sustainability

Article
Investigation and Evaluation of Energy Consumption
Performance for Hospital Buildings in China
Ru Ji and Shilin Qu *
School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing 100083, China;
jiru@ustb.edu.cn
* Correspondence: q.shilin@163.com




Received: 20 February 2019; Accepted: 18 March 2019; Published: 21 March 2019


Abstract: Energy use in hospitals is higher than other public buildings, so it is essential to investigate
and evaluate its energy consumption performance to save energy. In this paper, a comprehensive
investigation was conducted to study energy consumption of hospitals in China. The investigation
results show that electricity use accounts for the maximum share in total energy consumption of
hospitals, especially in south China. Improving air conditioning systems is the most direct and
effective way for realizing hospital building energy savings. What’s more, a new evaluation system
of energy-saving performance for hospital buildings was developed. This evaluation system could
evaluate performance of energy use in hospital, find out the weakness of energy use, and provide
improving suggestions. Furthermore, a kind of visual software was given by our paper, which can be
used intuitively by practitioners to evaluate building energy consumption performance of a hospital.

Keywords: hospital buildings; energy consumption; energy saving; evaluation system

1. Introduction
For the design of ‘nearly zero-energy’ buildings (NZEB) [1], there are two aspects needing
to be considered, IEQ (Indoor Environmental Quality) and Energy saving/efficiency. First, at the
international level (EU, USA) the new legislations claim that NZEB goals have to be reached in the
presence of acceptable IEQ levels for occupants. This is especially for Health Facilities (hospital
buildings) where IEQ requirements have to be calibrated by thinking about two different groups
of people: on one hand the patients, and the medical/paramedic staff. Therefore, there are many
literatures were conducted to investigate IEQ in hospital buildings [2–10]. Among them, Fanger’s
studies are very important in the field of indoor environment quality, which have inspired (and still
inspire) professional design engineers and academic researchers on human thermal comfort and indoor
air quality [11]. Secondly, under the premise of considering IEQ, hospital energy saving research is
also a very key issue.
As we know, building energy consumption has kept rising during the past few decades, and the
proportion of building sections rose form 10% in 1980 to more than 30% now [12,13]. Recently, China
has become the largest energy consumer in the world [14]. In particular, hospital’s energy use is more
than twice as much as other general public buildings. The higher energy use in hospital buildings is
due to the high space heating, cooling and ventilation loads, continuous operation for the majority
of facilities, and high number of medical equipment [15]. Therefore, hospitals should be the most
important in implementing energy saving and environmentally sustainable development [16].
First, it is significant to conduct a national statistical investigation of hospital energy consumption.
In recent years, there are many related studies being developed. For example, in 1999 Ahmed H.S [17]
suggested that the economic and technological considerations must be observed in the design and
construction of hospitals in the low-income regions of developing countries. In 2007 in UK [15], in

Sustainability 2019, 11, 1724; doi:10.3390/su11061724 www.mdpi.com/journal/sustainability

Sustainability 2019, 11, 1724 2 of 14

order to reduce primary energy consumption by 15% during this decade, for all existing buildings
the healthcare target is to improve the total energy consumption to a level of 445 kWh/m2 and 550
kWh/m2 for good practice and typical practice, respectively. For Asia [18], Japanese researchers
conducted a sensitivity analysis in structure optimization of energy supply systems for a hospital
in 2007.
It can be concluded that there are not many comprehensive investigations of energy consumption
performance of hospitals. Especially, in China, there is hardly any comprehensive energy investigation
data of hospitals with different levels in all over climatic zones. This study, therefore, was motivated
to conduct a comprehensive investigation to fill this gap for the first time. The purpose is to clarify
the status of energy consumption, to identify and to illustrate the weak links for hospital buildings’
energy efficiency improvement.
Secondly, it is also necessary to give a reasonable evaluation of the energy consumption of
hospital buildings based on this investigation. There are various rating systems that can be used on
assessment in operation and management of energy systems in hospitals. BREEAM is the earliest
rating system of green buildings and was created in U.K in 1990 [19,20]. Among the BREEAM products,
BREEAM Healthcare version was developed in 2008 for green hospital buildings [21]. LEED is another
commonly used green building rating system, which was launched by U.S. Green Building Council
in 1998 [22–24]. Among the LEED products family, LEED for Healthcare was released by USGBC in
2011. What’s more, Green Guide for Health Care (GGHC) is created by Steering Committee from U.S.
healthcare industry [25,26]. Rating systems in these developed countries have set a good example for
other countries.
However, different countries have different characteristics of energy consumption and influence
mechanisms, so the rating methods must suit the actual conditions of their own countries. Hence, in
2006, China issued Evaluation Standard for Green Building (ESGB), which is the first multi-objective
and multi-level comprehensive evaluation standard of green building “environment performance
grade” in China [27–29]. However, it is vacant in rating systems of hospitals in China. In this instance,
a rating system of energy consumption in the hospital building sector needs to be established in China.
Therefore, in this study, the comprehensive energy investigation of hospitals in China was
undertaken to investigate the status of energy consumption. Then a new evaluation system of energy
consumption in operation and management for hospitals was established, and which can identify the
weak links in energy efficiency of energy supply system of a hospital. The results obtained by this
paper provide owners and operators of hospitals in China to enhance the efficient of energy-savings.

2. Investigation Methodology and Energy Structure of 100 Hospitals

2.1. Sample Description

In order to make comprehensive statistics on building energy consumption for hospitals in China,
100 hospitals were investigated. In this investigation, their annual and monthly energy consumption
and energy consumption structure will be analyzed systematically.
First, as shown in Table 1, 100 selected hospitals were distributed in four climate zones: Frozen,
cold, hot summer & cold winter, and hot summer & warm winter, which is due to that different zones
have their own characteristics on energy consumption. It can be seen that most hospitals (38%) are
located in hot summer & cold winter zone and there are 10 hospitals in frozen zone.
Sustainability 2019, 11, 1724 3 of 14

Table 1. Hospital numbers for different levels in different climatic zone.

