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As healthcare organizations began discussing climate change nearly 20 years ago, discussions focused on how much energy hospitals, doctor’s offices, and clinics use.
“Healthcare organizations have an incredible opportunity to reduce both their environmental footprint and operating cost associated with energy usage,” according to Kim Shinn, principal and sustainability wizard for TLC Engineering Solutions of Brentwood, Tennessee.
Climate change refers to long-term shifts in temperatures and weather patterns caused by natural factors, like changes in solar activity or volcanic eruptions, as well as human activities, particularly from burning fossil fuels like coal, oil, or gas; human activities create greenhouse emissions such as carbon dioxide and methane that trap sun’s heat causing temperature increases.
As our understanding of climate change and greenhouse gas emissions has expanded, healthcare – which accounts for roughly 8.5% of U.S. emissions – has recognized its ability to play an even more significant role in combatting it.
Shinn states: “We are beginning to understand that climate change has profound health impacts,” including higher temperature events that put individuals at risk of heat exhaustion; changing climate conditions introducing diseases previously unseen before; and the downstream effects of energy generation producing air pollution with adverse health outcomes for populations.
Sustainability’s Role in Population Health
Concurrent with this relationship was a shift within healthcare to focus on population health. Healthcare organizations now consider how their services and facilities impact community members’ wellbeing, with value-based reimbursement models providing incentives for keeping people out of hospitals.
“Reducing climate-induced health impacts will relieve strains on healthcare systems,” states Rame Hemstreet, Vice President of Operations for National Facilities Services at Kaiser Permanente Oakland California. There are both ethical and financial motivations for doing this work.
As a result, healthcare is evolving beyond simply energy reduction to address greenhouse gas emissions that stem from buildings and associated activities, including carbon dioxide (CO2) emissions as well as methane and nitrous oxide emissions (decarbonization is used as shorthand for greenhouse gases such as these).
Healthcare systems are taking steps toward meeting their environmental goals by adopting new technologies and strategies, such as all-electric hospitals and microgrid systems, that may help lower or eliminate fossil fuel burning at power plants and boilers that releases emissions into the atmosphere.
System performance or efficiency standards are also driving change through new voluntary or mandated building codes and local/state regulations that focus on them.
Since last year, numerous organizations have joined the White House and Department of Health and Human Services’ (HHS) Health Sector Climate Pledge. The pledge encourages healthcare stakeholders to assist with combatting climate change by setting goals such as cutting emissions by 50 percent by 2030 or reaching net zero (meaning zero emissions from their entire supply chains) by 2050.
“Many of our clients who are participating are now turning back to the A/E/C industry for help in understanding this,” Shinn states.
State of Decarbonization in Healthcare
The Greenhouse Gas Protocol, an industry standard method for tracking emissions, classes these substances as Scope 1, 2 or 3. Traditionally, healthcare organizations seeking to reduce emissions have focused their efforts on direct emissions from facilities (known as Scope 1) as well as indirect emissions caused by utility providers producing energy ( known as Scope 2) as a primary area for reduction.
Scope 1 strategies in healthcare could involve being better stewards of anesthesia gases, choosing refrigerants with reduced global warming impact and employing equipment that decreases energy needed for space heating.
Concerning Scope 2, organizations can contract with energy providers who use renewable sources, like wind or solar power, instead of fossil-fuel based energy to produce electricity.
Reaching net zero requires systems to implement strategies aimed at controlling emissions associated with supply chains or business activities such as pharmaceuticals, construction materials, transportation and investments.
Shinn estimates that in the U.S., three quarters of greenhouse gas emissions associated with healthcare businesses like hospital systems fall under Scope 3, with the remaining 25 percent nearly evenly split among Scope 1 and Scope 2 emissions.
Addressing Scope 3 emissions in healthcare projects
Kaiser Permanente has long been at the forefront of efforts to combat climate change, and achieved carbon neutral status (when an organization’s total greenhouse gas equivalent emissions equal what was removed from the atmosphere) in 2020.
Organization employs various strategies to achieve its success, including an energy efficiency campaign which has resulted in an 8 percent drop in overall energy intensity since 2013, as well as an onsite solar program.
Hemstreet credits this agreement as the major factor behind their organization becoming carbon neutral. Hemstreet noted how these contracts had played a huge part in helping the organization become carbon-neutral.
Now, as part of its HHS pledge to reach net zero emissions, Hemstreet says the organization is setting its sights on the embodied carbon emissions associated with its facilities – specifically materials extraction, supply and manufacturing processes for building or maintaining facilities.
