Author: Barlow, Rick Dana
Date published: September 1, 2010
Journal code: HCPN
One of the finer, if not fundamental, points of consumption analysis involves what to do with a product after use.
Throw it in the trash, or if it's touched a patient, toss it in a red bag for proper treatment and disposal. Yet as concerns about environmental awareness and sustainability continue to gain popularity, recycling and repurposing used product still turns heads.
Whether they're reusing a product that has been processed properly to eliminate infectious threats or they're reallocating a used product's basic materials into something else, more hospitals are trying to do their part in diverting loads of waste from landfills by reining in their carbon footprint with overt green teams. They're also trying to comply with increasingly complex and demanding federal and state regulations.
But in the grander scheme of generating high-quality patient care and positive fiscal returns, just how important are green efforts and sustainability projects, as well as their short- and long-term return on investment?
Debra Gillmeister, director of marketing for the healthcare services division of Stericycle Inc., one of the market-leading companies in waste management treatment and disposal, keeps her fingers squarely on the pulse of the hospital industry's environmental and waste management practices.
Gillmeister cited statistics from Practice Grenhealth and Stericycle that highlighted how deeply environmental sustainability has taken root within healthcare organizations as well as how much more room it has to grow.
For example, Practice Greenhealth surveyed 1,550 hospitals last year - nearly one-third of which were members in the organization and committed to sustainable, eco-friendly practices - and found that 67 percent had created a team or committee for environmental sustainability planning. Further, surveys conducted of more than 800 attendees during Stericycle's educational seminars found that 54 percent of hospital respondents have established a green team, with many more facilities planning to establish one, according to Gillmeister.
Because these green teams touch so many functions across a hospital facility, she noted, they tend to recruit clinical and non-clinical staff to explore a variety of opportunities in managing waste streams. They include implementing recycling programs, removing mercury, minimizing electricity and natural resource use during noncritical times, minimizing food waste through composting, reusing kitchen oil as transportation fuel and offering shuttle and bicycle commuting options.
To jump start a facility-wide green effort a hospital should examine its waste streams, Gillmeister recommended. Stericycle identified 10 key waste streams but point to regulated medical waste, municipal solid waste and recyctables as a key focus for green teams.
Gillmeister emphasized recycling as an achievable and noteworthy best practice for managing waste. A Stericycle survey of 200 hospitals this year uncovered that an average hospital recycles fewer than 14 percent of its total waste. Currently, Practice Greenhealth's Hospital Partners for Change report an average percentage of recyclables from total waste at 27 percent, with the average high at 35 percent. Meanwhile, the average regulated medical waste percentage represents approximately 9 percent of total waste and the average percentage of total waste for municipal solid waste is 56 percent, according to Practice Greenhealth's 2010 Benchmark Report.
"Increasing recycling percentages is a great place for a green team to start," she added.
Using reusable sharps containers in place of disposable models contribute to reducing carbon emissions and landfill waste, Gillmeister noted. In addition, a comprehensive pharmaceutical waste compliance program can keep drugs out of the water, improving long-term water quality.
But she admitted that measuring the environmental impact of green team efforts and green programs can be challenging. "Few tools exist," she said. Stericycle created a "Carbon Footprint Estimator" to record progress in reducing environmental footprints by switching to reusable sharps containers. It calculates carbon diversion numbers and recognizes the pounds of plastic and cardboard diverted from landfills.
Establishing green teams may not be as challenging as complying with regulations, according to Gillmeister. In fact, it's essential to sustainability. "Eighty-percent of a hospital's waste streams are highly regulated," she said. "Modification of staff behavior is the most critical element of a successful waste stream solution."
Healthcare Purchasing News asked Gillmeister and other waste management experts to offer strategies and tips to launch, justify and maintain environmental sustainability or green teams and programs to more effectively manage waste. Here's what they shared.
Establishing a green team
Stericycle's Gillmeister cited five tips for sprouting a green team.
* Gain support of administration and set a benchmark for success.
* Be specific about goals, such as the percentage of recycling.
* Influential green team champions are critical to successful implementation.
* Identify best demonstrated practices, such as using a sharps management system or keeping drugs out of the water.
* Create a timeline to achieve goals and measure progress.
Tom Bang, CEO and president, Trinova Medical Waste Solutions LLC, which manufactures the TrinovaMed Monarch Green Machine to process regulated medical waste, suggested similar strategies.
* Recruit a champion or small group of champions who are personally motivated to support the success of the green team.
* Generate administrative support for the resources and time needed by participants, including leadership and staff.
* Dedicate space for sorting and storing recycled and diverted materials, such as furniture, electronics, equipment, etc.
* Maintain ongoing public relations support and promotion for goals achieved and ongoing reduction/ reuse targets.
* Develop metrics, such as baseline indicators for targeted activities and ongoing success measurement.
The TrinovaMed Monarch Green Machine converts biohazardous materials, including surgical instruments and waste generated by hospitals and medical facilities, into a sanitized, environmentally safe material.
