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When Less Means More
The motivation to institute green initiatives in health care facilities comes in different forms for every organization. Maybe it’s the monetary benefits. Maybe it’s part of the organization’s mission to provide the best possible care for its patients. Maybe it’s a combination of both.
For Abington (Pa.) Memorial Hospital, those motivating factors did come into play. But fulfilling a sense of responsibility also fueled Abington’s ambition to become a more environmentally friendly organization.
“Some of us just feel pretty strongly that as a hospital, we have an obligation as a member of the community who consumes huge resources, we have an obligation to use them wisely,” says Judith Kratka, director of facilities planning at Abington.
Abington is one of 20 Philadelphia-area hospitals participating in the Green Hospital Pilot Project to help reduce waste, increase recycling, establish green purchasing programs, and develop strategies for energy-efficient, environmentally friendly initiatives. Region 3 of the U.S. Environmental Protection Agency awarded Abington and a handful of other Philadelphia-area hospitals, including the Holy Redeemer Health System, with Trailblazer Awards for their leadership in greening the health care industry.
Holy Redeemer, in Meadowbrook, Pa., identified its infectious-waste stream as the initial target for green improvements. James Smith, Holy Redeemer’s director of environmental services, worked with hospital staff and a consultant to address the facility’s waste reduction and recycling programs. They realized too much non-infectious waste made its way into the infectious-waste stream, creating large volumes of trash that couldn’t be sorted and recycled.
“The first step was to go to the infection-control committee and convince them that what we were doing was appropriate and within the guidelines of the state of Pennsylvania Department of Environmental Protection,” Smith says. “So we went back to the (regulations), and we reviewed them and explained to them the true nature of what infectious waste is, which is basically blood and body fluids — significant amounts of blood and body fluids. So it certainly didn’t need to be the pizza box or the tissue or the wrapper or a whole number of assorted items” that aren’t infectious waste and shouldn’t be in that waste stream.
Redeemer, a 303-bed hospital, placed a 30-gallon trash container dedicated to infectious waste in every patient room, Smith says. He and his staff addressed the need for red-bag containers on a case-by-case basis, and the results were both immediate and substantial.
Before instituting this initiative, Holy Redeemer produced about 5,000 pounds of infectious waste per week, Smith says. Now, it takes about three weeks to a month to produce the same amount. Smith says the hospital also saves about $100,000 a year due to the reduction in waste collection and disposal, money he and his colleagues use to address other environmental concerns within the hospital.
“It was kind of what I call low-hanging fruit; it was pretty easy once people recognized what infectious waste was,” Smith says. “It was kind of a no-brainer.”
Abington began phasing out medical devices that contained mercury before 2000, and the hospital was virtually mercury-free three years later. Ridding the hospital of mercury and other materials, such as Di(2-ethylhexyl)phthalate (DEHP) in intravenous (IV) bags and tubing, was an important part of the hospital’s green efforts early on. That activity built the framework for the hospital’s present and future green initiatives.
“It sort of grew into, ‘What can we do next?’,” says Rick Szatkowski, Abington’s director of plant operations.
Abington, a 570-bed facility, formed a Think Green team about 18 months ago to spearhead the hospital’s green projects. The team created a new policy called Environmental Purchasing Guidelines. This initiative encourages employees to purchase the safest, least toxic and most environmentally friendly products and services. The goal of the policy is to reduce the use of valuable resources, reuse and recycle materials, and address the way products are manufactured and delivered to the hospital.
“This environmental purchasing guideline, it’s to make sure less packaging is better, (and to make sure) that we ask questions about the manufacturer of the product in terms of, ‘Do they produce toxic waste as a result of manufacturing?’,” Kratka says. “What efforts do the vendors go to to make their product environmentally friendly?”
Kratka and others at the hospital realized that addressing the way a product is manufactured and shipped has a significant impact on the facility’s waste stream. Products that arrived with layer upon layer of plastic and cardboard created waste that was too difficult to ignore.
“Not only did we want to manage the waste on the back end after it’s used,” Kratka says. “We wanted to reduce the amount of stuff coming into the institution so, frankly, we had less waste at the back end.”
As with many of the green initiatives at Abington, the green purchasing program fell under two important categories: It’s the right thing to do, and it’s designed to have a positive impact on the facility’s bottom line.
“It’s sort of a domino effect all the way down the line,” Kratka says. “It saves manpower, it saves resources on the front and back end, and it certainly saves the environment. We just think it’s a triple-level home run.”
