Every day people are exposed to a complex mixture of industrial chemicals, some of which are linked to increases in diseases and conditions such as cancers, birth defects, asthma, and infertility. A commitment to a healthy and safe environment requires a closer scrutiny of hazardous ingredients in pharmaceuticals, finishes, fragrances, cleaners, paints, medical devices, furniture, fabrics, wall coverings, and other building materials and equipment. Sustainability initiatives may start off with low-hanging fruit like recycling, for example. But further along the journey, one comes to acknowledge the imperative for education and recognition of the irony that healthcare building materials, equipment, and devices frequently contain toxic materials that can impact human health and the environment.

Heinz and Magee-Womens partnership

A city where steel and iron production and coal mining led to severe environmental damage, Pittsburgh has benefited from The Heinz Endowments' goal for the region to “thrive as a whole community” with a commitment to people, culture, and environmental health. In 2005, The Heinz Endowments reached out to Magee-Womens Hospital, part of University of Pittsburgh Medical Center, to explore the potential for increased education around women's health and environmental toxicants.

With 10,000 births per year and a No. 6 ranking for women's care from US News and World Report, Magee-Womens had the audience and the opportunity to make positive change through their leadership in wellness, prevention, and healthy babies. A five-year grant from Heinz between 2005 and 2010 resulted in a two-pronged approach to addressing reproductive toxicants at Magee-development of evidence-based educational programming and implementation of sustainability initiatives within the medical center-or walking the talk. The firm commitment to education and action around environmental sustainability resulted in an emerging culture of awareness on the part of leadership, educators, clinicians, the general staff population, and, most importantly, families. In addition, it provided a model partnership for other regions.


How it started

Educators at Magee-Womens had long been aware of health impacts for the developing fetus due to exposures to cigarette smoke, lead, and mercury, and included this information in their classes for new and expectant parents. The challenge was to build on this foundation and begin to educate on emerging hazards such as pesticides and phthalates.

With support from The Heinz Endowments, the staff at Magee-Womens formed a “green team” and created a staff position to coordinate the team and its sustainability efforts. Judy Focareta, RN, MEd, was appointed to this position. As a mother herself with a passion for the environment and background in nursing and education, Focareta was the perfect fit for the project. In addition to her, the core team consisted of representatives from all hospital departments and was truly multidisciplinary. The team created goals and a set of guiding principles-science as the foundation for education around environmental toxicants and health, and a strategy to implement programs at the facility itself that modeled what was being taught. For example, prenatal classes include guidance for parents about unhealthy mercury levels in certain kinds of seafood and provide resources for making safe choices. Staff at Magee-Womens then set a goal to eliminate mercury within the hospital, and received Practice Greenhealth's Making Medicine Mercury Free Award in 2006.

Leadership engagement

Magee-Womens realized that leadership support was critical to the success of their environmental initiatives. Just like any other new program, it started with education. Barb Sattler, DrPh, RN, FAAN, director of the Environmental Health Center, and associate professor at University of Maryland School of Nursing, was invited to present on environmental health and safety from the perspectives of the healthcare worker as well as the developing fetus. Leslie Davis, the president of Magee-Womens, was impressed. Davis recognized the critical importance of education around chemical exposure, staff education, and mother/child wellness.

That spring, Magee-Womens sponsored Teresa Heinz's Women's Health & the Environment conference in Pittsburgh. Davis provided the welcoming address and stayed for the entire day. So the “ah-ha” moment had occurred. Now that the Magee-Womens' leadership was onboard, how could that vision translate into actionable items?


Within the green team, a smaller “green education team” was formed. Led by Focareta and Michele Ondeck, clinical education specialist, and fully supported by the education director, Connie Feiler, the team developed a series of educational programs. Those programs integrated environmental health into its curriculum, which included topics such as early pregnancy, baby basics, Lamaze, parenting, breastfeeding, and an educational video, “Baby Steps to Green Parenting.” The film is separated into six sections that address environmental health concerns throughout the childbearing year from pre-conception to infancy and early childhood. The video may be used to educate patients, assist in childbirth classes, and play in waiting rooms or on hospital televisions for antepartum and postpartum patients. The video provides valuable resources on well-known toxins such as lead and mercury as well as lesser-known hazards like Bisphenol A and the antimicrobial triclosan.

