Allison Tsai

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From Recycling and waste management programs to nontoxic paint and permeable pavement, hospitals across the country are implementing green initiatives to produce healthier environments for patients and staff, which they say saves not only energy, but money. 

Among several provider facilities going green is Stony Brook University Hospital, in Stony Book, N.Y., which recently signed an agreement with the U.S. Environmental Protection Agency (EPA). The agreement outlines energy and water conservation, waste management and the use of environmentally friendly products, and the hospital is currently auditing areas to reduce energy consumption. 

				"A hospital is unique in that it's a structure that operates 24/7," says Andrew Bellina, EPA program coordinator, "So, there are opportunities for powering down in many areas of the hospital that do not impact the people that are working or the care of the patients."			

In addition, the hospital is taking on a number of initiatives designed to reuse materials and reduce material waste. For example, staff has eliminated the blue, disposable wrapping used for sanitary operating tools, says Bellina. Tools now arrive in reusable containers. 

However, he notes, the hospital has to evaluate recycling from a practical standpoint while also maintaining strict accreditation standards. Even so, recycling at the hospital increased by about 420 tons in 2007 and 2008, and it is expected to be higher this year.  

"It significantly affects your carbon footprint when you recycle waste instead of just throwing it out, because you don't go through the actual mining, the treatment, the procurement, the manufacturing and the transportation," he says. "You're cutting all that out." 

Water conservation is another important aspect of the agreement struck with the EPA. Bellina notes water supply costs recently increased 20% in New York City. He predicts water shortages in as many as 36 states in the next three to five years. 

The hospital is looking to conserve water in two ways. First, captured storm water can be reused for non-contact functions, such as watering lawns and landscaping. Second, he says, it will be important to reduce demand for water. The hospital is monitoring water use with equipment that limits water flow and reduces total use. 

Going green will definitely show a return on investment in the long run, and in most cases, produce immediate savings, Bellina says. 

"Five years ago it [going green] would have cost you money, and the payback would be seven, 10 or 12 years, but now there are immediate cost savings. For example, recycling is an immediate cost saver," he says, "And you reap the economic benefits through the lifetime of the structure after that." 

Determining effects on the quality of care is not as easy, he says, but he postulates that once the hospital's energy audits are complete and the air handling is upgraded to a more efficient mix of outdoor and indoor air, the quality of air will improve within the hospital. Better air means better health, especially for those who need respiratory care. 

The structure has only been open for a year, but was built with energy efficiency in mind, according to Brian Floyd, executive director of the Heart Institute. It also contains recycled materials in the carpet as well as in bathroom, kitchen and ceiling tile.  

Natural lighting is one feature that overlaps in the green movement and healthy hospital movement. An effort was made to light the Institute with large windows in patient rooms, physician work areas, waiting rooms, lobbies and cafes.  

"Many studies show that people recover faster when they have access to sunlight, and we want to make people as comfortable as possible and acclimate them to the day and night cycles so they can heal faster," Floyd says. 

It also requires less energy to light the facility during the day. With the help of sensors, artificial lighting turns on only when someone is in the room and dims when natural light levels are adequate. 

The utility plant powering the Institute operates on energy efficient air conditioning chillers, high-efficiency electric motors and variable-speed pumping and air flow systems, according to Floyd. 

The monthly electricity expenses at the Heart Institute have averaged 30 cents per square foot, or $142,000 per month, since opening in January 2009, according to James Ryals, Media Specialist for the Heart Institute and Pitt County Memorial Hospital. To compare, over the same period, monthly electricity expenses in the main hospital have averaged 45 cents per square foot, or $533,000 per month. The main hospital was built in 1977, and is twice as big as the Heart Institute, says Ryals. 

"The per-square-foot figures are a better basis for comparison than the monthly totals," he says. "It's safe to say that, with the efficiency measures we've taken, our power expenses at the Heart Institute are roughly 33% lower than the main hospital." 

Certain intangible cost savings, such as worker productivity, are harder to define, says Floyd, but he has noticed that retention of staff is higher and length of patient stays are shorter. 

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Reducing water and electricity use can produce immediate savings for hospitals while recycling efforts pay off in the longrun

Green initiatives growing among healthcare facilities

Tell me about the green features and programs you have implemented at Seattle Children's. 

In 2006, Children's became an active member of Hospitals for a Healthier Environment (H2E) which included participation in online seminars to learn more about green initiatives. During this time, I noticed the work of a partner at H2E and had done some groundbreaking work on medical waste minimization as Beth Israel Medical Center's Medical Waste Manager. Seattle Children's initial goals in 2006 included reducing waste and making Children's mercury free.  

Children's has additionally followed Continuous Performance Improvement (CPI) methodologies for nearly a decade. As one of the goals from CPI projects was to eliminate waste, it fit right in line with the 2006 goals.  

