Power reliability is becoming a leadership issue in healthcare | Viewpoint

For decades, healthcare organizations treated power reliability as a facility's responsibility. If outages occurred, backup generators were expected to bridge the gap. If there were questions, the engineering team answered them. For most executives, it sat outside core decisions around operations, strategy and finance.

That framing no longer reflects reality.

Health systems across many parts of the country are encountering more frequent and long duration disruptions tied to extreme weather, rising electricity demand and strain on regional grids. These are not always catastrophic events. More often, they show up as shorter outages, rolling curtailments, setting unexpected peak demands or systems that do not perform as expected under stress. The challenge is not just the frequency of outages, but the growing unpredictability surrounding them and the substantial cost impacts. In many regions, power conditions are becoming less stable, significantly more expensive and harder to plan around.

At the same time, hospital operations are more dependent on electricity than they were even a decade ago and what we learned from COVID, is that hospitals cannot reduce services dramatically during these events. People need not only procedures but also diagnostics, and preventive care, which in the past with these events simply stopped. Clinical care, digital infrastructure, building systems, and day-to-day workflows are all tightly connected to continuous, reliable power. When that stability is disrupted, it affects how the organization functions.

Most hospitals have invested heavily in emergency power systems which are based on very short outages and only backing up critical and life safety systems, and those systems remain essential. The issue is not whether backup power exists. It is whether it is designed for the conditions organizations are now facing. This includes backing more of the hospitals services, hardening the emergency systems, but also adding to the components of the emergency systems that can respond to high power demand events with more resiliency and climate friendly.

Many continuity plans still reflect an earlier model of outage risk, where disruptions were expected to be short and relatively straightforward to manage. Increasingly, that is not what organizations are encountering.

In more complex scenarios, challenges begin to compound. Fuel delivery can become uncertain. Systems that perform well during routine testing may behave differently under sustained load or can unexpectedly set a new electrical demand peak. Facilities teams may be forced to make real-time decisions about which functions can realistically be maintained over multiple days, not just hours or have large financial implications.

This is where many organizations discover that being compliant does not mean being prepared.

Maintaining life safety systems is essential, but it is often insufficient to support hospital operations during extended disruptions. Keeping operating rooms on schedule, maintaining temperature control for medications, supporting IT infrastructure, and avoiding disruptions to patient flow all require a broader definition of what needs to stay online. Even supporting outpatient procedures, diagnostics and treatments are critical elements that need to be supported all the time.

When power becomes unstable or unpredictable, the consequences move quickly across the organization. Clinically, it can delay procedures or force changes in care delivery. Operationally, it can disrupt scheduling, staffing and throughput. Even brief interruptions can affect access to the systems teams rely on to coordinate care.

There are financial implications as well. Disruptions can lead to lost revenue from canceled procedures, increased labor costs and emergency response expenses. Over time, repeated events can influence capital planning decisions and overall risk exposure.

One challenge is that not all of this risk is easy to quantify. In some cases, organizations are exposed to operational disruptions that are difficult to model financially until they happen. That can make resilience investments harder to prioritize, even as the underlying risk continues to grow.

That is why this conversation is moving to the executive level. The question is no longer whether backup systems are in place. It is how the organization performs under stress under multiple scenarios.

Leaders cannot get into technical detail, but they do need clear visibility into a few critical areas. What functions must remain operational to sustain patient care and financial performance in practice, not just on paper? How long can the organization operate if power is constrained for an extended period? Where are the most significant vulnerabilities, whether in infrastructure, fuel supply or system capacity? And how are decisions made if not everything can be maintained at once? How versatile can our systems be to shift based on availability or financial implications of certain resources that support electrical generation?

The value is not just in the infrastructure itself, but in asking the right questions early and knowing what resources are available to them now and what the future looks like for those resources or possibly new resources. Organizations that define what they need to maintain operationally under stress are better positioned to make targeted, cost-effective decisions over time.

In many health systems, these questions are still being answered in silos or based on how they have always designed for them in the past. Facilities, clinical leadership, IT and finance may each have part of the picture, but not always a shared view. When conditions become less predictable, that lack of alignment becomes a risk in itself. The fragmentation slows critical decision-making during outages and makes it harder to prioritize investments before a crisis occurs.

Addressing this does not require a single large investment. It starts with a more realistic understanding of how systems actually perform under different conditions and what are the possible options that are available in that region.

On one healthcare campus, leadership realized through a resilience assessment that while emergency systems could meet life safety requirements, they would not sustain the combination of clinical services, IT systems and environmental controls needed to operate at anything close to normal levels during a multi-day outage. That insight shifted the focus from compliance to operational continuity and changed how future investments were prioritized.

Most organizations are balancing resilience priorities, new unexpected financial costs against financial constraints. Even when the need is clear, decisions still come down to options, understanding future trends, cost, timing and competing capital demands.

For that reason, many health systems are taking a phased and modular approach. They are refining how critical loads are defined, identifying gaps in existing infrastructure and making targeted investments that improve flexibility over time. These decisions are often aligned with broader capital planning cycles rather than driven by a single initiative.

Resilience planning is also becoming more integrated into enterprise risk management. Instead of being treated as a standalone facilities concern, it should be part of broader discussions about operational continuity, financial performance and long-term strategy.

No health system can eliminate the risk of outages entirely. But leaders can get a much clearer exposure picture of how their organization would perform under stress.

The question is no longer whether an organization has backup power. It is whether it can sustain operations under increasingly unpredictable conditions. That is a different standard, and it requires a different level of leadership attention.

Mark Brumfield is CEO of HEAPY.