If green is the new black, why are some seeing red?

Oct. 27, 2023
Ethical, moral, responsible concerns clouded by financial, operational aims
Recycling and sustainability, the dynamic duo of a circular economy, seems ensnared between a rock and a hard place. Some might see it as running in circles, questioning perceived outcomes as well as the pathways to those outcomes. Skeptics may debate the necessity and severity of it all as cynics effectively dismiss the never-ending hue and cry.

However, many converge around a single – and simple – question: What is the value proposition for recycling and sustainability? If it costs more to do “what’s right,” is that worth it? Sift your response through administrative, clinical, ethical, financial, moral, operational, and societal filters. 

Emerging from the nearly three-year pandemic era, which generally seemed to dominate priorities, healthcare organizations, by and large, have returned to a host of priorities that they likely relegated to lower ranks from 2020 to earlier this year – such as recycling and sustainability. 

Yet as healthcare organizations “reboot” their post-pandemic strategic plans, have those organizations elevated recycling and sustainability on the priority list or returned to standard operations circa 2019? Reviews are mixed even as views are variable (see sidebar titled "What motivates recycling, sustainability in healthcare organizations?"). 

“Legacy sustainability programs had no value proposition – they were a financial burden to hospitals, and the question became whether to do the right thing or to do the thing that made financial sense,” Lars Thording, vice president, Marketing & Public Affairs, Innovative Health, told Healthcare Purchasing News. “This is because legacy sustainability programs were straight-out recycling programs where used items were broken down to component parts and inserted into ill-equipped recycled parts manufacturing – in a very expensive process. The fact is that in terms of circular utilization, recycling is a very poor solution. 

“Today’s emerging circular programs combine environmental sustainability with financial upside,” Thording continued. “When an item is not broken down into its component parts, but rather made ready for a second use, there is balance in the sustainability-cost equation: Tomorrow’s circular solutions reduce costs and environmental impact. Single-use device reprocessing, for example, retains the value of devices while reducing carbon footprint by 50% or more. Recycling solutions are the enemy of financially and environmentally responsible reuse. High-value circular solutions achieve both because they are about bringing extra life to items, not piecing out their death.” 

Circular pain in the gas 

Whether a healthcare organization has yet to embark on a recycling/sustainability project or program for the first time, looks to re-engage in environmental responsibility after a multi-year gap or seeks a fresh new target to accelerate ongoing efforts post-pandemic, corporate supplier executives whose companies service and support recycling and sustainability strategies and tactics industrywide offer plenty of recommendations. To begin, any prospective project or program should be preceded by an operational audit of supply chain operations. 

“Be strategic in your efforts by identifying an area in the supply chain where you can reduce your environmental footprint,” suggested Jim Burgess, director, Sustainability, Medline Industries. “Supply chain, specifically purchased products, make up the majority of emissions for a healthcare organization. If progress is to be made on reducing the impact of healthcare, a major focus must be purchasing only those materials that are both made from renewable energy and can be 100% recycled. Health systems can set green purchasing goals and work with their suppliers to identify sustainable products that will help them achieve their objectives.” 

Burgess touches on one area that seems to resonate the most, echoed by Innovative Health’s Thording and several others who zero in on reducing carbon emissions with no impact on finances or patient care. 

“Our most pressing sustainability challenge is climate change, so every organization needs to work towards carbon neutrality or net zero,” said Deb Fillis Ryba, global director, Corporate Social Responsibility and Sustainability, Nice-Pak/PDI Healthcare. “This is an ambitious goal that would allow for a broad range of sustainability initiatives, including recycling programs. Organizations can look across their value chain to identify the areas they want to impact, from engaging suppliers to address their carbon footprint, to focusing on their own waste streams or making it easier for staff, patients, and visitors to use less energy.” 
Mikhail Davis, director, Technical Sustainability, Interface, concurs, homing in on specific areas of concern. He said, “Currently, healthcare systems contribute to around 5% of annual greenhouse gas (GHG) emissions, with a majority of that percentage corresponding to embodied carbon emissions. Embodied carbon is defined as the GHG emissions generated by the manufacturing, transportation, installation, and disposal of materials used in buildings.” 

