Health care industry seeks 'green' alternatives to curtail its substantial waste stream

The health-care industry is beginning to adopt the principles of sustainable procurement — a "green" approach to purchasing which takes into account the efficient use of nonrenewable resources and the potential for recycling. Research Professor Helen Walker, an international expert visiting ASU from the University of Bath in the United Kingdom, recently focused attention on the trend during a speech sponsored by the W. P. Carey School's Health Sector Supply Chain Research Consortium. A number of the consortium's corporate members, including Premier, Novation and Amerinet, are actively involved in advancing sustainable purchasing.

The typical acute-care hospital produces a sprawling variety of trash including I.V. bags that spawn deadly dioxin when incinerated, bloody bandages, the dregs of toxic chemotherapy "cocktails," soiled linens, one-time-use medical instruments, computer compact discs and countless tons of paper and cardboard.

Combined, it is a mucky mess that worsens our already stressed-out environment, drives up medical costs and potentially compromises patient care. So says Laura Brannen, executive director of Hospitals for a Healthy Environment. H2E, as it's more commonly known, is, a nonprofit coalition working with the American Hospital Association and the U.S. Environmental Protection Agency to reduce pollution from hospitals. H2E's focus is coaching member hospitals to obtain better, environmentally-sound service from suppliers.

The pollution solution may be "sustainable procurement," a supply-chain term referring to the environmentally-savvy production, selection, transportation, use, recycling and disposal of everything required to feed the giant machinery of a modern-day hospital.

It's an ambitious, complex goal that involves every supplier and service provider from local farmers to dump truck operators, according to Helen Walker, a research professor at the University of Bath in the United Kingdom. Sustainability is a high priority abroad, with the governments of both the U.K. and the European Union forging far ahead of U.S. efforts.

A philosophy of 'sustainable purchasing'

Walker, who is a senior research scholar at the Centre for Research in Strategic Purchasing Supply in Bath's management school, is a visiting faculty member at W. P. Carey School of Business. Over the next three years, she will collaborate with Eugene Schneller, a W. P. Carey professor and founder of a new research initiative — the Health Sector Supply Chain Research Consortium. Consortium members, including three of the nation's largest group purchasing organizations (Novation, Premier and Amerinet) have committed to advancing a philosophy of sustainable purchasing.

One goal of the consortium is to generate research comparing and evaluating American, British and EU sustainable procurement efforts, Schneller says. Why are some foreign governments so interested in sustainability? Bottom line, sustainable procurement experts insist the strategy saves money. Add in the undeniable environmental boost, the pull of social responsibility and baby-boomer guilt, and it may be the next social trend on this side of the Atlantic.

Note: countries like Japan say that high-consumer/polluter countries like the U.S. should be compelled to shoulder a higher percentage of pollution-remedying costs, a topic for another story. Fostering sustainability starts with an analysis of every product and service used in a hospital setting, Walker says. Can latex gloves be ordered in larger lots, cutting down on transport costs and fuel consumption? Are the patient's personal-care products packaged and distributed together — toothpaste, lotion, shampoo, tissues, plastic basin — or piecemeal?

Do office supplies arrive in bulky, padded boxes? Does a piece of medical equipment contain mercury? Is produce raised within a 100-mile radius of a hospital more healthy, given the lower need for stabilizing chemicals to keep it fresh? Every product or service has a life cycle that must be studied, according to sustainable procurement theory; once the answers are in, managers can decide to use it as is, modify it or discard it in favor of a "greener" product.

"Sustainability affects everything. Sustainable consumption means using products better. We've got to do this, because if we carry on in the U.K. as we do now, we'll need three planets worth of resources," Walker says. While sustainable procurement ranks as high priority on the government agenda in the U.K. and the European Union, the U.S. lags behind, she adds.

U.S./U.K. strategies

While part of the gap can be attributed to nationalized health care, hospitals in the U.K. continue to have a great deal of discretion in their purchasing decisions. The National Health Service (NHS) in the U.K. is organized into more than 150 regional "trusts," divided into acute care (hospitals) and primary care (doctors' offices and clinics). There are also 28 "strategic health authorities," four directors of health and social care and roughly 11 billion pounds spent on health care but not adequately tracked or accounted for, Walker notes. "We don't have exact data collection on who pays what, to whom, for what. It's a bit of a 'finger in the wind' problem," she adds.

As a result, the British government is restructuring NHS' purchasing and supply policy around purchasing hubs. While all purchasing and supply activity is not coordinated through a national agency, national goals and objectives can frequently be linked to the various points of purchasing. It's a workable remedy, but one that the U.S., with its network of private and government hospitals dominated by Medicare, Medicaid and private insurance plans requirements would be hard pressed to copy. There are already many promising projects under way in the U.S., though.

Along with cutting overall regulated and unregulated waste in half by 2010, H2E and its cohorts are determined to eliminate mercury and identify, then deal more effectively with hazardous chemicals, toxic pollutants and "bio-accumulative" agents common in hospitals, nursing homes, clinics and other health-care facilities. These are enormous goals, but boil them down to the basics and they're less intimidating.

For instance, one recent hospital sustainability study looked at replacing conventional loop mops with microfiber mops. The microfibers have a positive charge that attracts dust, making for more efficient cleaning, according to researchers with the Sustainable Hospitals Project, part of the University of Massachusetts Lowell. The UM Lowell study also found that the washable microfiber mop pads are more absorbent, holding six times the water of a loop mop, so less water is needed to clean the same size floor.

