May 29, 2013 — We rely on hospitals and other health care facilities to keep us healthy, but that care comes at a hefty environmental cost. Health care is one of the top consumers of energy in the U.S., and it’s estimated that health care facilities in this country create more than 6,600 tons of waste every day.
But that picture is beginning to change. A growing cohort of hospitals, nonprofits and businesses is working to kick-start a movement to make health care leaner and less harmful to the environment.
To be sure, there are financial reasons to embrace sustainability: Hospitals are facing rising costs along with declining financial reimbursement from government and health insurance companies for medical procedures. But advocates say institutions that provide health care also have a moral imperative to contribute to the health of the environment in their communities.
The Healthier Hospitals Initiative, launched in 2012 by a group of large health systems and three nonprofit organizations, has recruited hundreds of hospitals in the U.S. to take on a set of three-year challenges to improve their environmental footprint. In April, HHI released its first milestone report showing steps hospitals had taken toward its six key challenge areas: engaged leadership, healthier food, leaner energy, less waste, safer chemicals and smarter purchasing. Although the program is still young, “over 330 hospitals reported progress in one or more areas,” says John Messervy, director of capital and facility planning for Partners HealthCare and chair of HHI. “I think that’s really remarkable.”
Similar organizations have been working to improve health care sustainability in Europe, and the Global Green and Healthy Hospitals Network was launched in 2012 to create an international community of institutions similar to HHI.
Low-Hanging Fruit
Concern for the environment hasn’t exactly been a top priority for health care — health and safety of patients and staff have understandably come first. The result has been long-standing inefficiency and waste. Relatively simple changes to recycling, energy use and waste management can make a big difference, however. “There’s a lot of low-hanging fruit out there when we start engaging with the hospitals,” says Laura Wenger, executive director of Practice Greenhealth, a membership and networking organization that runs the annual conference CleanMed and provides practical tools and resources to help institutions interested in health care sustainability.
A vivid example is the operating room. To ensure ORs are available when needed, hospitals often ventilate and heat or cool them around the clock, even when not in use. Energy-intense lights bathe the rooms during operations. Surgical instruments are sterilized with harsh chemicals or with energy-sucking steam. Hazardous and biological wastes from ORs require special processing. Anesthetic gases, if allowed to escape into the atmosphere, contribute greenhouse gas emissions. And ORs use prolific amounts of supplies — one study estimated that more than half of an OR’s costs were devoted to supplies — which often arrive from vendors double- or triple-wrapped in packaging. Even though they occupy just a small portion of the square footage of a typical hospital, ORs generate up to 30 percent of its waste, Wenger says.
Hospitals making the most dramatic changes in their environmental footprint are saving money doing it.But health care organizations have found they can reconfigure operating rooms without compromising patient or staff safety. Changes include using energy-efficient LED lights, recycling packaging, capturing anesthetic gases, reprocessing and reusing supplies such as cardiac catheters and surgical instruments that otherwise would be discarded, and installing more efficient systems for sterilization, temperature control and ventilation.
Saving Money
A report by the Commonwealth Fund released last November showed that hospitals making the most dramatic changes in their environmental footprint are saving money doing it. Susan Kaplan, lead author of the report, says that while there’s a widespread assumption that sustainability measures are costly, “we found that every one of the activities we studied saved money.”
Kaplan and her co-authors chose several hospitals that had been identified by Practice Greenhealth as leaders in sustainability and looked at the costs and returns on investment of a set of changes. Some of the changes required initial investments, such as purchasing energy-efficient equipment. Others, though, yielded cost savings immediately — for example, using a reprocessing service for single-use devices, which are instruments labeled for only one use by manufacturers, but which evidence shows can be safely reused. The report estimates that if hospitals nationwide adopted these practices, they could save the industry at least $5.4 billion over five years and $15 billion over 10 years.
The report also shed light on factors that lead to successful change. Kaplan says strong leadership is key. “This has become part of the way they do business,” she says. Another factor is designating a person or team who can take the lead in implementing changes. Sustainability initiatives fall under the purview of several existing roles at a hospital, including facilities management, waste management, maintenance, supply procurement and food services teams. Motivated people working in these areas can make inroads, but hospitals have begun to hire full-time sustainability coordinators and managers who can bring well-meaning projects to fruition that may have otherwise languished for lack of time or resources.
Krisanne Hanson, sustainability director at Stanford University Medical Center, works with a team that has implemented an array of changes since performing a sustainability assessment in 2008. These include reducing the use of harmful chemicals in linens, cleaning products and building materials; installing a more water-efficient system for steam-sterilizing instruments; implementing a plastics recycling program for needle-disposal containers; and launching a campaign to restrict the inappropriate use of biohazard waste “red bags” for materials that could be recycled instead. The group recently worked on a pilot study with the Healthcare Plastics Recycling Council on procedures and recycling in the hospital’s catheterization laboratory, which Hanson says identified an additional 110 tons of materials that could be diverted from landfills annually.
Building on Success
As hospitals begin to share data and case studies, it is clear that small initial successes can grow incrementally. One of the luminaries of health care sustainability efforts is Gundersen Health System, based in La Crosse, Wis., which embarked on an energy audit in 2008. Sustainability director Tom Thompson says that by tackling not just low-hanging fruit, but “fruit rotting on the ground,” the organization reduced its energy consumption by a whopping 25 percent in just over a year. “We realized we could take this even further,” he says. The organization has undertaken an ambitious series of projects to reduce energy use and invest in renewable energy, including wind power, geothermal energy, landfill and dairy gas, and a new biomass boiler, with the goal of becoming energy independent by 2014.
The next challenge is to begin reaching community health centers, physician practices and clinics that have some of the same environmental issues as major hospitals but fewer resources to revamp their operations.Thompson says these efforts, as well as a series of other sustainability projects, required strong commitment from the health system’s leadership and a willingness to see efficiency projects as capital investments that will pay off over time. He says hospitals are the ideal setting for these investments because they aren’t ephemeral businesses. “We are long term in our community; we plan on being here for generations,” he says.
Hospitals and vendors have taken the lead on sustainability, but the health care industry extends much further, and patient care is increasingly being diverted to smaller settings. Wenger of Practice Greenhealth says the next challenge is to begin reaching community health centers, physician practices and clinics that have some of the same environmental issues as major hospitals but fewer resources to revamp their operations.
The movement to make hospitals greener has taken a high-profile first step toward identifying concrete, manageable changes that can improve the sustainability of the health care industry. But proponents say that a broader shift is afoot to realign the values of health care. Because the environment has profound effects on health, they argue, good environmental stewardship should be an integral part of every health care organization. 
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