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Editorial

M a r ga r e t F . S c h u l t e, D B A , F A C H E

Feature Articles

Hospitals and the Environment

Sustainable initiatives can be attained by starting small, gaining broad participation, accomplish-

ing achievements, publicizing them, and bestowing recognition upon the participants.

D a v i d P . G e h a n t , F A C H E

Demonstrating Reverence for the Earth

As a community hospital and a major employer, St. Marys Hospital Medical Center in Green Bay,

Wisconsin, assumes responsibility not only for the health of people in the community but also for

the health of the environment in which they live.

J a m e s G . C o l l e r , F A C H E , a n d A n n e t t e L . G r u ns e t h

Commentaries

Why Should Healthcare Bother?

The healthcare sector is realizing that green construction and operation makes business sense.

Rob i n G u e nt h e r

The Challenge of Sustainable Hospital BuildingFew topics are as timely as discussions of our shared sustainable future, and there are few settings

more difficult to design for sustainability than hospitals.

D . K i r k H a m i lt o n

Greening Healthcare: 21st Century and Beyond

As we move ahead in the 21st century, what future steps will hospitals need to take to protect not

only patients and staff, but the planet?

A nna G i l m or e H a l l

V O L U M E 2 5 N U M B E R 1 F A L L 2 0 0 8

O F H E A L T H S E R V I C E S M A N A G E M E N T

Frontiers of Health Services Management is committed to providing our readers with compelling, in-depthfeatures and commentaries that are of current importance to the practice of health services management by

drawing on the expertise of the best practitioners and scholars.

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Scott E. Armstrong, FACHEPresident & CEO, Group Health Cooperative,Seattle, WA

Gabrielle K. Causby, FACHEPresident, Thomasville Medical Center,Thomasville, NC

Dolores G. Clement, DrPH, FACHE

Professor, Virginia Commonwealth University,Richmond, VA

Terence T. Cunningham III, FACHEAdministrator/CEO, Shriners Hospitals forChildren Los Angeles, Los Angeles, CA

Rosemarie T. Dunn, FACHECOO, First Class Solutions, Inc.,Maryland Heights, MO

Trent E. Gordon, FACHEManager, Business Development and PlanningAdvocate Health CareGood Shepherd Hospital,Barrington, IL

Erica Hamilton, RNExecutive Director of Emergency ServicesUniversity of New Mexico Hospital,Albuquerque, NM

Steven M. Hatkin, FACHEPresident, Buffalo Hospital, Buffalo, MN

Erie J. Hebert II, FACHEEVP, West Jefferson Medical Center, Marrero, LA

Lt. Col. Heather M. Landon, FACHECommander, 75th Medical Support Squadron,75th Medical Group, Hill AFB, UT

Maria R. Shirey, FACHE

Principal, Shirey & Associates, Evansville, INDennis G. Tobin, FACHEAdministrative DirectorDartmouth-Hitchcock Medical Center,Lebanon, NH

Maj. Randall Webb, FACHEChief, Medical Facilities Modernization,U.S. Air Force, Falls Church, VA

Lauren E. YedvabSr. Vice President, New York Methodist Hospital,Brooklyn, NY

Frontiers of Health Services Management (ISSN 0748-8157) is pub-

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Volume 8, Number 1.

Frontiers of Health Services Management

Maureen C. Glass, FACHE, CAEPublisher, American College

of Healthcare Executives

Chicago, IL

Eduard B. AvisManaging Editor

Health Administration Press

Chicago, IL

Margaret F. Schulte, DBA,FACHE, Editor


Chicago, IL

Scott R. MillerLayout Editor


Chicago, IL

Frontiers 25.1:20.4 8/13/08 1:13 PM Page ii


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LMargaret F. Schulte, DBA, FACHE, is an associate professor in the Graduate Program in

Health Administration at Grand Valley State University in Grand Rapids, Michigan.

I w a s d r i v i n g o n a c o u n t r y r o a d the other day, the rain falling

fiercely for a while, and the sky to the left was black as night. As I questioned

the wisdom of picking that day and time to go shopping, I came to a sharp left

turn in the road, and suddenly the sun came out brilliantly on my right. I knew

there had to be a rainbow. I made the left turn, and as I slowed my car to look

for it (a safe maneuver on what is typically an almost deserted country road),

there it was, a brilliant full arc! I pulled over and watched the rainbow in all its

brilliance. After a few minutes it began to fade, and I continued on my mun-

dane trip. The dying rainbow became a metaphor for what this issue of Fron-

tiers is all aboutthe fading of our amazing, life-sustaining planet, and theimportance of doing something about it.

We in healthcare, with our abounding construction, tons of waste mate-

rials (some hazardous), 24/7 operations, and ongoing potential to injure or

help our environment, share enormous responsibility for protecting our envi-

ronment. Many healthcare organizations have already unleashed green ini-

tiatives. They recognize that people heal better in environmentally friendly

spaces, that all humans do better in such spaces. They also know that, with the

significant presence healthcare providers have in their communities, there is

abundant opportunity to take the lead in curing the environmental ills of those

communities. In many towns, the healthcare provider organizations are

among the largest employers. From that strong presence, we have the oppor-

tunity and the responsibility to provide leadership and example to others to, as

our authors from St. Marys in Green Bay, Wisconsin, say, do the right thing.

Now, you might be sitting there saying, Yes, but doing this right thing is

going to cost me money! Think again. In this issue of Frontiers youll read

about hospitals that have made it work financially, and youll hear from some

of our leading green experts reporting on the positive financial impact of envi-

ronmentally friendly initiatives.

Boulder Community Hospital in Boulder, Colorado, and St. Marys

Health System in Green Bay are two hospitals that have taken action in their

building projects, waste disposal, purchasing, and in other functions to ensure

Editorial

Margaret F. Schulte 1

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that they take care of their locality. Their award-winning initiatives have grown,

and they have enjoyed not only recognition and appreciation, but financial ben-

efits, growing employee pride, and the satisfaction of fulfilling a mission to

improve and protect the earth while they heal people. They, and our commen-

tators, while from divergent roles, all send a resounding message about the

impact of hospitals on our environment: The need to act is nowa healing

urgency is upon us.

Back to thinking of that rainbowat one time we dreamed childhood

dreams of a magical pot of gold at the end of the rainbow, but somehow we

could never find that pot. Now we come to know that the pot of gold is the rain-

bow itself. Our earth, and the environment it provides for us, must not be

allowed to fade or our pot of gold will be lost.

The editor ofFrontiers would like to hear from you! If you have comments

or thoughts about this or any issue of Frontiers, please share them bye-mailing Margaret Schulte at [email protected].



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David P. Gehant 3

Hospitals and the Environment

BY DAVID P. GEHANT, FACHE

S u mma r y Think globally and act locally! This should not be viewed as a

worn-out clich because it is the call to action that has propelled Boulder Com-

munity Hospital to the forefront of those exemplary hospitals in the United

States that have successfully executed environmentally friendly initiatives. It isthis notion that inspired the leadership and staff at the hospital to initiate and

embrace changes in their approach to eliminating waste. These achievements,

by all measures, are nothing short of amazing.

David P. Gehant, FACHE, is president and CEO of Boulder Community Hospitalin Boulder, Colorado. He holds a doctorate in healthcare administration from

the Medical University of South Carolina.

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Background

The city of Boulder is best known for

being the hometown of the University of

Colorado. It lies in Boulder Valley, nestledagainst the Rocky Mountains. Its citizens

are well educated and, in general, outdoor

enthusiasts. Its comprised of approxi-

mately 100,000 people, and the list of

major employers includes IBM, Ball

Aerospace, Celestial Seasonings, and the

university.

