H2E http://www.h2e-online.org

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H2E http//www.h2e-online.org
Providing Practical Solutions to Todays
Environmental Challenges
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Todays Objectives

• Health cares footprint
• H2Es Data Tool
• The vision for its roll-out
• What next?

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You want me to do what???
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Health Cares Footprint

• Healthcare is 16 GDP - 20 by 2015
• Hospital workforce 4.1 million
• 24/7 operations
• 6.5 billion on energy each year
• Water facilities are often largest water users
  in the community
• Over 2 million tons of waste per year - increase
  in disposables, packaging, chemicals, toxics

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Evidence of Inefficiency
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Understand your waste!
Thats a difference of 351,000 every year!
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Benchmarking
Waste Stream Avg. Disposal Cost per ton Avg. Disposal Cost per pound Percent of total Waste
Municipal solid waste (MSW) 40-120 0.02-0.06 45
Regulated medical waste (RMW) 450-1,000 0.24-0.40 6-12
Hazardous chemical waste 1,000 or more 0.50-10 lt1
Recycling (average for all recyclables") breakeven breakeven Up to 50
Other Stuff Universal Waste Construction and
Demolition Donated Supplies Bulky Waste Grease .
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Normalization Options

• Direct patient care activity related factors
  (this should be average per month)
• Number of Licensed Beds  
• industry standard - permitted size of a
  facility
• often much larger than the number of operating
  beds. 
• consistent from year to year - standard way to
  describe a facility. 
• Number of Staffed Beds 
• reflects the maximum number of beds the hospital
  is staffed to manage.   may not reflect the true
  level of activity.
• Average Inpatient Days per month (or Daily
  Census/mo) 
• changes daily but the average reflects the level
  of activity
• Adjusted Patient Days
• account inpatient and outpatient activity, 
  unlike the values above that only measures
  inpatient activity.   APD is calculated as
  follows
• APD (Total Patient Days) (Total Inpatient
  Outpatient Revenues)
•                                                   
            Inpatient Revenue
• Patient Day
• period of service defined in whole days between
  the census-taking hours on 2 successive calendar
  days, including inpatient census and out-patient
  surgical days. 
• Outpatient visits
• useful for facilities that have a lot of clinics
  or only have clinics.  Interestingly, university
  hospitals tended to have by far the greatest
  outpatient activity --  over a million outpatient
  visits a year.

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Other factors

• Number of FTEs
• measures staff size in full time equivalents.
•                    
• Square footage
• includes facility space where waste generated is
  included in the total waste weights and cost. 
• primarily used to describe the size of the
  facility and normalize energy and water data in
  building metrics. 
• It has not typically been used to normalize waste
  data

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The Tool
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Success Story

• From Pam Starlin mailtopams_at_fmchealth.org
  Sent Thursday, October 26, 2006 1100 AMTo
  Susan ZaboSubject Success Story
• Just wanted to share my first big victory which
  I have the Waste Management tool to thank. I met
  with Stericyle this morning and showed them what
  my costs had snuck up to over the years for
  back-up services. Bags and boxes which were once
  free were suddenly being charged for and the cost
  per pound had nearly doubled over the past 6
  years or so. All of this was due to the fact that
  since we are not a regular customer, we are not
  on contract pricing. I offered to sign a 3 year
  back up service agreement it they would improve
  their pricing structure. Right off the bat, they
  agreed to eliminate the charges for the bags and
  boxes and he will bring back an agreement with
  better pricing. Don't know what the bottom line
  will look like, but I expect to be able to report
  substantial savings. It was wonderful to be able
  to pull up the spreadsheet and have all the
  history and figures right on the desktop. The rep
  was pretty impressed and it sent a clear message
  to him that I am keeping tabs on this now.
• Have a good day Susan!
• Pamela S. Starlin Manager, Environmental
  Services Patient Transport Fairfield Medical
  Center

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Wheaton Franciscan Healthcare

• Early Pilot 12 hospitals
• Did not have a process to track
  and trend our waste streams
• Numerous waste streams to
  manage and collect data
• Value of Stewardship

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Metro Hospital Grand Rapids MI

• Saved 40,000 first year
• Asked our data your questions
• It gave us a loud and clear response
• We acted and wont stop asking and listening

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Questions to ask of your Solid Waste Program

• Where does your waste go? Have you had a recent
  waste stream analysis?
• What types of solid do you generate?
• Assessing your fees. Do you understand them?
• Container sizes?
• Hauling frequency?
• Opportunities for Improvement?

