MODULE 4:CONTROLLING IDEA: How do we evaluate what’s a good project? (Part 1)

What might a process look like and what are the components?

Homework reflection

5 minutes

What did you learn, see, hear, during your interviews? Who did you interview and why? Was it difficult or easy? Why?

ESL Instructor

Anchoring Question/Vocabulary

10 minutes

Let’s review what we have so far as information via the observation and interviewing. How do both of these skills help us select a green project? What might be missing? Instructor to anticipate possible responses.

FOR DISCUSSION: Instructor to discuss that data collecting is part of the investigation or inquiry process and that analyzing the data is another part. Before getting to analysis, students will practice one more data gathering skill.

Vocabulary: Introduce vocabulary word list in the appropriate context for the topics in the mini lessons and activities. – TBD Ensure that carbon footprint from the vocabulary in Module 1 is reintroduced here as well.

Green WashingAuthorityBiasCurrentDocumentation

ESL Instructor

BRIDGE to next and application: Continuing with the discussion of data gathering. Introduce how to gather basic Internet information.Mini Lesson/Activity

45 MINUTES

Content to review: Data Gathering Skill #3: Internet searches, listservs and websites.

HANDS ON ACTIVITY: Practice Computer literacy by introducing Internet searches to find information. -How to Google? (Handout Module 4:1) and how to capture and record information. Instructor provides an appropriate handout for students to practice obtaining information through a basic search. Students should be in their “Bucket” groups. (Handout Module 4.2)

Mini assessment from structured computer activity. How do you know a website is legitimate? (Learning Your ABCDs) (Handout Module 4.3)

Optional: Evaluating Websites Video: http://www.youtube.com/watch?v=Ba9-

ESL Instructor

DnferiQ&annotation_id=annotation_547799&feature=ivBRIDGE to next concept and application: Now that you have some data gathering skills (observation, interview, and Internet/computer) how do we analyze the data to determine if it warrants a green project? How do we build assessment, analysis, and evaluation skills?

45 minutes CASE STUDY: Students run a hospital scenarios (provided by the instructor on a healthcare challenge) through a SWOT analysis (strengths, opportunities, weakness, threats through the student’s eyes as it relates to the hospital, department, etc.) or a Root Cause Analysis (cause and effect)- Instructor selects most appropriate tool. (Handout Module 4.4)

INSTRUCTOR NOTE: This is a good time to focus on a variety of green scenarios, allows for gradual development of self-confidence as students engage in a casual conversation leading up to group work, leadership roles in the group and eventual presentations.

Discuss the concept (SWOT or Root Cause), perform the analysis as a class by populating the form with examples of data gathered by the students around this idea. As an example, Instructor can use page 140 from “Writing for a Change” from the National Writing Project (linked on website) or the Root Case Analysis process from Facilitation at a Glance!, by Ingrid Bens, pages 148-149 (linked on website). Each letter has a quadrant on a form that students can populate. Students practice with their own handout simultaneously. Discuss how the data gathering performed so far connects with the analysis of the case study. How does it connect with the triple bottom line?

Content Instructor

ADDED ACTIVITY30 minutes

Writing Practice and Assessment – structured writing activity on the whiteboard to support interview and data gathering process of creating a write up report following an interview.

ESL Instructor

Wednesday’s classBRIDGE to next concept and application: First data collection, then analysis, then goal development. We are on this last stage (Handout Module 4.5).

Mini Lesson10 minutes

MINI LESSON- Introduce SMART goal development but contextualized with goal examples from John Ebers, Practice Greenhealth (Handout Module 4:6). Instructor introduces SMART goal development worksheet (Handout Module 4:7) before pre-teaching aspects of timeline and metrics (more focus on metrics in Module 5).

ContentInstructor

BRIDGE to next concept and application: Analysis and SMART Goals involve measurement. What are some ways we can incorporate data from our fieldwork into these two concepts?

Activity Creating a timeline. How is something counted over time?

(Eliminated due to time constraints)

Students work in small groups to chart out a timeline (personal accomplishments, hospital highlights, or their progression in the course – pick one). Report out to the class.

MINI LESSON10 minutes

Teaching Time as measurement; units over time, money over time, etc. and how to record and report it. NOTE: Some processes in a healthcare facility happen over time (e.g. waste management companies pick up 3 times a week, water billing might occur every 3 months, etc. Connect with completed timeline activity.

Instructor consideration: As a way to teach timeline, consider using “Now/Soon/Later” exercise, page 149 from Writing for a Change from the National Writing Project. Question prompts might include: What is it? When does it happen? How to record it? (Handout Module 4:8)

ContentInstructor

5 minutes Vocabulary: Introduce vocabulary word list in the appropriate context for the topics in the analysis and SMART goal part of the lesson. Reinforce vocabulary through the group activities and class report out. Handouts created: see EPA and MeasurementsCarbon FootprintkBtu/SFGallons/SF Energy Star EPA

ESL Instructor

MINI LESSON5 minutes

Form for metrics (get from a generic anonymous site visit report from Practice Greenhealth) (Handout Module 4.9); instructor walks through the different sections; invites students to look at how things are measured (gallons, btus over time, weigh, etc.); comparing and contrasting; putting it into context.

