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Why "sustainable" hospitals


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Sustainable development paradigm applies accurately to healthcare facilities. Here is explained why and how

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Why "sustainable" hospitals

  1. 1. Why “sustainable” hospitals? … and what could make hospitals environmentally sustainable? Dr. Jean-Jacques BERNATAS ADB, July 2013 1
  2. 2. … and why it should be so. More than just showcasing, health sector is supposed to be a leader and to bring onboard the other sectors. A hospital is usually one of the main employers in a community and has a high economic impact on it. A hospital has a corporate social responsibilities. The hospitals are dealing with highly toxic substances. The hospitals are among the heaviest energy consumers. The hospitals produce a huge amount of regular and hazardous waste. • Not a marketing-driven initiative. • Shared interest between the medical service providers and the users, about a “development that must allow current generations to satisfy their needs,without prevening future generations from doing the same”. 2
  3. 3. The context of SD in HCF Input (equipment, supply, consummables, …) $ (investment, capital, income) People (staff, patients, visitors) Strategy Management Process (SOP) curativepreventive HEALTH  Adverse public health impact: • toxic substances • energy and water consumption • carbon footprint  Individual adverse events: • nosocomial infections, • accidental deaths and disabilities • work accident and occupational diseases Immediate profitability vs. Sustainable development Lowest cost vs. Sustainable input 3
  4. 4. Back to fundamental: The Hippocratic Oath Better health (patients, community, country) Adverse events (patients, visitors), work accident (staff), and negative environmental impact (indoor/outdoor) 4
  5. 5. Conceptual framework of SD in healthcare sector Improving outcomes Mitigating adverse events and negative environmental impact Sustainable management Ecoconstruction Saving energy and water Preserving the atmosphere Sustainable buying Sorting, recycling and re-using Sustainable health 5
  6. 6. Sustainable management From quality grass-roots: • Structure/process/outcome Donabedian’s framework and its further improvements, for evaluation and quality improvement • Non-quality as a factor of increased costs of healthcare, • P-D-C-A and continuous quality improvement in health. to sustainable management: • Motivate: motivation is the cornerstone • Link: network of hospitals sharing experience on SD • Train: knowledge is power; on-site, hands-on and continuous is better • Validate: certification (ISO14001, LEED, EMAS, …)(*) • Communicate: creation of SD commissions, sharing experience with a larger audience, and to convince people on the relevance of SD. (*): ISO: International Standard Organizatio; LEED (US Green building Council): Leadership in Energy & Environmental Design; EMAS: European Eco-Management and Audit Scheme. 6
  7. 7. Ecoconstruction •Usually a higher immediate investment for a mid- even long-term profitability « only ». •Refers to specific labelling such as LEED, BREAM, ISO 14001, … •Starts with a decision-making, then a choice of a site, and a participative multidisciplinary approach. •Environmental impact studies to be conducted. •Energy performance, choice of materials, noise reduction, choice of light, … among others. 7
  8. 8. Saving energy and water • A hospital energy consumtion in France is around 350 kWh/m2/year (energy efficiency index) where the new low energy building standard for healthcare buildings in France is now 50 kWh/m2/year. • Hospitals energy consumption represents an average 11% of energy consumption of tertiary sector in Western countries. • A German study evaluated one hospital bed to consume as much electricity and heating as two households. • Energy performance assessment applies to hospitals. Benchmarking is ongoing. • Water is a finite resource: the estimated average consumption of a medico-surgical hospital is 300 to 750 liters/bed per day: • Using less « thirsty » autoclaves, recycling water from hemodialysis for flushing systems, using bio-digestive membranes 8
  9. 9. Preserving the atmosphere • Carbon footprint: the University Hospital of Geneva (HUG) has evaluated that it consumes yearly as much energy as a European city of 16,000 inhabitants, and producing 10 tons CO2 • HUG carried out a « life-cycle analysis » showing that 40% of carbon emission comes from materials and incoming products (mainly from drugs and textile objects); energy consumption of the buildings counts for 25%; transport makes 25% of total carbon emission, and infrastructure and traetment of waste counts for 10%:  Reducing the impact of transport on CO2 production: • Hospital better connected to the city • Green mobility: hybrid engine ambulances, carsharing for ambulances, staff mobility (car pooling, bicycle, …)  Improving the hospital functionning in reducing CO2 production: • Promotion of green spaces • Shortening of the supply chain • Energy saving policy 9