Boulder Community Hospital (BCH)

employs over 2,000 individuals and has a

medical staff of over 350

physicians. Its a nonprofit

corporation, governed bylocal residents. Since 1989,

when it merged with a com-

peting hospital, there has

been significant growth in

volume and the range of ser-

vices provided. Having out-

grown existing facilities, it

built a satellite hospital on

the eastern edge of the com-

munity in 2003. This satel-

lite facility was the first

hospital in the world to earn the prestigiousLeadership in Energy and Environmental

Design certification (LEED). The award was

granted as a silver certification, which is the

second level in LEED.

The Start

It began in 1989, bit by bit, with environ-

mentally conscientious employees taking

action in a small way. Not more than a

handful of people were involved. But they

could see the waste that was generated

operating a hospital. Just as they weredoing in their homes, they started to recy-

cle paper and containers from the hospital.

Their grassroots efforts were observed by

co-workers, physicians, and management.

Questions were raised. What is the

state of our environment? What about

global warming, pollution, and conserva-

tion? Discussions were held in the hall-ways, the cafeteria, offices, and conference

rooms. As a result, management decided

to jump in with both feet and make it an

organizational priority to act in an envi-

ronmentally friendly manner whenever

possible. It was the right thing to do, and

it was an innovative approach that

brought the goals of the organization and

personal goals of employees into align-

ment.

A green team was soon appointed, con-

sisting of interested employees willing toplan and act in concert with a volunteer

environmental coordinator. This group for-

malized the recycling program and in the

year 2000 collected over 150,000 pounds

of recycled material. Not only employees,

but physicians were becoming involved,

applauding the efforts. Because of the syn-

ergy this created, a full-time employee was

hired to publicly formalize the hospitals

commitment to initiate and sustain envi-

ronmentally friendly initiatives. Selecting a

person to assume the duties of this positiondeserves careful consideration. He or she

must be passionate about the environment.

It is also important for this person to be a

good communicator, have a personality that

can build trust, is easily approachable, and

possess the ability to work in the political

environment that exists in hospitals.

Management set about to create guiding

principles. These principles had been

espoused by many of the employees work-

ing diligently in the environmental pro-

gram. With their input, the statement wascreated and presented formally in a docu-

ment to the board of directors. Getting its

endorsement was important for organiza-

tional commitment and funding. A docu-

This satellite facility

was the first hospital inthe world to earn the

prestigious Leadership in

Energy and Environmental

Design certification

(LEED). The award was

granted as a silver

certification, which is the

second level in LEED.

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ment entitled Statement of Principles of the

Environment was approved. At that point,

environmentally friendly initiatives were

being identified from the top down, as wellas from the bottom up. They permeated the

culture. The statement reads as follows:

Boulder Community Hospital

Statement of Principles of

the Evironment

With deep concern and respect for our

environment and the quality of life of

our staff and consumers, Boulder

Community Hospital is committed to

the following principles:

To minimize waste and ensure con-

taminated waste is disposed of in asafe and responsible fashion.

To support and encourage recycling of

the materials used within the hospital.

To actively seek, evaluate, and imple-

ment methodologies that limit the

use of non-renewable resources.

To minimize and strive to eliminate

emissions of toxic or dangerous sub-

stances into the air, water, or earth.

To encourage the use of transporta-

tion alternatives to the private auto-

mobile, through financial and otherincentives.

To purchase and use recycled prod-

ucts when the cost of such products

is comparable to or slightly more

expensive than virgin materials.

To favor the use of reusable prod-

ucts and materials, as opposed to

disposable products, such as surgi-

cal gowns, packs, and diapers.

To encourage conservation of water

resources.

To disclose to employees and pub-lic, incidents due to our operation

that cause environmental harm or

pose health or safety hazards and

not take any action against employ-

ees who report to management

such an adverse condition.

Our efforts then advanced from recy-

cling to a goal of eliminating waste. These

principals expanded our horizon beyond

recycling into a broad scope of waste

reduction. These expanded efforts

included using water efficiently and pur-

chasing green supplies, and ultimately led

to our pursuit of the LEED certification at

our new hospital. During this process, the

hospital received public recognition and

was awarded Colorados prestigious Recy-

cler of the Year Award. This public honor

struck a resounding chord with all of the

hospitals constituents.

LEED Certification

The LEED process started with all parties

having a mutual understanding of and

shared commitment to this end. They

forged a team going into uncharted waters

for a hospital facility. Prior to this, only less

sophisticated buildings were able to secure

LEED designation. Some of the green con-

struction elements of our new building

were the use of energy efficient windows,

the diversion of construction waste,

xeriscaping (landscaping that doesnt need

extra irrigation), the use of reprocessed and

recycled materials, and yes, even installa-

tion of waterless urinals. The result was an

environmentally friendly building and a

highly efficient hospital, delivering the best

in high technology.

Gaining Momentum

The original green team that consisted of

interested volunteers from the hospital

evolved in the organization to sustainable

advisors in every department of the hos-

pital. These individuals serve as resources

David P. Gehant 5



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for our full-time sustainability coordina-

tor. Several of the green team volunteers

assumed this duty in their department.

This has worked well, because now alldepartments have environmental cham-

pions. Each serves as an advocate to the

process and provides a channel of com-

munication for employees that is reliable

and easily accessible. Recycling alone has

now grown threefold to 500,000 pounds

per year.

One suggestion of the advocates that

the hospital accepted was to start purchas-

ing green supplies. Purchas-

ing green supplies means

selecting items by assessingtheir environmental impact.

It means selecting those

supplies that can be reused

rather than recycled. Seek-

ing green supplies also

entails working with manu-

facturers to modify their process in order

to eliminate bulky packaging. It was in this

area that the hospital scored its first big

cost reduction. The sterile processing

department switched to hard, reusable con-

tainers instead of plastic wrap, whichreduced expenses in excess of $100,000

per year.

It is noteworthy to examine the variety

of recycling activities shown in Table 1.

The hospitals efforts to reduce waste

go beyond recycling. Table 2 summarizes

other actions that contributed to healthy

environmental initiatives.

Whats Next?

As is evident from reviewing Tables 1

and 2, the hospital has been successfulin sustaining an environmental mind-

set in its planning and decision mak-

ingbut were not done yet. There are

still numerous initiatives in the works.

The sterile processing

department switched to

hard, reusable containers

instead of plastic wrap,

which reduced expenses in

excess of $100,000 per year.

Table 1 Types of Recycling

containers

cardboard

paper

electronic equipment

medical equipment

medical supplies

batteries

furniture

food for commercial composting

reprocessing

Totaling 500,000 pounds annually

Table 2 Other Environmental Initiatives

Board approval of environmentalprinciples to guide decision making

Achievement of LEED Silver Certification

Alternative transportation provisonfreebus pass for every employee

Wind power purchase

Green supplies procurement

Lighting retrofit

Water conservation audit

Solar panel installation

Elimination of mercury

Elimination of latex

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They include more solar installations on

buildings, construction of a solar roof

covering one or both of the hospitals

parking garages, creation of furtherincentives for employees to promote

alternative modes of transportation, and

the creation of a document that provides

specifications to build green whenever



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Recognition

It is gratifying to be recognized locally and

nationally for the work and accomplish-

ments of our employees to minimize thenegative impact of hospital operations on

the environment.

One of my favorite awards was given to

us in 2004 by Eco-cycle, a local nonprofit

environmental organization. Eco-cycle

made an effort to quantify BCH initiatives

in terms of conservation. The award reads:

Going for Zero Wasteor Darn Near

in 2004

Conserved:

3,786 30 ft. trees1,558,970 gallons of water

999,773 kilowatt-hours of energy

1,779 cubic yards of landfill

13,501 lbs of air pollutants

We also received two major awards

from the State of Colorado. In 2005 and

2007, we were recognized as a leader by

the Colorado Department of Public

Health and Environment.

