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MultiCare Health System's environmental sustainability program started in the same manner as many others -- through a grassroots movement led by employees who were passionate about recycling and good nutrition. After adding some initial structure, gap assessments revealed how the organization could reduce costs while creating better processes and saving operational expenses. Now, MultiCare is tapping into the passion of its staff to help create green teams by locations, as well as focus system-wide efforts for waste, energy, and chemicals reduction. Additional efforts focus on adopting and improving environmentally preferable purchasing practices. This article discusses MultiCare's efforts to create and implement a comprehensive sustainability program to serve the needs of patients, staff, community, and the environment. MultiCare continues to partner with the community, agencies, and other nonprofit organizations to identify opportunities to improve its relationship with the environment. Every initiative contributes to a healthier environment.
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Acting responsibility with a focus on the fututre
MultiCare Health System's environmental sustainability program started in the same manner as many others - through a grassroots movement led by employees who were passionate about recycling and good nutrition. After adding some initial structure, gap assessments revealed how the organization could reduce costs while creating better processes and saving operational expenses.
Now, MultiCare is tapping into the passion of its staff to help create green teams by locations, as well as focus system-wide efforts for waste, energy, and chemicals reduction. Additional efforts focus on adopting and improving environmentally preferable purchasing practices. This article discusses MultiCare's efforts to create and implement a comprehensive sustainability program to serve the needs of patients, staff, community, and the environment.
Healthcare and the Environment
The healthcare industry is quickly embracing the practice of environmental sustainability - not only to improve the environment it inhabits, but also because reducing waste in operations and going green come together to save money. The following statistics1 show the effect that healthcare has on resources:
* Healthcare accounts for 16 percent of the gross domestic product and will grow to 20 percent by 2015.
* Hospitals employ more than 4.1 million people to carry out their 24/7 operations.
* The healthcare industry spends $8.3 billion on energy each year.
* Healthcare facilities are often the largest water users in the community while also producing two million tons of waste per year with increasing amounts of disposable packaging chemicals, and toxins.
Does going green really pay? Using environmentally sound practices is not only good for the planet, but it's also often the right thing for a hospital's bottom line. It's estimated that every dollar a nonprofit healthcare organization saves on energy is equivalent to generating $20 in new revenue.2 While the environmental and human health benefits of green building have been widely recognized, a report to California's Sustainable Building Task Force3 confirms that minimal increases in upfront costs of approximately 2 percent to support green design would, on average, result in life cycle savings of 20 percent of total construction costs - more than 10 times the initial investment. For example, an initial upfront investment of up to $100,000 to incorporate green building features into a $5 million project would result in a savings of $1 million in today's dollars over the life of the building.
As the healthcare industry addresses myriad environmental issues, the question becomes: Can healthcare organizations focus on their care of their patients, the health of the environment, and still stay profitable? The new focus on the triple bottom line indicates that these components contribute to the foundation of a socially responsible organization:1
* People: patients, employees.
* Planet: environmental performance, community health.
* Profit: economic performance, improved efficiency.
Furthermore, there is an interaction between the environment and healthcare that affects the wellbeing of patients as well as industry costs. The need for socially responsible practices in the healthcare industry is clear once this linkage is acknowledged.
One example involves the effect of pollutants on newborns. In 2005, the Environmental Working Group studied industrial chemicals, pollutants, and pesticides found in human umbilical cord blood. Although scientists once believed that the womb protected developing babies from pollution, this study found umbilical cord blood from newborns contained an average of 200 industrial chemicals, pesticides, and other pollutants in 10 newborns. Of 287 chemicals detected, 180 are linked to cancer, 21 7 are neurotoxins, and 208 are linked to birth defects.4
MultiCare's Journey Begins
MultiCare, based in Tacoma, WA, is the South Puget Sound's largest provider of healthcare services, helping patients at 93 locations in four counties through four hospitals: Tacoma General, Mary Bridge Children's Hospital, Allenmore, and Good Samaritan.
The organization's environmental sustainability initiatives started in a place familiar to nearly every employee and visitor - the cafeteria. After MultiCare Health System adopted the "Healthy Food in Health Care Pledge"5 in early 2008, the Nutritional Services department worked with vendors and farmers to implement some components of the sustainability program. Accomplishments thus far include the following:
* Eliminated all Styrofoam packaging and cups used in the food service operation. Reusable coffee cups and fountain cups are now offered and provide a price incentive for customers.
* Changed to a green product cleaning system.
* Recycled all coffee grounds, which are now packaged and offered to employees for their gardens or used in the hospital gardens.
* Provided a letter to major vendors asking for assistance on sustainable practices.
* Updated cafeteria menu to include a daily fresh vegetable from a local farm, which is listed with the vegetable on the menu.
* Changed produce vendors to one that has a "meet the farmer" program and sources produces locally.
* Started a community-based agriculture program that delivers local, organic produce to staff throughout the summer.
* Made local sourcing of products a priority for choosing products and vendors.
* Implemented a program to recycle vegetable oil to a company that produces biodiesel.
* Created a pilot site in the Nutrition Services department for mixed recycling.
Practice Greenhealth
MultiCare's next step was joining Practice Greenhealth, a nonprofit organization founded on principles of positive environmental stewardship and best practices by healthcare organizations. Practice Greenhealth professionals adopt best environmental practices that increase operational efficiency and support an environmentally sustainable system to improve the health of patients, staff, and the community. By joining this organization, MultiCare pledged to work toward the following goals:
* Eliminating mercury as much as possible.