ESL Instructor

and Content Instructor

Group Activity15 minutes

GROUP ACTIVITY: Practice walking through the development of a SMART goal (Handout Module 4:7). Practice identifying the components, defining them, and then applying it to the previous hospital scenario (Handout Module 4:4) or one of the SMART goals at their hospitals if they are familiar with one. Connect how SMART goals impact the Triple Bottom Line.

ESL Instructor

Review/Assessment

Due to time constraints, this carbon footprint

exercise was moved to the following

week.

EXERCISE: Estimating the carbon footprint (of self and hospital – use scale: 1 low, 5 medium, 10 high, for each area below and compare the ratings.

a. # of miles people and products travelb. waste disposalc. electricity/ energy used. gas/heat use, etc.

Content Instructor

Share with each other in class. Connect hospital’s footprint to the bottom line and how this connects to “green” projects at the hospital. Connect the rating scale to an example of measuring units over time. Connect this activity to the previous analysis activity. Emphasis on measurement as it relates to the number of miles traveled over time, tons of waste disposed over time, and energy and power used over time as standard units of measurement for tracking and monitoring.

5 minutes Added: PowerPoint about group projects – clarifying questions Content Instructor

Added to Support Homework

Development

45 minutes

Added: Bucket Groups – go over homework (Handout Module 4.10) together in “bucket” groups; work on clarifying 1) what projects you’re really interested in, and 2) who else is interested in the same project; after 30 minutes report out of possible projects and possible group members. Instructors write possible projects on whiteboard and discuss. Goal: to begin narrowing down and focusing on possible green projects

Content Instructor

Homework Field work: Students complete the structured form for recording responses and info gathering. (Handout Module 4.10)

Given the data collection and analysis performed this week around possible “green” projects, what other information do you think you need before selecting a project? What new people might you interview? What other pieces of information or data might you need?

Content Instructor

Journal Selected question related to the content introduced and how the student could apply it to prepare a “green project” for class within a labor and management environment. What might be some challenges or opportunities?

Content Instructor

CLASS ENDS WEEK WITH A LEARNING CIRCLEINSTRUCTOR NOTE: Identify and prepare appropriate rubrics for evaluation of work during this module.

How To Do A Google Search

A Google Search is simple: just type whatever comes to mind in the search box, hit Enter or click the Search button, and Google will search the web for content that's relevant to your search. Most of the time, you'll find exactly what you're looking for with just a basic query (the word or phrase you search for). However, the following tips can help you make the most of your searches. Note: use square brackets [ ] to signal a search query, so [ black and white ] is one query, while [ black ] and [ white ] are two separate searches.

Some basic facts

Every word matters. Generally, all the words you put in the query will be used. Search is always case insensitive. A search for [ new york times ] is the same as a search

for [ New York Times ]. Generally, punctuation is ignored, including @#$%^&*()=+[]\ and other special characters.

Tips for better searches

Keep it simple. If you're looking for a particular company, just enter its name, or as much of its name as you can recall. If you're looking for a particular concept, place, or product, start with its name. If you're looking for a pizza restaurant, just enter pizza and the name of your town or your zip code. Simple is good.

Think how the page you are looking for will be written. A search engine is not a human. It is a program that matches the words you give to pages on the web. Use the words that are most likely to appear on the page. For example, instead of saying [ my head hurts ], say [ headache ], because that's the term a medical page will use.

Describe what you need with as few terms as possible. The goal of each word in a query is to focus it further. Since all words are used, each additional word limits the results. If you limit too much, you will miss a lot of useful information. The main advantage to starting with fewer keywords is that, if you don't get what you need, the results will likely give you a good indication of what additional words are needed to refine your results on the next search. For example, [ weather cancun ] is a simple way to find the weather and it is likely to give better results than the longer [ weather report for cancun mexico ].

Choose descriptive words. The more unique the word is the more likely you are to get relevant results. Words that are not very descriptive, like 'document,' 'website,' 'company,' or 'info,' are usually not needed. Keep in mind, however, that even if the word has the correct meaning but it is not the one most people use, it may not match the pages you need. For example, [ celebrity ringtones ] is more descriptive and specific than [ celebrity sounds ].

From: http://www.google.com/support/websearch/bin/answer.py?answer=134479

Handout 4:1

Exceptions to Google Rules: http://www.google.com/support/websearch/bin/answer.py?answer=136861#exceptions

Google Search Practice

Group 1:Find Practice Greenhealth’s website

Find Practice Greenhealth’s listserv (hint: click on Tools and Education link)

Group 2:Find Healthcare Without Harm website

Find Healthcare Without Harm’s library of downloadable documents

Group 3:Find Healthier Hospitals Initiative website

Group 4:

Green Guide for Health Care website

SUSTAINABILITY IN HEALTHCARE RESEARCH WORKSHEETEnergy To start you off on your research: review these websites:

http://www.sustainabilityroadmap.org/topics/energy.shtmlhttp://www.sustainabilityroadmap.org/strategies/planenergy.shtmlhttp://www.practicegreenhealth.org/educate/energy/

When you search [ energy conversation in hospitals ], what do you find? Correctly cite URLs for any information found:

Websites:

Regulatory Agencies:

Water To start you off on your research:http://www.practicegreenhealth.org/educate/regs/cwa/http://www.noharm.org/seasia/news_hcwh/2010/mar/hcwh2010-03-23.phphttp://www.sustainabilityroadmap.org/topics/water.shtml

