Editor's note: This blog is part of Fiscal Fitness, a regular H&HN series exploring the cost containment strategies hospitals are employing in response to reimbursement pressures and an uncertain economic climate. Read more at our Fiscal Fitness page.

At most hospitals, John Danby, the sustainability administrator for University of California-Davis Health System, says, "if somebody gets past 50 percent in [waste reduction], they have a big party." But UC-Davis has a steeper mandate to fulfill. As part of the University of California system, the hospital is tied to a system-wide pledge to achieve zero waste by 2020. Achieving that goal for a hospital will prove to be an extremely tall order, but Danby says there are plenty of creative ways to reduce its overall footprint while improving the bottom line.


"For any hospital in the environment we are in today, the easiest way to get traction with sustainability is to show a cost containment," Danby says.

That ethos has translated to a widespread and eclectic range of initiatives that target both reduced environmental impact and cost savings. Several years ago, Sally Lee, who now directs the hospital's value analysis program, was working on a technology committee with a focus on physician preference items when she discovered that a number of other hospitals, including UC-San Francisco, were reprocessing single-use medical devices instead of throwing them out and buying new ones.

"It was fairly mainstream," Lee says.

To convince doctors there was no downside to using recycled items, the hospital created a reprocessing committee, which worked with physicans, the hospital's risk management team and infection prevention experts to research its clinical impact. Ultimately, the commitee determined that device re-processors are held to the same Food & Drug Administration standards as medical device manufacturers, and identified a 2008 Government Accountability Office report that found no elevated health risk for reprocessed devices.

Subsequently, the hospital began reprocessing catheters and sending them to a third party vendor that disassembled, cleaned, sterilized and repackaged the items; other efforts have targeted scalpels, laparoscopic shears and leg clamps. In the first 12 months of the initiative, UC-Davis saved $400,000.

Since then, Lee has taken over UC-Davis's entire value analysis program; a recent effort to recycle blood pressure cuffs, at $1 per item, has reaped a $30,000 savings. UC-Davis has also worked to improve the source segregation of its medical waste stream from its operating room, resulting in a 30 percent reduction in medical waste and a savings of $30,000.

Energy efficiency initiatives, meanwhile, are often a challenge for hospitals, given that medical providers have stricter lighting standards than non-clinical enterprises. Still, UC-Davis has been able to take advantage of state rebates for lighting controls that use motion detectors to regulate use, allowing the hospital to install much more efficient lighting at a steep discount, Danby says.

"The fixtures were $220, and the rebate was $200," Danby says. "A lot of it is opportunities like that."

But the impact on UC-Davis has gone beyond the incremental bottom line improvements; the far-reaching collection of sustainable practices helped UC-Davis nab Practice Greenhealth's 2012 Partner for Change Award.

"Making that synergy there is really what makes a sustainability program move forward," Danby says.