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Use Standardized Environmental Questions in Purchasing Medical Products

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Using a common set of environmental questions in the request for proposal (RFP)/request for information (RFI) process can help drive the manufacture of goods and services with reduced human health and environmental impacts. A consistent set of questions helps to prioritize key environmental attributes of concern to the health care sector and creates a consistent platform for suppliers to improve the availability of environmentally sustainable, cost effective medical products.

  • Project Talking Points

    • What we buy matters. Health care products can contain chemicals of concern that may harm patients or staff and are damaging to the environment. Products can create significant amounts of waste that incur costs at the end of use. 
    • Health care organizations can save money, improve worker retention, and add to community benefit by purchasing environmentally preferable products (EPP) and services.
    • Standardized questions should address aspects of both, the total cost of ownership (TCO) and cost, quality, and outcomes (CQO) of using a product. TCO includes acquisition costs plus all operating costs (e.g., maintenance, spills, waste), and costs of incurring risks (e.g., liability, environmental and human health impacts that may be difficult to quantify). CQO incorporates the principles of TCO but also includes quality and clinical impacts.
    • In 2011, five of the largest group purchasing organizations (GPOs)* committed to working collaboratively on environmentally preferable purchasing (EPP) and put competition aside to do so. Through a consensus-based approach, they developed a set of environmental questions they will ask in RFPs and RFIs for medical products. The set of questions was developed with feedback from suppliers, government agencies and others, and finalized as the Standardized Environmental Questions for Medical Products (Version 1.0).
    • The Standardized Questions program is a project of Practice Greenhealth’s Greening the Supply Chain Initiative.
    • Medical products, for the purposes of this questionnaire, are defined as selected products used to diagnose, treat or care for patients. This excludes electronic medical products (anything that plugs in or has a battery).
    • Chemicals of concern are used in medical products on the market today. Products made from polyvinyl chloride (PVC) plastic, such as IV bags and tubes, contain a softener (DEHP) that can leach out during procedures. According to the U.S. Food and Drug Administration (FDA), DEHP produced a range of adverse effects in laboratory animals, but of greatest concern are effects on the development of the male reproductive system and production of normal sperm in young animals. The FDA “recommends considering such alternatives when these high-risk procedures are to be performed on male neonates, pregnant women who are carrying male fetuses, and peripubertal males.” Alternatives are available.
    • Selectively choosing the medical products that enter hospital facilities will generate demand for inherently safer products and services for patients, workers, and the environment.
    • Unlike some products categories, such as janitorial cleaners that are Green Seal certified, medical products do not have environmental standards or certifications to help define what is environmentally preferable.
    • The Standardized Environmental Questions were based in part on Kaiser’s Sustainability Scorecard (V.2)

    *The 5 signatory GPOs: AmeriNet, Inc., HealthTrust Purchasing Group, MedAssets, Inc., Novation LLC, Premier Healthcare Alliance.

  • Triple Bottom Line Benefits

    Cost benefits: Savings may be found in the total cost of owning environmentally preferable products versus traditional products:

    • Reduced patient stays and reduced health impacts to patients and staff exposed to products with chemicals of concern
    • Reduced workers compensation, sick leave, and worker injury
    • Reduced waste costs (such as hazardous waste)
    • Savings on energy or water costs
    • Eliminating costs associated with hazmat cleanup for harmful chemicals
    • Reducing the greenhouse gas emissions from a facility
    • Improving surrounding community health by reducing air, water, waste impacts

    Environmental benefits: By including environmental considerations in the purchasing process, before products enter a health care facility, hospitals and health care systems can reduce and even eliminate some of the potentially harmful environmental impacts (and associated costs) with product use and at the end-of-life.

    Social benefits: Using products that are environmentally preferable can eliminate or reduce human health concerns to patients and staff. This can result in reduced patient stays, reduced worker costs for exposures and improvements in the environment of the community.

  • Purchasing Considerations

    The following are sample phrases that can be used in communication with suppliers:

    • [Our organization] supports [our Group Purchasing Organization’s] use of the Standardized Environmental Questions for Medical Products (Version 1.0)
    • Please answer the set of 13 questions [listed in the How-To, #6]

    For additional sample environmental specifications for products and services purchased, see additional EPP guidance at Practice Greenhealth’s EPP Specifications and Resources Guide.

