In the highly regulated and risk-adverse healthcare industry, energy use is often viewed as a fixed cost, causing energy efficiency improvements to be overlooked in favor of larger operational goals, directly related to the health of their patients. Sensing an opportunity to create significant energy savings, the alliance launched its 10-year Hospitals and Healthcare Strategic Energy Management (SEM) initiative in 2005 to increase awareness of Strategic Energy Management Plans (SEMPs) and foster energy management integration into standard business practice.