate the creation, operation, and maintenance of high-performance healing environments

Energy Star for Health care

Energy Star is a partnership of the EPA, the Department of Energy, and over 8,000 private and public sector organizations that provide extensive technical information and other resources promoting energy efficiency. Its Portfolio Manager tool is also the premier energy and water tracking mechanism for the health care sector. Its resources include:

Better Buildings Alliance

The Department of Energy through the Better Buildings Alliance partners with leading health care organizations to improve energy efficiency and reduce greenhouse gas emissions of health care systems throughout the country. By leveraging access to advanced technologies emerging from the national laboratories, the Better Buildings Alliance creates a national forum for industry to share evidence-based technology and market solutions proven to drive energy reductions. Through the Better Buildings Alliance, DOE is providing the resources, tools, and strategies to identify clear pathways to cost and energy savings through efficient and renewable energy technology applications. The following fact sheets offer more detailed information.

IFMA Healthcare Council

IFMA Healthcare Council is a membership organization for facility management professionals. The Health Care Council (HCC) consists of 500 hospital administrators, facility managers, design and construction professional, consultants, vendors, and students serving academic medical centers and community hospitals, retirement facilities, and specialty hospitals and clinics. As a council of IFMA, their goal is to holistically enhance the skills of facility management professionals within the health care industry and to further the profession overall. 

American Society for Healthcare Engineering

With 10,000 members, ASHE is the largest membership association devoted to optimizing the health care physical environment. ASHE counts health care facility managers and engineers amongst its primary members and works to provide resources on best practices for managing the physical environment of health care. ASHE has a wealth of resources on its website—from compliance with codes and, regulations, to energy efficiency guidance to webinars and conferences. ASHE is also a sponsor of the Sustainability Roadmap, which has a host of resources on energy.

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