Climatic Zone
Hospital Category Hot Summer & Hot Summer &
Frozen Cold Total
Cold Winter Warm Winter
Grade 3A 4 14 18 14 50
Grade 3B 1 5 5 2 13
Grade 2A 3 7 8 5 23
Grade 2B 2 4 7 1 14
Total 10 30 38 22 100
Sustainability 2019, 11, x FOR PEER REVIEW 3 of 14

Secondly,the
Secondly, thedistribution
distributionofofdifferent
differentgrades
grades ofof hospitals
hospitals in in different
different regions
regions willwill greatly
greatly affect
affect its
its distribution of energy consumption. Here, these 100 hospitals we investigated
distribution of energy consumption. Here, these 100 hospitals we investigated were selected based were selected based
on different grades. As
on Asshown
shownininTable
Table1 1and
andFigure
Figure1, 1,
according
according to to
hospital grade,
hospital 100100
grade, hospitals
hospitals are
divided
are dividedintointo
4 categories:
4 categories: Grade 3A,3A,
Grade Grade
Grade 3B,3B,
Grade
Grade 2A2Aand
andGrade
Grade2B. 2B.From
FromTable
Table 11 it can be be
concluded that
concluded that in
in China
China roughly
roughly half
half of
of the
the hospitals
hospitals are
are Grade
Grade 3A 3A hospital.
hospital. Moreover, Figure
Figure 11
indicated that,
indicated that, in
in the
the hot
hot summer
summer & & warm
warm winter
winter areas,
areas, the
the proportion
proportion of of Grade
Grade 33 hospitals
hospitals is is the
the
largest (73%, in which 64% for Grade 3A hospitals and 9% for Grade 3B hospitals), while
largest (73%, in which 64% for Grade 3A hospitals and 9% for Grade 3B hospitals), while in the frozen in the frozen
region the proportion of
region of the
the Grade
Grade33hospitals
hospitalsisisthethesmallest
smallest(only
(only 50%).
50%).At At
thethe
same time,
same the the
time, hot
summer
hot summer& warm
& warm winter
winterareas accounted
areas accountedfor for
thethe
smallest proportion
smallest proportion of Grade 2 hospitals
of Grade 2 hospitals (27%,
(27%, in
which the proportion of Grade 2B is only 4%), while the
in which the proportion of Grade 2B is only 4%), while the frozen region frozen region accounted for the largest
largest
proportionof
proportion ofGrade
Grade22 hospitals
hospitals (50%,
(50%, especially
especially for
for Grade
Grade 2B
2B hospitals
hospitals the proportion
proportion is high to 20%).

Frozen 40% 10% 30% 20%

Cold 47% 17% 23% 13%

Hot summer & cold winter 47% 13% 21% 19%

Hot summer & warm winter 64% 9% 23% 4%

0% 20% 40% 60% 80% 100%

Grade 3A Grade 3B Grade 2A Grade 2B

Figure 1. The proportion of hospital number with different grade in each climate zone.
Figure 1. The proportion of hospital number with different grade in each climate zone.
Thirdly, hospital bed number also has an impact on its energy consumption. Therefore, as shown
Thirdly, hospital bed number also has an impact on its energy consumption. Therefore, as shown
in Table 2, based on bed numbers, hospitals are also classified into 4 kinds. It can also be seen that
in Table 2, based on bed numbers, hospitals are also classified into 4 kinds. It can also be seen that for
for most of hospitals there are less than 1000 beds, while only 11 hospitals have bed numbers of more
most of hospitals there are less than 1000 beds, while only 11 hospitals have bed numbers of more
than 1500.
than 1500.
Table 2. Hospital numbers in different bed number range.
Table 2. Hospital numbers in different bed number range.
Bed Number 100~500 500~1000 1000~1500 >1500 Total
Bed Number 100~500 500~1000 1000~1500 >1500 Total
Hospital Number 39
Hospital Number 39 40 40 1010 11 11100 100

2.2.
2.2. Analysis
Analysis of
of Hospital
Hospital Building
Building Energy
Energy Structure
Structure
Before
Beforeanalyzing
analyzinghospital
hospitalbuilding
building energy consumption,
energy consumption,it is necessary to investigate
it is necessary their energy
to investigate their
structures and findand
energy structures the find
mainthetypes
main of types
energyofconsumption. In this investigation,
energy consumption. it is found
In this investigation, that
it is the
found
energy
that thesupply
energysystems
supplyin hospitals
systems mainly consist
in hospitals mainlyof consist
air conditioning system and
of air conditioning domestic
system andhot water
domestic
supply system.
hot water Figure
supply 2 shows
system. the2 composition
Figure of energy structure
shows the composition of energy (cooling and(cooling
structure heatingand
source) for
heating
each energy
source) supply
for each system.
energy supply system.
2.2. Analysis of Hospital Building Energy Structure
Before analyzing hospital building energy consumption, it is necessary to investigate their
energy structures and find the main types of energy consumption. In this investigation, it is found
that the energy supply systems in hospitals mainly consist of air conditioning system and domestic
Sustainability
hot 2019, 11, 1724
water supply 4 of 14
system. Figure 2 shows the composition of energy structure (cooling and heating
source) for each energy supply system.