“Reducing a healthcare facility’s embodied carbon emissions presents a huge opportunity for the industry to decarbonize,” Davis continued. “To do this, healthcare organizations must begin tracking the embodied carbon of all purchases. This accounts for emissions generated by their providers and suppliers on their behalf, called ‘Scope 3, Category 1 Emissions’ by regulators.” 

“By tracking the emissions generated by their purchases, healthcare organizations can begin identifying opportunities to reduce their footprint and even reduce costs. More importantly, they can begin to influence their key suppliers to decarbonize across their supply chains, prompting a shift to production of lower-carbon materials and encouraging sustainable innovation,” he added. 

Cristina Indiveri, associate vice president, Core Tenet Programs, Vizient, recommends reducing emissions based on cause-and-effect links to significant and numerous negative health impacts — from cardiovascular disease to heat-related death. “Extreme climate events and pollution endanger human health, and some groups are disproportionately impacted, including minority groups, the poor, the elderly, and children. Ultimately, climate change fractures the healthcare organization’s ability to deliver safe, effective care,” she indicated. 
Such efforts likely will take time for research, according to John Ullman, director, Safer Chemicals and Procurement, Health Care Without Harm. “An organization should work to accurately baseline its Scope 1, 2, and 3 greenhouse gas emissions and come up with an emissions reduction strategy,” Ullman said. “Fortunately, these steps entail an initial investment of time for collecting and analyzing data and are not reliant on making major purchases.”

Beyond carbon emissions and greenhouse gas reduction, Ashley Perry, Hazardous Waste Specialist, Daniels Health, urges healthcare organizations to evaluate waste generation in the operating room for a variety of reasons. 

“The OR is responsible for a significant portion of the healthcare organization’s waste,” Perry insisted. “There are massive opportunities for waste reduction, whether through elimination of single-use plastics – and replacing them with reusable containers – or looking for recycling opportunities for the actual waste being generated. Multiple studies estimate that 70% of OR waste is ‘blue wrap’ where there is a recycling opportunity for that material and would drive significant landfill diversion. The opportunity in the OR allows for a major impact without the effort required for certain larger projects or overarching approaches.” 
Rob Chase, founder and CEO, NewGen Surgical Inc., pinpoints trays as a key option. “Start transitioning your plastic procedure kit packaging trays to renewable plant-based trays currently on the market,” he said. “Transition off plastic in the area that is easiest first, packaging, and then move to renewable plant-based OR consumable products where available.” 
Options to make a difference abound, acknowledges Richard Radford, CEO, Cenorin. “Every institution has its own set of opportunities to significantly improve its sustainability programs,” Radford noted. “Many have begun by assessing a variety of sustainability initiatives, from better purchasing programs to the utilization of third-party reprocessors and incorporating those that seem easily workable. The result: reduced costs, environmental impact, and material waste. This approach is incremental and will certainly make steady progress.” 

What if financial concerns were removed from the equation? 

“Develop a list of all [single-patient use] devices and set priorities – from Pareto analysis [80-20 rule] for which devices would bring the best value if processed inside the hospital and saving on packaging, shipping, storage, and disposal,” Radford noted. “Follow this by determining which devices have reprocessable alternatives and creating a plan to integrate them into inventory. Next, determine the necessary FDA-cleared reprocessing technologies required to safely return these devices for next safe use on a patent. Hospitals that have taken this course have found that the savings gained will offset both labor and capital investment costs with payback in less than 18 months. This is a big step and project. However, it is safe, sound, and meets the larger goals of sustainability.” 

If money were no object, according to Tom Ricciardelli, president and CEO, SelecTech Inc., he suggests “implementing renewable energy to completely offset consumption.” 

Modifying behaviors 

Short of mandates, regulations and requirements that may involve certification, licensing and reimbursement issues, among others, the playbook to motivate healthcare organizations to participate in recycling and sustainability efforts likely centers on economic incentives. 

“I think monetary incentives are the primary driver for implementing any new program,” insisted SelecTech’s Ricciardelli. “Healthcare organizations, in particular, often operate on tight profit margins and have to drive decisions based, in large part, on use of capital and ROI. Tax credits seem to be the most implementable and attractive to organizations.” 

Others assess benefits from short-term and long-term perspectives, along with micro- and macro- impacts. 

