H2E Providing Practical Solutions to Today’s Environmental Challenges

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Providing Practical Providing Practical Solutions to Today’s Solutions to Today’s

Environmental ChallengesEnvironmental Challenges

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Today’s Objectives Today’s Objectives

Health care’s footprint

H2E’s Data Tool

The vision for it’s roll-out

What next?

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You want me to do what???You want me to do what???

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Health Care’s FootprintHealth Care’s Footprint

Healthcare is 16% GDP - 20% by 2015

Hospital workforce: 4.1 million 24/7 operations $6.5 billion on energy each year* Water – facilities are often largest

water users in the community Over 2 million tons of waste per

year - increase in disposables, packaging, chemicals, toxics

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Evidence of InefficiencyEvidence of Inefficiency

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Understand your waste!Understand your waste!BROWN MEDICAL CENTER

Total Waste Disposal Costs= $596,000

66%

33%

1% 0%

Solid Waste: ~ 1550 tons = $93,000

RMW: ~ 775 tons = $465,000

Hazardous Chemical Waste: ~19 tons =$38,000Recycling: No recycling Program

GREEN MEMORIAL HOSPITALTotal Waste Disposal Costs=$245,000

51%

10%

1%

38%

Solid Waste: ~ 1200 tons = $72,000

RMW: ~ 225 tons = $135,000

Hazardous Chemical Waste: ~19 tons =$38,000Recycling: Assumes breakeven costs.Avoided landfill cost of $54,000!

That’s a difference of $351,000 every year!

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BIOHAZARD

Benchmarking…Waste Stream Avg. Disposal Cost

per tonAvg. Disposal

Cost per poundPercent of

total Waste

Municipal solid waste (MSW)

$40-$120 $0.02-0.06 45%

Regulated medical waste (RMW)

$450-$1,000 $0.24-0.40 6-12%

Hazardous chemical waste

$1,000 or more $0.50-$10 <1%

Recycling (average for all recyclables")

breakeven Up to 50%

Other Stuff: Universal Waste

Construction and Demolition

Donated Supplies

Bulky Waste

Grease ….

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Normalization OptionsNormalization Options Direct patient care activity related factors: (this should be average per month)

Number of Licensed Beds: industry standard - “permitted” size of a facility often much larger than the number of operating beds. consistent from year to year - standard way to describe a facility.

Number of Staffed Beds: reflects the maximum number of beds the hospital is staffed to manage. may not

reflect the true level of activity. Average Inpatient Days per month (or Daily Census/mo):

changes daily but the average reflects the level of activity Adjusted Patient Days

account inpatient and outpatient activity, unlike the values above that only measures inpatient activity. APD is calculated as follows:

APD= (Total Patient Days) * (Total Inpatient + Outpatient Revenues) Inpatient Revenue Patient Day

period of service defined in whole days between the census-taking hours on 2 successive calendar days, including inpatient census and out-patient surgical days.

Outpatient visits useful for facilities that have a lot of clinics or only have clinics. Interestingly,

university hospitals tended to have by far the greatest outpatient activity -- over a million outpatient visits a year.

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Other factors:Other factors:

Number of FTE’s measures staff size in full time equivalents.

Square footage –

includes facility space where waste generated is included in the total waste weights and cost.

primarily used to describe the size of the facility and normalize energy and water data in building metrics.

It has not typically been used to normalize waste data

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The ToolThe Tool

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Success Story Success Story From: Pam Starlin [mailto:[email protected]]

Sent: Thursday, October 26, 2006 11:00 AMTo: Susan ZaboSubject: Success Story

Just wanted to share my first big victory which I have the Waste Management tool to thank. I met with Stericyle this morning and showed them what my costs had snuck up to over the years for back-up services. Bags and boxes which were once free were suddenly being charged for and the cost per pound had nearly doubled over the past 6 years or so. All of this was due to the fact that since we are not a regular customer, we are not on contract pricing. I offered to sign a 3 year back up service agreement it they would improve their pricing structure. Right off the bat, they agreed to eliminate the charges for the bags and boxes and he will bring back an agreement with better pricing. Don't know what the bottom line will look like, but I expect to be able to report substantial savings. It was wonderful to be able to pull up the spreadsheet and have all the history and figures right on the desktop. The rep was pretty impressed and it sent a clear message to him that I am keeping tabs on this now.

Have a good day Susan!

Pamela S. Starlin Manager, Environmental Services & Patient Transport Fairfield Medical Center

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Early Pilot – 12 hospitals Did not have a process to

track and trend our waste streams Numerous waste streams to

manage and collect data Value of Stewardship

Wheaton Franciscan HealthcareWheaton Franciscan HealthcareWheaton Franciscan HealthcareWheaton Franciscan Healthcare

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Metro Hospital – Grand Rapids MIMetro Hospital – Grand Rapids MI

Saved $40,000 first year “Asked our data your questions It gave us a loud and clear response We acted and won’t stop asking and

listening”

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Questions to ask of your Questions to ask of your Solid Waste ProgramSolid Waste Program

Where does your waste go? Have you had a recent waste stream analysis?

