Going Green Hospitals Strive to Protect Patients, the Environment, and the Bottom Line

It’s called the Rotoclave.

Located deep inside a well-hidden wing of Baystate Medical Center, where much of the facility’s power is generated and its waste handled, the massive contraption is fed a steady diet of eight tons of medical waste each week, which it chews into a fine confetti.

The Rotoclave has, in many ways, become an unsung hero on the BMC campus. It eliminates the need to incinerate infectious waste, a common practice in the past, and processes more than one million pounds of trash per year.

“It’s a cool concept,” said Tim Culhane, director of Environmental Services for Baystate Health. “We used to burn needles and gauze and other waste, which was of course bad for the atmosphere. This sterilizes the waste and grinds it down, so it has less of an impact on traditional landfills.”

The Rotoclave is a major player in the ‘greening of Baystate,’ an effort underway in all of Baystate Health’s facilities to implement a wide array of environmentally friendly, community-conscious, economically driven initiatives — all of which reflect the increasingly prevalent business practice nationwide of going green.

For Culhane, this has meant an addition to his job title. He’s now also the chair of Baystate’s Green Team, an interdepartmental committee charged with both creating and overseeing a comprehensive suite of green practices for the entire system.

“The goal is to make a difference in the community, and to create an entire environmental philosophy,” he said, noting that the Green Team has just completed its first formal year of work, implementing and publicizing everything from ‘green training’ for new employees to the facilities’ switch to anti-microbial, micro-fiber mops.

There are bright posters and logos to visibly reflect these efforts on Baystate’s campuses too, as there are at a number of regional health care facilities. But as the monstrous Rotoclave proves, most of the dirty work is being done behind the scenes.

Waste Not

That’s certainly true at Holyoke Medical Center as well, said Sharon Flynn, director of Materials Management.

“Most of our environmental efforts relate in one way or another to removing items from the waste stream,” she said. Those efforts include gradually removing all mercury thermometers and blood pressure cuffs from the hospital, and using remanufactured toner cartridges and recycled copy paper in offices.

In addition, the hospital contracts with a New Hampshire company that picks up items such as batteries, fluorescent bulbs, and batteries; that firm is part of the Institutional Recycling Network, which strives to reduce waste in health care and educational facilities across New England.

“It’s surprising how many of those things appear in a hospital,” Flynn said. “And with computer monitors, you can’t just put it in the trash. We were having to pay a considerable amount of money to have all these things taken away.” Going the recycling route, she added, has actually saved HMC some of that cost.

And finances are no small matter, Flynn said. “From a senior level, there’s an awareness and certainly a desire to protect the environment, but patient safety comes first — and the other thing is, we need to be very careful how we spend our dollars, because we don’t get a lot of them, and reimbursements have fallen year after year. So, yes, if we could protect the environment and patients and finances, it would be a wonderful outcome, but I’m not sure we can always get all three.”

Cleaning products comprise one good example of the balance between safety and environmental concerns.

“In our Environmental Services Department, we continue to evaluate green-friendly products like floor finishes and disinfectants,” Flynn said, “but if I’m being 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} honest, we haven’t really found them to be as effective as some of the cleaning products currently being used — which are still all water-soluble and environmentally safe.

“We’re not going to compromise patient safety by using a product that wouldn’t kill viruses and bacteria. But we’ll continue to look at products as they become available.”

Running a cleaner operation is also a concern for Baystate Health, which is now in the midst of a three-year plan to identify and evaluate new policies and procedures. Culhane said one such initiative could be converting its own vehicles to earth-friendly fuels, as part of an overall effort to reduce the amount of harmful waste returned to the environment.

“We’re constantly evaluating ways that we can partner with other organizations to mutually benefit the community,” he said, offering as an example a partnership with Goodwill Industries, which accepts computers and other electronic equipment for recycling, thus addressing a major category of waste that, as in HMC’s case, cannot be disposed of in conventional ways due to pollution regulations.

Other possibilities being mulled by Baystate include the creation of an on-site recycling center, obtaining Leadership in Energy and Environmental Design (LEED) certification for a new, green building, and creating a green design and construction plan for a master facility project slated to be completed in 2012. “By then, we hope to have a building that encompasses these goals in their entirety,” said Culhane.

Feeling Chipper

Cooley Dickinson Hospital in Northampton has created plenty of buzz with its innovative use of woodchips to both clean up its energy operation and save money in the process.

When it created its woodchip plant in 1985, the hospital’s administration felt that being overly tied to fossil fuels could potentially take dollars away from the hospital’s core business of providing health care services. Indeed, wood chips have been hailed as a renewable energy source, an environmentally friendly alternative to fossil fuels — and a money-saver as well.

Meanwhile, since wood chips are produced locally, the money the hospital does spend stays in the local economy. Plus, the main byproduct of burning wood, potash (ash), is an excellent soil amendment used in organic farming, said Richard Corder, vice president of Operations and Facilities Management. Cooley donates the ash to local farms, such as the Food Bank Farm in Hadley, which in turn gives half its crop yield to local food pantries and shelters. ”The entire process saves us about $1 million a year, which translates into being able to fund that many more clinical positions,” said Corder.

