Energy Efficiency Strategies for Hospitals in Australia: Analysis

This report investigates energy efficiency in Australian hospitals, addressing high energy consumption due to 24-hour operations. It reviews the literature on energy usage, including lighting, heating, air conditioning, and new technologies. The study employs a multiple case study methodology to analy...Read More

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
Energy Efficiency in Australia Hospitals
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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
Abstract
Australian electricity sector undergoes various challenges such as having high deficit rate of
electricity, high transmission among others that are as a result of high consumption by
institutions such as hospitals. Many hospitals operate by the 24hrs system, leading to vast usage
of the amount of energy. About 30% of Australian hospitals consume averagely 60% of the total
public sector energy, that’s way too high as compared to other industries. Hospitals can address
the energy efficiency through various strategies such as the use of co-generation, use of natural
and renewable energy sources, remodification of the machines among many others. That will
ensure much consumption of energy. The low energy management strategies in these hospitals
have led to high energy consumption. The paper focuses on using proper strategy in the
Australian hospitals in managing the energy usage to reduce the public energy deficit.
Table of Contents

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1.0.0 Introduction.............................................................................................................................4
2.0.0 Literature review.....................................................................................................................5
2.1.0 Australia Hospitals Energy Consumption...........................................................................5
2.2.0 Energy Efficiency Strategies...............................................................................................6
2.2.1 Lighting Strategies..........................................................................................................7
2.2.2 Heating System................................................................................................................8
2.2.3 Air conditioning and ventilation......................................................................................9
2.2.4 New Technologies...........................................................................................................9
2.3.0 Summary of the Literature Review...................................................................................10
3.0.0 Study Methodology..............................................................................................................10
3.1.0 Aim of the Study...............................................................................................................11
3.2.0 Objectives..........................................................................................................................11
3.3.0 Study Hypothesis..............................................................................................................12
3.4.0 Research Logic..................................................................................................................12
3.5.0 Research Philosophy.........................................................................................................13
3.6.0 Study Design.....................................................................................................................14
3.6.1 Multiple case studies.........................................................................................................14
3.7.0 The Case Studies...............................................................................................................15
4.0.0 Data Collection.....................................................................................................................16
4.1.0 Ethical Issues.....................................................................................................................17

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
5.0.0 Discussion.............................................................................................................................17
6.0.0 Conclusion............................................................................................................................18
6.1.0 Recommendation..............................................................................................................18
7.0.0 List of References.................................................................................................................20

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1.0.0 Introduction
Management of energy through various strategies is a practical aspect as it reduces the energy
cost; protect the environment and saves money. Australian energy consumption rate rose by 2%
to about 6.100 pet joules in 2016(Court, Jouvet & Lants, 2018, p.31). The level is the highest
amount of energy that has ever been experienced by the energy sector. During 2015-16 the
energy productivity: that’s the gross domestic divided by the energy consumption, was relatively
flat with the subsequent annual growth of 2% for the successive ten years. Most of the
institutions in Australia depend on energy for their daily operations and consume a lot of energy.
Energy consumptions by sectors in Australia differ about the size, type of services and the
intensity of the machines. The total of energy consumption by Hospitals is quite high since they
operate on the daily basis of the 24hrs system all the year (Papineau 2017, p.198). In these
hospitals, there are always significant buildings with vast machines and lighters that are
important in maintaining the lifecycle of the patients within the vicinities. The daily usage of
energy in such hospitals is considered high.

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Figure 1: Amount of Energy Consumption in Australia (obtained from Ozkan 2018)
4%
2%
48%
37%
Australia Energy Consumption
Hydroecletric
Renewables
Coal
Oil
In the current world, fuel-based energy such as old natural gas coal, fossils, and water generated
power are the significant sources of energy used in most of the industrial activities (Ozkan 2018,
p. 42). Above 48 % of the industrial energy needs are met by use of coal that are significant
emitters of carbon (ii) oxide into the atmosphere, which has reasonable adverse effects on the
natural environment. Research shows that shortly, most of the renewable energy will be depleted
hence most of the power driven activities will be stranded thus calling for efficient strategies
used in managing the energy consumptions are essential in decreasing the hospital's energy
bills(Croner & Frankovic 2018,p.110). Therefore this paper explores the possible strategies that
can be used by Australian hospitals in reducing energy consumptions.

