Emergency: Code Green

The Gundersen Onalaska Campus
The Gundersen Onalaska Campus

Dr. Jeff Thompson isn’t your typical clean energy advocate. A practicing pediatric intensivist and neonatologist, he took over as chief executive of Gundersen Health System in 2001 with a strict focus on improving patient care. Neither the La Crosse, Wisconsin-based institution itself, nor the rural countries in which it operates, had any prior history of environmental activism.

Yet after finding that energy costs were increasing by more than $350,000 per year, Thompson launched a $2 million energy efficiency campaign in 2008 by replacing light bulbs, generators, pumps and other devices with more efficient ones. Along with retrofits of existing buildings, sustainable design elements were incorporated into new LEED (Leadership in Energy and Environmental Design) certified buildings.

Savings from the retrofit now add up to $1.2 million annually,,

Encouraged by the rapid return on investment, Thompson began to explore the idea of Gundersen shifting towards generation of it’s own energy. It is now on track to become one of the only energy-independent health care systems in the United States, by the end of 2014, through a mix of wind, solar, biogas and hydrokinetic power. Annual returns on energy investments are expected to run between $3 million and $5 million. Becoming energy independent isn’t just about saving money, Thompson insists. It’s about improving the health of the communities that Gundersen serves. Sixty-two per cent of Wisconsin’s energy is generated by coal power, causing respiratory and other problems. “We’re health care providers – you cant tell me we shouldn’t take responsibility for that,” says Thompson. The White House honoured him as a “Champion of Change” last year for his visionary work in the area of environmental stewardship for health care organizations.


Cultural change

With health care budgets under perpetual strain and climate change set to impose further pressure on the system throughout North America, U.S. hospital networks are beginning to adopt wide-ranging sustainability measures on everything from waste reduction to energy savings. Despite patient care remaining (understandably) front of the mind for most hospital administrators, facilities are discovering that sustainability and patient care are not mutually exclusive.

The U.S Department of Energy estimates that American health care facilities spend $8.8 billion per year on energy, maintaining buildings that have more than 2.5 times the energy intensity of average commercial offices. A recent report in the Journal of the American Medical Association calculated that the health care sector was responsible for 8 per cent of U.S. green house gas emissions. Hospitals also produce a sizeable amount of waste, measured by the U.S. Environmental Protection Agency at roughly 7,000 tons a day per hospital. Up to $10 billion is spent on disposal annually throughout the industry.

Coordinated efforts to curtail the environmental footprint of the health care industry began in the mid-1990’s, when Gary Cohen founded the organization Health Care Without Harm (HCWH). After an EPA report pegged on-site medical waste incinerators as the largest source of noxious dioxin emissions, he launched a successful campaign tjat resulted in over 90 per cent of hospital incinerators being shuttered by 2006. Medical products containing mercury were also phased out after they were found to be a potent source of pollution in landfills.

“Back in 1997, health care people such as myself had no idea we were contributing in this way to such a toxic problem,” says Kathy Gerwig, environmental stewardship officer at integrated managed care consortium Kaiser Permanente. Under her leadership, the Oakland, California-based company has evolved into a leading proponent of sustainability in the industry.

A number of related organizations have now joined HCWH in advocating for reform, including Greenfield Health Center and the Center for Health Design. These non-profits, working with Kaiser Permanente and 11 other health systems representing 490 hospitals across the nation formed the Healthier Hospitals Initiative (HHI) in 2012. Working to provide resources, facilitate dialogue between hospitals and encourage disclosure within the sector, it has already grown to encompass 900 hospitals.


Replacing waste

HHI and HCWH recently commissioned a survey of nine leading sustainability-minded hospitals and health systems to help take stock of the savings captured. If the policies adopted at these institutions were expanded nationwide, the study concluded that savings of $5.4 billion in five years and up to $15 billion in 10 years could be achieved. “It increasingly appears that going green not only benefits health and the environment, but saves money, which meets the Triple Aim of hospital quality improvements,” wrote Susan Kaplan, study author and director of the Health Care Research Collaborative.

After labor, supply chain costs remain the second-largest expense for hospitals. Comprising close to one-third of a hospital’s budget, most products will eventually end up as waste. One of the main challenges comes from regulated medical waste (RMW). Although RMW only comprises 15-20 per cent of the overall waste stream at hospitals, it can cost six to 10 times as much to dispose of. For HCWH’s Cohen, discussions about cutting waste in the health industry tend to focus instead on unnecessary treatments and bureaucracy, “but priorities are beginning to shift,” he says.

Educating hospital staff on what exactly constitutes RMW has proven to be the first step. Placing non-contaminated waste such as diapers, tissue papers and batteries in with RMW waste can balloon disposal costs as much as 5o per cent. Inova Health System, based in Falls Church, Virginia, eliminated one million tons of waste over 14 months from it’s RMW stream following a successful employee education program. That amounted to savings over $250,000 a year.

Amending procurement policy is another necessary step. In 2012, Johnson & Johnson surveyed purchasing managers and executives at 257 hospitals in the U.S., Italy, Germany and Brazil. Fifty-four per cent of hospitals responded that eco-friendly attribute are “extremely important” in their purchasing decisions.

Health systems often work together through group purchasing organizations to reduce costs. The goal, says Gerwig, is to create enough demand for products that are easily reusable, recyclable and free of toxics that it becomes the industry norm.

More research is emerging on the negative health effects of certain chemicals used in many medical devices. Kaiser made a decision in 2012 to eliminate intravenous bags and tubing that contain significant amounts of PVCs and DEHP from its supply chain. PVC creates dioxin during manufacturing, while DHEP is thought to result in reproductive complications.

Single use medical devices make up a sizeable portion of both supply chain costs and waste generated, leading more health systems to consider reusing them after being properly cleaned and sterilized. A U.S. Government Accountability Office report in 2008 found this practice to be entirely safe, as it already involved greater regulatory insight. More than half of all hospitals now divert some medical devices for reprocessing, with industry estimates placing the potential savings at $2 billion per year if replicated across the country.


Energy efficiency

The other pillar of hospital sustainability involves a reduction in electricity costs as exemplified by the Gundersen Health System. A green building construction boom has led to more than 250 new healthcare buildings achieving LEED certification with the LEED for Healthcare system being introduced by the U.S. Green Building Council in 2011. Seventy-five of those new builds are hospitals. Organizations like Gundersen and Kaiser have mandated that going forward, all new buildings in its network be certified as LEED Gold or higher.

While new green facilities and efforts to establish energy self sufficiency are important, the greatest opportunities lie in orchestrating energy retrofits of existing buildings. The National Renewable Energy Laboratory’s “Advanced Energy Retrofit Guide for Healthcare Facilities,” published last November, identified potential savings of 10 to 32 percent across the board, depending on facility and regional climate.

Gunderson Health System’s retrofit involved exchanging existing steam traps with sturdier and more efficient models, replacing older lighting systems, swapping out it’s chiller and installing more efficient prepackaged gas burners. It took under two years to recoup its initial investment

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