The second largest expense on a hospital's balance sheet (following labor) is supply chain costs. As reported in 2009, 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 procured by a hospital ultimately become waste, resulting in nearly 7,000 tons of waste every day and $10 billion annually in disposal costs across the health care industry.
By instituting waste management programs along with changes in material consumption patterns, a health care facility can reduce the amount of waste it generates and thus its waste handling and disposal costs as well as its environmental impact.
Health care facilities can generate up to 25 pounds of waste per day per patient; however, that waste represents an environmental footprint much larger than just the cost and impact of disposing of the materials: For every pound of product manufactured in the United States, 32 pounds of waste are created during the manufacturing process, and transportation also adds to the environmental impact of products a hospital purchases.
Waste management initiatives offer tremendous opportunities for a facility to reduce both its environmental footprint and its supply chain and waste disposal expenses. Estimates of cost savings can be as high as 40–70 percent of waste disposal outlays, representing $4–7 billion in savings for the industry as a whole.
Understanding Your Waste. The first step to improving a facility's waste management is to understand its overall waste stream. Non-regulated waste, which makes up around 85 percent of a hospital's total waste stream, is no different from the waste generated by a hotel, where up to 60 percent is either recyclable or compostable. Regulated medical waste (sharps, pathological waste, trace chemo, and so on) makes up about 5–15 percent and hazardous chemical waste makes up a smaller percentage (less than 5 percent) of a health care organization's waste by total volume.
Some waste materials are categorized according to the method by which they are handled. For example, construction and demolition (C&D) waste is considered solid waste if it is landfilled or incinerated, but C&D also includes recyclable waste (wood, metal, concrete, sheet rock, etc.). Pharmaceutical waste is its own category, and the type of chemical dictates if the waste is managed as hazardous waste or trash.
Each waste stream has different costs, and the simplest strategy for managing waste is to properly categorize it and make sure it is handled properly (e.g., that the right material goes into the right container). This approach allows an organization to safely and appropriately maximize the amount of waste materials that fall into lower cost, more environmentally friendly categories.
For an overview of the main waste stream categories in hospitals, view the table Main Health Care Waste Categories—Treatment and Disposal. More detail can be found in the table Subcategories of Main Health Care Waste Types.
Material Use, Waste Management, and Climate Change. Throwing out unused supplies is one of the most wasteful practices at health care facilities. The energy it takes to manufacture these products produces GHG emissions that contribute to climate change. Health care facilities can improve their environmental performance by changing material consumption patterns. For example, they can eliminate unnecessary purchases and, when possible, require the use of products made with recycled content.
In addition to saving money, changes in material consumption patterns and proper waste management have significant implications for improving environmental performance and reducing climate change. Climate change efforts focus on reduction of carbon dioxide (CO2) emissions from energy use and reduction of other GHGs like methane or nitrous oxide. Waste reduction strategies and related efforts to "close the loop"and purchase more items with recycled content are consistent with these efforts and should be part of a comprehensive strategy for GHG reductions.
Materials In. The materials used by the health care industry take energy to mine, manufacture, and deliver to the point of use in a hospital. Factors that contribute to the overall environmental footprint of a product from cradle to grave might include energy and water use, toxic chemicals generated, waste created, and related climate change impacts. For example:
- Mining or extraction of materials: Are materials energy intensive to mine and extract, or are they sustainably harvested using renewable resources? Some organizations certify products to make it easier to answer this question (e.g., the Forest Stewardship Council and Greenseal)
- Manufacture: Are products energy intensive to manufacture? Are alternative products available?
- Transportation: Are locally produced goods available?
- Product choices: Are reusable, durable goods available to replace single-use products is currently purchased by the facility?
Waste Out. When materials move into the waste stream, energy is used to transport the waste to its final disposition. When waste is landfilled, methane gas is created by organic materials decomposing in an oxygen poor environment. Methane, a powerful GHG, is eight times more potent as a GHG than CO2. When waste is incinerated, CO2 and N2O are the primary GHGs emitted. For more information on this subject, read a brief summary from a 2002 EPA report on the impact of municipal solid waste on greenhouse gas emissions.
