Improving energy efficiency, financed with incentives, while increasing operational efficiency

Start with Efficiency

Since 2011, Mazzetti has served as an energy efficiency consultant to this client, a premier global communications provider. This partnership started when we initially helped with selecting a controls vendor to implement the current front-end controls that had been deployed throughout their data centers across the country. These controls provide remote access for cooling system automated control as well as energy efficiency data to enable continuous commissioning of these systems.

With this background, we have continued to provide consulting for additional retrofit projects to improve cooling air delivery efficiencies by way of air containment measures and retrofitting Computer Room Air Conditioning (CRAC) units with Electronically Commutated Motor (ECM) plug fans. For these projects and the control system retrofit projects, Mazzetti secured significant utility energy efficiency incentives to offset implementation costs.

Financial Mapping

As part of financing-identified projects, we have helped the client secure over $3.2 million in utility energy efficiency incentives/rebates. Mazzetti developed custom energy models, approved by utility incentive programs, as part of securing incentives for the client.  This process has equipped Mazzetti with unique knowledge of the existing cooling systems for all of the client’s major facilities around the country.

Perhaps most significantly, Mazzetti has leveraged its intimate knowledge of the client’s cooling system operations to provide life cycle cost analysis studies of major cooling plant retrofits. The results have provided the client with the information needed to choose optimal paths for facility improvements and have identified pinch points in systems to help guide the facility on future technology deployment. These studies have led to several projects for which Mazzetti provided design services and helped support partial financing of these projects through additional utility energy efficiency incentives. By working on these projects nationwide, Mazzetti has unique knowledge of over 50 utility incentive programs across North America.

A Roadmap to the Future

Our goal is to continue working closely with the client to develop flexible options that will provide a cost efficient way to manage growth while maintaining MEP system reliability and redundancies. As we provide these services, we actively stay attuned to changes in utility incentive programs for leveraging the highest possible energy efficiency incentives/rebates available for any given project.

Positioning the John Muir Medical Center to welcome the future of healthcare

Staying Current

With regulatory compliance driving a seismic upgrade of the existing John Muir Medical Center, the hospital replacement created a sanctuary environment for patients while equipping staff with upgraded medical equipment and increased capacity for patients.

The overall project included increased bed capacity and single patient rooms, expanded Trauma Center/Emergency Dept. (ED) treatment space, additional OR capacity and additional parking. The new tower features single patient rooms for Intensive Care Unit (ICU), medical surgical, acute inpatient rehabilitation, ante/postpartum care and a new neonatal ICU (NICU) nursery with 33 private rooms.

Technology updates were implemented in the new areas, specifically within the surgical suites, adding space for current and future technology, as will pre-operative and recovery spaces. The NICU now has a combination of private and semi-private noise-reducing rooms for critically ill newborns, with sleep chairs for parents. Each room features lighting that mimics day/night cycles facilitating maximum comfort for newborns. And ICU rooms are now equipped with additional support through remote, 24/7 audio and video monitoring of patients.

Increased Capacity

Key areas were identified for expansion early in the project–emergency, trauma, imaging, surgery, critical care, pediatrics and birth, neonatal ICU, orthopedics, neurosciences, and rehabilitation.  The new hospital delivers on these focus areas in the hospital expansion and creates a distinctly modern experience for patients.

The total bed capacity was increased from 308 to 414 beds with 242 licensed beds in the new tower. Trauma Care/ED was nearly doubled to 30,500 sf to handle a volume of 65,000 patient visits per year! Three new cath labs and three new OR’s comprise the major elements of this project. Secondary increases include 24 new, private critical care rooms (12 designated for trauma and 12 for neuroscience), an increase of NICU beds, and an increase in inpatient surgical suites.

To increase operational efficiency, the helistop was relocated to the patient tower rooftop, nearby an elevator bank that is one stop away from the Emergency Department.

A Healing Environment for Patients

In order to promote a “non-institutional” environment, the hospital facilitates copious natural light, includes six roof gardens, a central courtyard, and a variety of colors and textures on the interiors. A co-generation power plant, skylights, LED lighting, and low VOC (volatile organic compounds) flooring promote a sustainable, environmentally friendly space to heal.

