True, but the easiest test is to pull the main power to the hospital and watch the system automatically take over. If anything fails you know what is wrong. This is scheduled so that those in surgery (or other worrisome situations) have extra help and can signal get back to mains power now.
ideally the hospital’s generator control system or transfer switch is able to start and synchronize the generators and turn up the throttle until no power is being imported from the utility prior to opening the utility feed, thereby transferring the load from the utility to the generators. This test is only performed when there are no surgeries scheduled and it is cancelled if there are any emergencies coming in all of the sudden. If the test is already in progress incoming ambulances with patients requiring surgery are diverted to another hospital.
To finish the test the hospital is synchronized to the utility, the throttle on the generators turned down until no power is flowing through the generator breaker which is then opened.
I’ve built and programmed control systems that do all this with multiple generators, multiple utility feeds, and multiple tiers of loads of different priorities.
That is a good way to test the generator without interruption, but at some point you still need to test the ATS under real world circumstances: unstable or suddenly missing utility power. Throwing the main covers one of those, and the other requires a little more planning and resources.
Honestly I am struggling to remember an instance where we purposefully plunged an operating hospital in to darkness.
You can test the system’s ability to detect loss of power or poor quality power by lifting sensing wires or injecting out of frequency or voltage range power with a test set, and load pickup and load testing we used a load bank. The actual hospital load is fed through bypass breakers during these tests so if the utility went out we would have to manually operate breakers to disconnect the load bank and swing the vital loads over to the generators.
If I am setting up electrical protection on a generator I don’t put a short circuit on the generator, I show the protection relay what it would see by injecting current and voltage with a relay test set and make sure the relay gives the signal to open the breaker when it should.
Greenfield hospital generation sites are straightforward to open the utility feeds since the vital loads are still fed through the old power system.
You can (and should) do all that. However until you actually disconnect from the utility power you don't know for sure that the systems all work. The generator powers a load, but turns out your hospital is more load than you thought. Or the generator starts but the switch to connect the hospital to the generator is broke and you didn't test that...
In the end you WILL test what happens when the hospital plunges into darkness. Would you prefer the first test to be a a bright sunny day when all the staff is ready for something (and you can turn the utility power back on quickly if something fails), or when someone with a backhoe/chainsaw has an accident with your power feed. The latter will happen, I don't know how or when, but at some point in your future trees will take down power lines, backhoes will cut something, major weather events will take out power for days, maybe a large blackout...
You should have course test everything separately often. However if you wouldn't let a random electrician (electrician only because they will know how to not kill themselves) turn off your utility connection with only a day of warning, your system isn't trusted to handle real events which are typically much worse than a clean turn off the switch.
I remember some complication with the elevators not working or homing properly at one place so we must have had an outage. it was probably at 3am, scheduled, and with incoming patients diverted. All our tests are and I’m in the electrical room so they all looks the same to me. An actual outage to vital loads would be done once and then you shut the door and walk away as there was never any question that it was going to work.
FYI where I’ve worked the tiers of loads are metered individually and picked up in order of priority and with a check to verify the combined capacity of the generators which are online is great enough to pick up the load. Likewise loads are shed in order if there isn’t enough generation such as one generator tripping.
I don’t really see that much difference between opening a breaker and bad quality power. It is the same sensing and logic in both cases: is the magnitude and frequency of the phase to phase voltages in the acceptable range or not?