Research and Education Workgroup

• Key Questions
• Project Components
•    Hospital Design
•    Hospital Emissions
•    Alternatives to Vinyl Flooring
•    Greener Cleaning Products
•    Evidence-Based Design Evaluation
• Outcomes and Benefits

Key Questions

The Global Health and Safety Initiative (GHSI) has formed a Research Workgroup to help answer key questions for improving patient, workplace and environment health and safety in hospitals and ambulatory care settings:

• What do we know (and not know) about the factors that contribute to unsafe hospitals and ambulatory care settings?
• Which intervention strategy/strategies make sense i.e. have evidence to support them?
• What are the priority of issues and improvements that hospitals and health systems can undertake that promise good outcome improvements for the resources invested?

This work is particularly important as there is currently not an organized and coherent research agenda within healthcare that focuses on the three safeties and practical steps that healthcare executives can take to make significant improvements.

GHSI is supportive of efforts to make clinical improvements in patient, workplace and environmental health and safety and applauds the work of others in making significant improvements in outcomes and the quality of care. GHSI seeks to complement this work by focusing on research that supports improving the built environment of healthcare facilities themselves, the materials and products used in healthcare and the operations of healthcare facilities.

Towards this end, the focus of the GHSI Research Workgroup is to help find funding and facilitate research that links better building designs, greener and safer materials and products and improved approaches to operations that will reduce the hazards associated with negative health affects and that contribute to healthier hospitals and an improved society.

Project Components

• Developing the Business Case for Greener and Safer Hospital Designs 
  There is a movement within society towards green building designs. The US Green Building Council has established LEED certification for buildings. The Green Guide for Health Care has incorporated some of the unique attributes of healthcare facilities and is serving as a reference document for LEED for Healthcare, which is currently in development.
   
  However in the healthcare environment, capital dollars are often in short supply and are in competition with dollars for direct patient care. Thus hospital and healthcare executives struggle to assess the economic and other impacts of making "greener" and safer choices for buildings versus committing healthcare dollars to other needs.
   
  Project 1: The business case for GHSI best practices. The GHSI Research Workgroup will support broader GHSI efforts with an analysis of both the cost-benefit and other health and safety benefits associated with various green and safe building design interventions, as well as operational and purchasing initiatives. It is supporting the evaluation of the state of knowledge about which interventions are supported by evidence, which appear promising but evidence is lacking, and which have not proven to be effective. Building on this database, the GHSI Business Case approach will also address return on investment (ROI) in traditional short-term payback of investment terms as well as in life-cycle terms. In addition, attempts will be made to factor in other considerations, such as improvements in health status. The end result should be a tool that helps healthcare executives understand that green and safe building designs are important and effective for their institutions and helps them think about the probable payback for various investments. This work is anticipated to be conducted by GHSI staff directly.
   
  Project 2: The Research Workgroup will continue to support partnerships with GHSI members and others seeking to develop a broad-based, multi-attribute business case for sustainable healthcare buildings and operations that focuses on categorizing and quantifying environmental, occupational and patient health and safety benefits. The Cornell University proposal to the US Green Building Council is an example of this initiative.
• Calculating Hospital Emissions and Improvement Strategies 
  In an era of concern about global warming and greenhouse gas emissions, hospitals have been characterized by the Department of Energy as the second most energy-intensive built environment sector of the economy. They are a major user of water, toxic and hazardous materials and waste generator. Yet today, few hospital executives are aware of their institutions' energy use and contributions to greenhouse gases and other air and waterborne environmental emission profiles. The intent of this research project is to identify point sources of air and water emissions; to quantify those emissions; to conduct a literature search of the science linking point source emissions to climate change impacts and occupational health and safety; to complete a scan of the regulatory frameworks in place or in development and prioritize the issues facing healthcare; and to collect best practices from health care organizations globally managing emissions of concern. Through its web page and other resources, GHSI will publicize best practices to address healthcare's emission concerns. In addition, this research will identify knowledge gaps and opportunities for additional research.
   
