Imagine, for a moment, a hospital that is able to provide its own energy through new renewable energy projects like biofuels and solar power and improved energy efficiency efforts. In other words, the hospital will never have to pay another energy bill again. Sounds a little far-fetched, right?

1. How Gundersen Lutheran
Health System Will Be
Energy Independent by 2014
http://www.beckershospitalreview.com/strategic-planning/how-gundersen-
lutheran-health-system-will-be-energy-independent-by-2014.html

2. Imagine, for a moment, a hospital that is able to provide its
own energy through new renewable energy projects like
biofuels and solar power and improved energy efficiency
efforts. In other words, the hospital will never have to pay
another energy bill again. Sounds a little far-fetched, right?
Well, it's not far-fetched at all. In fact, officials at Gundersen
Lutheran Health System in La Crosse, Wis., are trying to make
their health system 100 percent energy independent —
meaning they will be completely self-sufficient on all their
energy needs — by 2014.

3. According to the U.S. Department of Energy, hospitals are some of
the most "complex and energy-intensive facilities" in the country.
Major heating and lighting needs, 24/7 access and large, energy-
sucking machines cause hospitals to use roughly 836 trillion BTUs
of energy every year, and they have more than 2.5 times the energy
intensity and carbon dioxide emissions of commercial office
buildings.
A hospital's energy consumption is both a drain on the environment
as well as its bottom line. The DOE estimates U.S. hospitals spend
more than $5 billion annually on energy, which equates to roughly 3
percent of an average hospital's operating budget.
However, Gundersen Lutheran is trying to change that path.
Through new green energy projects, Gundersen Lutheran is trying
to couple sustainable energy efforts through "solid financial
business decisions" — and it all starts with its Envision program.

4. Gundersen Lutheran's Envision
program
The Envision program, essentially, is the model and planning of
projects that will put Gundersen Lutheran on a path of energy
independence by 2014. Jeff Rich, a certified Lean Six Sigma master
black belt, is the executive director of Envision and has been with
the health system since 2006.
Gundersen Lutheran conducted an energy audit in 2008 after
discovering their energy costs were increasing by more than
$350,000 per year in 2007. After reviewing the audit, the health
system decided Mr. Rich, his colleague Corey Zarecki and the
facilities operations team should take on a program to revamp the
entire energy strategy — and thus, Envision began.
In the first 18 months of the program, starting in May 2008, Mr.
Rich and his team were able to save 20 percent of energy
consumption per square foot across the health system through
several different projects.

5. To bring Gundersen Lutheran to "net zero," they developed a road
map to get them from point A to point B, although it's run into
barriers and changed several times. The three key elements they
focused on were energy, waste management and recycling, and
sustainable design.
• Energy. The energy component consists of both energy
conservation measures as well as new renewable energy measures.
In terms of energy conservation, Gundersen Lutheran has focused
on retrocommissioning — a process that examines heating and
cooling systems, lighting, employee behavior and other areas that
use low- or no-cost measures to improve efficiency. For example,
Gundersen Lutheran reprogrammed its cooling system to reduce
consumption, adjusted boiler controls, added more efficiency
lighting and installed an automatic computer shutdown program
among many other changes. All in all, retrocommissioning saved
Gundersen Lutheran $1 million in annual savings by the end of
2009.

6. The renewable energy efforts are the big-ticket items that
involve bigger investments but are resulting in a complete
shift of the energy paradigm. For example, in 2009,
Gundersen Lutheran teamed up with the La Crosse City
Brewery to turn the brewery's wasted biogas discharge into
electricity. The result? Roughly 2 million kilowatt hours per
year of electricity are being produced — enough to power 170
average-sized homes — which is roughly 2 percent of the
health system's energy independent goal.