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2.0.0 Literature review
Energy refers to efforts or power used to perform a task. In this context, energy refers to the
power obtained from the utilization of chemical resource to produce heat and light. Hospitals use
different forms of energy in the daily operations such as electricity, fuel, gas, wood, thermal and
solar (Pincetl et al 2014, p.873). The latter forms of energy are considered as the renewable and
are always cheap as compared to others.
Energy forms a vital input in every institution’s operations and the whole country and with the
increasing number of industries and organizations; the energy demand also increases
considerably. The high demand of energy ignites the cost met by such institutions in acquiring
the energy services resulting into high operation cost for the respective organizations. The cost is
quite high for institutions such as hospitals that depend on the energy to save the lives of
individuals especially those that are in comma state: require throughout supply of power to
operate the machines (Burpee & McDade 2014, p.32). The full-time usage of energy by
hospitals, resulting in high energy bills calls for proper management of the energy to make the
hospital because of operations to be manageable. Otherwise, there will be significant losses.
2.1.0 Australia Hospitals Energy Consumption
Australia energy use intensity varies from less than 100 to more than 1800 kBtu/ft square across
all the hospital with hospitals that are at the 95th percentiles consuming three times more than
those that at the 5th percentile(Cuddeback 2014,p.152). The consumptions of energy by the
hospitals differ by various characteristics such as full-time equivalent, number of staffed beds per
square meter

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2.2.0 Energy Efficiency Strategies
Energy efficiency refers to the quantity of energy that is required to facilitate the output of
activity. It is the ratio between the amounts of outcome performance; goods services ad
compared to the energy input (McCaffrie 2016, p.874). The efficiency of energy is measured
through the relationship of E/O whereby the E is the total amount of consumed energy while is
the total output of performance and services.
The energy saving measures and strategies in hospitals will ensure that the rate of consumption is
reduced, a strategy that is advantageous to both the institutions and the country as a whole.
(Poullikras, Kourtis & Hadijipaschalis 2013, p.989). Among the strategies that Australia
hospitals are categorized under there aspects that are simple measures, low-cost measures and
reconstruction measures.
The simple measures form strategies that do not require much money to implement and are
always applied on a daily basis (Rabner 2012, p.8). The measures always depend on the
behaviour of the energy users within the vicinity such as switching off the sockets and lamps that
are not in use and also using natural light during the day instead of the artificial light. These
measures are always cultured and adopted by the employees depending on the rules laid by the
hospitals.
The low-cost measures entail activities and actions that are undertaken once in an extended
period and always financed by the existing administrators of the hospitals. Such costs at times
may be returned to the investor within the same administrative year that is usually less than two
years. Finally, the reconstruction measures are actions that require a considerable amount of

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capital to implement (Di Giuljo et al 2017, p.245). The implementation of such measure always
requires a socio-techno-economic survey to access the viability of the investment.
However, most of these measures lie in the daily operations of the hospital that attract a high
amount of energy. The 24hr operation system of most of the hospitals in Australia needs
strategies that will ensure that the energy consumption is reduced to the minimal level (Pinetl et
al 2014, p.872). Some of the possible plans for the 24hr system lies on the lighting, air-
condition, electricity, and heating.
2.2.2 Heating System
Most of the hospitals use electricity as a form of energy. However some also use gases for
cooking staffs and patient’s foods, and warming of the patient’s rooms to control temperature.
The everyday use of such energy results into high consumptions and these can be addressed
through the introduction of alternatives such as thermal insulation for gas consumption, using
insulation to non-insulated buildings. Additionally, usage of natural gas instead of oil can be of
great significance and can reduce the consumption of energy to about 25% from 60%.
Co-generation System in Mater Hospital
The most efficient way of addressing energy consumption through heating today is through
construction and instalment of co-generation system purposed to produce heat and electricity at
the same time reducing the level of consumption. The co-generation also commonly known to as
combined heat and power simultaneously produce two forms of energy from a single fuel and are capable
of operating up to 70 per cent higher efficiency than single-generations facilities. The system utilizes

