Ask an expert: Hospitals, health care facilities: Sustainability and energy efficiency

Health care facility designers are expected to keep pace with increasingly complex, advanced engineered systems and features

By Consulting-Specifying Engineer November 18, 2019


Neal Boothe

TLC Engineering Solutions

Boothe has more than 24 years of experience in the health care industry. As Principal/Senior Electrical Engineer, he has led numerous projects, including new greenfield hospitals and additions and renovations to existing health care facilities.

Mark Chrisman

Henderson Engineers

In his role as Vice President and Health care Practice Director, Chrisman coordinates strategy for the company’s health care projects nationwide. His areas of technical expertise include fire protection and code consulting.

Tom Divine

Johnston, LLC

As Senior Electrical Engineer, Divine has spent 21 years in the consulting engineering field, with the past 17 years designing and engineering health care facilities. He is responsible for power, lighting and fire alarm design for hospital and health care projects.

Roger Koppenheffer

Certus Consulting Engineers

As a founding Principal of Certus Consulting Engineers, Koppenheffer brings 24 years of experience in the MEP consulting engineering industry specializing in health care facilities. He has a range of expertise in mechanical and plumbing engineering.

Nick Martin

Affiliated Engineers Inc.

As principal, Martin oversees multidiscipline engineering teams with a focus on national and international health care markets. He originally joined the firm as an electrical project engineer.

Michael Phillips

Southland Industries/Envise

Phillips works with consulting engineers, customers and internal business development staff. He is responsible for educating them on the solutions offered through controls and building automation.

Jose Torres

RMF Engineering

As Health care Team Leader in the company’s North Carolina Building Systems Division, Torres works with organizations such as Duke Health, UNC Hospitals and Rex Health care. He has been with RMF since January 2001.

April Woods


As vice president and mechanical department head of Florida building systems for the company, Woods has played a key role in engineering mechanical solutions for major health care projects. She has facilitated sustainable design for several successful green building projects.

CSE: What level of performance are you being asked to achieve, such as WELL Building Standards, U.S. Green Building CouncilLEED certification, net zero energy, Passive House or other guidelines?

Martin: We have seen some interest in WELL Building Standardand have designed a few buildings as such, but certainly not at a high level in the national market yet, though trends suggest this will grow in popularity. Health care providers are always conscience of LEED certification and in most cases, we are finding that LEED Silver is the acceptable minimum standard with higher levels of certification often desired if achievable without an exorbitant cost increase.

Koppenheffer: I have been involved in many levels of sustainability certification over the course of my career. Some of the most successful and sustainable projects did not have an official certification level. The entire team needs to develop sustainability goals and build a matrix at the onset. Set a target for and energy usage intensity and for and return on investment for any given system decision and stick to it.

Woods: Although seeking LEED and other certifications has overall plateaued in the health care industry, sustainable building concepts continue to be on the forefront of most owner’s minds. We are in the business of helping people get well and that starts with a healthy building. Many sustainable building philosophies come with a sensible return on investment, which make them an attractive and sensible choice for many savvy owners. High-performing buildings can be marketed back to the community even without certification statuses.

CSE: What unusual systems or features are being requested to make hospital projects more energy efficient?

Divine: Our hospital clients are often skeptical of new or unusual sustainability features and prefer systems with established track records and large installed bases. We do review our control sequences to identify opportunities for better efficiency. An example would be providing air change rate setbacks for operating rooms when they’re not in use.

Martin: Carbon reduction goals and net zero goals continue to gain more traction in the health care community. These often express aspirations for health care campuses to become self-resilient.

CSE: What types of sustainable features or concerns might you encounter for these buildings that you wouldn’t on other projects?

Koppenheffer: One particular sustainable feature that would apply to most facilities may be more attractive in health care facilities due to the nature of the facility itself. Cooling coil condensate recovery, while dependent on geographic location, better lends itself to hospitals. This is because hospitals are required to have larger ventilation requirements and lower discharge air temperature setpoints necessary for humidity control. This leads to larger quantities of condensate to be recovered and becomes more attractive from a return on investment perspective.