What types of solid do you generate? Assessing your fees. Do you

understand them? Container sizes? Hauling frequency? Opportunities for Improvement?

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Questions to ask of your Regulated Questions to ask of your Regulated Medical Waste (RMW)Medical Waste (RMW)

One of the largest opportunities to save money

GOAL: Hospitals should be at about 6-12% and or a RMW generation rate or 1 pound per adjusted patient day…

Does your clinical staff understand what qualifies as RMW?

How is your waste treated? Waste treatment and COST is critical to any successful program

Hauler negotiations. How are you charged? Per pound? Per tub?

What is your pick up frequency?

BIOHAZARD

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RecyclablesRecyclables

Are you recycling? What are you recycling? How are you recycling? With a comprehensive paper and cardboard

recycling program, you can hit a minimum 20% recycling rate

GOAL: Hospitals should at least hit a overall 25% rate although the stretch goal should be 50%

Opportunities to reduce costs, even generate revenue

Use net benefit…

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Hazardous WasteHazardous Waste Do you generate hazardous waste? What

type? If yes, do you know where and how it is

disposed of? Is it recycled? Electronic scrap is the most rapidly growing

recycling problem in the world E-scrap is not only a crisis of quantity, but of a

toxic content due to toxins such as lead and mercury.

Solvent recovery – xylene, formalin, alcohol Biggest volume of HW in an acute care hospital

with a lab.

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System goal to become mercury free and reduce RMW by 50%

Needed to understand problem to then set goals, short and long term

Lack of system wide recycling Identify opportunities for improvement Identify cost savings and efficiencies System compliance, vendor compliance and

contracts Celebrate successes

Why Wheaton participated?Why Wheaton participated?Why Wheaton participated?Why Wheaton participated?

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Benchmarking

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Wheaton findingsWheaton findings Solid waste % was above benchmark Inconsistent lbs per load of solid waste Not utilizing a pressure gauge on the

compactor, inconsistent lbs per pull Lack of data on hazardous and recyclable

hazardous waste Lack of formal recycling program for plastic

and aluminum and mixed office paper Inconsistent revenue for recycled cardboard

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(continued)(continued)

Cardboard recycling is sub contracted and they did not receive any revenue

Receive 50% of mixed paper revenue, although this has not been verified

Shred all paper Lack of a commingled program

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Wheaton Franciscan Healthcare Action Wheaton Franciscan Healthcare Action Plan for 2006Plan for 2006

Consolidate vendors Negotiate new contracts Hold vendors accountable Choose benchmarks

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Wheaton Franciscan Healthcare Action Wheaton Franciscan Healthcare Action Plan Update and AccomplishmentsPlan Update and Accomplishments

RMW and Recycling contracts are in negotiations Neptune System Bio Systems (3 pilots)

Consolidated to one RMW vendor Vendors are being held accountable by

Corporate Materials and on-site management

Utilizing the H2E guidelines as the benchmark

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WFHC-All Saints Solid Waste outcomes WFHC-All Saints Solid Waste outcomes YTD 2006 vs. 2005YTD 2006 vs. 2005

Reduced solid waste from 67% of the waste stream to 55% (YTD June 2006)

Moved from a set pull to a requested pull

Then requested Waste Link System Re-calibrated compactors

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Waste management Category

Baseline* Current Baseline Current

Solid Waste 942.74 440.26 0.671390725 55%

Recyclable, Solid 376.33 293.80 0.268010768 37%

Regulated Medical Waste 84.18 57.09 0.059950433 7%

Hazardous Waste

Recycled Hazardous Waste 0.91 7.69 0.000648074 1%

Total 1404.16 798.84 1 100%

Tons Percent of Total Waste

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Solid Waste 942.74 440.26 0.671390725 55%



Hazardous Waste


Total 1404.16 798.84 1 100%


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Solid Waste 942.74 440.26 0.671390725 55%



Hazardous Waste


Total 1404.16 798.84 1 100%


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Recyclable Solid Waste outcomes YTD Recyclable Solid Waste outcomes YTD 2006 vs. 20052006 vs. 2005

Increased Recyclable solid waste from 27% of our waste stream to 37% (YTD 2006)

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Re-construction of the facility to better accommodate recycling program

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Enhanced commingled program in Aug 2006

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WFHC-All Saints Recyclable Hazardous WFHC-All Saints Recyclable Hazardous Waste outcomes YTD 2006 vs. 2005Waste outcomes YTD 2006 vs. 2005

Increased Recyclable Hazardous Waste from .91 tons to 7.69 tons

Increased storage space New E-Scrap contractor Captured all of the lbs

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TOOLS for Change – e.g.,RMW TOOLS for Change – e.g.,RMW generation…generation…

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What goes in a red bag anyway?*What goes in a red bag anyway?*

Blood, Products of Blood Anything caked, soaked or

dripping in blood Tissues from surgery and

autopsy Cultures and stocks of

infectious agents and discarded vaccines.

