Sustainable and Safe Healthcare: Return on Investment

Gina Pugliese, Premier Safety Institute ®Susan Vickers, RSM, Catholic Healthcare West

Christina Vernon Ayers, Cleveland Clinic Foundation

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Green, Sustainable and Safer EnvironmentsBecoming a Key Component Of The Corporate Strategy

Recent global survey of CEOs on the topic of sustainability:• 75% report sustainability an important part of corporate

strategy

• Why?– To be leaders– Social responsibility – Public health – To reduce cost

In partnership with our members to improve the health and safety of patients, workers, environment, and communities.

GreenHealthy® – Premier’s award-winning environmental leadership platform

GreenHealthyTM includes

EPPEnvironmentally

Preferable Purchasing

Program

Yes to GreenInternal

corporate-wide initiative

SPHERECollaborative climate and

energy initiative to reduce

healthcare’s carbon footprint

Tools, Resources on Patient, Worker, Environmental Safety, and Green-Sustainability

500,000 visitors a year

Premier Safety Institute Website

www.premierinc.com/safety

Executive Scorecard•Rate your program

GreenLink newsletter•18,000 subscribers

Tools - Resources

Audioconference Series-Experts discuss the business

case for energy management

- Free audio files, slides and resources at

www.premierinc.com/forum

Program examples:•Geisinger saves $3 million annually with doubling campus size•Ingalls saves $800,000 in reverse auction – 5% renewable•Catholic Healthcare West renewable energy with methane gas waste•St Francis cuts gas bill by 50%

Premier’s Employee “Yes to Green” Pledge

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Sustainable and Safe Healthcare: ROI

Susan Vickers, RSMCatholic Healthcare West

Goal

• Introduce CHW’s sustainability approach

• Highlight ROI in supply chain & energy reduction

• Share resources and learnings

About CHW

• Non-profit founded in 1986• Both religious and community sponsored facilities• California, Arizona and Nevada• $9.0b net operating revenue FY 2009• $1.2b community benefit and charity care FY 2009• 8,800 acute care beds• 9.800 physicians• 54,000 employees

What is sustainability in healthcare?

• Patient care sustainability:How do we ensure the highest quality care?

• Environmental sustainability: How do we do our part to protect the environment?

• Financial sustainability:How do we redirect resources from unnecessary expenses to impactful patient care focused initiatives?

CHW’s Environmental Commitment

0

50,000

100,000

150,000

200,000

250,000

Ther

ms

July

August

September

October

November

December

January

February

March Ap

ril May

June

FY06 FY07 FY08 FY09

Operational Energy Efficiency Program

Energy and environmental benefits are as follows:•Electric reduction – 1.2M kWh•Natural gas reduction – 360K therms•CO2 reduction – 2,340 Metric tons•Equivalency – 340 automobiles driven 20K miles per year @ 25 MPG•Program Costs - $180,000•Maintenance Costs - $65,000•Program Savings - $265,000 per year

Capital Energy Conservation Program

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Ther

ms

July

August

September

October

November

December

January

February

March Ap

ril May

June

FY06 FY07 FY08 FY09

Energy and environmental benefits are as follows:•Electric reduction – 1.8M kWh•Natural gas reduction – 50K therms•CO2 reduction – 920 Metric tons•Equivalency – 135 automobiles driven 20K miles per year @ 25 MPG•Capital Costs - $773,000•Project Savings - $210,000 per year

Renewable Energy Project

Energy and environmental benefits are as follows:•Electric reduction – 7.2M kWh•CO2 reduction – 2,630 Metric tons•Equivalency – 385 automobiles @ 15K per year •Capital Costs - $2.9M Third Party•Project Savings - $280,000 per year

Marian Medical CenterEnergy Consumption (fossil fuel only)

0

10,000

20,000

30,000

40,000

50,000

60,000

July August September October November December January February March April May June

Ther

ms

FY06 FY07 FY08 FY09

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ROI - Celebrating Progress

• Employee engagement and pride• Stakeholder engagement and collaboration• Corporate responsibility and leadership• Reputation enhancement• Mission extension• www.chwhealth.org/Who_We_Are/Community_Health

