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#GreenHC - Environmental Stewardship in Health Care

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Presentation given at Rollins School of Public Health, Emory University, live from Kaiser Permanente Center for Total Health, Washington, DC

Presentation given at Rollins School of Public Health, Emory University, live from Kaiser Permanente Center for Total Health, Washington, DC

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  • 1. Ted Eytan, MD MS MPHPhysician Director, The Kaiser Permanente Center for Total Health • The Permanente Federation, LLC • @tedeytanApril 30, 2013© 2013 The Permanente Federation, LLC#GreenHC • Environmental StewardshipEmory University | Rollins School of Public Health
  • 2. Hi. I’m Ted.@tedeytan
  • 3. We’re here from the future.kp.org/centerfortotalhealth | @kptotalhealth
  • 4. To heal, you have to not harmNHS EnglandKP0.8675MtCO2e 5.04MtCO2e(energyonly)9millionmembers178,000employees37hospitals611medicalofficebuildings607otherfaciliGes52millionpeopleMtCO2e : Metric Tonne (ton) Carbon Dioxide Equivalent, 2010 Reporting YearSource: http://www.theclimateregistry.org/ ; http://www.sdu.nhs.uk/sd_and_the_nhs/
  • 5. Medical Care only happens here?
  • 6. doctor | 19th century
  • 7. !24/7 access worldwide!9,000,000 members can–email their doctor–check lab test results–order prescription refills–manage appointmentspatient | 21st century
  • 8. discovery
  • 9. Health doesn’t happen here
  • 10. It happens here
  • 11. It happens herePhoto: M.V. Jantzen - http://www.flickr.com/photos/mvjantzen/8464490630/
  • 12. It happens hereLa Mesa Medical Offices, California Photograph: Ted Eytan, MD, http://www.flickr.com/photos/taedc/8382776635/
  • 13. “Dream Grounds for a Dream Hospital”Why.Source: http://kasierpermanentehistory.org ; Joe Bialowitz, MS, HEM, Senior Environmental Stewardship Consultant, Kaiser Permanente
  • 14. “Showcases of modern, green hospital design”Why.Source: http://xnet.kp.org/centralvalley/pages/green_features/green_features.html ; http://xnet.kp.org/newscenter/pressreleases/scal/2012/011712sandiegosolar.html
  • 15. How - Better food
  • 16. How - Better food
  • 17. How - Better foodSource: http://www.nytimes.com/2010/09/22/dining/22doctors.html
  • 18. How - Better food! 190 tons of fruits andvegetables served topatients sustainablyproduced (50% of total)! Milk, yogurt free of rBGH! Cage-free shelled eggs! Partnership with UCSF,John Muir, others forRegional ProduceSourcing ProjectSource: http://www.nytimes.com/2010/09/22/dining/22doctors.html
  • 19. How - Better food! 190 tons of fruits andvegetables served topatients sustainablyproduced (50% of total)! Milk, yogurt free of rBGH! Cage-free shelled eggs! Partnership with UCSF,John Muir, others forRegional ProduceSourcing ProjectSource: http://www.nytimes.com/2010/09/22/dining/22doctors.html
  • 20. How - Safer Chemicals!Steam instead of chemical sterlization ofendoscopes!PVC-free carpet!PVC-free and DEHP-free IV bags and tubing!PVC-free and DEHP-free PCA sets!Green Seal-certified cleaning productsSource: http://xnet.kp.org/newscenter/pressreleases/nat/2012/011912ecofriendlyIVbags.html
  • 21. Source: http://xnet.kp.org/newscenter/pressreleases/nat/2012/011912ecofriendlyIVbags.htmlHow - Safer Chemicals! IV tubing / bags: 100 tons of medical products! PVC : Cancer, through dioxin generation! DEHP : Neuroendocrine abnormalities! Safer product saves $5 million / year
  • 22. How - Better care models: Blood pressure control60%73%85%2005 2006 2007 2008KP memberUS 90th %Source: Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.Health Affairs. 2010;29(7):1370-1375. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010].
  • 23. How - Better care models: Blood pressure control60%73%85%2005 2006 2007 2008+ emailUS 90th %Significant? Howabout p<0.0001Source: Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.Health Affairs. 2010;29(7):1370-1375. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010].
  • 24. 2,500,000 members5,000,000 members20032005 2007 20092012 (4Q)4.2 million members connected, via kp.orgSource: Kaiser Permanente Web Analytics, updated 12/18/2012
  • 25. Environmentally responsible, tooHealth Affairs, May 2011: “KaiserPermanente Study Finds Use ofElectronic Health RecordsReduces Carbon Emissions,Waste and Water Consumption”PotenGalCO2emissionsreducGonsasmuchas1.7milliontonsacrosstheenGreU.S.populaGonSource: Turley M, Porter C, Garrido T, et al. Use of electronic health records can improve the health care industry’s environmentalfootprint. Health affairs (Project Hope). 2011;30(5):938-46. Available at: http://content.healthaffairs.org/cgi/content/abstract/30/5/938[Accessed January 3, 2012].
