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Editorial
M a r ga r e t F . S c h u l t e, D B A , F A C H E
Feature Articles
Hospitals and the Environment
Sustainable initiatives can be attained by starting small, gaining broad participation, accomplish-
ing achievements, publicizing them, and bestowing recognition upon the participants.
D a v i d P . G e h a n t , F A C H E
Demonstrating Reverence for the Earth
As a community hospital and a major employer, St. Marys Hospital Medical Center in Green Bay,
Wisconsin, assumes responsibility not only for the health of people in the community but also for
the health of the environment in which they live.
J a m e s G . C o l l e r , F A C H E , a n d A n n e t t e L . G r u ns e t h
Commentaries
Why Should Healthcare Bother?
The healthcare sector is realizing that green construction and operation makes business sense.
Rob i n G u e nt h e r
The Challenge of Sustainable Hospital BuildingFew topics are as timely as discussions of our shared sustainable future, and there are few settings
more difficult to design for sustainability than hospitals.
D . K i r k H a m i lt o n
Greening Healthcare: 21st Century and Beyond
As we move ahead in the 21st century, what future steps will hospitals need to take to protect not
only patients and staff, but the planet?
A nna G i l m or e H a l l
V O L U M E 2 5 N U M B E R 1 F A L L 2 0 0 8
O F H E A L T H S E R V I C E S M A N A G E M E N T
Frontiers of Health Services Management is committed to providing our readers with compelling, in-depthfeatures and commentaries that are of current importance to the practice of health services management by
drawing on the expertise of the best practitioners and scholars.
1
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FRONTIERS
Roche Diagnostics Corporation
Roche Diagnostics offers products and services in all fields of medical testing. We have a
unique capacity in people and technology to provide innovative, cost-effective, timely and
reliable solutions for laboratory diagnostics, point-of-care diagnostics, information technology
and consultative services.
This issue ofFrontiers is sponsored in part by Roche Diagnostics Corporation, which supports the independent role of
Frontiers. In no way has this sponsor influenced the content or decisions of the editors or editorial board of the journal.
Frontiers 25.1:20.4 8/13/08 1:13 PM Page i
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Scott E. Armstrong, FACHEPresident & CEO, Group Health Cooperative,Seattle, WA
Gabrielle K. Causby, FACHEPresident, Thomasville Medical Center,Thomasville, NC
Dolores G. Clement, DrPH, FACHE
Professor, Virginia Commonwealth University,Richmond, VA
Terence T. Cunningham III, FACHEAdministrator/CEO, Shriners Hospitals forChildren Los Angeles, Los Angeles, CA
Rosemarie T. Dunn, FACHECOO, First Class Solutions, Inc.,Maryland Heights, MO
Trent E. Gordon, FACHEManager, Business Development and PlanningAdvocate Health CareGood Shepherd Hospital,Barrington, IL
Erica Hamilton, RNExecutive Director of Emergency ServicesUniversity of New Mexico Hospital,Albuquerque, NM
Steven M. Hatkin, FACHEPresident, Buffalo Hospital, Buffalo, MN
Erie J. Hebert II, FACHEEVP, West Jefferson Medical Center, Marrero, LA
Lt. Col. Heather M. Landon, FACHECommander, 75th Medical Support Squadron,75th Medical Group, Hill AFB, UT
Maria R. Shirey, FACHE
Principal, Shirey & Associates, Evansville, INDennis G. Tobin, FACHEAdministrative DirectorDartmouth-Hitchcock Medical Center,Lebanon, NH
Maj. Randall Webb, FACHEChief, Medical Facilities Modernization,U.S. Air Force, Falls Church, VA
Lauren E. YedvabSr. Vice President, New York Methodist Hospital,Brooklyn, NY
Frontiers of Health Services Management (ISSN 0748-8157) is pub-
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2008. Foundation of the American College of Healthcare
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Correspondence on editorial matters should be addressed to the
Managing Editor in care of theeditorial o;ce at Health Administration
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Volume 8, Number 1.
Frontiers of Health Services Management
Maureen C. Glass, FACHE, CAEPublisher, American College
of Healthcare Executives
Chicago, IL
Eduard B. AvisManaging Editor
Health Administration Press
Chicago, IL
Margaret F. Schulte, DBA,FACHE, Editor
Health Administration Press
Chicago, IL
Scott R. MillerLayout Editor
Health Administration Press
Chicago, IL
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LMargaret F. Schulte, DBA, FACHE, is an associate professor in the Graduate Program in
Health Administration at Grand Valley State University in Grand Rapids, Michigan.
I w a s d r i v i n g o n a c o u n t r y r o a d the other day, the rain falling
fiercely for a while, and the sky to the left was black as night. As I questioned
the wisdom of picking that day and time to go shopping, I came to a sharp left
turn in the road, and suddenly the sun came out brilliantly on my right. I knew
there had to be a rainbow. I made the left turn, and as I slowed my car to look
for it (a safe maneuver on what is typically an almost deserted country road),
there it was, a brilliant full arc! I pulled over and watched the rainbow in all its
brilliance. After a few minutes it began to fade, and I continued on my mun-
dane trip. The dying rainbow became a metaphor for what this issue of Fron-
tiers is all aboutthe fading of our amazing, life-sustaining planet, and theimportance of doing something about it.
We in healthcare, with our abounding construction, tons of waste mate-
rials (some hazardous), 24/7 operations, and ongoing potential to injure or
help our environment, share enormous responsibility for protecting our envi-
ronment. Many healthcare organizations have already unleashed green ini-
tiatives. They recognize that people heal better in environmentally friendly
spaces, that all humans do better in such spaces. They also know that, with the
significant presence healthcare providers have in their communities, there is
abundant opportunity to take the lead in curing the environmental ills of those
communities. In many towns, the healthcare provider organizations are
among the largest employers. From that strong presence, we have the oppor-
tunity and the responsibility to provide leadership and example to others to, as
our authors from St. Marys in Green Bay, Wisconsin, say, do the right thing.
Now, you might be sitting there saying, Yes, but doing this right thing is
going to cost me money! Think again. In this issue of Frontiers youll read
about hospitals that have made it work financially, and youll hear from some
of our leading green experts reporting on the positive financial impact of envi-
ronmentally friendly initiatives.
Boulder Community Hospital in Boulder, Colorado, and St. Marys
Health System in Green Bay are two hospitals that have taken action in their
building projects, waste disposal, purchasing, and in other functions to ensure
Editorial
Margaret F. Schulte 1
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2 f r o n t i er s o f h e a l t h s e r v i c es m a n a g e m en t 2 5 : 1
that they take care of their locality. Their award-winning initiatives have grown,
and they have enjoyed not only recognition and appreciation, but financial ben-
efits, growing employee pride, and the satisfaction of fulfilling a mission to
improve and protect the earth while they heal people. They, and our commen-
tators, while from divergent roles, all send a resounding message about the
impact of hospitals on our environment: The need to act is nowa healing
urgency is upon us.
Back to thinking of that rainbowat one time we dreamed childhood
dreams of a magical pot of gold at the end of the rainbow, but somehow we
could never find that pot. Now we come to know that the pot of gold is the rain-
bow itself. Our earth, and the environment it provides for us, must not be
allowed to fade or our pot of gold will be lost.
The editor ofFrontiers would like to hear from you! If you have comments
or thoughts about this or any issue of Frontiers, please share them bye-mailing Margaret Schulte at [email protected].
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David P. Gehant 3
Hospitals and the Environment
BY DAVID P. GEHANT, FACHE
S u mma r y Think globally and act locally! This should not be viewed as a
worn-out clich because it is the call to action that has propelled Boulder Com-
munity Hospital to the forefront of those exemplary hospitals in the United
States that have successfully executed environmentally friendly initiatives. It isthis notion that inspired the leadership and staff at the hospital to initiate and
embrace changes in their approach to eliminating waste. These achievements,
by all measures, are nothing short of amazing.
