Final ACHE 08 2008 Frontiers 25 1 INT

FRONTIERS
Frontiers 25.1:20.4 8/13/08 1:13 PM Page i
O F H E A LT 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-depth
features 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 Editorial
Margaret F. Schulte, DB A , F A C H E
3 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.
Da vid P. Gehant, FACHE
11 Demonstrating Reverence for the Earth

As a community hospital and a major employer, St. Mary’s 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.
James G. Coller, FACHE, a n d A n n e t t e L . Gr u n se t h
C O N T E N T S
25 Commentaries
Why Should Healthcare Bother?
The healthcare sector is realizing that green construction and operation makes business sense.
Robin Guenther
33 The Challenge of Sustainable Hospital Building

Few 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. Kirk Hamilton
37 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?
Anna Gilmore Hall
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 of Frontiers 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.
VOLUME 25 • NUMBER 1 • FALL 2008

Frontiers 25.1:20.4 8/13/08 1:13 PM Page ii
Frontiers of Health Services Management

Maureen C. Glass, FACHE, CAE Margaret F. Schulte, DBA, Eduard B. Avis Scott R. Miller
Publisher, American College FACHE, Editor Managing Editor Layout Editor
of Healthcare Executives Health Administration Press Health Administration Press Health Administration Press
Chicago, IL Chicago, IL Chicago, IL Chicago, IL
Frontiers of Health Services Management (ISSN 0748-8157) is pub- Scott E. Armstrong, FACHE
lished quarterly by the Foundation of the American College of President & CEO, Group Health Cooperative,
Healthcare Executives, One North Franklin Street, Chicago, Illinois Seattle, WA
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Administrative Director
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Maj. Randall Webb, FACHE
of the Foundation of the American College of Healthcare Executives. Chief, Medical Facilities Modernization,
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Lauren E. Yedvab
Volume 8, Number 1. Sr. Vice President, New York Methodist Hospital,
Brooklyn, NY
Frontiers 25.1:20.4 8/13/08 1:13 PM Page 1
Editorial
I w a s d r i v i n g o n a country road 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 about—the fading of our amazing, life-sustaining planet, and the
importance 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-
E D I T O R I A L
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. Mary’s 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 you’ll read
about hospitals that have made it work financially, and you’ll 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. Mary’s
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
Margaret F. Schulte, DBA, FACHE, is an associate professor in the Graduate Program in

Health Administration at Grand Valley State University in Grand Rapids, Michigan.
Margaret F. Schulte • 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 now—a healing
urgency is upon us.
Back to thinking of that rainbow—at 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 of Frontiers would like to hear from you! If you have comments
or thoughts about this or any issue of Frontiers, please share them by
e-mailing Margaret Schulte at mfschulte@aol.com.
2 • frontier s of hea lt h s e r v i c e s m a n a ge m e n t 2 5 : 1
Hospitals and the Environment
B Y D AVID P. G EHANT, FACHE

Su m m a r y • Think globally and act locally! This should not be viewed as a
worn-out cliché 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 is
this 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.
F E A T U R E
David P. Gehant, FACHE, is president and CEO of Boulder Community Hospital

in Boulder, Colorado. He holds a doctorate in healthcare administration from
the Medical University of South Carolina.
David P. Gehant • 3
Background Questions were raised. What is the

The city of Boulder is best known for state of our environment? What about
being the hometown of the University of global warming, pollution, and conserva-
Colorado. It lies in Boulder Valley, nestled tion? Discussions were held in the hall-
against the Rocky Mountains. Its citizens ways, the cafeteria, offices, and conference
are well educated and, in general, outdoor rooms. As a result, management decided
enthusiasts. It’s comprised of approxi- to jump in with both feet and make it an
mately 100,000 people, and the list of organizational priority to act in an envi-
major employers includes IBM, Ball ronmentally friendly manner whenever
Aerospace, Celestial Seasonings, and the possible. It was the right thing to do, and
university. it was an innovative approach that
Boulder Community Hospital (BCH) brought the goals of the organization and
employs over 2,000 individuals and has a personal goals of employees into align-
medical staff of over 350 ment.
This satellite facility physicians. It’s a nonprofit A “green team” was soon appointed, con-
was the first hospital in corporation, governed by sisting of interested employees willing to
local residents. Since 1989, plan and act in concert with a volunteer
the world to earn the
when it merged with a com- environmental coordinator. This group for-
prestigious Leadership in peting hospital, there has malized the recycling program and in the
Energy and Environmental been significant growth in year 2000 collected over 150,000 pounds
Design certification volume and the range of ser- of recycled material. Not only employees,
but physicians were becoming involved,
(LEED). The award was vices provided. Having out- applauding the efforts. Because of the syn-
grown existing facilities, it
granted as a silver built a satellite hospital on ergy this created, a full-time employee was
certification, which is the the eastern edge of the com- hired to publicly formalize the hospital’s
munity in 2003. This satel- commitment to initiate and sustain envi-
second level in LEED.
lite facility was the first ronmentally friendly initiatives. Selecting a
hospital in the world to earn the prestigious person to assume the duties of this position
Leadership in Energy and Environmental deserves careful consideration. He or she
Design certification (LEED). The award was must be passionate about the environment.
granted as a silver certification, which is the It is also important for this person to be a
second level in LEED. good communicator, have a personality that
can build trust, is easily approachable, and
The Start possess the ability to work in the political
It began in 1989, bit by bit, with environ- environment that exists in hospitals.
mentally conscientious employees taking Management set about to create guiding
action in a small way. Not more than a principles. These principles had been
handful of people were involved. But they espoused by many of the employees work-
could see the waste that was generated ing diligently in the environmental pro-
operating a hospital. Just as they were gram. With their input, the statement was
doing in their homes, they started to recy- created and presented formally in a docu-
cle paper and containers from the hospital. ment to the board of directors. Getting its
Their grassroots efforts were observed by endorsement was important for organiza-
co-workers, physicians, and management. tional commitment and funding. A docu-
ment entitled Statement of Principles of the not take any action against employ-
Environment was approved. At that point, ees who report to management
environmentally friendly initiatives were such an adverse condition.
being identified from the top down, as well
as from the bottom up. They permeated the Our efforts then advanced from recy-
culture. The statement reads as follows: cling to a goal of eliminating waste. These
principals expanded our horizon beyond
Boulder Community Hospital recycling into a broad scope of waste
Statement of Principles of reduction. These expanded efforts
the Evironment included using water efficiently and pur-
With deep concern and respect for our chasing green supplies, and ultimately led
environment and the quality of life of to our pursuit of the LEED certification at
our staff and consumers, Boulder our new hospital. During this process, the
Community Hospital is committed to hospital received public recognition and
the following principles: was awarded Colorado’s prestigious Recy-
• To minimize waste and ensure con- cler of the Year Award. This public honor
taminated waste is disposed of in a struck a resounding chord with all of the
safe and responsible fashion. hospital’s constituents.
• To support and encourage recycling of
the materials used within the hospital. LEED Certification
• To actively seek, evaluate, and imple- The LEED process started with all parties
ment methodologies that limit the having a mutual understanding of and
use of non-renewable resources. shared commitment to this end. They
• To minimize and strive to eliminate forged a team going into uncharted waters
emissions of toxic or dangerous sub- for a hospital facility. Prior to this, only less
stances into the air, water, or earth. sophisticated buildings were able to secure
• To encourage the use of transporta- LEED designation. Some of the green con-
F E A T U R E
tion alternatives to the private auto- struction elements of our new building
mobile, through financial and other were the use of energy efficient windows,
incentives. the diversion of construction waste,
• To purchase and use recycled prod- xeriscaping (landscaping that doesn’t need
ucts when the cost of such products extra irrigation), the use of reprocessed and
is comparable to or slightly more recycled materials, and yes, even installa-
expensive than virgin materials. tion of waterless urinals. The result was an
• To favor the use of reusable prod- environmentally friendly building and a
ucts and materials, as opposed to highly efficient hospital, delivering the best
disposable products, such as surgi- in high technology.
cal gowns, packs, and diapers.
• To encourage conservation of water Gaining Momentum
resources. The original green team that consisted of
• To disclose to employees and pub- interested volunteers from the hospital
lic, incidents due to our operation evolved in the organization to “sustainable
that cause environmental harm or advisors” in every department of the hos-
pose health or safety hazards and pital. These individuals serve as resources
for our full-time sustainability coordina- They include more solar installations on
tor. Several of the green team volunteers buildings, construction of a solar roof
assumed this duty in their department. covering one or both of the hospital’s
This has worked well, because now all parking garages, creation of further
departments have environmental cham- incentives for employees to promote
pions. Each serves as an advocate to the alternative modes of transportation, and
process and provides a channel of com- the creation of a document that provides
munication for employees that is reliable specifications to “build green” whenever
and easily accessible. Recycling alone has
now grown threefold to 500,000 pounds Table 1 Types of Recycling
per year.
One suggestion of the advocates that • containers
the hospital accepted was to start purchas- • cardboard
ing green supplies. Purchas-
The sterile processing • paper
ing green supplies means
department switched to selecting items by assessing • electronic equipment
hard, reusable containers their environmental impact. • medical equipment
instead of plastic wrap, It means selecting those • medical supplies
supplies that can be reused
which reduced expenses in rather than recycled. Seek- • batteries
excess of $100,000 per year. ing green supplies also • furniture
entails working with manu-
• food for commercial composting
facturers to modify their process in order
to eliminate bulky packaging. It was in this • reprocessing
area that the hospital scored its first big Totaling 500,000 pounds annually
cost reduction. The sterile processing
department switched to hard, reusable con-
tainers instead of plastic wrap, which Table 2 Other Environmental Initiatives
reduced expenses in excess of $100,000
• Board approval of environmental
per year. principles to guide decision making
It is noteworthy to examine the variety
of recycling activities shown in Table 1. • Achievement of LEED Silver Certification
The hospital’s efforts to reduce waste • Alternative transportation provison—free
go beyond recycling. Table 2 summarizes bus pass for every employee
other actions that contributed to healthy • Wind power purchase
environmental initiatives.
• Green supplies procurement
What’s Next? • Lighting retrofit
As is evident from reviewing Tables 1 • Water conservation audit
and 2, the hospital has been successful
in sustaining an “environmental mind- • Solar panel installation
set” in its planning and decision mak- • Elimination of mercury
ing—but we’re not done yet. There are • Elimination of latex
still numerous initiatives in the works.
6 • frontier s of hea lt h s e r v i c e s m a n a g e me n t 2 5 : 1
remodeling or construction occurs. It is Recognition