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Resources

• Practice Greenhealth (www.practicegreenhealth.org)• Health Care Without Harm (www.noharm.org)• Ceres (www.ceres.org)• Global Reporting Initiative (www.globalreporting.org)

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Steps to Sustainability

• Secure commitment• Link to mission• Engage key stakeholders• Set goals• Track and Report progress• Celebrate successes

Sustainable Savings:Greening for Greenbacks

Christina E. Vernon, AIA, LEED APSr. Director, Sustainability and Environmental Strategy

Cleveland Clinic Health System

Sustainable Savings

• Cleveland Clinic’s Journey

• Organizing for change

• Opportunities for action

• Results!

≈9MAnnual Savings$

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A balanced, triple bottom line approach

Selecting meaningful “e3”projects that promote:

• Ecology: systemic respect for our ecosystem, of which humans are a part

• Economy: Foster and support economic growth and success

• Equity: Support communities and employees

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Mission Alignment

The Office for a Healthy EnvironmentTo encourage healthy buildings, healthy operations, and better buying while finding champions and innovators in our institution and our community to create a healthcare system that is ecologically, socially, and economically sustainable and not a source of harm to human health and the environment.

Supporting healthy environments for healthy communities

Organizing for successful change:

System Resource TeamsSystem Resource Teams represent specific areas of 

specialization that are centralized within the system. This allows us to make changes with a broad impact and 

depth. Supply Chain is not only supporting the changes we aspire to within each hospital, but is increasingly leveraging our volume for market transformation.

Hospital or Medical Center Green TeamsAre composed of a cross‐functional group of team members to help troubleshoot, create and implement projects at their specific campus. Chairs of the teams report to the monthly System Green Team meetings and track/share data with the system. Typical Team Members Include:

System Green TeamSystem Green Team meets monthly to share best practices, develop new project ideas, track and 

share results and implement system‐wide changes

Office for a Healthy EnvironmentProject concept and execution, data tracking, employee/community education, sustainability reporting, website, newsletter, and change management. Oversees network of Green Teams

Executive Sustainability Advisory TeamSenior Executive Team guides OHE in priority setting and project development. Structure includes structured meetings as a group as well as targeted or ad‐hoc meetings to focus on collaborative projects. Key advisors include Executive Administration, Chief Financial Officer, 

Chief Marketing Officer, Chief Community and Diversity Officer, Executive Director of Operations and Support Services, Chief Patient Experience Officer, Chief Wellness Officer, Medical 

Operations.

Main Campus Green Team

Supply Chain Green Team

Pharmacy Green Team

Regional Hospital Green Teams

RMP Green Teams

External Advisors

OHE participates in dialogue with City of 

Cleveland, Foundations, Solid Waste district, Sewer District, Carbon 

Fund, Education Community, 

GreenCityBlueLake, E4S, Green Building 

Coalition, and others

National OrgsOHE learns from and 

serves as expert faculty and advisory council member for national 

Green Healthcare .Orgs

Employees All are invited to engage in active dialogue with 

OHE via idea submissions, event 

attendance, electronic newsletters and 

websites.

•Nursing•Materials Handling•EVS

•Physicians•Compliance•Infection Control

•Facilities Management•Employee Communications•Enthusiastic Employees

Supply/GPOsSuppliers and GPOsinfluence product 

choices and availability, drive change, and create markets for materials

Metrics Make it Happen:

Waste ReductionEnergy ConservationLocal FoodTransportationToxicity ReductionBetter BuyingHealthy BuildingsClimate Change Action

Landfill Diversion Rate and Volume ReductionEnergy Utilization Index% Food Procured Locally (200 miles)Fleet MPG and commuter incentivesPVC/DEHP product migration% Recycled content, SavingsLEED System ScoringGreenhouse Gas Inventory

What gets measured, gets done… and gets funded

Developing Measurement Tools

Cleveland Clinic co-developed and tested tool

Allows for system-wide reporting and visibility

Can produce aggregate landfill diversion rate and savings information

Is designed for large or small sitesAllows multiple users to share

responsibilityDesigned for our sector

Visibility of spend, incentive for action$

Focused on Results:

Approx $70K less than baseline

Approx $160K less than baseline

2007 Baseline

$$

Increasing Recycling, Reducing Cost

 Main Campus Total Waste Cost(Unadjusted for growth)

$‐

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

$450,000

1/07‐8/07 1/08‐8/08 1/09‐8/09

Total D

ispo

sal C

ost (Exclusive

 of C

&D)

‐4%‐10%

‐14%2007

2008

2009

through Q3 each year

Source Reduction: Less waste per Patient Day

Pounds of Waste Generated Per Occupied Bed Per Day(includes all waste, including non‐clinical functions)

y = ‐276.93Ln(x) + 2043

0

10

20

30

40

50

60

70

Jan‐08

Feb‐08

Mar‐08

Apr‐08

May‐08

Jun‐08

Jul‐0

8

Aug‐08

Sep‐08

Oct‐08

Nov

‐08

Dec

‐08

Jan‐09

Feb‐09

Mar‐09

Apr‐09

May‐09

Jun‐09

Jul‐0

9

Aug‐09

Source reduction means reduced delivery cost

$

Reuse and Donation

• Donations to MedWish International are distributed through humanitarian missions worldwide instead of landfill. In 2007, CCHS donated 80,000 lbs of material to MedWish. In 2008 and 2009 we donated over 200,000lbs each year

• In 2008 we donated 13,055 lbs of much-needed furniture to Cleveland families. in 2009, we donated over 120,000 lbs of furniture to charitable recipients

• In 2009, facilities donated more than 5 tons of scrap material, tools and other materials to Habitat for Humanity

Contributes to Community Benefit$

Energy Usage Index

200

250

300

350

Year

kBTU

/SF

CC Goal

2007 2008 2009 2010

$500K Investment each year:4.3M Savings in 2 years$

$4.3M Peak‐to‐Peak Avoidance 

Represents an 11% Reduction in EUI

$1.59/Second

Community Value

Community Farmer’s Markets• Main Campus• Huron Hospital• Beachwood ASC• Strongsville FHC• Independence FHC• Hillcrest Hospital (2010)

At Main Campus, $35K/year reaped no-cost brand exposure. Air time valued at over $100K

$

Better Transportation

Our fleetVehicle selectionTechnology adoption and Alt FuelsManagement and data collection

improvementsReduced Carbon Commuter

IncentivesHybrid purchase incentiveDiscounted parking for high-

efficiency vehiclesUltra-low Carbon Commuter

IncentivesBike commuter recognitionTransit pass access improvementsHousing financial incentives for

immediate

Fuel savings for our own fleet

Savings for our employees

$$

Toxicity Reduction

Latex-safe work and healing environment

Green cleaning system-widerBGH-free local dairyOrganic lawn care pilotPVC removed from most standard

building productsPVC/DEHP reduction goals on the

horizonMercury reduction program across

system won awards in 2008 and 2009

Microfiber mop system reduces water and chemical use

Huron’s seen reduced worker’s comp

Save on cleaning products, waste & water

$$

Opportunities everywhere:

Reusable Sharps

Saves approx $250K per year$

Paper Destruction Single Use Device Reprocessing

Save on pickup fees by understanding paper’s value on the market

$ Save about $1M/year$

Opportunities everywhere:

Virtual PharmSamples

Reduce waste, save dollars$

Reusable Plastic Pallets

Save on shipping fees and some waste fees

$Fluid

ManagementSave on disposal, vacuum canisters and exposure risk

$

The Bottom Lines

• This work has:– Reduced environmental impact of

our operations – Conserved natural resources– Supported local businesses– Enhanced our community– Improved employee engagement– Created a safer place to work and

heal– Saved money for the organization– Reduced costs for our employees

Ecology

Equity

Economy

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Thank You!

Christina E. Vernon, AIA, LEED APSr. Director, Sustainability and Environmental StrategyOffice for a Healthy Environment216.445.7019healthyenvironment@ccf.org

www.clevelandclinic.org