Structure materials in healthcare buildings represent one of the primary targets within this category for carbon reduction, due to their large carbon footprints associated with production. According to Shinn, because carbon emissions associated with concrete, steel, aluminum and glass production get released into the atmosphere before reaching any building site, its carbon footprint becomes substantial even before operations commence and greenhouse gas emissions accrue due to operation.
Hemstreet believes efforts are already underway in the construction industry to reduce carbon emissions from material manufacturing processes. “Decarbonize these production chains,” she states.
“Hope exists that, one day soon, we may be able to purchase low or no carbon steel and concrete,” according to Professor.
Kaiser Permanente is also considering the potential of mass timber, an engineered, smooth-surface product with reduced off-gassing that could improve air quality.
Hemstreet acknowledges there may be obstacles related to using wood in healthcare settings, yet remains optimistic the method could be adopted at primary care facilities with plans in place to launch a pilot project this decade.
As with any strategy in healthcare design, Hemstreet emphasizes the need to evaluate any new approach based on both its affordability and its ability to support decarbonization efforts. “We need to make sure we are not adding additional costs for those new facilities,” he argues.
Are Electric Hospitals the Answer? One idea gaining momentum on the path toward decarbonization in healthcare is electrification – replacing fossil-based energy sources with energy produced via electricity instead.
Healthcare facilities have begun converting from boilers or water heaters to heat pump systems as an efficient means of domestic water heating and space heating, thus helping them eliminate one major source of emissions–burning fossil fuels like natural gas for heat. This equipment helps eliminate one major source of emissions that occur at healthcare facilities–burning fossil fuels for heat.
“Reducing or discontinuing natural gas usage not only reduces emissions from its combustion process, but it can also prevent leakage of methane gas that’s present as part of natural gas,” according to Shinn.
Where steam is still necessary, such as for sterile processing, facilities may use smaller steam generators that only run when necessary instead of an all-encompassing central steam system.
Some are already making strides toward this end, including California’s UCI Medical Center Irvine-Newport which, when completed in 2025, will feature an essential utilities plant without carbon combustion or natural gas use.
Mazzetti Consulting Services LLC, a decarbonization, technology, financial, and engineering consulting firm focused on healthcare, has been helping its clients develop and implement sustainable strategies. Recently the firm released the California Energy Commission’s A Guidebook for Decarbonizing Healthcare to offer technology, design, finance strategies to help minimize natural gas usage while simultaneously decreasing greenhouse gas emissions.
Walt Vernon, CEO at Mazzetti (San Francisco), believes there are several obstacles to electrification of healthcare facilities; including regulatory ones. “The National Electrical Code contains outdated demand factors which don’t reflect today’s reality,” according to him.
As a result, facilities must install electrical systems which are far larger than necessary – “we’re spending money we don’t need to spend and electrification is more costly than necessary,” according to him.
Emergency power requirements in healthcare is another challenge. Historically, National Fire Protection Association (NFPA) code dictated a fossil fuel generator as emergency backup. Unfortunately, due to increasing air quality management regulations this option typically only works during utility power outages; making electricity very costly per unit of use.
“It isn’t very economically efficient,” Vernon asserts, noting that modern technologies operate more constantly and thus offer both economic benefits as well as reduced environmental impacts.
As more recent versions of the NFPA code adapted to accommodate fuel cells, batteries, photovoltaic panels, and microgrids as sources of emergency power, CMS enforced more stringent codes for healthcare facilities.
CMS granted healthcare organizations permission this spring to adopt the latest NFPA standards that permit these new clean energy technologies for emergency power generation, through a Categorical Waiver. “This decision was absolutely essential because now owners have access to them,” Vernon states.
Microgrid Adoption in Healthcare
Despite previous restrictions, several healthcare organizations had begun testing microgrids as a solution for providing resilience or cutting utility costs at their facilities.
Kaiser Permanente installed a solar-powered microgrid with battery storage at their Kaiser Permanente Richmond Medical Center in Richmond, California in 2018. The 1 megawatt battery stored power from this pilot project funded by California Energy Commission – while an onsite diesel generator provides backup in case of extended power outages.
By year’s end, Hemstreet anticipates that their organization will have completed installation of an even larger microgrid consisting of 9 megawatts of battery storage at their Ontario Hospital in California.
“We’re piloting green microgrids (solar + battery storage) as part of our overall plan for emergency power production,” according to Paul. “This facility represents another step along this journey.”
Hemstreet notes that microgrids aren’t yet cost-competitive with diesel generators, but technology is evolving. State grants were essential in making California home to two large-scale green microgrid projects possible; yet their investments should help these lines converge over time.