our intention to make this working doc- It is gratifying to be recognized locally and
ument available to any organization nationally for the work and accomplish-
planning construction. ments of our employees to minimize the
Solar panels on the roofs of buildings negative impact of hospital operations on
serve as an alternative energy generating the environment.
source. To date, panels generating 60 One of my favorite awards was given to
kilowatts are fully operational. There are us in 2004 by Eco-cycle, a local nonprofit
plans to install additional capacity of 107 environmental organization. Eco-cycle
kilowatts over the next several months. made an effort to quantify BCH initiatives
The amount of energy currently generated in terms of conservation. The award reads:
is enough to power 28 average homes in
the United States. Going for Zero Waste—or Darn Near
We are studying the feasibility of con- in 2004
structing a roof grid over parking Conserved:
garages upon which solar panels can be 3,786 30 ft. trees
secured. If our study confirms that this 1,558,970 gallons of water
is financially feasible, it would increase 999,773 kilowatt-hours of energy
our solar power capacity by more than 1,779 cubic yards of landfill
tenfold. 13,501 lbs of air pollutants
Creating additional incentives for
staff to utilize alternative transportation We also received two major awards
is a high priority. Providing all employ- from the State of Colorado. In 2005 and
ees with a free bus pass has yielded sig- 2007, we were recognized as a leader by
nificant results, but our parking garages the Colorado Department of Public
and parking lots are still full. Not only Health and Environment.
F E A T U R E
would successful initiatives cut down on In 2006, the American Hospital Asso-
global warming from fossil fuels, but ciation recognized the hospital with its
having more employee parking places Environmental Leadership Award from
unoccupied makes accessing the hospi- Hospitals for a Healthy Environment.
tal more convenient for patients and Also in 2006, the hospital was recognized
their families. with the 2006 Making Medicine Mercury
Creating a usable, working document Free award.
that can serve as specifications for remod- In addition, the hospital received the
eling or new construction would be a Our World Award from Rotary Interna-
worthwhile project. Not only would it pro- tional for its environmental stewardship.
vide guidelines to our staff in Boulder, but Table 3 lists our awards chronologically.
it could be disseminated and applied by
any hospital manager. Cost Savings
Finally, we would like to identify our Environmental initiatives sound good to
carbon footprint. This analysis quantifies altruistic people, but they also produce sig-
the amount of pollution the hospital cre- nificant savings. At our hospital, being able
ates. Once determined, we will make to track cost savings is important—it also
plans to effectively offset it. serves as a basis to justify further invest-
ments in environmental initiatives. Savings “I took this job because of the hospital’s
have been extracted as a result of reprocess- commitment to helping the environment.”
ing, reduced hauling, electrical savings, and
overall waste reduction. Table 4 specifies A hospital that supports environmen-
the tangible savings from the listed activity. tally friendly initiatives will gain a strong
The management team is convinced allegiance from its employees.
there are more cost savings than these.
These just happen to be the most signifi- Obstacles: Maintaining
cant, and easiest to clearly identify. Confidentiality
There is no question that “going green” Shredding documents protects the confi-
generates a beneficial financial return. dential information they once held, but it is
One good example not included on the list
has to do with our solar panel installation.
Table 3 Awards Earned by Boulder
These arrangements are referred to as
Community Hospital
power purchase agreements. The hospital
leases space to an entity that finances and
2004 Eco-cycle
installs the solar panels at no cost to the
hospital. This entity, in turn, sells the 2004 Our World Award, Rotary
power to the hospital. The financial bene-
2005 Bronze Achiever, State of Colorado
fit to the hospital is that the price of the
electricity is guaranteed at a fixed rate for 2006 Hospitals for a Healthy Environment
a period of 20 years. This is important to 2006 Making Medicine Mercury Free
the hospital, because it protects us from
increasing electricity costs. The price per 2007 Gold Leaders, Colorado Department
kilowatt-hour is frozen at today’s price of Public Health and Environment
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. Table 4 Sustainable Cost Savings—Annually
Employee Allegiance Reduction in surgical wrap $120,000

Embracing environmentally healthy ini-
tiatives becomes woven into an organiza- Reprocessing instruments $95,000
tion’s culture by motivated and loyal Elimination of shredding $90,000
employees. Not only does the hospital services
gain in strength of character, but this new
Reduced trash hauling $45,000
profile helps recruit dedicated staff mem-
bers who aspire to attain these initiatives. Lighting efficiency upgrade $35,000
Comments like these are not unusual:
Full-time employee $150,000
reduction in housekeeping
“I’m proud to work for this hospital
because it cares about our environment.” Water efficiency $25,000
“I’m glad to have the chance to partici- Total Savings: $460,000

pate in a worthy cause.”
costly and creates too much waste. We Advice to Others Considering

embarked upon a procedure that yielded Environmental Initiatives
cost savings, eliminated waste, and secured One doesn’t have to look far to see the
important information. Following this pro- urgency to minimize the environmental
cedure enabled us to take a confidential impact of operating our nation’s hospitals.
document from a nursing floor in Boulder The disasters resulting from global cli-
to an ink removal facility in Arizona, with- mate change, the effects of pollution on
out fear of violating the Health Insurance our health, the costs of energy, and the
Portability and Accountability Act (HIPAA). heavy damage to our waterways all under-
Below is a step-by-step explanation of what score the situation.
our hospital did to achieve this. Enough is enough. It’s time to get
started, and many are taking this seri-
Securing transfer of recyclable ously. Our sustainability coordinator has
documents now provided more than 75 tours to hos-
Step 1: Paper is tossed in bin on a nursing pitals, architects, and other companies
unit. The bin is located in an area where from throughout the United States, all
public access is restricted. seeking information about our projects
and LEED certification. In addition,
Step 2: The nursing staff empties their
healthcare offices from seven countries,
bins into a 90-gallon recycling toter.
including England, France, Australia,
Step 3: Housekeeping staff picks up the New Zealand, Canada, Mexico, and
toter and replaces it with an empty toter. Malaysia, have communicated with us to
Toters are locked at all times. learn more about our successful environ-
Step 4: Our local recycling organization mental initiatives.
places the material from the toters into its My advice is to take action now. Here
truck. are some simple steps to get started on
F E A T U R E
your hospital’s environmental program:
Step 5: The material is bailed at a process-
ing center. 11. Talk it up with co-workers.
12. Stress the urgency of the situation.
Step 6: Bailed material is placed in a locked 13. Appoint a steering committee.
train car and transported to Arizona. 14. Create an environmental principles
Step 7: The reprocessing center in Ari- statement.
zona dumps documents into a vat that 15. Create a position for an environmental
removes the ink from the documents. sustainability coordinator.
16. Get early buy-in from a department that
Step 8: Once the confidential information
is willing to pilot a recycling project.
has been removed in the de-inking
17. Buy large recycling containers.
process, the paper is processed into recy-
18. Record achievements.
cled material.
19. Communicate achievements through-
(Key point: The hauling company has out the organization.
adopted a HIPAA policy that all employ- 10. Recognize the individuals involved.
ees must adhere to. This includes drivers 11. Expand the efforts to more depart-
and material handlers.) ments
12. Add/plan new initiatives. upon the participants. In our particular

13. Refer to the change process as defined case the results are amazing. Since 2000
by Kotter (1996). our comprehensive waste reduction
efforts have diverted over 3 million
pounds of material from landfills.
Summary
Sustainable initiatives can be attained by
Reference
starting small, gaining broad participa- Kotter, John. 1996. Leading Change. Harvard Busi-
tion, accomplishing achievements, publi- ness School Press, Cambridge, MA.
cizing them, and bestowing recognition
10 • frontier s of h e a lt h s e r v i c e s m a n a ge m e n t 2 5 : 1
Demonstrating Reverence for the Earth
B Y J AMES G. C OLLER , FACHE, AND

A NNETTE L. G RUNSETH
Su m m a r y • As a community hospital and a major employer, St. Mary’s

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. Demonstrating reverence for the earth is a pri-
mary strategic goal, originating with its sponsoring organization, Hospital Sis-
ters Health System, Springfield, Illinois. St. Mary’s 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. Mary’s Hospital Medical Center has
brainstormed and implemented innovative ideas to mend the earth, improving
F E A T U R E
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 passion
and 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. Mary’s Hospital
Medical Center and St. Vincent Hospital in Green Bay, Wisconsin. Annette L.
Grunseth is a writer/editor and public relations specialist with St. Mary’s Hos-
pital Medical Center in Green Bay, Wisconsin. She is a Fellow of the Wisconsin
Healthcare Public Relations and Marketing Society.
James G. Coller and Annette L. Grunseth • 11

Early Adopter Environmental Statement for

In our consuming culture we are increas- St. Mary’s Hospital Medical Center
ingly aware of the need to be good stew- As part of our Franciscan values as a
ards of our environment and resources, member of Hospital Sisters Health
especially in healthcare. We are at the core System to show reverence for the
of our community, often the largest earth, St. Mary’s Hospital Medical Cen-
employer and a large consumer of energy ter believes protecting the environment
and resources. Hospitals generate waste while providing quality patient care is
materials 24 hours a day, seven days a critical to our community’s long-term
week, 365 days every year. St. Mary’s Hos- health. It is our goal to continue our
pital Medical Center, located in Green Bay, commitment to the environment by
Wisconsin, is in the business of health— improving existing programs and
health of people and health implementing new initiatives annually.
Hospitals generate waste
of our environment.
materials 24 hours a day, St. Mary’s Hospital has This article presents a study of what St.
Mary’s Hospital Medical Center accom-
seven days a week, 365 been an “early adopter” of
the environmental move- plished over the past two and a half
days every year. decades by taking responsibility for the
ment because of firm
encouragement from its sponsors, Hospital environment as a health issue. This stew-
Sisters Health System (HSHS), Springfield, ardship under the guidance of HSHS, the
Illinois. St. Mary’s Hospital Medical Center goals of “reverence for the earth,” and the
is one of 15 HSHS hospitals in Wisconsin local board of directors provide a steady
and Illinois that follow the teachings of direction as St. Mary’s Hospital Medical
Christ, St. Francis of Assisi, and St. Clare, Center continues to find new ways of mak-
who believed in “reverence for the earth” ing a positive presence and impact on the
and all its living creatures. To this goal, the land for which we are responsible. These
Hospital Sisters required each hospital to efforts have evolved as we have invested
integrate environmental standards into our dollars, our collective talent and skill,
each of their facilities and communities. St. as well as volunteer hours to make our
Mary’s, along with its local board of direc- environment cleaner and healthier. It is an
tors, took an immediate interest and the annual commitment that has grown
lead within the hospital system more than rapidly through the enthusiasm and cre-
25 years ago, long before other hospitals felt ativity of our managers and employees.
the need to pursue “green” practices. The
core belief is that protecting our environ- It Was the Right Thing To Do
ment, along with quality patient care, is crit- In the early 1980s employees rallied
ical to the community’s long-term health. together with a community team as part
The local board of directors eagerly sup- of a community-wide project called River-
ported this healing ministry and saw the Bay Clean Up. The initial enthusiasm
role of the hospital as a leader to serve the started with employee groups that volun-
community with health for all, including teered to go out into the community and
the environment. Over the years, an envi- pick up trash along the shores. Later,
ronmental philosophy has evolved to another community effort was initiated
include a summarizing statement: with “A Day at the Museum,” which was a
12 • frontier s of h ea lt h s e r v i c e s m a n a ge m e n t 2 5 : 1
challenge to see who could be most cre- Green Bay/Great Lakes area. This project
ative with ways to recycle and reuse mate- received national recognition and several
rials. St. Mary’s employees were creative grants from state and federal agencies to
and competitive, and they often won become a prototype project for third world
awards for their environmental efforts. countries to consider for implementation
In 1984, our Nutritional Services depart- as appropriate in their climates.
ment began donating good, leftover food to
local food pantries. It was mission-driven to Environmental Action
help those less fortunate while not having Continues
food go to waste. Addressing the needs of While these earlier programs continued, a
the hungry by sharing what we have is new director of Environmental Services
important to us. St. Mary’s currently pro- was hired. With a keen interest in environ-
vides 12,000 pounds of food each year to mental issues and a passion to make
several food pantries. St. Mary’s also serves things happen, she raised awareness to a
as a preparation and delivery site for the higher level and initiated additional envi-
community Meals on Wheels program. ronmentally friendly programs. We now
In 1996, as HSHS continued to had an internal champion to continue and
require its hospitals to integrate “rever- grow the “reverence for the earth” mission
ence for the earth” into its operations, sev- of the Hospital Sisters. With her leader-
eral employees formed the initial “Green ship, the Green Team tackled recycling,
Team” to brainstorm ideas to meet the reduced medical waste, located and elimi-
challenge. One idea was to capture and nated unused chemicals, streamlined
improve the storm run-off water from energy use, developed programs to go
hospital parking lots. Pollutants such as mercury-free, and improved green space
gas, oil, and salt coat the parking lots. on our campus.
When snow and ice melt, or it rains, pol-
F E A T U R E
lutants dissolve in the water, which flows Recycling Gets Everyone
into sewers and eventually into the Fox Involved
River, headed for the Bay of Green Bay Paper, plastic, aluminum, and daily trash
and the Great Lakes. from throughout the hospital and office
In 1998, a storm water management areas was audited and every area provided
system was built on campus to capture all with appropriate recycling receptacles. This
storm water run-off. For the past decade, was an effort everyone could become
all storm water is sent through a unique involved in and feel good about while con-
filtering system that extracts the pollu- tributing to the improvement of the envi-
tants and releases purified and clean ronment. Formal in-services were held to
water into the river and ultimately into the train staff. Refresher mini-classes at
Great Lakes. In 1998, this process was the department meetings along with articles
only one of its kind in a northern climate. sent via our internal employee newsletter
Cleaner water and fewer pollutants enter- and intranet reinforced the environmental
ing our environment improve the health message to every employee and physician,
of the river—including the fish, a food reminding them how and where to recycle.
source—while indirectly reducing health St. Mary’s took environmental prac-
hazards for the people who live in the tices to a new level in 2003 with member-

ship in the not-for-profit organization safely reused. St. Mary’s formerly con-
Hospitals for a Healthy Environment, also sumed 16 gallons of xylene per month,
known as H2E. This national organization but the distilling process reduced that to 4
“works together to improve the environ- gallons per month. The positive result is
mental performance of the healthcare less chemical needs to be handled, dis-
industry” (Practice Greenhealth 2008). posed of, and purchased.
By 2006, St. Mary’s overall recycling As of 2007, St. Mary’s overall recycling
rate was 31.5 percent. A recycling rate of 25 rate has increased from 31.5 percent to 40
percent was considered exceptional by percent, which means in all our waste
H2E. St. Mary’s felt proud to streams, 40 percent less trash is sent to the
St. Mary’s formerly be doing better than the landfill. In the calendar year of 2007, we
consumed 16 gallons of industry standards in our had a total of 806,515 pounds of waste
materials. We recycled 327,536 pounds of
xylene per month, but the corner of the world. Our
waste streams were given materials, which went to other sources or
distilling process reduced continual attention by was recovered by other companies, and in
that to 4 gallons per employees and the list of many cases turned into other “new” prod-
month. recyclables grew. ucts (see Table 1). We often received rev-
To deal with xylene, a enue for materials recycled. It is our
chemical used in laboratory tests, the hos- annual goal to keep increasing the percent-
pital invested in a distiller that recycles age of recycling pounds while decreasing
used xylene. The xylene is converted into the percentage of true waste that is headed
vapor and recaptured so that it can be for the landfill.
Table 1 2007 Waste Stream Summary

