Minimizing Environmental Footprint while Delivering Affordable Healthcare

Most people agree that a healthy environment is a necessary foundation for human health. And yet, our society faces an interesting paradox in health care: as hospitals deliver care to individuals, their environmental footprints – pollution, energy use, waste production, unsustainable food services – can be harmful to our health.

Greening health care, the benefits

The health care sector can have a significant impact in improving the environment in a number of crucial areas, but a key question remains: can environmental stewardship strategies in health care coexist with today’s constant pressure to cut costs? In short, the answer is yes – and it can help reduce health care costs for everyone.

There is a preponderance of evidence that a greener health care enterprise is not only affordable but often results in an improved cost structure. With little or no investment, significant operating savings can be realized. A recent study published by the Commonwealth Fund found that if the health care industry conserved energy, reduced waste and more efficiently purchased operating supplies, it could save more than $15 billion over 10 years.

While these numbers are impressive, the importance of sustainability in health care cannot be boiled down to just the bottom line. We have to remember that greening the health care industry does not just save money, it also saves lives and makes care more affordable for everyone.

Take for example the Fable Hospital, a 300-bed, 600,000 square-foot regional medical center built at a cost of $350 million in 2011. Fable was designed and constructed to meet the US Green Building Council’s Leadership in Energy and Environmental Design (LEED) gold-certification level for green building design, construction, operations and maintenance. To do so, it included the best innovations for which there was strong evidence in the scientific literature that they would improve patient and employee safety and health care quality while also reducing operating costs, even if initial construction costs are higher.

Fable Hospital’s features include:

• Larger single-patient, acuity-adaptable rooms to reduce incidents of health care-associated infections and patient transfers
• Use of nontoxic building materials to reduce the effects of indoor air pollution
• High-efficiency particulate air (HEPA) filtration systems
• Larger windows to increase the beneficial effects of natural light and nature views
• Single-use air circulation systems to minimize the spread of infections
• Heat recovery systems, high-efficiency mechanical equipment, and external building glazing to reduce fossil fuel consumption
• Healing gardens accessible by patients and staff
• Low-flow water fixtures and rainwater recapture systems to reduce water consumption; among dozens of other features.

The Fable Hospital is, in fact, a fable, illustrated in an essay by Blair Sadler and other health care quality experts with assistance from the Center for Health Design. But the economic value of the improved clinical quality and environmental impacts of the added features, based on evidence from actual hospitals, is real.

The economic and environmental value totaled more than $10 million a year, which resulted in a payback period of just three years. Among the significant cost benefits were savings from a 20 percent reduction in hospital-associated infections, a 10 percent reduction in patient length of stay, a 50 percent reduction nursing turnover due to increased safety and job satisfaction, an 18 percent reduction in energy demand, and a 30 percent reduction in water demand, totaling almost 10 million gallons.

As this example shows, when weighing issues of environmental impact in health care, we have to look at the triple bottom line of social impact, environmental impact and economic performance. While the three are frequently intertwined, in our industry, we are frequently guilty of focusing so intensely on cutting costs that we overlook these two other critical areas and the impact they can have on those exact areas we are focusing on.

Taking action – how we can make a difference

What will it take to turn the hospital leaders into environmental champions motivated by environmental and human health benefits in addition to bottom-line calculations?

• New level of commitment by senior leaders: Move the work from the mostly isolated, grassroots-inspired efforts to a commitment to be models of health, including environmental health, in their communities. One excellent first step is to sign up with the Healthier Hospitals Initiative (www.healthierhospitals.org) and accept their leadership challenge.
• Strategy: Put effort into assessing the organization’s environmental footprint and the costs of that to the community in terms of health effects. Then explore opportunities to reduce or eliminate those impacts and document this in a strategy.
• Engage with staff and the community: Hospitals are mission-driven institutions that improve community health. Engaging with staff and local residents about environmental health is an extension of that mission. Their engagement informs priorities and makes success much more likely.

Changing an industry isn’t easy, but the greening health care revolution is already underway and the patients will benefit as much as we will from a business side. We’re making great progress. I hope you’ll join us!

As environmental stewardship officer, Kathy Gerwig is responsible for organizing and managing a nationwide environmental initiative for the organization. Under her leadership, Kaiser Permanente has become widely recognized as an environmental leader in the health care sector. Kathy has testified twice to Congress on the need for federal chemical policy reform, and she has appeared at numerous hearings on environmental issues. Kathy is also Kaiser Permanente’s national leader for Employee Safety, Health and Wellness. She oversees the national departments of workplace safety, workforce wellness, integrated disability management, employee assistance programs and environmental, health and safety. Kathy is author of the recently published Greening Health Care: How Hospitals Can Health the Planet. To learn more, visit share.kp.org/greeninghc