Sustainable and Safe Healthcare: Return on Investment
Gina Pugliese, Premier Safety Institute ®Susan Vickers, RSM, Catholic Healthcare West
Christina Vernon Ayers, Cleveland Clinic Foundation
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Green, Sustainable and Safer EnvironmentsBecoming a Key Component Of The Corporate Strategy
Recent global survey of CEOs on the topic of sustainability:• 75% report sustainability an important part of corporate
strategy
• Why?– To be leaders– Social responsibility – Public health – To reduce cost
In partnership with our members to improve the health and safety of patients, workers, environment, and communities.
GreenHealthy® – Premier’s award-winning environmental leadership platform
GreenHealthyTM includes
EPPEnvironmentally
Preferable Purchasing
Program
Yes to GreenInternal
corporate-wide initiative
SPHERECollaborative climate and
energy initiative to reduce
healthcare’s carbon footprint
Tools, Resources on Patient, Worker, Environmental Safety, and Green-Sustainability
500,000 visitors a year
Premier Safety Institute Website
www.premierinc.com/safety
Executive Scorecard•Rate your program
GreenLink newsletter•18,000 subscribers
Tools - Resources
Audioconference Series-Experts discuss the business
case for energy management
- Free audio files, slides and resources at
www.premierinc.com/forum
Program examples:•Geisinger saves $3 million annually with doubling campus size•Ingalls saves $800,000 in reverse auction – 5% renewable•Catholic Healthcare West renewable energy with methane gas waste•St Francis cuts gas bill by 50%
Premier’s Employee “Yes to Green” Pledge
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Sustainable and Safe Healthcare: ROI
Susan Vickers, RSMCatholic Healthcare West
Goal
• Introduce CHW’s sustainability approach
• Highlight ROI in supply chain & energy reduction
• Share resources and learnings
About CHW
• Non-profit founded in 1986• Both religious and community sponsored facilities• California, Arizona and Nevada• $9.0b net operating revenue FY 2009• $1.2b community benefit and charity care FY 2009• 8,800 acute care beds• 9.800 physicians• 54,000 employees
What is sustainability in healthcare?
• Patient care sustainability:How do we ensure the highest quality care?
• Environmental sustainability: How do we do our part to protect the environment?
• Financial sustainability:How do we redirect resources from unnecessary expenses to impactful patient care focused initiatives?
CHW’s Environmental Commitment
0
50,000
100,000
150,000
200,000
250,000
Ther
ms
July
August
September
October
November
December
January
February
March Ap
ril May
June
FY06 FY07 FY08 FY09
Operational Energy Efficiency Program
Energy and environmental benefits are as follows:•Electric reduction – 1.2M kWh•Natural gas reduction – 360K therms•CO2 reduction – 2,340 Metric tons•Equivalency – 340 automobiles driven 20K miles per year @ 25 MPG•Program Costs - $180,000•Maintenance Costs - $65,000•Program Savings - $265,000 per year
Capital Energy Conservation Program
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Ther
ms
July
August
September
October
November
December
January
February
March Ap
ril May
June
FY06 FY07 FY08 FY09
Energy and environmental benefits are as follows:•Electric reduction – 1.8M kWh•Natural gas reduction – 50K therms•CO2 reduction – 920 Metric tons•Equivalency – 135 automobiles driven 20K miles per year @ 25 MPG•Capital Costs - $773,000•Project Savings - $210,000 per year
Renewable Energy Project
Energy and environmental benefits are as follows:•Electric reduction – 7.2M kWh•CO2 reduction – 2,630 Metric tons•Equivalency – 385 automobiles @ 15K per year •Capital Costs - $2.9M Third Party•Project Savings - $280,000 per year
Marian Medical CenterEnergy Consumption (fossil fuel only)
0
10,000
20,000
30,000
40,000
50,000
60,000
July August September October November December January February March April May June
Ther
ms
FY06 FY07 FY08 FY09
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ROI - Celebrating Progress
• Employee engagement and pride• Stakeholder engagement and collaboration• Corporate responsibility and leadership• Reputation enhancement• Mission extension• www.chwhealth.org/Who_We_Are/Community_Health
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Resources
• Practice Greenhealth (www.practicegreenhealth.org)• Health Care Without Harm (www.noharm.org)• Ceres (www.ceres.org)• Global Reporting Initiative (www.globalreporting.org)
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Steps to Sustainability
• Secure commitment• Link to mission• Engage key stakeholders• Set goals• Track and Report progress• Celebrate successes
Sustainable Savings:Greening for Greenbacks
Christina E. Vernon, AIA, LEED APSr. Director, Sustainability and Environmental Strategy
Cleveland Clinic Health System
Sustainable Savings
• Cleveland Clinic’s Journey
• Organizing for change
• Opportunities for action
• Results!
