Sustainability – not the main priority for the very top decisionmakers (yet).

Thanks for all being done, but more needs to be done.

If we don’t do it, it won’t get done.

We need to reach out to out bosses and boards, and create links between this conference and the efforts of all healthcare leaders.

Current top issues include disparities (very important), access, safety, etc.

We need to address safety of workers, patients, environment.

She herself was told by colleagues about how the built environment contributes to global warming and also to the bottom line.  Once she herself connected the dots, then she jumped on board with the sustainability movement for herself and for Kaiser. 

Once we show how one part of the economy (health care) can work in a sustainable way, then others will jump on board.

The Global Health and Safety Initiative
Pat Burdullis, Catholic Healthcare West
Kathy Gerwig, Kaiser Permanente
Robin Guenther, Perkins and Will
Bob McCoole, Ascension Health
Bob Eisenman, Global Health and Safety Initiative
Christina Ayers, Cleveland Clinic Foundation

Bob Eisenman

New strategy to combine environmental and sustainability movement with hospital concern about patient safety.

The case for change
- Patient safety – addressing medical errors
- Workplace safety – hospitals very dangerous places to work
- Environmental health and safety – unhealthy environments and large eco-footprint

Powerful synergy between the need to address each of these three safety concerns

GHSI is a social movement providing sector-wide leadership to transform health care

Presently includes 18 of largest health systems, significant partner organizations, major government agencies

Five work groups:
* Built environment
* Environmentally preferable purchasing
* Sustainable operations
* Research collaborative
* Corp. responsibility and public policy

Bob McCoole – Built Environment Work Group

- Design, energy and materials sub-committees
- Shared web databases – PHAROS and CHD database
- PGH’s Green Guide for Health Care
- Creating fact sheets
- Energy Efficient High Performance Hospitals Toolkit
  – Clean Energy Exchange Program
  – ASHRAE Advanced Energy Design Guide
  – Energy Impact Calculator
 
Pat Burdullis – Healthy Purchasing Work Group

- Environmentally Preferable Purchasing tools
- Creating markets for more sustainable products
- Online resource with case studies and educational materials
- Share model RFPs and other docs
- Group purchasing organizations with $1 billion in purchases per year are on board with notion of environmentally preferable purchasing

Christina Ayers – Sustainable Operations Work Group

- Building database of sustainable operations
- Define benchmark metrics for sustainability operations
- Develop infrastructure guidance for sustainable ops
- Outline environmental specs, job descriptions, model RFP language
- Partner with GHSI research group
- Green Cleaning Study – e.g., microfiber mops

Kathy Gerwig – CSR-PP Work Group (Corp Soc. Resp and Public Policy)

- Leverage corporate assets to promote economic, social and environmental health
- Environmental Footprint for Health Care
- CSR Assessment Tool – help groups build business case
- Community Benefit Investment
- Public Policy Decision-making Criteria

Robin Guenther – Research Work Group

- Facilitates research to increase understanding and remove obstacles to going green
- Building business case for greener and safer hospital designs
- Evidence-based design evaluation

Bob Eisenman

- Lots of projects in process
- More help needed and more participants welcomed
- Reaching out on the internet and via other media avenues

- More – visit www.globalhealthsafety.org

Hospitals can begin reducing their disproportionate contribution to climate change by participating in the Healthcare Clean Energy Exchange (HCEE) for the procurement of energy and environmental commodities at prices significantly lower than the prices found on the open energy market.

Nick and Tom
- tremendous energy savings from green energy
- ask for green energy, because it creates demand

Jeffrey
- RFPs include requirement of amount of green power
- power purchase agreement – asked for photovoltaic
- political, legal and financial issues require use of experts as soon as possible in the procurement process

Walt
-Hospitals do not have processes set up for this, so time needed to set up decision-making process
-Risks from uncertainties must be balanced by benefits of certain energy costs

E1. Defining the 21st Century Hospital

E2. Industrialized Food Systems and Public Health

E3. Construction and Demolition Recycling Successes

E4. Growing Wealth, Growing Health

E5. Energy Purchasing:  Clean and Green Energy Procurement

Feel free to start a separate thread on one of these, or contribute comments below.

MBA programs are now including environmental issues.  Social equity and governance are also being discussed.

