Engineer checking wires in a building

Hospital Commissioning: The ROI of Health Facility Commissioning

What are the benefits of hospital commissioning? Great question. Health facility commissioning comes with a range of benefits, including financial benefits, as well as improved safety for patients and staff. Our own hospital commissioning case studies, which we talk about below, found significant cost savings for five different hospitals.

Want to learn more? Read on!

What is hospital commissioning?

What are commissioning services? As building systems get more complex, the assurance of quality provided by the commissioning process becomes even more important. This is especially true for buildings with a high expectation for control and performance such as is the case for healthcare facilities.

Hospital commissioning is a process that’s used to assure that all building systems in a facility are completed to predefined standards. The ASHRAE Standards and Guides defines it as:

“A quality-focused process for enhancing the delivery of a project. The process focuses upon verifying and documenting that all of the commissioned systems and assemblies are planned, designed, installed, tested, operated, and maintained to meet the Owner’s Project Requirements.”

Raghid GabrielAlpin’s Senior Commissioning Authority, Raghid Gabrial explains, “In a simple words Commissioning is fine-tuning for buildings’ systems and equipment during different phases of the project. It is very common we take our cars to the car dealer work shop to fine-tuning the cars every few months to maintain car performance and minimize fuel consumption. Such a practice is really considered by building owners despite the huge defiance in the investment between a building or a car. The Commissioning Authority (CxA) is the one responsible to fine-tune building systems.

The CxA is the entity identified by the owner to lead, plan, schedule, and coordinates the Cx team to implement the commissioning process. To fulfil the facilities Owner’s requirements”

Some of the major system categories that can be commissioned are:

  • Building envelope
  • HVAC systems
  • Building Automation System
  • Plumbing systems
  • Medical gas systems
  • Electrical systems
  • Life safety systems
  • Lighting and lighting control system
  • Fire alarm and protection systems
  • ELV systems (i.e. nurse call systems, queue management systems, etc.)

But what are the benefits of hospital commissioning? That’s what we’ll look at next.

The benefits of health facility commissioning

Some of the key benefits of hospital commissioning include cost and resource savings, fewer deficiencies and delays, better maintenance, and a more secure and healthier environment for staff and patients.

Overall, the cost of commissioning is relatively small, but it can have a big impact on the building maintenance and operation cost in addition to the other benefits during design and construction phase which will have impact on the project cost. In fact, in 2017, a survey administered by Keithly Barber Associates, a Washington state based commissioning services firm, found that 80% of respondents believe that commissioning has had a positive impact on building delivery.

Commissioning is particularly useful in meeting aggressive schedules, addressing construction issues before they happen, keeping an eye out on the overall quality of construction, better design and construction team coordination, and reducing warranty call-backs. Commissioning also reduces the number of change orders encountered in a typical construction cycle; partially if the CxA is onboard at early schematic design phase.

And specifically for hospitals, patients and staff can rest assured that the building is safe for them. At the same time, commissioning will increase the life cycle of healthcare facilities.

Suhail MohammedAlpin Senior Commissioning Authority Suhail Muhammad notes, “The most critical issue that is faced during commissioning audits for hospitals is indoor air quality. IAQ involves the process of providing air which is comfortable in every way and does not cause negative health effects in humans. It is all the more important in hospitals, as it contains critical environments such as operating rooms, patient isolation rooms etc. Improperly commissioned HVAC systems is a major contributor to poor indoor air quality. Irregular maintenance of air filtration systems, humidification/dehumidification systems etc. often lead to the growth of fungus and bacteria in air duct systems.”

Plus, commissioning is a highly cost-effective investment. According to a study by the Lawrence Berkeley National Laboratory the median whole-building energy savings for retro-commissioning is 16%. The cost is amortized already in 1.1 years.

New construction building commissioning costs, on the other hand, are just 0.4% of the overall construction costs and come with median whole-building energy savings of 13%. The costs for commissioning are amortized on average 4.2 years after a building is built due to energy savings, lower operation costs, and fewer change orders.

But what are some concrete examples of the ROI of commissioning?

Let’s take a look at our own case studies and their results.

Case studies: Hospital commissioning

Thanks to years of experience, we know just how beneficial hospital commissioning is. It’s sometimes hard to see them at first glance, but our case studies from eight confidential hospitals in the GCC clearly shows the financial benefits of commissioning for healthcare facilities.

Curious to know what results we got? That’s what we’ll look at next.

What our commissioning team focused on

During the case studies, we studied various commissioning aspects and activities from the Design stage to Construction and through to Operations, and highlighted the financial benefits that could be achieved through water and energy savings.

To achieve this, Alpin Commissioning Team (all are ASHRAE BCxP certified) followed ASHRAE standards, as did some of the team certified as  ASHRAE Healthcare Facility Design Professional Certification (HFDP).

In addition to design and construction technical audits phase commissioning, the Alpin Commissioning team verified the seasonal testing; differed test during the normal operations phase of the hospitals, during which the projects’ consultants and contractors would not be available.

The results of our commissioning services

Our role was to ensure that all systems were performing efficiently and to ensure the ongoing optimized performance of buildings (to save energy and water). Alpin then reported these findings directly to the Client(s) and explained that 15-20% of the overall power and water consumption could be saved.

We implemented design reviews that concerned everything from missing emergency lights to sump pump emergency operations. As the Commissioning Advisor, Alpin also recommended a TAB contractor to be hired to perform Testing, Adjusting, and Air Balancing for the systems to be commissioned, particularly for the Air Conditioning System (HVAC). An unbalanced HVAC system will lead to air infiltration, increased humidity, mold growth (destroying built asset values and increasing operational repair costs), and increased HVAC power consumption.

We also ran energy modeling simulation software. In one hospital, we found that the pressurization of the building limits the effects of infiltration and reduces the air conditioning system’s electricity bill by 20%. In general, 60% of the electrical power supply cost comes from the air conditioning system. As a conclusion, not conducting the TAB services may lead to an increase in power consumption by an estimated 12%.

In the end, for the eight hospitals, we estimated a total loss of AED 2,718,665.16/year (USD740,175). This is no small sum, especially as the costs stack up over several years.

Emphatic losses like these can be avoided through commissioning – which makes hospital commissioning services a modest investment for the benefits that can be achieved.

Want to learn more?

There you have it. Now you know how beneficial hospital commissioning can be. Ultimately, commissioning for hospitals can achieve resource and cost savings, improve building management, and make buildings safer for people who use them.

Want to read more about health facility commissioning? Read our whitepaper on commissioning for hospitals here!