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Hospital Sustainability Gets Executives' Attention

Joe Cantlupe, for HealthLeaders Media, August 13, 2010
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The flow of trash seems endless, from Styrofoam cups and cardboard boxes to blood-strewn surgical gowns, unused pharmaceuticals, and other medical waste. The energy consumption seems extravagant, with 24-hour-running HVAC systems and a constant stream of air-polluting carbon dioxide emissions. But that’s just your typical hospital.

Hospital leaders, who also are community leaders, face a challenge to be environmentally responsible, even as their facilities drain so much energy and release so much waste.

Hospitals spend more than $5 billion on energy costs annually. The Department of Energy says the nation’s hospitals contribute 2.5 times the carbon dioxide emissions of commercial buildings.

One of the major tasks for healthcare leaders today is dealing with the continual flow of waste that surrounds a hospital environment, which accumulates simply by the nature of what hospitals do. Hospitals generate in excess of 2 million tons, or 4 billion pounds, of general waste each year—nearly six times the weight of the Empire State Building, which soars 102 stories, rising to a quarter of a mile above Manhattan.

Solid waste makes up the largest portion of healthcare facility waste, about 80%, but there is pharmaceutical as well as medical waste. A Johns Hopkins University study says hospitals are the second largest waste producers after the food industry.
There are multifaceted issues facing hospitals on the environmental front. Across the American landscape, regulators and communities are changing their expectations of healthcare facilities for energy reduction and environmental improvements. 
“We’re often the largest employers in the communities we serve, and our environmental footprint is huge within that community,” says John Koster, MD, president and CEO of Renton, WA-based Providence Health & Services, which runs 27 hospitals and employs about 49,000 people. “We want to make sure our role in keeping communities healthy is with both caring for patients and caring for the local environment.” For hospitals to have a positive environmental footprint, the answer rests in their organizational structure and leadership from the CEO on down.
Leading hospitals that have been working for years to attain energy and environmental sustainability have an organizational structure with designated sustainability officers and green teams with clear authority from the CEO.

Christina Vernon, senior director of the office for a healthy environment for the Cleveland Clinic, the large regional hospital system in Northeast Ohio, ticks off a list of environmental issues facing hospitals for which a coordinated response is needed. “We have general office waste, food waste, construction waste, medical waste, packaging waste—the list goes on and on. It’s incredibly complex,” says Vernon, who has been a leader of Cleveland Clinic’s initiatives over the past several years.

Having an environmentally sound facility is no longer just a matter of planting trees, replacing light bulbs, doing a better job of removing trash—it’s that all right—but it’s more than that, she and other hospital leaders say. Indeed, when it comes to being environmentally conscious, healthcare facilities are increasingly expected by their communities, as well as the government, to have sustainable and environmentally improved facilities; in short, Vernon says: to go beyond green.

“We became focused on building and operating a safe place for people to work, and to have a healthy environment. That’s what hospitals are about,” Vernon says. “When you talk about a ‘green’ structure, it becomes much more—a place with safer paints, low-impact cleaning methods, safer overall cleaning products, and areas with reduced patient and workplace exposure to irritants. It’s the responsibility of not just one department, but it extends from maintenance staff to the executive suite.”

The Providence Newberg (OR) Medical Center was described as the first in the nation to acquire enough renewable energy to meet all its needs, meaning it was using everything natural—from the sun, wind, and rain—as opposed to conventional power from fossil fuels.  Providence agreed to purchase 183,294 kilowatt-hours per month of renewable power from Portland General Electric through its Clean Wind program and offset the need for conventional power that would have generated more than 300,000 pounds of carbon dioxide emissions each year.

Under Koster’s leadership, in 2004 Providence embarked on a plan to initiate systemwide environmental improvements, including solid waste reduction and energy-saving plans. There was an immediate understanding of the connection between healthcare taking the responsibility for its impact on environment as well as the overall impact on disease and public health, says Richard Beam, system director of construction and sustainability in the office of supply chain management for Providence.

Since 1995, Providence Health & Services has realized savings of $27 million throughout the system as a result.

“We came up with a triple bottom line: sustainability for the planet and humanity for the long term, integrating performance of environmental practices, and social and financial benefits,” says Beam.

Officials at hospitals that have taken up significant environmental improvements say they have seen waste disposal and energy cost savings. Out of every dollar spent for operations, the average facility spends the vast majority on utility costs. When it’s time to look for savings “the place with the most potential is clearly utilities,” Beam says.

In some respects, the amounts saved may seem relatively small compared to the larger budget picture of healthcare facilities, but the returns are great because of a healthy environment, hospital officials say. The lack of an immediate ROI is often what holds hospitals back from moving forward in environmental or energy cost-savings improvements, says Robert Van Rees, senior director of facilities and support services for the Metro Health Hospital, a 208-staffed-bed facility in Wyoming, MI.

“There’s the theory or logic that environmental improvements are going to cost more,” Van Rees says. “But I don’t think that’s how you want to quantify cost. It’s much more than that. You are working with the community, the patients, and for those who work at the hospital. So it’s much more than [cost]. The important thing is to have commitment to do the right thing.”

When Metro Health Hospital built its new facility three years ago not far from Grand Rapids, it focused on major environmental improvements, such as construction of a 48,400-square-foot green roof that minimizes storm water runoff at the facility. The roof has different types of plants, which are changed during the seasons. The idea of the rooftop is to capture runoff and to develop energy efficiency by losing heat in the summer, but adding another layer of insulation in the winter.

Recycling efforts are also important to the hospital staff. Officials have now attained a 30% recycling rate, still short of the 40% goal, but headed in the right direction, Van Rees says.

“We want to be good stewards of our money and what makes sense for the people and the environment,” he says. “Whether you want it to be called green or not, it’s becoming more the norm—like dealing with pharmaceutical waste, it makes sense to deal with it. We have to be good stewards, too, of the land and the money.”

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