Greening America's Hospitals Part 2

Uploaded by whitehouse on 25.07.2012

Speaker: All right, folks, thank you guys so much
again for being here.
For all of you online, I just want to repeat the
hashtag or Twitter hashtag is healthier hospitals.
And on a very -- on a personal note,
I'm very excited to have been able to work with SEMA and the
rest of the team to put this on.
And I want to give special thanks to Courtney Henkel on our
team, Eli Levine and Kevin who is not here,
but these guys are the ones who really put this on and did all
the work and did the logistics of this,
so thanks to Courtney and Eli for making this happen.
(applause) So I've been over sitting here in the corner
taking feverish notes, and not just because I've been very
interested in the subject, but also because this subject
hits home particularly for me.
My wife is a pulmonologist at Johns Hopkins and focuses on
public health impacts, and so every day I think she generally
asks me how the day was, I think tonight she actually is going to
be extremely interested in what I have to say.
(laughter) To moderate our second panel,
and this panel is going to really focus on the
transformative impact of the supply chain,
will talk some -- about some of the overall impacts,
but want to focus in on the supply chain and how the supply
chain can affect sustainability in the
healthier hospitals sphere.
To moderate our second panel, we're very,
very lucky to have Bicky Corman who is the Deputy Associate
Administrator at the EPA.
Bicky is -- has been at the EPA since the beginning of the
administration and has handled environmental litigation and
policy at the state and federal level,
previously serving in EPA's New York office and in the
DOJ's environmental enforcement section,
also was in the District of Columbia's Department of the
Environment where she served as the general counsel.
On our panel, our first panelist is Al Ianuzzi,
he is the senior director of product stewardship at
Johnson & Johnson.
Thanks, Al, for being here.
Al is the Senior Director in The Worldwide Environment Health and
Safety department at Johnson & Johnson where he directs the
global product stewardship in green marketing programs.
Prior to being at Johnson & Johnson,
Al worked for the New Jersey Department of Environmental
Protection, and he is author of the books Greener Products,
the Making and Marketing of Sustainable Brands,
and Industry Self Regulation and Voluntary
Environmental Compliance.
Our second panelist is Kathy Gerwig,
VP of Workplace Safety and Environmental Stewardship at
Kaiser Permanente.
Kathy has -- is responsible for developing,
organizing and managing a nationwide environmental
initiative for the organization.
And under her leadership, Kaiser has been become widely
recognized as an environmental leader in
the health care sector.
She has testified to Congress on the need for federal chemical
policy reform, and she has appeared at numerous,
numerous hearings on environmental issues.
Kaiser Permanente is one of America's leading health care
providers and not-for-profit health plans serving 8.9 million
members, including Eli Levine who is on our staff.
Brad Perkins, the Executive VP for Strategy and Innovation and
Chief Transformation Officer at Vanguard Health Systems is here
with us today.
Brad came to Vanguard from the CDC where he served as Chief
Strategy and Innovation Officer.
And while at the CDC, he worked to lead the first large-scale
modernization of the strategic direction since 1977.
He has a long list of other distinguish leadership and
research accomplishments at the CDC and elsewhere,
including successful efforts in the United States and worldwide
to control bacterial meningitis and other epidemic-prone
infectious diseases.
He founded and led many of CDC's emergency response efforts over
the last decade, including leading the CDC's 2001 anthrax
bio terrorism response.
John Messervy, he's the Director of Capital and Facilities
Planning at Partners HealthCare, and he's the chair of the
Healthier Hospitals Initiative.
John is an architect and the director of the initiative and
is responsible for Partners' multi-year facility planning
program and their large-scale construction projects.
During the past decade, Partners has invested more than
$2 billion in new facility construction and renovation in
support of the highest level of clinical care,
medical research and teaching for what Partners
is internationally known.
John founded the Partners Sustainability Initiative in
2008 and is chair of the Healthier Hospitals Initiative,
a coalition of the nation's leading hospitals committed
to reducing the environmental footprint
of the hospital sector.
And finally, Blair Sadler is the senior fellow at the Institute
for Healthcare Improvement and the former CEO of Rady
Children's Hospital.
Blair is the founder of the center's Peeble -- sorry,
Pebble program, a collaborative effort to identify,
support and disseminate the work of pioneering organizations
throughout the world in evidence-based design.
He has consulted with several health systems throughout the
world, from Australia to Norway and beyond,
and has written extensively about the business case for
evidence-based design.
Bicky, take it away.
Bicky Corman: Thank you very much.
It's a privilege to be here.
We're really looking forward to hearing all of the wonderful
things that our panelists will have to say, excuse me,
and also to get questions from the audience so that we can
continue in this dialogue.
So why don't we just start right out with Mr. Ianuzzi.
I don't know if it's doctor or mister.
Al Ianuzzi: However you want it.
Either works, but I go by Al.
Bicky Corman: Al, okay, great.
Thank you, go ahead.
Do you want to make some remarks?
Al Ianuzzi: Well, I'd just like to, first of all,
thank everyone for the privilege to be here.
And real excited with the healthy hospital initiative,
and being able to play a part as Johnson & Johnson, we're really,
really excited about the opportunities.
It's really an awesome thing to see your customers looking for
greener products and focusing on energy efficiency and reducing
their environmental footprint.
And I know it's a real core value to us through our credo
and we are just very much interested in helping to meet
our customers' needs in this regards.
Bicky Corman: Thanks so much.
And how about Kathy Gerwig, care to make any opening remarks?
Kathy Gerwig: Well, I will start by saying that the reason
that I think we're all here is because we want to
reduce environmental contributors to disease.
And so this is about health, and we might be talking about
supply chain, we might be talking about energy,
we might be talking about any variety of things,
but I think the undercurrent for it all is that we want to reduce
environmental contributors to disease,
and if we don't use carcinogens, we will have
fewer cases of cancer.
If we don't pollute the environment,
we will have fewer incidence of asthma.
