Energy efficiency in hospitals: A pilot project for energy efficiency in the public sector - OPET Slovenia - Jozef Stefan Institute, Energy Efficiency Centre, Slovenia

Summary
The aim of the project was to present and introduce energy management in Slovene hospitals. This involved the promotion of innovative energy technologies, support for the networking of energy managers, preparation for energy efficient investments and the introduction of new financial schemes in hospitals. As a result of the project, energy efficiency in hospitals should improve. The hospitals are energy consumers with an economic energy saving potential estimated at approximately 20 to 30%. The approach used and the experience acquired in the project are applicable to other public institutions and sub sectors.

End-user area	Education Financial instruments Refurbishment of buildings Sustainable communities User behaviour
Target audience	Decision makers ESCOs Local and regional authorities Property owners Schools and universities Other: Public sector
Technical scope	CHP Cooling Energy efficiency Heating Lighting

Context
Energy consumption is substantial within Slovene hospitals. However, within the public sector energy management is not regarded as a priority and staff are unlikely to be trained in energy matters.

The sector concerned was limited in size (27 hospitals) and considered to be an appropriate to test bed for pilot schemes concerning energy management, including the introduction of new energy technologies, innovative financing in the public sector (TPF, using private capital for investments), and the development of a network of energy managers who could collaborate on similar ideas within the sector. The project was managed as one of the work packages within the OPET Slovenia contract with the European Commission. Work on the project started in November 2000 and finished in May 2002.

Objectives
The work on the project was divided into several tasks, as follows:

• Data collection concerning the hospital sector in Slovenia regarding energy and energy management
• Production of software for energy book-keeping
• Energy efficiency programme for hospitals
• Identification of potential projects for performance and supply contracting
• Networking of energy managers in hospitals and information dissemination
• Promotion of energy management in hospitals (public sector) to the wider public

Process
Of the 27 hospitals in Slovenia, a total of 20 took part in the "basic energy survey", accounting for around 85% of all hospital beds in Slovenia. A detailed energy survey, via a questionnaire, was completed for 10 hospitals, accounting for 67% of all hospital beds. The energy saving potential for hospitals was defined and potential TPF projects were identified according to the results of the questionnaires, the experience of other countries for hospital sector and the recommendations of different technical/standardization/benchmarking data. Based on these findings, an Energy Efficiency Programme for hospitals was prepared, representing the first programme of that kind within the Slovene public sector.

A network of hospital energy managers was established in order to exchange ideas, opinions and expert knowledge. Several meetings, seminars and site visits were organized, a software application for energy book-keeping was prepared and information packages for energy managers and the wider (public) audience were produced. More detailed information on events can be found below. At a later stage of the project, the Slovene Ministry of Health became involved.

Actions
- Initializing projects
- Seminar
- Market Analysis
- Technical Handbook
- Database
- Other

Financial resources and partners
The total cost of the project was 37,000 Euro, of which European Commission financing amounted to 50% of the total. The remaining funds were obtained from the Slovene Energy Efficiency Agency (AURE). Partners on the project were the Berliner Energieagentur, Germany and EVA, Austria, whose role involved supplying information on benchmarking and energy savings/potentials for hospitals and on TPF in the (public) hospital sector.

