When designing electrical, power and lighting systems in hospitals and health care buildings, codes, standards and resiliency must be considered.
Electrical insights
- Electrical design for hospitals requires strict separation of power branches, redundancy and uninterrupted operation, making electrical infrastructure far more regulated, resilient and complex than in typical buildings.
- Clinical demands, severe-weather planning and long-term flexibility are pushing engineers to enhance electrical systems with hardened distribution, layered backup power and campus-level resiliency strategies.
Describe any issues unique to designing electrical/power systems for these types of facilities.
Caleb Marvin: Electrical system design for buildings is very prescriptive and code based. In health care design, the path to code compliance is magnified with entire chapters and code articles dedicated to systems design to help ensure patient safety. Most notably is the separation of emergency branches of power into life safety, equipment and critical. The codes are very specific as to what loads are required and permitted on each branch which must be strictly adhered to. A deep understanding of these requirements and their underlying intent is crucial to successful Health care design.
Meagan Gibbs: Health care facilities are unique as electrical systems directly affect patient safety and clinical outcomes. Unlike most building types, hospitals must maintain continuous operation — power cannot be lost, even momentarily, during procedures or patient care. This drives stringent design requirements, such as segregation of the essential electrical system into life safety, critical and equipment branches as defined by NFPA 99, NFPA 110 and NEC 517. In addition, the density of specialized medical equipment creates high electrical loads and complex grounding requirements. Systems must also anticipate phased expansions and renovations, thus providing reliability while accommodating long-term flexibility.
Jason Butler: One of the most unique systems to health care are isolated power systems. While trends for how to safely and reliably deliver power in wet locations has ebbed and flowed a bit over time and facility owners sometimes have different stances on preferred approach, isolation panels are still the predominant approach. With advancing surgical procedures and many faculties increasing their operating room capacity I expect the amount of these systems to increase.
Richard Vedvik: Health care facilities have areas that are always occupied, in which engineers need to carefully plan outage mitigation. Replacing and/or upgrading existing infrastructure requires detailed phasing plans. It is an error for engineers to assume that outage mitigation is a “means and methods” responsibility of contractors. Project design needs to include all of the temporary infrastructure changes, with detailed discussions to determine whether provisions are temporary or permanent.
What types of unusual standby, emergency or backup power systems have you specified for such facilities? Describe the project.
Caleb Marvin: Facilities are requesting more and more resiliency in the emergency power systems beyond what has been historically provided and certainly above code minimum requirements. Equipment such as large imaging modalities, HVAC cooling equipment, etc. is often desired to be connected to the standby power systems which can have a large impact on the cost of the distribution system. Finding the balance in the design to provide enough power to keep a facility functional in an extended outage while avoiding significantly oversized equipment requires strategic planning and intricate control strategies for staging optional loads on and off.
Richard Vedvik: When comparing Health Care Facilities to other building types, the primary difference is going to be the amount of resiliency in the system. Hospitals are the last facility that a functional society wants to lose and in emergency scenarios, hospitals need to remain online. That means decisions will be made to ensure continued operation despite natural disasters or long utility outages. These facilities require HVAC systems to remain operational in order to maintain patient comfort. Heating systems are required to be on standby emergency power and it’s common for air conditioning systems, chillers, cooling towers, etc. to be on emergency power. This increases the size of the the EPS while requiring levels of redundancy that aren’t necessary for other building types. The testing requirements for Level 1 EPS, as defined by NFPA 110, need to be considered during design such that testing is not disruptive to the facility.
In the aftermath of several recent severe weather events, owners of such projects are increasingly interested in electrical/power resiliency features. How are you meeting these demands?
Meagan Gibbs: Resiliency is now at the forefront of health care design. Our strategies include elevating critical electrical equipment above flood levels, hardening switchgear enclosures and routing feeders in multiple redundant loops so power can be restored quickly if a feeder is compromised. Dual utility feeds with automatic transfer capability provide additional reliability. We are also designing hybrid systems that pair diesel generation with natural gas supply and battery storage, giving facilities multiple options during prolonged outages. In some cases, clients are seeking microgrid solutions that allow them to “island” from the grid during severe weather, ensuring uninterrupted care delivery.
