Hospitals are essential to public health, yet they rank among the most energy-intensive buildings. As the construction sector embraces cleaner technologies, how can healthcare facilities decarbonise in a practical and cost-effective way?
Just as we rely on healthcare services to support and improve our well-being, the industry is focused on positively impacting human health for communities at large, including by reducing its carbon footprint. The United States' healthcare sector is responsible for 7.6 percent of the country's greenhouse gas (GHG) emissions, making it the largest global emitter for the sector.
Hospitals especially have an outsized climate impact. There are more than 6,000 hospitals in the United States, most of which still rely on fossil fuels for building operations and medical functions. Because of these operations, which include heat for sterilisation, humidity control, and a large amount of outside air, they are high energy consumers — with an energy use intensity averaging nearly three times higher than that of other commercial buildings — making carbon reduction a considerable challenge.
Decarbonising these existing facilities, which often include laboratories, academic research buildings, and medical campuses, is further complicated by mission-critical operations that must be in service at all times. The transition process to lower-carbon energy sources can also include significant financial investments and higher operating costs in the short term.
Nevertheless, as thousands of hospitals age in the coming decade, the majority of the inpatient healthcare industry will need to lower GHG emissions and electrify their building stock. Given this reality, how can these complex, energy-intensive existing facilities best lower carbon emissions while keeping costs in check, upholding quality care, and yielding long-term gains? And how might hospitals align their healthcare missions with their climate impacts?
The big picture advantage
Some healthcare pioneers are embracing ambitious carbon reduction strategies that exceed regulatory requirements and proactively advance the transition process. In one such case, a major healthcare organization is eliminating onsite combustion of natural gas and implementing zero carbon operations in concert with state net-zero emissions targets by 2050. But for most hospitals, an energy transition is an unchartered journey with ill-defined costs.
Applying a strategic decision-making framework based on big-picture comprehensive inputs and analyses brings definition to the process. This approach should be used to generate feasible combinations of efficiency, electrification, and alternative fuel measures; provide energy and life cycle cost analyses; map out payback scenarios; and help owners make critical business decisions about what systems and technologies to transition to and when.
Lowering both carbon and cost
Hospital owners will want to find technically viable low-carbon site-specific solutions that also reduce operating costs, even as electricity costs initially may be higher than natural gas. Focusing on energy efficiency, the “first fuel,” by identifying possible ECMs for a facility, a central utility plant (CUP), and/or for a whole medical campus provides a cost-effective way to reduce energy consumption in the near-term.
Early planning can help institutions take advantage of incentives for implementing lower-carbon solutions and explore power purchase agreements that may reduce costs. Hospital owners can investigate alternative structures for financing and procuring large infrastructure and for defining large energy conservation measures (ECM) programs.
Hospitals can also strategically save on costs throughout an energy transition by phasing the process, such as converting systems at end-of-life if most efficient, and timing major investments with capital plans. For the University of California San Francisco (UCSF) Decarbonization Roadmap, Arup’s plan balances intentional replacements of end-of-life equipment with retention of natural gas equipment as an added resource for rare backup or peak heating needs. This reduces the impact of the capital cost required for full implementation while allowing new technology to be integrated.
The plan’s strategic transition timeline also provides the means for phasing capital across the lifetime of the Roadmap that is aligned with other investments, such as lab modernization, reconstruction of aging facilities, and seismic renovations. Early planning also enabled capturing additional cost efficiencies from the electrical distribution provider and identifying available federal funding for this project.
Knowing your options
Arup helped the University of Massachusetts Chan Medical School (UMass Chan) develop a strategy to achieve its goal of carbon neutrality of Scope 1 and 2 GHG emissions by 2050 for its main campus of seven buildings connected to the CUP. Our team began by analyzing the most recent five years of monthly historical utility data, identifying trends in usage and comparing UMass Chan’s usage to industry benchmarks. This enabled us to focus on the greatest opportunities to reduce energy consumption and fossil fuel use.
We developed a comprehensive list of ECMs with related estimated costs, expected energy savings, simple payback period, and available incentives for lower-carbon solutions. The long list of options ranged from replacing leaky valves and installing occupancy sensors to deep energy retrofits to replace the building’s aging mechanical systems.
We often employ a multicriteria decision assessment (MCDA) process to help hospitals with decarbonizing decisions involving multiple facets. This foregrounds broader drivers along with technical issues relevant to a hospital’s situation, such as geographical or resilience conditions, constructability and feasibility of solutions, mission critical functions, as well as potential workforce training needed to operate new technologies. For UCSF’s Roadmap, the MCDA serves as a valuable ongoing guidepost, informing decision making throughout the life of decarbonizing the project, including when revisiting decisions as new technology emerges or when projects become better defined.
Evaluating potential pathways
Once hospitals have begun lowering their energy use, their decarbonization plans can focus more on electrifying heat generation plants and other systems, maximizing the utilization of waste heat, and scaling down electricity demands to offset the higher costs of electricity to gas. This is when a strategic approach to decision-making is essential.
For UMass Chan’s phased 25-year decarbonization plan, Arup focused on transitioning away from natural gas along with reducing chiller load and energy losses. We used a decision tree for evaluating pivotal decarbonization decision points facing the hospital. A key focus was on whether UMass Chan should retain the steam heat distribution network on campus or convert to a hot water system. The decision tree helped to better understand the balance between utilizing existing assets and achieving institutional goals for lowering carbon.
Arup then developed a dashboard tool to allow the university to examine the different pathways to achieving desired carbon reductions at a granular level. It reveals the many permutations inherent in different decarbonization strategies — such as the technologies to be deployed, fuel type required, the type and quantities of green-energy procurement, and implementation timelines — all with related trade-offs and opportunities.
The dashboard introduces flexibility and a future focus to decarbonization strategies by incorporating technologies that, if not feasible in the short-term, may be increasingly viable in the longer term. This includes options for fuel-switch pathways to achieve net zero onsite in the future, including options for micronuclear reactors, green hydrogen, biofuels, and electric boilers.
After reviewing all their options, UMass Chan decided to maintain the existing steam system, since it is efficient and cost effective, while continuing to reduce the steam load and eventually to convert to a low-carbon energy source for steam generation.
For UMass Chan, Arup used a decision tree to evaluate retrofitting the heating system or retaining the steam heat system.
Arup developed a similar dashboard for UCSF that enabled the project team to shift the timeline of decarbonization measures to reveal the related total cost and payback impacts. It also allows UCSF to explore different pathways of rising capital, operational, and energy costs to test different future financial scenarios.
Leveraging the long term
Having both this level of detailed information and a framework for decision making is paramount for hospitals as they make choices that will shape their lower energy and carbon strategies and timelines. Plans should also be agile and future-focused, including alternatives and offramps for incorporating new technologies as these achieve market readiness and cost parity with currently available options.
Additionally, plans should enable adaptation to the changing energy landscape. With smart grids on the horizon, hospitals may want to prepare for how they will integrate with them, for example. In other words, hospitals should plan for not knowing what their eventual net zero solution may be and build in monitoring processes to track advances in the low-carbon energy supply market. In this way, hospitals will realize long-term value while achieving lower-carbon outcomes without diverting from their mission to deliver health and wellbeing outcomes to their communities.
