Hospitals that go green can see green with effective waste strategies

by Debra Gillmeister

It is no secret to many hospital executives that the American healthcare sector’s carbon footprint is growing. At 8 percent of the U.S. footprint, hospitals are the largest contributor of carbon emissions, and the second most energy-intensive industry1.

U.S. hospitals generate 6,600 tons of waste each day2. Drugs in drinking water, syringes on beaches, and infectious waste in landfills have intensified scrutiny of healthcare organizations.

What is your plan? There will be roadblocks, complications and many cost considerations for developing an integrated program. Managing hospital healthcare waste streams is a complex process. Almost 80 percent of waste streams in a hospital are highly regulated. Internally, no single department is in charge of the collective waste effort.

To start you can perform a compliance and waste audit of current practices unit-by-unit and include an analysis of all waste invoices for 12 months. This will help you identify collective practices and potential opportunities for improvement. Co-dependencies for managing waste reveal a spider web of activity. For example, there can be more than 12 types of waste streams that are a byproduct of more than 10 major departments of the hospital. See Figure 1.

Figure 1

Consider six areas for the strategic management of healthcare waste streams:

• Understand roadblocks and complications for implementing a coordinated approach to managing waste streams

• Recognize variables (regulations, facility size, adjusted patient days) that dictate total costs of consumption and disposal

• Consider use of a licensed third-party vendor for compliant healthcare waste stream management

• Choose sustainable efforts, such as reusable containers, instead of disposable containers

• Observe costs – regulatory, direct and indirect

• Consider developing a Green Team or a multi-disciplinary team that will assist in driving change through the organization and is sponsored by hospital administration.

When analyzing waste stream management, a thorough approach includes identifying regulatory risk factors. A survey of 450 hospitals3 uncovered an average of 15 regulatory compliance issues per hospital.

Yet in seeking to understand total costs, 90 percent of hospital leaders surveyed could not delineate the cost of managing their waste streams. This means most leaders do not have an understanding of monthly dollars spent managing healthcare waste. A hospital must analyze the various areas relating to consumption patterns, waste activity and associated operational costs.

Cost strategies

A 2009 survey by Practice Greenhealth found that 64 percent of hospitals implement medical waste reduction programs. How do you measure your environmental impact?

For instance, how do you determine the amount of plastic, cardboard and resulting CO² emissions diverted from the environment by switching to reusable sharps containers? Since 1986, U.S. hospitals using reusable containers have kept more than 105 million disposable containers out of landfills.4 Are your containers in the correct location, the right size and routinely exchanged to prevent overfilling and the resulting needle sticks? Are the containers installed at NIOSH-enforced heights?

Make waste reduction a focus of your hospital’s plan and culture. Hospitals have "cradle-to-grave" responsibility for regulated medical waste disposal. Employees are responsible for properly managing it. A high degree of program customization means there are few national benchmarks for cost savings. Every hospital experience is different, depending on location, depth and type of services, size of facility, and more.

A facility can realize savings by consolidating service providers for an integrated solution that focuses on segregation and appropriate diversion of waste.

Consider Washington, Oregon and a number of metropolitan areas that have "franchises." Waste vendors are selected in these areas by the city and pay a fee to be considered by hospitals. In California, laws make it difficult for medical waste incineration to exist. Hospitals must ship certain types of waste long distances for treatment and disposal. Other variables such as consumption patterns and types of waste make it challenging to budget. A budget must also include education, training and services to identify, segregate, package, collect, and transport waste internally and externally.

Costs can be examined in three strategic areas:

• Regulatory requirements (staff, training)

• Direct costs (equipment, transport, infrastructure)

• Indirect costs (cost containment, risk management and hidden costs)

Regulatory requirement training costs. Internal staff or an outsourced team is required for the collection and dock management of various waste streams. Agencies such as the Department of Transportation and Occupational Health and Safety Administration require hospital employees be trained in the proper handling of regulated waste streams. The Resource Conservation and Recovery Act enforced by the Environmental Protection Agency oversees and regulates hazardous wastes, including pharmaceutical waste. Additionally, adhering to state and local regulations, and appropriate planning and management of waste is outlined in approximately 20 of The Joint Commission standards.

Direct costs. These include the following:

• Insurance (workers compensation and other claims) for safety, risk and compliance issues

• Data collection and record retention for regulatory compliance, self-audits and monitoring of regulatory updates/changes

• Replacement, repair and maintenance of leased or owned equipment (carts, containers, bags, compactors, shredders, ergonomic equipment)

• External collection assets such as cart tippers, compactors, shredders

• Ancillary equipment such as scales, radiation monitors, security gates, cages and ramps

• Waste disposal and tracking

• Redundancy of operations for emergency preparedness and natural disasters

• Infrastructure and IT – storage, utilities, security, document management systems, a back-up system and audit system

Indirect costs. These involve cost containment, risk management and hidden costs, including the following:

• Increased treatment costs if waste segregation is not managed well

• Potential fines for regulatory non-compliance and civil penalties

• No preparedness plan

• Liability to risk exposure for patients and staff

• Increased workers compensation

• Negative news coverage which could trigger possible decreased physician referrals, patient satisfaction and visits, Medicare reimbursement, and employee turnover costs

Management model options

Staffing to manage the waste function ranges from direct management by employees to a hybrid of outsourced management with staff to 100 percent outsourcing. There are benefits and challenges to each model. The majority of hospitals have existing relationships with different waste companies. Either way, overseeing relationships with multiple vendors and assuring they are meeting contract commitments, as well as hospital goals, can be very challenging.

Measured and managed

Systematically collecting data allows hospital or integrated delivery network leadership to identify trends, compare to industry averages and benchmark against best demonstrated practices (BDPs), so that a hospital can focus on improving performance. In addition to comparing monthly trends, methodologies exist to track the amount of waste generated by department.

According to Practice Greenhealth’s 2010 Environmental Excellence Awards Sustainability Benchmark Report, the average percentage of a hospital’s recyclables from total waste is 27 percent, while industry leaders reach 35 percent. The average hospital has a percentage of total waste volume for municipal solid waste (MSW) as a BDP of 68 percent, while the industry average is 56 percent. Regulated medical waste (RMW) from the total waste stream has a BDP of 8 percent, while the industry average is more than 15 percent, according to the survey. Several Florida hospitals that use Stericycle’s Sustainable Solutions service indicate that the service helps them coordinate their greening efforts. Boca Raton Regional Hospital, a 400-bed hospital in southeast Florida, recycled an average of 54,000 pounds per month from January to August 2011. "With a formal program and a hospital-wide effort, we have increased recycling to 648,000 pounds a year, and decreased RMW total pounds from 62 percent of total waste stream to 15 percent. Also by using reusable containers, we have diverted 12,000 pounds of CO2," said Karen Poole, COO.

In more than a year, Miami Children’s Hospital has dropped its total pounds of MSW to 65 percent with a goal of 38 percent. Total RMW pounds have decreased to 12 percent of total waste stream, while recycling percentages have more than doubled to 25 percent from 11 percent as the hospital strives toward a 38 percent goal.