A Conversation With the Memorial Sloan Kettering Green Team
The cancer center has long made sustainability a priority in its ORs, and its experience could benefit your hospital.
They say practice makes perfect, and New York City’s Memorial Sloan Kettering Cancer Center has long been in the practice of making sustainability a priority in its operating rooms. The 473-bed academic and oncological medical center with on-site research facilities has 28 operating rooms, in which it has performed outstanding work related to LED lighting, HVAC systems and other areas—with a focus toward higher energy efficiency and a dedication to green practices in order to help improve patient care.
In fact, MSK is ranked nationally for excellence in patient care, one of Practice Greenhealth’s Top 25 Environmental Excellence winners and a recipient of the Greening the OR Circle of Excellence. In this Q&A, Sustainability Manager Shane Dunne and General Manager of Plant Operations, Energy & Engineering Bob Berninger share details on MSK’s experience that could benefit your hospital.
Greenhealth: Tell us about your organization.
Memorial Sloan Kettering: Memorial Sloan Kettering Cancer Center—the world’s oldest and largest private cancer center—has devoted more than 130 years to exceptional patient care, innovative research and outstanding educational programs. Today, we are one of 41 National Cancer Institute-designated Comprehensive Cancer Centers, with state-of-the-art science flourishing side by side with clinical studies and treatment.
According to U.S. News & World Report, Memorial Sloan Kettering has ranked as one of the top two hospitals for cancer care in the country for more than 25 years and among the nation’s top pediatric hospitals for cancer care.
G: Highlight some of the sustainability work of your organization.
MSK: Sustainability initiatives at Memorial Sloan Kettering Cancer Center strive to reduce the environmental impact of daily operations while promoting staff, patient and community health and maximizing social benefits. MSK’s Green Team committee represents a range of departments that work together to implement sustainability initiatives across the center, including energy efficiency, green building, waste reduction, recycling, healthy food and nutrition, as well as staff engagement.
In 2009, MSK accepted Mayor Bill de Blasio’s New York City Carbon Challenge to hospitals, committing to reduce emissions from its New York City buildings by 30 percent from 2007 levels by 2019. Even more, as part of our continued commitment, MSK recently agreed to the city’s new goal of reaching 50 percent reduction by 2025. By early 2015, MSK has achieved a 27 percent reduction in greenhouse gas emissions and is on target for achieving the 30 percent reduction goal by 2019.
Work to formulate and implement prioritized projects to reduce energy use across the center is done within our facilities’ management division. As general manager of plant operations, energy and engineering, Bob Berninger is heavily involved in vetting vendors while formulating and managing energy efficiency projects from inception to completion.
G: What are some unique challenges your organization faces in regards to energy conservation measures? What are specific challenges in your ORs?
MSK: There are definitely challenges around conveying priorities to upper management and all levels of staff in such a diverse work environment.
Along with consultants and other experts, we work as a team to identify possible projects; determine feasibility, incentives and payback; and vet with a multidepartmental approach.
Energy management in a hospital environment can be extremely satisfying and frustrating at the same time. It requires the energy manager to reduce/maintain the overall energy profile of the institution while providing the end users (patients, visitors, staff and researchers) with the heating and cooling required for comfort, infection control and proper operation of equipment. It also needs to take into consideration the fact that many ventilation rates are dictated by various governing bodies that may not always agree.
Memorial Sloan Kettering is also located in an urban environment, with operating rooms located on various floors and towers across the facility. There are a number of end users throughout the center, so we need to ensure that any efforts to drive efficiencies do not affect the processes in place.
G: MSK has some great energy-savings successes specific to the OR. Can you talk a little more about those projects?
MSK: The operating room was targeted for several energy efficiency projects that were relatively low cost, yet offered considerable savings:
- upgrades to audio/video equipment
- conversion to LED surgical lighting
- air acuity/demand ventilation control
- HVAC setback in the ORs
In 2013, the audiovisual systems were upgraded in four operating rooms, and another six operating rooms were upgraded in 2014. These upgrades included the installation of more energy-efficient video-switching technology, as well as the shutdown of various OR computers, monitors and AV equipment at night during unoccupied hours (confirmed by motion sensors).
LED surgical lighting has been updated in seven out of 28 ORs, or 25 percent. This project is ongoing, and we will continue to work with in-house electricians to find opportunities to convert lighting to LEDs in the remaining ORs.
The HVAC system was also a target for MSK. The OR can have one of the highest air exchange rate requirements in a hospital as outlined by ASHRAE 170-2008 guidance (20 air exchanges per hour when occupied). However, these systems can safely be set back to six air changes per hour when unoccupied or not in use.
In 2014, MSK implemented an HVAC setback program across all 28 operating rooms using occupancy sensors. The team identified an HVAC control system being piloted at another hospital using demand ventilation control. A lot of prep work was done before proposing the system to OR staff, including a thorough vetting with staff at the pilot hospital. Then the team brought in infection control experts from MSK to review and ensure safety protocols met their standards. The final installed air acuity system lowers air changes during “off hours” from 25 air exchanges per hour down to 12 air exchanges per hour. (Although Bob Berninger indicated that the system could probably go even lower than 12, this was the agreed-upon setback point the team felt comfortable with.)
