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Green with Envy

Can a hospital really be a sustainable business?

   “One hundred years ago, people worried that we didn’t have enough wood. New ideas made the use of wood for fuel no longer necessary. Now we worry about not having enough petroleum, or the environmental consequences of using what we do have. In another hundred years people will wonder what the fuss with oil was all about because we will innovate away from fossil fuels. The role of the idea is completely unappreciated in daily life. Ideas aren’t just academic abstractions. Our lives depend on them.”—Eric Schmidt, CEO Google Inc.

    Our lives depend on ideas. This was my focus when exploring the topic of what hospitals are doing to become more ecologically friendly, or “greener.”  In discussing the subject with some of my colleagues, one particularly insightful cardiologist observed, “The hospital is not a green place. In fact, Kermit the Frog could have been talking about the hospital when he said, ‘It’s not easy being green.’ Everything is disposable. Everything is highly packaged. There is entrenched waste. We have three surgical towels on each cardiac cath setup, all new, all disposable, and most go untouched. Why not just keep packets of reusable towels and use them as needed? On top of that, people would be amazed how many cardboard boxes come through a hospital. It’s packaging for the packaging.”
  The cardiologist’s diagnosis was confirmed by others—hospitals, by their very nature, are not especially green places. Besides all the disposable products, throwaways, packaging of packaging and lots and lots of Styrofoam, there are the ubiquitous petrochemical products and disposable batteries. To say nothing of the fact that unlike most businesses, the hospital is a 24 hour/day, 365-day/year workplace. Visit any medium-sized American city at 4 AM and the odds are the most brightly lit buildings in the skyline are the hospitals—a lot of energy expenditure late at night.
   Ironically, this lack of attention to environmental concerns provides a number of opportunities for hospitals to address the problem, and many are already doing so. The most visible evidence of this is the electronic medical record, where the patient’s medical chart has been converted to an electronic form, substituting electrons for paper.
   In a sense, the goal is to make the hospital a paperless workplace, and in at least one hospital I am familiar with, there are virtually no paper records. The ubiquitous reams of paper that were present on every ward and office are nowhere to be found. I’ve begun wondering whether I actually have to carry a pen any longer—gone are the days when it seemed every nurse wore a pen on a string around her neck to chart notes.
   The Federal government is encouraging the paperless trend by proposing the appropriation of billions of dollars to standardize electronic medical records across the country. There are a number of unsolved problems with electronic medical records. Among them are a lack of uniform standards, user unfriendliness and acceptance problems, especially among older staff. But it is undeniable that, for the medium of medical recording, electrons, rather than the pulp of dead trees, create a more ecologically sound hospital and clinic.
   The same is true for radiology procedures, where it truly is a brave new world. William Roentgen discovered electromagnetic radiation and developed the X-ray in 1895, and for over a century, the medical profession has used the X-ray as a diagnostic tool. Until recently, an X-ray required the use of silver, plastic and a developing solution. This produced the X-ray we are all familiar with: the kind doctors would mount on a screen that had to be lighted so they could interpret the film. All the X-rays, in turn, were stored in large paper envelopes and filed like books in a library in a large storage room, which usually required staffing around the clock to catalogue and retrieve films. In addition, at some point a radiologist would look at the film, interpret it and submit his interpretation to be recorded on paper.
   Today, virtually all films are recorded digitally. No more films in an envelope. They are transmitted by computer, as are the radiology reports. No more paper records. Besides a paperless workflow, this means all those supplies, along with the resources and manpower required for storage of the final product are no longer necessary.  The radiology department just might be the greenest department in the hospital.
 Technology has not benefited other departments of the hospital nearly as much. The aforementioned amphibian-quoting cardiologist identified a common thread in many areas where emergency procedures are performed—the problem of disposables. In an interview illustrating the problem, a University of Maryland pediatric anesthesiologist says, “We have tried to reduce the use of disposables, especially plastic endotracheal tubes (breathing tubes inserted during surgery). My generation of anesthesiologists was taught to open three separate packages of incrementally sized tubes for every pediatric operation, (even if we didn’t anticipate using them). This was to expedite airway management during emergencies and was a well-intentioned practice focused on readiness and patient safety. However, when these tubes are not used, they are discarded after surgery. This created a lot of waste; thousands of endotracheal tubes were thrown away every year. Instead, we have initiated a practice of having the appropriate packages ready, on top of our anesthesia table, just not opened, allowing immediate access if necessary, but allowing unopened, sterile tubes to go back in stock for future use.”
  The University of Maryland Hospital where the anesthesiologist works is notable for its comprehensive “green” program, which includes a number of initiatives like a cardboard recycling program (nearly 400,000 pounds recycled in 2008) and a battery-recycling program. In 2008, 490 pounds of alkaline batteries were recycled offsite while rechargeable batteries were disposed of in an environmentally proper way.
   The Maryland hospital has instituted an energy-efficient heat recovery system to capture wasted heat and reuse it, thereby reducing the need for steam to heat water. The program also includes a switch from disposable to reusable pillows, eliminating over 100,000 pounds of waste that would otherwise be incinerated. The medical center has even created a computer-generated program identifying similar employee zip codes to facilitate car-pooling on different shifts. Like programs elsewhere, the Maryland plan includes donations of unused medical equipment to urban clinics serving the indigent and hospitals in underdeveloped countries.
  In his new book Sonic Boom, Gregg Easterbrook discusses the globalization trends American business will likely see in the 21st century. He dissects different industries, looking for the factors that will make them successful or cause them to fail in the future, and analyzes issues including the global economy, education and environmental concerns. One of his key points is how important health care is to the American economy. He notes that in the United States today health care is now about four times larger as an economic sector than national defense—the country’s largest single industry, at 15.6 percent of GDP in 2007, versus somewhat less than 4 percent for national defense.
  If nothing else, the size alone of the health-care industry makes it crucial for hospitals to become more environmentally conscious. According to data compiled by research from the U.S. Census, the health care industry consists of 340,650 separate establishments employing 5,508,926 people. There are a lot of ideas and a lot of potential in those numbers to create greener workplaces. That’s why more and more hospitals are looking for new plans and creating programs similar to the one at the University of Maryland.
   One of the most offbeat, yet interesting ideas I encountered was from University Hospitals Case Medical Center in Cleveland. Their nutrition department has partnered with an outside company to collect food scraps and uneaten food from their hospitals. They divert it from the general waste stream, turn it into a renewable resource and then donate it to the community in a novel way.  The uneaten food is sent to a local compost center that mulches it using a method called “lasagna layering,” where it is combined with wood chips, cardboard, leaf hummus, straw and topsoil. This mulch is then spread over garden beds in a new learning farm that is part of an urban vegetable garden in Cleveland. (I told this to one patient who commented, “That’s where hospital food belongs.”) The Case Medical Center Green Corps Initiative is testimony to Eric Schmidt’s observation that the role of the idea is completely unappreciated in daily life.
   In Sonic Boom, Easterbrook makes a general point about health care, which is that if health care delivery continues on its present course while life expectancy continues to rise at a comparable pace to what we have seen in the last 100 hundred years, the entire system will crash. As he describes it, “Innovation is the only choice.” Nowhere is that more true for the health care industry than in its concern for the environment.

Published: April 09, 2010
Issue: 2010 Spring Green Issue