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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



September 2015

Special Focus


Preventing unsustainable sustainability

Sustainability hits and misses

Preventing unsustainable sustainability

Healthcare organizations occasionally slip up when trying to implement a sustainability initiative. What are some common mistakes made, along with some suggestions on making good? Sustainability experts share their thoughts.

  • Not engaging the customer soon enough.

  • Where will this product end up after its useful life has ended? Or does it not have to end?

  • Not knowing the customers’ needs and resources when developing a sustainable plan or process. From the supply chain or vendor prospective it may be a great program or initiative, but I cannot afford it or have the space at my site to institute the program. Be connected and understand what each other’s needs and resources are.

– Rick Beckler, Director of Environment, Hospital Sisters Health System

  • The most common mistake that supply chain leaders make when implementing a [single-use device] reprocessing program is focusing on purchase price instead of the volume of reprocessed product as the key factor in delivering savings. This includes contract bundling agreements where the original device manufacturer designs the agreement to limit a hospital’s ability to reprocess. Some SUD reprocessing contracts bundle reprocessed devices with original devices or capital equipment. These contracts might require the purchase of one new device for every two reprocessed, and if a minimum purchase volume is met, the health system may receive a discount on the new devices. These terms and conditions might look attractive on paper, but these contracts can fall short of meeting expectations. Maximum savings are achieved by minimizing the number of new devices purchased. To avoid contracting pitfalls, select a vendor that doesn’t tie reprocessing savings to minimum purchase requirements for new devices.

  • Another common mistake is believing program education is only necessary at the program’s inception. Long-term success of reprocessing is dependent upon constant education, measurement and promotion of results.

– Bill Scott, Senior Director of Marketing, Stryker Sustainability Solutions

  • Distribution & Transportation. According to the EPA, in 2008, 27 percent of greenhouse gases came from transportation sources. Greenhouse gases are forecasted to increase dramatically for this sector. When making purchasing decisions, it’s important to ponder where the product comes from and how it is transported. Distributors can commit to ship with carriers that are committed to reducing impacts from transportation. EPA’s SmartWay Program is a partnership with businesses to achieve supply chain fuel efficiencies to minimize the environmental impact of transportation. Distributors can commit to ship more freight with more high-performing SmartWay carriers. Using fuel-efficient vehicles and sourcing locally are additional ways to reduce transportation-associated impacts.

  • Hazardous Materials & Waste. It’s important to consider "back-door" issues and costs when reviewing contracts. While mercury-containing equipment may cost less upfront, the spill clean-up and eventual material removal ups the cost tremendously. Every product is paid for twice — when it comes in and when it goes out. Mercury, lead, excessive packaging, lead-based tape for blue wrap, computers, refrigerants, hand soaps, disposable isolation gowns, Styrofoam food ware — all of these materials have hidden costs. Hazardous waste removal is the most costly waste stream per unit. This is followed by infectious waste, solid waste and then recyclables. Keep in mind the "back-door" or "back-dock" impacts of procurement to address total cost when making purchasing decisions. Ask facility managers for the cost-per-pound for solid and hazardous waste and, based on the weight of the products purchased and ultimately disposed, use these calculations in purchasing evaluations.

– Janet Howard, Director of Member Engagement, Practice Greenhealth

  • Synergy Health consultants understand that each project has multiple participants within the institutional decision making process. Each will have different concerns as it relates to their position, department, and current driving goals for their institution. In reality, it is understood that healthcare management leaders within our institutions are somewhat overwhelmed by multiple priority projects and the related time requirements. A requirement for success in elevating a sustainability project to a high priority is in understanding that our leadership and partnering support is required at a level of "hands-on" attention to every detail, at every level of development, at every level of management.

  • A common mistake in Supply Chain is the requirement of unit pricing per each product to be compared to existing product pricing. A product with multiple cost impact features for the institution must be compared as a part of the "whole" with net or overall costing impact definitively presented. A Synergy analysis provides that snapshot for clarity in understanding real cost and the spend improvement.

  • The last component of success in sustainability projects is that the answers to why, what, who, and how must be clearly demonstrated by a Synergy consultant in tandem with demonstrating leadership that will build trust and confidence that the project will transition without difficulty or complicated involvement by leadership.

– Vickie Alexander, Director of Corporate Solutions, Synergy Health

  • The biggest mistake when trying to implement any sustainability initiative is not engaging all stakeholder groups in the process to set up implementation. It is important to engage all stakeholders prior to the implementation phase of an initiative. Anyone affected by the initiative is a stakeholder.

  • The second mistake is trying to engage stakeholders without understanding their perspective in the aspects of the particular sustainability initiative that are relevant to them. It is best to identify scenarios in which each stakeholder benefits and then align with a champion within each group.

  • Plan, Act, Do: Measure to manage, check and adjust, reward behaviors. Recognition goes a long way, especially if the leadership is engaged to provide the recognition. Engaging leadership into any initiative provides both relevance and motivation.

– Judson Boothe, Vice President, Global Product Supply, Halyard Health

Thomas Edison said that a mistake just gets you closer to success. We use the Virginia Mason Production System (VMPS), which was inspired by the lean manufacturing principles of the Toyota Production System, to implement and support our sustainability initiatives. With VMPS as our management methodology, we strive for continuous improvement.

Here are three key issues we’ve learned:

  • The person that mops the floor should buy the broom. Make sure you have the end-users input and support prior to "pressing go" on the initiative. Sometimes the purchase can impact them in ways you don’t understand.

