Resources

The Resources section of the Sustainability Roadmap for Hospitals is divided by topic, with the content on each sorted under these headings: talking points, resource library (articles, books, organizations, and additional resources), and case studies. A glossary and list of acronyms are provided to help you navigate the material on this website.

The talking point sections of each category are combined below to provide a quick resource for those preparing a presentation, proposal, and so on.

If you have additional resources, talking points, or any other information others might find helpful, we invite you to share them with your colleagues by sending them to us.

Overall Sustainability Talking Points

The health care industry affects the lives of nearly every person in the United States. Nearly 6,000 hospitals include almost a million staffed beds, admit almost 37 million patients (not including outpatient visits), employ nearly 5 million people¹, and directly or indirectly support one in every nine jobs. Today, the sector accounts for 17 percent of the GDP.

Health care is resource intensive with significant input of materials, water, and energy that results in output of waste, effluents, and emission pollution. Health care generates material in almost every category of waste and emissions.

Hospitals consume two-and-a-half times more energy than other commercial buildings, spending more than $8.7 billion per year according to the EPA Energy Star program. Energy Star for Healthcare and the U.S. Department of Energy (DOE) Better Buildings Alliance both have challenged the health care sector to significantly reduce its energy use. The goal of the DOE initiative is to see commercial buildings reduce energy consumption by close to 70 percent based on today’s building codes. What’s clear is that the health care sector can save billions of dollars by reducing its energy use, helping to reduce the nation’s dependence on foreign fossil fuels and the industry’s climate change impacts in the process.

Supply chain expenses alone represent the second largest expense line on a hospital's balance sheet, following labor: the average hospital provider spends more than $72 million a year on supply chain functions, nearly one-third of its annual operating budget. The majority of the materials consumed in health care facilities ultimately become waste, costing health care consumers $10 billion annually in waste disposal costs. The opportunity for cost reduction through smart source reduction and waste management may be as high 40 to 70 percent, representing $4 to $7 billion for the health care industry.

• Health care realities: Rising costs, lower reimbursements, aging population, aging facilities, staff retention, diverse operations
• Energy realities: Rising costs, $8 billion annually, growing demand, carbon emissions, energy security, increasing intensity (DOE)

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Energy

• Hospitals use 836 trillion Btu of energy annually. (DOE - 1—2. 2003 CBECS)
• Hospitals have more than 2.5 times the energy intensity and CO₂ emissions of commercial office buildings, producing more than 30 lbs. of CO₂ emissions per square foot.² (1—2. 2003 CBECS)
• A 2006 survey published in Health Facilities Management identified the top factors that stop energy efficiency improvements:
  • Lack of funds
  • Other priorities
  • Long payback periods
  • Underfunded O&M budgets
  • Lack of senior management commitment and support
• 91 percent of hospitals reported higher energy costs over the previous year, and more than half cited an increase of more than 10 percent (ASHE survey, Health Facilities Management, June 2006.)

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Waste

General

• Materials consumption in health care facilities costs health care consumers $10 billion annually in waste disposal costs. The opportunity for cost reduction through smart source reduction and waste management may be as high 40 to 70 percent, representing $4 to $7 billion for the health care industry.
• Hospitals in the US generate upwards towards 7,000 tons of waste per day.
• A small but significant amount of that waste, about 15–20 percent, is highly regulated by multiple regulatory agencies including EPA, OSHA, DOT, Joint Commission, DEA and others. Items like regulated medical waste, pharmaceutical and hazardous chemical waste, radiological waste, sharps and others are expensive to manage—up to 10–100 times more than solid waste or recycling.
• The non-regulated waste, the other 80+ percent, is no different from that generated by a hotel, up to 60 percent of which is either recyclable or compostable.
• Landfill facts: In the early 1970s, about 20,000 landfills, most of which were actually unlined dumps, were being used. Today, as a result of the regulations, the dumps are closed and slightly more than 1,700 MSW landfills are in use. New landfills are difficult to site and build due to community pressure (not in my backyard) and the cost of the required technology. The strategy today is to extend the operating life of a landfill by recycling and reusing materials that don’t need to be landfilled.
• Methane gas: When waste is landfilled, methane gas is created by organic materials decomposing in an oxygen poor environment. Methane, a powerful greenhouse gas (GHG), is 8 times more potent as a GHG than CO2. The strategy for improvement is an integrated waste management plan that includes reuse and recycling, and composting programs to remove organic materials. Also ensuring your landfill has mitigation strategies for capturing the methane gas as an energy source or at least burning it off to reduce methane emissions.

Recycling

• Cardboard alone makes up almost 15-20 percent of the waste stream of a typical hospital.
• Cardboard is used to ship 90 percent of all products in the United States.
• Recycled cardboard (sometimes called old corrugated containers—OCC) only takes 75 percent of the energy needed to make new cardboard and lessens the emission of sulfur dioxide that is produced when making pulp from wood trees.
• Recycling 1 ton of cardboard saves 9 cubic yards of landfill space and 46 gallons of oil.
• While OCC is very recyclable, finding opportunities to reduce it is a priority—like implementing a reusable tote program.
• Beverage containers (glass, plastic, aluminum containers) make a combined rate of about 6&ndash10 percent of healthcare waste. (Practice Greenhealth)
• Blue sterilization wrap accounts for up to 19 percent of waste generated in the Operating Room (www.premierinc.com/quality-safety/tools-services/safety/green-link/green-corner/Harbor_Blue_Wrap_MDH2E.pdf).
• A standard recycling program in a hospital consists of cardboard, confidential paper collection (HIPAA), mixed fibers (magazines, newspapers, non-confidential mixed office paper, boxboard), beverage containers, metal, recyclable construction/building materials, some non-traditional mixed plastics. This level of program can reduce waste by 30–40 percent.