David P. Gehant, FACHE, is president and CEO of Boulder Community Hospitalin Boulder, Colorado. He holds a doctorate in healthcare administration from
the Medical University of South Carolina.
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Background
The city of Boulder is best known for
being the hometown of the University of
Colorado. It lies in Boulder Valley, nestledagainst the Rocky Mountains. Its citizens
are well educated and, in general, outdoor
enthusiasts. Its comprised of approxi-
mately 100,000 people, and the list of
major employers includes IBM, Ball
Aerospace, Celestial Seasonings, and the
university.
Boulder Community Hospital (BCH)
employs over 2,000 individuals and has a
medical staff of over 350
physicians. Its a nonprofit
corporation, governed bylocal residents. Since 1989,
when it merged with a com-
peting hospital, there has
been significant growth in
volume and the range of ser-
vices provided. Having out-
grown existing facilities, it
built a satellite hospital on
the eastern edge of the com-
munity in 2003. This satel-
lite facility was the first
hospital in the world to earn the prestigiousLeadership in Energy and Environmental
Design certification (LEED). The award was
granted as a silver certification, which is the
second level in LEED.
The Start
It began in 1989, bit by bit, with environ-
mentally conscientious employees taking
action in a small way. Not more than a
handful of people were involved. But they
could see the waste that was generated
operating a hospital. Just as they weredoing in their homes, they started to recy-
cle paper and containers from the hospital.
Their grassroots efforts were observed by
co-workers, physicians, and management.
Questions were raised. What is the
state of our environment? What about
global warming, pollution, and conserva-
tion? Discussions were held in the hall-ways, the cafeteria, offices, and conference
rooms. As a result, management decided
to jump in with both feet and make it an
organizational priority to act in an envi-
ronmentally friendly manner whenever
possible. It was the right thing to do, and
it was an innovative approach that
brought the goals of the organization and
personal goals of employees into align-
ment.
A green team was soon appointed, con-
sisting of interested employees willing toplan and act in concert with a volunteer
environmental coordinator. This group for-
malized the recycling program and in the
year 2000 collected over 150,000 pounds
of recycled material. Not only employees,
but physicians were becoming involved,
applauding the efforts. Because of the syn-
ergy this created, a full-time employee was
hired to publicly formalize the hospitals
commitment to initiate and sustain envi-
ronmentally friendly initiatives. Selecting a
person to assume the duties of this positiondeserves careful consideration. He or she
must be passionate about the environment.
It is also important for this person to be a
good communicator, have a personality that
can build trust, is easily approachable, and
possess the ability to work in the political
environment that exists in hospitals.
Management set about to create guiding
principles. These principles had been
espoused by many of the employees work-
ing diligently in the environmental pro-
gram. With their input, the statement wascreated and presented formally in a docu-
ment to the board of directors. Getting its
endorsement was important for organiza-
tional commitment and funding. A docu-
This satellite facility
was the first hospital inthe world to earn the
prestigious Leadership in
Energy and Environmental
Design certification
(LEED). The award was
granted as a silver
certification, which is the
second level in LEED.
4 f r o n t i er s o f h e a l t h s e rv i c e s m a n a g em e n t 2 5 : 1
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ment entitled Statement of Principles of the
Environment was approved. At that point,
environmentally friendly initiatives were
being identified from the top down, as wellas from the bottom up. They permeated the
culture. The statement reads as follows:
Boulder Community Hospital
Statement of Principles of
the Evironment
With deep concern and respect for our
environment and the quality of life of
our staff and consumers, Boulder
Community Hospital is committed to
the following principles:
To minimize waste and ensure con-
taminated waste is disposed of in asafe and responsible fashion.
To support and encourage recycling of
the materials used within the hospital.
To actively seek, evaluate, and imple-
ment methodologies that limit the
use of non-renewable resources.
To minimize and strive to eliminate
emissions of toxic or dangerous sub-
stances into the air, water, or earth.
To encourage the use of transporta-
tion alternatives to the private auto-
mobile, through financial and otherincentives.
To purchase and use recycled prod-
ucts when the cost of such products
is comparable to or slightly more
expensive than virgin materials.
To favor the use of reusable prod-
ucts and materials, as opposed to
disposable products, such as surgi-
cal gowns, packs, and diapers.
To encourage conservation of water
resources.
To disclose to employees and pub-lic, incidents due to our operation
that cause environmental harm or
pose health or safety hazards and
not take any action against employ-
ees who report to management
such an adverse condition.
Our efforts then advanced from recy-
cling to a goal of eliminating waste. These
principals expanded our horizon beyond
recycling into a broad scope of waste
reduction. These expanded efforts
included using water efficiently and pur-
chasing green supplies, and ultimately led
to our pursuit of the LEED certification at
our new hospital. During this process, the
hospital received public recognition and
was awarded Colorados prestigious Recy-
cler of the Year Award. This public honor
struck a resounding chord with all of the
hospitals constituents.
LEED Certification
The LEED process started with all parties
having a mutual understanding of and
shared commitment to this end. They
forged a team going into uncharted waters
for a hospital facility. Prior to this, only less
sophisticated buildings were able to secure
LEED designation. Some of the green con-
struction elements of our new building
were the use of energy efficient windows,
the diversion of construction waste,
xeriscaping (landscaping that doesnt need
extra irrigation), the use of reprocessed and
recycled materials, and yes, even installa-
tion of waterless urinals. The result was an
environmentally friendly building and a
highly efficient hospital, delivering the best
in high technology.
Gaining Momentum
The original green team that consisted of
interested volunteers from the hospital
evolved in the organization to sustainable
advisors in every department of the hos-
pital. These individuals serve as resources
David P. Gehant 5
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for our full-time sustainability coordina-
tor. Several of the green team volunteers
assumed this duty in their department.
This has worked well, because now alldepartments have environmental cham-
pions. Each serves as an advocate to the
process and provides a channel of com-
munication for employees that is reliable
and easily accessible. Recycling alone has
now grown threefold to 500,000 pounds
per year.
One suggestion of the advocates that
the hospital accepted was to start purchas-
ing green supplies. Purchas-
ing green supplies means
selecting items by assessingtheir environmental impact.
It means selecting those
supplies that can be reused
rather than recycled. Seek-
ing green supplies also
entails working with manu-
facturers to modify their process in order
to eliminate bulky packaging. It was in this
area that the hospital scored its first big
cost reduction. The sterile processing
department switched to hard, reusable con-
tainers instead of plastic wrap, whichreduced expenses in excess of $100,000
per year.
It is noteworthy to examine the variety
of recycling activities shown in Table 1.
The hospitals efforts to reduce waste
go beyond recycling. Table 2 summarizes
other actions that contributed to healthy
environmental initiatives.
Whats Next?
As is evident from reviewing Tables 1
and 2, the hospital has been successfulin sustaining an environmental mind-
set in its planning and decision mak-
ingbut were not done yet. There are
still numerous initiatives in the works.
The sterile processing
department switched to
hard, reusable containers
instead of plastic wrap,
which reduced expenses in
excess of $100,000 per year.
Table 1 Types of Recycling
containers
cardboard
paper
electronic equipment
medical equipment
medical supplies
batteries
furniture
food for commercial composting
reprocessing
Totaling 500,000 pounds annually
Table 2 Other Environmental Initiatives
Board approval of environmentalprinciples to guide decision making
Achievement of LEED Silver Certification
Alternative transportation provisonfreebus pass for every employee
Wind power purchase
Green supplies procurement
Lighting retrofit
Water conservation audit
Solar panel installation
Elimination of mercury
Elimination of latex
6 f r o n t i er s o f h e a l t h s e r vi c e s m a n a g e me n t 2 5 : 1
They include more solar installations on
buildings, construction of a solar roof
covering one or both of the hospitals
parking garages, creation of furtherincentives for employees to promote
alternative modes of transportation, and
the creation of a document that provides
specifications to build green whenever
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Recognition
It is gratifying to be recognized locally and
nationally for the work and accomplish-
ments of our employees to minimize thenegative impact of hospital operations on
the environment.