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what is to be wasted such as a pollutant, by producing extra energy, eventually saving the
environment.This strategy has been employed by Mater Hospital in Australia that has provided
the hospital with an N+1 redundancy. Using the system, the hospital was able to reduce energy
consumption by approximately 14 percent (kWh) hence reducing energy demand by46 precent
(kVa).
The most common gas-generation that can be used by the hospitals is a gas-fired generator. The
co-generation plants produce both electricity for lighting and heat energy for heating water,
space heating and sterilization of surgical equipment’s (Mart et al. 2016, p.1254). Shortly, the tri-
generators will be more applicable when fully launched into the market, since the new machines
consume the extra heat in the absorption chiller to generate cold water used for air conditioning
system in the same facility.
The process is called solar cooling and is advantageous since it is a renewable form of energy
with no greenhouse gas emissions. The system is applicable in hot areas that have long hot
periods and will save a lot of energy and cost to the hospitals that will adopt the tri-generator
(Stojiljkovic et al. 2012). Additionally, the hospitals can employ heat pumps such as such those
designed from the sewage and solar energy to heat water system.
2.2.1 Lighting Strategies
Hospital lighting sector consumes a lot of energy to give clear illumination during night and
daytime, especially in operations rooms. To manage the amount of the energy consumed in

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lighting, hospitals need to employee energy saving potential lights and bulbs in the indoors
positions (Lee et al 2018). While on the outdoor positioning, that requires security lamps with
bright lights, capacitors can be used to correct the power consumptions hence reducing to a
considerable amount of about 50%.
The lighting of new hospitals can be enhanced during the constructions by having a design that
maximizes the use of natural daytime to decrease the quantity of non-natural light needed:
through this, considerable lighting cost is saved. Studies that assessed the role of natural light in
buildings suggest those brighter sunlit rooms reduce stress and depression among the patients,
hence reducing their stay in hospitals. The reduction of the stay period is indirectly linked with
the energy consumption in those hospitals.
Figure 2: Australia Hospitals Energy Consumption (obtained from Burpee & MacDade 2014)
42.80%
18.10%
16.40%
13.70%
9.30%
Australia Hospitals Energy Consumption
Cooling
Lighting
Ventilation
Heating
New Technologies

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
2.2.3 Air conditioning and ventilation
A large number of Australian’s hospitals is always populated with patients that require fresh air
and stable temperature all the time through the use of a cooling system that consumes a lot of
energy (Cubi et al 2015, p.231). The cooling system should be energy saving in that the design
should allow better control whenever needed. However, adequate thermal insulations and
improvement and maintenance of the system are capable of reducing the needs for cooling.
Hospitals can also adopt low energy efficient ways of ventilating the rooms of the hospitals such
as displacement ventilation (Melikov 2016, p.116). Through this, the outside air is impelled in at
the base level; whereby the cold air will push the warm air that had been collected in the room
upwards towards the roof and escape to the atmosphere through the exhaust system. The system
is more favourable than overhead ventilation supply system a less costly since less energy is
consumed.
2.2.4 New Technologies
Hospitals can considerably reduce the electricity consumption through the adoption of new
technologies that have low electricity consumptions, unlike the old motors that require a large
amount of energy to operate (Fraile, San-Jose & Gonzalez-Alonso 2014, and p.3284).
Additionally, hospitals can correct power through the use of capacitors to reduce the energy
consumptions. Shortly, health facilities will be efficient and buildings will be constructed in a
good manner to have energy saving and efficient structures, where health workers will be in a
contended and well lit workplace provided by the solar system(Pinto & Castor 2017,p.69).