Material Pounds Waste Stream
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
Giant Steps needed to diagnose and treat patients. One

Medical waste, such as tissue and fluids procedure is replaced by another, and in
from surgeries and procedures, is col- that process, items no longer needed get
lected in suction canisters, which previ- pushed aside and soon forgotten. One of
ously were discarded as trash. St. Mary’s the ideas from our Green Team was to
purchased a fully automated suction canis- implement a proactive “Chemical Round-
ter transposal system that now handles all ing Team” that would attempt to locate and
surgical canisters safely. No employee has dispose of unused and unwanted chemi-
to handle any surgical waste, as this sys- cals by visiting departments with an edu-
tem safely processes the waste in an envi- cational intent. Regulatory agencies such
ronmentally sound manner and sterilizes as the Occupational Health and Safety
the canisters for reuse. We are now safely Administration, the Joint Commission,
recycling and re-using 7,000 canisters the Department of Natural Resources, and
annually. That means 7,000 fewer canis- the Environmental Protection Agency pro-
ters in the landfill! We expect this system vided understanding and direction on cur-
to pay for itself in 4.5 years. rent chemical/safety standards. Armed
In another project, we partnered with a with this source of learning and the com-
company that manages sharps disposal. bined knowledge of the Chemical Round-
The company provides receptacles, and ing Team, ten departments were initially
retrieves and disposes of all sharps mate- visited, which resulted in removal of 419
rials. The receptacles are completely safe, gallons of expired and obsolete chemicals.
and once again, no employee handles any Fifty-eight pounds of dry chemicals were
sharps. St. Mary’s Hospital Medical Cen- also removed during that first round-up,
ter will have to purchase 1,608 fewer and mercury switches were removed from
receptacles. The savings realized in this equipment. Hard copies of Material Safety
program is $9,422 annually. This trend of Data Sheet (MSDS) Manuals were
F E A T U R E
partnering for sharps disposal is a new removed and made current through the 3E
trend in the Midwest, and our hospital, Company’s MSDS on Demand program.
along with the 12 others in our health sys- Outdated MSDS sheets and binders are no
tem, is one of the first to adopt this newer longer stored in departments. From the
environmental arrangement. beginning of our efforts through Decem-
ber 2007, 4,700 pounds of liquid or dry
A Smoke-Free Hospital and chemicals have been removed and prop-
Campus erly disposed of.
For the safety and health of patients, fami- The Chemical Rounding Team concen-
lies, and employees, St. Mary’s Hospital trated efforts in key areas that housed
Medical Center is completely smoke-free larger quantities of these materials, such
within all buildings as well as outside. For as Plant Operations, Housekeeping, and
the entire campus, including parking the Laboratory. The team properly dis-
areas and green spaces, smoking and posed of old paint, anti-freeze, toxic chem-
tobacco products are prohibited. icals, and cleaning supplies. As it visited
each department, the team used an educa-
Chemical Rounding tional approach and did not expect depart-
Healthcare technology and procedures ment staff to have all the answers. The
advance or change as do the supplies team conferred with the MSDS contract

and educated employees to be aware of surgery. The savings realized on this unit
products that aren’t used any longer. The was $28,375 per year, with a payback of
team sought out expired chemicals and four years. Focus on Energy paid St.
caustic materials and also cautioned Mary’s Hospital Medical Center a grant of
departments not to over-stock too much of $13,352 to help fund this acquisition.
an item. In April 2007, St. Mary’s began the
The Chemical Rounding Team also project of replacing four older air han-
consolidated materials with other depart- dling units with one larger unit. The sav-
ments, which increased efficiency and ings per year is $5,945 in power. Focus on
safety, and reduced costs. In addition, the Energy gave us a grant of $3,565 for this.
team took the opportunity to fit employ- In March 2008, St. Mary’s replaced
ees with current personal protective gear another older air handling unit that serves
and to check for proper secondary con- the kitchen area. This project will save the
tainers and labeling. It also advised hospital $9,431 per year in both electricity
departments on proper storage areas to and gas. Focus on Energy gave a grant of
ensure fire and chemical $6,100 for this project. For all of these
When St. Mary’s Hospital safety. efforts, St. Mary’s Hospital Medical Cen-
Medical Center needs to ter became an Energy Star partner.
make changes with major Streamlining St. Mary’s Hospital Medical Center
Energy does load shedding in the summer
equipment, energy Consumption months for Wisconsin Public Service on
conservation is at the Energy usage affects every- peak days. When there is a large draw of
forefront of thing we do today and in electricity, the hospital starts a small gen-
the future. Therefore, when erator, which runs one of our larger
decision making.
St. Mary’s Hospital Medical chillers. For having this capability, Wis-
Center needs to make consin Public Service deducts $1,500 per
changes with major equipment, energy month from our electric bill from April
conservation is at the forefront of deci- through September.
sion-making (See Figure 2).
Focus on Energy is an organization that Another Major Effort:
works with Wisconsin residents and busi- Making Medicine Mercury-free
nesses to install cost-effective, energy effi- Removing mercury from the healthcare
cient, and renewable energy projects. Focus environment demanded great attention
on Energy supplies grants to make energy to detail in clinical and plant operations
changes that help to control the state’s ris- areas. H2E, which sponsors the Making
ing costs and growing demand for electric- Medicine Mercury Free award, created
ity and gas. guidelines for establishing safe handling
In June 2006, a desiccant dehumidi- protocols and spill clean-up procedures
fier was added to our new surgery air han- for mercury. St. Mary’s Hospital Medical
dling unit. This system cools surgery Center implemented these procedures
faster and removes condensation. The and began extensive education and train-
surgery rooms are run at a cooler temper- ing of employees about facility protocols,
ature, which is safer for the patient having including information about mercury
16 • frontier s of h ea lt h s e r v i c e s m a n a g e me n t 2 5 : 1
Table 2 Focus on Energy Project Expenses, Savings, and Grants
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
and its effects on human health and the day thermometer exchange event was
environment. A mercury-free purchasing held from 11 a.m. to 6 p.m. The general
policy was implemented that banned the public could drive through the Emergency
F E A T U R E
purchase of mercury-containing items driveway under a weather-protected
without approval (e.g., if a non mercury canopy to drop off mercury fever ther-
alternative was not available.) Clinical mometers and receive a free digital ther-
and facility devices were replaced with mometer. Consumers were given
non mercury alternatives. All mercury instructions in ads and publicity on how
devices were disposed of properly and to safely secure their old thermometer for
safely. transport to bring it to the hospital for
exchange.
Community Connections— An exchange station was set up so that
Mercury Thermometer people did not have to get out of their
Exchange cars. A day in spring was chosen so this
The mercury-free initiative was taken into could be done outdoors, and we were
the community. The Temperature is lucky enough to have good weather.
Changing at St. Mary’s was the name of a Signage and creative latex-free balloons
program offering the public a free digital were used to draw people to the correct
thermometer in exchange for a mercury entrance. Many area vendors donated
fever thermometer. In May 2006, a one- refreshments, digital thermometers, and

recycling services to properly dispose of Demolition Recovery and

the more than 800 mercury thermome- Green Construction
ters that were turned in. In fact, two years We are also committed to green construc-
later, people are still calling to ask if we tion, as it is the right thing to do.
will take their old thermometers, and of During earlier interior construction
course, the answer is, yes. projects, St. Mary’s required vendors to
Along with the free digital thermome- separate metal, copper, and cardboard for
ter, each person who stopped was pro- recycling. Now that mandate incorporates
vided a give away bag with hospital a wide range of other materials to be recy-
information from key service lines, a cled. In all current and future construc-
woman’s health newsletter, and environ- tion projects, St. Mary’s and its architects
mental information. Large displays were require that the guidelines in the Leader-
stationed at the drop-off ship in Energy and Environmental
In all current and future point, illustrating environ- Design (LEED) Green Building Rating
construction projects, St. mental information that System be followed.
Mary’s and its architects could be viewed from cars. In 2005, during our construction pro-
Two environmentally ject for a new Emergency department and
require that the guidelines conscious consumers rode
new surgical suites, we began recycling
in the Leadership in up on bicycles to exchange construction debris throughout the course
Energy and Environmental thermometers. of construction. We recycled 21.85 tons, or
The work to remove about 24 percent of the project. Our envi-
Design (LEED) Green
mercury from within the ronmental champion even recycled some
Building Rating System be hospital was recognized of the demolition debris to construct tile
followed. when H2E awarded St. and metal flower arrangements for an
Mary’s Hospital Medical H2E conference.
Center the Making Medicine Mercury In 2007, St. Mary’s Hospital Medical
Free award in 2006 for internal efforts Center began constructing a new wing
and for the consumer effort. onto the existing hospital for cancer care.
In order to make room, an outdated clinic
More Environmental Awards building was demolished. With the ven-
In 2007, the H2E organization singled out dors proactively involved, 81 percent of
St. Mary’s Hospital Medical Center again the demolished material was recycled.
with two prestigious awards for environ- Concrete, asphalt, clean steel, mixed
mental innovations: The Hospitals for a metal, and copper were separated as they
Healthy Environment Leadership Award were removed and hauled to recycling
and the elite Environmental Leadership centers. Also diverted from landfill or
Circle award (one of eight hospitals nation- incineration was land-clearing debris,
wide given this award in 2007) for design- asphalt, Portland cement concrete, con-
ing and implementing programs that set crete masonry units, brick, clay products,
industry-wide benchmarks for environ- and ceramic tile; wood products, includ-
mental stewardship. Again in 2008 we ing pallets; metal, insulation, asphalt roof
won the Environmental Leadership Circle shingles, glass, gypsum drywall, acoustic
Award from H2E. ceiling tiles, resilient flooring materials,
Table 3 Table of Recylced Materials pathway, outdoor seating, and a statue of St.
Francis, along with perennial and annual
plants and shrubs, which were nestled into
Recycled steels 6.95 tons of
the space just outside the hospital chapel
unprepared steel
between two wings of the building. The
Recycled sheet metal 45.73 tons shrubs provide privacy and decrease noise
from the adjacent busy street. The prayer
Recycled blacktop 1,025 tons
garden is used daily by patients, families,
Recycled concrete 1,674 tons and employees, who pause there for a
moment of prayer and peace.
Mixed to landfill 637.17 tons
Throughout the campus, seasonal
flowers and lawns provide an inviting
environment where people can also sit at
carpeting, paint, plastics, cardboard, picnic tables. The recently completed
paper, and packaging; and field office Emergency Department also has a healing
waste including office paper, aluminum atmosphere, with a wall-mounted water
cans, and plastic bottles. (See Table 3.) garden and plants in the waiting areas.
There will be no polyvinyl chloride For the new construction project, heal-
(PVC) products in any materials used for ing “infusion gardens” are planned as a
the construction. In past years, it has vital part of the interior atrium design and
been difficult to find vendors that offer a treatment areas for the cancer center. The
variety of PVC-free products, but now creation of healing gardens at both the
that the concept of “green construction” ground level and rooftop will provide places
has grown, we are currently working of serenity and gracefulness for patients
with vendors that have a wider variety of and families to reflect and re-energize. The
natural rubber or ceramic flooring, PVC- healing gardens are being called infusion
F E A T U R E
free wall covering, PVC-free glue, and gardens because the infusion patients in
PVC-free paint and laminates. The west the cancer center will look out onto them
wing addition of our facility, currently as they receive their treatments.
under construction, is a regional cancer The landscaping consultant is including
center, and we believe it is important to a lot of water in the design. There will be
use green building practices to construct water fountains in the healing gardens for
a treatment facility that will be helping the cancer center and outside in front of the
patients regain their health. atrium, in the center of the drop-off area.
The roof is being prepped for a rooftop
Healing Green Spaces—The garden area. Timing for its completion
Power of Landscaping will be staged to fit with plans for addi-
Green spaces are vital to the appearance of tional expansion, if more floors are added.
the hospital campus, and they create a heal-
ing atmosphere. Twelve years ago we devel- Mission Outreach: Local,
oped an outdoor prayer garden constructed State, Nation, World
with eco-friendly materials. A local donor St. Mary’s Hospital Medical Center, along
provided funding to establish the brick with the other 12 hospitals in the Hospital