In 2006, the American Hospital Asso-

ciation recognized the hospital with itsEnvironmental Leadership Award from

Hospitals for a Healthy Environment.

Also in 2006, the hospital was recognized

with the 2006 Making Medicine Mercury

Free award.

In addition, the hospital received the

Our World Award from Rotary Interna-

tional for its environmental stewardship.

Table 3 lists our awards chronologically.

Cost Savings

Environmental initiatives sound good toaltruistic people, but they also produce sig-

nificant savings. At our hospital, being able

to track cost savings is importantit also

serves as a basis to justify further invest-

remodeling or construction occurs. It is

our intention to make this working doc-

ument available to any organization

planning construction.Solar panels on the roofs of buildings

serve as an alternative energy generating

source. To date, panels generating 60

kilowatts are fully operational. There are

plans to install additional capacity of 107

kilowatts over the next several months.

The amount of energy currently generated

is enough to power 28 average homes in

the United States.

We are studying the feasibility of con-

structing a roof grid over parking

garages upon which solar panels can besecured. If our study confirms that this

is financially feasible, it would increase

our solar power capacity by more than

tenfold.

Creating additional incentives for

staff to utilize alternative transportation

is a high priority. Providing all employ-

ees with a free bus pass has yielded sig-

nificant results, but our parking garages

and parking lots are still full. Not only

would successful initiatives cut down on

global warming from fossil fuels, buthaving more employee parking places

unoccupied makes accessing the hospi-

tal more convenient for patients and

their families.

Creating a usable, working document

that can serve as specifications for remod-

eling or new construction would be a

worthwhile project. Not only would it pro-

vide guidelines to our staff in Boulder, but

it could be disseminated and applied by

any hospital manager.

Finally, we would like to identify ourcarbon footprint. This analysis quantifies

the amount of pollution the hospital cre-

ates. Once determined, we will make

plans to effectively offset it.

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Table 4 Sustainable Cost Savings

Annually

ments in environmental initiatives. Savings

have been extracted as a result of reprocess-

ing, reduced hauling, electrical savings, and

overall waste reduction. Table 4 specifiesthe tangible savings from the listed activity.

The management team is convinced

there are more cost savings than these.

These just happen to be the most signifi-

cant, and easiest to clearly identify.

There is no question that going green

generates a beneficial financial return.

One good example not included on the list

has to do with our solar panel installation.

These arrangements are referred to as

power purchase agreements. The hospital

leases space to an entity that finances andinstalls the solar panels at no cost to the

hospital. This entity, in turn, sells the

power to the hospital. The financial bene-

fit to the hospital is that the price of the

electricity is guaranteed at a fixed rate for

a period of 20 years. This is important to

the hospital, because it protects us from

increasing electricity costs. The price per

kilowatt-hour is frozen at todays price

and remains in effect for the term of the

agreement. At the end of 20 years, owner-

ship of the panels reverts to the hospital.

Employee Allegiance

Embracing environmentally healthy ini-

tiatives becomes woven into an organiza-

tions culture by motivated and loyal

employees. Not only does the hospital

gain in strength of character, but this new

profile helps recruit dedicated staff mem-

bers who aspire to attain these initiatives.

Comments like these are not unusual:

Im proud to work for this hospitalbecause it cares about our environment.

Im glad to have the chance to partici-

pate in a worthy cause.

I took this job because of the hospitals

commitment to helping the environment.

A hospital that supports environmen-tally friendly initiatives will gain a strong

allegiance from its employees.

Obstacles: Maintaining

Confidentiality

Shredding documents protects the confi-

dential information they once held, but it is

Reduction in surgical wrap

Reprocessing instruments

Elimination of shredding

services

Reduced trash hauling

Lighting efficiency upgrade

Full-time employee

reduction in housekeeping

Water efficiency

Total Savings:

$120,000

$95,000

$90,000

$45,000

$35,000

$150,000

$25,000

$460,000

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Table 3 Awards Earned by Boulder

Community Hospital

2004 Eco-cycle

2004 Our World Award, Rotary

2005 Bronze Achiever, State of Colorado

2006 Hospitals for a Healthy Environment

2006 Making Medicine Mercury Free

2007 Gold Leaders, Colorado Department

of Public Health and Environment



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costly and creates too much waste. We

embarked upon a procedure that yielded

cost savings, eliminated waste, and secured

important information. Following this pro-cedure enabled us to take a confidential

document from a nursing floor in Boulder

to an ink removal facility in Arizona, with-

out fear of violating the Health Insurance

Portability and Accountability Act (HIPAA).

Below is a step-by-step explanation of what

our hospital did to achieve this.

Securing transfer of recyclabledocuments

Step 1: Paper is tossed in bin on a nursing

unit. The bin is located in an area wherepublic access is restricted.

Step 2: The nursing staff empties their

bins into a 90-gallon recycling toter.

Step 3: Housekeeping staff picks up the

toter and replaces it with an empty toter.

Toters are locked at all times.

Step 4: Our local recycling organization

places the material from the toters into its

truck.

Step 5: The material is bailed at a process-ing center.

Step 6: Bailed material is placed in a locked

train car and transported to Arizona.

Step 7: The reprocessing center in Ari-

zona dumps documents into a vat that

removes the ink from the documents.

Step 8: Once the confidential information

has been removed in the de-inking

process, the paper is processed into recy-

cled material.

(Key point: The hauling company has

adopted a HIPAA policy that all employ-

ees must adhere to. This includes drivers

and material handlers.)

Advice to Others Considering

Environmental Initiatives

One doesnt have to look far to see the

urgency to minimize the environmentalimpact of operating our nations hospitals.

The disasters resulting from global cli-

mate change, the effects of pollution on

our health, the costs of energy, and the

heavy damage to our waterways all under-

score the situation.

Enough is enough. Its time to get

started, and many are taking this seri-

ously. Our sustainability coordinator has

now provided more than 75 tours to hos-

pitals, architects, and other companies

from throughout the United States, allseeking information about our projects

and LEED certification. In addition,

healthcare offices from seven countries,

including England, France, Australia,

New Zealand, Canada, Mexico, and

Malaysia, have communicated with us to

learn more about our successful environ-

mental initiatives.

My advice is to take action now. Here

are some simple steps to get started on

your hospitals environmental program:

11. Talk it up with co-workers.

12. Stress the urgency of the situation.

13. Appoint a steering committee.

14. Create an environmental principles

statement.

15. Create a position for an environmental

sustainability coordinator.

16. Get early buy-in from a department that

is willing to pilot a recycling project.

17. Buy large recycling containers.

18. Record achievements.

19. Communicate achievements through-

out the organization.

10. Recognize the individuals involved.

11. Expand the efforts to more depart-

ments

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upon the participants. In our particular

case the results are amazing. Since 2000

our comprehensive waste reduction

efforts have diverted over 3 millionpounds of material from landfills.

ReferenceKotter, John. 1996. Leading Change. Harvard Busi-

ness School Press, Cambridge, MA.

12. Add/plan new initiatives.

13. Refer to the change process as defined

by Kotter (1996).