Results

• A questionnaire, providing a detailed analysis of energy supply and use in hospitals in 1999, was carried out in 20 hospitals, representing almost 85% of all hospital beds. Energy costs were estimated to be 8.2 million Euro for 287.7 GWh of consumed energy, with about 81,000 tons of CO2 released. Following the analysis of costs and energy consumption, the specific costs of energy use and CO2 emissions were determined and a realistic energy saving potential was estimated. Hospitals could reduce energy usage by up to 33.5%, which represents a total possible decrease in energy use of 114 GWh, a reduction in energy costs of 3.2 millions Euro and a reduction in CO2 emissions of 32,000 ton per year.
  The Analysis included an overview of the barriers preventing more efficient use of energy on the part of staff as well as on the energy managers' side. It also included data concerning the organisation and financing of the energy and maintenance sector in hospitals and a proposed list of feasible energy efficiency measures.
• The energy efficiency programme in hospitals was the first such programme in the Slovene public sector. The programme was prepared on the basis of results from the analysis of energy supply and use in hospitals.
• The results of the questionnaire concerning energy supply and use in hospitals were also used to identify potential projects for performance and supply contracting. Three of the hospitals were considered to have good potential for using alternative financing mechanisms (third party financing).
• A software application for energy book-keeping was prepared. The package enables users to manage a simple and transparent overview of costs and energy consumption, as well as monitor the effects of any energy efficiency measures realized (monitoring and targeting). The programme was tested and then promoted and distributed to all Slovene hospitals.
• Networking of energy managers in hospitals was successful and all together 41 participants from 22 hospitals took part in the organized events. Three more seminars were organised, which included visits to energy systems in different hospitals and published seminar materials and reports.
• Hospital energy managers also participated in other relevant public seminars and their interest in performing energy audits was increased. In addition, many informal individual contacts between the managers were established and one of the hospitals took part in competition for the most energy efficient establishment in 2002.
  • In October 2001 a seminar on third party financing (Third Party Financing - TPF) was organised in cooperation with the Novo mesto General Hospital. An outline of TPF was presented by a representative of the Berliner Energy Agency, while the practical experiences of introducing TPF were explained by the technical head of the Evangelic Hospital Hubertus from Berlin. The meeting was attended by 19 representatives from 13 hospitals.
  • The topics of the second seminar were electricity production in hospitals using combined heat and power, the liberalisation of the electricity market and the introduction of a software application for energy book-keeping. The seminar was organised together with the Maribor General Hospital in January 2002 and 30 participants took part at the event.
  • At the conclusion of the project in May 2002, a final seminar for energy and senior managers in hospitals was carried out and was attended by 14 representatives from 11 hospitals. Representatives from the Ministry of Health and the Association of Slovenian Health Institutions took part at the seminar, which elaborated current themes such as the purchasing electricity in an open market, monitoring & targeting, and raising the energy efficiency awareness of employees. The seminar concluded with a discussion where participants identified the lack of hospital standards and the allocation of finance through the Ministry of Health as particular barriers to action.
• Information material (Info-pack) on energy efficiency for energy managers in hospitals was supplemented with additional information (including most of the important OPET brochures) throughout the year,. The project has disseminated information and raised awareness amongst managers responsible for efficient energy use and supply, and has supported them with appropriate handbooks and brochures.
• A leaflet on energy efficiency in hospitals was prepared and distributed among the employees in hospitals. The leaflet focused on low cost measures with some simple but efficient advice for energy saving in relation to lighting, medical and office equipment, and water usage.
• Several articles based on the OPET project results were published, including "Millions Vapour into the Air ", "Energy Supply and Use in Hospitals", and "Energy Use in Hospitals".

Lessons learned and replication potential
The energy saving potential in Slovene hospitals is estimated at around 30% when compared to the recommended EU and German figures for specific energy consumption per heated area or number of hospital beds. Energy consumption is growing in this sector and the issue had to be addressed as soon as possible. Third Party Financing projects look very promising in the hospital sector and experience gained in the project it is expected to serve as recommended practice in other public sectors. With the agreement of the Ministry of Health and the Ministry responsible for Energy, a new programme on energy efficiency in hospitals will be launched in 2005 in order to replicate and expand activities for energy savings in hospitals.

The major obstacles identified throughout the project were a lack of involvement on the part of the Ministry of Health, which only showed interest at the end of the project. Energy managers also reported difficulties with the management in their own organizations and it is clear that not all managers understood the need for such project. A weak point in the project turned out to be lack of data for Slovene hospitals. This necessitated additional detailed energy audits in the sector.

As a result of the networking of energy managers, active collaboration and information exchange is ongoing and several new projects were developed in the sector (CHP installed, studies on trigeneration and potential TPF, a public tender for TPF project in one hospital). The active participation of hospital energy managers is also observed in the preparation of TPF procedure manuals. The approach can be replicated in all public sectors since it outlines the use of known mechanisms, approaches and technologies which can be integrated into a comprehensive approach to energy management in every organization.

Printed reports or other literature available
Deliverables from chapter "Results" above.
Cost: N.A. Report available at request (language: Slovene).