When search for [ water conversation in hospitals ], what do you find? Correctly cite URLs for any information found:

Websites:

Regulatory Agencies:

Waste – General To start you off on your research:http://cms.h2e-online.org/ee/waste-reduction/http://www.practicegreenhealth.org/educate/operations/wastehttp://www.sustainabilityroadmap.org/topics/waste.shtmlhttp://www.wastecare.com/Articles/Cardboard_Recycling.htmhttp://www.sustainabilityroadmap.org/implementation/pim/waste/conduct_a_basic_recycling_program.shtml

When you search [ waste conversation in hospitals ], what do you find? Correctly cite URLs for any information found:

Websites:

Regulatory Agencies

Handout 4:2

Waste – Regulated To start you off on your research:http://cms.h2e-online.org/ee/rmw/

When you search [ regulated waste conversation in hospitals ] what do you find? Correctly cite URLs for any information found:

Listservs/publications

Regulatory AgenciesGreen Cleaning To start you off on your research:

http://cms.h2e-online.org/ee/facilities/greencleaning/http://www.sustainabilityroadmap.org/topics/chemical.shtmlhttps://greencleaning.ny.gov/ (New York State’s green cleaning program)

When you search [ regulated green cleaning in hospitals ], what do you find? Correctly cite URLs for any information found:

Regulatory Agencies

Green Purchasingor Environmentally Preferred Purchasing

To start you off on your research:http://cms.h2e-online.org/ee/waste-reduction/epp/http://www.epa.gov/epp/

When you search [environmentally preferred purchasing in hospitals ], what do you find? Correctly cite URLs for any information found:

Websites:

Regulatory Agencies that Oversee Health Facility Operations

Agency/Organization Focus Major Areas Related to WasteU.S. Environmental Protection Agency (EPA)

Protection of the planet, primarily from hazardous

chemicals

RCRA—Resource Conservation and Recovery Act (hazardous chemicals)CWA—Clean Water Act CAA—Clean Air Act Compensation, and Liability Act (Superfund)EPCRA—Emergency Planning and Community Right-to-Know Act TSCA—Toxic Substance Control Act

U.S. Occupational Safety and Health Administration (OSHA)

Protection of workers from work-related injuries

Bloodborne Pathogens Standard

Hazard Communication Standard

Respiratory Protection Standard

Joint Commission on Accreditation of Healthcare Organizations (Joint Commission)

Protection of patient health and safety

Safety and leadership

Environment of care

U.S. Department of Transportation (DOT)

Protection of public safety by regulation of material

transportation on public roads and highways

U.S. Postal Service has mailing requirements for shipment of health care-related items

U.S. Drug Enforcement Agency (DEA)

Protection of the public from controlled substances

(pharmaceutical wastes)

DEA-controlled substance management

Nuclear Regulatory Agency (NRC)

Protection of the public from use of radioactive materials

and wastes

Resource Conservation and Recovery Act (RCRA) also regulates mixed waste.

Centers for Disease Control and Prevention (CDC)

Protection of workers and public health related to

regulated medical wastes, infection control, etc.

Guidelines and recommendations for infection control, sterilization, hand hygiene, etc.

U.S. Department of Health and Human Services (HHS)

Provision of regulations overseeing a variety of

health care-related issues

Food and Drug Administration (FDA)

Centers for Medicare & Medicaid

Services (CMS)

HIPAA

State governments

Public health department

State EPA

Regulatory authority in many waste-related areas. In

particular, states mandate rules for the management of

regulated medical waste.

Have the ability to be more stringent than federal regulations.

Local POTWs (publicly owned treatment works)

Water treatment from local and regional communities

and businesses

Can set local standard requirements for water discharge allowances and issue permits

Green Question “How do you know that something you find on the Internet that says it’s “green” or sustainable is actually true?”

ABCD analysis

Authority: who created the content? What makes this author credible, accountable, or an authority, on the topic?

Bias: what is the bias? Is the bias clear or hidden?  What about its purpose? Is it educational, entertainment, or commercial?

Current: when was the page last updated? Is the information still relevant?

Documentation: is there additional information to support the information or stance provided?

Handout 4:3

Healthcare “Green” Scenario The Green Challenge: Your supervisor has given your team the task of recommending a strategy for increasing the healthcare institution’s paper and cardboard recycling program.  Currently the institution’s overall recycling rate is at 10% annually.  The goal is to achieve 30% in two years. 

Current Observation: Since cardboard takes up about 20% of the waste stream, there is speculation that there is still a lot of waste in paper and cardboard that isn’t being sorted correctly, and or being disposed of improperly. In addition, the vendor only comes once a week and instead of piling up the cardboard for the scheduled pick-up, many workers throw cardboard bundles into the general waste stream.

Data from Observation and Interviews: Your supervisor has shared with your team that one of the major concerns is staff engagement, education, and morale. Your supervisor tells you that there are quite a few people who are already upset about these proposed “green” changes:

Interview: When interviewed, the pharmacy staff has said that they feel that obtaining a higher recycling rate has become competitive in the healthcare institution pitting one department against another, especially considering that most of the cardboard boxes come from their department because of all the packaged medication and supplies they receive. 