Sustainability 2019, 11, x FOR PEER REVIEW 4 of 14

Figure 2. The proportion of energy structures in different cooling and heating sources.
2. The proportion of energy structures in different cooling and heating sources.
Figure 2Figure
indicates that hospital buildings use a variety of energy sources for heating and cooling,
including electricity, renewable energy, nature gas and fossil fuel. Among them, electricity is most
Figure 2 indicates that hospital buildings use a variety of energy sources for heating and cooling,
widely used as cooling source in air conditioning system, accounting for 74%. While natural gas is
including electricity, renewable energy, nature gas and fossil fuel. Among them, electricity is most
most commonly used as heating sources in both air conditioning system and domestic hot water
widely used as cooling source in air conditioning system, accounting for 74%. While natural gas
supply system, accounting for 46% and 52%, respectively. It is interesting to note that, renewable
is most commonly used as heating sources in both air conditioning system and domestic hot water
energy utilization is mainly used in domestic hot water supply systems, accounting for 33%.
supply system, accounting for 46% and 52%, respectively. It is interesting to note that, renewable
However, the overall utilization of renewable energy is relatively small, and it needs to be improved.
energy utilization is mainly used in domestic hot water supply systems, accounting for 33%. However,
Moreover, according to these three kinds of cooling and heating sources, the percentage statistics
the overall utilization of renewable energy is relatively small, and it needs to be improved.
of the specific energy supply system in different climate zones were made. That is, the ratio between
Moreover, according to these three kinds of cooling and heating sources, the percentage statistics
the building area served by each energy supply system and the overall building area of the surveyed
of the specific energy supply system in different climate zones were made. That is, the ratio between
hospital in this climate zone, as shown in Figure 3. It can be seen that there are a variety of energy
the building area served by each energy supply system and the overall building area of the surveyed
supply systems in each heating and cooling source, including split air conditioning, air source heat
hospital in this climate zone, as shown in Figure 3. It can be seen that there are a variety of energy
pump, ground source heat pump, lithium bromide chiller, screw chiller, centrifugal chiller, etc. Each
supply systems in each heating and cooling source, including split air conditioning, air source heat
energy supply system needs to consume its own energy structure, that is, the form of each energy
pump, ground source heat pump, lithium bromide chiller, screw chiller, centrifugal chiller, etc. Each
supply system determines its corresponding energy structure. Therefore, from Figure 3, it can be
energy supply system needs to consume its own energy structure, that is, the form of each energy
further concluded that the composition of the energy structure in the cold and heat sources of
supply system determines its corresponding energy structure. Therefore, from Figure 3, it can be
hospitals. For example, in Figure 3a, two types of energy structures can be seen, namely electricity
further concluded that the composition of the energy structure in the cold and heat sources of hospitals.
(corresponding energy supply systems are split air conditioning, lithium bromide chiller, screw
For example, in Figure 3a, two types of energy structures can be seen, namely electricity (corresponding
chiller, centrifugal chiller) and renewable energy (corresponding energy supply systems are air
energy supply systems are split air conditioning, lithium bromide chiller, screw chiller, centrifugal
source heat pump and ground source heat pump). And it turns out that electricity is used far more
chiller) and renewable energy (corresponding energy supply systems are air source heat pump and
than renewable energy in any climate, which is consistent to the trend in cooling source of air
ground source heat pump). And it turns out that electricity is used far more than renewable energy in
conditioning systemin in Figure 2.
any climate, which is consistent to the trend in cooling source of air conditioning systemin in Figure 2.

(a)

Figure 3. Cont.
Sustainability 2019, 11, 1724 5 of 14

(a)

Sustainability 2019, 11, x FOR PEER REVIEW 5 of 14

(b)

(c)

Figure 3.
Figure 3. Percentage
Percentagestatistics
statisticsofofthe
thespecific
specificenergy supply
energy system
supply system in in
different climate
different zones.
climate (a)
zones.
(a) Cooling
Cooling source
source in in
airair conditioningsystem;
conditioning system;(b)
(b)heating
heatingsource
sourcein
inair
air conditioning
conditioning system; (c)
(c) heating
heating
source
sourcein
indomestic
domestichothotwater.
water.

3.
3. Energy
Energy Consumption
Consumption Investigation
Investigation Results
Results of
of 100
100 Hospitals
Hospitals
3.1. Analysis of Hospital Building Energy Consumption
3.1. Analysis of Hospital Building Energy Consumption
As analyzed in the previous section, electricity and natural gas are the two most used energy
As analyzed in the previous section, electricity and natural gas are the two most used energy
structures in these 100 hospitals. In this section, two kinds of energy consumption will be investigated,
structures in these 100 hospitals. In this section, two kinds of energy consumption will be
i.e., electricity consumption and total energy consumption. Here, electricity consumption was
investigated, i.e., electricity consumption and total energy consumption. Here, electricity
directly measured by flow meters. While, total energy consumption was calculated by the sum
consumption was directly measured by flow meters. While, total energy consumption was calculated
of electricity consumption and natural gas. Specifically, total energy consumption was defined as the
by the sum of electricity consumption and natural gas. Specifically, total energy consumption was
equivalent calorific values of electricity consumption and gas usage (10.91 MJ/kWh and 17.6 MJ/m3 ,
defined as the equivalent calorific values of electricity consumption and gas usage (10.91 MJ/kWh
respectively) [30]. What’s more, the energy consumption bears definite seasonal characteristics, so two
and 17.6 MJ/m3, respectively) [30]. What’s more, the energy consumption bears definite seasonal
important energy statistical parameters, including annual energy consumption and monthly energy
characteristics, so two important energy statistical parameters, including annual energy consumption
consumption, will be discussed in the next.
and monthly energy consumption, will be discussed in the next.
3.1.1. Electrical Consumption
3.1.1. Electrical Consumption
Figures 4 and 5 show the distribution of annual electricity consumption by 100 hospitals according
to theFigures
climate 4zone
andcategory
5 showand thethe
distribution
bed numberofcategory,
annual respectively.
electricity consumption by 100
Figure 4 indicates thathospitals
there is
according to the climate zone category and the bed number category, respectively. Figure
a significant disparity among the four climatic regions. It can be seen that for hospitals in hot summer 4 indicates
&that there
warm is a significant
winter zone annual disparity among
electricity the four isclimatic
consumption regions.
140.7 kWh/m 2 , It can the
while be seen
valuethat for kWh/m
is 45.2 hospitals 2
in hot summer & warm winter zone annual electricity consumption is 140.7 kWh/m
in frozen zone, which is 67.9% decreased. It can be concluded that annual electricity consumption
2, while the value

