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Research; Lee Ann Jarousse

Do no harm. The underlying tenet in health care applies to all hospital operations, not just those that take place within hospital walls. Saving lives and promoting community health certainly are commendable undertakings. To fully realize those goals, hospitals must be good environmental stewards.

Yet hospitals are in an unusual predicament. As community leaders and stewards of community health, providing care generates considerable waste material — more than 6,500 tons per day nationwide — that jams landfills and creates environmental and health hazards. Environmental sustainability programs help hospitals significantly reduce their impact. They also can lower costs, improve organizational performance and enhance the patient and employee experience.

There are multiple opportunities to enhance organizational sustainability, from waste management, energy efficiency, water management and the build environment. Sustainability programs should reflect each organization's unique needs and characteristics. Implementing a sustainability program requires significant cultural change and time.

A good place to start is by examining what comes out of the facility. Waste reduction involves diverting waste from landfills through recycling, source reduction, reuse, repurposing and composting. Eighty percent of hospital waste is solid waste, about 50 percent of which is recyclable. Focusing on waste disposal will provide some easy gains that can build support and recognition for more challenging sustainability efforts.

"Waste management is a critical piece of an overall sustainability plan," says Janet Brown, director of sustainable operations for Practice Greenheath. "Hospitals need to look at the amount of waste generated in the process of care and the associated costs." Many hospitals do not know how much they spend on total waste management because they have a variety of waste streams managed by different departments and operated by different vendors. Hospital waste typically falls into one of the following categories: solid waste, regulated medical waste, hazardous waste, pharmaceutical waste, universal waste and recycled waste. Getting a handle on the totality of waste coming out of the facility will help organizations establish a baseline, set goals and prioritize actions.

Involvement by the C-suite and board of trustees is essential. "The more that leadership is involved, the better," says Sister Mary Ellen Leciejewski, ecology program coordinator for Catholic Healthcare West, San Francisco. Executives set the tone and garner support for the initiative. Trustees help establish policy and set goals.

The next step is to establish teams to oversee implementation and evaluation of the organization's performance. Sustainability teams should include individuals and departments from throughout the organization. If possible, organizations should hire a sustainability director to coordinate the efforts. "Most employees live in the community, so garnering support is not very challenging," says Linda Lee, health care solutions operations director for Waste Management Inc., Houston. Adds Leciejewski, "Sustainability isn't just about saving money and the environment. It's about relationship-building with employees and the community."

Making the business case

There are multiple reasons for organizations to embrace environmental sustainability; key among them are fulfilling your mission and your commitment to community health. The improper management of health care waste can pose a significant risk to patients, employees, the community and the environment. Environmental sustainability programs can curb these risks while providing additional benefits to health care organizations. These include:

Enhance performance improvement

Sustainability initiatives increase efficiency and effectiveness, improve clinical outcomes, enhance patient and employee experience and support high-reliability systems and culture.

Reduce risks

Regulatory oversight of hospital energy consumption and waste disposal likely will increase because of growing public concern about energy security and depletion of oil and other natural resources. The Environ- mental Protection Agency, for example, is taking steps to enhance oversight of pharmaceutical waste.

Reduce costs

Hospitals spend about $10 billion annually on waste disposal. Sustainability initiatives can save on costs by consuming fewer resources and producing less waste.

Enhance public perception

Sustainability programs build good will within the community, promote the health and well-being of patients and staff and conserve scarce resources.

Source: H&HN research, 2011

Creating a Sustainability Plan

There are many opportunities for health care organizations to become sustainable. The best place to start is with a cohesive plan that will integrate sustainability into the organization strategic framework.

Make a commitment

Senior leadership and the board must commit to sustainability and establish a comprehensive environmental policy. Senior leadership should establish the link between the organization's mission and sustainability.

Establish a baseline

Organizations must establish a baseline before embarking on a sustainability program. The best place to start is with a facility wide audit of waste, energy consumption and water usage. Benchmarking data is available from Practice Greenhealth and the U.S. Environmental Protection Agency's Energy Star Program, among others.

Create a Green Team

Establish a Green Team to oversee the sustainability initiative. The team should reflect a broad representation of the organization, including senior management,
purchasing, food services, environmental services and nursing.

Identify Drivers and Barriers

Be clear about what's behind your organization's sustainability initiative. Whether it's cost savings or better environmental performance or improved community health, identifying the drivers — and barriers — will help set goals and increase the likelihood of the initiative's success.

1. Set Goals - It's important to set both short- and long-term goals. Set some initial, achievable goals to build momentum and support for the
organization's sustainability initiative.

2. Assess Performance - Organizations should continually evaluate the organization's performance toward meeting sustainability goals.

3. Celebrate Achievements - The achievement of goals and milestones should be celebrated. It's important to share the organization's efforts with the community as well.