“If there is short-term economic opportunity involved, the business will take advantage of it,” assured Medline’s Burgess. “This is what we call double materiality, where an opportunity for improvement is both good for the business and the planet. An area that remains yet to be explored for economic payback is climate risk in both physical and transitional. There can be long-term business incentives found here to take advantage of and reduce the risks of relying on current systems.” 

Interface’s Davis emphasizes the competitive impact of environmental responsibility. “The threat of losing business should be an initial motivator for providers and suppliers to implement recycling and sustainability programs,” Davis insisted. “Today, sustainability is no longer a ‘nice to have.’ Instead, it’s an expectation and a pathway for winning additional business. 

“It’s important to prioritize sustainability and continuous innovation to remain competitive in the marketplace,” he continued. “If you are going up against another supplier to win business but cannot show that sustainability is deeply integrated into your organization’s strategy, you will most likely lose out on that business.” 

Still, much hinges on specific choices and actions made, according to Cenorin’s Radford. 

“Recycling has its own set of incentives that will return some benefits to healthcare institutions,” he said. “However, reuse of devices has a far larger impact on cost savings and sustainability, and thus, a stronger incentive to implement as broadly as possible. The reuse of devices does not eliminate recycling; it may just postpone it. The alternative is to repurpose the device construction materials to another purpose. An easy example is found in any number of plastic devices used throughout the hospital. These devices have a natural or stated useful life, many times listed in the [instructions for use]. There may be hundreds of examples of this in most hospitals. The motivation to move in this direction is found in the values held by most providers/practitioners: Don’t be wasteful and do protect the environment. The challenge for management at all levels is to create policies and processes that will allow hospital staff to act on their natural tendencies to do what is right for sustainability.” 

To move the healthcare market toward low-carbon patient care, NewGen Surgical’s Chase posits a carrot-and-stick approach that is applied to providers and suppliers alike. 

“For suppliers it is quite possible that manufacturers of single-use plastic products could be held responsible for the end-of-life impacts to the commons and society at large – the stick – or more likely and a more effective way to move the market would be for a change in reimbursement – the carrot – to providers, paying more for measuring and achieving lower carbon surgical procedures [and] patient care. This would really drive change and get manufacturers working on low-carbon product solutions. Absent some regulatory lever being put in place, providers and suppliers should act now because we all have families and we need to do the right thing, where we have expertise and can make a difference for future generations.” 

Obvious value proposition 

Vizient’s Indiveri argues that sustainability’s value proposition should be evident already. “It yields cost savings, mitigates risk, improves resiliency, increases efficiency and most importantly, is critical for human health and safety,” she said, adding that many facilities already recognize it. 

“Many healthcare organizations are connecting their mission statements with the health impacts occurring due to climate change,” she continued. “Everyone’s health will benefit from efforts to reduce carbon emissions. Other healthcare providers are leveraging sustainability’s comprehensive economic benefits through reprocessing programs, energy-efficient initiatives and anesthetic gas management to reduce costs. In addition to cost reductions, funding mechanisms are now available through the Inflation Reduction Act and other climate action resources to provide incentives for this work.” 

Plus, some providers are leveraging sustainability to support resiliency, Indiveri adds. “Prioritizing sustainability supports supply assurance, value chain sustainability, and furthers transparency and visibility to encourage agile decision-making. For instance, sustainability goes hand-in-hand with local purchases to reduce carbon emissions and transportation costs, assure supply chain resiliency and domestic sourcing, improve quality control, and forge partnerships with community-based suppliers for job creation to stimulate the local economy,” she noted. 

If anything, recycling and sustainability encourage healthcare facilities to evaluate what they do holistically, according to Health Care Without Harm’s Ullman. “Sustainability and recycling programs can spur organizations to more closely analyze their procurement practices as well as waste streams, which has the potential for creating operational efficiencies and cost savings,” he indicated. 

PDI Healthcare’s Ryba offers more of a global viewpoint. “Ultimately, healthcare leaders need to understand that the effects of climate change have direct impact on population health and could lead to overburdening the healthcare system,” she concluded. “We are all in the business of healthcare delivery and prevention, and protecting the health of the planet is necessary to protect the health of its people.”