Sisters Health System, recycles used equipment. For example, there was a
medical equipment and supplies to third patient monitor that had no EKG cable,
world countries. Through the HSHS no blood pressure hose or cuff, and no
Mission Outreach Program, equipment oxygen sensor. The team tracked down
is collected and transported to a Mission and ordered various parts, then assembled
Outreach warehouse in Springfield, Illi- them and repaired the unit.
nois. HSHS Mission Outreach is also a As equipment was repaired and pre-
preferred partner with the U.S. Navy Pro- pared for shipping, the bio-medical team
ject Handclasp, which employs Navy made sure ample supplies and acces-
ships to distribute medical equipment sories were included. In a developing
and supplies worldwide to needy coun- country, access to these supplies is nearly
tries. See Table 4 for a list of places our nonexistent. The bio-med team included
equipment is being used. extra bulbs, batteries, and other common
Additionally, one of St. Mary’s Hospital parts that needed to be shipped with each
Medical Center Bio-Medical Electronics item. Overall, the team checked out and
employees helped develop a partnership assembled more than 100 different
between TriMedx Founda- pieces of medical equipment, valued at
Overall, the team tion and Hospital Sisters more than $120,000, in its four-day
checked out and Mission Outreach. This repair marathon. It also identified nearly
assembled more than 100 partnership provided volun- 70 additional items that needed parts
teer bio-medical services for and/or accessories.
different pieces of medical
recovery and redistribution Proper disposal is vital. If developing
equipment, valued at of medical equipment and countries are sent unusable equipment,
more than $120,000, in supplies in developing they do not have proper methods to dispose
countries. of the equipment. At Mission Outreach,
their four-day repair
In January 2008, one of any unusable items are disposed of in a
marathon. our contracted employees safe and environmentally friendly manner.
became a team leader for a
group of volunteers from TriMedx Foun- Challenges: Past, Present,
dation who traveled to the Mission Out- and Future
reach warehouse in Springfield, Illinois. Our commitment at St. Mary’s Hospital
Together, this team worked with the logis- Medical Center with the guidance of our
tics and warehouse manager to identify sponsors, Hospital Sisters Health System,
equipment in need of repair and servicing is a long-term pledge, and for that, our
to make it operational before shipping it financial investment continues to be a
to healthcare providers in developing challenge as well as an opportunity. The
countries. Bio-medical expertise was des- cost of recycling and reusing materials is
perately needed to make the equipment often more expensive than adding to the
useful. Most often equipment is donated landfill, but in the long run, we want our
with missing parts and accessories or no earth healthier for its citizens today, and
operation and service manuals. This vol- for future generations (See Table 5). We
unteer team worked for four intensive have partnered with agencies and organi-
days to check, test, repair, assemble, order zations that have helped us with grants,
parts for, and repair many types of medical and yet we also choose to endure costs to
Table 4 Where Our Recycled Equipment is Being Used
Thanks to a new, advanced computer Stretchers/mattress, stretcher with foot

ordering and tracking system in Spring- extender (InstaCare Stryker 1000), two
field, in the past two years (2006–2007), warming cabinets
St. Mary’s Hospital Medical Center Trinidad and Tobago, Eagles Nest Ministries:
received confirmation that our used equip- Overbed table
ment and supplies landed all over the
world, specifically in: Russian Federation, Voronezh Region:
Crutches, two surgical lights/lamps
Orkhon Tus charity organization, Mongo-
lia: Surgical light/lamp Ghana, International Health and Develop-
ment: Overbed table, birthing
Ukraine, Bilokurakone Central Rayon Hos- bed/mattress, visitor chair
pital: Two recliner chairs
Honduras, Mercy International: X-ray film
Cuba, Caritas Cubana: Birthing bed, crutches illuminator
Haiti, Centre De Sante: Pedicraft crib with Morocco, National Oncology Institute:
top and mattress, two Stryker 921 stretch- Bedside table
ers with mattress
Dominican Republic, Santiago Rodriguez
Haiti, Hospital St. Antoine de Jeremie: Hospital: Bedside table
Hamper, mattress, birthing bed
U.S. Navy Project Handclasp: Five visitor
Pakistan, Children of Abraham, Inc.: chairs and an exam stool
fulfill our ministry of leaving the earth in the community and region who help
F E A T U R E
and the health of those who inhabit it in share some of these costs. It is estimated
better shape. The future holds more part- that during the past two decades we have
nerships for us, such as the sharps dis- invested a million dollars, and we will
posal vendor, to ensure the health and continue to invest, as efficiently as we
safety of our employees and patients. can, to make this annual commitment to
Healing the earth also heals our patients, “reverence for the earth” a priority.
the people of our community, by provid-
ing cleaner water for the fish we eat and Hindsight Insight
better soil for the gardens that grow food. St. Mary’s Hospital Medical Center started
We choose to have green space on our small and kept building upon new green,
campus, sometimes compromising our sustainable opportunities. If I were to
parking spaces. We choose to filter our advise other hospital chief executive offi-
storm water run-off; invest in the most cers on how to get started, here are some
energy efficient heating and cooling recommendations:
equipment; and pursue recycling, reuse, Engage your owners in the commit-
and recovery. As we move forward, we ment to improve the environment—Share
have a cumulative financial investment with the board of directors, advisory com-
and rely on volunteer hours and partners mittees, physicians, department directors,

Table 5 List of St. Mary’s Hospital people find purpose and meaning in giv-
Recycled Items ing back to the environment and the com-
munity.
• Cardboard, mixed paper Partner with community leaders—Get to
• Newsprint, boxboard know and partner with city planners, the
mayor, the city council, and governmental
• Plastics: #1 PET, #2 HDPE, #5 agencies. If you are proactive with them and
Polypropylene, #6 PS they know you care about the environment,
• Mixed recyclables: Glass, aluminum, tin, these officials will be more likely to be posi-
steel tive and cooperative, and they will be less
likely to criticize the hospital for being a
• Wood pallets, scrap, and demolition high-end consumer and waste producer. If
wood they see your intentions and efforts, positive
• All oil products perceptions and relationships will develop.
Everyone cares about the environment of a
• Ink jet cartridges, toner cartridges
community. When talk of taxation and your
• Electronic equipment and components tax-exempt status comes up, hopefully, they
• All batteries will remember your investment of money
and time improving the community and
• Fluorescent lamps, light bulbs will be more aware of your service commit-
• Landscape waste ment and charitable ministry.
Find more partners—Get more people
• Solvents on board with your goals. Share your pas-
• Diagnostic film sion. The more people you have partnered
with you, the greater your impact. Look to
• Construction demolition
all contacts, vendors, advisors, patients,
• Surgical instrumentation (for third world employees, and acquaintances. A side
countries) benefit will be a growing positive image
• Precious metals and more resources becoming available to
your projects.
• Xylene, ethanol Tell your story—Every other year, or
whenever we have new programs to share,
we tell our story with printed brochures
and employees your ideas for an envi- (printed on recycled paper and with envi-
ronmental initiative. Tell them your ronmentally friendly ink), news releases,
goals, your ideas, and your passion for and letters. We communicate with politi-
the projects. Ask for their ideas—and cians, legislators, city officials and health-
their help. Perhaps a board member owns care associations, board members,
a company with whom you can partner to advisors, physicians and employees, news
share costs and accomplish recycling. media—everyone. As our prosperous
Look to your employees, owners, and ven- nation is viewed globally as a large con-
dors to help donate supplies, services, and sumer, we are doing our part to make the
time. It will be enjoyable for all, as most world better and we communicate about it.
We are making positive changes about Environmental awareness and sustain-

environmental sustainability, something ability happen one plastic soda bottle at a
for which Americans care deeply. time, one sheet of paper at a time, one
Take small steps to get started—Start mop head at a time, one surgical suction
with a few small ideas, like recycling canister at a time. Become a champion or
paper, plastic, and aluminum, then carry find someone in your organization who is
it throughout your organization. Ask passionate to make a difference. Next
employees closest to the work in a given thing you know, you will have a depart-
area to suggest ideas. The xylene distiller ment director making flower arrange-
project we did was one of those departments out of demolition rubble; your
mental ideas that is making a large, vendors will help you recycle; and you
ongoing impact. Using bio-friendly might even find a partner like Mission
materials that are able to be sanitized Outreach, helping others around the
and reused is one small item, but long world. And like St. Mary’s Hospital Med-
term makes a big impact. The little pro- ical Center, perhaps the governor will be
jects add up to a collective, positive commending you for your efforts and
impact. H2E will recognize you as one of the top
Conduct environmental audits, facilities in the United States, setting an
department by department, with a posi- example for others to follow. Whatever it
tive educational approach, and keep is you choose, start small and think big.
information in front of constituents so
they are reminded to continue their recy- Reference
cle/reuse efforts. It takes everyone, every Practice Greenhealth. 2008. “Vision, Mission,
day, doing a small part to create a big Goals and MOU.” http://cms.h2e-
influence. online.org/about/.
F E A T U R E

Why Should Healthcare Bother?
B Y R OBIN G UENTHER
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 sector—namely, 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 should
C O M M E N T A R Y
healthcare 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 isn’t 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 can’t 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. Mary’s, the organization’s explicit stewardship mission lies
at the core of its decision making—a common trend for religious-based health-
care organizations. Many non religious healthcare organizations—lacking a
reference to stewardship in their mission—approach green initiatives through
a community benefit lens.
Robin 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 of Sustainable Healthcare Architecture
(Wiley, 2007) with Gail Vittori.
Robin Guenther • 25
A third compelling reason to go green is of healthcare that has an impact. We may