Darren Harvey: Most urban hospitals already have dual feeds from the local utility provider that are 100% redundant and have a contractual priority agreement for service. However, with those systems still being susceptible to power sags, brown-outs or physical damage, we are seeing a trend in wanting on-site power generation and the implementation of a micro-grid approach (array of natural gas fired turbines) to back-up the normal utility power source. These micro-grid’s can often be used for utility load shedding purposes as well as they typically don’t serve the life safety and critical branches of the emergency power system.
Richard Vedvik: Electrical power systems should have levels and layers of redundancy. Engineers should study possible failure points to ensure single points of failure are avoided. NFPA 110 Chapter 7 requires protection of EPS and EPSS from natural or man-made disasters, guiding designs to incorporate robust safeguards against disruptions.
What are some of the challenges when designing high-voltage power systems in hospitals, health care facilities and medical campus projects?
Meagan Gibbs: High-voltage distribution on medical campuses presents unique challenges. Hospitals operate continuously, which means upgrades and cutovers must be phased carefully to avoid unplanned outages. Coordination studies are critical to balance short-circuit protection and arc-flash safety, ensuring equipment protection without compromising operational continuity.
Richard Vedvik: Medium voltage systems, 5kV to 15kV are common on large campuses and these systems often include single points of failure that are difficult to shut down when changes are required. The benefits of medium voltage distribution are realized when long feeders are needed, while medium voltage equipment demands careful safety protocols to prevent risks.
What are some key differences in electrical, lighting and power systems you might incorporate in this kind of facility, compared to other projects?
Caleb Marvin: A growing trend in commercial building design is the use of wireless lighting controls. In healthcare, however, fully wired systems remain the preferred option. Hospitals depend heavily on wireless technologies for patient monitoring, equipment tracking and communication, which raises concerns about interference, security and reliability if lighting systems were also wireless. A wireless control system could introduce vulnerabilities that risk data breaches or HIPAA violations and more critically, any system failure could compromise lighting in patient care areas. Health care facilities must prioritize robust, hardwired lighting and power systems that ensure reliability, security and patient safety above all.
Meagan Gibbs: Health care facilities are constantly evolving, so electrical systems must be designed with flexibility and future expansion in mind. As space use changes over the life of a facility, a resiliently designed power distribution system will be able to support the ever-changing needs without major disruption to facility operation and patient care.
Electrical systems must also be designed with an understanding of the level of maintenance required. A complicated control system may be the most appropriate choice to increase efficiency and improve user satisfaction for a facility with staff to properly operate and maintain it, however, may be counterproductive in a small critical access facility where staff do not have the time available to maintain the system. Health care facilities have patients and other occupants who are transitory in nature, so simple, intuitive interfaces are necessary to improve the user experience. A lighting control system that patients cannot easily operate will lead to frustration and the typical occupant will not have time to learn all the intricacies of the controls.
Finally, spaces must be designed as a balance between the competing needs of diverse occupant groups. Patients, visitors, providers, nurses, environmental services and maintenance workers all have different uses for spaces that must be accommodated without hindering the other users.
Jason Butler: While there are a lot of differences in the details of electrical design in healthcare, I think some of the key items are; code and regulatory requirements for the vast number of clinical rooms types; essential power system design that includes appropriate capacity and flexibility for growth; and the specific product types & wiring methods.
Richard Vedvik: The primary difference that health care facilities have is that the building is always occupied and some departments function during evening hours, with frequent access to all areas of the facility. Another impact is related to patient care tasks, which impact the requirements for power and lighting systems. For example, we will not control the lighting with occupancy sensors in procedure rooms or operating rooms where nuisance turn off would endanger patient safety. Our primary focus is ensuring that patient care can be delivered safely, accurately and rapidly. That mindset drives all decisions, sometimes at the sacrifice of maximum energy saving potential. Health care facilities need to be online at all times, meaning shutting down departments to perform maintenance is not an option. Instead, systems need to be designed such that maintenance can occur without disruption of services. This requires the designer or engineer to carefully coordinate system resiliency and redundancy with the facility maintenance staff. one example is the location of control components, placing things in more accessible areas than above ceilings.