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
Other new technologies such Ice Cold strategy in the health industry will aid to counteract an
extra waste of energy that can be managed by the proper action of environmental awareness. It
will expand the lifetime of the apparatus and reduce its maintenance price whereas reducing the
energy consumption (Jiajub,Claridge & Linyan 2018, p.76). Ice Cold is an exceptional and
proven explanation for refrigeration and air conditioning systems. It has a mechanised synthetic
formula, comprised of two catalysts and an advanced lubricant, designed specifically to remove
oil fouling and prevent it from reforming
2.3.0 Summary of the Literature Review
Energy is a vital aspect of every hospital in Australia, and they cannot operate without it. The
24hr system, the high number of users forms factors that affect the daily and amount of energy
used by most hospitals, that attract a significant amount of money from the hospital's profits.
Additionally, the high amount required by hospital results into energy deficit in Australia,
therefore maximizing the efficient use of energy is the first and vital step in reducing the energy
consumption and creating hospitals sustainability.
Energy efficient strategies cover daily aspects such as lighting, heating, and air-conditioning and
electricity consumptions by heavy and old machines. Proper management of activities in these
alternatives helps in reducing the energy consumption by an average of 45%.
3.0.0 Study Methodology
This Chapter pinpoints the central areas of study and outlines the epistemological approaches
that arise as a consequence of the domain of the study, its scope and nature. The study employs a

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variety of research designs and rationale to investigate the multiple case studies presented in the
work. Subsequently it details data collection methods and analyses approaches are covered.
3.1.0 Aim of the Study
As identified in the literature review, the energy efficiency and conservation methods that are
staff-centred is the future of carbon reduction in Australian hospitals. However, the assumptions
currently existing towards the potential of the same are rather vague. In the future, it will be
prudent to evaluate energy efficiency initiatives of behavioural nature relative to the physical
context of the hospital building, service provision structure and health care process. To close this
gap in the pool of knowledge, this study’s aim is constructed as follows; how clinical staffs
influence electricity consumption in hospitals do and what role can they play in the reduction of
the energy spending?
3.2.0 Objectives
More particularly, the study seeks to achieve the following objectives through case study
analyses;
1. Determine the theoretical amount of energy that could potentially be saved by effecting
changes in the manner that hospital departments are utilised by clinical staff and other
principal occupants.
2. To single out the regulatory constraints on the reduction of energy consumption in the
web of the socio-technical structures currently employed by hospital sections.
3. Identify a mechanism to determine the pertinence of changes in behaviour and operation
as a means of reducing carbon production in hospitals

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4. To add to the pool of knowledge existing on the potential of the idea of socio-technical
energy efficiency as a tool for carbon reduction.
3.3.0 Study Hypothesis
This study hypothesizes that the impact of clinical staff on the hospital’s consumptions –without
regard to the constraints-is dependent on the structural organization and the arrangement of
departmental procedures (specifying requirements for electricity with respect to operating hours).
There are two dimensions that effectively capture this concept;
1. Local Control-This refers to the degree to which clinical staff can check energy
consumption vis-à-vis the same being regulated somewhere else e.g. through a central
management system or automated systems. The theory here is that locally effected
control will potentially up the effect of clinical staff on energy consumption.
2. Time not utilised-How many hours of reduced electricity needs exist which could allow
for lower demand for energy in the hospital. The theory here is that time not in use has
potential to boost the respective department’s energy consumption. The limitations on the
hypothesised influence can then be evaluated using the empirical social practices
framework.
3.4.0 Research Logic
Logic infers the larger reasoning that is applied in the course of the study. This research employs
the deductive process. This approach operates from the top-down. It involves moving from the
general to the more specific (Ryan 2018 p. 17) the research identifies influence of clinical staff

