A New Way of Thinking
Ascension Health is challenging the status quo with an innovative sustainability program focused on reducing energy use, saving millions of dollars that can be redirected to its core health care mission.
IT’S RARE when a health system’s work pleases both the U.S. Department of Energy and the Vatican.
But facility managers, engineers and other leaders throughout Ascension Health, the nation’s largest nonprofit health system and the world’s largest Catholic health system, are utilizing data and metrics to meet the expectations of both U.S. Secretary of Energy Ernest Moniz and Pope Francis.
Ascension’s roots in stewardship and sustainability can be traced back hundreds of years to the religious principles of its founders. Today, digital dashboards and spreadsheets help Ascension’s leaders achieve benchmarks that contribute to a triple bottom line—environmental benefit, financial performance and social impact.
The Energy Efficiency Expert
Energy efficiency is the backbone of Ascension’s Environmental Stewardship Program and was the first area of focus when the program was developed by Ascension’s Facilities Resource Group. In 2007, energy use began to be tracked at all acute care hospitals through the Environmental Protection Agency’s Energy Star Portfolio Manager® database. Although an initial goal was set for a 5 percent energy-use reduction, Ascension achieved a 13.8 percent reduction during its first six years (2008–14).
As a result, the health system prevented 718,900 tons of carbon dioxide emissions and saved $43 million. The overall impact of these savings on a hospital’s operating cost is substantial. Consider this: Saving $1 in energy is equal to approximately $20 in new revenue for a typical nonprofit health care organization. Based on Ascension’s data, that’s equal to $860 million in revenue across the health system, significant for an organization that last year provided $1.8 billion in care for persons living in poverty and other community benefit programs.
Although the initial 5 percent goal was not scientific, it’s important for facilities embarking on a program to establish a goal so they can know where to go. In Ascension’s case, once they met that 5 percent goal the facility set a more ambitious one.
Ascension’s new goal is reducing energy use by 20 percent by 2020 throughout its more than 100 acute-care hospitals, which cover 35 million square feet. The annual savings is estimated at $30 million. As a result of this program, Ascension became a founding partner of the Department of Energy’s Better Buildings Challenge, which publishes data on progress made toward energy reduction on the www.energy.gov website.
Several factors contributed to the rapid improvement in energy reduction at Ascension. One was the discovery of an underlying culture already dedicated to proper stewardship of resources throughout Ascension’s Health Ministries in 23 states and the District of Columbia.
For example, I recently visited a Health Ministry, and one of the executives told me: “This [sustainability] is so important. It ties into our mission. Yes, we look at it from a financial standpoint, but we also need to keep in mind the environmental and social considerations. We need to improve population health, reduce our energy use and reduce our use of coal that puts toxins in the air.” It was so great to hear him express all the issues that are key to our environmental stewardship program.
As a result, hospital facilities system-wide express appreciation for assistance from Ascension’s main office in St. Louis.
“That’s been one of the most exciting things about this job,” said Jim Prince, energymanager for Ascension’s Facilities Resource Group. “I remember asking about that when I interviewed for this position. Facilities really need and welcome the help. I can’t think of any exceptions.”
Another huge factor is that the emphasis on environmental stewardship begins at the top—the Vatican. Pope Francis’ focus on the care of other persons and the environment is challenging Ascension’s people and organizations to reflect deeply on ecology.
“I would like to ask all those who have positions of responsibility in economic, political and social life, and all men and women of goodwill: Let us be protectors of creation, protectors of God’s plan inscribed in nature, protectors of one another and of the environment,” Pope Francis said.
Ascension’s historical sponsors have also long been advocates for societal change and environmental stewardship, and that legacy helps inform Ascension’s efforts.
As representatives from the environmental stewardship program met with Health Ministry leaders throughout Ascension, they learned about many initiatives that align with the founders’ approach to environmentalism.
The challenge was that previously no one was tracking all of those across the system. Ascension formalized its program following the model from Practice Greenhealth, which has served as an outstanding resource.
How Ascension Made It Happen
As Ascension developed and executed a plan to reduce energy usage, its number of facilities and the diversity of its acute-care hospitals created unique challenges in an already complex health care environment. As a start, the health system selected four engineering firms as partners and reviewed best practices in energy efficiency throughout the industry. A playbook was created to facilitate consistent adoption of methods and predictable results.
Next, Ascension gathered data on energy utilization throughout its facilities by conducting a supply-side audit. Utility bills and other utility data were collected. Energy consumption was analyzed along with how utilities charged the facilities. Each facility’s energy performance was benchmarked against a system average.
With playbook and data in hand, Ascension conducted a system-wide webinar to roll out the program with facility managers and learn what actions needed to be completed at individual facilities.
“We explained the simplicity of the program and I think it gave facility managers a lot of comfort in our plan,” Prince said. “Providing early success stories and immediate impact raised their interest.”
