Steps to establish sustainability best practices in clinical labs

By Yoav Einy Vizient Client Programs Director
Mellissa Nguyen Vizient Senior Program Services Manager

We've written extensively about the future of sustainable procurement in healthcare, and it's heartening to see there's an increased focus on developing more sustainable practices across the industry as a whole.

Sustainable procurement in clinical labs, however, remains in its infancy — but we can, and should, harness the potential of environmental stewardship to evolve current laboratory practices.

After all, laboratory services play a critical role in the healthcare ecosystem. According to the National Library of Medicine, approximately 70% of clinical decisions are based on an initial lab result that highly influences downstream medical care. Despite this crucial role, the lab is often overlooked when it comes to spend management.

Currently, clinical labs contribute to 4.4% of the world's greenhouse gas emissions and are responsible for more than 5 million tons of waste each year, largely due to electricity, gas consumption and waste production. Climate change is the greatest threat to global public health, with 10% of all emissions coming from the U.S. healthcare sector — meaning all of us must work together to identify and implement ways to improve sustainability in every aspect of healthcare.

What makes this tricky in clinical labs is the lack of sustainable best practices specific to this setting, which is why partnerships with organizations like My Green Lab are so crucial to enacting necessary changes.
So, where to begin?

Develop key strategies

The following are three steps that can help you make strides toward more sustainable labs.

1. Establish strong collaboration and communication: Clinical laboratories should ensure that sustainability principles are deeply integrated into their supply chain management, sourcing and procurement processes. This involves setting clear sustainability criteria; integrating that criteria into supplier codes of conduct, policies and procurement contracts; and fostering collaboration across departments.
2. Choose sustainable suppliers: Clinical labs should select vendors that prioritize sustainability in their offerings. This includes opting for products designed with ecofriendly materials and sustainable processes to reduce environmental impact. Vendors that offer product take-back and recycling initiatives can significantly contribute to sustainable lab practices.
3. Review and update standards: It's essential for clinical labs to periodically review and update standards and requirements to reflect the latest best practices in sustainable procurement. By staying informed about industry advancements and adjusting standards accordingly, labs can ensure they are aligning with the most sustainable practices.

There's a lot to consider for sustainability criteria, and it's fairly complex. Is there a resource that can make it easier?

The My Green Lab ACT EcoLabel program serves as a valuable tool for consumers, including clinical labs, by offering clear and verified information on the environmental impact of laboratory products. It enables informed decision-making for more sustainable procurement practices within the scientific community. In 2021, Vizient announced a partnership with My Green Lab to lower environmental impact in clinical laboratories. Kaiser Permanente also has included the ACT Eco Label as part of its environmentally preferable purchasing criteria for Lab products.

The ACT EcoLabel program was designed by scientists and procurement specialists to provide clear, third-party verified information about the sustainability profile of laboratory products. A third-party certification reduces the amount of data suppliers must fill out during a request for proposal (RFP), which can be cumbersome.

A key concern for many suppliers is how inconsistent sustainability questions are in RFPs. The adoption of an ecolabel helps reduce the cumbersome questionnaires, provides a consistent metric for sustainability for all lab products and helps suppliers identify areas for improvement.

The next step: Upgrade your practices in the clinical lab.

Ways to improve efficiencies and remove costs in labs — including how a demand management assessment of the hospital laboratory can help improve quality and cost reduction — were previously discussed in blogs by Vizient consulting directors Mark Tiemeyer and Walter Vallière and Vizient senior principal Akiva Faerber. They argued that one key strategy to achieve these goals involves eliminating unnecessary testing — for example, a national study found that testing for patients in the ICU increases over time, even as most results move closer to normal values. Unnecessary testing consumes limited labor and supply resources and increases the potential for additional (and costly) interventions, which can lead to reduced patient outcomes.

There are six steps you can take to eliminate unnecessary tests:

1. Delve into the analytics: Begin by evaluating which laboratory tests were used during a window of time (one year is a good place to start). Leverage available sources of such information like laboratory information system orders, reference lab usage, Hospice Item Set (HIS) reports or Vizient tools. My Green Lab's ACT Environmental Impact Factor Label can be used to identify the environmental impact factor for each product used in the tests.
2. Establish a governance structure: Once your analyses have identified areas of focus, a governance structure should be established consisting of physicians and scientists such as chief pathologists/chief science officers, microbiologists and chemists. The environmental impact needs to be quantified and made visible so that the group can discuss findings and develop recommendations.
3. Develop a formulary: The next step is to create a list of appropriate laboratory tests and who may order them, then include those in the computerized provider order entry (CPOE). You also might consider developing a laboratory formulary, which is analogous to the drug formulary maintained by a hospital pharmacy. The environmental impact must be made visible for each recommended formulary.
4. Define your policies: In addition to deciding the "what" and "how" of tests to be offered in the laboratory formulary, policies must be established that define what tests can be ordered and any limitations or restrictions. The environmental impact must be clearly defined and written, including those for sustainable procurement. Additionally, the My Green Lab Ambassador Program should be considered to educate staff on sustainability best practices.
   
5. Begin implementation: Implementation of best practices will vary according to each facility's governance around introducing changes to test ordering, but communication of the testing policy is essential in implementing any proposed changes. Frequently, medical executive committees are engaged to disseminate information, with follow up in specialized areas of focus — such as cardiology or genetics — and in other physician communications. Support of administration, quality, pharmacy, nursing, laboratory, IT and other staff is critical. 
6. Determine maintenance cadence: Regular reviews of ordering behavior, published literature and professional physician organization recommendations are crucial, and the environmental impact of each test should be regularly communicated and shared until sustainability becomes normalized.

By following these steps, organizations can achieve greater sustainability in their clinical labs — a move that helps to meet healthcare's most important goal of ensuring better human and environmental health while also allowing for increased efficiencies, quality and cost savings.