Publications

Essential steps for improving hospital resilience and safety

May 11, 2017

Just as most hospital departments employ systems to stay up to date with technology and medical procedures, they also need to plan for resiliency. Energy management is one of the most critical components of life safety and a factor that affects patients, staff, and the local community. The entire facility depends on electrical and thermal energy to function optimally, and emergency power management must be resilient so that the facility can operate 24 hours a day, 365 days a year, despite storms or natural disasters. Each facility faces unique challenges and must develop its own road map, but all facilities can benefit from taking some essential steps to improve hospital resilience and safety.

When our internal research team started to scrutinize the energy component of life safety, its complexity quickly became apparent. Our initial goal was to develop a case study comparing two hospitals, analyzing their respective costs and efficiencies. When we realized how multi-faceted the energy question was, however, we modified our strategy to include a methodology for creating and implementing a resiliency road map to help hospitals determine how to harden the existing infrastructure and prepare for future infrastructure improvements.

Our investigative analysis yielded lessons in resiliency that have broad applications. The most critical discovery is that a facilities generation system that is continuously operated is more reliable than one that is utilized only during maintenance exercises. During normal operation, continuous generation can provide low cost electrical and thermal feeds. During natural disasters, it then becomes a valuable asset that can effectively respond to increased pressures associated with disaster relief. Evidence supporting continuous operation was gathered from historical accounts of facilities that fared well during major storms that devastated the East Coast and the Gulf Coast.

Since several accounts suggested that natural gas generators, CHP systems, and fuel cells were more resilient than diesel generators, we developed a case study assessing the proposed model path to analyze an East Coast facility. The initial financial analysis supported the application of alternative generation systems. To assist facilities with the transition to alternative sources, we also developed a process diagram with a resiliency measuring system. This metric can be used to assess a facility’s current resiliency and highlight the additional components needed to advance it to a higher level of resiliency. The methodology is generic enough to address current and future technology developments.

The first step of the proposed model path identified weaknesses in the existing infrastructure of the case study facility. These findings, along with an interview and the resiliency metric, were then analyzed together to uncover opportunities for improvement. The overall strategy for improving resiliency is diversify both technology and generation sources. Ultimately, the most resilient facility will have the capacity to go off-grid and run autonomously. To achieve that goal without negatively impacting the environment, our recommendations identify immediate solutions and identify future opportunities for increasing resiliency by steering development towards cleaner fuels.

Our report presents alternative generation systems along with their respective payback periods, which range from one to ten years. In our case study facility, a natural gas generator with CHP capabilities pays for itself in 3.5 years. If the system is limited to electrical output only, then the payback period rises to 5.28 years. However, there are also opportunities to participate in PPAs with minimal upfront costs, making the payback virtually immediate. With our analysis of alternative options in hand, a hospital can then decide which direction to take.

We also developed a long‐term plan for the case study facility with recommendations for addressing resiliency for the next ten years. We anticipate that the proposed model path, with the proposed methodology, can be utilized on a yearly basis by critical facilities to assess their course towards improving their resiliency status.

Javier Conejo, RA, NCARB, is an architect in EYP’s Houston office. His research project was funded by a grant from EYP.