Sustainable Operations Workgroup

The Sustainable Operations strategy focuses on the acceleration of best practices for operations among the GHSI partners and the entire healthcare sector. Operations includes nearly every facet of support/ancillary services, including Environmental Services, Engineering, Pharmacy, Laboratory, Hazardous Materials, Dietary/Food Services, Safety, Risk Management, and Environmental Health and Safety. Sustainable Operations makes the link between the daily operating practices of the facility and the health of its patients, workers and the community. From cleaning chemicals and work-related asthma to medical waste minimization and needle sticks to organic, locally grown foods and obesity — the Sustainable Operations group seeks to identify best management practices that will help improve worker and patient safety, save money, increase environmental compliance and create a culture of accountability. This strategy brings together administrators and managers from across the country to help define the most successful sustainable operating practices, develop an appropriate staffing structure to implement and maintain these programs, and benchmark the successes as a means of continuous quality improvement.

Project Components

• Sustainable Operations Matrix and Best Practices Database
  Using the Green Guide to Health Care's Operations Section as a roadmap, the GHSI will develop a matrix of programs related to sustainable operations in a healthcare setting. Each facility has specific factors that may influence what programs it pursues, including community culture, enforcement activities, profit margin, leadership and energy security, to name a few. The programs will be cross-referenced with various attributes, including:
  • Ease of Implementation
  • Regulatory Concerns
  • Financial/Economic Factors
  • Relevance to Worker Safety
  • Relevance to Patient Safety
  • Significant Environmental Impact
  • Case Studies Available
  This Sustainable Operations matrix will be organized by department, i.e. who's responsible, and by topic areas, such as recycling, cleaning, and food service. This resource will be used as a "laundry list" of programs that administrators can consider when developing their plans to integrate sustainability programs. The goal is to have this matrix be web accessible and searchable via a database format. Users will be able to look at the matrix by topic, by area of responsibility, by ease of implementation or any of the other attributes above. The other attributes will help to provide an understanding of how they may prioritize the implementation of some programs over others. As the GHSI tracks the implementation of new programs and the expansion of existing efforts, potential case study candidates for each program area will be identified and shared with the sector.
• Green Specifications for Contracted Services
  Hospitals often use contractors for certain department management, including environmental services and dietary/food services. Many of the sustainable operations programs fall under the span of control of these departments. It is essential then that specifications targeting sustainability goals be inserted into contract language with these contractors in order to pursue different initiatives, including green cleaning, medical waste minimization, recycling, and healthy food programs, for example. This project would aim to create contract language specific to outsourced departments related to sustainability goals. For example, one might require an outsourced EVS program to help the hospital attain and maintain a 15% regulated medical waste generation rate.
• GHSI Benchmark Metrics for Sustainable Operations
  As facilities implement various environmental programs, they are interested in measures of success. Managers want to know whether they are measuring up to the best performing hospitals for different program areas, and they also want to know HOW they should be capturing data related to different program areas. For example, does one use adjusted patient days as the metric that captures patient intensity? And how is acuity captured? How is research handled? This project will work to identify the most relevant and measureable metrics for the health sector in different program areas-based on available measurement tools already on the market, the manner in which healthcare facilities currently track and record date, and the ease of tracking. Metrics will allow administrators to determine the success of programs underway, and inform continuous improvement efforts. Metrics may include regulated medical waste, recycling, energy use, food miles, hazardous waste, water use, or greenhouse gas emissions. As an increasing number of healthcare facilities engage in this work, a more systematic means to evaluate program success is necessary. While ROI is an important element to track, it does not capture all of the benefits of engaging in these program areas-including environmental and community health benefits.
• Collaboration with GHSI Research Workgroup to study cleaning products, procedures and training, and their relationship to HAIs and work-related asthma
  Green cleaning is an area of growing interest in healthcare facilities. A July 2007 study in the Lancet found that nurses have the highest rates of work-related asthma of any profession studied, followed closely by cleaning staff. Exposure to cleaning chemicals is pinpointed as a leading cause. At the same time, hospitals are growing increasingly alarmed at the prevalence of healthcare-acquired infections (HAIs) and have targeted the efficacy of cleaning practices, the improper use of certain cleaning products and lack of education as a means to address some of the root causes of HAIs. A recent study at Suburban Hospital in Bethesda, Maryland examined the role of education for cleaning staff and a hand washing encouragement program as a means to reduce HAIs, and found a significant decrease in HAIs, as measured by pre- and post-antibiotic use in the hospital. A second phase of the study looked at the use of a hydrogen peroxide based environmentally friendly cleaner with a dramatically shortened residence time in combination with a microfiber mopping program and again, found significant decreases in post-antibiotic use. There is a significant knowledge gap concerning the role of education and training for environmental services staff, proper cleaning and disinfection processes, and efficacy of different chemical products in preventing HAIs. In collaboration with the Research Collaborative, the Operations workgroup hopes to develop a controlled study to examine these factors in isolation from each other with replicable data. The group hopes that the study (s) will help inform strategies to reduce HAIs while concurrently improving indoor air quality for patients and frontline staff. The group aims to collaborate with APIC, the CDC/NIOSH and/or ASHES in developing this project.
• Organizational Infrastructure Guidance on Sustainable Operations Implementation
  Different organizational infrastructure models are being used across the healthcare sector to implement sustainable operations, including corporate environmental leadership (or 'green') teams, environment of care committees or the hiring of a system-wide Sustainability Director. Additionally, many facilities are creating overarching environmental policies and goals tied directly to their missions. This project will develop guidance tools to assist hospitals and health systems in determining an optimal model for engagement. The GHSI will collaborate with Practice Greenhealth, which has developed drafts of many of these models. Tools include:
  • Job description for Sustainability Coordinator
  • 'Green' Team Composition
  • Corporate/Health System Team Structure
  • Practice Greenhealth's Statement of Environmental Principles
  • Update of Practice Greenhealth's Ten Steps for Healthcare Executives
  • Performance Improvement Goals related to Sustainability
  • Management Incentives/Evaluation Criteria for Sustainability Programs
  • Departmental Operating Plans incorporating Sustainability

Outcomes and Benefits

• Increased access for health care systems to information about how to transition to more sustainable operations with clearly identified impacts of those changes on patient safety, worker safety, and environmental health.
• A prioritized matrix of sustainable operations programs and organizational infrastructure guidance tools for more comprehensive strategic planning.
• Increased availability of access to technical assistance and organizing support in conjunction with Practice Greenhealth, for facilities working towards safer, sustainable operations.
• The development of GHSI benchmark metrics for sustainable operations.
• Completed study about cleaning products/procedures and their relationship to HAIs and work-related asthma.