It’s been nine months since the opening of the country’s largest all-electric acute care hospital in Irvine, California.
UCI Health was already in the planning stages of its new Irvine campus when the University of California (UC) established a policy that no new or renovated buildings could burn fossil fuels for space and water heating.
The health system may have gotten an exemption as a healthcare facility. But leadership decided to push the boundaries of hospital design by going all-electric. The ambitious plan was not purely a cost-saving strategy. According to Tony Dover, UCI Health’s energy management & sustainability officer, it was a moral imperative.
“We were doing it because it was the right thing to do,” Dover told Fierce Healthcare. “It was for decarbonization, resilience, and we’re mitigating our pollution for the community that we serve.”
The U.S. healthcare sector is responsible for about 9% of the country’s greenhouse gas emissions, emitting significantly more carbon than the aviation industry. A growing number of doctors and hospital administrators have implemented sustainability agendas that include phasing out harmful pollutants and improving waste disposal. Electrification is the next frontier.
The compact UCI Health-Irvine campus consists of a 144-bed acute care hospital, a comprehensive cancer center and ambulatory care building, and an advanced care center. While its unique electrification is not immediately apparent, the perks of modern design include clearly labeled buildings, parking garages with free wifi and outdoor seating facing the San Joaquin Marsh Reserve.
Unsurprisingly, the hospital building leans heavily into technology. Patient rooms are noise-controlled, free of beeping equipment and equipped with flatscreen TVs to connect patients with care teams or families. Lights remain off in unoccupied rooms and automatically dim in public spaces at night.
UCI Health was among over 100 orgs that signed HHS’ Health Sector Climate Pledge, which aims to halve emissions by 2030 and achieve net-zero by 2050. (The Biden-era HHS pledge is no longer operational at the federal level, as sustainability efforts were broadly abandoned by the Trump administration.) While the broader UC system hoped to get to carbon neutrality by 2025, that goal proved too ambitious. It has since pivoted to decarbonizing by 2045, the same year as California’s own carbon-neutral mandate. In particular, UC aims for a 90% reduction in total greenhouse gas emissions, with any residual emissions negated through carbon removal.
Tactics to lower emissions
If UCI Health-Irvine’s goal is to lower its carbon footprint, it should expect to succeed.
By going all-electric, the bulk of the campus’ emissions shifted from Scope 1, direct emissions from on-site fuel combustion, to Scope 2, or indirect emissions from purchased energy like electricity. Other design choices helped, like building with low-carbon concrete. Modular furniture largely free of harmful chemicals also means better air quality. The site’s full emissions data will be publicly available in late 2027.
The site uses a combination of solar and procured clean electricity to power itself. Solar panels on the parking structure roofs were designed to generate 10% of the site’s annual energy demand. Across the board, electrification is a growing decarbonization strategy in the U.S., driven by policy mandates and business resiliency goals. “The all-electric design gave us more efficiency,” Dover said.
Cost savings are a bit less cut-and-dry. Electricity costs are generally less volatile than natural gas, although electricity costs are expected to grow over time. This is attributed to rising demand and an outdated national grid requiring major investments. “It’s highly, highly likely that electricity will continue increasing in price much faster than natural gas will,” said Walt Vernon, CEO of healthcare design and engineering firm Mazzetti.
Even if electricity costs go up, this wouldn’t necessarily be a major blow to UCI Health. A 2017 cost analysis of carbon-neutral UC buildings (excluding healthcare facilities) estimated that all-electric buildings are comparable to, or slightly less expensive than, those that use gas and electricity. The report noted that energy costs are not the primary driver of total lifecycle costs—the capital costs associated with standing up equipment are.
“Whole building design efficiency that is able to downsize costly equipment and save initial capital costs, could have more impact on total lifecycle costs,” per the report.
The amount of hot water a hospital needs, from domestic use to sterilization, is enormous. And using electricity alone to heat that water can get expensive compared to natural gas. To help with this, UCI Health-Irvine takes a multipronged approach. It combines heat-recovery chillers, heat pumps and electric resistance heaters to maximize efficiency. The campus is also shaving off costs by not operating and maintaining a gas central steam plant.
“Of course we are concerned about electricity costs rising,” Dover acknowledged, “and that’s why we supply and procure our own, because we can manage those numbers.” The UC system has its own utility company that buys electricity from renewable sources and has been supplying 100% clean electricity since 2018.
Similar projects in the works
There are a number of other all-electric hospitals under construction around the country.
Kaiser Permanente is replacing three of its hospitals with all-electric facilities in Sacramento and San Jose, California, and Clackamas, Oregon. They are slated to open by 2029.
“It was a leadership decision that had to do with knowing that it can be done,” Seth Baruch, national director of energy and utilities at Kaiser, told Fierce Healthcare. “We could be building a hospital that is more efficient, lower-emitting … and potentially [has] a lower lifecycle cost.”
Kaiser has experienced the volatile nature of natural gas in California. “We’ve been hurt sometimes, budget-wise, with these gas spikes,” Baruch explained.
A lifecycle cost analysis for Kaiser’s San Jose project found an all-electric hospital with solar and battery storage could cut annual emissions by up to 48% and pay for itself within seven years compared with a traditional gas-heated hospital. “All-electric campuses can pay for themselves economically when they’re planned as a coordinated, whole-campus system,” Baruch said.
Kaiser became carbon neutral for Scope 1 and Scope 2 emissions in 2020, and has pledged to achieve net-zero, including Scope 3 emissions—which come from the supply chain—by 2050. By transitioning from fossil fuels to electricity at its renovated hospitals, Kaiser expects to significantly reduce Scope 1 emissions.