Sustainability roadmap


The Sustainability Roadmap for Hospitals will help you chart a course of action, set targets, and monitor your road to sustainability and sustainable operations. Whether you are a CEO, sustainability manager, facility engineer, supply chain director, environmental services director, or other healthcare professional committed to performance improvement and sustainable health care operations, the Sustainability Roadmap will help you learn best practice, strategize, prioritize, and implement plans to achieve your organization's sustainability goals, regardless of where you are in the journey.

Leadership responsibilities

Sustainability touches every aspect of the organization, from food and environmental services to materials management and front-line caregivers. It's important for senior leadership to set the tone and provide the oversight and resources necessary to become a truly sustainable organization.

Chief Operating Officer: The COO plays a pivotal role in sustainability implementation, as well as monitoring its operational and performance benefits. Once the executive team has completed an initial evaluation of the organization's readiness, the COO should consider leveraging internal and external resources to conduct a complete sustainability assessment.

Trustees: Trustees can play a central role in establishing policy, setting goals and priorities, identifying resources and overseeing progress.

Chief Executive Officer: The CEO sets the vision, leadership and accountability to make sustainability a success. The CEO participates in an assessment process to evaluate the organization's current practices and readiness to advance on a sustainability journey.

Chief Financial Officer: The CFO helps build the business case for sustainability, identifies financial resources, and monitors costs, savings and return on investment.

Chief Sustainability Officer: The CSO oversees the sustainability initiative, including its implementation by managers across the organization. The CSO provides technical expertise and oversees the formation and workings of sustainability teams.

Source: AHA Executive Primer on Hospital Environmental Sustainability, 2010

Sustainability Checklist

To be effective, environmental sustainability practices require significant leadership engagement. This checklist can help organizations determine their current engagement in sustainability practices, identify areas that require further attention and prioritize projects.

  • The executive team and board have been introduced to sustainability in health care.
  • A board member or board committee has oversight of environmental sustainability.
  • The hospital has a written sustainability policy.
  • A specific staff person or team is accountable for planning and implementing sustainability initiatives.
  • The hospital has identified its current environmental sustainable practices.
  • The hospital has assessed compliance risks, costs, benefits and return on investment for specific sustainability initiatives.
  • The hospital has a sustainability plan with priorities, goals and timelines for implementation.
  • The hospital tracks the financial, operational, environmental, health and other impacts of sustainability initiatives.
  • The hospital communicates its commitment to sustainability to patients, staff and the community.

Source: AHA Executive Primer on Hospital Environmental Sustainability, 2010



City of Hope | Duarte, Calif.

In 2009, City of Hope Hospital began an assessment of its waste management system to identify ways to improve safety, lower cost, achieve regulatory compliance, reduce the environmental impact and enhance campus aesthetics. The 217-bed facility, located on a 100-plus-acre campus, quickly identified opportunities for improvement. Trash collection, in particular, needed a revamp. Throughout the campus, trash was left on the sidewalks for collection in the evening. In partnership with its waste management provider, the organization developed an integrated system that separates waste into distinct streams, such as medical waste, cardboard and electronics. Landfill waste was reduced by more than 30 percent, saving between $8,000 and $10,000 a year. "We've made huge strides, but we still have a lot more to do," says Charles Pickering, chief safety officer. "I was a little naïve in thinking everything would happen at once. But you can't move on to more complex programs, like composting, until you figure out how to pick up trash."

Catholic Healthcare West | San Francisco

Environmental sustainability is a core value of Catholic health care, guiding hospitals to act responsibly toward the environment and promoting health in the community. Catholic Healthcare West launched a sustainability program in 1996, focusing on waste reduction, recycling and environmentally preferable purchasing. "We started with the low-hanging fruit — solid waste," says Sister Mary Ellen Leciejewski, ecology program coordinator. "From there, we moved on to more challenging items such as food, water and energy." The organization has set a waste reduction goal to reduce the volume of materials sent to the landfill to 15 pounds per adjusted patient day. In 2010, the organization reached 16 pounds per adjusted patient day. Recycling reached 29 percent in 2010, up from 26 percent in 2008. Tactics include substituting hazardous materials with non-hazardous alternatives, and establishing a comprehensive electronics management program and programs to donate surplus and other usable items to health care facilities in the United States and across the globe.

MetroHealth | Grand Rapids, Mich.

MetroHealth opened a LEED-certified replacement hospital in 2007. Its sustainability initiative seeks to provide patients with the best health care experience possible and provide a healthy environment for the community. Recycling is a key component of the sustainability program; the organization set a goal to surpass the 25 percent recycling threshold indentified in the AHA's Sustainability Roadmap. In June 2011, the recycling rate reached 47.9 percent. That was accomplished, in part, through the rollout of a single-stream recycling program that allows placement of all recyclable items in a single container. More than 50 recycling containers have been placed throughout the facility. MetroHealth has achieved significant savings as a result of its waste management initiatives. Alison Waske, sustainable business officer, estimates the organization saved $173,000 through its recycling program. "It's much cheaper to recycle a pound of paper than to throw it away," she says. "Our recycling and composting programs are significantly cheaper than trash disposal."