Valley Children’s Hospital of Central California in Madera, Calif. recently won a $55 million grant from the U.S. Department of Energy to construct a renewable energy microgrid on its campus and accelerate and expand its clean energy storage capabilities. (For more on a healthcare campus microgrid read “Valley Children’s Healthcare Will Install Microgrid on California Hospital Campus.”)
Continued Momentum
Going forward, Shinn anticipates regulatory components becoming an even larger part of decarbonization efforts as jurisdictions across the United States- including Colorado, Washington state, California, New York state and Maryland- implement regulations regarding greenhouse gas emissions.
“That will become a key driver for healthcare organizations in those locations,” according to Mr. Weiland.
Kaiser Permanente’s Hemstreet advises facilities seeking to begin decarbonization by understanding both their utility usage and costs, as well as their carbon emissions associated with them.
Understanding and reducing energy use as much as possible, while understanding local regulations which could support or impede emission reduction efforts are great starting points,” advises He.
Shinn encourages A/E/C companies to use their purchasing power to leverage supply chains and suppliers into producing materials and products with reduced greenhouse gas impact, and then using environmentally preferable purchasing practices, prioritize those over other products with higher carbon footprints.
Mazzetti’s Vernon notes that time will continue to present an obstacle in addressing climate change for the industry. Acting quickly could bring unexpected issues; but when managed well these risks can be overcome and eventually lead to improved performance over time. To reach better solutions requires courage and dedication for greater good.
Anne DiNardo is the Executive Editor of Healthcare Design. To reach her, email anne.dinardo@emeralddx.com.
2023 HCD Conference Session Spotlight: New Tools and Strategies for Decarbonization
At this year’s Healthcare Design Conference in New Orleans from November 4-7th, several educational sessions will address decarbonization within healthcare projects as well as available tools and strategies that may assist them with meeting emission-reduction goals.
Here is a glimpse of what lies on the agenda at HCD Conference 2016. For a full schedule and lineup, please visit: hcdconference.com
E45: Decarbonization Guidebook for Healthcare–Tell Me More! Speakers included Austin Barolin, Senior Energy Analyst from Mazzetti; Troy Savage, Director of Strategic Projects & Innovation from Mazzetti and Geoff Glass Director of Facility & Technology Services from Providence Healthcare.
Healthcare industries contribute a substantial percentage of carbon emissions both domestically and internationally, fuelling an already-existing fire.
Speakers will present a new guidebook for decarbonization of hospitals. This tool aims to assist hospital owners, operators, designers, architects, engineers and regulators understand the advantages of employing advanced technologies and designs that use less natural gas while decreasing greenhouse gas emissions, healthcare costs and providing benefits for investor-owned utility rate payers.
E55: Attaining Net Zero Energy Consumption and Flexible Resilience at Massachusetts General Hospital
Speakers included Peter Alspach, Director of Design Performance for NBBJ; Paul D. Biddinger, Chief Preparedness and Continuity Officer from MassGeneral Brigham; Andy Martino, Licensed Professional Electrical Engineer Director of Facilities Engineering Massachusetts General Hospital as well as Jacob Knowles Principal/Director of Sustainable Design at BR+A Consulting Engineers as speakers.
With an eye on achieving net zero carbon emission targets and greater climate resiliency, healthcare facilities must perform at unprecedented levels to remain viable in an increasingly unstable global climate.
Cambridge Street Project, situated near Beacon Hill on Massachusetts General Hospital campus with over two centuries-old foundation, demands sensitive consideration of neighborhood context while meeting Boston’s goal of 65 percent carbon emissions reduction by 2050. Our experts on this panel will share this case study and explore its implementation process towards carbon neutrality on this complex project.
E65: We Have Designed the First All Electric Hospital in the US–Want to See How? ordinaire Speakers: Gary Hamilton, USA Director of Healthcare – Senior Vice President at WSP USA and Jonathan Hunley, System Director of Facilities Infrastructure of Bon Secours Mercy Health Network will share insights.
Decarbonization of healthcare sector operations is a pressing and pressing global challenge. Could electrification provide part of the solution? Ultimately, if more hospitals worldwide adopted more electrified energy use or switched entirely over to electric power sources it could create an unstoppable cycle that benefits everyone involved.
As electricity grids decarbonize, greater use of electricity in healthcare will play an increasingly significant role in reaching operational net zero outcomes. This presentation will cover all of the design considerations required to construct an all-electric hospital and demonstrate its cost benefits relative to hybrid hospitals currently in operation.