After Smith and Holy Redeemer reaped the rewards of the red-bag initiative, it was time for the hospital to focus on its recycling program. Once the non-infectious waste was out of the red bags and tossed where it belongs, Smith’s consultant examined the hospital’s waste stream for recycling opportunities. He determined that 70 percent of the waste was paper in some form, such as wrappers, packaging or cardboard.
The hospital was paying about $45,000 a year to have its confidential paper waste shredded, Smith says. So, as he did with the red-bag initiative, Smith checked the state regulations to review his options.
“We determined that we didn’t have to shred it, we could take it to a paper mill,” Smith says. “And as long as it was destroyed and we received a document of destruction, we could make that into new items.”
So instead of paying $45,000 a year for the paper-shredding contract, Holy Redeemer contracted with a paper firm to destroy the confidential waste and make it into usable items. Before Holy Redeemer implemented the initiative, the hospital had to separate its confidential paper waste from regular paper. Now, the hospital treats all paper as confidential.
Smith used the money saved from the red-bag initiative to buy 90-gallon containers with wheels and a lock to house all paper waste. The contractor picks up the 90-gallon containers — and the hospital’s cardboard bales — on a tractor trailer and empties them each week. Smith says the key to these initiatives is reviewing the regulations and understanding the available options.
A significant similarity between these hospitals — aside from their location and award-winning green ambitions — is the universal support for these initiatives throughout the facilities. Green purchasing programs, along with recycling and waste-reduction projects, affect all departments in hospitals. Implementing new ways to manage waste and materials takes training, education and organization to be successful.
“If you don’t have leadership at the top who feels that this kind of thing is important, then it’s hard to get excited about it,” Smith says. “Obviously, we’re in the business of healing people, and trash and waste doesn’t really excite too many people. But it all adds up.”
Szatkowski echoes those sentiments.
“I also think it’s important to know that this backing was from the highest level of administration who really felt deeply committed to it,” he says. “It takes that commitment from the top-down for that to work.”
Smith and his staff had to educate clinicians, doctors, nurses and other employees who have contact with patients on the proper disposal of infectious waste. He selected people in each department who displayed interest in the green initiatives to explain the programs to their colleagues.
“Initially, like any change, there was some wait-and-see,” Smith says. “To be honest with you, we’ve got a pretty good culture of willingness to try things if it makes sense. When we approached the infection-control committee and got the doctors’ committee on board, and we quoted the regs of the state and the federal government and other regulatory bodies, it’s hard to argue.”
Both Holy Redeemer and Abington recognized the need to reduce their environmental impact while still providing top-notch care and maintaining a healthy bottom line. The initial steps weren’t easy, but now the process is in place for future improvements.
Says Smith, “This is something that needs a full-time approach if you want to accomplish significant change. You’re really not just talking about reducing waste. You’re really talking about changing the culture and the training.”
|Hospitals Join Forces in Sustainability Efforts
As Abington Memorial Hospital and the Holy Redeemer Health System were establishing their respective green initiatives, one thing was certain: They weren’t going it alone.
Both organizations understand the power hospitals have when they approach something like the implementation of environmentally friendly projects as a group. Abington, Holy Redeemer and 18 other southeastern Pennsylvania hospitals joined the Health Care Improvement Foundation, the Pennsylvania Department of Environmental Protection and the U.S. Environmental Protection Agency to develop the Green Hospital Pilot Project.
A major part of the pilot project is environmentally preferable purchasing, so the hospitals expect results when they go to manufacturers as one entity instead of individual organizations.
“It’s fair to say that anytime you have a group that can get together and have as much purchasing power as a group of hospitals, a group of hotels or a group of manufacturing plants would have, the suppliers have to listen,” says Rick Szatkowski, Abington’s director of plant operations.
James Smith, Holy Redeemer’s director of environmental services, says addressing green purchasing is on the horizon for the Meadowbrook, Pa., hospital, and he will work to convince vendors they don’t have to triple-wrap products and include so much cardboard during shipping.
“You create savings, both dollar and volume, but you want to do the right thing, (too),” he says.
In September 2007, Abington hosted a workshop for hospitals and manufacturer representatives. About five representatives and seven hospitals attended, generating a dialogue the hospitals hope will reduce the environmental impact of purchasing programs.
“We’re trying to use our collective voices to pressure vendors to understand the hospitals are serious about this,” says Judith Kratka, Abington’s director of facilities planning. “This isn’t just a slogan.”
— Chris Matt