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on managing the energy efficiency in the hospital as a general issue and then goes ahead to
narrow down to the 4 particular issues as identified in the objectives above.
3.5.0 Research Philosophy
A research philosophy is the perspective on how data about a specific subject matter should be
obtained, how the analysis should be conducted and how the data ought to be utilized (Bunniss et
al. 20110 p. 516).This research principally engages the philosophical approach called
pragmatism. This research tradition is instrumental in developing ideas. It holds that the import
of any statement is dependent on the impact of the same in real life experience. The philosophy
submits that empirical studies into the practical significances of ideas are pivotal to the building
of knowledge. A pragmatic approach to research puts more emphasis on the research questions
and raises the same above the methods of the study. Pragmatic approaches have been
demonstrated to be essential in the investigation of not only social but also technical phenomena
(Ryan 2018 p. 17). The limitations that arise with the application of this approach is that it
requires one to master a broader range of theoretical standpoints as well as data gathering
techniques and the data analysis methods. These may have a consequence on the quality of the
research. As a method in research, the pragmatic philosophy places the focus between the
qualitative and quantitative research methods as follows;
1. Correspondence to research mechanism-Pragmatism does not find fault with postulating
that there is one world and individuals apply varied and unique interpretations of this
world. This study mirrors this dualism with regard to control interfaces provided for
hospital occupants including clinical staff and how this impacts on the use of energy and
hence efficiency in the hospital.

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
2. Deduction from data-This approach promotes the mobility of results depending on the
study of the aspects that determine whether the information that has been obtained in one
aspect is transferrable to another setting. In particular this pragmatic process was the
basis of the research question which objective was to unpick the aspects across different
hospital structures and buildings.
3. Relationship Between theory and data-rather than being exclusively inductive or
deductive, the pragmatic approach recognizes the mobility of both models in a back and
forth fashion in the process of changing observations into theory and evaluation of the
identified hypotheses through action.
3.6.0 Study Design
3.6.1 Multiple case studies
3.6.1.1Rationale for case study design
The selection of a relevant study design ought to be guided by the nature of the research question
or hypotheses outlined and secondly the degree of influence the researcher can exercise over the
particular behavioral events. This research dedicates itself to exploring the interaction of
principal hospital staff and the utilization of energy in their departments. It answers to the
question of how hospital staffs are relevant in the execution of strategies of energy conservation
and efficiency. This study is typical of the studies conducted on the performance of buildings and
is seeks to unearth the contests as opposed to containing them (Paulose-Ram, et al. 2017 p. 918).
Consequently, a case study design emerges as the most pertinent taking preference over archival
analysis and other forms of study designs. This is also supported by the research subject (it

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makes the research expository) as is contrasted with theory testing because it would be
challenging to subject the currently existing evidence to quantitative study since it is too thin.
Finally, the case study approach will allow the study to handle a larger volume of data yielded
from a variety of methods which is requisite in grasping the complex research questions.
3.7.0 The Case Studies
The paper looks at 3 different hospital types in the case study and five departmental types. This
variation in hospital types allows the paper to explorer the establishment of composite
benchmarks on hospital energy consumption and efficiency based on the determinations made
upon the analysis of fata on electricity use. The study focuses on general acute hospitals a since
they occupy a larger floor area. The three hospital types were guided by a sampling strategy that
employs purposeful variation. Three types of departmental structures were selected with an
objective of optimizing sample diversity as follows;
1. Hospital Built form and age-this accounts for the variations in building interface like
localized space heating systems versus decentralize space heating, manual versus
automated light switches.
2. Departments with high energy consumption intensity e.g. surgical theatres, laboratories
and imaging section. Also low energy intensity consuming sections such as the wards and
day clinics.
3. Other hospitals such as those which offer sterile services were an impediment to data
collection although they fall in the category of those hospitals with relevant energy
consumption intensities. As a consequence of the resources that were at the disposal of
this study, accident and emergency sections had to be excluded from this study.

