Keeping sustainability front of mind on the front line and back office internally

“On an organization level: Sustainability Policy embeds sustainability criteria, unifies the work and adds consistency for the organization.

• Identify priority sustainability issues to focus/educate on
• Establish goals based on above, communicate them widely and track progress
• Embed sustainability focus into job descriptions, reports, etc., to communicate the importance of this work within the organization
• Include sustainability criteria in RFP/RFI
• Utilize existing tools from GPO and also inform GPO that sustainability is a priority
• When moving to more sustainable products, use the opportunity to educate on the benefits of the new criteria and why it is important, what it achieves towards goals, etc.
• “On a personnel level: Be a champion within your own organization.
• Participate in the “Green team” where they exist so that product specifications, etc. can be communicated and effectively implemented
• Identify other champions (whenever possible, clinicians) with whom to work within the organization
• Partner with outside organizations that provide education and sharing opportunities in sustainability, network with other supply chain professionals doing this work and get educated on sustainability issues/work.”

“In the current environment, supply chain has been focused on ensuring patients and staff are supported appropriately to manage COVID-19. While their efforts have been focused on COVID-19, some very important sustainability efforts have continued.

• Reprocessing. These efforts have expanded to non-traditional products and though most have done this out of necessity, it has helped to ease supply availability and save hospitals money. This is an effort that has been maintained and will continue to support the resiliency of our hospitals.
• Reduce waste. Hospitals have generally worked to reduce waste over time and have continued these efforts recently. Most efforts toward reducing waste save money and help to keep waste out of landfills. These efforts will also continue to support resiliency in our hospitals.
• Reduce chemicals of concern. These efforts have definitely fallen in priority recently as hospitals have raced to focus on keeping supplies available for patient and caregiver safety. However, as hospitals look to the future, consumers are leery about returning to hospitals in general. As hospitals look to reopen and perform more elective procedures, consumers (especially those in younger generations) are looking to feel safe in hospitals. By working tao reduce/eliminate chemicals of concern, they will be better positioned to make patients feel safe in the hospital environment. This includes both medical products and those found in the interior of the hospital (the built environment).”

“Start integrating low-carbon sustainable products in areas that are non-procedure critical. That way you are making meaningful progress without changing anything procedurally on the Operating Room. For example: Eliminating polystyrene packaging trays that are the foundation for many of the custom surgical kits used in the OR. By substituting these with plant-based, recyclable alternatives, supply chain can make an easy change with the OR and eliminate tons of plastics waste and corresponding CO₂ emissions.

“With 35 percent of all hospital waste being generated in the OR, this is a good place to focus. There are two ways to reduce waste coming from the OR.

1. Keep single use items destined for landfill in circulation longer (reprocessing)
2. Move off of single-use plastic products over to reusable or renewable plant-based alternatives and achieving a source reduction of single-use plastic production, use and disposal. Plant-based renewable products can be easy to integrate and offer a low-carbon, bio-degradable, sustainable alternative to petroleum-based plastic.

“Supporting companies and purchasing products that have a better climate footprint is something that needs to happen across all industries, and in healthcare it supports healthy communities for today and tomorrow. When companies innovate and create sustainable products, supply chain needs to consider and support [by] purchasing these products, assuming they meet the clinical requirements, and support the transition to responsible production and consumption. So really, responsible production and consumption will affect ‘Goal 3: Good Health and Well-Being,’ ‘Goal 14: Life Below Water,’ Goal 9: Industry Innovation and Infrastructure, ‘Goal 15: Life on Land’ and ‘Goal 17: Partnerships for the Goals.’ [Editor’s Note: These are part of the ‘The Global Goals For Sustainable Development’ initiative.] That is key – working together and collaboratively to make these changes happen.” [Editor’s Note: For more information, visit https://www.globalgoals.org/.]

“Incorporate recycling/zero-landfill initiatives.

“Develop a [first-in-first-out] FIFO system and perform routine no-move reports for inventory with a finite shelf life. Facilities should properly track their inventory, allowing them to identify excess or slow-moving items. Prior to expiration, facilities should attempt to return, transfer, or liquidate products for which they have no use. If items are unable to be returned or transferred, utilize companies offering a sustainable alternative for excess inventory, like WestCMR.”

