hospital& agedcare PR

INT

POST

APP

ROVE

D 10

0005

335

AustrAliA’s leAding business mAgAzine for heAlth & Aged cAre mAnAgers 11/12 | 13www.hospitalandagedcare.com.au

EnvironmEntal StratEgy:

inSidE:Food and Nutrition: SAN makes 12500 mighty meals a week to help heal

Aged Care: Managing wound care cases is a strategic business at RDNS

Fiona Stanley Hospital’s DON works to develop best practices

20 24 28

St vincent’s Health australia’s plan to save millions

20 | hospital & aGEDCaRE | November_December 2013

Facilities - environmental strategy

With a portfolio comprising six public hospitals, eight private hospitals, about 13 aged care facilities, and four co-located research institutes, and a territory spanning mainland Australia’s three eastern seaboard states, St Vincent’s Health Australia has a Goliath-size environmental footprint which its resolved to reduce.

SVHA operates 27 facilities on the eastern seaboard of Australia and employs more than 16,000 staff. It is the nation’s largest Catholic not-for-profit health and aged care provider. Some of the nation’s finest research institutes are affiliated within the group including the Victor Chang Cardiac Institute, Garvan Institute of Medical Research, O’Brien Institute, and St

Vincent’s Institute of Medical Research.Its environmental resolution is much more

a full body immersion, than a toe in the water pilot. It will be enterprise-wide, audited and reportable to all key stake holders.

The project commenced in 2012 and scheduled to run until at least 2015.

Matthew Power SVHA’s Group Manager, Energy and Environment has responsibility for formulating and implementing the ambitious enterprise-wide environmental imperative, which he says is the organisation’s response to several key factors.

“There are a number of reasons for committing to an environmental strategy but probably the biggest was that St Vincent’s used

to consist of four separate organisations. They amalgamated to form SVHA and there was an opportunity to address our environmental impact at a group level and in a uniform way.

“Equally, as separate entities each sometimes “flew under the radar” as far as federal legislation was concerned (such as National Greenhouse Energy Reporting System, or Energy Efficient Opportunities or EEO, ) and having breached those legislative thresholds we needed to organise ourselves to address them.

“Primarily the driver for SVHA is that we feel strongly that it is inherent in our mission as a catholic health organisation to not only help those at the margins particularly through healthcare but to also be good stewards of the earth.

“ Hospitals and healthcare by their nature have a major environmental footprint so it would be in our view irresponsible not to address that impact,” Power says.

Business cases for environmental change will, he says, be developed with a common purpose in that the returns they offer must equal or

St ViNceNt’S HealtH auStralia iS 12 moNtHS iNto a Strategy DeSigNeD to traNSform itS eNViroNmeNtal footpriNt aND SVHa’S group maNager, eNergy aND eNViroNmeNt mattHew power SHareS Some of tHe commercial returNS of tHe projectS witH DaViD HutcHiNS.

www.hospitalandagedcare.com.au

REPORTs

st vincent’s health australia progresses organisation wide environmental strategy

better those generated by other conventional commercial investments. These will be used to impact four fundamental areas of SVHA’s facilities and management. These include:• Supply Chain and Procurement• Waste Avoidance and Resource Recovery• Buildings and Physical Environment• Utilities and GHG Emissions

“The Sustainable/Environmental Hospital is a very interesting and relevant facilities planning and management topic. Modern health facilities must integrate environmental concerns and ensure their facilities have reducing environmental footprints, energy costs, emissions etc,” Power says

As well as addressing the four elements above, Power says the strategy’s aim is to reduce consumption of energy, water and outputs of waste and emissions across the enterprise.

It prescribes significant pre-work, surveys and audits to establish baselines and benchmarks.

These works are analysed and distilled into business cases for ongoing environmental transformational change projects.

Power says these projects will be visible and will impact areas across the group and possibly some interactions with suppliers and partners.

“Sustainable environmental initiatives will be included within all future capital development proposals and we will develop an environmental database of audit solutions containing accurate SVHA environmental metrics, KPIs , targets and report annually on usage.

“We will develop a formal Environmental Management System to ISO 14001 standard legislative monitoring practices to ensure all current requirements are addressed, as well as an

Environmental Communications and Education Plan, and an Environmental Champions Network.

“Environmental outcomes will be measured and reported to stakeholders and we will isolate current or future technologies for implementation across the organisation,” Power says adding that SVHA’s commitment to the plan cannot be understated.

“The commitment is demonstrated by the appointment of a senior manager to drive the strategy at an organisation level and with the sponsorship of the CEO and Board.

“The SVHA environmental strategy was signed off by the Board and CEO along with our environmental policy. The policy and strategy apply across the organisation,” he says emphasizing that executive stewardship is essential for such a program.

“Executive stewardship is vital to any activity in an organisation but even more so with environmental or sustainability practices. Without executive sponsorship environmental practices invariably wither.

“The need for senior leadership to lead by example on environmental issues is pivotal in getting an organisation to change its behavioural practices. The most difficult

part of driving environmental outcomes in organisations is not providing the tools to enable reductions in environmental impact but facilitating staff to utilise them, particularly in those areas where staff have a direct impact such as waste,” Power says.

Executive stewardship can, Power says, make or break ambitious transformational change projects which in brownfield hospital and health sites are always going to be formidable because of challenges associated with accessing the existing infrastructure.

“Foremost hospitals are aimed at addressing the health issues of their patients and therefore most other considerations tend to be secondary including such things as energy efficiency. The primary aim particularly of base building services is to maintain occupancy conditions that are often very tightly defined and/or regulated and this is exacerbated when addressing specialist areas such as operating theatres.