So with that being the spirit that brings us all together,
I think we're looking forward to the dialogue.
Bicky Corman: Okay, great.
Thank you.
Blair Sadler.
Blair Sadler: Thank you, Bicky.
I'm kind of new to the environmental world,
but I can tell you as a hospital CEO for 26 years,
where this makes -- resonates with me completely is that
probably over the last 15 of those 26 years,
the quality safety improvement effort went from sort of the
periphery to the IOM reports, you know,
and kind of lot of denial, no, we can't be making all these
errors to saying, oh, my God, we really have a problem.
And, you know, I will take you inside the boardroom of a
hospital in America today, and the conversations are
fundamentally different than they were ten or 12 years ago.
Ten or 12 years ago, most boards said that's the job of the
medical staff, I know that's how I felt, I'm not a clinician,
and now that's part and parcel of everything hospitals do in
America, relentlessly getting better.
The Institute for Health Care Improvement has been a
bellwether in helping hospitals learn how to do that,
do that easily and spread that.
And then through the 100,000 lives campaign in '06, '07,
to take it to scale.
And so as I look at this, I see this as a wonderful next
logical progression on that train of improvement,
of relentless improvement, because now,
just like we had the data ten, 12 years ago in other areas of
quality and safety and harm, we now have,
as you heard this morning from the panel and you're going to
hear for some other compelling examples,
these are ready to go to prime time.
And so I think it's just so exciting,
because conversations are now occurring in boardrooms often
around return on investment that would have been unthinkable
three to five years ago.
I can tell you if you'd ask me my last few years what's
the carbon footprint of Rady Children's Hospital,
I couldn't have told you.
Now that is common knowledge.
And so it's very exciting, and I commend the White House
to be launching and hosting this conference today,
because in my opinion it just couldn't come at a better time.
Bicky Corman: Thank you.
Excuse me, again.
Thank you very much for that and for these remarks.
I think I'm just going to start with a question with you
if I may.
Which is, to Brad Perkins, could you also describe what drove you
to this on a personal level, why is it that you're recommending
in your leadership role these adoptions of green practices and
what steps you have recommended be taken in your organization.
And then anyone else who would like to answer.
Brad Perkins: So leaders change stuff,
and they do so in a purposeful way that inspires followers.
And if you're leading in health and health care right now and
you have not rebooted your operating system and loaded the
notions of improving health, improving care and doing both at
a lower cost, you're sort of off the ranch.
And I think for people that are on that journey,
on that new operating system in health and health care,
the Healthier Hospital Initiative has really provided a
great service in terms of a road map that you can -- you can
embark on, but it requires leadership.
And, you know, I think that's the ingredient that we're most
short of, and I would encourage others to get on this program
and get on this journey with Healthier Hospital Initiative
and with the Triple Aim notion.
What we've done, and I'm representing some of the work
that the Healthier Hospital Initiative advocates for food,
you know, I think you can start off with the notion that
hospitals are no places for donut shops.
So if you have a donut shop or the equivalent in your hospital,
you've got a problem.
It's off tone for what we're talking about with the Triple
Aim improving the health of the community,
improving care and doing that at a lower cost.
We have a toxic food environment in the United States.
And hospitals and health care need to firmly reject that
environment and do so based on science.
There's 79 million prediabetics in the United
States, it's not hard to see.
It's a tsunami of cost and tragedy that confronts our
society and our basic fiscal stability as a country.
So I'm really asking for all of you to lead health and health
care in rejection of this toxic food environment.
And there's some very simple things you can do,
and we've done a number of them at Vanguard and have some
examples of success.
I -- you know, the challenge is broken up into three parts,
basically a balanced menu challenge where you can start to
reduce the level of meat consumption by 20% over a
period of time.
Increase the purchases of healthy beverages,
and this is something we've taken really seriously
at Vanguard.
And, in fact, on July 1st, we crossed an important
threshold in our four Chicago hospitals where we eliminated
sugar-sweetened beverages.
We're a little bit behind the schools, but we're there.
And very few health care systems are there.
With great science and 79 million prediabetics,
let me ask you, why aren't you there?
The other notion of the challenge is sort of increase
purchase of locally-produced and sustainable foods.
And we're taking attack on this in one of our new sort of green
field projects where in a city in between Austin and San
Antonio, we're starting at the baseline cultural level building
a community health commons, if you will.
We're making a big investment.
There will be a hospital, but that's not what we started with.
What we started with was a community
multi-generational garden.
Our CFO is not so impressed because there's not much cash
flow, but we have ignited in this community a cultural
movement involving third and fourth graders in collaboration
with the school district and senior master gardens,
to the point that kids weekly look forward to visiting this
garden to spend time with their garden grandparents.
Let's talk about that as a basis for building a health and
a health care organization.
There are sad stories, too.
One child said, my mom is going to be so happy about these
vegetables because we'll be able to add those to our
Ramen noodles.
We eat Ramen noodles every night.
So let me invite your leadership into the construct of the
Healthier Hospital Initiative.
The water is fine, come on in and lead.
Bicky Corman: Thank you very much.
That's very helpful.
And if there are others who would also like to speak about
maybe what their own personal view of this is as passionate as
is Brad Perkins, it would be to hear.
John Messervy: John Messervy from Partners HealthCare,
and I'm chair of the steering committee of the Healthier
Hospitals Initiative.
And I want to thank the council for giving us the opportunity to
be in the spotlight today.
It's -- we are a nation organization but it's
growing rapidly.
And as Brad mentioned, you know, there are tremendous
opportunities for all of us, all the hospitals.
He's speaking to food.
Kathy is probably going to speak to purchasing,
environmentally preferrable purchasing.
We have challenges in the area also of energy, of chemicals,
of leadership and waste.
And we're not each doing all of them necessarily, we're trying,
but there are other hospitals out there who I think can
contribute and participate with us.
So we're inviting you to participate with us today.
