This document summarizes a presentation on applying lean techniques to reduce waste in healthcare. It discusses how healthcare facilities generate large amounts of waste, much of which is plastic, and the associated costs. It then introduces lean principles like value stream mapping to understand current waste processes and identify opportunities for improvement. The presentation describes a waste characterization study conducted at Kaiser Permanente to establish metrics and map waste streams. The goal is to standardize metrics to track progress in waste reduction and recycling over time.

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Waste Mapping
Lean Techniques Applied in Healthcare
October 3, 2013

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Speakers
• Millie Calistri-Yeh, PhD
– Senior Staff Engineer, Becton Dickinson
– Leader, Technical Working Group, Healthcare Plastics
Recycling Council
• Timothy Eng, PE, CIE
– Project Manager, Kaiser Permanente

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What is HPRC?
HPRC is a private, technical coalition of
industry peers across healthcare, recycling
and waste management industries seeking
to improve recyclability of plastic products
within healthcare.
HPRC Members
Mission
To inspire and enable the
healthcare community to
implement sustainable, cost-
effective recycling solutions for
plastic products and materials
used in the delivery of healthcare.
Value Chain Approach
HPRC is unique in its focus on
identification of plastics recycling
barriers and solution development
along the entire value chain.
HPRC is seeking to affect plastics
recycling from healthcare product
design and manufacturing
through product use, disposal and
recycle.
© 2013 HPRC

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 37 Hospitals
 568 Medical Office Buildings
 336 Administrative locations
 Over 56 million square feet of real estate
 9 million members
 173,300 technical, administrative, and
clerical employees and caregivers
 16,658 physicians representing all
specialties
 14 Medical Centers
 198 Medical Offices
 3.5 million members
 70,000 technical and clerical
employees and caregivers
 5,700 SCPMG physicians
 Los Angeles County's largest
private employer
Southern California

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Outline
• Introduction
– Waste Issues & their Costs in Healthcare
– Lean Principles
• Kaiser Permanente Story
– Understanding Baseline & Metrics Development
– Value Stream Mapping as a Tool to Ideate, Propose, Communicate,
and Drive Change
• Waste Exercise
• Conclusions
• Questions

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INTRODUCTION
WASTE & LEAN

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Here’s the Situation…

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Waste Issues
• Healthcare facilities in the United States generate 6,6001 –
14,2002-3 tons of waste per day, most of which is being
disposed of in landfills or by incineration.
• It is estimated that between 20 and 25 percent can be
attributed to plastic packaging and plastic products.4
• In addition, 85 percent of the hospital waste generated is
non-hazardous, meaning free from patient contact and
contamination.5
1. 6,600 tons - American Plastics Council, Hospital Plastics Characterization and Recycling Feasibility Study (1999).
2. 30.9 pounds waste/bed/day – Practice Greenhealth Benchmark Report (2013).
3. 924,333 staffed beds in US hospitals. American Hospital Association Fast Facts (http://www.aha.org/research/rc/stat-
studies/fast-facts.shtml 2013).
4. Lee, B., M. Ellenbecker, and R. Moure-Eraso. “Analyses of the Recycling Potential of Medical Plastic Wastes.” Waste
Management (2002): 461-470
5. Grogan, Terry. “Solid Waste Reduction in US Hospitals.” Hospital Engineering & Facilities Management (2003): 88‐91.
© 2012-2013 HPRC

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Waste Characterization
Waste study conducted
by the City of Los
Angeles:
Services: Medical / Health
•Other Organic – 37.8%
•Paper – 27.8%*
•Plastic – 24.3%
•Metal – 9.4%
*Paper recycling through Goodwill

10. CleanMed 2013_Less Waste using LEAN principles_April 25, 2013 © 2013 Partners Sustainable Initiatives
10
Waste Characterization
Paper, 25.8%
Plastics, 14.0%
Metals, 5.5%
Glass, 2.2%
Organic Materials,
20.6%
Construction and
Demolition, 13.9%
Household Hazardous
Waste, 3.2%
Electronics, 3.3%
Other Materials,
11.3%
Other Miscellaneous,
1.9%
Commonwealth of Massachusetts

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Cost of Waste
• Average healthcare provider spent ~$98 million on supply
chain functions.1
• Estimated $10 billion/year in disposal costs for US health
care industry.2
Average Costs of Waste Streams for PGH Award Winners:3
1 Nachtmann, H; and Pohl, E. State of Healthcare Logistics: Cost and Quality Improvement Opportunities, Center for
Innovation in Healthcare Logistics, University of Arkansas (2009).
2 American Hospital Association. “Sustainability Roadmap for Hospitals – Waste” (downloaded 3/4/2013).
3 Practice Greenhealth Benchmark Report, 2013 (21)
Waste Stream Solid Waste
Cost per Ton
Recycled Cost per
Ton
RMW Cost per
Ton
Hazardous Waste
Cost per Pound
Average, 2011 $126 $90 $1015 $3.1
Average, 2012 $105 $113 for hospitals
reporting costs
$109 for hospitals
reporting savings
$905 $3.2
© 2012-2013 HPRC