One of my favorite awards was given to
us in 2004 by Eco-cycle, a local nonprofit
environmental organization. Eco-cycle
made an effort to quantify BCH initiatives
in terms of conservation. The award reads:
Going for Zero Wasteor Darn Near
in 2004
Conserved:
3,786 30 ft. trees1,558,970 gallons of water
999,773 kilowatt-hours of energy
1,779 cubic yards of landfill
13,501 lbs of air pollutants
We also received two major awards
from the State of Colorado. In 2005 and
2007, we were recognized as a leader by
the Colorado Department of Public
Health and Environment.
In 2006, the American Hospital Asso-
ciation recognized the hospital with itsEnvironmental Leadership Award from
Hospitals for a Healthy Environment.
Also in 2006, the hospital was recognized
with the 2006 Making Medicine Mercury
Free award.
In addition, the hospital received the
Our World Award from Rotary Interna-
tional for its environmental stewardship.
Table 3 lists our awards chronologically.
Cost Savings
Environmental initiatives sound good toaltruistic people, but they also produce sig-
nificant savings. At our hospital, being able
to track cost savings is importantit also
serves as a basis to justify further invest-
remodeling or construction occurs. It is
our intention to make this working doc-
ument available to any organization
planning construction.Solar panels on the roofs of buildings
serve as an alternative energy generating
source. To date, panels generating 60
kilowatts are fully operational. There are
plans to install additional capacity of 107
kilowatts over the next several months.
The amount of energy currently generated
is enough to power 28 average homes in
the United States.
We are studying the feasibility of con-
structing a roof grid over parking
garages upon which solar panels can besecured. If our study confirms that this
is financially feasible, it would increase
our solar power capacity by more than
tenfold.
Creating additional incentives for
staff to utilize alternative transportation
is a high priority. Providing all employ-
ees with a free bus pass has yielded sig-
nificant results, but our parking garages
and parking lots are still full. Not only
would successful initiatives cut down on
global warming from fossil fuels, buthaving more employee parking places
unoccupied makes accessing the hospi-
tal more convenient for patients and
their families.
Creating a usable, working document
that can serve as specifications for remod-
eling or new construction would be a
worthwhile project. Not only would it pro-
vide guidelines to our staff in Boulder, but
it could be disseminated and applied by
any hospital manager.
Finally, we would like to identify ourcarbon footprint. This analysis quantifies
the amount of pollution the hospital cre-
ates. Once determined, we will make
plans to effectively offset it.
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Table 4 Sustainable Cost Savings
Annually
ments in environmental initiatives. Savings
have been extracted as a result of reprocess-
ing, reduced hauling, electrical savings, and
overall waste reduction. Table 4 specifiesthe tangible savings from the listed activity.
The management team is convinced
there are more cost savings than these.
These just happen to be the most signifi-
cant, and easiest to clearly identify.
There is no question that going green
generates a beneficial financial return.
One good example not included on the list
has to do with our solar panel installation.
These arrangements are referred to as
power purchase agreements. The hospital
leases space to an entity that finances andinstalls the solar panels at no cost to the
hospital. This entity, in turn, sells the
power to the hospital. The financial bene-
fit to the hospital is that the price of the
electricity is guaranteed at a fixed rate for
a period of 20 years. This is important to
the hospital, because it protects us from
increasing electricity costs. The price per
kilowatt-hour is frozen at todays price
and remains in effect for the term of the
agreement. At the end of 20 years, owner-
ship of the panels reverts to the hospital.
Employee Allegiance
Embracing environmentally healthy ini-
tiatives becomes woven into an organiza-
tions culture by motivated and loyal
employees. Not only does the hospital
gain in strength of character, but this new
profile helps recruit dedicated staff mem-
bers who aspire to attain these initiatives.
Comments like these are not unusual:
Im proud to work for this hospitalbecause it cares about our environment.
Im glad to have the chance to partici-
pate in a worthy cause.
I took this job because of the hospitals
commitment to helping the environment.
A hospital that supports environmen-tally friendly initiatives will gain a strong
allegiance from its employees.
Obstacles: Maintaining
Confidentiality
Shredding documents protects the confi-
dential information they once held, but it is
Reduction in surgical wrap
Reprocessing instruments
Elimination of shredding
services
Reduced trash hauling
Lighting efficiency upgrade
Full-time employee
reduction in housekeeping
Water efficiency
Total Savings:
$120,000
$95,000
$90,000
$45,000
$35,000
$150,000
$25,000
$460,000
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Table 3 Awards Earned by Boulder
Community Hospital
2004 Eco-cycle
2004 Our World Award, Rotary
2005 Bronze Achiever, State of Colorado
2006 Hospitals for a Healthy Environment
2006 Making Medicine Mercury Free
2007 Gold Leaders, Colorado Department
of Public Health and Environment
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costly and creates too much waste. We
embarked upon a procedure that yielded
cost savings, eliminated waste, and secured
important information. Following this pro-cedure enabled us to take a confidential
document from a nursing floor in Boulder
to an ink removal facility in Arizona, with-
out fear of violating the Health Insurance
Portability and Accountability Act (HIPAA).
Below is a step-by-step explanation of what
our hospital did to achieve this.
Securing transfer of recyclabledocuments
Step 1: Paper is tossed in bin on a nursing
unit. The bin is located in an area wherepublic access is restricted.
Step 2: The nursing staff empties their
bins into a 90-gallon recycling toter.
Step 3: Housekeeping staff picks up the
toter and replaces it with an empty toter.
Toters are locked at all times.
Step 4: Our local recycling organization
places the material from the toters into its
truck.
Step 5: The material is bailed at a process-ing center.
Step 6: Bailed material is placed in a locked
train car and transported to Arizona.
Step 7: The reprocessing center in Ari-
zona dumps documents into a vat that
removes the ink from the documents.
Step 8: Once the confidential information
has been removed in the de-inking
process, the paper is processed into recy-
cled material.
(Key point: The hauling company has
adopted a HIPAA policy that all employ-
ees must adhere to. This includes drivers
and material handlers.)
Advice to Others Considering
Environmental Initiatives
One doesnt have to look far to see the
urgency to minimize the environmentalimpact of operating our nations hospitals.
The disasters resulting from global cli-
mate change, the effects of pollution on
our health, the costs of energy, and the
heavy damage to our waterways all under-
score the situation.
Enough is enough. Its time to get
started, and many are taking this seri-
ously. Our sustainability coordinator has
now provided more than 75 tours to hos-
pitals, architects, and other companies
from throughout the United States, allseeking information about our projects
and LEED certification. In addition,
healthcare offices from seven countries,
including England, France, Australia,
New Zealand, Canada, Mexico, and
Malaysia, have communicated with us to
learn more about our successful environ-
mental initiatives.
My advice is to take action now. Here
are some simple steps to get started on
your hospitals environmental program:
11. Talk it up with co-workers.
12. Stress the urgency of the situation.
13. Appoint a steering committee.
14. Create an environmental principles
statement.
15. Create a position for an environmental
sustainability coordinator.
16. Get early buy-in from a department that
is willing to pilot a recycling project.
17. Buy large recycling containers.
18. Record achievements.
19. Communicate achievements through-
out the organization.
10. Recognize the individuals involved.
11. Expand the efforts to more depart-
ments
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upon the participants. In our particular
case the results are amazing. Since 2000
our comprehensive waste reduction
efforts have diverted over 3 millionpounds of material from landfills.
ReferenceKotter, John. 1996. Leading Change. Harvard Busi-
ness School Press, Cambridge, MA.