is higher
is 45.2 kWh/m 2 in frozen zone, which is 67.9% decreased. It can be concluded that annual electricity
in the southern area in China than in northern area, which is caused by a lot of use of air
consumptionsystems
conditioning is higherin in the southern
summer. areathe
Therefore, in China than in northern
south hospitals play the area, which
largest is caused
part in by a lot
total electricity
of use of air conditioning
consumption, accounting for systems
39.1%.in summer. Therefore, the south hospitals play the largest part in
total electricity consumption, accounting for 39.1%.
that there is a significant disparity among the four climatic regions. It can be seen that for hospitals
in hot summer & warm winter zone annual electricity consumption is 140.7 kWh/m2, while the value
is 45.2 kWh/m2 in frozen zone, which is 67.9% decreased. It can be concluded that annual electricity
consumption is higher in the southern area in China than in northern area, which is caused by a lot
of use of air conditioning
Sustainability 2019, 11, 1724 systems in summer. Therefore, the south hospitals play the largest
6 of part
14 in
total electricity consumption, accounting for 39.1%.

Figure
Figure 4. 4. Annualelectricity
Annual electricity consumption
consumption per
perunit
unitinin
each climate
each zone.
climate zone.

Sustainability 2019, 511,

Figure x FORannual
shows PEER REVIEW
electricity consumption by 100 hospitals according to bed number. It can6 of 14
Figure 5 shows annual electricity consumption by 100 hospitals according to bed number. It can
be seen that annual electricity consumption per bed increased with increasing number of beds, i.e.,
be seen
for the that annual
hospital with electricity
more consumption perisbed increased withelectricity
increasing number of beds, i.e.,
for the hospital with morebedbednumbers
numbers there
there is aa higher
higher annual
annual consumption
electricity consumption per bed.
per bed.
Specifically, forfor
Specifically, hospitals
hospitalswith
with100~500
100~500 beds annualelectricity
beds annual electricity consumption
consumption is 6515.9
is 6515.9 kWh/bed,
kWh/bed, whilewhile
the electricity consumption value
the electricity consumption value is 7999.8 is 7999.8 kWh/bed for hospitals with >1500 beds, which is 22.8%
for hospitals with >1500 beds, which is 22.8%
increased.
increased. However,
However, it is
it is interestingto
interesting tonote
note that,
that, when
whenthe thehospital’s
hospital’sbed
bednumber
numberis over thanthan
is over 1000,1000,
the growth rate becomes
the growth rate becomes smaller. smaller.

Figure 5. Annual
Figure electricity
5. Annual electricityconsumption perbed
consumption per bedbased
basedonon hospital
hospital bedbed capacity.
capacity.

3.1.2.3.1.2.
TotalTotal Energy
Energy Consumption
Consumption
Figure 6 shows the values of annual total energy consumption by two grades hospitals according
Figure 6 shows the values of annual total energy consumption by two grades hospitals according
to the climate zone category. It can be seen that, for all climate zones, all of annual total energy
to the climate zone category. It can be seen that, for all climate zones, all of annual total energy
consumptions in Grade 3 hospitals are higher than that in Grade 2 hospitals. Particularly for hospitals
consumptions in Grade
in frozen zone, 3 hospitals
the higher annual aretotalhigher
energythan that in Grade
consumption ratio 2
ishospitals. Particularly
1.2 times. The for hospitals
reason perhaps is
in frozen zone, the higher annual total energy consumption ratio is 1.2 times. The reason
that Grade 3 hospitals have the large building size and provide nationwide healthcare service, in which perhaps is
that there
Grade 3 hospitals have the large building size and provide nationwide healthcare
are a large number of beds and patients. And in Grade 3 hospitals, the participation of central air service, in
which there are systems
conditioning a large is
number of high
relatively beds[31],
andwhich
patients. And ininGrade
also results 3 hospitals,
high energy demand.theIn participation
addition, in of
central
ChinaairGrade
conditioning systems
3 hospitals, is national
as large relatively high [31],
hospitals, which
often also
operate 24results
h a day,inwhich
high resulting
energy demand.
in that In
the demand for energy supply is also continuous. Therefore, Grade 3 hospitals have
addition, in China Grade 3 hospitals, as large national hospitals, often operate 24 h a day, which the higher annual
total energy
resulting in thatconsumptions.
the demand for energy supply is also continuous. Therefore, Grade 3 hospitals have
the higher annual total energy consumptions.

Annual total energy consumption per unit (kWh/m2.a)

400
Grade 2 Grade 3

350

300

250

200
that Grade 3 hospitals have the large building size and provide nationwide healthcare service, in
which there are a large number of beds and patients. And in Grade 3 hospitals, the participation of
central air conditioning systems is relatively high [31], which also results in high energy demand. In
addition, in China Grade 3 hospitals, as large national hospitals, often operate 24 h a day, which
resulting in2019,
Sustainability that11,the demand for energy supply is also continuous. Therefore, Grade 3 hospitals7have
1724 of 14
the higher annual total energy consumptions.

