Responsible purchasing
While one may not understand, at first glance, the difference between a nitrile glove and a PVC glove, through working with group purchasing organizations, purchasing departments, and experts from industry, environmentally preferable practices and protocol can be put into place, including a chemical policy to avoid priority chemicals. (See Health Care without Harm’s Chemical Policy page.)

The Green Guide’s Environmentally Preferable Purchasing credits provide the goals, the health implications, and the tools to shift markets away from excessive packaging, poisonous plastics, inefficient equipment, and short-sighted solutions. Recognizing the purchasing department’s role as the gatekeeper of the institution helps visualize the critical importance of adding environmental sustainability protocol to existing supply chain and product evaluation committees. Of course we can’t address all products at one time, but just like any other greening activity, environmental criteria can be assessed a step at a time. The best place to start is by addressing whatever contract is being worked on right now.

Assessing responsible material purchasing requires fact-finding, research, and partnerships to identify less-toxic processes, waste prevention opportunities, energy and water efficiency, planet- and people-friendly possibilities, recycling and donation opportunities, and innovation. While a facility may be tempted to have a separate committee look at opportunities for greening through purchasing in order to eventually make environmentally preferable purchasing a regular course of business, the activities can be integrated directly into existing purchasing and supply­chain–committee structures.

The Green Guide’s Environmentally Preferable Purchasing Section helps identify some focus areas, including energy, water, toxins, general waste, office products, and more. Many of the problems we end up having to address in the healthcare environment only come to the forefront of our minds when they become a problem. So whether it’s an exorbitant waste removal fee; a chemical spill; an air quality test; or other safety, cost, or regulatory issue, by taking a close look at the toxic baggage of this product, we realize the value of discussing these “back door issues” at the front door—in the supply chain committee—and preferably before the material has entered the facility itself. This way we can take steps to prevent the surprises, the associated costs or other burdens that we experienced the last time around. A few examples:

  • A decision was made to go with a thinner waste bag to reduce costs. But when the product usage was tracked, it increased because the bag was too weak and the environmental services staffers had to double bag.
  • A waterless hand soap that came in an aerosol can was purchased. If the can was not emptied 100%, it was considered hazardous material and had to be removed by a licensed hazardous waste hauler at a much higher cost.
  • A mercury-containing device appeared less costly at the point of purchase, but when tracked through the facility, the true cost of the mercury-containing device was identified by adding on the “toxic baggage” including spill kit supply cost, employee response training, chemical respirator fit testing, air quality testing after a spill, and removal of the spill material as a hazardous material. One or two spills would make it pretty clear that a nonmercury device was the way to go.

A lot of these details would go unnoticed at the front door, and this is why the individual with the “back-door” knowledge should participate in the supply­chain–committee meetings. (The Practice Greenhealth Web site’s Environmentally Purchasing section provides sample specification language and more information on greening purchasing practices.)

Group purchasing organizations have stepped up with identification of environmentally preferred products and services. If no contract is available for the product or service you seek, the group purchasing organizations may assess the interest within their membership and identify this as an important area for future contracting. Communicate needs and “wish lists” to your group purchasing organization and help shift markets to safer materials and responsible manufacturers, service providers, and material/waste vendors. A commitment to health includes the necessity to control the flow of materials—so departmental purchases that occur outside the purchasing department and the existing contracts need to be reined in. Running to the corner store to replace a broken microwave is a short-term solution. It may appear cheaper, but it won’t stand up to frequent use and meet energy-conservation goals. Resist the urge for quick purchases and going around the purchasing department. Bundling cost-saving opportunities with an environmental imperative helps to balance cost savings with “must do” activities, such as eliminating Styrofoam in conjunction with implementing composting or purchasing recycled paper in conjunction with a paper-prevention program.

Responsible operations
With the good news that green building is growing in the healthcare sector, comes the responsibility to address the operational activities that take place within the “green” structure and the reorganization to address that healing environments require the integration of both green building and improved environmental performance from an operational perspective. While numerous facilities are simultaneously addressing green building strategies and green operations, they aren’t always communicating with each other and connecting their activities into one broad environmental mission as part of their strategic plan. It’s a lot easier to show off a green building than its “greener operations.” Taking a picture of a garden and natural daylighting is far more attractive than photographing mercury free devices and composting bins! These “back door” and behind-the–scenes activities are easily ignored, but by scrutinizing the activities occurring in the space, one learns of the numerous opportunities and imperative to take control and responsibility for the by-products of healing.

Materials are talking
The “back door” of the facility is rich with information. Our material is talking to us, but we have to make sure to listen to what it’s saying and not turn our backs on it like it’s an annoyance. Instead of thinking it will just go away, we need to closely scrutinize and hear its message of inefficiency, health, safety, and mission. By working with waste- and material-removal vendors and getting weights of the types of materials that are removed, facilities can start getting a handle on just how much “stuff” is removed from their site and start to appreciate the magnitude of the problem and the urgency for action. The good news is there is potential for cost savings through improved segregation and reduction of red-bag waste (regulated medical waste); increased recycling; composting; and equipment donation, refurbishing, and reuse.

In spring 2009, Practice Greenhealth will release Greenhealth Tracker, a software devoted to improved waste and material data collection and management, assisting healthcare providers in ongoing tracking of the types and amounts of waste and materials generated. The data collection will help the industry set much-desired benchmarks so that facilities can work toward “zero waste” by more clearly understanding what they generate and what methods they can use to reduce the volume and toxicity of the waste stream.