Observation: An EVS worker has expressed frustration because this proposed program puts more work on him – answering questions, moving bins, weighing recyclables, correcting other people’s recycling errors, etc.  It may be good for the healthcare institution, he says, but it is more work for him.

Sphere of Influence: Your supervisor has asked for your help because the EVS department has already been successful in piloting a recycling program in the Emergency Department (ED) where your team developed positive rapport with the nursing staff and doctors. In addition, you and your team have been recognized as EVS Green Champions and are very excited about continuing to work on green projects that impact the triple bottom line. One thing your team wonders about is whether you have the necessary tools to support your recommendation.

Your job: Work as a team using this handout and the accompanying worksheet to analyze the situation that can be used to develop a recommendation for strategies on how to implement this campus-wide “green” initiative without negatively affecting staff and department morale. Your recommendation will be given to your supervisor and the Labor/Management Committee for consideration.

Ultimately the Labor /Management Committee is looking for a recommendation that frontline workers can play a leadership role in.

Handout 4:4

SWOT ANALYSIS

Strengths:What is being done well in this scenario?

What unique resources can be utilized?

What strengths do others see?

Weaknesses:Where could you improve?

Where are resources challenged or stressed?

What weaknesses do others see?

Opportunities:What opportunities are being presented here?

How can you turn your strengths into opportunities?

What new initiatives or changes are happening that you could take advantage of?

Threats:What threats could harm your hospital?

Handout 4:4

What threats do your weaknesses expose you to?

Root Cause Analysis

What is it? A systematic analysis of an issue to identify the root causes rather than the symptoms.

When should you use it? When you need to delve beneath the surface and uncover the underlying causes of a problem.

What is its purpose? Leads to more complete and final solutions.

What’s the outcome? Root-case analysis forces groups to look more deeply at problems and to deal with the underlying causes. This often means that problems are more likely to be resolved once and for all.

How to do a Root-Cause Analysis

Step 1: Explain the difference between causes and effects to group members. For example, is a noisy muffler a cause or effect? Once people have identified that it’s an effect, ask them to list all of the causes. Point out that effects can’t be solved, but underlying causes can.

Step 2: Use the basic method called Cause and Effect Charting (see below) for determining root causes.

Step 3: Once all causes are identified, brainstorm solutions for each one.

Method: Cause and Effect Charting

i) When analyzing a problem, divide a sheet of paper in two and write effects on the right side and causes on the left.

ii) Whenever anyone offers a point of analysis ask if it’s a cause or effect. Write each item in its appropriate column. Probe each item in the effect column to determine what causes it. Continue until all causes have been identified.

Adapted from Ingrid Bens. Facilitation at a Glance! 2nd edition, a publication of GoalQPC, 148-149.

Causes Effects* cause #1 * effect 1* cause #2 * effect 2

6 Steps to Creating a Green Project or Initiative that Supports a Triple Bottom Line

1. Observations – what are you seeing that is a problem or a potential green opportunity?

2. Recording – how many times have you noticed this particular situation or the absence of something? At what intervals does something occur (or not occur)? Or is there a specific time or place something happens or doesn’t happen? How do you write this up?

3. Interviewing – what additional information can you gather by talking with people?

4. Internet Search – what additional information can you find that supports your hypothesis?

5. Quantifying – what do you learn by tracking, weighing, measuring, counting, and averaging that supports the economic aspect of the Triple Bottom Line?

6. Goal Development – using a SMART form to develop a project that is time-bound, replicable, and measurable that supports a Triple Bottom Line analysis

We’re here

Handout 4:5

SAMPLE S.M.A.R.T. GOAL FROM PRACTICE GREENHEALTH

S.M.A.R.T Goal Example:“Recycling, Waste and Cost Reduction Initiative”

1. Specific:a. Divert 50% of the solid waste that leaves the surgical processing department

(SPD) through recycling.

2. Measurable: a. Environmental service workers will visually inspect the contents of the solid and

recyclable waste for two weeks following the project kick-off. Materials will be weighed and recorded at minimum 4 different days and times. Example Day 1 – First shift; Day 4 – 2nd shift. Calculate the waste diverted from landfills and incinerators if this project were to continue for the next year and determine the cost impacts.

b. Chart this information to the SPD and EVS staff.

3. Attainable: a. Collaborate with the SPD staff to determine the goal for the department.

4. Repeatable: a. The broader implications of this project will determine the success of future

projects. Include an evaluation component that enables the project team to learn and adjust accordingly.

5. Time-bound: a. Identify the reporting frequency and determine a deadline for the achievement of

the stated goal.

Handout 4:6

DRAFT OF A “GREEN” PROJECT SMART GOAL

1. Specific:

2. Measurable:

3. Attainable:

4. Repeatable:

5. Time-Based:

Handout 4:7

Healthcare “Green” Scenario The Green Challenge: Your supervisor has given your team the task of recommending a strategy for increasing the healthcare institution’s paper and cardboard recycling program.  Currently the institution’s overall recycling rate is at 10% annually.  The goal is to achieve 30% in two years. 

Current Observation: Since cardboard takes up about 20% of the waste stream, there is speculation that there is still a lot of waste in paper and cardboard that isn’t being sorted correctly, and or being disposed of improperly. In addition, the vendor only comes once a week and instead of piling up the cardboard for the scheduled pick-up, many workers throw cardboard bundles into the general waste stream.

