Healthy Approach

By Karen Aho

With sustainability and community in mind, Gundersen Health System strives for zero energy this year.


When designers talk about healthy buildings, they often focus on interior considerations: air circulation, light, temperature, and maybe energy efficiency as it translates to lower customer costs. Gundersen Health System takes a broader view. The physician-led nonprofit, which includes a leading teaching hospital, trauma center, and dozens of community clinics in Wisconsin, Iowa, and Minnesota, didn’t think it was right to go green without considering the more far-reaching effects beyond its buildings’ walls.

Whether powering boilers or running chillers, Gundersen wanted to develop efficient operations with the health of everyone in mind, and that meant tapping into alternative energy sources. Ideally, those sources would also create local jobs and improve air quality, even for those living hundreds of miles downwind. “We really take to heart our organization’s mission and purpose, to say that we are about the health and well-being of our patients and communities,” says Dr. Jeffrey Thompson, Gundersen’s CEO. For Thompson, setting a goal of eliminating his health system’s dependence on fossil fuels represents a vital step toward improving public health: The byproducts of fossil fuels are known to cause cancer, liver, and kidney diseases; reproductive and respiratory issues; cardiovascular death; and stroke. Although no small task for any building, reducing energy use is particularly daunting for a medical facility. Hospitals, which continually heat and chill air, burn an average of 2.5 times more energy than other commercial buildings, according to the U.S. Department of Energy. Medical buildings alone are responsible for 8 percent of this country’s greenhouse gas emissions. “That’s one of the lessons I’ve learned: how consumptive we are,” says Jeff Rich, executive director of Gundersen’s energy-efficiency program, Envision. Rich headed the Gundersen energy audit in 2008 after energy bills were projected to increase by as much as $500,000 every year. In response, the organization decided to reduce consumption and slashed its energy use by 10 percent within six months and by 25 percent within two years. “One day a few of us got to talking and we asked ourselves, What would it take to get the entire hospital to net zero? Would that even be possible? Or economical?” he says At the time, Gundersen Health System used an average of some 250,000 BTUs per square foot a year—a typical output for a hospital. By 2013, just five years later, Gundersen was averaging 150,000 BTUs per square foot and its new hospital, the LEED-certified Legacy Building began performing this past January at a remarkable 115,000 BTUs per square foot, a level many didn’t think possible. “I remember the conversation with the Legacy project manager and design team, and they kept asking whether 115,000 BTUs per square foot was a goal or more of a target,” recalls Kari Houser, Gundersen’s director of construction and engineering. ”But we set the goal and we achieved it.”

Renewable Sources

In an effort to break free from fossil fuels, Gundersen Health System has partnered with counties and farms in Wisconsin to create local, renewable energy. Gundersen says it is on track to achieve energy independence this winter. Projects include:

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    Biomass Boiler


    The largest energy producer in the Envision portfolio is the La Crosse-based biomass boiler, which burns organic wood materials, such as wood chips and forest residue. The process creates steam for boilers that is in turn used for heat, sanitation, and dehumidifiers. The steam also powers a turbine that generates 2.5 million kWh of electricity a year. The biomass boiler is expected to offset 38 percent of the entire health system’s fossil fuel use.

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    Biogas Landfill


    The biogas project captures methane gas produced by degrading waste at the La Crosse County Landfill. The gas is piped into the Gundersen Onalaska Campus, where it powers engines used to generate heat and electricity. By producing more energy than the multi-building campus needs, the biogas project has made the healthcare site energy independent.

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    Geothermal Heat Pump


    The geothermal system is comprised of 156 wells drilled under a parking lot to a depth of 400 feet, where the ground remains a constant 48 degrees. A 300-ton geothermal heat pump circulates water throughout the system, acting as a moderator: In winter, it takes energy (heat) from warmed underground water and transfers it to the building; in summer, it takes energy (heat) from the building and transfers it to the water wells. It is the largest energy-saving component, saving 70 to 80 kBTUs per square foot annually.