≈9MAnnual Savings$
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A balanced, triple bottom line approach
Selecting meaningful “e3”projects that promote:
• Ecology: systemic respect for our ecosystem, of which humans are a part
• Economy: Foster and support economic growth and success
• Equity: Support communities and employees
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Mission Alignment
The Office for a Healthy EnvironmentTo encourage healthy buildings, healthy operations, and better buying while finding champions and innovators in our institution and our community to create a healthcare system that is ecologically, socially, and economically sustainable and not a source of harm to human health and the environment.
Supporting healthy environments for healthy communities
Organizing for successful change:
System Resource TeamsSystem Resource Teams represent specific areas of
specialization that are centralized within the system. This allows us to make changes with a broad impact and
depth. Supply Chain is not only supporting the changes we aspire to within each hospital, but is increasingly leveraging our volume for market transformation.
Hospital or Medical Center Green TeamsAre composed of a cross‐functional group of team members to help troubleshoot, create and implement projects at their specific campus. Chairs of the teams report to the monthly System Green Team meetings and track/share data with the system. Typical Team Members Include:
System Green TeamSystem Green Team meets monthly to share best practices, develop new project ideas, track and
share results and implement system‐wide changes
Office for a Healthy EnvironmentProject concept and execution, data tracking, employee/community education, sustainability reporting, website, newsletter, and change management. Oversees network of Green Teams
Executive Sustainability Advisory TeamSenior Executive Team guides OHE in priority setting and project development. Structure includes structured meetings as a group as well as targeted or ad‐hoc meetings to focus on collaborative projects. Key advisors include Executive Administration, Chief Financial Officer,
Chief Marketing Officer, Chief Community and Diversity Officer, Executive Director of Operations and Support Services, Chief Patient Experience Officer, Chief Wellness Officer, Medical
Operations.
Main Campus Green Team
Supply Chain Green Team
Pharmacy Green Team
Regional Hospital Green Teams
RMP Green Teams
External Advisors
OHE participates in dialogue with City of
Cleveland, Foundations, Solid Waste district, Sewer District, Carbon
Fund, Education Community,
GreenCityBlueLake, E4S, Green Building
Coalition, and others
National OrgsOHE learns from and
serves as expert faculty and advisory council member for national
Green Healthcare .Orgs
Employees All are invited to engage in active dialogue with
OHE via idea submissions, event
attendance, electronic newsletters and
websites.