Annual total energy consumption per unit (kWh/m2.a)

400
Grade 2 Grade 3

350

300

250

200
Hot summer & Hot summer & Cold Frozen
warm winter cold winter

Figure
Figure 6. Annual total
6. Annual total energy
energy consumption
consumption per
per unit
unit by
by two
two grades
grades hospitals
hospitals in
in each
each climate
climate zone.
zone.

Figure 7 shows that the distribution of monthly total energy consumption per unit according to
Figure 7 shows that the distribution of monthly total energy consumption per unit according to
the climate zone category. It can be seen that in hot summer & warm winter zone, the trend of monthly
the climate zone category. It can be seen that in hot summer & warm winter zone, the trend of
total energy consumption fluctuates dramatically and reaches a peak in August. It can be concluded
monthly total energy consumption fluctuates dramatically and reaches a peak in August. It can be
from the figure that, for most of the year (April to October), the energy consumption in hot summer &
concluded from the figure that, for most of the year (April to October), the energy consumption in
warm winter zone is the highest in the four climate zones, and much higher than that in cold region
hot summer & warm winter zone is the highest in the four climate zones, and much higher than that
and frozen region. While in frozen zone, energy use in winter is higher than that in other zones, but
in cold region and frozen region. While in frozen zone, energy use in winter is higher than that in
compared with most other months, its energy consumption is only slightly higher. This phenomenon,
other zones, but compared with most other months, its energy consumption is only slightly higher.
therefore, further reflects the importance of the impact of the hospital grade distribution on the energy
This phenomenon, therefore, further reflects the importance of the impact of the hospital grade
consumption per unit area in the different climatic zone.
distribution on 11,
Sustainability 2019, thex energy consumption
FOR PEER REVIEW per unit area in the different climatic zone. 7 of 14

Figure 7. Monthly total energy consumption per unit in each climate zone.
Figure 7. Monthly total energy consumption per unit in each climate zone.
Figures 8 and 9 show annual total energy consumption by 100 hospitals according to the climate
zone Figures
category8 andand the
9 show
bed annual
numbertotal energy
category, consumption
respectively. It isbyinteresting
100 hospitals according
to note to the climate
that, compared with
the annual electricity consumption, annual total energy consumption shows the consistent trend.with
zone category and the bed number category, respectively. It is interesting to note that, compared
the annual electricity
First, Figure consumption,
8 illustrates that theannual total energy
total energy consumption
consumption in south shows the consistent
hospitals trend.
is still higher than
First, Figure 8 illustrates that the total energy consumption in south
2
that in north hospitals, and the corresponding values are 278.7 kWh/m , 300.5 kWh/m , 379.6 kWh/m hospitals is 2still higher than
2
that 414.6
and in north hospitals,
kWh/m 2 forand the corresponding
frozen, cold, hot summer values & are
cold278.7 kWh/m
winter, and ,hot
2 300.5 kWh/m&, 379.6
summer
2
warmkWh/mwinter
2

and 414.6
zone, kWh/m It
respectively.
2 forcan
frozen, cold, hot
be noticed that,summer & cold
in the hot winter,
summer and hot
& warm summer
winter areas,&annual
warm winter zone,
total energy
respectively. It can be noticed that, in the hot summer & warm winter
consumption is the highest, the frozen region has the smallest. This phenomenon is consistent with the areas, annual total energy
consumption
trend of hospitalis the highest,
number withthe frozen grade
different regioninhas the smallest.
Figure 1 and theThis phenomenon
conclusion in Figureis consistent with
7. As indicated
the trend of hospital number with different grade in Figure 1 and the
in Figure 6, annual total energy consumptions in Grade 3 hospitals is much higher than that of Grade conclusion in Figure 7. As
indicated in Figure 6, annual total energy consumptions in Grade 3 hospitals
2 hospitals due to their scale and facilities. Moreover, in areas of hot summer & warm winter, the is much higher than
that of Grade
proportion 2 hospitals
of Grade due tointheir
3 hospitals scale and
the survey facilities.
scope Moreover,
is far greater than inthat areas of hotareas
in frozen summer & warm
(in Figure 1).
winter, the proportion of Grade 3 hospitals in the survey scope is far greater
As a result, the annual total energy consumption in hot summer & warm winter areas is the highest than that in frozen areas
(in Figure
among the 1). Asclimatic
four a result,zones,
the annual
while total energy
that in consumption
cold areas it is lower inthan
hot summer
the average.& warm winter areas
is the highest among the four climatic zones, while that in cold areas it is lower than the average.
 the trend of hospital number with different grade in Figure 1 and the conclusion in Figure 7. As
indicated in Figure 6, annual total energy consumptions in Grade 3 hospitals is much higher than
that of Grade 2 hospitals due to their scale and facilities. Moreover, in areas of hot summer & warm
winter, the proportion of Grade 3 hospitals in the survey scope is far greater than that in frozen areas
(in Figure2019,
Sustainability 1). As a result, the annual total energy consumption in hot summer & warm winter8 of
11, 1724 areas
14
is the highest among the four climatic zones, while that in cold areas it is lower than the average.

Figure8.8.Annual
Figure Annualtotal
totalenergy
energyconsumption
consumptionper
perunit
unitinineach
eachclimate
climatezone.
zone.