  • 26. “Kaiser (Permanente) is so far past faxingorders that they’re into sustainable apples”-Jess Jacobs, April, 2013, TEDMEDhttp://http://jessjacobs.me/my-intravenous-lecture/For whom
  • 27. seeing that there is a long list of crazyadministrative headaches shows how verybroken the communication process is forevery single step of getting healthcare.http://http://jessjacobs.me/my-intravenous-lecture/@jess_jacobsFor whom
  • 28. next year’s medicalchallenge: wastehttp://http://jessjacobs.me/my-intravenous-lecture/@jess_jacobsFor whom
  • 29. Catalyzed by…!“Only one health insurer,Kaiser Permanente, has astrong climate position.”Source: Insurer Climate Risk Disclosure Survey: 2012 Findings and Recommendations - Ceres -https://www.ceres.org/resources/reports/naic-report/view
  • 30. Catalyzed by…Source: Insurer Climate Risk Disclosure Survey: 2012 Findings and Recommendations - Ceres -https://www.ceres.org/resources/reports/naic-report/view! “If greenhouse gasemissions continue toincrease, climate change willcause health effects that willdirectly impact KaiserPermanente’s ability to fulfillour promise of quality,affordable care.”
  • 31. Catalyzed by…VisionforEnvironmentalStewardship&GuidelineforClimateChangeSource: Kaiser Permanente Environmental Stewardship, Strategies, Principles, and Guidelines;http://blog.epa.gov/blog/2009/10/15/healthy-health-care-leader-kaiser-permanente/ Ted Eytan, MD! “If greenhouse gasemissions continue toincrease, climate change willcause health effects that willdirectly impact KaiserPermanente’s ability to fulfillour promise of quality,affordable care.”
  • 32. Catalyzed by…VisionforEnvironmentalStewardship&GuidelineforClimateChangeSource: Kaiser Permanente Environmental Stewardship, Strategies, Principles, and Guidelines;http://blog.epa.gov/blog/2009/10/15/healthy-health-care-leader-kaiser-permanente/ Ted Eytan, MD! “If greenhouse gasemissions continue toincrease, climate change willcause health effects that willdirectly impact KaiserPermanente’s ability to fulfillour promise of quality,affordable care.”
  • 33. Healthier Hospitals #youcandoittoo!healthierhospitals.org!@hhiorgThe Healthier Hospitals Initiative (HHI) is a national campaign tolead change in the health care sector. Twelve influential U.S. healthsystems have joined with Health Care Without Harm (HCWH), PracticeGreenhealth and the Center for Health Design (CHD) to provide a freeway for hospitals to incorporate environmentally friendly practicesinto daily operations. By sharing win-win strategies, and collectivesustainability experience, hospitals see results quickly in improvedhealth of patients, staff and their communities, reduced environmentalimpact, and considerable financial savings.LEANERENERGYHEALTHIERFOODLESSWASTEENGAGEDLEADERSHIPSAFERCHEMICALSSMARTERPURCHASINGLeading Communities to a Healthier Future
  • 34. KAISER PERMANENTEREDUCING, RE-USING & RECYCLING TO ELIMINATE WASTEHospitals in the U.S. annually generate more than 5.9 million tons of waste,much of which comes from scarce natural resources and ends up in our nation’slandfills where wastes emit greenhouse gases and other pollutants. In additionto standard waste products—paper, cardboard, bottles and cans—health carehas unique waste streams such as electronic equipment, infectious waste,radiological waste and other hazardous waste, such as solvents, that must beproperly managed and treated in order to protect both the environment andpublic health. Cutting waste within the health care setting reduces operatingcosts while lowering exposure risks for health care workers and often creatinggood jobs for people in the local recycling industry.Kaiser Permanente has set an ambitious waste reduction target to re-use,recycle or compost at least 40% of our waste materials by the end of 2015(excluding construction and demolition debris, where we often achieve muchhigher rates of recycling on a typical project).Examples of Kaiser Permanente’s rigorous waste reduction initiatives include:Recycling or composting non-medical wasteSafely re-using medical devicesPurchasing products high in recycled content and recyclabilityBuilding efficiency into our care delivery systemRecycling and Composting Non-Medical WasteKaiser Permanente makes a priority of involving our staff and physicians inefforts to reduce the use of plastic bags, single-use water bottles, and officepaper. Our organization is rolling out efforts to compost food as well as papertowel waste in several of our facilities and office buildings.In Southern California, Kaiser Permanente and Goodwill Industries havejoined forces to collect and recycle many of the waste materials generatedby Kaiser Permanente. Each year, the two organizations also host a series ofregion-wide community waste and donation campaigns to recycle, reduce andre-use thousands of pounds of electronics, clothing and other items.Many Kaiser Permanente hospitals have developed innovative programsto recycle blue wrap, the material used to preserve the sterility of medicalinstruments. The material feels like soft paper, but is actually made fromheavy-duty polypropylene plastic that can take years to disintegrate inlandfills. Blue wrap can be recycled into wash buckets, lawn furniture,flowerpots, squirt bottles, plastic lumber for picnic tables and thousands ofother commonly