Data from Observation and Interviews: Your supervisor has shared with your team that one of the major concerns is staff engagement, education, and morale. Your supervisor tells you that there are quite a few people who are already upset about these proposed “green” changes:

Interview: When interviewed, the pharmacy staff has said that they feel that obtaining a higher recycling rate has become competitive in the healthcare institution pitting one department against another, especially considering that most of the cardboard boxes come from their department because of all the packaged medication and supplies they receive. 

Observation: An EVS worker has expressed frustration because this proposed program puts more work on him – answering questions, moving bins, weighing recyclables, correcting other people’s recycling errors, etc.  It may be good for the healthcare institution, he says, but it is more work for him.

Sphere of Influence: Your supervisor has asked for your help because the EVS department has already been successful in piloting a recycling program in the Emergency Department (ED) where your team developed positive rapport with the nursing staff and doctors. In addition, you and your team have been recognized as EVS Green Champions and are very excited about continuing to work on green projects that impact the triple bottom line. One thing your team wonders about is whether you have the necessary tools to support your recommendation.

Your job: Work as a team using this handout and the accompanying worksheet to analyze the situation that can be used to develop a recommendation for strategies on how to implement this campus-wide “green” initiative without negatively affecting staff and department morale. Your recommendation will be given to your supervisor and the Labor/Management Committee for consideration.

Ultimately the Labor /Management Committee is looking for a recommendation that frontline workers can play a leadership role in.

Now/Soon/Later: Creating a Timeline

Instructions:

1. The facilitator asks each group member to list the activities necessary to carry out their ideas for action on a separate sheet or on sticky notes. Then ask them to answerthe following questions:

Who will do it? When does it have to happen?

2. Use the matrix below to create your timeline. The time frame is indicated across the top, while the responsibility assignments run down the left side.

3. Every activity should be written into one of the boxes. For example, a taskto be done "now" by "us" goes in the upper-left cell; one to be done "soon"by "us, with help" goes in the center cell. When every activity has been allocated a specific time and a responsible person (or persons), your action plan is completed.

Handout 4:8

PRACTICE GREENHEALTH™

Generic Site Assessmentcompiled from multiple hospital site visits

John R. Ebers2010

This report is based on the quantitative analysis, site visit interviews and observations by Practice GreenHealth™ as a deliverable to the H-CAP Grant: From Entry Level To A Green Career: National Green Environmental Service Worker Project. It is meant as a guidance document only.

Handout 4.9

Table of Contents

Introduction: Setting a Foundation a ‘Green’ Culture...................................Error! Bookmark not defined.

The Green Team............................................................................................Error! Bookmark not defined.

Recycling & Waste Reduction........................................................................Error! Bookmark not defined.

Water Conservation.....................................................................................................................................9

Energy Optimization......................................................................................Error! Bookmark not defined.

Less Toxic Cleaning Chemicals.......................................................................Error! Bookmark not defined.

Integrating New Equipment & Technology....................................................Error! Bookmark not defined.

Reduction of HAIs in ESW Work.....................................................................Error! Bookmark not defined.

Communication.............................................................................................Error! Bookmark not defined.

S.M.A.R.T Goal Example:...........................................................................................................................17

Introduction: Setting a Foundation a ‘Green’ CultureThe interconnection between the environmental service worker (EVS) and the ability for the hospital to integrate “green systems change” is critical to the success of any hospital’s sustainability program.1 The EVS comes into contact with virtually every area & department in a hospital. The observations gleaned by the EVS should be used strategically to promote waste reduction, energy and water conservation.

The Green TeamPractice Green Health and H-CAP recommend that the Labor Management Committee (LMC) adopt a ‘green’ team concept to promote waste reduction, energy and water conservation. Below is a list of areas that will help guide the LMCs efforts for the purpose of the grant. Furthermore, the new EVS ‘green’ position, as described in the grant, can play key role in establishing the environmental services departmental strategy and implementation. This experience will provide real time training and leadership preparation for programs and projects that should eventually cross departments and have a meaningful impact on the hospitals’ sustainability initiatives2.

The make-up of green teams from hospital to hospital is not the same. Below are the categories that hospital green teams should consider, the point department to lead, example indicators to measure and the reporting frequency.

Environmentally Preferred Purchasingo Point Department: Materials Management/Procuremento Example Indicator(s) EI: 1.) Quantity of purchase

reprocessed/remanufactured single use devices compared to brand new single use devices procured.

o Reporting Frequency: Monthly

Waste and Recyclingo Point Department: Environmental Serviceso Example Indicator(s) EI: 1.) Monthly waste profile matrix. 2.) Measured

in pounds/adjusted patient day.o Tools: GreenHealth Trackero Reporting Frequency: Monthly

1 “Green Systems Change” is the phrase used in the ‘From Entry Level to a Green career: National Green Environmental Services Worker Project’ grant proposal.2Sustainability/Green: The author uses these terms interchangeably and utilizes the definition of the term The author uses these terms interchangeably and utilizes the definition of the term sustainable from the sustainable from the United Nations World Commission on Environment and Development (Brundtland United Nations World Commission on Environment and Development (Brundtland Commission) Report, 1987.Commission) Report, 1987. Sustainability: “ Sustainability: “meets the needs of the present without compromising the ability of future generations to meet their own needs”.

