With so many potential benefits, from cost savings to improved patient care and employee health, it’s a wonder that more health care facilities aren’t jumping onto the environmentally conscious bandwagon. But, there’s a good reason for that - from an institutional perspective, it turns out greening a hospital isn’t easy.

“Green health” is just one of umpteen buzzwords out there, confusing health care facilities and leading them to question whether all the hubbub is warranted.

“[Going green] is really tricky,” says Barbara Hamilton, sustainability manager for San Diego’s Palomar Health system.

Although complex, Hamilton believes it’s worth the trouble. “At Palomar Health, we believe there is a direct correlation between human health and environmental sustainability. So we look for and work to explain these connections.”

As with any other revolution, there are those who lead, those who follow and those who are dragged kicking and screaming in a new direction. But the green health “choir is getting louder,” notes Kai Abelkis, environmental coordinator for Boulder Community Hospital in Boulder, Colo.

“The more enlightened and forward thinking a hospital is, and the more they get the connection between human health and the environment, the more likely they will see it is a moral obligation for health care providers to do this,” he says.

Going green doesn’t have to be complicated. Industry experts advised DOTmed News on why hospitals should implement these changes, and how the task can be efficiently accomplished.

Pinpoint a champion
The big picture can be overwhelming, but it’s all about baby steps, says Dr. Linda McCauley, dean and professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Ga.

“A lot of health systems will tell you it’s too expensive to retrofit old facilities to be more environmentally friendly, but there is a huge number of small scale things they can do,” she explains. “So they may not be able to change their lighting, but what’s to stop them from changing where they buy their food or switching out all of their trash containers for recyclable containers? Do it gradually, one floor at a time, one unit at a time, one hospital at a time. You don’t have to turn on the switch and make everything green tomorrow. Realistically, you just need a plan for moving forward.”

Before this can be accomplished, however, hospitals need to identify the environmental steward in their leadership team. For example, if a hospital doesn’t have someone in the supply chain that is aware of the benefits of biodegradable products or items that can be reprocessed, they just won’t order them.

“You have to have people who set the goals and monitor progress and communicate and reinforce that progress you are making,” she says. “It’s best to start by showing the savings and impact little differences can make.”

Last month, Palomar Medical Center, dubbed a so-called “Hospital of the Future,” held its grand opening in Escondido, Calif. When Hamilton joined Palomar Health, she told the CEO that it was very impressive they were building this “beautiful new green building,” but that it would only really make a difference if the building were operated in a sustainable way.


“We understand that even though our building is super energy-efficient, we need to track and monitor our consumption and its impact,” she says.

While a strategic focus on sustainability has not always been a high priority for U.S. hospitals, Laura Wenger, executive director of Practice Greenhealth, has noticed the creation of more roles targeting this issue.

“We are seeing more and more hospitals that are now hiring sustainability managers and other professionals to lead the charge and address the need for sustainability work which crosses over into multiple departments in hospitals,” she says.

Seek out valuable resources and roadmaps
As the green movement gains greater recognition on a national and global scale, sustainable health care is also receiving more attention. The wider availability of sustainable solutions, including products, services and education, has made it much easier for hospitals to go green.

“When I lived in the northwest in the ‘90s, there was a joke that people in Portland were the tree huggers of the USA,” McCauley says. “Now it has really permeated all areas. There are a lot of roadmaps organizations have put together that make it easier for health care institutions to join in.”

Among the organizations and tools in place to aid hospitals with greening efforts, there is: Practice Greenhealth, the nation’s leading membership and networking organization for health care institutions that have made a commitment to sustainable, environmentally preferable practices; the Green Guide for Health Care, which adapts the U.S. Green Building Council’s Leadership in Energy and Environmental Design (USGBC’s LEED) standards to the special needs of hospitals; and Hospitals for a Healthy Environment, an organization that aims to reduce mercury and improve waste management. Health care facilities can also use the Sustainability Tracking, Assessment and Rating System (STARS), a self reporting sustainability evaluation tool developed by the Association for the Advancement of Sustainability in Higher Education (AASHE).