And the stories we have I'm sure probably resonate for many of
you, they are stories that are occurring in many hospitals
around the country.
I'm going to talk a little bit about where I came from in terms
of my commitment to sustainability.
Bicky Corman: Please.
John Messervy: And that is through my training as an
architect, which gave me a fairly basic understanding of
the way the world works in terms of built form and interaction of
people with that built form.
And, of course, with the natural landscape.
So under the tutelage of several mentors along the way,
I ended up working in a hospital system and was responsible for
building some new buildings.
And through that process, I found that I engaged in that
new building process with almost every department within
the hospital.
Obviously the physicians and nursing and caregivers,
but also the environmental services, also the dietary,
also the cleaning stuff, the watch people, security.
So at the same time there was a push to move our hospitals to
being green hospitals, to commit to the lead checklist.
And with the support of the CEO's of the hospital,
we did that.
In fact, we built one silver and three gold inpatient buildings,
but the interesting thing is through their commitment to the
lead process, in fact, they were also committing to a lot of the
other activities which are fundamental to the HHI promise.
So it wasn't much of a stretch, but we are still stretching to
embrace everybody who's interested.
Our new buildings are operating at a significantly less energy
intensity than the baseline.
If 250 KBTU's is the baseline, the hospital we have in
construction is at 142.
It doesn't -- it doesn't meet Jeff's 115,
but he has I think a geothermal system,
which if you can get geothermal, that really reduces your
KBTU's dramatically.
But for an urban hospital, I think 142 is pretty good.
Around the energy, just generally around energy,
we've committed to a 25% reduction in our energy
consumption by 2014.
We undertook an energy master plan for the system,
identified a series of conservation projects,
they involved investment, but the payback on those investments
are less than four years, and we are moving forward with it,
and we are already seeing a 13% reduction in our energy
consumption in the past three years.
We're also committing heavily to cogeneration,
which we see as a bridging strategy to renewables.
This is natural gas-fired, again,
we're not -- we're in an urban environment,
so we don't have the luxury of biogas systems to fire those
generators, so we're relying on natural gas,
but we're nevertheless seeing a reduction in consumption just
because of the savings that accrue from increased deficiency
from on-site generation.
And then on the renewable side, actually we have out on the
street right now an RFP for 30 megawatts of renewable power.
So it will be interesting to see how the marketplace responds to
that kind of opportunity.
Hospitals are energy hogs, no getting around it,
we operate 24/7, and as do many of our research facilities.
So there's a tremendous opportunity that falls right to
the bottom line through the HHI program,
there are many hospitals already signed up who have committed to
reducing their energy consumption,
to taking that savings, and there are mentors within those
hospitals who are available to help other hospitals who would
like to sign up and work with us.
Bicky Corman: Thank you, thank you.
I want to stick with the buildings for a moment and maybe
ask you either a follow-up or ask you to jump in, Blair,
on in addition to the energy efficiency aspect that we were
just hearing about, what are some of the other benefits that
hospitals or the health care industry are realizing as a
result of greening their buildings?
Blair Sadler: Well, I think, first of all,
there's a larger backdrop to all of this called evidence-based
design, you know, and it really parallels
evidence-based medicine.
And the Center for Health Design,
it's a partner with this wonderful effort,
has been a leader in that and as a nonprofit,
and basically in a nutshell, there are now between 1500 and
2,000 published articles in peer-reviewed journals that
speak directly to the relationship between things like
single patient rooms and getting more -- or less hospital
acquired infections.
Somebody mentioned this morning about better air
filtration systems.
Variable -- what we call variable acuity rooms,
which is kind of code for you put all the technology in a room
and instead of having to transfer a patient three or four
times during their stay, which costs money,
which disrupts their care relationships with their doctor
and their nurse, there's a tremendous dissatisfier and
often contributes to errors, you can avoid that.
Go to the employee side, go to nurses,
nurses have more back injuries than construction workers.
And the last time I looked, patients were getting bigger,
not smaller, and many nurses are getting older and not younger,
this is an epidemic, so do I put in things like hydraulic ceiling
lifts to help lift patients can reduce direct costs by 83%.
Lots of things you can do with natural light to give
more reduced anxiety.
Reducing overhead paging systems to make places quieter.
You know, God, I want to get home from the hospital so I can
start learning to sleep, that's kind of an anomaly, isn't it?
You know, because there's so much noise all over the place.
So what's so exciting about buildings from my perspective in
a sustainability world is building on this platform of
knowledge, Bicky, that's emerged over the last 20 years.
And between the two, when you're going and building the
new building that Jeff was talking about at his place,
you not only have the value of what can you do from a
sustainability standpoint, but from a lot of other efforts.
The other thing I would say just in closing,
putting on my ROI hat, is we've done a lot of work in what,
if you really did it right, what would the costing a better
hospital, we call it the fable hospital,
if you play pretend and the put all the things together that you
know how to do, including reducing energy that John is
doing, and the answer is there would be a one-time incremental
cost, sort of Jeff's model, and you get the full payback
within three years.
So imagine a 300-bed hospital that would save you $10 million
year after year after year.
And so it's changing those conversations in the boardrooms
that we talked about earlier, getting that awareness,
it's not just about the one-time capital cost,
it's the ongoing operating cost, and I think in terms of what
Knox was saying about how do you get CO's to
think about this differently, it's recognizing we have a
capital cost and an operating cost and savings,
which dramatically greater.
Bicky Corman: Thank you.
Those are really important pieces of information for
everybody I think to take home.
Is the boardroom getting involved in this simply chain
decisions as well, and if they are, why are they doing so?
Kathy Gerwig: At Kaiser Permanente,
we have a very robust supply chain effort around
environmental purchasing.
And in terms of board involvement, I mean,
most boards of directors don't put their fingers into that --
that level of an organization.
But what I can tell you about our board of directors is that
they regularly hear updates about what's going on in
sustainability in the organization.
We've gone to them to talk about safer chemicals,
we've talked about climate change and our energy programs
that are responsive to that.