Figure
Figure9 9shows
showsthat thatthe
theaverage
averageannual
annualtotal
totalenergy
energyconsumption
consumptionperperbed
bedfor
forhospitals
hospitalswith
with
different
differentbed
bednumbers
numbersexerts
exerts same
same growth pattern
pattern with
withelectricity
electricityconsumption.
consumption.However,
However, there
there are
are some fluctuations in the maximum and minimum values for hospitals with large
some fluctuations in the maximum and minimum values for hospitals with large bed numbers. For bed numbers.
For example,
example, there
there is isone
onehospital
hospitalwith
withaa capacity
capacity of
of 1000~1500
1000~1500 beds having
having higher
higher total
totalenergy
energy
consumption
consumptionthan thanthatthatininhospitals
hospitalswith
withover
over1500
1500beds
beds(20,282.4
(20,282.4kWh/bed
kWh/bedfor forhospital
hospitalwith
with
1000~1500
1000~1500beds,
beds,and
and19,733.6
19,733.6kWh/bed
kWh/bedforforhospital
hospitalwith
with>1500
>1500beds).
beds).
Sustainability 2019, 11, x FOR PEER REVIEW 8 of 14

Figure 9. Annual
Annual total
total energy
energy consumption per bed for different bed capacity.
capacity.

3.2. Analysis on
3.2. Analysis on the
the Energy
Energy Consumption
Consumption Cost
Cost
Analysis
Analysis on on hospital
hospital energy
energy consumption
consumption shouldshould focus
focus on
on the
the amount
amount of of energy
energy consumed,
consumed, butbut
also
also the
the cost
cost of
of energy
energy use. Therefore, in
use. Therefore, in this
this section,
section, the
the sources
sources of of energy
energy use
use costs and the
costs and the energy
energy
end
end components
components of of the
the highest
highest cost
cost source
source will
will be
be investigated.
investigated.
As shown in the Figure 10a, it can be seen
As shown in the Figure 10a, it can be seen that for that for hospitals
hospitals in in China
China the
the energy
energy use
use cost
cost sources
sources
include
include electricity,
electricity, steam,
steam, water,
water, medical,
medical, gas,
gas, and
and others. Figure 10a
others. Figure 10a also
also indicates
indicates that
that electricity
electricity
costs the most, which accounts for up to 64%. Then the cost of steam comes
costs the most, which accounts for up to 64%. Then the cost of steam comes second, which takes second, which takes up
up
16%.
16%. While
While the
the total
total cost
cost of other types
of other types only
only account
account for
for 20%.
20%. ItIt can
can be
be concluded
concluded that
that electricity
electricity plays
plays
aa key
key role in hospitals, which is the most direct and effective way for achieving energy savings in
role in hospitals, which is the most direct and effective way for achieving energy savings in
hospital
hospital buildings.
buildings.
Figure
Figure 10b
10b shows energy end
shows energy components of
end components electricity. As
of electricity. As shown
shown in this figure,
in this figure, air
air conditioning
conditioning
systems account for the maximum share (50%), which is roughly the same
systems account for the maximum share (50%), which is roughly the same as the sum of other as the sum of other energy
energy
end. So how to improve the efficiency of air conditioning is the key to energy saving
end. So how to improve the efficiency of air conditioning is the key to energy saving in hospitals. in hospitals.
16%. While the total cost of other types only account for 20%. It can be concluded that electricity plays
a key role in hospitals, which is the most direct and effective way for achieving energy savings in
hospital buildings.
Figure 10b shows energy end components of electricity. As shown in this figure, air conditioning
systems account
Sustainability 2019, 11,for the maximum share (50%), which is roughly the same as the sum of other energy
1724 9 of 14
end. So how to improve the efficiency of air conditioning is the key to energy saving in hospitals.

Figure 10. The sources ofof energy

energyuse
usecosts
costsand
andthe
theenergy
energyend
endcomponents
componentsofof
the highest
the cost
highest source
cost sourcein
the 100 hospitals. (a) The proportion of energy use cost source. (b) Energy end components of
in the 100 hospitals. (a) The proportion of energy use cost source. (b) Energy end components ofelectricity.
electricity.
In addition, in order to further analyze the energy use costs, this investigation on energy end
will be
In conducted
addition, inbased orderon
tospace composition
further analyze theofenergy
hospital
usebuildings,
costs, thisincluding outpatient
investigation area end
on energy and
inpatient area. The outpatient area comprises operating rooms, surgical theatres, their
will be conducted based on space composition of hospital buildings, including outpatient area and interconnecting
hallways, and
inpatient ancillary
area. work areas, while
The outpatient area ward is a major
comprises part in inpatient
operating rooms, area.
surgical theatres, their
First, Figurehallways,
interconnecting 11 indicates
andthat, in outpatient
ancillary area,while
work areas, the highest electricity
ward is consumption
a major part is attributed
in inpatient area.
to airFirst,
conditioning systems, which make up to 40%. Specifically, the energy costs by the host and
Figure 11 indicates that, in outpatient area, the highest electricity consumption is attributed
water pump are the two major compositions in air conditioning systems, which
to air conditioning systems, which make up to 40%. Specifically, the energy costs by the host account for 40% and
and
36%,
water respectively.
pump
Sustainability are11,the
2019, twoPEER
x FOR major compositions in air conditioning systems, which account for 40%9 and
REVIEW of 14
36%, respectively.

Figure 11. Electricity cost compositions

compositions in outpatient
outpatient area.
area. (a)
(a) Energy
Energy end
end components
components of
of electricity.
electricity.
proportion of
(b) The equipment proportion of air
air conditioning
conditioning system.
system.

Second, Figure 12 indicates that, in inpatient area, the highest electricity consumption is also
attributed to air conditioning systems, accounting
accounting for 63%. Specifically,
Specifically, in air conditioning systems,
the energy cost of the host is the highest, which accounts for 70%, much higher than those of the other
air conditioning system equipment.
 (b) The equipment proportion of air conditioning system.

Second, Figure 12 indicates that, in inpatient area, the highest electricity consumption is also
attributed to air conditioning systems, accounting for 63%. Specifically, in air conditioning systems,
the energy2019,
Sustainability cost11,
of1724
the host is the highest, which accounts for 70%, much higher than those of the10other
of 14
air conditioning system equipment.

