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Go Green

From: The Hospitalist, November 2006

How hospitals are righting their environmental wrongs

by Jane Jerrard

How healthy is your hospital? When considering your answer, tally up latex gloves, sterilizing cleansers, disposable instruments, and gowns as pluses. However, these items and hundreds more can count against your facility—when you consider the effect your hospital has on its immediate (and not so immediate) environment.

Hospitals are tremendous producers of toxins, including mercury and excess pharmaceuticals, as well as solid and hazardous wastes.

“In healthcare, the footprint we’re leaving behind directly impacts our health,” points out Mary Daubach-Larsen, director of material operations and chairman of the Green LEEDers Task Force at Advocate Lutheran General Hospital in Park Ridge, Ill.

Many hospitals are taking steps to reduce that footprint.

It’s Easy Being Green

Hospitals that want to make a commitment to become more environmentally friendly can hire a full-time expert to guide their efforts, and/or they can appoint a task force—often called a green team. Lutheran General has had great success with the green team model.

A 617-bed teaching, research, and tertiary care hospital and Level 1 trauma center, Lutheran General is one of the largest hospitals in the Chicago area. Under the leadership of Daubach-Larsen, the hospital’s Green LEEDers Task Force has made great strides in several areas, earning Lutheran General a national 2006 Partners in Change award from Hospitals for a Healthy Environment (H2E).

“We’ve been recycling for more than five years,” says Daubach-Larsen. “We’ve stepped up and widened our efforts to include recycling glass, plastic, and aluminum, and we’re also reducing mercury in our environment. We’re close to being mercury free—that’s a goal of all [U.S.] hospitals.”

Lutheran General is now focusing on reducing toxins, examining their cleansers and their disposal of pharmaceuticals.

Like most hospitals that make an environmental commitment, Lutheran General began its efforts with guidance from H2E (www.h2e-online.org), a nonprofit group founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

“H2E’s mission is to green the entire healthcare sector,” says Laura Brannen, executive director of H2E. “We focus on reducing waste, toxic chemicals, and mercury.” Hospitals can join H2E for free, and nearly 25% of all U.S. hospitals currently belong to H2E.

An easy and obvious place to start an environmental effort is by reducing the amount of waste your hospital produces.

About the Green Team

An effective hospital green team should include members from multiple departments, to ensure that new environmentally friendly practices, such as using recycling bins for specific waste materials or purchasing “green” cleansers, are taught to all applicable staff and followed by all necessary departments.

“A traditional green team brings together people from a variety of backgrounds,” says Brannen. “It’s best to have a balance between people who need to be [on the team] and those who are motivated to be there because they care.”

In addition to Daubach-Larsen, Lutheran General’s task force includes four nurses, a physician, a psychologist, and representatives from food/nutrition, infection control, pharmacy, public relations, physician relations, and guests from facilities.

Catholic Healthcare West (CHW), which made a commitment to environmentally friendly practices in 1996, has an environmental action committee at each of its 40 hospitals.

“Each of these committees is responsible for establishing goals, monitoring progress, overseeing implementation, and training staff at their hospital,” explains Sister Mary Ellen Leciejewski, OP, ecology program coordinator, CHW, Santa Cruz, Calif. “They also look for groups in their community that they should be partnering with.”

In addition to this overall team, Brannen recommends two other groups for a successful approach: recycling coordinators and an executive group. “Recycling coordinators are department liaisons for the staff in that area,” she explains. “They’re responsible for number and placement of recycling bins, labeling, and staff training in their area. This brings implementation down directly where it’s happening. You can have a coordinator for every shift.”

As for the executive level, Brannen recommends an “environmental leadership council” made up of the highest-level executives possible from a variety of departments. “This council would only meet twice a year, or maybe quarterly,” explains Brannen. “They make institutional decisions and commitments. They might sign off on an environmental mission statement, for example. They legitimize in a big way what the institution is doing.”

Talk Trash

An easy and obvious place to start an environmental effort is by reducing the amount of waste your hospital produces.

