What makes energy savings tough for hospitals is the intensity of use. Hospitals are 24/7 operations, creating whopping demands for power and water; they require hourly air changes and cool constantly running equipment, all with tons of lights on. Oh yeah, there’s a lot of nasty waste that has to be processed, too.

In essence, a hospital is like an aircraft carrier: self-sustaining with an insatiable appetite for power and several thousand mission-oriented people working on board.

It is no surprise that in the past two years there has been tremendous interest by our healthcare clients in sustainable design, particularly LEED accreditation. But the now popular idea of the net zero hospital, as captivating as that sounds, I’m afraid is more wishful thinking than achievable reality.

Don’t get me wrong, I love the idea of the net zero hospital and my “occupy” engineers pushing green initiatives, but I’m positive that getting to 60% energy savings—even by the year 2030—is unachievable without a new model of delivery and a revamping of the way we design hospitals.  

Solar power, yes; orientation of building, check; green roofs, got it—all of it low-hanging fruit. But equipment loads and renewable resources—ah … no. Stop.  

There are two reasons facilities can’t get to a net zero energy use: One is lack of renewable resources for power, and the other is plug load demand. There is so much equipment generating demand and shedding heat that the most savings we can wring out will be in the range of 50% and, hopefully, 60% savings. And that’s if everything else is perfected.  

The traditional design and construction method for hospitals doesn’t make sense anymore. The lack of integration, the handing-off to contractors, the RFIs over the fence, the coordination of systems during construction rather than in design no longer works. We need a new model.

The navigation path below requires a new tack to steer toward true healthcare sustainability.

  • Sustainable goals and criteria have to be included as program elements that are required, just like planning exam rooms or ORs, or stacking the building.
  • The only way to achieve even 50% savings in energy and carbon neutrality is to have an integrated team of client, architects, planners, and engineers working toward synergistic solutions. The innovations required are only what a team can produce.
  • Same-platform BIM tools are required. We have to see it, visualize it, and be able to model performance like building a car. It needs to be simulated, crash-tested, and then built
  • The operational/planning model will have to adapt to a building configuration that has a more connected response to the environment. As an example, deep, windowless platforms for diagnostic services—they’re great for adjacencies but do not support sustainable practices and will have to be rethought.
  • The bottom line: That which provides the greatest benefit at the lowest cost will be the modality embraced and implemented. And although there are first-time costs associated with super efficiencies, having a wasteful building for 50 years beacons a short-term vision in long-term game.  

Are we fooling ourselves by saying net zero? Maybe, but overreaching may be the best way to keep these ships afloat.