The Energy Transition in Hospitals: Management Systems Are Becoming Essential
Healthcare institutions are facing the fundamental challenge of how to permanently reduce their energy consumption. The solution lies in implementing an energy management system based on the internationally proven framework of ISO 50001:2018.
The consequences of the energy transition - rising costs and stricter climate targets - particularly affect large medical facilities such as hospitals, clinics, and healthcare centers. A single hospital bed consumes up to 15,000 kWh of electricity and 30,000 kWh of heat per year. This corresponds to the consumption of up to four single-family homes. Emergency departments, operating rooms, intensive care units, and large-scale medical equipment generate significant continuous energy demand. In addition, there are high energy requirements for HVAC systems and lighting.
The Energy Efficiency Act (Energieeffizienzgesetz, EnEfG), which came into force in 2023, obliges all energy-intensive companies to improve their operational energy efficiency and implement savings potentials. Organizations with an average annual energy consumption of more than 7.5 gigawatt hours must introduce a certified energy management system. This also affects many institutions in the healthcare sector.
Growing Demand for Energy Data
Due to regulatory requirements and changing service portfolios, the need for meaningful energy data is increasing across all industries, including healthcare. New care structures between specialized hospital operators, medical practices, healthcare centers, rehabilitation facilities, and nursing homes are changing energy consumption patterns and the composition of purchased energy sources such as electricity, heat, and cooling.
This new information demand results directly from the EnEfG, political climate targets, and the EU-wide Corporate Sustainability Reporting Directive (CSRD). Although the CSRD primarily affects large companies, improvements in energy performance and CO₂ footprints are now of high importance to all companies, stakeholders, and investors.
Requirements of the Energy Efficiency Act
The EnEfG primarily focuses on energy consumption rather than reporting. Organizations with high energy consumption are required to publish implementation plans for economically viable energy efficiency measures and/or introduce an energy management system (EnMS) or an environmental management system (EMS) in accordance with EMAS (Eco-Management and Audit Scheme). Which thresholds and requirements apply?
- For final energy consumption above 2.5 GWh: Action plans for savings measures: Companies with an average annual final energy consumption of more than 2.5 GWh must, within three years, develop concrete and feasible implementation plans for identified final energy-saving measures. The basis may be energy audits pursuant to Section 8 of the Energy Services Act (EDL-G) (in the sense of an internal audit) or action plans from an energy management system (EnMS) or environmental management system (EMS) in accordance with Section 8 EnEfG or Section 8 (3) EDL-G. Measures must be evaluated economically in accordance with DIN EN 17463 (VALERI).
- For final energy consumption above 7.5 GWh: Introduction of an energy management system: Companies with an average annual final energy consumption of more than 7.5 GWh in the last three completed calendar years are required under Section 8 EnEfG to introduce and operate an energy management system (EnMS) in accordance with DIN EN ISO 50001 or an environmental management system (EMS) in accordance with EMAS within 20 months of determining that this threshold has been exceeded.
Example: If an energy audit completed by November 17, 2023 determines that the average final energy consumption for the years 2020, 2021, and 2022 exceeds 7.5 GWh per year, the EnMS or EMS must be fully implemented by July 18, 2025 at the latest.
Medical institutions and service providers subject to the EnEfG must collect data on their energy use. This includes energy input and output, process temperatures, and information on waste heat media such as temperature and heat quantity. In addition, waste heat sources must be identified - regardless of whether they are technically avoidable - and potential measures for recovery and use must be examined. Measures with a net investment volume of up to €2,000 are considered minor and may be implemented without an economic efficiency calculation in accordance with DIN EN 17463.
The Energy Management System According to ISO 50001:2018
The healthcare sector faces particular challenges because energy improvement measures must be reconciled with high standards of patient care and healthcare regulations. In practice, implementing a structured energy management system in accordance with ISO 50001:2018 has proven effective. The EnMS can be operated alongside an existing quality management or quality assurance system.
Thanks to its clear structural and process organization, improvement potential in terms of risks, costs, and benefits can be systematically identified, evaluated, and implemented. The process begins with establishing the energy baseline. Comparing this baseline with measured energy consumption enables continuous improvement of energy performance and cost efficiency across all processes.
Energy Policy and Context Analysis
A core element of the EnMS is the formulation of a binding energy policy (Section 5.2). Energy includes all forms such as steam, electricity, compressed air, heat, and fuels. The energy policy represents a voluntary commitment. It defines both strategic objectives - such as increasing the share of renewable energy to X percent - and operational targets, such as reducing energy consumption by X percent.
The energy policy is based on a comprehensive context analysis. While energy audits often focus on the internal organization, ISO 50001 also considers external influences within the process chain that affect energy performance. As a result, energy and action planning - alongside establishing a transparent energy baseline - becomes another core component of the EnMS. This is based on meaningful key performance indicators (KPIs). The rule is: the higher the energy consumption of a given area, the more detailed the indicators in the measurement concept should be.
If an energy audit in accordance with the Energy Services Act (EDL-G) or DIN EN 16247 has already been conducted, existing lists of energy-consuming systems and analyses can be used. These include operating metrics, site characteristics, technical equipment features, operating times, and historical consumption data.
Efficiency Gains Through Procurement
Another key focus of ISO 50001 is the procurement of energy services, products, equipment, and energy (Section 8.3). When sites, facilities, or processes that significantly impact energy performance are renewed or modified, potential energy improvements must be assessed and incorporated into procurement activities (Section 8.2: Design). In medical technology in particular, electricity consumption can vary considerably. Large imaging systems such as MRI or CT scanners often consume more energy in standby mode than during treatment. As a result, energy-efficiency specifications in procurement have significant leverage over the entire lifecycle.
Hospital operators report that introducing an EnMS has helped them avoid substantial follow-up costs because energy consumption was assessed during procurement. The recognized net present value method in DIN EN 17463 (VALERI) serves as the evaluation standard and must be applied under the legal obligations of the EnEfG. An energy measure is considered economically viable if its net present value becomes positive within half of its technical service life, and no later than 15 years.
Management Review
Following internal audits (Section 9.2) and any corrective actions after identified non-conformities (Section 10.1), the management review (Section 9.3) takes place. Its focus is on the continuing suitability, adequacy, and effectiveness of energy measures. It primarily considers internal audit reports, energy performance indicators, compliance evaluations regarding regulatory and legal requirements, and corporate objectives. Management review often results in adjustments to the energy policy or to strategic and operational objectives. It significantly influences future energy and action planning and drives the process of continuous improvement.
Certification and Economic Evaluation
Once the EnMS is established and substantial improvements in energy performance can be demonstrated, an accredited body such as DEKRA Certification can certify the management system. After initial certification, annual internal and external surveillance audits take place, followed by a recertification audit after three years. As an accredited certification body for energy management systems in accordance with ISO 50001:2018 across various industries, DEKRA’s experts also have the expertise to assess investments in climate-friendly technologies or processes in terms of economic viability.
Conclusion
High performance density and limited personnel resources pose a challenge for the healthcare sector to systematically and sustainably improve energy efficiency across all processes. ISO 50001:2018 provides a practical and proven framework. The resulting energy data, risk analyses, and action plans lead to cost savings, contributions to climate protection, and legal certainty. Stakeholders and investors gain measurable added value that goes beyond the core mission of patient care and provides important momentum for social responsibility and economic stability.