  • How-To

    1. Understand the critical concepts around using “standardized questions” in your contracting process, whether your GPO is an endorser of the program, and the benefits of your support. See the talking points section in this PIM. 
    2. Introduce the project in the Green Team/Sustainability Committee and/or specific Sustainable Supply Chain/value analysis committee if you have one. 
    3. If you have questions, you can contact your GPO’s Sustainability, Environmental Purchasing, or Contracting department through their GPO member services representative or customer service to let them know you are interested in supporting the initiative and the use of the Standardized Questions. Consider doing a joint presentation to your committee(s).
    4. Determine your Key Performance Indicators (KPIs) and/or how you will track your progress. Suggestions include how many responses included answers to the standardized questions; or which contracts were impacted by the responses to the questions. Work with your GPO and suppliers to track responses, challenges, and successes.
    5. Determine whether your organization wants to formally endorse the initiative. If so, hospitals wishing to do, must have a supply chain executive sign the EPP Pledge to support greening the supply chain and the Standardized Questions integration into their contracting process. Signing the pledge is optional but the hospitals and systems that have pledged, signal the marketplace that they are using the list of questions.
    6. Supply chain/materials management departments can also use the Standardized Environmental Questions for Medical Products in contracts, Request for Proposals (RFPs) or Requests for Information (RFIs). Refer to the matrix for a complete description of each of the 13 questions, summarized here:

    1. Does this product contain postconsumer recycled content (excluding steel)? (Yes/No) If yes, what percentage by weight?

    2. Is this product recyclable? (Yes/No)

    3. Does the product’s primary packaging contain postconsumer recycled content? (Yes/No) If yes, what percentage?

    4. Is this product packaged without polystyrene? (Yes/No)

    5. Is this product sold as a multi-use product or device (not single patient use)?  (Yes/No)

    6. Is this product free of intentionally added polyvinyl chloride (PVC)? (Yes/No)

    7. Is this product free of intentionally added phthalates: DEHP, BBP, DnHP, DIDP, and DBP?  (Yes/No) If no, please specify the phthalate(s)

    8. Is this product free of intentionally added Bisphenol A (BPA) or BPA derived plastics (such as polycarbonate plastic and resins)? (Yes/No)

    9. Does this product contain less than 1000 ppm halogenated organic flame retardants by weight of homogenous material? (Yes/No)

    10. Is this product free of intentionally added mercury? (Yes/No)

    11. Is this product free of intentionally added latex? (Yes/No)

    12. Will this product be classified (on its own or when aggregated) as non-hazardous waste according to EPA’s RCRA when disposed? (under 40 CFR 261.31-33)?  (Yes/No)

    13. Does this product contain carcinogens or reproductive toxicants, as listed under the California Safe Drinking Water and Toxic Enforcement Act of 1986, Proposition 65, below Prop 65 Safe harbor levels? (Yes/No)

    7. To use the questions, select an upcoming medical product contract and include the Standardized Environmental Questions for Medical Products questionnaire. 

    8. In the evaluation process, weigh the responses to the environmental questions. Responses can be scored in line with organizational priorities.

    9. Include costs of use in the evaluation, i.e., costs to throw away disposables versus reusables ($/pound), costs of energy or water ($/kw) and other cost impacts (some will not be measurable).

    10. Track progress and write a case study.

  • Tools

    Do you have a tool or ROI calculator to share? Comment in the section below or  contact us to let us know!

  • Case Studies

    If you have a case study on the use of the Standardized Questions, please contact us.

  • Regulations, Codes and Standards, Policies

    • The White House has several Executive Orders that all federal facilities must follow, outlined here: Office of Federal Procurement Policy and Sustainable Acquisition. While purchasing is not a governmentally mandated program for most organizations, there are some lessons learned from these policies.
    • GS1/GDSN includes several environmental attributes for health care products, such DEHP and product recyclability, and may eventually include the environmental attributes in the Standardized Environmental Questions.
  • Cross References: LEED

    LEED Existing Building Operations (EBOM) 2009. Several of the Materials and Resources (MR) credits might apply for items that are recyclable, include recycled content, or specific less toxic ingredients. Innovations in Operations (IO) credits might also apply. 

  • PIM Synergies

  • Education Resources

    Practice Greenhealth provides Webinars for a fee. There are several programs on Greening the Supply Chain.

  • More Resources

  • PIM Descriptors

    Supply Chain

    Level: Beginner

    Category List:

    • Strategic Operations

    PIM Attributes:

    Improvement Type:


    • Purchasing/Materials Management/Supply Chain
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  1. Comment, and please add information, tools, or additional resources you think should be added to the PIM.
  2. Write a case study or a PIM to contribute to the Roadmap (links are to instructions).

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