Health care waste is complex not only because of its sheer volume, but also because a small but significant amount of that waste, about 15–20 percent, is regulated by multiple agencies, including EPA, OSHA, DOT, the Joint Commission, DEA, and others. Items like regulated medical waste (RMW), pharmaceutical and hazardous chemical waste, radiological waste, and so on are 10 to 100 times more costly to manage than solid waste or recyclables. Minimizing the amount of expensive regulated waste a hospital produces will both save money and reduce compliance risks.
In addition, potential legislation regarding reduction of greenhouse gas (GHG) emissions may lead to compliance requirements in the future. Twenty-five states have climate action plans that include waste reduction as part of a strategy to reduce GHGs. These plans can serve as models (and potential requirements) when setting an organization's goals.
A list of the agencies that oversee regulated waste, including brief summaries, is posted in the Regulatory Requirements section under the Roadmap Drivers tab. Also see the Roadmap's "Being in Compliance" performance improvement measure under the Implementation tab. Another excellent resource is the Healthcare Environmental Resource Center (HERC), which is sponsored by the U.S. EPA Office of Environmental Compliance.
A 1998 Memorandum of Understanding between the American Hospital Association (AHA) and the U.S. Environmental Protection Agency set ambitious waste reduction goals, most of which we're still striving to achieve. Some hospitals are working on the most basic recycling programs, while others have progressed to more advanced and sometimes more creative ways to reduce waste. All facilities are encouraged to take the next step, whatever that may be. AHE members have seen firsthand the benefits of comprehensive, integrated waste management practices, and recognize that a wide spectrum of opportunities exists.
Numerous opportunities for reducing and recycling waste can be found in the Implementation section of this website.
Cost Savings. Much of the waste generated by U.S. hospitals represents "tossed resources." For example, if more than 10–15 percent of its total waste ends up in red bags, a hospital is tossing resources. (Disposing of RMW costs up to 10 times more than disposing of municipal solid waste (MSW) and up to 30 times more than recycling.) If a facility is not recycling at least 20 percent of its waste, it is tossing resources. Finally, if a facility is not auditing its waste--identifying sources of unopened and unused supplies going into the waste stream--it is tossing resources. A waste management system can help an organization find and respond to the areas such as these where it is wasting resources.
A waste management system offers true opportunities for cost savings, and the investments required are typically minimal. For example, the cost of purchasing recycling containers can be offset by the cost savings from avoided waste disposal. As well, there may be a public perception value to having visible recycling receptacles.
Environmental Benefits: Waste management initiatives often reveal additional, and less obvious, ways to reduce a health care facility's environment impact. Examples include composting food waste and other compostable materials; recycling furniture, equipment, and supplies to keep them out of landfills; and, of course, recycling paper, cardboard, metals, plastic, and glass. Minimizing the amount of waste going to landfills or being incinerated reduces associated GHG emissions.
Health and Safety Benefits: Developing and implementing a comprehensive waste management program ensures that staff will know and follow proper disposal requirements, leading to a healthier, safer environment.
The Roadmap is designed to help facilities design a customized short- and/or long-term waste management plan to achieve its waste reduction goals. And if now is not the right time to develop a full plan or strategy, the Roadmap can also help you launch easy-to-implement projects today.
The Roadmap identifies opportunities for improving waste performance and explains the strategies involved to achieve those reductions. The Roadmap allows you to customize your plan based on your organization's current progress on sustainability and how aggressively you want to pursue waste minimization goals.
Click on the Roadmap sections below to take the next steps:
- Information on drivers and barriers for sustainability efforts
- Strategies for building sustainability teams
- Strategies for getting leadership support
- Steps for creating a waste management plan
- Strategies for financing sustainability projects
- A target-setting tool for waste-related projects
- Performance improvement measures—projects or activities that will help improve your facility's sustainability profile. Information on many PIM pages includes references to case studies and tools for implementing specific projects.
- Green light projects for waste—easily adopted PIMs that can provide meaningful results at low cost