Design and Construction, Energy Management and Lighting, Maintenance and Operations

Balancing Energy Efficiency, Compliance, and Patient Care in Healthcare Facilities

When patients visit a healthcare facility, they are not thinking about how many kilowatt-hours of energy the facility is using, or how the facility may be reducing its cubic feet of natural gas consumption annually. When patients visit a healthcare facility, they are thinking about the care they’re going to receive.

As healthcare facility managers, though, we know that while patients’ minds may be on their upcoming procedure, the environment around them is influencing them—Is the air conditioning too cold? Does the air feel moist? Do they feel comfortable coming to and staying in this environment, or are they eager to leave as fast as possible?

It is a healthcare facility manager’s job to ensure every element of the healthcare environment strikes the correct balance of function, comfort, security, safety, efficiency, and compliance. This is no easy task, yet there are some best practices managers can tap into to set an ideal baseline of comfort and function for everyone within a facility.

Energy Efficiency

Hospitals are one of the largest commercial consumers of energy, meaning energy efficiency and sustainability are important for the environment and the facility’s longevity. From environmental systems that maintain humidity levels and proper pressurization to generating steam to sterilize equipment for procedures, every hospital process requires some form of energy to operate within its strict health and environmental parameters.


Take lighting, for example. Dimming lights may technically be energy efficient, but if patients struggle to sign intake forms because they can’t read the form, dimming is not sustainable. It is also not safe depending on where in the facility the lighting may be too dim, such as outdoor structures like parking lots or garages.

It’s important to have the right light ratio outdoors so a person’s eyes can appropriately adjust from high-light to low-light as they walk. This should typically be no more than a 15:1 light ratio in surface lots and parking structures to limit how much a person’s eyes need to adjust.

This became an issue several years ago when there was a push for facilities to switch out their lighting fixtures to be more efficient. When they switched their outdoor lights, they sacrificed industry design standards and the appropriate high-to-low light ratios, which posed a safety risk. Many of these same facilities have had to backtrack and install new fixtures to address the safety concerns.

Indoor spaces can have the opposite challenge, particularly for waiting and visiting rooms and other common spaces. Facilities should choose the right product for indoor spaces to ensure they’re not over lit as LED lamps typically produce more light than traditional bulbs. Products that are field-adjustable (lumens and color temperature) may be better solutions for these spaces.

Optimizing Existing Assets and Incorporating New Technologies

Supply chain challenges are ongoing, so facilities that may be examining ways to be more efficient should strongly consider optimizing their existing assets. Retrocommissioning and recommissioning are great routes, because they are all about optimizing existing assets. Make sure the hydronics system is pumping optimally, outdoor air dampers and economizer modes are working correctly, building automation system sequences and end devices are functioning as designed, etc. When facility managers do find discrepancies between a system’s optimal performance and its actual performance, that is when they should examine how they can implement new technologies, which may include software, new sequences, or application of innovated products.

Technology becomes more sophisticated with each new iteration that is released or adapted for healthcare. This is ideal for efficiency, but it also means users will need more training and education on how the technologies work, as well as how to maintain the systems so they produce the savings they said they would. Facility managers must ensure their employees who own the education, maintenance, and vendor relationships for these technologies are in place. The biggest barrier healthcare facilities face in streamlining and improving their energy efficiency is the application of these new technologies in existing systems (i.e., change management).


There is a common misconception that compliance standards reflect the best practice or ideal level of regulation. In reality, they are the baseline standards a facility must meet.

A particularly apt example for healthcare facilities is Operating Room environmental design conditions. ASHE Standard 170-2017 specifies that operating rooms should be designed and maintained between 68 and 75 degrees Fahrenheit within a relative humidity range of 20% to 60% RH. However, with new technologies being introduced into operating rooms and the evolution of surgical attire, most users prefer to operate the operating room theater below 68 degrees Fahrenheit. Although 68 degrees is the minimum standard, best practice is to design an operating room that can be used at temperatures lower than 68 degrees while staying in compliance with humidity standards, which limits potential risks.

When appropriate, reaching above and beyond with compliance standards communicates to caregivers and patients that their comfort is also an important part of their experience.

Managers who share reasoning for why a standard is in place or why a deviation to minimum standards is acceptable provide staff with a deeper understanding of potential safety issues that could arise. Too many standards are developed in response to serious safety incidents, and sometimes simply sharing what hard lessons were learned is the best way to cement the importance of standards and why they are in place. Ensuring staff understand the risks of being non-compliant takes efforts a step further than simply satisfying an inspector.

From lighting levels to ligature risks, the balancing act between patient care and all the standards required in a hospital can be complicated. The best way to ensure a facility is maintaining the right balance is through proactive action.

Proactively evaluate energy use rather than waiting for someone to say a fan won’t shut off. Proactively assess compliance risks before an inspector points it out. Paint the hallway before patients or their relatives complain that the facility is run-down and questions the care they’ll receive.

Rarely will these efforts result in easy fixes, but they will ensure facility managers know not only how well their hospital is running, but how comfortable their patients are, too.

Scott Czubkowski, PE, CHC, serves as the national director for energy and facility performance at Medxcel.