Figure12.
Figure 12. Electricity cost
costcompositions
compositionsinininpatient
inpatientarea.
area.(a)(a)
Energy end
Energy components
end of electricity.
components (b)
of electricity.
TheThe
(b) equipment
equipment proportion of air
proportion conditioning
of air system.
conditioning system.

4.
4. Evaluation
Evaluation of
of Building
Building Energy-Saving
Energy-Saving
According
Accordingto tothe
theinvestigation
investigation above,
above, itit cancan bebe concluded
concluded that that there
there is
is aa specific
specific trend
trend of of energy
energy
consumption of hospital buildings, and operation and management
consumption of hospital buildings, and operation and management is very important to hospital is very important to hospital
building,
building,while,
while,atat
present,
present,there is noisnational
there no national standard for thefor
standard operation and management
the operation and managementof hospital of
buildings in China.in Due
hospital buildings to Due
China. the difference
to the difference of national conditions,
of national therethere
conditions, are obvious
are obvious differences
differences in
relevant codes
in relevant and standards,
codes and standards,so foreign
so foreignstandards cannotcannot
standards be blindly copied. Moreover,
be blindly copied. Moreover,the existing the
evaluation indexes “green hospital building evaluation standard” in
existing evaluation indexes “green hospital building evaluation standard” in China has some China has some shortcomings
in operation evaluation.
shortcomings Therefore,
in operation this paper
evaluation. attempts
Therefore, thistopaper
establish an evaluation
attempts to establish system ansuitable
evaluationfor
China’s national conditions and targeted at the operation and management
system suitable for China’s national conditions and targeted at the operation and management of of hospital buildings.
Combined
hospital with investigation results, this paper proposed a novel evaluation system of building
buildings.
energy-saving
Combined forwith
hospitals in China.
investigation The establishment
results, this paper proposedof the evaluation system is system
a novel evaluation based on of abuilding
careful
analysis of LEED HC in US, GGHC operations and Assessment Standard for Healthcare
energy-saving for hospitals in China. The establishment of the evaluation system is based on a careful Green Building
in China. of
analysis This evaluation
LEED HC insystem
US, GGHCconsistsoperations
of three indexes, which are the
and Assessment comprehensive
Standard index (IeGreen
for Healthcare ), the
index of energy saving performance (I ), and the index of energy saving
Building in China. This evaluation system consists of three indexes, which are the comprehensive
p level (I l ). The relationship of
these three indexes is shown as follows. In this formula, a and b are constant,
index (Ie), the index of energy saving performance (Ip), and the index of energy saving level (Il). The and their values are 10
and 7, respectively.
relationship of these three indexes is shown as follows. In this formula, a and b are constant, and
their values are 10 and 7, respectively. Ie = a × MI N [ Il , 3] + b × Ip (1)

4.1. The Index of Energy Saving Level

According to the results of our investigation, we can calculate the average annual total energy
consumption (Ea ) of hospital buildings in each bed number range, as shown in Table 3. Then energy
saving level (Il ) can be got by Equation (2), i.e., the ratio of Ea to total annual energy consumption of a
hospital (Ea ). Then according to the tri-sectional quantile of Il score, hospitals could be divided into
three groups, as shown in Table 4.
Ea
Il = (2)
Ea

Table 3. Average annual total energy consumption of hospital buildings in each bed number range and
tri-sectional quantile of Il .

Number of Beds Ea (kWh/m2 ·a) Tri-Sectional Quantile of Il

100~500 338.42 0.86 1.19
500~1000 357.83 0.90 1.44
1000~1500 368.27 0.85 1.16
>1500 382.65 0.90 1.15
Sustainability 2019, 11, 1724 11 of 14

Table 4. Energy saving level of the energy system in hospitals.

Level
Number of Beds
Low Middle High
100~500 Il < 0.86 0.86 ≤ Il < 1.19 Il ≥ 1.19
500~1000 Il < 0.90 0.90 ≤ Il < 1.44 Il ≥ 1.44
1000~1500 Il < 0.85 0.85 ≤ Il < 1.16 Il ≥ 1.16
>1500 Il < 0.90 0.90≤ Il <1.15 Il ≥ 1.15
“Low” were awarded to hospitals that had a low level of energy saving and suggested to conduct energy audit to
determine the main reason for high energy use. “Middle” were awarded to hospitals that had a middle level of
energy saving and suggested to conduct retrofitting of energy saving and operation optimization. “High” were
awarded to hospitals that had a high level of energy saving and suggested to find energy-saving potential according
to the index of energy saving performance.

4.2. The Index of Energy Saving Performance

The scores of Ip were calculated through comprehensive consideration of performances of different
evaluation items, such as subentry measures, building automation, air conditioning unit energy-saving,
renewable energy utilization, pump frequency control, heat recovery of exhaust air, condensation
water recovery, natural cooling, intelligent lighting, energy-saving lamps and reduction in water use.
Here, the calculation of Ip will strengthen consideration on high energy consumption items, such as air
conditioning system and lighting system (as mentioned in Section 2). According to the scores of Ip ,
hospitals were divided into four groups, as shown in Table 5.

Table 5. Energy saving performance of the energy system in hospitals.

Performance Score of Ip
Bad 0 ≤ Ip < 25
Middle 25 ≤ Ip < 50
Good 50 ≤ Ip < 75
Excellent 75 ≤ Ip < 100
“Bad” were judged to hospitals that lacked energy saving measures, and mast conduct retrofitting of energy saving.
“Middle” were judged to hospitals that achieved parts of energy saving and suggested to apply more technology
and strategy of energy saving. “Good” were judged to hospitals that are performing well overall but not achieving
the same consistently high level of energy saving measures as” Excellent” hospitals. “Excellent” were judged to
hospitals that have the highest level of performance on energy saving, and suggested to apply more advanced
technology application of energy saving.