Special attention was given to noise reduction/tempering, lighting (both natural and artificial) in patient care areas. The team used the new Institute of Medicine (IOM) recommendations to create an environment that allows care to be provided in a manner that is safe, effective, patient-centered, timely, efficient, and equitable.

Developing an overarching strategic plan to reduce EUI across a building portfolio

Mazzetti worked with a large hospital system to develop an overarching strategic plan to reduce energy use intensity (EUI) across its building portfolio.

Energy Expertise Beyond the “Engineering”

Our client took a unique approach on its energy journey. While some organizations approach energy reduction by planning specific projects, this client focused on developing a comprehensive strategy to drive its energy future and plan specific projects. They chose Mazzetti for the strategic component, our strong expertise in hospital energy management and our ability to be flexible, nimble and collaborative.  For a project more akin to management consulting, Mazzetti had the engineering expertise and change agent acumen necessary to make it possible.

Establishing a Shared Vision

The client had an energy reduction goal but wanted to take a holistic approach to achieve that goal. Mazzetti and the client worked together to develop and articulate a vision, mission, and shared principles that would help drive the over-arching project.  Mazzetti helped facilitate an interactive workshop that led to articulating a vision of national healthcare energy leadership and principles (values).

Problem Orientation and Opportunity Identification

With an overarching vision, mission and principles, the client could evaluate how current ways of working aligned (or did not align) with their mission.  The client held a “focus group” to hear from their consultant community. Mazzetti led internal meetings to discern people’s understanding of their roles as they related to energy and determined structures that could best align with the organization.

Mazzetti analyzed the findings, worked with the client, and suggested governance structures and accountabilities to align strategy, operating model and execution with the new energy vision.   

Identifying Key Strategic Management Levers

Mazzetti identified strategic levers the client could use to expedite its energy future.

Finance: Mazzetti facilitated conversations to understand the client’s financial tolerance, conducting an A3 analysis (Healthcare process improvement model), and suggested viable financing options to explore expedited energy project investments.

Data: Too much data can actually be counterproductive. Mazzetti analyzed how the organization was using data and recommended ways to make the data actionable to empower people within the new operating model.

New Buildings: Mazzetti identified areas in the current building process that could be leveraged to produce energy efficient buildings.

Behavior: Mazzetti helped the client plan and take initial successful steps to reduce energy use through occupant behavioral awareness.

Leadership: Mazzetti helped the client think through and plan how it could be among local and/or national leaders in healthcare energy reduction.

Engaging leaders across the country

Mazzetti interviewed and continues to interview healthcare energy management gurus across the country to inform the solutions we provided our client. We tailored best practices to the client’s perspective.  We provide this unique perspective to all our clients.

Flexibility and nimbleness

The client’s energy strategy champion changed roles just as the project was ending and this led to other internal changes.  Portions of the strategy that were not embedded no longer had the necessary driver to get them embedded.  Mazzetti is currently working with the client to modify deliverables so that the strategy can be driven forward despite this change.

Mazzetti and Perkins+Will (P+W) jointly submitted for Kaiser Permanente’s first-ever healthcare design competition, ‘Small Hospital, Big Idea’ (SHBI). Participants were challenged to imagine a small-scale, forward-thinking healthcare facility that would combine the best of facility design, sustainability, and modern technology. Out team submission tied for the first place win.

The Competition

Kaiser Permanente, a leading not-for-profit health plan and care provider, invited students, designers, architects, engineers, and individuals everywhere to design a small hospital that evolves the way we deliver health care. Multidisciplinary teams were encouraged.

The Project Concept

The team’s winning concept sought to create spaces to inspire human-to-human connection and to blur the boundary between the community and the traditional hospital setting. Mazzetti and Perkins+Will looked to transform the process of receiving and giving care by re-conceptualizing people’s relationship to both technology and nature. Spatial elements of the design served to improve communication and create a sense of community between patients and practitioners.

The space was designed to maintain a minimal environmental footprint. We significantly reduced demand for all resources–the regenerative systems designed minimized the generation of waste and emitted no greenhouse gases to the atmosphere or harmful contaminants to the water cycle.

The Team & Deliverables

Perkins+Will and Mazzetti have been working together for over a decade to create healthcare projects that are high-design, human-centric, and energy efficient. Walt Vernon, CEO of Mazzetti, and Robin Guenther, (at the time) Sustainable Healthcare Design Leader & Principal at P+W, co-led the project, combining their respective roles as leaders in sustainable engineering and design to create a proposal that would actualize their most innovative ideas into a single project.

