Three Ways Sustainability Can Drive Immediate Cost Savings Across Health Systems

By Cristina Indiveri, Vizient Associate Vice President, Core Tenet Programs

Health systems are in an unenviable position when it comes to environmental sustainability. According to the New England Journal of Medicine, health systems, medical device manufacturers and pharmaceutical firms account for 8.5% of U.S. greenhouse gas emissions.

Clinical staff at hospitals work tirelessly tending to patients with chronic conditions like asthma and bronchitis. At the same time, the greenhouse gases emitted by hospitals exasperate those same cases. Moving away from fossil fuels can help. For example, by converting to 30% renewable energy, a 200-bed hospital in the Midwest using 7 million kilowatt-hours annually can avoid an estimated 52 health-related incidents per year.

To have healthier hospitals and communities, it is essential for health systems to devote more resources to sustainability. Because 80% of a hospital's carbon footprint is embedded in supply chain operations, cross-functional collaboration between sustainability and supply chain is required to arrive at new solutions.

But in many cases, the connection between sustainability and supply chain is missing.

"Supporting the health of our planet isn't just the right thing to do — it's critical to our mission of improving health in our communities and around the globe," said David Entwistle, president and CEO of Stanford Health Care, and the keynote speaker at the 2023 Vizient Connections Summit. "We are committed to prioritizing sustainability in our operations and collaborating across the healthcare industry to reduce our environmental footprint."

There is a common misconception that sustainability programs require major up-front capital and long payoff periods. That is simply not true. In fact, at a time when health systems are struggling financially, sustainability represents an area that can drive near-term savings across the organization. According to The Commonwealth Fund, the total five-year national savings of hospitals' sustainability interventions is valued at more than $5.4 billion. At 10 years, national savings are projected to triple, exceeding $15 billion.

The following strategies represent quick wins and immediate savings. These proof-of-concept projects can drive meaningful sustainability efforts throughout a health system.

Focus on energy conservation and power healthcare with clean, renewable energy

Energy conservation represents one the greatest savings opportunities and carries the double benefit of reducing greenhouse gases. Studies show that every dollar a nonprofit hospital saves on energy has the equivalent impact on operating margin as increasing revenues by $20.

Boston Medical Center has reduced its utility bills by more than $7 million, savings that are invested into patient care. The primary driver behind these carbon reduction strategies is BMC's ability to generate much of its own electricity and heat from its own natural gas, two-megawatt combined heat and power plant (CHP). The system also provides energy assurance in case of a natural disaster. If the electric grid shuts down, BMC's system can power its inpatient units for months at a time, provided it has natural gas.
Other examples include:

• Downers Grove, Illinois-based Advocate Health Care saved $23 million from 2008-2015 by reducing its energy consumption by 23% per square foot.
• Saint Anthony Hospital used a grant from the city of Chicago to buy four new electric vehicles and charging stations for the hospital's free transportation service.
• Electric transport vehicles can be used to transport laundry, meals and food, and hospital supplies.

Increase reprocessing and recycling in the operating room

Health systems also should focus on responsible healthcare waste management, especially in the OR, which is a major contributor to greenhouse gases. Generally, the OR is linked to about 30% of overall hospital waste. Because of the quick turnaround needed to maintain surgical volumes, items that should be recycled are often disposed of as general waste. Most healthcare waste is incinerated, which harms air quality.

Reprocessing items like scopes and other single-use devices represents low hanging fruit for quick savings. Cleveland Clinic has collected approximately 256 tons of single-use devices for reprocessing in the past five years. In many cases, the items are repurchased by Cleveland Clinic or other health systems.

Yale New Haven Health System (YNHHS) has saved millions on reprocessing through its "Greening the Operating Room" program, which drives sustainable strategies to reduce energy use and waste generation, including reprocessing medical devices such as laryngoscopes. In 2013, Yale became the first health system to stop using desflurane, an inhaled anesthetic that has a significant negative impact on the atmosphere. The switch to sevoflurane resulted in annual savings of $1.2 million. Yale's initiative spearheaded an international movement to reduce desflurane usage.

Eliminating waste from the OR, as well as hospital-wide, carries the double savings of not having to store it or have it removed. After completing a state-of-the-art surgical suite renovation, Iowa City VA Medical Center saved more than $1 million, removed 23 tons of waste and achieved a 50% reduction in greenhouse gas emissions from inhaled anesthetics. And new utility and fluid management systems in the OR have eliminated unnecessary packaging and supplies, reducing medical waste by 12.8 tons and saving nearly $30,000 since implementation.

Iowa City VA's renovation results show just how much can be achieved when a hospital makes its operating rooms more sustainable. However, OR staff often do not fully understand the consequences of placing common contaminants in recycling bins and the damage this can cause to equipment.

To help communicate this, Cleveland Clinic's sustainability team visited a local material recovery facility to learn more about recycling trends. The sustainability team shared its learnings with its zero waste committee to inform educational materials and signage. Additionally, the sustainability team conducted an audit of comingled recycling bins to better understand which non-recyclables are common contaminants in its blue bag recycling program.

The audit revealed that plastic bottles that contained a significant amount of liquid were commonly placed in recycling bins. As a result, emphasis was placed on ensuring they are empty and dry.

Pursue environmentally preferred purchasing

Many health systems are pursuing the use of sustainable and safe products and/or services, from foodservice to medical supplies and even sustainable furniture. Sourcing locally grown food is a proven way to boost sustainability by supporting local businesses and cutting the greenhouse gases associated with longer deliveries. Some health systems even grow their own food on rooftop gardens or nearby farms.

Boston Medical Center built its own 2,658-square-foot rooftop garden in 2017, which produces $18,000 worth of fresh produce annually. As part of its sustainability commitment, the farm reduces storm water runoff and the energy required to transport food. Consider that vegetables travel approximately 2,000 miles to reach consumers — at BMC, vegetables are grown 1,000 feet from the hospital cafeteria and travel only 2,500 feet to reach inpatient rooms.

Altering menus can also push sustainability initiatives. Reducing meats and transitioning to plant-based options clearly demonstrate the tie between better health and climate strategies.

Converting sustainable products within a health system doesn't have to cost money. In fact, many furniture items now don't contain harmful chemicals and are cost neutral, representing another easy way to move forward on sustainability initiatives without adding to expenses. Vizient has woven increased transparency into its contract portfolio with the new Vizient Domestic Sourcing program, in which members see two distinctions in the catalog:

1. If products meet Vizient's "Assembled in USA" standard, which states that the final place of manufacturing is within the U.S., and
2. If they comply with the Federal Trade Commission's "Made in USA" standard, meaning that all or virtually all of the product has been made in the U.S.

With medical journals like The Lancet and the New England Journal of Medicine stating that the rapidly warming climate is the single greatest threat to public health, it's essential that healthcare organizations embrace safer, more sustainable ways of doing business — and the fact that environmentally preferred purchasing is better for the bottom line is undoubtedly a plus. One thing we should all be able to agree on: The time to act is now.