4.3. The Comprehensive Index

Finally, Ie can be calculated by bringing Il and Ip of the hospital into the formula 1. As shown
in Table 6, hospitals are classified into four levels. Specifically, three stars (FFF) are awarded for a
hospital with the best energy-saving level and performance, while zero star (I) is for a hospital with
the worst energy-saving level and performance.

Table 6. The comprehensive level of the energy system in hospitals.

Level Score of Ie
I 0 ≤ Ie < 40
F 40 ≤ Ie < 60
FF 60 ≤ Ie < 80
FFF 80 ≤ Ie ≤ 100
I were awarded to hospitals that have the lowest level of performance on operations and maintenance, and must
conduct retrofitting of energy saving. F were awarded to hospitals that performed poorly on operations and
maintenance, and were suggested to conduct retrofitting of energy saving. FF were awarded to hospitals that
achieved good performance on operations and maintenance but not achieving the same consistently high level
of performance as three-star hospitals, and were suggested to conduct upgrading of energy saving. FFF were
awarded to hospitals that demonstrated very high performance on operations and maintenance, and were suggested
to strengthen the system maintenance and energy saving behavior.
 maintenance, and must conduct retrofitting of energy saving. ★ were awarded to hospitals that
performed poorly on operations and maintenance, and were suggested to conduct retrofitting of
energy saving. ★★ were awarded to hospitals that achieved good performance on operations and
maintenance but not achieving the same consistently high level of performance as three-star hospitals,
and were suggested to conduct upgrading of energy saving. ★★★ were awarded to hospitals that
Sustainability 2019, 11, 1724 12 of 14
demonstrated very high performance on operations and maintenance, and were suggested to
strengthen the system maintenance and energy saving behavior.
4.4. Visual Application of Evaluation System
4.4. Visual Application of Evaluation System
Sections 4.1–4.3 described the evaluation index composition and its calculation procedure, which
Section 4.1–4.3 described the evaluation index composition and its calculation procedure, which
is affected by many parameters of the energy consumption and energy supply system of hospitals.
is affected by many parameters of the energy consumption and energy supply system of hospitals.
Therefore, considering the application convenience, this paper further gave visual software as shown
Therefore, considering the application convenience, this paper further gave visual software as shown
in Figure 13, which can be applied by practitioners evaluating the building energy consumption
in Figure 13, which can be applied by practitioners evaluating the building energy consumption
performance. Practitioners only input relevant parameters of one hospital, and the output will be
performance. Practitioners only input relevant parameters of one hospital, and the output will be
given by this visual software (Figure 14).
given by this visual software (Figure 14).

Figure 13. The evaluation software for energy system performance for hospitals.
Sustainability 2019,Figure The evaluation
13. PEER
11, x FOR REVIEW software for energy system performance for hospitals. 12 of 14

Figure 14. The

Figure 14. The evaluation
evaluation result of energy
result of energy system
system performance
performance for
for one
one hospital
hospital in
in Beijing.
Beijing.

5. Conclusions
This study carried outout aa comprehensive
comprehensive energy
energy use
use investigation
investigation ofof hospitals
hospitals in
in China.
China. The
investigation results indicate that electricity consumption is the highest in the total energy
investigation results indicate that electricity consumption is the highest in the total energy consumption,
consumption,
which which
accounts accounts
for 64%. Air for 64%. Air conditioning
conditioning system
system accounts foraccounts for the share
the maximum maximum share in
in electricity
electricity consumption, especially in south China. Therefore, saving electricity in the south hospital
is the most direct way for achieving hospital energy savings.
Then a novel rating system of energy consumption in operation and management for Chinese
hospitals was established. This rating system can evaluate energy use performance of a hospital,
which also can be compared to another hospital due to using a standard evaluation process. What’s
more, this evaluation system can find out weak links of energy use and provide corresponding
Sustainability 2019, 11, 1724 13 of 14

consumption, especially in south China. Therefore, saving electricity in the south hospital is the most
direct way for achieving hospital energy savings.
Then a novel rating system of energy consumption in operation and management for Chinese
hospitals was established. This rating system can evaluate energy use performance of a hospital, which
also can be compared to another hospital due to using a standard evaluation process. What’s more,
this evaluation system can find out weak links of energy use and provide corresponding improving
suggestions. Furthermore, to achieve these evaluations, a kind of visual software was given by our
paper, which can be easily used by practitioners.
Through the results of this investigation and rating system, some suggestions on energy saving
in hospitals were given as follows. Compared with other types of public buildings, the function of
hospital buildings is much more complex, and the healthcare environment is under strict control.
Therefore, hospital energy saving must start from the concept of comprehensive energy utilization
and energy balance. And the traditional measures of hospital energy saving need to be changed and
conducted based on the comfort of the healthcare environment. During the expansion of the hospital,
the energy supply and demand of the whole hospital should be comprehensively planned to achieve
energy balance as far as possible, to improve the efficiency of the system, and to strengthen the heat
recovery and utilization. Only in this way, the energy saving in hospital buildings can be realized with
the assurance of the service level of the hospital.
Finally, this investigation is only a first step of a more in-depth analysis where energy assessment
has to be carried out simultaneously to IEQ investigations.

Author Contributions: R.J. and S.Q. jointly designed the research paper and reviewed the paper findings; R.J.
analyzed the data, and wrote the major parts of the manuscript; and S.Q. reviewed and revised the manuscript
prior to the submission.
Funding: This research was funded by National Key R&D Plan of China [2017YFC0702600].
Conflicts of Interest: The authors declare no conflict of interest.

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