Summary

Sustainable initiatives can be attained by

starting small, gaining broad participa-

tion, accomplishing achievements, publi-

cizing them, and bestowing recognition

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James G. Coller and Annette L. Grunseth 11

Demonstrating Reverence for the Earth

BY JAMES G. COLLER, FACHE, ANDANNETTE L. GRUNSETH

S u m m a r y As a community hospital and a major employer, St. Marys

Hospital Medical Center in Green Bay, Wisconsin, assumes responsibility notonly for the health of people in the community but also for the health of the

environment in which they live. Demonstrating reverence for the earth is a pri-

mary strategic goal, originating with its sponsoring organization, Hospital Sis-

ters Health System, Springfield, Illinois. St. Marys Hospital Medical Center is

one of 13 hospitals in this system dedicated to healing ministries. Healing the

earth is as important to this mission as is prevention and treatment to heal the

human body. Over the past 25 years, St. Marys Hospital Medical Center has

brainstormed and implemented innovative ideas to mend the earth, improving

the health of air, water, and land, and ultimately improving the health of the

people who come into contact with our dynamic environment. It is a passionand commitment of time and resources, but one in which there is no question

that it is the right thing to do.

James G. (Jim) Coller, FACHE, is president and CEO of both St. Marys Hospital

Medical Center and St. Vincent Hospital in Green Bay, Wisconsin. Annette L.

Grunseth is a writer/editor and public relations specialist with St. Marys Hos-pital Medical Center in Green Bay, Wisconsin. She is a Fellow of the Wisconsin

Healthcare Public Relations and Marketing Society.

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Early Adopter

In our consuming culture we are increas-

ingly aware of the need to be good stew-

ards of our environment and resources,especially in healthcare. We are at the core

of our community, often the largest

employer and a large consumer of energy

and resources. Hospitals generate waste

materials 24 hours a day, seven days a

week, 365 days every year. St. Marys Hos-

pital Medical Center, located in Green Bay,

Wisconsin, is in the business of health

health of people and health

of our environment.

St. Marys Hospital has

been an early adopter ofthe environmental move-

ment because of firm

encouragement from its sponsors, Hospital

Sisters Health System (HSHS), Springfield,

Illinois. St. Marys Hospital Medical Center

is one of 15 HSHS hospitals in Wisconsin

and Illinois that follow the teachings of

Christ, St. Francis of Assisi, and St. Clare,

who believed in reverence for the earth

and all its living creatures. To this goal, the

Hospital Sisters required each hospital to

integrate environmental standards intoeach of their facilities and communities. St.

Marys, along with its local board of direc-

tors, took an immediate interest and the

lead within the hospital system more than

25 years ago, long before other hospitals felt

the need to pursue green practices. The

core belief is that protecting our environ-

ment, along with quality patient care, is crit-

ical to the communitys long-term health.

The local board of directors eagerly sup-

ported this healing ministry and saw the

role of the hospital as a leader to serve thecommunity with health for all, including

the environment. Over the years, an envi-

ronmental philosophy has evolved to

include a summarizing statement:

Environmental Statement for

St. Marys Hospital Medical Center

As part of our Franciscan values as a

member of Hospital Sisters HealthSystem to show reverence for the

earth, St. Marys Hospital Medical Cen-

ter believes protecting the environment

while providing quality patient care is

critical to our communitys long-term

health. It is our goal to continue our

commitment to the environment by

improving existing programs and

implementing new initiatives annually.

This article presents a study of what St.

Marys Hospital Medical Center accom-

plished over the past two and a half

decades by taking responsibility for the

environment as a health issue. This stew-

ardship under the guidance of HSHS, the

goals of reverence for the earth, and the

local board of directors provide a steady

direction as St. Marys Hospital Medical

Center continues to find new ways of mak-

ing a positive presence and impact on the

land for which we are responsible. These

efforts have evolved as we have invested

our dollars, our collective talent and skill,

as well as volunteer hours to make our

environment cleaner and healthier. It is an

annual commitment that has grown

rapidly through the enthusiasm and cre-

ativity of our managers and employees.

It Was the Right Thing To Do

In the early 1980s employees rallied

together with a community team as part

of a community-wide project called River-

Bay Clean Up. The initial enthusiasm

started with employee groups that volun-

teered to go out into the community and

pick up trash along the shores. Later,

another community effort was initiated

with A Day at the Museum, which was a

Hospitals generate waste

materials 24 hours a day,

seven days a week, 365days every year.

12 f r o n t i er s o f h e a l t h s e r v i c e s m a n a g e m e nt 2 5 : 1



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challenge to see who could be most cre-

ative with ways to recycle and reuse mate-

rials. St. Marys employees were creative

and competitive, and they often wonawards for their environmental efforts.

In 1984, our Nutritional Services depart-

ment began donating good, leftover food to

local food pantries. It was mission-driven tohelp those less fortunate while not having

food go to waste. Addressing the needs of

the hungry by sharing what we have is

important to us. St. Marys currently pro-

vides 12,000 pounds of food each year to

several food pantries. St. Marys also serves

as a preparation and delivery site for the

community Meals on Wheels program.In 1996, as HSHS continued to

require its hospitals to integrate rever-

ence for the earth into its operations, sev-

eral employees formed the initial Green

Team to brainstorm ideas to meet the

challenge. One idea was to capture and

improve the storm run-off water from

hospital parking lots. Pollutants such as

gas, oil, and salt coat the parking lots.

When snow and ice melt, or it rains, pol-

lutants dissolve in the water, which flows

into sewers and eventually into the FoxRiver, headed for the Bay of Green Bay

and the Great Lakes.

In 1998, a storm water management

system was built on campus to capture all

storm water run-off. For the past decade,

all storm water is sent through a unique

filtering system that extracts the pollu-

tants and releases purified and clean

water into the river and ultimately into the

Great Lakes. In 1998, this process was the

only one of its kind in a northern climate.

Cleaner water and fewer pollutants enter-ing our environment improve the health

of the riverincluding the fish, a food

sourcewhile indirectly reducing health

hazards for the people who live in the

Green Bay/Great Lakes area. This project

received national recognition and several

grants from state and federal agencies to

become a prototype project for third worldcountries to consider for implementation

as appropriate in their climates.

Environmental Action

Continues

While these earlier programs continued, a

new director of Environmental Services

was hired. With a keen interest in environ-

mental issues and a passion to make

things happen, she raised awareness to a

higher level and initiated additional envi-

ronmentally friendly programs. We nowhad an internal champion to continue and

grow the reverence for the earth mission

of the Hospital Sisters. With her leader-

ship, the Green Team tackled recycling,

reduced medical waste, located and elimi-

nated unused chemicals, streamlined

energy use, developed programs to go

mercury-free, and improved green space

on our campus.

Recycling Gets Everyone

InvolvedPaper, plastic, aluminum, and daily trash

from throughout the hospital and office

areas was audited and every area provided

with appropriate recycling receptacles. This

was an effort everyone could become

involved in and feel good about while con-

tributing to the improvement of the envi-

ronment. Formal in-services were held to

train staff. Refresher mini-classes at

department meetings along with articles

sent via our internal employee newsletter

and intranet reinforced the environmentalmessage to every employee and physician,

reminding them how and where to recycle.

St. Marys took environmental prac-

tices to a new level in 2003 with member-



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safely reused. St. Marys formerly con-

sumed 16 gallons of xylene per month,

but the distilling process reduced that to 4

gallons per month. The positive result isless chemical needs to be handled, dis-

posed of, and purchased.

As of 2007, St. Marys overall recycling

rate has increased from 31.5 percent to 40

percent, which means in all our waste

streams, 40 percent less trash is sent to the

landfill. In the calendar year of 2007, we

had a total of 806,515 pounds of waste

materials. We recycled 327,536 pounds of

materials, which went to other sources or

was recovered by other companies, and in

many cases turned into other new prod-ucts (see Table 1). We often received rev-

enue for materials recycled. It is our

annual goal to keep increasing the percent-

age of recycling pounds while decreasing

the percentage of true waste that is headed

for the landfill.

ship in the not-for-profit organization

Hospitals for a Healthy Environment, also

known as H2E. This national organization

works together to improve the environ-mental performance of the healthcare

industry (Practice Greenhealth 2008).