12. Add/plan new initiatives.
13. Refer to the change process as defined
by Kotter (1996).
Summary
Sustainable initiatives can be attained by
starting small, gaining broad participa-
tion, accomplishing achievements, publi-
cizing them, and bestowing recognition
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James G. Coller and Annette L. Grunseth 11
Demonstrating Reverence for the Earth
BY JAMES G. COLLER, FACHE, ANDANNETTE L. GRUNSETH
S u m m a r y As a community hospital and a major employer, St. Marys
Hospital Medical Center in Green Bay, Wisconsin, assumes responsibility notonly for the health of people in the community but also for the health of the
environment in which they live. Demonstrating reverence for the earth is a pri-
mary strategic goal, originating with its sponsoring organization, Hospital Sis-
ters Health System, Springfield, Illinois. St. Marys Hospital Medical Center is
one of 13 hospitals in this system dedicated to healing ministries. Healing the
earth is as important to this mission as is prevention and treatment to heal the
human body. Over the past 25 years, St. Marys Hospital Medical Center has
brainstormed and implemented innovative ideas to mend the earth, improving
the health of air, water, and land, and ultimately improving the health of the
people who come into contact with our dynamic environment. It is a passionand commitment of time and resources, but one in which there is no question
that it is the right thing to do.
James G. (Jim) Coller, FACHE, is president and CEO of both St. Marys Hospital
Medical Center and St. Vincent Hospital in Green Bay, Wisconsin. Annette L.
Grunseth is a writer/editor and public relations specialist with St. Marys Hos-pital Medical Center in Green Bay, Wisconsin. She is a Fellow of the Wisconsin
Healthcare Public Relations and Marketing Society.
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Early Adopter
In our consuming culture we are increas-
ingly aware of the need to be good stew-
ards of our environment and resources,especially in healthcare. We are at the core
of our community, often the largest
employer and a large consumer of energy
and resources. Hospitals generate waste
materials 24 hours a day, seven days a
week, 365 days every year. St. Marys Hos-
pital Medical Center, located in Green Bay,
Wisconsin, is in the business of health
health of people and health
of our environment.
St. Marys Hospital has
been an early adopter ofthe environmental move-
ment because of firm
encouragement from its sponsors, Hospital
Sisters Health System (HSHS), Springfield,
Illinois. St. Marys Hospital Medical Center
is one of 15 HSHS hospitals in Wisconsin
and Illinois that follow the teachings of
Christ, St. Francis of Assisi, and St. Clare,
who believed in reverence for the earth
and all its living creatures. To this goal, the
Hospital Sisters required each hospital to
integrate environmental standards intoeach of their facilities and communities. St.
Marys, along with its local board of direc-
tors, took an immediate interest and the
lead within the hospital system more than
25 years ago, long before other hospitals felt
the need to pursue green practices. The
core belief is that protecting our environ-
ment, along with quality patient care, is crit-
ical to the communitys long-term health.
The local board of directors eagerly sup-
ported this healing ministry and saw the
role of the hospital as a leader to serve thecommunity with health for all, including
the environment. Over the years, an envi-
ronmental philosophy has evolved to
include a summarizing statement:
Environmental Statement for
St. Marys Hospital Medical Center
As part of our Franciscan values as a
member of Hospital Sisters HealthSystem to show reverence for the
earth, St. Marys Hospital Medical Cen-
ter believes protecting the environment
while providing quality patient care is
critical to our communitys long-term
health. It is our goal to continue our
commitment to the environment by
improving existing programs and
implementing new initiatives annually.
This article presents a study of what St.
Marys Hospital Medical Center accom-
plished over the past two and a half
decades by taking responsibility for the
environment as a health issue. This stew-
ardship under the guidance of HSHS, the
goals of reverence for the earth, and the
local board of directors provide a steady
direction as St. Marys Hospital Medical
Center continues to find new ways of mak-
ing a positive presence and impact on the
land for which we are responsible. These
efforts have evolved as we have invested
our dollars, our collective talent and skill,
as well as volunteer hours to make our
environment cleaner and healthier. It is an
annual commitment that has grown
rapidly through the enthusiasm and cre-
ativity of our managers and employees.
It Was the Right Thing To Do
In the early 1980s employees rallied
together with a community team as part
of a community-wide project called River-
Bay Clean Up. The initial enthusiasm
started with employee groups that volun-
teered to go out into the community and
pick up trash along the shores. Later,
another community effort was initiated
with A Day at the Museum, which was a
Hospitals generate waste
materials 24 hours a day,
seven days a week, 365days every year.
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James G. Coller and Annette L. Grunseth 13
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challenge to see who could be most cre-
ative with ways to recycle and reuse mate-
rials. St. Marys employees were creative
and competitive, and they often wonawards for their environmental efforts.
In 1984, our Nutritional Services depart-
ment began donating good, leftover food to
local food pantries. It was mission-driven tohelp those less fortunate while not having
food go to waste. Addressing the needs of
the hungry by sharing what we have is
important to us. St. Marys currently pro-
vides 12,000 pounds of food each year to
several food pantries. St. Marys also serves
as a preparation and delivery site for the
community Meals on Wheels program.In 1996, as HSHS continued to
require its hospitals to integrate rever-
ence for the earth into its operations, sev-
eral employees formed the initial Green
Team to brainstorm ideas to meet the
challenge. One idea was to capture and
improve the storm run-off water from
hospital parking lots. Pollutants such as
gas, oil, and salt coat the parking lots.
When snow and ice melt, or it rains, pol-
lutants dissolve in the water, which flows
into sewers and eventually into the FoxRiver, headed for the Bay of Green Bay
and the Great Lakes.
In 1998, a storm water management
system was built on campus to capture all
storm water run-off. For the past decade,
all storm water is sent through a unique
filtering system that extracts the pollu-
tants and releases purified and clean
water into the river and ultimately into the
Great Lakes. In 1998, this process was the
only one of its kind in a northern climate.
Cleaner water and fewer pollutants enter-ing our environment improve the health
of the riverincluding the fish, a food
sourcewhile indirectly reducing health
hazards for the people who live in the
Green Bay/Great Lakes area. This project
received national recognition and several
grants from state and federal agencies to
become a prototype project for third worldcountries to consider for implementation
as appropriate in their climates.
Environmental Action
Continues
While these earlier programs continued, a
new director of Environmental Services
was hired. With a keen interest in environ-
mental issues and a passion to make
things happen, she raised awareness to a
higher level and initiated additional envi-
ronmentally friendly programs. We nowhad an internal champion to continue and
grow the reverence for the earth mission
of the Hospital Sisters. With her leader-
ship, the Green Team tackled recycling,
reduced medical waste, located and elimi-
nated unused chemicals, streamlined
energy use, developed programs to go
mercury-free, and improved green space
on our campus.
Recycling Gets Everyone
InvolvedPaper, plastic, aluminum, and daily trash
from throughout the hospital and office
areas was audited and every area provided
with appropriate recycling receptacles. This
was an effort everyone could become
involved in and feel good about while con-
tributing to the improvement of the envi-
ronment. Formal in-services were held to
train staff. Refresher mini-classes at
department meetings along with articles
sent via our internal employee newsletter
and intranet reinforced the environmentalmessage to every employee and physician,
reminding them how and where to recycle.
St. Marys took environmental prac-
tices to a new level in 2003 with member-
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safely reused. St. Marys formerly con-
sumed 16 gallons of xylene per month,
but the distilling process reduced that to 4
gallons per month. The positive result isless chemical needs to be handled, dis-
posed of, and purchased.
