Green Commuting in Healthcare

Ning Ai, PhD Assistant Professor UPP & IESP

Susan Kaplan, JDResearch Assistant ProfessorSPH

Peter Orris, MD, MPHProfessor and Chief of Occupational and Environmental Medicine UofI Hospital and Health Sciences System

P.S. Sriraj, PhDResearch Associate ProfessorUTC 

UTC Seminar Series, April 21, 2016  

Agenda• Research Motivation• Project Overview 

• Phase I: Case Study in Chicago• Phase II: Nationwide best practices 

• Research Methodology• Findings

• Phase I Survey Results• Carbon emission estimates 

• Recommendations• Future Research Needs• Acknowledgements   

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https://www.estrellamountain.edu/sites/default/files/page‐images/sustainability/1125‐alternative‐transportation.jpg

Research Motivation 

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Number of Healthcare Establishments:Historical Trend (2004‐2014) 

U.S. Total  State of Illinois 

 ‐

 5,000

 10,000

 15,000

 20,000

 25,000

 30,000

 35,000

Num

ber o

f Establishm

ents

General Medical and Surgical Hospitals Outpatient Care Centers

 ‐

 200

 400

 600

 800

 1,000

Num

ber o

f Establishm

ents

General Medical and Surgical Hospitals Outpatient Care Centers

Data Source: US. Bureau of Labor Statistics.  4

Number of Healthcare Workers:Historical Trend (1999‐2015) 

U.S. Total  State of Illinois 

Data Source: US. Bureau of Labor Statistics. 

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Num

ber o

f Workers

5

0

100,000

200,000

300,000

400,000

500,000

Num

ber o

f Workers

Healthcare Support Occupation Workers

Healthcare Practitioners and Technical Occupation Workers

Percent of Commuters Driving Alone to Work 

Industry Drove Alone All Commuters Percent Drove AloneManufacturing 3,666,014         4,260,931              86.0%Health Care and Social Assistance 7,564,712         8,861,970              85.4%Wholesale Trade 269,068             315,902                  85.2%Public Administration 4,430,965         5,274,387              84.0%Transportation and Warehousing 4,597,599         5,503,769              83.5%Mining, Quarrying, and Oil and Gas Extraction 600,402             718,850                  83.5%Utilities 83,164               100,268                  82.9%Management of Companies and enterprises 80,550               97,401                    82.7%Retail Trade 1,130,769         1,383,077              81.8%Information 664,508             818,109                  81.2%Finance and Insurance 4,859,220         6,014,860              80.8%Real Estate and Rental and Leasing 1,868,624         2,336,543              80.0%Admin and Support and Waste Mgmt and Remediation 616,904             773,647                  79.7%

Educa onal Services 9,985,748         12,744,742            78.4%Arts, Entertainment, and Recreation 2,288,896         2,938,700              77.9%Construction 6,680,236         8,671,736              77.0%Accommodation and Food Services 6,534,995         9,154,007              71.4%Other Services 970,146             1,366,119              71.0%Agriculture, Forestry, Fishing and Hunting 1,127,421         1,588,674              71.0%Source: American Community Survey, Public Use Microdata Sample, 2014

Percent of Commuters That Drove Alone to Work by NAICS Industry

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Green Initiatives in Healthcare 

Missing Element of Alternative Transportation Planning7

Kaplan, Susan, Blair Sadler, Kevin Little, Calvin Franz, and Peter Orris. Can Sustainable Hospitals Help Bend the Health Care Cost Curve? New York, NY: Commonwealth Fund, 2012. 2012. Web. 20 Mar. 2016.