A second woodchip-fired boiler plant was built in 2005 to support the heating and cooling needs of the hospital’s new North Building and the Kittredge Surgery Center, which opened this past spring. The second plant acts as a backup to the existing woodchip plant and is available to go online, if necessary.

On top of that, Cooley Dickinson was awarded a $372,780 grant from the Massachusetts Technology Collaborative last year. That grant, coupled with Cooley’s own contribution, will soon allow the hospital to generate electricity from a steam turbine, thus reducing the hospital’s dependence on the city’s power grid. The turbine is due to arrive later this year.

At the same time, the hospital was honored last year by both the U.S. Environmental Protection Agency and the Hospitals for the Healthy Environment organization for its recycling and environmental-protection policies. Over a two-year period, Cooley Dickinson reduced regulated medical waste by nearly 10 tons.

“Our employees have a lot to be proud of, knowing they serve as models for other health care facilities across the country by supporting the goals of a total waste management program,” said Daniel English, acting director of Environmental Services at CDH. “It is another example of employees wanting to do the right thing for the right reasons.”

Food for Thought

Currently, Baystate Health System is already recycling as much material produced at its facilities — from scrap metal to kitchen grease — as it safely can.

Doug Martin, BMC’s director of Food and Nutrition, said one example of managing green efforts within a system as large as Baystate Health is its Green in the Kitchen program. Centered on addressing system-wide issues in one specific area — the preparation and serving of food — Martin said Green in the Kitchen has already become one of BMC’s most successful eco-projects.

“We’ve already seen a savings in food through our room service program,” he began, “and we’re looking at switching to biodegradable paper products to complement the switch from Styrofoam to china cups we’ve already made.”
Martin said the food-service programs are also a part of a larger effort dubbed Healthcare Without Harm, which takes into account many of the same community, economic, and environmental concerns as green programs.

“The Healthcare Without Harm pledge includes reducing paper consumption, buying local whenever possible, and using hormone-free meat,” he said. “We serve a Mediterranean diet, which uses a lot of fruits and vegetables that we procure from local sources.”

Outside of food preparation, Martin is also charged with controlling energy costs, and BMC has recently installed ‘VendMisers’ on all of its vending machines, to reduce the amount of electricity they use throughout the day.

Cooley Dickinson has been innovative in the kitchen as well, earning Local Hero status from the Community Involved in Sustaining Agriculture organization for its efforts to buy as much locally grown food as possible.

English said some hospital leaders were initially concerned about additional prep time in the kitchen and higher food costs. “We were totally wrong about that, and at the end of the day, it’s so much nicer for the cooks to work with fresh produce, and so much more tasty and wholesome for our employees,” he said.

The effort has gone hand in hand with Cooley’s partnership with a local fair-trade coffee supplier, as well as the kitchen’s use of biodegradable paper plates that break down in the environment in less than two weeks.

Diggin’ the Dirt

Still, energy consumption, and efforts to reduce it, comprise the greatest challenges for most businesses going green. However, it’s also a concern that, when properly addressed, can provide convincing returns on investment.

Culhane said that space is another issue. As waste increases within health care facilities — more than one million pounds of waste is created each year at BMC, due in part to the greater use of more sanitary disposable items such as gowns, drapes, and pre-packaged medical tools — the means to process that waste must also grow.

“We have to start thinking now for 2012,” he said, referring to the construction projects that are now taking place. “Following green health care practices means adding the necessary areas to safely handle waste, and there’s only so much space to work with.”

Culhane’s own job description has expanded in recent years as well. As director of Environmental Services, he said he used to be in charge of several departments and their operations. But now, he said, in many ways he’s responsible for a new, systemwide culture at Baystate.

“I’d say the scope of my career has definitely broadened,” he said. “There’s much more time spent looking at the long term, and at the big picture.”

Gary Cohen’s looking at the same picture — and considering the bottom line as well. When Cohen, the executive director of the Environmental Health Fund and Healthcare Without Harm, was recently awarded the Frank Hatch Award for Enlightened Public Service by the John Merck Fund, he noted that going green and making green don’t have to be mutually exclusive.

“We are awakening to the reality that it is getting harder to support healthy people on a sick planet,” he said. “We are also realizing there is no conflict between the environment and the economy — in fact, the economy of the 21st century needs to be a green economy. Over the next decade, we will need to transition from a petrochemically based economy to one that is based on green chemistry, sustainable agriculture, and global consciousness.”

As for Culhane, he also spends a considerable amount of time outside of the bright, sterile halls that encompass most of Baystate’s medical facilities. Instead, he’s in the less-than-auspicious home of the Rotoclave, or outside near the compost bins, or in the basement, making sure the paper recycling bins are securely locked for HIPAA compliance.

It’s a dirty job. And lately, everyone wants to do it.