Users can identify responsible vendors to help manage the materials, waste, and other “remnants of healing,” while working to improve segregation and management. This would include electronics waste recyclers, HIPAA compliance vendors, regulated medical waste alternative treatment technologies, hazardous pharmaceutical waste management, food composting, and so on. When something seems too good to be true, it probably is, and hospitals should do their homework before letting “Joe and his truck” remove all of the computer equipment waste for free. Lack of control of materials and waste is risky and can end up coming back to bite in the form of negative press, community exposure, or a violation.

Respectful environments
Respectful environments extend beyond regulatory compliance in day-to-day activities to address workplace conditions and strive for a satisfied worker, regardless of their job title or hierarchy in the facility. Working to address staff education, material handling, change of work practices, and worker safety requires walking a line between administration and support services staff. By continuously identifying cost savings, safety, regulatory compliance, and mission demonstration, the path to the board room can remain clear and the door will stay open.

Sidebar 2
Potential research agenda for greening operations in healthcare
Not all the evidence is in, and it would be helpful if we had evidence based operational activities. Here are a few areas of potential research on operational improvement strategies in a healing environment:

  • Hospitals that have identified Sustainability Officers have maintained that position five years after hiring.
  • Reusable dishware is environmentally preferable to disposable dishware, taking into consideration manufacture, transport, energy, water, and disposal.
  • Transitioning to flooring that does not require waxing and stripping improves air quality and reduces complaints associated with floor care.
  • Hospitals using greener cleaners (where appropriate) do not see a rise in infection rates.
  • Hospitals committed to sustainability attract and retain workers.
  • Hospitals can demonstrate their environmental improvements through cost savings, reduced chemical exposures, reduced number of chemical spills, and positive press coverage.
  • Facilities that have gone “mercury free” have a clearer understanding of the imperative for action, which is measurable through community and employee educational activity and knowledge.
  • Hospitals can reduce their greenhouse gas emissions through alternative energy procurement, conservation, transportation options, and employee education.
  • LEED-certified facilities attract and retain staff at a greater rate than their previous, older facility.
  • Hospitals recovering single-use devices for reprocessing and reuse save money, reduce waste, and do not have a rise in infection rates in surgical procedures.

Taking a close look at hospital workers and workplaces may reveal disparities among the level of training, workplace cleanliness, the potential to be heard, and the safety of the physical work environment. By listening and learning from workers in the hallways, break rooms, work areas, labs, waste management areas, and the units, one can, over time, form the necessary relationships so the information flows both ways. Written policy and procedure manuals should be compared with reality and modified, as necessary, to be accurate and most efficient. Identifying overlaps of regulatory and safety issues with morale or engagement issues, activities can address several outcomes by focusing on one area or activity. This can be addressed in a number of committees including environment of care, healing environment team, green team, or quality improvement committee. Addressing a safety issue that overlays with a worker morale issue through the required The Joint Commission Performance Improvement activity provides the focus and ongoing reporting that will most likely get the attention it deserves and the positive outcome to report to The Joint Commission.

A community of resources
Active membership communities, like Practice Greenhealth, offer a virtual space where facilities, businesses, and individuals can share ideas, best practices, access tools, participate in Webinars, and network on their greening success stories. Facilities leading the way through years of action are guiding those that are just getting started.

The Global Health and Safety Initiative is working on worker safety, patient safety, and environmental safety through its high-level engagement with major systems in the United States. Health Care Without Harm continues to identify and address emerging issues like chemical policy for eliminating priority toxic chemicals from supply chain, safer materials, medical waste treatment, green building, and more through a work-group structure, including regional organizing. Healthy Food in Health Care and the “Healthy Food Pledge” are also part of this coalition. The annual CleanMed conference offers two days of nonstop education on environmental sustainability in healthcare and Practice Greenhealth’s Environmental Excellence Awards Ceremony.

It’s time for change!
We’re pretty close to being done explaining why there is an imperative for action and are turning our time and focus on how to get busy tackling the by-products of healing. Researchers can help by measuring the outcomes of those facilities that are improving their environmental activities, whether it’s toxicity reduction; community engagement; carbon footprint reduction; or locally sourced, seasonal food procurement, to name a few. Hospitals are obligated to take action or their mission is only a plaque on the wall by the elevator (sidebar 2).

Hospitals are stepping up to environmental challenges. Practice Greenhealth has awarded more than 200 Making Medicine Mercury-Free Awards and currently works with more than 600 hospitals in the United States and Canada that have demonstrated their interest through joining a membership community, working together to green the healthcare sector.

There is tremendous passion, commitment, and energy in those buildings, hallways, sub-basements, offices, and units. By providing the structure and support to manage the process, there’s no end to where the sector will go. We can change the landscape of healthcare. Everyone has a role to play in this work and there is plenty to go around. So whether a building owner, designer, linen transporter, architect, waste hauler, clinician, patient, activist, group purchasing organization, mail sorter, researcher, grant writer, funder, dietician, lab technician, environmental services supervisor, contractor, healer, technician, thinker, reporter, board member, patient transporter, trainer, volunteer, accountant, writer, funder, or CFO—you have a role to play. Do your part to complete this complex puzzle. We can do this together, all of us, and change the impact of providing care.

Janet Brown is Director of Sustainable Operations at Practice Greenhealth and is a member of the Green Guide Steering Committee and the Planetree Design Advisory Council. For more information contact her at