As of 2007, St. Marys overall recycling
rate has increased from 31.5 percent to 40
percent, which means in all our waste
streams, 40 percent less trash is sent to the
landfill. In the calendar year of 2007, we
had a total of 806,515 pounds of waste
materials. We recycled 327,536 pounds of
materials, which went to other sources or
was recovered by other companies, and in
many cases turned into other new prod-ucts (see Table 1). We often received rev-
enue for materials recycled. It is our
annual goal to keep increasing the percent-
age of recycling pounds while decreasing
the percentage of true waste that is headed
for the landfill.
ship in the not-for-profit organization
Hospitals for a Healthy Environment, also
known as H2E. This national organization
works together to improve the environ-mental performance of the healthcare
industry (Practice Greenhealth 2008).
By 2006, St. Marys overall recycling
rate was 31.5 percent. A recycling rate of 25
percent was considered exceptional by
H2E. St. Marys felt proud to
be doing better than the
industry standards in our
corner of the world. Our
waste streams were given
continual attention by
employees and the list ofrecyclables grew.
To deal with xylene, a
chemical used in laboratory tests, the hos-
pital invested in a distiller that recycles
used xylene. The xylene is converted into
vapor and recaptured so that it can be
St. Marys formerly
consumed 16 gallons of
xylene per month, but the
distilling process reduced
that to 4 gallons permonth.
Solid Waste 433,717 General Trash
Medical Bio Waste 45,262 General Trash
Total Waste 478,979 General Trash
Shredded Confidential 102,218 Recycle
Paper/Cardboard 151,440 Recycle
Silver Recycling 720 Recycle
Pallets/Scrapwood 1,872 Recycle
Grease/Oil 9,720 Recycle
Electronic Recycles/Lamps 11,556 Recycle
Print Cartridges/Ink Rollers 1,774 Recycle
Scrap Metal 7,784 Recycle
Tin-Glass-Aluminum 7,780 Recycle
Food Bank 11,040 Reuse
Missions Donations 21,632 Reuse
Total Recycle/Reuse 327,536 Recycle/Reuse
Material Pounds Waste Stream
Table 1 2007 Waste Stream Summary
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needed to diagnose and treat patients. One
procedure is replaced by another, and in
that process, items no longer needed get
pushed aside and soon forgotten. One ofthe ideas from our Green Team was to
implement a proactive Chemical Round-
ing Team that would attempt to locate and
dispose of unused and unwanted chemi-
cals by visiting departments with an edu-
cational intent. Regulatory agencies such
as the Occupational Health and Safety
Administration, the Joint Commission,
the Department of Natural Resources, and
the Environmental Protection Agency pro-
vided understanding and direction on cur-
rent chemical/safety standards. Armedwith this source of learning and the com-
bined knowledge of the Chemical Round-
ing Team, ten departments were initially
visited, which resulted in removal of 419
gallons of expired and obsolete chemicals.
Fifty-eight pounds of dry chemicals were
also removed during that first round-up,
and mercury switches were removed from
equipment. Hard copies of Material Safety
Data Sheet (MSDS) Manuals were
removed and made current through the 3E
Companys MSDS on Demand program.Outdated MSDS sheets and binders are no
longer stored in departments. From the
beginning of our efforts through Decem-
ber 2007, 4,700 pounds of liquid or dry
chemicals have been removed and prop-
erly disposed of.
The Chemical Rounding Team concen-
trated efforts in key areas that housed
larger quantities of these materials, such
as Plant Operations, Housekeeping, and
the Laboratory. The team properly dis-
posed of old paint, anti-freeze, toxic chem-icals, and cleaning supplies. As it visited
each department, the team used an educa-
tional approach and did not expect depart-
ment staff to have all the answers. The
team conferred with the MSDS contract
Giant Steps
Medical waste, such as tissue and fluids
from surgeries and procedures, is col-
lected in suction canisters, which previ-ously were discarded as trash. St. Marys
purchased a fully automated suction canis-
ter transposal system that now handles all
surgical canisters safely. No employee has
to handle any surgical waste, as this sys-
tem safely processes the waste in an envi-
ronmentally sound manner and sterilizes
the canisters for reuse. We are now safely
recycling and re-using 7,000 canisters
annually. That means 7,000 fewer canis-
ters in the landfill! We expect this system
to pay for itself in 4.5 years.In another project, we partnered with a
company that manages sharps disposal.
The company provides receptacles, and
retrieves and disposes of all sharps mate-
rials. The receptacles are completely safe,
and once again, no employee handles any
sharps. St. Marys Hospital Medical Cen-
ter will have to purchase 1,608 fewer
receptacles. The savings realized in this
program is $9,422 annually. This trend of
partnering for sharps disposal is a new
trend in the Midwest, and our hospital,along with the 12 others in our health sys-
tem, is one of the first to adopt this newer
environmental arrangement.
A Smoke-Free Hospital and
Campus
For the safety and health of patients, fami-
lies, and employees, St. Marys Hospital
Medical Center is completely smoke-free
within all buildings as well as outside. For
the entire campus, including parking
areas and green spaces, smoking andtobacco products are prohibited.
Chemical Rounding
Healthcare technology and procedures
advance or change as do the supplies
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and educated employees to be aware of
products that arent used any longer. The
team sought out expired chemicals and
caustic materials and also cautioneddepartments not to over-stock too much of
an item.
The Chemical Rounding Team also
consolidated materials with other depart-
ments, which increased efficiency and
safety, and reduced costs. In addition, the
team took the opportunity to fit employ-
ees with current personal protective gear
and to check for proper secondary con-
tainers and labeling. It also advised
departments on proper storage areas to
ensure fire and chemicalsafety.
Streamlining
Energy
Consumption
Energy usage affects every-
thing we do today and in
the future. Therefore, when
St. Marys Hospital Medical
Center needs to make
changes with major equipment, energy
conservation is at the forefront of deci-sion-making (See Figure 2).
Focus on Energy is an organization that
works with Wisconsin residents and busi-
nesses to install cost-effective, energy effi-
cient, and renewable energy projects. Focus
on Energy supplies grants to make energy
changes that help to control the states ris-
ing costs and growing demand for electric-
ity and gas.
In June 2006, a desiccant dehumidi-
fier was added to our new surgery air han-
dling unit. This system cools surgeryfaster and removes condensation. The
surgery rooms are run at a cooler temper-
ature, which is safer for the patient having
surgery. The savings realized on this unit
was $28,375 per year, with a payback of
four years. Focus on Energy paid St.
Marys Hospital Medical Center a grant of$13,352 to help fund this acquisition.
In April 2007, St. Marys began the
project of replacing four older air han-
dling units with one larger unit. The sav-
ings per year is $5,945 in power. Focus on
Energy gave us a grant of $3,565 for this.
In March 2008, St. Marys replaced
another older air handling unit that serves
the kitchen area. This project will save the
hospital $9,431 per year in both electricity
and gas. Focus on Energy gave a grant of
$6,100 for this project. For all of theseefforts, St. Marys Hospital Medical Cen-
ter became an Energy Star partner.
St. Marys Hospital Medical Center
does load shedding in the summer
months for Wisconsin Public Service on
peak days. When there is a large draw of
electricity, the hospital starts a small gen-
erator, which runs one of our larger
chillers. For having this capability, Wis-
consin Public Service deducts $1,500 per
month from our electric bill from April
through September.
Another Major Effort:
Making Medicine Mercury-free
Removing mercury from the healthcare
environment demanded great attention
to detail in clinical and plant operations
areas. H2E, which sponsors the Making
Medicine Mercury Free award, created
guidelines for establishing safe handling
protocols and spill clean-up procedures
for mercury. St. Marys Hospital Medical
Center implemented these proceduresand began extensive education and train-
ing of employees about facility protocols,
including information about mercury
When St. Marys Hospital
Medical Center needs to
make changes with major
equipment, energy
conservation is at the
forefront of
decision making.
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and its effects on human health and the
environment. A mercury-free purchasing
policy was implemented that banned the
purchase of mercury-containing items
without approval (e.g., if a non mercuryalternative was not available.) Clinical
and facility devices were replaced with
non mercury alternatives. All mercury
devices were disposed of properly and
safely.