And one of the -- one of the six areas of focus for the Healthier
Hospitals Initiative is engage leadership,
and to the extent that we can have a board of directors that's
engaged enough to want to hear, to ask to hear reports on these
types of programs means that our entire senior leadership,
of course, pays attention to that,
and that ripples throughout the organization,
so it creates this really nice dynamic of we clearly have a lot
of grassroots interest in this, doctors and nurses and EVS
workers and others who work in a hospital organization care
deeply about these sorts of issues.
They get the environmental health impacts.
And to have that coupled with leadership and board engagement
is really important.
So it is why the HHI focuses on engaged leadership.
It doesn't mean just CEO's, it doesn't mean just the senior
leadership, it really does include the board of directors.
And I know in our case at Kaiser Permanente,
it's created a really wonderful healthy dynamic.
Bicky Corman: So how is it that -- that the -- that the
embracing of the food chain, excuse me, excuse me, I'm sorry,
of the health care supply chain, I mean,
how is that having an impact on the delivery of care or how is
it having a delivery on the health benefits that the
patients are enjoying?
Kathy Gerwig: One really great example is mercury.
So it used to be that every time you go in and have your
temperature taken or blood pressure taken,
it was done with a mercury device.
And today -- those days are long gone.
I'll just say that.
And that was no accident.
Mercury came into the health care system very deliberately,
and it is out of the health care system very deliberately.
And that's a result of customers coming together under the
leadership of health care without harm,
one of the founding partners of the Healthier Hospital
Initiative, because they realized mercury is a
neurotoxin, what is a neurotoxin doing in a health
care environment.
And by communicating that information throughout the
health care sector and by notifying suppliers that we want
mercury-free products that meet our quality needs that are
affordable, do the trick, but without the neurotoxin.
And it turns out those alternatives were
readily available.
So we began that changeout.
One important point I do want to make in terms of supply chain,
because I -- all of us I know are asked this question all the
time, and it has to do with cost, but, you know,
you probably had to spend more for that mercury-free device.
So this is where learned a really important lesson around
supply chain management, and that is to focus on the cost
of ownership, not just the cost of a particular device.
So it is true, mercury thermometer,
mercury-free thermometer, yeah, the mercury-free one may cost a
little more unit by unit, but what aren't we paying for?
Well, we're not paying for any spills that happen,
we're not paying for hazardous waste disposal of mercury,
we're not paying to not have an exam room available every time a
mercury device breaks, we're not paying to train people to handle
mercury, believe it or not, that's a requirement,
you don't have to have a spill kit on a unit that isn't using
mercury anymore.
All of those things cost a lot of money,
so it turns out the cost of ownership of going mercury-free
was a bargain.
And it's safer for patients, safer for workers,
and obviously safer for the environment.
So that experience, when you think about what creates
culture, well, experiences and beliefs change culture,
and that changed the culture in Kaiser Permanente and many of
the other organizations that are part of the Healthier Hospitals
Initiative, because we learned a lot of important information
that we now can apply across the supply chain,
so as we now look at other kinds of activities we want to engage
in, they really are the six challenge areas of the Healthier
Hospital Initiative.
It's around food that Brad talked about,
it's safer chemicals, it's environmental purchasing.
It's leaner energy, it's waste.
So those are all of the things -- we can put our suppliers on
notice that we're not being mysterious about what we're
going to be looking for next, we're looking for the things
that HHI is promoting that we recruit many more
hospitals around.
Bicky Corman: Thank you.
So those are six categories that you all are hitting in the
supply chain.
And maybe, Al, could you maybe talk to us about the impact as
the purchaser that you're seeing happen in the supply chain?
Al Ianuzzi: Yeah, so, as you know,
we sell products to hospitals.
And I've been in the environmental field all my life,
since -- all my work life.
And to me, it's really the most important thing as far as
environmental improvements go is when your customers start asking
for more environmentally friendly products.
And when the customers start asking,
people like me in the larger organizations,
like Johnson & Johnson, start getting more leverage than we
ever had before to bring greener products to market and to focus
on things that are important to our customers.
Because, I mean, that's what business is all about.
So the whole idea of score cards,
which a lot of the leadership came out of Kaiser Permanente
and it has been adopted by just about all the -- main hospital
systems right now is really making a big difference.
So any time that we have to do a bid or a request for proposal
for a hospital, we have to answer questions about the
sustainability of our company, the sustainability of individual
products and units.
So this is forcing a whole different discussion than we
ever did before.
And that's the greatest force is I think of making change out
there are markets pressures, so when a customer starts asking
for things, you know, then suppliers,
they'll have to follow, because then it becomes a competitive
issue and that's what we're good at, competing with one another.
And when this becomes one of the key attributes of making
decisions for purchase, then it's even more important,
it gets more attention within our management.
So because of these type of things,
it's enabled us to be able to develop more greener products.
So we developed this process called earth words,
which is our process to make products greener.
And so we're getting a lot more traction with that program in
our company as a result of our customers asking for this,
you know, mostly we think about customers,
retail customers asking for, but in the hospitals,
the hospital customers are asking for these greener
products is making such a big difference and it's changing the
whole paradigm of the way that we sell to -- to our customers.
And that is a beautiful thing in my eyes,
and it's really a great thing for the environment.
And not only is it good for the environment,
but it reduces cost, too.
As we heard some of the examples already,
when you're asking for a more energy efficient product,
you know, I mean, that's going to reduce greenhouse gases and
it's going to cost less to operate that piece of equipment.
And when we start competing against that as one of the
viewpoints of bringing a product to market,
then everybody is a winner, you know, when it comes to that.
Bicky Corman: Thank you.
Would you say you are early adopters or is this becoming
more pervasive throughout the selling industry?
Al Ianuzzi: I'll let others speak about -- speak about that,
but I can tell you we -- I know we've had a design for the
environment program for -- since the late '90s,
so we've been looking at making our products greener
for a long time.
