Finance leaders should look at costs across the lifecycle, rather than just the “first costs” of supplies purchased.
Hospitals create 29 pounds of waste per staffed bed each day, according to Practice Greenhealth, a not-for-profit membership organization that helps hospitals and health systems adopt greener solutions. Although this represents an improvement over the 33 pounds of waste per staffed bed per day recorded just a few years ago, hospitals still have some work to do in this area, says Elizabeth Schenk, a nurse scientist and the sustainability coordinator at Providence St. Patrick Hospital, a 250-bed hospital in Missoula, Mont.
In her role, Schenk leads a group of sustainability coordinators for a region that includes 13 hospitals and contributes to system-level projects for the Renton, Washington-based Providence St. Joseph Health’s 51 hospitals.
“Waste in health care is really complex,” she says, pointing to nearly a dozen waste streams, which can be broken down broadly into regulated and nonregulated waste. Each type of regulated waste—including hazardous waste, infectious waste, pathological waste, chemotherapy waste, nuclear waste, and pharmaceutical waste—needs to be segregated properly. Otherwise, hospitals risk violations. Non-regulated waste streams, such as recycling, landfill, composting, and philanthropic giveaways (such as to missions, animal control, and schools), also require proper segregation.
Smart waste segregation practices save money by ensuring that regular, municipal solid waste does not get mixed in with hazardous and infectious waste that requires special (often costly) disposal, Schenk says. “Recycling is by far the cheapest, even though we pay for it, while chemical hazardous waste is by far the most expensive, which is why we want to keep inappropriate waste out of that waste stream,” she says.
Because clinicians typically segregate waste at the point of care, they need to be engaged on proper waste disposal through educational campaigns, Schenk says. At Providence St. Patrick Hospital, staff “champions” help educate colleagues on strategies to reduce waste through the “Green 4 Good” program. As part of this program, which Schenk founded, leaders set different monthly goals (such as reducing linen use) for their area. In many cases, staff have strong buy-in because they recognize the enormity of the problem from their daily practices, Schenk says. As a result, the program achieves nearly $1 million each year in cost savings.
Reducing Waste in the OR and Beyond
Most hospital leaders recognize that operating rooms (ORs) are a significant source of waste. Schenk offers the following strategies to curb waste in the OR.
Choose reprocessed or reusable items over disposable when possible. By using reprocessed single-use items, Providence St. Patrick Hospital saves up to $250,000 per year. For example, trocars used to access part of the body during surgery can be reprocessed.
Explore alternatives to “blue wrap.” Blue wrap, a type of plastic known as a No. 5 polypropylene, is used to wrap items for sterilization prior to surgery. ORs generate large amounts of this disposable plastic, which is difficult for many organizations to recycle, especially if they are not near major metropolitan centers with advanced recycling capabilities.
To curb the use of this plastic, leaders at Providence St. Patrick Hospital have purchased reusable steel cases that serve the same purpose. But leaders need to plan for this investment, Schenk says.
Reduce waste anesthesia gas (WAG) impact. Schenk says four commonly used inhalation anesthetic agents are significantly more potent greenhouse gases than even carbon dioxide, meaning they absorb infrared radiation in the atmosphere and contribute to global warming. “Unfortunately, WAG is just typically vented out into the atmosphere,” she says. These agents also have a longer half-life than carbon dioxide, so they remain in the atmosphere longer.
At Providence St. Patrick Hospital, WAG accounts for 10 percent of greenhouse gas emissions. Although WAG is not regulated, Schenk urges leaders to educate anesthesiologists and other clinicians on the environmental impact so they may choose greener anesthetic agents and processes.
For example, they may select anesthesia drugs with lower greenhouse gas potential and use lower volumes of inhaled anesthetic agents by supporting care with more intravenous medications. In addition, clinicians may opt for wider use of epidural analgesia or patient-controlled analgesia when appropriate, such as during labor. “This is a great team project for clinicians and administrators to save money and reduce environmental harm,” she says.
In the future, hospitals may be able to collect and distill WAG for reuse. This technology is in development, and sustainability coordinators are watching for when its use is available and feasible in the United States, Schenk says.
Pursuing Other Strategies
Schenk provides several tips leaders can use to tackle waste outside of the OR.
Deconstruct old buildings. In 2017, Providence St. Patrick Hospital kept 42.5 percent of its waste out of landfills through proper waste segregation, saving the hospital approximately $100,000 per year. One strategy it used to limit landfill waste was to recycle items like sinks, siding, and furniture when dismantling old buildings, Schenk says.
Reuse laboratory agents. To reduce chemical waste, hospitals can distill and reuse some laboratory agents, such as xylene (a solvent used for tissue processing) and formalin (which includes formaldehyde).
Choose washable gowns. At Providence St. Patrick Hospital, leaders have invested in washable fluid-impermeable cloth gowns in the patient care units for isolation patients. However, leaders need to ensure they can handle the processing, distribution, and storage of such items.
Saving Energy and Water
To conserve energy and water, leaders should consider the following strategies, Schenk says.
Find a good energy procurement partner. Several hospitals in the Providence St. Joseph Health system work with a vendor to track the energy market and find the best energy prices. For nine system hospitals, the company has saved more than $1.4 million through better contracting.
Consider occupancy setbacks. HVAC systems that reduce airflow or lower temperature when patient rooms and operating rooms are unoccupied can cut a hospital’s energy use by as much as one-third, Schenk says.
Install LED lighting. An LED bulb uses less energy to produce the same amount of light as an incandescent bulb. It also does not generate as much heat that an incandescent bulb does, so it is easier to control room temperature, Schenk says. In addition, LED bulbs last years longer than incandescent bulbs, so they do not need to be changed as frequently, which reduces maintenance costs. Some local utilities even offer rebates to organizations that install LED bulbs.
Focus on water conservation. Almost all organizations can reduce water consumption, Schenk says. She recommends finance leaders engage and support facility managers in their conservation efforts, which may involve some up-front costs, but often saves money in the long term.
For example, hospitals that use cooling towers as part of their HVAC systems can adjust operations and maintenance to make the towers more energy efficient. Or hospitals can employ other cooling strategies. For example, Providence St. Patrick Hospital has saved millions of dollars in costs since implementing a groundwater cooling system in 1992.
Low-flow sinks, toilets, and showers also can help conserve water and save money. Choosing appropriate landscaping also cuts irrigation needs and reduces costs.
Considering the Cost Lifecycle
Schenk urges finance leaders to look at costs across the lifecycle, rather than just “first costs” of supplies. “Sometimes people are hamstrung because there is not enough money to make long-term decisions,” she says. “But this is one of the reasons why we spend more than we need to.”
Although many finance leaders recognize the need to make green investments when planning new construction, they may fail to apply the same long-term thinking when purchasing products. For this reason, Schenk urges leaders to think of these missed opportunities as budget line items denoting “money intentionally wasted” to help reframe their perspective. She also recommends setting goals and measuring progress on metrics such as pounds of waste generated per staffed bed per day.
“Conservation saves money,” she says. “And it’s not just in this budget cycle for this quarter or this year. This is an investment in the sustainability of the organization.”
Interviewed for this article:
Elizabeth Schenk, PhD, MHI, RN-BC, FAAN, is a nurse scientist and a sustainability coordinator for Providence St. Patrick Hospital, Missoula, Mont., and Providence St. Joseph Health, Renton, Wash.