Studies show the quality and type of lighting in such facilities may impact patient wellness and recovery time. How, if at all, is your team taking that concept into consideration with your designs? Discuss the use of human-centric or other lighting techniques, where related.
Meagan Gibbs: Lighting design impacts patient recovery. Studies show that the use of lighting that encourages the circadian rhythms of patients enhance recovery times and provides staff with a comfortable environment. Many spaces within hospitals have little to no access to daylighting, therefore, providing tunable white lighting can often ameliorate the staff and patient experience – enhancing their wellbeing.
The implementation of such systems is not easy, however. Working with a lighting designer to carefully coordinate between lighting fixture selections, as well as the integration with sophisticated lighting controls, is required to achieve successful results.
Jason Butler: This is one area where advances in LED lighting technology have been a help. For example, the benefits of lighting that helps maintain circadian rhythm for both patient and staff have been known for a long time. In the not too distant history, this technology was rather expensive, but the increased availability of tunable white LED lighting and controls, as well as decreased cost, have made this beneficial technology more accessible for more projects.
Richard Vedvik: We are providing a lot of lighting flexibility within patient care space. The primary challenge that engineers have is conveying the lighting design intent with the client and users. This is because modern lighting control systems are drastically different from the existing toggle switches that users are used to. Our team discusses human centric lighting and circadian rhythm-based controls on every project with patient care and recovery spaces. However, most facilities would like to avoid added complexity and cost of those systems. Because all patient bed locations have exterior lighting and windows. Our team focuses on low-glare lighting solutions that the patient can control to optimize visual comfort
Are you seeing more smart- or microgrid aspects on such projects? If so, how have you served these needs?
Meagan Gibbs: Microgrids are primarily utilized when there is a significant on-site generation or storage component, whether it is renewables, a combined heat and power plant, curtailment, energy storage or similar. For most of the United States, electrical utility rates are too low to make significant on-site generation feasible. Where significant on-site generation or storage exist, microgrids provide flexibility to optimize the utilization of available sources. As utility costs or demand charges increase, renewable energy costs decrease or grid reliability becomes a concern, microgrids with on-site generation and storage will become increasingly prevalent.
When designing lighting systems for these types of structures, what design factors are being requested? Are there any particular technical advantages that are or need to be considered?
Meagan Gibbs: The integration of lighting design within other systems such as smart glass and shades is becoming an industry standard. Facilities aspire to provide patients with experiences that are close to hospitality environments while maintaining the complex aspects of health care lighting design. Fixtures need to meet stringent requirements of cleanliness and ease of maintenance; however, clients are asking for products that are significantly slimmer and integrate seamlessly within the architecture of the space. The use of medical covers and sconces are also emerging to make the spaces feel comfortable, homey and lofty.
Pillow speaker integration as well as touch screens are also emerging as technology advances. The offerings of current technologies make the integration seamless and easy to use by patients and staff. Health care facilities feel that providing quality design for the patients enhances their experience and reduces their stress levels. This also provides them with a sense of belonging by achieving high levels of control.
Richard Vedvik: I think the primary challenge that designers face today is communicating what the new lighting controls will look like to the owner and the building users. There has been a dramatic change in how lighting controls are designed and they are less intuitive than ever before. For example, an eight-button control station in which you have to select zones to control them is only understood by lighting designers and not users. Our industry also suffers from a lack of labeling, building users have more buttons with less information than ever before. Another issue that I see with modern lighting controls is the slow response of dimming systems. I am moving towards dimming levels that are preset, such as 10%, 50%, 80% and full. The slow response time in dimmers is to provide user’s sufficient time to assess the lighting level and then stop pressing the button. but that means the controls are way too slow to be useful. For that reason, I think preset levels are probably easier for everyone to understand.