  10. 10. Sustainable buying • Appropriate purchase is of utmost importance to: • Getting rid of toxic substances • Reducing waste and energy consumption • Decreasing greenhouse gas production • About toxic substances: • endocrine disrupters (transgenerational effect of Distilbene; BPA and feeding bottels; DEHP and nutrition pockets, tube, transfusion packs) • Nanoparticulated titanium in wall paints (production of titanium dioxide under UV exposure with antibacterial effects, but nanoTiO2 has possible adverse effects on membrane blood-brain barrier) • Ethylene oxide sterilization, including bottle teats: listed as carcinogen to man, but still in use to sterilize enteral feeding devices. • Solutions: • Responsible and professionalized purchase based on transparent information made available, traceability of the products to face the fragmentation of internal and external purchases, purchasing centrals, pooled purchases ... • Substitution of toxic/carcinogenetic substances (Karolinska Hospital in Huddinge, Sweden: list of 100 substances to be abolished). Bisphenol A Phtalates nanoTiO2 10
  11. 11. Sorting, recycling and re-using • Chemical releases • REACH regulation (European Community Regulation on chemicals and their safe use): guidelines for identification and substitution of chemicals • Effluents: • Effects of low concentration persistant residues in discharged water: drugs, radioactive substances, antibiotics, • Possible bioaccumulation in aquatic organisms. • Reduction of drugs in effluents requires better prescription (less /appropriate prescription of antibiotics), specialized treatment plants, separate sewage network for hospital. • Substitution of reagents (cyanide for blood count), • Issues in disinfection/sterilization: place of incineration? Substitution to autoclaves for some mediacal waste (grinding and chlorine dioxide treatment) • Sorting channels and recycling: up to 30 channels in some hospitals, with a specific lifecycle for each type. • Chasing any unnecessary packaging. Waste reduction and recovery policy in place. 11
  12. 12. Sustainable health (1) • Taking care of employees: • Occupational health improvement, based on prevention: back pain prevention, tobaco-free environment/smoking cessation support, ... • Psychological stress, specific issue of HCW: counseling, adapted innovative management (decentralized management unit providing more autonomy for nursing staff). Experience of « magnetic hospital » keeping low attrition rate among workers in providing better conditions at work – ARIQ label in Canada (attractiveness of a hospital/ ability to keep staff/ involvement of nurses/ quality of care) • For patients • The International Declaration on Diseases due to Chemical Pollution, known as the Paris Appeal, launched at the Paris conference on Cancer, Environment and Society on 7 May 2004: an agenda to deal with environmental health. • Implementation of environmental medicine services in hospitals: multiple sensitivity, low fertility due to endocrine disrupters, ... 12
  13. 13. Sustainable health (2) • Prevention is the cornerstone of sustainable health, but: • Can hospitals shift to prevention+care, when they primarily exist for care only and when the competition is based on the scope of services and cutting-edge technology access? For private sector: Is prevention a good business?? • Another reason to rethink care more globally and to revisit the primary health care concept = PHC as the grassroots of sustainable health in all development setting (LIC/MIC/HIC) = essential health care based on 8 components through a transversal and intersectoral approach. • Was considered as cheap basic – and then affordable - quality medical services • Now comes back on our radar, brushed up (see Jim Yong Kim’s Speech at World Health Assembly: Poverty, Health and the Human Future, May 2013) • Addresses not only Health for All (in 2000 …) but quality of care and universal coverage • Is a strong rationale to bring hospitals on board of SD • The diagonal approach: sustainable development of hospitals will support health system strengthening. 13
  14. 14. WHY the poor must benefit from such an approach? When it comes to saving money, the poor are the first to be affected: • Similar to double-burden of nutrition: the poorest are more often sick and will have only access to the cheapset care, which includes the use of the cheapest materials. The poor are more exposed to environmental risks. • This includes risks generated by the hospitals in the neighborhood: unsafe waste management, incinerator producing dioxines production, for exemple. 14
  15. 15. HOW the poor must benefit from such an approach? Environment regulations to be reinforced • and to apply to all healthcare facilities, including public and decentralized. Adequate financing and existing agenda. Promotion of projects or projects components adressing this issue: • just to incorporate the hospital in the picture and see what can support its sustainable development. An assessment is necessary in public healthcare facilities. Possibility to start with a version of an autodiagnostic tool, implemented already in more than 1,200 hospitals in Europe, now in Canada with the support of C2DS. 15
  16. 16. • No way to escape • Asian/South-East Asian countries are more exposed to the environmental risks and should take up the lead in developing sustainable healthcare facilities. Finally … 16
  17. 17. Acknowledgements • Olivier TOMA, C2DS ( ) • Health Community of Practice, Asian Development Bank, Manila. 17