The team delivered well beyond the net-zero mandate. The design reintroduced natural systems to restore biodiversity and habitat to the stressed and degraded surrounding land, while symbolizing a new focus on health promotion and management. The plan incorporated natural elements into the patient experience by orienting rooms around the large central courtyard, due to the positive correlation between exposure to nature and healing.

Significance

Our work with P+W illustrated our ability to anticipate the future of healthcare and to envision daring, but workable solutions. We sought to transform healthcare’s built environment into a new Civic Architecture–not a scary place for enduring suffering, but a place of life, central to community. And since, elements of the design have helped inform mainstream thinking for new healthcare buildings.

Offsetting electricity expenses through solar-generated energy

Energy & Financial Efficiency

Mazzetti successfully managed the design and installation of a 20 kW solar PV plant to provide [80%] of the energy for the clinic with careful planning and precision that will help offset the astronomical cost of electricity from the utility company. Mazzetti’s Sextant Foundation provided resources—fundraising, time, and people–to support. Before the installations of the Solar Panels, La Clinica was spending more money on energy bills than on critical medications for patients. Solar power provides reliable energy, resiliency to operate after a natural disaster, reduced operating costs, improved local air quality, carbon emissions reductions, and local skills to the community to operate the new systems.

About 10 months after installation, the system had produced 26.557 kWh, resulting in:

• Saving 20 tons of CO2
• Saving $4500

What can an extra $500 a month buy? Just to put financial savings in context, $500/mo. buys:

• A doctor´s monthly salary
• A child’s participation in the clinic´s annual summer camp for children with HIV
• A sex education program administered at three different high schools
• Lab tests for 10 patients with HIV
• The monthly cost of a nutritional program for 50 malnourished clients with HIV

Community Impact

The impact is real. The nutrition program, specifically for malnourished kids with HIV, has been extremely successful. The program provides them with home visits and education for the family, in addition to pediatric visits at the clinic and monthly food packets. Mina Halpern Lozada, Executive Director at the clinic, recalled one particular seven-year-old girl who has directly benefited from the program (her identity to remain anonymous for privacy purposes).

“In just less than a year, we’ve seen her weight improve substantially. She has a lot more energy, goes to school every day and is able to participate actively… And because she has a full stomach, it is easier for her to take her HIV medication; she has become much healthier overall.”

And not only is the clinic positively impacting the local community, it’s setting a standard for other clinics in the Dominican Republic to follow, to reap similar savings to inject back into the healthcare delivery.

Read More Here

Providing a Permanent Solution to help Heal a Cholera-Inflicted Community

In 2010, shortly after the catastrophic earthquake impacting millions of people, Haiti was soon afflicted with a rampant cholera epidemic. Cholera is an infectious disease caused by eating food or drinking water contaminated with a bacteria called “Vibrio Cholerae.” Due to the displacement of many people after the earthquake, the already existing Cholera epidemic resurfaced with vengeance. The overcrowding communities coupled with poor sanitation in facilities, caused many illnesses, some leading to death. A vaccine was produced to help counteract this ongoing epidemic but providing treatment required an immense amount of support. Check out the video to learn more about the devastating earthquake.

Temporary Solution Challenges

Emergency medical crews established temporary tent stations, providing immediate aid to cholera victims. The tents were never intended as a long-term plan. They lacked piped-toilets, pumped water systems, and any decontamination facilities.

“There were no piped toilets or wastewater decontamination in the tents,” says Michael Murphy, MASS cofounder and executive director, “And the method of dealing with the crisis (i.e., privatized collection and removal) was not happening appropriately.”

A treatment facility with proper sanitation, including clean water & sewage capabilities was needed to not only care for patients, but for setting an example of proper facility standards for the community and nation as a whole. New standards needed to be precedented.

Facility Solutions

Mazzetti provided design development support of the plumbing system and ventilation design for the GHESKIO Cholera Treatment Center (CTC). The CTC added to the services of the existing GHESKIO Hospital. The CTC treats all of its waste-water onsite and increases well-source water supply with a rainwater collection system. The rainwater is purified and used for all treatment needs. The “anaerobic bio-digester” is a quad-chamber system, incorporating a chlorine-purifying process. The reinforced-concrete and steel structure is earthquake and hurricane resistant; that is, CTC was erected on a three-foot platform in the event of a flood. This also contributes to the rain-water cache system.

