Q&A with Seattle Children’s Hospital Director of Environmental Services

Tell me about the green features and programs you have implemented at Seattle Children’s.

In 2006, Children’s became an active member of Hospitals for a Healthier Environment (H2E) which included participation in online seminars to learn more about green initiatives. During this time, I noticed the work of a partner at H2E and had done some groundbreaking work on medical waste minimization as Beth Israel Medical Center’s Medical Waste Manager. Seattle Children’s initial goals in 2006 included reducing waste and making Children’s mercury free.

Children’s has additionally followed Continuous Performance Improvement (CPI) methodologies for nearly a decade. As one of the goals from CPI projects was to eliminate waste, it fit right in line with the 2006 goals.

Waste in reference to CPI is used somewhat metaphorically for wasted parts of a process and can be a physical waste or essentially anything that doesn’t add value to the customer. CPI work is really all about defining a metric and continually measuring and monitoring those defined metrics to see if you are making progress.

I quickly realized there are many costs associated with reducing waste. For example, there’s a difference between solid waste and recycling or the common misunderstanding that recycling is free when it is not. Additionally, people assume hospitals produce a lot of medical waste and that the preferred method for dealing with this waste is incineration, but this is not true either.

From 2006 to 2007, we started to look at our waste overall and were able to start profiling our waste and recycling streams. We began using a scorecard to see a baseline of our waste and from this scorecard, we found that of all the materials we processed solid waste was about 65%, recycling about 24%, regulated medical waste about 10% and hazardous materials 1%. For perspective, the numbers in terms of percentages were fairly consistent with hospitals of Children’s size.

Throughout 2006 we started to work on basic recycling schemes which included developing and promoting signage, and monitoring recycling flows. During this time we were also approved to replace the hospital’s old cardboard balers with recycle auger compactors, which could compact materials on a 6-to-1 ratio. The compactor was a game changing moment for Children’s because it meant that we could go from a labor intensive process of breaking down cardboard, to a machine that pulverized and compacted paper and cardboard materials.

What other opportunities were there to reduce waste?

One of the most interesting issues in sustainability projects is once things start to happen you can’t stop the momentum. Our Operating Room (OR) group has done very impressive CPI work and the initial program in this division consisted of a very low tech CPI approach. OR staff positioned containers in the determined right locations to capture solid waste and recycle waste. The results of this on-going work has been impressive and the OR team was able to divert solid waste and recycling materials from the medical waste stream. In 2008, the OR diverted 38,000 pounds of solid waste and recycling from the medical waste stream and since the beginning of 2009 the OR team has diverted approximately 66,000 pounds of medical waste or approximately $63,000 in cost savings.

In 2008, Seattle Children’s continued our ambitious “Go Green” initiative along with a collaborative multidisciplinary sustainability committee to promote green programs and practices. We expanded our recycling programs to include all mixed recycle materials to make it easy to recycle. In 2008, we achieved a 32% overall recycling rate as compared to 24% in 2007.

On Earth Day 2008, Children’s finalized an agreement with a vendor to recycle our sharps containers which would eliminate 9,000 pounds of plastics from the landfill in 2008 (and estimated 18,000 pounds diverted for 2009).

Additionally, we implemented a single stream recycling program allowing us to recycle mixed materials into single blue recycle containers which allows us to divert a few more tons of materials each month from the solid waste.

In September 2008, we implemented a new pharmaceutical drug waste program. and we are the first hospital in the state of Washington to implement this comprehensive program that meets both compliance and the environmental intent to ensure that we will not pollute our waterways in an effort to protect our environment and human health.

Our 2008 waste management plan: recycled 450 tons of mixed recyclable materials (90 more tons of recycled materials compared to 2007) cardboard, paper, glass, and plastics, compost, recovered metals, including recycling 3 tons of batteries, 4,930 fluorescent lights, 2,599 printer toner cartridges, 17 tons of computers and electronic equipment, 3 tons of hazardous chemicals, and 50 gallons of kitchen grease was recovered to produce bio-diesel. In 2008, we shredded and recycled so much confidential paper we saved 4,780 trees from the paper mills. Through better sorting and segregating medical waste our OR diverted 38,000 pounds of solid waste and recycling from the medical waste stream. Overall by using better ways of identifying, single stream recycling, OR segregation of waste and recycle from medical waste, consuming less and using non-hazardous alternatives, or recovery options, Children’s reduced 3.5 more tons of hazardous waste in 2008 compared to 2007.

Do these green features improve quality of care and/or create healthier patients?

Healthcare facilities are always occupied with staff and patients, requiring cleaning, disinfecting, and maintenance procedures to be performed in proximity to patients and staff at all times. Hospitals use a host of different kinds of chemicals in the cleaning process. Chemicals typically found in these products can cause: headaches, asthma, burns, permanent eye damage, major organ damage, cancer and sensitization.

Our cleaning policy is designed to provide healthy environments, reduce environmental impacts, along with many other benefits. In general this policy aims to reduce chemical use, reduce toxic chemical levels, reduce building contaminants, minimize noise/vibration, environmentally preferred purchasing, minimize damage to building surfaces/prolong the life of building materials.

All contractors must provide their cleaning schedules and list of products in advance of working with Children’s. They must also show procedures or methods for high-level and medium-level disinfection as well as evidence of employee training and log books including the times Children’s areas are cleaned.

Are the green features cost saving or do they add more cost to the hospital in the short and long term?

One of the projects we are struggling with now is our pharmaceutical waste program. Currently, we are doing an excellent job in following the intent of the state policy entitled, “WA State Department Interim Pharmaceutical Waste Disposal.” We are also making sure our waterways are not polluted and are reducing costs in a very appropriate and responsible way.

Overall, Washington state’s policy is tough but also a model policy as each state adopts its own. Seattle Children’s has additionally been active in working with the State and our licensed vendors to get guidance on how to best implement the policy and providing inputs on how we can do a better job in processing this waste. I also know that direct clinical staff, including nurses and pharmacists, view this program with great importance and are doing well in following somewhat complex disposal rules. Since we work in a 24/7 dynamic environment, by the end of 2009 I am confident Children’s will have success on the cost issues and will continue to be win for the environment and also a win for reducing our costs.

I believe healthcare organizations have an obligation to help promote the health of communities, environment and exercise overall proven and prudent business practices and organizational stewardship. Seattle Children’s has taken this leadership role as we network with our colleagues at other regional hospitals (and at hospitals across the country). I’m encouraged we are using the CPI principles to promote best practices, to even leverage with suppliers and other businesses and to understand our operations, green and sustainability projects.

This is the strategy that has little to do with promotion and more to do with building upon relationships with our patients, families, staff, vendors, suppliers and colleagues. A strategy across the organization about committing to our ultimate goal that patients and families come first and that Seattle Children’s envisions “hope, care, cure” not as a slogan but as a real goal.

If you enjoyed this post, make sure you subscribe to my RSS feed!