“The challenge presents itself in that often facilities managers are prevented from undertaking full maintenance regimes due to the difficulty in shutting down major pieces of building service infrastructure particularly in facilities that are deemed critical infrastructure this is a unique consideration not generally faced by many other sectors in the built environment,” Power says.

Negotiating such complexities can be like running a gauntlet with the environmental business case in one arm and screeds on savings, asset management, governance and risk management in the other. Getting the case over the try line can be complicated.

“These complexities apply to pretty much any existing healthcare facility and is one our major considerations particularly when addressing our energy consumption. That is how we isolate opportunities to do full works overhaul or a major plant upgrade.

“Funding can often be an issue but generally less so with major plant as the impact of a catastrophic failure and the additional down

22 | hospital & aGEDCaRE | November_December 2013

REPORTs

www.hospitalandagedcare.com.au

“executiVe StewarDSHip iS Vital to aNy actiVity iN aN orgaNiSatioN but eVeN more So witH eNViroNmeNtal or SuStaiNability practiceS. witHout executiVe SpoNSorSHip eNViroNmeNtal practiceS iNVariably witHer.

November_December 2013 | hospital & aGEDCaRE | 23

Facilities - environmental strategy

www.hospitalandagedcare.com.au

environmental breakoutDue to need to maintain services while trying to upgrade them SVHa has been seeking innovative ways to drive environmental outcomes. probably the best examples have been the use or trial of:

energy efficient filtration – the solution we are currently examining primarily drives reductions in HVac fan/vsd energy use by providing similar or greater filtration levels while reducing resistance thus reducing the amount of energy required to maintain air flow and replenishment cycles. it is estimated that this could drive savings of up to $700K per annum alone.

bmS technology – physically upgrading bmS is both expensive and time consuming. working with entro.py we have been seeking an innovative way to drive greater control through a tertiary layer control system that works with the existing bmS to bring greater control and increase the levels of input from the building in

terms of conditions thus allowing more precise changes which are already driving substantial reductions in energy primarily from HVac.

lighting – SVHa has complete a major lighting upgrade which involved a move to electronically ballasted t5s replacing magnetically ballasted t8s and leDs as replacements for twin compact fluorescent downlights. while not technically innovative anymore the reason this is included is that SVHa after examining the technology available went with t5 adaptors which are often maligned in the marketplace. use of this technology allowed rapid deployment with low operational impact while achieving a confirmed 50% reduction in energy consumption. overall the lighting upgrade generated a reduction of more than 2.5 million kwh and savings of over $350,000 per year.

time this generates a compelling argument when put against costs.

“We had an example of this in a major Heating Ventilation Air Conditioning (HVAC) replacement of an aging existing plant at one of our private hospitals in Melbourne.

“The logistics were quite substantial given the importance of the system to building performance and the reliance on supplementary systems during change-out.

“However, due to the passage of time, efficiencies in HVAC design and performance have seen substantial reductions in their energy consumption. At this facility the HVAC replacement was also coupled with a lighting upgrade leading to an almost 20% reduction in energy consumption at that site, primarily driven by the plant replacement, “ Power says, adding that sometimes simple plant and asset management made the business case.

“There’s an interesting example of a catastrophic chiller failure at a regional Australian hospital which led to the evacuation of one wing and the extended use of supplementary air conditioning systems at substantial costs. The cost of the supplementary units was obviously additional to the cost of the planned chiller replacement and created additional delays in project implementation.

He says other inhibitors to such projects include making a winning business case and obtaining funding.

“Funding is also a constant issue. Hospitals and the health sector generally have lean budgets which mean funding for additional activities such as environmental programmes is often difficult to obtain.

“Another major issue is the ability to mount compelling business cases; it is often difficult to justify an environmental project outcome against providing primary care to the sick, however compelling the return on investment.

“These days substantial environmental upgrades can offer have produced compelling returns, which are often better than conventional commercial investments. Property and equity investments have produced long term returns of between 10 and 11 per cent, but environmental investments can yield as much as a 15 percent return on investment,” Power says. Consideration of such projects must, Power says, be balanced and consider cost factors and savings alongside promised environmental benefits.

“Like all things there needs to be a balance. SVHA is aware that not all environmental

initiatives will have a strong cost benefit attached to them. The balance is always between compelling environmental outcomes and real world cost implications.

“However, across the board on most occasions the financial case is quite strong and meets basic internal cost benefit thresholds. Particularly in relation to such things as energy reduction measures, these projects often return financial outcomes superior to just about any other commercial investment opportunity.

“We have demonstrated similar outcomes when addressing waste reduction opportunities given the pressures being applied to waste disposal costs which like electricity and gas are only heading higher.

“Our size and the nature of hospitals in terms of running costs offer huge economies of scale so even small initiatives repeated many times across campuses invariably lead to sizable outcomes,” he says.

After just over a year into implementing the SVHA Environmental Strategy Power says its already produced substantial results such as: • $400,000 dollar savings per annum after

upgrading the lighting at Sydney’s St Vincent’s in Darlinghurst; and,

• More than $200,000 in savings for upgrading lighting and HVAC at Melbourne St Vincent’s Private Power says notable partners and suppliers

assisting SVHA’s environmental strategy have included: • Energetics – for Energy Efficient

Opportunities (EEO), audits and professional advice

• NetBalance – ditto• Entropy – Building Management Systems

performance upgrades• Envizi – environmental database solution• RDE Energy – lighting• SteriHealth Clinical Waste Management • Freudenberg filtration

With the current undertaking about one third complete and with significant work remaining, Power agrees that the process and policies being formed will likely mould SVHA’s environmental footprint for years beyond the current three year 2013 term.