Perpetuating a movement for better global healthcare delivery

Mazzetti has had the privilege of co-designing the University of Global Health Equity (UGHE) in Rwanda for Partners in Heath (PIH), an organization pioneering global health delivery. The concept of global health delivery centers on how we can provide healthcare to those that need it the most, regardless of remote locations. Diagnosis and treatment of illnesses is mostly consistent throughout the world. How we get that care to all those that need it, however, requires a very specialized approach in resource-limited settings such as in east Africa.

The History

As of 15 years ago, Rwanda was one of the leading countries in maternal mortality, infant mortality, and deaths due to illnesses such as AIDS, tuberculosis, and malaria. With the support of organizations such as PIH, Rwanda is now leading the world in decreasing these same statistics. In just the past 15 years, Rwanda has DOUBLED life expectancy! The positive trend is primarily a result of the focus on global health delivery.

Building on the great work that has already been done and that all has been achieved in Rwanda and Haiti, PIH is building this university to take the valuable lessons learned and train the next generation of leaders in global health delivery, including students from Rwanda, greater Africa, and throughout the world.

Mazzetti’s Role

In 2013, Mazzetti partnered with Partners In Health and Shepley Bulfinch to develop a master plan for the 400,000 SF university and hospital expansion. Mazzetti’s focus was on identifying the infrastructure and building systems requirements for the campus as well as developing a sustainable resource conservation strategy.

Global Vision

Dr. Paul Farmer, co-founder of Partners In Health (PIH), shared a vision to make healthcare accessible to everyone. His work and that of others catalyzed the start of a strong ‘Global Health Delivery’ movement. The development of PIH’s health sciences university, University of Global Health Equity (UGHE), is illustrative of this movement.

Phase 1

In 2015 Mazzetti partnered with Shepley Bulfinch and MASS Design Group to design the first phase of the university based on the master plan. This first phase included academic facilities and housing for students and faculty. Mazzetti provided MEPT and Sustainability services for the development of UGHE. Mazzetti helped bridge the connection between sustainability and healthcare delivery. Less capital needed for physical resources, the more funds available for healthcare delivery.

Construction began in July of 2016; estimated completion date is in 2018. In the meantime, UGHE completed its first year of instruction in a temporary location in Rwanda.

Check out the video of faculty and students describing their experience at this groundbreaking university.

Providing the additional space and services needed to care for an aging population

Mazzetti designed the mechanical, plumbing, technology and electrical systems for the new 330,00sf U.S. Department of Veterans Affairs medical office building/ambulatory care unit. The project included house dialysis, nephrology, oncology, prosthetics, as well as elements of primary care, dental, mental health, women’s health and various other services.

“We have been waiting for this day for a long, long time.”

– Barbara Fallen, Medical Center Director

Additional Space

The new three-story building will provide the additional space and medical services needed to care for the aging population, particularly men, in the area. And, with the additional mental health services to be provided, the intent is to reduce the number of veteran suicides.

Expanded Services

With the expanded functional space, come expanded (and new) services including: expanded operating and procedure rooms, physical therapy, occupational therapy, a radiology and ultrasound department, dentistry area and oral surgery center, mental health area (with social work employees), psychology offices, lab facilities, infectious isolation rooms, a pharmacy, prosthetic laboratory, gynecology offices, and X-ray rooms.

A major emphasis has been placed on the psychological care portion of the new medical building. Psychological resources on-site coupled with primary care creates a “one stop shop” for veterans to simplify their medical care experience.

Patient Experience

With the goal of efficiency being built into the patient experience, the new building features more functional spaces than its predecessor. With open spaces and more examination rooms, the building will be more conducive to doctors visiting patients more efficiently, attending to rooms of patients who have been pre-screened to reduce patient wait times.

Additionally, the facility will feature more green spaces for patient well-being, complete with a reflective pool at the front entrance. A city park is located adjacent to the ambulatory care site; the outside fence line will be open for patients and their visitors to read, play chess, or enjoy a game of bocce ball.

Other amenity-driven areas include a cafeteria, patient/staff lounge areas, resident education areas, a coffee shop, staff locker rooms and showers, and a retail store.