Shibesh Banerji, principal at Tompkins Associates, a global supply chain consultancy, concurred with Gillmeister and Bang on the necessary fundamentals. For Banerji, they include:
* Generating corporate sponsorship with top-down approach.
* Establishing open channels of communication to attract ideas from every level.
* Setting up cross-functional teams with accountability and rewards.
* Using financial benefits of the effort as a key driver.
* Creating and maintaining a feedback mechanism to monitor progress and celebrate success.
Banerji emphasized five fundamental areas that must be targeted to manage waste streams effectively, including awareness and education, culture changes, communication, linking to financial drivers and measuring success.
Where to plant green teams
Housekeeping or environmental services typically carry responsibility for waste disposal, according to Gillmeister, "The cafeteria is a prime target for recyclables as axe patient floors and care areas. Clinical areas like the lab and the OR have sharps, pharmaceuticals and other waste streams. AH of these areas make sense for cross functional green teams. Get nursing involved. Then add senior managers, educators, materials managers and administrators. Invite pharmacists, physicians, safety officers, risk management staff and infection preventionists."
Bang de-emphasized any size limitation on the benefits of a green team. "All facilities regardless of size face resource issues that inhibit the ability to maintain a progressive green team," he noted. "Many efforts fail because the majority of the activity or work is placed on the service departments, such as housekeeping, that has staffing and other operational issues. That interferes with a successful program."
But these efforts extend beyond the physical work of moving and diverting material to reduce waste and increase recycling efforts, according to Bang. "The areas that make the most sense for establishing green teams are not department-based, they are philosophy-based," he said. "Hospital leadership must establish a green team with a commitment to implement ideas and strategies that meet the goal of reducing, recycling and reusing resources. This effort may include, but not be limited to, increasing online storage of meeting documentation to reduce paper use, working with the GPOs and suppliers to reduce packaging, making recycling in non-clinical areas mandatory and rewarding success. If you create an active committee that encourages and implements ideas throughout the organization the green team will become significantly larger and more powerful than the traditional overworked committee."
Bang offered this blueprint for going green:
* Perform waste stream audits throughout the facility. Know what is really being put into the waste can and could be diverted to become a resource.
* Determine what the total waste and recycling efforts are by using the metric of pounds of waste and recycling per adjusted patient day. "Best practice is practically zero," he said, "but realistically 15 pounds is considered best practice and 20 to 25 pounds per APD would indicate significant opportunity.''
* Research strategies, tactics and techniques that have been successful and documented by non-profit organizations such as Practice Greenhealth and Healthcare Without Harm.
* Evaluate the use of paper in your organization and the trust oí using electronic media rather than paper records for every thing from meeting minutes to patient records. "Many hospitals have been very successful in reducing the paper traditionally used in the patient record as they upgrade their information technology infrastructure," he noted.
* Tour successful facilities "Successful facilities have a green vibe that is transparent and observable throughout the facility at mostly all levels," he added.
Banerji singled out specific departments and functions, such as laboratories, infection control, environmental services, facilities/plant operations, nutrition services, biomedical engineering, information technology and nursing.
Doing your due diligence
A financial benefit for establishing green teams is the cost reduction realized by appropriately managing all waste streams, Gillmeister indicated.
* Benchmark current efforts and establish a staged expansion plan.
* Find out who in your hospital is committed to green initiatives. What committees exist? Attend these meetings.
* Foster communication so all departments are involved. Talk about success stories in the hospital newsletter.
* Develop a score card to measure your progress and benchmark with peers in other hospitals.
Bang concurred that hospitals can generate favorable financial results through green efforts.
* Cost reduction can be achieved by using compacting equipment more efficiently, and by diverting large bulky items to non-profit agencies.
* Reduction of paper: "Individuals will be surprised by how much is spent unnecessarily on paper when electronic options are available," he said.
* New revenue streams stem from the creation of revenue and zero cost for items such as cardboard and electronic waste.
* Reduction in waste volume through increased compactor efficiency and reduces direct cost where "per- tip" charges apply.
* Energy reduction and energy conservation have direct financial benefits.
Beyond being the "right thing to do," Banerji indicated that green projects help conserve energy and resources, reduce operating costs and promote the use of clean energy such as wind, solar and biomass power. But he cautioned: "Management of upstream environmental impact by greening supply chain sustainability strategies vary from business to business," so there is no universal approach to going green.
Still, Bang emphasized the foundational work that remains.
"It is important to understand that there is a significant amount of waste that is put into the medical waste stream that doesn't meet the criteria for medical waste, such as paper, wrapping, uncontaminated supplies and containers," he said. "Many hospitals are working with their GPOs and suppliers to reduce packaging and to increase awareness and educate staff on proper disposal. Many hospitals are resource challenged. However, much of the effort needed to reduce waste can. be accomplished without impacting productivity.
"Where we go from here is to continually challenge ourselves and our healthcare providers to do more," Bang continued. "Each person within the healthcare setting has the power and ability to create change. More education and resources are needed. Businesses that provide green technology and products should be incentivized and rewarded. Many employees want to participate and help, but need to know how and need to be encouraged by hospital leadership."