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The Greening of Healthcare 

Little changes mean a lot for the massive health care industry

Take comfort in this, Al Gore: You can make a difference.

In the two years since An Inconvenient Truth was released, discussion of global warming has grown from a niggling gnat buzzing in the back of the public mind into a teeming swarm of magazine articles, press releases and environmental initiatives.

Take Sacred Heart Medical Center. Along with other Providence Health Care hospitals, Sacred Heart just established a “Green Team” to turn all the “Hey, we should help the environment” talk into action. At Sacred Heart, the team’s led by facilities director Philip Kercher.

Each month, he plans to join similar Green Teams throughout Washington and Montana  — including one at Holy Family Hospital in Spokane — where they will brainstorm ways to make their hospitals more environmentally friendly places. Then, he’ll meet with hospital administrators and employees to plot out a plan of attack.

“The Green Teams will review our current efforts at recycling and sustainability and environmental actions and look to ways to improve and add on to those services,” Kercher says.

Meanwhile at Kootenai Medical Center in Coeur d’Alene, there’s also an informal group to head up environmental initiatives, to bump up KMC’s environmental quality a few notches. Despite having no connection with Sacred Heart’s initiative, the group is also called a “Green Team.”

It isn’t just coincidence. It’s convergence.

Both Sacred Heart and Kootenai have tapped into the same vein of the zeitgeist. So has Deaconess Medical Center, which has peppered its walls with posters encouraging recycling, and set screensavers to give “save power, turn off your computer”-style reminders. The Spokane Veterans Administration Hospital just walked away with a “System for Change” Award from Practice Green Health for its environmental efforts.

Suddenly Green, for lack of a better word, is good.

Traditionally, hospitals, for all the good they do, haven’t been all that environmentally friendly.

Consider your last doctor visit. You drove across town in your car, spewing carbon dioxide from your exhaust pipe the entire way. You filled out three separate forms — each attached to two pieces of carbon paper. You walked in and sat down on a clean strip of paper, which will be torn off and thrown away. You had your mouth checked with a tongue depressor, which was thrown away. You were given a shot, which was thrown away into a sharps container, which itself is thrown away.

Multiply that by the hundreds of patients at the average hospital and you begin to see the problem.

Hospitals are huge. They’re kingdoms unto themselves. Sacred Heart Medical Center has hundreds of patients and more than 4,000 employees. They all require water, electricity, heating, food, and supplies.

“Often we hear Sacred Heart referred to as the City of Sacred Heart,” Kercher says. “Like any small city, in many ways it’s a self-contained entity that requires all of these utility services — electricity, natural gas, food products and patient-care supply.”

The underlying issue is a flawed institutional mindset, says Peter Yellowlees, instructor at the University of California, Davis, and deputy editor for The Medscape Journal of Medicine. where he’s written about the issue of environmentalism and healthcare.

“There’s an attitude in health care that, because of the nature of some of the work that’s involved, that somehow there’s [already] quite a lot being done to help other people,” Yellowlees says. “They already think they’re doing good things.”

Where some megacorporation might try to go green to alleviate their own guilt about making a profit instead of a positive impact, Yellowlees says that many people in health care feel they’ve already reached their Good Deed Quota by saving lives — so they don’t feel pressed to worry about the environment as well.

“Health care’s been slow to adapt compared to other industries, but I think they will catch up,” Yellowlees says. “People who work in health care tend to be fairly intelligent. They have started to look around their work environment … [and ask], ‘Why can’t we do more for our environment?’”

One problem, Yellowlees says, is the sheer volume of waste that comes from health care every year.

“There’s an assumption that everything’s got to be disposable, that health care’s too important to use techniques to be environmentally friendly,” Yellowlees says.

Since hospitals are a unique concentration of pathogens and people susceptible to pathogens, keeping the two separate is a task of life-and-death importance.

For many hospital materials, reuse is not an option. The gauze, the bandages, the gloves and even the pillows are disposable. One use and it’s marked for destruction.

Hailey Erickson, a registered nurse at Kootenai Medical Center, is head of their Green Team. She explains that once a patient touches an item, it’s considered contaminated, so the hospital — and the operating room in particular — generates waste galore.

The Program

But hospitals are now making efforts to reuse some contaminated items.

At Sacred Heart, when a doctor pokes or prods a patient with a syringe, he immediately places it in a medical waste receptacle and the container is sent to Stericycle, an Illinois-based medical waste management company.

Stericycle safely disposes of the syringes — but since 2005, they’ve gone one step further. Instead of simply tossing away the containers that the syringes come in, Stericycle sends a sterilized container back to the hospital through their Bio Systems management program. In the end, that means less packaging and less trash clogging up landfills and incinerators. It may not sound like much until you remember just how much waste is generated by hospitals.

“Over 10 million pounds per year we reduce in materials that are not going to landfills,” Stericycle Chief Financial Officer Frank Ten Brick says.

Kercher says he appreciates Stericycle’s program.

“They provide a very valuable service to the community,” Kercher says. “This is a safe, efficient and financially viable way of handling a very sensitive item.”