“Utilize outlets like WestCMR that offer sustainable solutions for your facility. WestCMR was developed to offer an alternative for when healthcare facilities encounter surplus or obsolete inventory, ultimately reducing material waste.”

Andrew Knox, Manager, Environmentally Preferred Products, Premier

“Today, sustainability is an absolute requirement for every company and organization. As the consequences of our current practices become clearer – climate change, habitat loss, plastic pollution and more – a greater number of organizations and people are making their voices heard, using sustainability as a lens through which to make economic choices and cutting back on waste.

“To support these goals, Supply Chain can help enable sustainable practices in three key ways:

• Supply Chain must ask questions. It’s critical [that] suppliers know and understand that sustainability is an issue of great importance to their customers, and suppliers must have the ability to accurately respond to questions about what’s in their product, how it’s packaged and other environmental attributes. Premier requests for information (RFIs) include questions on environmentally preferable policies and practices given an organization’s sustainability efforts rely on strong data collection.
• Make the data available. Supply Chain is in a unique position to obtain vital sustainability-related information from suppliers and pass it on to decision makers within their organizations. It’s also important that Supply Chain has the ability to separate meaningful environmental claims and data from  ‘greenwashing.’
• Provide feedback to suppliers. Alongside an organization’s commitment to purchase environmentally preferable products, it’s also imperative to let suppliers know that these products were purchased because of their reduced impact. This feedback helps reinforce to suppliers that the sustainable efforts and environmental improvements they undertake provide value and ROI to their purchasers and the market at large.”

“Supply chain leaders can help their organization grow in the area of environmentally preferred sourcing through education, setting goals and tracking performance. Education of supply chain staff starts with providing an understanding of environmentally preferred attributes and the significance of those in meeting organizational goals. Educating clinical and non-clinical staff will be important for the adoption of environmentally preferred products when changes occur. They need to understand ‘the what’ and ‘the why’ when product changes occur. In addition, they need to understand how they can provide feedback when product changes occur so concerns can be efficiently addressed. Lastly, the supply chain needs to set goals for the adoption of environmentally preferred products and then ensure there will be data and analytics to support the work and measure performance.”

“Sustainable supply chain encourages organizations to consider lateral, deep programs in scale that have the power to affect meaningful change. The most common approaches are recycling, reusability and reducing supply chain waste. Some tips to help maintain efforts:

• Look at what your organization could close the loop on to increase circularity – removing the ‘dispose’ element from the pervasive ‘take, make, dispose’ model much of our economy operates within today. As one example, question the way you transport goods. Could those containers be substituted with a non-virgin material, choosing from options like renewable or recycled content, and reused throughout the supply chain?
• For items that require virgin material, look at local facility recycling capabilities in the areas where you operate.
• Finally, look at surplus products. Is there a better outlet for these items than the landfill and opportunity to reduce waste?”

“Supply Chain can help organizations achieve and maintain sustainability goals in a number of ways. Not only can they assist internal initiatives in supporting operations and facility management and achieving energy conservation, waste elimination, etc., by identifying opportunities within different categories of spend and being diligent themselves as employees, but Supply Chain teams can also extend the sustainability initiatives into their Tier 1 and Tier 2 supply base to expand the impact across the integrated supply chain.”

Supplier-based external focus

The key strategy and tactic for this effort is to incorporate sustainability into contract language and negotiations upfront, experts advise.

Thresa Pattee, Director, Sustainability, Greenhealth Exchange

“Develop contracts for sustainable products that:

• Include criteria and reporting requirements in RFI/RFP/RFQ.
• Include sustainability data submission requirements as part of the terms and conditions.
• Encourage GPOs to include criteria and reporting requirements in RFI/RFP/RFQ and require data submission requirements as part of the terms and conditions.
• Encourage GPOs to expand informational data around sustainability criteria
• Encourage GPOs to highlight sustainable products in their product catalogs and contract launch documents.