Suction canisters with any fluid. Hemovac and pleurovac drainage.

Operating room waste saturated with body fluids as defined by OSHA.

Waste from patients isolated with HIGHLY communicable diseases. (These are CDC Class IV definitions including Ebola, Lassa Fever, Marburg and Small Pox. NOT such conditions as AIDS< Hepatitis or TB.)

Sharps, including syringes and unused sharps.

IV Bags, tubing, foley bags Non bloody gloves Packaging, Urine-soaked waste, feces,

vomit Blood-tainted waste

(Note distinction between blood-soaked and blood-tainted. A little bit of blood on an item can go in the regular waste stream.)

YES! RED BAGNO! Put in Clear Bag

* Check your local regulations

Questions? Call Waste Manager

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Waste Segregation – ImplementationWaste Segregation – Implementation

Present PlanSurvey FacilityDevelop MaterialsPurchase equipment, supplies.Issue MemoContainer placementProperly Labeled, SignageProper placementTraining (never ends.)Monitoring and reportingCQI!

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Suction CanistersSuction Canisters

http://mntap.umn.edu/health/91-Canister.htm

40% of Operating Room Waste is from suction Canisters!

Potential for occupationalExposure in transport.

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Business Model for the LaunchBusiness Model for the LaunchSubscription Pricing

Annual Pricing per facility:up to beds = 50 $500 25%

350 $1,000 65%350+ $2,000 10%

Support OptionsPrice Description services included

included Included DCT listserv, getting started teleconference

$2,200 1st Year Support Plan

$1,200 2nd Year Support Plan

$5,000 On site consulting

$1,000 Benchmarking

Health System Packages (>= #hospitals)10 25 50 100

5% 10% 20% 30%

phone support @20 hours per year, initital benchmarking (4 hours)phone support @8 hours per year, initital benchmarking (4 hours) (2 days on site, + expenses) + 12 hours of phone support

ongoing benchmarking/goal setting report, EOY benchmarking

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Models – Shared Savings vs Fee for Models – Shared Savings vs Fee for Product/ServiceProduct/Service Fee for Product and Service - A combined strategy of program sales

combined with assessment consulting

Shared savings model – Three year - 50-30-20% Calculated using total annual waste costs

RMW reductions, HIPAA, recycling increases, etc Contracting savings Will consider changes in operations and impacts on big costs

Benefits: No money upfront Risk free

Disadvantages: Contract negotiations and tracking are more difficult Accounting challenges – inconsistent with the mission of the tool Improvements in operations may not be reflected in total waste budget ( “I haven’t

had time to implement the operational changes but it’s valuable knowing what I need to do”)

Tool should drive a culture change – facility should “own” the potential savings and invest it back into the program

Risk of unintended lowering of motivation Contract negotiations

Facility will sign off on statement of intent and purpose – fully understanding the goals Tool must be used for one year Facility must have a dedicated staff person to launch tool If facility doesn’t hold up their end of the bargain, a $1,000 fee per user is charged Use of the tool must be discontinued

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Next Steps - Next Steps -

New Features Additional modules Benchmarking

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BenchmarkingBenchmarking

Input data points to describe level of activity Square Footage # beds Adjusted Patient Days FTEs # emergency room visits Facility type **$$$ basic costs, waste disposal fees, KWH energy

costs, per gallon water costs, etc.

Output For each target area, “acceptable” range Identifies opportunities for improvement

Costs savings and environmental performance

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EnergyEnergy

Hospitals use more than twice as much energy per square foot as office buildings.

~ 50 billion kilowatt hours of electricity $3 billion each year on electricity costs. If hospitals improved their energy efficiency

by an average of 30%, the annual electricity bill savings would be nearly $1 billion and 11 million fewer tons of carbon dioxide

would be emitted--equivalent to taking 2 million cars off the road.

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0

1,000

2,000

3,000

4,000

5,000

6,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

kgal

s/m

onth

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$/m

onth

2001 kgals

2002 kgals

2003 kgals

2001 $

2002 $

2003 $

Comparison of Pre- and Post-Conservation Water and Sewer Costs Based on Utility Bills (Southwest Florida Regional Medical Center)

WaterWater

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Next StepsNext Steps

Launch Tool in 2007 with systems and state groups

Gather benchmarking data How can we work together? HELP US FIND A NAME:

H2E Waste Data Compactor H2E WOW Strategies – (working on

waste) H2E Sustainable Strategies for

Environmental Programs H2E Environmental Excellence

Strategies

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Save the Date!Save the Date!

May 14 and 15, 2007, Minneapolis, MN

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Safe Disposal of Pharmaceuticals - Workshop

Tuesday, May 15th – Minn. MN

Documents

H2E Providing Practical Solutions to Today’s Environmental Challenges