Perceived Challenges of Alternative Commuting in Healthcare 

• Often 24/7 service needs • Serving many differing types of populations, including patients, visitors, and staff 

• Widely varying shifts, including overnight • Multiple work locations may be involved 

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Inspirations from Seattle Children’s Hospital

• Daily parking only; rates raised over time• $4/day bonus for not driving alone• Shuttle services• Carpool matching• Carpool and vanpool premium parking• Emergency rides home• Reduced‐price transit passes• Walking and biking infrastructure, gear bonuses

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https://www.seashare.org/uploads/blog/_1800xAUTO_crop_center‐center/photo‐4.JPG

SCH: Commute Calendar (courtesy Colleen Groll, SCH)

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SCH: “My Impact” Dashboard

11http://www.healthcaredesignmagazine.com/sites/healthcaredesignmagazine.com/files/imagecache/570x360/014_HCD1103_ufig2.jpg

SCH: Reported Results 

• “Seattle Children's cyclists ranked #2 in the region's bike‐to‐work challenge, #2 in team, and #3 in bike travel miles.”

• “Seattle Children's alternative commuting efforts have taken 630,000 car trips off the roads and freeways, reduced vehicle miles travelled by 6.5 million miles (the equivalent of 13 round trips to the moon), and saved 235,000 gallons of gas.”

12http://www.healthcaredesignmagazine.com/article/conscious‐commuting‐look‐comprehensive‐transportation‐plan‐developed‐seattle‐childrens‐hospi?page=3

http://thetomorrowcompany.com/wp‐content/uploads/2012/08/green‐transport.jpg

Project Overview 

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Research Goals

• Better understand the commuting patterns of healthcare workforce • Explore the factors that impact commuting behavior• Identify opportunities and suggest policy interventions for reducing transportation‐related environmental impacts from healthcare workforce

14http://my.edgewood.edu/sites/services/Transportation‐Services/PublishingImages/Web%20Logo%20copy.jpg

Two‐Phase Study  • Phase I: Exploratory study 

• Employee surveys at three hospitals in Chicago• Phase II:  Nationwide study

• Emission Estimates• Best practices 

• Seattle Children’s Hospital  (SCH)• University of Washington Medical Center • UCSF Medical Center • Oregon Health & Science University (OHSU) • University Medical Center of Princeton at Plainsboro (NJ)

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Research Methodology 

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Survey Study 

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Survey Instrument Design 

• Hospital specific 

Case Study Hospital Selection 

• Out‐patient clinics

Sample Population Selection

• Mix of job types

Survey Adminis‐tration

• Test survey

• In‐person written 

Data Entry and Processing 

• Multi‐staff verify‐cation

Spatial & Tabular Data Analysis  

• Cluster analysis

• Cross‐tab  

Participating Hospitals

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Hospital ID #1 #2 #3Total # of Employees at this location

3173 800 2000

Location Urban  Urban  SuburbanDistance to the Closest Train Station (miles) 

0.3 1.2 2.5

No. of Bus Stops within Half Mile Buffer

91 63 15

No. of Bus Routes within Half Mile Buffer 

7 5 2

No. of Rail Stations within Half Mile Buffer 

2 0 0

Surrounding Land Uses Mostly institutional buildings. Small parcels of mixed 

uses. Mostly residential. A park is nearby.

Large land parcels of institutional buildings. Cul‐de‐sac streets.

Parking Structure/Fees Fee based (can be used for 

pre‐tax dollars) Free Free

Participating Hospitals: Employee Transportation Benefit Programs

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Hospital ID #1 #2 #3

Employee Transportation Benefit Programs 

• Transit Benefit Program to pay for transit services using pre‐tax dollars•Discount rate on bike‐share program•Shared parking pass if two or more people regularly carpool together•Online carpooling match program •Discount rate on car–sharing services (cars available on/near campus) • Free intra‐campus and commuter bus shuttles• Showers on campus available for use by bicyclists

• Commuter reimbursement program pays for transit services  using pre‐tax dollars

• Public transportation passes/vouchers through pre‐tax payroll deductions• $20 subsidy toward the purchase of a public transit pass/voucher• Bicycle racks on site• Free hospital shuttle between multiple hospitals in the system

Carbon Emission Estimates 

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Emissions = VMT by Travel Mode * Emission Factors by Vehicle Type  

APTA Mode Average Speed Bus 12.8 mphHeavy Rail 20.0 mphHeavy Rail 20.0 mphCommuter Rail 32.8 mphFerryboat 8.8 mphSource: APTA