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Questions to ask of your Regulated Medical Waste
(RMW)

• One of the largest opportunities to save money
• GOAL Hospitals should be at about 6-12 and or
  a RMW generation rate or 1 pound per adjusted
  patient day
• Does your clinical staff understand what
  qualifies as RMW?
• How is your waste treated? Waste treatment and
  COST is critical to any successful program
• Hauler negotiations. How are you charged? Per
  pound? Per tub?
• What is your pick up frequency?

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Recyclables

• Are you recycling?
• What are you recycling?
• How are you recycling?
• With a comprehensive paper and cardboard
  recycling program, you can hit a minimum 20
  recycling rate
• GOAL Hospitals should at least hit a overall
  25 rate although the stretch goal should be 50
• Opportunities to reduce costs, even generate
  revenue
• Use net benefit

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Hazardous Waste

• Do you generate hazardous waste? What type?
• If yes, do you know where and how it is disposed
  of? Is it recycled?
• Electronic scrap is the most rapidly growing
  recycling problem in the world
• E-scrap is not only a crisis of quantity, but of
  a toxic content due to toxins such as lead and
  mercury.
• Solvent recovery xylene, formalin, alcohol
• Biggest volume of HW in an acute care hospital
  with a lab.

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Why Wheaton participated?

• System goal to become mercury free and reduce RMW
  by 50
• Needed to understand problem to then set goals,
  short and long term
• Lack of system wide recycling
• Identify opportunities for improvement
• Identify cost savings and efficiencies
• System compliance, vendor compliance and
  contracts
• Celebrate successes

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Benchmarking
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Wheaton findings

• Solid waste was above benchmark
• Inconsistent lbs per load of solid waste
• Not utilizing a pressure gauge on the compactor,
  inconsistent lbs per pull
• Lack of data on hazardous and recyclable
  hazardous waste
• Lack of formal recycling program for plastic and
  aluminum and mixed office paper
• Inconsistent revenue for recycled cardboard

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(continued)

• Cardboard recycling is sub contracted and they
  did not receive any revenue
• Receive 50 of mixed paper revenue, although this
  has not been verified
• Shred all paper
• Lack of a commingled program

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Wheaton Franciscan Healthcare Action Plan for 2006

• Consolidate vendors
• Negotiate new contracts
• Hold vendors accountable
• Choose benchmarks

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Wheaton Franciscan Healthcare Action Plan Update
and Accomplishments

• RMW and Recycling contracts are in negotiations
• Neptune System
• Bio Systems (3 pilots)
• Consolidated to one RMW vendor
• Vendors are being held accountable by Corporate
  Materials and on-site management
• Utilizing the H2E guidelines as the benchmark

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WFHC-All Saints Solid Waste outcomes YTD 2006 vs.
2005

• Reduced solid waste from 67 of the waste stream
  to 55 (YTD June 2006)
• Moved from a set pull to a requested pull
• Then requested Waste Link System
• Re-calibrated compactors

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WFHC-All Saints Solid Waste outcomes YTD 2006 vs.
2005
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WFHC-All Saints Solid Waste outcomes YTD 2006 vs.
2005
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WFHC-All Saints Solid Waste outcomes YTD 2006 vs.
2005
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Recyclable Solid Waste outcomes YTD 2006 vs. 2005

• Increased Recyclable solid waste from 27 of our
  waste stream to 37 (YTD 2006)

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Recyclable Solid Waste outcomes YTD 2006 vs. 2005

• Re-construction of the facility to better
  accommodate recycling program

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Recyclable Solid Waste outcomes YTD 2006 vs. 2005

• Enhanced commingled program in Aug 2006

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WFHC-All Saints Recyclable Hazardous Waste
outcomes YTD 2006 vs. 2005

