Safety Series: Environmental Safety

Waste Not
Environmentally preferable purchasing takes the long view.

Today’s material is tomorrow’s garbage, says Janet Brown of Hospitals for a Healthy Environment in Washington, D.C. “We need to help hospitals recognize that waste management should be started at the point of purchase,” she says. “It took me years to understand that.”

That might be called the long view of purchasing. Contracting professionals who take such a view consider not only what’s coming into the hospital or integrated delivery network (IDN), but also what’s going out, in the form of infectious or hazardous waste, or plain old trash. They practice what some call “life-cycle costing,” in that they consider the total cost of a product or piece of equipment to be its purchase price and the cost of disposing of it at the end of its useful life.

Life-cycle costing is not only good for a hospital’s or IDN’s bottom line, it’s in line with the mission. “If you care about your community, you have to care about what you’re purchasing,” says Brown. She says eliminating hazardous waste and minimizing general waste is good for the environment. And that’s good for everyone.

“People work in healthcare because they want to heal people,” says Sarah O’Brien, who also is with Hospitals for a Healthy Environment. “They’re interested in doing good for the community. When they realize that the activities that are healing people have a downside – that they may release toxic substances that can make people ill – it’s a clear impetus for them to get onboard and solve these problems.”

Some are even making the case that practicing what has come to be known as environmentally preferable purchasing is good for hospital staff and, hence, for patients. “We look at a commitment to the environment as respect and commitment to the staff, patients and community,” says Brown.

Catching on
Indeed, standing up for the environment is catching on. After just three years, more than 3,500 healthcare facilities in the country have signed up to be “partners” in the Hospitals for a Healthy Environment campaign for environmentally preferable purchasing. (Partnership entitles facilities access to listservs, teleconferences, awards programs and other resources of Hospitals for a Healthy Environment.)

“We have a huge number of folks interested in this, and more every day,” says O’Brien. More than 60 facilities have received the organization’s Making Medicine Mercury-Free award by eliminating or severely curtailing the purchase of products containing mercury.

Group purchasing organizations (GPOs), government entities, state hospital and nursing associations, as well as state health and environmental departments, are getting into the act. More than 90 have signed on as Hospitals for a Healthy Environment “champions.” As such, they agree to sponsor seminars and networking and educational opportunities for the hospitals and professionals represented.

“Large national healthcare organizations have a real opportunity to drive change,” says Pierre Gonyon, hazardous substance specialist for St. Joseph Mercy Hospital in Ann Arbor, Mich., a member of Novi, Mich.-based Trinity Health. He says it’s tough for individual facilities to persuade manufacturers to modify their products for environmental reasons. “Early on, we couldn’t get manufacturers and suppliers to talk to us, because a lot of purchasing was going through GPOs. It really wasn’t until the GPOs got involved…that these issues got raised. Then the dominos started to fall. For example, you can hardly buy anything with mercury in it anymore.”

Wide gamut of initiatives
Environmentally preferable purchasing encompasses a wide gamut of initiatives, many of which were summed up in a 1998 Memo of Understanding signed by the American Hospital Association and the U.S. Environmental Protection Agency, with active participation from Washington, D.C.-based Health Care Without Harm. The impetus for the agreement was an EPA report to Congress on mercury.

“One of the alarming findings of the report was that hospitals and healthcare in general were one of the primary sources of mercury release in the environment,” says O’Brien. “That awakened people’s concerns.”

The Memo of Understanding set a number of goals for hospital pollution prevention for the next five-to-10 years, including:

The virtual elimination of mercury-containing waste from the healthcare industry waste stream by 2005
A 33-percent reduction in the total volume of all waste (both regulated and non-regulated) generated by the healthcare industry by 2005, and a 50-percent reduction by 2010
Creation of a Model Chemical Waste Minimization Plan, beginning with mercury
Creation by the American Hospital Association of an Environmental Leadership Council, to make recommendations on educational and outreach activities.