NHTS Mode Average SpeedPrivate Vehicle 28.87 mphPrivate Vehicle 28.87 mphPrivate Vehicle 28.87 mphWalk 4.77 mphSource: FHA

Vehicle TypeCO2 Factor (kg/unit) Unit

Passenger Car 0.368 Vehicle‐MileMotorcycle 0.197 Vehicle‐MileTransit Rail 0.133 Passenger‐MileCommuter Rail 0.174 Passenger‐MileBus 0.058 Passenger‐MileSource: EPA

Source: ACS PUMS. Modes:

Car/Truck/VanBus or Trolley BusStreetcarSubway or ElevatedRailroadFerry BoatTaxicabMotorcycleBicycleWalk

Average Travel Time * Average Travel Speed

Ferry EmissionsCO2 (kg) Per Gallon of Diesel

Ave Passenger Mile per Gallon

CO2 (kg) per Passenger‐Mile

10.25 24.817 0.413 Source: Studies in WA and CA

Results 

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Strong Interest from Healthcare Workers in Commuting Issues

• 141 hospital staff contacted• 135 responded to the survey• 95.7% response rate

22http://1ec3qk2gowcy3luxr31yisiwjdm.wpengine.netdna‐cdn.com/wp‐content/uploads/2013/03/RWR‐Logo‐Figures1‐300x117.jpg

Respondent Statistics

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10

20

30

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50

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 Hospital #1 Hospital #2 Hospital #3

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%

R1: Commuting Mode 

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Hospital 1 Hospital  2 Hospital 3Drive Alone 65% 93% 80%Carpool, car share, taxi 19% 0% 14%Public Transit 30% 7% 20%Bicycle or Walk 7% 3% 2%Other 7% 0% 2%

R2: Influential Factors for Commuting Mode Choice 

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Factors for Taking Alternative Transportation Hospital 1 Hospital 2 Hospital 3Less crime/increased safety 37% 24% 20%Financial savings 33% 45% 24%Financial incentives from employer 28% 38% 16%Flexible work shift hours 28% 21% 16%Quicker trips on public transportation 30% 34% 14%Better quality of sidewalks or paths 23% 34% 8%Discounted or free rides home on weather‐prohibitive days 21% 21% 12%Better service of bus or train 23% 28% 6%Hospital shuttle to/from public transit 23% 28% 16%Better quality of bicycle lanes 23% 28% 4%More parking at transit stations close to  home 19% 28% 6%Increased availability of storage/showers close to work site 19% 21% 8%Better service of car‐sharing programs 19% 24% 4%Employer assistance identifying others with whom to share rides 19% 31% 8%More accessible information about options, schedules, routes. 14% 24% 20%Other 12% 3% 4%

R3: Awareness of Employer‐Sponsored Transportation Benefits  

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Hospital 1 Hospital 2 Hospital 3

% of Employees Aware of at least one program 42% 26% 54%

% of Informed Employees Using at least one program 35% 0% 57%

R4: Peak vs. Off‐peak Commuting 

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Hospital #1 Day‐Shift Workers

Night‐ Shift Workers

Unknown

Total Respondents  31 22 4Transportation Mode (% of Respondents) 

Drive alone 68% 59% 75%Carpool, car share, or taxi 19% 23% 0%Public transit (Metra train, CTA train/bus, and/or Pace bus) 42% 45% 0%Bicycle and/or Walk 16% 0% 0%Other 6% 5% 25%

Hospital #3 Day‐Shift Workers

Night‐ Shift Workers

Unknown

Total Respondents  35 11 3Transportation Mode (% of Respondents) 

Drive alone 86% 73% 33%Carpool, car share, or taxi 14% 9% 33%Public transit (Metra train, CTA train/bus, and/or Pace bus) 26% 45% 67%Bicycle and/or Walk 3% 0% 0%Other 0% 9% 0%

R5: Spatial Distribution of Respondents’ Residence

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Anecdotal Notes from Survey Respondents 

• Daycare at work • Seasonal impacts• Reserved parking • Multiple work locations• Route selection for pedestrians 