The webinar provided managers with an opportunity to ask questions. However, a few managers wanted more information. Some requested one-on-one explanations of the data, benchmarking and program features. One lesson learned was to include chief operating officers and chief financial officers in early phases of communication with facility managers.
As Ascension continues to move toward centralized services throughout its system, additional time and communication were required to develop understanding and achieve buy-in to the program.
“Communication is the key, and you can’t over-communicate something like this,” Prince said. “The combination of data, early success and the playbook—with few exceptions—convinced people and they started asking when we could come to help.
“I had to do public relations with facilities to show them how our approach is unique compared to what others in the industry are doing. About 10 minutes into the conversation, the lightbulb would go on and they would see our program is much more comprehensive than simply doing a few tweaks here and there. The results we’ve seen so far across the system demonstrate not only that our playbook works, it’s scalable.”
The Ascension playbook reviews energy utilization and improvement opportunities in two areas: retro-commissioning and infrastructure review and repair.
Ascension requires commissioning for new construction and retro-commissioning for existing buildings. The quality-control processes ensure optimization of operations and proper maintenance of heating, ventilation and air-conditioning systems. The four pillars of Ascension’s retro-commissioning are:
- Identify broken items and systems. Repair or replace them.
- Review the facility’s occupied and unoccupied scheduling to determine if systems can be shut down or set back when specific areas aren’t being utilized.
- Ensure the amount and quality of air is being delivered according to current codes and standards.
- Establish standards for climate control sequences for optimal performance.
The infrastructure review and repair includes an analysis of a facility’s building control systems. Energy reduction opportunities are limited in buildings with outdated controls, so improving those control systems allows precise regulation of temperature and airflow. It also provides the capability to turn some systems off during unoccupied hours while still ensuring comfortable conditions when occupants arrive.
“Conventional wisdom might lead us to believe that newer facilities are more efficient,” Prince said. “The reality is newer facilities often are the least efficient. They have modern controls, but sometimes proper commissioning is value-engineered out. … If construction is over budget, you may save $100,000 to $250,000 by eliminating commissioning, but it can result in more than $1 million in wasted operating costs over several years.”
A common barrier to improving infrastructure in health care facilities is a lack of dedicated capital for replacement, renewal or improvement of existing equipment and other building infrastructure. Throughout health care, there’s competition for capital dollars between needed infrastructure improvements and clinical equipment.
Ascension achieved a 13.8 percent reduction in energy use from 2008 through 2014. As a result, the health system prevented 718,900 tons of carbon dioxide emissions and saved $43 million.
Ascension committed to invest more than $50 million in capital expenditures for energy improvement measures in pursuit of its goals. In fiscal year 2014, 20 percent of Ascension hospitals reported leveraging capital dollars by capturing energy conservation rebates from local utilities to pay for retro-commissioning fees, LED lighting retrofits, chiller and cooling tower replacements and photovoltaic renewable energy installations.
“That was a key differentiator for me before I came to work here,” Prince said. “I’ve done energy work in health care for 25 years and everybody wants to save energy, but most will not make the necessary investment.
“Ascension said they want to save 20 percent on energy and they realize it’s going to take an investment to do that. We have the funding available for energy improvements, and that’s critical. You just can’t save 20 percent on a wing and a prayer.”
Accurate and timely data informs and motivates facility managers and engineers throughout Ascension. Currently, monthly reports—scorecards—are compiled and distributed. The information contributes to accountability and, in some cases, spurs healthy competition.
“The level of interest in improving performance is much better,” Prince said. “Facility and operations managers have the data right in front of them and they can see we’re making significant improvements. That fuels their excitement even more. At some ministries, we have a battle of the buildings. A system-wide real-time reporting platform will heighten the interest and foster additional improvement.”
The current method of measurement and verification—collecting all utility bills, entering and analyzing data—is labor intensive. Ascension is developing a system that would collect all utility billing data and create a dashboard for reporting results on a real-time basis, providing high-level information at a glance.
The measurements, metrics and key performance indicators are not only for the facility managers, but can be shared with people in operations, the chief operating officer and the chief executive officer. Facilities should make sure to simplify this data so it can be understood by a wide audience. For example, Energy Star score and energy cost per adjusted patient day are good metrics to include.
With a defined energy reduction timeline of 2020, many people ask Prince what he will work on after that date.
“There are many ways to help our hospitals save money by reducing operating expenses,” he said. “We have some 1,900 smaller sites of care that will afford an opportunity for improvement. But acute care was a good place to start.
“The good news is that everybody is aware and understands the importance of efficiency and being good stewards of our resources. There’s not a recipe for doing this. It’s a way of thinking.”
Lois Sechrist is a senior analyst in environmental stewardship with the Facilities Resource Group for Ascension Health.