We like to think of ourselves as a leader,
but I'll let our customers make that call,
but it definitely is on our radar screen and it's definitely
something that's a core value to us,
it's part of our sustainability programs,
it's embedded in the way that we do business,
it's part of our credo.
And as the largest health care company in the world, you know,
we feel like we can make a difference.
And this could be a product differentiator,
the greenness of our products.
Bicky Corman: Okay.
Thank you.
I think we heard a little bit from Blair about paying
attention to nurses and the practitioners and the effects
of all of the products in the building and the design.
Are there -- how are you all affirmatively engaging,
or are you affirmatively engaging patients,
the deliverers in the design of your buildings or the purchases
that you make?
Or consumers, patients?
Brad Perkins: Yeah.
Definitely on this journey, one of the early opportunities for a
win in multiple dimensions is to focus on improving the health
of employees.
Improving their health directly through some of the food and
beverage interventions, but also inspiring them.
And I really learned this lesson from Walmart in 2006 when they
introduced a program to involve all of their associates called
the Personal Sustainability Pledge, or practice.
And it was designed by environmental folks.
And so when all of these pledges came back,
the environmental folks were actually a little disappointed
because many of the associates wanted to lose weight or stop
smoking as their personal sustainability pledge.
Well, I think that that is a really important observation,
because it reflects a problem with our orientation
not people's.
So people naturally in the course of their lives connect
these notions of environmental sustainability to their
own health.
It is we as leaders and silo drivers that disassociate these.
And so we have worked very hard in Van Guard to,
to bring environmental sustainability to the fore
around our definition of health and health care.
Because it resonates and inspires our employees and
our patients.
And when you are talking to your CFO again,
you can turn these things into dollars that resonate with
those audiences.
I mean, I think it is something about,
it is a purpose that is much bigger than that.
But all of these things, I mean the building stuff,
the supply chain, the food, these things work in a financial
environment now.
This is mainstream.
It is not fringe anymore.
It is, it is, it is doing business responsibly.
And you know, I think we hear that message across,
across the panel.
Bicky Corman: Thank you.
Does anyone have anything else on engaging the, the doctors,
the nurses, the patients?
Blair Sadler: Well, certainly in the whole building process of
a replacement or a new building, is a golden opportunity for
full engagement.
And Debra Levin from the center can tell you we see the spectrum
from people who just don't get it, and don't do it.
And it's a colossal missed opportunity to others who
have them embedded every part of the way.
And so guess what happens?
They, first of all, it is a much better environment.
Two, they own it.
Three, the culture that Sema and others talked about earlier
this morning is fundamentally changed.
So when that move occurs, they go in places that they designed
that feels right to them.
And as a result, they are engaged, they are inspired,
in your word.
They are delighted.
They are proud to be there.
And that word of mouth, that ripple effect is you
know infectious.
Brad Perkins: Right.
Blair Sadler: And I know and Debra can tell you about studies
as well, in terms of recruitment and retention of employees in
places that people like to work.
We are all human.
We like to work in, in environments where it
is easy to find things.
It is not noisy.
It is not cluttered.
We have privacy, and, you know, all of those things,
but they take away -- Kaizer has done with their Garfield center,
where they actually mock up rooms and have the best doctors
and nurses come up and say, what if this works for you.
You design it.
So that is a big piece of this, Bicky.
Then on a smaller level, you can do very small things
like changing the way finding in the signage.
So it is not this way to otolaryngology which 11 people
understand what the word means to you know have it written for
and designed by to reduce the unnecessary anxiety,
unnecessary confusion, you know, the unnecessary turmoil that
employees feel and spend their time hunting and gathering for
stuff rather than direct patient care.
So it is a real motivator and there is a tremendous return
to employees.
Brad Perkins: Yup.
Bicky Corman: Thank you.
Kathy Gerwig: Can I pick up on this theme of connecting
employee wellness and environmental health?
Bicky Corman: Yes.
Kathy Gerwig: So we have an employee and physician
engagement campaign called Reduce Your Use,
and we periodically refresh that with new areas of focus.
And the one that we are focused on right now is
active transportation.
And the idea is that if you walk or bicycle or take transit
instead of driving, that you are more active,
you will be healthier, and your carbon footprint is less.
So in thinking about the kinds of, you know,
how do you incent people to be engaged in that sort of thing?
Bicky Corman: I am presuming it is the practitioners,
not the patients.
Kathy Gerwig: This is an employee campaign, yeah.
Employees, physicians, nurses, staff.
It is an internal campaign.
And what we decided was that they care more about a community
benefit than they do about getting a chotskie
or a personal reward.
So the reward was if you pledge in this active transportation
campaign that we would donate money that would go to buying
bicycles to go to kids that were effected by Hurricane Katrina.
And we have as part of our community benefit,
we have teams of volunteers every year that go to the gulf
area and support the rebuilding of that area.
So we already have teams of people who volunteer their time
to go there.
And so we sent some bicycles with them on their last visit.
And we matched them with kids in the area who needed
the bicycles.
And in one case, we had one of our volunteer physicians ended
up teaching the kid to ride the bike upon presenting
the bicycle.
And you know that story has just gone viral in the organization
and created much more engagement and interest in the campaign,
so it wasn't you know here is another environmental campaign.
It was here is a campaign about total health and here is how you
can engage in a way that really benefits everybody.
And it is, it is finding all of those linkages that I think in
health care settings appeal most to folks.
Bicky Corman: Thank you.
And how about engaging folks in the energy efficiency drive?
Are they engaged?
John Messervy: Well, they certainly engage.
But that, I, I sort of wanted to pick up a little bit on the
previous conversation.
And, you know, for instance just last week I was invited by the
Council of our Chief Nursing Offices to come and make a
presentation about the sustainability program across
the hospitals.
Because they want to figure out how to engage at their level.
And obviously there are tremendous opportunities.