Simpler recycling programs — the usual paperwork and such — have sprung up as well. The Spokane VA hospital sends 43 percent of their waste to recycling, says Todd Bennatt, the hospital’s Green Environmental Management system manager. Just by recycling, he says, the Spokane VA saved more than $18,000 last year.

“We’re always evaluating our process and trying to reduce any kind of packaging waste,” Bennatt says.

At Kootenai, Erickson says once the Green Team started focusing on shredding and recycling paper, they logged around 64,000 recycled pounds. Kootenai not only recycles its sharps containers, but also its laundry detergent bins and wood pallets. Erickson says the hospital encourages patients to take their personal wash basins home with them, but she’s looking into ways to recycle the ones left at the hospital.

Of course, the simplest way to deal with waste is to simply not produce it at all. Kootenai only prints a small fraction of their newsletters — most are e-mailed. And Erickson says that many employees tag a little “Do not print unless absolutely necessary” message at the bottom of their e-mail messages.

The Spokane VA, meanwhile, has a program that looks at cutting waste at the level of purchasing. They try to find items light on packaging and heavy on recycled material.

“It’s basically become the way to do business in the future,” Bennatt says.

The Power

Hospitals don’t just expel waste, they drain power and water. A key component of the Green Teams’ plans has to do with transforming the hospitals innards — the boilers and cooling towers and ventilation systems — to use fewer resources.

Deaconess spokeswoman Christine Verala says the medical center recently completed a top-to-bottom engineering review to find which facilities needed upgrading. Deaconess’ sister hospital, Valley Hospital, just constructed a new energy plant.

At Sacred Heart, Kercher says they’ve begun to use electronic motors with “variable frequency drives.” Instead of running at a constant speed, these motors are constantly modulating, shifting and adjusting to the need of that minute.

“You can deliver just the amount of air or water you need,” Kercher says.

And in 1995, Sacred Heart changed their light bulbs. Almost all of them.

Kercher points to two lights in his office. One has a 25-watt bulb. The other has a 32-watt bulb. Guess which is which, Kercher says.

They look identical.

Fluorescent bulbs have come a long way since the flickering pallid ghost-beams often associated with hospitals.

They’ve become cheaper and more efficient, and they beam out softer, more natural light. They’ve also had their mercury content substantially reduced, Kercher says. Going from 32 watts to 25 watts may not seem like a big difference, Kercher says. But multiply that by 30,000 points of light — the approximate number of bulbs at Sacred Heart — and you’re talking real energy savings.

The money saved by creating a more efficient facility can be spent on other, less cost-effective environmental initiatives, Kercher says.

The Mindset

At Sacred Heart and other facilities run by the Sisters of Providence, much of their concern for the environment stems for their Catholic affiliation.

In his office, Kercher has a glossy poster called the “Providence Commitment” taped to a filing cabinet. The Commitment quotes Psalm 24:1,

“The earth is the Lord’s and all that is in it.”

Three bullet points follow: “We believe that everything entrusted to us is for the common good. We strive to care wisely for our people, our resources, and our earth. We seek simplicity in our lives and in our work.”

Sacred Heart was built in 1886 to aid the poor and underserved, Kercher says. This new commitment to the environment is simply a natural evolution of that philosophy: Help the less-fortunate. Use resources wisely. Slowly improve the world around them.

For Kercher and others, the success of their program is about subtly changing philosophies from cavalier to sustainable.

Kim Anderson, Kootenai Medical Center’s spokeswoman, says the recycling mindset at Kootenai has slowly seeped into their employees.

“It has really helped the employee base to develop more of a recycling mindset personally,” Anderson says. “It’s like when your neighbor jogs and you think, ‘oh, maybe I should start jogging in the morning.’ When you’re at home you start thinking about ways you’re reducing and reusing.”

At Sacred Heart, Kercher says about 300 employees carpool. Eighty employees come to work in five vanpools provided by Sacred Heart as part of the county’s Commute Trip Reduction program. Kercher, for his part, bikes to work every day.

“I think it’s important that we all consider what I regard as simple changes in our personal lives — changes that really won’t change the quality of our life,” Kercher says.

The Future

Yellowlees appreciates efforts toward recycling and energy conservation, but he thinks health care needs to look beyond that.

“What hasn’t happened is people haven’t thought about how [to] change the way they behave and practice,” Yellowlees says. He says the world of medicine needs a fairly dramatic paradigm shift. Telemedicine, videoconferencing and e-mail can all revolutionize the way patients and doctors interact, saving the patient time and gas, and saving the environment the extra carbon impact.

Videoconferencing and e-mail could even be used for hospital visitation, Yellowlees says. Too often, he says, friends and family drive all the way to the hospital, only to find that the person they planned to visit is sleeping.

Yellowlees says using e-mail and videoconferencing could actually increase the amount of patient-visitor interaction, simply because it’s so much easier to log on and type a few keystrokes than drive across town.

As health care makes up 16 percent of the gross national product, Yellowlees says it’s imperative for hospitals to keep the environment healthy, not just their patients: “This big segment of our society can operate on a better ecological level.”

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