HEALTHCARE ENERGY EFFICIENCY How to Communicate to the C Suite

Transcription

1 HEALTHCARE ENERGY EFFICIENCY How to Communicate to the C Suite March 16, 2016 York Chan, CHFM, CHC, SASHE Administrator of Facilities Advocate Health Care

2 YORK CHAN, CHFM, CHSP, SASHE Administrator of Facilities Board of Directors Current Faculty Environment of Care Advisory Board Faculty - Environment of Care & Life Safety Code Classes, Current Board of Directors Editorial Advisory Board City of Chicago Solar Advisory Board

3 Healthcare Energy Usage Overview Ø Hospitals use 2.7 times more energy than a commercial office building Average U. S. hospital consumes about 260,000 btu s per square foot* Average European hospital consumes about 150,000 btu s per square foot Ø I can t worry about energy costs because patient comfort has a higher priority! - MYTH * U.S. Dept. of Energy

4 ENERGY EFFICIENCY Ø Three factors that affect energy cost Cost of commodity fuel and energy crap shoot, market driven Weather can t control How effective we are at utilization WE CAN CONTROL! Ø Every $1 a non-profit healthcare organization saves on energy is equivalent to $20 in new revenues for the hospital.

5 FACILITIES CHECKLIST Ø Operational Checklist Chiller Plant Operations Boiler Plant Operations HVAC Systems Building Envelope Lighting Cooling Towers Exhaust Systems

6 HVAC Systems Ø Variable Air Volume (VAV) Systems Utilize Technology - Variable Frequency Drives Ø Variable Pumping Hydronic Heating/Cooling Systems House Pumps (Domestic Water Systems) Ø Chiller Optimization Programs Ø Minimize use of reheats Ø Identify time of day operations Ø Balance all air and hydronic distribution systems Ø Good maintenance practices crucial to energy efficiency

7 Top Finding in Joint Commission Surveys Cited in 56% off all surveys in 2014 EC : The organization establishes and maintains a safe, functional environment. EP13: Maintain ventilation, temperature and humidity EC : The hospital manages risks associated with its utility systems. EP15:

8 Air Exchanges and Building Pressurization Know how much air is being pulled out of you building O.R. Rooms Isolation Rooms Kitchens Labs Dirty Utility Rooms Toilets Should never be Wind Tunnels between buildings Cause of building envelope problems Excessive humidity and moisture Door operations problems

9 Exhaust Systems Ø Kitchen Hoods and Lab Fume Hoods Know how much condition air is being pulled out of your buildings Minimally, use time of day controls to turn off exhaust fans when not in use Use technology to sense operation needs to cycle exhaust fans when required Hotels and restaurants have been using this for years Track supply make up air to exhaust air volumes

10 Chiller Optimization Cycle chill water on return temperature and reset temperature by wet bulb Utilize chiller load management program to stage chiller operations based on optimal efficiency Different chillers have different efficiencies at various loads Brush condenser tubing and check water flow through bundles. Monitor temperature gains/drops (Delta T) Convert primary chilled water loop to variable pumping

11 Boiler Optimization Install burner management system utilizing stack gas analysis to adjust fuel/air settings Perform flue gas analysis on a regular basis to ensure proper air to fuel ratio Maintain an effective steam trap maintenance program Account for all condensate returning to the boiler room Install flue stack economizer to capture heat loss going up the flue stack

12 Utilize Technology Use technology to augment human performance Hospitals already use technology for patient care Chiller Optimization, Air and Water Systems All maintenance staff must be computer literate

13 Building Automation Systems Ensure that critical points are calibrated and accurate Investigate and correct alarms to avoid Overrides Calibrate critical points as least annually Utilize algorithm based analysis for trending Utilize BAS technician time effectively Set expectations for BAS Techs Utilize maintenance contract time to review operations Constant commissioning Retro commissioning Avoid Spray and Wipe maintenance

14 Maintenance Clean condenser on air cooled systems Clean evaporator coil, fins and tubes Remove scale deposits and accumulation of sediments on water side surfaces Maintain good water treatment chemical program Clean heat transfer surfaces (tube bundles) on boilers chillers, and heat exchangers Clean and flush tower(s) before seasonal start up and whenever needed during cooling season Ensure filters are cleaned and that coils are maintained and cleaned to reduce fan horsepower to overcome resistance caused by plugged coils in air handlers Basic maintenance is still the #1 priority!

15 LIGHTING Low Hanging Fruit Ø T-12 to T-8 to T-5 Fluorescent retrofits Ø Incandescent to Compact Fluorescent 90% of energy used in incandescent is heat Ø Incandescent to LED exit signs Ø High pressure sodium/mercury vapor retrofits Ø Occupancy sensors Ø Sunlight harvesting

16 Exterior Lighting

17 Establishing a Energy Management Program Establish baseline & trend consumption Establish target and goal Review and identify operational procedures Retro-commission for optimum system performance Identify Energy Conservation Measures (ECM s) requiring capital expenditures Develop financial analysis (ROI) Implement ECM s Validate performance and perform necessary maintenance