the connection between green buildings and not be able to measure or test, but I’m con-
human health—a connection recognized by vinced it has a tremendous impact on a per-
the healthcare industry that is increasingly son’s ability to attain health. Not just to be
adopted by other market sectors. The Ameri- not sick, but to be in health” (Guenther, Vit-
can Society of Healthcare Engineering tori, and Atwood 2006).
(ASHE 2002) first framed green building Finally, the healthcare sector is realizing
initiatives around “protecting health at three that green construction and operation
scales: the immediate health of building makes business sense. The authors of the
occupants, health of the surrounding com- feature articles delineate three major bene-
munity, and health of the larger global com- fits: reduced operating cost, avoided risk,
munity and natural resources.” and tangible impacts on employee satisfac-
Environmental scholar David Orr (2004) tion, recruitment, and retention. The focus
writes: “The standard for ecological design is on employee satisfaction is not surprising,
neither efficiency nor pro- given chronic staffing shortages and person-
Green strategies aimed at ductivity but health; begin- nel expenses. In 2004, the American Hos-
improved indoor air ning with that of the soil and pital Association estimated that hospitals
extending upward through spent more than 50 percent of their operat-
quality—from using
plants, animals, and people. ing budgets on personnel, and 1.4 percent
building materials that It is impossible to impair on energy. With the threefold increase in the
emit less fumes to cleaning health at any level without cost of energy, this figure may be approach-
with greener products— affecting it at other levels.” ing 3 percent today for many institutions.
The Green Guide for Reducing energy demand is increasingly
reduce occupational Health Care, the first volun- seen as not just about dollars saved today,
health and safety risks. tary self-certification metric but is a “risk avoidance” strategy in a time of
tool for ranking sustainable uncertain energy economics. Likewise,
building strategies in healthcare, includes green strategies aimed at improved indoor
specific “health issue” statements that intro- air quality—from using building materials
duce each construction and operation topic that emit less fumes to cleaning with
(GGHC 2006). The Green Guide has become greener products— reduce occupational
the foundation for the U.S. Green Building health and safety risks.
Council’s Leadership in Energy and Environ- Almost without exception, hospitals that
mental Design (LEED) for Healthcare rating undertake green building and operation
system. Providence Health and Services CEO strategies report improved worker recruit-
John Koster, MD, describing their new LEED ment, satisfaction, and retention. Green
Gold Certified hospital in Newberg, Oregon, building is viewed as a major catalyst for
summed it up this way: “In healthcare, sus- organizational culture transformation—by
tainable building represents a bold move connecting with employee values, the work
toward precaution and prevention. The build- experience is transformed. Moreover, as the
ing stands for health. In creating it, the orga- Boulder Community Hospital story demon-
nization is essentially saying, ‘We’re strates, the completion of a green building
investing in keeping people healthier.’ Being is really only the beginning of organiza-
attentive to sustainability, wellness, and tional transformation. Once the building is
resource stewardship presents a holistic view in place, new green programs and initia-
tives are implemented. Boulder installed try. U.S. Energy Information Agency data
solar photovoltaic panels nearly four years (EIA 2007) rate acute care hospitals the
after achieving its LEED certified building, second most energy intensive building
and continues implementing operations type, just below food service. The data
programs that earn it environmental excel- show that hospitals use twice the energy of
lence awards each year. commercial office buildings.
Across the United States, in the absence
What is Driving this ‘Green of federal action, states and municipalities
Tsunami’ in Healthcare? are enacting legislation aimed at achieving
One can barely move in contemporary cul- rapid reduction of greenhouse gas emis-
ture without encountering “green initia- sions through public transportation invest-
tives.” Mainstream media are relentlessly ments and green building programs. In
reporting on environmental leaders and 2006, the American Institute of Architects
laggards—industries that are slow to (AIA) launched the 2030 Challenge with
respond are increasingly vilified. There are the goal of achieving carbon neutrality in
three distinct but interconnected factors the built environment by 2030.
C O M M E N T A R Y
driving this movement: mounting climate At the same time, the healthcare indus-
change concern, increasing scientific link- try is just beginning to articulate the impact
ages between environmental degradation of climate change on healthcare services
and human/ecosystem health, and global delivery. As average temperatures rise, heat
resource competition. Together, these island impacts in dense urban areas will
issues will change the way we live and con- exacerbate chronic respiratory conditions in
duct business in the future—and are likely the elderly and children. More extreme
to have profound impacts on healthcare weather events—hurricanes in the coastal
delivery—as each of them in turn impacts Southeast, tornadoes and floods in the Mid-
human health. Moreover, as described ear- west, fires and drought on the West
lier, these factors are fundamentally Coast—will require a more resilient emer-
changing economics as we begin to mone- gency care infrastructure capable of deliver-
tize previously “externalized” costs to soci- ing potable water as well as healthcare. Grid
ety: the cost of carbon emissions, toxics, or reliability is likely to continue to be an issue
pollution impacts. in unstable energy markets.
There is growing scientific consensus The science linking industrial chemi-
around climate change impacts and the cals with human health impacts continues
need for rapid global action to reduce to provide new information about our
greenhouse gas emissions associated with toxic body burdens—ranging from the
the burning of fossil fuels. The National effects of low-dose exposures on both a
Aeronautics and Space Administration cli- developing fetus and young children to the
mate scientist Jim Hansen (2006) writes: cumulative impacts on people and wildlife
“We have at most ten years—not ten years of an environment rife with persistent bio-
to decide upon action, but ten years to accumulative toxic industrial chemicals.
alter fundamentally the trajectory of global The recent market reaction to bisphenol A
greenhouse emissions.” The building sec- (BPA) in nalgene athletic water bottles and
tor is by far the largest emitter of carbon, baby bottles—in which products literally
outpacing both transportation and indus- disappeared from stores in a market
stampede—is only one of a growing num- construction cost escalation that outpaces
ber of consumer product issues around the rate of U.S. inflation, as we compete
toxic chemicals. In the medical device in a global materials marketplace for a
markets, movement away from PVC diminishing natural resource base. It is
devices containing DEHP plasticizers rep- clear that demand for oil outstrips global
resents a similar adjustment. This simple extraction and refining capacity (and prob-
idea, “imagine a cancer center constructed ably basic supply)—the end of cheap oil is
without materials that contain known or driving focus on reduced consumption
suspected carcinogens, or pediatric clinics and improved efficiency/reduced waste.
without asthma triggers”(GGHC 2006), is What does this mean for healthcare? Lee
driving market transformation of building Jong-Wook, MD, former director general of
materials and medical devices. the World Health Organization, in the
The linked movements of “green Health Synthesis Report of the Millennium
chemistry,” “clean production,” or “cra- Ecosystem Assessment (Corvalan, Hales, and
dle-to-cradle thinking” are ushering in a McMichael 2005), notes, “Nature’s goods
materials revolution that is and services are the ultimate foundations of
Pioneers and early producing a range of alter- life and health, even though in modern
adopters of green building native healthier products. societies this fundamental dependency may
Healthcare organizations, be indirect, displaced in space and time,
practices have reported and their design profes- and therefore poorly recognized. This [is] a
energy demand reductions sionals, are utilizing a call to the health sector, not only to cure the
ranging from 15 to 30 growing number of alter- diseases that result from environmental
natives to long-established degradation, but also to ensure that the
percent
materials and products. benefits that the natural environment pro-
PVC-free products—from IV bags to vide to human health and well-being are
carpet backing, window treatments to preserved for future generations.”
wall protection; linoleum and synthetic In summary, these seemingly disparate
rubber flooring maintained with no-wax trends signal a fundamental shift in eco-
protocols; formaldehyde-free insulation nomics and cost accounting. Once upon a
and casework—are all examples of an time, we could dispose of things “away”—
emerging palette of safer and healthier the seemingly limitless air and water. The
building and medical products. impacts of using our air and water as
Another important factor in the green dumping grounds for waste—species loss,
tsunami is global resource competition. air pollution, and toxic contamination—
There is growing consensus that we are are moving into economic cost accounting
consuming natural resources faster than models. Carbon trading models and life-
the planet can replenish them—the World cycle assessment methodologies are in
Wildlife Fund’s Living Planet Report their infancy, but ecological economics is
(2005) estimates that we are consuming gaining momentum.
global resources at 30 percent above carry-
ing capacity. However, if the planet con- Where Is the Healthcare
sumed at the level of present U.S. Sector Now?
consumption, more than three planets In its October 2006 operations survey,
would be necessary. This is reflected in FacilityCare magazine received responses
from 250 healthcare facility managers and jects are new construction, a number of
executives. Asked whether they were major renovations or adaptive reuse projects
addressing sustainable design in their con- have achieved certification. They range in
struction and operations, 12 percent indi- size from 25,000 square feet to 500,000
cated it was a “top priority,” while another square feet—in the second wave of regis-
48 percent indicated they were “looking for tered projects, many are in excess of a
affordable solutions” (Helmer 2006). This million square feet—are geographically
year, in a survey conducted by Health Facili- dispersed, and are located in urban, sub-
ties Management and ASHE, more than 50 urban, and rural settings (Guenther and
percent of 600 respondents indicated they Vittori 2008; USGBC 2008).
were using the Green Guide or LEED on In terms of financial metrics, these
some of their projects (HFM and ASHE green building projects are finding
2008). At the end of 2006, there were diverse and unique mechanisms to
approximately 170 LEED-registered health- resolve the inherent tension between
care projects representing more than 29 cost and quality and trade-offs between
million square feet of construction; only 12, capital and operating costs. Dell Chil-
C O M M E N T A R Y
including Boulder Community Hospital, dren’s Medical Center of Central Texas,
had achieved certification. In April 2008, for example, entered into a long-term
barely 16 months later, LEED-registered pro- energy purchase agreement with Austin
jects have doubled to 340, with 30 having Energy, which constructed and operates
achieved certification (USGBC 2006, a combined heat and power plant facility
2008). Healthcare continues to represent that provides both thermal energy and
approximately 2 percent of total registered electricity. By eliminating $6 million in
and certified projects, but the U.S. Green building infrastructure (the building
Building Council is anticipating a major requires no central plant), the hospital
increase in registration following the launch was able to invest in other energy effi-
of LEED for Healthcare in early 2009, ciency measures and sustainable build-
building on the success of the Green Guide. ing features—and hopes to become the
Collectively, pioneers and early first LEED-Platinum acute care facility in
adopters of green building practices have the United States. The impact on its cap-
reported energy demand reductions rang- ital budget: none. Overall energy
ing from 15 to 30 percent, potable water demand reduction: 45 percent (Guenther
usage reductions in the range of 30 per- and Vittori 2008).
cent, successful integration of local and At the Boston Design for Health Sum-
regional materials palettes alongside a mit in 2004, hospital chief financial offi-
host of environmentally preferable mater- cers agreed that economic models must be
ial choices, and improved indoor air qual- developed to recognize the cost/quality
ity through enhanced ventilation and trade-off, and healthcare organizations
occupant controls, low-emitting materials, need to be creative in finding incremental
and an increased focus on using more capital to invest in strategies that deliver
natural light and connecting to nature long-term operational savings. Early
(often through the integration of outdoor adopters have been creative in defining
places of respite, or healing gardens). simple acceptable payback periods or
While the majority of LEED-certified pro- return-on-investment criteria, have
Figure 1 Tiered Strategies of Environmental buildings provide financial benefits that

Performance traditional “brown” buildings do not.
Tier 1: Meet minimum local, state and Why Isn’t Everyone Doing It?
national environmental regulatory compli- Transformation is work. As the authors in
ance requirements this issue illustrate, change occurs one
program at a time, one project at a time,
Tier 2: Move beyond compliance to mea- building upon each success to achieve
sures that save money both measurable and documentable
Tier 3: Those informed by the inextricable improvement. Ted Schettler, MD (2001),
link between environment and human science director of the Science and Envi-
health move beyond both compliance and ronmental Health Network, identified
monetary savings, with a long-term plan to three tiers of performance evolving in
reduce environmental footprint—a triple hospitals (see Figure 1). Tier 1 facilities
bottom-line approach wait for regulation that compels them to
act; Tier 2 embrace those that deliver
monetary savings; and Tier 3 will make
the broader connections between ecology,
accessed local public incentive programs economy, and equity to embrace a broader
to offset capital premiums, or have been set of goals and strategies.
the beneficiaries of philanthropic gifts that Clearly, not every hospital or healthcare
launch their green building initiatives. system is Tier 3. Boulder Community and
Industry-wide, there is St. Mary’s demonstrate how hospitals can
“We desperately need to no conclusive data that engage in a journey that evolves to Tier 3
redesign our organizations green buildings cost more. over time. At the same time, issues of
to rekindle a commitment In the Cost of Green Revis- organizational culture, metrics, knowl-
ited, cost consultants Davis edge, and regulation present roadblocks to
to healing, hope,
Langdon (2007) revisited engagement.
optimism, innovation their 2003 study that con- Architect Kirk Hamilton and organi-
and creativity.” cluded there was no corre- zational change consultant Robin Orr
lation between (2005) observe: “We desperately need to
construction cost and level of sustain- redesign our organizations to rekindle a
able design features, although there is commitment to healing, hope, opti-
great variation in the cost of buildings mism, innovation and creativity.” The
within a sector, and even within the feature article institutions have achieved
same building program type. They con- some measure of this through environ-
cluded: “Many projects achieve sustain- mental improvement programs and
able design within their initial budgets, green buildings. However, green build-
or with very small supplemental funding and operation is about mind-set
ing.” Further, “the cost per square foot change—organizations that can effec-
for buildings seeking LEED certification tively negotiate change and innovation
fall into the existing range of costs for stand a better chance of success.
buildings of similar program type” (BDC There is a strong need for easily
2006). Finally, they concluded, green understood tools that reliably measure
consumption—for energy, waste, water, What Lies Ahead?