Henry Ford Health is also redeveloping its Detroit hospital as fully electric-capable, set to open in 2029. The health system is interested in cutting emissions and has signed the HHS Climate Pledge. The old Detroit campus was over 110 years old with an aging energy plant. The electric redesign is actually costing up to 20% more than it would have for a campus that used natural gas.
“We really knew that for us to even come close to achieving our [sustainability] goals, ... we would have to get fairly aggressive with this development,” Jerry Darby, SVP of strategic environment and infrastructure at Henry Ford Health, told Fierce Healthcare. “We believe it’s the right thing to do.”
The health system had unique considerations going into the project. “This is in a Northern environment,” Darby said. “We do have pretty wide swings in heating and cooling needs, and I think this is probably the largest and farthest North version of a facility like this in the country. We’re working really hard to make sure that we’re doing the best we can within the environment that we live [in].”
Hence the need to be electric-capable. The new 432-bed hospital will start out with some fossil fuels: natural gas will supplement electric heat pumps on the coldest and hottest days. Darby expects to get to fully electric over the next decade.
Meanwhile in sunny Florida, Baptist Health plans to open what will be the state’s first all-electric hospital in Sunrise in 2029. The site will serve as a “flagship hospital” in Baptist’s overall corporate sustainability goals, executives say, with the goal of reducing reliance on fossil fuels and reducing emissions.
“The uniqueness of the site location required a sensitive approach to reduce our impact and to do no harm to the adjacent wetlands, the Everglades and our neighbors in the community of Sunrise,” Richard Jones, VP of construction and facilities management at Baptist Health South Florida, said in emailed comments.
The Sunrise site will have on-site solar panels for generating electricity and a solar hot water system, both totaling over one megawatt. The solar system will be the primary way of heating water but will be supplemented by electric water heaters and localized point-of-use steam generators.
“We find that using decentralized electric systems is more efficient, cleaner and more cost-effective than large traditional boiler systems that require much more maintenance and gas consumption, and are subject to the volatility of natural gas prices,” Jones said.
Power purchase agreements or utility-run subscription programs can help hospitals fund renewable projects outside their facilities. Baptist buys a share of its total electricity consumption through Florida’s community solar subscription program known as FPL SolarTogether. This supports renewables at off-site facilities connected to the broader grid and helps reduce the emissions associated with Baptist’s overall electricity consumption. Kaiser similarly does this in some markets, which it said helps support the development of new clean energy resources and reaps modest utility cost savings.
Beyond off-site renewable generation, health systems must think about ways to address downstream activity contributing to Scope 3 emissions. That means working on sustainability with the supply chain, a tall order. Some are trying: Kaiser encourages its vendors to reduce their own climate footprint, offering a toolkit to help them get started. It also requests annual updates from key suppliers on their progress.
“We are working to incorporate greenhouse gas (GHG) reporting and emissions-reduction commitment language into new supplier contracts as opportunities arise,” Baruch said. “Our goal is to strengthen expectations around transparency and environmental performance while recognizing that suppliers are at different stages of their sustainability journeys.”
The backup power problem
No matter how advanced green technology is, hospitals still require backup power.
Today, that’s most often delivered via diesel generators. This means electric hospitals can’t completely avoid burning fossil fuels, which raises the risk of poor health in emergencies. All the electric hospital projects featured in this story have or will have diesel backup generators.
UCI Health-Irvine has four diesel-powered backup generators totaling 12 megawatts that can provide at least 96 hours of backup power, or more when refueled. Because the generators’ controls are computerized, they wouldn’t be able to start on their own in a power outage and thus require their own batteries as a backup.
Kaiser, too, plans to have diesel backup generators at its redesigned hospitals. But it is considering a way to phase them out.
The idea comes from a recent project in Southern California, where, supported by a multi-million-dollar state grant, Kaiser built a massive renewable energy microgrid at its Ontario Medical Center. It features nearly two megawatts of solar generation and a nine megawatt-hour battery, plus a one-megawatt fuel cell. Part of what made this possible was having enough space for the panels and battery, which is about the size of six industrial shipping containers.
“What we hope to do is replicate the experience we had in our Ontario Medical Center, where we built a renewable energy-based microgrid and solar batteries that would be able to displace the use of diesel generators when there’s a power outage,” Baruch said.
The setup provides 10 hours of continuous emergency power, though diesel generators are also still on site. Kaiser has a non-hospital facility in Hawaii that can be powered entirely through solar and battery. “Maybe some day, the alternative energy-based microgrids will provide a backup that’s sufficient [for hospitals],” Baruch noted.
To Vernon, whose firm worked on Kaiser’s Ontario project, fuel cells are the key component. Almost no hospital can generate enough backup power from solar alone, because of the amount of land required. It would need to be able to tap into renewable energy sources like UCI Health can, but resources are too limited.
“It is not feasible for the entire healthcare sector to buy renewable electricity for all of its needs,” Vernon said.
Fuel cells are promising because they're a relatively clean energy source, typically running on methane. They have lower emissions than diesel and even non-renewable electrical grids, Vernon explained. They also generate high-quality waste heat, which can be repurposed. Today, fuel cells can be used anywhere except California, where unique earthquake regulations have delayed their adoption in healthcare.
They can also take hydrogen, though it remains pricey. In what Vernon says was a first for a hospital anywhere in the world, Mazzetti built a 100-kilowatt hydrogen fuel cell at a rural hospital in Washington, which can run for about four hours at a time. Still, implementing hydrogen also remains tricky due to overlapping safety codes, many not yet accounting for hospital applications.
“I don’t pretend that the fuel cell is the perfect option, because it isn’t. The fuel cell, in my view, is a bridge to a better future,” Vernon said.