“Contract Management for sustainability-focused agreements [should]:

• Communicate to suppliers that the submission of sustainability data to GPOs and on your RFP/RFI is important and may be factored into vendor performance measurements.
• Include sustainability components in [quarterly business reviews] and track progress against previous quarter.
• Encourage your GPO to require submission of supplier sustainability data and include it in their [quarterly business reviews].
• Communicate with suppliers on what the organizational sustainability priorities are so that suppliers can respond with opportunities and prepare with product development.

“Contract Renewals [should include]:

• Evaluation of progress towards goals at the health system and GPO level.
• Review of roadblocks at the health system and GPO level.
• Review of goals to determine success at the health system and GPO level.
• Evaluation of market evolution/movement to determine if new (improved) goals are feasible at the health system and GPO level.
• Communication of new goals to suppliers at the health system and GPO level.”

Zoë Beck, Manager, Sustainability, HealthTrust

“Continue to ask the standard questions about medical products. Continue to present the answers to these questions in the sourcing process to encourage discussion around environmental health attributes of products. By continuing to ask the questions and present them in the sourcing process, the conversation continues and we continue to encourage suppliers and health systems to consider sustainability in their purchasing decisions.

“Incorporate questions about the supplier’s internal efforts on sustainability to better understand the companies with whom we do business. This will also help health systems and hospitals to report out on environmental, social and governance factors. This is currently a decision factor for many in choosing with whom they do business and from whom they consume goods or services.

“Educate supply chain professionals on the environmental factors that you are considering in contracting. Many are not aware of these factors and how they affect patients, clinicians, staff and the surrounding communities. When supply chain teams are more educated, they will be more equipped to take environmental health factors into account when contracting.”

Rob Chase, Founder and President, NewGen Surgical

“Include in new supply agreements language that allows for the flexibility to purchase sustainable products. If a new vendor brings to market a sustainable product, you want to be able to evaluate and potentially integrate that product into your surgical suites without being negatively penalized for doing the right thing and supporting a healthy planet. Call it the ‘Sustainability Clause.’ Like a new technology clause in many contracts, this is an area where hospitals should support innovation, especially when it addresses climate change and or plastic pollution.

“Healthcare contributes 10 percent of all CO₂ emissions in the U.S. Recent studies (Health Care Without Harm) suggest that up to 71 percent of healthcare’s CO₂ emissions are ‘Scope 3’ and associated with the products and services used in the delivery of care. The healthcare industry can reduce its emissions with what we call climate smart procurement and products, but it’s going to need the support of distributors. Hospitals that have carbon reduction goals are going to need to engage supply chain and communicate to vendors the importance of understanding and measuring their own product emissions. [They must be] able to measure the embedded energy and emissions associated with the production of each product, which will be essential to greening the supply chain. [They must] discuss sustainability and possibly require submissions of product environmental metrics by the vendors. Every product has a footprint. If you have a product that performs as good as or better, and is better for the environment, aren’t we compelled to use it?

“Require vendors to measure and report on Chemical of Concerns in their products through the use of an environmental scorecard. We also have a program Small Change Big Impact – where we worked with Dr. Ann Blake to scientifically and methodically measure our environmental impacts – plastic reduction and Scope 3 GHG. So many companies make claims, but you have to measure and have them based in science. While we pass all environmental scorecards, there is an excellent article by Dr. Jodi Sherman of the Yale University School of Medicine and Public Health and Dr. Cassandra Thiel, PhD, ‘Reducing Plastic Pollution from the Health Care Industry.’ that really outlines the need for a central widely adopted measurement that is clinical and science-based. I believe once one of these certifications and guidelines becomes the standard, it will be easier to know you are making the most impactful and measurable decisions on sustainability initiatives you can.” [Editor’s Note: For more information, visit https://ghgprotocol.org/standards/scope-3-standard  and https://www.carbontrust.com/.]

Elise Bexley, Manager, Strategic Accounts, WestCMR

“Supply Chains may seek out partnerships with healthcare consulting companies or explore joining a collaborative. These types of organizations are committed to providing their facilities with resources that offer sustainable solutions.”