* Reducing the quantity and toxicity of healthcare waste - from manufacturing, purchase and use of products and materials - to improved end-of-life management.
* Minimizing the use and exposure to hazardous chemicals, including persistent, bioaccumulative, and toxic (PBT) substances.
* Reducing healthcare's environmental footprint through resource conservation and other measurable environmental improvements.
* Integrating sustainable design and building techniques with environmentally sound operational practices to create a true healing environment.
Waste Assessment
To evaluate its performance to some of these promises, MultiCare needed to gather baseline data and deploy gap assessments. Practice Greenhealth provided a spreadsheet tool to help with data collection, categorization, and financial calculations. Figure 1 shows the summary data from 2008.
MultiCare's three-year goal is to convert more than 50 percent of the solid waste to recycled waste. If this goal is achieved it will result in $192,000 in avoided costs with additional earned rebates of $15 to $65 per ton for recycled waste. The organization also identified other opportunities for improvement, all of which offer operational cost avoidance opportunities:
* Universal garbage. MultiCare found that garbage compacters were picked up when they were only 25-percent full. Charges are calculated by tipping fee and not by volume or weight. In 2009, MultiCare reduced the number of pick ups at two locations and saved approximately $45,000 in just eight months.
* Regulated medical waste. The organization is working to convert 20 percent of regulated medical waste to universal solid waste or reduce the volume by managing the upstream processes for an estimated savings of nearly $54,000. Strategies to reduce regulated medical waste include recycling formalin and xylene onsite through a distilling process and through re-use. Regulated medical waste and hazardous waste are the most expensive categories of waste, as well as the most hazardous; therefore approaches to reduce their use and disposal will result in significant cost savings and provide a safer environment.
* Recycling. MultiCare also started a pilot commingled recycling program focused in the cafeteria at Tacoma General Hospital. This program saved approximately $15,000 in avoided landfill fees while rebates increased from $15 to $44 per ton. Efforts to expand this program continue as it is deployed to more locations throughout the system to improve the collection and disposal process for the environmental services staff. In addition, MultiCare selected a vendor to recycle its surgical blue wrap and is utilizing a medical device re-processing program that has the potential to save up to $250,000 annually.
Main Components of Environmental Sustainability
Of course, sustainability means more than recycling, nutrition, and energy; it includes programs such as:
* Environmental stewardship.
* Education and communication.
* Environmentally preferable purchasing.
* Waste management and reduction.
* Mercury elimination.
* Energy, water, and climate management and mitigation.
* Environmental services.
* Food services/healthy food.
* Sustainable sites management/builtenvironment.
* Transportation operations.
* Chemical management.
Green Built Environment
MultiCare is using more assessment tools to identify and evaluate the opportunities for improvement in each area listed above. One of the organization's facilities, Good Samaritan Hospital, is building Washington state's first Leadership in Energy and Environmental Design (LEED) silver certified hospital. To ensure the benefits of green building practices are realized after commissioning, MultiCare is using the Green Guide for Healthcare.6 This voluntary guide provides the tools and structure to help healthcare organizations operate buildings, systems, and equipment in a more efficient, effective, and sustainable manner. One of the biggest mistakes organizations make is to operate new green buildings as they managed the old building, tiius failing to realize the financial gains possible through the new design and building standards for LEED. Some of the design features included in this facility's plan are shown in Figure 2.
MultiCare continues to partner with the community, agencies, and other nonprofit organizations to identify opportunities to improve its relationship with the environment. Every initiative contributes to a healthier environment. We look forward to developing additional gap assessments to identify opportunities for improvement and further engage staff, patients, and the community.
References
1. Practice Greenhealth, www.practicegreenhealth.org.
2. U.S. Environmental Protection Agency, Energy Star for Healthcare, www.epa.gov.
3. Greg Kats, Leon Alevantis, Adam Berman, Evan Mills, Jeff Perlman, "The Costs and Financial Benefits of Green Buildings, A Report to California's Sustainable Building Task Force," www.usgbc.org/docs/news/news477.pdf.
4. Environmental Working Group, "Body Burden - The Pollution in Newborns," www.ewg.org/reports/bodyburden2/execsumm.php.
5. Healthcare Without Harm Healthy Food Pledge, www.noharm.org/us/food/pledge.
6. Green Guide for Healthcare, http://gghc.org/.
Other Resources
Health Care Without Harm: www.noharm.org.
American Nurses Association: http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental.aspx.
Environmental Health News: www.EnvironmentalHealthNews.org.
International Council of Nurses: www.icn.ch.
Sustainable Hospitals: www.sustainablehospitals.org.
The Luminary Project: www.theluminaryproject.org.
Laura Kinney is the practice leader, environmental sustainability for MultiCare Health System. She began her career as a fisheries biologist and later transitioned into quality management systems, including QS-9000 for the automotive industry. Prior to assuming her current role, she was involved in organizational effectiveness at MultiCare. Kinney serves as a senior lead examiner and process and examiner mentor for the Washington State Quality Award and volunteered as a Baldrige National Quality Award Examiner. She has held several leadership roles in ASQ's Seattle Section and is treasurer for the Healthcare Division. Kinney is a member of the technical program committee for ASQ's World Conference on Quality and Improvement and the Quality Institute for Healthcare. Contact Kinney at [email protected] for more information on MultiCare's program.
Copyright Association for Quality and Participation Jul 2010