This year, for the first time, Practice Greenhealth has compiled data from its 2009 Partner for Change (PFC) Award applications, in an effort to break “greening” down into specific activities and help identify the structure that supports ongoing environmental improvement activities in the healthcare setting. This benchmark report can help hospitals identify sustainability projects, see how their facility compares to other engaged facilities, and help identify sustainability trends in the healthcare sector. The benchmarks are not meant as a best practice in any way, but rather, a snapshot of where engaged hospitals are at this point in time. As markets continue to develop and facilities continue on this trajectory, the benchmarks will reflect market transformation, new technology, and increased leadership commitment.

Data pool

PFC Award winners cover a broad greening spectrum. In 2009, PFC Award winning facilities ranged in size from 17 to 1,168 licensed beds, with an average of 334 beds per facility. The hospitals are located on the east coast (from Maine to Maryland), in the Midwest, and on the West Coast, primarily in California. One facility is located in Hawaii. The data from the broad range in the environmental performance of PFC Award winners presents a relatively good snapshot of the greening of hospitals across America.

Report findings

Sustainability structure. No one department takes the lead on sustainability initiatives in healthcare facilities at this time. The data reflects the diversity, with those leading sustainability initiatives reported as Facilities Management, Environmental Health and Safety, Administration, Environmental Services, Safety, Support Services, Nursing, Engineering, and 17% reported “other” demonstrating that sustainability has not found a standardized department in the sector, to date. While the position of sustainability coordinator continues to emerge, the majority of facilities rest the leadership role squarely on the shoulders of an existing employee with an often already overfilled plate; 78% of the facilities indicated that they had someone on staff identified as the lead on sustainability for their facility.

Greening activity is moving beyond grassroots and departmental efforts towards a more coordinated effort and strategy. In fact, 97% of the applicant pool has a green team at their facility and 52% report the activity takes place within the Environment of Care Committee structure. Green teams provide the structure to gather baseline data, set goals, develop metrics, and through a diverse team approach and subcommittees for specific programmatic areas, work together to improve performance. In addition to the departments listed above, other members include physicians, marketing, and communications.

Mission statements. We all know that the most successful sustainability programs have leadership support. The measure for this support is the development of a system or a facility-wide environmental mission statement; 78% of the facilities had an environmental mission in place. The other critical piece is education and saturation of the message; 82% of facilities report that sustainability training is included in new employee orientation.

Environmentally Preferable Purchasing (EPP). The award applications indicate progress in the area of EPP and life cycle analysis.

  • 77% reported that their new product evaluation committees consider environmental impact when selecting products and services.
  • 68% reported having an EPP policy. EPP has spread into Food Services where sustainability is getting increased focus.
  • About 25% of the data pool has signed Health Care without Harm's Healthy Food Pledge.
  • 75% report that they still use some Styrofoam products, while this is a material most wish to eliminate.
  • 53% have switched some disposable dishware items back to reusable.
  • 60% are using paper or biodegradable products.
  • Only 10% of facilities are composting.

Green building, sustainable design, and facilities management. The LEED rating system and use of the Green Guide for Health Care (GGHC) for self-certification has made it easier for facilities to commit to a level of greening for new construction and renovation.

  • 60% are currently planning new building projects.
  • 52% are considering use of the GGHC or LEED rating system.
  • 38% are Energy Star Partners.
  • 80% have engaged in some type of water conservation strategy.
  • 97% in energy conservation strategies.

One of the most popular energy conservation measures reported were lighting upgrades and motion sensors. The interest in energy conservation and focus on carbon reduction has led to an enhancement of this section of the awards application. We look forward to a more robust benchmark for next year's report.

St. Mary's in Green Bay, Wisconsin, opened a 22,000-square-foot living roof system on the roof of their new cancer center, the largest living roof in Wisconsin. Corrine VercauterenDirector, Environmental Services, says, “St. Mary's never would have achieved this accomplishment without Practice Greenhealth. We started with recycling, red bag reduction, mercury elimination and here we are-opening our living roof!” This speaks to the sustainability path and the traditional programmatic areas are the stepping stones to innovation and creativity.