•Nursing•Materials Handling•EVS
•Physicians•Compliance•Infection Control
•Facilities Management•Employee Communications•Enthusiastic Employees
Supply/GPOsSuppliers and GPOsinfluence product
choices and availability, drive change, and create markets for materials
Metrics Make it Happen:
Waste ReductionEnergy ConservationLocal FoodTransportationToxicity ReductionBetter BuyingHealthy BuildingsClimate Change Action
Landfill Diversion Rate and Volume ReductionEnergy Utilization Index% Food Procured Locally (200 miles)Fleet MPG and commuter incentivesPVC/DEHP product migration% Recycled content, SavingsLEED System ScoringGreenhouse Gas Inventory
What gets measured, gets done… and gets funded
Developing Measurement Tools
Cleveland Clinic co-developed and tested tool
Allows for system-wide reporting and visibility
Can produce aggregate landfill diversion rate and savings information
Is designed for large or small sitesAllows multiple users to share
responsibilityDesigned for our sector
Visibility of spend, incentive for action$
Focused on Results:
Approx $70K less than baseline
Approx $160K less than baseline
2007 Baseline
$$
Increasing Recycling, Reducing Cost
Main Campus Total Waste Cost(Unadjusted for growth)
$‐
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
1/07‐8/07 1/08‐8/08 1/09‐8/09
Total D
ispo
sal C
ost (Exclusive
of C
&D)
‐4%‐10%
‐14%2007
2008
2009
through Q3 each year
Source Reduction: Less waste per Patient Day
Pounds of Waste Generated Per Occupied Bed Per Day(includes all waste, including non‐clinical functions)
y = ‐276.93Ln(x) + 2043
0
10
20
30
40
50
60
70
Jan‐08
Feb‐08
Mar‐08
Apr‐08
May‐08
Jun‐08
Jul‐0
8
Aug‐08
Sep‐08
Oct‐08
Nov
‐08
Dec
‐08
Jan‐09
Feb‐09
Mar‐09
Apr‐09
May‐09
Jun‐09
Jul‐0
9
Aug‐09
Source reduction means reduced delivery cost
$
Reuse and Donation
• Donations to MedWish International are distributed through humanitarian missions worldwide instead of landfill. In 2007, CCHS donated 80,000 lbs of material to MedWish. In 2008 and 2009 we donated over 200,000lbs each year
• In 2008 we donated 13,055 lbs of much-needed furniture to Cleveland families. in 2009, we donated over 120,000 lbs of furniture to charitable recipients
• In 2009, facilities donated more than 5 tons of scrap material, tools and other materials to Habitat for Humanity
Contributes to Community Benefit$
Energy Usage Index
200
250
300
350
Year
kBTU
/SF
CC Goal
2007 2008 2009 2010
$500K Investment each year:4.3M Savings in 2 years$
$4.3M Peak‐to‐Peak Avoidance
Represents an 11% Reduction in EUI
$1.59/Second
Community Value
Community Farmer’s Markets• Main Campus• Huron Hospital• Beachwood ASC• Strongsville FHC• Independence FHC• Hillcrest Hospital (2010)
At Main Campus, $35K/year reaped no-cost brand exposure. Air time valued at over $100K
$
Better Transportation
Our fleetVehicle selectionTechnology adoption and Alt FuelsManagement and data collection
improvementsReduced Carbon Commuter
IncentivesHybrid purchase incentiveDiscounted parking for high-
efficiency vehiclesUltra-low Carbon Commuter
IncentivesBike commuter recognitionTransit pass access improvementsHousing financial incentives for
immediate
Fuel savings for our own fleet
Savings for our employees
$$
Toxicity Reduction
Latex-safe work and healing environment
Green cleaning system-widerBGH-free local dairyOrganic lawn care pilotPVC removed from most standard
building productsPVC/DEHP reduction goals on the
horizonMercury reduction program across
system won awards in 2008 and 2009
Microfiber mop system reduces water and chemical use
Huron’s seen reduced worker’s comp
Save on cleaning products, waste & water
$$
Opportunities everywhere:
Reusable Sharps
Saves approx $250K per year$
Paper Destruction Single Use Device Reprocessing
Save on pickup fees by understanding paper’s value on the market
$ Save about $1M/year$
Opportunities everywhere:
Virtual PharmSamples
Reduce waste, save dollars$
Reusable Plastic Pallets
Save on shipping fees and some waste fees
$Fluid
ManagementSave on disposal, vacuum canisters and exposure risk
$
The Bottom Lines
• This work has:– Reduced environmental impact of
our operations – Conserved natural resources– Supported local businesses– Enhanced our community– Improved employee engagement– Created a safer place to work and
heal– Saved money for the organization– Reduced costs for our employees
Ecology
Equity
Economy
ee33
Thank You!
Christina E. Vernon, AIA, LEED APSr. Director, Sustainability and Environmental StrategyOffice for a Healthy [email protected]
www.clevelandclinic.org
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