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4.0.0 Data Collection
This study makes use of quantitative methods of data collection to evaluate the consumption of
electricity in different hospital buildings and departments thereof and determining how this is
impacted by the clinical staff of the hospital. Low energy consumption basically arising from use
of appliance and lighting occurs apart from the fact that there are also a number of energy
services that are provided centrally. These include ventilation and space heating. With regard to
the latter, energy is consumed by a central plant and it becomes a challenge to apportion the
consumption upon individual department. Following a study of the methodologies available the
paper creates an understanding of the use of electricity using two basic components; a bottom –
up model and top-down model. Electricity consumption data was collected from hospital
departments at least after every half an hour. This included power use such as those arising from
coils, fans and heaters as well as lighting loads but excludes ventilation and cooling. For
particular departments, automatic meter readings were availed. As for some the electrical
measurements were conducted in the distribution boards which served the respective
departments using a variety of types of equipment. Three data collection methods were applied;
1. Audit of lighting and Medical appliances.
Room to room inspection of the hospital departments was done and the building plans guided the
assessment of the distribution in space of the lighting installations.
2. Interview guide
Interview guides were drafted to inquire the personal experiences of the clinical staff on their
departments and how much influence they have on coming up with and implementing the energy

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efficiency strategies. The interviews also sought to know if there were any abnormalities in the
electricity use profile and how fast such issues were addressed by the hospital management.
3. Informed consent forms
Obtaining informed consent forms was an essential part of the study as it is a standard practice to
make certain that the rights of those participating in the study are protected.
4.1.0 Ethical Issues
No major ethical issues came up in this study. In one case, a volunteer nursing officer offered to
be interviewed in the study but pulled out after she got the full explanation of the purpose and the
procedure of the study. On 5 occasions, staff had to take the interviews in the presence of other
staff as there was no room for the interviews to be done in private. Staffs were requested to be
honest about whether or not they were comfortable taking the interviews in the presence of the
rest or if they preferred to make other arrangements but they preferred the former. This paper
recognizes that this may not be an ideal environment from an ethical standpoint as well as from a
professional analytical view. The departmental heads authorized the presence of the researcher
and all employees were informed of the pending arrival of the researcher and the purpose of his
stay. The major challenge for most employees was finding time to take part in the interviews.
This is because they had to find someone to cover for them as they took the interviews.
5.0.0 Discussion
Surveys and energy audits are some of the most employed tools in deterring the levels of energy
conservation and efficiency strategies. This study found a number of strategies that could be

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
affected to ensure energy efficiency. Implementing lighting changes can present the hospital with
avenues to achieve significant cuts on the consumption of energy. It was noted in the study that
most clinical staff do not have influence over the utilization of energy in their work places
because most of the major supply are controlled from a central place. All the same strategies of
energy conservation ought not to be limited to the employees. It is a broad subject that should
include the hospital management and departmental heads. Innovation is a leading contributor to
the energy efficiency strategies (Marshall et al. 2018 p. 12). Apart from this, reducing on wasted
energy contributes to the achievement of the cuts on energy consumption.
6.0.0 Conclusion
This study espouses the centrality of the strategies that contribute to the conservation of energy.
It exemplifies the need for energy efficiency strategies to be carried out in a manner that brings
on board all clinical staff to ensure they are part of the implementation of the strategies. Staff and
management in the hospital must benchmark energy performance with regard to their lighting
uses, air conditioning and space heating needs as well as the ventilation. Use of equipment which
are not operating at optimum output is a major contributor to excess energy consumption levels.
The state department also supports the use of green energy practices to which implementation of
energy efficiency strategies are an integral part.
6.1.0 Recommendation
Clinical staffs have a major role to play in the implementation of energy efficiency strategies in
their departments. By doing simple things like switching of computers and equipment when not
in use, checking and fixing faulty connections and ensuring that equipment operate at optimum,

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EFFICENT ENERGY USE IN AUSTRALIA HOSPITALS
they could contribute to huge cuts in the utilization of energy. It is also necessary that the various
departments benchmark their energy use using internationally recognized tools such as Energy
Star Portfolio to assess the facility’s performance and find any ways of incentivizing
improvements. Creating a green energy team and/or starting or joining a council for green energy
is also a powerful tool in efficient energy management.

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7.0.0 List of References
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& Sustainable Energy, 10, 2, p. N.PAG, Academic Search Premier, EBSCOhost, viewed 14 May
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