Cleveland Clinic: Twinsburg Family Health and Surgery Center


A state-of-the-art facility situated on 80 wooded acres, the Twinsburg Family Health & Surgery Center is committed to serving the healthcare needs of the community through advanced specialty care, primary care, and surgical services. Equipped with the latest technologies, some of the many services available include an outpatient surgery center, infusion suite for chemotherapy, full scale imaging center, and a retail pharmacy on site.


The building was designed utilizing U.S. Green Building Council (USGBC) standards and was certified LEED Gold. After construction was completed, building commissioning and optimization were performed to determine if functional testing met the expected performance for the efficient design. As the building continued to operate and utility data became available, the facilities team learned the building was not performing as well as expected. The designed site energy use intensity (EUI) was 98 kBtu/sq. ft. but the facility was operating at 190 kBtu/sq. ft. after its first year.



To bring the medical center up to expected performance, a variety of energy reduction strategies were implemented, focusing on low- and no-cost opportunities to benefit patient care, improve patient comfort, and reduce environmental impact. The measures included operational changes, basic maintenance, and employee engagement.

The most impactful strategies included:

  • Optimizing air change rates in operating rooms by standardizing rates to be no more than 20 air exchanges per hour while in use, and no more than six air exchanges per hour when unoccupied. One “air exchange” is when the entire volume of a room’s air is replaced with fresh air, which is important for maintaining patient health, but also a significant energy driver due to the necessity of conditioning such a large volume of air. This strategy saves about 480,000 kWh of electricity and 20,000 therms of natural gas annually.
  • Maintaining and optimizing air filters to maximize the trapping of particles and contaminants with the minimal amount of additional energy consumption.
  • Setting temperatures in the range of 68-74°F for non-patient care areas, which requires no additional cost, and improves staff comfort. With these temperature settings, total annual savings are about 475,000 kWh of electricity and 17,000 therms of natural gas. When spaces in the hospital are unoccupied by staff or patients, further temperature setbacks (i.e. setting a space temperature to be warmer than 74°F to minimize air conditioning or cooler than 68°F to minimize heating, depending on the season) are implemented, which contribute to additional annual savings of 260,000 kWh of electricity and 5,600 therms of natural gas.
  • Rooftop Unit (RTU) optimization, saving 432,500 kWh of electricity annually, minimizes unnecessary RTU runtime by:
    • Tying the RTUs to the temperature set points in the non-patient care areas and to the unoccupied temperature setbacks;
    • Resetting the discharge air temperature (i.e. the temperature of the air supplied to the building space) based on outside air temperature to meet the heating and cooling needs of the space;
    • Implementing resets for the hot water heating system and RTUs to control when the boiler makes hot water and the temperature of the hot water used to heat the building based on outside air temperature.

Additionally, Twinsburg implemented the EcoCaregiver employee engagement program, which is a standard across Cleveland Clinic. Through this program, caregivers are empowered to be an integral part of the organization’s sustainability efforts and contribute to the culture of sustainability within Cleveland Clinic – to reduce cost, waste, and emissions while providing the highest quality medical care.

Since the EcoCaregiver program launched in 2014, all caregivers complete an annual 15-minute training module on energy demand management. The training module is updated with new information each year. This training reinforces an organizational expectation for energy conversation and emphasizes the important role that each caregiver plays in advancing Cleveland Clinic’s energy demand reduction goals.

In addition to the training, Cleveland Clinic has implemented a robust, ongoing communications campaign to prompt desired workplace behaviors by its caregivers. By acting to cut energy waste, Twinsburg caregivers are helping making patient care more affordable. It is estimated that caregivers contribute to 345,000 kWh of electricity savings and 5,600 therms of natural gas savings annually.



A centrally-created action plan organizes and drives energy conservation implementation across the Cleveland Clinic enterprise, including the Twinsburg Family Health Center. The plan includes:

  • Directives on how energy is managed in new and existing projects;
  • Approved energy conservation goals;
  • Energy modeling and analysis;
  • Guidance on stakeholder education;
  • Measurement and verification requirements for energy projects; and
  • Commissioning and retrocommissioning HVAC equipment, hot water systems, exhaust fans, lab ventilation, data center air conditioning, kitchen ventilation, and lighting.

As part of the action plan, the projects at Twinsburg were approved and implemented, significantly improving the building performance towards the expected efficiency of a LEED Gold facility.


Annual Energy Use

Baseline (2012)
403 kBtu/sq. ft.
Actual (2016)
257 kBtu/sq. ft.

Energy Savings:


Annual Energy Cost

Baseline (2012)
Actual (2016)

Cost Savings:


Sector Type



Twinsburg, Ohio

Project Size

190,000 square feet

Twinsburg Family Health and Surgery Center
Twinsburg Family Health and Surgery Center

Twinsburg Family Health and Surgery Center
Twinsburg Family Health and Surgery Center