By 2006, St. Marys overall recycling

rate was 31.5 percent. A recycling rate of 25

percent was considered exceptional by

H2E. St. Marys felt proud to

be doing better than the

industry standards in our

corner of the world. Our

waste streams were given

continual attention by

employees and the list ofrecyclables grew.

To deal with xylene, a

chemical used in laboratory tests, the hos-

pital invested in a distiller that recycles

used xylene. The xylene is converted into

vapor and recaptured so that it can be

St. Marys formerly

consumed 16 gallons of

xylene per month, but the

distilling process reduced

that to 4 gallons permonth.

Solid Waste 433,717 General Trash

Medical Bio Waste 45,262 General Trash

Total Waste 478,979 General Trash

Shredded Confidential 102,218 Recycle

Paper/Cardboard 151,440 Recycle

Silver Recycling 720 Recycle

Pallets/Scrapwood 1,872 Recycle

Grease/Oil 9,720 Recycle

Electronic Recycles/Lamps 11,556 Recycle

Print Cartridges/Ink Rollers 1,774 Recycle

Scrap Metal 7,784 Recycle

Tin-Glass-Aluminum 7,780 Recycle

Food Bank 11,040 Reuse

Missions Donations 21,632 Reuse

Total Recycle/Reuse 327,536 Recycle/Reuse

Material Pounds Waste Stream

Table 1 2007 Waste Stream Summary




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needed to diagnose and treat patients. One

procedure is replaced by another, and in

that process, items no longer needed get

pushed aside and soon forgotten. One ofthe ideas from our Green Team was to

implement a proactive Chemical Round-

ing Team that would attempt to locate and

dispose of unused and unwanted chemi-

cals by visiting departments with an edu-

cational intent. Regulatory agencies such

as the Occupational Health and Safety

Administration, the Joint Commission,

the Department of Natural Resources, and

the Environmental Protection Agency pro-

vided understanding and direction on cur-

rent chemical/safety standards. Armedwith this source of learning and the com-

bined knowledge of the Chemical Round-

ing Team, ten departments were initially

visited, which resulted in removal of 419

gallons of expired and obsolete chemicals.

Fifty-eight pounds of dry chemicals were

also removed during that first round-up,

and mercury switches were removed from

equipment. Hard copies of Material Safety

Data Sheet (MSDS) Manuals were

removed and made current through the 3E

Companys MSDS on Demand program.Outdated MSDS sheets and binders are no

longer stored in departments. From the

beginning of our efforts through Decem-

ber 2007, 4,700 pounds of liquid or dry

chemicals have been removed and prop-

erly disposed of.

The Chemical Rounding Team concen-

trated efforts in key areas that housed

larger quantities of these materials, such

as Plant Operations, Housekeeping, and

the Laboratory. The team properly dis-

posed of old paint, anti-freeze, toxic chem-icals, and cleaning supplies. As it visited

each department, the team used an educa-

tional approach and did not expect depart-

ment staff to have all the answers. The

team conferred with the MSDS contract

Giant Steps

Medical waste, such as tissue and fluids

from surgeries and procedures, is col-

lected in suction canisters, which previ-ously were discarded as trash. St. Marys

purchased a fully automated suction canis-

ter transposal system that now handles all

surgical canisters safely. No employee has

to handle any surgical waste, as this sys-

tem safely processes the waste in an envi-

ronmentally sound manner and sterilizes

the canisters for reuse. We are now safely

recycling and re-using 7,000 canisters

annually. That means 7,000 fewer canis-

ters in the landfill! We expect this system

to pay for itself in 4.5 years.In another project, we partnered with a

company that manages sharps disposal.

The company provides receptacles, and

retrieves and disposes of all sharps mate-

rials. The receptacles are completely safe,

and once again, no employee handles any

sharps. St. Marys Hospital Medical Cen-

ter will have to purchase 1,608 fewer

receptacles. The savings realized in this

program is $9,422 annually. This trend of

partnering for sharps disposal is a new

trend in the Midwest, and our hospital,along with the 12 others in our health sys-

tem, is one of the first to adopt this newer

environmental arrangement.

A Smoke-Free Hospital and

Campus

For the safety and health of patients, fami-

lies, and employees, St. Marys Hospital

Medical Center is completely smoke-free

within all buildings as well as outside. For

the entire campus, including parking

areas and green spaces, smoking andtobacco products are prohibited.

Chemical Rounding

Healthcare technology and procedures

advance or change as do the supplies

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and educated employees to be aware of

products that arent used any longer. The

team sought out expired chemicals and

caustic materials and also cautioneddepartments not to over-stock too much of

an item.

The Chemical Rounding Team also

consolidated materials with other depart-

ments, which increased efficiency and

safety, and reduced costs. In addition, the

team took the opportunity to fit employ-

ees with current personal protective gear

and to check for proper secondary con-

tainers and labeling. It also advised

departments on proper storage areas to

ensure fire and chemicalsafety.

Streamlining

Energy

Consumption

Energy usage affects every-

thing we do today and in

the future. Therefore, when

St. Marys Hospital Medical

Center needs to make

changes with major equipment, energy

conservation is at the forefront of deci-sion-making (See Figure 2).

Focus on Energy is an organization that

works with Wisconsin residents and busi-

nesses to install cost-effective, energy effi-

cient, and renewable energy projects. Focus

on Energy supplies grants to make energy

changes that help to control the states ris-

ing costs and growing demand for electric-

ity and gas.

In June 2006, a desiccant dehumidi-

fier was added to our new surgery air han-

dling unit. This system cools surgeryfaster and removes condensation. The

surgery rooms are run at a cooler temper-

ature, which is safer for the patient having

surgery. The savings realized on this unit

was $28,375 per year, with a payback of

four years. Focus on Energy paid St.

Marys Hospital Medical Center a grant of$13,352 to help fund this acquisition.

In April 2007, St. Marys began the

project of replacing four older air han-

dling units with one larger unit. The sav-

ings per year is $5,945 in power. Focus on

Energy gave us a grant of $3,565 for this.

In March 2008, St. Marys replaced

another older air handling unit that serves

the kitchen area. This project will save the

hospital $9,431 per year in both electricity

and gas. Focus on Energy gave a grant of

$6,100 for this project. For all of theseefforts, St. Marys Hospital Medical Cen-

ter became an Energy Star partner.


does load shedding in the summer

months for Wisconsin Public Service on

peak days. When there is a large draw of

electricity, the hospital starts a small gen-

erator, which runs one of our larger

chillers. For having this capability, Wis-

consin Public Service deducts $1,500 per

month from our electric bill from April

through September.

Another Major Effort:

Making Medicine Mercury-free

Removing mercury from the healthcare

environment demanded great attention

to detail in clinical and plant operations

areas. H2E, which sponsors the Making

Medicine Mercury Free award, created

guidelines for establishing safe handling

protocols and spill clean-up procedures

for mercury. St. Marys Hospital Medical

Center implemented these proceduresand began extensive education and train-

ing of employees about facility protocols,

including information about mercury

When St. Marys Hospital

Medical Center needs to

make changes with major

equipment, energy

conservation is at the

forefront of

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and its effects on human health and the

environment. A mercury-free purchasing

policy was implemented that banned the

purchase of mercury-containing items

without approval (e.g., if a non mercuryalternative was not available.) Clinical

and facility devices were replaced with

non mercury alternatives. All mercury

devices were disposed of properly and

safely.