Community Connections
Mercury Thermometer
Exchange
The mercury-free initiative was taken into
the community. The Temperature is
Changing at St. Marys was the name of aprogram offering the public a free digital
thermometer in exchange for a mercury
fever thermometer. In May 2006, a one-
day thermometer exchange event was
held from 11 a.m. to 6 p.m. The general
public could drive through the Emergency
driveway under a weather-protected
canopy to drop off mercury fever ther-mometers and receive a free digital ther-
mometer. Consumers were given
instructions in ads and publicity on how
to safely secure their old thermometer for
transport to bring it to the hospital for
exchange.
An exchange station was set up so that
people did not have to get out of their
cars. A day in spring was chosen so this
could be done outdoors, and we were
lucky enough to have good weather.
Signage and creative latex-free balloonswere used to draw people to the correct
entrance. Many area vendors donated
refreshments, digital thermometers, and
James G. Coller and Annette L. Grunseth 17
Project Total Cost Annual Energy Savings Grants Awarded
Heat recovery system $27,390 $8,814 $2,667
for new boiler
Desiccant dehumidifier $140,000 $28,375 $13,352
system
Boiler addition $ 175,000 $32,848 $16,824
(to run smaller boiler
in summer)
Air handling unit $165,000 $9,270 $3,564
replacement (this
one unit replaced
4 older units)
Replacement air $120,000 $9,431 $9,699
handler for the
kitchen area
Table 2 Focus on Energy Project Expenses, Savings, and Grants
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recycling services to properly dispose of
the more than 800 mercury thermome-
ters that were turned in. In fact, two years
later, people are still calling to ask if wewill take their old thermometers, and of
course, the answer is, yes.
Along with the free digital thermome-
ter, each person who stopped was pro-
vided a give away bag with hospital
information from key service lines, a
womans health newsletter, and environ-
mental information. Large displays were
stationed at the drop-off
point, illustrating environ-
mental information that
could be viewed from cars.Two environmentally
conscious consumers rode
up on bicycles to exchange
thermometers.
The work to remove
mercury from within the
hospital was recognized
when H2E awarded St.
Marys Hospital Medical
Center the Making Medicine Mercury
Free award in 2006 for internal efforts
and for the consumer effort.
More Environmental Awards
In 2007, the H2E organization singled out
St. Marys Hospital Medical Center again
with two prestigious awards for environ-
mental innovations: The Hospitals for a
Healthy Environment Leadership Award
and the elite Environmental Leadership
Circle award (one of eight hospitals nation-
wide given this award in 2007) for design-
ing and implementing programs that set
industry-wide benchmarks for environ-mental stewardship. Again in 2008 we
won the Environmental Leadership Circle
Award from H2E.
Demolition Recovery and
Green Construction
We are also committed to green construc-
tion, as it is the right thing to do.During earlier interior construction
projects, St. Marys required vendors to
separate metal, copper, and cardboard for
recycling. Now that mandate incorporates
a wide range of other materials to be recy-
cled. In all current and future construc-
tion projects, St. Marys and its architects
require that the guidelines in the Leader-
ship in Energy and Environmental
Design (LEED) Green Building Rating
System be followed.
In 2005, during our construction pro-ject for a new Emergency department and
new surgical suites, we began recycling
construction debris throughout the course
of construction. We recycled 21.85 tons, or
about 24 percent of the project. Our envi-
ronmental champion even recycled some
of the demolition debris to construct tile
and metal flower arrangements for an
H2E conference.
In 2007, St. Marys Hospital Medical
Center began constructing a new wing
onto the existing hospital for cancer care.In order to make room, an outdated clinic
building was demolished. With the ven-
dors proactively involved, 81 percent of
the demolished material was recycled.
Concrete, asphalt, clean steel, mixed
metal, and copper were separated as they
were removed and hauled to recycling
centers. Also diverted from landfill or
incineration was land-clearing debris,
asphalt, Portland cement concrete, con-
crete masonry units, brick, clay products,
and ceramic tile; wood products, includ-ing pallets; metal, insulation, asphalt roof
shingles, glass, gypsum drywall, acoustic
ceiling tiles, resilient flooring materials,
In all current and future
construction projects, St.
Marys and its architectsrequire that the guidelines
in the Leadership in
Energy and Environmental
Design (LEED) Green
Building Rating System be
followed.
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carpeting, paint, plastics, cardboard,
paper, and packaging; and field office
waste including office paper, aluminumcans, and plastic bottles. (See Table 3.)
There will be no polyvinyl chloride
(PVC) products in any materials used for
the construction. In past years, it has
been difficult to find vendors that offer a
variety of PVC-free products, but now
that the concept of green construction
has grown, we are currently working
with vendors that have a wider variety of
natural rubber or ceramic flooring, PVC-
free wall covering, PVC-free glue, and
PVC-free paint and laminates. The westwing addition of our facility, currently
under construction, is a regional cancer
center, and we believe it is important to
use green building practices to construct
a treatment facility that will be helping
patients regain their health.
Healing Green SpacesThe
Power of Landscaping
Green spaces are vital to the appearance of
the hospital campus, and they create a heal-
ing atmosphere. Twelve years ago we devel-oped an outdoor prayer garden constructed
with eco-friendly materials. A local donor
provided funding to establish the brick
pathway, outdoor seating, and a statue of St.
Francis, along with perennial and annual
plants and shrubs, which were nestled into
the space just outside the hospital chapelbetween two wings of the building. The
shrubs provide privacy and decrease noise
from the adjacent busy street. The prayer
garden is used daily by patients, families,
and employees, who pause there for a
moment of prayer and peace.
Throughout the campus, seasonal
flowers and lawns provide an inviting
environment where people can also sit at
picnic tables. The recently completed
Emergency Department also has a healing
atmosphere, with a wall-mounted watergarden and plants in the waiting areas.
For the new construction project, heal-
ing infusion gardens are planned as a
vital part of the interior atrium design and
treatment areas for the cancer center. The
creation of healing gardens at both the
ground level and rooftop will provide places
of serenity and gracefulness for patients
and families to reflect and re-energize. The
healing gardens are being called infusion
gardens because the infusion patients in
the cancer center will look out onto themas they receive their treatments.
The landscaping consultant is including
a lot of water in the design. There will be
water fountains in the healing gardens for
the cancer center and outside in front of the
atrium, in the center of the drop-off area.
The roof is being prepped for a rooftop
garden area. Timing for its completion
will be staged to fit with plans for addi-
tional expansion, if more floors are added.
Mission Outreach: Local,State, Nation, World
St. Marys Hospital Medical Center, along
with the other 12 hospitals in the Hospital
Recycled steels
Recycled sheet metal
Recycled blacktop
Recycled concrete
Mixed to landfill
6.95 tons of
unprepared steel
45.73 tons
1,025 tons
1,674 tons
637.17 tons
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Table 3 Table of Recylced Materials
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equipment. For example, there was a
patient monitor that had no EKG cable,
no blood pressure hose or cuff, and no
oxygen sensor. The team tracked downand ordered various parts, then assembled
them and repaired the unit.
As equipment was repaired and pre-
pared for shipping, the bio-medical team
made sure ample supplies and acces-
sories were included. In a developing
country, access to these supplies is nearly
nonexistent. The bio-med team included
extra bulbs, batteries, and other common
parts that needed to be shipped with each
item. Overall, the team checked out and
assembled more than 100 differentpieces of medical equipment, valued at
more than $120,000, in its four-day
repair marathon. It also identified nearly
70 additional items that needed parts
and/or accessories.
Proper disposal is vital. If developing
countries are sent unusable equipment,
they do not have proper methods to dispose
of the equipment. At Mission Outreach,
any unusable items are disposed of in a
safe and environmentally friendly manner.