  GHSI is developing an Eco-Health Footprint tool for Healthcare and will help healthcare executives understand the nature and extent of the issue. In addition, the GHSI Research Workgroup will help conduct a scan of the regulatory and legal changes in place or in development and prioritize the issues facing healthcare. The GHSI Research Workgroup will coordinate this effort and, with other groups affiliated with GHSI, help institutions implement concrete actions to improve their Eco-Health Footprint impacts. These actions in turn become the source for continued research, case studies and evaluation of effective interventions.
• Evaluation of the Effectiveness of Alternatives to Vinyl Flooring 
  

  A collaboration between the Healthy Building Network, Georgia Institute of Technology and Practice Greenhealth, this project begins with a market survey of the extent of installation of "green" flooring options in health care settings, and the design, installation and maintenance experience (including interaction with the AAHID knowledge-sharing network currently in place collecting market experience). It continues with tabulation of perceived cost/benefit, review of any post-occupancy studies or performance data, and compilation of product experience.

  

  April 2009 Report
  Resilient Flooring and Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care. 56 pp, pdf  download now

  The study will include considerations such as acoustics, slip and fall, and responses of building occupants to both the installation of products and ongoing maintenance. The goal of this project is to document the benefits and challenges of current "green" market alternatives to vinyl resilient flooring, offer in-use experiences to product manufacturers, and to provide an analysis of the case for change, i.e. do the benefits over time outweigh any initial cost increase for installing green flooring.

  It is anticipated that this study will result in a white paper report as well as web based resources and forum for continued product information and development. It will also develop a format for conducting additional studies on broader materials applications — paint, surfaces and casework, for example.

• Evaluation of the Effectiveness of Greener Cleaning Products 
  
  

  April 2009 Report
  Cleaning in Healthcare Facilities: Reducing Human Health Effects and Environmental Impacts. 40pp, pdf  download now

  In cooperation with the University of Massachusetts, Lowell, Epidemiology Consulting Services, The National Institute for Occupational Safety and Health (NIOSH) and Practice Greenhealth, this project will conduct a market survey of the extent of green cleaning protocols and product adoption in healthcare facilities coupled with a product review of the market-available products and certifications.

  A literature search of health impact data will be conducted, both in the U.S. and abroad. Survey respondents and literature searches will determine what, if any, efficacy data has been collected and peer reviewed in order to evaluate continuing research needs. The goal of the research is to determine which greener cleaning products are safe and effective for use in healthcare settings and to help prioritize products or classes of products that offer advantages in healthcare settings over traditional cleaners.

• Evidence-Based Design Evaluation 
  There is considerable interest in evidence-based design in healthcare, i.e., designs that have been shown to improve patient and/or worker satisfaction and outcomes. However how strong the evidence is and which design interventions have been proven to be effective is not well understood. Working with academic research centers like Georgia Tech, Texas A&M, The Center for Health Design (CHD) and others, the GHSI Research Workgroup will be publicizing an extensive literature review of the evidence for improvements in patient outcomes from building designs. This literature search is expected to provide the state of our present day knowledge about evidence-based design in healthcare, as well as document areas where we don't know enough yet.
   
  Kaiser Permanente, in collaboration with the Centers for Disease Control, NIOSH, CHD, and the GHSI Research Workgroup, will conduct a series of studies to document patient outcome improvements from its design interventions. One aspect of this work will be structured before-and-after studies based on moving from existing facilities into new hospitals with greener and safer designs. (In Kaiser's case the new hospitals are replacements for older facilities and maintain virtually the same service (patient) population and workforce.) The study methodology is currently under development, but likely key variables to be measured include changes in patient days and patient status, patient satisfaction, possible reductions in hospital acquired infections and accidents (e.g. slips, trips and falls), changes in workplace injuries, worker compensation claims and time off work, etc. This work will be conducted through CHD's Pebble Project.
   
  In cooperation with the GHSI-Built Environment Workgroup, the Center for Health Design (CHD) is also developing a new website devoted to green and safe design best practices and recommendations. The website will initially house more than 170 design recommendations from Kaiser Permanente, along with the rationale of why those designs were chosen and the evidence to support them.

Outcomes and Benefits

The initial efforts of the GHSI Research Workgroup will provide direct benefit to healthcare executives and society in helping to answer key questions in designing and operating safer and greener facilities. GHSI is helping to prioritize the facilities and products research agenda for healthcare, building websites and tools that will help hospitals and systems evaluate the state of knowledge and specifically will help clarify the following:

• Which hospital designs and other sustainable clinical design features are supported by evidence?
• What are the quantifiable benefits associated with greener and safer design, beyond merely short-term return on investment? For example, life-cycle cost/benefits, patient and workplace benefits, patient and worker satisfaction, image enhancement, and so on.
• How to measure key hospital emissions, and how to measure assistance in developing strategies and approaches to reduce system or facility-specific emissions?
• What is the evidence to support switching to "green" resilient flooring products and greener cleaning products?