Community Connections

Mercury Thermometer

Exchange

The mercury-free initiative was taken into

the community. The Temperature is

Changing at St. Marys was the name of aprogram offering the public a free digital

thermometer in exchange for a mercury

fever thermometer. In May 2006, a one-

day thermometer exchange event was

held from 11 a.m. to 6 p.m. The general

public could drive through the Emergency

driveway under a weather-protected

canopy to drop off mercury fever ther-mometers and receive a free digital ther-

mometer. Consumers were given

instructions in ads and publicity on how

to safely secure their old thermometer for

transport to bring it to the hospital for

exchange.

An exchange station was set up so that

people did not have to get out of their

cars. A day in spring was chosen so this

could be done outdoors, and we were

lucky enough to have good weather.

Signage and creative latex-free balloonswere used to draw people to the correct

entrance. Many area vendors donated

refreshments, digital thermometers, and


Project Total Cost Annual Energy Savings Grants Awarded

Heat recovery system $27,390 $8,814 $2,667

for new boiler

Desiccant dehumidifier $140,000 $28,375 $13,352

system

Boiler addition $ 175,000 $32,848 $16,824

(to run smaller boiler

in summer)

Air handling unit $165,000 $9,270 $3,564

replacement (this

one unit replaced

4 older units)

Replacement air $120,000 $9,431 $9,699

handler for the

kitchen area

Table 2 Focus on Energy Project Expenses, Savings, and Grants



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recycling services to properly dispose of

the more than 800 mercury thermome-

ters that were turned in. In fact, two years

later, people are still calling to ask if wewill take their old thermometers, and of

course, the answer is, yes.

Along with the free digital thermome-

ter, each person who stopped was pro-

vided a give away bag with hospital

information from key service lines, a

womans health newsletter, and environ-

mental information. Large displays were

stationed at the drop-off

point, illustrating environ-

mental information that

could be viewed from cars.Two environmentally

conscious consumers rode

up on bicycles to exchange

thermometers.

The work to remove

mercury from within the

hospital was recognized

when H2E awarded St.

Marys Hospital Medical

Center the Making Medicine Mercury

Free award in 2006 for internal efforts

and for the consumer effort.

More Environmental Awards

In 2007, the H2E organization singled out

St. Marys Hospital Medical Center again

with two prestigious awards for environ-

mental innovations: The Hospitals for a

Healthy Environment Leadership Award

and the elite Environmental Leadership

Circle award (one of eight hospitals nation-

wide given this award in 2007) for design-

ing and implementing programs that set

industry-wide benchmarks for environ-mental stewardship. Again in 2008 we

won the Environmental Leadership Circle

Award from H2E.

Demolition Recovery and

Green Construction

We are also committed to green construc-

tion, as it is the right thing to do.During earlier interior construction

projects, St. Marys required vendors to

separate metal, copper, and cardboard for

recycling. Now that mandate incorporates

a wide range of other materials to be recy-

cled. In all current and future construc-

tion projects, St. Marys and its architects

require that the guidelines in the Leader-

ship in Energy and Environmental

Design (LEED) Green Building Rating

System be followed.

In 2005, during our construction pro-ject for a new Emergency department and

new surgical suites, we began recycling

construction debris throughout the course

of construction. We recycled 21.85 tons, or

about 24 percent of the project. Our envi-

ronmental champion even recycled some

of the demolition debris to construct tile

and metal flower arrangements for an

H2E conference.

In 2007, St. Marys Hospital Medical

Center began constructing a new wing

onto the existing hospital for cancer care.In order to make room, an outdated clinic

building was demolished. With the ven-

dors proactively involved, 81 percent of

the demolished material was recycled.

Concrete, asphalt, clean steel, mixed

metal, and copper were separated as they

were removed and hauled to recycling

centers. Also diverted from landfill or

incineration was land-clearing debris,

asphalt, Portland cement concrete, con-

crete masonry units, brick, clay products,

and ceramic tile; wood products, includ-ing pallets; metal, insulation, asphalt roof

shingles, glass, gypsum drywall, acoustic

ceiling tiles, resilient flooring materials,

In all current and future

construction projects, St.

Marys and its architectsrequire that the guidelines

in the Leadership in

Energy and Environmental

Design (LEED) Green

Building Rating System be

followed.




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carpeting, paint, plastics, cardboard,

paper, and packaging; and field office

waste including office paper, aluminumcans, and plastic bottles. (See Table 3.)

There will be no polyvinyl chloride

(PVC) products in any materials used for

the construction. In past years, it has

been difficult to find vendors that offer a

variety of PVC-free products, but now

that the concept of green construction

has grown, we are currently working

with vendors that have a wider variety of

natural rubber or ceramic flooring, PVC-

free wall covering, PVC-free glue, and

PVC-free paint and laminates. The westwing addition of our facility, currently

under construction, is a regional cancer

center, and we believe it is important to

use green building practices to construct

a treatment facility that will be helping

patients regain their health.

Healing Green SpacesThe

Power of Landscaping

Green spaces are vital to the appearance of

the hospital campus, and they create a heal-

ing atmosphere. Twelve years ago we devel-oped an outdoor prayer garden constructed

with eco-friendly materials. A local donor

provided funding to establish the brick

pathway, outdoor seating, and a statue of St.

Francis, along with perennial and annual

plants and shrubs, which were nestled into

the space just outside the hospital chapelbetween two wings of the building. The

shrubs provide privacy and decrease noise

from the adjacent busy street. The prayer

garden is used daily by patients, families,

and employees, who pause there for a

moment of prayer and peace.

Throughout the campus, seasonal

flowers and lawns provide an inviting

environment where people can also sit at

picnic tables. The recently completed

Emergency Department also has a healing

atmosphere, with a wall-mounted watergarden and plants in the waiting areas.

For the new construction project, heal-

ing infusion gardens are planned as a

vital part of the interior atrium design and

treatment areas for the cancer center. The

creation of healing gardens at both the

ground level and rooftop will provide places

of serenity and gracefulness for patients

and families to reflect and re-energize. The

healing gardens are being called infusion

gardens because the infusion patients in

the cancer center will look out onto themas they receive their treatments.

The landscaping consultant is including

a lot of water in the design. There will be

water fountains in the healing gardens for

the cancer center and outside in front of the

atrium, in the center of the drop-off area.

The roof is being prepped for a rooftop

garden area. Timing for its completion

will be staged to fit with plans for addi-

tional expansion, if more floors are added.

Mission Outreach: Local,State, Nation, World

St. Marys Hospital Medical Center, along

with the other 12 hospitals in the Hospital

Recycled steels

Recycled sheet metal

Recycled blacktop

Recycled concrete

Mixed to landfill

6.95 tons of

unprepared steel

45.73 tons

1,025 tons

1,674 tons

637.17 tons


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Table 3 Table of Recylced Materials



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equipment. For example, there was a

patient monitor that had no EKG cable,

no blood pressure hose or cuff, and no

oxygen sensor. The team tracked downand ordered various parts, then assembled

them and repaired the unit.

As equipment was repaired and pre-

pared for shipping, the bio-medical team

made sure ample supplies and acces-

sories were included. In a developing

country, access to these supplies is nearly

nonexistent. The bio-med team included

extra bulbs, batteries, and other common

parts that needed to be shipped with each

item. Overall, the team checked out and

assembled more than 100 differentpieces of medical equipment, valued at

more than $120,000, in its four-day

repair marathon. It also identified nearly

70 additional items that needed parts

and/or accessories.

Proper disposal is vital. If developing

countries are sent unusable equipment,

they do not have proper methods to dispose

of the equipment. At Mission Outreach,

any unusable items are disposed of in a

safe and environmentally friendly manner.