and materials and processes. The lack of Imagined futures are always more about
standardized measures—pounds of waste where we have been than where we are
per adjusted patient day, for example— going. The challenge for all of us is to look
that allow hospitals to track and bench- back at history but focus on the path
mark performance against peer ahead. There seems to be no question that
institutions is an obstacle to more wide- our future depends upon this vision. The
spread adoption of specific goals. Two green tsunami will continue to strengthen
new nonprofit organizations have as public policy aligns and comes to bear
emerged to fill this need—The Global on the sector through mandatory green
Health and Safety Initiative, working in building requirements and carbon taxation.
conjunction with Practice Greenhealth, is The challenges ahead are daunting: carbon
developing a series of audit tools and an neutrality, toxic-free, water-balanced, and
ecohealth footprint toolkit. zero waste are already emerging as the
Healthcare faces the challenges of a BHAGs (big hairy audacious goals) of sus-
system of regulation based on technol- tainable healthcare (Guenther and Vittori
C O M M E N T A R Y
ogy mandates rather than performance 2008). While this may seem an impossi-
standards. The industry must rigorously ble undertaking for an industry with so
examine innovative ideas and overcome many fundamental economic, occupa-
regulatory challenges to improve energy tional, regulatory, and safety challenges,
performance and begin to embrace sus- healthcare leaders are nonetheless
tainable ideology as an essential compo- embarking on this journey.
nent of resilience and passive As important local employers and ser-
survivability. Examples like the displace- vice providers, the healthcare industry is
ment ventilation study now in develop- uniquely positioned to support the resur-
ment—a partnership between Kaiser gence of support for local economies.
Permanente, Oakland, California; Part- Recent changes in the Internal Revenue
ners HealthCare, Boston; and Provi- Service definition of “community benefit”
dence Health and Services, Portland, are increasing the ability for healthcare
Oregon—are the cornerstone of regula- organizations to invest in sustainable pro-
tory innovation. grams that benefit community health as
Finally, it’s a matter of knowledge and part of maintaining their nonprofit status.
experience. The market is moving so As Gary Cohen (2006) notes, “hospitals
rapidly it quickly overtakes the core can situate themselves within the ecology
knowledge and capability of well- of their communities and act as a force for
intended healthcare professionals, healing.”
administrators, and their design and The sector should not need to argue
operations teams. Educational forums, that delivering high-quality healthcare
roundtables, and focused learning com- requires excess waste production and
munities—aided by web-based tools— energy usage—or that saving lives is
are necessary to move information and somehow outside of broader ecosystems
build collective knowledge and experi- and ecological concerns. According to Sus-
ence that can accelerate the adoption of tainable Healthcare Architecture, “The
these programs. healthcare industry is in a pivotal position
to lead the twenty-first century reintegra- Corvalan, C., S. Hales, and A. McMichael. 2005.
tion of environment, health, and economic Health Synthesis Report of the Millennium
Ecosystem Assessment. Geneva: World Health
prosperity. By critically reinventing the
Organization.
hospital as a regenerative place of healing, Davis Langdon 2007. Cost of Green Revisited: Reex-
marshalling purchasing power, and mod- amining the Feasibility and Cost Impacts of Sus-
eling health and wellness within a society tainable Design in the Light of Increased Market
in critical need of alternatives to fast food Adoption. http://www.davislangdon.com/USA/.
and retail culture, the healthcare industry Guenther, R. and G. Vittori. 2008. Sustainable
Healthcare Architecture. Hoboken, NJ: John
can signal a new relationship to healing
Wiley and Sons, Inc.
and health” (Guenther and Vittori 2008). Guenther, R., G. Vittori, and C. Atwood. 2006.
The hospitals in this issue, in concert “Values Driven Design and Construction:
with a growing number of others, are act- Enriching Community Benefits Through
ing as if everything they do matters and Green Hospitals.” In Designing the 21st Century
makes a difference. To paraphrase Hospital: Creating Safe and Healthy Environ-
ments for Patients and Staff. Concord, CA,
Michael Pollan (2008), they have begun
Arlington, VA, and Princeton, NJ: The Center
to heal the split between what they believe for Health Design, Healthcare Without Harm,
and what they do, to commingle their and Robert Wood Johnson Foundation, Sept.
identities as consumers, industries, and http://www.healthdesign.org/research/reports
citizens. They are exerting both upstream /documents/CHD_GuentherVittoriAtwood_ed
leverage on their supply chains, and it_v2.pdf.
Hamilton, D. K. and R. D. Orr. 2005. “Cultural
downstream influence on their employees
Transformation and Design.” In Improving
and patients. Through their green con- Healthcare with Better Building Design, ed. S. Mar-
struction and operations initiatives, they berry, 145. Chicago: Health Administration Press,
demonstrate a broad commitment to Hansen, Jim. 2006. “The Threat to the Planet.” The
more than high-quality patient care—they New York Review of Books, July 13.
are committed to saving lives and improv- Health Facilities Management (HFM) and American
Society for Healthcare Engineering. 2008.
ing health without undermining ecosys-
“2008 Hospital Green Construction Survey;”
tems or diminishing the world. unpublished data.
Helmer, S. 2006. “FacilityCare, 2006 Operations
References Survey.” www.facilitycare.com
American Institute of Architects (AIA). “The 2030 Orr, David. 2004. The Nature of Design, 29. New
Challenge.” www.2030challenge.org. York: Oxford University Press, Inc., .
American Society of Healthcare Engineering Pollan, Michael. 2008. “Why Bother?” The New
(ASHE). 2002. “ASHE Green Healthcare Con- York Times Online, April 18.
struction Guidance Statement.” www.ashe.org. Schettler, T., 2001. “Environmental Challenges and
Building Design and Construction (BDC). 2006. Visions of Sustainable Healthcare.” Presented at
“White Paper on Sustainability,” November. CleanMed Conference, Boston. www.sehn.org
http://www.bdcnetwork.com/article/ca6390371 U.S. Energy Information Administration (EIA). 2007.
.html Commercial Buildings Energy “Consumption
Cohen, G. 2006. “First Do No Harm.” In Designing Survey.” http://www.eia.doe.gov/emeu
the 21st Century Hospital: Creating Safe and /cbecs/pba03/intro.html.
Healthy Environments for Patients and Staff. Con- U.S. Green Building Council (USGBC). 2006,
cord, CA, Arlington, VA, and Princeton, NJ: The 2008. www.usgbc.org.
Center for Health Design, Healthcare Without World Wildlife Fund International, Zoology Society
Harm, and Robert Wood Johnson Foundation, of London, and Global Footprint Network, 2006.
September. Living Planet Report 2006. http://www.panda.org.
The Challenge of Sustainable

Hospital Building
B Y D. K IRK H AMILTON
Fe w t o p i c s a r e as timely as discussions of our shared sustainable future,

and there are few settings more difficult to design for sustainability than hos-
pitals with their critical functions, continuous operation, constant energy con-
sumption, huge demand for water, and enormous generation of waste. It is
almost a cartoon caricature to say that the gargantuan volume of dangerous
and toxic wastes constantly spewed out of our hospitals is making the commu-
C O M M E N T A R Y
nities and environments around them sick, and so to wonder about the irony
that to some degree they are probably creating their future clientele.
Boulder Community Hospital, Boulder, Colorado

David Gehant lets us know early in his piece on Boulder Community Hospital
that grassroots activity by environmentally conscientious employees spurred the
hospital’s involvement and commitment to environmental principles. These are
folks from a progressive college community in Colorado with an activist history.
Management’s decision to develop a volunteer “green team” and the actions that
followed began to align the goals of the organization with the goals of its employ-
ees. The decision to hire a full-time sustainability coordinator to develop and
maintain environmental initiatives strikes me as forward thinking and relatively
rare in the industry. Following the decision to support the bottom-up initiatives
of the staff, board approval of the Statement of Principles of the Environment
completed the process of endorsement at every level of the organization and
allowed the environmental attitude to permeate the culture. This strikes me as
an important lesson for organizations wishing to emulate Boulder Community
Hospital’s success.
D. Kirk Hamilton, FAIA, FACHA, is an associate professor of architecture at

Texas A&M University.
D. Kirk Hamilton • 33
Its Statement of Principles of the Envi- place to capture the kinds of data that Boul-
ronment deals with waste reduction, waste der Community Hospital has collected to
disposal, recycling, nonrenewable document its sustainability performance. It
resources, toxic emissions, alternative is said that one can’t manage anything that
transportation, purchase of recyclable and is not measured; if so, healthcare organiza-
reusable products, water conservation, and tions must learn to measure new indica-
commitment to disclosure of incidents of tors of stewardship, such as gallons used in
environmental harm. While the list is irrigation, amounts of disposables, pounds
impressive and laudable, I wondered why of red bag waste, or tons of landfill.
energy consumption didn’t appear. By the Boulder Community Hospital is a sys-
conclusion of Gehant’s paper, it is obvious tem of facilities, one of which is the new
that attention to energy use became impor- and well-documented Boulder Commu-
tant to the organization and nity Foothills Hospital, which earned
Boulder Community that it received significant LEED Silver Certification. Another is the
Hospital makes a strong results in that area. older main Boulder Community Hospital
business case for Gehant’s documentation in Boulder. It would be interesting to be
of the system’s results is able to see a breakdown of the numbers
enlightened healthcare
extraordinary. It is recycling provided at the different sites in the sys-
organizations. 500,000 pounds per year, tem. Are virtually all the initiatives and
saving more than savings at the new site? Do each of the
$200,000 per year in surgical instrument sites recycle a similar percentage of mate-
wraps and instrument reprocessing, and rials used in the hospital? Are there signif-
generating more than 100 kilowatts from icant differences in the waste reductions at
solar panels. In 2004 it was able to docu- the different sites? What portion of the
ment saving more than 1.5 million gallons energy use and energy savings occur at the
of water, nearly a million kilowatt-hours of different sites? Can one achieve dramatic
energy, 1,779 cubic yards of landfill, and results in existing buildings that match the
13,500 pounds of air pollutants for which kinds of results gained in a new building?
it won the Eco-cycle Award. My naïve assumption is that it is harder to
Boulder Community Hospital makes a obtain spectacular savings in older build-
strong business case for enlightened ings. If there are differences, it would be
healthcare organizations. The numbers instructive to know what the system is
and resulting savings from its decision to doing to spread the positive behaviors and
“go green” would seem to tickle the fancy positive results to other sites.
of any chief financial officer at any hospi- Gehant’s success story is exciting and
tal. I would have liked some additional encouraging to all of us who hope to experi-
comments from the author about what ence a more sustainable future for health-
kind of effort is required to gather this sort care organizations. I am, however, left with
of data. While hospitals are awash with a few questions. I wonder what the system
more data than any reasonable manager found to be the simplest and most effective
might need, and under regulatory obliga- quick wins, and which were the most diffi-
tion to report practically everything associ- cult to achieve. It might have been espe-
ated with the services they provide, few cially useful to learn what barriers at
healthcare organizations have a system in existing facilities were most difficult to
overcome, as compared to what was possi- began to address issues related to the hos-
ble in a new building constructed with the pital property, which led to a nationally
intent to be more sustainable. I am recognized storm water management sys-
impressed with the spectacular results from tem. A new director of environmental ser-
Boulder Community Hospital, and would vices led efforts to recycle, reduce waste,
have enjoyed more explicit advice that could and conserve energy.
have given me a deeper understanding of Coller and Grunseth share a litany of
the hard work required to make it a reality. successful results. I found myself incredu-
After all, what is really important here is lous at the report of an overall recycling
whether this can be accomplished else- rate of 31.5 percent by 2006, which had
where. I feel certain that other healthcare grown to 40 percent in 2007. The authors
organizations that share Boulder’s commit- contend that a typical hospital is doing well
ment to environmental stewardship and are to recycle 25 percent, according to Hospi-
prepared for the demanding work required tals for a Healthy Environment (H2E).
can achieve similarly dramatic results. They explain that in 2007 St. Mary’s recy-
cled more than 163 tons of waste material.
C O M M E N T A R Y
St. Mary’s Hospital Medical Its innovative programs, like recycling
Center, Green Bay, Wisconsin medical waste suction canisters, to name
Jim Coller and Annette Grunseth tell only one example, are superb models for
another story of environmental success that others to emulate, and the authors openly
springs from the stewardship obligations of share the lessons they have learned.
the Hospital Sisters Health System and the One of the biggest lessons from St.
teachings of Christ, St. Francis, and St. Mary’s seems to be its decision to partner
Clare, who believed in “reverence for the with anyone who was willing, and to make
earth” and all living creatures. The Hospital especially fruitful use of gifts and pro-
Sisters required every hospital in its system grams such as the Focus on Energy grants
to integrate environmental standards into to help purchase energy-saving equipment.
its facilities and communities. St. Mary’s Its community program to exchange digital
already had a history of brainstorming con- thermometers for mercury thermometers
cepts and trying new ideas. With the sup- must have paid off in goodwill while it pro-
port of the local board, its Environmental tected the community.
Statement for St. Mary’s Hospital Medical The authors provide a helpful set of sug-
Center declared its reverence for the earth gestions for others who intend to follow
and recognition that protecting the environ- the environmental path they have pio-
ment “is critical to our community’s long- neered: engage the ownership, partner
term health.” It states its commitment to with community leaders, find more part-
the environment and implementing new ners, tell the story, start with small steps,
initiatives annually. and conduct environmental audits. The
Environmental activity at St. Mary’s issue of audits seems to be a bit too quickly
began more than two decades ago with glossed over in the sense that understand-
employee- initiated projects to clean up ing where the organization stands is vital
the river and bay, begin recycling at a local to the decisions that must be made to take
museum, and make donations to food the organization to a new and better place.
pantries. A “Green Team” formed in 1996 I would imagine that most organizations
D. Kirk Hamilton • 35
starting this activity would need consider- in some fashion that it chose to do it
able coaching to perform the types of envi- because it was “the right thing to do.” It is
ronmental audits needed to guide their interesting to contrast Boulder’s activist
subsequent actions. Bills from utility com- employee beginnings to St. Mary’s require-
panies tell the organization how much ment from the system’s faith-based spon-
water, electricity, natural gas, sors. A commitment to the environment
Commitment to the and heating oil is used, but can begin at the grassroots or the gover-
community’s environmental auditing where and how they nance level, but for environmental initia-
health and stewardship of are used in order to reduce tives to become a success, the commitment
consumption requires another must spread to the entire organization and
valuable resources seems
level of analysis. Every hospital infuse the culture. Each organization
to fit comfortably within will have a community rela- adopted a statement, although quite differ-
the mission of every tions staff able to manage and ent, that helped spread a shared under-
healthcare organization. promote public campaigns, standing of the goal to the members of the
but few will have the skills and larger organization. Each organization had
expertise on staff to assess the organization’s an energetic champion—the sustainability
environmental impact and confidently lead coordinator at Boulder and the director of
the change initiatives. A common thread in environmental services at St. Mary’s. Both
these stories might be the need for the orga- examples feature a guiding coalition in the
nization and its champions to educate form of green teams. Each began with
themselves about what can be done. smaller steps and over time moved to larger
and more comprehensive initiatives. Both
Conclusion proudly tell their stories publicly in a way
Together these articles make a strong case that helps consolidate their gains, embed
for more aggressive environmental action the culture of sustainable practice, and build
on behalf of hospitals and healthcare orga- momentum for the next initiative. I believe
nizations. I sincerely applaud them both it is fair to observe that neither accom-
for their role as exemplars for the industry plished it all at once, and both would tell us
and hope their stories will spread widely. they are not through improving.
Both have obtained notable results in recy- As the early adopters show us the way, I
cling, reduction of waste, protection from sincerely hope the mainstream of the
toxic chemicals, conservation of energy, healthcare industry will rapidly grasp that
conservation of water, and considerations organizational self-interest will be served
of sustainability associated with construc- by a genuine commitment to conserva-
tion of their facilities. Each used a wide tion, environmental impact, and sustain-
array of programs to achieve its overall ability principles. Commitment to the
impact. Their investment in environmen- community’s environmental health and
tal initiatives has resulted in positive finan- stewardship of valuable resources seems
cial returns. I am especially pleased to to fit comfortably within the mission of
note the numbers and frequency of tours every healthcare organization. Thanks to
they conduct to share with others what Gehant, Coller, and Grunseth, we have evi-
they have accomplished and learned. dence that “doing the right thing” can
These two organizations have exhibited work to the benefit of the organization, the
the courage to try something before others community, and this precious green and
had shown it to be possible, each indicating blue planet we share.
Greening Healthcare: 21st Century