Sustainable Development and Triple Bottom Line (People, Profit, Planet) are other names for CSR.

85% of execs see importance of environmental impact (up from 41% in 1999)

Climate change, resource use, waste, air pollution and chemical exposure are part of Environmental Impact

Willard’s Seven Benefits of Sustainability
1. Easier hiring of best talent
2. Higher retention
3. Increasing productivity
4. Reducing expenses in manufacturing
5. Reducing expenses at commercial sites
6. Increase revenue and market share
7. Reduce risk and easier financing

Operationalizing Envir Sustainability
Assessment->Reporting->Resource Use->Supply Chain Mgmt->Product/Service Redesign or Reengineering

Human Impact

* Staff recruitment and retention
* Safe and healthy work environments
* Livable wages
* Respect for diversity and gender
* Supporting socially conscious communities

Financial Impact

* Needs of shareholders
* Traditional bottom line
* Internalized v externalized costs
* Brining financial value to the community (tax base, jobs, development money)
* Black line budgets

UN Global Impact

10 principles for CSR for global companies:  help environment, stop child labor, eliminate compulsory labor and human rights abuses.

The Equator principles

9 principles:  if project over $50 million, financiers should review social and environmental standards, disclosure, independent reviews, action plans, etc.

Global Reporting Initiative

Providing global standards for sustainability reporting

Healthcare Perspective

* Community benefit reporting
* Relationship to community health
* Link between humans and environment
* Staff shortages
* Models in the community
* Regulatory threats

======================

Rachelle Reyes Wenger
Catholic Healthcare West

This we know.  The earth does not belong to us, we belong to the Earth. (Chief Seattle)

Sustainability and corporate social responsibility.

Six topics:
* CSR – a frame in which we realize and further our work
* Sustainability work – a reflection of our values
* Leadership
* Standards, principles and policies (our social contract)
* Planning, implementation and evaluation
* Accounting and reporting

D1. Transitioning Away From PVC to safer Alternatives

D2. Human Health Impacts of Intensive Animal Agriculture

D3. Working Together for Sustainability

D4. Pharmaceutical Management Models

D5. Climate Change 401:  Ecological Footprint

Feel free to start a separate thread on one of these, or contribute comments below.

Lara Sutherland, Practice Greenhealth

Participatory workshop where about 50 particpants are sitting in a large circle.  Everyone is given a colored piece of paper by role -

Yellow- procurement
Red – provider
Purple- advocacy group
Green – Supplier

True and false questions about government processes and standards related to defining what is toxic.  Those answering true and false go to opposite sides of the room.  easy questions first, getting progressively harder.

For example:  Products containing cancer-causing agents cannot be sold in California. [false - you must be warned, but then they can sell it]

Question:  why don’t people use natural cleaners such as baking soda, vinegar. lemon juice, H2O2, etc? 

Answer is usually that some supplier company has won a contract to us a product that kills all germs at all times in all areas.   So, when contract comes up for renewal, then you can ask questions and try to change the standards. Local vendor pointed out that even standard cleaners require minimum contact times to get the cleaning done properly, and current labor standards do not allow for this.

Question:  How do chemicals end up in the environment?

Answer is that they come from runoff into watersheds, burning, and being passed up the food change.  Not enough research to know exactly how info goes up the food chain. Mining, transport, and natural disasters, also send info into the environment.

One participant had heard that for every pound of waste carted to a landfill, there are 7 pounds more that are still in the environment.  Can anyone corroborate this?

Environmentally Preferable Purchasing – choosing products and services that are perferable to those of alternatives.  Don’t wait to prove everything before acting!

Question:  What are you doing to address mercury in the workplace?

Participant said her facility was stopping it from coming in.

Question:  What about latex or PVC/DEHP?

Participant switched supplier when market came up for renewal.

Targeted Chemical Strategy – identity targeted chemicals, ask suppliers to disclose, and choose products without those chemicals (more on this and other topics in the booklet Guide to Choosing Safer Products and Chemicals:  Implementing Chemicals Policy in Health Care by HCWH (Health Care Without Harm).

Game – Product 1 versus Product 2.  List of issues related to what is in it and price.  Participants asked if they prefer 1 or 2.  Discussion about whether you would want 1 or 2 (what is disclosed, what is more dangerous, which performs better, etc).  Also ask for verification of what is on the list.