18 Saving Energy As A Culture Energy efficiency must be carried out throughout the organization Cannot rest on one individual person Educate staff on system operations All maintenance staff must be computer literate Solicit ideas from entire staff Share your performance with your entire staff Share budget line items with entire staff From Chief Engineer to light bulb changer Savings will fund future projects

19 Think Out of the Box Ø Installed coil/filter rack at inlet of boiler room exhaust fan to preheat make up water Ø Installed cost - $7, Ø 1 st Year savings - $23, Outlet Water Inlet Water To Boiler Make Up City Water In

20 GOING GREEN IN HEALTHCARE Ø Provide a healing environment that does no harm Ø Focus on Energy Efficiency and Clean Increasing Energy Prices Energy Independence Climate Change Concerns Legislation, Regulation and Incentives Midwest is years behind Green Movement Ø Healthcare lags behind other industries in the adoption of Green buildings Ø Lower Emissions Decrease energy consumption Green House Gas Discharges Ø Increase Recycling Ø Mercury Free Environment Ø Ultimately good for the organization s bottom line

21 Speak The C Suite Language Ø ROI Return on Investment Ø NPV Net Present Value The amount of money earned or saved in today s dollars The higher the better Ø LCC Life Cycle Cost Capital + Maintenance + Energy + Replacement Costs Ø FCI Facility Condition Index Cost to restore/renovate vs. cost to replace

22 Payment Based on Performance Ø Hospital Value Based Purchasing Program (HVBP) Began in FY 2013 (Oct 1, 2012), hospitals are paid based on their actual performance on quality measures* Clinical outcomes will count for 70% Patient experience (satisfaction) will count for 30% * AHA Special Bulletin April 29, 2011

23 Aging Facilities Ø A lot of hospitals have aging plants that need significant rehab or new building Ø Average age of a U.S. hospital power plant is 40+ years old* ASHRAE s service life expectancy for: Chillers 23 Years Boilers 24 Years (water tube) 25 Years (fire tube) Fans 25 Years (centrifugal) 20 Years (axial) Operational efficiencies and reliability in question * Health Facilities Management, Feb. 2011

24 Tour With C Suite Ø A Must for every new Vice President starting at your organization Ø Explain the complexities of a hospital building Compartmentalization Fire/smoke dampers Fire suppression systems Fire/smoke detection system Elevator recall systems

25 Tour with the C Suite Ø Mechanical systems HVAC, Air Handlers, Chillers Explain pressure relationships Temperature/Humidity parameters Air filtration Power Plant/Boiler Room Building Automation Medical gas systems

26 Coffee With the Crew Ø Invite CEO, CFO or COO to informal chats l l Show off accomplishments Let staff talk to C suite Ø Not to be a laundry list of complaints Joint Commission Perspectives, Nov. 2011

27 Coffee with the Crew Initiative Ø Opportunity for staff to discuss condition of power plant and facilities with Leadership Staff can identify specific vulnerabilities they are concerned about Also ideas for energy and other cost savings Ø Increases Leadership s knowledge of the infrastructure Power plant condition Fire protection systems and building structure Ø Give Facilities Staff a chance to showcase their accomplishments Projects that were done in-house versus out-sourcing Cleanliness of mechanical areas and boiler room Ø Shows the staff that senior Leadership cares

28 CHALLENGES Ø Fighting for the capital dollars Facility Operations are always looked upon as non-revenue generating services. Clinical services and equipment are considered money makers. We have to convince hospital administrators the positives in facilities and energy related projects. Convince CFO s to compete projects based on Net Cost Reduction

29 HOW CAN A FACILITY MANAGER AFFECT CLINICAL OUTCOMES? Ø 78,000 Deaths a year from adverse events after admission Hospital acquired infections, medication errors, wrong site surgeries, etc. 8th leading cause of death Greater than motor vehicle accidents, breast cancer, or AIDS Ø Less than 1 Death per year from fire related events in hospitals We spend billions per year to ensure no fires Ø Facilities Managers must partner with clinical staff to improve clinical outcomes!

30 HOSPITAL ACQUIRED INFECTIONS Ø Est. Annual Cost of Treatment $5 Billion Ø CMS No Pay - patients cannot be billed Ø Surgical patients who acquire HAI infections 6.5 more days in the hospital, 5 times more likely to be readmitted, two times more likely to die Average costs to treat - $13,973

31 HOSPITAL ACQUIRED INFECTIONS Ø Air Handling Systems Filtration Humidification Pressurization Clean to Less Clean Airflows Positive for O.R./Surgery, Immuno-compromised patients Negative for infectious patients, soiled storage Air Exchanges Hourly Air Changes for Dilution Preventive Maintenance Ø Hospital administrators need to know this

32 OPERATING ROOM TEMPERATURES Ø It is a myth that O.R. s are kept cold for infection control reasons. Ø Main reason O.R. s are kept so cold is for the comfort of the surgeon. Ø Clinical trials have shown that perioperative normothermia (36.5 degrees C) in patients undergoing surgery has been shown to reduce infection rates. Ø Perioperative hypothermia (34.5 degrees C) may promote surgical wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Ø Hypothermia also affects other body parts such as liver functions and blood coagulation.

33 COMMENTS & QUESTIONS YORK CHAN, CHFM, CHC, SASHE (630)