• Increased Recyclable Hazardous Waste from .91
  tons to 7.69 tons
• Increased storage space
• New E-Scrap contractor
• Captured all of the lbs

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TOOLS for Change e.g.,RMW generation
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What goes in a red bag anyway?
YES! RED BAG
NO! Put in Clear Bag

• Blood, Products of Blood
• Anything caked, soaked or dripping in blood
• Tissues from surgery and autopsy
• Cultures and stocks of infectious agents and
  discarded vaccines.
• Suction canisters with any fluid. Hemovac and
  pleurovac drainage.
• Operating room waste saturated with body fluids
  as defined by OSHA.
• Waste from patients isolated with HIGHLY
  communicable diseases. (These are CDC Class IV
  definitions including Ebola, Lassa Fever, Marburg
  and Small Pox. NOT such conditions as AIDSlt
  Hepatitis or TB.)
• Sharps, including syringes and unused sharps.

• IV Bags, tubing, foley bags
• Non bloody gloves
• Packaging,
• Urine-soaked waste, feces, vomit
• Blood-tainted waste
• (Note distinction between blood-soaked and
  blood-tainted. A little bit of blood on an item
  can go in the regular waste stream.)

Questions? Call Waste Manager
Check your local regulations
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Waste Segregation Implementation

• Present Plan
• Survey Facility
• Develop Materials
• Purchase equipment, supplies.
• Issue Memo
• Container placement
• Properly Labeled, Signage
• Proper placement
• Training (never ends.)
• Monitoring and reporting
• CQI!

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Suction Canisters
40 of Operating Room Waste is from suction
Canisters! Potential for occupational Exposure
in transport.
http//mntap.umn.edu/health/91-Canister.htm
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Business Model for the Launch
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Models Shared Savings vs Fee for Product/Service

• Fee for Product and Service - A combined strategy
  of program sales combined with assessment
  consulting
• Shared savings model Three year - 50-30-20
• Calculated using total annual waste costs
• RMW reductions, HIPAA, recycling increases, etc
• Contracting savings
• Will consider changes in operations and impacts
  on big costs
• Benefits
• No money upfront
• Risk free
• Disadvantages
• Contract negotiations and tracking are more
  difficult
• Accounting challenges inconsistent with the
  mission of the tool
• Improvements in operations may not be reflected
  in total waste budget ( I havent had time to
  implement the operational changes but its
  valuable knowing what I need to do)
• Tool should drive a culture change facility
  should own the potential savings and invest it
  back into the program
• Risk of unintended lowering of motivation
• Contract negotiations
• Facility will sign off on statement of intent and
  purpose fully understanding the goals
• Tool must be used for one year

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Next Steps -

• New Features
• Additional modules
• Benchmarking

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Benchmarking

• Input data points to describe level of activity
• Square Footage
• beds
• Adjusted Patient Days
• FTEs
• emergency room visits
• Facility type
• basic costs, waste disposal fees, KWH
  energy costs, per gallon water costs, etc.
• Output
• For each target area, acceptable range
• Identifies opportunities for improvement
• Costs savings and environmental performance

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Energy

• Hospitals use more than twice as much energy per
  square foot as office buildings.
• 50 billion kilowatt hours of electricity
• 3 billion each year on electricity costs.
• If hospitals improved their energy efficiency by
  an average of 30, the annual electricity bill
  savings would be nearly 1 billion
• and 11 million fewer tons of carbon dioxide would
  be emitted--equivalent to taking 2 million cars
  off the road.

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Water
Comparison of Pre- and Post-Conservation Water
and Sewer Costs Based on Utility Bills (Southwest
Florida Regional Medical Center)
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Next Steps

• Launch Tool in 2007 with systems and state groups
• Gather benchmarking data
• How can we work together?
• HELP US FIND A NAME
• H2E Waste Data Compactor
• H2E WOW Strategies (working on waste)
• H2E Sustainable Strategies for Environmental
  Programs
• H2E Environmental Excellence Strategies

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Save the Date!
May 14 and 15, 2007, Minneapolis, MN
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Safe Disposal of Pharmaceuticals -
Workshop Tuesday, May 15th Minn. MN