Because even brief outages in healthcare environments can have severe consequences, system upgrades and maintenance must be planned with surgical precision. | Photo Credit: gorodenkoff
By Kristi Vilminot
Healthcare facilities today face unprecedented pressure to plan for power disruptions and infrastructure upgrades. Aging transmission lines, soaring energy demand from data centers, and evolving sustainability mandates have made resilience planning more complex than ever. For hospital leaders, planning for energy resilience is no longer a future consideration—it’s a present-day imperative. Many health systems struggle with where to begin, how far to go, and what tools to use to make the right investment at the right time.
Here we explore the often-overlooked complexities of long-term power resilience in healthcare settings, offering a pragmatic look at what successful planning and maintenance entail. We examine the technical, regulatory, and cultural pressures reshaping utility decisions—and why delays can expose hospitals to unacceptable risk. Drawing from industrial best practices that are increasingly relevant to healthcare, we outline a phased, step-by-step approach to building resilience without disrupting care.
Technical, Regulatory, and Cultural Pressures That Complicate Utility Decisions
External forces—grid limitations, stakeholder perceptions, and state regulations—are influencing internal infrastructure decisions. Failure to navigate these forces effectively can leave hospitals exposed to both operational and financial vulnerabilities.
Limitations of the national grid have made long-term power resilience an urgent priority for healthcare facilities. Aging infrastructure, particularly transmission lines, has triggered nationwide efforts to upgrade substations and lines. Meanwhile, electricity demand—fueled by the proliferation of data centers and electronics—continues to rise, increasing the likelihood of brownouts.
Public pressure to pursue sustainable energy solutions can steer institutional decision-making in directions that aren’t always fiscally sound. For example, many universities in Michigan shifted from coal to natural gas in response to student protests, despite higher operational costs at the time. More recently, students have petitioned institutions to adopt renewables like wind and solar, which still come at a premium per kilowatt hour.
Financial incentives such as investment tax credits (ITCs) and state or federal grants can support sustainable power adoption—but only if healthcare leaders act quickly. These opportunities often come with deadlines, requiring that a certain percentage of construction be completed by a specific date. Delays can result in missed funding, while new incentives may emerge with little advance notice or publicity.
Clearly, power resilience today involves far more than installing backup generators. It requires strategic foresight and phased implementation to mitigate risks related to infrastructure failure, brownouts, and lost funding opportunities. In today’s landscape, a phased, deliberate approach offers the clearest path to resilience and continuity of care.
Assessing What to Back Up—and How Much
Hospital leaders don’t always know which systems require backup—or how much backup capacity they truly need. The first step is conducting targeted interviews and questionnaires to assess anticipated growth, outage history, and critical service needs. Will a new ICU or research wing be added that increases the facility’s energy demand? Could the expansion incorporate solar to enhance sustainability and provide usable backup power? When have power outages occurred in the past, and how long did restoration take?
Based on this data, facilities can create tailored backup strategies aligned with realistic thresholds. If outages have historically lasted several days, portable generators or supplemental systems may be essential. Decision-makers must identify which components truly need backup support—not all areas require it. Plans to incorporate solar or other alternatives must comply with state-specific regulations and incentives.
Keeping Systems Up to Date
Many facilities operate critical systems well beyond their intended lifespan without sufficient inspection or upgrades. It’s not uncommon to find plants from the 1970s—designed for 20- or 30-year lifespans—still in use today. Routine, code-mandated inspections such as energy piping assessments and arc flash testing are often delayed or overlooked amidst competing interests that emerge with urgency.
The ideal maintenance strategy is threefold: conduct routine inspections, initiate timely repairs when issues are identified, and plan for upgrades based on equipment efficiency and projected return on investment (ROI). Leaders focused on resilience should prioritize all three actions.
Pressure piping should be operated and maintained according to current codes. Metering systems must be closely monitored, and any irregularities should trigger immediate investigation and correction. Meters also need regular recalibration to match actual operating conditions.
Deciding when to upgrade becomes easier with sound analytics. If a system’s efficiency, maintenance costs, or reliability begins to decline, it’s time to assess replacement options. As with an aging vehicle, the optimal time to make a change is before it fails on the freeway—not after.
Performing Maintenance and Upgrades Without Disrupting Care
Because even brief outages in healthcare environments can have severe consequences, system upgrades and maintenance must be planned with surgical precision. The most effective approach involves phased isolation supported by accurate, up-to-date single-line diagrams for both piping and electrical systems. These diagrams help teams identify isolation points and reroute utilities around work zones without interrupting care.
Work can be scheduled during low-risk periods—avoiding times like flu season or peak cooling loads. For example, an isolation valve can be pre-fabricated offsite and installed during a planned one-day outage. In a subsequent window, piping can be replaced, sealed, or upgraded, minimizing disruption.
This preemptive, phased strategy reduces the risk of emergency shutdowns and avoids the steep costs of unplanned repairs—such as bringing in union workers on a weekend night. Leaders who adopt this method often find that resilience and cost-efficiency go hand in hand.
Balancing Sustainability with Practicality
In sustainability planning, perception often outweighs data—leading to costly, sometimes unnecessary, investments. To guide facilities toward sound choices, provide ROI-focused comparisons between existing systems and proposed upgrades. These can factor in stakeholder values, regulatory requirements, and long-term compliance goals.
For major equipment decisions, the evaluation often comes down to efficiency. Comparing fuel and maintenance costs of current systems with those of newer technologies—and calculating projected ROI—can illuminate the best path forward.
Delayed action can also cost money. Missed deadlines for tax credits or grants can translate into millions in lost funding. Proactive engagement with evolving state and federal incentive programs can help healthcare leaders avoid the financial penalties of indecision.
Planning is power
The future of healthcare resilience depends on decisions made today. As hospitals grapple with the risks of brownouts, missed incentives, and infrastructure failures, the smartest path forward is not reactive—it’s intentional. With expert guidance and a long-term perspective, healthcare leaders can ensure their facilities remain operational during crises and thrive amid an increasingly uncertain energy future. In a world where power can no longer be taken for granted, planning is power.
Kristi A. Vilminot, P.E., is Director of Engineering – Power Generation & Energy with Commonwealth Associates Inc., and can be reached at Kristi.Vilminot@cai-engr.com.