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    Twin Wind Turbines


    Two twin-turbine wind farms in rural Wisconsin, one built in partnership with an organic farm cooperative, produce about 5 megawatts of electricity apiece, enough to power a combined 2,600 homes. The electricity is sent to the grid and sold to homes and businesses. The project offsets about 13 percent of Gundersen’s energy independence goal.

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    Dairy Manure Digesters


    Scheduled to begin this year, the GL Dairy Biogas Project, a partnership with Dane County and three family farms, will use manure from more than 2,000 cows to generate an expected 16 million kWh annually, enough to offset 14 percent of Gundersen’s energy needs. Captured in airtight digester tanks and heated to 100 degrees, the dung decomposes and produces methane, which is trapped and burned in a generator to create electricity.

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    Solar Power


    Installed in 2008 on the La Crosse site, solar panels atop an entry ramp power most of the underground garage’s lighting, making it the country’s first LEED-certified parking garage. Solar hot water heaters installed in 2010 at a La Crosse campus daycare and in 2012 at an Onalaska renal dialysis center meet most of each building’s hot water needs.

The health network slashed $2 million from what began as a $5 million annual energy bill and partnered with farms and counties to produce renewable energy projects, create jobs, and lower patient costs. By 2013 Gundersen had reduced its carbon dioxide, sulfur dioxide, and mercury emissions by more than half—even while adding facilities.

“We see reducing emissions as part of our mission: to treat and prevent disease,” Rich says. “We’ve really had to have a consistency of purpose to get here.” Gundersen is hardly alone in its desire to incorporate healthy energy use—across the country, hundreds of hospitals have joined the Healthier Hospitals Initiative. But Gundersen has set a high bar, prompting other healthcare facilities to consider and address the public health implications of its operations. Envision received so many requests for information from health systems around the world that it set up a for-profit consulting service.

Jeff Rich, executive director, GL Envision, LLC.; Jeffrey Thompson, MD, CEO, Gundersen Health System; Kari Houser, director of Construction and Project Management, Gundersen Health System; Alan Eber, manager, Gundersen Facilities Operation, Gundersen Health System.

Jeff Rich, executive director, GL Envision, LLC.; Jeffrey Thompson, MD, CEO, Gundersen Health System; Kari Houser, director of Construction and Project Management, Gundersen Health System; Alan Eber, manager, Gundersen Facilities Operation, Gundersen Health System.
Photo: Gundersen Health System

Setting new standards for energy efficiency was not easy, however. Gundersen boldly set out to achieve net-zero energy use in Wisconsin, a state where winters are long and coal is cheap, making it tough to justify scrapping the fossil fuel for a potentially risky unknown. “We’re not rich in ocean currents or geothermal springs; other areas of the country are blessed with better sunlight,” says Rich. At times, engineers, already understandably conservative when navigating the highly regulated and complex requirements of hospital design, were skeptical. Some projects fell through due to changes in regulatory incentives or when initial savings projections turned out to be wildly optimistic.


“We see reducing emissions as part of our mission: to treat and prevent disease.”– Jeff Rich


A heavily promoted and highly anticipated brewery biogas project, expected to generate 3 million kWh of electricity a year, ended up with unanticipated impurities in the gas stream and had to be scrapped. “When you’re working with a technology that’s new to you, you have to prepare for the unknown and the unexpected,” says Rich. “Not everything goes as planned, but some things go better than planned,” he adds. By harnessing the biogas from a single landfill project, Gundersen powers its entire Onalaska campus, making it the only energy-independent multi-building healthcare complex in the country. A geothermal heat pump at the Legacy Building is alone expected to save 70 to 80 kBTUs per square foot annually. Thompson, a pediatric intensivist and neonatologist, hopes that Gundersen’s lead will encourage organizations to take more responsibility for the long-range health implications of their energy policies, too often pushed downstream as somebody else’s problem. “A lot of things in human health aren’t directly measurable,” he says. “It’s hard to draw a direct line between the coal burned in Ohio and the child affected by the particulates raining down later in Pennsylvania. But we believe it’s our responsibility as a healthcare organization to take that issue on and to think as broadly as possible.”