July 2, 2019

Taking a Stand

By Pat Curry

Several Washington state hospital systems have been recognized for their efforts to reduce their effect on climate change. WSMA Reports talked to the sustainability managers at three health care organizations about the steps they have taken and asked them to suggest small steps individual physicians can take.

Virginia Mason Medical Center

Since 2011, Virginia Mason's energy conservation efforts have saved more than 4.5 million kilowatt hours per year, and water conservation efforts have saved around 7 million gallons of water annually. The hospital's food and nutrition department purchases nearly 40 percent locally or sustainably, and the hospital's recycling and composting efforts achieved a 48 percent rate.

"Our footprint is giant as an industry," says John Leigh, director of sustainability for Virginia Mason. "We are in the business of human well-being. Knowing climate change will have negative effects on the health of human beings, it would be unconscionable to not doing something about it as soon as possible."

An ad hoc green team at Virginia Mason focuses on recycling, looking at ways to improve signage and locate recycling bins. Every effort is important because hospitals generate so much waste through single-use or disposable items for infection control.

"Patient safety will always trump waste generation," he says. "It always will—and it should."

The health care industry is responsible for 10 percent of the nation's total emissions in greenhouse gases, including the use of anesthetic gases. One of the biggest impacts of the efforts at Virginia Mason is a radical reduction in the use of desflurane. The available options are more sustainable and less expensive.

"One doctor got behind this work here with my predecessor," Leigh says. "It just takes one champion to start asking questions in their department and pushing those who are reluctant to give it a try and see it can be done. ... That was one thing we could do without a lot of difficulty or fanfare."

Leigh says his "grand plan" is for Virginia Mason to achieve carbon neutrality, which means taking action to remove as much carbon dioxide from the atmosphere as you put into it. That means spending money on upgrading equipment. Justifying the expense can be tough at a health care facility, he says.

"This is an industry with not a lot of surplus capital to perform important facility upgrades like this," he says. "We tend to lose out on internal competition for capital improvements. It's hard to compete against an MRI or another important piece of equipment."

A quick win for individual physicians is to "green up" the supplies; use less in the first place wherever possible, and then challenge manufacturers and suppliers to find ways to move toward environmentally preferable products and packaging.

They can also look at whether any items in their clinics expire before they are used.

"Focusing on reducing waste can have a lot of environmental benefit," he says. "Reducing 5 percent is pretty doable from my observation."

MultiCare Health Systems

MultiCare has been focused on sustainability for at least a decade, and is the parent company to Washington state's first green hospital, Good Samaritan Hospital Dally Tower in Puyallup. The system recently hired Tony Garcia, who ran the sustainability program at the Disneyland Resort for 10 years.

His early efforts are focusing on establishing task forces looking at technology, waste management, and water conservation. A sustainability committee of senior leaders steers the direction of the program.

The big wins in sustainability occur when senior executives see saving energy, water, and solid waste as a revenue stream, Garcia says.

"If you save costs on utilities, it's the same as generating revenue," he explained. "Cost cutting is nothing new in health care; this is a painless way to cut costs because you're not affecting your service level, you're reducing what you spend on a utility."

The easiest way to reduce energy and water consumption, he says, is through technology and automation.

"Sometimes the hardest part is getting authorization to invest in technologies, but there is a lot of proven technology out there we can leverage," he says.

For example, sensors help reduce energy use because they "don't require someone to turn something on or off, so there's no training required," Garcia says. Software ensures air handlers work efficiently, filters are clean, and the system is sequenced accurately and calibrated for the use of each space.

Small changes can add up as well. LED lights use less energy, require far less maintenance, and provide better light quality than incandescent or fluorescent bulbs. Ultra-low-flow toilets reduce the water usage rate per fixture; if automatic flush vales are used, careful calibration could reduce the amount of false flushes.

One area that can make a big difference is space management, says Ron Fues, project director with construction engineering firm McKinstry, which works with MultiCare.

"Your space changes all the time; an office could have once been a storage room or a waiting room," he says. "What often gets overlooked is the HVAC system that supports that space. ... In some cases, spaces need to be adjusted for more or less air flow."

If physicians lease a building, they should "be the squeaky wheel," Fues says. "If you see that things are automatically on at weird hours, put in a work order. That's an easy fix. If you own your own building, the EPA has a utility bill benchmarking tool (portfoliomanager.energystar.gov). You should be benchmarking your building to see how your building compares on a per square foot basis versus other similar buildings."

Seattle Children's Hospital

A 2019 winner of the Practice Greenhealth Environmental Excellence Award, Seattle Children's Hospital set several environmental goals in 2017 and achieved them within a year. Water use for irrigation was reduced by about a million gallons.

The hospital also increased a daily pay incentive to $4.50 to employees to carpool, bike, walk, or take public transit. Staff members who carpool or vanpool can park on campus. A shuttle is provided from the Link light rail station to the hospital.

"Asthma is always in our top 5 in admissions," says Colleen Groll, manager of Seattle Children's sustainability program. "When we get more staff out of their cars, we're reducing pollution because in Seattle, transportation is the Number 1 emission."

Pulmonologist Jonathan Cogen, MD, noted that many of his patients drive long distances to see him. He could help with that.

"[One] morning, four of my five patients came over from Yakima for a half-hour visit," he says. "If I went out there, it would have cut those drives."

Reducing waste reduces carbon emissions, so dermatologist Markus Boos, MD, changed the way he has his staff set up his trays for skin biopsies. "The nurses are great and they would set up these beautiful trays," he says. "I would use half of it and the rest was thrown away. I had them put on the bare minimum and then hand me whatever else is needed."

Physicians can help the environment and save money for their practices by properly disposing of medical waste.

"Some people think a piece of gauze with a little blood on it needs to go in the red waste bag," he says. "Those bags are actually for things that are soaked with waste that can be expressed. Those items are a lot more involved to dispose of."

Whether physicians have their own prac- tices or work in a group or a hospital system, they can make a difference by speaking up.

"Sometimes, as physicians, we are afraid of talking about controversial issues," he says. "There's nothing controversial about this; the world is getting warmer. We should care about the children in front of us. That is a way to talk about it without getting on our high horse or use terms that are off putting. When I hear about climate change, it can feel overwhelming. What can I do as one person? As a society, everybody's voice matters."

Pat Curry is WSMA Reports' senior editor.

This article was featured in the July/August 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may purchase a subscription.