In a perfect world, all new healthcare buildings would operate exactly as designed and would stay that way for the life of the facility. However, in the non-perfect world we live in, most buildings don't operate as designed.

Is this the fault of the engineer, the contractor, or some other entity? All new healthcare buildings are complex and one of a kind—a prototype. There are hundreds of people involved at all levels. There are thousands of moving parts, featuring dynamic systems that are essential for health and safety.

It's impossible to have a perfectly operating building the first time the switch is turned on.

The great thing about technology today is it gives us the ability to measure, sense, and trend certain moving parameters that indicate how the building is operating and performing. The environmental control systems and sensors that are available today are accurate and affordable.

Technology exists that allows you to connect the user interface building system graphics to the Internet, so the engineer who designed the systems has a way to look into the internal operation of the building in real time. These data points can be trended over time to create a record of how the building systems are adjusting to changing conditions, such as weather and occupancy.

The engineer can look at the building much like a doctor can look at his patient using the results of tests and measurements to compare the results to what should be expected. The power of this diagnostic tool is incredible in the hands of the engineer who has knowledge of how the building should operate.

From those observations of the trend data, the engineer can diagnose problems and correct those problems by making adjustments from a computer. The building can be tuned to operate as designed and given a full bill of health.

Going forward, the building’s performance can be monitored and adjusted, as necessary, to meet new or changing conditions.

New buildings are more complex than ever. It pays dividends to invest in a good monitoring and trending system. The better the building is operating, the lower the operating costs and the safer the environment.

After all, a healthcare building is a lot like the patients it serves. It needs a physical by a doctor from time to time.

John Sauer, PE, LEED AP, is Senior Director Engineering Design at BSA LifeStructures in Indianapolis. John is a strong advocate for sustainability and the use of energy-efficient design in traditionally high-consuming healthcare environments. John has leveraged his knowledge of heating, ventilation, vacuum, air conditioning, steam distribution, energy centers, and piping design to identify cost efficient and sustainable solutions for all types of healthcare facilities. He can be reached at For more information, please visit