Martin: Sustainable goals and features in health care must first be balanced with the priority of patient safety, comfort and attention to infection prevention. Some sustainable solutions, such as water reuse, are hard to accept in an inpatient setting.

Divine: Our hospital clients are often skeptical of new or unusual sustainability features. We find that those clients prefer to use a system with a well-established track record for performance and a large installed base.

CSE: What types of renewable or alternative energy systems have you recently specified to provide power?

Woods: As the economics continue to add up, photovoltaic systems tend to be the most sought after for renewable energy sources to be considered. Besides the infrastructure costs, one challenge that continues to be limiting is the vast amount of space required for the cells to be effective in offsetting the electrical demands. Analyses are completed on many projects but often show that the area required, even for a portion of the power needs, is not practical.

Martin: One of the biggest challenges in implementing renewables is justifying the cost upfront, though prices in these technologies have drastically reduced in recent years. In many cases building designs intend to have some level of photovoltaics installed in the future and are set up as being PV ready. The challenge with these technologies in health care is finding available space on a congested site or roof plan for their installation. Any facility planned for vertical expansion also presents an issue for the deployment of PV technology from day one.

CSE: What are some of the challenges or issues when designing for water use in such facilities, particularly buildings with high water needs?

Martin: Legionella remains the top concern with health care providers and more conscious efforts are being made to mitigate it in existing facilities. New construction allows the opportunity to incorporate some fundamental design practices focused on minimizing the potential for Legionella growth. Appropriate chemical treatment is one part of the equation, but mindful designs that minimize long runs of piping that can hold stagnant water makes a huge difference as well, particularly with regards to inpatient bathrooms/showers. Facilities are also implementing flushing plans for these rooms to make sure water doesn’t sit in a pipe for long periods of time before someone turns on a shower.

Koppenheffer: With the increases in water conservation requirements, low-flow fixtures have become more prevalent in health care facilities. This lower flow leads to water savings, but also comes with its drawbacks including patient and staff satisfaction and recirculation system design complexity. It is imperative that design engineers coordinate closely with the end users to minimize the effects of conservation measures on clinical operations and look for alternative measures where necessary.

Woods: Capturing of cooling coil condensate for reuse in irrigation systems and cooling tower makeup is an excellent strategy where pipe and pumping requirements are not limiting. This allows for the use of clean water to be reclaimed for other purposes rather than discharged as a single-use back into the sanitary system. Due to the weather patterns, the cooling coil demand will coincide with the cooling tower makeup needs, making this a very attractive arrangement.

CSE: How has the demand for energy recovery technology influenced the design for these kinds of projects?

Martin: Energy recovery solutions are a mainstay in health care designs we develop. It’s hard to recall a project where we didn’t implement some level of energy recovery technology, such as heat recovery chillers or heat exchangers.

CSE: What value-add items are you adding these kinds offacilities to make the buildings perform at a higher and more efficient level?

Koppenheffer: When designing health care facilities, the total cost of ownership over the life of the building is more important than the first cost of the systems. Providing detailed cost analysis and return on investment studies to inform the owner of the benefits of spending a little more money now to save on energy over the life of the building should be at the core of engineering strategies. Some of the major items we have been able to put in place due to their quick payback include heat pump chillers, energy recovery systems, LED lighting, daylight controls and condensate recovery systems.

Martin: Expanded building automation controls and metering are value-add items that we are adding to help enhance an owner’s ability to trend data and make operational adjustments throughout their systems, to fine-tune energy focused building operations.

CSE: How have energy recovery products evolved to better assist in designing these projects?

Martin: These products continue to become more and more reliable in the field and are beginning to develop proven track records that make their implementation more digestible to an owner who may not be familiar with them.