The creation of a cost indicator and the implementation of green energy policies in Italian healthcare: a case study

In recent years in Italy, we have assisted a marked acceleration of energy policies in the public sector, including healthcare. The debate surrounding energy efficiency policies in healthcare companies has been extensive, primarily due to the challenges in curbing energy consumption (Coccagna et al., 2017; Dion & Evans, 2023; McGain & Naylor, 2014). The need to move towards an environmentally and economically sustainable system has led to the implementation of new policies to reduce excessive consumption, self-produce energy, and use alternative sources to fossil fuels (García-Sanz-Calcedo et al., 2018; Hussain Khahro et al., 2021). To measure and evaluate the efficiency and savings derived from these actions through the years, it is necessary to create new energy performance measurement indicators. The Region of Tuscany has developed an indicator for measuring energy costs in local health authorities. This indicator at the numerator considers the summer and winter temperature and the expenditure for the supply of electric and thermal energy, adjusted for the coefficients of the electric and thermal energy consumed and the price revision coefficients of power and fuels, and provides for the volume of the heated gross in the denominator. The indicator was used experimentally as a case study in the hospitals of the South East local health authority in the years 2021 and 2022 and showed a reduction in the index in all facilities involved. Semi-structured interviews were also administered to top management and energy managers to verify which strategies have been adopted to reduce consumption and the role of the indicator in measuring and implementing these strategies. These actions also involve changing staff behaviour through awareness-raising with specific campaigns, such as 'Mi illumino di meno' (I light up less)and the inclusion of energy efficiency actions in the company's code of conduct. The implemented actions also include producing energy from renewable sources, such as photovoltaic and cogeneration systems, and replacing traditional lighting fixtures. These good practices, combined with the infrastructural changes, have reduced electricity consumption in 2022 by 19 percent compared to 2021, with a quantifiable cost saving of approximately EUR 4 million, bringing self-production of the same to 25 percent of the total. These values, for the public sector, are undoubtedly of particular relevance, especially in terms of reducing operating costs. In conclusion, this study shows that the implementation of energy-efficient practices in healthcare can lead to several benefits, including cost savings and a reduced carbon footprint.