Challenges: Past, Present,
and Future
Our commitment at St. Marys Hospital
Medical Center with the guidance of our
sponsors, Hospital Sisters Health System,
is a long-term pledge, and for that, our
financial investment continues to be a
challenge as well as an opportunity. The
cost of recycling and reusing materials is
often more expensive than adding to the
landfill, but in the long run, we want our
earth healthier for its citizens today, andfor future generations (See Table 5). We
have partnered with agencies and organi-
zations that have helped us with grants,
and yet we also choose to endure costs to
Sisters Health System, recycles used
medical equipment and supplies to third
world countries. Through the HSHS
Mission Outreach Program, equipmentis collected and transported to a Mission
Outreach warehouse in Springfield, Illi-
nois. HSHS Mission Outreach is also a
preferred partner with the U.S. Navy Pro-
ject Handclasp, which employs Navy
ships to distribute medical equipment
and supplies worldwide to needy coun-
tries. See Table 4 for a list of places our
equipment is being used.
Additionally, one of St. Marys Hospital
Medical Center Bio-Medical Electronics
employees helped develop a partnershipbetween TriMedx Founda-
tion and Hospital Sisters
Mission Outreach. This
partnership provided volun-
teer bio-medical services for
recovery and redistribution
of medical equipment and
supplies in developing
countries.
In January 2008, one of
our contracted employees
became a team leader for agroup of volunteers from TriMedx Foun-
dation who traveled to the Mission Out-
reach warehouse in Springfield, Illinois.
Together, this team worked with the logis-
tics and warehouse manager to identify
equipment in need of repair and servicing
to make it operational before shipping it
to healthcare providers in developing
countries. Bio-medical expertise was des-
perately needed to make the equipment
useful. Most often equipment is donated
with missing parts and accessories or nooperation and service manuals. This vol-
unteer team worked for four intensive
days to check, test, repair, assemble, order
parts for, and repair many types of medical
Overall, the team
checked out and
assembled more than 100
different pieces of medical
equipment, valued at
more than $120,000, in
their four-day repair
marathon.
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in the community and region who help
share some of these costs. It is estimated
that during the past two decades we haveinvested a million dollars, and we will
continue to invest, as efficiently as we
can, to make this annual commitment to
reverence for the earth a priority.
Hindsight Insight
St. Marys Hospital Medical Center started
small and kept building upon new green,
sustainable opportunities. If I were to
advise other hospital chief executive offi-
cers on how to get started, here are some
recommendations:Engage your owners in the commit-
ment to improve the environmentShare
with the board of directors, advisory com-
mittees, physicians, department directors,
fulfill our ministry of leaving the earth
and the health of those who inhabit it in
better shape. The future holds more part-nerships for us, such as the sharps dis-
posal vendor, to ensure the health and
safety of our employees and patients.
Healing the earth also heals our patients,
the people of our community, by provid-
ing cleaner water for the fish we eat and
better soil for the gardens that grow food.
We choose to have green space on our
campus, sometimes compromising our
parking spaces. We choose to filter our
storm water run-off; invest in the most
energy efficient heating and coolingequipment; and pursue recycling, reuse,
and recovery. As we move forward, we
have a cumulative financial investment
and rely on volunteer hours and partners
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Stretchers/mattress, stretcher with foot
extender (InstaCare Stryker 1000), twowarming cabinets
Trinidad and Tobago, Eagles Nest Ministries:
Overbed table
Russian Federation, Voronezh Region:Crutches, two surgical lights/lamps
Ghana, International Health and Develop-
ment: Overbed table, birthingbed/mattress, visitor chair
Honduras, Mercy International: X-ray film
illuminator
Morocco, National Oncology Institute:Bedside table
Dominican Republic, Santiago Rodriguez
Hospital: Bedside table
U.S. Navy Project Handclasp: Five visitor
chairs and an exam stool
Thanks to a new, advanced computer
ordering and tracking system in Spring-field, in the past two years (20062007),
St. Marys Hospital Medical Center
received confirmation that our used equip-
ment and supplies landed all over the
world, specifically in:
Orkhon Tus charity organization, Mongo-
lia: Surgical light/lamp
Ukraine, Bilokurakone Central Rayon Hos-
pital: Two recliner chairs
Cuba, Caritas Cubana: Birthing bed, crutches
Haiti, Centre De Sante: Pedicraft crib with
top and mattress, two Stryker 921 stretch-
ers with mattress
Haiti, Hospital St. Antoine de Jeremie:
Hamper, mattress, birthing bed
Pakistan, Children of Abraham, Inc.:
Table 4 Where Our Recycled Equipment is Being Used
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people find purpose and meaning in giv-
ing back to the environment and the com-
munity.
Partner with community leadersGet to
know and partner with city planners, the
mayor, the city council, and governmental
agencies. If you are proactive with them and
they know you care about the environment,
these officials will be more likely to be posi-
tive and cooperative, and they will be less
likely to criticize the hospital for being a
high-end consumer and waste producer. If
they see your intentions and efforts, positive
perceptions and relationships will develop.
Everyone cares about the environment of a
community. When talk of taxation and your
tax-exempt status comes up, hopefully, they
will remember your investment of money
and time improving the community and
will be more aware of your service commit-
ment and charitable ministry.
Find more partnersGet more people
on board with your goals. Share your pas-
sion. The more people you have partnered
with you, the greater your impact. Look to
all contacts, vendors, advisors, patients,
employees, and acquaintances. A side
benefit will be a growing positive image
and more resources becoming available to
your projects.
Tell your storyEvery other year, or
whenever we have new programs to share,
we tell our story with printed brochures
(printed on recycled paper and with envi-
ronmentally friendly ink), news releases,
and letters. We communicate with politi-
cians, legislators, city officials and health-
care associations, board members,
advisors, physicians and employees, news
mediaeveryone. As our prosperous
nation is viewed globally as a large con-
sumer, we are doing our part to make the
world better and we communicate about it.
and employees your ideas for an envi-
ronmental initiative. Tell them your
goals, your ideas, and your passion for
the projects. Ask for their ideasand
their help. Perhaps a board member owns
a company with whom you can partner to
share costs and accomplish recycling.
Look to your employees, owners, and ven-
dors to help donate supplies, services, and
time. It will be enjoyable for all, as most
2 2 fr o n ti e r s o f h e alth s e r vi ce s m an age m e n t 2 5 : 1
Cardboard, mixed paper
Newsprint, boxboard
Plastics: #1 PET, #2 HDPE, #5
Polypropylene, #6 PS
Mixed recyclables: Glass, aluminum, tin,
steel
Wood pallets, scrap, and demolition
wood
All oil products
Ink jet cartridges, toner cartridges
Electronic equipment and components
All batteries
Fluorescent lamps, light bulbs
Landscape waste
Solvents
Diagnostic film
Construction demolition
Surgical instrumentation (for third world
countries)
Precious metals
Xylene, ethanol
Table 5 List of St. Marys Hospital
Recycled Items
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Environmental awareness and sustain-
ability happen one plastic soda bottle at a
time, one sheet of paper at a time, onemop head at a time, one surgical suction
canister at a time. Become a champion or
find someone in your organization who is
passionate to make a difference. Next
thing you know, you will have a depart-
ment director making flower arrange-
ments out of demolition rubble; your
vendors will help you recycle; and you
might even find a partner like Mission
Outreach, helping others around the
world. And like St. Marys Hospital Med-
ical Center, perhaps the governor will becommending you for your efforts and
H2E will recognize you as one of the top
facilities in the United States, setting an
example for others to follow. Whatever it
is you choose, start small and think big.
ReferencePractice Greenhealth. 2008. Vision, Mission,
Goals and MOU. http://cms.h2e-
online.org/about/.