The “Mom and Baby Discharge Guide” is given to every mother as she leaves the hospital with her new baby. The guide offers guidance and expertise on everything from car seats to breastfeeding to sleeping, crying, and more. The Greater Boston Physicians for Social Responsibility gave permission for Magee-Womens to add its document, “The Rx for Prevention-Environmental Health Initiatives,” which was approved by the American Academy of Pediatrics. Nurses on the postpartum units are trained in environmental health principles so they can counsel new moms and families, and answer questions and concerns. Environmental health education is also provided in the women's cancer unit via literature and classes on healthy nutrition for cancer survivors.

Sustainable operations

To walk the talk, the hospital's green team has addressed issues such as waste and toxicity reduction and surgical services initiatives with Practice Greenhealth's Greening the OR Program and created an annual symposium for nurses and doctors. An executive committee was formed to further support the work of the green team. This committee consists of Dennis English MD, vice president of medical affairs; Linda Antonelli, vice president of facilities; Ondeck; Judy Balk, MD, MPH; Noedahn Copley-Woods, MD; and Focareta.

Each year, a national expert is identified to further the education and report on emerging science related to chemical exposure and reproductive health. Magee-Womens doesn't have to look far to identify experts-one of which is Dr. Yoel Sadovsky, a Magee-Womens researcher who studies whether placenta acts as a barrier to chemical and other exposures. Also, Copley-Woods has taken notice of the vast amounts of waste generated during surgical cases. Copley-Woods is currently researching the physician's green preference card and waste variations by case type, and educating others about her findings in a talk titled “Creating a Sustainable Surgery-A Trashy Operation,” which will be presented at CleanMed in April.

Organic garden oasis

The Magee-Womens garden offers an oasis and a sensory experience by providing a pond with goldfish, touchable plants, a butterfly garden, and fragrant herbs to reduce the stress of patients, their friends and families, and the staff. Two years ago, green team members Greg Brown, the hospital's dietary director, and Anna Ardine, a clinical nutritionist, came up with the idea of growing organic vegetables and herbs in the enclosed gardens. Produce from the garden is used in patient meals and by the cafeteria and gift shop café. The garden also has demonstrated value as a mechanism to educate about healthier food choices and nutrition. Local horticulturists visit to give talks about biodiversity and health for people and the planet. A recent news item from the Pittsburgh Post Gazette included a video piece, which best communicates the value of this sacred spot with a wonderful sentiment offered by a young visitor, describing the garden as “inspiration” as her mother undergoes surgery.

While the Heinz grant has ended, the work at Magee-Womens is far from over. Focareta continues in her role, and her green team is currently developing an environmental health assessment tool to add to the electronic medical record per physicians' requests. By adding specific questions regarding hazards to the electronic patient assessment, clinicians reported they would be more likely to ask questions about environmental health and safety. Topic areas include mercury exposure, fish consumption, lead in the home, drinking water testing, smoking, personal care products, cleaning products, food safety, and more.

The variety of educational offerings-grand rounds, new employee orientation, lunch-and-learn sessions, the “Baby Steps to Green Parenting” film, assessment tools, and annual symposium-teach healthcare providers so they are better equipped to educate their patients. They also have the science to back up their recommendations and the confidence to tackle the topic of reproductive toxicants in a practical way, like offering low-cost green cleaning guidance, for example.

Reach out to your grants department and think about how you can partner with your local philanthropic organization for a greening initiative, whether through construction, a healing garden, educational program, or other innovation. Let us know your story! HCD

Janet Brown is Director, Sustainable Operations for Practice Greenhealth. She can be reached at

jbrown@practicegreenhealth.org. Healthcare Design 2011 February;11(2):10-12