“It makes sense to start with waste and move on from there,” advises Daubach-Larsen of starting a Green Team effort. “H2E offers a waste management template to help you gather data on your waste streams. You can use that data to show management” how much more efficiently your hospital can work. She advises that hospitals audit their various waste outputs, including hazardous waste, recycling, and general trash, with the help of their waste vendor. “You can save money immediately, starting with a study of what’s going on,” she says.

With the data collected on waste and the buy-in of management, you can begin the work of shifting more waste toward recycling—or perhaps eliminating some waste altogether.

“Improve your relationship with your waste vendor,” advises Daubach-Larsen. “You can start to push them to accept more recyclables. When they realize there’s a demand, they’ll accept different materials.”

Address Toxins, Energy, and More

Beyond reducing waste, hospitals can make many environmental improvements—it’s simply a matter of choosing priorities. “The spectrum is large and can be overwhelming,” admits Daubach-Larsen.

In addition to waste and recycling, H2E helps hospitals address a wide variety of environmental issues. “We’ve moved on to environmentally friendly purchasing, green building, safer material choices, and energy efficiency,” says Brannen.

One area many green hospitals are beginning to watch closely is their purchasing, including their vendors. “We’re members of a group purchasing company that has green management strategies,” says Daubach-Larsen. “Most of the big groups are now on that bandwagon.” As part of their green purchasing habits, Lutheran General is trying to expand their use of products that are environmentally friendly. “We’ve also started sending out an RFP [request for proposal] asking vendors about their practices,” says Daubach-Larsen.

“Supply chain management is so important,” stresses Leciejewski. “If we watch what’s coming in our front door, we don’t have to worry so much about what we’re sending out our back door.”

CHW is currently working on multiple projects, including reprocessing surgical instruments, responsible disposal of their electronic waste (such as computers), reusable sharp’s containers, and a commitment to the healthiest food possible. “We’re looking at everything from working with organic vendors to the silverware and Styrofoam we use in our cafeterias,” says Leciejewski.

Another area of environmental consciousness is new construction. So-called green building is becoming a trend that reaches beyond healthcare. “If you’re not designing a green building before you break ground, you’re behind the times,” says Brannen. “This movement is really gaining steam, and the cost payback is pretty staggering over the life of the building.”

Daubach-Larsen adds, “Even if you’re not building, you can still incorporate new behaviors that will reduce your footprint on the environment.”

Save the Environment=Save Money

Are green practices too expensive for some hospitals? “The challenge is that people say they don’t have the money to spend [on better environmental practices], but they’re spending too much [now] and they’re tossing resources,” says Brannen.

Daubach-Larsen adds, “There are a lot of efficiencies” that can be realized through green practices. “Reducing solid waste and increasing recycling can save money,” she points out. “Our numbers of hazardous waste, or ‘red bag waste,’ are very low compared to other hospitals—it costs more to dispose of this waste.”

Green Hospitalists?

Where do hospitalists and other physicians fit into the green team picture? “There are hospitalists [who] get the relationships between their hospital[s] and the environment,” says Daubach-Larsen. “They can be ambassadors for that message.”

While green team leadership tends to fall on hospital operations staff, physicians can provide tremendous support simply by advocating with hospital leadership. “Executive sponsorship is key,” says Daubach-Larsen. “And physicians have a direct line to management. They can communicate that their satisfaction in the organization would be improved if that organization took an interest in the environment.”

Brannen says that physicians are “often the hardest community to reach” when spreading the message of environmentally friendly changes. “They can advocate or they can pitch in; having them in a leadership role is best, particularly if they have clout.”

Leciejewski recommends that hospitalists get involved in specific efforts. “We know that PVC (polyvinyl chloride )/DEHP (di[2-ethylhexyl]phthalate) IV bags are a known carcinogen, especially for preemies,” she says. “Doctors can support changing to different products or bring new products to our attention. They can write letters to [the companies we purchase from].”

Has your hospital made a commitment to reduce waste or otherwise reduce its footprint on the environment? If not, consider recommending a green team to start with some easy changes that can make a difference—and join the growing number of hospitals and healthcare workers committed to healing the environment.

“By collaborating, we can make a difference,” says Leciejewski. “Restoring the earth depends on us coming together as a community.” TH

Jane Jerrard is a frequent contributor to The Hospitalist.


This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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