“After a few years, it became apparent that a big effort with dedicated staff and resources would be needed to move toward the challenging goals that were set,” says O’Brien. The result was Hospitals for a Healthy Environment.

Commitment is key
Just as the industry at large has recognized that environmentally preferable purchasing won’t happen without a concerted effort, so too have individual hospitals and IDNs. The key word is “commitment,” not only on the part of administrators, but also environmental and safety specialists, nurses, department heads and contracting professionals.

“We find that people are enthusiastic in a general way,” says O’Brien. “But to actually make things work on a day-to-day basis, in the face of other obligations and pressures, you need assistance prioritizing and breaking things down into smaller steps. That’s the kind of help [Hospitals for a Healthy Environment] provides.”

Janet Brown knows all about commitment. After working with New York’s Beth Israel Medical Center as a consultant, she convinced the facility to hire her as waste manager in 1991. “I was convinced I could save them money,” she says.

She began at the end – that is, examining the facility’s waste. “You can learn a lot by looking at waste,” she says. “It teaches you about our actions and about how wasteful we are.” By educating the facility’s staff about smart waste-management practices, Brown was able to help Beth Israel reduce its waste haulage fees by $1 million a year, predominantly by reducing its red-bag waste, which costs five-to-10 times more to dispose of than non-regulated waste. “There’s so much confusion” about what constitutes red-bag waste and what doesn’t, Brown says. “It takes a lot of education and training to clear it up.”

But pursuing an environmentally friendly agenda while helping the hospital save money isn’t magic, says Brown, who ended up working at Beth Israel for 13 years before joining Hospitals for a Healthy Environment. “When you initiate a new program, it can be very exciting and motivating. The challenge is maintaining that energy.”

Maintaining momentum
Brown instituted a program called “Portrait of a Housekeeper,” designed to put a face to environmental initiatives. She photographed housekeepers and hung posters around the hospital that identified the person and included a message, such as, “If you don’t segregate waste properly, you put my health at risk.”

“The person putting material in the garbage doesn’t want to hurt anyone,” says Brown. “They just don’t always make the connection to that housekeeper who might get exposed to infectious waste.” She instituted “Portrait” programs for a number of other front-line workers, including those in security, transport and food service. The programs she initiated demonstrated Beth Israel’s commitment to its mission: healing people.

“We weren’t looking just for improved liability,” she says. “Reducing exposure to chemical and hazardous waste improves staff morale, and that correlates to better patient care. There are so many positive outcomes, but it does require energy.”

Passion helps
It helps to have someone who is passionate about the environment to act as the champion for environmentally preferable purchasing initiatives. Kai Abelkis is that kind of person. A native of Chicago, he was involved in the birth of that city’s blue-bag recycling program years ago. Today, he is environmental coordinator for Boulder (Colorado) Community Hospital and a member of Novation’s Capital and Facilities Council.

Prior to Abelkis’s arrival, Boulder Community devoted part-time resources to its environmental mission. But he convinced administration that it was a 40-hour per week job.

“There are so many issues involved,” he says, including waste reduction, reprocessing of single-use items, enhanced energy and water efficiency, and even an alternative transportation program for employees. Boulder became the first hospital to receive certification from Leadership in Environmental Energy and Design (LEAD) for its work in designing and building a so-called “green” building – one that has minimal impact on the environment.

Abelkis has helped Boulder Community take a broad view of its environmental mission. In addition to coordinating the shared transportation system for its employees, the hospital is replacing all its lighting with more energy-efficient lights. It is also negotiating the purchase of a wind turbine in the eastern part of the state. Even though the hospital would not use electricity generated by that specific turbine, the purchase would:

  • Demonstrate the hospital’s commitment to the environment
  • Yield a monetary return on its investment.

“It’s an environmental benefit and a financial one,” says Abelkis. With such a broad mandate, Abelkis approaches the job the only way he can, one step at a time.