You know, everything from the sort of lead processes around
delivery of medical services so that they are not spending all
of their time hunting and gathering.
But they are providing direct patient care.
To the noise on the, on the patient floors,
to the food that is being served to the patients.
To the building environments.
And then obviously to the clinical products and medical
products and what chemicals are contained in those products.
And they are already engaged around the DEHP issue and IV
tubing and IV bags.
So, you know, I mean, they are, they are at front line.
And I am just so excited about the opportunity to go
and speak with our chief nursing offices about what
opportunities they have.
And that in fact they are motivated and ready to go.
You know, they have told me that speaking individually with some
of them, that, you know, there are,
there are some very active nurses.
And in fact, I know some of them.
They are working down in the operating rooms, for instance,
and for the last twelve years they have been sorting through
the waste streams and trying to get the different waste streams
in place.
And we have a, you know, we have an OR program,
a green OR program through Practice Green Health that
hospitals should take a look at.
Because there is tremendous waste in the OR.
There is tremendous opportunity, I mean waste,
green we should talk about.
And tremendous opportunities for savings.
So, you know, nurses in particular are really the front
lines and if we can get them on board, then the day is won.
Bicky Corman: Okay.
So I also was, back on the energy efficiency question,
the Obama Administration set a goal of 20 percent energy
efficiency for commercial buildings by 2020.
And so we are curious to hear, how do you all think
you are doing?
Or are there things you might be doing differently in order to
further achievement to that objective?
John Messervy: Well, we, we are on that track.
In fact, we are -- you are being upstaged by the state
of Massachusetts.
Commonwealth of Massachusetts which has a 25 percent, yeah,
25 percent reduction goal by 2020.
But that is on a 1990 baseline.
So in fact for us, because our energy density increased from
1990 to 2008 by 18 percent, we have got to add the 18
percent to 25 percent.
So it is actually 43 percent reduction in green house gases
is what we are looking at by 2020.
That is, that is a significant challenge.
And if we are, if we are successful in reducing our
consumption by 25 percent and then finding another 20 or so
percent through on site cogeneration and renewables,
you know, we get, we get pretty close.
The interesting thing though, you know,
we have been involved actively involved in energy conservation
since the early 2000s.
But in fact our energy consumption is still increasing
on an average of one and a half percent a year.
And so the question is, you know, why is that?
How is that?
What is driving that?
Well, it is in fact clinical medical devices that are coming
into the hospital environment.
And you know, while we are up on the roof fixing the big air
handlers, these boxes of medical equipment are showing up at the
loading dock and are being plugged in.
And, you know, it just wasn't on the radar screen.
In fact, there are some recent studies that indicate that up to
25 percent of the energy consumption within an acute
hospital could be driven by clinical equipment.
And there, there are no Energy Star versions of MRI's or any
other clinical equipment.
So that is a real challenge.
And we are, we are starting to bring it to the,
to the medical device manufacturers.
But a case in point, is a hematology machine which is an
$800,000 piece of testing equipment that we use in the
clinical labs in one of our hospitals was being replaced.
And the labs brought this evaluation down to two companies
who met all of the criteria that they had.
And we asked them, what is the difference
in energy consumption?
Well, it turned out that one used 22 percent more power
than the other.
For the same, essentially the same process.
So we are saying, well, 22 percent,
across all of the equipment in the hospital?
That is driving you the wrong direction.
So, you know, there is a real challenge there.
And it is, as I said, it is something we are going to be
engaging the major manufacturers with.
But it has to be brought under control.
Otherwise, all of our investments and our conservation
programs are just not going to work.
Brad Perkins: I would say that I am really encouraged
about the goal that has been set and our ability to meet that.
Because it is such a great fit for what we need to do in health
care generally.
So we need to take 30 percent of costs out of our delivery of
care, and I will tell you what has happened.
Is that all of the, all of the areas of focus in the Healthier
Hospital Initiatives including energy,
are now considered to be part of that solution of taking costs
out of our system.
And, and, and so, you know, when they are at that level of
dialogue in the board room, I am really encouraged that,
that you can get, you can get some traction.
And, and I am saying this as a, as an organization
that pays taxes.
And, and I think when you get, when you get that, you know,
underlying, a, a, you know a solid business model,
the potential for scalability is enormous.
So I'm, I'm encouraged and inspired by the goal you set
and confident that, that we can get there.
Bicky Corman: Great.
Thank you.
Do we have time for some questions from the audience?
Thank you very much.
Please in the blue dress.
I will repeat the question since there are no mic's in the back.
Audience member: (inaudible) I am Tracy Allen with the HA.
We are an association of 1400 non profit hoapitals and
we meet with suppliers about sustainability and a lot of
medical manufacturers and (inaudible) we have a room full
of sponsors.
The question for us -- (inaudible) do you know how to
address, how we can address manufacturers on providing more
sustainable solutions?
Bicky Corman: Sure, thank you.
Association of Non Profits wants advice on how to engage
the suppliers.
Kathy Gerwig: I can maybe take that one.
At Kaiser Permanente, we, we spend billions of dollars
a year on products to provide care to our patients.
And I think that Al mentioned earlier a score card tool that
we developed.
And that is one way to communicate to suppliers.
So even if they don't have a product today that meets our
wishes, they are definitely on notice where we are going.
That we don't want chemicals of concern in the products that we
are using in the provision of health care.
The score card we referenced which is available through links
on the Healthier Hospital Initiative is a device to bring
environmental considerations into the product by product
decisions that purchasers are making.
So we ask specific questions at the point of bid,
product by product.
We name certain chemicals like is it free of PVC?
Does it have flame retardants, et cetera.
Ten specific questions around chemicals and waste.
And those get scored and that score goes into the decision
making about the product.
It is right there with the quality, the efficacy, service,
et cetera.
So when suppliers have to fill out that information,
the first thing is, oh, they have to know that information.
Which isn't always obvious.
In some cases, they have to do some digging to be able to tell
us if a chemical is in there or not.