We are making positive changes about
environmental sustainability, something
for which Americans care deeply.Take small steps to get startedStart
with a few small ideas, like recycling
paper, plastic, and aluminum, then carry
it throughout your organization. Ask
employees closest to the work in a given
area to suggest ideas. The xylene distiller
project we did was one of those depart-
mental ideas that is making a large,
ongoing impact. Using bio-friendly
materials that are able to be sanitized
and reused is one small item, but long
term makes a big impact. The little pro-jects add up to a collective, positive
impact.
Conduct environmental audits,
department by department, with a posi-
tive educational approach, and keep
information in front of constituents so
they are reminded to continue their recy-
cle/reuse efforts. It takes everyone, every
day, doing a small part to create a big
influence.
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YRobin Guenther, FAIA, is a healthcare architect at Perkins and Will in New York.She co-coordinates the Green Guide for Health Care, serves on the LEED-HC
committee, is a board member of Practice Greenhealth and the Center for
Health Design, and is the co-author ofSustainable Healthcare Architecture
(Wiley, 2007) with Gail Vittori.
BY ROBIN GUENTHER
The authors of the lead articles in this issue offer important insights
into key questions that frame the integration of sustainable principles in the
healthcare sectornamely, why should healthcare engage in sustainable build-
ing and operation and how do organizations begin the journey? Their important
work is part of a dispersed but exponentially growing movement among health-
care organizations in the United States and beyond that deserves a broader con-
text. The movement centers around these fundamental questions: Why shouldhealthcare lead health-based green initiatives? What is driving the green
tsunami in business (and in particular, the business of healthcare)? Where is
the healthcare sector at this moment in time? Why isnt everyone doing it? and
What lies ahead that may shape future responses? In short, why bother?
On Earth Day, 2008 the writer Michael Pollan (2008) had a provocative
essay titled Why Bother? published in The New York Times. He posed this
challenge: Sometimes you have to act as if acting will make a difference, even
when you cant prove that it will. The hospitals profiled in this issue, and the
growing list of institutions that share their vision and goals, embarked on a
sustainability journey in the absence of business case data or proven opera-tional models, motivated by mission and led by individuals who cared enough
to make a difference. Through their success, they have become unintentional
leaders for this industry.
Why Should Healthcare Lead Health-Based Green Initiatives?
For the CEO of St. Marys, the organizations explicit stewardship mission lies
at the core of its decision makinga common trend for religious-based health-
care organizations. Many non religious healthcare organizationslacking a
reference to stewardship in their missionapproach green initiatives through
a community benefit lens.
Why Should Healthcare Bother?
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A third compelling reason to go green is
the connection between green buildings and
human healtha connection recognized by
the healthcare industry that is increasinglyadopted by other market sectors. The Ameri-
can Society of Healthcare Engineering
(ASHE 2002) first framed green building
initiatives around protecting health at three
scales: the immediate health of building
occupants, health of the surrounding com-
munity, and health of the larger global com-
munity and natural resources.
Environmental scholar David Orr (2004)
writes: The standard for ecological design is
neither efficiency nor pro-
ductivity but health; begin-ning with that of the soil and
extending upward through
plants, animals, and people.
It is impossible to impair
health at any level without
affecting it at other levels.
The Green Guide for
Health Care, the first volun-
tary self-certification metric
tool for ranking sustainable
building strategies in healthcare, includes
specific health issue statements that intro-duce each construction and operation topic
(GGHC 2006). The Green Guide has become
the foundation for the U.S. Green Building
Councils Leadership in Energy and Environ-
mental Design (LEED) for Healthcare rating
system. Providence Health and Services CEO
John Koster, MD, describing their new LEED
Gold Certified hospital in Newberg, Oregon,
summed it up this way: In healthcare, sus-
tainable building represents a bold move
toward precaution and prevention. The build-
ing stands for health. In creating it, the orga-nization is essentially saying, Were
investing in keeping people healthier. Being
attentive to sustainability, wellness, and
resource stewardship presents a holistic view
of healthcare that has an impact. We may
not be able to measure or test, but Im con-
vinced it has a tremendous impact on a per-
sons ability to attain health. Not just to benot sick, but to be in health (Guenther, Vit-
tori, and Atwood 2006).
Finally, the healthcare sector is realizing
that green construction and operation
makes business sense. The authors of the
feature articles delineate three major bene-
fits: reduced operating cost, avoided risk,
and tangible impacts on employee satisfac-
tion, recruitment, and retention. The focus
on employee satisfaction is not surprising,
given chronic staffing shortages and person-
nel expenses. In 2004, the American Hos-pital Association estimated that hospitals
spent more than 50 percent of their operat-
ing budgets on personnel, and 1.4 percent
on energy. With the threefold increase in the
cost of energy, this figure may be approach-
ing 3 percent today for many institutions.
Reducing energy demand is increasingly
seen as not just about dollars saved today,
but is a risk avoidance strategy in a time of
uncertain energy economics. Likewise,
green strategies aimed at improved indoor
air qualityfrom using building materialsthat emit less fumes to cleaning with
greener products reduce occupational
health and safety risks.
Almost without exception, hospitals that
undertake green building and operation
strategies report improved worker recruit-
ment, satisfaction, and retention. Green
building is viewed as a major catalyst for
organizational culture transformationby
connecting with employee values, the work
experience is transformed. Moreover, as the
Boulder Community Hospital story demon-strates, the completion of a green building
is really only the beginning of organiza-
tional transformation. Once the building is
in place, new green programs and initia-
Green strategies aimed atimproved indoor air
qualityfrom using
building materials that
emit less fumes to cleaning
with greener products
reduce occupational
health and safety risks.
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tives are implemented. Boulder installed
solar photovoltaic panels nearly four years
after achieving its LEED certified building,
and continues implementing operationsprograms that earn it environmental excel-
lence awards each year.
What is Driving this Green
Tsunami in Healthcare?
One can barely move in contemporary cul-
ture without encountering green initia-
tives. Mainstream media are relentlessly
reporting on environmental leaders and
laggardsindustries that are slow to
respond are increasingly vilified. There are
three distinct but interconnected factorsdriving this movement: mounting climate
change concern, increasing scientific link-
ages between environmental degradation
and human/ecosystem health, and global
resource competition. Together, these
issues will change the way we live and con-
duct business in the futureand are likely
to have profound impacts on healthcare
deliveryas each of them in turn impacts
human health. Moreover, as described ear-
lier, these factors are fundamentally
changing economics as we begin to mone-tize previously externalized costs to soci-
ety: the cost of carbon emissions, toxics, or
pollution impacts.
There is growing scientific consensus
around climate change impacts and the
need for rapid global action to reduce
greenhouse gas emissions associated with
the burning of fossil fuels. The National
Aeronautics and Space Administration cli-
mate scientist Jim Hansen (2006) writes:
We have at most ten yearsnot ten years
to decide upon action, but ten years toalter fundamentally the trajectory of global
greenhouse emissions. The building sec-
tor is by far the largest emitter of carbon,
outpacing both transportation and indus-
try. U.S. Energy Information Agency data
(EIA 2007) rate acute care hospitals the
second most energy intensive building
type, just below food service. The datashow that hospitals use twice the energy of
commercial office buildings.
Across the United States, in the absence
of federal action, states and municipalities
are enacting legislation aimed at achieving
rapid reduction of greenhouse gas emis-
sions through public transportation invest-
ments and green building programs. In
2006, the American Institute of Architects
(AIA) launched the 2030 Challenge with
the goal of achieving carbon neutrality in
the built environment by 2030.At the same time, the healthcare indus-
try is just beginning to articulate the impact
of climate change on healthcare services
delivery. As average temperatures rise, heat
island impacts in dense urban areas will
exacerbate chronic respiratory conditions in
the elderly and children. More extreme
weather eventshurricanes in the coastal
Southeast, tornadoes and floods in the Mid-
west, fires and drought on the West
Coastwill require a more resilient emer-
gency care