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Water

• Hospitals use an average of 139,214 gallons of water per day.
• Water is finite; it cannot be created or manufactured. What is available on the planet is all there is. Only 3 percent is fresh water, and only a fraction of that is available for our water consumption needs. Water conservation has two main categories: (1) using less waste through better technologies in systems and fixtures and (2) capturing rainwater and other “used” water for other purposes. (IFMA Water Sustainability Guide)

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Supply Chain

Supply chain professionals are tasked to contribute to the overall value in the lifecycle of goods, services and equipment for health care organizations. Balancing price and savings with quality, safety and outcomes the supply chain has significant impact to both the bottom line and patient care experience.

• Hospitals are environments for healing but many of the products and materials used may be harmful if they contain or release during production, use or disposal carcinogens, reproductive toxics or other materials that may be hazardous to human health and/or the environment.
• Ninety percent of [all sector] companies that perceive sustainability issues as significant have developed a comprehensive sustainability strategy, 70% have included sustainability on their senior leadership’s agenda and 69% have addressed a sustainability business case.
• Supply chain stats:
  • Purchased goods and services about to over $300 billion in expenses for US hospitals. 
  • Cost of supplies is second only to that of labor. As technology continues to advance, supply costs may overtake labor costs.
  • Medical devices and materials account for as much as 30 percent of an IDN's spend.
  • $630 billion dollars of potential waste stream materials.  
  • Final disposal costs range can range from xx to xx per pound depending on the type of waste.
• It takes a $1,000 increase in revenue to have the same impact on the bottom line as a $1 reduction in operating expense (depending on facility margin). Sustainable projects can assist in impacting the bottom line decreasing disposable expense.  
• Sustainable supply chains are profitable supply chains: sustainability often goes hand-in-hand with resource efficiency, reduced costs, increased durability, profitability and increased stakeholder value of quality.
• Studies on what qualities that Generation X’ers (ages between 18 and 25+) value in the workplace, topping the list is working for and in an organization that values sustainability.
• Supply chain has been traditionally motivated to find savings based on first cost. Today, total supply chain professionals are learning the importance of looking beyond first cost and using a combined approach using the strategies of AHRMM’s Cost, Quality, Outcomes (CQO) Movement, embodying principles of VAT – Value Analysis and combined with Total Cost of Ownership approaches.  
• The health care industry as a whole could save $5.4 billion in five years and up to $15 billion in 10 years if it adopts sustainable practices. Among the areas for potential savings, according to the study:
  • reduce medical waste through better segregation;
  • reduce landfilled waste through recycling;
  • more efficient purchase of operating room supplies;
  • switch to reprocessed devices in the operating room over single-use devices.
• Material choices matter when purchasing. For example:
  • It is estimated that Styrofoam is responsible for significant volume of material in a landfill and it will never, ever decompose.
  • Paper accounts for approximately 40% of the solid waste clogging up U.S. landfills.
  • For every ton of recycled paper fiber that displaces a ton of virgin paper fiber results in the following reductions in usage:
    •  
      • Wood - 100%
      • Total energy consumption - 27%
      • Waste water - 33%
      • Air particulate emissions - 28%
      • Solid waste - 54%
• Glutaraldehyde, one of many chemical hazards in the healthcare workplace, is a potent sensitizer that causes occupational asthma.
• Cleaning agents and materials and their methods of use are increasingly implicated in asthma.
• Exposure to toxic chemicals in everyday life has increasingly become a health concern. More than 80,000 chemicals are used in commerce today, and only a small fraction has been tested for effects on human health. There is growing evidence that environmental exposures to some chemicals contribute to cancer, asthma, reproductive disorders and other health impacts.

Senior management has begun to reconsider where to strategically position the supply chain within the organization and many organizations have moved supply chain into the executive suite at the vice president level. At the same time, some hospitals have shifted sustainability program management into supply chain/procurement (e.g., Bon Secours).  This is important as sustainability considerations are being embedded into the organizational fabric as well. 

In a global transportation network, 95% of shipments are by ocean, truck, and rail, and 5% were air. The 5% of air transportation accounts for over 40% of the total transportation carbon footprint.

The United States sends other countries almost $1 billion each day for oil to power our cars, trucks, planes, trains, and ships. In addition, estimates have shown that emissions cause more than $55 billion per year in health and other damages, and vulnerability to unexpected increases in oil prices costs an additional $45 billion per year.

Through transportation efficiencies, US EPA’s SmartWay industry partners have eliminated 51.6 million metric tons of CO2, resulting in savings of 120.7 million barrels of oil and $16.8 billion in fuel costs.

The OR is one of the largest users of supplies within a hospital as well as one of the largest producers of waste. Case studies have estimated that between 20% and 30% of the total waste generated by the hospital comes from the OR.

OR studies have shown that in 50 diagnosis related groups (DRG), the cost of supplies plus operating room time exceeds half the total cost of admission. In these examples, savings are accrued by clinician collaboration in the selection of goods and processes and management. Chain plays a critical role in sourcing products and/or services that contribute to the major program area opportunities for improvement, including:

- Regulated medical waste reduction and segregation
- Fluid management systems
- Single-use device reprocessing
- OR kit reformulation
- Reusable surgical gowns and basins
- LED lighting and power booms
- Displacement ventilation
- Waste anesthetic gas (WAG) capture and reclamation
- Medical plastics recycling
- Reusable hard cases for surgical instruments

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