And if they really can't find out, we assume the negative.
That the chemical is present and so they get a
deduction for that.
So that is a tool that is now widely available.
We started using it.
We applied it to about a billion dollars worth of R Spend.
It was taken to the -- from the does our contracting and it
expanded from there.
And now most of the group purchasing organizations are
utilizing a score card that was developed with that as sort of
background and it is being applied to more than $135
billion worth of spend.
So when we think about the Healthier Hospitals Initiative
and the you know why are we all here supporting it?
It is because we can leverage that kind of thing.
It is not just a tool that Kaiser Permanente can use.
But by sharing it, by improving on it,
by having everybody utilize it, the leveraging power is immense.
And suppliers cannot ignore that kind of leveraging power.
John Messervy: And they aren't.
You know, the DEHP free plastics is a,
is a perfect example with dignity and then Kaiser and then
hopefully partners very soon contracting for DEHP IV bags
and tubing.
The word got out in the trade in the plastics press,
so Plastics Today Magazine which isn't one of my everyday reads
was calling me for interviews, you know, what is going on here?
Why, why are you heading in that direction?
And they had a follow-up article,
that because there were some technical issues.
It is not just you know in terms of manufacturing and reliability
of this product.
They had a follow-up story about a small company out in Ohio,
that was perfecting the welding process,
that they needed to perfect in order to produce this,
this product with reliability.
Because I guess there being some leaks in other things.
And so for three weeks running, in the trade press there were
articles about, sort of the trickle down consequences of
these large organizations moving in that direction.
And then that was followed up by at our Clean Med Conference in
Denver in May where representatives of three
different plastics organizations came to the conference and were
talking with us about you know, what is going on here?
And where are you heading?
And why do you think, you know, why do you think this is an
important, important chemical to remove from the supply chain?
Blair Sadler: So Bicky, I think, you know,
to pick up on some things that Gary mentioned first panel about
the purchasing power.
You have heard three or four very powerful examples.
These are game changers, you know.
And I think hospitals sort of felt victims to sort of,
that is the menu, that is what it is.
That is who we are going to choose from to say,
wait a minute.
We have a voice at this table.
We can change the conversation as Kaiser has
done and others have done.
And now through the sharing of HHI and the people who are
leading this extraordinarily generous and not just holding
that purchasing power to them.
But, you know, that is what Gary was referring to.
So there is almost the sky is almost the limit here.
And I think Al would agree.
I mean, you guys are leading it.
You said it.
It is the market forces that are going to drive this.
Al Ianuzzi: Yeah.
I would just add on to, all it takes is like one loss of sales,
you know, if a company loses a sale,
let's say it is a PVC free blood bag,
you have seen a lot of that in the press where some health
systems have moved away from that.
We heard about that already.
But let's say you are manufacturing PVC containing
blood bags, and you are at a competitive disadvantage now.
How long is it going to be before you start changing?
I mean, you know, it just takes one loss of sale that
gets in the press.
And it could even be something that is not even
in your product line.
I can tell you, I use, we don't sell blood bags,
but I use that as an example for my own management saying,
look what is going on in this industry.
That is why we have a target list of materials we want to try
to move out of our product, so we that you know we
will not be at a competitive disadvantage.
Or maybe at a competitive advantage.
So when you start asking as customers for more greener
products and you get really specific, what you mean by that.
You know, we will listen.
Suppliers will listen because they want to be in the game.
Bicky Corman: Thanks.
I am going to grab that gentleman with the green tie.
Audience member: (inaudible) partners are working together to
(inaudible) across the industry.
But where do you think that program is at now engaging with
the American Hospital Association and they are still
changing for -- (inaudible).
We have college and (inaudible) as a matter of fact to discuss
-- (inaudible).
And now is not -- (inaudible) -- but I think it can be not to
mention the collaboration that is going on with them and in the
health care sector right now through a business leadership,
coalition through a practice community,
and frankly our organization is not two of the three leaders
with Kimberly Clark and -- (inaudible) -- and who are
really working together in this area to put aside a lot
of the competition.
Much like the GPO network did, put aside the competition and
work together on this.
That is how we move and make major shifts in the industry and
what is available to -- (inaudible).
Bicky Corman: Okay.
Thank you.
Is that your experience?
Are you seeing collaboration amongst the vendors as a result
in addition to competition?
Thank you.
I am sorry.
I don't think that we have time for anymore.
I think there was one more remark you were going to make.
Blair Sadler: Yeah, I think as the oldest person in the room
I want to say something.
Bicky Corman: Okay.
Not necessarily.
Don't be so sure.
Blair Sadler: I just thought, in all of our correspondence
with Eli and Sema planning this and Courtney, one of the things,
one of your objectives, at least I read in the lines or between
the lines was how we could all partner with you all.
Bicky Corman: Yes.
Blair Sadler: And where there is some nuggets that were coming
out and I am sure already a number have.
But I just like to be explicit for a minute.
Bicky Corman: Please.
Blair Sadler: I think that the synergy between some of the
bold goals you have set and we have are, you said it, they are,
you know, they are part and parcel
That magic and that catalytic effect is already occurring.
And that is not to be minimized.
And the way you are pushing the messages out is going
to be great.
And Jerry and everyone will work with you hand and glove on that.
So first thing is awareness, awareness, awareness.
I think it could have an exponential effect on them.
Not to be minimized.
And it will be in various journals like plastics and
all kinds of places that are very powerful.
But I had two other thoughts.
One would be to be thinking and brain storming about what kind
of policies, either the carrots or sticks,
incentives or you know rewards to hospital systems
to encourage this?
And, you know, we don't have a three by five card that says
that what those are.
But we are very serious about that.
And I think speaking if I could, Sema, on behalf of the group,
we would be very happy to work with you in any one of
these six areas.
The other is further research.
So while in many areas we now feel that there is enough data,
there is enough research, there is enough science,
there is enough knowledge to be ready for prime time.