Energy Optimizationo Point Department: Facilities/Engineering and Maintenanceo Example Indicator(s) EI: 1.) kBtu/SF and APD. 2.) Energy Star Scoreo Tools: EnergyStar Portfolio Managero Reporting Frequency: Monthly

Water Conservationo Point Department: Facilities/Engineering and Maintenanceo Example Indicator(s) EI: 1.) Gallons/SF and APDo Tools: EPAs Water Senseo Reporting: Monthly

An important aspect to consider with each of the above topics is to establish specific, measurable, attainable, realistic and timely goals for each one. See S.M.A.R.T. Example on page 14.

A quick word on cost: Quantifying cost savings for projects is clearly up to the hospital to determine the feasibility of any project. The information provided below is meant as a reference for the hospital. Understanding how the hospital compares nationally will help guide the institution on where it is doing well and where inefficiencies exist.

Recycling & Waste ReductionThe EVS has a direct impact on the success of a hospital’s recycling program. They often know where the large quantities of waste are generated in the hospital and can play an important role in communicating this knowledge to the department and the hospital as a whole. If this knowledge is connected with education and training that supports tracking and monitoring, the hospitals recycling and waste reduction efforts will be reflected in the hospital’s data.

It is clear throughout the hospital that recycling is available and utilized by many departments. Furthermore, many of the individuals interviewed were aware of the recycling programs and were active participants in making the recycling program successful. Nevertheless there are still ways to improve recycling and waste reduction that can realize a cost reduction for the hospital.

Though Table 1 shows a high recycling rate in terms of the hospitals waste profile, their recycling percentage may not be accurately portrayed because this is not an exact weigh measurement. Rather it is a weight estimation based on the volume (in cubic yards) quantity provided by Acme Hospital.

Solid Waste40%

Recycled 56%

Recycled Hazardous0%

Regulated Medical Waste4%

Table 1

1. Establish baseline measurements for all waste streams:a. Preparation:

i. Using the Greenhealth Tracker® establish baseline measurements for waste.

1. Identify a year (calendar or fiscal) that the hospital will work to reduce/compare their waste too.

2. Trend the impact a departmental waste reduction and/or recycling project has on the hospitals’ waste data.

3. Report this monthly to the project team and to the hospital’s administration.

ii. Identify possible recycling and waste reduction goals from the baseline year

1. Example: reduce solid waste by 2% in the next quarter.

b. Implementation:i. Facilitate inter-departmental waste reduction and recycling project teams.

1. Have the EVS identify where most of the waste is generated.2. Collaborate with key departments (i.e. OR/Patient Floor) to

identify specific waste streams to target for recycling. ii. Weigh the waste from a patient room after a patient is discharge,

following a surgical case and after a new delivery to the pharmacy as examples of how to quantify the waste from departments.

1. Retain these materials and use as examples when meeting with the recycling vendor or recycling center personnel.

2. Integrate single stream recycling throughout the hospital:

The hospital has a single stream recycling that is used sporadically. Recycling costs $0.02 cents per pound, for its solid waste the cost is $0.11 cents per pound. The opportunities for cost reduction seem feasible with a well articulated recycling program.

a. Preparation:i. Meet with the recycling vendor and/or recycling center personnel and

bring high volume materials commonly disposed of as solid waste to the meeting. Make sure to have the minimum materials for this meeting:

1. IV Bag overwrap2. The most common single use device packaging trays from the OR.3. Examples of packaging, both plastic and cardboard, from the

laboratory and pharmacy.4. Blue wrap. 5. And any others that the team discovers through their research.

ii. Outline a department implementation timeline for single stream recycling.b. Implementation:

i. Develop department specific recycling signage using photos and/or actual materials of the departments’ materials that can be recycled.

ii. Highly consider this type of signage in training and as EVS works with departments to kick off their recycling and waste reduction programs.

3. Establish Baseline Measurements for all Waste Streams:a. Administrative

i. Establish baseline measurements for waste and identify a year (calendar or fiscal) that the hospital will work to reduce and compare their waste to.

ii. Work collaboratively with the LMC to identify possible recycling and waste reduction goals.

iii. Help facilitate inter-departmental waste reduction and recycling efforts.1. EVS will certainly play a role in the success of the hospital’s

recycling efforts. Ultimately, much of the success will be derived from the front line staff & clinicians that know and use recycling containers appropriately.

2. Support the LMCs efforts on interdepartmental communication

b. LMCi. Collaborate with key departments (i.e. OR/Patient Floor) to identify

specific waste streams to target for recycling.

ii. Work with EVS to understand where most of the waste is generated.

iii. Weigh and identify the waste that leaves the patient room and identify the quantities that could be recycled.

iv. Utilize the GreenHealth Tracker™ to trend the impact a department has on the hospitals overall recycling and waste reduction efforts.