Greener operations. On average, PFC winners recycle 24% of their waste and generate 8% Regulated Medical Waste (RMW). This generation rate of RMW demonstrates the financial incentive for this initiative and it is often one of the first activities in a sustainability program; 82% have engaged in an RMW reduction program. Facilities can easily achieve a 10% recycling rate through paper and corrugated box recycling alone. With the recent availability (in most regions) for single stream recycling, a 24% recycling rate is achievable, with the highest rate in this data achieving a 52% rate. With an increased focus on waste prevention and life cycle analysis, some waste prevention activities are harder to capture. Cleveland Clinic, for example, boasts an over 25% recycling rate, which recently dipped as they conducted life cycle computing and electronics, which reduced the amount of computer “waste” generated altogether. All computers now go back to the manufacturer for refurbish, reuse, and redeployment. So while one may be impressed by hefty recycling rates, waste prevention activities deserve mention and can sometimes get lost in the numbers. This is why total waste generation should be tracked to reflect waste prevention successes.

RMW Reduction:

  • 82% have addressed Regulated Medical Waste Reduction Programs through improved segregation.
  • 68% have implemented single use device reprocessing.
  • 57% have implemented a reusable sharps container program.
  • 47% have implemented fluid management systems in the operating room.

Hazardous waste. While hazardous waste stream is the smallest waste type in the facility, it is the most expensive to manage. With the raised awareness of pharmaceuticals in the water supply, pharmaceutical waste management is a focus for most facilities today, in one form or another; 65% reported that they have implemented “some form” of pharmaceutical waste management. There are many approaches and much confusion over the best management approach to pharmaceutical waste, so this percentage doesn't reflect the diversity of approaches and this area will be further scrutinized for next year's report. Alternatively, when facilities report that they don't have any hazardous wastes this is a red flag. Even facilities that contract off-site for laboratories generate hazardous materials within facilities and engineering departments. All of the applicants reported that they recycle their fluorescent light bulbs, 82% toner cartridges, 78% cooking/motor oil, 90% batteries (not all considered hazardous waste), 49% electronics, and 52% are distilling solvents such as xylene and alcohol for reuse; 78% have already won Practice Greenhealth's Making Medicine Mercury Free Award for virtual elimination of mercury and continued prevention at purchase for mercury-free devices, laboratory chemicals, and equipment.

While this is the first year that this type of data has been summarized and released, Practice Greenhealth intends to track this data illustrating how sustainability matures over time. We hope to have even more information available after our 2010 Environmental Excellence Awards to be presented at CleanMed 2010 in Baltimore Maryland, May 11-13.

Practice Greenhealth's Environmental Excellence Awards program has celebrated healthcare sustainability success since its inception in 2002, under the Hospitals for a Healthy Environment Program (H2E). Now, under the membership organization, Practice Greenhealth, the Awards recognize the different players in the greening community (hospitals, health systems, clinics, manufacturers, GPOs, A&E firms, vendors, etc…) Hospitals and clinics cannot do this work alone and rely on responsible businesses to support their efforts.

68% have eliminated or reduced the use of glutaraldehyde for high level disinfection.

It takes a village to transform the healthcare sector and this is one competition where more is better. Healthcare sustainability is a team sport. So find your pace, prepare for the long journey and join the pack. HD

Janet Brown is Director of Facility Engagement for Practice Greenhealth. Practice Greenhealth ( is a membership organization leading the greening of healthcare to improve the health of patients, staff, and the environment. Members include hospitals, healthcare systems, clinics, healthcare professionals, businesses and other stakeholders committed to sustainable eco-friendly practices.

Web links

  1. CleanMed:
  2. Green Guide for Health Care:
  3. Global Health and Safety Initiative:
  4. Health Care Without Harm:
  5. Practice Greenhealth:
  6. The Center for Health Design:

Healthcare Design 2010 February;10(2):10-13