  • Ask why five times. When you explore the purpose of an item, sometimes you realize that it can be combined with another, or that it is not needed. Reducing the waste of unneeded items from the supply chain is an important step in reducing the environmental impact of health care.

  • If in doubt, over-communicate. Communication is everything – we need to keep lines of communication open between supply chain, stakeholders, subject matter experts, and suppliers in order to get the best outcome. If in doubt, over-communicate.

– Brenna Davis, M.S., Director of Sustainability, Virginia Mason Health System

Sustainability hits and misses

When it comes to sustainability projects, what worked and what didn’t, at least at first? Several sustainability sources shared their perspectives.

Hospital Sisters Health System has a storied history of Mission Integration far and wide, national and international. We looked internally at what more can we do to impact or lessen the impact of our healthcare business on the environment. We developed a system wide program, called "Reverence for the Earth," with a team lead in each ministry and yearly functional and monthly conference calls. Our success story is sharing the initiatives, processes, successes and what did not work. Through this process we have been able to educate, communicate, share and expand our programs throughout the system and locally.

Successes: We recycled Christmas lights. We thought it would be nice, but what a turnout. We had to have the copper/metal recycler return multiple times to pick up the carts and cart loads. We did not have a clue about all the lights our colleagues and even patients and their families had and wanted to recycle.

Another one involves multiple gardens around our properties. Some are for those that have no land and want to produce for themselves. Some grow and produce for the needy. Some are planted and picked by colleagues at the ministries. In the end it brings the community and the business together. However, we had to remember to install the proper fencing to protect the gardens from wild animals and neighbors who loved the free and fresh produce.

Challenges: We held an electronics recycling event at one hospital, but did not put a lot of controls or specify what was accepted and what was not. We had truckloads of old TVs and electronics showing up that we could not recycle or did not have a place to store. We were able to partner with a local recycler and community college to help us resolve the backlog.

– Rick Beckler, Director of Environment, Hospital Sisters Health System

Virginia Mason Medical Center is a participant in Practice Greenhealth’s Healthier Hospitals program. The system’s commitment to environmental sustainability is integrated into its work. Medical devices are an important part of providing the highest quality care in Virginia Mason’s hospital. The total cost of device use includes both initial purchasing and the cost environmentally responsible disposal. Virginia Mason’s Perioperative Services team challenged themselves to find a way to reduce the total cost and environmental impact of these devices.

What happened: Stryker Sustainability approached Virginia Mason with the idea of utilizing reprocessed medical devices. Reprocessed medical devices are FDA-cleared (and pre-audited for quality), demonstrate the same high level of quality, have a lower total cost and a reduced environmental impact than many single-use devices. Physicians joined the leadership team to evaluate the devices, including visiting the reprocessing plant and consulting with other surgeons. The group decided to start with a few devices and expanded as time went on. After learning how each device is inspected for quality and held to the highest standard, the team moved forward.

With Supply Chain’s support, the devices were integrated into the facility’s operations. Implementation required a new process, staff education, installation of new bins and signage. The Perioperative team and vendor conducted the in-service for staff. To make the process easier, the system was set up so that the staff can put all the devices in one bin, which the vendor then sorts. A Stryker representative also visits regularly to ship the collected devices off site for reprocessing as well as assist the hospital team with regular reports. The hospital purchases back the reprocessed devices, creating significant cost savings. As a result, Virginia Mason reduced purchasing costs by more than $3 million since 2012, reduced annual waste disposal costs as well as toxins released into the environment.

Challenges: Patient safety is Virginia Mason’s first priority. Lack of understanding as to the value of reprocessed devices can be an initial roadblock. Sharing the clinical data and research proving that the reprocessed device has equal quality and safety to a single-use device is essential.

– Janet Howard, Director of Member Engagement, Practice Greenhealth

A recent case study centered around a large university medical center. That institution has 757 beds and 31 operating room suites. The results were as follows: 138,748 pounds of waste were eliminated annually, with a related waste disposal cost reduction of more than $38,000 per year. Additionally, the annual instrument replacement budget/spend was reduced by $39,000 as a result of instruments no longer going erroneously to the trash with disposable back-table covers. Instead they were retrieved by Synergy Health when the used reusable back-table cover returned to Synergy Health for processing and sterilization. Acquisition costs for the Synergy Health products were neutral with no spend increase.

– Vickie Alexander, Director of Corporate Solutions, Synergy Health

One of our sustainability successes can be found through a cooperative effort of many companies across the healthcare industry. Halyard Health is a founding member of the Healthcare Plastics Recycling Council (HPRC), a coalition which has been formed across the hospital plastics value chain to provide key resources for recycling. Together, the member companies and hospital advisors have created and tested tools, which are openly available through www.hprc.org. Case studies provided by The Cleveland Clinic, Stanford Medical Center and Kaiser Permanente, along with the HospiCycle toolbox and aligned accredited education modules through Pfiedler, provide a foundation of proof and knowledge to help hospitals implement a plastics recycling program.

In addition, HPRC has formalized a set of design guidelines for use in the development of new products, so that recycling is part of the product solution at the beginning of the design process. Those guidelines are also openly available through hprc.org.

Coalitions are effective ways to engage multiple stakeholders and amplify the sustainability efforts beyond any one participant, as pooled money goes further, pooled resources provide the greatest return for the effort, and total results are greater than the sum of each stakeholder’s efforts. This multi-stakeholder focused initiative can be very effective for many types of problem-solving.

– Judson Boothe, Vice President, Global Product Supply, Halyard Health