The quest for greater energy efficiency is invisible in hospital mission statements. Those stated goals are all about providing exemplary patient care, promoting wellness and serving community needs.

Yet, increasingly, facility managers and others are starting to realize how greater energy efficiency may help hospitals gather the resources to achieve their patient care goals. "For a hospital with a 3 percent operating margin, saving a dollar in energy is equivalent to gener­ating $33 in new revenues," says Delbert Reed, director of facilities engineering at Ben Taub General Hospital in Houston.

A review this spring of energy management initiatives under way at hospitals around the country found signs that those efforts are regaining momentum from budget cutbacks during the Great Recession. However, the review also testified to many shortcomings and missed opportunities.

"It's not back to where it was three or four years ago, but people are realizing we're coming out of this thing and it's time to get back to business," says Dale Woodin, executive director of the American Society for Healthcare Engineering.

While awareness of various energy-saving options is up, the 2011 Hospital Energy Management Survey conducted by H&HN's sister publication, Health Facilities Management, and ASHE, showed that a majority of organizations still are not taking such basic recommended steps as performing regular energy audits, creating a strategic master energy plan, using commissioning of existing buildings or following the Green Guide for Health Care to monitor baseline energy performance. Those that do conduct audits frequently fail to follow up to make sure that deficiencies are fixed.

On the positive side, large percentages of respondents cited plans to implement those or other initiatives in the next 24 months and most already have pursued what Woodin calls the low-hanging fruit of energy conservation measures, such as preventive maintenance and more energy-efficient lighting.

The percentage of those who say they participate in the Environmental Protection Agency's Energy Star program has doubled since HFM/ASHE conducted the last survey five years ago. And the percentage of facilities to have upgraded central heating and cooling systems in the past two years (40 percent) has risen sharply from the 2006 survey.

"There's a tremendous amount of savings that can be achieved beyond what we're saving now," says Reed, who is also a member of an ASHE task force compiling energy-management strategies to share with members. "You don't understand how many millions of dollars' worth of opportunities you're walking past every day. People think, 'Oh, that's not going to save me very much.' But it can be something as simple as turning off a light."

Ben Taub General Hospital saved more than $800,000 a year in energy costs, Reed says, by reducing the pressure level on its boilers, ending the practice of always keeping a backup boiler idling, and adjusting air and water temperature settings to the original design specifications.

But it's not just about dollars and cents. Paul Lipke, senior adviser for energy and buildings for Health Care Without Harm, says more organizations are using many energy tools — available at sites like www.practicegreen They are even estimating their energy-related pollutants' contributions to such illnesses as asthma and chronic bronchitis and even to premature death.

In his group's past dealings with hospitals and health systems, he says, they would rarely mention that energy efficiency was part of meeting their mission to communities. Now, organizations like Cleveland Clinic have embedded energy efficiency and clean energy into their commitment to patient care.

"More people are connecting the dots — from energy efficiency to patient care, health prevention and community well-being," he says.