4. Regulated Medical Wastea. Administrative:

i. Advocate that the LMC share with hospital administration the percentage of red bag waste it generates relative to other hospitals. Use this data to leverage the ability to build a broader and more systematic approach to the hospital’s sustainability initiatives.

ii. Identify causes and sources of supplies left in patient rooms. Collaborate with nursing and materials management to identify opportunities for possible supply reduction in rooms to reduce waste while still providing exceptional patient care.

b. LMCi. Empower EVS through retraining on what is and what is not RMW to help

identify areas in the hospital where non-RMW materials are consistently appearing. Use this information to collaborate with nursing, the safety officer and infection control to determine RMW reduction strategies.

ii. Train workers to quantify unused supplies left in patient rooms upon discharge, which appear to be increasing waste.

5. Solid Waste:a. Administrative

i. Provide an opportunity for the LMC to report all of its waste data, including solid waste, monthly to the hospitals value analysis committee or similar team.

b. LMC

i. Utilize the GreenHealth Tracker™ to trend frequency of solid waste removal and tonnage per waste compactor pick-up. Determine if SMC could reduce the number of solid waste compactor pick-ups along with the cost implications.

6. Recycling Signage:a. Administrative

i. The single stream recycling program will provide an opportunity to integrate standardized signage & containers for the hospital. The administration should provide adequate resources for signage, internal marketing and its support both in their words and their actions for the program.

ii. Consider participating in a recycle competition with other departments as a way to kick off the hospitals upcoming transition to the single stream recycling program.

b. LMCi. Meet with recycling vendor and bring a sample of the medical packaging

and supplies that the hospital would like to recycle. 1. Start with one department’s waste. 2. Identify high volume items: blue wrap, plastic peal packs and IV

bag over wrap.3. Determine what is and what is not recyclable with the vendor.

ii. Develop departmental specific signage that clearly identifies, with photos of actual medical packaging and/or supplies, what is and what is not recyclable. Example: Photos of IV bag over wrap that could be recycled.

iii. Train EVS on materials that will be included in the new program. Furthermore, take this opportunity to educate/train them on the other recycling programs that they may not be directly involved with, but might be asked about from other hospital staff:

1. Batteries2. Hazardous Waste3. Pharmaceutical Waste4. Light Bulb recycling

iv. Consider standardizing all waste containers to assist staff and new employees to increase compliance and participation.

7. Expand Compostinga. Administrative

i. Provide resources for composting containers.

b. LMTi. Consider expanding the food waste composting program to staff lounges

and during catered events i.e. lunch meetings.

Water ConservationWith the amount of water used by the EVS in terms of floor cleaning and accurate chemical ratios this is an area that EVS can directly impact. Consider using the study conducted by the Massachusetts Water Resources Authority (Table 2)3, to directly measure and/or estimate the hospitals water usage.

To date water consumption data for hospitals has not been readily available. Table 3 is PGHs best comparison estimate using member hospitals that have reported this data. Considering the low water usage in comparison to other hospitals, it’s highly recommended the hospital ensure all water meters are accounted for in this data set. If the consumption is accurate, this would be a tremendous community reporting category the hospital could feature in its marketing literature.

Sanitary37%

HVAC20%

Medical Processes15%

Food Services10%

Unaccounted10%

Laundry8%

Average Water Use by Category

Table 23 Facilities studied in the chart include hospitals with 138 to 550 bed capacities, in-patient admissions of 5,100 to 11,600 per year and annual water usage ranging from 15 to 67.2 million gallons. The 7 hospitals studied include: 1 large Boston, 1 large long-term care, 4 small communities and 1 regional urban.

0

50

100

150

200

250

195

82

40

169

Gallons/SF

Gallons/SF

Table 34

Hospital’s water consumption was based on the following data:

23,218,260 gallons585,530 sf

=40 gallonssf

1. Establish baseline measurements for water consumptiona. Administrative

Establish baseline metrics for water consumption and identify a year (calendar or fiscal) that the hospital will work to reduce/compare their water data to. Work collaboratively with the facilities department to identify possible strategies and water reduction goals.

b. LMCi. Collaborate with the facilities department to identify where water is

wasted. Examples may include: leaky faucets, toilets and urinal valves that remain on.

4 Data is from hospitals located in the western, mid-western and eastern United States. The sample size is less than ten and is not considered statistically significant. The table is meant to provide hospitals with a frame of reference.

ii. Develop a succinct communication plan between the EVS and facilities department. Example Information:

1. What is leaking?2. Where is it located?

iii. Consider trending the water savings yielded from this cross department collaboration.

iv. Identify water using devices used by the ESW and determine if other products or technologies are available to reduce water consumption.

Energy OptimizationThe EVS has an indirect impact on energy optimization of a hospital. Certainly, turning off lights in patient rooms and offices will provide a small savings to the hospital and it should be a standard practice. However, the greater opportunity for the EVS is through the identification of energy misuse. Examples: Computer & monitors in offices that remain on or exhaust fans in restrooms that do not shut off. Because the EVS works in every space in the hospital and at all times during the day, there is a huge opportunity to harness their knowledge and observations. The success in turning their observations into energy optimization strategies will be predicated upon a strong relationship with the facilities department and/or energy manager.