Challenges: Past, Present,

and Future

Our commitment at St. Marys Hospital

Medical Center with the guidance of our

sponsors, Hospital Sisters Health System,

is a long-term pledge, and for that, our

financial investment continues to be a

challenge as well as an opportunity. The

cost of recycling and reusing materials is

often more expensive than adding to the

landfill, but in the long run, we want our

earth healthier for its citizens today, andfor future generations (See Table 5). We

have partnered with agencies and organi-

zations that have helped us with grants,

and yet we also choose to endure costs to

Sisters Health System, recycles used

medical equipment and supplies to third

world countries. Through the HSHS

Mission Outreach Program, equipmentis collected and transported to a Mission

Outreach warehouse in Springfield, Illi-

nois. HSHS Mission Outreach is also a

preferred partner with the U.S. Navy Pro-

ject Handclasp, which employs Navy

ships to distribute medical equipment

and supplies worldwide to needy coun-

tries. See Table 4 for a list of places our

equipment is being used.

Additionally, one of St. Marys Hospital

Medical Center Bio-Medical Electronics

employees helped develop a partnershipbetween TriMedx Founda-

tion and Hospital Sisters

Mission Outreach. This

partnership provided volun-

teer bio-medical services for

recovery and redistribution

of medical equipment and

supplies in developing

countries.

In January 2008, one of

our contracted employees

became a team leader for agroup of volunteers from TriMedx Foun-

dation who traveled to the Mission Out-

reach warehouse in Springfield, Illinois.

Together, this team worked with the logis-

tics and warehouse manager to identify

equipment in need of repair and servicing

to make it operational before shipping it

to healthcare providers in developing

countries. Bio-medical expertise was des-

perately needed to make the equipment

useful. Most often equipment is donated

with missing parts and accessories or nooperation and service manuals. This vol-

unteer team worked for four intensive

days to check, test, repair, assemble, order

parts for, and repair many types of medical

Overall, the team

checked out and

assembled more than 100

different pieces of medical

equipment, valued at

more than $120,000, in

their four-day repair

marathon.




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in the community and region who help

share some of these costs. It is estimated

that during the past two decades we haveinvested a million dollars, and we will

continue to invest, as efficiently as we

can, to make this annual commitment to

reverence for the earth a priority.

Hindsight Insight

St. Marys Hospital Medical Center started

small and kept building upon new green,

sustainable opportunities. If I were to

advise other hospital chief executive offi-

cers on how to get started, here are some

recommendations:Engage your owners in the commit-

ment to improve the environmentShare

with the board of directors, advisory com-

mittees, physicians, department directors,

fulfill our ministry of leaving the earth

and the health of those who inhabit it in

better shape. The future holds more part-nerships for us, such as the sharps dis-

posal vendor, to ensure the health and

safety of our employees and patients.

Healing the earth also heals our patients,

the people of our community, by provid-

ing cleaner water for the fish we eat and

better soil for the gardens that grow food.

We choose to have green space on our

campus, sometimes compromising our

parking spaces. We choose to filter our

storm water run-off; invest in the most

energy efficient heating and coolingequipment; and pursue recycling, reuse,

and recovery. As we move forward, we

have a cumulative financial investment

and rely on volunteer hours and partners

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Stretchers/mattress, stretcher with foot

extender (InstaCare Stryker 1000), twowarming cabinets

Trinidad and Tobago, Eagles Nest Ministries:

Overbed table

Russian Federation, Voronezh Region:Crutches, two surgical lights/lamps

Ghana, International Health and Develop-

ment: Overbed table, birthingbed/mattress, visitor chair

Honduras, Mercy International: X-ray film

illuminator

Morocco, National Oncology Institute:Bedside table

Dominican Republic, Santiago Rodriguez

Hospital: Bedside table

U.S. Navy Project Handclasp: Five visitor

chairs and an exam stool

Thanks to a new, advanced computer

ordering and tracking system in Spring-field, in the past two years (20062007),


received confirmation that our used equip-

ment and supplies landed all over the

world, specifically in:

Orkhon Tus charity organization, Mongo-

lia: Surgical light/lamp

Ukraine, Bilokurakone Central Rayon Hos-

pital: Two recliner chairs

Cuba, Caritas Cubana: Birthing bed, crutches

Haiti, Centre De Sante: Pedicraft crib with

top and mattress, two Stryker 921 stretch-

ers with mattress

Haiti, Hospital St. Antoine de Jeremie:

Hamper, mattress, birthing bed

Pakistan, Children of Abraham, Inc.:

Table 4 Where Our Recycled Equipment is Being Used



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people find purpose and meaning in giv-

ing back to the environment and the com-

munity.

Partner with community leadersGet to

know and partner with city planners, the

mayor, the city council, and governmental

agencies. If you are proactive with them and

they know you care about the environment,

these officials will be more likely to be posi-

tive and cooperative, and they will be less

likely to criticize the hospital for being a

high-end consumer and waste producer. If

they see your intentions and efforts, positive

perceptions and relationships will develop.

Everyone cares about the environment of a

community. When talk of taxation and your

tax-exempt status comes up, hopefully, they

will remember your investment of money

and time improving the community and

will be more aware of your service commit-

ment and charitable ministry.

Find more partnersGet more people

on board with your goals. Share your pas-

sion. The more people you have partnered

with you, the greater your impact. Look to

all contacts, vendors, advisors, patients,

employees, and acquaintances. A side

benefit will be a growing positive image

and more resources becoming available to

your projects.

Tell your storyEvery other year, or

whenever we have new programs to share,

we tell our story with printed brochures

(printed on recycled paper and with envi-

ronmentally friendly ink), news releases,

and letters. We communicate with politi-

cians, legislators, city officials and health-

care associations, board members,

advisors, physicians and employees, news

mediaeveryone. As our prosperous

nation is viewed globally as a large con-

sumer, we are doing our part to make the

world better and we communicate about it.

and employees your ideas for an envi-

ronmental initiative. Tell them your

goals, your ideas, and your passion for

the projects. Ask for their ideasand

their help. Perhaps a board member owns

a company with whom you can partner to

share costs and accomplish recycling.

Look to your employees, owners, and ven-

dors to help donate supplies, services, and

time. It will be enjoyable for all, as most


Cardboard, mixed paper

Newsprint, boxboard

Plastics: #1 PET, #2 HDPE, #5

Polypropylene, #6 PS

Mixed recyclables: Glass, aluminum, tin,

steel

Wood pallets, scrap, and demolition

wood

All oil products

Ink jet cartridges, toner cartridges

Electronic equipment and components

All batteries

Fluorescent lamps, light bulbs

Landscape waste

Solvents

Diagnostic film

Construction demolition

Surgical instrumentation (for third world

countries)

Precious metals

Xylene, ethanol

Table 5 List of St. Marys Hospital

Recycled Items



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Environmental awareness and sustain-

ability happen one plastic soda bottle at a

time, one sheet of paper at a time, onemop head at a time, one surgical suction

canister at a time. Become a champion or

find someone in your organization who is

passionate to make a difference. Next

thing you know, you will have a depart-

ment director making flower arrange-

ments out of demolition rubble; your

vendors will help you recycle; and you

might even find a partner like Mission

Outreach, helping others around the

world. And like St. Marys Hospital Med-

ical Center, perhaps the governor will becommending you for your efforts and

H2E will recognize you as one of the top

facilities in the United States, setting an

example for others to follow. Whatever it

is you choose, start small and think big.

ReferencePractice Greenhealth. 2008. Vision, Mission,

Goals and MOU. http://cms.h2e-

online.org/about/.

We are making positive changes about

environmental sustainability, something

for which Americans care deeply.Take small steps to get startedStart

with a few small ideas, like recycling

paper, plastic, and aluminum, then carry

it throughout your organization. Ask

employees closest to the work in a given

area to suggest ideas. The xylene distiller

project we did was one of those depart-

mental ideas that is making a large,

ongoing impact. Using bio-friendly

materials that are able to be sanitized

and reused is one small item, but long

term makes a big impact. The little pro-jects add up to a collective, positive

impact.