A national study released in September 2005 indicates 97 percent of American hospitals surveyed are at least labeling mercury-containing devices such as thermometers and blood-pressure machines, and replacing them with non-mercury-containing substitutes. Eighty percent have "completely eliminated the use of mercury fever thermometers," and more than half of hospitals responding have adopted a policy to eliminate mercury in their facilities.

Hospitals in Maine have partnered to treat and dispose of contaminated items (surgical sponges, tubes and gowns) themselves rather than shipping it out of state to be incinerated, then buried in a landfill with everyday trash. The hospitals helped build their own waste treatment plant in Pittsfield, the Maine Waste Facility. Owned by the Maine Hospital Association, the plant can process six tons of waste daily. Currently, the state's hospitals produce 2.4 million pounds of biomedical waste yearly, with a cost savings of $300,000 annually.

CleanMed 2006 conference

This year there will be more opportunities for hospital decision makers to get on the sustainable procurement band wagon. Example: CleanMed 2006, a national conference planned for April 19-20 in Seattle, Wash. The agenda includes workshops on designing and operating green buildings, preferable purchasing for health care, reducing toxicity and waste and healthy food service.

Six weeks ago, San Francisco-based Catholic Healthcare West announced a five-year, $70 million contract to buy I.V. bags, tubing and solutions made without polyvinyl chloride or di-2-thylhexyl phthalate from B. Braun Medical Inc., for its 40 hospitals. PVC and DEHP are carcinogens. A healthy-food initiative related to sustainability at a Catholic Healthcare West facility in Santa Cruz — Dominican Hospital — has transformed a former park into a garden that produces pesticide-free tomatoes, basil, carrots, bell peppers, beets, onions, gourmet salad blend, arugula, radishes, summer squash, lavender, thyme, rosemary and tarragon.

Local high-school students spend one day a week watering and weeding the hospital garden, and also learn to harvest seeds, dry tomatoes and use beneficial insects to control bugs that otherwise would eat their crops. An organic-gardening video produced by Premier and Dominican's staff is making the rounds of other hospitals interested in starting their own gardens.

Similar programs are common in Britain, where the NHS runs more than 600 kitchens supplying hospitals. Menus depend partly on locally-produced food and are influenced by the ethnic tastes, Walker reports. Small groups of hospitals team up to buy, say, yogurt from local farmers that is served to hospital patients and staff, she says. The NHS also signs contracts guaranteeing purchase of the local fishermen's catch, and also provides a daily piece of fruit, free, to each British school child.

In the U.S., the huge systems like Catholic Healthcare West and Kaiser Permanente that are ground zero for the sustainable procurement movement, but great strides are also being made in states like Michigan. There, a state-mandated "universal waste" program requires that computers, televisions, calculators, cell phones and anything else with a circuit board is recycled or classified as hazardous waste, and disposed of accordingly.

The first plunge at enterprise-wide sustainability at the University of Michigan Hospitals and Health System's sustainability program netted impressive results for the Ann Arbor medical center: 370 tons of cardboard, 300 tons of office paper, 2.7 tons of phone books and more than 11 tons of plastic and glass were recycled.

Hospitals getting on board

Most hospitals buy supplies and contract for services through group-purchasing organizations. The largest is Premier Inc., based in San Diego and affiliated with more than 1,500 of the nation's approximately 5,000 hospitals. Through a group purchasing organization, members like St. Joseph's Mercy Health System in Ann Arbor, Mich., negotiate detailed vendor contracts to buy only the greenest, most recyclable, least packaged products on the market, given budget and other considerations.

Their environmental push began even before the hospital eliminated on-site incineration back in 1996. St. Joe's currently recycles newsprint, catalogs, PVC plastic, cards, No. 2 plastic, polystyrene foam packaging, glass, mixed office paper, corrugated cardboard, computer equipment, light tubes, batteries, oil, cooking grease and solvents. Safety manager Pierre Gonyon says that with these basics of sustainable procurement established through group purchasing muscle, he now can begin to focus on the next level: source reduction, or "using less, to end up with less waste to recycle."

"Many hospital managers think it's impossible to get from where they are to [sustainability]. But suppliers are finally beginning to get the message that we'll buy according to what we don't want in our waste streams," Gonyon explains. Right, now, as part of a larger construction project, St. Joe's is building a new waste management center that will allow even more recycling, "which means buying even less virgin material," he adds. Gunyon is most excited that St. Joe's parent organization, Trinity Health, last year contracted for a companywide assessment, redesign and implementation overhaul to consolidate sustainable procurement throughout the 44-hospital Trinity system.

Catholic Healthcare West, a Premier hospital, recently signed a contract with Vanguard, a Phoenix-based company, to reprocess single-use items from surgical instruments to scrubs for multiple uses, stretching its procurement dollars and reducing waste. In fiscal year 2004, the hospital system reprocessed 90 tons of medical devices, for a savings of $1.9 million. This year's reprocessing goal is $2.4 million.

"Five or six years ago, hospital procurement managers and group-purchasing organizations hardly knew what environmentally preferable purchasing/procurement was," says H2E's Brannen. "It's still pretty new, there is still a lot of work to do on sustainability, but things are really starting to move in health care." Her prediction: an increasing number of hospitals will hire or train an insider to anchor a crucial, new position: sustainability manager.

"At W. P. Carey we think that this is a very important issue," states Schneller. "Our MBA graduates will go to work for companies that are key suppliers to the health-care industry. And in almost any town in the U.S. the hospital industry is one of the top three employers — and potentially one of the top contributors to pollution. Part of every business's special conscience must be stewardship. By bringing scholars such as Walker to ASU we can hope to impress upon our students our own commitment to this important area."