“Interpersonal skills are very important,” he says. For example, he says reducing red-bag waste always boils down to education, education, education. He conducts new-employee orientations every two weeks, during which he speaks about the hospital’s environmental program at large, including its transportation system and voluntary waste reduction program. In addition, he meets with departments “all the time.” “I try to become relevant to the departments and show them I’m there to serve them,” he says. What’s more, he participates in the hospital’s product committee.

Double-barreled mission
Boulder’s commitment to the environment is such that its board of directors has decided that even if the hospital must pay a little more for products with recycled content, those products should be purchased anyway.

“We believe that if we’re collecting materials to be recycled, we should purchase them too,” says Abelkis. But that doesn’t mean the hospital is ready to concede that protecting the environment will cost more money. “Anywhere there’s waste, there’s not only an environmental impact, but there’s also money being wasted. I always keep my eye on the prize, reducing the environmental impact [of our buying decisions and practice patterns], and saving the hospital money,” he says. “Those two go hand in hand.”

That’s why Abelkis made an economic case for discontinuing purchases of mercury-containing products. “I asked [the members of the product committee], ‘If we had one mercury spill, what would it cost for a hazmat team to remove it?’ And I researched products that would work just as well. Yes, it’s a matter of product preference. But it’s also a matter of convincing people that this change is appropriate.”

Abelkis considers his participation on the Novation Council to be an extension of that double-barreled mission: minding the environment while saving healthcare facilities money. “As a medium-sized community hospital, we can chase after this or that,” he says. But a GPO such as Novation can bring pressure to bear on manufacturers that individual facilities cannot. “My goal of getting onto Novation’s task force was to persuade and request [manufacturers] to make better decisions,” he says. As a group, Novation can prevail upon manufacturers to become more aware of how much hospitals must pay to discard the packaging they receive every day. “I’m trying to make products better, with less packaging and better packaging, and with materials that can be reused, so that at the end of the day, we’re saving hospitals money and saving resources,” he says.

Strength in numbers
Indeed, GPOs and IDNs can bring pressure to bear. Hospitals for a Healthy Environment, for example, is working with its GPO “champions” to get vendors to disclose in the contracts the existence of any hazardous, bioaccumulative or toxic substances in products, such as lead, chlorinated chemicals and mercury.

In addition, some GPOs are drawing upon federal and state contracts to establish guidelines for recycled content in the products for which they contract. “If you don’t buy recycled materials, there will be no market for them,” says O’Brien. “That’s why large institutional buyers have stepped up to the plate and are buying products with recycled content.”

Some GPOs have established databases of environmentally preferable contracts for members’ use. And GPOs can help members analyze the total cost of the products on contract, that is, the purchase price as well as disposal costs and even (in the case of some chemicals) the cost of worker protection. But Gonyon of St. Joseph Mercy Hospital says you don’t need to be a 1,800-member GPO to make inroads in environmentally preferable purchasing. A committed IDN, such as Trinity, which has 40 medical organizations (each with satellite facilities) around the country, can do quite well, too. Currently, each of Trinity’s medical organizations contracts for its own waste hauling services. “Basically, those local vendors want to sell landfill space and truck away waste,” says Gonyon. But Trinity believes it can do better by signing a national waste management contract with just one service provider. It is pursuing such an agreement now.

Such a contract would call for the service provider to help Trinity assess the waste streams of its facilities, so that they can learn where they’re being wasteful, what materials they can recover and what markets are available for recycled products. “We want to avoid landfill costs, and potentially collect rebates on recycled materials,” Gonyon says.

The future of contracting
Gonyon believes that working as a group, healthcare facilities can hold manufacturers and distributors accountable for the packaging and dunnage materials associated with products. He envisions vendors taking back empty boxes and packaging materials in the same trucks in which they deliver their products. He says such a system would save both the provider and the seller money.

Gonyon also believes that in the future, GPO contracts will call for manufacturers and suppliers of electronic equipment to take responsibility for a product’s lifecycle cost.

“The key to the success of our program and others is that everyone in the medical industry is values-driven,” says Abelkis. “All I’m doing is allowing people to reflect those values, whether it’s recycling, alternative transportation or purchasing products that are environmentally sound.”

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