Andrew Knox, Manager, Environmentally Preferred Products, Premier

“On a fundamental level, Supply Chain must incorporate sustainability-related questions into the RFI/RFP process and documentation. Meaningful action starts with asking strong questions. In addition, Supply Chain should work with suppliers and service companies to make sure sustainability-related information and data is readily available at the point where purchasing decisions are made.

“Supply Chain can help sustainably minded suppliers make the case as to why one product may be preferable to another. A great example of this is the decision to buy reusable versus disposable products. Reusable items can sometimes bring a bigger price tag, but they are often economically favorable over their lifetime as compared to buying and disposing of a new item for each use. Supply Chain can be critical in helping educate purchasers and enable environmentally conscious decision making.

“Supply Chain should work collaboratively with healthcare systems’ subject matter experts. Premier maintains an Environmentally Preferred Purchasing Advisory Council made up of specialists in this area from a cross-section of our membership. The Council’s input is vital to ensuring that our sustainability efforts reflect their goals and that the documentation sent to suppliers is fit for purpose.”

Cristina Indiveri, Senior Director, Strategic Programs, Vizient

“We believe that a critical step toward incorporating sustainability into their contracting work is adopting a set of environmentally preferred attributes and requesting that this information be included in all requests for proposals (RFPs). They can also incentivize suppliers to submit environmentally preferred information by offering additional points within the RFP process. We also encourage supply chains to directly communicate their organization’s preference and use of environmentally preferred items via public reports and public, organizational mission statements.

“Vizient took this step in 2017 and we now have 81 percent compliance from suppliers, and it has resulted in increased engagement and adoption of environmentally preferred products in our contact portfolio.”

Hannah Anderson, Sustainability Specialist, Medline Industries

“When working with a supplier, I think the top priority is to create a roadmap for sustainability efforts and have a conversation with suppliers and service companies so they understand the organization’s goals/priorities. This will help them guide your contracting efforts and most importantly, help determine if that supplier is a right fit. To help guide success, I recommend that healthcare providers work with suppliers who are operationally energy efficient and consider certifications like LEED, BCI, ISO14001 and more. A few other things to consider:

• Be clear about the chemicals your organization allows and the chemicals of concern the organization is trying to eliminate. Some of the chemicals we’ve heard that customers are trying to eliminate include formaldehyde, flame retardants, and polyvinyl chloride. I suggest that healthcare organizations develop a standards document that they can have as a reference to share with suppliers.
• Incorporate a recycled content standard for your packaging. Determine a threshold, based on your product offering that makes sense for your organization, and include those percentages in your documentation. At Medline, we reference the EPA’s procurement guidelines, the Federal Trade Commission’s Green Guides, and industry leadership for direction on best practice.”

Stacey Winston, Vice President, Program Management, Intalere

“It’s important to ensure that you have visibility to your entire supply chain and that you map it out from the context of sustainability, understanding social, economic and environmental challenges they face and how they are addressing. You can then better understand potential opportunities for those suppliers to respond to those challenges and improve their sustainability footprint.

“In addition, as an organization adopts sustainability goals internally, it’s critical that those very same goals, metrics, and KPIs are extended to supplier partners so they can better align to those enterprise goals. In addition, these should be included in RFPs to ensure that any new or prospective suppliers are evaluated in the context of how they will assist the enterprise in achieving these goals. A supplier is much more likely to adopt those goals and standards in order to win the business as opposed to simply maintaining existing business.

“Finally, it’s important that sustainability goals are captured in a contractual document, either explicitly or as part of a supplier performance management program. This could also include sustainability goals for the supplier to implement with their supply base. On an agreed upon frequency, at least annually, the supply chain team and the supplier should meet to discuss mutual actions and performance on sustainability initiatives.”      

Editor’s Note: For additional tips and techniques, be sure to visit “Environmental Sustainability: More process than progress?” November 2019 HPN, https://www.hpnonline.com/21114109 and “Embarking on environmental sustainability,” November 2019 HPN, https://www.hpnonline.com/21114251.