Kalispell Regional Medical Center (KRMC), in Kalispell, Montana, is a community hospital and a regional referral center offering the most advanced health services and medical technology in the area. In 2005, KRMC began exploring energy efficiency and leveraging a Strategic Energy Management Plan (SEMP) when few healthcare organizations embraced comprehensive energy efficiency as a cost-effective operations solution. At the time, there was no SEMP example to follow and little knowledge in the healthcare sector related to Strategic Energy Management (SEM). Moreover, the healthcare sector is risk averse and methodical when considering systemic change, and decision-makers often perceive energy management as not aligned with traditional organizational goals such as better patient care or honing top-tier medical capabilities. In fact, projects with perceived alignment with traditional goals, such as funding for an advanced MRI machine to improve patient care, directly compete with SEM projects for budget and resource allocation.