The system keeps the room in a ready state and can be back into full operating mode within moments of the system detecting that a person has entered the room. That way, the system can be set on a timer to go into unoccupied mode, but the ORs will be available if an emergent case occurs. As an added benefit, the team from infection control was pleased that the system was constantly monitoring CO2 levels, VOCs, humidity, temperature, air exchanges, particulate matter and more so they were able to more closely control the patient’s environment.
The organization was so pleased with this system that it has been automatically incorporated into the design of the new Josie Robertson Surgery Center, slated to open in January 2016.
Savings from HVAC setbacks in 2014 include:
- 652,150 kWh saved
- $91,933 savings from project
- steam reduction of 39,741 therms
- In the future, we will continue to work on optimal temperature control using the HVAC setback while taking into account doctor/clinician preferences and optimal temperature for patients.
G: For hospitals planning to have a conversation with OR clinical staff about a specific energy project, what tips/effective strategies have you learned and can share for other energy/facilities personnel who are just starting out?
MSK: At MSK, we work to clearly communicate a project’s feasibility, ROI, timeline and potential retro commissioning. In addition, we employ a defined project team to leverage appropriate consultants/vendors and in-house staff to achieve defined objectives.
Utilizing metrics to communicate energy and financial savings and the resulting greenhouse gas reductions can also help achieve stakeholder buy-in from the appropriate clinical staff. Communicating these projected results of a project to staff not only helps build the business case for approval from the C-suite, but it can help obtain support at the clinical level.
“Communicating projected results of a project to staff not only helps build the business case for approval from the C-suite, but it can help obtain support at the clinical level.”
G: Now you’re going to have a conversation with senior leadership. What tips or strategies would you suggest?
MSK: For senior leadership, a clear and concise ROI and timeline are key to obtaining buy-in and bringing a project up the chain for approval.
G: How did you establish a baseline and goals and track energy savings specific to the OR? Do you think it’s valuable to track energy savings for a specific department?
MSK: Managing data on all building operations and tracking project impacts on energy usage and costs are crucial. A great deal of our data stems from portable meters on building management systems and is tracked in customized spreadsheets with the facilities management department.
To propose a project, we must define the need for an upgrade or addition to the built environment, which in the OR can be done through evaluations with consultants, identification of new technology available for upgrades to older equipment or the availability of industry best practices related to energy and sustainability.
G: What are the best tools or education resources to support your team?
MSK: To help accomplish our aggressive goals, the facilities operations department created a tracking sheet of all major energy efficiency projects implemented to date, highlighting the total cost avoidance these projects created over time. This allowed facilities management to better understand the financial impact these various efficiency projects provided. It was also a powerful tool to garner ongoing support for future projects. To date, for the Manhattan campus alone, our projects have avoided over $5.6 million in energy use.
Then, MSK conducted a baseline energy audit for our Manhattam campus. The purpose of this report was threefold:
- To determine a benchmarking score based on the efficiency of the buildings utilizing energy use intensity measures.
- To identify low or no-cost measures for improving energy efficiency. These measures would be based on building system adjustments to achieve performance as intended in the original design and to optimize or improve the performance of existing systems. The primary objective would be to optimize daily operations, thereby reducing energy consumption without significant capital investment.
- To determine energy improvement projects that could be implemented in order to improve energy efficiency.
G: What final insights, project details or information would you like to share?
MSK: For anyone starting out, education is key. Educate yourself. Educate others. It all comes down to education in order to be successful and to successfully implement these projects. Don’t be afraid to ask questions and to go to the source or others. Educate others so they can identify opportunities and help teach others. Work with departmental and organizational leadership to help introduce ideas in the right context. Also, know which war to win and which field to battle on. You might be passionate and right, but sometimes you need to let others come around.
For institutions, collaboration is key. In addition to the Green Team committee, MSK has also formulated a Greening the OR subcommittee focused on driving energy efficiency and waste reduction efforts in the OR and interventional radiology areas. This committee is driven by Shane Dunne, project manager for sustainability, and is comprised of attending physicians, nurse leaders and RNs, as well as staff members from logistics, perioperative services, OR materials management and anesthesia, with support from the facilities management, environmental services and pharmacy departments. All these departments work in conjunction on prioritized projects and initiatives. This collaborative approach allows MSK to leverage expertise from across the organization to continually work at identifying opportunities within our operations to reduce the environmental impacts of the operating room.
As part of its commitment to research and the Greening the OR Initiative, Memorial Sloan Kettering Cancer Center maintains and updates an online resource library with articles and peer-reviewed research relevant to greening the OR. Check it out here: libguides.mskcc.org/greeningtheOR
Shane Dunne (left) is sustainability manager and Bob Berninger is general manager of plant operations, energy and engineering at Memorial Sloan Kettering Cancer Center.