It may seem odd that a leading proponent for water conservation in hospitals works in Washington, a state famous for its prodigious rainfall.
For more than a decade, Geoffrey W. Glass, director of Facility and Technology Services at Providence St. Peter Hospital in Olympia, has been finding ways to dramatically cut water use and waste. Through simple, economical, and incremental steps, the water conservation program has saved the 390-bed hospital at least $250,000 a year.
"We pay a penny a gallon to purchase water and to dispose of it, so we use the mantra that every gallon of water we see going down the drain is a penny of cost," Glass tells HealthLeaders Media.
"When we started this campaign we were consuming about 62,203,000 gallons of water a year in 1999. We consumed 31,188,000 gallons in 2010 gallons. That is just straight utility consumption, even though in the last decade our campus has grown about 15%."
At Providence St. Peter, Glass says, water is a precious resource both from an economic and an environmental perspective. "We are blessed to have probably the most sustainable supply of water in the United States. But we have other problems. For example all of our wastewater goes into Puget Sound, and as such it's challenging when we introduce pollutants and it's difficult to flush them out," he says. "In addition, through federal mandates the requirements to treat sewer water have generated huge costs. We have been seeing 10% to 15% rate increases for the last decade, to where our sewage costs have doubled in 10 years."
Laura Brannen, a senior environmental performance analyst with San Francisco–based engineering firm Mazzetti Nash Lipsey Burch, says more hospitals are coming to recognize the return on investment for water conservation.
"In the 1990s, there was this big focus on materials and waste reduction and having waste management plans. In the 2000s, hospitals realized we are using more energy than needed to still provide quality care, so we started focusing on energy reduction," she says. "We are anticipating that this decade is going to be around water conservation. Like waste in the '90s and energy in the last decade, hospitals are hugely inefficient."
Brannen says determining ROI for water conservation "is pretty simple."
"With fixtures, for example, determine gallons per flush or gallons per minute used in faucets or showers. A typical ROI around toilet bowls, for example, is literally how many toilet bowls, how much do they cost, and how much water will we save on a per-flush basis," she says. "Go around the hospital and look for leaks or running water. When we do a water audit, that is where we start—fix what's broken. And it's amazing what is broken."
That's where Providence St. Peter started.
"The first step is to collect data," Glass says. "Knowing where you stand is job one. You can't manage what you can't measure."
"We found and fixed major leaks. That is an important message. Every place I have been there have been leaks in irrigation systems, building mechanical systems, even plumbing fixtures that result in money going down the drain," he says.
Brennan says a "big offender" for water waste is irrigation. "Go on Google Maps in dry areas and you can see the lawn around the hospital is green like a golf course and yet everything around it is brown," she says. "Native planting—xeriscaping—and natural landscaping are the easy way to totally eliminate that water use. If you live in a desert or a dry area, you expect to see that kind of native planning. More and more people don't expect to see golf course lawns in places that are really dry."
Once water usage is determined and waste is identified, compare results with peer hospitals.
"In our case, we are part of a health system that includes 20 hospitals from Anchorage to Burbank" CA, Glass says. "That allows us to collect and share and compare information about how we consume all utilities. Several years ago we pulled that data and let everybody know where they stacked up."
Providence St. Peter and the local water utility in Olympia partnered in 2009 to replace 700 toilets, shower heads, and sink fixtures with modern low-flow alternatives. "That project cost us $192,000 and the utility paid 75% of the cost, which was $144,000. They paid us to do the work," Glass says.
The hospital installed a more efficient irrigation system for the campus grounds and moved away from plantings that required extensive irrigation. The water-cooled equipment in the air conditioning plant—the single largest user of water at most hospitals—was swapped out for air-cooled equipment. Refrigeration equipment and sterilizers were retrofitted for efficiency. The cafeteria's massive dishwasher was replaced with a newer model, and the garbage disposal was eliminated.
The garbage disposal "used a tremendous amount of water to flush food down the drain, so we went to a food collection system in lieu of that," Glass says. "We pick the food out of the waste stream before it could get chewed up and spit down the drain. We use a contained compactor. It is transported to the composter, cleaned, and returned. We have challenges for cleaning to keep that area sanitary, and at times it is not done as well as we like, but generally it's not a big problem."
Glass estimates that Providence St. Peter has spent about $500,000 on water conservation projects over the past decade, and has finagled about $1 million in rebates from the local gas, water, and electric utilities over the same period as part of the overall energy conservation plan.
"We are confident we can state that we are saving $700,000 a year as a result of all of these programs that we wouldn't have saved if we were doing business the way we were in 1998," Glass says. "At times there are dual benefits. Electrical pumping energy is reduced when you don't have as much water flow. We have an 11-story tower and we have to pump to get water to the 11th floor. When we use a fraction of the water we were using, that is less pumping energy."
Even in areas like Washington state where water is plentiful, hospitals should be concerned about water quality and their role as stewards, Brannen says. "Hospitals have a unique obligation to address the chemicals and pharmaceuticals that they are inadvertently or sloppily putting into the water," she says. "And the burden on the publicly owned treatment waterworks to take out a toxic soup of chemicals and to anticipate what those chemicals are and to provide clean water is an expensive endeavor, so the cost of water is going up."
Glass says finding the right person for the job is critical.
"If you have the person coordinating the hospital who has the talent to investigate this kind of stuff, turn them loose," he says. "Incentivize them too. In our case, a lot of our ROI, we invested back into programs that saved more. It created momentum. Sometimes leaders are quick to take all of the savings and divert them to another use, and that discourages the person who found the savings. Come up with a reward system that encourages this."
Glass believes that water conservation programs will become more popular with hospitals as operating margins narrow, the cost of water inevitably increases, and leadership sees the almost guaranteed ROI through conservation.
"If you can have a long-term perspective, this is a predictable way of reducing costs without having to take significant risk. And it is pretty dependable—the returns you can measure, versus business strategies that might depend on recruiting that world-class surgeon to your campus who might leave after a year," he says. "All hospitals are in a mode of trying to respond to healthcare reform and declining reimbursements. This has the benefit of being good for the environment and also good for finances."
(Note: The American Hospital Association maintains a Sustainability Roadmap for Hospitals that includes benchmarks and water-saving strategies.)
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.