and Beyond
B Y A NNA G ILMORE H ALL
We a r e i n u n d a t e d with news reports, advertising campaigns, and

media blitzes about the need to go green. “Going green” has become the buzz
phrase of the new millennium. If manufacturers aren’t green, then their prod-
uct just isn’t “in.”
Healthcare hasn’t been left out of this trend. We have been steadily making
changes to protect the health and safety of patients, as well as provide for a
C O M M E N T A R Y
healthier planet. Many hospitals started by making small changes that ulti-
mately led to a big difference. Others, such as the two hospitals profiled in this
issue, began greening their hospitals from the very start.
By taking a good operational look at how care is delivered, enlisting staff vol-
unteers to serve on green teams, and working with suppliers, Boulder Com-
munity Hospital in Colorado and St. Mary’s Hospital Medical Center in Green
Bay, Wisconsin, are outstanding examples of how more and more hospitals are
going green—from design and construction of their buildings to greener oper-
ations and more sustainable purchasing.
These two hospitals have been at the forefront of the greening healthcare
movement and have incorporated an “environmental mind-set” in their plan-
ning and decision-making. As we move ahead in the 21st century, what future
steps will other hospitals need to take to protect not only patients and staff, but
the planet?
Anna Gilmore Hall, RN, CAE, is the executive director of Health Care Without
Harm in Arlington, Virginia.
Anna Gilmore Hall • 37

Greening the Supply Chain • safer and healthier for patients, workers,
Healthcare providers always face the chal- and the environment;
lenge of providing high-quality care in an • high in recycled content;
ever-changing industry. Many of the key • packaged more efficiently; and
changes these days deal with the environ- • fragrance-free.
ment. For example, research has long
linked chemical contaminants in the envi- Boulder Community’s EPP program
ronment with a high inci- clearly demonstrated that purchasing
Hospitals purchase dence of disease. And now green supplies meant selecting items
thousands of different increasing scientific evidence that use less wasteful packaging. The
products each day, and shows that chemical exposure hospital successfully collaborated with
in healthcare products and manufacturers to modify their process in
often may not know order to eliminate bulky packaging. In
devices is having an impact
which products and on the health of patients and doing so, the hospital achieved its first
devices contain toxic healthcare providers (Health- big cost reduction. The Sterile Process-
care Environmental Resource ing department switched to hard,
components.
Center 2008). reusable containers instead of plastic
Consider the number of items in a wrap—reducing expenses in excess of
hospital that contain potentially harmful $100,000 per year.
chemicals: cleaners and disinfectants, From eliminating unnecessary packag-
medical devices with phthalates, furniture ing to seeking substitutes for mercury-
with flame retardants and formaldehyde, and polyvinyl chloride (PVC)-containing
solvents in labs, and countless others. products, it’s clear the hospital purchasing
Patients and staff are exposed daily to a decisions do have a major impact in pro-
stew of chemicals. viding healthcare without harm as well as
Hospitals purchase thousands of differ- positively impacting the bottom line.
ent products each day, and often may not
know which products and devices contain Managing the Waste Stream
toxic components. And product toxicity is Hospitals on average generate more than
only the beginning. Other green purchas- 5 million tons of waste each year (Bran-
ing issues include the amount of pollution nan 2006). In the past, many hospitals
created and the energy consumed in the simply dumped all waste together, from
manufacture of the product and how recy- reception area trash to operating room
clable it is. Boulder Community and St. waste, and burned it in incinerators. Not
Mary’s have implemented environmen- surprisingly, these incinerators often
tally preferable purchasing (EPP) practices spewed highly toxic dioxin, mercury, lead,
to help identify safe and environmentally and other dangerous air pollutants.
smart products. Environmentally prefer- While medical waste treatment and
able products are generally: waste disposal constitute a multibillion dol-
lar industry, most hospitals are unaware of
• less toxic; the amounts of waste they generate, or
• minimally polluting; even how much they spend annually on
• more energy efficient; disposal, not to mention the environmental
impacts created in the process.
Waste disposal practices produce green- Greener Hospitals

house emissions, along with other environ- Environmental exposures in the hospital
mental pollutants. Anaerobic decomposition environment can lead to compromised
of organic matter in landfills produces health for both patients and healthcare pro-
methane gas (although landfills are also car- viders. Some of these issues arise from hos-
bon sinks), and certain types of waste inciner- pital design and materials used in building
ation emit N2O and CO2. Food and organics healthcare facilities. Did you know that 75
are the second largest constituent of the percent of all PVC is used in construction?
healthcare waste stream, comprising close to Studies have linked interior PVC exposure
20 percent of the solid waste volume in med- to asthma (Bornehag et al. 2004). Other
ical facilities with food service operations exposures are tied to day-to-day hospital
(Brannan 2006). A comprehensive approach operations, such as the use of toxic cleaners
to hospital waste management includes diver- and pesticides in healthcare facilities.
sion of construction and demolition debris, Pharmaceuticals are also emerging as a
material recycling, composting of food waste, major environmental and public health
reuse, and donation. This approach reduces threat that until recently was virtually
C O M M E N T A R Y
pollution and lowers demand for virgin unknown. Many pharmaceuticals contain
resources, which further mitigates emissions hormone-disrupting chemicals, which
from resource extraction, manufacturing, and migrate from hospitals and homes to bodies
product transportation. of water. This can damage aquatic life and
Since 2000, Boulder Community’s wind up in our drinking water. Additionally,
comprehensive waste reduction efforts many drugs contain compounds that are
have diverted more than 3 million pounds persistent in the environment or bioaccumu-
of material from landfills. And the late in the food chain. As more drugs are
hospital’s recycling program has grown consumed by Americans, more of these bio-
threefold, reducing waste by 500,000 logically active agents are building up in our
pounds per year. environment. More than 100 pharmaceuti-
St. Mary’s has increased its overall cals or their metabolites have been found in
recycling rate for all waste streams, and water bodies in Europe and the United
as of 2007 the rate has grown from 31.5 States, some of them in drinking water sup-
percent to 40 percent. This success has plies (Donn, Mendoza, and Pritchard 2008).
meant that 40 percent less trash is sent As the need to address human-caused
to the landfill. Last year, St. Mary’s pro- climate change becomes ever more
duced a total of 806,515 pounds of waste urgent, it has become clear that the health-
materials, and recycled 327,536 pounds care industry has a critical role to play in
of materials that went to other sources or climate change mitigation. Energy usage
was recovered by other companies. And, in medical facilities is highly intensive.
in many cases, these materials were Many healthcare facilities occupy aging,
turned into other “new” products. energy inefficient buildings; many also
As demonstrated by Boulder Commu- operate around the clock, 365 days a year.
nity and St. Mary’s, minimizing waste not In total, healthcare spends $8.3 billion on
only protects people and the environment, energy every year (Energy Star 2007a).
but it can save hospitals substantial Medical facilities consume large amounts
amounts of money. of other resources as well—one medical

center in the San Francisco Bay Area gen- relationships with local communities. They
erates an average of six tons of waste every are promoting transparency in food pro-
day (Health Care Without Harm 2008a). duction practices and advocating for public
In 2005, each square foot of healthcare policies supportive of localized, sustainable
space cost an average of $2.15 in electrical health food systems. Following are a few
and natural gas expenses (American Hos- examples of what some hospitals are doing
pital Association 2004). Some of these (Health Care Without Harm 2008b):
costs can be addressed by energy-efficiency
upgrades and smart design. Until recently, • Oregon Health and Science University
hospitals paid little attention to the energy Hospital has opened a healthy conve-
performance and efficiency nience store for staff and visitors called
As of May 2008, 122 of their building infrastruc- It’s All Good. Its products include
hospitals had signed the ture. New York-Presbyterian organic and locally grown food, and
Health Care Without Harm Hospital has worked with products free of hormones, high fruc-
the Environmental Protec- tose corn syrup, trans-fat, and artificial
(HCWH) Healthy Food in tion Agency’s (EPA) Energy colorings or dyes. And the store
Health Care Pledge. Star program since 2003, emphasizes food with high nutrient
comprehensively retrofitting content.
its HVAC system, lighting, building con- • Dominican Hospital in Santa Cruz, Cali-
trol system, and central plant and educat- fornia, buys produce from a local,
ing staff about energy conservation minority-run organic farm and has an
strategies. It has pursued Leadership in on-site garden that provides produce and
Energy and Environmental Design (LEED) flowers for the facility.
certification for several buildings. By • Catholic Healthcare West (CHW) adopted
2005, the hospital had reduced building a food and nutrition services policy state-
energy use by 11 percent system wide; ment that reads: “CHW recognizes food
managers believe the projects imple- production and distribution systems have
mented save the hospital $1.77 million wide ranging impacts on the health of
every year (Energy Star 2007b). people, their communities and the
As the environmental and health effects ecosystems in which they live.…Healthy
of global warming become more pressing, food is defined not only by nutritional
healthcare, like other major sectors, will quality, but equally by a food system
need to reduce overall energy use and which is economically viable, environ-
move to cleaner energy sources. In keeping mentally sustainable and which supports
with the dictum of “First, do no harm,” human dignity and justice.…CHW
they have an innate responsibility to do so. aspires to develop a healthy food system.”
Hospital Food Although it is clear that these changes