7. Similar to the brewery project, Gundersen Lutheran has also
partnered with the county landfill to use their flaring gas
discharge as a renewable energy source for one of its
campuses. "The flaring gas was just wasted," Mr. Rich says.
"It's a heat source. Now, they pipe the gas to us underneath
Interstate 90. We produce the energy from a generator here,
and now the campus produces more energy than the entire
campus uses."
Mr. Rich says they've also installed some smaller solar
projects and are gaining electricity from two large wind
turbine sites. This fall, the team will be installing a massive
biomass boiler that will take woody biomass from around the
area and turn it into heat and electricity through a steam
turbine. Perhaps one of the most innovative projects involves
poop — literally. Gundersen Lutheran is teaming up with local
farmers to capture cow manure and turn it into renewable
energy.

8. "It creates gas in an anaerobic digester just like a landfill, and the
process is cleaning water pollution from manure runoff," Mr. Rich
says. "Through anaerobic digesters, we can also turn [the
byproduct] into a composted soil amendment or potting soil, which
can be sold."
• Waste management and recycling. Waste is a major cost and
concern for hospitals and health systems, and Envision has taken
steps to control the health system's waste management and boost
recycling efforts. For example, Gundersen Lutheran has increased
its recycling of solid waste to 37 percent over the past three years —
anything around 25 percent in healthcare is pretty good, Mr. Rich
says — and the system also reduces waste in the operating room by
reusing, cleaning and sterilizing the right OR instruments.
In addition, Gundersen Lutheran has eliminated Styrofoam
completely, reduced food waste by 60 percent and donates what
goes unused to a local food shelter. Gundersen Lutheran was also a
founding member of a local food co-op that will save money in
distributor costs and boost the local La Crosse-area economy.

9. • Sustainable design. Going forward, Mr. Rich says all new buildings
at Gundersen Lutheran will have energy efficiency in mind: LEED
certification, energy intensity targets, commissioning requirements,
environmentally friendly materials and high-efficiency HVAC
systems. The health system will also be opening a new hospital
addition in 2013, and he says a new geothermal pump system will be
a major part of its energy-sustaining design.
Gundersen Lutheran has completely shifted how it looks at its
energy costs and environmental footprint. For other systems to
follow the trend, it requires a systemic outline and a realization that
there is always room for improvement. "It's about how do we throw
less in a landfill every year, not wasting packaging, handling waste
in the OR properly and safely," Mr. Rich says. "We try not to create
it to begin with. We've done great things, but we're still very humble
and will learn from others. And there are still a lot of opportunities
for us to improve."

10. What makes it work?
• Although the Envision program is headed by a somewhat
small group of engineers, sustainability professionals and
project managers, it was able to get a foothold because it
gained immediate acceptance at the C-suite level. "There's
been a really intense effort," Mr. Rich says. "You have to have
good leadership that is really committed. If you don't have
committed leadership, you won't go very far, and our CEO is
the biggest champion you can have."

11. Jeff Thompson, MD, Gundersen Lutheran's president and CEO, has led the
culture behind the mass-scale energy shift at the health system. He says the
long-term financial, clinical and environmental benefits of an energy
independent health system outweigh any of the short-term costs. "As
healthcare organizations, our goal is to improve the health of the
communities we serve," Dr. Thompson says. "We believe we need to 'look in
the mirror' when it comes to environmental factors that affect human
disease. We cannot improve the health of the communities we serve without
looking at our organization's environmental impact and how that
contributes to disease. In addition, rising energy costs directly affect our
ability to invest in and deliver patient care, and they contribute to the rising
cost of healthcare."
Achieving energy independence by 2014 is an ambitious goal — Mr. Rich
says ultimately he believes the health system can get there within the first
few months of the year — and if achieved, Gundersen Lutheran will have set
the bar for the entire hospital and healthcare industry. "We can improve the
health of the communities we serve and reduce the cost of care with savings
generated from our program," Dr. Thompson says. "For us, it was never a
question of why would we develop a program like this. It's a question of,
why wouldn't we?"