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Estimates for Carbon Emissions from Healthcare Commuters  

All OccupationsHealthcare 

OccupationsAll Occupations

Healthcare Occupations

All OccupationsHealthcare 

OccupationsAll Occupations

Healthcare Occupations

All OccupationsHealthcare 

OccupationsDrive Alone 111,442,130           10,041,772       80.07% 86.33% 11.88                       11.93                  4.37                          4.39                     2,143.07                 2,151.75                 Carpool 13,481,925             780,619             9.69% 6.71% 13.47                       12.65                  2.21                          2.07                     1,081.14                 1,015.50                 Taxi 159,284                   9,732                  0.11% 0.08% 9.53                          8.95                     3.51                          3.29                     1,717.93                 1,613.81                 Motorcycle 286,240                   12,314               0.21% 0.11% 10.63                       9.71                     2.09                          1.91                     1,025.73                 936.92                    Bus 3,857,717                253,362             2.77% 2.18% 9.94                          10.41                  0.58                          0.60                     282.53                     295.87                    Transit Rail 2,750,750                192,125             1.98% 1.65% 15.87                       17.40                  2.11                          2.31                     1,034.03                 1,133.96                 Regional Rail 829,495                   39,188               0.60% 0.34% 38.87                       38.43                  6.76                          6.69                     3,313.89                 3,276.60                 Street Car 78,056                      5,122                  0.06% 0.04% 5.39                          5.38                     0.72                          0.72                     351.27                     350.43                    Ferry 53,237                      2,791                  0.04% 0.02% 9.15                          10.35                  3.78                          4.28                     1,852.09                 2,095.47                 Walk 4,007,388                196,765             2.88% 1.69% 0.97                          1.01                     ‐                            ‐                       ‐                            ‐                           Bike 918,851                   49,095               0.66% 0.42% 3.43                          3.43                     ‐                            ‐                       ‐                            ‐                           Other 1,323,081                48,594               0.95% 0.42%

U.S. Estimated Travel Distance to Work and CO2 Emissions by Mode  All Occupations vs Healthcare Occupations, 2014

Estimated Average Distance to Work (Miles)

Estimated Carbon Dioxide Emissions Per Commuter Trip 

(kg)

Estimated Carbon Dioxide Emissions Per Commuter Per Year 

(kg)ModePercent of WorkersSurvey Sample Size

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U.S. Commuter on Average: 1,873.58 kg/YearHealthcare Commuter: 1,965.03 kg/Year  

Policy Recommendations 

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Key Factors of Implementation 

• Great potential of promoting alternative commuting in the healthcare sector Education, especially of new employees

• Better understanding of employees’ needs• Programs tailored to night‐shift vs. day‐shift workers• Economic incentives (and disincentives) as daily reminders of commuting impacts  

• Information sharing • Partnerships with transit agencies• One size cannot fit all 

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Limitations and Future Research Needs 

• Larger sample size for survey studies • Cost‐effectiveness of alternative transportation programs • Commuter‐Networking• Combined policy approaches   

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Publications Resulted from This Study 

• Ning Ai, Susan Kaplan, Peter Orris, and P. S. Sriraj. “Reducing Commuting‐Related Environmental Impacts in the Healthcare Sector: An Exploratory Study.” Transportation Research Board Annual Meeting Compendium, Washington, DC, January 13, 2015. Paper ID: 15‐6057. 

• Susan Kaplan, Ning Ai, Peter Orris, and P. S. Sriraj. “Green Commuting in the Health Care Sector: Obstacles and Best Practices.“ Journal of Occupational and Environmental Medicine, 58(2):e34‐8. 

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Images: Oregon Health & Science University tram and bicycle valet

Acknowledgements

• Support by the Illinois Department of Transportation (through a grant from the University of Illinois at Chicago Urban Transportation Center) and the U.S. Department of Transportation National Center for Transit Research (through a grant from the University of South Florida). 

• Research assistance from: Erica Burt, Jeff Griffin, Yining Li, Ada Morgan, Jennifer Maddux

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