I quickly realized there are many costs associated with reducing waste. For example, there's a difference between solid waste and recycling or the common misunderstanding that recycling is free when it is not. Additionally, people assume hospitals produce a lot of medical waste and that the preferred method for dealing with this waste is incineration, but this is not true either.  

From 2006 to 2007, we started to look at our waste overall and were able to start profiling our waste and recycling streams. We began using a scorecard to see a baseline of our waste and from this scorecard, we found that of all the materials we processed solid waste was about 65%, recycling about 24%, regulated medical waste about 10% and hazardous materials 1%. For perspective, the numbers in terms of percentages were fairly consistent with hospitals of Children's size.  

Throughout 2006 we started to work on basic recycling schemes which included developing and promoting signage, and monitoring recycling flows. During this time we were also approved to replace the hospital's old cardboard balers with recycle auger compactors, which could compact materials on a 6-to-1 ratio. The compactor was a game changing moment for Children's because it meant that we could go from a labor intensive process of breaking down cardboard, to a machine that pulverized and compacted paper and cardboard materials.  

What other opportunities were there to reduce waste?

One of the most interesting issues in sustainability projects is once things start to happen you can't stop the momentum. Our Operating Room (OR) group has done very impressive CPI work and the initial program in this division consisted of a very low tech CPI approach. OR staff positioned containers in the determined right locations to capture solid waste and recycle waste. The results of this on-going work has been impressive and the OR team was able to divert solid waste and recycling materials from the medical waste stream. In 2008, the OR diverted 38,000 pounds of solid waste and recycling from the medical waste stream and since the beginning of 2009 the OR team has diverted approximately 66,000 pounds of medical waste or approximately $63,000 in cost savings. 

In 2008, Seattle Children's continued our ambitious "Go Green" initiative along with a collaborative multidisciplinary sustainability committee to promote green programs and practices. We expanded our recycling programs to include all mixed recycle materials to make it easy to recycle. In 2008, we achieved a 32% overall recycling rate as compared to 24% in 2007. 

				On Earth Day 2008, Children's finalized an agreement with a vendor to recycle our sharps containers which would eliminate 9,000 pounds of plastics from the landfill in 2008 (and estimated 18,000 pounds diverted for 2009). 			

Additionally, we implemented a single stream recycling program allowing us to recycle mixed materials into single blue recycle containers which allows us to divert a few more tons of materials each month from the solid waste.  

In September 2008, we implemented a new pharmaceutical drug waste program. and we are the first hospital in the state of Washington to implement this comprehensive program that meets both compliance and the environmental intent to ensure that we will not pollute our waterways in an effort to protect our environment and human health.   

Our 2008 waste management plan: recycled 450 tons of mixed recyclable materials (90 more tons of recycled materials compared to 2007) cardboard, paper, glass, and plastics, compost, recovered metals, including recycling 3 tons of batteries, 4,930 fluorescent lights, 2,599 printer toner cartridges, 17 tons of computers and electronic equipment, 3 tons of hazardous chemicals, and 50 gallons of kitchen grease was recovered to produce bio-diesel. In 2008, we shredded and recycled so much confidential paper we saved 4,780 trees from the paper mills. Through better sorting and segregating medical waste our OR diverted 38,000 pounds of solid waste and recycling from the medical waste stream. Overall by using better ways of identifying, single stream recycling, OR segregation of waste and recycle from medical waste, consuming less and using non-hazardous alternatives, or recovery options, Children's reduced 3.5 more tons of hazardous waste in 2008 compared to 2007. 

More healthcare facilities want to cut back on consumption to save money and save the environment

Q&A with Seattle Children's Hospital Director of Environmental Services

Though a two-tier formulary for generics and brand-name drugs was cutting edge 20 years ago, this decade has given rise to the three-tier formulary, according to Perry Cohen, president of The Pharmacy Group. He predicts the third tier will likely expand within the next 20 years. 

"Specialty health benefits will deal mostly with drugs that are currently in tier four and five, because they are specialty drugs that cost perhaps $10,000 a year," says Cohen. "So, over the next 20 years you're going to see traditional drugs covered under a three-tier copay system, but that third tier is going to get more funky." 

				"So the incidence is really small, the drugs are expensive, and they need a lot of case management to go with it, such as tracking, use, genetic testing-and all those things are going to lead to a third category of health benefits, called specialty health benefits."			

In addition, Cohen says the market is moving from drug formulary management toward drug utilization management. 

Over the next 20 years, expect to see funky formularies and new drug benefit designs to manage costs

Allison Tsai

Articles

Green initiatives growing among healthcare facilities

Q&A with Seattle Children's Hospital Director of Environmental Services

Additional drug benefit possible