Otherwise we wouldn't be putting these six out.
As Brad can tell you, in another three to five years,
there could be another six.
Brad Perkins: Oh, yeah.
Blair Sadler: And so peeling, it is like peeling the
layers of the onion.
As we get smarter about this, that answers a question.
But it often raises three more.
And what you have is a very robust and excited committed
group of hospitals and organizations.
Many of whom are parts of big time research arms,
schools of public health, schools of medicine,
schools of nursing, schools of business who would be delighted
to work with you.
As well as the cost savings things, big picture.
And we would really welcome opportunities with whatever the
appropriate agencies are that have this on your radar screen
to, to do that.
So how did I do, Gary?
Was that --
Bicky Corman: We appreciate that.
Thank you.
Thank you.
I think we really all would be very grateful to continue
the engagement.
It has been valuable thus far and we look forward to
more of it.
So thank you, thank you all very much.
Speaker: Thank you so much to the panel.
Thanks to Bicky and our moderator for the first
panel, Maria Vargas.
To close out this session and this event,
we are -- I have the privilege of being able to introduce Nancy
Sutley who is the Chair of the Council,
the White House Council on Environmental Quality.
Over the last two decades, Nancy has served in senior leadership
posts at the California EPA.
Was appointed by President Clinton at the US EPA.
She was the top energy adviser to Governor Gray Davis.
Served on the Water Resources Control Board in California.
Most recently, was the Deputy Mayor of Los Angeles and
currently is my boss and the top Environmental Adviser to
President Obama.
Chair Nancy Sutley.
Nancy Sutley: Thank you.
Good morning, everyone.
And let me adds my welcome.
I guess on the last thing to the White House.
And thank you all for being here.
I just came in for a little bit of this last discussion and it
sounds like a lot of good ideas have been put out on the table
and a lot of opportunity I think to follow-up.
So let me just also say thank you to,
to Rohan and to his team who has put this together.
And everybody who helped organize this.
And, you know, I think this is a conversation that is a start as
you just said.
One where we can continue to work together on this very
important issue.
You know, our health care facilities are really important
institutions in communities, and the opportunity to make them
greener, and more energy efficient,
is tremendous and important for our nation.
You know, the President is very strongly committed to protecting
our environment and preserving our natural resources.
And he does that not only as the president, but as a father.
As he works to protect our environment for
generations to come.
And he said again and again that he believes that energy
efficiency and clean energy are essential to our economy.
Essential to our security.
And essential to the health and prosperity of Americans.
We have the best innovators and the best entrepreneurs in the
world and that has helped us to grow and to thrive throughout
our history.
And now it is really time as you already have started to,
to tackle this very important challenge and this real
opportunity to grow clean energy industries and green jobs that
will keep us safe and that will keep us healthy and prosperous
into the 21st century.
You know, for decades, a volatile energy prices have
threatened economic security for millions of middle
class Americans.
It hits consumers and businesses very hard including hospitals
and health care facilities, rising gas prices,
rising energy prices that really strain the budgets of millions
of American families.
And it is a familiar story.
We are all familiar with it.
But to really to restore the lasting security for middle
class families, we need a sustained plan
for American energy.
And to create an economy that is built to last,
we need to take control of our energy future by out innovating
and out building our global competitors.
And one of the strongest ways that we can fight to create jobs
to curb pollution and to save people money is through a robust
commitment to energy efficiency.
You know, the United States spends $1.1 trillion a year
on energy.
That is about 8.8 percent of our GDP.
If we became as a country 20 percent more energy efficient,
we would save more than two hundred billion
dollars annually.
And that is money that goes back into people's pocket,
back into businesses, to grow and to prosperity.
You know, and all kinds of buildings including medical labs
and hospitals and community clinics and everything else
consume about 40 percent of the energy in the US.
The health care industry commands nearly ten percent of
total energy used by commercial buildings and the spending from
this sector alone is about eight billion dollars a year.
Investments in energy efficiency allow hospitals to reduce their
energy costs, saving millions and improving the bottom line.
And as hospitals reduce their energy costs,
they can take this savings and allocate resources to,
to whatever, to improving patient care and to investing
in equipment.
And energy clearly is a major issue for hospitals
for a lot of reasons.
Hospitals face escalating energy costs at the very same time that
all of the advanced technologies that is helping to improve the
health of Americans are rapidly increasing the demand
for energy.
And also for hospitals as you know,
energy reliability is an incredibly important issue to
provide around the clock care even during catastrophes that
may effect an entire community.
And that is why as part of the American Recovery and
Reinvestment Act, the Obama Administration has made an
unprecedented commitment to expand energy efficiency in the
overall energy retro fit market.
Energy efficiency and renewable energy can increase a hospital's
energy reliability even during times of crisis.
And the purchasing power of the health care industry as you all
have been talking about has really created a market for
greener products and more advanced technologies and making
hospitals safer, even safer and more environmentally friendly.
And this is just the beginning.
Working with you will make sure that smart programs like these
continue to support jobs, businesses,
and healthy communities across the country.
And we asked you to come here today,
because you are the ones who are making this happen
on the ground.
And so we thank you for your innovation and your hard work.
This administration is on your side and we'll keep doing
everything that we can to support you.
Together we will continue to pursue a healthy and prosperous
future for your communities and for all Americans as we create
healthier hospitals.
And we hope that this great event marks the beginning of a
partnership between the Healthier Hospitals Initiative
and the Obama Administration.
And we look forward to working together closely in the months
and years to come.
So thank you again all of you for being here today.
For sharing your thoughts and your ideas.
The things that you are working on.
And talking to each other and talking to us about the
opportunities to create a healthier future.
So we thank you again for coming and wish you all safe travels if
you have come from around the country.
And we are really glad that you came here today and we hope that
you found this as valuable as I know we all have.
Thank you very much.
Speaker: Thanks so much, Nancy.
And that concludes our event.
Thanks everyone.