While not actually part of the Hippocratic Oath, the phrase “Do No Harm” is accepted by many as a fundamental principle of healthcare delivery. Unfortunately, as we have learned, hospitals struggle with a very high rate of preventable medical error.1 As we have previously discussed, the use of standards to unambiguously identify places, products and people can help us reduce those errors. My question this month is: Can standards help address the harm caused by hospitals and healthcare systems to the environment?
Consider these statistics:2
Healthcare is one of the largest users of toxic chemicals in the U.S. economy and a significant waste producer, sending 6,600 tons of trash to landfills every day.
As one of the nation’s largest energy users, hospitals produce a large percentage of our greenhouse gas emissions.
These facts also contribute to higher hospital costs and poorer population health. As examples, hospitals alone spend more than $10 billion a year on energy, while poor air quality has been identified as the most frequent cause of work-related asthma in healthcare workers, not to mention the impact on the general population.
The healthcare supply chain can help address these problems. Many of the decisions made in procurement result in waste streams or increased energy usage. More sustainable procurement practices can help reduce unnecessary purchases and source products and services that reduce the negative impacts on the environment.
Gary Cohen, president and co-founder of Health Care without Harm (HCWH), shared a few examples at the fall forum of the Strategic Marketplace Initiative.
In 1995, the Environmental Protection Agency identified hospitals as the largest source of dioxin emissions and responsible for 10 percent of mercury air emissions in the U.S. Both of these chemicals can harm the health of unborn and young children. A year later, HCWH was founded to help minimize healthcare practices that pollute the environment and contribute to disease. Working with the United Nations and the World Health Organization, HCWH helped demonstrate the efficacy of new technologies to treat medical waste without incineration. More than 4,500 medical waste incinerators have since closed in the United States. Further, thanks to an effort started at Beth Israel Deaconess and advanced by the American Hospital Association, the market for mercury thermometers has been virtually eliminated in the U.S., as hospitals and pharmacies moved to mercury-free devices.
The majority of procurement professionals still believe that the cost of green products is a major barrier to their sustainability initiatives.3 Not so, according to Kathy Gerwig, the environmental stewardship officer for Kaiser Permanente (KP). In her book, Greening Health Care, she writes: “There is a preponderance of evidence that a greener health care enterprise is not only affordable, but in most cases it results in an improved cost structure.”
Gerwig ought to know, as KP has one of the most substantial and successful environmental stewardship programs around. KP has documented tens of millions of dollars in savings through energy efficiency, waste minimization, and reprocessing.4 In 2011 alone, KP’s increased use of safely reprocessed medical devices avoided more than $8 million in costs for supplies and waste disposal. Chief Procurement Officer Laurel Junk told the SMI audience that KP has reduced greenhouse emissions by 30 percent since 2008, even as the healthcare organization increased both its membership and energy usage. Cleaner energy sources, such as wind and solar, have also reduced KP’s water profile by more than 100 million gallons per year.
KP has also led the move toward more environmentally friendly office furniture. In April of 2014, it became the first health system in the country to commit to no longer purchase office furniture treated with harmful flame retardants. Five months later, other major systems had followed suit, and the percentage of hospitals prioritizing the purchase of compound-free furniture doubled from 2015 to 2016.
Many hospitals focus their green initiatives in the OR. In the September 2015 issue of HPN, Synergy Health noted that 30 percent of its waste originates in the OR, with nearly 5 pounds of disposable waste generated by an average surgical procedure. By identifying which products are used most often in each case, such as surgical gowns, wraps and drapes, Synergy has focused its efforts to convert to more environmentally friendly products. Cohen noted that the 185 hospitals participating in the Greening the OR campaign, sponsored by Practice Green Health, reported more than $83 million in savings from 2014 to 2016.
While many are, not all greener products are less expensive to purchase. Dignity Health, which works with Green Health Exchange to source sustainable products, told an audience at AHRMM17 that increases in costs for some categories of products need to be offset initially by savings from green products that are less expensive and over time by their positive downstream impacts.
It’s about thinking beyond the purchase price. Healthcare professionals need to consider the impact of products and services on total costs — including for both patient care and hospital operations — and on quality — not just in terms of patient care but also the environment. As with so many things in healthcare, there are numerous factors to consider when making your decisions.
As for the standards question, the Global Data Synchronization Network (GDSN) does include chemical attributes, which can help determine if products include toxic chemicals such as DEHP. Standards could also be incorporated as part of “green formularies.” Let me know how you are using standards to identify green products and services and/or if you are standardizing practices to improve health and the environment.
1 Makary MA, Daniel, M. Medical error—the third leading cause of death in the US. BMJ 2016;353:i2139.
2 Can Sustainable Hospitals Help Bend the Health Care Cost Curve? http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2012/nov/1641_kaplan_can_sustainable_hosps_bend_cost_curve_ib.pdf. Published November 2012. Accessed November 6, 2017.
3 Greener Hospitals: Building Consensus for Health Care Sustainability. http://knowledge.wharton.upenn.edu/special-report/greener-hospitals-building-consensus-health-care-sustainability/. Published March 3, 2015. Accessed November 6, 2017.
4 Sustainable Hospitals Can Help Bend the Cost Curve: Kaiser Permanente’s Environmental Stewardship. http://www.commonwealthfund.org/publications/blog/2012/nov/sustainable-hospitals-can-help-bend-the-cost-curve. Published November 2, 2012. Accessed November 6, 2017.