Game – small group exercise to decide questions you should ask before purchasing items that are on a sheet that is handed out to each group.  Each small group should have a member from each of the categories of participants determined at the start of the workshop.

Responses – groups pointed out that suppliers should be willing to use products on their own children, should be aware of respiratory issues, check for EPA Extremely hazardous Substances list, test in hospital’s internal lab, check for artificial flavors/colors, check for innovative vendors, cheeck for formaldehyde and endocrine disruptors, and supply contact person willing to sign no-harm pledge.

Are you willing to go back to your group and start this process?

C1.  Improving Energy Effectiveness in Health Care

C2. There’s Gotta Be A Better way:  Participatory Workshop on Reducing the Use of Toxic and Untested Chemicals in Products

C3. Engagement:  The Key to Environmental Responsibility

C4. Reducing Chemical Exposure Through Purchasing:  Case Studies in Green Cleaners and Integrated Pest management

C5. Regulated Medical Waste Treatment: Case Studies for On-site and Off-site Treatment

Feel free to start a separate thread on one of these, or contribute comments below.

Here are some of their actions:
* “Health=Local Food” T-shirts created for kids.
* Opposition to farm bill promoted among legilslators
* Plow-to-Plate program set up with chef
* Coordination with local small farms, even if not certified as organic, as long as their practices follow organic guidelines
* Set up website
* Work with mayor to support local “New Milford Plow to Plate farmer’s Market”
* Create local “Farm Bucks.” Tractor mack created as spokesman for market and placed on currency that can be used at farmer’s market.
* Everyone taking ownership of new ideas, such as farmer market.
* Partner with local youth agency to get grant and develop corps of peer food counselors. This already-established youth agency helps kids learn how to choose food, cut food, develop menus, and serve to families. Kids get school credit while rotating through restaurants. Gets them to think about how to live as well as make a living.
* Now having kids mentor the next generation of kids.
* Speaker series set up to invite speakers, paid by funder monies.
* Keep doing what works, add new things, share knowledge, do advocacy.

====================
Erica Frank, MD, MPH, UBC in Vancouver, Pres of PSR

Why bother changing food in health care facilities?
Why change physician eating habits?

To better encourage interventions, we need to practice what we preach, e.g. walking to work.

Doctors are better than general pop with exercise, low alcohol use and low smoking rates, but fruit and veggie intake was as bad as peers.

Prevention is discussed by doctors more often if doctors themselves are good on those issues.

Emory med school four year study – encouraged healthy nutrition and exercise among students, which led to more students talking to their patients about it.

Why we should eat lower on the food chain:
* 22% of greenhouse gases from agriculture sector, 18% from meat alone
* each American responsible for three tons of manure each year, which then promotes more gas emissions (cows and other ruminants)
* $30 to 60B per year in less med costs

=======================
Lorenzo Wimmer from Kentfield Rehabilitation and Specialty Hospital in N CA
LTAC Longterm acute care facility
Food service perspective

* Hospital salad bar was closed when he came
* “Pepper steak” – trying to create patients or heal them?
* Came in under budget because food so profitable
* Make home made soups, humos, etc
* Calif has 28-page contract, including inspection of trucks.
* So, he had contract with farmer’s market and bought $2000/week
* Now farmers deliver to many Marin County facilities
* Rice from Thailand, so he changed to sustainable rice farm 100 miles away
* Switched to reusable plastic plates, and charged for cups taken out
* Uses only lean meats
* Bought from local dairy farms rBGH-free
* Reduced waste by $200/month (one dumpster)
* Must remind people why we separate trash
* Try to share ideas, pool purchasing power
* Access more local and seasonal fruits
* Accountability is as important as organic designation
* Stocking Amy’s organic food for night crew vending machines
* Trying to get more compostable dinnerware
* Food committee sets up plan, and Strategic Food committee implements it

B1. Raising Awareness about Exposures and Advocacy

B2. Greening the Red Bag – Single Use Device Reprocessing and Success

B3. Define and Conquer – Accomplishing Green Healthcare Projects

B4. Greening the NICU and Beyond – Pediatric Hospitals Highlight Green Advances

B5. Innovations in Sustainable Healthcare Food Service – Case Studies

Feel free to start a separate thread on one of these, or contribute comments below.