used products.KAISER PERMANENTEPROMOTING SUSTAINABLE FARMING AND FOOD CHOICESLocally grown, sustainably farmed and produced food choices are good for theenvironment and for people’s health. Kaiser Permanente offers sustainable foodchoices on patient menus and in cafeterias and vending machines at many ofour hospitals and medical centers. We support the development of local andsustainable food systems as a public health tool.At Kaiser Permanente, we recognize that sustainable food promotes goodhealth by reducing the prevalence of synthetic pesticides and chemicals inthe food stream and the environment and by fostering the availability andconsumption of locally grown, fresh food choices. We advance sustainablefarming and food choices through these efforts:Increasing sourcing of locally grown, sustainably farmed and produced food inKaiser Permanente hospitals, cafeterias and vending machinesSponsoring farmers’ markets as a means to promote access to fresh, local produceand support investments in local economiesIncreasing awareness about toxins in the food chainCollaborating with other major health care systems and non-governmentalorganizations to accelerate improvements in sustainable food procurementthroughout the health care sectorSourcing Locally Grown, Sustainable FoodAs part of their mission of healing, health care providers have a responsibility totheir patients, employees, visitors and the communities they serve to offer foodoptions in their patient meals, cafeterias and vending machines that supportoverall health. At Kaiser Permanente, we recognize that the way food is produced,processed, packaged, distributed and consumed in the United States has significantimpacts on human health and the environment. We are working to shift the foodsystem in a more sustainable direction by increasing our sourcing of locally grownand sustainably produced food options.Kaiser Permanente devotes approximately 16 percent of our overall foodspending to sustainable food across the organization, nearly two times as muchsustainable food as most other hospital systems of our size. By the end of year2015, that number is expected to grow to 20 percent.Kaiser Permanente has developed specific sustainability criteria within eachfood category which align with the Green Guide for Healthcare Food ServiceCredits, a benchmarking tool for sustainable food in health care. Someexamples include: food produced within 250 miles of the Kaiser Permanentefacility; produced without pesticides, antibiotics or added hormones; andcertified as sustainably produced by a third-party eco-label. Food productsmust meet at least one of these criteria to be considered sustainable, thoughpreference is given to products that meet multiple criteria for sustainability.KAISER PERMANENTEFINDING SAFER ALTERNATIVES TO HARMFUL CHEMICALSExposure to toxic chemicals in everyday life has increasingly become a healthconcern. More than 80,000 chemicals are used in commerce today, and onlya small fraction has been tested for effects on human health. There is growingevidence that environmental exposures to some chemicals contribute to cancer,asthma, reproductive disorders and other heath impacts.Kaiser Permanente is committed to researching and sourcing saferalternatives to products used in health care settings such as cleaners, solvents,disinfectants, plastics used in medical devices and building materials, flameretardants and formaldehyde.The organization promotes safer alternatives to harmful chemicals in four ways:Sourcing products with safer ingredientsAdding to the body of knowledge through research into health effects ofchemical exposuresInforming public policy and decision-making pertaining to safer chemical useCollaborating with other major health care systems and non-governmentalorganizations to accelerate improvements in safer chemical use throughout thehealth care sectorSourcing Safer ProductsIn 2006, Kaiser Permanente created an Environmental Purchasing Policy insupport of its social mission to improve the health of its members and thecommunities it serves. The policy requires that the principles of environmentallypreferred purchasing be applied to all major purchasing decisions.To further embed these principles in its decision-making process, KaiserPermanente developed the Sustainability Scorecard in 2010 as a way to ratemedical supplies on how eco-friendly and non-toxic they are. The scorecardis the first of its kind for health care and enables Kaiser Permanente tobetter choose products that reduce environmental and human healthimpacts while also encouraging our suppliers to increase their offerings ofeco-friendly supplies.With coordination by Practice Greenhealth, Kaiser Permanente made theSustainability Scorecard available to the health care industry’s largest grouppurchasing organizations (GPOs) representing an estimated $135 billion inannual purchasing volume. This significant leveraging power is helping toadvance an economy where the production and use of chemicals are notharmful for humans or the environment.KAISER PERMANENTERESPONDING TO CLIMATE CHANGEGreenhouse gas emissions are a known contributor to climate change and therise of pollution and disease. At Kaiser Permanente, we realize that we have aresponsibility to try to limit our greenhouse gas emissions, even while growingour