Another area environmentally savvy hospi- are essential, it is fitting that healthcare
tals can improve is their food service. Hos- is at the lead in building models for a
pitals around the United States are healthier future. As of July 2008, 128
developing new models of food supply and hospitals had signed the Health Care
distribution, and are favorably changing Without Harm (HCWH) Healthy Food in
Health Care Pledge. The pledge is a edly been recognized for their leadership
framework that outlines steps to be taken in greening healthcare. The case studies
by the healthcare industry to improve the contained in this issue have clearly demon-
health of patients, communities, and the strated that by making simple changes, a
global environment. hospital can create long-lasting benefits.
Education Is Key Save the Environment and

With its oath of “First, do no harm,” the Bottom Line
healthcare institutions and the industries Hospitals are learning they can save the
that support them have a special responsi- environment as well as the bottom line. In
bility to ensure that their operations are 2000, the EPA reported that every $1 of sav-
not major sources of chemical exposure ings in operations is equivalent to $20 of
and environmental harm. But, until new revenue for the healthcare system
recently, healthcare professionals and hos- (Reed 2000). That is strong incentive for
pital administrators were unaware of their those in the hospital C-suite to approve such
contribution to chemical contamination expenditures. A cost-benefit analysis of
C O M M E N T A R Y
and the consequent societal disease bur- green buildings for the state of California
dens. The educational curriculum for determined that “a minimal upfront invest-
physicians, nurses, and hospital adminis- ment of about 2 percent of construction
trators does not provide the latest scien- costs typically yields life-cycle savings of over
tific information on the environmental 10 times the initial investment” (Kats
consequences of healthcare delivery. 2003a).
During the past ten years, however, A study by the David and Lucille
we’ve seen the information gap begin to Packard Foundation found that the cost dif-
close. The healthcare field has expanded its ferential between a certified LEED hospital
definition of health to include environmen- and one built the traditional way was less
tal health—the body of scientific evidence than 1 percent (Kats 2003b). When the cost
that links the health of the environment to of environmental pollution was taken into
the incidence of human disease. This has account, the LEED-certified building cost
led to the emergence of HCWH, a global less over a period of 20 years.
coalition of more than 500 organizations in A green hospital building not only
55 countries working to transform the saves energy—it also can improve patient
healthcare industry without compromising health and outcomes. By allowing more
patient safety or care, so that it is ecologi- natural light into rooms, installing envi-
cally sustainable and no longer a source of ronmentally friendly wall and floor cover-
harm to people and the environment. ings, and using green cleaning products,
In response to the changing regulatory hospitals often see the following benefits:
climate, many hospital administrators have
chosen to reduce waste and adopt safer • Fewer medication errors
waste disposal and treatment technologies. • Decreased pain medication for some
Both Boulder Community Hospital and St. patients
Mary’s, with their pioneering implementa- • Shorter patient stays/quicker recovery
tion of sustainable strategies, have repeat- times

• Increased staff retention • Support the creation of the infrastruc-

• Lower rates of occupational asthma ture necessary to escalate and improve
• Improved patient outcomes environmental programs.
• Hire a sustainability director to lead and
The Role of Healthcare coordinate environmental initiatives
Executives throughout the organization.
Boulder Community Hospital and St. • Understand where your hospital is
Mary’s Hospital Medical Center are on starting from and develop a baseline of
top of the green wave, and many other information.
hospitals are contributing • Direct staff representing materials man-
The hospital of the 21st to the greening of health- agement/purchasing to purchase more
century will be a place of care. All share one impor- environmentally preferable products and
healing that protects not tant common thread that is services.
integral to their success: • Integrate environmental considerations
only the health of its senior-level engagement, into any new building design, construc-
patients, staff, and the support, and leadership. tion, or hospital renovation project.
general public, but also Executives from each of • Direct marketing/public relations to create
the environment. these hospitals have played awareness of the hospital’s environmental
a critical role in helping commitment and achievements within
green hospital programs come to fruition the local community.
and become successful. • Track environmental performance met-
Healthcare executives and hospital rics each year against industry bench-
leaders now have two non-profit organiza- marks and report annually on progress.
tions that can help them achieve similar • Commit your healthcare organization to
results: Practice Greenhealth and the becoming a Practice Greenhealth partner.
Global Health and Safety Initiative • Apply for a Practice Greenhealth Envi-
(GHSI). ronmental Excellence Award each year to
Practice Greenhealth is a member- gain recognition for achieving annual
ship-based nonprofit organization com- environmental goals.
bining the experience of three powerful
initiatives to improve the environmental Healthcare executives will find them-
performance of the healthcare sector: selves in good company in the GHSI. This
Hospitals for a Healthy Environment initiative was launched in October 2007
(H2E), the Green Guide for Health Care, by executives of some of the leading
and the Health Care Clean Energy healthcare systems, nonprofit groups,
Exchange. Practice Greenhealth group purchasing organizations (GPOs),
(www.practicegreenhealth.org) has cre- government agencies, and others to make
ated a step-by-step guide for healthcare improvements in patient, workplace, and
executives that illustrates the actions they environmental health and safety.
can take. Some of these steps include: GHSI promotes safety and sustainabil-
ity in key areas of healthcare, and by exten-
• Announce senior-level support for envi- sion society. The organization uses
ronmental stewardship as part of your healthcare’s collective purchasing power to
organization’s community health mission. obtain safer and more sustainable products
and materials; emphasizes safer and into places that promote healing, while
greener practices; researches sustainabil- using their purchasing power to heal
ity and safety issues; and promotes public their communities and the planet.
and corporate policy to make those issues
priorities of healthcare.
References:
GHSI produced an Environmentally American Hospital Association. 2004. Healthcare
Preferable Purchasing (EPP) Policy, Energy Guidebook. Chicago: American Hospital
endorsed by systems and GPOs; created Association.
fact sheets for building materials; and Bornehag, C., J. Sundell, C. Weschler, T. Sigsgaard,
developed a searchable database of evi- B. Lundgren, M. Hasselgren, and L. Hagerhed-
Engman. 2004. The “Association Between Asthma
dence-based facility design practices (with
and Allergic Symptoms in Children and Phthalates
partner Center for Health Design). In the in House Dust: A Nested Case-Control Study,” Envi-
coming months GHSI also will release a ronmental Health Perspectives 112 (14).
custom-designed Eco-Health Footprint Brannan, L. 2006. Designing the 21st Century Hospi-
tool and an EPP specifications database to tal: Creating Safe and Healthy Environments for
assist systems and GPOs in assessing the Patients and Staff. Concord, CA: Center for
Health Design.
C O M M E N T A R Y
environmental aspects of products. For
Donn, J., M. Mendoza and J. Pritchard. 2008.
more information visit GHSI’s website: “Drugs Found in Drinking Water.” Associated
www.globalhealthsafety.org Press, March 11.
Energy Star. 2007a. “Energy Star for Healthcare.”
The Future of Green http://www.energystar.gov/index.cfm?c=healthc
Hospitals are.bus_healthcare.
______. 2007b “Energy Star Success Story: New York-
The hospital of the 21st century will be a
Presbyterian Hospital.”
place of healing that protects not only the http://www.energystar.gov/index.cfm?c=healthc
health of its patients, staff, and the gen- are.bus_healthcare_ny_presb_hospital.
eral public, but also the environment. Healthcare Environmental Resource Center. 2008.
Hospital design and operations will “Hazardous Materials: Overview.”
undergo a transformation in order to http://www.hercenter.org/hazmat/hazoverview.
cfm.
accomplish this goal. The hospital of the
Health Care Without Harm. 2008a. Addressing Cli-
21st century will support the local econ- mate Change in the Health Care Setting. Arling-
omy by purchasing an array of safe prod- ton VA: Health Care Without Harm
ucts and technologies. It will also become www.noharm.org.
the model for environmentally responsi- ________. 2008b. “Menu of Change: Healthy Food
ble institutions for every community. The in Health Care—A 2008 Survey of Healthy
Food in Health Care Pledge Hospitals.” Arling-
21st century hospital can situate itself in
ton, VA: Health Care Without Harm
the broader ecology of its community and www.noharm.org.
region and act as a healing force. Kats, Gregory. 2003a. “Green Building Costs and
In the 21st century, healthcare leaders Financial Benefits.” A report for the Massachu-
will come to understand that it is difficult setts Technology Cooperative, Westborough, MA.
to have healthy people on a sick planet. ________. 2003b. “The Costs and Benefits of Green
Buildings.” A report to California’s Sustainable
To heal their patients and safeguard the
Buildings Task Force, Sacramento, CA.
health of their staff, hospital leaders Reed, C. 2000. U.S. Environmental Protection
must recognize that they must also do Agency research on Energy Star hospital partners.
their part to transform their hospitals Unpublished data.

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FRONTIERS

Frontiers 25.1:20.4 8/13/08 1:13 PM Page i

11 Demonstrating Reverence for the Earth

33 The Challenge of Sustainable Hospital Building

37 Greening Healthcare: 21st Century and Beyond

Roche Diagnostics Corporation

VOLUME 25 • NUMBER 1 • FALL 2008

Frontiers of Health Services Management

I w a s d r i v i n g o n a country road the other day, the rain falling

Margaret F. Schulte, DBA, FACHE, is an associate professor in the Graduate Program in

Hospitals and the Environment

B Y D AVID P. G EHANT, FACHE

David P. Gehant, FACHE, is president and CEO of Boulder Community Hospital

Background Questions were raised. What is the

remodeling or construction occurs. It is Recognition

Employee Allegiance Reduction in surgical wrap $120,000

“I’m glad to have the chance to partici- Total Savings: $460,000

costly and creates too much waste. We Advice to Others Considering

12. Add/plan new initiatives. upon the participants. In our particular

Demonstrating Reverence for the Earth

B Y J AMES G. C OLLER , FACHE, AND

Su m m a r y • As a community hospital and a major employer, St. Mary’s

James G. Coller and Annette L. Grunseth • 11

Early Adopter Environmental Statement for

James G. Coller and Annette L. Grunseth • 13

Table 1 2007 Waste Stream Summary

Total Waste 478,979 General Trash

Shredded Confidential 102,218 Recycle

Total Recycle/Reuse 327,536 Recycle/Reuse

Giant Steps needed to diagnose and treat patients. One

James G. Coller and Annette L. Grunseth • 15

Table 2 Focus on Energy Project Expenses, Savings, and Grants

Project Total Cost Annual Energy Savings Grants Awarded

Desiccant dehumidifier $140,000 $28,375 $13,352

Boiler addition $ 175,000 $32,848 $16,824

Air handling unit $165,000 $9,270 $3,564

Replacement air $120,000 $9,431 $9,699

James G. Coller and Annette L. Grunseth • 17

recycling services to properly dispose of Demolition Recovery and

James G. Coller and Annette L. Grunseth • 19

Table 4 Where Our Recycled Equipment is Being Used

Thanks to a new, advanced computer Stretchers/mattress, stretcher with foot

James G. Coller and Annette L. Grunseth • 21

We are making positive changes about Environmental awareness and sustain-

James G. Coller and Annette L. Grunseth • 23

Why Should Healthcare Bother?

Why Should Healthcare Lead Health-Based Green Initiatives?

A third compelling reason to go green is of healthcare that has an impact. We may

Figure 1 Tiered Strategies of Environmental buildings provide financial benefits that

consumption—for energy, waste, water, What Lies Ahead?

The Challenge of Sustainable

Fe w t o p i c s a r e as timely as discussions of our shared sustainable future,

Boulder Community Hospital, Boulder, Colorado

D. Kirk Hamilton, FAIA, FACHA, is an associate professor of architecture at

Greening Healthcare: 21st Century

B Y A NNA G ILMORE H ALL

We a r e i n u n d a t e d with news reports, advertising campaigns, and

Anna Gilmore Hall • 37

Waste disposal practices produce green- Greener Hospitals

Anna Gilmore Hall • 39

Hospital Food Although it is clear that these changes

Education Is Key Save the Environment and

Anna Gilmore Hall • 41