“[When building Palomar Medical Center], CO Architects used tools like USGBC’s LEED rating system and the Green Guide to Healthcare to ensure that the most energy, water, and waste-efficient facility was designed,” says Hamilton. “At the same time, they considered materials’ toxic reduction, useful life, and platform flexibility for the future.”

Meanwhile, the Council on Environmental Quality spotlighted green health in July at a White House event on sustainable health care. The Healthier Hospital Initiative, born from the conjunction of Health Care Without Harm, Practice Greenhealth, The Center for Health Design and 11 of the largest hospital systems in America, shared a roadmap they created for hospitals to embed sustainability into their core business model and provide technical assistance to offer every hospital in America the chance to participate for free. More than 600 hospitals are already involved with the initiative.

“Awareness is definitely growing as evidenced by the rapid growth within the Practice Greenhealth membership,” says Wenger. “When Practice Greenhealth was officially formed in 2008, we had a few early adopter systems but now our membership encompasses close to 1,200 hospitals.”

Consider the financial Savings
With almost 20 percent of the U.S. marketplace based around health care purchases, the industry has significant power, according to McCauley.


“If hospitals as a unit went toward green purchasing decisions, they could significantly reduce costs in the USA, because they are such big buyers,” she says. “So there is the financial savings, but there is also the social cost.”

The health care industry spends $2 billion per year in energy costs, according to Abelkis. And that is just money spent on electricity or utility bills.

“What if every health care facility had renewable energy and didn’t use energy from the coal plant or utility company and was self-reliant when emergency situations came on board?” he asks. “That is $2 billion back in the health care industry, and a reduction of energy of fossil fuels that are making people sick. Could you imagine what that would do for the health care industry and the country?”

The root of the problem lies with the fact many hospitals are over 50-years-old. These structures were not built to be as energy efficient as more modern facilities. But this doesn’t mean they are mission impossible to update.

“Plumbing fixtures, to chillers and HVAC systems can make a massive impact on operational costs when you consider hospitals are open 24/7 and have a high demand for energy and water,” Wenger says.

Small changes, such as waste minimization, can have an enormous impact on a hospital’s environmental footprint and wallet, starting with the operating room (OR), one of the largest users of supplies within the hospital as well as one of the largest producers of waste, according to Wenger. Case studies have estimated that between 20 to 30 percent of the total waste generated by the hospital comes from the OR.

“Some hospitals would put red bag liners in their trashcans (indicating biohazard waste) in every patient room and by their nurses’ stations,” Wenger says. “These bags would get filled with paper towels, package wrappings, and numerous other things that are not biohazards. It would then cost the hospital eight to ten times more to have that removed. By properly placing and using trashcans, hospitals can save huge amounts of money on what goes out the back door.”

Refurbishing/reprocessing medical equipment
Refurbishment/reprocessing programs offer hospitals yet another cost cutting route, through long-term fiscal and environmental value, reducing supply costs and the environmental impact of providing care, according to Tamara Cutler, VP of public affairs at Stryker Sustainability Solutions.

“Reprocessed medical devices are roughly half the cost of their original counterparts,” she says. “The savings add up quickly. Some hospitals save millions of dollars each year and can redirect these cost savings to patient care quality initiatives.”

Sustainability benefits for hospitals don’t come solely from materials used to construct the devices – but also from the fact that implementing a reprocessing program diverts medical waste from landfills. Put another way: with reprocessing, single-use medical devices are treated as assets, not waste. As a result, hospitals can also save money by diverting waste away from costly disposal techniques, notes Cutler.


Siemens Healthcare, which sells refurbished systems for all imaging modalities, carefully disposes of any remaining, unusable parts, with only 2 percent of the original equipment manufacturers’ systems actually going to waste in the end. Because of this, the company saves 20,000 tons of CO2 per year, by avoiding the production of brand new materials.

Additionally, the proceeds from Siemens’ refurbishment process benefit the Sebangau National Forest in Central Kalimantan, Indonesia. In conjunction with the World Wildlife Fund, Siemens plants trees to double the amount of CO2 savings and gives customers certificate plaques telling them what amount of CO2 they are saving. The reforestation efforts are also saving Sebangau’s orangutan population.

