By Kate Gillespie and Joann R. Moon
Virtua Health, a Marlton, N.J.-based comprehensive health system that consists of four hospitals, has implemented various recycling and waste-minimization initiatives in recent years to help the environment and cut costs.
See sidebar:Organizing a Systemwide Green Initiative
Using education, communication, and standardization, Virtua's systemwide Green Council has maximized existing green initiatives and launched new ones. One of the most significant to date: cutting the cost of regulated medical waste (RMW) disposal by more than $85,000 in one year.
Virtua's newly formed Green Council established Green Teams at each of the health system's four hospitals. In June 2009, the council asked the Green Teams to spend time observing employees to see how they reduced, reused, and recycled waste and to see if proper procedures were being followed for RMW.
RMW includes any hospital item, such as gloves and dressings, that is saturated in blood, body fluid, waste, and chemicals. Federal laws require RMW to be disposed of in red RMW bags or containers. Syringes are disposed of separately per U.S. Environmental Protection Agency regulations.
Green Team members found that hospital staff were often not following RMW protocols. For instance, at one hospital, employees were placing all waste into red RMW bags to avoid any risk of not complying with RMW regulations. This proved to be expensive for the facility because RMW costs approximately four times as much to dispose of as regular trash.
At other sites, employees routinely put inappropriate items into the red bags, including gloves, bedpans, coffee cups, pizza boxes, and fast-food wrappers. In one instance, 12 pounds of waste was found in a red bag-10 pounds of which should have been placed in a regular trash bin.
According to John Marcinkevich, contract manager at Virtua, the health system spent $465,000 on trash hauling in 2008, including tipping fees and per-ton disposal. Most of that cost-$363,000-was for red bag trash disposal.
The Green Council decided on a three-pronged approach to address the high cost of RMW.
Educate employees about RMW/red bag use. An employee survey conducted by the health system's Green Team revealed numerous insights about employees' recycling attitudes and habits. One key finding was that clinicians were confused the most by RMW and, as a result, misused red bags. Of clinicians who completed the survey, 88 percent admitted they did not know what was supposed to go into the red bags, and 42 percent said they knowingly threw regular trash into the red bags.
See sidebar:Survey Gauges Green Initiative Interest
The Green Council worked with Virtua's marketing department to develop a communication approach and effective messaging about RMW and the proper use of red bags. A presentation was developed and given during staff meetings and special events, such as Earth Day, by council members and volunteers on local Green Teams. The presentation was also posted on the Virtua intranet.
Educational posters promoting environmental stewardship and appropriate use of red bags also were presented during monthly department meetings. Bulletin boards in the cafeterias displayed educational information related to single-stream recycling, where all recyclable materials can be placed in the same recycling bin (as opposed to sorting different recyclables into different bins). The Green Council also placed RMW labels and single-stream labels on containers to designate what waste belong in each.
Reduce the size of red bag containers based on the amount of RMW generated on the different clinical units. Based on feedback from frontline workers, plant operations, employee surveys, and observations, the Green Council recommended changing the size of RMW containers. The Green Council believed that by shrinking the size of the red bag containers, staff would be less likely to discard inappropriate trash (e.g., coffee cups, bedpans, newspapers) in them, resulting in decreased misuse of RMW containers and improved financial savings.
Container size was determined after each patient area and the amount of RMW generated from that area were assessed. Many areas had oversized containers, so container size was reduced from 8 to 10 gallons to 1 to 5 gallons. It was also determined that there was no need to have RMW containers in every room in some areas, so they were instead placed in a central location.
Strategically place red bag containers where they are most likely to be used correctly. Most RMW containers and red bags were previously placed next to a room's exit door. Nurses had a habit of dropping both RMW and general trash into the container closest to the door as they left the room.
The Green Council currently uses a Lean process improvement methodology tool called a "spaghetti diagram" to follow the employee process flow in each area to identify the most appropriate location for RMW containers. Based on the results of the spaghetti diagram and feedback from staff, RMW containers were mounted on the wall, and regular trash containers were placed at the exit of each room.
The goal of the RMW initiative was to reduce the cost of RMW by 25 percent. Between 2008-09 and 2009-10, Virtua decreased the amount of RMW by more than 453,000 pounds, or 31 percent, for a savings of more than $85,000. Virtua continues to monitor RMW. The contract manager sends a spreadsheet with RMW information each month to the chair of the Green Council, who then shares a chart that trends the data with the other council members and local Green Teams. The chart is also posted on Virtua's intranet. When an increase in red bag usage occurs, the Green Council and local Green Teams look into the matter and address the issue.
By gathering employee feedback, helping employees understand what changes needed to be made and why, and using a Lean process improvement methodology that leant credibility to its work, the Virtua Green Council developed an effective, employee-focused approach to environmental stewardship and cost savings.
Kate Gillespie is a Six Sigma black belt at Virtua Health, Marlton, N.J. (firstname.lastname@example.org).
Joann R. Moon is a Six Sigma black belt at Virtua Health (email@example.com).
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