health care services.With nearly 78 million square feet of real estate across nine states, KaiserPermanente is aware that our environmental footprint is substantial. That’s whywe have set an aggressive goal to reduce our greenhouse gas emissions by 30percent by the year 2020 (compared to 2008). By lessening our reliance on fossilfuels and reducing our overall energy consumption, we are working to minimizeour impact on the climate. The fact that this also reduces operating costs isgood news for our members.Kaiser Permanente follows a two-pronged approach to reducing greenhousegas emissions:Maximize energy efficiency through green building solutions in new and existing facilitiesIncreasing use of on-site and off-site clean and renewable energy solutionsMaximizing Energy Efficiency Through Greenbuilding SolutionsRecognizing the link between the health of the environment and human health,we have sought to make our health care facilities among the “greenest” andmost sustainable around. To that end, Kaiser Permanente has played a key role indeveloping nationally recognized green building strategies for the health care sector.Working with architects, engineers and public health care advocates, KaiserPermanente helped to design and pilot test strategies for the Green Guide forHealth Care and the more recent Leadership in Energy and Environmental Design(LEED) for Healthcare rating system — both premier tools for building facilitiesthat are healthier for employees, patients, communities and the environment.Several of Kaiser Permanente’s buildings have received the U.S. EnvironmentalProtection Agency’s Energy Star certification. This signifies that a building’senergy performance rates in the top 25 percent of facilities nationwide.In 2012, Kaiser Permanente adopted a policy to pursue LEED Gold certificationfor all new major building projects. The Westside Medical Center in Portland,Ore., set to open in 2013, will be among the first LEED gold-certified hospitalsin the Portland area, using green power sourcing and water-conservationfeatures. One of our California data centers was the first (and currently theonly) data center in the world to achieve LEED EB—Leadership in Energy andEnvironmental Design for Existing Buildings—Platinum certification.Finding Safe Alternatives to Harmful ChemicalsExposure to toxic chemicals in everyday life has increasingly become a healthconcern. Unfortunately, many products used within the health care industrycontain harmful chemicals—products such as cleaners, solvents, disinfectants,plastics, and building materials such as flooring and paint. At Kaiser Permanente,we’re committed to researching and sourcing safer alternatives to reduce harmfulexposure to our patients, staff, and communities.Our Sustainability Scorecard was developed in 2010 as a way to rate our supplierson how eco-friendly and non-toxic their products are. It encourages our suppliersto increase their offerings of environmentally responsible products and enablesKaiser Permanente to better choose products that are safer for our patients, staffand communities. Most of our environmentally preferable product choices—suchas intravenous bags manufactured without PVC and DEHP—are either costneutral or cost less than the more toxic products.Reducing Greenhouse Gas EmissionsGreenhouse gas emissions contribute to climate change and the rise of pollutionand disease. As a health care provider, we understand that it’s our responsibilityto try to limit our greenhouse gas emissions, even as we increase our health careservices. By reducing our reliance on fossil fuels, we are working to mitigateclimate change and create healthier communities.Kaiser Permanente has been at the forefront of embracing clean energy solutions,developing standards for sustainable building in health care, and looking for ways tocut back our energy consumption.We have deployed 15 megawatts of solar powerand four megawatts of fuel cell energy across our facilities, part of a larger plan touse sustainable energy sources to reduce the total greenhouse gas emissions of KaiserPermanente’s operations by 30 percent by the year 2020 (compared to 2008).EnvironmentalStewardshipMany of the solutions that are good for people’s healthare also good for the planet.At Kaiser Permanente, we recognizethat healthy communities and a healthyenvironment are critical to the health andwellness of every person. Creating thesehas always been central to our mission.We are dedicated to environmentalstewardship, and we aspire to providehealth care services in a manner thatprotects and enhances the environmentand the health of communities now andfor future generations.Kaiser Permanente has been committedto the environment since our foundingin the early 1940s. Our EnvironmentalStewardship program is part of ourCommunity Benefit work and isanchored in promoting the health of ourcommunities. Healthier communitieswith healthier people are more resilientto disease. By eliminating or mitigatingenvironmental contributors to disease, wehelp people lead healthier lives.To encourage healthy environments,we lead or support innovative effortsthroughout our organization to decreasewaste and pollutants, conserve water andenergy, promote sustainable agricultureand food procurement, and take steps toreduce our carbon footprint.kp.org/green