12. CleanMed 2013_Less Waste using LEAN principles_April 25, 2013 © 2013 Partners Sustainable Initiatives
12
Complexity of Waste
OR
ER
Med Surg
Isolation
PharmacyLab
Research
Engineering
Administration
Dietary
MSW RMW C&D Recycle Sharps Trace
Chemo
Path HIPAA Universal Compost E-waste Rx Haz
WASTE
Partners System (and HHI) Waste Goals
 Reduce RMW to less than 10%
 Achieve a 15% recycling rate compared to total waste

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Lean Essentials
Creating a Lean Culture, David Mann, CRC Press, 2010
Lean Healthcare: Get Your Facility in Shape, Sarah Cottington & Shawna Forst, HCPro, 2010
1. Cross Functional:
expedite decision
making
2. Focused amount
of time – reach
consensus & avoid
future rework
3. Co-develop the
plan – ideas come
from team
4. Clear metrics &
goals – shared by
team
5. Anticipate and
recognize problems
6. Interactive process of
continuous improvement –
Plan, Do, Check, Adjust
7. Changes are
Embraced

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Actual Operations

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Integrated Waste Management Hierarchy
http://www.epa.gov/osw/homeland/hierarchy.htm

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Waste Characterization Study
for Zero Waste Planning
Conducted by E. Tseng and Associates for City of Los Angeles 2009

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Three-Year Project
• Contractor establishes initial “Reference Baseline”
– Develop basic correlative environmental metrics
– Conduct on-site “Functional Assessments”
– Develop a tracking/monitoring database
• KP/Contractor conducts joint assessment of progress and update
metrics (training)
• KP conducts assessment / metrics under supervision of
contractor

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Goals / Objectives of Solid Waste Baseline Study
1. Compliance with the Kaiser Permanente National Waste Minimization (NWM) policy of make a significant effort
to reduce the amount of waste that is generated by implementing waste reduction and recycling programs.
2. Promote the overall Kaiser Permanente environmental sustainability strategy which also promotes individual and
community health, environmental stewardship, cost savings and legal compliance by reducing the amount of waste
generated in Kaiser Permanente buildings and establishing waste minimization as part of it operational thinking.
3. Create a standardized comparative quantitative basis with legally and technically defensible environmental
metrics which can be used to be compare against other medical centers, cites, and other organizations/entities.
4. Create an institutionalized Kaiser Permanente infrastructure with trained personnel which can quantitatively
monitor, evaluate, track the progress of the implemented waste reduction and recycling programs and the disposal at
each medical center with legally and technically defensible environmental metrics.
5. Create an award-winning Kaiser Permanente solid waste reduction and recycling program which will be a UCLA
“Best Management Practices” (BMP) reference teaching model at and peer match model for the medical services
industry.

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Waste Mapping Team

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Conduct Detailed On-site “Functional
Assessment”

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Identify Existing Programs

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Identify Opportunities for Reducing
Disposal and Increasing Recycling
Shrink Wrap /
Cardboard Recycling
Pallet and Metal
Recovery/Recycling

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Opportunities for Improvement,
Communication, and/or Education

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Learning to See

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Joining efforts at the
Los Angeles Medical Center

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Loading Dock / Materials Management

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Emergency Department

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Oncology

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Regional Waste Profile 2012
Highlights
•Panorama City at Zero Landfill at year-
end
•Increases in recyclable tonnage
Solid Waste Medical Waste Hazardous Waste
Cost by Category
2010
2011
2012
2010 2011 2012
Waste Disposal Costs
14%
12% Increase
Solid Waste (lbs) Recyclables (lbs) Medical Waste
(lbs)
Hazardous Waste
(lbs)
Waste Totals
2010
2011
2012
-6%, 15%
0, 14%
-34%,

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Waste Map / Exercise

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Conclusions
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• Waste is a Big Deal!
• Effective management of waste streams is Essential
• Hospital
• Product & packaging design & reduction
• Space optimized for inventory & waste & disposal
• Reduce cost for hospital
• Ease of waste stream optimization
• Opportunities for Suppliers to make impact!

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Questions?

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Environmental Purchasing Program (EPP)

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EPP Disclosure Questions
http://xnet.kp.org/compliance/supplier/ep/policies.html

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Additional Questions?
• Contact Information:
–Millie Calistri-Yeh,
millie_calistriyeh@bd.com
–Tim Eng, timothy.c.eng@kp.org