Conduct environmental audits,

department by department, with a posi-

tive educational approach, and keep

information in front of constituents so

they are reminded to continue their recy-

cle/reuse efforts. It takes everyone, every

day, doing a small part to create a big

influence.




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YRobin Guenther, FAIA, is a healthcare architect at Perkins and Will in New York.She co-coordinates the Green Guide for Health Care, serves on the LEED-HC

committee, is a board member of Practice Greenhealth and the Center for

Health Design, and is the co-author ofSustainable Healthcare Architecture

(Wiley, 2007) with Gail Vittori.

BY ROBIN GUENTHER

The authors of the lead articles in this issue offer important insights

into key questions that frame the integration of sustainable principles in the

healthcare sectornamely, why should healthcare engage in sustainable build-

ing and operation and how do organizations begin the journey? Their important

work is part of a dispersed but exponentially growing movement among health-

care organizations in the United States and beyond that deserves a broader con-

text. The movement centers around these fundamental questions: Why shouldhealthcare lead health-based green initiatives? What is driving the green

tsunami in business (and in particular, the business of healthcare)? Where is

the healthcare sector at this moment in time? Why isnt everyone doing it? and

What lies ahead that may shape future responses? In short, why bother?

On Earth Day, 2008 the writer Michael Pollan (2008) had a provocative

essay titled Why Bother? published in The New York Times. He posed this

challenge: Sometimes you have to act as if acting will make a difference, even

when you cant prove that it will. The hospitals profiled in this issue, and the

growing list of institutions that share their vision and goals, embarked on a

sustainability journey in the absence of business case data or proven opera-tional models, motivated by mission and led by individuals who cared enough

to make a difference. Through their success, they have become unintentional

leaders for this industry.

Why Should Healthcare Lead Health-Based Green Initiatives?

For the CEO of St. Marys, the organizations explicit stewardship mission lies

at the core of its decision makinga common trend for religious-based health-

care organizations. Many non religious healthcare organizationslacking a

reference to stewardship in their missionapproach green initiatives through

a community benefit lens.

Why Should Healthcare Bother?

Robin Guenther 25



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A third compelling reason to go green is

the connection between green buildings and

human healtha connection recognized by

the healthcare industry that is increasinglyadopted by other market sectors. The Ameri-

can Society of Healthcare Engineering

(ASHE 2002) first framed green building

initiatives around protecting health at three

scales: the immediate health of building

occupants, health of the surrounding com-

munity, and health of the larger global com-

munity and natural resources.

Environmental scholar David Orr (2004)

writes: The standard for ecological design is

neither efficiency nor pro-

ductivity but health; begin-ning with that of the soil and

extending upward through

plants, animals, and people.

It is impossible to impair

health at any level without

affecting it at other levels.

The Green Guide for

Health Care, the first volun-

tary self-certification metric

tool for ranking sustainable

building strategies in healthcare, includes

specific health issue statements that intro-duce each construction and operation topic

(GGHC 2006). The Green Guide has become

the foundation for the U.S. Green Building

Councils Leadership in Energy and Environ-

mental Design (LEED) for Healthcare rating

system. Providence Health and Services CEO

John Koster, MD, describing their new LEED

Gold Certified hospital in Newberg, Oregon,

summed it up this way: In healthcare, sus-

tainable building represents a bold move

toward precaution and prevention. The build-

ing stands for health. In creating it, the orga-nization is essentially saying, Were

investing in keeping people healthier. Being

attentive to sustainability, wellness, and

resource stewardship presents a holistic view

of healthcare that has an impact. We may

not be able to measure or test, but Im con-

vinced it has a tremendous impact on a per-

sons ability to attain health. Not just to benot sick, but to be in health (Guenther, Vit-

tori, and Atwood 2006).

Finally, the healthcare sector is realizing

that green construction and operation

makes business sense. The authors of the

feature articles delineate three major bene-

fits: reduced operating cost, avoided risk,

and tangible impacts on employee satisfac-

tion, recruitment, and retention. The focus

on employee satisfaction is not surprising,

given chronic staffing shortages and person-

nel expenses. In 2004, the American Hos-pital Association estimated that hospitals

spent more than 50 percent of their operat-

ing budgets on personnel, and 1.4 percent

on energy. With the threefold increase in the

cost of energy, this figure may be approach-

ing 3 percent today for many institutions.

Reducing energy demand is increasingly

seen as not just about dollars saved today,

but is a risk avoidance strategy in a time of

uncertain energy economics. Likewise,

green strategies aimed at improved indoor

air qualityfrom using building materialsthat emit less fumes to cleaning with

greener products reduce occupational

health and safety risks.

Almost without exception, hospitals that

undertake green building and operation

strategies report improved worker recruit-

ment, satisfaction, and retention. Green

building is viewed as a major catalyst for

organizational culture transformationby

connecting with employee values, the work

experience is transformed. Moreover, as the

Boulder Community Hospital story demon-strates, the completion of a green building

is really only the beginning of organiza-

tional transformation. Once the building is

in place, new green programs and initia-

Green strategies aimed atimproved indoor air

qualityfrom using

building materials that

emit less fumes to cleaning

with greener products

reduce occupational

health and safety risks.




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tives are implemented. Boulder installed

solar photovoltaic panels nearly four years

after achieving its LEED certified building,

and continues implementing operationsprograms that earn it environmental excel-

lence awards each year.

What is Driving this Green

Tsunami in Healthcare?

One can barely move in contemporary cul-

ture without encountering green initia-

tives. Mainstream media are relentlessly

reporting on environmental leaders and

laggardsindustries that are slow to

respond are increasingly vilified. There are

three distinct but interconnected factorsdriving this movement: mounting climate

change concern, increasing scientific link-

ages between environmental degradation

and human/ecosystem health, and global

resource competition. Together, these

issues will change the way we live and con-

duct business in the futureand are likely

to have profound impacts on healthcare

deliveryas each of them in turn impacts

human health. Moreover, as described ear-

lier, these factors are fundamentally

changing economics as we begin to mone-tize previously externalized costs to soci-

ety: the cost of carbon emissions, toxics, or

pollution impacts.

There is growing scientific consensus

around climate change impacts and the

need for rapid global action to reduce

greenhouse gas emissions associated with

the burning of fossil fuels. The National

Aeronautics and Space Administration cli-

mate scientist Jim Hansen (2006) writes:

We have at most ten yearsnot ten years

to decide upon action, but ten years toalter fundamentally the trajectory of global

greenhouse emissions. The building sec-

tor is by far the largest emitter of carbon,

outpacing both transportation and indus-

try. U.S. Energy Information Agency data

(EIA 2007) rate acute care hospitals the

second most energy intensive building

type, just below food service. The datashow that hospitals use twice the energy of

commercial office buildings.

Across the United States, in the absence

of federal action, states and municipalities

are enacting legislation aimed at achieving

rapid reduction of greenhouse gas emis-

sions through public transportation invest-

ments and green building programs. In

2006, the American Institute of Architects

(AIA) launched the 2030 Challenge with

the goal of achieving carbon neutrality in

the built environment by 2030.At the same time, the healthcare indus-

try is just beginning to articulate the impact

of climate change on healthcare services

delivery. As average temperatures rise, heat

island impacts in dense urban areas will

exacerbate chronic respiratory conditions in

the elderly and children. More extreme

weather eventshurricanes in the coastal

Southeast, tornadoes and floods in the Mid-

west, fires and drought on the West

Coastwill require a more resilient emer-

gency care

final ache 08 2008 frontiers 25 1 int

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