“Using refurbished equipment is something that a hospital can market to a community,” says Sabine Duffy- Sandstrom, vice president of the refurbished systems business unit at Siemens. “It not only shows patients what services they offer and what technology they have, but also that they want to be a participant in the green movement of their community. This awareness is important.”


Likewise, Stryker’s reprocessing programs are in use at more than 1,900 leading hospitals and hospital systems across the U.S. Last year, the company helped divert nearly 3,400 tons of medical waste and saved hospitals $206 million in supply expenses. On a per-hospital basis, some save more than $600,000 annually.

How going green stops patients and staff from turning green
Any hospital’s top priority is treating ill patients. But many hidden dangers lurk that can actually impede the health of a hospital’s community, including patients, visitors and staff.

“Hospitals have an inherent responsibility in their mission to help treat and provide patients with high quality care, but this treatment includes not only treating disease and injuries, but also protecting health and making the community they serve a better place to live,” says Wenger. “In many communities the hospital is one of the largest employers, so it is also imperative to provide the staff within that facility with a safe environment that promotes health and is not just focused on treating disease.”



Nursing has one of the highest rates of occupational asthma of any discipline, according to Wenger. And it is no wonder: On any given day, nurses are inhaling fumes from harsh cleaners, paints, adhesives and furnishings, which give off volatile organic compounds (VOCs), including formaldehyde.

“When I did my doctoral work, my dissertation was on nurses who handle cancer therapy drugs,” explains McCauley. “What we actually found was that in handling these drugs, nurses were exposed to substances in those drugs, and started having health symptoms related to exposure to those drugs. So I became very interested in how hospital staff can be exposed to things that may not be optimal to their health.”

Low-VOC products help to alleviate this problem, and chemical cleaners, essential for preventing the spread of germs in a hospital setting, can in many cases be switched out for greener alternatives. For example, hospitals like Palomar use cleaning products certified by Green Seal, a non-profit organization that uses science-based programs to empower consumers, purchasers and companies to create a more sustainable world.

Aside from chemicals, a 2006 study by The Center for Health Design proved poor indoor lighting can negatively impact employee performance and increase their stress levels, compromising medical care.

With this in mind, Palomar’s designers, CO Architects, separated the diagnostic-and-treatment wing from the patient tower. This design decision allows for a 1.5-acre green roof with courtyards and skylights to bring natural light into the prep, recovery, and operating areas. In fact, Palomar is one of only two hospitals in the U.S. with natural daylight in the operating rooms.

“There are many non-patient areas in the new facility where many health care systems would not have included such access to nature, views, and sunlight,” says Hamilton. “But studies have shown that this investment in staff contributes to fewer medical errors and increased staff satisfaction.”

Create targets and measure environmental impact
While there are many different ways hospitals are working to make an environmental difference, some of the most common include: Waste minimization and proper segregation, leaner energy and water usage, healthier foods, smarter purchasing of more environmentally friendly products, and decreasing chemical usage and exposure.

Besides cost-savings and internal impact, there is also the global payoff to consider. For example, only about 1 percent of Earth’s water is fresh, and over-consumption, drought, and poor water management have led 36 states in the U.S. to anticipate local, regional, or statewide water shortages by 2013, according to Hamilton. So, maintaining adequate potable water supplies is a key benefit to smart environmental health planning.

“We monitor and track energy and water use at our most energy-intensive facilities; we have been quite successful at identifying and targeting efficiency measures,” says Hamilton. “In fact, we expect to achieve a 20 percent energy efficiency goal by 2015.”

Meanwhile, Boulder Community Hospital has held steady with its energy consumption and is reducing its use of fossil fuels by adding alternative energy resources.

“We have reduced our waste by 42 percent,” says Abelkis. “One day, we will be a zero waste organization. Everything will either be recycled, composted, reused or reduced altogether.”
Of course, this is just a sampling of the endless array of green choices and decisions at hand. But hospital decision makers shouldn’t get stressed out, advises McCauley.

“There is a huge menu of things hospitals could do, from solar-powered transportation to energy efficient machines and lighting to sustainable food to getting rid of plasticizers to reusing things instead of disposing everything,” she says. “By advertising that you are doing just a few of these things you can make a huge social impact.”