Table 4 uses data from the Department of Energy’s Hospital Energy Alliance work group.5

220

230

240

250

250

240

Energy Usage Comparison

Annual kBtu/SF

Table 4

5 http://www1.eere.energy.gov/buildings/alliances/hospital_energy_alliance.html

240 Average kBTU/SF

The hospital’s energy consumption was based on the following data:

Electricity: 14,102,934 kWh× 3.413=48,133,314Btu

Natural Gas: 839,022 ccf ×103=86,419,266 Btu

(48,133,314+86,419,266 ) ÷ 585,530=230 kBtu /SF

1. Establish baseline measurements for energy consumptiona. Administrative

i. Recruit members from the facilities department to spearhead energy reduction efforts. Establish an energy baseline and determine how the information is reported along with the frequency. Set energy reduction goals for each quarter.

b. L/M Committeei. Identify areas in the hospital that consistently leave on lights, televisions

and computer monitors.

ii. Collaborate with facilities to measure energy savings derived from EVS procedures that promote energy conservation. Examples:

1. Measure energy savings of patient rooms that turn lights off compared with rooms that leave lights on and extrapolate the data to determine annual savings.

2. Measure energy savings of turning lights off in soiled linen rooms and janitorial closets.

iii. Consider a pilot program in conjunction with nursing to demonstrate energy and cost savings on one patient floor.

Less Toxic Cleaning ChemicalsThe EVS has a direct impact on the cleanliness and air quality of the hospital. Every person is impacted by the chemicals used in the hospital. It is imperative that appropriate chemicals are selected with the least amount of deleterious by products. PGH strongly encourages hospitals to utilize either the Environmental Protection Agency’s Design for the Environment®6 or GreenSeal’s®7 environmental criteria for cleaning agents when available.

1. Hospital Chemicalsa. Administrative

6 http://www.epa.gov/dfe/7 http://www.greenseal.org/

i. Include a chemical sub-committee as a part of the hospital’s green team. Recruit members from the hospital to spearhead chemical reduction and ensure appropriate use policies and procedures are in place. Conduct a chemical inventory and determine how the information is reported along with the frequency. Identify chemicals that maybe safer and less obtrusive to staff and patients.

ii. Identify materials management personnel to determine what chemicals might be available through the hospitals group purchasing organization.

b. LMTi. Conduct a chemical inventory of all chemicals used by the EVS.

ii. Identify existing chemicals that meet the above third party certifications. Determine if alternatives are available for the most obtrusive chemicals used by the EVS.

Integrating New Equipment & TechnologyNew equipment and technology are and will continue to be a part of the EVS tools of the trade. What tools are purchased and how they are used will directly impact the hospitals strategy to reduce waste, save energy and conserve water. In terms of the EVS worker and the environmental services department, third party certifications should be considered during any evaluation of new equipment & technology. Specifically, consider the following:

1. Equipmenta. Preparation

i. Identify all EVS equipment. 1. For energy consuming equipment check with EnergyStar® to

determine if that product line has an EnergyStar® rating.2. For water consuming equipment check with WaterSense® to

determine if that product line has a WaterSense® rating.3. For other criteria such as ergonomics and sound attenuation you

may want to refer to product/trade association guidelines to help develop request for proposal templates.

a. Example: The Carpet and Rug Institute’s Green label vacuum program.8

8 http://www.carpet-rug.org

When integrating new equipment and technology, consider the health and safety of workers in the department to ensure they receive proper training. In addition, engage the union in discussion to ensure there is agreement on changes in work load and assignments.

Reduction of HAIs in EVS WorkIn order to implement successful programs that reduce waste, save energy and conserve water the EVS will need to work closely with infection control and nursing to determine impacts to HAIs. All projects should be run past the infection control officer to determine any benefits or deficiencies.

CommunicationThe success and failure of many sustainability programs is dependent upon the communication plan. We recommend that communication within the department and throughout the hospital be an important part of the LMT discussions on the development of a new job title/upgrade as well as a part of the training for all EVSs. The LMT should work closely with the trainers to determine appropriate talking points for the EVS to use when asked about a ‘green’ program. And certainly, any internal marketing should reflect those talking points as well.

S.M.A.R.T Goal Example:“Recycling, Waste and Cost Reduction Initiative”

6. Specific:a. Divert 50% of the solid waste that leaves the surgical processing department

(SPD) through recycling.

7. Measurable: a. Environmental service workers will visually inspect the contents of the solid and

recyclable waste for two weeks following the project kick-off. Materials will be weighed and recorded at minimum 4 different days and times. Example Day 1 – First shift; Day 4 – 2 nd shift. Calculate the waste diverted from landfills and incinerators if this project were to continue for the next year and determine the cost impacts.

b. Chart this information to the SPD and ESW staff.

8. Attainable: a. Collaborate with the SPD staff to determine the goal for the department.

9. Repeatable: a. The broader implications of this project will determine the success of future

projects. Include an evaluation component that enables the project team to learn and adjust accordingly.

10. Time-bound: a. Identify the reporting frequency and determine a deadline for the achievement of

the stated goal.

Name:__________________

Sustainability in HealthcareHomework for Week 4Due: Wednesday, June 1

Thinking about your Possible “Bucket” Green Project

1. What is the possible green project you are interested in researching?

2. Who is your group?

3. Given the data collection and analysis performed this week around possible “green” projects, what other information do you think you need before selecting a project?

4. What other people might you interview?

5. What other pieces of information or data might you need?

JOURNAL: What might be the strengths, weaknesses, opportunities, or threats related to your project idea?

Handout 4:10